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INTRODUCTION AND OBJECTIVE:Ureteric stricture is the most common urological complication post transplant(3%), with majority(73%) of them occuringat the distal end. Success rate of primary endo-urol...

The overall complication rate of Transurethral resection of prostate (TURP) is about 11.1%. Amongst all complications, ocular complications are one of the rarest. In this paper, we present a case of vision loss due to paradoxical embolism as a rare complication following TURP. Ocular complications are very rare in urological surgeries but can happen due to paradoxical embolism following patent foramen ovale. Therefore, we recommend the early diagnosis and treatment of PFO prior to this type of surgery.

Indication has led ureteroscopy to be a worldwide technique, with the expected appearance of multiple complications. The ureteral avulsion is an uncommon severe urological complication of ureteroscopy (URS). Surgery in patients with a total ureteral loss is a demanding challenge for urologist. It requires usually immediate open or laparoscopic intervention. This case report was to present the treatment modality after ureteral avulsion. We have presented a case of 58-year-old male patient who underwent a successful repair of an upper ureteral injury. We have comprehensively described the effectiveness of an extended Boari-flap procedure for reconstruction after iatrogenic ureteral trauma. Particularly in an unexpected and casual situations, the presented extended Boari flap modification can be a great alternative for reconstructing a total ureteral loss. In conclusion we have recommend useful tips, how to counteract such unwanted events.

This article reports the current evidence and expert opinions on the diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and a combination of these two. Priorities in the management of NLUTD, in order of importance, should be the following: (1) preservation of renal function; (2) freedom from urinary tract infection; (3) efficient bladder emptying; (4) freedom from indwelling catheters; (5) patient agreement with the management modality; and (6) avoidance of medication after proper management. Management of the urinary tract in patients with spinal cord injuries or multiple sclerosis must be based on urodynamic findings rather than on inferences from the neurological evaluation. Identification of high-risk patients is important to prevent renal functional impairment in those with chronic NLUTD. The lower urinary tract function of patients with NLUTD should be regularly followed up by urodynamic study, and any urological complication should be treated adequately. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids and injecting botulinum toxin-A are alternative treatments for refractory detrusor overactivity or a low compliant bladder, and can replace the need for bladder augmentation. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without the interference of neuromuscular continuity provides patients with NLUTD the opportunity to use new technologies in the future. Improving the quality of life in patients with neurogenic voiding dysfunction is the most important aspect of treatment.

Ureteric stricture is the most common urological complication following renal transplantation. Management often involves endo-urological interventions and open surgery. The definitive treatment is surgical reconstruction to restore continuity. Where this is not possible or contra-indicated and a stent cannot be placed in the ureter, an extra-anatomic stent (EAS) could be used to bypass a complete ureteric obstruction. Using an existing nephrostomy tract, a percutaneous stent is placed in the kidney and is tunneled under the skin into the bladder establishing extra-anatomical urinary drainage. We report the use of a novel EAS system in a patient with transplant ureteric stricture when antegrade stent placement or surgical reconstruction was not possible.

