How safe and effective is routine left hand-assisted laparoscopic donor nephrectomy with multiple renal arteries? A high-volume, single-center experience.

BACKGROUND: We investigated the safety and effectiveness of routine harvest of the left kidney for renal transplantation regardless of the presence of multiple renal arteries to obtain the longer renal vein. PATIENTS AND METHODS: Between February 2000 and July 2008, 325 patients underwent left hand-assisted laparoscopic living donor nephrectomy. The true renal arterial anatomy as evaluated intraoperatively was compared with the renal arterial anatomy by computed tomography (CT). We compared the results for the patients with a single renal artery (group I) with the patients with multiple renal arteries (group II) in terms of the donor and recipient outcomes. RESULTS: Multiple renal arteries in left kidney were identified in 86 patients (26.5%). Thirty-seven CTs (11.4%) were in discord with the renal arterial anatomy evaluated intraoperatively. There was no difference in age, gender, body mass index, estimated blood loss, complication rate, or length of hospital stay between the 2 groups in the donor. Although the warm ischemic time and the operation time were significantly longer in group II (P = .008 and .001), overall graft survival was similar between the groups. CONCLUSION: Routine harvest of the left kidney can be performed safely and effectively for the donor and recipient, even in the presence of multiple renal arteries.

Long-term risk of hypertension and chronic kidney disease in living kidney donors.

OBJECTIVE: The aim of this study was to assess the long-term risks of chronic kidney disease and arterial hypertension in living kidney donors. METHODS: Donors who were followed for more than 1 year after nephrectomy were included. We assessed each donor's blood pressure, urine protein, and estimated glomerular filtration rate (eGFR). RESULTS: The follow-up rate was 11% (154 out of 1,356 donors), only 19% of whom were followed by nephrologists. Blood pressure had increased from 113/75 to 116/77 mm Hg (P < .01), urinary protein excretion after donation did not increase, and renal function was well preserved after donor nephrectomy. However, 33 patients (21.4%) showed a decreased eGFR of <60 mL/min/1.73 m(2), and 3 donors developed end-stage renal disease that required renal replacement therapy. CONCLUSIONS: The follow-up rate of living donors after donation was low, and we observed an increased risk of developing chronic kidney disease after donation.

Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea.

A Korean multicenter study was conducted to assess the effectiveness of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dysfunction (ED) who were enrolled in 21 clinical centers. Patients with psychogenic impotence comprised about 30% of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in the clinics from 250 to 500 or 1000 mcg based on erectile response and tolerability. The erectile responses were evaluated using an erection assessment scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full tumescence, partial rigidity) was selected for home treatment. Patients who showed partial erection (score of 3) with 1000 mcg were also included in the home-treatment group. In-clinic phase: 198 men (59.3%) had maximal penile responses of score 4 or 5. The rate of maximal responses was not related to patient age, etiology or duration of the ED. A total of 228 (68.3%) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated as uncomfortable or very uncomfortable in 12%. Home phase: During the two-month period of home treatment, 178 (78.1%) men had successful sexual intercourse at least once, and 78.2% of administrations (1976) resulted in successful intercourse. The main causes of drop-out were insufficient erectile response in 27 men (11.8%), adverse reactions (mostly penile or urethral pain) in 7 (3.1%) or both in 7 (3.1%). In conclusion, transurethral alprostadil could be a suitable treatment option for patients with ED regardless of age and etiology of ED. Efficacy in an Asian population (Korea) is comparable to that reported previously in Caucasians.

Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder: ultrasound and CT findings.

We report the imaging findings in a case of Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder. Ultrasound and CT demonstrated multiple nodular masses in the pelvis of the transplanted kidney, ureter and bladder. The masses enhanced well on CT following i.v. contrast medium.

Effects of partial bladder outlet obstruction and its relief on types I and III collagen and detrusor contractility in the rat.

Bladder outlet obstruction induces a rapid hypertrophy characterized by increased bladder mass and collagen deposition. An increase in collagen is likely to reduce the contractility and compliance of bladder wall. This study was undertaken to investigate the effects of partial bladder outlet obstruction and its relief on types I and III collagen, and the relationship between detrusor contractility and collagen types. A total of 40 female rats was used for experiment and divided into one control, one obstruction, and three recovery groups. The contractility to field stimulation was recorded; total collagen and collagen concentration were quantified. The localization of types I and III collagen and the expression of pro-alpha1(I) and alpha1(III) collagen mRNA were determined by immunohistochemical staining and Northern blot hybridization, respectively. Contractile response to field stimulation was reduced after obstruction and recovered following relief. The total amount of collagen increased after obstruction and decreased after relief; however, collagen concentration decreased after obstruction and increased following relief. Contractility correlated negatively with total collagen but positively with collagen concentration. The protein deposition of types I and III collagen was localized in lamina propria and muscle bundles in all groups. The expression of types I and III collagen gene was up regulated after obstruction, but down regulated after relief. Negative correlation between contractility and gene expressions of collagen types was significant. These data suggest that the change in localization and quantity of collagen types leads to morphologic changes of bladder and can have an impact on the contractility of detrusor. Neurourol. Urodynam. 19:29-42, 2000.

