Short- and long-term outcomes of kidney transplants with kidneys lavaged by retrograde perfusion technique.

OBJECTIVE: To evaluate the clinical safety and efficacy of the retrograde perfusion technique in kidney transplantation. METHODS: Between January 2001 and June 2011, 24 cases of kidney transplantation with kidneys perfused using the retrograde perfusion technique due to renal artery variations or injury were selected as the observation group (retrograde perfussion group, RP group). Twenty-two cases of kidney transplantation via conventional perfusion were chosen as the control group (antegrade perfussion group, AP group). There were no statistically significant differences in donor data between the two groups. Cold ischemia time, warm ischemia time, renal perfusion time, amount of perfusion fluid, acute renal tubular necrosis, wound infection, urinary fistula, graft kidney function, and the 1-year, 3-year, and 5-year survival rates for the grafted kidney in both groups were observed and recorded. RESULTS: The kidney perfusion time was shorter in the RP group than that in the AP group (3.14 ± 1.00 vs. 5.02 ± 1.15 min, P = 0.030). There were 10 cases of acute renal tubule necrosis in the RP group and 5 in the AP group. The length of hospital stay was 40 ± 14 d in the RP group and 25 ± 12 d in the AP group. The follow-up time was 3.5-8.5 years (mean 6.25 years). The 1-, 3-, and 5-year survival rates for the grafted kidney were 95.8%, 75.5%, and 65.5% in the RP group and 97.1%, 82.5%, and 68.4% in the AP group, respectively (P>0.05). CONCLUSIONS: This study indicates that retrograde perfusion is safe and practicable for cadaveric kidney harvesting and can be regarded as a better alternative or remedial measure for a poorly perfused kidney due to vascular deformity or injury.

Retroperitoneal laparoendoscopic single-site surgery for the treatment of retrocaval ureter.

PURPOSE: To present our surgical techniques for retroperitoneal laparoendoscopic single-site (LESS) pyelopyelostomy for retrocaval ureter and our initial experience with this method in 4 patients. METHODS: From June 2010 to May 2011, 4 patients with retrocaval ureter underwent retroperitoneal LESS pyelopyelostomy with a homemade single-port device and standard straight laparoscopic instruments. The single-port device was made with a surgical glove and Foley catheter and allowed the introduction of three trocars. A 3-cm incision was made at the middle axillary line, midway between the iliac crest and the twelfth rib. The retrocaval segment of the ureter was mobilized and transposed anteriorly to the inferior vena cava. The pyelopyelostomy anastomosis was completed with intracorporeal freehand suturing. A double-pigtail ureteral stent assembly was implanted in 3 of the 4 patients. RESULTS: All retroperitoneal LESS pyelopyelostomies were successful without conversion to standard laparoscopy or open surgery. The mean operating time was 105 min (range, 90-135 min). The mean blood loss was 18 mL (range, 5-50 mL). None of the patients required blood transfusion. The double-pigtail ureteral stent was removed 4-6 weeks postoperatively. The mean postoperative hospital stay was 7.3 days (range, 6-9 days). No intraoperative or postoperative complications occurred. At a mean follow-up of 10 months, excellent improvement in the ureteral obstruction was observed. CONCLUSIONS: We report our initial experience using LESS for the treatment of retrocaval ureter. Our results in 4 patients suggest that this minimally invasive approach is a feasible treatment of retrocaval ureter. Long-term follow-up of more cases is needed to confirm its benefits.

[A novel technique of ureterointestinal anastomosis for urinary diversion].

OBJECTIVE: To introduce a novel technique of ureterointestinal anastomosis for urinary diversion and report the preliminary clinical data. METHODS: Between June 2007 and June 2011, a total of 50 patients underwent radical cystectomy and ileal neobladder for invasive bladder carcinoma or carcinoma in situ. A novel, separate and direct end-to-end technique for ureteral reimplantation to the entrance of a segment of ileum was applied. in all patients. Details are as follow. The entrance of afferent loop was divided equally in to two lumens. Then each ureter was directly, end-to-end anastomosed to the above lumens respectively after lengthwise incisions for 1.5 cm. The mean follow-up period was 22 months (range, 3 - 48 months). RESULTS: Ureterointestinal anastomosis was performed successfully in 100 units. The operative durations were (18.4 ± 4.2) minutes. Ureteral stricture developed in 4 of 100 (4%) units and refluxing in 6 of 100 (6%) units. One patient with stricture was successful repaired by balloon dilation. CONCLUSION: With low stricture and reflux rates, this novel procedure of ureterointestinal anastomosis is simple to handle and worthy of further promotion.

[Pilot study of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder].

