Postoperative urological complications of renal transplantation; Al Karama hospital experience

Studying early post kidney transplant urological complication will provide a feed back evaluation for the surgical technique used and the way of complication management. To study the postoperative urological complications and their management in the first 6 months following renal transplantation. This is a retrospective study in which 123 patients with end stage renal disease [ESRD] underwent renal transplantation from January 2001 to October 2004 in Al Karama teaching hospital, Baghdad -Iraq. All the transplanted kidneys were from living donors. Direct matching between the serum of recipient and lymphocytes of the donor was negative. Extravesical ureteroneosystostomy was carried out using a stent across the anastomotic site. Postoperatively recipients were followed for 6 months by clinical and regular laboratory tests. Ultrasound and color Doppler examinations were performed when there was any evidence of decreased urinary output, allograft dysfunction, or clinical suspicion of rejection. In 123 patients aged 5-59 years with a mean age of 34 years, renal transplantation was carried out. Postoperative urological complications within the first 6 months were reported in 12 [9.75%] patients including urinary leakage in 6 [4.8%], ureteral obstruction in 3 [2.4%], and lymphocele in 3 [2.4%] patients. Major urological complications after renal transplantation contribute to patient morbidity and compromise graft function. Early diagnosis and treatment will avoid loss of the graft

Ileal-conduit following cystectomy, single-institution revision of indications and outcome

To revise indications, case fatality ratio, and postoperative early and late complications of ileal conduit as a method of urinary diversion. This is a retrospective study in which 200 patients underwent an ileal conduit from August 1994 to December 2000 in Mansoura Urology and Nephrology Center, Mansoura, Egypt. Preoperative criteria of patient selection, peroperative findings, and postoperative follow-up data were reviewed. In 200 patients aged 29-75 years, with a mean age of 55.84 +/- 8.91 years, the ileal conduit was chosen as a method of urinary diversion, due to one of the following patient or surgical factors; 50 [25%] cardiopulmonary co-morbidities, 27 [13.5%] liver cirrhosis, 20 [10%] impaired renal function, 18 [9%] poorly controlled diabetes mellitus, and 3 [1.5%] morbid obesity. Frozen section pathological examination showed carcinoma invasion of the urethra in 26 [13%], and prostate stroma in 16 [8%] male patients. Severe adhesions and difficult cystectomy were encountered in 25 [12.5%] patients. Tumor was found at or close to the bladder neck in 13 [6.5%] female patients, and 2 [1%] patients were found to have short mesentery. The mean follow up period was 90.02 +/- 22.63 months. Fatality rate was 2%. Twenty-three [11.5%] patients had early complications, while 36 [23.7%] patients had late complications. Ileal conduit is still the best urinary diversion method in many patients who have bladder cancer with associated chronic medical disease or certain surgical factors that render other urinary diversion methods more difficult, carry more postoperative morbidity and mortality, or both