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SOME KIDNEY TRANSPLANT PROBLEMS
IN PATIENTS
WITH SMALL BLADDER CAPACITY
INITIAL RESULTS AT CR Institute BV
nSOTORGANTRANSPLANTATION
CONFERENCE2023
MINISTRYOFHEALTH TE
1
MD. DLQV
OUTLINE
1. INTRODUCTION TOPIC
2. THEORY AND PRACTICE
3. RESEARCH RESCUE
2
QUESTION
1. USRDS annual data report ( 2020).
Name book waiting : 75,747 TH.
23,853 TH
76% words People give die
United
States
[1]
KIDNEY
TRANSPLANTATION
QUESTION
VN (1992): [1]
• 5500 combined TH kidney /30 years .
• 22 middle heart graft chief water .
CR Institute (December 1992):
• 1100 combined TH kidney from People give live (93.5%).
• 64 TH words People give death (2008).
• 03 TH words People give ABOi (2021).
• Extended standard: DSA (+)…
1. . Pham Gia Khanh et al (2017), “Pre-transplant Treatment”, VN Kidney Transplant Guide, Medical Publishing House, p. 58- 59
2. Cornell (2015). American Journal of Transplantation, Vol. 15(5), 1293-1302
2. Montgomery (2012). Transplantation, Vol. 93(6), 603.
QUESTION
Conclude fruit living still kidney graft extra belong enter much weak element soy
sauce [ 1 ]
• Weak element surgery is one in these original core main cause lost kidney graft
phase paragraph early .
• Variable proof details urinary accounting for billion rule from 1-15%. Special
special when PTV is transplanted Are not Right uncle doctor Foreign details
urinary .
• Including: Urine leakage, ureteral stricture obstruction, vesicoureteral retrograde
flow, lower urinary tract dysfunction and accompanying bladder abnormalities..
• Sister rule real often eagle optical When graft accounting for about 20%-30%.
• In That's it , graft kidney above sick core Have eagle optical capacity​ small To
be question topic rather often meet ( billion rate 10%-20%), still To be challenge
awake big give surgery art plug urinary management eagle optical .
Choosing appropriate interventions in transplant patients attached real often eagle
optical capacity​ Is there still a lot of controversy? [2]
1. Neri F., Tsivian M., Coccolini F. et al (2009), “ Ulogical complications after kidney transplantation: experience of more than 1000
transplantations”, Transplant Proc, 41, pp. 1224- 1226.
2. Buttigieg J, Agius -Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J
Transplant. 2018 Sep 10;8(5):142-149. doi : 10.5500/wjt.v8.i5.142. PMID: 30211022; PMCID: PMC6134271.
5
Quy submit pepper standard give graft kidney
[1][2]
• Grafting location kidney : pit pot Right or left ,
outside happiness fascia , edge eagle optical .
• Road surgery To be Gibson street side Right or left .
• Peel cup create cavity after happiness membrane
• Sew connect static circuit kidney : end – side with
static circuit pot outside .
• Sew connect dynamic circuit kidney : end - side
with dynamic circuit pot outside or connect end -
end with dynamic circuit pot in .
• Sew connect urinary admin : Urine management
kidney graft Okay sew connect with eagle optical
use carefully art Lich – Gregoir .
1. Bare Gem Born and add ( 2004 ), “ Conclusion 82 schools result fit graft kidney in sick institute CR Institute”, Specialized topic Urology , City Medicine . Lake Chi Minh, assistant copy
volume 8(2), p. 6- 15.
2. Surgical Techniques of Kidney Transplantation (2014) .
Image:
A. Applied anatomy in kidney transplantation.
B. Method of inserting kidney into kidney
according to Lich-Grégoir in kidney
transplantation.
Source: Surgical Techniques of Kidney
Transplantation (2014) .
6
THEORY AND PRACTICE
Standard bladder for kidney transplant surgery: sufficient urine storage
capacity with low pressure , no leakage , complete urine expulsion and on
one's own owner . [first]
• Capacity eagle optical small in children me will big gradually according
to degree year old arrive When obtain musty central 300ml – 500ml
bottle in humans adult (>18 years old). [3]
• The bladder in patients with STMGDC will gradually lose function with
urine output < 100 ml in 24 hours when not used for a period of time
after dialysis or peritoneal dialysis. [2]
7
THEORY AND PRACTICE
1. Weide , Marian & Cornelissen, Elisabeth & van Achterberg , Theo & Smits, jeroen & Feitz , Wouter . (2006). Dysfunction of lower urinary tract in renal transplant children with
nephrologic disease. Urology. 67. 1060-5;
2. Rudge CJ. Transplantation in the abnormal bladder. In: Kidney transplantation, principles and practice. Morris PJ. WB Saunders Company, 1994: 138-148.
3. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
8
1. Weide , Marian & Cornelissen, Elisabeth & van Achterberg , Theo & Smits, jeroen & Feitz , Wouter . (2006). Dysfunction of lower urinary tract in renal transplant children with
nephrologic disease. Urology. 67. 1060-5;
2. Rudge CJ. Transplantation in the abnormal bladder. In: Kidney transplantation, principles and practice. Morris PJ. WB Saunders Company, 1994: 138-148.
3. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
Bang optical pepper
standard [first]
People big Young me
Direction France
measure measure
Capacity eagle optical . ≥ 300ml, ≤500ml ( Age /2+6)x28.35
Measure can accumulation
water pee often regulation
Pressure force eagle optical ≤40cm H20 ≤40cm H20 Urine dynamic learn
Enter bacteria Infection bacteria when ≥ 10 5 water pee between current Implantation water pee
Tong export on one's own
owner
>18-25 ml/s Urine current thing
Tong export complete full
Exist save <40% of total can
BQ
Water pee noise save <20ml
Super minus Abdominal &
urinary dynamic learn .
THEORY AND PRACTICE
DEFINITION OF SMALL CAPACITY BLADDER:
To be eagle optical reduce degree piano rebound ,
decrease can accumulation contain contain with
capacity < 100ml . [first]
• Or capacity reduction < 30 % compared to pepper standard live
young I (<18 years old ) followed labour awake above ( according to
Campbell). [2]
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018;
173-183.
2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation.
Campbell 12 May .
THEORY AND PRACTICE
Small-capacity bladder abnormalities can be congenital or
acquired, as well as other urinary defects . [twelfth]
• Bang optical reduced capacity on one's own due to the small amount urinary ,
void urinary , usually after one time time run kidney or judge stool happiness
membrane .
• Bladder disorders due to neuromuscular disease.
• Birth defects.
• Outlet obstruction (posterior urethral valve, urethral stricture, etc.)
• Acquired cystitis (fibrosing cystitis, radiotherapy, intravesical chemotherapy...)
• Scarring next to the bladder (hemorrhagic metritis, inflammation of implants
next to the bladder)
• Bang optical intervened surgery art , bladder optical new create equal intestine
.
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder,
Elsevier, 2018; 173-183.
2. Buttigieg J, Agius -Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J
Transplant. 2018 Sep 10;8(5):142-149. doi : 10.5500/wjt.v8.i5.142. PMID: 30211022; PMCID: PMC6134271. 10
THEORY AND PRACTICE
Abnormal bladder optical When graft If not treated will
lead arrive much variable proof like pee Are not check
control , infection bacteria , damage love kidney graft and
image enjoy living still full set . [1], [3]
•Sister rule the real often eagle optical about 20-30%, a lot live young you ,
person young . [2]
•Often accompanied by infection, stones and other complicated
complications before and after transplantation.
11
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
2. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4.
3. Salman, Baher & Hassan, Ahmed & Sultan, Sultan & Tophill , Paul & Halawa , Ahmed. (2017). Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 16. 10.6002/ect.2016.0193.
THEORY AND PRACTICE
12
1. Inoue T, Satoh S, Obara T, Saito M, Numakura K, Narita S, Tsuchiya N, Habuchi T. Cystometric evaluation of recovery in hypocompliant defunctionalized bladder as a result
of long-term dialysis after kidney transplantation. Int J Urol. 2016 Aug;
2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
Figure 3: [1]
The replace change can
accumulation eagle optical
after graft Kidney 01 year :
(a) Increase capacity contain
contain ;
(b) Reduce pressure force
paternal eagle optical ;
(c) Increase strength piano
Anise eagle optical .
Transplant surgery kidney above group eagle optical capacity​ small
due to STMGDC, yes can give permission Anise dress position power
complete full after surgery . [2]
THEORY AND PRACTICE
Need intervention above eagle optical When graft kidney based above the only determined after :
[2]
• Million proof road details urinary below complex miscellaneous ;
• Bang optical decrease / loss position power before failure kidney ;
• Money history occlusion blockage road details urinary early .
Original occlusion shared to thing treat eagle optical capacity​ small give permission graft kidney
dark advantages , including : [1]
• Damn tell possible power Tong export complete full water pee When Are not can Go pee on one's own owner ;
• Phuc Anise possible power contain contain and strength piano Anise belong to eagle optical ;
• Damn tell increase strength hinder road go out When muscle ring bag failure cause pee Are not on one's own owner .
13
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
2. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4.
3. Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996;3:69–76
THEORY AND PRACTICE
Specific goals to restore bladder function after transplantation: [1]
• Khoi restore capacity and contractility eagle optical to tell
guard kidney safe grafting .
• Natural urine flow from the grafted kidney ureter into the
bladder.
• The bladder can hold enough urine at low pressure for daily
activities (2-3 hours/time).
• Autonomous ability to empty the bladder.
• Keep urine sterile.
• Choose minimal, less traumatic bladder intervention.
