Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was ...found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient's case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient's case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.
Kidney transplantation is the most efficient method of renal replacement therapy. When this method is performed, native urinary bladder is the preferred urinary reservoir. However, in some patients ...with an anatomically and functionally abnormal lower urinary tract, the urinary bladder cannot be used for transplantation. In these patients, urinary diversion should be performed before kidney transplantation. We present a case of a 32-year-old male patient with orthotopic kidney transplantation performed using a colon pouch (Mainz-pouch III). He was born with severe anomalies including sacral agenesis, anorectal atresia, and hypospadias, which were corrected during childhood. Neurogenic bladder with severe vesicoureteral reflux led to end-stage renal disease. This dysfunctional bladder was unsuitable for kidney transplantation, and a staged approach for future transplantation was chosen. The first step was the creation of urinary diversion. Due to a short appendix, we created a continent, colon pouch (Mainz pouch III). Two years later, orthotopic kidney transplantation was performed using a right cadaveric kidney. The renal vessels were anastomosed to the aorta and inferior vena cava and the pyelon to the native ureter. Four years after transplantation, the patient has stable renal function without any complications. This is the first documented case of using Mainz-pouch III as a reliable option for kidney transplantation in selected patients.
Prostate cancer is one of the most important men's health issues in developed countries. For patients with prostate cancer a preoperative staging of the disease must be made. Involvement of lymph ...nodes could be assessed using imaging methods (CT or/and MRI), however, newer methods also exist (PET/CT, PSMA PET/CT). For some patients during radical prostatectomy a pelvic lymphadenectomy is recommended. Pelvic lymphadenectomy is indicated in intermediate- and high-risk group patients and with increased probability of lymph node invasion. The most used prediction tools for preoperative assessment of lymph nodes are Briganti and MSKCC nomograms and Partin tables. Pelvic lymphadenectomy can include different lymph nodes group, but extended lymphadenectomy is the recommended procedure. In 1-20% of patients, the lymph node invasion is present. Pelvic lymphadenectomy is primarily a diagnostic and staging method, and in minority of patients with positive lymph nodes it can be a curative method, too. In other patients with positive lymph nodes adjuvant therapy (radiotherapy and androgen deprivation therapy) can be beneficial.
Riječki transplantacijski program započeo je eksperimentalnom kirurgijom i organizacijom centra za dijalizu na Odjelu za urologiju Klinike za kirurgiju na Sušaku. Uz pomoć vlastitog iskustva i ...boravkom u vanjskim centrima izvrsnosti ostvareni su uvjeti za početak rada s kandidatima za transplantaciju bubrega. Tako je 30. siječnja 1971. godine u našem centru učinjena prva uspješna transplantacija bubrega u Hrvatskoj i tadašnjoj Jugoslaviji. Slijedile su godine u kojima je transplantacija bubrega postala rutinski operacijski zahvat, ali zahvat koji je uvijek zahtijevao angažman multidisciplinarnog tima. Tijekom pet desetljeća predanog rada s kirurške strane su uvedena brojna unaprjeđenja transplantacijskoga programa, od kojih su mnoga po prvi put učinjena u Hrvatskoj i u zemljama u okruženju. To su, primjerice, ortotopne transplantacije bubrega, en-bloc transplantacija bubrega, transplantacija uz korištenje urinarne derivacije i supstitucije vijugom tankog crijeva, dvostruka transplantacija bubrega te transplantacija potkovičastog bubrega. U ovom preglednom radu prikazat ćemo kirurške posebnosti našega transplantacijskog programa.
Kidney transplantation programme in Rijeka started with experimental surgery. The experience from this field combined with education in foreign centers of excellence was a prerequisite for starting this programme on the patients. The first kidney transplantation in our center was performed on January 30th 1971. This was also the first kidney transplantation in Croatia and former Yugoslavia. In the following years the kidney transplantation became a routine surgical procedure but always using multidisciplinary approach. During years and decades of dedicated surgical work many surgical improvements were achieved and many of them were performed in our center for the first time in Croatia and surrounding countries. Some of them are: orthotopic kidney transplantation, en-bloc kidney transplantation, transplantation using urinary diversion and transplantation of horseshoe kidney. In this review article we will present surgical achievements of our transplant team.
