ABSTRACT
Introduction Renal transplantation with multiple arteries is associated with a major index of surgical complications. Relevant papers and meta-analyses have shown relatively more vascular and urological complications in transplant of donor kidneys with multiple arteries. In live donor grafts due to the unavailability of a carrel patch, several techniques for bench and in situ reconstruction have been described in order to reduce the incidence of these vascular complications. In this study, the short and long-term results of living donor kidney transplants with multiple renal arteries (MRAs) versus single renal artery (SRA) were compared retrospectively. Methods This is a retrospective study done on patients who received a living donor kidney between January 2012 and January 2018 at the Institute of Urology, Madras Medical College, Chennai. We have excluded deceased donor kidney transplants and ABO-incompatible cases done in the same time period. The study was approved by the Institutional Ethics Committee (Approval No: IES-MMC-008) and performed in accordance with the guidelines of the Declaration of Helsinki. Open live donor nephrectomy was performed through an extra-peritoneal flank incision in all cases. In the SRA group, the renal artery was anastomosed end to end to the Internal iliac artery, while the renal vein was anastomosed to the external iliac vein in the end to side fashion. Urinary tract reconstruction was accomplished by the Gregoir technique in both groups. We looked at recipient complications, baseline and postoperative serum creatinine, total ischemia time, mean operating time, and short- and long-term graft and patient survival as postoperative outcomes. Results In a six-year period (2012-2018) at our institute, 256 living donor transplantations were performed; 36 (14%) kidneys had two or more renal arteries which were anastomosed using various techniques. Cold ischemia time was relatively longer in the MRA group (45 mins vs 28 mins in the SRA group) (p-value <0.05). while warm ischemia time was comparable in both groups (2.5 vs 2.9 mins) serum creatinine was comparable in both groups at the 30th postoperative day (1.4 in SRA group vs 1.2 in MRA group) (p-value >0.05). Incidence of surgical complications in SRA and MRA groups was: vascular - 3.6% and 2.7%; urological - 3.2% and 2.7%; the incidence of lymphocele was 4.5% and 5.5% and delayed graft function 4.5% and 5.5% respectively. Conclusion Multiple renal arteries are no longer a relative contraindication with advanced surgical techniques. in renal grafts with multiple arteries, all techniques of vessel anastomosis are comparable in terms of post-surgical complications.
ABSTRACT
Background The majority of bladder cancer patients are elderly and have various comorbidities, increasing the risk of complications following general anesthesia. Spinal anesthesia with a selective obturator nerve block (ONB) is an alternative to general anesthesia for transurethral resection of bladder tumor (TURBT); however, incomplete ONB can cause adductor muscle spasm. The objective of this study was to assess if the ultrasound-guided interfascial injection approach is compatible with the blind nerve stimulating technique for ONB in bladder cancers undergoing TURBT. Methodology A total of 50 ONBs were performed for TURBTs under spinal anesthesia and were divided into two groups, that is, ONB with nerve stimulation control group (group RD1) and an experimental ultrasound-guided interfascial injection group (group RD2). During TURBT surgeries, one urology assistant determined obturator reflex grade (I-IV) at 15 minutes after injection completion in both groups. Results A success rate of 88% was achieved in group RD1 compared to 76% in group RD2, which was clinically significant. Three cases failed to achieve complete ONB in group RD1, and six cases in group RD2 failed to achieve complete ONB. One case in group RD1 and two cases in group RD2 exhibited grade II obturator re-flex during the surgery. Conclusions Ultrasound-guided interfascial injection approach was inferior to the ultrasound-guided nerve stimulating technique for ONB at the inguinal crease; hence, we recommend using both ultrasound and nerve stimulators for ONB.