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
2. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4.
3. Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996;3:69–76
14
THEORY AND PRACTICE
Treatment methods for small-capacity
bladder in kidney transplant recipients
[1],[2]
• Bladder training by irrigating physiological solution with daily antibiotics.
• Medical treatment using anticholinergics
• When unable to control urination, practice intermittent urethral
catheterization.
• Surgical diversion of urine through a collection bag using a Bricker ileal
loop ( or type Mitrofanoff ) , at the same time as transplantation.
• Bowel bladder expansion surgery performed before transplant is
reported to be highly feasible at some major Urology - Kidney
Transplant centers.
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
3. Salman, Baher & Hassan, Ahmed & Sultan, Sultan & Tophill , Paul & Halawa , Ahmed. (2017). Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up.
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 16. 10.6002/ect.2016.0193. 15
THEORY AND PRACTICE
SUGGESTED FLOW CHART FOR PRE-PLANTATION EVALUATION AND STEPS
FOR TREATMENT OF SMALL CAPACITY BLADDER ABNORMALITIES
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
16
Bệnh sử:
- Nhiễm khuẩn tái phát
- Bất thường bẩm sinh hệ niệu dục
- Bất thường khi tiểu.
- Rối loạn chức năng bàng quang đã biết
-Siêu âm bụng.
- VCUG
-Siêu âm bụng.
- Nước tiểu tồn lưu
Bàng quang
dung tích nhỏ
(100ml)
Nội khoa (Kháng
Cholinnergic)
Bàng quang phục hồi
dung tích
Tập bàng quang.
Đặt thông ngắt quãng.
Tt kháng Cholinergic
Phẫu thuật chống
trào ngược niệu
quản bể thận
Bàng quang phục hồi
chức năng tống xuất
Đặt thông ngắt quãng.
Bàng quang phục hồi
dung tích
PT mở rộng bàng
quang bằng ruột
Đủ điều kiện ghép
thận an toàn
Tống xuất
không hoàn
toàn
Tập vật lý
trị liệu
Trào ngược niệu
quản bể thận nặng
/ Thận ứ nước
Niệu động
học
Bất thường
niệu đạo
PT sửa
niệu đạo
Thận ứ nước.
Không tống xuất
hết nước tiểu
Bình thường
Mở bàng quang ra da/
chuyển lưu nước tiểu
CIC: Clean intermittent
catheterization;
PVR: Post void residual;
RUS: Renal ultrasound;
VCUG: Voiding
cystourethrogram.
• Position gender presently still many opinions Not yet copper
favorable about way choose choose to intervene fit physical
best
• Love image research rescue question topic This in VN still
exists cancel open .
• => At CR Institute Hospital , they I in progress up onion
research save : Hit price signal fruit graft kidney above group
opposite to statue eagle optical capacity​ small before and
after graft .
SUMMARY OF THE PROBLEM
1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May
.
17
RESEARCH QUESTION:
What are the results after kidney transplant in patients with
small bladder capacity at CR Institute hospital?
18
ITEM RESEARCH TARGET
Fight price conclude fruit graft kidney
above sick core Have eagle optical
capacity​ small in sick institute CR Institute.
ITEM SPECIFIC TARGET
1- Corpse determined dense point Lam ready and near Lam ready the school fit graft
kidney above sick core Have eagle optical capacity​ small before graft in sick institute
CR Institute.
2- Hit price count signal fruit and possible power dress volume recovery​ eagle optical
When pressure use surgery art graft kidney above sick core Have eagle optical
capacity​ small .
3- Corpse determined billion rule and conclude fruit thing treat variable proof early and
late contact mandarin arrive real often eagle optical capacity​ small after surgery art
19
ITEM RESEARCH TARGET
Fight price conclude fruit graft kidney above sick core
Have eagle optical capacity​ small in sick institute CR
Institute.
OPPOSITE TO STATUE AND DIRECTION
FRANCESTUDY RESCUE
Object research rescue
• Socks chief the sick core Okay graft kidney from People
give living in sick institute CR Institute has capacity​
eagle optical before graft small according to pepper
standard <100ml,
Time to get study variables rescue
• 06 years , from 2017 to 2023.
