DOWNLOAD PDF UROLOGICAL AND VASCULAR COMPLICATIONS POST-RENAL TRANSPLANTATION TAREK EL-DIASTY AND YASSER OSMAN

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1 Chapter 1 : - NLM Catalog Result Complications following renal transplantation are usually assessed with ultrasound. The time frame in which complications can occur stretches from the immediate postoperative period to months or. Sep 28, - Calcular pulmonary embolism. Authors; Authors and affiliations. Int Urol Nephrol In this report, we present a rare complication, which has never been reported. It is the migration of stone fragments into the venous system causing pulmonary emboli. We reviewed the literatures reporting complications following PNL, and there was no available previous report about such complication. It was suspected intraoperative and confirmed radiologically postoperative. In this case, pulmonary emboli have had no clinical consequences and were managed conservatively. Many complications have been reported in the urological literatures and were extensively discussed regarding their incidence, risk factors, diagnosis, proper managements, and their outcomes [3, 4]. This case report discusses a rare complication of PNL we faced during our clinical practice. It is the migration of stone fragments into the venous system during PNL. Case report A year-old male has been complaining of recurrent attacks of left loin pain for 6 months. He has undergone left pyelolithotomy twice and left PNL before. Examination was only relevant for presence of the scars of the previous surgical procedures. Renal ultrasonography revealed multiple stones in the renal pelvis, lower, and middle calyces of the left kidney. Urinalysis demonstrated microscopic hematuria, pyuria, and calcium oxalate crystals. Urine culture was positive for Escherichia coli growth. Results of other laboratory tests such as for serum creatinine, prothrombin concentration, and liver function and a complete blood cell count were normal. Computerized tomography CT of the abdomen revealed presence of left renal staghorn stone Fig. The patient initially received oral antibiotics according to the culture and sensitivity results. Then, PNL was performed for retrieval of the stone in the left kidney. Under general anesthesia, cystoscopic placement of ureteral catheter was done, and then, the patient was put in prone position. The skin was punctured at the posterior axillary line. The planned tract was made, and guidewires were secured inside the calyceal system before dilatation of the tract. A 26 F rigid nephroscopy Karl Storz Endoskope was used for stone retrieval. The irrigation fluid was 60 cm above the level of the table. Under direct visual control, ultrasonic lithotriptor was used for stone fragmentation and suction. During the procedure, the surgeon noticed smoothwalled tubular structure that differs from the pelvicalyceal system. Three small stone fragments escaped through and trials to retrieve them failed. With direct injection of iodinated contrast material into the pelvicalyceal system, he noticed opacification of the venous system of the kidney and the inferior vena cava. The surgeon stopped the procedure and placed a 22 F nephrostomy tube. The patient was kept under close monitoring for 24 h with clamped nephrostomy tube. The postoperative period was uneventful with no hypoxemia or cardiac instabilities. Hemoglobin level decreases only one gm. The nephrostomy tube was opened after 24 h and drained smoky urine. After stabilization of the patient, CT of the chest was done to assess the fate of the escaped stones into the venous system. It was a surprise to identify the presence of intraluminal hyperdense calcular shadows at the lower lobe branches of the right pulmonary artery and the lingular branch of the left pulmonary artery. No distal lung changes can be demonstrated bilaterally Fig. The radiologist compared these images with the preoperative CT images, and these findings were not apparent in the preoperative images. This means that the stone fragments formed silent pulmonary emboli. In order to avoid further complications and reopening of the mouth of the injured vein, we decided to delay further intervention for awhile. Cystoscopic placement of double J stent was done few days after to avoid obstruction by stone fragments. PNL was planned after 1 month to allow proper healing of the site of the previous puncture. Under general anesthesia, PNL was performed through lower and middle calyceal punctures with complete retrieval of the stone fragments. The patient passed smooth postoperative course and discharged safely from the hospital. The Page 1

