Risk factors of severe incisional hernia after renal transplantation: a retrospective multicentric case-control study on 225 patients.

PURPOSE: The aim of this study was to analyze the incidence of severe incisional hernias and find their specific risk factors in renal transplant patients. METHODS: This retrospective multicentric case-control study focused on 225 kidney transplant patients among 4348 patients transplanted during this period within two French university hospitals (Saint-Louis/Lariboisière in Paris and Tours, Loire Valley) from 2000 to 2014 and from 1995 to 2014, respectively. Forty-five patients developed a severe incisional hernia after renal transplantation. The primary outcome measure was the development of a severe incisional hernia after surgery. Statistical analysis included an univariate analysis and a multivariate analysis using a logistic regression according to the Cox model. RESULTS: Forty-five patients (1.03%) had a severe incisional hernia surgery after renal transplantation. The median follow-up was 55.5 months. In univariate analysis, smoking, the occurrence of a lymphocele and parietal closure in a single musculo-fascial layer was significantly associated with the occurrence of incisional hernia after renal transplantation. Former or active smoking (OR 2.32, p = 0.0370), lymphocele (OR 4.3903, p = 0.0018) and parietal musculo-fascial closure in one single layer (OR 3.37, p = 0.0088) significantly increased the risk of incisional hernia after kidney transplant in multivariate analysis. CONCLUSIONS: We report in this study one of the largest series of patients who had incisional hernia after renal transplantation. Former or active smoking, lymphocele and parietal closure in one single musculo-fascial layer were independent risk factors for incisional hernia following kidney transplant.

Long-term outcomes of 80-watt KTP and 120-watt HPS GreenLight photoselective vaporization of the prostate.

OBJECTIVE: Photoselective vaporization of the prostate (PVP) is becoming a surgical treatment alternative of transurethral resection of the prostate for male lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). We evaluated the outcome and postoperative complications of PVP performed by 80-W KTP and 120-W HPS GreenLight lasers (AMS®) over a 4-year period. MATERIALS AND METHODS: This is a prospective monocentric study that included all patients who underwent PVP. They had routine follow-up at 1 month, 3 months, 6 months and every year until the fourth postoperative year. Listed data were maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), post-void residual (PVR) volume, prostate-specific antigen (PSA) and prostate volume. We collected the postoperative complications. RESULTS: From September 2005 to May 2008, 77 patients out of a 409 patients cohort underwent surgery and were followed during 4 years. At 4 years mean Qmax increase was 82.5%; mean IPSS, PVR volume, PSA and prostate volume decreases were 79.1, 69.8, 43.8 and 22.9%, respectively. The main side effects observed were storage LUTS. A urinary catheter was replaced after a first withdrawal failure in 10 patients (15.6%) after surgery. CONCLUSIONS: PVP showed a sustainable efficacy and an appealing tolerance profile during a 4-year period in patients with LUTS secondary to BPO.