An alternative for short renal vein during kidney transplantation: long-term experience with polyethylene terephthalate (Dacron) vascular graft.

OBJECTIVE: To describe the first long-term experience with the polyethylene perephthalate vascular graft to lengthen a short renal vein during kidney transplantation. MATERIALS AND METHODS: The polyethylene terephthalate vascular graft was interposed between the short renal vein of the donor kidney and the recipient's external iliac vein using 6-0 Prolene suture on a 13-mm needle. The postoperative follow-up protocol of the patients included regular serum creatinine levels and Doppler ultrasound scans. RESULTS: The median follow-up period was 74.5 months (range 51-128). Postoperative Doppler ultrasonography showed no complications in any of the patients. None of our patients experienced any kind of rejection. The median creatinine level at the last follow-up visit was 0.99 mg/dL (range 0.73-1.56). CONCLUSION: In our experience, the use of polyethylene terephthalate vascular grafts as a venous graft for the short renal vein in kidney transplantation provides an alternative option with long-term success.

The value of sacral skin lesions in predicting occult spinal dysraphism in children with voiding dysfunction and normal neurological examination.

OBJECTIVE: The role of magnetic resonance imaging (MRI) in detecting occult spinal dysraphism (OSD) in children with voiding dysfunction and a normal neurological examination is still under debate. The aim of this study was to assess the correlation of sacral skin lesions with OSD detected on MRI, in a population of children with resistant lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: A total of 114 children over 5 years of age with urinary tract infection (UTI) and/or LUTS and normal neurological examination were enrolled. All children underwent sacral neurological examination, urine analysis and cultures, renal/bladder ultrasound, voiding cystourethrogram and urodynamic examination. After a treatment period of 6 months, the patients were re-evaluated and spinal MRI was performed in 61 with ongoing LUTS or UTI. RESULTS: Nineteen of 61 children (31%) had cutaneous stigmas. MRI detected spinal abnormality in 2/42 children with a normal sacral examination in comparison to 7/19 children with an abnormal sacral finding (Chi-squared test, P < 0.005). The sensitivity and specificity of an abnormal sacral finding in predicting MRI abnormality were 0.76 and 0.77, respectively. Urodynamic parameters did not predict an abnormal spinal MRI. CONCLUSIONS: Abnormal sacral findings, but not urodynamic studies, are strong predictors of OSD. A normal sacral examination does not rule out OSD.

Long-term results of endoscopic treatment of vesicoureteral reflux with the sub-ureteric injection of calcium hydroxyapatite.

AIM: To review our long-term results of the sub-ureteric injection of calcium hydroxyapatite in the endoscopic management of vesicoureteral reflux (VUR) in children. MATERIALS AND METHODS: A sub-ureteric injection of calcium hydroxyapatite was given to 14 children (23 ureteral units) affected by VUR grades I-V. All children were followed-up with monthly urine cultures, and a renal ultrasound was done on the postoperative 4th week, while the first voiding cysto-urethrogram (VCUG) control was performed on postoperative week 12. The children were followed-up with yearly renal ultrasound and monthly urine cultures, thereafter. Data from the patients' charts were retrospectively analyzed regarding the outcome of the procedures. RESULTS: Mean follow-up time was 52 months (47-60 months). VUR was cured in 47.4% of cases after a single injection. After the second injection the global success rate was 52.1%. Ureteroneocystostomy was performed on seven refluxing ureters of five children unresponsive to sub-ureteric injection therapy. One patient underwent nephroureterectomy because of a non-functioning kidney secondary to ureteral obstruction due to migration of material at the 23rd month postoperatively. CONCLUSION: Although favorable short-term success rates have been reported with the sub-ureteric injection of calcium hydroxyapatite without any side effects, our long-term results showed a low success rate, with the only reported serious morbidity.

The inhibitory effect of vitamin E on cigarette smoke-induced oxidative damage to the rat urothelium: can it prevent transitional cell carcinoma?