Research time rescue
• From August 2023 to July 2024
20
21
MAIN STUDY VARIABLES
Variable name Type Content
HLA incompatibility Nominal From June 0 to June 6
PRA Quantitative %
DSA Two prices 0: Negative
1: Positive
History of blood transfusion before transplant Two prices 0: Negative
1: Positive
History of pregnancy before transplant Two prices 0: Negative
1: Positive
History of previous kidney transplant Two prices 0: Negative
1: Positive
BMI (Kg/m 2 ) Quantitative
Donor GFR (ml/min/1.73m 2 ) Quantitative Radioisotope renal radioscopy with 99m Tc- DTPA
Bladder volume measured before
transplantation
Quantitative
Bladder volume was measured after
transplantation
Quantitative
Ultrasound evaluates other abnormalities in the Qualitative
Objective 1 : Identify dense point sick core eagle optical capacity​ small
22
MAIN STUDY VARIABLES
Name variable number Type Content
Technique of inserting the ureter into
the bladder
Dinh name 0: Politano Lead-Better
1: Lich Gregor cabbage record
Variable proof details urinary Dinh name
Warm ischemia time (seconds) Dinh quantity Catch head from When clip dynamic circuit
master ( or dynamic circuit kidney ) of People
give and conclude end When catch head infusion
of solution do cold enter muscle mandarin
Satisfied Okay take go out
Cold ischemia time (minutes) Quantitative To be time time kidney Okay hold in lip school
tell management with heat degree short .
Characteristics of lower urinary tract symptoms after
kidney transplantation (LUTS)
Qualitative
Blood BUN (mg/dl) Quantitative
Blood creatinine (mg/dl) Quantitative
RUV on ultrasound Quantitative
Goal 3 : Identify dense point variable PT disease​ core eagle optical capacity​ small
Initial results
• Research on 50 kidney transplants from living donors
in a group of patients with small bladder capacity
(bladder volume <100ml before transplant) at CR
Institute hospital.
• Mainly the left kidney is transplanted into the
recipient's right iliac fossa (77.8%).
• When transplanted, the renal vein (TM) is sutured to
the external iliac vein in an end-to-side fashion
(96.2%).
• The renal artery (artery) is connected to the external
iliac artery in an end-to-side manner 79.5%.
23
• Technique of inserting the ureter into the recipient's
bladder according to the Politano-leadbetter method
with double J ureteral catheter placement: 12.6%,
Lich-Gregoir method with combined JJ catheter
placement: 87.4%.
• After transplantation, 88.9% of transplanted kidneys
secreted good urine, with an average urine volume of
6000-8000 ml/24 hours.
• Urinary tract complications seen after
transplantation were initially recorded at 11.1%.
24
Initial results
• PROGRESS OF KIDNEY FUNCTION AFTER TRANSPLANTATION
1.1
1.11
1.12
1.13
1.14
1.15
1.16
Xuất viện 1 tháng 6 tháng
Creatinine central jar after transplant (N=50)
Results
Newness
Currently in VN there are not many studies about topic talent hey .
Applicability
Research will help provide more information to predict and advise patients.
Calculate possible exam :
According to preliminary statistics at CR Institute Hospital from January 2017 -
July 2023 , there were about 60-80 transplant cases . kidney above eagle
optical capacity​ small , almost run out of the following THs graft even Have
conclude fruit dress Anise position power eagle optical , about 5-10 TH there
posterior urine flow graft .
The expected number of samples for the study is from 50-60 after deducting
10% sample loss.
26
SUMMARY
Challenges and solutions
Difficulty in making follow-up appointments for patients, lost results fruit
movie cystography
 Contact through many means: phone, zalo, can visit at home if the
address is convenient.
The retrospective study sample was heterogeneous (subjects, time of
surgery), so assessing the impact on quality of life may not be objective
and reliable.
 Analyze data by patient group
27
SUMMARY
THANK YOU
FOR YOUR ATTENTION!
28
REFERENCES
1. Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System website. https://nccd.cdc.gov/CKD. Accessed 2/19/2021.
2. Ramirez SP, Lebowitz RL, Harmon WE, Somers MJ. Predictors for abnormal voiding cystourethrography in pediatric patients undergoing renal transplant evaluation. Pediatr Transplant.
2001 Apr;5(2):99-104. Doi: 10.1034/j.1399-3046.2001.005002099.x. PMID: 11328547.
3. Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant. 2018 Sep 10;8(5):142-149. doi:
10.5500/wjt.v8.i5.142. PMID: 30211022; PMCID: PMC6134271.
4. Morizawa Y, Satoh H, Iwasa S, Sato A, Aoki Y, Harada R, Hamada R, Hataya H. Increasing bladder capacity and vesicoureteral reflux in pediatric kidney transplant patients. Int J Urol. 2020
Nov;27(11):1008-1012. doi: 10.1111/iju.14348. Epub 2020 Aug 12. PMID: 32789949.
5. Chen JL, Lee MC, Kuo HC. Reduction of cystometric bladder capacity and bladder compliance with time in patients with end-stage renal disease. J Formos Med Assoc. 2012
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6. Hotta K, Miura M, Wada Y, Fukuzawa N, Iwami D, Sasaki H, Seki T, Harada H. Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney
transplantation. Int J Urol. 2017 Apr;24(4):314-319. doi: 10.1111/iju.13297. Epub 2017 Feb 12. PMID: 28190268.
