Cadaver transplantation in recent era: is cadaveric graft survival similar to living kidney transplantation?

Renal transplantation is the procedure of choice for most of patients with end-stage renal disease. The graft, however can be procured from either cadaver or living donors. To compare graft and patient survival among patients who underwent kidney transplantation from cadaver donor vs. living donor. From April 2002 to February 2010, we performed 138 cadaver kidney transplantations. We reviewed and compared one-year graft and patient survival with 138 living kidney transplantations. One-year graft and patient survivals in cadaveric groups were 93% and 96%, respectively, and in living groups were 92% and 97%, respectively. There was no significant difference in one-year graft and patient survival between living and cadaver donor kidney transplantation

impact of hepatitis b infection on outcome of kidney transplantation: a long-term study

With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients. To determine the impact of hepatitis B virus [HBV] infection on patients and graft survival in both short- and long-terms. 99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: [1] those only positive for hepatitis B surface antigen [HBsAg] and [2] those who were also positive for hepatitis C virus antibodies [HCV Ab]. There were 88 patients with HBsAg[+] and 11 with both HBsAg[+] and HCV Ab[+]. The mean +/- SD age of patients was 38.8 +/- 13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group [HBV[+] was better compared to that in the second group [HBV[+] and HCV[+]; 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively [P=0.07]. The overall mortality was 5% [4 of 88] in the first and 27% [3 of 11] in the second group [P=0.02]. Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to pa- tients with only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups

Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens

Renal colic: pathophysiology, diagnosis and management

Renal colic not only leads to significant morbidity, but also imposes a financial burden on society in that it decreases productivity and increases healthcare costs. A review of medical literature regarding reno - urethral colic was performed using MEDLINE and on-line publications, like European Association of Urology [EAU] Guidelines. Clinical presentation of renal colic, mechanisms of urethral peristalsis and pathophysiology of renal colic were studied. An overview of available medical treatments was presented. The classic presentation of acute renal colic is sudden onset of severe pain in flank, primarily caused by acute urethral obstruction. The pain associated with urethral obstruction is caused by a rise in intra luminal pressure which produces an increase in urethral smooth muscle tension. The diagnosis is often made on clinical symptoms. The objectives of therapy at this stage are to eliminate pain, preserve renal function and eliminate the obstruction. Many drugs have been used in the treatment of renal colic, such as NSAIDs, opioid analgesics, and even loco-regional anesthesia and acupuncture. Nonetheless, the safest and most effective treatment has not yet been clearly defined. An accurate understanding of the pathophysiology of reno- urethral colic allows the physician to tailor the best treatment for each patient. Although many drugs have been suggested for treating renal colic, it seems that the first line medications should be NSAIDs, mostly in oral form. Fluid intake is encouraged and chemical analysis of stone should be performed whenever possible

Modern status of laparoscopic surgery in the urology of iran and world

First, we would like to introduce laparoscopic procedures conducted at Labbafinejad Medical Center [1057 cases], some of which were performed for the first time in Iran and some others were conducted for the first time worldwide, by which Iran has been known as a leading country among Mediterranean countries in laparoscopic urology. 1. Laparoscopic ileocystoplasty [to extend bladder by ileum with intestinal anastomosis] simultaneously with laparoscopic Malon to control stool incontinence [First case in the world] [9 cases] 2. Laparoscopic urethrocystoplasty [First case in the world] [2 cases] 3. Radical laparoscopic prostatectomy by an innovative technique with no suture [35 cases] 4. Laparoscopic antireflux in children by Lich method [40 cases] 5. Laparoscopic retroperitoneal and pelvic lymphadenectomy [10 cases] 6. Laparoscopic pyeloplasty [to repair pelvic obstruction] [60 cases] 7. Laparoscopic donor Nephrectomy [220 cases] 8. Laparoscopic Nephrectomy [71 cases] 9. Laparoscopic adrenalectomy [14 cases] 10. Laparoscopic adrenalectomy [25 cases] 11. Laparoscopic surgery of retrocaval ureter [3 cases] 12. Laparoscopic removal of ureteral and pelvic stones [140 cases] 13. Nephropexy [1 cases] 14. Varicocelectomy [110 cases] 15. Laparoscopic repair of hydrocele and hernia [32 cases] 16. Laparoscopic therapy of renal cyst [30 cases] 17. The detection and treatment of ectopic testis [247 cases] 18. Partial adernalectomy [4 cases] 19. Histrosalpingoanorectomy [4 cases]

