RESUMEN
Objetivo: Revisar los resultados de la uretroplastia bulbar utilizando dos técnicas quirúrgicas. Material y métodos: De 35 pacientes estudiados 22 corresponden a técnica de anastomosis término-terminal (ATT) y 13 a técnica de injerto libre dorsal (ILD) en sus variantes prepucial y bucal. En el seguimiento clínico se consideró fallo la necesidad de tratamiento quirúrgico o una flujometría inferior a 15ml/sg. Se estudian las variables: edad, cirugía previa, número de uretrotomías previas y longitud de estenosis. Se elaboran curvas de seguimiento y comparativas de log-rank (LR), con modelo de regresión Cox para factores de riesgo. Resultados: La media de seguimiento fue de 40,02 meses. Del total de casos el 85,71% fueron considerados éxito, un 86,36% en el grupo de ATT y un 84,61% en el grupo de ILD. No hubo diferencias significativas en las comparativas LR de longitud de estenosis, cirugía previa entre ambos grupos e individualizado para cada grupo de tratamiento. El modelo de regresión de Cox muestra un mayor riesgo de fallo en la técnica en aquellos pacientes de mayor edad (OR: 2,2), no alcanzando significación en el resto de variables. Conclusiones: Las tasas de éxito alcanzadas con el procedimiento ATT la ratifican como técnica de elección en estenosis corta, mostrando las estenosis largas de uretra bulbar un buen manejo u opción válida a medio plazo mediante injerto dorsal libre prepucial o bucal. Sería aconsejable realizar seguimientos a más largo plazo con mayor número de pacientes (AU)
Objective: To review the outcome of bulbar urethroplasty using two stage surgical techniques. Material and methods: Twenty-two of the 35 patients studied corresponded to end-to-end urethroplasty (ATT) and 13 to dorsal onlay graft (DOG) in preputial skin or oral mucosa variants. Clinical outcome was considered a failure when postoperative surgery was needed or the uroflowmetry was less than 15ml/s. The following variables were studied: age, previous surgery, number of urethrotomies and stricture length. The curves and log-rank Curves using the log-rank were elaborated for follow-up and comparison, with the Cox regression model for risk factors. Results: Mean follow-up was 40.02 months. Of all the cases. 85.71% were successful. Of these, 86.36% were in the ATT group and 84.61% in the DOG group. There were no significant differences in the comparative LR test based in stricture length, previous surgery between both group and individualized for each management. The Cox regression model showed a risk of failure in the technique for the elderly patients (OR 2.2), it not achieving statistical significance in the remaining variables. Conclusions: The success rate achieved with the ATT technique is verified a gold standard option in short strictures. The DOG is shown as a valid option in long strictures in bulbar urethral in medium follow-up, using a oral mucosa or preputial onlay graft. More long-term follow-up must be performed with a greater number of patients to better evaluate these results (AU)
Asunto(s)
Humanos , Estrechez Uretral/cirugía , Anastomosis Quirúrgica/métodos , Procedimientos de Cirugía Plástica/métodosRESUMEN
OBJECTIVE: To review the outcome of bulbar urethroplasty using two stage surgical techniques. MATERIAL AND METHODS: Twenty-two of the 35 patients studied corresponded to end-to-end urethroplasty (ATT) and 13 to dorsal onlay graft (DOG) in preputial skin or oral mucosa variants. Clinical outcome was considered a failure when postoperative surgery was needed or the uroflowmetry was less than 15ml/s. The following variables were studied: age, previous surgery, number of urethrotomies and stricture length. The curves and log-rank Curves using the log-rank were elaborated for follow-up and comparison, with the Cox regression model for risk factors. RESULTS: Mean follow-up was 40.02 months. Of all the cases. 85.71% were successful. Of these, 86.36% were in the ATT group and 84.61% in the DOG group. There were no significant differences in the comparative LR test based in stricture length, previous surgery between both group and individualized for each management. The Cox regression model showed a risk of failure in the technique for the elderly patients (OR 2.2), it not achieving statistical significance in the remaining variables. CONCLUSIONS: The success rate achieved with the ATT technique is verified a gold standard option in short strictures. The DOG is shown as a valid option in long strictures in bulbar urethral in medium follow-up, using a oral mucosa or preputial onlay graft. More long-term follow-up must be performed with a greater number of patients to better evaluate these results.
Asunto(s)
Uretra/cirugía , Estrechez Uretral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adulto JovenRESUMEN
PURPOSE: The purpose of the study was to analyze the incidence of intra-abdominal infectious complications after the application of a fibrinogen sealant to the duodenojejunal anastomosis in simultaneous pancreas-kidney transplants (SPK) with enteric drainage. METHODS: Results of 68 SPKs with enteric drainage were prospectively assessed. A fibrinogen and thrombin sheet was applied to the duodenojejunal anastomosis in 34 patients, who were compared to a control group of 34 patients. The incidence and severity of intra-abdominal infectious complications and the 1-year patient and grafts survival were analyzed. RESULTS: Eighteen patients experienced intra-abdominal infectious complications. Grade 1a complications occurred in the study group, whereas surgery was required only in patients from the control group: complications grade 3a (15%) and complications grade 3b (18%) (p = 0.003 vs. study group, respectively). The overall rate of anastomotic leakage (complications grade 2b and 3b) was 10%, all of which occurred in the control group. The length of hospital stay was higher in the control group was 34.6 ± 11.3 days vs. 22.8 ± 11.1 days (p = 0.03). There were no significant differences in 1-year patient and graft survival between groups. CONCLUSIONS: In our study, the application of fibrinogen and thrombin sheets was associated to a decrease in the number and severity of intra-abdominal infectious complications.
Asunto(s)
Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/prevención & control , Infecciones Bacterianas/prevención & control , Fibrinógeno/administración & dosificación , Trasplante de Páncreas/efectos adversos , Adhesivos Tisulares/administración & dosificación , Cavidad Abdominal , Administración Tópica , Adulto , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/etiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/cirugía , Drenaje , Duodeno/cirugía , Femenino , Humanos , Incidencia , Yeyuno/cirugía , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Insuficiencia Renal/etiología , Insuficiencia Renal/cirugía , Trombina/administración & dosificaciónRESUMEN
INTRODUCTION: Management of the exocrine drainage of the pancreatic graft in simultaneous pancreas kidney (SPK) transplantation has been a matter of debate for years. There is currently a trend toward a more physiological enteric drainage (ED). This study compared short- and long-term complications and graft survival in patients with enteric versus bladder exocrine secretion drainage. PATIENTS AND METHODS: Between January 1995 and November 2005, we performed 75 SPK transplants: 55 with ED and 20 with bladder drainage (BD). The rates of complications and graft survival were monitored over at least 36 months after transplantation. RESULTS: Mean posttransplant follow-up was 119.5 +/- 6.6 months. Urinary infection, hematuria, reflux pancreatitis, and repeat surgery rates were all significantly higher among the BD area. There was no intergroup difference in rejection rates or in the incidence of graft thrombosis, transplantectomy, anastomotic dehiscence, or intra-abdominal abscesses. Pancreas and kidney graft survival rates were similar in the two groups. CONCLUSIONS: In our experience, ED was more physiological than BD, and was associated with fewer complications.
Asunto(s)
Glándulas Exocrinas/metabolismo , Trasplante de Riñón/métodos , Trasplante de Páncreas/métodos , Adolescente , Adulto , Complicaciones de la Diabetes/cirugía , Diálisis/métodos , Drenaje/métodos , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Hemorragia/epidemiología , Humanos , Trasplante de Riñón/mortalidad , Masculino , Trasplante de Páncreas/mortalidad , Pancreatitis/epidemiología , Diálisis Peritoneal/métodos , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de Tiempo , Vejiga Urinaria/metabolismo , Infecciones Urinarias/epidemiologíaRESUMEN
INTRODUCTION: Among patients with type 1 diabetes mellitus and end-stage renal disease, simultaneous pancreas-kidney (SPK) transplantation is associated with increased survival compared with solitary kidney transplants or dialysis. METHODS: A retrospective, descriptive study was performed on 101 consecutive SPK transplantation performed in our center over the last 20 years. We excluded six pancreas alone, eight pancreas after kidney, and four retransplantations. We analyzed demographic characteristics and patient and graft survivals. We also compared patient and pancreatic graft survivals between three periods: 1989 to 1999, 2000 to 2003, and 2004 to 2007. In the first period, bladder drainage was performed in all patients. In the second and third periods, it was replaced by enteric drainage. RESULTS: Overall patient survival was 83.2%. Kidney graft loss occurred in 12 (11.8%) patients and pancreas graft loss in 21 (20.7%) patients. Overall pancreatic graft survival was 79.2% with a 1-year value of 87.1%. By periods, pancreatic graft survival was 75% during the bladder drainage era; 76.9% in the second period; and 85.7% in the third period (P = .88). CONCLUSION: SPK transplantations in diabetic patients with end-stage renal disease were associated with improving pancreas graft survival throughout the study period.