Potkovičasti bubreg najčešća je fuzijska anomalija bubrega. Darivatelji koji imaju potkovičasti bubreg smatraju se suboptimalnima zbog čestih vaskularnih i uroloških anomalija. Prikazat ćemo ...transplantaciju potkovičastog bubrega mladoga kadaveričnog darivatelja. Nakon učinjene eksplantacije en bloc bubreg je uz adekvatno prepariranje krvnih žila i uretera razdvojen na dva dijela. Oba dijela potkovičastog bubrega uspješno su transplantirana u dva različita bolesnika u terminalnom stadiju kronične bubrežne insuficijencije. Poslijeoperacijski tijek bio je uredan i oba bolesnika 18 mjeseci nakon transplantacije imaju normalnu bubrežnu funkciju. Transplantacija potkovičastog bubrega zbog anatomskih je razloga zahtjevnija, ali s obzirom na to da su njezini rezultati podjednaki onima u standardnoj transplantacijskoj populaciji, trebalo bi potaknuti transplantacijske kirurge da iskoriste
bubrege s ovom anomalijom.
Summary
Background
Bladder outlet obstruction is an uncommon condition in women. Primary bladder neck obstruction is one of the functional causes of bladder outlet obstruction. We evaluated surgical ...treatment in our patients with primary bladder neck obstruction.
Patients and methods
We retrospectively evaluated the medical data of 47 female patients from the Department of Urology who underwent transurethral incision of the bladder neck from January 2000 to December 2012. All patients underwent transurethral bladder neck incision at the vesical neck and proximal urethra at the 5- and 7-o’clock positions. We compared symptoms and urodynamic parameters before and after the operation.
Results
Out of 47 female patients who underwent the operation, primary bladder neck obstruction was diagnosed in 42. The mean age was 44.3 ± 16.8 (range: 21–78) years. The postoperative maximal flow rates were significantly increased (20.6 ± 3.9 vs. 7.6 ± 3.2 mL/s,
P
< 0.0001), and the postvoid residual urine was decreased (31.3 ± 7.8 vs. 132.1 ± 22.24 mL,
P
= 0.0002) compared with preoperative findings. Improvement was evident in most patients (83.3 %). A repeat operation had to be performed in seven patients (16.7 %). Operative therapy failed in one patient (2.4 %).
Discussion and conclusions
The diagnosis of primary bladder neck obstruction in women is based on typical symptoms, uroflowmetry and multichannel urodynamics, including electromyography. Videourodynamics is obligatory in doubtful cases. Transurethral bladder neck incision is an effective therapy for female patients with primary bladder neck obstruction, and if necessary, a second procedure can be safely performed.
Limfocele su jedna od češćih kirurških komplikacija transplantacije bubrega. Retrospektivno smo analizirali bolesnike s transplantiranim bubregom u našem centru u kojih su dijagnosticirane limfocele. ...Tijekom 39 godina učinili smo 922 transplantacije bubrega, a limfocele su dijagnosticirane u 45 (4,9%) bolesnika. Limfocele smo liječili na sljedeći način: perkutana drenaža s instilacijom povidon-jodida u 36 (80%) bolesnika, perkutana drenaža s instilacijom tetraciklina u jednog (2,2%), perkutana aspiracija u četiri (8,9%) i kirurško liječenje u četiri (8,9%) bolesnika. U četiri (8,9%) bolesnika s recidivom sekundarni postupak bio je uspješan. Ukupno smo otvorenim kirurškim zahvatom liječili pet (11,1%) bolesnika, a laparoskopski četiri (8,9%) bolesnika. Perkutana drenaža limfocele, s instilacijom sklerozirajućeg sredstva ili bez instilacije, je metoda izbora u liječenju limfocele. Laparoskopska fenestracija limfocela je alternativa perkutanoj drenaži, posebno kod recidiva.