INTRODUCTION: We aimed to detect reactive oxygen species (ROS) and assess subsequent carcinogenesis in terms of cellular proliferation in the bladder and kidney epithelial tissues of rats exposed to cigarette smoke (CS), and to investigate the changes following vitamin E treatment. MATERIALS AND METHODS: Twenty-four male Sprague-Dawley rats were divided into 3 groups: group 1 was kept intact; group 2 was subjected to CS exposure for 8 weeks, and group 3 received intraperitoneal vitamin E injections (200 mg/kg/week) for 8 weeks in addition to CS exposure. Histological examination and Ki67 antigen expression measurements were made from bladder and renal pelvic tissue sections. Luminol-amplified chemiluminescence was used to measure ROS levels. All results were compared using a one-way ANOVA test. RESULTS: In CS-exposed rats, light microscopy of renal and bladder tissues revealed nonspecific epithelial changes; however, Ki67 expression was significantly increased in bladder tissues compared to other groups (17.5 +/- 4.7, 35 +/- 2.9 and 18.7 +/- 5.1% in groups 1, 2 and 3, respectively, p < 0.05). Chemiluminescence levels in bladder and renal tissues were also significantly higher in the CS-exposed animals (78.1 +/- 11.4, 148 +/- 13.3, 97.8 +/- 6.1 rlu/mg for the bladder, and 99.8 +/- 12.2, 176.1 +/- 27.9, 67.1 +/- 9 rlu/mg, for renal pelvic tissues, respectively, p < 0.05). CONCLUSIONS: Vitamin E can alleviate CS-induced oxidative damage in rat bladder and kidney epithelium suggesting a potential role for vitamin E in the prevention of CS-mediated carcinogenesis.

A new suture technique for anastomosis in radical retropubic prostatectomy and early removal of urethral catheter.

INTRODUCTION: A modified suture technique for urethro-vesical anastomosis during radical retropubic prostatectomy was developed and utilized in a cohort of patients. Comparative analysis of postoperative outcome was performed with a previous group of patients who had an anastomosis with the conventional technique. MATERIAL AND METHODS: A consecutive group of patients who underwent radical retropubic prostatectomy in our department with the diagnosis of localized prostate cancer was included in this retrospective study. Urethro-vesical anastomosis was performed either with the new or conventional method (CM). Outcome data of these two different patient sets were compared. RESULTS: One-hundred and one consecutive patients (mean age of 61.9 years) who were operated by either one of the two anastomotic suture techniques composed our study group. The mean follow-up period was 18 months (min: 12-max: 24). Urethro-vesical "U" (UVU) suture was performed in 51 patients, and CM in 50 patients. Foley catheter was removed at postoperative fourth day in 33 (64.7%) and 18 (36%) patients in UVU and CM groups, respectively (p < 0.01). Incontinence rate was significantly lower in the UVU group at postoperative first year (p < 0.0005). Anastomotic strictures were observed in only 1.9% of the cases in UVU group, compared to 4% in CM group. CONCLUSION: Outcome data from our patient group indicate that UVU suture may allow a high quality urethro-vesical anastomosis with a very favorable outcome in terms of early catheter removal, high continence and low stricture formation rates in patients undergoing radical retropubic prostatectomy. Further validation of these results requires a prospective randomized trial.

A new approach for the surgery of large renal masses: abdominal wall flap incision.

INTRODUCTION: The type of skin incision affects the course of surgery during radical nephrectomy. We investigated the efficacy of a new type of incision for the surgical approach to large renal masses. PATIENTS AND METHODS: Fourty patients (23 males and 17 females, mean age 63 years) who underwent radical nephrectomy in our department between 2002 and 2004 were evaluated. The outcomes in the groups with chevron incision and abdominal wall flap incision (AFI) were compared in terms of greatest tumor diameter, operation duration, perioperative blood loss, postoperative complications, and duration of hospitalization. Statistical analysis was made by independent-samples t test. RESULTS: Chevron incision was used in the first 15 patients, while subsequent 25 patients were operated via AFI. The operation duration was slightly longer in the AFI group (3.78 vs. 3 h); however, the mean largest tumor diameter was significantly greater in patients operated via AFI (11.3 vs. 7.4 cm, p < 0.05). The mean blood losses were 1,100 and 590 ml in the chevron incision and AFI groups, respectively (p < 0.05). There was no significant difference in terms of duration of hospitalization and postoperative morbidity. CONCLUSION: In our experience, AFI provides the best exposure and improved control of renal vessels and vena cava during radical nephrectomy and enables a safe dissection even in very large tumors with minimal blood loss.