2 proper recognition and management of these complications limits the postoperative morbidities [2]. Since the first reported PNL for treatment for staghorn stone by Clayman et al. Bleeding is the most common and most serious complications in PNL occurring in 0. The staghorn stone was identified as a risk factor for bleeding after PNL [3, 7, 8]. Other complications as injury of adjacent organs like colon, duodenum, liver, spleen and pleura, urinary extravasation, stricture at the UPJ and lumbar ureter, infundibular stenosis were reported. Retained foreign bodies such as stent, stone basket, guidewire, laser fiber, or other instrument were reported [3, 4]. Infection and sepsis are rare complications occurring in up to 2. Extrarenal stone fragments migration was reported and of no clinical significance provided the urine and stone are not infected and the stone fragment is not embedded in the submucosa [4]. Air embolism is an extremely rare complication that may occur after injection of air or carbon dioxide in the collecting system to identify a posterior calyx or if there is reversal of airflow in an ultrasonic lithotriptor [10]. Postoperative death is extremely rare and has been reported in 0. The majority of these deaths have resulted from myocardial infarction and pulmonary embolism occurring in high-risk patients [4]. To the best of our knowledge, there is no previous report about migration of stone fragments into the vascular system and formation of pulmonary embolism during endourological procedures. In spite of the surgeon experience, the proper selection of the posterior lower calyx and puncturing the calyx at the site of renal papilla to avoid unnecessary vascular injury, venous injury was inflected and resulted in stone migration into the venous system. This may be explained by two factors: In this case, the emboli were silent and cause no clinical manifestations and require no intervention. This raises many questions, whether this occurred in previous cases and passed unnoticed or it is truly the first time? Is it necessary to follow up patients with recurrent or staghorn stone who had undergone PNL by chest imaging? Conclusion Calcular pulmonary embolism may occur post PNL. Recurrent surgery and staghorn stones may be risk factors. In such case, stoppage of the procedure may be the best option to avoid stone migration into the venous system by the effect of the wash and the negative pressure in the veins. Follow-up by chest imaging after PNL for staghorn stone may be required to exclude such rare complication. Conflict of interest The authors have no conflict of interest to declare. AUA guideline on management of staghorn calculi: J Urol 2: Eur Urol 53 1: Arab J Urol Eur Urol 37 2: J Endourol 21 8: Lewis S, Patel U Major complications after percutaneous nephrostomy-lessons from a department audit. Page 2

3 Chapter 2 : Final Programme - blog.quintoapp.com [et al.] -- Retroperitoneal masses / Pietro Pavlica, Massimo Valentino, and Libero Barozzi -- Imaging of renal artery stenosis / Robert Hartman -- Renal masses / Philip J. Kenney -- Non-neoplastic renal cystic lesions / Sameh K. Morcos -- Urological and vascular complications post-renal transplantation / Tarek El-Diasty and Yasser Osman. Experimental and clinical Jan J. Weening, The Netherlands Hypertension. Experimental Andreas Kribben, Germany www. Rehabilitation Naomi Clyne, Sweden Diabetes. Cardiovascular complications Carmine Zoccali, Italy Dialysis. Protein energy wasting, inflammation and oxidative stress Peter Barany, Sweden Renal transplantation. Experimental, immune-tolerance of allogenic and xenogenic transplants Bruno Watschinger, Austria Renal transplantation. Fevzi Ersoy, Turkey Vincent L. Griffin, Ireland Josep M. Molnar, Hungary Leo A. Pedersen, Denmark Norberto Perico, Italy www. Tsakiris, Greece Photini-Effie C. We strongly encourage you to access our online version available at www. Certificate of attendance The certificate of attendance will be sent to all regularly registered delegates by after the congress. If you need a hard copy, you can collect it at the dedicated desk located in the Registration Area of the ExCeL London starting from May 28, after Coffee and tea break Complimentary coffee and tea will be served in the Exhibition, during all coffee breaks, except on May 28, when refreshments will be served close to the session halls. Congress membership Regularly registered participants are entitled to attend all Scientific and Poster Sessions, Welcome Ceremony and Reception and the Industrial Exhibition. Onsite they will also receive a congress kit including the Final Programme and the voucher for the Abstract CD. Accompanying guest registration is not available; however, all participants can take part, with their accompanying guests, in the Welcome Ceremony and Welcome Reception on May 28, All participants must wear their name badge when attending any congress event. Please note that only attendants wearing delegate badges are entitled to attend lecture and poster sessions. The information printed on the badges is exactly the one provided by participants during the registration procedure. A replacement badge will cost EUR The courses are reserved to regularly registered congress members and are included in the registration fee. An internet point is available in the Registration Area; a Wi-Fi service is provided in the main public spaces of the congress centre, meeting rooms and exhibition. There is a business centre located in the Boulevard, Level 1. No additional travel grants, reduced fees or financial support of any kind can be given to participants. Upon registration, the participant accepts this proviso. Language of the Congress The official language of the Congress is English. No simultaneous translation will be provided. Lunch Snack bars and catering areas will offer snacks and sandwiches for purchase; they are located in the Exhibition. Most of the Companies that have arranged Industry Sponsored Symposia will offer lunch to the participants. The desks will be open at the following times: Wednesday, May 27 Please refer to page 18 for further accreditation details. All speakers should bring their presentations stored on a CD, DVD or USB memory stick to this room no later than 2 hours before the start of their session or the afternoon of the day before if the presentation refers to the first morning sessions. The use of laptop computers and traditional slides will not be possible. The Disclosure of Interest of all Invited Speakers and Chairs will be made available at the beginning of each session. Moreover, they have been posted on the London Congress website www. Information on this matter can be found at www. For more information, visit www. All Congress members will then be awarded the number of credits towards the hours actually spent participating in the sessions of the congress. All speakers are requested to keep to their allotted time. Please ensure that you are in your session hall at least 10 minutes before the session starts, and remain until the end of the session. All presentations need to be prepared in PowerPoint. There will be two poster sessions, with the following timetable: Friday, May 29 The organisers will provide suitable fixing material during this period When the exhibition is closed, only authors with a congress badge will be able to enter and go through the exhibition area through a preferential Page 3

4 way to get to the poster area. The code number of each poster indicates both the position of the display board as well as the abstract number in the Abstract CD-ROM. Presenting authors are kindly requested to be present throughout the official poster viewing time in order to explain their research and to answer questions from the delegates. There will be no guided formal discussion. Posters which are not dismounted by the end of each day will automatically be disposed of. Abstract numbering system e. The total sum â EUR 50, - has thus been allocated to the best rated abstracts in the various categories. All winners will receive: The Presenting Authors of the two best abstracts of each category will also receive a diploma, independently of age. The Paper Selection Committee has also selected the 11 best abstracts overall, the authors of which will receive a diploma. No other grants or financial support of any kind, besides the grants mentioned above, will be given to Congress participants. Abduzhappar Gaipov, Asana, Kazakhstan www. This grant is meant to cover travel and accommodation expenses; all winners also receive a free congress registration. Be sure to help and support this initiative, which is based on the number of replies received to the survey sent to all Congress participants after the event: The bursaries are awarded competitively each year. Andrew Streets, Sheffield www. On 30 May, the voting station will close at Voting will also be possible immediately before the start of the General Assembly, which will take place from 9. A valid identification document ie passport or national identity card of the full member who wishes to vote must be shown in order to receive the voting credentials, should a member no longer remember them. Voting by proxy is NOT possible. Candidates for Ordinary Council Membership in alphabetical order according to last name: Access is open to current members only: The meeting will take place on May 30, from 9. Both lists of books and order forms are available at the OUP booth in the exhibition area. Exclusive free access to EuroPD videos. European National Societies The RA has worked to promote and disseminate research that may ultimately improve outcomes for patients with kidney disease, and has taken a leading role in the education of clinicians and scientists interested in kidney disease, and the planning and development of clinical services. The RA has become