Laparoscopic ureteropelvic junction decompression for the management of obstruction

We reported the outcome and complications of laparoscopic aberrant vessels transposition without performing pyeloplasty in patients with ureteropelvic stenosis. A total of 10 patients with ureteropelvic stenosis accompanying with aberrant vessels underwent laparoscopic transposition of vessels between June 2001 and March 2003. 4 of the cases were male and 6 were female, and 4 out of 10 had right side and 6 had left side involvement. The mean age was 31.9 [14-59]. Reaction of aberrant vessels was performed by cutting the vain and fixing the artery to the lipid layer around the kidney and renal pelvis. The procedure was successful in all the cases without any perioperative complications. The operative time was 2.20 hours [1.45-2.50] including cystoscopy, DJ placement, and transposition. Mean hospital stay was 2.9 [2-5] days, and patients were followed up an average of 9.1 [3-22] months. Except one case of rehospitalization due to pain, no complication occurred. The rate of clinical and radiological improvement was 100% and IVP showed a decrease in the degree of hydronephrosis as well as the resolution of obstruction observed in renogram. With regard to our findings, it seems, at least in a proportion of patients with UPJ stenosis accompanied with crossing vessels, that mechanical compression is the mere cause of obstruction and primary stenosis does not coexist. As a result, treatment is achieved by transposition of the crossing vessels without entering the renal unit

role of ureteroscopy in the treatment of renal transplantation complications

To determine the feasibility, safety, and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters. We reviewed 1560 consecutive renal allografts have been preformed between June 1989 and February 2002. Twenty-eight patients [1.8%] had indication for endoscopic procedure on allograft ureter. Six patients had obstructive ureteral calculi with a history of failed ESWL, 3 had suspected ureteral stricture, 9 had upward migrated ureteral stents and 10 had ureteral stricture at ureteroneocystostomy site. Ureters were anastomosed to bladder using Leadbetter- Politano and Lich-GreGoire methods in 6 and 22 cases, respectively. Ureteroscopies were performed with semi rigid 9.8F wolf ureteroscope. Identifying and introducing the ureteral orifice was successful in 19 [68%] cases. If we exclude 10 patients with ureteral stricture, ureteroscopy was successful in 13 out of 18 [72%]. Four ureteral calculi [67%] were removed with ureteroscope.Seven out of nine migrated stents [78%] were retrieved. Four patients with ureteral stricture at ureteroneocystostomy site [40%] had successful ureteral dilatation and double J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications including one urinary leakage and one symptomatic urinary tract infection occurred that were managed conservatively. Ureteral endoscopy was safe and effective method for management of urological complications after RT [renal transplantation]. This procedure can be considered as the first choice compared with percutaneous and antegrade modalities

comparison of augmentation cystoplasty before and after renal transplantation with the control group

We compared two surgical methods of augmentation cystoplasty [AC], before and after renal transplantation, and the outcomes of both methods with transplant patients with normal bladder function. 1520 kidney transplantations were performed at Shahid Labbafinejad Center between March 1988 and February 2002 of which 36 cases was accompanied with AC. In 20 patients [group A] AC was performed before transplantation. This group consisted of 14 males and 6 females with a mean age of 26.1 [13-39] at the time of transplantation. Sixteen patients consisting of 11 males and 5 females [mean age 27.3, 12-44] underwent AC after transplantation. Eventually 40 transplant patients with normal bladder function were assigned in the control group including 18 males and 22 females with a mean age of 31.2 [11-55] [group C]. Normal graft function was achieved in 16, 13, and 33 patients of groups A, B, and C respectively over the mean follow-up of 70, 59, and 76 months [p<0.7]. Mean serum creatinine during the follow-up was 1.48 +/- 0.4, 1.7 +/- 1, and 1.4 +/- 0.55 for groups A, B, and C respectively. 9, 12, and 17 patients [26, 64, and 34 cases] with UTI requiring hospital admission were observed in the 3 groups respectively. The incident of UTI and the resultant hospitalization in group B was more than the one in group C [p<0.03], but it did not differ significantly from group A to group C. AC is a safe and effective method to improve the lower urinary system function and with the exception of increased risk of UTI following AC after transplantation [group B], there is no considerable difference in the complication rates between AC before and after renal transplantation. As a result, we can perform AC before or after kidney transplantation in patients with dysfunctional lower urinary tract system up to their specific conditions

