[The percutaneous treatment of the urological complications following kidney transplantation]. / Trattamento percutaneo delle complicanze urologiche dopo trapianto renale.

Renal transplantation is considered the treatment of choice in most cases of renal failure; the urologic complication rate ranges 1 to 10% in different surveys. This work was aimed at evaluating the application and results of interventional radiology in these cases. Since 1983, 24 patients (20 males and 4 females) whose age ranged from 18 to 63 years (mean age: 42 years) have been submitted to percutaneous maneuvers in our department. Thirty-four complications were treated: 14 stenoses, 11 fistulas, 7 urinomas and 2 transient obstructions. Complete success was obtained in 15/24 patients (62.5%), while 7/24 patients (29.16%) underwent reoperation and in 2/24 cases (8.34%) a definitive pyelostomy catheter was inserted. In 7 stenosis cases ureteroplasty was successfully performed and a double-J endoprosthesis inserted; the follow-up results (5-21 months) were satisfying in all cases. The only complication was one case of endoperitoneal hematoma. Considering the good results obtained, the low morbidity and mortality and the low cost, percutaneous maneuvers must be considered the treatment of choice in the urologic complications of renal transplants. When the percutaneous treatment of the main lesion fails, pyelostomy does nonetheless allow the drainage of urinary collections, the maintenance of renal function and the improvement of local and general conditions, which makes it easier to reoperate under elective conditions.

[Cost-effectiveness analysis of extracorporeal lithotripsy]. / Analyse coûts-efficacité de la lithotripsie extra-corporelle.

The recent introduction of extracorporeal lithotripsy (ECL) for the treatment of urinary stones has raised new questions for doctors and economic policy decision makers. This study presents a cost-effectiveness analysis of extracorporeal lithotripsy conducted in an Italian hospital which has used a Sonolith 3000 lithotriptor since 1989. The overall cost of treatment by ECL (of a simple case of urinary stones) is 5,080 FF and the cost per cured case (taking into account the number of sessions per patient and the percentage of cured cases) varies between 6,200 FF and 9,500 FF. The results obtained (influenced by the lack of certain clinical data due to the recent use of this technique) appear to be in favour of extension of ECL treatments in comparison with surgical treatment due to their lower cost, lower morbidity and shorter convalescent period.