Quality System of Kidney Donation for Transplantation From Living Donors in Poland.

OBJECTIVE: The program aims to build and develop a high-quality donation system at the hospital and national level. Thirty coordinator posts for the transplantation of kidneys from living donors (LDs) were created. The coordinators' tasks were identified as determining or excluding the possibility of LD donation for kidney transplantation for every potential kidney recipient referred to the waiting list, qualifying potential LDs, supervising health monitoring for LDs and kidney recipients, and education and promotion of transplantation from LDs. METHODS: The coordinators' reports and verification of data in the national transplant register from June 1, 2018 to November 30, 2019 were analyzed. ETHICS: The study was conducted according to principles of the Declaration of Helsinki, and the Declaration of Istanbul participation was on a voluntary basis. RESULTS: Information on possible LDs was obtained from 707 (43%) of the 1630 potential recipients entered on the waiting list. In 373 cases there was no potential LD; 16 recipients did not give consent for kidney transplantation from a LD; for 318 recipients, 340 potential LDs were identified; 90 potential LDs were rejected at the initial stage for medical reasons; 60 potential donors were rejected at further stages of the qualification process; 3 persons resigned from donation; and 23 recipients were transplanted from deceased donors. Kidneys from 73 LDs were qualified and transplanted. On November 30, 2019, 91 potential donors were awaiting further qualification. As part of the program, 27 potential pairs for paired kidney exchange were reported to Poltransplant (17 pairs with positive HLA crossmatch, 10 with incompatible blood groups). CONCLUSIONS: The creation of posts for coordinators for LD kidney transplantation in centers that qualify for LD kidney transplantation enabled systematic monitoring of donation potential, which led to an increase in the number of LD kidney transplants in 2019. Making full use of donation potential should significantly increase these numbers in the coming years.

Organ Donation From Elderly Deceased Donors and Transplantation to Elderly Recipients in Poland: Numbers and Outcomes.

The age of a donor and recipient is one medical criterion in the kidney allocation system. The number of elderly donors and recipients is steadily growing. The aim of the study was to retrospectively evaluate the 5-year results of kidney transplantation from donors over 65 years of age to recipients over 60 years of age. In the years 1998 to 2010, 8526 potential deceased donation after brain death organ donors and 8206 people (81%), who had been treated with transplantation of kidneys were referred to the Poltransplant. The actual number of deceased donors >65 years was 358 and <65 years was 7207. The actual 5-year survival of a kidney transplant from donors >65 years was 59.2% (55.3% of recipients >60 years and 60.7% of recipients <60 years of age; P < .0001) and from donors <65 years was 75.1% (67.5% of recipients >60 years and 75.7% of recipients <60 years; P < .0001). The actual 5-year survival of kidney recipients from all donors >65 years was 75.6% (79.5% younger recipients vs 65.9% elderly recipients; P < .0001). The 5-year survival of kidney recipients from all donors <65 years was 88.1% (P < .0001); 89% younger recipients and 74.3% elderly recipients (P < .0001). The above analysis of the material from the Polish registry displayed significantly worse results of kidney transplantation from donors >65 years, regardless of the age group of recipients.

Clinical experience with 80 inflatable penile prostheses.

OBJECTIVES: Prosthetic surgery for impotence has been transformed by the use of inflatable prostheses, superseding the old semi-rigid designs. Our objective is to report the functional results and the complications of this type of surgery. METHODS: 80 inflatable prostheses were implanted between October 1987 and October 1994. The mean follow-up was 3 years and assessment of the objective (mechanical functioning of the prosthesis and complications) and subjective results (sexuality of the patients) was made in 68 patients. RESULTS: There were: 54.5% functional disturbances, 7% infections, and 27.5% prosthesis removals. Most of the patients were satisfied, although only 65% returned to regular sexual activity. CONCLUSIONS: The choice between an inflatable and a semi-rigid prosthesis should be carefully discussed because of the frequent mechanical complications that have been reported for the sophisticated designs. Inflatable penile prostheses nevertheless remain the design of choice. Their reliability has been increasing since the manufacture of monobloc designs. Such a device is costly, and should be compared with that of intracavernous injections.

[The inflatable penile prosthesis. Experiences apropos of 58 implants]. / Les prothèses de verge gonflables. Expérience à propos de 58 implantations.

