[Five years of kidney transplantation in Iasi]. / Cinci ani de transplant renal în centrul universitar Iasi.

The activity of Renal Transplant Center Iasi started in November 2000, when we realized the first renal transplant from a live donor. Since then, 46 renal transplants were successfully realized in our center, to patients aged between 13-47 years (medium age = 30 +/- 5), M/F=27/19, 25 (56.8%) of them selected from HD, 17 (39.9%) from CAPD and 4 (8.7%) pre-emptive. Medium age of donors was 49.1 years (30-64), M/F=29/17. The donors were, in 78.3% of cases, first-degree relatives (parents, siblings). In 10 cases (21.7%) the grafts were donated by "emotionally related"donors (in most cases, spouses). An urologist-cardiovascular surgeon team, performed the transplant operations. There were no important complications during operation. We had one major vascular complication (graft artery thrombosis) in a 13 years recipient, successfully resolved after thrombectomy and stenting. Immunosuppressive therapy associated induction with monoclonal antibodies anti-Tac, cyclosporine, MMF and prednisone. Eight patients from 46 (17.39%) presented acute rejection episodes and all responded at corticosteroids. Medium values of serum creatinine were: 1.54 mg% at 1 month, 1.42 mg% at 6 months, 1.44 mg% at 1 year, 1.21 mg% at 2 years, 1.38 mg% at 3 years, 1.4 mg% at 4 years and 1.2 at 5 years. The survival of patients and donors is 100% and the survival of renal graft--97.1% (one case of chronic allograft nephropathy with lost of renal function). We also present the satisfactory evolution of the 51 renal transplanted patients addressed to our center from different other renal transplantation centers in Romania for management follow-up.

[Can selective alpha-blockers help the spontaneous passage of the stones located in the uretero-bladder junction?]. / Pot ajuta alfa-blocantele selective eliminarea calculilor ureterali aflati la jonctiunea uretero-vezicala?

The majority of ureteral stones at presentation in hospital are located within the distal ureter. Knowing that only half of the stones 4 to 5.9 mm will pass spontaneously, we tried to see: if we can facilitate this elimination for the stones smaller than 8 mm by selectve alpha-blockers (alfuzosin and tamsulosin) which induce relaxation of the smooth muscle of uretrotrigonal area and if there is any difference between these two drugs, concerning efficiency and tolerance. The inclusion criteria for each group were: stone size between 4 and 8 mm--even patients with steinstrasse--and previous, at least 2 weeks of expulsion treatment with nonsteroidal antiinflammatory and antispasmodic agents and Rowatinex. The results were encouraging: almost all the patients eliminated the stones without any pain in the first 5-10 days of treatment (only two patients from alfuzosin group did not tolerate this drug). We believe that both alfuzosin and tamsulosin have a crucial impact in spontaneous painless elimination of the stones smaller than 8 mm located in the uretero-bladder junction.

[Ureteral stenting after retrograde ureteroscopy. Experience of Iasi urological department]. / Protezarea ureterului dupa ureteroscopia retrograda. Experienta clinicii urologice Iasi.

Ureteroscopy is a well-established procedure, which has proven the efficiency for diagnostic purposes, but mostly for ureteric stone removal. The authors describe their strategy after ureteroscopic lithotripsy with Wolf 8 Ch semirigid ureteroscope. Insertion of a double J stent for 2-4 weeks was the rule when there was an important bleeding during the procedure, the fragments were big and could not be extracted, some fragments migrated in upper third of the ureter or renal pelvis, a perforation occurred or it was found a ureteral stenosis. If the stone can be extracted without any problems (in one piece) and the ureter is normal there is no need for ureteral stenting. Having in mind that many patients describe problems with the double J stent (pains, polakiuria, etc) we recommend to insert a stent at the end of ureteroscopy only for selected cases.