The aim of this study was to evaluate the expression of matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinase 9 (MMP-9) in prostate cancer in the main tumor mass and tumor cells at the ...positive margin as well as the influence of these biomarkers on the biochemical recurrence of the disease in prostatectomy patients. Tissue microarrays of 120 archival prostate carcinoma samples were immunohistochemically evaluated for MMP-2 and MMP-9 expression and compared with clinicopathological parameters. Tumors with positive surgical margins showed significantly higher overall expression of MMP-9 versus tumors with negative resection margins P = 0.0121 . MMP-9 expression was significantly elevated in tumors from patients who had biochemical recurrence P = 0.0207 . In the group of patients with negative margins, MMP-9 expression above the cut-off value was significantly associated with recurrence P = 0.0065 . Multivariate analysis indicated that MMP-9 is a good predictor of biochemical recurrence (odds ratio = 10.29; P = 0.0052 ). Expression of MMP-2 in tumor cells was significantly higher at the positive margins than in the main tumor mass P = 0.0301 . The present results highlight the potential value of MMP-2 and MMP-9 expression for predicting the behavior of prostate tumors after prostatectomy with both positive and negative surgical margins.
Cilj: Ispitati učestalost, kliničku evaluaciju i kirurško liječenje pacijenata s karcinomom bubrega (KB). Pacijenti i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti u ...Kliničkom bolničkom centru Rijeka koji su između 1. siječnja 1972. i 31. prosinca 2012. godine operirani zbog KB-a. Rezultati: U promatranom razdoblju u našem centru zbog KB-a bilo je operirano 1045 pacijenata. Broj pacijenata se tijekom vremena povećao, s 5 pacijenata godišnje početkom 70-ih godina na preko 50 posljednjih nekoliko godina. Broj asimptomatskih pacijenata povećao se s 6 % na 75 %. Prosječna dob pacijenata bila je 63 godine (raspon 21 – 86 godina). Nefrektomija je učinjena u 95,3 % pacijenata, u 2,6 % parcijalna nefrektomija, a u 2,1 % eksplorativna lumbotomija. U promatranom razdoblju 5-godišnje preživljenje bilo je u 64 %, a 10-godišnje preživljenje 47 %. Zaključak: Učestalost KB-a se tijekom posljednja četiri desetljeća višestruko povećala. Novije dijagnostičke metode omogućuju njegovo otkrivanje u ranijoj fazi, a samim time se omogućuje poštednije kirurško liječenje, ne umanjujući onkološki učinak.
Cilj: Prikazati učestalost uroloških komplikacija nakon transplantacije bubrega u našem transplantacijskom centru. Ispitanici i metode: Retrospektivnim istraživanjem bili su obuhvaćeni svi pacijenti ...u Kliničkom bolničkom centru Rijeka u kojih je između 30. siječnja 1971. godine i 31. prosinca 2018. godine učinjena transplantacija bubrega. Rezultati: U promatranom razdoblju u našem transplantacijskom centru učinjeno je 1160 transplantacija bubrega. Urološke komplikacije imala su ukupno 154 pacijenta (13,3 %). Najčešće komplikacije su bile stenoza uretera u 52 pacijenta (4,5 %), urinarna fistula u 50 pacijenata (4,3 %), retencija urina u 23 pacijenta (1,9 %) te urolitijaza u 8 pacijenata (0,7 %). U većine pacijenata je provedeno kirurško liječenje. U posljednje vrijeme značajno se povećalo rješavanje uroloških komplikacija korištenjem minimalno-invazivnih metoda. U dvoje pacijenata (0,17 %) je zbog uroloških komplikacija došlo do gubitka grafta, a u troje pacijenata (0,25 %) su one dovele do smrtnog ishoda. Zaključak: Urološke komplikacije u našoj transplantacijskoj populaciji nisu česte. U pacijenata u kojih je potrebno kirurško liječenje endourološke metode predstavljaju danas inicijalnu metodu liječenja.
Aim: To evaluate the incidence of urological complications after kidney transplantation in our transplant center. Patients and Methods: We retrospectively analyzed all patients with kidney transplantation operated in University Hospital Rijeka from January 30st 1971 to December 31st 2018. Results: In the observed period 1160 kidney transplantations were performed in our transplant center. Urological complications were noticed in the 154 patients (13.3%). The most frequent complications were ureteral stenosis in 52 patients (4.5%), urinary fistula in 50 patients (4.3%), urinary retention in 23 patients (1.9%) and urolithiasis in the 8 patients (0.7%). The majority of the patients underwent surgical treatment. Recently, minimally invasive surgery was the method of choice for treatment of urological complications. In two patients (0,17%) urological complications caused graft loss and in the three patients (0,25%) this complications lead to death. Conclusion: Urological complications are not frequent in our transplant population. In the group of patients that required surgical treatment endourology methods are currently the initial treatment modality.
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