Prosthetic surgery for impotence has been transformed by the development of inflatable prostheses in the place of older semirigid models. Despite the popularity of this new technique, it raises certain questions concerning the functional results and complications of this surgery, which have only occasionally been studied concomitantly in the literature. The sexuality of patients has generally been evaluated on the basis of answers to a questionnaire sent to the patients. This study reports our experience, compared to the data in the literature, based on 58 insertions of inflatable prosthesis between October 1987 and October 1991. After rigorous patient selection and a mean follow-up of 30 months, the surgeon evaluated the objective results (mechanical functioning of the prosthesis, complications) and subjective results (sexuality) in 51 patients. 69.4% of patients presented an anomaly of prosthesis function, 10.3% developed an infection of the prosthesis, 34.5% required removal of the prosthesis, 59% declared that they were satisfied sexually and sexual activity was restored in 55%. This study therefore appears to contradict the optimistic data reported in the literature.

Combination of standard cytology and immunocytology with BL2-10D1 monoclonal antibody for monitoring-treated bladder cancer patients.

Monoclonal antibody BL2-10D1 directed against a tumor-associated antigen of bladder carcinoma was used for monitoring 11 intravesically treated patients. Thirty-three bladder washout specimens were used for standard cytology and immunological staining. Prior to treatment, 9 of 11 cytologic specimens examined with standard cytology were found to be positive. Using BL2-10D1 alone, only 6 were positive but 1 patient negative with standard cytology was positive with the antibody and corresponded to a positive histological control. Thus, before treatment, an increase in positive rate was observed using the combination of the 2 methods from 82 to 91%. At the end of treatment, 9 washout specimens remained positive with standard cytology, whereas 1 case negative in standard cytology was positive in immunocytology. Thus, the positive rate increased from 82 to 91%. One month after the end of treatment, of 11 washout specimens tested, 3 false-negative standard cytologies and 4 false-negative immunocytologies were shown. However, used in combination, the two methods lead to an increase in positive rate from 67 to 89%. In view of these results, BL2-10D1 may be considered as a useful reagent in combination with the standard cytology for the confirmation of the presence of tumor cells before and after immunotherapy.

[Primary tumors of the upper urinary tract. Apropos of 49 cases and a review of the literature]. / Les tumeurs primitives de la voie excrétrice urinaire supérieure. A propos de quarante-neuf observations et revue de la littérature.

We report 49 tumors of the upper urinary tract treated between 1980 and 1988. Intravenous pyelography with direct opacification technics gave the diagnosis in 83.7% of patients. Ultrasonography and computed tomography were only reliable for tumors of renal pelvis. Urinary cytology gave good results only in high grade invasive transitional cell carcinoma. Nephro-ureterectomy is always recommended.

[Results of the surgical treatment of impotence due to venous leakage by insertion of a prosthetic venous tourniquet. 26 patients reviewed with a 1-year follow-up]. / Résultats du traitement chirurgical de l'impuissance par fuite veineuse par mise en place d'un garrot veineux prothétique. Vingt-six malades revus avec un an de recul.

Twenty-six patients have been operated by pericavernoplasty with a band of synthetic material. After 1 year, 61.6% had a good result. Venous leaking is certainly a disease of the corpora cavernosa.

[The results of urethro-cervicolysis after surgical over-correction of stress urinary incontinence. Apropos of 10 cases]. / Les résultats des urétro-cervicolyses après hypercorrection dans la chirurgie de l'incontinence urinaire d'effort. A propos de dix observations.

Between 1985 and 1988, 10 female patients between the ages of 35 and 76 years, suffering from dysuria after surgical correction of urinary stress incontinence (7 sub-urethral bands, 3 colposuspensions) were observed. The abnormality of the course of the urethra compressed anteriorly against the symphysis pubis, observed on clinical examination and on intravenous pyelography as well as urodynamic investigations allowed this dysuria to be attributed to a cervico-urethral obstruction resulting from over correction during the initial surgical operation. The 10 patients were treated by urethro-cervicolysis (9 out of 10) associated with repeated colposuspension in 3 cases. The overall results were disappointing as although 8 of the 10 patients were improved at 3 month, only 4 out of 9 were still improved at 6 months. These poor results raise the question of the value of combining urethro-cervicolysis with colposuspension and possible VY plasty of the bladder neck.

[Long-term evaluation of the treatment results of male urethral stenosis]. / Evaluation à long terme du résultat des traitements des sténoses de l'urètre masculin.

