The Urologic clinics of North America
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Urol. Clin. North Am. · Nov 2001
ReviewLong-term outcome of ABO-incompatible renal transplantation.
Based on the long-term experience with ABO-incompatible kidney transplantation, the following can be concluded: 1. Renal transplantation across ABO incompatibility is an acceptable treatment for patients with end-stage renal failure. [table: see text] 2. Long-term patient and graft survival in ABO-incompatible kidney transplantation is influenced primarily by acute rejection episodes occurring within 1 year. 3. ⋯ Even though most of this rejection is controllable with anti-rejection therapy, the prognosis for a graft that undergoes humoral rejection is significantly poor. 5. The maximum IgG titers of anti-A/B antibody before transplantation may have a harmful effect on graft acceptance in ABO-incompatible kidney transplantation. 6. Renal transplantation across ABO incompatibility is principally the most significant risk factor to affect long-term allograft function in ABO-incompatible living kidney transplantation.
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Laparoscopic pyeloplasty must be compared with open surgery in terms of efficacy and with endopyelotomy in terms of morbidity. All of the series published so far show that the results of laparoscopic pyeloplasty equal those of open surgery. Laparoscopy is associated with a lower morbidity; therefore, it is preferable to open surgery. ⋯ Laparoscopic dismembered pyeloplasty is technically feasible but difficult. The authors prefer nondismembered techniques that yield equally good results in selected patients. Nondismembered pyeloplasty as described by Fenger is easy to perform and well suited for laparoscopy.
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Gram-negative sepsis syndrome is an increasingly common complication in medical and surgical patients. The molecular and cellular mechanisms underlying this dreaded complication are yielding to investigation. These studies have led to a multiplicity of targets for novel therapies. Despite highly promising results in many animal studies, clinical studies have been disappointing.
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Urol. Clin. North Am. · Nov 1999
ReviewManagement of pyelonephritis and upper urinary tract infections.
The most frequent cause of upper urinary tract infection remains E. coli. Other organisms are found in complicated infections associated with diabetes mellitus, instrumentation, stone, and immunosuppression. The pathogenesis of acute pyelonephritis is reviewed herein, with an emphasis on the virulence factors responsible for its initiation, including urothelial adhesion by P-fimbriae of E. coli and other common factors including hemolysin and aerobactin. ⋯ The symptoms of renal tuberculosis are usually limited to fever, frequency, urgency, and dysuria. Hematuria with sterile pyuria is the usual laboratory finding. The young urologist should remember this renal disease in the differential diagnosis of hematuria, because medical therapy can provide a cure.
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Urol. Clin. North Am. · Nov 1998
ReviewEvaluation and nonsurgical management of erectile dysfunction.
The addition of oral drugs to the armamentarium of therapies for erectile dysfunction promises to dramatically increase the number of men seeking treatment for this condition. It is important to have a rational approach to the diagnostic evaluation of erectile dysfunction and to tailor the evaluation to each patient's goals for his sexual function. ⋯ This article reviews the outpatient diagnostic work-up and current treatment possibilities for erectile dysfunction. The article also discusses clinical research experience with new forms or oral and topical therapies now being developed for future treatment of erectile dysfunction.