Anterior and posterior nutcracker syndrome: A report on 11 cases

29

30

RENAL PRESERVATION BY MACHINE PERFUSION. EXPERIMENTAL COMPUTERIZED DESIGN

ANTERIOR AND POSTERIOR REPORT ON 11 CASES

Lledo-Garcra E.‘, Subira D.‘, Castaiio I.~, Moralejo Cabello R.‘, del Cai?izo-Lhpez J.?, HemBndez-Femandez

Ali-El-Dein M.A.

‘Hospital Universitario Gregorio Maration, Universitario Gregorio Maration, Experimental

M.‘, Martincr-Salamanca C.’

Urology, Medicine,

Madrid, Spain, Madrid, Spain

INTRODUCTION & OBJECTIVES: Hypothermic

renal perfusion which modifies renal vascular resistance (RVR). Objectives. l.To influence of the pump type and perfusion solution on the hydrodynamic 2.To show evidence of the presence of new appearance of nitric oxide perfusion solution 3.To study histologic consequences of the perfusion.

J ‘,

‘Hospital

is a process evaluate the renal results (NO) m the

MATERIAL & METHODS: A computerized

renal perfusion system was used. The device allowed us to obtain information on screen in real terms on the renal hydrodynamics during perfusion (RVR). The system is composed of different parts: the organ chamber where the kidney IS maintained at a constant temperature of 4°C through a cooling system. An interface retrieves all the information from the organ through flow/pressure transducers to the computer via software. The organ is perfused either with a classical roller pump (RP) or a model of pump designed in our lab (VP). which uses vacuum or atmospheric pressure sequentially in order to achieve a truly pulsatile wave. We used I6 mini-pigs. All the kidneys obtained were perfused at a constant flow either with Eurocollins (ECS) or Belzer (BS) solution. The kidneys were weighed before and after the perfusion. Samples of perfusion solution were taken at predefined intenals. Histological studies of the organs were carried out.

RESULTS: There were no significant

differences m weight Increase in relation to the type of pump. However, kidneys perfused with ECS increased their weight significantly in comparison to BS. New appearance of NO could be detected in the perfusion solution. Its concentration increased along the process. Moreover, the NO levels maintained an inverse relation with the RVR values. The highest levels of NO and the lowest levels of RVR were obtained when we used BS and the VP. In relation to the histologic results, those kidneys perfused with BS in VP offered a histologic appearance similar to normal tissue. Kidneys perfused in RP with ECS showed a high degree of tubular and glomerular edema.

CONCLUSIONS:

1, lntrarenal circulation at 4°C responds actively both to perfusion waveform and p&&ion solution type. These changes can be recorded in real time through a computerized per&ion control 2. There seems to be the existence of NO synthesis durmg kidney perfusion process. The NO concentration in the solution maintains an inverse relationship with RVR value 3. It seems that BS and VP model provide the best experimental results Grant 96/056 I -Fonda de Investigaci6n Sanitaria.

31 EFFECT OF RENAL TRANSPLANTATION SEX HORMONE LEVELS Pourmand Akbari

G., Alavi M., Esteghamati

Asbagh

Sina Hospital,

ON SPERM QUALITY

A.. Mcht%ai A.. DJaladat H.. Zohrevand

AND

and Nephrology

Center. Urology,

A., El-Diasty

Mansoura,

SYNDROME:

T., Mansour

A

O., Ghoneim

Egypt

INTRODUCTION & OBJECTIVES: The nutcracker syndrome is one of the rare causes of hematuria. Anterior nutcracker syndrome refers to compression of the left renal vein (LRV) in the fork between the aorta and superior mcsenteric artery (SMA), while the posterior variant refers to compression of LRV behind the aorta. The diagnosis and management of this syndrome arc challenging. Between 1990 and 2000, I1 patients with nutcracker MATERIAL & METHODS: syndrome; mean age 31.5 years, were diagnosed. 9 patients complained of gross hematuria and leti loin pain, while 2 complained of occasional pain and microscopic hematuria (> 100 RBCs/HPF). Phase contrast microscopy revealed isomorphic RBCs III all patients. Abdominal ultrasonography and IVU were free. Urethrocystoscopy localized the hematuria to the left side, while left flexible ureterorenoscopy and selective urine cytology were free. Tests for urinary TB and bilharziasis, selective renal anglography, coagulation profile and renal biopsy showed no abnormalities. CT scan, MRI and left renal and vcna cava venography were perfomxd in all patients and in 20 healthy kidney donors serving as controls. RESULTS: On CT and MRI angiography the mean angle between the aorta ad SMA !n 8 patients with anterior nutcracker syndrome was 54 and in healthy controls 91. The

mean &stance between SM.4 and the aorta at the level of LRV was 3.2 and 7 mm, respectively. In 3 patients with posterior nutcracker syndrome the vein was found compressed behind the aorta. LRV and vena cava venography revealed evidence of a delayed drainage of the contrast from LRV (in all) with venous collaterals and adrenal and gonadal vein reflux (in 8). Mean pressure gradient between LRV and IVC was 9.5 cm H20. Autotransplantation was performed for 6 patients with anterior nutcracker syndrome leaving the ureter as such in 5 and reimplantation in 1. Transposition of LRV was carried out in I patient with posterior nutcracker syndrome and venolysis with omen&l packing in the other patient. The other 3 patients with mild symptoms are under longitudinal observatmn. After a mean followup of 4.5 years. complete disappearance of pam occurred in all but I patient. Hematuria disappeared in 6 and improved (~50 RBCs/HPF) in the other 2. Kidney function was maintained in all.

