Download or read book P121 Timing of Ureteric Stent Removal and Occurrence of Urological Complications After Kidney Transplantation A Systematic Review and Meta analysis written by Jeffrey Anthony Lafranca and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTI). The aim of this study is to determine a more definite moment for ureteric stent removal after KTx. Methods: Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of science and Google scholar. For this systematic review all aspects of the Cochrane Handbook for Interventional Systematic Reviews are followed and it is written based on the PRISMA-statement. Articles discussing JJ-stents and their time of removal in relation to outcomes were included. Studied outcome measures were UTI, urinary leakage, ureteral stenosis and re-intervention. Results: 1043 articles were identified, of which 14 articles were included. Meta-analysis showed a significant reduction of UTI when stents were removed earlier than three weeks (OR 0.49, p = 0.0009). Regarding incidence of urinary leakage, there is no significant difference between early ( three weeks) and late stent removal ( three weeks) (OR 0,60, p= 0,16). No meta-analysis could be performed on the outcome of ureteral stenosis, because of the lack data. Conclusion: Based on our results, earlier stent removal after KTx ( three weeks) is associated with a decreased incidence of UTI and does not show a higher incidence of urinary leakage compared to later removal ( three weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks postoperatively.

Download or read book Timing of Ureteric Stent Removal and Occurrence of Urological Complications After Kidney Transplantation written by Jeffrey Anthony Lafranca and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTI). The aim of this study is to determine a more definite moment for ureteric stent removal after KTx. Methods: Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of science and Google scholar. For this systematic review all aspects of the Cochrane Handbook for Interventional Systematic Reviews are followed and it is written based on the PRISMA-statement. Articles discussing JJ-stents and their time of removal in relation to outcomes were included. Studied outcome measures were UTI, urinary leakage, ureteral stenosis and re-intervention. Results: 1043 articles were identified, of which 14 articles were included. Meta-analysis showed a significant reduction of UTI when stents were removed earlier than three weeks (OR 0.49, p = 0.0009). Regarding incidence of urinary leakage, there is no significant difference between early ( three weeks) and late stent removal ( three weeks) (OR 0,60, p= 0,16). No meta-analysis could be performed on the outcome of ureteral stenosis, because of the lack data. Conclusion: Based on our results, earlier stent removal after KTx ( three weeks) is associated with a decreased incidence of UTI and does not show a higher incidence of urinary leakage compared to later removal ( three weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks postoperatively.

Download or read book Early Versus Late Ureteric Stent Removal After Kidney Transplantation written by Emily Thompson and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Kidney transplantation is the treatment of choice for patients with end-stage kidney disease. In a previous review we concluded routine ureteric stenting in kidney transplantation reduces the incidence of major urological complications (MUCs). Unfortunately, this reduction appears to lead to a concomitant rise in urinary tract infections (UTI). For kidney recipients UTI is now the commonest post-transplant complication. This represents a considerable risk to immunosuppressed transplant recipients. There are a number of different approaches taken to ureteric stenting which are associated with varying degrees of morbidity and hospital cost. This review aimed to look at the benefits and harms of early versus late removal of the ureteric stent in kidney transplant recipients.Methods: We searched the Cochrane Kidney and Transplant Specialised Register using terms relevant to this review. All RCTs and quasi-RCTs were included in our meta-analysis. Two authors reviewed the identified studies. Early removal was considered as stent removal before day 15 post-op or during the index transplant admission. The primary outcome of interest was the incidence of MUCs. Secondary outcomes were UTI, idiosyncratic stent-related complications, hospital related costs and adverse events. A subgroup analysis was performed examining complications reported in different ureteric stenting techniques; bladder indwelling (BI) vs per-urethral (PU). Statistical analyses were performed using the random effects model and results expressed as relative risk (RR) with 95% confidence intervals (CI).Results: Five RCTs (1097 patients) were included in our analysis. There was no significant difference in the incidence of MUCs in early vs late removal; RR 1.65 95% CI [0.57, 4.83], p=0.36. The incidence of UTI was significantly reduced in the early removal group; RR 0.60 95% CI [0.41, 0.87], p=0.007. UTIs were significantly less likely to occur if a BI stent was used, RR 0.45 95% CI [0.29, 0.70], p=0.0004, compared with PU stents; RR 0.81 95% CI [0.51, 1.27] p=0.36. Discussion: Early removal of ureteric stents following kidney transplantation significantly reduces the incidence of UTI and is not associated with a higher risk of MUC. Bladder indwelling stents are the optimum method for achieving this benefit.