increasingly aware of the importance of healthcare delivery by a multidisciplinary team and is affiliated with the British Renal Society, the umbrella organisation for healthcare and patient organisations with an interest in kidney disease. The objectives of the Renal Association are: We also welcome clinicians in other fields who have an interest in nephrology to join us as members. The whole UK renal community must work together to develop service delivery models and share innovation and good practice in order to overcome the challenges facing the NHS today. As a smaller community within the Renal Association, all members can feel a part of the association and there are always opportunities to play an active role. The BAPN has historically been a medical organisation but as a part of the multi-professional Renal Association, membership is now open to other professionals working with children with kidney disease and we are keen to attract other members of the multi-disciplinary team to work with us to improve standards of care. In addition to the Renal Association membership benefits, as a member of the BAPN, you would have the following benefits: Key RA named lectures for are as follows: The press pass provides access to all sessions and symposia of this congress. Also for onsite registration, media representatives are kindly asked to come to the press room. The following identification will be required: Public relations personnel and exhibitors cannot register as Press! Press folders and other materials will be available. Thursday, May 28 Kidney Congress Insights Tuesday, May 26, 7. Scientific Press Conference Friday, May 29, 9. Press Get-together Friday, May 29, 8. We would like to invite all who join the press conference to an informal Press Get-together location to be announced â please sign up in the press office on Friday if you wish to attend. The embargo is lifted at the beginning of the presentation, not at the beginning of the session! No other city on the planet matches London for energy, diversity, creativity and constant reinvention. A city that offers 8, restaurants, museums and over galleries, as well as a great range of accommodation, free attractions and an efficient transport network. The quickest way to get around is on the underground system known as the Tube. Travel cards and tickets can be purchased at Page 4

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6 Chapter 3 : Urogenital Imaging (1st Ed.) by Morcos, Morcos, Thomsen, Thomsen & Morcos Urogenital Imaging: A Problem-Oriented Approach. 6 Urological and Vascular Complications Post-renal Transplantation 99 Tarek El-Diasty and Yasser Osman. National award for Medical Sciences, Egypt, King Faisal International Prize, Arab America Association, Recipient of the Egyptian National Scientific Award, [9] European Urology Society nominated him in to receive its annual award. Member, the Society of Surgical Oncology, U. Member, International Scoiety of Urology, Results of Treatment in Carcinoma of the Bilharzial Bladder. Pathobiology and management of carcinoma in situ of the bladder. Management of superficial bladder cancer. Urinary diversion following Cystectomy, P. ElSebai, Rad preoperative radiotherapy and cystectomy for the treatment of carcinoma of the bilharzial bladder. Tropical Urology; Churchil-Livingstone, Edinburgh, Bilharziasis the lower genitourinary tract. Urologie; Masson, Paris, Bladder Reconstruction and Continent Diversion, King, Stone and Webster. The Modified Rectal bladder P. Non-transitional Cell Bladder Cancer, P. Orthotopic bladder substitutes, P. Radical Cystectomy in Men. Textbook of Genitourinary Surgery: Blackwell Science,, H. The rectal bladder for urinary diversion, Transposition of the penis and tesits Bilharzial strictures of the ureter presenting with anuria. Radical Cystectomy for the treatment of Carcinoma of the bilharzial bladder, The use of ileum for the correction of advanced or complicated bilharzial lesions of the urinary tract, International Urology and Nephrology 4: Carcinoma of the bilharzial bladder in Egypt clinical and pathological features. Staging of carcinoma of the bilharzial bladder, Carcinoma of the bilharzial bladder: Diagnostic value of urine cytology, The rectal bladder with perineal colostomy for urinary diversion, Verrucose carcinoma of the urinary bladder, Further experience with the rectal bladder for urinary diversion, The urethral pressure profile: The urethral response to vesical distension, the collecting phase, The urethral response to vesical distension: Gaballah The role of dialysis in the management of obstructive renal failure, Mansoura Medical Bulletin, 3: A study on the efficiency of electric stimulation of the pelvic floor, Radical cystectomy for carcinoma of the bilharzial bladder: Radical cystectomy with or without prior