Are there any relations among transplant centre volume, surgical technique and anatomy for donor graft selection? Ten-year multicentric Italian experience on mini-invasive living donor nephrectomy.

BACKGROUND: Selection of the right or left living donor kidney for transplantation is influenced by many variables. In the present multi centric study including 21 Italian transplant centres, we evaluated whether centre volume or surgical technique may influence the selection process. METHODS: Intra- and perioperative donor data, donor kidney function, and recipient and graft survival were collected among 693 mini-invasive living donor nephrectomies performed from 2002 to 2014. Centre volume (LOW, 1-50 cases; HIGH, >50 cases) and surgical technique (FULL-LAP, full laparoscopic and robotic; HA-LAP, hand-assisted laparoscopy; MINI-OPEN, mini-lumbotomy) were correlated with selection of right or left donor kidney and with donor and recipient outcome. RESULTS: HIGH-volume centres retrieved a higher rate of donor right kidneys (29.3% versus 17.6%, P < 0.01) with single artery (83.1% versus 76.4%, P < 0.05) compared with LOW-volume centres. Surgical technique correlated significantly with rate of donor right kidney and presence of multiple arteries: MINI-OPEN (53% and 13%) versus HA-LAP (29% and 22%) versus FULL-LAP (11% and 23%), P < 0.001 and P < 0.05, respectively. All donors had an uneventful outcome; donor bleeding was more frequent in LOW-volume centres (4% versus 0.9%, P < 0.05). CONCLUSIONS: Centre volume and surgical technique influenced donor kidney side selection. Donor nephrectomy in LOW-volume centres was associated with higher risk of donor bleeding.

An unusual "linitis plastica" like breast cancer bladder metastasis.

Breast cancer (BrC) is the most frequently diagnosed malignancy in woman and most BrC related deaths are due to metastasis. BrC frequently metastasizes to the lymph nodes, liver, lung, bone and brain while the urinary bladder is considered as an unusual site for breast metastasis. We report a case of bladder metastasis identified in a patient with past BrC history, presenting with hematuria, low urinary tract symptoms, and hydronephrosis.

Fibromuscular dysplasia causing renal artery aneurysm and renovascular hypertension: a case report.

OBJECTIVE: Renal artery aneurysm is a rare disease and usually is due to fibromuscular dysplasia. We describe a case in a woman who had renovascular hypertension due to aneurysm of fibromuscular dysplasia-associated renal artery. MATERIAL AND METHODS: The clinical presentation, renal function, radiologic data, complications and treatment were studied. RESULTS: To report a case of 37-year-old female with a history of hypertension in the last year in pharmacological therapy and in absence of other clinical symptoms. A Doppler ultrasound and a spiral tomography revealed the presence of a right renal artery aneurysm with a hypoplastic kidney. Controlateral kidney was normal. We carried out total nephrectomy to resolve high blood pression and the risk of rupture. The patient was discharged home in 5th post operative day. Serum creatinine level remained normal as it was before. Her blood pressure normalized over a period of several months using a single antihypertensive medication. CONCLUSION: We suggested that in presence of renovascular hypertension in young adult fibromuscular dysplasia-related renal artery aneurysm will be suspected. When possible aneurysmectomy and angioplastic renal artery closure or segmental renal artery reimplantation and renal artery bypass are the gold standard while nephrectomy will be reserved for unreconstructable renal arteries or advanced parenchymal disease.

Primary obstructive megaureter in adults: management strategy in a young woman.

OBJECTIVE: Primary obstructive megaureter is an uncommon disease in adults. We describe a case in a thirty years old woman affected by monolateral megaureter complicated by ureteric calculi. MATERIAL AND METHOD: The clinical presentation, renal function, radiologic data, complications and treatment were studied. RESULTS: The patient, with a history of recurrent right flank pain in the last ten years, had a right primary obstructive megaureter radiologically revealed complicated by ureteric calculi. Omolateral kidney result malrotate. Extensive ureteral tailoring with an extravesical ureteral reimplantation was performed. The calculi were removed at the time of ureteroneocystostomy. CONCLUSION: Adult and adolescent primary obstructive megaureter is a congenital abnormality that do not regress. Complications such us stone formation and altered function of the affected kidney are common and when associated to recurrent urinary tract infections require surgical intervention. Conservative management probably has a role only in the uncomplicated primary megaureter patients with normal creatinine clearance and who have possibility of a regular lifelong follow-up.

Thrombosis of the posterior scrotal vein associated with essential thrombocytemia: Report of a case.

Mondor's disease is a rare superficial thrombophlebitis of subcutaneous vein and usually occurs in the anterior and lateral chest. Penile Mondor's disease is a rare condition characterized by superficial thrombophlebitis of the dorsal vein of the penis. We report a rare case of atypical penile Mondor's disease involved the right posterior scrotal vein, in a patient affected by essential thrombocythemia. A 50-years old man presented with thrombosis of right posterior scrotal vein. He presented with an indurated subcutaneous and painful cord, palpable along the length of the involved vein and located parallel to the urethra in the posterior aspect of the scrotum. It was treated with lowmolecular- weight heparin and resolves without sequelae. The scrotal vein thrombosis is a fairly rare disease.

