Prevalencia de Complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato y su impacto a corto plazo en la función renal / Prevalence of clinical and surgical complications in immediate post-renal transplantation and their short-term impact on renal function

INTRODUCCIÓN. La enfermedad renal crónica es definida como la pérdida progresiva, permanente e irreversible de la función renal, uno de los tratamientos es el trasplante renal el mismo que aumenta la calidad de vida de los pacientes que presentan esta patología, sin embargo, a pesar de ser uno de las mejores terapias no está exento de complicaciones especialmente las que se presentan posterior al acto quirúrgico ya que afectan al buen funcionamiento del injerto y afecta la supervivencia del mismo. OBJETIVO. Determinar la prevalencia de complicaciones clínicas y quirúrgicas en el postrasplante renal inmediato con el fin de identificar las principales complicaciones que ocasionan mayor deterioro en la función renal a corto plazo. MATERIAL Y MÉTODOS. Estudio Observacional descriptivo transversal, de pacientes trasplantados que se encuentran en seguimiento desde enero del 2015 hasta diciembre del 2018 en el servicio de Trasplante renal del Hospital de Especialidades Carlos Andrade Marín. La muestra será los 211 pacientes trasplantados de donante cadavérico. Los análisis se realizaron con el paquete estadístico IBM SPSS versión 25, para lo cual se empleó estadísticas descriptivas, utilizando tablas y representando los valores absolutos y relativos de las variables cualitativas, así como medidas de tendencia central y de variabilidad para las variables cuantitativas. RESULTADOS. Se estudiaron 193 pacientes trasplantados de los cuales el 49.66% tuvieron complicaciones, de los mismos el 33.16% fueron complicaciones clínicas y 16,5% complicaciones quirúrgicas; de las clínicas la infección de tracto urinario fueron las más prevalentes con 15%, seguida por el rechazo agudo 6,7%, las infecciones por virus poliomavirus BK fueron un porcentaje de 6,2%, la necrosis tubular aguda el 3,16% terminando con el rechazo hiperagudo en el 1,5% y la toxicidad por calcineurínicos 1,04%. Mientras tanto las complicaciones quirúrgicas las urológicas son las más prevalentes 8,8% seguida por las colecciones liquidas con el 6,74% finalmente la trombosis vascular con el 1,04%. CONCLUSIONES. Las complicaciones más prevalentes son las clínicas vs las quirúrgicas, afectando de igual forma la función renal al año sin diferencia estadísticamente significativa.

INTRODUCTION. Chronic kidney disease is defined as the progressive, permanent and irreversible loss of renal function, one of the treatments is renal transplantation, which increases the quality of life of patients with this pathology, however, despite being one of the best therapies, it is not free of complications, especially those that occur after surgery, since they affect the proper functioning of the graft and affect its survival. OBJECTIVE. To determine the prevalence of clinical and surgical complications in immediate post-renal transplantation in order to identify the main complications that cause greater deterioration in short-term renal function. MATERIAL AND METHODS. Cross-sectional descriptive observational study, of transplanted patients under follow-up from January 2015 to December 2018 in the Renal Transplant service of the Hospital de Especialidades Carlos Andrade Marín. The sample will be the 211 cadaveric donor transplanted patients. The analyses were performed with the IBM SPSS version 25 statistical package, for which descriptive statistics were used, using tables and representing the absolute and relative values of qualitative variables, as well as measures of central tendency and variability for quantitative variables. RESULTS. We studied 193 transplanted patients of whom 49.66% had complications, of which 33. Of the clinical complications, urinary tract infection was the most prevalent with 15%, followed by acute rejection 6.7%, polyomavirus BK infections were 6.2%, acute tubular necrosis 3.16%, ending with hyperacute rejection in 1.5% and calcineurin toxicity 1.04%. Meanwhile, urological surgical complications are the most prevalent 8.8% followed by liquid collections with 6.74% and finally vascular thrombosis with 1.04%. CONCLUSIONS. The most prevalent complications are clinical vs. surgical, affecting renal function at one year with no statistically significant difference.

