Murilo Ferreira de Andrade

Anatomical features of the urethra and urinary bladder catheterization in female mice and rats. An essential translational tool

PURPOSE To present fundamental anatomical aspects and technical skills necessary to urethra and urinary bladder catheterization in female mice and rats. METHODS Urethral and bladder catheterization has been widely utilized for carcinogenesis and cancer research and still remains very useful in several applications: from toxicological purposes as well as inflammatory and infectious conditions to functional aspects as bladder dynamics and vesicoureteral reflux, among many others. RESULTS Animal models are in the center of translational research and those involving rodents are the most important nowadays due to several advantages including human reproducibility, easy handling and low cost. CONCLUSIONS Although technical and anatomical pearls for rodent urethral and bladder access are presented as tackles to the advancement of lower urinary tract preclinical investigation in a broaden sight, restriction to female animals hampers the male microenvironment, demanding future advances.

Renal Abscess in Hyper-IgE Syndrome

Kidney disease due to Aspergillus fumigatus is a rare finding in hyper-IgE syndrome. We report a patient with autosomal dominant hyper-IgE syndrome, recurrent pneumonia, and acute necrosuppurative pyelonephritis caused by Aspergillus fumigatus with a fatal outcome. We emphasize the severity and the difficulties in the management of renal complications that could be limiting the survival of these patients.

Imaging in Kidney Transplantation

At the end-stage of renal failure, the best option for treatment is kidney transplantation, before starting any form of dialysis. The scarcity of organs from cadaveric donors and the comorbidity of the receptors patients, delay this treatment from being routinely performed prior to dialysis. Living-donor kidney transplantation can meet this objective perfectly, since it does not depend on waiting lists imposed by cadaveric donation [1]. In recent years, the expansion of genetically unrelated living donation has facilitated living-donor kidney transplantation as spouses, distant relatives, and even good friends have increased the pool of potential living donors. The living-donor transplants offer better survival than those of cadaveric-donor transplants, despite of HLA compatibility [2, 3].

Complications after bladder augmentation in children

PURPOSE Bladder augmentation is an effective surgical procedure for increasing bladder capacity and reducing pressure on the urinary system. It is indicated for patients with anomalies such as spina bifida, myelomeningocele, urethral valve and bladder exstrophy, who progress with low tolerance of medication. CASES This was a retrospective study conducted on pediatric patients submitted to bladder augmentation from 2000 to 2011. RESULTS 34 patients aged 4 to 17 years were submitted to bladder augmentation, 30 of them with an ileal loop and 4 with a ureter.A continent urinary shunt was performed in 16 patients, the Mitrofanoff conduit was associated in 15, and the Macedo technique was used in one. Mean follow-up was 34.35 months (1 to 122 months). Mean creatinine was 1.5 ng/ml (0.4 to 7.5 ng/ml) preoperatively and 1.78 ng/ml postoperatively. Three patients required a renal transplant during follow-up. There was improvement or resolution of vesicoureteral reflux in 83.5% of the kidneys on the right and in 75% on the left. Bladder capacity increased, on average, from 152.5 ml to 410 ml. The main complications were vesical lithiasis in 3 patients and conduit perforation in one. CONCLUSION Bladder augmentation showed good results in this series, preserving renal function in most of the patients.

Abdominal compartment syndrome caused by massive pyonephrosis in an infant with primary obstructive megaureter.

The authors report a case of abdominal compartment syndrome caused by massive pyonephrosis in an infant with primary obstructive megaureter successfully treated with emergency surgical decompression.

Chronic partial urethral obstruction in female rats: description of an experimental model and initial results

PURPOSE To develop an experimental model of infravesical urinary obstruction in female rats. METHODS After median caudal laparotomy, the urethra of 14 female rats was delicately separated from the vagina and loosely wrapped with cellophane tape measuring 0.4 x 1.0 cm. The animals were evaluated 4 (n=7) and 8 (n=7) weeks later. Five additional control animals were only subjected to separation of the urethra and vagina and monitored for 12 weeks. RESULTS After four weeks, three rats presented vesical dilation associated with discrete ureteral ectasis in 2 animals, with the third presenting discrete hydronephrosis in one kidney. After eight weeks, five rats (71.4%) presented vesical distension with bilateral ureterohydronephrosis. No significant changes (p>0.05) in serum urea or creatinine occurred in any group compared to preoperative values. CONCLUSION We present here an inexpensive and simple method for the slow induction of urethral obstruction in adult female rats, with the development of progressive vesical hypertrophy and ureterohydronephrosis, which may be used as an experimental model for the study of different aspects of obstructive nephropathy.

Surgical Complications of Renal Transplantation

In the early era of kidney transplant, surgical complications were a major cause of graft loss. Between 1960 and 1980, the estimated incidence was around 20%. With the improvement of surgical techniques, the frequency of these complications has dropped significantly and this subject until then common in the medical literature came to be seldom discussed (Botto V, 1993; Hernandez D, 2006). Currently, it is estimated that in large transplant centers the incidence of surgical complications is less than 5%. In general, the results of renal transplantation have improved primarily as a consequence of advances in medical and immunosuppressive therapy and progress in surgical techniques. Posttransplant urologic complications are unusual, with the range of 2.5% to 27% in most series, and can cause significant morbidity and mortality (Zargar MA, 2005; Dalgic A, 2006) Results have improved over the past decade as a direct application of less invasive endourologic diagnostic and therapeutic techniques of the surgical complications (Streem SS, 1994). However, the etiologies are the most common technical problems and association with immunological complications. Surgical complications after renal transplantation can be classified mainly as vascular (arterial and venous thrombosis, renal arterial stenosis, lymphocele, hemorrhage) and urologic (ureteral obstruction, vesicoureteral reflux, urinary fistula), although other types of complications are not uncommon, like graft’s rupture and hematoma. These complications can occur early in the intra-operative, immediate postoperative period or later, and imply in increase morbidity, hospitalization and costs (Humar A, 2005). Urologic complications are the most common surgical complication after renal transplantation, causing significant morbidity and mortality. Recently, the incidence of urologic complications after renal transplantation has decreased to 2.5% to 12.5% (Emiroglu R, 2001). Unfortunately, there is a still higher incidence of technical complications in pediatric recipients, reaching approximately 20% with an associated 58% and 74% graft survival rates for cadaveric and living-related transplantation (Salvatierra O Jr, 1997; US Renal Data System, 1996). Urologic complications represent an important cause of morbidity, delaying normal graft functioning, and in some cases leading graft loss and/or patient death (Beyga ZT, 1998; Colfry AJ Jr, 1974; Mundy AR, 1981; Hakim NS, 1994).