Surgical Complications are Major Problems Concerning Overseas Kidney Transplantation in Comparison Study with Domestic Deceased Donor Kidney Transplantation / 대한이식학회지

PURPOSE: As increasing overseas kidney transplant recipients, the post-transplantation management of these recipients is not unusual. Shortage of donor information and operative findings is an obstacle to post-transplant evaluation and management of overseas transplant recipients. We retrospectively reviewed the post-transplant clinical manifestation of overseas transplant recipient, and compared with those of domestic deceased donor transplant recipient. METHODS: Sixty overseas transplant recipients and 39 deceased donor transplant recipient in our center from January 2002 to August 2006 were enrolled in this study. Among the post-transplant outcomes, we focused the episodes of post-transplant complication, acute rejection and graft functional status. RESULTS: In comparison of pre-transplant clinical manifestation, overseas transplant recipients were more elderly, male predominant and less retransplantation than domestic deceased transplant cases. Remarkable surgical complications (35%, 21/60) were observed in overseas transplant recipients which was significantly higher than those of domestic transplant recipients (5.1%, 2/39 cases)(P=0.03). The urologic complication was major (14 cases) complication, and intraoperative hematoma (5 cases) and vascular complication (2 cases) succeed. Interventional procedure or surgical correction was performed in six recipients with urinary leakage obstruction. Excluding post-transplant acute tubular necrosis, the post-transplant outcomes, such as incidence of acute rejection, graft survival rate and graft function within post-transplant 3 year, of overseas transplant recipient were statistically similar with these of domestic deceased donor recipients. CONCLUSION: Considering that overseas transplant recipient had high incidence of surgical or urologic complication, the initial evaluation of post-transplant recipient was focused on completion of surgical procedure by using radiologic imaging study.

Urologic Complications and Management in 337 Spinal Cord Injured Patients / 대한비뇨기과학회지

337 spinal cord injured patients had been followed up for urologic management in Korea Veterans Hospital. 106 spinal cord injured patients, admitted due to urologic complications from 1990 to 1995, were analyzed. The level of cord injury was cervical in 26, thoracic in 63 and lumbar in 17 patients. The voiding method was suprapubic cystostomy in 32, clean intermittent catheterization in 27, self-voiding in 25, condom catheter in 14, urethral catheter in 6 and others in 2 patients. The common urologic complications were acute pyelonephritis, bladder stone, epididymitis, vesicoureteral reflux, low vesical compliance, autonomic dysreflexia and bladder tumor. Medical treatments for urologic complications were performed for 79 cases (46%) and surgical treatments for 92 cases (54%) We conclude that periodic urologic follow-up will be needed for early detection and management of urologic complications due to spinal cord injury.

Urologic Complications Associated with Prolapse Uteri / 대한비뇨기과학회지

Changes in the urinary tract associated with prolapse uteri have been known for a long time. However, women who have a prolapse uteri are often free of symptoms. When symptoms are present they are above all, urinary tract infection, difficulties in emptying the bladder, increased frequency of micturition, stress incontinence, and ureteral obstruction. We reviewed 82 patients who had prolapse uteri of grade II and III in order to evaluate the effects of prolapse uteri to the urinary tract. There were 5 patients (6.1%) who had urinary tract infection and urine culture revealed the growth of E. coli in 3 of them. Only 1 patient (1.2%) had high blood urea nitrogen. 51 (62.2%) out of 82 patients showed voiding problems (frequency, voiding difficulty, stress incontinence) and 53 (64.6%) out of 82 patients had cystocele of several degrees, but there was no difference between the degree of prolapse uteri and both voiding problems and cystocele. Vaginal hysterectomy with anterior and posterior colpoperineorraphy was performed in 68 (88. 3%) out of 77 patients who underwent surgical treatment by gynecologists, and in 22 (91.7%) out of 24 patients who showed difficult urination, their symptoms were improved immediately after surgery. Bladder neck suspension was performed simultaneously in 3 patients who showed stress urinary incontinence with prolapse uteri. Intravenous pyelography or abdominal ultrasonography was performed to evaluate accompanied ureteral obstruction in 8 patients who had severe cystocele. In 5 patients, upper tract deteriorations were noted. Bilateral hydroureteronephrosis was found in 3 patient, unilateral lower ureteral dilatation in 1 patient, and severe parenchymal damage in 1 patient. In conclusion, we believe that urologist should participate in managing those patients who have prolapse uteri to improve their voiding problems and prevent upper urinary tract deterioration.