Long-term results of percutaneous endourologic management of renal infundibular stricture.

PURPOSE: The long-term result of percutaneous endourologic management in the relief of infundibular stricture is not clear. We reviewed the long-term efficacy in our series of patients. PATIENTS AND METHODS: Twenty-seven patients underwent percutaneous endourologic management between August 1990 and February 1996. This study included the 21 who could be followed for more than 2 years (mean 4.8 years). The causes of stricture were tuberculosis (N = 18; 86%) and stone (N = 3; 14%). We made a cold-knife incision in eight patients; the others underwent only dilation with fascial dilators from 20F to 30F. Success was defined as symptomatic improvement and radiographic resolution of obstruction. RESULTS: The overall success rate was 76% (16 of 21). Seven of the eleven patients (64%) with concomitant ureteral stricture had a successful result. In the nine patients with multiple infundibular strictures, five procedure (56%) were successful. The success rates of the cold-knife or fascial dilator were 88% (7 of 8) and 69% (8 of 13), respectively. In the five patients in whom the procedure failed, ureteral stricture was associated in four and multiple infundibular strictures in four. All of them had tuberculous infundibular strictures. No significant difference in the success rate was observed according to the duration of indwelling catheter. There was no significant complication except pyelonephritis in four patients, which was controlled with conservative treatment. CONCLUSIONS: Percutaneous endourologic management is an effective and safe procedure to treat renal infundibular stricture. Risk factors for failure are multiple infundibular strictures and concomitant ureteral stricture. If the procedure does fail, other treatments have not been compromised. Cold-knife incision seems to be more effective than dilation.

Collagen studies for pediatric ureteropelvic junction obstruction.

OBJECTIVES: Ureteropelvic junction (UPJ) obstruction is the most common form of urinary tract obstruction in pediatrics. There is controversy regarding the need for early surgical intervention in many patients with apparent neonatal UPJ obstruction. To demonstrate the differences in type and amount of collagen in adult and pediatric UPJ obstruction, collagen studies were performed. METHODS: The experimental groups are 9 pediatric patients with UPJ obstruction and 13 adult patients with UPJ obstruction. Six patients with normal UPJ were assigned as controls for each experimental group. The collagen content of UPJ was quantitated by hydroxyproline analysis. Immunohistochemical staining and Western blotting for collagen types I and III were performed. RESULTS: The collagen content of pediatric UPJ was significantly lower in value than that of adult UPJ (P < 0.05). Immunohistochemical staining revealed that collagen type I was located in interfascicular space and collagen type III was located in intrafascicular space in both age groups. In Western blotting the relative intensity of collagen type III for pediatric UPJ was weaker than that of adult groups. CONCLUSIONS: These results suggest that a larger series of patients should be examined to determine whether quantitative analysis for collagen types I and III would provide some kind of prognostic test for UPJ outcome in pediatric patients.

Prevalence and risk factors of urinary stones in Koreans.

To estimate the prevalence of urinary stone disease in Koreans, and to determine the inter-relationships between urinary stone disease and various epidemiological factors, 1,521 controls and 1,177 cases with urinary stones were evaluated. Of special interest in this study were: 1) proportion of past urinary stone history among controls; 1.9% 2) the point prevalence rate of urinary stones among controls; 0.2% 3) the recurrence rate of urinary stones (the proportion of past history of urinary stone) among cases; 56.8% 4) high incidences (76.3%) in the thirties to the fifties among cases 5) the risk factors for urolithogenesis; obesity [higher than 25 of BMI (body mass index, weight/height2)], more than 10 year-experience as a production worker, past stone history, familial stone history, low physical activity (< 2,000 Kcal/day), and low intake of fruit. However, the well-known risk factors for urinary stones; over intake of meat or fish and milk or dairy products, perspiration, amount and kind of drinking water, and stress unexpectedly were not significantly different between the controls and the cases.

Resistive index of the intrascrotal artery in scrotal inflammatory disease.

