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Background: Use of ureteral stents has become an integral part of urological practice. However, it also brought with it many complications. Double J (DJ) stent knotting is a rare stent complication, and only a few cases have been reported in the literature. Although the exact cause is unknown and, in the literature, it is generally thought that knots occur due to traction. In this case report we present for the first time that spontaneous knots can occur due to ureteral peristalsis or ureteral anomalies. Case presentation: Two patients (67 and 35 aged-Caucasian person) with ureteral stones who presented to the emergency department with colicky pain and had no previous history of urological surgery. We observed knot formation in the routine urinary system radiographs taken before stent removal in two patients whose ureters were observed to be narrow during endoscopic ureteral stone treatment. The stents were successfully removed using gentle traction under general anesthesia. Conclusions: We discussed the cause and solution of spontaneous knot formation. We emphasized the importance of the direct urinary system radiograph taken before DJ stent removal. [ABSTRACT FROM AUTHOR]

Objective: To report on the occurrence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders (PAS). Methods: MEDLINE, EMBASE and the Cochrane databases were searched electronically up to 1 November 2022. Studies reporting on the urological outcome of women undergoing Cesarean section for PAS were included. Two independent reviewers performed data extraction using a predefined protocol and assessed the risk of bias using the Newcastle–Ottawa scale for observational studies, with disagreements resolved by consensus.The primary outcome was the overall occurrence of urological complications. Secondary outcomes were the occurrence of any cystotomy, intentional cystotomy, unintentional cystotomy, ureteral damage, ureteral fistula and vesicovaginal fistula. All outcomes were explored in the overall population of women undergoing surgery for PAS. In addition, we performed subgroup analyses according to the type of surgery (Cesarean hysterectomy, or conservative surgery or management), severity of PAS at histopathology (placenta accreta/increta and placenta percreta), type of intervention (planned vs emergency) and number of cases per year. Random‐effects meta‐analyses of proportions were used to analyze the data. Results: There were 62 studies included in the systematic review and 56 were included in the meta‐analysis. Urological complications occurred in 15.2% (95% CI, 12.9–17.7%) of cases. Cystotomy complicated 13.5% (95% CI, 9.7–17.9%) of surgical operations. Intentional cystotomy was required in 7.7% (95% CI, 6.5–9.1%) of cases, while unintentional cystotomy occurred in 7.2% (95% CI, 6.0–8.5%) of cases. Urological complications occurred in 19.4% (95% CI, 16.3–22.7%) of cases undergoing hysterectomy and 12.2% (95% CI, 7.5–17.8%) of those undergoing conservative treatment. In the subgroup analyses, urological complications occurred in 9.4% (95% CI, 5.4–14.4%) of women with placenta accreta/increta and 38.5% (95% CI, 21.6–57.0%) of those described as having placenta percreta, and included mainly cystotomy (5.5% (95% CI, 0.6–15.1%) and 22.0% (95% CI, 5.4–45.5%), respectively). Urological complications occurred in 15.4% (95% CI, 8.1–24.6%) of cases undergoing a planned procedure and 24.6% (95% CI, 13.0–38.5%) of those undergoing an emergency intervention. In subanalysis of studies reporting on ≥ 12 cases per year, the incidence of urological complication was similar to that reported in the primary analysis. Conclusions: Women undergoing surgery for PAS are at high risk of urological complication, mainly cystotomy. The incidence of these complications was particularly high in women described as having placenta percreta at birth and in those undergoing emergency surgical intervention. The high heterogeneity between the included studies highlights the need for a standardized protocol for the diagnosis of PAS to identify prenatal imaging signs associated with the increased risk of urological morbidity at delivery. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Many complications due to double j (DJ) stent placement have been reported. DJ stent knotting is a rare complication, with only a few cases reported in the literature. We presented a case of DJ stent knotting and reviewed the literature regarding this complication. We reported a 20-year-old man with a history of cystinuria and ureteral stone managed with retrograde ureteroscopy and holmium laser three months ago. The patient comes for DJ stent removal. Firstly, we tried to remove the DJ stent via the cystoscopic procedure, which failed. A fluoroscopic image revealed a knotted DJ stent lodged at the ureteropelvic junction and was removed via holmium laser ureteroscopic procedure without complications. In conclusion, when cystoscopic procedure with simple traction fails to remove DJ stents, multimodality urological procedures such as holmium laser should be tried, especially in patients with urolithiasis predisposing factors. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the risk for urological complications after kidney transplantation at a single medical center in Japan. Methods In the present study, 408 kidney recipients (255 men, 153 women) were enrolled. There were 349 living and 59 deceased donors. The average age of the recipients was 42.5 ± 13.5 years, and the average pretransplant dialysis period was 71.8 ± 88.2 months. Ureteroneocystostomy was carried out on 347 patients, and ureteroureterostomy on 61 patients. We investigated the relationship between pretransplant duration of dialysis and bladder capacity, and examined the risk factors for urological complication. We also evaluated the incidence of vesicoureteral reflux in 191 recipients who underwent ureteroneocystostomy during transplantation. Results The preoperative duration of dialysis therapy showed a significant negative correlation with bladder capacity ( R2 = 0.33, P < 0.001). The overall urological complication rate was 3.4% (14 patients), including urinary leakage (12 patients) and ureteral stricture (two patients). Univariate analysis showed that atrophic bladder, long-term dialysis therapy, deceased donor and ureteroureterostomy were associated with a higher incidence of urological complications (odds ratio 8.05, 4.43, 3.42 and 3.35; P < 0.01, P = 0.01, P = 0.04 and P = 0.04, respectively). Furthermore, multivariate analysis showed that atrophic bladder was the only significant factor associated with urological complications (odds ratio 10.37; P = 0.01). Among 191 recipients, vesicoureteral reflux was observed in 32 (16.8%). The incidence of vesicoureteral reflux was significantly higher in patients with atrophic bladder. Conclusions Bladder atrophy in renal transplant recipients after long-term dialysis therapy is associated with a higher risk of urological complications. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: There is a growing number of overweight and obese patients receiving kidney transplants, despite elevated body mass index (BMI) being associated with postoperative complications. Understanding associations between BMI and complications would allow more objectivity when recommending patients for transplantation or otherwise. Methods: We analysed a retrospective cohort of 508 adult patients who received primary kidney grafts at a single centre in South Australia, 2002-2009, using hospital records and Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Complications within 1 year of transplantation were classified into: surgical, wound, urological, delayed graft function, early nephrectomy and admission to intensive care unit (ICU). Results: Overall, 62% of transplant recipients had a BMI above 25 kg/m2 at transplant. Higher BMI was associated with an increased risk of wound complications ( P < 0.001), early nephrectomy ( P = 0.002) and delayed graft function ( P = 0.03), but not associated with surgical or urological complications, or ICU admission. These associations were stronger for Indigenous Australians than other patients, especially for surgical complications. There was no BMI value above which risks of complications increase substantially. Conclusion: Delayed graft function is an important determinant of patient outcomes. Wound complications can be serious, and are more common in patients with higher BMI. This may justify the use of elevated BMI as a contraindication for transplantation, although no obvious cut-off value exists. Investigations into other measures of body fat composition and distribution are warranted. [ABSTRACT FROM AUTHOR]

Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in the renal transplant process and provide a unique opportunity to the trainees of that particular program. For renal transplant recipients, preoperative evaluation of voiding dysfunction and other genitourinary anomalies might be necessary before the transplant. Also, occasional surgical intervention to prepare a patient for renal transplant might be necessary, such as in a patient with a small renal mass that is detected by a screening pretransplant ultrasound. Intraoperatively, for patients with complex urological reconstructions that might be related to the etiology of the renal failure (urinary diversion, bladder augmentation), a urologist who is familiar with the anatomy should be available. Postoperatively, urological evaluation and intervention might be necessary for patients who had a pre-existing urological condition or who might have developed something de novo after the transplant. Although renal transplant programs could consult an on-call urologist for particular issues on an as-needed basis, having a urologist, who has repeated exposure to the particular issues and procedures that are involved with renal transplantation, and who is part of a dedicated multidisciplinary renal transplant team, provides optimal quality of care to these complex patients. [ABSTRACT FROM AUTHOR]

Urological complications after kidney transplantation may result in significant morbidity and mortality. However, the incidence of such complications after deceased cardiac death (DCD) donor kidney transplantation and their effect on survival is unknown. Purpose of this study was to estimate the incidence of urological complications after DCD kidney transplantation, and to estimate their impact on survival. Patient records of all 76 DCD kidney transplantations in the period 1997–2004 were reviewed for (urological) complications during the initial hospitalization until 30 days after discharge, and graft survival until the last hospital visit. Urological complications occurred in 32 patients (42.1%), with leakage and/or obstruction occurring in seven patients (9.2%). The latter seems to be comparable with the incidence reported in the literature for deceased heart-beating (DHB) transplantations (range 2.5–10%). Overall graft survival was 92% at 1 year and 88% at 3 years, comparable to the rates reported in the literature for kidneys from DHB donors, and was not affected by urological complications (χ2 = 0.27, P = 0.61). Only a first warm-ischaemia time of 30 min or more reduced graft survival (χ2 = 4.38, P < 0.05). We conclude that urological complications occur frequently after DCD kidney transplantation, but do not influence graft survival. The only risk factor for reduced graft survival in DCD transplant recipients was the first warm-ischaemia time. [ABSTRACT FROM AUTHOR]