irradiation in the treatment of bladder cancer, Whitmore, M Batata and M. A comparative study of two preoperative radiation regimens with cystectomy for bladder cancer, Renal allotransplantation in Egypt: Process-Verbaux, Memories et Discussion, Renal allotransplantation at Mansoura: The Egyptian Journal of Urology, 6: Intravesical administration of Misonidazole in bladder carcinoma. Cystectomy for carcinoma of the bilharzial bladder: La vessie rectale en tant que derivation urinaire, Bulletin Alexandria Faculty of Medicine, The urinary bladder in bilharziasis: Emirates Medical Journal, 3: Results of treatment in carcinoma of the bilharzial bladder, Uroflowmetric evaluation of the prostatic patient Mansoura Medical Bulletin, Impact of Schistosomasis on the pathology of bladder carcinoma, The effect of exogenous prostaglandins and indomethacis on micturition, Evolution of the rectal bladder as a method for urinary diversion, Cytologic detection of bladder cancer in a rural Egyptian population infested with Scistosomaisis, Partial flap ureteroneo cystostomy for bilharzial strictures of the lower ureter, Intravesical administration of Misonidazole in bladder carcinoma, Percutaneous Nephrostomy in Urologic practice, Cystectomy for carcinoma of the bilharzial bladder patients, 10 years later, Randomized trial of cystectomy with or without preoperative radiotherapy for carcinoma of the bilharzial bladder, Rigid ureteroscopy for the treatment of ureteric calculi. An experience in cases, An appliance free, sphincter controlled bladder substitute: The urethral Kock pouch, Elective conversion from cyclosporin to azathioprine in living related donor kidney transplants,, Nephrol. A computer based system for Urology and Nephrology,, Brit. Schistosomal specific nephropathy leading to end-stage renal failure,, kidney International, Value of Renal Biopsy in Chronic renal failure, International Urology and Nephrology, Prophylactic maltose tetrapalmitate and B. Preliminary report,, J. Characterization of kidney lesions in early Schistosomal-specific Page 6

7 nephropathy. Cytokeratin shedding in urine: Effect of anti-schistosomal treatment on schistosomal-specific nephropathy,, Nephrol. Urinary diversion to the augmented and valved rectum: Endourologic treatment of strictures of the bilharzial ureter,, J. Could it be of valve in prediction and diagnosis of renal allograft rejection? A prospective randomized study of the protective effect of verapamil on ischemic renal injury in renal allotransplantation,, Transplantation proceedings, Replacement of the bladder by the urethral Kock pouch,,j. Schistosoma haematobium induced glomerular disease;, Nephron, Tribukait, Abdel Fattah A. Characterization of squamous cell bladder tumours by flow cystometric analysis;, J. Prediction of lymph node metastases in bladder carcinoma with flow cytometric analysis;, J. ESWL of renal and ureteric stones,, Urologie poster, 2: Optimization of replacement of ureter by ileum,, J. Bladder substitutes controlled by the anal sphincter: A comparison of the different absorption potentials. Urethral controlled bladder substitution: Urological complications following live donor kidney transplantation: Effect of Urinary Schistosomiasis. Further Experience with the Urethral Kock Pouch. Further Experience with the Modified Rectal Bladder. Chapter 4 : Renal Transplant Introduction. The urological complications after renal transplantation have been addressed in many reports. With current improvements in graft survival concomitant with better immunosuppression, it would be unacceptable to lose a patient or graft as a result of technical issues. Chapter 5 : Publications Authored by Yasser Osman PubFacts Objective To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors. Patients and methods A consecutive series of renal transplants were audited, and a database of donor and recipient characteristics. Chapter 6 : Urogenital Imaging: A Problem-Oriented Approach Purpose. We performed a randomized, prospective trial to compare the incidence of early urological complications and health care expenditures in renal transplant recipients with or without ureteral stenting. Chapter 7 : Publications Authored by Ahmed S El-Hefnawy PubFacts Our cheapest price for Urogenital Imaging A Problem-Oriented Approach is $ Free shipping on all orders over $ Chapter 8 : Calcular pulmonary embolism SpringerLink - blog.quintoapp.com Postoperative surgical complications were vascular in %, urological in %. Late surgical complication were rare. The one year and 5 years graft survival were 80% and 69% respectively, while the patient survival were 93% and 87% respectively. Chapter 9 : shareat-mn(english Urogenital Imaging A Problem-Oriented Approach 6 Urological and Vascular Complications Post-renal Transplantation Tarek El-Diasty and Yasser Osman. Page 7