Summary Renal transplantation is the best renal replacement treatment. It provides longer survival and a better quality of life. The outcome of renal transplantation is influenced by the occurrence of various complications, including urological. One of the most frequently occurring complications is lymphocele. Most cases of lymphocele develop during a period of several weeks after the procedure of transplantation. However, there are some literature reports concerning lymphocele diagnosis in the later period, even after several years. Most cases of lymphocele are asymptomatic and are diagnosed accidentally. Nevertheless, a large lymphocele may press the kidney, ureter, urinary bladder or neighbouring blood vessels, causing deterioration of renal function, leg oedema and thrombosis of iliac vessels. Among other complications there are Streszczenie Przeszczep nerki jest najlepszą metodą leczenia nerkozastepczego, zapewniającą pacjentom dluzsze przezycia i lepszą jakośc zycia. Na wynik leczenia przeszczepianiem nerki wplywa wystepowanie powiklan, w tym urologicznych. Jednym z najcześciej wystepujących jest limfocele. Wiekszośc pojawia sie podczas kilku tygodni po zabiegu transplantacji, zdarzają sie jednak przypadki wystepowania limfocele w poźniejszej obserwacji. Przewaznie nie dają objawow klinicznych i są wykrywane przypadkowo. Jednak gdy limfocele ma duze rozmiary moze uciskac na przeszczepioną nerke, moczowod, pecherz moczowy lub okoliczne naczynia i pogarszac funkcje przeszczepionego narządu, powodowac obrzek konczyny oraz zakrzepice naczyn biodrowych. Do powiklan limfocele nalezą tez zakazenia. Przyczyną jego powstania jest gromadzenie sie chlonki pochodzącej z uszkodzonych naczyn limfatycznych otaczających naczynia biodrowe lub z naczyn limfatycznych przeszczepianej nerki. Czynnikami predysponującymi są stosowane leczenie immunosupresyjne, w tym inhibitory mTOR, pochodne kwasu mykofenolowego oraz wysokie dawki glikokortykosteroidow. Wystąpieniu limfocele sprzyjają rowniez otylośc, cukrzyca, zaawansowany wiek biorcy, dlugi czas cieplego niedokrwienia, epizody ostrego odrzucania i opoźnienie podjecia funkcji przez przeszczepioną nerke. Autorzy opisują dostepne obecnie metody leczenia, w tym aspiracje i drenaz przezskorny z i bez sklerotyzacji, drenaz z zastosowaniem cewnika Tenckhoffa, a takze fenestracje laparoskopową i otwartą. Obecnie za najefektywniejszą, ale takze najbezpieczniejszą uwazana jest fenestracja laparoskopowa, chociaz istnieją sytuacje kliniczne, w ktorych konieczny jest otwarty zabieg operacyjny.

Context: Urological complications are inevitable in renal transplantation; however, their occurrence and brunt on graft survival can be downsized. The aim of our study was to analyze and review the literature on various urological complications and their management in renal transplant patients. Materials and Methods: We reviewed all cases of urological complications in renal transplantation managed at our institution from January 2010 to March 2017. Results: Urological complications arose in 29 renal transplant patients amidst the study period with median identification time of 24 days (range 0–1500 days). Ten (34.5%) patients developed complications pertaining to ureteric handling and reimplantation followed by significant lymphocele in 9 (31%) patients. Four (13.8%) cases succumbed to vascular anastomosis-related complications. Out of 29 patients, 45% of these complications manifested within a month posttransplant. Complications were tackled individually. Sixteen (55%) cases were treated with either endoscopic or minimally invasive methods, whereas 13 (45%) cases required open surgery. Two grafts were lost as a consequence of vascular complications and a fatality which was directly or indirectly linked with urological complication. Remaining all treated patients improved on follow-up. Conclusion: Comprehensive preoperative recipient evaluation, meticulous organ procurement, and integrated multidisciplinary teamwork are helpful in achieving optimal outcome of transplant. Endourological and minimally invasive procedures are emerging as main modality in the management of these complications; however, many cases still requires contemporary surgical management.

Summary 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

Background Urological complications are frequent in Menkes syndrome, a very rare X-linked recessive disorder of copper (Cu) metabolism. Aim To evaluate the role of Cu therapy in preventing the progression of urological complications. Subjects and methods We retrospectively enrolled 57 patients with Menkes syndrome (55 published case reports and two of our own unpublished cases) and investigated the reported urological complications, distinguishing the patients with or without Cu replacement therapy and evaluating the efficacy of this therapy in the prevention of urological complications. Results The most frequent urological complication was bladder diverticulum (38.6% of the total patients); obstruction bladder outflow and rupture of the kidney were less frequent (both 1.8% of the total). The number of congenital urological complications increased progressively by age category; in fact, 77.8% of patients did not report urological complications at the age of 0.4+/-0.2 y, and 28.6% of them displayed > or = two congenital urological complications at the age of 9.3+/-2.6 y. The percentage of urological complications found in younger patients not on Cu therapy did not differ from that of older patients treated with Cu therapy. A comparison between patients of the same age interval, who were or were not treated with Cu, showed that treated children had fewer urological complications than untreated children. Conclusion Our investigation suggests that Cu therapy in patients with Menkes syndrome does not prevent the progression of urological complications; however, it might delay their worsening.