7. Inoue T, Satoh S, Obara T, Saito M, Numakura K, Narita S, Tsuchiya N, Habuchi T. Cystometric evaluation of recovery in hypocompliant defunctionalized bladder as a result of long-term
dialysis after kidney transplantation. Int J Urol. 2016 Aug;23(8):694-700. doi: 10.1111/iju.13122. Epub 2016 May 15. PMID: 27195975.
8. Neri F., Tsivian M., Coccolini F. et al (2009), “Ulogical complications after kidney transplantation: experience of more than 1000 transplantations”, Transplant Proc, 41, pp. 1224- 1226.
9. Marchal S, Kalfa N, Iborra F, Badet L, Karam G, Broudeur L, Branchereau J, Abdo N, Thuret R. Long-term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract
Malformations: A Multicenter Study. Transplantation. 2020 Jan;104(1):165-171. doi: 10.1097/TP.0000000000002746. PMID: 30964838.
10. Hamid R Davari, Hooman Yarmohammandi, Seyed A Malekhosseini, Heshmatollah Salahi, Ali Bahador, Mehdi Salehipour (2006), “Urologic complications in 980 consecutive patients with
renal transplantation”, International Journal of Urology, pp. 1271- 1275.
11. Brescacin A, Iesari S, Guzzo S, Alfieri CM, Darisi R, Perego M, Puliatti C, Ferraresso M, Favi E. Allograft Vesicoureteral Reflux after Kidney Transplantation. Medicina (Kaunas). 2022 Jan
5;58(1):81. doi: 10.3390/medicina58010081. PMID: 35056389; PMCID: PMC8780114.
12. Factors associated with low-compliance bladder in end-stage renal disease patients and development of a clinical prediction model for urodynamic evaluation: the dudi score.
29. Salman, Baher & Hassan, Ahmed & Sultan, Sultan & Tophill, Paul & Halawa, Ahmed. (2017). Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up. Experimental and clinical
transplantation : official journal of the Middle East Society for Organ Transplantation. 16. 10.6002/ect.2016.0193.
30. Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996;3:69–76
31. Weide, Marian & Cornelissen, Elisabeth & van Achterberg, Theo & Smits, jeroen & Feitz, Wouter. (2006). Dysfunction of lower urinary tract in renal transplant children with nephrologic
disease. Urology. 67. 1060-5;
32. Rudge CJ. Transplantation in the abnormal bladder. In: Kidney transplantation, principles and practice. Morris PJ. WB Saunders Company, 1994: 138-148.
29
13. Silva DM, Prudente AC, Mazzali M, Borges CF, D'Ancona C. Bladder function evaluation before renal transplantation in nonurologic disease: is it necessary? Urology. 2014 Feb;83(2):406-
10. doi: 10.1016/j.urology.2013.09.015. Epub 2013 Nov 6. PMID: 24210566.
14. Song M, Park J, Kim YH, Han DJ, Song SH, Choo MS, Hong B. Bladder capacity in kidney transplant patients with end-stage renal disease. Int Urol Nephrol. 2015 Jan;47(1):101-6. doi:
10.1007/s11255-014-0848-1. Epub 2014 Sep 28. PMID: 25262149.
15. Salman B, Hassan A, Sultan S, Tophill P, Halawa A. Renal transplant in the abnormal bladder: long-term follow-up. Experimental and clinical transplantation. Official journal of the Middle
ECT. 2018;16(1):10–5
16. Mckay AM, Kim S, Kennedy SE. Long-term outcome of kidney transplantation in patients with congenital anomalies of the kidney and urinary tract. Pediatr Nephrol. 2019;34(11):2409-
2415
17. Kashi SH, Wynne KS, Sadek SA, Lodge JP. An evaluation of vesical urodynamics before renal transplantation and its effect on renal allograft function and survival. Transplantation. 1994
May 27;57(10):1455-7. PMID: 8197607.
18. Alexopoulos, Sophoclis1,2; Lightner, Amy1,3,4; Concepcion, Waldo2; Rose, Marilyn2; Salcedo-Concepcion, Kathrine2; Salvatierra, Oscar2. Pediatric Kidney Recipients With Small Capacity,
Defunctionalized Urinary Bladders Receiving Adult-Sized Kidney Without Prior Bladder Augmentation. Transplantation 91(4):p 452-456, February 27, 2011. | DOI:
10.1097/TP.0b013e318204381a .
19. Singer JS, Zaid U, Gritsch HA, Lerman SE, Churchill BM. Selective use of voiding cystourethrography in children undergoing renal transplant evaluation. J Urol. 2009 Sep;182(3):1158-62.
Doi: 10.1016/j.juro.2009.05.048. Epub 2009 Jul 21. PMID: 19625052.
20. Tran Ngoc Sinh et al (2004), "Results of 82 kidney transplant cases at CR Institute hospital", Urology topic, City Medicine. Ho Chi Minh, supplement volume 8(2), p. 6- 15.
