Radiology; USG and Colour Doppler of Post Renal Transplant Complications

 

Abstract

Kidney transplant is the treatment of choice for patients with end-stage renal disease. Kidney transplant offers better quality of life. It is more cost effective than hemodialysis. Advances in surgical technique, along with improvement in organ preservation and immunosuppression have improved patient outcomes. Post-operative complications, however, can limit this success. Ultrasound and Doppler study is the primary imaging modality for evaluation of renal transplant, providing real –time information about complication in graft. A multimodality approach including CT scan, MRI or conventional angiography may be necessary in cases when sonography and Doppler are inconclusive to diagnose the etiologies of these complications. Radiologists play an integral role within the multidisciplinary team in care of transplant patient at every stage of the transplant process. Therefore, the radiologist should always be aware when evaluating the failing renal graft, whether the cause is renal or extrinsic. In this pictorial essay we tried to gather the most common complication of transplant kidney in different cases that occurred in our hospital, with an emphasis on Ultrasound and Doppler study.

 

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Evaluation of Buccal Mucosal Graft Urethroplasty for The Treatment of Female Urethral Strictures- A Single Centre Experience

 

Abstract

Introduction: Female urethral stricture is a highly under-reported and underdiagnosed condition encountered by the reconstructive urologist. Urethral dilatation is often performed with urethroplasty offered in select cases. In the present study, we describe our results in a series of women surgically treated for female urethral stricture disease using a suprameatal approach with a buccal mucosal graft dorsal on lay technique.
Materials and Methods: All females diagnosed of urethral stricture who underwent buccal mucosal graft urethroplasty from January 2015 to January 2020 were evaluated retrospectively. Intraoperative and postoperative parameters were assessed.
Results: A total of 14 female patients underwent buccal mucosal urethroplasty were evaluated. The mean age of the patients was 49.5 years ranging from 35 to 64 years. Mean preoperative maximum flow rate [Qmax] on uroflometry was 6.5 ml/second and the mean residual urine 156 ml. All patients underwent uneventful buccal mucosal graft dorsal on lay technique. At 3 months follow up, the mean Qmax was 23.2 ml/second with mean residual urine of 14 ml. A Self-reporting satisfaction scores using the Patient Global Impression of Improvement showed that seven patients scored 1 (very much better), four scored 2 (much better), two patients scored 3 (a little better), and one scored 4 (no change) none of the patients scored a 5 (worse).No recurrence was noted.
Conclusion: Buccal mucosal graft urethroplasty is a feasible surgery for female urethral strictures with minimal short term complications.

 

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Safety and Efficacy Assessment of Pcnl in The Pediatric Population: A Single Centre Experience

 

 

Abstract

Introduction and Objective: Renal stone disease in children is on the rise with increased incidence and better modalities to diagnose the disease. Hence there is a necessity to strategize the evaluation and treatment of children with kidney stones. Our study was conducted to assess stone distribution, stone burden, and efficacy of PCNL in pediatric age group.
Methods: All paediatric patients with renal stone disease who subsequently underwent PCNL at our department from January 2017 to December 2020 were analysed.
Results: 84 patients ranging 1-18 years were analysed. Pain abdomen was the most common presenting symptom (61.9%) followed by fever (19.04%). The mean stone size was 2.16cm with equal side distribution. Most stones were located in the lower calyx (38%). The mean operative time was 65 minutes. Exposure to radiation from C arm ranged from 1.6-8.3 minutes. Complete stone clearance was achieved in 90.47% with a mean post- drop in Hb value to 0.72 gm/dl. Mean duration of nephrostomy tube in situ was 2.4 days and with a mean hospital stay of 3.8 days. Calcium oxalate was the most common type of stone (48%) Conclusion: PCNL is safe and effective treatment for pediatric renal calculi with minimal morbidity and increased stone free rates irrespective of stone size. Proper patient selection, surgical skill and postoperative care contribute towards the success of the procedure

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Reasons and Outcome of Patients after Permanent Transfer from Peritoneal Dialysis to Hemodialysis: A Review of 16 years of Experience in Senegal

 

Abstract

Introduction: Peritoneal dialysis (PD) and haemodialysis (HD) are two complementary and non-competitive renal replacement therapy (RRT). A patient can be transferred from one technique to the other. The objective of this study was to assess the reasons for transferring patients from PD to HD and to follow their outcome.
Patients and Methods: This is a 16-year descriptive and analytical retrospective study (March 1, 2004 - August 31, 2020) conducted at the PD unit of the Aristide Le Dantec University Hospital in Dakar. Were included, patients on PD for at least 30 days, over 18 years of age and permanently transferred to HD. The probability of survival for any duration of post-transfer follow-up was estimated by the Kaplan-Meier method.
Results: The analysis covered 98 out of 113 cases. The mean age of the patients was 45.2 ± 14.09 years at the initiation of PD and 47 ± 13.91 years at the time of transfer, with a sex ratio of 0.66. The mean duration in PD was 19.9 ± 17.25 months [range, 1.0-90.0 months]. The transfer to HD concerned 73.5% of patients in the first two years. The reasons for transfer were mainly associated with infection (82.7%), mechanical complications (23.5%), social reasons (12.2%) and inadequate dialysis (6.1%). It was programmed in 11.4% of cases and 6% of patients had a permanent approach. At the endpoint date, the mean duration in hemodialysis was 43.3 months with 42.8% of patients still in HD. There was a kidney transplant patient; a return to PD. Mortality was 34.6%. The mean HD survival was 126 months. There was a statistically significant relationship between infection as a reason for transfer and mortality (p = 0.047).
Conclusion: The main reasons for transferring PD to hemodialysis identified in the literature are found in our context. This transfer must be anticipated to reduce morbidity and mortality.

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A Rare Case of Penile Schwannomatosis Presenting with Painful Nocturnal Penile Tumescence

 

Abstract

Background: Penile schwannoma is a rare tumor. They commonly present as an asymptomatic, painless and slow growing mass. Other presentations include sexual dysfunction, most commonly dyspareunia, followed by erectile dysfunction, abnormal penile curvature or pain with ejaculation.
Case presentation: A 26-year-old male presented atypically with painful nocturnal penile tumescence, along with multiple nodules over the dorsal penis. Excision of multiple penile tumors under general anaesthesia was performed and histopathologic examination revealed benign schwannoma.
Conclusion: Our hypothesis is that the schwannoma lies along the axis of the dorsal penile nerve, and compression of this nerve occurs during his erection causing pain. However, there are limited presentations of painful erections in penile schwannomas, and we hope that future studies can help confirm this theory.

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The TUR Syndrome Re-Incarnating as ARDS after Saline use as Irrigating Fluid in Endoscopic Surgery

 

Abstract

Objective: To demonstrate the TUR syndrome characterized with hyponatraemia (HN) will no longer be seen after using saline as irrigating fluid in urology, but it has re-incarnated as the acute respiratory distress syndrome (ARDS) presenting with the same clinical picture of the multiple organ dysfunction syndrome (MODS).
Material and Methods: A focused objective and relevant narrative review of other eminent authors’ work and mine are used here.
Results: The TUR syndrome characterized with HN will no longer occur in urology after the use of saline as irrigating fluid in endoscopic surgery. It has reincarnated as ARDS presenting with the same MODS clinical picture. It is induced by VO caused by iv fluid infusions. This induces cardiovascular shock (VOS) that cause ARDS. The latter is already common in clinical practice due to the excessive us of iv fluids in the management of shock, acutely ill patients, and prolonged major surgery as iatrogenic complication of fluid therapy. The wrong Starling’s law dictates the current faulty rules on fluid management of shock that mislead physicians into giving too much fluid. The correct replacement is the hydrodynamics of the porous orifice (G) tube which should be the new scientific basis for fluid therapy in shock management. The currently available hypertonic sodium therapy of 5%NaCl and/ or 8.4%NaCo3 is lifesaving therapy for HN, the TUR syndrome and ARDS.
Conclusion: The TUR syndrome may seem to have been eradicated in urology with the use of saline as irrigating fluid in endoscopic surgery. However, it has reincarnated as ARDS with the same clinical picture of MODS. It is an iatrogenic complication of fluid therapy dictated by the wrong Starling’s law for which the hydrodynamic of the G tube is the correct replacement that should be the new scientific basis for a new policy on fluid management of shock.

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Swathed Ureter, an Enigma in Diagnosis- A Pictorial Essay

  Abstract

This pictorial essay is an educational article aiming to provide both textual and visual portrayals consisting of a collection of images and texts on an important issue by reviewing and extrinsic encasing pathology of the ureter to provide a guide to those who are involved in diagnostic intervention. While considering diseases of the urinary system, physicians mainly focus on the kidneys and the bladder. Only scant attention is paid to the ureters. Most of the UTO due to calculi are readily identifiable whereas many cases of ureteric exterior encasement are frequently missed from early detection even by experienced clinicians and radiologists. Failure in recognition of the encasement of ureters and its causes may lead to mistaken diagnosis with resultant inappropriate management. However, problems with the ureters can adversely affect the functioning of the kidneys and could even be lethal. In this article we focus only ‘encasement of ureters’ with a few common examples and salient signs that help in the diagnosis.

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