ABSTRACT
There are different surgical techniques for reconstruction of the urinary tract in kidney transplant. However, urinary complications are frequent in the postoperative period, being the ureter the frequent location of these complications. This results in high health care costs, increasing patient morbimortality and sometimes graft loss. For this reason, prevention, correct diagnosis and treatment are important. The aim of this review is to describe the surgical techniques most commonly used in kidney transplant for ureteroneocystostomy. To analyze the advantages and disadvantages of each of them and to compare their complications. On the other hand, we summarize the recent literature on the four most frequent urinary complications in the postoperative period after transplantation. The possible causes and treatment of urine leak, ureteri cobstruction, hematuria and vesicoureteral reflux are presented.
Existen diferentes técnicas quirúrgicas para la reconstrucción del tracto urinario en el trasplante renal. Sin embargo es frecuente la aparición de complicaciones urinarias en el postoperatorio, siendo el uréterla localización frecuente de las mismas. Esto implica un alto gasto sanitario, aumentando la morbimortalidad del paciente y pudiendo llegar a desencadenar la pérdida del injerto. Por ello es importante la prevención, el correcto diagnóstico y su tratamiento. El objetivo de esta revisión es describir las técnicas quirúrgicas más usadas en el trasplante renal para la ureteroneocistostomía. Analizar las ventajas y desventajas de cada una de ellas y comparar sus complicaciones. Por otro lado se resume la literatura reciente sobre las cuatro complicaciones urinarias más frecuentes en el postoperatorio del trasplante. Se exponen las posibles causas y tratamiento de la fuga urinaria, la obstrucción ureteral, la hematuria y el reflujo ureterovesical.
Subject(s)
Kidney Transplantation , Ureter , Urinary Tract , Vesico-Ureteral Reflux , Cystostomy , Humans , Kidney Transplantation/adverse effects , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/therapy , Retrospective StudiesABSTRACT
La hemorragia retroperitoneal es un evento raro, y aún más durante la gestación, asociándose a una alta morbimortalidad, tanto materna como perinatal. Su origen suele ser traumático, aunque se puede producir de manera espontánea, lo que dificulta todavía más su diagnóstico. Entre sus síntomas de presentación se deben destacar el dolor abdominal y el shock hipovolémico maternos, junto con un rápido compromiso fetal. En este contexto, se presenta el caso de una hemorragia retroperitoneal materna, acontecida en la semana 35 y debida a la rotura espontánea de la vena renal izquierda, aunque comenzó con un cuadro de abruptio placentae (AU)
Retroperitoneal hemorrhage is a very rare event, especially during pregnancy, and is associated with high morbimortality for both the mother and fetus. The cause is usually traumatic, but these hemorrhages can occur spontaneously, which further hampers their diagnosis. Presenting symptoms are abdominal pain and maternal hypovolemic shock, with rapid fetal compromise. We present a case of maternal retroperitoneal hemorrhage, which occurred at week 35 of pregnancy due to spontaneous rupture of the left renal vein, although the first manifestation was placental abruption (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Renal Veins/injuries , Rupture, Spontaneous/complications , Rupture, Spontaneous/diagnosis , Pregnancy Complications/therapy , Hemorrhage/complications , Shock/complications , Rupture, Spontaneous , Pregnancy Complications/physiopathology , Pregnancy Complications , Abdominal Pain/etiology , Indicators of Morbidity and MortalityABSTRACT
OBJECTIVES: The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter. METHODS: Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy. RESULTS: Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days. CONCLUSIONS: We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today.
Subject(s)
Laparoscopy , Nephrectomy/methods , Ureter/surgery , Aged , Female , Humans , Male , PostureABSTRACT
Objetivo: El principal reto de la nefroureterectomía laparoscópica es el manejo del uréter distal que además tendrá una repercusión importante en el resultado oncológico en muchos de los casos. Presentamos nuestra experiencia en este aspecto, teniendo en cuenta que las 5 últimas nefroureterectomías laparoscópicas las hemos realizado con una posición de Trendelemburg forzado, lo que ha supuesto un manejo más cómodo y seguro del uréter distal. Métodos: Desde agosto hasta diciembre de 2006 se han realizado 5 nefroureterectomías con rodete vesical puramente laparoscópico con el paciente en posición de Trendelemburg forzado, muy similar a la posición empleada en las cistectomías o prostatectomías radicales laparoscópicas. Resultados: El tiempo quirúrgico medio es de 182 minutos (170-210). El sangrado medio intraoperatorio es de 100cc y ninguno de estos pacientes ha precisado transfusión. El tiempo hospitalario medio es de 4 días. Conclusiones: Creemos que esta posición es una buena alternativa para el manejo del uréter distal en el abordaje laparoscópico. Se trata de una técnica muy similar a la cirugía abierta, que hoy por hoy continúa siendo el gold Standard (AU)
Objectives: The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter. Methods: Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy. Results: Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days. Conclusions: We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today (AU)
