Retrospective analysis of the perioperative outcome in living donor kidney transplantation with multiple renal arteries: does accessory vessel ligation affect the outcome?

PURPOSE: Accurate surgical reconstruction of arterial vascular supply is a crucial part of living kidney transplantation (LDKT). The presence of multiple renal arteries (MRA) in grafts can be challenging. In the present study, we investigated the impact of ligation versus anastomosis of small accessory graft arteries on the perioperative outcome. METHODS: Clinical and radiological outcomes of 51 patients with MRA out of a total of 308 patients who underwent LDKT with MRA between 2011 and 2020 were stratified in two groups and analyzed. In group 1 (20 patients), ligation of accessory arteries (ARAs) and group 2 (31 patients) anastomosis of ARAs was performed. RESULTS: Significant differences were observed in the anastomosis-, surgery-, and warm ischemia time (WIT) in favor of group 1. Students t-test showed comparable serum creatinine levels of 2.33 (± 1.75) to 1.68 (± 0.83) mg/dL in group 1 and 2.63 (± 2.47) to 1.50 (± 0.41) mg/dL in group 2, were seen from 1 week to 1 year after transplant. No increased rates of Delayed graft function (DGF), primary transplant dysfunction and transplant rejection were seen, but graft loss and revision rates were slightly higher when the ARAs were ligated. Analysis of Doppler sonography revealed that segmental perfusion deficits tend to regenerate during the clinical course. CONCLUSION: Ligation of smaller accessory renal arteries may not affect the outcome of living kidney transplantation, except for a minor increase in the reoperation rate. Segmental perfusion deficits of the graft seem to regenerate in most cases as seen in Doppler sonography.

[Female urology: review of the development in the past 5 decades]. / Urologie der Frau ­ Rückblick auf die Entwicklung in den letzten 5 Jahrzehnten.

Urogynaecology is a highly specialised interdisciplinary medical field. It aims to investigate and treat functional, static, endocrine and sexual disorders of the genitourinary system and pelvic area in a sustainable and holistic manner.The "Urological Functional Diagnostics and Female Urology" working group of the German Urologist Academy was founded in 1977. It focuses on developing and updating diagnostics and clinical therapy, contributing to urogynaecological guidelines as well as establishing programmes for further education.Urinary incontinence and other pelvic floor disorders are increasing for demographic reasons. Rising socio-cultural expectations of women require more effective treatments using methods that guarantee success and a low level of complications.Milestones in urogynaecology include the introduction and further development of minimally-invasive surgical procedures such as tension-free vaginal tape (TVT) systems, laparoscopic and robot-assisted techniques, the development of a modern complication management, more targeted drug therapies, and the possibilities of modern functional diagnostics including pelvic floor sonography and MRI examinations.Classic surgical techniques such as colposuspension or colposacropexy and vaginal native tissue repair continue to be very important. In special cases, e. g. recurrent pelvic organ prolapse, mesh-based repair has proven to be superior to conventional procedures because of good long-term success and low recurrence rates. However, this method requires an anatomically correct surgical technique, critical selection of textile implants, and adequate patient education. Suturing devices and robot-assisted surgery may be helpful due to the narrow access and limited surgical spaces. For apical direct fixations, the elevation angle of the vagina is the therapeutically relevant outcome. Tried-and-tested anatomical fixation points should be preferred.Education and training in the field of urogynaecology and harmonisation with European standards (European Board & College of Obstetrics and Gynaecology) should be implemented. Skills for highly specialised mesh-based surgery and effective techniques for managing complications should be taught in the same interdisciplinary manner as diagnostic procedures such as pelvic floor sonography, which are easy to learn and use.Only an interdisciplinary urogynecological sub-specialisation can guarantee the development of required professional competences. Interdisciplinary education should be organised by the participating societies (urology, surgery and gynaecology) together.