Search

Vesicoureteral reflux (VUR) is a common urological complication in renal transplant patients.of this study is to evaluate the performance of contrast-enhanced voiding urosonography (CEvUS) in the diagnosis and classification of reflux into the renal allograft, to evaluate and classify VUR into the allograft using voiding cystourethrography (VCUG) and CEvUS, to compare the two methods, and to propose a new classification of reflux into the allograft based on CEvUS and VCUG assessment, in line with the international reflux grading system. From January 2017 to July 2019, 84 kidney transplant patients were enrolled. All patients underwent VCUG and CEvUS. In 76 cases there was agreement between VCUG and CEvUS (90 %) (Kappa = 0.7). The sensitivity of CEvUS using VCUG as the gold standard was 90 %, and the specificity was 92 %. Of the 7 cases diagnosed by VCUG and not by CEvUS, 6 were grade 1 and 1 was grade 2. Transplant patients with reflux symptoms should undergo CEvUS. If the outcome is negative, VCUG should be performed. The classification that we propose is better suited to describe VUR in transplant patients, because it is simpler and takes into account whether reflux occurs not only during urination but also when the bladder is relaxed.Vesikoureteraler Reflux (VUR) ist eine häufige urologische Komplikation bei Patienten mit Nierentransplantation. ZIEL: dieser Studie ist es, die Leistung der kontrastmittelverstärkten Miktionsurosonografie (CEmUS) bei der Diagnose und Klassifizierung des Reflux in das Nieren-Allotransplantat zu bewerten, den VUR in das Allotransplantat mittels Miktionszystourethrografie (MCU) und CEmUS zu bewerten und zu klassifizieren, die beiden Methoden zu vergleichen und eine neue Klassifikation des Reflux in das Allotransplantat basierend auf der CEmUS- und MCU-Beurteilung in Übereinstimmung mit dem internationalen Reflux-Klassifikationssystem vorzuschlagen. Von Januar 2017 bis Juli 2019 wurden 84 nierentransplantierte Patienten eingeschlossen. Bei allen Patienten wurden MCU und CEmUS durchgeführt. In 76 Fällen bestand Übereinstimmung zwischen MCU und CEmUS (90 %) (Kappa = 0,7). Die Sensitivität von CEmUS bei Verwendung der MCU als Goldstandard betrug 90 %, die Spezifität betrug 92 %. Von den 7 Fällen, die mittels MCU, aber nicht durch CEmUS diagnostiziert wurden, hatten 6 Patienten Grad 1 und 1 Patient hatte Grad 2. Transplantationspatienten mit Refluxsymptomen sollten sich einer CEmUS unterziehen. Wenn das Ergebnis negativ ist, sollte eine MCU durchgeführt werden. Die von uns vorgeschlagene Klassifikation ist besser geeignet, um den VUR bei Transplantationspatienten zu beschreiben, da sie einfacher ist und berücksichtigt, ob der Reflux nicht nur bei der Blasenentleerung, sondern auch bei entspannter Blase auftritt.

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.

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.

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.

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.

ResumenLa hiperplasia benigna de próstata (HPB) es una enfermedad con alta prevalencia entre los varones de más de 50 años que requiere una continuidad asistencial entre los 2 niveles existentes en nuestro país, el de atención primaria (AP) y el de atención especializada; motivo por el que era necesario consensuar unos criterios de derivación o de continuidad que sirvan de orientación a ambos colectivos. La historia clínica del paciente, el Índice Internacional de Síntomas Prostáticos (IPSS, International Prostate Symptom Score), el tacto rectal y el antígeno prostático específico (PSA, prostate-specific antigen) son herramientas accesibles en el ámbito de la AP que permiten un diagnóstico adecuado de la HBP. Conscientes de tal necesidad, las sociedades científicas de atención primaria (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina General [SEMG] y Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) y la Asociación Española de Urología (AEU) elaboraron este documento de consenso. A los pacientes con IPSS20, PSA >10 ng/ml o PSA >4 ng/ml y PSA libre 1.5ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with α-blockers, or the sixth month with 5α-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10ng/ml or PSA>4ng/ml and free PSA

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.

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.

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.