ABSTRACT
INTRODUCTION: Urinary complications after kidney transplantation are common and can compromise renal function. While they are mainly attributed to ischemic lesions of the ureter, there is no existing method to evaluate its vascularization during surgery. The aim of the study was to evaluate if indocyanine green, revealed by infra-red light andused to visualize tissue perfusion, could provide an appreciation of the ureter's vascularization during kidney transplantation. METHODS: This feasibility study was conducted over one month, on eleven consecutive kidney transplants. During transplantation, an injection of indocyanine green enabled the surgeon to visualize in real time with an infra-red camera the ureter fluorescence. Its intensity was reported on a qualitative and semi-quantitative scale. Occurrence of urinary complications such as stenosis or ureteral fistula were collected during 6 months. RESULTS: In all of the 11 cases (100%), the last centimeters of the ureters were not fluorescent. Three (27%) ureters were poorly or partiallly fluorescent. Out of these three cases, only one case of urinary fistula occurred, followed by ureteric stenosis. In the series, two fistulas (18%) and two ureteric stenoses (18%) occurred. No side effects were observed. The low number of events did not allow statistical analysis. CONCLUSION: Infra-red fluorescence of indocyanine green could be a simple and innovative way to appreciate the transplant's ureteric vascularization during kidney transplantation. It could help surgeons to identify the level of ureter section and to decide the anastomosis technique, in order to limit urinary complications. LEVEL OF EVIDENCE: 3.
Subject(s)
Kidney Transplantation , Ureter/diagnostic imaging , Urinary Fistula/diagnostic imaging , Urologic Diseases/diagnostic imaging , Adult , Aged , Feasibility Studies , Female , Fluorescence , Fluorescent Dyes , Humans , Indocyanine Green , Male , Middle Aged , Ureteral Diseases/diagnostic imaging , Ureteral Diseases/etiology , Ureteral Obstruction/diagnostic imaging , Ureteral Obstruction/etiology , Urinary Fistula/etiology , Urologic Diseases/etiologyABSTRACT
INTRODUCTION: The aim of this study was to assess efficacy, complication and feasibility of outpatient suburethral slings for stress urinary incontinence in women. MATERIAL AND METHODS: A systematic review of the literature was done from the Pubmed data-base by searching following keywords: suburethral sling, midurethral sling, TVT, TOT, outpatient surgery, day surgery. RESULTS: Seventy-eight percent to 88% of patients were continent postoperatively, and 6.8 to 12% of patients were significantly improved. No major complication occurred and minor complications were observed in 7.2 to 19.8% of patients. Eighty to 86.6% of patients experienced no complication. Seventy percent to 100% of patients were discharged on post operative day 0. The satisfaction rate was 89.4 to 95%. CONCLUSION: Outpatient suburethral sling for stress urinary incontinence is suitable, effective, with a low complication rate, and with a high rate of satisfaction.
