The role of stent and cotrimoxazole in prevention of UTI after kidney transplantation

Tabriz University of Medical Sciences, Tebriz, East Azarbaijan, Iran
Transplantation Proceedings (Impact Factor: 0.98). 09/2001; 33(5):2667. DOI: 10.1016/S0041-1345(01)02138-8
Source: PubMed
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    ABSTRACT: Zusammenfassung Die urologisch-chirurgischen Techniken der Nierentransplantation sind standardisiert und haben in den letzten 50 Jahren kaum wichtige nderungen erfahren. Durch den anhaltenden Spendermangel kommen aber zunehmend technisch anspruchsvolle operative Verfahren und marginale Organe zum Einsatz. Das betrifft Kinderspendernieren, anatomische Varianten, En-bloc-Transplantationen und Mehrfachgefversorgungen. Die operativ-technischen Entwicklungen (z. B. laparoskopische Techniken) sind auch im Bereich der Nierentransplantation etabliert. Wir geben mit unserem Artikel einen berblick ber den Standard der Technik der Nierentransplantation, mglicher chirurgischer und urologischer Komplikationen, Ergebnisse des eigenen Patientenguts und gehen auf technische Modifikationen bezglich der Gefnahttechniken, Besonderheiten im Kindesalter, Management von Komplikationen und auf Sonderflle sowie experimentelle Verfahren ein. Abstract Surgical techniques in renal transplantation are standardized and have remained basically unchanged for the last 50 years. A limited pool of donor organs is still an unsolved problem. Therefore, marginal organs are also used. Sophisticated techniques are used in children and in cases with vascular problems or complications. Laparoscopic techniques are emerging in renal transplantation. The article provides an overview on current technical standards of renal transplantation and potential surgical and urological complications. We report the results of our own renal transplantation program with special emphasis on vascular techniques, pediatric transplantation, and the management of complications. Special case reports are included.
    Der Urologe 02/2003; 42(3):328-337. · 0.44 Impact Factor
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    ABSTRACT: The early urinary tract infection (EUTI) in kidney transplant recipients is an infection develop during the first 3 months post transplant surgery. The effect of EUTI on graft survival and risk factors have been scarcely studied. Our objetives were the evaluation of risk factors to EUTI, the assessment of the causal agent and graft survival impact. A retrospective analysis of kidney transplantation, period 1997-2000 in Hospital Privado-Centro Médico de Córdoba was carried out. There were two groups of patients with (EUTI group) and without EUTI (control group). Cox model was used to analyze risk factors and Kaplan-Meier method for graft survival. A total of 226 consecutive patients received kidney transplantation. In 55 patients (24.3%) EUTI was detected. Risk factors for EUTI were: invasive urological maneuvers (RR = 4.34, CI 95% 1.42-13.21), diabetes mellitus (RR = 3.79, CI 95% 1.42-10.14), cytomegalovirus infection (RR = 2.9, CI 95% 1.02-8.24) and previous transplants (RR = 2.83, CI 95% 1.08-7.45). Delayed graft function was associated with lower incidence of EUTI (RR = 0.38, CI 95% 0.15-0.94). The causal agents were: Klebsiella pneumoniae (36%), Pseudomonas aeruginosa (24%) and Escherichia coli (9%). Graft survival at 2 years was similar in EUTI (87.2%) and control group (81.2%, p = 0.32). This series shows that invasive urological maneuvers were the main risk factors for EUTI. Graft survival was similar. High prevalence of non coli bacteria need further evaluation.
    Medicina 02/2005; 65(5):409-14. · 0.56 Impact Factor
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    ABSTRACT: To evaluate the impact of the routine use of double-J stents in live-donor renal transplantation at a single institute from a prospective randomized study. A total of 100 patients were prospectively randomized into two groups of 50 patients each. Group 1 received a routine double-J silicone ureteral stent and group 2 did not. A standard Lich-Gregoir ureteroneocystostomy was performed in both groups. In group 1, the patients were scheduled for stent removal after 2 weeks. Both groups were comparable in terms of age, sex, ischemia time, number of renal arteries, and time to diuresis. In group 1, two grafts were lost in the early postoperative period and those patients were excluded from the final analysis. None of our patients in either group had developed a ureteral stricture at a mean follow-up of 10.8 +/- 3.6 months. In the stented group, 2 patients developed a urinary leak, but no leakage was reported in the nonstented group (P = 0.14). Although 19 patients in group 1 (39.6%) had a urinary tract infection, only 9 in group 2 (18%) showed evidence of a positive urine culture (P = 0.02). The presence of a ureteral stent and female sex were the independent predictors of postoperative urinary tract infection on multivariate analysis. The mean serum creatinine at discharge was 1.2 +/- 0.3 mg% and 1.2 +/- 0.4 mg% in groups 1 and 2, respectively (P = 0.2). The results of our study have shown that routine ureteral stent insertion has no impact on the rate of vesicoureteral leakage or obstruction in live-donor renal transplantation, whereas it is significantly associated with an increased incidence of urinary tract infection. Stenting should be limited to patients with a pathologic and/or defunctionalized bladder.
    Urology 06/2005; 65(5):867-71. DOI:10.1016/j.urology.2004.11.050 · 2.19 Impact Factor
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