21. Pham Gia Khanh et al (2017), “Pre-transplant Treatment”, VN Kidney Transplant Guide, Medical Publishing House, p. 58- 59.
22. Rude, T., Nassiri, N., Naser-Tavakolian, A. Et al. The Role of Urodynamics in the Pre-transplant Evaluation of Renal Transplant. Curr Urol Rep 20, 26 (2019).
23. Capizzi A, Zanon GF, Zacchello G, Rigamonti W. Kidney transplantation in children with reconstructed bladder. Transplantation. 2004 Apr 15;77(7):1113-6. doi:
10.1097/01.tp.0000116710.73099.8a. PMID: 15087783.
24. Martin X, Aboutaieb R, Soliman S, el Essawy A, Dawahra M, Lefrancois N. The use of long-term defunctionalized bladder in renal transplantation: is it safe? Eur Urol. 1999 Nov;36(5):450-
3. doi: 10.1159/000020029. PMID: 10516458.
25. Craig A. Peters, MD. Campbell-Walsh Urology, Eleventh Edition, 2016, Urologic Considerations in Pediatric Renal Transplantation, Chapter 153, Figure 153-1 : 3528-3529.
25. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4.
27. Nguyen Tri Thuc and colleagues (2022), "History of formation and development of the organ donation - tissue - transplantation system at CR Institute Hospital", Management network in
selecting and coordinating donated kidneys from organ donors alive, brain dead or circulatory arrest, Ho Chi Minh City National University Publishing House. Ho Chi Minh, p. 2-21.
28. Arman A. Kahokehr, Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183.
REFERENCES
30

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Small bladder capacity on kidney transplantation

  • 1. SOME KIDNEY TRANSPLANT PROBLEMS IN PATIENTS WITH SMALL BLADDER CAPACITY INITIAL RESULTS AT CR Institute BV nSOTORGANTRANSPLANTATION CONFERENCE2023 MINISTRYOFHEALTH TE 1 MD. DLQV
  • 2. OUTLINE 1. INTRODUCTION TOPIC 2. THEORY AND PRACTICE 3. RESEARCH RESCUE 2
  • 3. QUESTION 1. USRDS annual data report ( 2020). Name book waiting : 75,747 TH. 23,853 TH 76% words People give die United States [1] KIDNEY TRANSPLANTATION
  • 4. QUESTION VN (1992): [1] • 5500 combined TH kidney /30 years . • 22 middle heart graft chief water . CR Institute (December 1992): • 1100 combined TH kidney from People give live (93.5%). • 64 TH words People give death (2008). • 03 TH words People give ABOi (2021). • Extended standard: DSA (+)… 1. . Pham Gia Khanh et al (2017), “Pre-transplant Treatment”, VN Kidney Transplant Guide, Medical Publishing House, p. 58- 59 2. Cornell (2015). American Journal of Transplantation, Vol. 15(5), 1293-1302 2. Montgomery (2012). Transplantation, Vol. 93(6), 603.
  • 5. QUESTION Conclude fruit living still kidney graft extra belong enter much weak element soy sauce [ 1 ] • Weak element surgery is one in these original core main cause lost kidney graft phase paragraph early . • Variable proof details urinary accounting for billion rule from 1-15%. Special special when PTV is transplanted Are not Right uncle doctor Foreign details urinary . • Including: Urine leakage, ureteral stricture obstruction, vesicoureteral retrograde flow, lower urinary tract dysfunction and accompanying bladder abnormalities.. • Sister rule real often eagle optical When graft accounting for about 20%-30%. • In That's it , graft kidney above sick core Have eagle optical capacity​ small To be question topic rather often meet ( billion rate 10%-20%), still To be challenge awake big give surgery art plug urinary management eagle optical . Choosing appropriate interventions in transplant patients attached real often eagle optical capacity​ Is there still a lot of controversy? [2] 1. Neri F., Tsivian M., Coccolini F. et al (2009), “ Ulogical complications after kidney transplantation: experience of more than 1000 transplantations”, Transplant Proc, 41, pp. 1224- 1226. 2. Buttigieg J, Agius -Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant. 2018 Sep 10;8(5):142-149. doi : 10.5500/wjt.v8.i5.142. PMID: 30211022; PMCID: PMC6134271. 5
  • 6. Quy submit pepper standard give graft kidney [1][2] • Grafting location kidney : pit pot Right or left , outside happiness fascia , edge eagle optical . • Road surgery To be Gibson street side Right or left . • Peel cup create cavity after happiness membrane • Sew connect static circuit kidney : end – side with static circuit pot outside . • Sew connect dynamic circuit kidney : end - side with dynamic circuit pot outside or connect end - end with dynamic circuit pot in . • Sew connect urinary admin : Urine management kidney graft Okay sew connect with eagle optical use carefully art Lich – Gregoir . 1. Bare Gem Born and add ( 2004 ), “ Conclusion 82 schools result fit graft kidney in sick institute CR Institute”, Specialized topic Urology , City Medicine . Lake Chi Minh, assistant copy volume 8(2), p. 6- 15. 2. Surgical Techniques of Kidney Transplantation (2014) . Image: A. Applied anatomy in kidney transplantation. B. Method of inserting kidney into kidney according to Lich-Grégoir in kidney transplantation. Source: Surgical Techniques of Kidney Transplantation (2014) . 6 THEORY AND PRACTICE
  • 7. Standard bladder for kidney transplant surgery: sufficient urine storage capacity with low pressure , no leakage , complete urine expulsion and on one's own owner . [first] • Capacity eagle optical small in children me will big gradually according to degree year old arrive When obtain musty central 300ml – 500ml bottle in humans adult (>18 years old). [3] • The bladder in patients with STMGDC will gradually lose function with urine output < 100 ml in 24 hours when not used for a period of time after dialysis or peritoneal dialysis. [2] 7 THEORY AND PRACTICE 1. Weide , Marian & Cornelissen, Elisabeth & van Achterberg , Theo & Smits, jeroen & Feitz , Wouter . (2006). Dysfunction of lower urinary tract in renal transplant children with nephrologic disease. Urology. 67. 1060-5; 2. Rudge CJ. Transplantation in the abnormal bladder. In: Kidney transplantation, principles and practice. Morris PJ. WB Saunders Company, 1994: 138-148. 3. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
  • 8. 8 1. Weide , Marian & Cornelissen, Elisabeth & van Achterberg , Theo & Smits, jeroen & Feitz , Wouter . (2006). Dysfunction of lower urinary tract in renal transplant children with nephrologic disease. Urology. 67. 1060-5; 2. Rudge CJ. Transplantation in the abnormal bladder. In: Kidney transplantation, principles and practice. Morris PJ. WB Saunders Company, 1994: 138-148. 3. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May . Bang optical pepper standard [first] People big Young me Direction France measure measure Capacity eagle optical . ≥ 300ml, ≤500ml ( Age /2+6)x28.35 Measure can accumulation water pee often regulation Pressure force eagle optical ≤40cm H20 ≤40cm H20 Urine dynamic learn Enter bacteria Infection bacteria when ≥ 10 5 water pee between current Implantation water pee Tong export on one's own owner >18-25 ml/s Urine current thing Tong export complete full Exist save <40% of total can BQ Water pee noise save <20ml Super minus Abdominal & urinary dynamic learn . THEORY AND PRACTICE
  • 9. DEFINITION OF SMALL CAPACITY BLADDER: To be eagle optical reduce degree piano rebound , decrease can accumulation contain contain with capacity < 100ml . [first] • Or capacity reduction < 30 % compared to pepper standard live young I (<18 years old ) followed labour awake above ( according to Campbell). [2] 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May . THEORY AND PRACTICE
  • 10. Small-capacity bladder abnormalities can be congenital or acquired, as well as other urinary defects . [twelfth] • Bang optical reduced capacity on one's own due to the small amount urinary , void urinary , usually after one time time run kidney or judge stool happiness membrane . • Bladder disorders due to neuromuscular disease. • Birth defects. • Outlet obstruction (posterior urethral valve, urethral stricture, etc.) • Acquired cystitis (fibrosing cystitis, radiotherapy, intravesical chemotherapy...) • Scarring next to the bladder (hemorrhagic metritis, inflammation of implants next to the bladder) • Bang optical intervened surgery art , bladder optical new create equal intestine . 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Buttigieg J, Agius -Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant. 2018 Sep 10;8(5):142-149. doi : 10.5500/wjt.v8.i5.142. PMID: 30211022; PMCID: PMC6134271. 10 THEORY AND PRACTICE
  • 11. Abnormal bladder optical When graft If not treated will lead arrive much variable proof like pee Are not check control , infection bacteria , damage love kidney graft and image enjoy living still full set . [1], [3] •Sister rule the real often eagle optical about 20-30%, a lot live young you , person young . [2] •Often accompanied by infection, stones and other complicated complications before and after transplantation. 11 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4. 3. Salman, Baher & Hassan, Ahmed & Sultan, Sultan & Tophill , Paul & Halawa , Ahmed. (2017). Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 16. 10.6002/ect.2016.0193. THEORY AND PRACTICE
  • 12. 12 1. Inoue T, Satoh S, Obara T, Saito M, Numakura K, Narita S, Tsuchiya N, Habuchi T. Cystometric evaluation of recovery in hypocompliant defunctionalized bladder as a result of long-term dialysis after kidney transplantation. Int J Urol. 2016 Aug; 2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May . Figure 3: [1] The replace change can accumulation eagle optical after graft Kidney 01 year : (a) Increase capacity contain contain ; (b) Reduce pressure force paternal eagle optical ; (c) Increase strength piano Anise eagle optical . Transplant surgery kidney above group eagle optical capacity​ small due to STMGDC, yes can give permission Anise dress position power complete full after surgery . [2] THEORY AND PRACTICE