Extravasación urinaria renal espontánea / Spontaneous renal urinary extravasation

La extravasación espontánea de orina, descrita por Albarrán y publicada por Sole se consideraba como un hallazgo radiológico poco frecuente y la definió en 198 como la salida de orina fuera del tracto urinario en ausencia de trauma, de intervención quirúrgica previa o reciente y tampoco sin antecedente de instrumentación urológica o de urografía excretora practicada con compresión externa. Se presenta a un paciente de 28 años, sin antecedentes de interés, que acudió con cuadro astenia de 1 mes de evolución, asociado a dolor en fosa lumbar izquierda. Que fue estudiado mediante ecografía y tomografía computarizada (TC). Las exploraciones radiológicas identificaron múltiples litiasis en uréter proximal y distal izquierdo. Voluminosa colección de baja densidad rodeando al riñón izquierdo, limitada por la fascia pararrenal sugestiva de urinoma, identificando solución de continuidad en cáliz superior, que se comunica con el urinoma. El tratamiento inicial del paciente fue la colocación de Nefrostomía percutánea de urgencia, para realizar posteriormente, ureteroscopia con ascensión de las litiasis y extracción de estas mediante pielolitotomía abierta. Conclusión: El conocimiento de la clínica y de los hallazgos radiológicos de la extravasación urinaria espontánea por litiasis ureteral en las distintas pruebas de imágenes son cruciales para el manejo de los pacientes afectados por esta infrecuente complicación...

Spontaneous extravasation of urine, described by Albarran and published by Sole was considered a rare radiological finding in 198 and defined as the flow of urine out of the urinary tract in the absence of trauma, previous surgery or recent nor no history of urological instrumentation or excretory urography performed with external compression. We report a patient of 28 years, with no history of interest came with asthenia of 1 month’s duration, associated with pain in left lumbar fossa. That was studied by ultrasound and computed tomography (CT). The radiological identified multiple stones in proximal and distal left ureter. Collection bulky low density surrounding the left kidney limited by suggesting pararenal urinoma fascia, identifying continuity solution upper calyx, which communicates with the urinoma. The patient’s initial treatment was percutaneous nephrostomy placement of urgency for later ascension of the stones with ureteroscopy and removal of these by open pyelolithotomy. The knowledge of the clinical and radiological findings of spontaneous urinary extravasation with ureteral stones in various imaging tests are crucial for the management of patients affected by this rare complication...

Spontaneous Perinephric Urinoma after the Removal of a Foley Catheter in a Girl with Acute Kidney Injury

Urinomas can occur after renal trauma or perforation of the collecting system during an endosurgical procedure. However, spontaneous urinomas are very rare. Here we report a case of a spontaneous perinephric urinoma following the removal of a Foley catheter in an 18-year-old girl with acute kidney injury caused by septic shock. The patient had been treated for septic shock, acute kidney injury, and acute respiratory distress syndrome, and had a Foley catheter in place for seven days. After Foley catheter removal, the patient complained of consistent voiding difficulty. An abdominal computed tomography scan showed a large amount of left perinephric fluid, and the aspirated fluid included urothelial cells, confirming the diagnosis of a urinoma. The urinoma was successfully treated by insertion of a double-J stent into the left ureter. This report discusses the available literature on urinomas, and their clinical features, diagnosis, and treatment.

A Rare Case of Upper Ureter Rupture: Ureteral Perforation Caused by Urinary Retention

Perforation of the ureter is a rare condition that causes a series of problems including retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal impairment. There are causative factors that induce ureteric rupture, including malignancy, urinary calculi, idiopathic retroperitoneal fibrosis, recent iatrogenic manipulation, external trauma, degenerative kidney conditions, urography with external compression, and spontaneous causes. We report a rare case of ureteric rupture caused by urinary retention. The patient was treated with temporary percutaneous drainage and antibiotics. The present case illustrates that urinary retention can induce not only bladder rupture, but also ureteric rupture. It is thus of paramount importance to effectively manage patients with voiding problems.