Download or read book P142 Novel Stent Removal Technology in Kidney Transplantation written by Amy Nagle and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction:Ureteric stents should be routinely used in kidney transplantation to reduce major urological complications. Standard practice is stent removal with flexible cystoscopy six weeks post-transplant. Increased rates of urinary tract infection (UTI) are associated with longer time transplant stents remain. Magnetic stents and Isiris single use technology allow outpatient portable removal. We aimed to investigate if the use of these technologies are feasible in kidney transplant patients and whether removal times could be reduced and outcomes improved.Methods:A prospective study of transplant stent removal in 181 patients who underwent either kidney transplant (KT) or simultaneous pancreas kidney transplantation (SPK) between 08/11/2017 and 12/08/2018. The type of stent, method of removal, location, time to removal and any procedure complications were recorded. 21 female patients had a 15cm magnetic stent inserted. All other patients had a standard 16cm stent.Results185 stent removal procedures were performed for 179 patients. 6 (3.3%) patients required two procedures to achieve stent removal. 47 (25.4%) removals used Isiris single use technology; performed in transplant outpatient clinic or occasionally on inpatient wards. 3 (6.5%) attempted Isiris removals required standard outpatient flexible cystoscopy to remove the stent. 107 (57.8%) used standard flexible cystoscopy. 10 (5.4%) stent removals were done in theatre under general anaesthetic or sedation. 14/21 (67%) magnetic stents were removed in transplant outpatient clinic. 4/21 (19%) magnet stents fell out early; 3/21 (6.5%) magnet stents required Isiris for removal. The mean time to stent removal (TtR) for all patients was 43.5 days (range 4 to 184 days). Mean Isiris TtR was 44 days. Mean magnet stent TtR was 29 days.DiscussionIsiris and magnetic stent technologies are feasible after kidneytransplantation. This has allowed for stent removal before discharge or during outpatient clinics. Both technologies have potential to reduce administration time, patient hospital visits and associated costs.

Download or read book Novel Stent Removal Technology in Kidney Transplantation written by Amy Nagle and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction:Ureteric stents should be routinely used in kidney transplantation to reduce major urological complications. Standard practice is stent removal with flexible cystoscopy six weeks post-transplant. Increased rates of urinary tract infection (UTI) are associated with longer time transplant stents remain. Magnetic stents and Isiris single use technology allow outpatient portable removal. We aimed to investigate if the use of these technologies are feasible in kidney transplant patients and whether removal times could be reduced and outcomes improved.Methods:A prospective study of transplant stent removal in 181 patients who underwent either kidney transplant (KT) or simultaneous pancreas kidney transplantation (SPK) between 08/11/2017 and 12/08/2018. The type of stent, method of removal, location, time to removal and any procedure complications were recorded. 21 female patients had a 15cm magnetic stent inserted. All other patients had a standard 16cm stent.Results185 stent removal procedures were performed for 179 patients. 6 (3.3%) patients required two procedures to achieve stent removal. 47 (25.4%) removals used Isiris single use technology; performed in transplant outpatient clinic or occasionally on inpatient wards. 3 (6.5%) attempted Isiris removals required standard outpatient flexible cystoscopy to remove the stent. 107 (57.8%) used standard flexible cystoscopy. 10 (5.4%) stent removals were done in theatre under general anaesthetic or sedation. 14/21 (67%) magnetic stents were removed in transplant outpatient clinic. 4/21 (19%) magnet stents fell out early; 3/21 (6.5%) magnet stents required Isiris for removal. The mean time to stent removal (TtR) for all patients was 43.5 days (range 4 to 184 days). Mean Isiris TtR was 44 days. Mean magnet stent TtR was 29 days.DiscussionIsiris and magnetic stent technologies are feasible after kidneytransplantation. This has allowed for stent removal before discharge or during outpatient clinics. Both technologies have potential to reduce administration time, patient hospital visits and associated costs.