CONCLUSIONS:

Diagnosis of nutcracker syndrome is only made after exclusion of causes of hematuria. Autotransplantation IS the treatment of choice for anterior, while transposition of LRV is the treatment of choice for posterior nutcracker syndrome.

all known

32 LONG-TERM SURVIVAL OF KIDNEY GRAFTS FROM PAEDIATRIC INFLUENCING FACTORS DONORS INTO PAEDIATRIC RECEPTORS.

R..

F. Urology,

Tehran.

Iran

INTRODUCTION & OBJECTIVES: We studied the effect of successful renal transplantation on semen parameters, sexual function and sex hormones profile in a clinical trial. MATERIAL & METHODS: A total of 30 patients on hemodyalysis underwent renal transplantation. Preoperative and postoperative sperm density, motility, and morphology were analysed. Preoperative follicle-stimulating hormone (FSH), luteinizing

Urology

B., Osman Y., Shchab El-Dcin

NUTCRACKER

hormone

(LH), prolactin

and testosterone

levels

were measured

and

compared with six months postoperative results. Sexual function was measured before and after transplantation using an abbreviated version of the International Index of Erectile Function (IIEF). with a successful outcome defined as a level of satisfaction of 4 or 5 on a 5-point scale. The paired t-test was used to measure the statistically significance of differences in all analyses. RESULTS: The sperm motility improsd significantly (p=O.O006); howcvcr no significant changes found in morphology or density (p=O.33, 0.068 respectively). Testosterone level increased and FSH, LH and prolactin decreased significantly (~~0.05) after renal transplantation. The IIEF questionnaires were given to all 30 patients. From these, 14 were impotent before operation and only 6 patients remained impotent after transplantation (p
2 (2003) No. 1, pp. 10

0 evaluaW \abcular comphcalion\ and long-term IUTKODUCTION & OBJECTI\‘KS: I‘ funcnonel outcome (j-year, IO-year and 15.year serum crcatinine and graft survival) of kidneys from donors O-6 years transplanted to pacdlatr!c rcciplents. MATERIAL & METHODS: A retrospective study was camed out. 34 renal transplants were performed (average reopient age I I .3 years) using grafts from small donors (average age: 2.7 years, range O-6 years). 19 patients received kidneys from donors less than 3 years (55.9%). I5 from donors 3-6 years (44. I%). 22 (64%) patlents were first, 9 (26.4%) second, 1(3%) third- transplants. 17 kidneys were preserved m UW solution (UW) and I7 in Eurocollins solution (EC). Average cold ischemia was 25.9 hs (19-36 hs). lnmunosupressmn was based on CSA in 14 cases (41%) and FKS06 in 6 (8%), with PDA+AZA with/without dntlbody induction III the rest (51%). All the kidneys were transplanted mto the iliac fossa as units and as “en bloc” in 3 cases. Immediate functional and long-term (5-10-15 years) outcome of patient and graft survival was done. Data analysis was performed using T-Student trot (pc 0.05) and a multivanatr stanstlcal model. RESULTS: Delayed graft function was obsened in 57% with an average duration of 9.6 days (S-14). IO vascular complications occurred of which 7 (20.5 %) were acute and produced loss ofthe graft: 3 arterial thrombosis, 3 venous thrombosis and I graftrupture. We also observed 3 arterial stenosis. with 2 cases successFully treated by percutaneous transluminal angloplasty. Me&urn donor age of kidneys with vascular complications was significantly lower in comparison to those without vascular mm’bidity (1.8 y. vs. 3.04, ~~0.05). No vascular morbidity was observed in en-bloc cases. On the other hand, 6 out of 7 acute vascular complications occurred In kidneys preserved m EC. Multivariate analysis showed as significant factors in relation to funcnonal status: donor age (p 0.02); vascular complications (p 0.005) and preservation solution (p 0.015). In relation to functional outcome, average creatinine at I, 5, IO years was I ,36 mg/dl, I ,35 mg/dl and I ,46 mg/dl. Average graft survival values at 5, 10 and 15 years are 57,8%-35,5%-35,5%. Nevertheless, after excluding cases of donors younger than 3 years these values Increased to 80%-58,6%58.6% (p < 0.001). Also. when we evaluate grafl survival on the basis of preservation solution type, EC offered 5, IO and 15 years values of 47%-26.8%-26.X. The use of UW increased these figures to 63%-63%-63% (p