Urinoma, un traumatismo olvidado / Urinoma: a forgetful trauma

Se presentó un paciente con APP de hipertensión arterial desde hace 15 años que 2 meses antes del ingreso comenzó a padecer cuadros de decaimiento, disminución del apetito, disuria y escalofríos. Se le diagnosticó sepsis urinarias a repetición, sin mejoría clínica. Al ingresar, presentaba aumento de volumen de los miembros inferiores, principalmente en horas de la tarde, pérdida de peso de, aproximadamente, 20 libras y dolor en hemiabdomen superior. Se describió la evolución clínica y los estudios realizados mediante los cuales se le diagnosticó la presencia de: urinoma infestado, sepsis urinaria, hiperplasia benigna de próstata y litiasis renal bilateral con hidronefrosis complicada con insuficiencia renal

This is the case of a patient presenting with APP of high blood pressure from 15 years ago that two months before admission suffered from weakness, lost of appetite, dysuria and shivers and also diagnosing repeated urinary sepsis without clinical improvement. At admission, patient showed an increase in volume of lower extremities mainly in the afternoon, weight loss of approximately 20 pounds and pain in the superior hemi-abdomen. We describe the clinical course and the studies conducted served to diagnose the presence of: infected urinoma, urinary sepsis, prostatic benign hyperplasia and bilateral renal lithiasis with hydronephrosis complicated by renal failure

A Case of Urine Leakage: An Unusual Complication after Renal Biopsy / 전남의대학술지

Renal biopsy is a crucial method in the diagnosis and treatment of acute renal failure of unknown origin, nephrotic syndrome, suspicious interstitial nephritis, and glomerulonephritis as a possible cause of hematuria or proteinuria. Complications occur in 2% to 8% of patients after percutaneous renal biopsy. Complications include gross hematuria, perirenal hematoma, arteriovenous fistula, aneurysm, injury of other organs, and urine leakage. Urine leakage as a complication after kidney biopsy is rare. We experienced a case of urine leakage into the intra-abdominal cavity after renal biopsy.

A Case of Urine Leakage: An Unusual Complication after Renal Biopsy / 전남의대학술지

Renal biopsy is a crucial method in the diagnosis and treatment of acute renal failure of unknown origin, nephrotic syndrome, suspicious interstitial nephritis, and glomerulonephritis as a possible cause of hematuria or proteinuria. Complications occur in 2% to 8% of patients after percutaneous renal biopsy. Complications include gross hematuria, perirenal hematoma, arteriovenous fistula, aneurysm, injury of other organs, and urine leakage. Urine leakage as a complication after kidney biopsy is rare. We experienced a case of urine leakage into the intra-abdominal cavity after renal biopsy.

A Case of Urinary Ascites with Urinoma Secondary to Ureteropelvic Junction Obstruction in a Neonate

Spontaneous intraperitoneal extravasation of urine is rare. Perirenal urinoma may develop when obstruction to urinary flow creates sufficient back pressure to produce extravasation of urine. Urinary ascites most commonly indicate a disruption to the integrity of the urinary tract. We report a case of urinary ascites with urinoma resulting from an ureteropelvic junction obstruction in a neonate.

Extravasación urinaria postraumatismo abdominal cerrado: ¿es posible un diagnóstico precoz?: informe de dos casos / Urinary extravasation post blunt abdominal trauma: is it possible an early diagnosis?: report of two cases

La lesión de la vía urinaria superior con extravasación urinaria ocasionada por un traumatismo abdominal cerrado es infrecuente y, a menudo, no reconocida en una evaluación inicial.Un diagnóstico tardío de esta lesión aumenta significativamente la morbilidad. Se presentan dos casos, uno con avulsión de uréter superior derecho y el otro con laceración parenquimatosay de pelvis renal derecha con diagnóstico tardío y complicacionesgraves postraumatismo abdominal cerrado directo. El conocimiento del mecanismo del traumatismo y la evaluación de signos y síntomas locales son datos de importancia parasospechar una lesión pieloureteral, independientemente de la gravedad del traumatismo. La ausencia de hematuria inicial no es infrecuente y su presencia y grado no guarda relación con lagravedad de la lesión. Una tomografía computada abdominal con contraste endovenoso, evaluada en fase excretora tardía, permite la identificación precoz de una extravasación de orina.