The indications for ureteral stent placement have expanded significantly with the progress of surgical procedures and techniques. Although such stents are now an integral part of contemporary urological practice, their use is not free of complications and consequences. There are very rare descriptions of knot formation in a ureteral stent and the consequences of this occurrence, with only 12 cases previously reported. Here, we report an additional case and review all the literature concerning this urological complication with emphasis on its predisposing factors and conservative and surgical management. [ABSTRACT FROM AUTHOR]

Caliceal fistula is a rare urological complication that can occur usually shortly after kidney transplantation (KTx). The occlusion of the renal accessory artery with subsequent necrosis of the kidney pole is the most common cause of the fistula development. We report a case of a 57-year-old man with reconstruction of two accessory renal arteries by anastomosis to the side of the main artery during graft placement complicated by late caliceal fistula, managed surgically. Directly after KTx good kidney graft function (serum creatinine concentration 151 µmol/L) was observed. The patient noticed protuberance and pain in the kidney graft area 5 months later. Diagnostic imaging revealed moderate urostasis and liquid collection in the region of the lower graft pole. Administration of a contrast medium through the inserted drain visualized a fistula of a lower renal calyx and ureteric stenosis. Percutaneous drainage was applied with subsequent stop of diuresis through the urethral catheter. During the surgery, the resection of a lower kidney graft pole necrosis was performed, with the closure of caliceal fistula. Simultaneously double pigtail ureteric stent was inserted. After the next two months the pigtail catheter was removed, and neither urostasis in the kidney graft nor liquid collection in the perigraft area were observed. The exceptionality of the case is the late caliceal fistula occurrence. We may only speculate, why it happened 5 months after KTx. The thrombosis of stenosed accessory artery is the most probable cause. [ABSTRACT FROM AUTHOR]

Objective Hereditary spastic paraplegia (HSP) represents a clinically and genetically heterogeneous group of neurodegenerative diseases, with a worldwide estimated prevalence of 1.3/100,000 [1] . The “pure” form of HSP is a characterized by a progressive spastic paraplegia, often associated with lower urinary tract symptoms (LUTS) (72.4% to 77.6%) [2,3] . However, urologic complications are rarely reported. The aim of this study was to characterize clinical and urodynamic aspects of LUTS following HSP, and to describe treatment and urological complications of LUTS in a large series of HSP patients. Materials/patients and methods We performed a monocentric retrospective evaluation based on review of medical records of HSP patients admitted in the department of PRM from 1999 to 2016. Inclusion criteria were patients > 18 years. Presenting HSP. Clinical, urodynamic and radiologic data were recorded. Statistical analysis was performed using Microsoft Excel software. Results Thirty-three HSP patients were included. Mean age was 62 ± 14 years with 70% of men. The mean follow-up was 8.10 ± 5 years. Patients presented LUTS: urgency (85%), hesitancy (85%), nocturia (56%) and urinary incontinence (54%). The post-void residual volume (PVR) was over 100 mL in 70%. NDO was diagnosed according to urodynamic testing in 83% of patients, associated in 76% of them with a detrusor-sphinctger-dyssinergia (DSD). HSP patients were exposed to urologic–nephrologic complications: febrile urinary tract infections (25%), urolithiasis (21%), hydronephrosis (8%) and renal failure (17%). HSP patients have been mainly treated with anticholinergics (69%) and 10% were switched to intradetrusor botulinum toxin. Clean intermittent catheterization was performed by 30% of patients. Three patients underwent a non-continent surgical urinary diversion. Discussion/conclusion A significant percentage of HSP patients presenting LUTS mainly resulting of the association of PVR, DO and DSD. However, for the first time, uro-nephrologic complications following LUTS related to HSP are underlined. Thus, HSP patients should be assessed, such as SCI patients, in order to improve management and HSP patients’ quality of life with a decrease of uro-nephrologic complications. [ABSTRACT FROM AUTHOR]