Repeat renal allografts treated with sirolimus, cyclosporine, anti-thymocyte globulin induction and continuous steroids achieve similar immunosuppressive efficacy as primary transplants.

OBJECTIVE: We sought to examine repeat versus primary renal transplantations using sirolimus-based regimens. METHODS: We compared 98 repeat versus 200 matched primary recipients treated de novo with sirolimus plus cyclosporine. Every repeat case received polyclonal antibody induction and continuous steroids. Outcomes were evaluated over a mean five-year follow-up by univariate and multivariate techniques. Kaplan-Meier plots were analyzed with using log-rank statistics with significance at P < or = 0.05. RESULTS: Significant differences in demographic features included greater panel reactive antibody (PRA), younger age, fewer HLA-mismatches and more pre-emptive repeat versus primary grafts. Neither graft and patient survivals, nor incidences of biopsy-proven acute rejection (BPAR), chronic vasculopathy or tubular atrophy/interstitial fibrosis among biopsies performed for cause were significantly different at 1 and 5 years. Younger recipients, better HLA matches and absence of diabetes promoted repeat graft survival; whereas older age, longer cold ischemia time and BPAR reduced primary transplant outcomes. Renal function was similar at 1, 3, 12, 24, 48 and 60 months. CONCLUSION: At 5 years this sirolimus regimen achieved similar efficacy for repeat versus primary transplantations.

Comparison of the long-term outcomes between incontinent men and women treated with artificial urinary sphincter.

PURPOSE: We compared the long-term outcome of AUS between men and women who received the device for the management of stress urinary incontinence. MATERIALS AND METHODS: Between August 1983 and January 2004, 126 consecutive patients received the AUS AMS 800 at our center placed by the senior author (ACD). Of these patients 108 (53 men, 55 women) and 168 devices (88 in men, 80 in women) were available for review. Outcome measures include complications, duration and etiology of AUS failure, and satisfactory continence. RESULTS: Mean followup was 8.1 +/- 5.6 years. Of the 108 patients 18 (40%) men and 31 (56%) women had no complications (p = 0.09). Of the 168 devices 76 (45%) eventually failed (44 or 50% in men, 32 or 40% in women, p = 0.19). The incidences of failed device classified as mechanical, nonmechanical or iatrogenic were not significantly different (p = 0.07). Median device durations were 6.9 and 11.2 years in men and women, respectively (p = 0.002). Satisfactory continence was achieved in 82% of patients, in 43 (81%) men and in 46 (84%) women (p = 0.73), including 5 (9%) men and 35 (64%) women who were dry (0 pads, p = 0.01), 28 (53%) men and 4 (7%) women who wear 1 pad (p = 0.01), and 10 (19%) men and 7 (13%) women who use 2 pads per day. CONCLUSIONS: There were no differences in overall satisfactory continence and device failure rates. However, women have a higher dry rate (0 pad use) and longer functioning device duration compared to their male counterparts.

Retroperitoneal laparoscopic adrenalectomy: A documentation of the first case in the country

The initial experience in laparoscopic adrenalectomy has been performed transperitoneally. To further minimize the invasiveness, the concept of retroperitoneal laparoscopy was developed and is rapidly gaining grounds as the standard of care. Locally, surgeons have been reluctant in adopting this remarkable alternative due to lack of facilities, experience and support. Thus, only 4 cases of laparoscopic adrenalectomies, all via the transperitoneal approach, had been performed for the past 4 years. Considering the limited experience, inadequate facilities and instruments, still, it was successfully performed with some procedural innovations and technical modifications. It follows the principles of minimally invasive surgery that can avoid some of the physiologic and technical complications of transperitoneal laparoscopic adrenalectomy in the country. It proves the possibility of the procedure in the local setting. As an innovative addition to urological practice, retroperitoneal laparoscopic adrenalectomy can therefore serve as an alternative treatment procedure for benign adrenal pathologies. (Author)