Urological complications in ureteric stenting live related renal transplantation

To determine the frequency and types of post-transplant urological complications in live-related kidney transplantation with reference to the impact of JJ ureteric stent. Case series. Shaikh Zayed Postgraduate Medical Institute and National Institute of Kidney Diseases, Lahore, from June 2006 to July 2010. Consecutive renal transplantations, donors being alive were relatives, reterospectively reviewed. All patients underwent extravesical ureteroneocystostomy and all, except one were stented. From the retrieved clinical records, the frequency and types of various minor and major urological complications and their management was studied. All the complications were managed according to standard guidelines. The overall incidence of urological complications among transplant recipients was 11.9%, observed in 12 patients. The complications were urinary leakage in 2 [2%] and clot retention, ureterovesical junction obstruction and wound infection in one [1%] patient each. Urinary tract infection was observed in 7 [6.9%] patients. Urinary tract infection was the most common urologic complication in the studied cases. The technique of stented extravesical ureteronecystostomy had a low rate of urological complications in this series. Other factors which may reduce the urological complications are preserving adventitia, fat and blood supply of ureter by delicate dissection during donor nephrectomy and prevent kinking and twisting of ureter are important factors in reducing the post-transplant urological complications

Live renal donors; comparison of CT angiographyand per operative findings

To compare the findings of helical computed tomographic angiography and intra-operative findings in live related donors. To evaluate the accuracy of helical computed tomography with advanced 3D techniques in depicting the renal vasculature, parenchymal and anatomy of collecting system. Sheikh Zayed Post Graduate Medical Institute and National Institute of kidney diseases Lahore. Between June 2006 to May 2009 eighty potential donors underwent CT angiogram as a part of their preoperative workup. We retrospectively studied the CT angiogram and compared the finding with the surgical findings. The results were reviewed with radiologists to determine the discrepancy in discordant cases. The accuracy of CT angiography was 93.40% to predict number of vessels. Five arteries and one vein was missed, this disconcordant comprised 7.59% during initial CT interpretation. The overall concordance between CT angiography and operative findings in delineating the arterial anatomy was found in 74 [93.67%] and venous in 78 [98.73%] donors. All CT scans demonstrated normal collecting system except one, which showed a dilated right pelvicalical system and ureter. Simple renal cysts about the size of 2-4 cm were found in the four left kidneys. CT scan supplied additional important anatomical information including kidney size and the presence of nephrolithiasis. Helical CT angiography is very specific for arterial and venous anatomy as well as other anatomical and functional details. It provides all the information required by a surgeon. It can become the single imaging modality for preoperative assessment of potential donors in place of conventional angiography and intravenous urography. CT angiography is minimally invasive and cost effective

Extracorporeal shock wave lithotripsy; outcome in pediatric urolithiasis

[1] To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. [2] To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Analytical case series study. Fifty patients of either sex below the age fourteen [14 years] having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Out of the fifty patients, 40 [80%] were males and 10 [20%] females with male to female ratio of 4.1. The age range of patients was 2-14 years [mean +/- SD 9.24 +/- 3.48 years]. Thirty three patients [66%] had renal stones, 7 [14%] ureteric and 10 patients [20%] had bladder stones. Single successful treatment session was noted in 22 patients [44%], 18 patients [36%] received two sessions and 10 patients [20%] required three sessions for successful stone fragmentation. Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients [42%] felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients [34%], impacted stone in five [10%], ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients [40%] developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics