ABSTRACT
Introduction: This article provides areview about techniques and pitfalls of arterialand venous reconstruction during kidneytransplantation. Main reasons of our clinicalstudy are to evaluate vascular variationsof kidney, posttransplantation vascularcomplication incidence and present status ofsurgery outcome.This retrospective researchbased on cross-sectional assessmentofconsecutive 102 kidney transplantation cases,which performed from 2006 to 2015 at theFirst Central Hospital of Mongolia.Materials and methods: Statisticalprocessing andanalysis on posttransplantionpatient history data are made byMicrosoftExcel, SPSS19.0software.Results: Despite rising technicaldifficulties caused by vascular variations,pelvic and inguinal morphology of recipientand the existence of multiple renal arterieskidney transplantation is a safe and highlyefficient procedure.On this article wereexplained 44 kidney transplantation caseswith reconstruction using microvasculartechniques to reconstruct renal arteriesand veins. About 10 different kinds ofreconstructions were done in our practice.Due to investigation of consecutive 102kidney transplanted recipients, 24,51% had avascular anatomical variations. And describedabout 44 vascular reconstructions used inour hospital in case of vascular variations.According to the lit., vascular complicationsranges from 1 to 16%. In our hospital,vascularcomplication of kidney transplantation withmultiple vessels is 4,0-12,0%. Also, incidenceof vascular complication in group with singlevessels from 1.3 to 2.6% and in group withmultiple vessel 4 to 12%.Even it is highcomparing with other international articles;it’s almost in same results. But lymphaticcomplication is higher than others; it showsneeds of careful and accurate dissection ofrecipient site anastomosing vessels.Conclusion: Multiple renal graft’sveselshave been associated with a higher rateof vascular complications, including arterialstenosis and lymphorrhea. It shows needs ofcareful and accurate dissection of recipientsite anastomosing vessels.
ABSTRACT
Introduction: Extracorporeal shockwave lithotripsy (ESWL) revolutionizedthe treatment of urolithiasis and graduallybecame the favorite treatment option sothat today it is considered to be the first lineof treatment for patients with urolithiasis.The purpose of this study was assessment oftherapeutic efficacy, complications of ESWLin urolithiasis in Mongolia.Material and methods: A total of46 patients harboring renal and ureteralstones underwent ESWL between March2016 and September 2016 at First CentralHospital of Mongolia. Karl Storz ModulithSLK electromagnetic machines were usedto impart shock waves. All collected stonefragments sent for biochemical analysis.Results: A total of 46 patients 23 weremales (50%). Patients were mean age of34. The stone size distribution was 0.5cmto 3.1cm. The average treatment time wasranging from 75-110 minutes. The averagenumber of shock waves per treatmentwas 3172±378 (range 1500-4000). Theoverall success rate was 75.73%. All calculidisintegrated satisfactorily except for 3stones, which is located lower 1/3rd ofureter. Stone composition analysis proved tobe composed entirely or predominantly ofcalcium oxalate monohydrate. These patientsrequired to have ureterolithoextraction. Calculicomposition for remaining patients 12 werecalcium oxalate monohydrate, 17 calciumoxalate dehydrate, 6 uric acid and 1 struvite.Complications were mostly minor and rare.Most of the patients (90.7%) developedmacroscopic hematuria after treatment; fewpatients developed mild bruising at the entryand exit sites of the shockwaves on the bodywall. Severe complications such as renalhematoma and steinstrasse were diagnosedfor one patient each and their managementwas non-surgical.Conclusion: ESWL is therefore the firstline treatment for urolithiasis with stonesize smaller than 2cm. It has an efficiencyrate above 75, low procedure time, highsafety and good tolerability and minimalcomplication.