Lymphocele in Kidney Transplantation: A Comparison of Ligation and Non-ligation Technique of Iliac Lymphatic Dissection.

BACKGROUND: To compare the incidence of lymphocele in kidney recipients following 2 lymphatic vessel division techniques: ligation and non-ligation. METHODS: Retrospective reviews of the records of 402 patients with end-stage renal disease who underwent kidney transplantation from April 2015 to December 2019 at Siriraj Hospital. RESULTS: Four hundred two patients were included in the study: 54.9% of the patients were male, and the patient's mean age was 41 years. There were 25.1% and 74.9% that received kidney grafts from living and deceased donors, respectively. The preoperative renal replacement therapies were 83.3% hemodialysis, 12.9% peritoneal dialysis, and 3.7% preemptive transplantation. Two hundred forty-nine patients received lymphatic division with the ligation technique and 153 patients received the non-ligation. Lymphoceles were found in 31 cases (7.7%). Lymphocele occurrence in the ligation group was lower than in the non-ligation group: 5.2% compared to 11.8% (P value = .017). There were 22.6% of lymphoceles that had a spontaneous resolution with no treatment. DISCUSSION: The ligation of iliac lymphatic vessels during division reduced the incidence of lymphoceles non-ligation.

Laparoscopic live-donor nephrectomy: a comparison with the open technique and how to reach quality standards: a single-center experience in Thailand.

OBJECTIVE: We report our experience with laparoscopic donor nephrectomy (LDN) compared with open donor nephrectomy (ODN). Prognostic factors associated with adverse outcomes in LDN were identified. METHODS: From January 2000 to December 2009, 243 consecutive live-donor nephrectomies were performed, including 129 LDNs and 114 ODNs. We compared patient demographics, perioperative outcomes, and recipient graft function in each group. Prognostic factors for adverse outcomes in LDN were investigated using uni- and multivariate analyses. RESULTS: Patient demographics, except mean donor age (P=.032), were similar between groups. Mean operative time (219 vs 163 minutes; P<.001) and warm ischemia time (WIT; 3.1 vs 1.7 minutes; P<.001) were significantly longer in LDN. Conversely, mean analgesic requirement (9.2 vs 14.7 mg morphine; P<.001) and postoperative hospital stay (6.5 vs 7.1 days; P=.003) were significantly lower with LDN. Mean estimated blood loss (EBL) was slightly lower in LDN (P=.15). There were 7 conversions from LDN to ODN. Complication rates were similar between the groups (P=.38). Delayed graft function (10.9% vs 1.7%; P=.016) and mean serum creatinine level at 1 month (1.47 vs 1.3 mg/dL; P=.04) were higher for LDN. However, 5-year allograft survival was not inferior among LDN (90% vs 85%; P=.42). Mean operative time (268 to 175 minutes; P<.001), EBL (316 to 66 mL; P<.001), and complication incidence (8 to 0 cases; P<.002) gradually decreased from the initial 43 cases to the last 43 cases of LDNs. Among surgeons who had performed-30 LDNs, the mean operative time and WIT were 197 mL and 2.8 minutes, respectively. CONCLUSIONS: Based on our evidence, LDN was a feasible and safe surgical option for live-donor nephrectomy, even in a small volume center. Better results can be achieved after a learning curve of experience for both the surgeon and the institution.

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy.

OBJECTIVE: To evaluate the preventive effects of alkaline citrate on stone recurrence as well as stone growth post-ESWL or PCNL in patients with calcium-containing stones. MATERIALS AND METHODS: A total of 76 patients with calcium calculi who were stone-free or had residual stones less than 4 mm following ESWL and PCNL were enrolled. All patients were independently randomized into two groups. The treated group (N = 39) was given 81 mEq per day of oral potassium-sodium citrate (27 mEq three times a day), and the untreated group (N = 37) serving as controls. Blood, twenty-four hour urine analysis, and plain KUB were measured and compared at the baseline and after 12 months. RESULTS: At baseline, hypocitraturia was found in 20 of 39 patients (46.05%) of Group I and 15 of 37 patients (40.5%) of Group II. At 12 months, hypocitraturia was found in 3 of 39 (7.69%) and 14 of 37 (37.83%) of Group I and Group II, respectively (p = 0.007). At the 12 month follow-up, of the stone-free group, 92.3% of the treated group and 57.7% of the control group were still stone free. Of the residual stone group, 30.8% and 9.1% of treated and control group were stone-free, respectively. The increased stone size found in 7.7%) and 54.5%) of treated and control groups, respectively. CONCLUSION: Sodium-potassium citrate provides positive effects on stone-forming activities in calcium stone patients suffering from urolithiasis following treatment with ESWL and PCNL procedures at the 12-month follow-up.

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

OBJECTIVE: To evaluate the preventive effects of alkaline citrate on stone recurrence as well as stone growth post-ESWL or PCNL in patients with calcium-containing stones. MATERIALS AND METHODS: A total of 76 patients with calcium calculi who were stone-free or had residual stones less than 4 mm following ESWL and PCNL were enrolled. All patients were independently randomized into two groups. The treated group (N = 39) was given 81 mEq per day of oral potassium-sodium citrate (27 mEq three times a day), and the untreated group (N = 37) serving as controls. Blood, twenty-four hour urine analysis, and plain KUB were measured and compared at the baseline and after 12 months. RESULTS: At baseline, hypocitraturia was found in 20 of 39 patients (46.05 percent) of Group I and 15 of 37 patients (40.5 percent) of Group II. At 12 months, hypocitraturia was found in 3 of 39 (7.69 percent) and 14 of 37 (37.83 percent) of Group I and Group II, respectively (p = 0.007). At the 12 month follow-up, of the stone-free group, 92.3 percent of the treated group and 57.7 percent of the control group were still stone free. Of the residual stone group, 30.8 percent and 9.1 percent of treated and control group were stone-free, respectively. The increased stone size found in 7.7 percent and 54.5 percent of treated and control groups, respectively. CONCLUSION: Sodium-potassium citrate provides positive effects on stone-forming activities in calcium stone patients suffering from urolithiasis following treatment with ESWL and PCNL procedures at the 12-month follow-up.

