Short-term outcome of kidney transplantation from deceased donors with nephrolithiasis / 中南大学学报(医学版)

Objective: Shortage of kidney allografts is a major barrier to end-stage renal disease patients receiving kidney transplantation, and it is necessary to enlarge the donor pool and find better ways of using available allografts. The global incidence of nephrolithiasis is increasing, nephrolithiasis affects approximately 10％ of adults worldwide, and it also affects the kidney donors. However, there is little information about the use of cadaveric kidney allografts with nephrolithiasis. This study aims to evaluate the safety and outcome of kidney transplantation with allografts from the deceased donors with nephrolithiasis. Methods: A total of 520 deceased donors who was at least 10 years old, and 945 adult recipients with single kidney transplantation at the Department of Kidney Transplantation, the Second Xiangya Hospital from 2016 to 2020 were included in this study. The donors were divided into 2 groups according to nephrolithiasis diagnoses: The donors with nephrolithiasis (D+) and the donors without nephrolithiasis (D?). The recipients were assigned into 3 groups according to their donors and the allografts they received: The allografts from donors without nephrolithiasis (D?K?), the allografts without nephrolithiasis from donors with nephrolithiasis (D+K?), and the allografts with nephrolithiasis (D+K+). The demographic and clinical data of enrolled subjects were retrospectively analyzed. The allograft discard ratio between different donors were analyzed. The one-year survival of allografts and recipients, as well as the allograft function and the complications of kidney transplantation were compared. Results: Fifty out of 520 donors had nephrolithiasis, and the nephrolithiasis incidence was 9.6％. We recovered 1040 kidneys, and total discard rate was 4.4％ (46/1040). The D+ group had a rate of 7％ discard. The donors with kidney discard accounted for 12％ in the D+ group, and this was higher than that of donors in the D? group (5.1％, P<0.05). The total incidence of delayed graft function (DGF) was 7.5％, and there were no significant differences in the incidence of DGF in recipients among the D?K?, D+K?, and D+K+ group (7.5％ vs 6.5％ vs 8.2％, P>0.05). During the one-year follow-up, 8 allografts lost function and 19 recipients died with a functional allograft. Recipients in the D?K?, D+K?, and D+K+ groups also had no significant difference between a one-year allograft and patient survival rate (P>0.05). However, recipients in the D+K+ group had a higher level of serum creatinine [(139.2±62.46) μmol/L vs (117.19±51.22) μmol/L, P<0.05] and lower estimated glomerular filtration rate [eGFR; (56.67±23.31) mL/(min·1.73 m?2) vs (66.86±21.90) mL/(min·1.73 m?2), P<0.05] compared with recipients in the D?K? group at 12 months after transplantation. During the first year after transplantation, 4 recipients developed urolithiasis, and recipients who received allografts from the D+ group donors had a higher incidence of urolithiasis than those who received allografts from the D? group donors (2.2％ vs 0.2％, P<0.05). There were no significant differences in the incidence of urinary tract infections and ureteral strictures at 1 year between recipients of D+ and D? donors (both P>0.05).Conclusion: The cadaveric kidney allografts with nephrolithiasis could be safely used for transplantation, and the short-term outcome is acceptable. However, nephrolithiasis in donors may increase the rate of kidney discard, disturb the short-term function of allografts, and increase the risk of urolithiasis in recipients. Further research with a long-term study is needed to verify the long-term outcome of kidney transplantation using cadaveric kidney allografts with nephrolithiasis.

Combination treatment of lfexible/lfexible sheath and rigid ureteroscopic lithotripsy for upper and middle ureteral stones / 中国内镜杂志

Objective To study the combination treatment of lfexible/lfexible sheath and rigid ureteroscopic lithotripsy (F-ul) for upper and middle ureteral stones. Methods The clinical data of patients diagnosed of upper and middle ureteral stones were collected. The treated group (110 cases):ifrstly treated with rigid ureteroscopic lithotripsy to broke and removed stones through lfexible sheath, then the lfexible ureteroscopic lithotripsy was used to broke and removed stones through lfexible sheath;The control group (110 cases):traditional operation for ureter calculi. The clinical data was compared between the two groups. Results The effective ratio of treatment group is 90.0%, which was better than that of control group (87.3%) (P>0.05). The operation time, stone processing time of treatment group were signiifcantly shorter than those of control group (P 0.05). Conclusion The method of combining flexible/flexible sheath and rigid ureteroscopic lithotripsy for upper and middle ureteral stones was better than that of traditional operation, which worth to be popularize in clincal treatment.

Efficiency and outcome of Boari bladder flap plasty surgery for the treatment of middle and lower ureteral carcinoma / 中南大学学报(医学版)