An injury to the upper urinary tract with urinary extravasation caused by blunt abdominal trauma is uncommon and often unrecognized in an initial evaluation. A late diagnosis of this injury significantly increases morbidity. Two cases are discussed, one with avulsion of right upper ureter and the other one with parenchymal and right renal pelvis laceration with delayed diagnosis and severe complications subsequent to a direct blunt abdominal trauma. Knowledge of the mechanismof trauma and the assessment of local signs and symptoms are important data for suspecting ureteropelvic injury regardless of the trauma severity. The absence of initial hematuria is notuncommon and their presence and degree is unrelated to the severity of the injury. An abdominal computed tomography with IV contrast evaluated in delayed excretory phase allows an early detection of extravasation of urine.

Cicatrização renal após nefrectomia parcial laparoscópica sem fechamento do sistema coletor em porcos / Kidney healing after laparoscopic partial nephrectomy without collecting system closure in pigs

Introdução: Embora alguns estudos tenham descrito as semelhanças e diferenças anatômicas entre o rim humano e o rim suíno, pouco é conhecido sobre a cicatrização renal neste animal. O conhecimento da cicatrização do rim do porco é especialmente importante em procedimentos cirúrgicos que incisem o tecido renal e o sistema coletor, como é o caso da nefrectomia parcial. O objetivo do presente trabalho é estudar a cicatrização renal em porcos após nefrectomia parcial laparoscópica sem o fechamento do sistema coletor. Materiais e Métodos: Quatorze porcos machos com peso médio de 30 kg foram submetidos à nefrectomia parcial laparoscópica esquerda, removendo 25% do comprimento renal no pólo caudal (n=7) ou no pólo cranial (n=7). A técnica cirúrgica empregada envolveu acesso laparoscópico transperitoneal, clampeamento em bloco dos vasos renais, excisão do tecido renal com tesoura a frio e aplicação de energia monopolar para hemostasia do parênquima, deixando o sistema coletor aberto. Os animais foram avaliados clinicamente por 14 dias e então foram mortos. Níveis séricos de creatinina e uréia foram obtidos antes e em diferentes momentos após a cirurgia. São relatados ainda os achados de necropsia, pielografia retrógrada ex vivo e aspectos histológicos dos pólos renais operados. Resultados: Os níveis séricos de uréia e creatinina tiveram leve aumento inicial retornando aos valores pré-operatórios durante o período avaliado. Durante a necropsia verificou-se que não houve extravasamento de urina a partir do rim operado e que este se cobriu com tecido fibroso, aderindo-se aos tecidos adjacentes. Nas pielografias retrógradas não foi verificado nenhum extravasamento de contraste pelos pólos operados. Os achados histológicos mostraram grande deposição de colágeno tipo I sobre o pólo renal operado, vedando-o completamente. Conclusão: O rim suíno não é um bom modelo para pesquisas ou treinamento cirúrgico em que a cicatrização do sistema coletor seja um aspecto importante.