Download or read book Ureteric Stenting written by Ravi Kulkarni and published by John Wiley & Sons. This book was released on 2017-05-01 with total page 317 pages. Available in PDF, EPUB and Kindle. Book excerpt: The only book dedicated to this important area of urology, Ureteric Stenting comprehensively reviews the entire topic, providing highly specialized advice to enable outstanding clinical management of patients. All aspects of ureteric stenting are covered, from basic to complex, giving urologists, nephrologists and trainees an authoritative and up-to-date guide on best clinical practice.

Download or read book Routine Ultrasound Imaging After Transplant Ureteric Stent Removal in Paediatric Renal Transplant Recipients Does it Change Clinical Practice written by Helen Jones and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction:Paediatric renal transplant recipients (RTR) at our centre undergo an elective post-stent removal graft ultrasonography (PSRGU). Here we evaluated whether this is useful in the detection of major urological complications (MUC).Methods:Retrospective data collection retrieved from electronic case notes. Data presented as median(range).Results:77 RTR between January 2012 and November 2016. 57 followed up at our centre (43/57 living donor transplants). 4/57 excluded from analysis (2 had cutaneous ureterostomies, 2 cases with spontaneous stent removal during clean intermittent catheterisation). 53 underwent transplant ureteric stent removal. 47/53 had ureteric stents removed electively at 38(16-73)days post transplant. 30 patients underwent a routine PSRGU 7.5(1-55)days later. 14 had urgent scans (most commonly for serum creatinine rise) at 6(1-20)days and 3 patients had no follow-up scan. 28/30 (93%) of the patients undergoing routine PSRGU had no change in their management. 2 required ultrasound angiology for incidental (non-ureteric) findings. 1/14 patients, whose PSRGU was performed urgently detected a MUC. This patient had an uncomplicated routine stent removal day 29 post-transplant. 4 days later the creatinine rose from 30 to 56u03bcmol/l and an urgent ultrasound reveled hydronephrosis. A nephrostogram showed a narrowed distal 1/3 of the ureter and the patient underwent successful surgical resection of ureteric stricture with ureteric re-implantation.6 patients underwent urgent stent removal at 24(13-48)days post transplant with the most common reason being urinary tract infection. None of this group had a MUC.Discussion:Routine PSRGU following elective stent removal did not lead to the detection of any MUC in this cohort. It will now no longer be undertaken in our centre unless there is a clinical indication to do so. The case with a MUC was diagnosed due to graft dysfunction. This highlights the importance of regular clinical review including measuring serum creatinine following stent removal, which is protocol in our centre.

Download or read book Stent Removal After Transplantation Ouch written by Avneesh Kumar and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Ureteric stents are routinely placed during renal transplantation and require removal after 6-8 weeks. Removal procedure is often a source of considerable anxiety and pain. The severity of pain during stent removal is not well documented among transplant recipients. Methods: A simple postal questionnaire was designed and sent to 103 patients. All patients who had renal transplantation within the last 18 months from Jan 2015 to June 2016 were included. They were asked to give a 0-10 numeric pain intensity score where 10 was the worst possible pain and 0 being no pain.Results: 52 responses were received. 5 patients were excluded due to the following (2 removal under spinal anaesthesia, 1 under general anaesthesia, 2 spontaneous passage) Total included in analysis=47, 31 men, 16 women. Median age 61 years (26-73). Median time for removal of stent 53 days (12-214). Median pain score 2(0-9) n=47. Median pain score in men 3 (0-9) and 1 (0-5) in women. 18 men had pain score of 3 or >3 (58%) while 4 women had a pain score of 3 or>3(25%)Discussion:Pain during stent removal is more common in men and is also more severe. Entonox, a self-administered mix of nitrous oxide and oxygen is used routinely for pain relief during short procedures. It is perhaps an underutilised analgesic and anxiolytic with minimal side effects. Rapid induction and recovery make it an ideal agent to use for stent removal. Based on this survey we intend to offer the use of Entonox during stent removal.