The 37-year kidney transplantation experience at Siriraj Hospital.

With 37-years of experience, a total of 801 kidney transplantations (59.4% were deceased donors and 40.6% were living donors) performed at Siriraj hospital were reported. The point system parallel to OPTN/UNOS for waitlists was utilized. Most of the recipients of deceased donor kidney transplantations had 3 HLA mismatches. Due to the point allocation system, none of them had 6 HLA mismatches. Extended criteria donor comprised 7.8% of all deceased donors. Mean duration of dialysis prior to deceased donor transplant was 53 +/- 34 months. Delayed graft function (DGF) was found in 54% of deceased donor kidney transplantation and resulted in significantly higher rate of 1 year biopsy-proven acute rejection, longer duration of kidney transplant admission, higher admission cost and lower patient survival compared to those with immediate graft function. Most of living donor kidney transplant recipient had 1 haplotype match. Mean donor age was 35.9 +/- 9.8 years. 95.6% of the recipients were on hemodialysis prior to transplantation. The current standard regimen includes calcineurin inhibitor, Mycophenolic acid and prednisolone. Interleukin-2 receptor monoclonal antibody has been used in the high immunological risk or high risk for DGF recipients that were 50% of the recipients. There was no statistically significant difference in the biopsy-proven acute rejection (BPAR) free survival between deceased and living donor transplantation. Proportion of cases with the diagnosis of acute rejection according to Banff 2007 classification is as follows: 32.4% acute cellular rejection (ACR), 39.4% antibody-mediated rejection (AMR) and 21.1% mixed cellular and antibody-mediated rejection. Seventy two patients, 35 deceased donor and 37 living donor kidney transplant recipients, had biopsy-proven glomerular disease after transplantation which IgA nephropathy is the most common form of glomerulonephritis. Median graft survival was 7.6 and 13.2 years and median patient survival was 12.1 and 15.5 years for recipient of deceased and living donor transplant respectively. The follow up program of living donors was introduced in 2003 and there were not any donors who required renal replacement therapy.

The risks of lymph node metastasis and the prognostic factors in carcinoma of the penis: analysis of 50 patients treated with bilateral ilioinguinal lymphadenectomy.

OBJECTIVE: To determine the risks of inguinal and pelvic lymph node metastasis as well as the prognostic factors in carcinoma of the penis. METHOD: Fifty patients with squamous cell carcinoma of the penis who consecutively underwent immediate bilateral ilioinguinal lymphadenectomy after treatment of the primary tumor. Clinical features were evaluated to determine the risk of inguinal and pelvic lymph node metastasis as well as prognostic factors. RESULTS: Patients with palpable inguinal lymph node had a high risk of inguinal lymph node metastasis compared with patients with a non palpable inguinal lymph node (p = 0.002). Patients with poor differentiated tumors had a high risk of pelvic lymph node metastasis compared with patients with well or moderately differentiated tumors (p = 0.021). Prognostic factors significantly related to survival were the clinical status of the inguinal lymph node, histological grade and the status of lymph node metastasis (N stage). None of the patients with stage N0 and N1 died with the longest follow-up at 85 and 67 months, respectively. Cumulative survivals were 0.6 at follow-up at 36 months for the patients with stage N2 and 0.5 at follow-up at 18 months for patients with stage N3. CONCLUSION: The clinical status of inguinal lymph node was related to the risk of inguinal lymph node metastasis. Histological grade was related to the risk of pelvic lymph node metastasis. The clinical status of the inguinal lymph node, histological grade and pathological N stage were the important factors affecting the prognosis.

Laparoscopic ureterolithotomy for upper ureteric calculi.

Laparoscopic ureterolithotomy was performed on 10 patients with upper ureteric stones indicated for open ureterolithotomy after failed prior minimally invasive approaches. Stone size ranged from 7 to 15 mm. (mean 9.3). The routes of approach were all done transperitoneally except in one case in which the retroperitoneal route was initially attempted and later converted to transperitoneal route due to contracted space and unclear landmarks. Stones were all removed successfully with the operating time ranging from 120 to 270 min. (mean 181.5). The only significant complication encountered was urine leak interval postoperatively which were long in 4 patients in whom ureterotomy was not sutured. The longest urine leak interval was seen in a patient whose ureterotomy was neither sutured nor stented. Postoperative pain was rewarding in that seven patients required a single dose of 50 mg of pethidine, two required only oral paracetamol and one required no analgesic at all. Postoperative hospital stay ranged from 5 to 23 days which was actually overwhelmed by urine leak complication. Recovery period was satisfactory which ranged from 10 to 28 days (mean 18.1). Overall laparoscopic ureterolithotomy offers an alternative procedure to open ureterolithotomy with the advantages of minimal postoperative pain and short recovery period.