Early Stent Removal After Kidney Transplantation: Is it Possible?

BACKGROUND: The most important surgical complications of renal transplantation are stenosis and obstruction of the ureterovesical anastomosis. Routine use of ureteral stents can prevent this complication, but the optimal time for ureteral stent use is still controversial. OBJECTIVES: The purpose of this study is to compare the benefits and complications of early and delayed stent removal after surgery. Early ureteral stent removal can decrease some complications, such as urinary tract infections (UTIs), bladder irritation symptoms, persistent hematuria, and the risk of stent crusting; its benefits include easier stent removal and shorter hospitalization time. PATIENTS AND METHODS: All patients who underwent kidney transplantation from May 2011 until March 2012 in Modarres Hospital were included in this study. We classified the patients into three groups, based on time of stent removal (10, 20, and 30 days after transplantation). RESULTS: Ninety-one patients were studied; urologic complications (hydroureteronephrosis and urinoma) in these three groups were analyzed and showed no statistical significant difference. CONCLUSIONS: We can remove the ureteral stent earlier after kidney transplantation with no increase in the prevalence of surgical complications.

Benefits and Complications of Removing Ureteral Stent Based on the Elapsed Time After Renal Transplantation Surgery.

BACKGROUND: The most important surgical complications of renal transplantation are stenosis and obstruction of anastomosis of the ureter to the bladder. Although the routine use of the ureteral stents to prevent such complications seems rational, the optimal time to keep the ureteral stent is still controversial. OBJECTIVES: This study presents the benefits and complications of removing the ureteral stent based on the elapsed time after the surgery. PATIENTS AND METHODS: All patients who underwent kidney transplantation between May 2011 and August 2014 in Modarres hospital, Tehran, Iran, were enrolled in the study. The patients were classified into three groups. The ureteral stent was removed 10, 20, and 30 days after the transplantation in these groups. RESULTS: A total of 529 patients underwent kidney transplant surgery in our center. Urologic complications among the three groups consisting of hydronephrosis, urinoma and collection did not have statistically significant differences. CONCLUSIONS: Ureteral stent can be picked up with no increased risk of urologic complications at shorter intervals after the kidney transplantation surgery.

In the Era of Shared Decision Making, How Would An Iranian Urologist Screen Himself For Prostate Cancer?

PURPOSE: Prostate cancer (PCa) poses a significant health problem in developed countries. Prostate specific antigen (PSA) based screening for PCa is controversial and large trials have failed to show a significant reduction in prostate-specific mortality and all-cause mortality. Considering the contradictory data on PCa screening, current guidelines emphasize shared decision making. Physicians are the ones in charge of helping patients with informed decision making, so we conducted this study to find out what urologists would do for themselves as patients. MATERIALS AND METHODS: Urologists attending the 15th congress of Iranian Urological Association were invited to participate in a questionnaire-based survey on PCa screening. A total of 184 physicians completed the questionnaire. RESULTS: Of participants 76.8% declared that they would like to be screened. 69.3% of those in favor of screening did not consider digital rectal examination (DRE) as part of their screening program. 62.8% of the urologists willing to be screened chose serial PSA as their follow up method in case their PSA level came above normal ranges, and 35.8% preferred to be biopsied. CONCLUSION: Urologists tend to prefer PSA screening despite the current controversy about its usefulness. Most of the urologists practicing in Iran do not choose DRE as part of their screening program. Large high quality studies conducted in other countries are needed to look into urologist's attitudes towards PCa screening, and to investigate their preferences in order to understand the rationale behind their decisions.

Impact of ureteral length on urological complications and patient survival after kidney transplantation.

BACKGROUND: Urologic complications are of the most important complications after kidney transplantation which increases mortality and morbidity significantly. OBJECTIVES: We designed this study to evaluate the association between ureteral length and postoperative complications. PATIENTS AND METHODS: We recorded the length of the transplanted ureter during the operation. Ureter-to-bladder anastomosis was performed using modified Lich-Gregoir method on the ureteral stent. Complications like urine leakage and increased creatinine were evaluated. We used both univariate and multivariate analyses and survival analysis according lengths of ureter. It means that the main variable is ureteral length and other variables are studied based on it. RESULT: A total of 395 patients with the mean age of 37 years (range, 18 to 68 years) were enrolled in the study, twenty six graft lost during the follow-up period. The Mean age of recipients was 37 ± 13 years. Urinary stenosis was seen in 6 patients (1.5%) and urinary leakage in 4 (1%) patients. The complication rate was not significantly different between these groups (P = 0.67). We found that there were no significant difference among complication (P = 0.25), hospitalization (P = 0.31) and survival (P = 0.84) at 5.5 cm length cut off. CONCLUSIONS: The length of transplanted ureter does not affect the postoperative urologic complications (including urinary fistula and ureter-to-bladder anastomosis stricture), and it seems that decreased rate of complication frequency during the recent years is due to technical improvement, surgeon's skillfulness and development in use of immunosuppressant's postoperatively.

Glutathione S-transferase polymorphisms (GSTM1, GSTT1, GSTP1) and male factor infertility risk: a pooled analysis of studies.

PURPOSE: To determine the role of glutathione S-transferases (GSTs; GSTM1, GSTT1, and GSTP1) gene polymorphisms in susceptibility to male factor infertility. MATERIALS AND METHODS: We report a pooled analysis of 11 studies on the association of GSTM1, GSTT1, and GSTP1 polymorphisms and male factor infertility, including 1323 cases and 1054 controls. RESULTS: An overall significant association was determined between the GSTM1 null genotype [odds ratio (OR), 2.74; 95% confidence interval (CI), 1.72 to 3.84; P = .003], GSTT1 null genotype (OR, 1.54; 95% CI, 1.43 to 3.47; P = .02), and male factor infertility. The GSTP1 Ile/Val genotype had overall protective effect against development of infertility (OR, 0.48; 95% CI, 0.27 to 0.77), while there was significant heterogeneity between studies. In sensitivity analysis, two studies were excluded; the association and direction between GSTM1 and GSTT1 null genotypes and GSTP1 Ile/Val genotype and male infertility remained unchanged. There was no significant interaction between smoking status and studied genotypes on male infertility risk (P = .26). CONCLUSION: These results demonstrated that amongst populations studied to date, GSTM1 and GSTT1 null genotypes are associated with strong and modest increase in the risk of male infertility, respectively. On the contrary, GSTP1 Ile/Val genotype has protective effect.