Download or read book Recent Advances and Clinical Outcomes of Kidney Transplantation written by Charat Thongprayoon and published by . This book was released on 2020-09-10 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt: Advances in immunosuppression and kidney transplant techniques have led to significant improvements in the short-term survival of the renal allograft. Long-term graft survival, however, has relatively lagged behind and has now become one of the main problems in kidney transplantation. In this Special Issue, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.

Download or read book Understanding the Complexities of Kidney Transplantation written by Jorge Ortiz and published by BoD – Books on Demand. This book was released on 2011-09-06 with total page 578 pages. Available in PDF, EPUB and Kindle. Book excerpt: Kidney transplantation is a complex field that incorporates several different specialties to manage the transplant patient. This book was created because of the importance of kidney transplantation. This volume focuses on the complexities of the transplant patient. In particular, there is a focus on the comorbidities and special considerations for a transplant patient and how they affect kidney transplant outcomes. Contributors to this book are from all over the world and are experts in their individual fields. They were all individually approached to add a chapter to this book and with their efforts this book was formed. Understanding the Complexities of Kidney Transplantation gives the reader an excellent foundation to build upon to truly understand kidney transplantation.

Download or read book Oxford Textbook of Urological Surgery written by Freddie C. Hamdy and published by Oxford University Press. This book was released on 2017-10-06 with total page 1201 pages. Available in PDF, EPUB and Kindle. Book excerpt: Offering a comprehensive guide, the Oxford Textbook of Urological Surgery is a practical resource mapped to the curriculum for urological training as approved by the General Medical Council (GMC), making it particularly useful in preparation for the Intercollegiate Examination. Presented in a clear and accessible way, this evidence based volume covers all major areas, including functional urology, stone disease, infection, andrology, nephrology, transplantation, uroradiology, and paediatric urology. This highly illustrated full colour textbook has an innovative and user-friendly style, including over 500 photographs, clinical images, and line drawings. Bringing together the expertise of over 100 specialist contributors in the field, the Oxford Textbook of Urological Surgery is a highly valuable source of information, and will become the standard reference text for all who study urological disease and its treatment.

Download or read book Challenging Cases in Urological Surgery written by Karl Pang and published by Oxford University Press. This book was released on 2023-01-20 with total page 529 pages. Available in PDF, EPUB and Kindle. Book excerpt: From challenges presented in everyday clinical practice to the complex cases without simple answers, Challenging Cases in Urological Surgery is an effective reference and revision aid for trainees and consultants alike. As part of the Challenging Cases series, cases are examined from a multidisciplinary approach considering all aspects of diagnostic, practical and evidence-based skills to provide a comprehensive and detailed demonstration of clinical investigation within real-world scenarios. With contributions from over 40 experienced and renowned consultants from the UK, the opinions within the 'Expert Commentary' includes an insight into real world case management and problem solving in complex cases. Using the most up-to-date evidence and clinical presentations highlighted in the UK ISCP curriculum, this book features the use of 'Clinical Tips', 'Evidence Base' and 'Future Advances' text boxes to highlight critical information in an easy-to-read format for efficient and effective learning. This book is split into 15 comprehensive sections; these include Urinary Tract Infection, Bladder Cancer, Male Infertility and Sexual Dysfunction and Emergency Urology and Trauma among other key areas in the field of Urology. Each chapter is a case-based guide which provides readers with practical yet clinically relevant advice on management of urological surgery cases. With every-day clinical observations, controversial topics and challenging cases, this book is a highly valuable resource for all those interested in urological surgery, trainees in the field and those sitting postgraduate urology examinations.