PURPOSE: To investigate the utility of the resistive indices (RIs) of the epididymal and intratesticular arteries, and to establish diagnostic criteria for scrotal inflammatory disease on the basis of quantitative color Doppler sonography. MATERIAL AND METHODS: We prospectively examined 29 consecutive patients with scrotal pain, and 15 normal control subjects. The RIs of the intratesticular and epididymal arteries were obtained from color Doppler sonographs. RESULTS: The RIs of the testicular artery in epididymoorchitis were significantly lower than those in normal control subjects and in epididymitis (p < 0.01) while the RIs of the testicular artery in epididymitis and control subjects were similar (p > 0.5). With a cut-off value of RI = 0.5, sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 94%, 94%, 83%, and 77% respectively. The mean RI of the epididymal arteries in epididymitis and epididymoorchitis was 0.49 +/- 0.11. A high level of diagnostic accuracy in scrotal inflammatory disease was achieved when the RIs of the intratesticular and epididymal arteries were less than 0.5 and 0.7 respectively. CONCLUSION: The RI of the intrascrotal artery would give a more objective evaluation than subjective assessment and could provide diagnostic criteria for scrotal inflammatory disease.

Hemangiopericytoma of renal sinus expanding to the renal hilum: an unusual presentation causes misinterpretation as transitional cell carcinoma.

We report a case of renal hemangiopericytoma occurring in renal sinus and expanding to the renal hilum. This unusual presentation caused misinterpretation of this tumor as transitional cell carcinoma of the renal pelvis clinically. The patient who was a 30-year-old woman had a relatively well demarcated solid tumor, 8 x 6 cm, in the renal sinus of the left kidney.

Percutaneous endoscopic management of upper ureteral stricture size of stent.

PURPOSE: We determined the optimal size (6F versus 14/7F) of stent after endoscopic surgery based on clinical data. MATERIALS AND METHODS: Between 1989 and 1993 we performed percutaneous endopyelotomy and endoureterotomy in 40 cases of ureteropelvic junction or upper ureteral strictures. The causes of stricture were primary in 20 cases, tuberculosis in 9, previous operation in 6 and others in 5. After endoscopic management we placed 6F internal stents in 25 patients (13 in primary and 12 in secondary cases) or 14/7F endopyelotomy stents in 15 patients (7 in primary and 8 in secondary cases) for 6 to 8 weeks (average 54.2 days). Coexisting stones or infundibular strictures were managed simultaneously. All patients have been followed for a minimum of 7 months postoperatively (range 7 to 55, average 38). RESULTS: Overall success rate was 84% (92.3 in primary and 75% in secondary cases) with the 6F stent and 93.3% (85.7% in primary and 100% in secondary cases) with the 14/7F endopyelotomy stent. CONCLUSIONS: The small number of patients in each group did not reach statistical significance. However, there was a definite trend for better results with the use of 14/7F stents in patients with secondary stricture (100% versus 75%), although the difference in success rates between 6F and 14/7F stents was not significant statistically (p = 0.13).

Endoscopic infundibulotomy in tuberculous renal infundibular stricture.

To salvage the renal parenchyma, percutaneous endoscopic infundibulotomy was performed in 10 patients with a tuberculous renal infundibular stricture. Followup ranged from 12 to 31 months. The sites of stricture were the upper calix in 6 patients and the lower calix in 4. A cold knife was used to incise the stricture and a stent was retained for 6 to 8 weeks. Postoperative excretory urography revealed marked shrinkage of the dilated calix in 5 patients, moderate shrinkage in 3 and no change in 2 (success rate 80%). Of 2 failed cases partial nephrectomy was done in 1 and 1 is being followed. There was no significant complication except for 2 cases of pyelonephritis that was controlled with conservative treatment. In conclusion, endoscopic infundibulotomy is a safe, less invasive, successful and parenchyma salvageable procedure to treat tuberculous renal infundibular stricture.

Cloning and in situ localization of a brain-derived porin that constitutes a large-conductance anion channel in astrocytic plasma membranes.

We have cloned a protein from bovine brain, brain-derived voltage-dependent anion channel 1 (BR1-VDAC), that is identical to a recently sequenced plasmalemmal-bound porin from human lymphocytes. mRNA hybridization indicates that BR1-VDAC is widely distributed throughout nervous and nonnervous tissues. In situ localization substantiated that the BR1-VDAC is associated with the plasmalemma of astrocytes. A monoclonal antibody that recognizes the N terminus of the BR1-VDAC protein completely blocks an astrocytic high-conductance anion channel that has electrophysiological similarities with the mitochondrial VDAC. Since the high-conductance anion channel in astrocytes has been shown to respond to hypoosmotic solutions, its molecular identification provides the basis for a better understanding of volume regulation in brain tissue.

Endocalicotomy in tuberculous renal caliceal stricture.