The most serious urological complication of endometriosis is hydronephrotic renal atrophy secondary to ureteric involvement. As only half of these patients are symptomatic, it is commonly diagnosed late and more by the clinicians awareness and suspicion of this entity. We report a case of an unmarried young female who presented primarily with left loin pain of 2-year duration. She was found to have lower ureteric stricture by an IVU done by her referring doctor. Further workup at our center showed that she had pelvic endometriosis with hydronephrosis secondary to extrinsic ureteric endometriosis. She had a first-degree relative with the same disease. She had no menstrual problems. Diagnostic laparoscopy, biopsy of the lesion, ureteric dilatation with stenting, along with hormonal treatment was given to her as first line of treatment. There was no improvement of the ureteric obstruction even after 6 months of treatment. Finally, surgical excision of the endometrioma, left oophorectomy, along with resection of the ureteric stricture with uretero-ureterostomy was done. This case report includes details of her further management and outcome along with a brief review of literature.

An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.

Ureteric obstruction of the transplanted kidney is the most common late urological complication and is caused mostly by ureteric stricture. We report the case of a patient who developed ureteric obstruction following trans-abdominal pre-peritoneal repair of a recurrent inguinal hernia (TAPP). High level evidence exists to support the laparoscopic approach to recurrent inguinal hernia repair; however, this case reports the potential complications and difficulties that may occur in the presence of a kidney transplant.

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.

Stenosing and calcified ureteritis occurring in Henoch–Schonlein purpura remains a rare urological complication. The authors describe their own experience of the diagnosis and treatment of this rare p

Abscess formation secondary to chronic urethritis of the posterior male urethra caused by Neisseria gonorrhoeae has become an atypical and rare urological complication. Periurethral abscess formation has been reported to be associated with gonococcal infections, but in such rare cases a delay in the diagnosis of gonococcal infection seems to have been the cause for this periurethral complication. A case with a primary diagnosis of periurethral abscess with N. gonorrhoeae infection is reported – successful treatment included transurethral incision and antibiotic therapy.

Bladder calculi are the second most common urological complication in those with spinal cord injury (SCI). Detection and removal of bladder stones are important to prevent possible complications.To determine the accuracy of bladder stone detection based on catheter encrustation in asymptomatic individuals with SCI.Prospective cohort study.Cystoscopy findings in persons with SCI who were noted to have catheter encrustation at the time of catheter removal for their scheduled cystoscopy were used in this prospective study. Indwelling catheters were examined for encrustation at the time of removal as they were being prepared for cystoscopy. Cystoscopy was performed, and the presence or absence of bladder stones was noted.Presence or absence of bladder stones detected with cystoscopy in those with precystoscopy catheter encrustation.Forty-nine individuals with indwelling catheters were evaluated. Overall, 17/49 (35%) individuals in this study had bladder stones. Catheter encrustation was noted in 13 patients. Of these 13 patients, 11 also had bladder stones. In other words, a positive result for catheter encrustation had a positive result for bladder stones 85% of the time. Thirty-six individuals had no catheter encrustation. Of these, 6 (16%) were found to have bladder stones.Encrustation of a catheter is highly predictive of the presence of bladder stones. This suggests that cystoscopy should be scheduled in a person undergoing a catheter change if catheter encrustation is noted.