Asunto(s)
Trasplante de Riñón/estadística & datos numéricos , Trasplante de Páncreas/estadística & datos numéricos , Adulto , Nefropatías Diabéticas/cirugía , Drenaje/métodos , Femenino , Supervivencia de Injerto , Humanos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Trasplante de Páncreas/mortalidad , Trasplante de Páncreas/fisiología , Terapia de Reemplazo Renal/estadística & datos numéricos , Estudios Retrospectivos , Tasa de Supervivencia , Sobrevivientes , Insuficiencia del Tratamiento , Resultado del TratamientoAsunto(s)
Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/cirugía , Supervivencia de Injerto/fisiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/fisiología , Trasplante de Páncreas/fisiología , Adulto , Cadáver , Creatinina/sangre , Femenino , Antígenos HLA-DR/inmunología , Prueba de Histocompatibilidad , Humanos , Trasplante de Riñón/mortalidad , Masculino , Trasplante de Páncreas/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia , Donantes de Tejidos , Insuficiencia del TratamientoAsunto(s)
Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/cirugía , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Trasplante de Páncreas , Adulto , Factores de Edad , Cadáver , Creatinina/sangre , Femenino , Rechazo de Injerto/epidemiología , Supervivencia de Injerto/fisiología , Antígenos HLA-DR/inmunología , Prueba de Histocompatibilidad , Humanos , Inmunosupresores/uso terapéutico , Fallo Renal Crónico/etiología , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/inmunología , Tiempo de Internación , Masculino , Trasplante de Páncreas/efectos adversos , Trasplante de Páncreas/inmunología , Reoperación , Estudios Retrospectivos , Donantes de Tejidos , Resultado del TratamientoAsunto(s)
Enfermedades Duodenales/etiología , Enfermedades Duodenales/terapia , Embolización Terapéutica/métodos , Fístula Intestinal/etiología , Fístula Intestinal/terapia , Trasplante de Páncreas/efectos adversos , Adulto , Fibrina , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Adhesivos TisularesRESUMEN
Study of group of 61 patients, nephrectomized as a result of various diseases and who before and three months after surgery underwent blood pressure, effective renal plasma flow (EPFF) and unilateral renal function determinations in order to verify the compensating ability of the remaining kidney. Effective renal plasma flow was determined by a single injection and removal of six serial blood samples with 125-I-Hippuran. Unilateral renal function was determined from the relative uptake of 99mTc-DMSA 24 hours after injection. The patients were divided into four groups according to their overall and unilateral renal function as well as the presence or absence of hypertension. Patients with normal EPFF and symmetrical renal function showed a significantly increase in the function of the remaining kidney after surgery (p < 0.001). Patients with normal or slightly reduced EPFF (< 10%) and highly asymmetrical unilateral function as well as those with decreased EPFF (> 10%) and symmetrical or asymmetrical unilateral renal function did not increased the function of the remaining kidney after nephrectomy, and hypertensive patients whose blood pressure returned to normal values after nephrectomy had a decreased function of the remaining kidney after surgery (< 0.001). It is concluded that it is possible to predict the functional behaviour of the remaining kidney after nephrectomy, and that the compensating ability will basically depend on the previously existing (overall and unilateral) renal function as well as the presence or absence of hypertension.