Laparoscopic adrenalectomy: a report of the first experiment in Iran

To report the first experiment in laparoscopic adrenalectomy and study its success and immunity in treating different adrenal diseases. From March 1997 to July 2001, 11 patients underwent laparoscopic adrenalectomy through transperitoneal approach. Five of whom were males and 6 were females. Their mean age was 35.5 [range 28 to 52] years. Lesion was located at left in 6 patients and at right in 5. All necessary steps were preoperatively taken including CT scan, MRI, MIBG scan, and endocrine tests such as ACTH, cortisol, mineralocorticoid, 17-hydroxyprogesterone, and VMA. Three [5, 10, and 12 mm] trocars were used in left laparoscopic adrenalectomy and three or four [12, 10, 5, and 5 mm] trocars were applied in right laparoscopic adrenalectomy. All patients have been followed up for three months by physical examination and paraclinical tests. Mean operation time [including anesthesia and surgery] was 205 +/- 65.95 [range 130 to 310] minutes. No significant difference was seen between the operation time in the left and the right adrenalectomy [p=0.5]. Mean hospitalization was 5.54 +/- 3.4 [range 3 to15] days. Mean size of mass was 5.45 +/- 1.7 [range 2 to 8] cm. Blood transfusion was performed in 2 patients and open surgery was conducted for one because of high adhesion. No mortality was reported. During a 3-month follow-up, hormonal tests and blood pressure were normal for all patients, with no medical treatment. This experiment showed that transperitoneal laparoscopic adrenalectomy is an effective and safe approach in the treatment of adrenal masses with the least morbidity

Transcutaneous ultrasound guided nephrolithotomy: the first report from Iran

To evaluate the safety and efficacy of transcutaneous ultrasound guided nephrolithotomy. From December 1999 to December 2000, 12 patients with renal stone were selected for PCNL. Six patients had failed ESWL and the remainder had multiple and large stones in pelvis and lower calyx. Ultrasonography was used in 11 patients during the entrance to the system and dilatation of the tract. Entrance to the system was impossible in one case for which open surgery with dorsal lumbotomy was performed. The stone was removed by just one session of PCNL in 8 and the residual stone was less than 1 cm in the 3 other cases. Repeated PCNL from the same tract was performed in one case and ESWL was carried out in the other 2 cases. After three months, all of the 11 patients were stone free. It seems that ultrasonography could replace fluoroscopy in patients with dilated collective urinary system and a single large stone in calyx or pelvis

Endourology: a comparison between laparoscopic and open pyeloplasty in patients with ureteropelvic junction obstruction

To compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction [UPJO] were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6% in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar [6.2 days] in the two groups. Mean follow-up was 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87% for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay is also not longer than that in open surgeries. Hence, laparoscopic pyeloplasty can be a substitute for skilled surgeons