Download or read book Current Issues and Future Direction in Kidney Transplantation written by Thomas Rath and published by BoD – Books on Demand. This book was released on 2013-02-13 with total page 494 pages. Available in PDF, EPUB and Kindle. Book excerpt: The here presented book covers different areas of clinical and scientific interest, reaching from donor evaluation to newest methods in immunological diagnostics. But also aspects of daily care of transplant recipients can be found in the carefully selected chapters. Everything driven by the aim to improve the care for all of our transplanted patients.

Download or read book Essential Clinical Anesthesia written by Charles Vacanti and published by Cambridge University Press. This book was released on 2011-07-11 with total page 1191 pages. Available in PDF, EPUB and Kindle. Book excerpt: The clinical practice of anesthesia has undergone many advances in the past few years, making this the perfect time for a new state-of-the-art anesthesia textbook for practitioners and trainees. The goal of this book is to provide a modern, clinically focused textbook giving rapid access to comprehensive, succinct knowledge from experts in the field. All clinical topics of relevance to anesthesiology are organized into 29 sections consisting of more than 180 chapters. The print version contains 166 chapters that cover all of the essential clinical topics, while an additional 17 chapters on subjects of interest to the more advanced practitioner can be freely accessed at www.cambridge.org/vacanti. Newer techniques such as ultrasound nerve blocks, robotic surgery and transesophageal echocardiography are included, and numerous illustrations and tables assist the reader in rapidly assimilating key information. This authoritative text is edited by distinguished Harvard Medical School faculty, with contributors from many of the leading academic anesthesiology departments in the United States and an introduction from Dr S. R. Mallampati. This book is your essential companion when preparing for board review and recertification exams and in your daily clinical practice.

Download or read book Urinary Tract Infection written by Tomas Jarzembowski and published by BoD – Books on Demand. This book was released on 2018-06-27 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: Urinary tract infection (UTI) is a problem so common and so significant in routine clinical practice that accurate diagnostics are especially important. In particular, complicated UTI is associated with an increased rate of therapy failures, as a result of possible biofilm formation on foreign elements and antibiotic resistance, as well as the increased possibility of an infection recurrence. These are the arguments for the constant search for novel diagnostic tools and techniques. These and many other vital topics regarding UTI complications, management, and treatment, in addition to antibiotic resistance and bacterial virulence traits allowing us to mitigate or avoid antibiotic action, are presented in this book.

Download or read book Retrograde Ureteroscopy written by Petrisor Aurelian Geavlete and published by Academic Press. This book was released on 2016-04-07 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: Retrograde Ureteroscopy: Handbook of Endourology contains five focused, review-oriented volumes that are ideal for students and clinicians looking for a comprehensive review rather than a whole course. Topics covered review both the endourological diagnosis and treatment of prostate, urethral, urinary bladder, upper urinary tract, and renal pathology, with all chapters describing the most recent techniques, reviewing the latest results, and analyzing the most modern technologies. In the past ten years, the field of endourology has expanded beyond the urinary tract to include all urologic, minimally-invasive surgical procedures. Recent advancements in robotic and laparoscopic bladder surgery make this one of the fastest moving fields in medicine. As current textbooks are too time-consuming for busy urologists or trainees who also need to learn other areas of urology, this collection provides a quick references with over 4000 images that are appropriate for fellows and those teaching in the field. Offers review content for urologists in training and “refresher” content for experts in endourology Explores new surgical techniques and technology through review-level content and extensive images of pathologies Includes over 500 images per volume that were taken from more than 4000 endourologic procedures performed annually at the editor’s hospital

Download or read book Endourology written by Culley C. Carson and published by . This book was released on 1985 with total page 352 pages. Available in PDF, EPUB and Kindle. Book excerpt: