The alpha-blocker tamsulosin seemed to facilitate stone clearance, particularly with larger stones during shock wave lithotripsy for renal and ureteral calculus. It also appeared to improve the outcome of steinstrasse. Tamsulosin may have a potential role in routine shock wave lithotripsy.
OBJECTIVE
To evaluate potential donor kidneys with asymptomatic calculi detected during screening, and the management of the calculus before, during and after transplantation, as with fewer live donors, marginal kidneys and donors are a significant subgroup in renal transplantation.
PATIENTS AND METHODS
Five live‐related donors, with one incidentally detected calculus during their routine evaluation, were accepted for transplantation. Of these, three were detected only on spiral computed angiography. There was no biochemical evidence of a metabolic abnormality or history of stone disease. One donor had elective lithotripsy and another nephrolithotomy under ultrasonographic control immediately after perfusion. The others were transplanted with the calculus in situ. Ureteric reimplantation was by the Leadbetter‐Politano technique over a JJ stent.
RESULTS
One recipient patient passed the calculus within 4 h of stent removal. The follow‐up ultrasonogram at 3 months showed a stone in only one recipient. In the others, the calculus could not be seen after stent removal. The maximum follow‐up was 2 years and graft function has remained normal in all.
CONCLUSIONS
Voluntary kidney donors with one calculus incidentally detected on routine evaluation form a unique group and can be accepted for transplantation in selected cases. Careful follow‐up of the donor and recipient is essential, with early intervention if necessary.
Bacteriuria due to Salmonella typhi usually occurs following recent typhoid fever or in chronic carrier states. Data from 18 patients with S. typhi bacteriuria, seen during 5 years, were analyzed. Fourteen patients had localized urinary tract infection due to S. typhi. Four others had bacteriuria, probably associated with typhoid fever. Localized abnormalities of the urinary tract and kidneys and also systemic diseases were found to predispose patients to S. typhi bacteriuria. Local abnormalities encountered included urolithiasis (n ؍ 3), prostatic hypertrophy (n ؍ 1), and tuberculosis (n ؍ 1). One renal transplant recipient and another with lupus nephritis had S. typhi bacteriuria. One had associated strongyloidosis, and another was pregnant.
High grade and LVI in the tumor along with clinical stage of the inguinal nodes were the strongest predictors of metastasis. These features helped us to develop a nomogram to predict and to identify patients at risk of nodal metastasis.
The TFL flap can reduce postoperative morbidity and decrease hospital stay. Prophylactic TFL flap reconstruction following ilioinguinal dissections is advisable.
In radiation cystitis, multiple hospital admissions and consequential increase in cost is the norm. In severe disease, early diversion is a prudent, cost-effective approach with good quality of life and early return to normal activity.
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