Introduction: Although some studies have described similarities and diferences between human and pig kidney anatomy, little is known regarding renal healing in this animal model. The knowledge of pig kidney healing is especially important in surgical procedures which incise the renal parenchyma and collecting system, such as partial nephrectomy. The aim of this study is to access kidney in pigs after laparoscopic partial nephrectomy without closuring of the collecting system. Materials and Methods: Fourteen male pigs with mean weight of 30 kg were submitted to left partial laparoscopic nephrectomy, removing 25% of the kidney length at caudal pole (n=7) or at cranial pole (n=7). Briefly, the surgical technique involved a transperitoneal laparoscopic access, en bloc vascular clamping of renal artery an vein, tissue excision with cold scissor and monopolar energy parenchyma hemostasis, leaving the collecting system opened. The animals were clinically evaluated during fourteen days, and afterwards were killed. Serum levels of creatinine and urea were assessed prior and at different moments after surgery. Necropsy findings, retrograde ex vivo pyelogram and histological aspects of operated renal poles are also described. Results: Serum creatinine and urea showed a slight initial increase with a gradual return to preoperative levels during the evaluated period. At necropsy, no signs of urine leakage were found and kidneys were covered by a fibrous tissue with adherences to adjacent organs. Also, in the retrograde pyelograms obtained, we did not find contrast medium leakage by operated poles. Histological findings showed great deposition of type I collagen over operated renal pole, sealing it completely. Conclusion: The pig kidney is not an adequate experimental model for research and training of surgery on which collecting system healing is an important aspect to be considered.

A case of spontaneous ureteral rupture in a patient on hemodialysis / 대한내과학회지

Spontaneous ureteral rupture is rare, and refers to leakage in the absence of prior ureteral manipulation, external trauma, previous surgery, or any destructive kidney disease. It presents a major diagnostic challenge due to the diversity at presentation. Here, we present a rare case of spontaneous ureteral rupture in a 62-year-old man with a history of fungal pyonephrosis (Candida) on maintenance hemodialysis, causing a large infected urinoma and abscess and a review the literature.

Válvula da uretra posterior associada a urinoma perinefrético e ascite urinária / Posterior urethral valve associated to perinephric urinoma and urinary ascitis

A válvula de uretra posterior é a principal causa de obstrução do fluxo urinário na infância. Relatamos um caso de válvula de uretra posterior diagnosticada por uretrocistografia e ultra-sonografia, cuja função renal foi poupada devido a incomuns mecanismos redutores das pressões endovesicais.Seu diagnóstico e tratamento precoces foram decisivos no prognóstico do paciente.

The posterior urethral valve is the main cause of urinal flow obstructionin childhood. Here we report a case of a posterior urethral valve diagnosed by urethrocystography and ultrasonography,whose renal function was saved due to unusual reducing mechanisms of endovesical pressures. The diagnosis and early treatment were decisive in the prognosis of the patient.

Spontaneous Perinephric Urinoma in a Patient with Neurogenic Bladder

Spontaneous rupture of the renal pelvis or ureteropelvic juction area with extravasation of urine into the perinephric space is an uncommon pathologic condition (1). We report a case of 72-year-old woman who suffered 2 days of left loin pain. The patient has got residual urine sensation and weak urine stream since she has gone through a radical hysterectomy 17 years before. Because of these symptoms of voiding difficulty, the patient had abdominal straining during her urination. A CT scan exhibited renal pelvis rupture with perirenal extravasation of urine due to severe hydronephrosis, that was exacerbated by hidden neurogenic bladder disease. Moreover, the patient has detrusor underactivity and high intravesical pressure at voiding trial in the urodynamic study. One month after the percutaneous nephrostomy insertion into the left renal pelvis, the patient was successfully treated. The size of renal pelvis decreased. Moreover, urinoma disappeared in follow up CT scan image.

Tubeless percutaneous nephrolithotomy in the management of renal calculi

To evaluate the status of tubeless percutaneous nephrolithotomy [PCNL] after managing uncomplicated renal calculi in selected patients. From August 2006 to May 2007, 28 patients with single renal stones were selected for tubeless PCNL. At the end of the procedure, a 6 Fr ureteral catheter was left in place and a nephrostomy tube was avoided. The outcomes measured were the operative time, change in the haematocrit value, urinary leak, blood transfusion requirement, hospital stay and the success rate. The mean age was 48 +/- 11 years. There were 25 male and 3 females. The mean stone size in these patients was 35 +/- 10 mm. The operative time was 56 +/- 20 minutes. 25 [89.3%] patients were stone free and three patients [10.7%] had residual fragments less than 5 mm. Two patients had prolonged urine leakage for more than three days and managed by DJ insertion. No patient required blood transfusion or had postoperative urinoma. The mean hospital stay was 2.6 +/- 1.1 days. Tubeless percutaneous nephrolithotomy is an option in selected patients when there is no bleeding, perforation, or repeat PCNL required

