RESUMEN
In 1980 Mitrofanoff described a method to achieve continent urinary diversion by surgically closing the bladder neck and creating a continent catheterizable stoma from the appendix which had been implanted in a nonrefluxing manner into the bladder or from a nonrefluxing distal ureter. The Mitrofanoff principle (MP) serves well as a continence mechanism for either the native bladder or intestinal reservoirs. We review 17 patients, including 10 children, who were treated with the MP and received a continent catheterizable channel. For the MP, appendix was used in 16 patients and ureter in 1. The continuity between the urinary reservoir and urethra was maintained wherever possible. Bladder neck suspension was preferred to bladder neck closure in incontinent females and boys. Complications and their management have been discussed at length. Stable renal functions, ease of catheterization and urinary continence were achieved in 93.8% of the patients.
Asunto(s)
Reservorios Urinarios Continentes/métodos , Adolescente , Adulto , Apéndice/cirugía , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Factores de Tiempo , Resultado del Tratamiento , Uréter/cirugía , Cateterismo Urinario , Derivación Urinaria/métodosRESUMEN
PURPOSE: The role of expandable metallic Z stents (non-mesh) in the treatment of recurrent posterior and bulbar urethral strictures was evaluated. PATIENTS AND METHODS: Seven men with recurrent posterior/bulbar urethral strictures underwent balloon angioplasty followed by insertion of two stents in tandem. Retrograde urethrography, micturating cystourethrography, and urodynamic evaluation of these patients was done initially. RESULTS: Successful dilation and placement of stents was possible in all cases. In one patient slight proximal migration of the stent occurred; terminal dysuria in this patient necessitated stent extraction. In two other patients near total occlusion of the stent by an exuberant fibrous reaction occurred and this open urethroplasty in the other. Immediate postprocedure urethrography and urodynamic evaluation showed significant improvement. Five patients continue to show a satisfactory clinical urodynamic response. The follow-up period in this patient group ranged from 5 months to 1 year. CONCLUSION: Short-term response (5 months to 1 year) in patients with posterior/bulbar urethral strictures treated with Z stents appears promising. However, the efficacy of the procedure on a long-term basis requires further follow-up and evaluation.
Asunto(s)
Stents , Estrechez Uretral/terapia , Adulto , Anciano , Aleaciones , Angioplastia de Balón , Dilatación , Diseño de Equipo , Falla de Equipo , Fibrosis , Estudios de Seguimiento , Migración de Cuerpo Extraño/etiología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Recurrencia , Stents/efectos adversos , Obstrucción Uretral/etiología , Estrechez Uretral/diagnóstico por imagen , Micción , Trastornos Urinarios/etiología , UrodinámicaRESUMEN
We report 2 cases of percutaneous drainage and alcohol instillation of renal hydatid cysts. The feasibility of percutaneous management of renal hydatidosis, emphasizing its safety, efficacy and obvious advantages, is discussed.
Asunto(s)
Equinococosis/terapia , Enfermedades Renales/terapia , Adulto , Drenaje , Equinococosis/diagnóstico , Equinococosis/diagnóstico por imagen , Etanol/administración & dosificación , Femenino , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/diagnóstico por imagen , Punciones , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalRESUMEN
Allograft lithiasis is usually secondary. Donor-graft lithiasis is a rare cause and only 5 cases have been reported. We report 2 such cases which are the first in the live-related transplantation programme. The pressing need to increase the donor pool in developing countries, safety of therapy in graft lithiasis coupled with minimal estimated risk of lithiasis recurrence in the donor are the main justifications for accepting calculi bearing kidney for transplantation. The 2 cases underwent extracorporeal shockwave lithotripsy using the overhead table module of the Lithostar Plus. The technical ease of lithotripsy using an on-line ultrasound module in these 'ectopically' placed kidneys is discussed. The effect of shockwaves on allograft function was studied by a pre- and post-renal scan (99Tc-DTPA) and serum creatinine. No adverse effect of shockwave on allograft function was noted both on short- and long-term follow-up.
Asunto(s)
Cálculos Renales/terapia , Trasplante de Riñón/efectos adversos , Litotricia/instrumentación , Adulto , Femenino , Humanos , Cálculos Renales/etiología , Litotricia/métodos , Masculino , Donantes de TejidosRESUMEN
It is a matter of concern that the elderly donor may have increased risks in the peri-operative period due to age-related changes in various organ. Nephrosclerosis, atherosclerosis and low GFR of an elderly kidney may portend a poor graft outcome. A retrospective analysis of our live related renal transplant program (from June 1989 to December 1993) revealed that 27 of the donors were above 60 years of age. 21 of the recipients have been followed up for more than 1 year. These patients were compared with a cohort of 25 patients (donor age < 45 years) with similar HLA match, immunosuppressive protocol, and follow-up period more than 1 year. Graft survival at 1 year was 86% and 88% in the recipients from elderly and younger donors respectively; 1 patient in the control group died of fulminant sepsis. Mean follow-up was 21.6 months in the study group and 22.8 months in the control group. Allograft function was evaluated by serum creatinine and differential GFR by Tc DTPA scan. Serum creatinine (mg%) was 1.3 +/- 0.2 and 1.4 +/- 0.2 in the study group and 1.3 +/- 0.3, 1.2 +/- 0.3 in the control group at 3 and 12 months respectively. Glomerular filtration rate (ml/min) was 36.5 +/- 11.6 and 43.7 +/- 12.4 in the recipients from elderly donors whereas those from the younger donors had GFR (ml/min) of 40.6 +/- 9.6 and 49.6 +/- 14.2 at 3 and 12 months respectively, GFR continued to improve in both groups with follow-up. There was no difference in incidence or severity of ATN In the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)