287 urethral strictures were treated between 1974 and 1984. Two-stage urethroplasty provided 47.6% of good results at 5 years, although there was a possibility of very delayed recurrences. Endoscopic urethrotomy only gave 26% of good results at 5 years, while 30% of good results were obtained after dilatation with Olbert's sound. Endourethral techniques do not compete with two-stage urethroplasty, provided they are performed repeatedly.

[Urinary calculi. Current role of in situ dissolution]. / Calculs urinaires. Place actuelle de la dissolution in situ.

The two cases reported here illustrated the advantages of urinary stone dissolution in situ. One patient had bilateral urate calculus with anuria; the other had recurrent staghorn calculus. In both cases a nephrostomy stent was installed percutaneously and the calculi were dissolved by irrigation.

[Treatment of stenoses of the urethra. 2]. / Traitement des sténoses de l'urètre. Deuxième partie.

This is a comparative study in 183 patients of the treatment of urethral stenoses by two-stage urethroplasty, internal endoscopic urethrotomy and urethrotomy via the Olbert catheter. Urethroplasty (39 patients) was preferentially carried out in patients with moniliform stenosis greater than 2 cm long in the penile and penoscrotal urethra. There was no significant difference in the indications for the two forms of urethrotomy. Good results were obtained for the 3 techniques in about 80% of cases but there was significantly higher complication rate with surgical urethroplasty. The failure rate of the 3 techniques did not differ significantly. The cost of treatment, on the other hand, greatly differed depending on the technique. Surgical urethroplasty was 2.8 times more costly than internal endoscopic urethrotomy and 10.4 times more costly than Olbert catheter urethrotomy. Olbert catheter urethrothomy was 3.7 times cheaper than internal endoscopic urethrotomy.

[Impotence caused by venous leakage. Placement of a prosthetic venous bandage]. / Impuissance par fuite veineuse. Mise en place d'un garrot veineux prothétique.

A new treatment of impotence by venous leakage is reported. It consists of tying the dorsal and lateral aspects of the cavernous body with a bandage of synthetic material. The bandage, inserted on the bulbo-cavernous muscles, restores a "carter effect" and prevents venous leakage during erection. This technique has been used in 20 patients, with satisfactory results in 10 who were followed up for more than 4 months.

[Cancer of the penis. Technic of amputation limited to the glans]. / Cancers du pénis. Technique d'amputation limitée au gland.

The authors report an original technique of glans resection without section of the cavernous bodies. A caverno-cutaneous suture enables a neo-glans to be obtained from the distal, tapering part of the cavernous bodies. This technique is used for small and superficial tumors without lymph nodes and located far enough from the balano-preputial fold.

[X-ray computed tomography in congenital and acquired anomalies of the inferior vena cava]. / Etude tomodensitométrique des anomalies congénitales et acquises de la veine cave inférieure.

The inferior vena cava (IVC) is a retroperitoneal key organ whose location and integrity must be checked in every scan. Computerized tomography (CT) of IVC provides interesting diagnostic elements which are complementary to the angiographic study: congenital abnormalities, even if they scarcely occur, are nevertheless important to detect, in order to prevent any mistake in the interpretation of the scan. Acquired abnormalities, are frequent. Today CT seems to be the most accurate method of exploration of neoplastic involvement in primary IVC tumors or external compression by retroperitoneal fibrosis. It is a non traumatic method allowing the visualization of the head of a caval thrombus inprecisely defined by phlebo-cavography. To summarize, a good scanning knowledge of the IVC and its abnormalities appears necessary, either to prevent any mistaken interpretation or to specify a pathological element with regard to a vascular exploration.

[Treatment of urethral stenosis. 1]. / Traitement des sténoses de l'urètre. Première partie.

The treatment of urethral strictures has considerably developed over recent years: surgical urethroplasty has been perfected at the same time as internal urethrotomy has gained a new lease of life as a result of endoscopy. Urethral dilatation by means of probes used for arterial stenoses constitutes another interesting development in this field. We reviewed our case files with a double objective in mind: to determine the reasons for our changing therapeutic practices and the results of these three methods. Our study was also interesting because it was the first time that the incidence of this therapeutic development on the economic consequences of this disease, which generally affects professionally active adults, has been assessed. Several factors can be taken into consideration: however, as the length of time off work and the cost of concomitant drug treatments were unable to be determined with sufficient accuracy by our survey, we finally assessed the duration and the number of hospital admissions for each patient. Although only fragmentary, these data appear to reflect fairly accurately the economic impact of the treatments used.