ABSTRACT
Introducción y Objetivo La técnica de Lich Gregoir es actualmente la de elección para la corrección del reflujo vesicoureteral (RVU) de alto grado, con complicaciones como la obstrucción ureteral. La literatura reporta tasas del 6% al 28% de hidronefrosis transitoria, las cuales, en su gran mayoría, corresponden a un hallazgo temporal sin repercusión clínica. El objetivo de este trabajo es establecer la incidencia de hidronefrosis transitoria y la asociación con factores de riesgo. Materiales y Metodos Realizamos una cohorte descriptiva retrospectiva, analizando 119 unidades ureterales reimplantadas mediante técnica de Lich Gregoir (LG) en menores de 18 años, entre Septiembre del 2009 y abril del 2017. Se excluyeron pacientes con megauréter primario, RVU secundario y cirugía previa para corrección de RVU. El análisis estadístico se realizó con Stata 13.0 Resultados Evaluamos 85 pacientes, 34 de ellos reimplantados de manera bilateral, para un total de 119 unidades ureterales. El promedio de edad fue de 4,4 años y el 68% fueron mujeres. El RVU grado IV fue el más prevalente con el 42%. Las ecografías renales prequirúrgicas fueron normales en el 63% de los casos y el 14,2% presentó hidronefrosis transitoria con resolución a los 3 meses. No se reportaron casos de obstrucción ureteral. El grado de reflujo prequirúrgico no se asoció con hidronefrosis transitoria (p = 0,64) así como tampoco la lateralidad (p = 0,06). Conclusión El reimplante vesicoureteral abierto con técnica de Lich Gregoir en nuestra institución, reporta tasas de hidronefrosis transitoria comparables a la literatura mundial. No se identificaron factores de asociación para hidronefrosis transitoria, diferentes a la técnica quirúrgica perse.
Introduction and Objective Lich Gregoir technique is currently the choice for correction of vesicoureteral reflux (VUR), with complications such as ureteral obstruction. Literature reports rates from 6% to 28% of transient hydronephrosis, from which, most correspond to a temporary finding without clinical repercussion. This study aims to establish the incidence of transient hydronephrosis and the association with risk factors. Material and Methods In a descriptive retrospective cohort, we analyzed 119 ureteral units reimplanted with Lich Gregoir, under 18 years old, between September 2009 and April 2017. We have excluded patients with primary megaureter, VUR secondary and previous surgery for VUR correction. Statistical analysis was performed with Stata 13.0. Results We have evaluated 85 patients, 34 bilaterally reimplanted, totaling 119 ureteral units. Mean age was 4.4 years and 68% were women. VUR grade IV was the most prevalent with 42%. Pre-surgical renal ultrasounds were normal in 63% of the cases, and 14.2% had transient hydronephrosis with resolution at 3 months. No case of ureteral obstruction was reported. Pre-surgical reflux grade was not associated with transient hydronephrosis (p = 0.64) as well as neither laterality (p = 0.06). Conclusion Open Vesicoureteral reimplantaion with Lich Gregoir technique in our institution reports transient hydronephrosis rates similar to the literature. We have not found association factors with transient hydronephrosis, except for the surgical technique perse.
Subject(s)
Humans , Male , Female , Child, Preschool , Ureteral Obstruction , Vesico-Ureteral Reflux , Kidney Diseases , Risk Factors , Hydronephrosis , Functional LateralityABSTRACT
Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.
OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Urologic Diseases/epidemiology , Urologic Diseases/etiology , Kidney Transplantation/adverse effects , Mexico , Retrospective Studies , Time Factors , Young AdultABSTRACT
Entre los años 1995 y 2003, fueron reimplantados un total de 490 unidades renales por técnica extravesical según Lich-Gregoir. Todos los casos correspondieron a pacientes pediátricos de ambos sexos portadores de reflujo vesico renal primario. Del total de unidades renales tratadas. 2 por ciento experimentaron persistencia del reflujo. El éxito global en el tratamiento de reflujo se logró en 480 unidades renales (98 por ciento). El porcentaje de hematuria macroscópica (4.08 por ciento) y disuria (2.71 por ciento) fue significativamente menor que el observado en las técnicas transvesicales (100 por ciento). El tiempo de estancia hospitalaria fue menos de 24 horas en 58 por ciento de los casos; entre 24 y 48 horas en 26 por ciento de los mismos, y sólo 16 por ciento de los infantes necesitaron 2 o mas días de hospitalización. Considerando los resultados, recomendamos la utilización de la técnica extravesical de Lich-Gregoir para el tratamiento del reflujo vesico renal primario de II, III y IV grado ya que ofrece menor morbilidad que las técnicas transvesicales.
Subject(s)
Humans , Male , Female , Child , Urinary Catheterization , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , Vesico-Ureteral Reflux/diagnosis , Vesico-Ureteral Reflux/pathology , Vesico-Ureteral Reflux/therapy , Renal Replacement Therapy/methods , Kidney Transplantation/methods , Ureter/abnormalities , Dysuria/complications , Dysuria/diagnosis , Hematuria/complications , Hematuria/diagnosis , PediatricsABSTRACT
Since the first successful kidney transplant in 1954, many advances have been made in renal transplantation technique and urinary reconstruction. Recently, there has been increasing interest in the use of extravesical technique to perform ureteroneocystostomy in renal transplantation. From January 1985 to September 1994, 93 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 5 total complications, for an over-all urologic complication rate 5.4 percent. Of these complications one was related to the ureteroneocystostomy, for an anastomotic complication rate of 1.07 percent We report our experience with the simple extravesical technique for ureteroneocystostomy that has provided excellent results and minimal morbidities.
Subject(s)
Humans , Kidney , Kidney Transplantation , UreterABSTRACT
We have performed experimental bilateral extravesical Ureteroneocystostomy in dogs. The technique of procedure was as follows : A longitudinal myotomy incision was made near the bladder dome directed forward the bladder neck for 2cm and then separated to allow the mucosa to pout. A 1 cm incision was then made in the bladder mucosa at the distal end of the detrusor incision. Excess ureter was excised and the ureter spatulated for 1 cm. A 6-0 Prolene suture was then placed at each apex and fullthickness of ureter anastomosed to the bladder mucosa in one layer with a continuous, nonlocking stitch. The myotomy incision was then closed over the ureter with interrupted 4-0 chromic catgut. The surgical wound was closed without drains. The roentgenographic findings and gross findings of the ureter and kidney were observed on the 3 wks after the operation For microscopic observation of the ureteroneocystostomy site were observed. The results are as follows: 1. Retrograde cystographic finding showed on ureterovesical reflux in 6 dogs. 2. Intravenous urographic findings were no hydronephrosis and dye were well drained into the bladder, except 1 dog which showed severe hydronephrosis on right kidney and mild hydronephrosis on left kidney. 3. Gross findings of ureter and kidney revealed no obstruction and renal enlargement, except one dog showed incomplete bilateral obstruction on ureteroneocystostomy site.
Subject(s)
Animals , Dogs , Catgut , Hydronephrosis , Kidney , Mucous Membrane , Neck , Polypropylenes , Sutures , Ureter , Urinary Bladder , Wounds and InjuriesABSTRACT
10 cases of renal transplantation was performed in Han Yang University from April, 1978 to August, 1978. And we used the technique of extravesical ureteroneocystostomy for anastomosis of transplant ureter to recipient bladder. The ureteral complication was occurred in 1 case, that was ureteral leakage, in all of them.