Clinical Analysis of 300 Renal Transplantations / 대한비뇨기과학회지

Three hundred renal transplantations were performed by the transplantation team in the Kosin Medical College from December, 1984 to August, 1993. Prognosis and complications with affecting factors and demographic data were analysed and the results were as follows; 1. In 300 recipients, 206 cases were male and 94 cases were female. 146 cases were male and 154 cases were female in 300 donors 2. All 300 cases were living transplantations ; among them, 207 cases were related and 93 cases were unrelated donors. 3. The most common underlying disease of recipients was chronic glomerulonephritis (89%). 4. In 263 donors, the left kidney was selected for graft. 5. For donor nephrectomy, flank incision( anterior incision) was used in all cases and among them 12th transcostal incision was made in 134 cases. 6. For ureteroneocystostomy, modified MacKinnon`s method was performed in 297 cases and Politano-Leadbetter procedure was used in only 3 cases. 7. Postoperative urologic complications occurred in 26 cases( 8.3%) ; perirenal hematoma, 16 cases for which revision was done; urine leakage, 8 cases for which 6 cases needed revision. 8. Complications of donor nephrectomy occurred in 8 cases( 2.6%) ; retroperitoneal hematoma, 2 cases; pneumothorax, 2 cases; pleural effusion, atelectasis, ulcer perforation and stress ulcer, one case respectively. 9. The survival rate for the graft was 91.6% for one year, 88.1 % for 2 years, 81.5% for 3 years, 77.7% for 4 years and 74.3% for 5 years. The survival rates of the recipients were 94.4%, 93.6%, 91.4%, 89.7% and 89.7% according to each year respectively.

The Urological Complications Associated with Long Term Management of Quadriplegics with or without Chronic Indwelling Urinary Catheter / 대한비뇨기과학회지

The most optimal voiding method for the quadriplegic patient has not been established due to the limitations imposed by deficient upper extremity function as well as the increased incidence of external sphincter dyssynergia. Our study was designed to compare the incidence of urological complications and renal deterioration for post-traumatic quadriplegic patients managed with or without a chronic indwelling urinary catheter. Our retrospective study was performed in the 21 patients in a catheterized group and 69 in a non-catheterized group followed at the Korea Veterans Hospital. Mean patient age was 25.8 years and 24.3 years , mean followup interval was 13.6 years and 19.6 years respectively. The followup interval and mechanism, level and degree of injury for the two groups were similar. Overall, the incidences of renal and bladder calculi, pyelonephritis, gross hematuria, epididymitis, urethrocutaneous fistula and vesicoureteral reflux were not significantly different in the catheterized and noncatheterized groups. 4 patients died during the followup. One of these patients died of bladder adenocarcinoma which was directly related to the urological complication. IVPs demonstrated that the incidences of renal deteriorations were 2 in the catheterized group and 20 in the noncatheterized group. The first onset of renal deteriorations developing after spinal cord injury were mean 11.0 years and 14.7 years respectively and were not significantly different between the two groups Our study suggests that the decision to manage quadriplegics with or without an indwelling catheter should not be based on relative risk of urological complications. We could decide voiding method in these patients, considering their comforts, conveniences and qualities of life.

Urologic Complication of Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

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.

Urological Complications Caused by Gynecologic Disorder / 대한비뇨기과학회지

It is well known that there always exists danger of injury to the urinary tract associated with gynecologic disorders and treatments. Herein the authors describe two different rare cases: bilateral complete ligations of the lower ureters following total hysterectomy and herniated urinary bladder as exstrophy of the bladder through vesico-vaginal fistula caused by cauterization of the uterine prolapse for treatment.