The stricture of the calix, renal pelvis, or ureter secondary to renal tuberculosis has been managed by nephrectomy, partial nephrectomy, ureteroileoneocystoplasty, or even pancaliceal-ileoneocystoplasty. To salvage the renal parenchyma, percutaneous endocalicotomy with or without endopyelotomy was performed in 10 patients. The main sites of stricture were an upper calix in six cases and a lower calix in four. A cold knife was used to incise the stricture, and a stenting two-section 14F endopyelotomy catheter was retained for 6 to 8 weeks. Postoperative intravenous urography revealed marked shrinkage of the dilated calix in seven cases, moderate shrinkage in one, and no change in two (success rate 80%). One of the patients in whom the procedure failed underwent partial nephrectomy, and the other is being followed. The only significant complication was one case of pyelonephritis. Endocalicotomy is a safe, less invasive, successful (in cases that a guidewire could pass), and parenchyma-saving procedure. Retrograde pyelography is mandatory just before the surgery because stricture can worsen during antituberculosis chemotherapy.

Expression of connexins in the developing olfactory system of the mouse.

To gain insight into the function of gap junctions' connexin43, connexin32 and connexin26 in a neural structure that retains neuronal turnover capacities throughout adulthood, the expression of these molecules has been investigated in the developing and adult olfactory system by immunocytochemical and biochemical methods. Connexin43 was detectable from the olfactory placode stage. During early embryonic development, the levels of connexin43 expression remained low. An increase in the expression of this connexin occurred perinatally. Expression of connexin43 became very high during the postnatal stages and adulthood. Electron microscopy (EM) immunocytochemistry of the olfactory system showed connexin43 expression in non-neuronal cells. Strong regional differences in the expression of connexin43 in the olfactory epithelium were observed. No apparent relationship between connexin43 expression and turnover activity of olfactory neurons was detected. Western blots of olfactory tissues revealed the presence of three different isoforms of connexin43. Connexin32 was detected in the olfactory bulb at late postnatal stages including adulthood. Connexin32 was observed on some cells tentatively identified as oligodendrocytes. Connexin26 was localized onto leptomeninges. Some immunofluorescence was also obtained in the periglomerular region and in the subependymal layer of the bulb. Northern blot analysis revealed the presence of mRNA of connexin32 and connexin26 in the adult olfactory system. Our results substantiate the cell specific expression of these three types of connexins and they document the primary of connexin43 in olfactory tissues. Moreover, our findings indicate that although expression of connexin43 in the olfactory system is developmentally regulated, it is not directly associated with the neuronal cell turnover of the olfactory epithelium.

The gap junction family: structure, function and chemistry.

Gap junctions are aggregates of transmembranous channels which bypass the extracellular space by transporting messenger molecules and ions from one cytoplasmic source to an adjacent cytoplasmic interior. The channels join the plasma membranes of adjacent cells by bridging the extracellular space between them. Thereby, cellular "compartments" which were once considered to be individual units are, in actuality, interconnected by a system of pathways which form a functional cellular syncytium. The evolutionary importance of a generalized intercellular communication system can be appreciated when one considers the widespread prevalence of gap junctions within animals of all multicellular phyla, and within almost all tissues of vertebrates. Only a few population of cells such as skeletal muscle cells (which are fused to form functional syncytia) and circulating blood cells are not equipped with gap junctions. This paper provides a brief review of the diverse structural, molecular and functional aspects of gap junctions as revealed by current research.

Differential expression of three gap junction proteins in developing and mature brain tissues.

By using antibodies directed against gap junction proteins of liver (connexins 26 and 32) and heart (connexin 43), we have localized immunoreactivity to specific cell types in frozen sections of adult rodent brains. Connexin 32 reactivity was found in oligodendrocytes and also in a few neurons, whereas reactivity to connexins 26 and 43 was localized to leptomeningeal cells, ependymal cells, and pineal gland. Immunoreactivity with antibodies to connexin 43 also occurred in astrocytes. Furthermore, during embryonic and postnatal maturation of brain tissues, gap junction proteins were differentially expressed. Connexins 43 and 26 predominated in the neuroepithelium of embryonic brains, whereas connexin 32 was virtually absent. Between 3 and 6 weeks after birth, connexin 26 largely disappeared from immature brain; this time course corresponded to the increased expression of connexin 32. Expression of connexin 43 remained high throughout embryonic and postnatal development. These findings demonstrate that gap junction expression in the brain is diverse, with specific cell types expressing different connexins; this cell-specific distribution may imply differences in the function of these intercellular channels in different loci and developmental stages.

A 16 kDa protein co-isolating with gap junctions from brain tissue belonging to the class of proteolipids of the vacuolar H+-ATPases.

A 16 kDa protein from an enriched gap junction preparation was isolated from bovine brain tissues. N-terminal amino acid microsequencing of the first 20 amino acids showed a complete homology with a recently published sequence of a proteolipid from a vacuolar H+-ATPase from chromaffin granules. Incubation of the brain gap junction preparation with 14C-N,N'-dicyclohexylcarbodiimide showed a significant binding of this compound to the 16 kDa protein, indicating that a proton binding site also occurs within that particular protein. The data suggest that this 16 kDa protein, which has also been described in gap junction preparations from various other tissues, belongs to the proton transporting ATPase.