Giant hydronephrosis secondary to ureterocele with duplex system in adults: Report of a case.

Giant hydronephrosis in adults is a rare entity. It is defined as an extensive dilatation of the pyelocaliceal cavities occupying a large part of the abdominal cavity. Giant hydronephrosis is usually due to pelvi-ureteric junction obstruction and is usually diagnosed in children and infants. Ureterocele, which is a cystic dilatation of the terminal ureter, often drains the upper part of the kidney in patients with a duplex system. Massive hydronephrosis in a patient with duplex system and obstructive ureterocele was described by Aeron et al. in 2017. A thorough search of the major medical databases disclosed that no other cases have been reported since. We describe a second case of unilateral complete duplex system with ureterocele and massive hydronephrosis of the upper moiety in an adult man with intermittent abdominal pain associated with constipation and a decrease in appetite. The renal function of the left kidney was 8% of total function by radionuclide renal scan. The patient subsequently underwent left laparoscopic nephrectomy.

Ablation of non functioning renal allograft by embolization: a valid alternative to graft nephrectomy?

OBJECTIVE: Removal of transplant for the treatment of graft intolerance syndrome (GIS) is an invasive procedure with high risk, often performed in patients with poor general conditions. Renal allograft embolization is a recent alternative treatment to surgical nephrectomy. The aim of this study was to evaluate the efficacy and safety of allograft embolization in a series of patients with GIS. PATIENTS AND METHODS: The study included 12 patients (9 males and 3 females) with irreversible renal graft rejection and GIS. All patients were in hemodialysis and they have not responded to medical treatment. Infection was ruled out by blood and urine cultures. The embolization was performed using polyvinyl alcohol particles and steel coils. Vascular access was obtained via femoral artery puncture in all the patients. Before starting embolization at the puncture site local anaesthesia was performed. RESULTS: Eleven of the twelve procedures were technically successful, but in one patient a second treatment was necessary, after a month, for the presence of collateral perirenal circulation caused hematuria. There were no major complications and the mean hospital stay was 5 days. CONCLUSION: The graft embolization is a simple, safe and effective technique that permits non-surgical ablation of a non-functioning renal allograft in a significant number of patients.

First Robotic-Assisted Dual Kidney Transplant: Surgical Technique and Report of a Case With 24-month Follow-up.

BACKGROUND: Open surgery is the gold standard procedure for kidney transplantation. There is a strong rationale for using minimally invasive surgery in patients with end-stage renal disease. A robotic-assisted dual kidney transplant was performed for the first time at our institution. METHODS: In August 2013, a 63-year-old man with end-stage renal disease and diabetes mellitus under pharmacological control received both kidneys from a 70-year-old marginal donor. Pretransplant donor biopsy demonstrated a bilateral Karpinski score greater than 5. The organs did not exhibit malformations and each had an artery and a vein. The procedure was carried out by a 7-port intraperitoneal approach using the da Vinci surgical system. The procedure was identical for the 2 kidneys except that mobilization of the sigmoid colon was required to introduce the left graft. The renal vessels were anastomosed to the left external iliac vessels. The novel aspect of the technique was the introduction of both grafts through a single, 7-cm upper midline incision. RESULTS: Total operative time was 400 minutes and blood loss was 120 mL. Both grafts immediately began functioning. There were no intraoperative or postoperative complications. The patient was discharged on the seventh postoperative day with normal renal function. At 24 months, he is well and does not require hemodialysis. CONCLUSIONS: Minimally invasive robotic-assisted technology is a promising technique that provides exceptional patient outcomes by reducing operative morbidity, immobilization, and time to recovery, while affording better esthetic results. Selected patients with multiple comorbidities benefit most. Grafts from marginal donors are an extremely valuable resource.

Embolization of a hypoplastic kidney with a vaginal ectopic ureter in a case of pseudo-incontinence.

Ureteral ectopy into the vagina is a cause of pseudo-incontinence. When the corresponding kidney has a good function, the treatment of choice is the ureter reimplantation, otherwise the alternative is partial or total nephrectomy. To report a case of 18-year-old girl presented with urinary leakage occurring between normal voids that at 11-year-old was found to have, at cistoscopy and vaginoscopy, an left ureteral ectopy into the vagina with a non demonstrable corresponding kidney at conventional intravenous urography, dimercaptosuccinic acid scintigraphy and ultrasonography. Moreover the right kidney was found enlarged but normally located. Her parents refused the explorative laparotomy to localize and to remove the left kidney. We completed the examination with computed tomography that revealed a small hypoplastic and ectopic left kidney located at L4 level. Because the contribution of the hypoplastic kidney to the total renal function was insignificant, we decided to eliminate it. A selective embolization of the left renal artery was performed using polyvinyl alcohol foam. The pseudo-incontinence stopped immediately after The patient was discharged home in II postoperative day and has been free from any leakage for 3 years. Serum creatinine levels and blood pressure returned to their normal values.