Current problems of diagnostics and treatment of urinary incontinence in females.

The incidence and prevalence of urinary incontinence in females is high, in women older than 60 yr of age it affects 30-60 per cent of them. The etiology of urinary incontinence is multifactorial. Urinary incontinence can be classified as stress, urgent, reflex, combined urinary incontinence and paradox ischuria.

[Acute conditions after kidney transplantation in patients with autosomal dominant polycystic kidney disease]. / Naliehavé situácie po transplantácii oblicky u pacientov s autozomálne dominantnou polycystózou obliciek.

There is a high risk of severe complications after kidney transplantation. In patients with autosomal dominant polycystic kidney disease (AD-PKD) the incidence of complications like ischaemic cardiac disease, acute myocardial infarction, pulmonary embolism, perforation of colonic diverticulosis is especially higher. The authors want to indicate another specific complication, rupture of the cyst of own polycystic kidney with retroperitoneal haemorrhage. Within the group of 658 patients who underwent kidney transplantation between January 1981 and January 2000 there were 54 (8.2%) patients with AD-PKD. Four patients with severe retroperitoneal haemorrhage due to rupture of the cyst of own polycystic kidney we present in a short case reports. All cases were fatal. Expect morphologic and functional follow up of the graft it is necessary to follow up polycystic kidney and indicate urgent nephrectomy in the case of any change.

The incidence of tumours in renal transplant recipients with long-term immunosuppressive therapy.

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.

[Urinary oxalic acid excretion in chronic kidney failure and after kidney transplantation]. / Vylucovanie kyseliny oxalovej do mocu pri chronickom zlyhaní obliciek a po transplantácii oblicky.

Urinary oxalic acid excretion was examined in 61 patients with chronic nephropathies and in 21 patients after renal transplantation with a varying mean glomerular filtration. In both groups of patients a correlation was found between the plasma oxalic acid and serum creatinine and by a hyperbolic correlation between plasma oxalic acid and creatinine clearance. Moreover the authors found a direct correlation between oxalic acid and FEoxalic acid and FE(Na)+, FEH20 and FE1-ascorbic acid in both patient groups. Various chronic nephropathies and treatment in both groups did not affect the revealed correlations. In 13 healthy subjects during the period of maximum water diuresis urinary Na+ excretion did not increase but there was a significant increase of the l-ascorbic acid and oxalic acid excretion. In a group of 8 patients in the polyuric stage of chronic renal failure without dialysis treatment under conditions of increased dietary NaCl intake (15 g/24 h) a significant increase of the urinary Na+ excretion was recorded while the l-ascorbic acid and oxalic acid excretion was unaltered. From the assembled values of the examined biochemical indicators ensues that urinary oxalic acid excretion, similarly as ascorbic acid excretion, depended on water excretion.

[Erectile dysfunctions in patients treated with hemodialysis and kidney transplantation]. / Erektilné poruchy u pacientov liecených hemodialýou a transplantáciou oblicky.

The incidence of erectile dysfunction in patients suffering from severe renal diseases in the stage of renal insufficiency is significantly higher in comparison with healthy men of the same age. In the etiopathogenesis of erectile disorders, both organic and psychogenic factors participate in combination. By means of a questionnaire, the authors have collected information from 53 men treated by hemodialysis and kidney transplantation because of renal failure. Erectile disorders occurred in 41.5 per cent of men with chronic renal insufficiency. On one side hemodialysis improved the erectile dysfunction in two patients, in total, however, the incidence of impotence increased to 64.2 per cent. Erectile dysfunction was reported by 71.7 per cent of patients after kidney transplantation. The authors describe two cases of iatrogenic arterial insufficiency of the penis as the cause of impotence after secondary renal transplantation. In uremic patients as possible therapeutic methods, intracavernous application of vasoactive drugs or penile prostheses implantation should be considered. (Fig. 2, Ref. 20).

[Vitamin B12 and folic acid in chronic kidney failure and after kidney transplantation]. / Vitamín B12 a kyselina listová pri chronickom zlyhaní oblicek a po transplantácii oblicky.

Vitamin B12 in plasma, folic acid in plasma and erythrocytes were examined in 11 patients in the polyuric stage of chronic renal failure without dialyzation treatment, in 38 patients included in a long-term dialyzation programme before and after 3 months' oral administration of folic acid--(2 X 5 mg week)--and in 23 patients after transplantation of the kidneys. In none of the examined groups vitamin B12) and folic acid deficiency in plasma was detected. A reduced folic acid level in erythrocytes, but still in the reference range, was found in patients in the long-term dialyzation programme without supplementation. Supplementation with folic acid increased its concentration in plasma 4.5 times and in red cells 5.5 times. Haemodialysis did not influence the concentration of the examined indicators in plasma and red cells. According to the recorded results it is not necessary to supplement patients in long-term dialyzation programme and after renal transplantation with vitamin B12 and folic acid, if their dietary protein intake is not restricted.