(99m)Tc-MAG3 Renal Scan and Ultrasonography in Early Surgical Complications of 203 Renal Transplants / 대한이식학회지

PURPOSE: This study is designed to evaluate the usefulness of (99m)Tc-MAG3 renal scan in the diagnosis of early surgical complication of renal transplantation comparing with that of ultrasonography. METHODS: 203 renal transplantations, from January 2000 to December 2004, were studied retrospectively. (99m)Tc-MAG3 renal scan and ultrasonography were performed routinely for evaluation of allograft kidney at postoperative day 3, 7, 14 and 21 or 28 respectively. RESULTS: Thirteen early surgical complications (6.4%) from 203 recipients were developed during the first one month after transplantation. Six cases of urological complications were noticed. And six cases of hematoma and one case of lymphocele were also developed. (99m)Tc-MAG3 renal scan showed abnormality in ten cases (76.9%) of thirteen early surgical complications. (99m)Tc-MAG3 renal scan revealed all of six urologic complications (100%), and four of six hematomas (66.7%). But one lymphocele was not detected by (99m)Tc-MAG3 renal scan. Ultrasonography showed abnormal findings in eight cases of 13 early surgical complications (61.5%): one of four urine leakage (25%), two of two urinomas (100%), four of six hematomas (66.7%), and one lymphocele (100%). CONCLUSION: (99m)Tc-MAG3 renal scan is more sensitive than ultrasonography in detection of earlysurgical complications of renal transplantation. Then (99m)Tc-MAG3 renal scan is useful test for screening and follow-up of early surgical complications after renal transplantation.

Huge Perirenal Urinomas in a Woman during the Postpartum Period / 대한비뇨기과학회지

Urinary tract dilation is one of the most common side effects during pregnancy. This is primarily a physiologic phenomenon that is typically more prominent on the right side, and it is caused by hormonal changes and mechanical obstruction. Occasionally, urinary tract dilation leads to more serious urinary tract problems such as infection, obstructive renal failure and urinomas. Urinomas are also known as pararenal pseudocysts, and they generally occur as a result of urinary system disruption, but they only rarely occur with pregnancy. We report here on an unusual case of extremely large bilateral perirenal urinomas that were detected during the postpartum period. This was successfully resolved by percutaneous drainage and ureteral stents.

Endopyelotomy and Endoureterotomy with the Ureteral Cutting Balloon Device (Acucise(R)) / 대한비뇨기과학회지

PURPOSE: Endourological management of ureteropelvic junction obstruction (UPJO) has gained increased acceptance with high procedural success rates and low morbidity being reported. It has been suggested that Acucise endopyelotomy should be the procedure of choice for patients with UPJO. The purpose of this study is to determine the efficacy of the Acucise balloon for the treatment of ureteral strictures and UPJO. MATERIALS AND METHODS: Between March 2004 and June 2005, 13 consecutive patients (8 primary and 5 secondary cases of UPJO) underwent Acucise endopyelotomy at our institution. The preoperative evaluation included ultrasound and/or intravenous urogram with diuretic renography. The success of the procedure was based on objective radiologic improvement and the subjective resolution of symptoms. RESULTS: The mean follow-up was 6.77+/-3.83 months (range: 3-14). The mean operating time was 64.23+/-34.87 min and the mean hospital stay was 4.15+/-2.44 days. The objective success rate was 61.5% and the subjective success rate was 69.2%. There were no major complications such as vascular injury requiring transfusion. Yet a small urinoma developed in one patient. Of the 5 objective failures, 3 patients have since successfully undergone open pyeloplasty. CONCLUSIONS: In this small series, Acucise endopyelotomy is a safe and minimally invasive procedure that offered effective first-line treatment for UPJO, although multicenter randomized trials are needed to make a better comparison with the other techniques.