Vesico-ureteric Reflux after Renal Transplantation

Abstract

BRITISH MEDICAL JOURNAL 31 JULY 1971 279 that prostaglandin E2 is more effective in inducing labour must be considered with caution, for though the patients were selected at random the groups were not identically matched. The differences found in these studies may be partly explained by essential differences in the plan of each investigation and the exact protocol undertaken. Beazley and Gillespie (1971) started the infusion of prostaglandin E, at 0-21 [Lg/min and oxytocin at 2 1 mU/min. These rates were doubled every hour until contractions were effective and then usually maintained at a fixed rate. In addition some patients' membranes were ruptured artificially when labour was established. Our approach was basically different in that rapid titration regimens were used to induce an early onset of regular contractions in each group, as we considered it was impossible to know that the stimulatory effect of doubling the infusion rates of prostaglandin E2 was quantitatively equivalent to doing the same with oxytocin. It is therefore not surprising that the results were different.By using the titration regimens an initial uterine response occurred at a comparable time with both substances, though regular contractions of similar amplitude generally occurred earlier with oxytocin. Despite this fact prostaglandin E2 was more effective in dilating the cervix, and it is our impression that this substance had a greater stimulatory effect on the uterus than oxytocin in the dose range used. One feature tending to confirm this impression was the finding that while prostaglandin E2 invariably resulted in spontaneous rupture of the membranes, this occurred before dilatation of the cervix had reached 6 cm in eight out of 15 patients. With oxytocin this was so in only two out of the nine successes. With both agents basically two types of response were elicited. One resembled normal labour in that progressive cervical dilatation occurred with time, while in the other little or no change in dilatation resulted for many hours, usually until the onset of spontaneous membrane rupture. About one-third of the successes in each group were in this latter category.With regard to the practicality of using oxytocin to induce labour in the presence of intact membranes, we feel that a greater success rate could probably be achieved if the infusion rate were increased above that required to induce contractions which appear "optimum" on an external tocograph. In effect oxytocin titration would be against cervical dilatation rather than contractions. The limitation of such a policy is a possibility of causing uterine hypertonus, though oxytocin infusions in doses ranging from 2 to 128 mU/min. We feel, however, that there are possible dangers of pursuing a similar policy of increasing the dose of prostaglandins above that required to induce optimum contractions. Besides maternal disturbance caused by possible vomiting and soreness of the arm it is our impression that fetal distress may be provoked, for contractions of excessive frequency or str...

Problems of the Distal Ureter in Renal transplantation

“…Spon taneous healing of ureteric fistulas has also been described after temporary nephrostomy [7,9,10]. Whether open 84 Dreikorn Problems of the Distal Ureter in Renal Transplantation surgery is necessary primarily depends on the status of the graft ureter. In case of extensive ureteral necrosis conser vative management alone will hardly be successful.…”

Vesico-Ureteric Reflux After Renal Transplantation

“…The investigations of Powis, Barnes and Dawson Edwards (1971) showed that 8 out of 18 cases reiluxed followiiig a tunnel type of re-implantation and perhaps suggested that there may be a special problem associated with ureteric re-implantations fo!lowing transplantation. However our studies do not support such a hypothesis.…”

“…The Royal Infirmary, Cardif -THE ureteric complications of renal transplantation have been discussed at length in several recent papers by Owen (1972), Rees (1972) and Robson and Calne (1971). There has been a review of ureterovesical competence following renal transplantation by Powis, Barnes and Dawson Edwards (1971).…”

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THE ureteric complications of renal transplantation have been discussed at length in several recent papers by Owen (1972), Rees (1972) and Robson and Calne (1971). There has been a review of ureterovesical competence following renal transplantation by Powis, Barnes and Dawson Edwards (1971).Micturating cysto-urethrography and excretion urography were performed on 21 patients following cadaveric renal transplantations. Ureterovesical competence was thus assessed at 24 anastomoses since 1 donor kidney had a double ureter and 2 patients had a second renal transplantation.

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Renal Transplantation

“…cesophagitis, diverticulitus (Fig 5), steatorrhcea) is approximately the same (Hadjiyannakis et al 1971). Ileocolonic ulceration has occurred at any time up to 18 months after transplantation (Powis et al 1971).…”