[Acute renal insufficiency after the administration of tetracycline and gentamycin]. / Akútna renálna insuficiencia po podávaní tetracyklínu a gentamicínu.

The clinical course of eight case reports of patients with acute renal failure after administration of nephrotoxic antibiotics--specially of tetracycline and gentamycin--is demonstrated. All patients were suffering on preexisting nephropathy, many of them in stage of chronic renal failure according to various etiopathogenesis. As concomitant factor inducing acute renal failure together with antibiotics are: elderly, hepatopathy, surgical interventions, administration of other nephrotoxic drugs. In 6 patients, where acute renal failure induced by nonreducted doses of antibiotics appeared, the treatment was successful, in five cases due to short term haemodialysis, once conservatively with diuretics and volume diuresis. Two patients died before the therapeutic measures and dialysis could be performed. Algorithms in diagnosis and treatment of chronic renal failure--patients where antibiotic treatment is necessary are discussed.

Urinary excretion of vitamin C in chronic renal failure and after renal transplantation.

Urinary excretion of vitamin C was investigated in 44 patients with chronic renal diseases and in 25 patients after renal transplantation with various mean glomerular filtration rates. In both groups a hyperbolic relationship was observed between FE vitamin C and CCr. In addition, direct relationships were found between FE vitamin C and FE Na, FEK and FE H2O in both groups. Various chronic renal diseases and treatments had no influence on the investigated relationships. In 16 healthy subjects urinary excretion of sodium during maximal water diuresis did not increase but urinary excretion of vitamin C significantly increased. In 10 patients in the polyuric stage of chronic renal failure without dialysis treatment during Giordano-Giovanetti-Maggiora diet with addition of sodium chloride the urinary excretion of sodium increased but that of vitamin C was not influenced. The results obtained for the biochemical parameters tested suggest that the urinary excretion of vitamin C depends on the urinary excretion of water.

Results of renal transplantations performed at the Clinic of Urology in Bratislava.

From June 1972 to the end of 1983, 145 transplantations of cadaveric kidneys were performed at the Clinic of Urology in Bratislava. A clinical analysis of the first 110 renal transplantations is presented with regard to patients and allograft survivals and occurrence of surgical and urological complications.

Dynamics of serum minerals changes after renal transplantation.

In 27 patients surviving with transplanted cadaver kidneys for 12-107 months, calcium, phosphorus, magnesium and creatinine serum levels, glomerular filtration rate and incidence of serum mineral levels pathological deviations following renal transplantation were evaluated. In early posttransplantation period hypercalcemia and hypomagnesemia developed in one fourth of the observed group of patients and hypophosphatemia in two thirds of patients. Expressive hypermagnesemia developed in one patient. Calcium and phosphorus levels gradually normalized, excluding rare exceptions; magnesium serum level exceeded an upper limit of normal values in majority of patients, nor to medicamentous treatment was stated.

Preparedness of patients to renal transplantation.

The outcome of renal transplantations depends to a considerable degree on the general condition of patients before the transplantation. The patients in the dialysis programme are regularly watched and any complications which might contraindicate the transplantation are recorded. Despite this, verging complications were repeatedly found which, by themselves, do not contraindicate the operation but may increase the risk of the operation and thereby the outcome of the transplantation. In the present study the general conditions of 38 patients coming from different dialysis centres in the Slovak Socialist Republic are assessed. These patients underwent renal transplantation at the Clinic of Urology in Bratislava.

Operations in patients treated by regular haemodialysis.

Patients with chronic renal insufficiency treated by regular dialysis tolerate well surgical interventions provided they are appropriately prepared for the operation. It is first of all the management of symptoms of the uraemic syndrome by an effective dialysis, the follow-up during the operation and in the immediate postoperative period. On the basis of experience with 31 regularly dialysed patients, the authors have set their criteria for a total anaesthesia. Also the risks and the most frequent complications occurring during and after the operation are pointed out.

Impaired tubular reabsorption of magnesium after renal transplantation.

Tubular reabsorption of magnesium ( TRMg ) was calculated from the values of plasma ultrafiltrable Mg and urinary Mg in 36 patients with transplanted kidneys. The study revealed a defect in TRMg in all investigated patients. The lowest TRMg values were found in patients with poor function of the transplanted kidneys. TRMg increased in relationship with the increment in glomerular filtration rate, nevertheless in the majority of the cases the TRMg values did not reach the values of healthy individuals.