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.
Background
Peritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus ...abdominis plane (TAP) block.
Methods
In the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015.
Results
The TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications.
Conclusion
The TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.
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.
Prostate cancer is the most common malignancy in men. The 5-year relative survival for all stages combined is 98.8%. Patients diagnosed with metastatic prostate cancer have median survival from 2 to ...3 years. We describe a case of 64-year old man who clinically presented with inguinal lymphadenopathy. Because of elevated PSA levels biopsy of prostate was done and adenocarcinoma was diagnosed. Biopsy of inguinal lymph nodes confirmed the diagnosis of prostate cancer. Hormonal treatment was started and at the most recent follow-up, 10 years later, the patient is asymptomatic with no clinical signs of disseminated disease.
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.
We report a case of a kidney-transplanted patient with urolithiasis treated with mini-percutaneous laser lithotripsy. The patient presented with renal dysfunction and graft hydronephrosis. Diagnostic ...procedures revealed ureterolithiasis as a cause of obstruction, and percutaneous nephrostomy was inserted as a temporary solution. Before surgery, the stone migrated to the renal pelvis. Mini-percutaneous laser lithotripsy was successfully performed, and during surgery, all stone fragments were removed. Six months after successful treatment, the patient has good functioning and stone-free graft.
Voiding dysfunction is frequently seen in the early posttransplant period. Among other causes, this condition can arise due to bladder outlet obstruction. Primary bladder neck obstruction (PBNO) is a ...possible but very rare cause of bladder outlet obstruction. We present the case of a 52-year-old woman who, after kidney transplantation, presented with PBNO. The diagnosis was established based on symptoms, uroflowmetry, and multichannel urodynamics with electromyography. The transurethral incision of the bladder neck was made at the 5- and 7-o’clock position. After the operation, the maximal flow rate was significantly increased, and postvoid residual urine was decreased compared to the preoperative findings. The patient was followed for 5 years, and her voiding improvement is persistent. This is the first reported case of PBNO treated with a transurethral incision of the bladder neck in a posttransplantation female patient.
Izvantjelesno mrvljenje kamenaca (ESWL) je novija terapijska metoda u liječenju urolitjaze. Temelji se na uporabi šok-valova koji se stvaraju u generatoru, fokusiraju i usmjeruju na kamenac u tijelu ...pacijenta. Razbijanje kamenca je posljedica nekoliko različith efekata tih valova na sam konkrement. Razbijanjem nastaju manji fragmenti koji se moraju izmokriti. ESWL se korist u liječenju bubrežnih kao i kamenaca u mokraćovodu. Metoda je izbora za liječenje bubrežnih kamenaca manjih od 2 cm te onih u proksimalnom dijelu mokraćovoda veličine do 1 cm. Komplikacije su rijetke i najčešće klinički beznačajne.
Efkasnost ove metode ovisi o veličini kamenca, njegovom sastavu, kanalnom sustavu bubrega te o iskustvu i vještni urologa. Velika prednost ove metode je da nije potrebna anestezija, za razliku od drugih minimalno invazivnih metoda. Tretman ESWL-a može se ponavljati više puta. Do sada nije dokazan štetan učinak na bubrežnu funkciju, a može se koristiti i u dječjoj populaciji.
Cilj: Prikazati naše rezultate u liječenju pacijenata s bubrežnim kamencima metodom miniperkutane nefrolitotripsije (miniPCNL). Pacijenti i metode: Retrospektivnim istraživanjem obuhvatili smo ...pacijente Klinike za urologiju, Kliničkog bolničkog centra u Rijeci
koji su između 1. kolovoza 2015. i 31. prosinca 2016. godine zbog bubrežnih kamenaca liječeni metodom miniPCNL-a. Rezultati: U promatranom razdoblju u našem centru operirano je 6 pacijenata ovom metodom, od kojih je jedan bio s transplantiranim bubregom. U svih pacijenata uspješno je učinjena litotripsija s holmium-laserom. Na kontrolnom RTG-u nije bilo ostatnih fragmenata. U četvoro pacijenata poslijeoperativno je došlo do razvoja febriliteta koji je uspješno liječen antibiotskom terapijom. Niti u jednog pacijenta nije bila potrebna reoperacija, dodatne procedure niti potreba za davanjem krvi. Zaključak: Miniperkutana
nefrolitotripsija je minimalno invazivna metoda koja se pokazala uspješnom i sigurnom u liječenju nefrolitijaze.
Urodinamika i njezina klinička primjena Trošelj, Marin; Rubinić, Nino; Vukelić, Ivan ...
Medicina fluminensis,
09/2017, Letnik:
53, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Urodinamika je metoda kojom se procjenjuje funkcija mokraćnoga sustava, najčešće njegovog donjeg dijela. Donji dio urinarnog sustava je funkcionalna cjelina koja se sastoji od mokraćnoga mjehura, ...sfinkterskoga mehanizma i mokraćne cijevi. Osnovna funkcija mu je punjenje i pražnjenje mjehura uz kontinenciju. Urodinamikom se mogu adekvatno evaluirati sve te funkcije. Urodinamika je indicirana kao nadopuna standardnim pretragama. Najčešće korištene metode su mikciometrija, cistometrija i profilometrija uretre. Mikciometrijom se određuje protok urina u jedinici vremena tijekom akta mikcije. Cistometrijom mjerimo
tlakove u mjehuru tijekom njegova punjenja i pražnjenja. Profilometrijom uretre određujemo tlakove u uretri, a dobiveni podaci govore nam o kontinenciji ispitanika. U preglednom radu prikazat ćemo osnove urodinamskog ispitivanja s kliničkim primjerima.
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