OBJECTIVE@#To study the effect and outcome of Boari bladder flap plasty surgery for the treatment of kidney-sparing strategy for patients with middle and lower ureteral carcinoma.@*METHODS@#Database at the department of urology in the Second Xiangya Hospital from 2002-2007 was screened and all cases of primary solitary lower ureteral carcinoma treated with Boari bladder flap plasty surgery or radical nephroureterectomy were collected. We performed a retrospective review of the clinical data including sex, age, smoking history, tumor site, size, stage, grade, bladder recurrence, renal function et al and evaluated survival rate. The Cox proportional hazards regression model was build to analyze the correlation between each variable and survival time.@*RESULTS@#Thirty nine patients in total were enrolled, including 16 cases underwent Boari bladder flap plasty surgery and 23 cases underwent radical nephroureterectomy. The median follow-up time was 53 months (range 10-84 months). During the follow-up time, 18 patients died, including 6 patients treated with Boari bladder flap plasty surgery and 12 patients treated with radical nephroureterectomy. The estimated bladder recurrence-free survival rate and cancer-specific survival rate at 5 years were 63% vs 59% and 73.8% vs 73.5%, respectively (P>0.05). The survival rate at 5 years and the overall survival rate were 61% vs 57 % and 64.8% vs 58.1% respectively in the 2 groups (P>0.05). There was no significant difference in renal function before surgery between the two groups [creatinine clearance 57 (32-104 ) mL/ min vs 55 (30-102) mL/ min, P>0.05]. Patients underwent Boari bladder flap plasty showed better renal function than patients underwent radical nephroureterectomy [creatinine clearance 55 (35-102) mL/ min vs 43 (30-89) mL/min, P<0.05]. In multivariate Cox regression analysis, the tumor size, pT stage, tumor cell grade and the estimated glomerular filtration rate level were independent factors that affected the overall survival rate of the patients (P<0.05). The tumor size, pT stage and tumor cell grade were positively correlated to the survival time, and the estimated glomerular filtration rate was negatively correlated to the survival time.@*CONCLUSION@#Boari bladder flap plasty surgery could be used to treat lower ureteral carcinoma. Compared with radical nephroureterectomy, Boari bladder flap plasty surgery has equal survival rate and shows superior postoperative renal function.

Application of tube gastrostomy in radical cystectomy with ileal conduit: a retrospective, comparative study / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the clinical results of tube gastrostomy in radical cystectomy and ileal conduit.</p><p><b>METHODS</b>We retrospectively analyzed the data of 98 patients undergoing radical cystectomy and ileal conduit between March 2007 and February 2010. According to postoperative gastrointestinal decompression methods, the patients were divided into nasogastric decompression group (n=50) and tube gastrostomy group (n=48), and the gastrointestinal recovery time, surgical complications and hospital stay were compared between them.</p><p><b>RESULTS</b>No statistical difference was found in gastrointestinal recovery time, hospital stay, or surgical complications between the two groups, but the incidence of pulmonary infection was significantly lower in tube gastrostomy group than in nasogastric decompression group (P<0.05).</p><p><b>CONCLUSION</b>Tube gastrostomy is an easy, safe and effective means for gastric decompression after radical cystectomy with ileal conduit, especially suitable for elderly patients and those with potential pulmonary disorder.</p>

Percutaneous nephrolithotomy of staghorn calculi in patients by mini-tract and standard-tract / 中南大学学报(医学版)

OBJECTIVE@#To compare the outcome of mini-tract vs standard-tract percutaneous nephrolithotomy (PCNL) in staghorn calculi.@*METHODS@#Between May 2009 and May 2011, 122 patients with renal staghorn calculi were treated by PCNL. Fifty-six patients underwent mini-PCNL and the others underwent standard-PCNL. The therapeutic effect and complication of the 2 groups were compared.@*RESULTS@#The two groups had comparable demographic conditions. Although the operation time was significantly longer in mini-PCNL group [(126±24.5) min vs (98±18.9) min], there was no striking difference in hospital stay [(5.7±1.3) d vs (5.3±1.1) d], hemoglobin drop [(9.5±3.2) g/L vs (10.5±3.3) g/L], stone-free state before charge (91.1% vs 89.4%) and complications.@*CONCLUSION@#The efficacy and safety of mini-PCNL and standard-PCNL are not significantly different.

Efficacy and safety of percutaneous nephrolithotomy for treatment of staghorn stones in solitary kidney / 中南大学学报(医学版)

OBJECTIVE@#To analyze efficacy and safety of percutaneous nephrolithotomy (PCNL) in the management of staghorn calculi with solitary kidney.@*METHODS@#Between April 2009 and December 2011, 13 patients with renal staghorn calculi in solitary kidney were treated by PCNL in our hospital. The therapeutic effects and complications were the main points of the analysis.@*RESULTS@#Of the 13 patients, surgery time was 92-164 (117.2±21.5) min; 9 cases underwent PCNL through a single access tract, 4 cases through multi-access tracts. The stone removal rate in one session of PCNL was 76.9%, and the total clearance rate was 92.3%. Hemoglobin dropped 11-32 (16.4±4.6) g/L; one case required blood transfusion; no patient had embolism. Hospital stay was 5-10 (6.9±1.5) days postoperatively. Serum creatinine before PCNL in these patients was 83-237 (146.24±38.73) μmol/L compared to 81-242 (134.56±21.52) μmol/L by the end of the 1-month follow-up period (not statistically different). Similar findings were observed in glomerular filtration rates: before PCNL it was 42-114 (71.32±20.82) mL/min and by the end of the 1-month follow-up it was 55-117 (79.40±22.14) mL/min (not statistically different).@*CONCLUSION@#PCNL is effective and safe for the treatment of staghorn stones in solitary kidney, and has advantages such as short surgical duration, fewer complications, rapid recovery, short hospital stay, effective stone removal rate, and so on.

Retroperitoneoscopic ureterolithotomy for upper ureteral calculus: 69 cases / 中南大学学报(医学版)

OBJECTIVE@#To review the technical details of retroperitoneoscopic ureterolithotomy and evaluate the clinical effect.@*METHODS@#Between June 2004 and December 2008, 69 patients (55 males and 14 females) with upper ureteral calculus received retroperitoneal laparoseopic ureterolithotomy (40 left sides and 29 right sides). The stone size ranged from 1.5 to 3.1 cm [(2.2±0.6) cm].@*RESULTS@#All the patients underwent retroperitoneoscopic ureterolithotomy. The operation time was 40-295 (63.1±19.8) min,and the blood loss was 30-150 (57.2±23.0) mL.The hospital stay was 5-8 (6.7±1.3) d. During the followup, there was neither ureteral stricture nor recurrent calculus.@*CONCLUSION@#Retroperitoneoscopic ureterolithotomy is safe, effective and minimally invasive, which may replace the conventional open surgery.