Rodrigo Guerra

Cold Renal Ischemia: Comparison of Efficacy Between Two Techniques of Cooling, in a Swine Model

OBJECTIVES In a swine model of renal ischemia, we compared the effectiveness of the transurethral retrograde cold saline perfusion technique to the traditional method of renal cooling with ice slush, in achieving adequate parenchymal temperatures for functional preservation of the organ. Physiological and histological effects were also assessed. METHODS Twenty-four domestic male pigs were sampled into four groups to be submitted to a 60-minute ischemia of the left kidney without cooling, with either one of the two cooling techniques (cold saline retrograde perfusion or ice slush), or sham surgery. All of them had also a concomitant right nephrectomy. Renal cortical and medullary temperatures were recorded throughout the experiment. Urinary output was measured, and serum renal function tests were carried on, pre- and postoperatively. After 5 days, the animals were euthanized and their kidneys were submitted to histological analysis. RESULTS Mean renal temperature fell in both groups submitted to kidney cooling. With ice slush, a faster drop was observed and a lower minimum temperature was achieved (5.0 degrees C in the cortex and 6.3 degrees C in the medulla, vs. 25.4 degrees C and 24.9 degrees C with retrograde cooling). In the other groups, temperature was unchanged. Urinary output and serum creatinine worsened after the experiment, but without significant differences among groups. The histological analysis showed no differences among the four groups, for the studied ischemia time. CONCLUSIONS Ice slush and retrograde perfusion of cold saline are both effective for cooling the kidney during ischemia. Ice slush is faster in doing so, and it allows much lower temperatures to be achieved in the renal parenchyma. With ischemia time of 60 minutes, no significant differences on the occurrence of functional and histological alterations were detected, even for the group without a cooling procedure.

Transplanting a horseshoe kidney: A case report and review of surgical strategies

Currently, most countries face a shortage of kidney, while a progressive increase in transplant waiting lists occurs. Measures such as the use of expanded criteria donors or continuous machine perfusion for organs aim to reduce the wastage of potentially usable kidneys. In such a scenario, transplanting a donated horseshoe kidney (HSK), although infrequent and technically challenging, could save more patients. The use of HSKs in transplantation has been hindered mostly by the complex anatomical features. HSKs commonly have multiple vessels, along with duplicated or anomalous collecting system, atop an isthmus (that may or not be vascularized) connecting both lower poles. A HSK may be implanted en bloc or split in two, which could be transplanted into two recipients. Either way, some kind of vascular or urinary reconstruction is likely. Few publications report the transplant of HSKs. In this paper we describe a transplant of a HSK and review technical strategies.

Impact of vulvovaginal atrophy on pelvic floor muscle strength in healthy continent women

To assess the correlation between hormonal status and pelvic floor muscle strength.

Single-port retroperitoneal renal biopsy using standard urological instruments

Objective To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB). Materials and Methods Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample. Results SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31. Conclusion SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy.

Do anticoagulant and antiplatelet agents prevent acute graft thrombosis in renal transplantation? A meta-analysis of case series studies

Universidade Estadual Paulista, Departamento de Urologia, Faculdade de Medicina de Botucatu