PCNL in the management of lower pole caliceal calculi

Several therapeutic methods are used in the management of lower pole caliceal calculi. This survey has been conducted to evaluate the safety and efficacy of percutaneous nephrolithotomy in the management of lower pole calculi. Fifty-five patients, 43 males and 12 females with a mean age of 41.5 [range 11 to 75] years, who had suffered from lower pole caliceal calculi and treated by standard percutaneous nephrolithotomy [PCNL] between 1997 and 2001, were enrolled in this study. The stones were classified as follows: small [less than 25 mm], intermediate [25 to 34 mm] and large [more than 35 mm]. Mean follow-up was 6.2 months [range 2 weeks to 34 months]. The stones were completely extracted by one session PCNL in 43 patients [79%]. Repeat PCNL was needed in one patient and another method was used for stone extraction in another patient. Regarding the size of stone, 88%, 79%, and 74% of small, intermediate, and large stones were completely extracted, respectively. No major complication was noted. PCNL has high success rate in patients with stones larger than 2 cm and its morbidity would be low, provided that it is performed by skilled surgeons

Laparoscopic adrenalectomy: a report of the first experience in Iran

To report the first experience in laparoscopic adrenalectomy and to study its efficacy and safety in the treatment of different adrenal diseases. From March 1997 to July 2001, 11 patients underwent laparoscopic adrenalectomy through transperitoneal approach, five of whom were males and 6 were females. Their mean age was 35.5 [range 28 to52] years. Lesion was located on the left side in 6 patients and on the right side in 5. All necessary evaluations were done preoperatively including CT scan, MRI, MIBG scan, and endocrine tests such as ACTH, cortisol, mineralocorticoid, 17-hydroxyprogesterone, and urinary VMA. Three [5, 10, and 12 mm] trocars were used in left laparoscopic adrenalectomy and three or four [12, 10, 5, and 5 mm] trocars were applied in right laparoscopic adrenalectomy. All the patients were followed up for three months with physical examination and paraclinical tests. Mean operative time [including anesthesia and surgery] was 205 +/- 65.95 [range 130 to 310] minutes. No significant difference was seen between the operative time in the left side and the right side adrenalectomy [p=0.5]. Mean hospitalization was 5.54 +/- 3.4 [range 3 to15] days. Mean size of mass was 5.45 +/- 1.7 [range 2 to 8] cm. Blood transfusion was performed in 2 patients and open surgery was conducted for one because of extensive adhesions. No mortality was reported. During a 3-month follow- up, hormonal tests and blood pressure were normal for all the patients, with no medical treatment being required. Our study demonstrated that transperitoneal laparoscopic adrenalectomy is an effective and safe approach in the treatment of adrenal masses with the least morbidity

Laparoscopic diagnosis of cryptorchidism and laparoscopic orchiopexy: the first report from the middle east

Laparoscopic orchiopexy [LO] was used in place of open surgery in 10 patients for diagnosing cryptorchidism in our department. In this method a large abdominal incision was not given in search of intra-abdominal testes. Anorchia was diagnosed in four patients, which was shown to be bilateral in one. In one subject with ambiguous genitalia, revealing the presence of intra-abdominal gonads established the infant's gender as male. In four patients, five laparoscopic orchiopexies were performed without celiotomy for the first time in Iran and the middle east which was bilateral in one patient. Except for two patients, all procedures were performed on an outpatient basis. Today laparoscopy is the method of choice for diagnosing cryptorchidism. Our report has shown that orchiopexy can be performed for intra-abdominal testes without submitting to open surgical techniques

Electroejaculation for fertility in men with spinal cord injury

From October 1990, to June 1992, more than 800 electroejaculations and 108 intrauterine inseminations [IUI] were performed in 250 paraplegic males and their wives. Seven successful pregnancies are the results of this 20-month effort. This is the first report of electroejaculation and successful pregnancy with its use in Iran and the Middle East

Subepithelial hematoma of the renal pelvicalyceal system simulating renal cystic tumor

Only 13 cases of subepithelial hematoma of the renal pelvicalyceal system have been reported. We report the fourteenth case. In 11 of the 13 reported cases, nephrectomy of the involved kidney was performed. Our case is the third case in which only partial nephrectomy was done in this benign lesion. A 38 year old male was referred due to hematuria and left flank pain. Intravenous pyelogram revealed a mass in the lower pole of the left kidney. Ultrasound and CT scanning revealed a cystic mass in the same area. Partial left lower pole nephrectomy was done. Pathology report was benign Anthopol Goldman lesion [subepithelial hematoma of renal pelvicalyceal system]