Recurrent functional and anatomical subvesical obstruction as urological complication in a tetraplegic patient

BACKGROUND The objects of this study is to evaluate the ipsilateral stone recurrence who became stone free status after extracorporeal shock wave lithotripsy (ESWL). METHODS Three hundred ninety five patients who became stone free after ESWL with Lithostar and followed more than 6 months, were analyzed stone recurrence. Stone recurrence were diagnosed by KUB and/or ultrasound. Actual recurrence free rate were calculated based on the period from the day of achieved stone free status to the day of estimated recurrence. Eight factors examined included sex, side, number, location, size, stone history urological complication, hydronephrosis and also contralateral recurrence was analyzed. RESULTS Over all ipsilateral recurrence free rate were 96.5%, 78.8%, 65.3% after 1, 3 and 5 years, respectively. Contralateral stone free rate were 98.1%, 92.5%, 87.2% after 1, 3 and 5 years. Five-year recurrence free rate according stone factors, there were significant difference in stone number (Single 71.1% and multiple 31.6%), in stone history (with history 77.1% and without 35.7%), in urological complication (without complication 67.7% and with complication 35.7%). However, there were no significant difference in sex, side, stone, location, stone size and hydronephrosis. CONCLUSION This results suggested that the stone number, stone history and urological complication were highly related to ipsilateral stone recurrence after stone free status by ESWL. Extracorporeal shock was lithotripsy had probability of higher stone recurrence rate.

Male genital self-mutilation is uncommon, with repeat mutilation even more rare. Our case is unique in that a urological complication of the first mutilating act (meatal stenosis) helped to precipitate the second incident. This case underscores the need not only for immediate urological and psychiatric care at the time of initial mutilation but also for close, combined followup care as well. In the majority of cases, when properly monitored, the men do not repeat the mutilating act.

Ureteral obstruction is the most common urological complication following renal transplantation. The obstruction most often occurs distal, secondary to ureteral ischemia and fibrosis or extrinsic compression. Rarely the level of obstruction occurs at the ureteropelvic junction. We report a case of torsion of a renal allograft causing ureteropelvic junction obstruction that was successfully treated endourologically.

From October 1970 to January 1986, 808 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 23 total complications, for an over-all urological complication rate of 2.8 per cent. Of these complications 17 were related to the ureteroneocystostomy, for an anastomotic complication rate of 2.1 per cent. Complications were almost universally repaired by another operation. Two patients died and 1 lost the allograft because of urological complications.

This article reports the current evidence and expert opinions on diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and combined failure to store and empty. The priority of management of NLUTD should follow the order of: (1) preservation of renal function; (2) freedom from urinary tract infection (UTI); (3) efficient bladder emptying; and (4) freedom from indwelling catheter, and patients' expectation of management should be respected. Management of the urinary tract in patients with spinal cord injury (SCI) or multiple sclerosis (MS) must be based on urodynamic findings, rather than inferences from the neurologic evaluation. Selecting high risk patients is important to prevent renal function impairment in patients with chronic NLUTD. Patients with NLUTD should be regularly followed up for their lower urinary tract dysfunction by urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Antimuscarinic agents with clean intermittent catheterization (CIC) may reduce urological complications and improve quality of life (QoL) in patients with NLUTD. Intravesical injection of botulinum toxin A provides an alternative treatment for refractory detrusor overactivity (DO) or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, we should consider the least invasive type of surgery and reversible procedure first and avoid any unnecessary surgery of the lower urinary tract. Keeping the bladder and urethra in a good condition without interference of the neuromuscular continuity provides patients with NLUTD a chance for future new technologies. It is most important to never give up on improving the QoL in patients with NLUTD.

ObjectivesNeurogenic voiding dysfunction (NVD) results in lower urinary tract symptoms and upper urinary tract complications. Management of urinary tract dysfunction in patients with spinal cord injury (SCI) must be based on patient needs and urological complications. This study surveyed the bladder management and urological complications in patients with SCI in Taiwan.Materials and methodsA total of 894 patients with SCI were surveyed throughout Taiwan over a period of 5 years (2007–2011). All patients received neurological and urological examinations, renal sonography, bladder sonography, and urinalysis. They were further requested to report urinary tract infections (UTI), voiding conditions, and bladder management in the past 3 years. The bladder management and urological complications were analyzed based on different SCI levels and duration of disease.ResultsAmong all patients, 39.7% voided spontaneously or by reflex, 23.8% used percussion to void, 20.9% voided by abdominal pressure, 18.1% used clean intermittent catheterization (CIC), and 22.9% had indwelling catheters or cystostomy. Detrusor sphincter dyssynergia (DSD) was noted in 39.7% of patients and autonomic dysreflexia (AD) in 19.9%. UTI was noted in 483 (54%) patients, hydronephrosis in 110 (12.3%) patients, and severe urinary incontinence in 257 (28.7%) patients. UTI occurred significantly more often in patients without, than with normal voiding. CIC was more frequently used in patients with duration of SCI 5 years chose indwelling catheters or a cystostomy more often than CIC.

The main problems in neurogenic voiding dysfunction (NVD) are failure to store, failure to empty, and combined failure to store and empty. The management priorities in NVD should be as follows, in order: (1) preservation of renal function, (2) freedom from urinary tract infection, (3) efficient bladder emptying, (4) freedom from an indwelling catheter, (5) patient satisfaction with voiding management and (6) avoiding medication after proper management. Management of the urinary tract in patients with spinal cord injury must be based on urodynamic findings rather than inferences from a neurologic evaluation. Selecting high-risk patients is important to prevent renal function impairment in patients with chronic NVD. Patients with NVD should be regularly followed-up for lower urinary tract dysfunction using urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids or injection of BOTOX provides an alternative treatment for refractory detrusor overactivity or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, a less invasive type of surgery and a reversible procedure should be considered first and unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without interfering with neuromuscular continuity will give patients with NVD a chance to benefit from new technologies in the future. It is most important that the physician continues to try to improve the quality of life of patients with NVD. [Tzu Chi Med J 2008;20(1):35–39]

The first reported urological complication of Dwyer Instrumentation for scoliosis is presented. This patient demonstrated ureteral obstruction secondary to retroperitoneal fibrosis temporally associated with this procedure. Routine IVP following surgery is recommended for early detection of urinary complication.

Our incidence of urological complications in 860 consecutive renal transplants is 3.4 per cent. A further reduction in incidence is demonstrated in the most recent 250 transplants of this series. Urological complications have been kept to a minimum by strict adherence to certain principles in donor nephrectomy, management of multiple and small arteries, and the technique of graft implantation.When urological complications were suspected early and judicious use of 131I hippurate scintiphotographic techniques has proved to be the most helpful method to evaluate patients. If a urological complication did occur prompt recognition and treatment were responsible for a high rate of graft salvage, low incidence of sepsis and absence of patient mortality.

The close proximity of the lower urinary tract to the female genital tract makes urological complication one of the commonest types of complication after gynaecological surgery. Some of these are a direct result of urological injury at the time of surgery and are apparent either peroperatively or very early in the postoperative period. These have already been described in Chap. 12 and will be mentioned only briefly here. Other complications only become apparent with the passage of time, although some nonetheless are due to operation trauma.

Summary— Two hundred and one urological complications have been diagnosed and treated in 123 transplant recipients in a series of 1000 consecutive renal transplant operations (overall incidence 12.5%). Obstructive uropathies and urinary fistulae accounted for 95% of these complications and all of the mortality (22%). Details of management and patient and graft survival are given. A relationship between mortality from a urological complication and steroid dosage was found. A 30% incidence of recurrent or secondary urological complications was also noted with correspondingly worsened prognosis. Early diagnosis followed by early aggressive surgical treatment is advocated.

A total of 43 consecutive renal transplant patients underwent extravesical ureteroneocystostomy via a parallel incision. The only urological complication (ureteral obstruction from a blood clot) did not appear to be related to this recently described technique. There were no instances of urinary leakage, extrinsic ureteral obstruction or reflux. This simplified technique of ureteroneocystostomy seems well suited to the special challenges presented by renal transplant patients.

Lumbar subarachnoid-peritoneal shunts are used occasionally in the treatment of communicating hydrocephalus. A 5-year-old girl with meningomyelocele and communicating hydrocephalus developed unilateral ureteral obstruction secondary to extrinsic compression by a nonfunctioning shunt of this type. Progressive hydronephrosis was reversed by excision of the shunt and ureterolysis.