James A. Tremann

The Use of Self-Retained Ureteral Stents in the Management of Urologic Complications in Renal Transplant Recipients

Nineteen self-retaining ureteral stents were used to manage postoperative ureteral obstruction and fistulas in 12 renal transplant recipients. In 3 patients with ureteral obstruction and 2 with a fistula placement of the self-retaining stents for 4 to 6 weeks allowed the complication to resolve. In 3 patients with ureteral obstruction placement of the self-retaining stents allowed for stabilization of the condition and reduction of immunosuppression therapy before an open surgical repair. In 6 patients self-retaining ureteral stents were used to protect the high risk anastomosis done at an open surgical repair of a complication. Placement of a self-retaining ureteral stent may be the best choice in the early management of ureteral obstruction and fistulas in transplant recipients.

Ureteroileostomy in renal transplant patients. A modified technique.

Abstract Five patients have received renal homografts with urinary drainage into ileal conduits since March 1970. The renal vessels were anastomosed end-to-side into the terminal vena cava and aorta. The ureter, in its normal dependent position, entered a short ileal segment. The only complication in the series was a parastomal hernia developing thirty-three months after the transplant. We believe this technique offers several advantages over those previously described.

Management of intrarenal vascular malformations

Abstract The management of any intrarenal vascular malformation requires precise radiologic identification of the type, location, and size of the lesion in addition to knowledge of its natural history. With few exceptions, surgical correction of these lesions should be performed at the time of diagnosis. A surgical technique utilizing transabdominal exposure, hilar dissection, selective hypothermia, and Doppler localization is outlined that should allow repair of most of these lesions with maximum renal preservation.

Ureteral stent in renal transplant recipients

Abstract The Gibbons indwelling ureteral stent was used in 5 renal recipients. Early post-operative obstructions at the ureterovesical junction in 2 cases and 1 at the ureteropelvic junction were treated by placing the stent through an open cystostomy. Late strictures were treated in 2 patients by inserting the stent endoscopically. It was also used to stent a ureteroureterostomy. After removal of the stent in 2 of 3 patients, no further treatment of the obstruction was required. In the third case it provided time to allow the steroid dose to be lowered so definitive repair could be undertaken. One stent has remained patent for fourteen months. The Gibbons stent appears to be a valuable new tool in the treatment of post-transplant ureteral obstruction.

Serum blocking factors in human recipients of renal allografts.

SUMMARY The host response of human renal allograft recipients was studied using the cell inhibition assay. Cellular immunity was present in the majority of recipients early in the post-transplant period, falling to a low incidence in later periods. Conversely, cellular immunity with a blocking effect or nonimmunity was most common late in the posttransplant period. The lack of immunity or the presence of blocking activity correlated well with a good clinical course. Sequential data on six patients support the importance of these factors.

Long-term ureteral replacement prosthesis.

A silicone rubber tube with bonded Dacron felt cuffs have been implanted in dogs as a ureteral replacement prosthesis. A one-way valve has also been developed to prevent reflux so the prosthesis may be put into the bladder. The prosthesis has been implanted for periods up to nine months. Although there are some problems associated with the prosthesis, most animals have maintained a normal serum creatinine, sterile urine, and a normal excretory urogram.

RESULTS OF LARGE-CALIBER INTERNAL URETHROTOMY"

Thirty-five patients undergoing internal urethrotomy for urethral stricture disease were reviewed retrospectively. Eight patients had conventional urethrotomies (less than 36 F) while 27 had large-caliber urethrotomies (greater than 40 F). Large-caliber urethrotomy tends to give longer symptom-free intervals immediately postoperatively, but long-term results show little difference between the two groups.

Urethral hyperthermia An alternative to urethrectomy

Nine male dogs were subjected to cystoprostatectomy, ileal loop diversion, and urethral hyperthermia. Five of the 9 dogs survived six weeks. Three of the 5 surviving dogs had complete destruction of the urethral epithelium, and the other 2 dogs had 95 per cent and 50 per cent destruction with the proximal urethral end incompletely destroyed. Complete urethral destruction may have been obtained with resection of the proximal urethra postirrigation. The irrigation added no extra time to the surgical procedure and was accompanied by few complications. Complications may have been averted with a dorsal slit and meatotomy.

Nephrectomy for Renovascular Hypertension in Azotemic Patients

AbstractAzotemic patients with malignant hypertension secondary to increased renin production benefit significantly from correction of the lesion by renal vascular repair, if that is possible, but unilateral nephrectomy should not be denied these patients despite the azotemia. We believe that this phenomenon is related to an altered hemodynamic state, which increases renal blood flow postoperatively and requires large volumes of fluid in the early postoperative phase.