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INTRODUCTION: Absolute priority in an LDKT programme are donnor safety and kidney optimal anatomical and functional preservation. Reduced donnor morbidities, both at short and long term, are important objectives. Excellent technical grafting is a must as are the strategies employed for facilitatig it. We revised the incidences of our whole LDKT programme (40 years 243 donors) to confirm if these exigences have been acomplished or a change to new surgical procedures is recommended. MATERIAL AND METHODS: Between 1968-2008 243 nephrectomies and grafting has been performed, a reduced number per year (A cadaver programme has been running simultaneously since 1964). For the nephrectomies a Turner-Warrick apprach was inititialy used and since 1973 a miniincisional, anterior, extraperitoneal approach of approximately 10 cm in length. The right kidney was removed in 75% of the cases and the right iliac area for the implant in 85% In adjacent opperating rooms, one team performs the nephrectomy while the other prepares and dissects free the grafting vessels. Most of the time the same senior surgeon performed both operatios: the nephrectomy and the implant. Peroperative and postoperative complications were evaluated by urologists and nephrologists in charge. RESULTS: No donors dead, organs lost or major complications in the donors have been documented. Minor complications such as intestinal paresia, wound infection, persistent incisional pain were common. Miniincisional abdominal approach reduced postoperative pain and hospital stay (4 days). At long term no incisional hernia or abdominal paresia have been documented. Simultaneous work reduces ischemia time (30-45 s warm: 30-45 min cold) and opperatig room occupation(patient preparation plus anesthesia plus operation) estimated in 90-120 min for the nephrectomy and 120-160 for the grafting. The responsibility of the senior surgeon in both procedures facilitates vessel selection for the grafting. CONCLUSIONS: No reasons have been found to reconvert our current nephrectomy procedure to laparoscopic or modify current surgical strategy. Superior safety of open surgery for donors and organs is confirmed. Pain and recovery time are reduced in laparoscopic surgery but not as much when compared with miniincisional approach. Open surgery permits optimal anatomical and functional organ extration facilitatig the quality of the implant. As numbers matter in laparoscopic surgery open nephrectomy is recommended for reduced LDKT programmes.
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Transplante de Rim , Doadores Vivos , Nefrectomia/métodos , Humanos , Fatores de TempoRESUMO
An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.
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Pesquisa Biomédica/métodos , Transplante de Rim/educação , Modelos Animais , AnimaisRESUMO
OBJECTIVE: [corrected] To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics. MATERIALS & METHODS: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between "absolute number of referrals" and "adequate referrals" was tested using a linear regression model. RESULTS: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between "absolute number of referrals" and "adequate referrals" was evident (r2=0.86). CONCLUSIONS: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center.
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Fidelidade a Diretrizes/estatística & dados numéricos , Departamentos Hospitalares , Atenção Primária à Saúde , Encaminhamento e Consulta/normas , Doenças Urológicas , Urologia , Protocolos Clínicos , HumanosRESUMO
Adrenal pseudocyst is the commonest type of benign lesions of adrenal gland althought is a very rare entity. Most of them are found as "incidentalomas" during imaging studies. A case of a patient with a left non-functioning and asymptomatic adrenal pseudocyst is reported. The diagnostic and therapeutic options are discussed and the literature is reviewed.
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Doenças das Glândulas Suprarrenais/diagnóstico , Calcinose/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/patologia , Calcinose/diagnóstico por imagem , Calcinose/patologia , Administração de Caso , Cistos/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
We report a case of renal artery stenosis after a living transplant kidney, treated successfully with percutaneous transluminal angioplasty (PTA) and vascular endoprosthesis. PTA is the initial treatment of choice for most patients with high grade transplant renal artery stenosis. Surgical revascularization is indicated if PTA cannot be done or is unsuccessful.