ABSTRACT
The role of the urologist in paediatric kidney transplantation has evolved alongside advances in management for the various causes of end-stage kidney disease. Improvements in antenatal intervention and postnatal care have seen children with increasingly complex urological anomalies survive until transplant. Once solely responsible for the oversight of a child's surgical care, the paediatric urologist now works within a multidisciplinary transplant team, alongside transplant surgeons, paediatric nephrologists, transplant coordinators, psychologists, social workers, and transitional care specialists. We sought to identify available pretransplant evaluation frameworks to guide urological preparation and decision-making. Drawing from available evidence and reflecting on multi-institutional experience, we propose a streamlined approach to urologic assessment, which recognises that optimal transplant outcomes in this heterogenous cohort require lower urinary tract dysfunction to be carefully defined preoperatively.
Subject(s)
Kidney Failure, Chronic , Kidney Transplantation , Transplants , Child , Female , Humans , Kidney Failure, Chronic/surgery , Pregnancy , Urinary BladderABSTRACT
BACKGROUND: Stomal stenosis is common following high gastric reduction or vertical banded gastroplasty for obesity. Open and laparoscopic approaches for reversal can be problematic due to expected adhesions from previous surgery. METHODS: A technical description of a novel approach for reversal of stomal stenosis following high gastric reduction is provided. This minimally invasive technique combines both "trans-gastric" and "endoscopic" principles for intraluminal reversal via a single port site incision. RESULTS: We describe our early experience in eight cases with this technique, highlighting its advantages and discussing potential pitfalls to be avoided to maximise its use and efficiency. It appears to be simple, safe and widely applicable. CONCLUSIONS: The single port trans-gastric, laparo-endoscopic technique provides a simple and effective minimally invasive method of reversing gastric stapling procedures without the need for extensive adhesiolysis.
