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C199: Urological patients on hemodialysis - a multidisciplinary approach
C199: Urological patients on hemodialysis - a multidisciplinary approach Rudziński M.R.1, Antoniewicz A.A.1, Zapała Ł.1, Dylewski K.2, Małecki R.2 1
Interdisciplinary Hospital Miedzylesie, The Uronephrology Center, Dept. of Urology, Warsaw, Poland, 2Interdisciplinary Hospital Miedzylesie, The Uronephrology Center, Dept. of Nephrology, Warsaw, Poland INTRODUCTION & OBJECTIVES: Departments of urology, nephrology, dialysis and renal transplantation units are integrated in multidisciplinary centers. Close cooperation allows urologists to perform successfully and safely high risk procedures in complex/comorbid urological patients. On the other hand nephrological patients on dialysis can also be treated urologically on demand. Our goal was to review hemodialysis patients treated urologically, recognize the profile of the patients, most frequent urological problems and procedures. The second objective was to measure surgical results and outcomes in this specific group of patients. MATERIAL & METHODS: Retrospective analysis of 57 hospitalizations in The Department of Urology of 36 dialysis patients, between June 2013 and July 2014 was conducted. RESULTS: Overall, 36 patients (24 male and 12 female) underwent 159 hemodialyses. 103 as part of a routine hemodialysis programme and 56 as urgency. The average age was 65. In this period 20 patients (56%) underwent 27 (41%) elective operations: radical prostatectomy - 1, radical cystectomy - 1, bilateral nephrectomy - 2, unilateral nephrectomy - 4, partial nephrectomy (4 tumours in a solitary kidney) - 1, radiofrequency ablation of a solitary kidney tumour - 1, bilateral orchidectomy 1, optical urethrotomy - 1, urethrocystoscopy - 11, double J stent replacement - 2. Aditionally 7 patients were qualified for renal transplantation. Another 16 (44%) and 4 (11%) after elective surgery with minor complications, underwent 39 (59%) urgent procedures: nephrectomy -1, ureterolithotomy and orthotopic bladder reconstruction - 1, bilateral internal iliac arteries embolization - 1, drainage of a complicated pararenal hematoma/abscess - 3, drainage of a prostatic abscess - 1, transurethral resection of bladder tumour - 5, urethrocystoscopy and bladder tumour fulguration - 3, bilateral nephrostomy - 7, unilateral nephrostomy - 10, double J stent insertion - 7. All urological procedures went uneventfully and were uncomplicated. Mean time of hospital stay was 8.5 day, which was twice as much, as for others. There was only one death in bladder cancer patient treated palliatively. CONCLUSIONS: The continuous ability of dialysis on demand makes the range of urologic treatment much wider. It ensures safety of the patient and gives comfort to the surgeon. In our material more than a half of dialysis patients underwent elective operations and on the other hand dialyses were made two times more likely as a scheduled procedure than an urgent one. Treatment of dialysis patients carries increased risk of adverse events and is ussualy longer. Eur Urol Suppl 2014; 13(6) e1369
Interdisciplinary Hospital Miedzylesie, The Uronephrology Center, Dept. of Urology, Warsaw, Poland, 2Interdisciplinary Hospital Miedzylesie, The Uronephrology Center, Dept. of Nephrology, Warsaw, Poland INTRODUCTION & OBJECTIVES: Departments of urology, nephrology, dialysis and renal transplantation units are integrated in multidisciplinary centers. Close cooperation allows urologists to perform successfully and safely high risk procedures in complex/comorbid urological patients. On the other hand nephrological patients on dialysis can also be treated urologically on demand. Our goal was to review hemodialysis patients treated urologically, recognize the profile of the patients, most frequent urological problems and procedures. The second objective was to measure surgical results and outcomes in this specific group of patients. MATERIAL & METHODS: Retrospective analysis of 57 hospitalizations in The Department of Urology of 36 dialysis patients, between June 2013 and July 2014 was conducted. RESULTS: Overall, 36 patients (24 male and 12 female) underwent 159 hemodialyses. 103 as part of a routine hemodialysis programme and 56 as urgency. The average age was 65. In this period 20 patients (56%) underwent 27 (41%) elective operations: radical prostatectomy - 1, radical cystectomy - 1, bilateral nephrectomy - 2, unilateral nephrectomy - 4, partial nephrectomy (4 tumours in a solitary kidney) - 1, radiofrequency ablation of a solitary kidney tumour - 1, bilateral orchidectomy 1, optical urethrotomy - 1, urethrocystoscopy - 11, double J stent replacement - 2. Aditionally 7 patients were qualified for renal transplantation. Another 16 (44%) and 4 (11%) after elective surgery with minor complications, underwent 39 (59%) urgent procedures: nephrectomy -1, ureterolithotomy and orthotopic bladder reconstruction - 1, bilateral internal iliac arteries embolization - 1, drainage of a complicated pararenal hematoma/abscess - 3, drainage of a prostatic abscess - 1, transurethral resection of bladder tumour - 5, urethrocystoscopy and bladder tumour fulguration - 3, bilateral nephrostomy - 7, unilateral nephrostomy - 10, double J stent insertion - 7. All urological procedures went uneventfully and were uncomplicated. Mean time of hospital stay was 8.5 day, which was twice as much, as for others. There was only one death in bladder cancer patient treated palliatively. CONCLUSIONS: The continuous ability of dialysis on demand makes the range of urologic treatment much wider. It ensures safety of the patient and gives comfort to the surgeon. In our material more than a half of dialysis patients underwent elective operations and on the other hand dialyses were made two times more likely as a scheduled procedure than an urgent one. Treatment of dialysis patients carries increased risk of adverse events and is ussualy longer. Eur Urol Suppl 2014; 13(6) e1369