Social aspects of kidney donation in Tunisia: a study of 189 living related donors.

INTRODUCTION: Our aim was to study the demographic and social characteristics of 189 living related kidney donors in Tunisia, and explore some of the social consequences of kidney donation. METHODS: This is a descriptive retrospective study of 189 living related kidney donors who had their nephrectomy in Charles Nicolle Hospital between 1986 and 2009. The demographic and social characteristics at the time of donation were studied and changes in the social and occupational status after donation were assessed. RESULTS: The average age at the time of donation was 41.8 ± 12.1 years (range: 20-67 years). Female predominance (59.2% of cases) was noted. Donors were siblings in 46% of cases, parents in 42% of cases and spouses in only 9% of cases. There were more mothers than fathers, more wives than husbands, but fewer sisters than brothers. Twenty-six percent of donors were illiterate and 40% were unemployed at the time of donation. After donation, the social status remained stable for 70% of donors. No divorces were reported. The occupational status was unchanged in 94% of cases. Sixteen percent of female donors had at least one pregnancy after nephrectomy. Nearly 90% of surveyed donors whose recipients were alive at the time of the survey were still in favor of kidney donation. CONCLUSIONS: Women play an important role in living related kidney donation in Tunisia. Family situation and occupational status did not seem to be compromised after nephrectomy, and most donors were willing to donate if the decision was to be repeated.

[Lumboscopic treatment of simple renal cysts]. / Traitement lomboscopique des kystes simples du rein.

AIM: To assess feasibility and efficiency of lumboscopy in the treatment of simple renal cysts. METHODS: We report 12 cases of patients presenting symptomatic simple renal cysts treated by lumboscopy from January 2000 to December 2004. The mean age was 57 years (43-72). They were 11 women and one man. The main revealing sign was pain in each case. A mass was found in 2 cases (16 %). Ultrasonography was realized in all cases. Computed Tomography was realized in 4 cases (33 %). It was a unique cyst in 9 cases (75 %), a double cysts in 2 cases (17 %) and 4 cysts in 1 case (8 %). The mean size of the cysts was 7.7 cm (5-16). A parapyelic cyst was found in one case. All the patients were operated through a retroperitoneal approach. Excision of cyst dome was made. RESULTS: The mean operating time was 80 min (50-160). No intraoperative complication was noted. The mean hospital stay was 3 days (1-4). All the cysts were found to be benign histologically. No recurrence is noted with a mean follow-up of 21 months (5-31). CONCLUSION: Lumboscopy is a safe and effective technique in the treatment of the symptomatic simple renal cysts with a low rate of complications and recurrence.

[Renal adenocarcinoma in horseshoe kidney, report of a case]. / L'adénocarcinome rénal sur rein en fer à cheval. A propos d'un cas.

Tumors arising within horseshoe kidney are uncommon and may be difficult to identify. The incidence of tumor within horseshoe kidney is higher than in the normal one. Adenocarcinoma is the most common tumor. The nephrectomy is considered as partial and the patients need a strict follow up. Horseshoe kidneys show a lot of variety with regard to supporting arteries and veins. Therefore, a selective study of the renal vessels should be performed preoperatively. Abdominal angiography should be done to study this vasculature.

[Ureterocalicostomy: last resort in the treatment of certain forms of ureteropelvic junction stenosis. Report of 5 cases]. / L'urétérocalicostomie: ultime recours dans le traitement de certaines sténoses de la jonction pyélourétérale (a propos de 5 cas).

INTRODUCTION: Iatrogenic stenoses of the ureteropelvic junction are now essentially treated by endoscopic techniques. However, conventional surgery is sometimes required to treat severe or extensive stenosis. The authors report the use of ureterocalicostomy to treat 5 patients with complex lesions. MATERIAL AND METHODS: Between 2001 and 2003, the authors treated five patients with iatrogenic stenosis of the ureteropelvic junction. Two of these patients had a history of percutaneous nephrolithotomy and the other three had undergone conventional pyelotomy, complicated by pyelocaliceal avulsion in one case. The diagnosis was confirmed by double anterograde and retrograde opacification in four patients and intravenous urography in one patient. It was decided to perform ureterocalicostomy due to the extent of the lesions. Inferior ureterocalicostomy was performed after lower pole nephrectomy in all cases. RESULTS: The mean follow-up was 21 months (range: 20 to 27 months). Three patients had an uneventful postoperative course and satisfactory radiological follow-up. One patient rapidly developed stenosis that was treated successfully by endoscopy and another patient obtained a poor result requiring nephrectomy. CONCLUSION: Ureterocalicostomy requires laborious surgical dissection and meticulous ureterocaliceal anastomosis, but it is a useful technique in some cases of severe and extensive iatrogenic stenosis of the ureteropelvic junction.

[Impact of the use of double J stents in renal transplantation on incidence of urologic complications and urinary infection]. / Impact de l'utilisation de la sonde JJ lors de la transplantation rénale sur l'incidence des complications urologiques et de l'infection urinaire.

OBJECTIVE: The authors evaluated the impact of systematic placement of a double J stent on urological complications and postoperative urinary tract infection. MATERIAL AND METHODS: 188 renal transplantations were performed between January 1991 and December 2001. All patients underwent Lich-Grégoire ureterovesical anastomosis. A double J stent was not used in one group (G1) of 110 patients and a double J stent was systematically inserted in another group (G2) of 78 patients and was removed after 3 weeks. Urine culture was performed in all patients. RESULTS: 11 patients of group 1 developed urinary fistula and one patient developed obstruction of the ureterovesical anastomosis. No urological complication was detected in group 2. The postoperative urinary tract infection rate was 47.2% in group 1 versus 48.7% in group 2. CONCLUSION: Systematic double J stenting appears to decrease the incidence of urological complications after renal transplantation without increasing the incidence of postoperative urinary tract infection.