OBJECTIVE: To summarize the preliminary experiences of 13 cases of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder and evaluate the oncological and functional outcomes of this procedure. METHODS: From August 2005 through July 2009, 13 patients underwent radical cystectomy and standard lymphadenectomy followed by construction of orthotopic T pouch ileal neobladder via mini-laparotomy for muscular invasive bladder cancer. The data were analyzed according to procedure time, blood loss volume, transfusion volume, number of dissected lymph nodes, peri-operative complications, morphology and function of upper urinary tract and status of urinary continence. RESULTS: The mean operating duration was 6 (5 - 8) hours, estimated volume of blood loss 480 (100 - 800) ml, transfusion volume 133 (0 - 400) ml and the number of dissected lymph nodes 16 (8 - 22). There was no peri-operative mortality. The peri-operative complications were found in 15.4% (2/13) and included urine leak at neobladder-urethra junction managed by drainage (n = 1) and urine leak at ureter-neobladder junction repaired (n = 1). The complete daytime continence rate was 84.6% (11/13), complete nocturnal continence rate 46.1% (6/13) and < 1 pad in 30.8% (4/13). No reflux into afferent limb of neobladder was observed by cystography. Temporary dilation of upper urinary tract was observed in 23.1% (3/13) at Day 45 post-operation and later it disappeared spontaneously. Serum creatinine remained in a normal range in all patients. Within a follow-up of 24 (16 - 63) months, 7.7% (1/13) died of myocardial infarction at Month 55 post-operation. And 92.3% (12/13) survived without a local relapse or a distal metastasis. CONCLUSION: Within an intermediate follow-up period, the oncological and functional outcomes are encouraging after laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder via mini-laparotomy. The anti-reflux mechanism is effective to preserve the morphology and function of upper urinary tract.

[Orthotopic T pouch ileal neobladder: evaluations of urodynamics and upper urinary tract functions].

OBJECTIVE: To evaluate the urodynamics and functions of upper urinary tract in a substitute of orthotopic T pouch ileal bladder. METHODS: From June 2004 through September 2009, 90 patients underwent the construction of an orthotopic T pouch ileal neobladder after radical cystectomy for muscle-invasive bladder cancer. The radiographic or ultrasound evaluation of upper urinary tract, determination of renal functions and urodynamic evaluation of T pouch ileal neobladder were performed by data analysis. RESULTS: Renal function as determined by serum creatinine remained in a normal range in all patients. Temporary dilation of renal pelvic and ureter was observed in 18 patients (20.0%) at Day 45 post-operation and then disappeared spontaneously in the late follow-up. A slight dilation of collecting system was found in other 4 patients (4.4%), but there was no negative impact on renal function. Reflux into afferent limb of neobladder was observed in 4 patients (4.4%) by cystography. Excellent daytime and nighttime continence was reported in 100% and 82.2% of evaluated patients respectively. The urodynamic assessment showed a mean capacity of (316 ± 96) ml with a mean intra-bladder pressure of (16 ± 10) cm H2O. These evaluated patients voided with a mean maximum intra-bladder pressure of (87 ± 25) cm H2O, a mean maximum flow rate of (17 ± 10) ml/s and a mean residual urine of (33 ± 29) ml. CONCLUSION: With an intermediate follow-up, the functional results of T pouch ileal neobladder are encouraging with an excellent capacity and compliance, successful daytime and nighttime continence and anti-reflux mechanism.

[Analysis of clinical efficacy and safety of combining pneumatic and ultrasonic power in percutaneous nephrolithotomy (PCNL) for renal stones].

OBJECTIVE: To investigate the clinical efficacy and safety of combining pneumatic and ultrasonic power during PCNL. METHODS: From Sep 2003 to Aug 2005, we treated 486 patients (509 kidneys) by combining pneumatic and ultrasonic power during percutaneous nephrolithotomy. Clinical data were analyzed retrospectively. RESULTS: The percutaneous renal access was successfully established in 478 patients under ultrasound guidance and immediate phase I lithotripsy was performed, and delayed phase II lithotripsy was performed for 6 patients. Average time required for entire procedure is 73 mins, and average time for stone management is 41 mins. No severe complications occurred. No Residual stone fragment in 438 kidneys, stone free rate was 86.1%. Residual stone fragment was found in 71 kidneys by postoperative KUB and received second PCNL or adjuvant ESWL. CONCLUSION: The combined application of pneumatic and ultrasonic power in PCNL appears to be efficacious and safe for disintegrating and removing renal calculi.

[Percutaneous nephrolithotripsy with pneumatic and ultrasonic power under B-type ultrasound guidance for treatment of renal calculi in non-dilated collecting system].

OBJECTIVE: To evaluate the efficacy and safety of management of renal stone in non-dilated collecting system by percutaneous nephrolithotripsy (PCNL) under ultrasound guidance. METHOD: From September 2003 to April 2005, 132 cases of renal stone in non-dilated collecting system were performed by percutaneous nephrolithotripsy. A stent was first inserted into the pelvis through cystoscope, and saline was instilled to dilate collecting system. Antegrade percutaneous access was obtained by B-type ultrasound guidance. A combination pneumatic and ultrasonic lithotrite were used to disintegrate and remove stone under direct vision. Clinical data including operation time, complications and stone free rate were analyzed retrospectively. RESULTS: The percutaneous renal access was successfully established under B-type ultrasound guidance in all patients, immediate phase I lithotripsy was performed in 129 cases and delayed phase II lithotripsy in 3 cases. Operation time ranged from 70 to 130 minutes, average time was (89 +/- 11) minutes, 3 cases were supported by blood transfusion, severe complications did not occur during nephrolithotripsy. Stones were cleared in 114 out of 132 cases (86.4%) during immediate phase I lithotripsy, residual stone fragment was found in 18 cases who received second PCNL or adjuvant extracorporeal shock wave lithotripsy. CONCLUSION: The management of renal stone in non-dilated collecting system using PCNL appears to be efficacious and safe under B-type ultrasound guidance.