ABSTRACT
Background: Multiple renal artery (MRA) kidneys represent a special challenge for surgeons, during both donor nephrectomy and renal transplantation. AIMS: This study aims to evaluate both donors and recipients outcomes of laparoscopically procured dual renal artery (DRA) kidneys. Patients and Methods: We reviewed the medical records of all living kidney donors who underwent laparoscopic donor nephrectomy between April 2009 and December 2014, and their recipients. Operative details and immediate outcomes of both donors and recipients of DRA kidneys were compared to those of donors and recipients of single renal artery (SRA) kidneys. Results: From a total of 250 laparoscopic donor nephrectomies, 43 (17.2%) were on kidneys having DRAs. The mean operative time was statistically higher in the group with DRA (168.1 mins vs 135.3 mins, p=0.001), however, mean warm and cold ischemia times were the same. There were no complications reported among donors in neither groups, nor conversion to open nephrectomy. Lengths of hospital stay of the donors were similar in both groups. There was no statistically significant difference in immediate allograft function among the two groups. Conclusions: Laparoscopic procurement of kidneys with dual renal arteries is safe, reliable, and has no significant impact on the neither donor's outcome, nor allograft function.
Subject(s)
Kidney Transplantation , Laparoscopy , Living Donors , Nephrectomy , Renal Artery/abnormalities , Renal Artery/surgery , Adult , Female , Graft Survival , Humans , Kidney Transplantation/methods , Laparoscopy/methods , Length of Stay , Male , Middle Aged , Nephrectomy/methods , Operative Time , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (<16 year) were performed of a total of 246 kidney transplants (14.2%). The mean age was 8.1 years, with a mean weight of 23.3 kg, and there were 21 (60%) boys in the study. Kidney dysplasia/hypoplasia was the most common etiology (51.4%). Preemptive kidney transplantation was performed in six (17%) patients. Peritoneal dialysis was the most common mode of dialysis [24 (69%) children]. Living donation was the source of kidney allografts in 13 (37%) cases. During a mean follow-up of 1.5 years, one patient died and one graft was lost due to kidney vein thrombosis. The one year patient and graft survival rates were 97% and 94%, respectively. Efforts should now be focused on achieving optimal long-term results. There is also a need to encourage preemptive transplantation and living donation in this population.
Subject(s)
Hospitals/statistics & numerical data , Kidney Failure, Chronic/surgery , Kidney Transplantation/statistics & numerical data , Outcome and Process Assessment, Health Care/statistics & numerical data , Adolescent , Age Factors , Child , Child, Preschool , Female , Graft Survival , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/epidemiology , Kidney Transplantation/adverse effects , Kidney Transplantation/mortality , Male , Postoperative Complications/etiology , Program Evaluation , Renal Dialysis , Retrospective Studies , Risk Factors , Saudi Arabia/epidemiology , Time Factors , Tissue Donors/statistics & numerical data , Treatment OutcomeABSTRACT
Operative positions commonly used in urogenital surgeries when perineal exposure is required include the lithotomy and the exaggerated lithotomy positions (LPs), which expose patients to the risk of rhabdomyolysis. We report a patient with bladder outflow obstruction, benign prostatic hypertrophy and a very large bladder stone, which was removed with cystoscopy and cystolitholapaxy in the LP. The procedure was complicated by posterior bladder perforation and abdominal distention leading to prolonged surgery duration (5.5 h). The patient developed rhabdomyolysis and acute renal failure (ARF) without compartmental syndrome. On the other hand, there was a potential role of glycine solution, used for bladder irrigation, in the appearance of ARF. Overall, our case shows that rhabdomyolysis and ARF can develop in operative positions, and duration of surgery is the most important risk factor for such complications.
Subject(s)
Acute Kidney Injury/etiology , Lithotripsy/adverse effects , Patient Positioning/adverse effects , Rhabdomyolysis/etiology , Urinary Bladder Calculi/surgery , Acute Kidney Injury/therapy , Aged, 80 and over , Cystoscopy , Glycine/adverse effects , Humans , Male , Renal Dialysis , Risk Factors , Therapeutic Irrigation/adverse effects , Time Factors , Treatment Outcome , Urinary Bladder/injuries , Urinary Bladder/surgery , Wounds, Penetrating/etiology , Wounds, Penetrating/surgeryABSTRACT
We present an unusual case of renal cell carcinoma in a 59-year-old Saudi male less than 3 cm in size showing a pelvicalyceal filling defect on excretory urography and retrograde pyelography. Renal stones and blood clots were excluded by ultrasound and computerized tomography scanning. A urothelial tumor was initially diagnosed; finally surgery revealed a papillary renal cell carcinoma.