  • 13. Need intervention above eagle optical When graft kidney based above the only determined after : [2] • Million proof road details urinary below complex miscellaneous ; • Bang optical decrease / loss position power before failure kidney ; • Money history occlusion blockage road details urinary early . Original occlusion shared to thing treat eagle optical capacity​ small give permission graft kidney dark advantages , including : [1] • Damn tell possible power Tong export complete full water pee When Are not can Go pee on one's own owner ; • Phuc Anise possible power contain contain and strength piano Anise belong to eagle optical ; • Damn tell increase strength hinder road go out When muscle ring bag failure cause pee Are not on one's own owner . 13 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4. 3. Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996;3:69–76 THEORY AND PRACTICE
  • 14. Specific goals to restore bladder function after transplantation: [1] • Khoi restore capacity and contractility eagle optical to tell guard kidney safe grafting . • Natural urine flow from the grafted kidney ureter into the bladder. • The bladder can hold enough urine at low pressure for daily activities (2-3 hours/time). • Autonomous ability to empty the bladder. • Keep urine sterile. • Choose minimal, less traumatic bladder intervention. 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4. 3. Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996;3:69–76 14 THEORY AND PRACTICE
  • 15. Treatment methods for small-capacity bladder in kidney transplant recipients [1],[2] • Bladder training by irrigating physiological solution with daily antibiotics. • Medical treatment using anticholinergics • When unable to control urination, practice intermittent urethral catheterization. • Surgical diversion of urine through a collection bag using a Bricker ileal loop ( or type Mitrofanoff ) , at the same time as transplantation. • Bowel bladder expansion surgery performed before transplant is reported to be highly feasible at some major Urology - Kidney Transplant centers. 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May . 3. Salman, Baher & Hassan, Ahmed & Sultan, Sultan & Tophill , Paul & Halawa , Ahmed. (2017). Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 16. 10.6002/ect.2016.0193. 15 THEORY AND PRACTICE
  • 16. SUGGESTED FLOW CHART FOR PRE-PLANTATION EVALUATION AND STEPS FOR TREATMENT OF SMALL CAPACITY BLADDER ABNORMALITIES 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May . 16 Bệnh sử: - Nhiễm khuẩn tái phát - Bất thường bẩm sinh hệ niệu dục - Bất thường khi tiểu. - Rối loạn chức năng bàng quang đã biết -Siêu âm bụng. - VCUG -Siêu âm bụng. - Nước tiểu tồn lưu Bàng quang dung tích nhỏ (100ml) Nội khoa (Kháng Cholinnergic) Bàng quang phục hồi dung tích Tập bàng quang. Đặt thông ngắt quãng. Tt kháng Cholinergic Phẫu thuật chống trào ngược niệu quản bể thận Bàng quang phục hồi chức năng tống xuất Đặt thông ngắt quãng. Bàng quang phục hồi dung tích PT mở rộng bàng quang bằng ruột Đủ điều kiện ghép thận an toàn Tống xuất không hoàn toàn Tập vật lý trị liệu Trào ngược niệu quản bể thận nặng / Thận ứ nước Niệu động học Bất thường niệu đạo PT sửa niệu đạo Thận ứ nước. Không tống xuất hết nước tiểu Bình thường Mở bàng quang ra da/ chuyển lưu nước tiểu CIC: Clean intermittent catheterization; PVR: Post void residual; RUS: Renal ultrasound; VCUG: Voiding cystourethrogram.
  • 17. • Position gender presently still many opinions Not yet copper favorable about way choose choose to intervene fit physical best • Love image research rescue question topic This in VN still exists cancel open . • => At CR Institute Hospital , they I in progress up onion research save : Hit price signal fruit graft kidney above group opposite to statue eagle optical capacity​ small before and after graft . SUMMARY OF THE PROBLEM 1. Arman A. Kahokehr , Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. 2. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May . 17
  • 18. RESEARCH QUESTION: What are the results after kidney transplant in patients with small bladder capacity at CR Institute hospital? 18 ITEM RESEARCH TARGET Fight price conclude fruit graft kidney above sick core Have eagle optical capacity​ small in sick institute CR Institute.
  • 19. ITEM SPECIFIC TARGET 1- Corpse determined dense point Lam ready and near Lam ready the school fit graft kidney above sick core Have eagle optical capacity​ small before graft in sick institute CR Institute. 2- Hit price count signal fruit and possible power dress volume recovery​ eagle optical When pressure use surgery art graft kidney above sick core Have eagle optical capacity​ small . 3- Corpse determined billion rule and conclude fruit thing treat variable proof early and late contact mandarin arrive real often eagle optical capacity​ small after surgery art 19 ITEM RESEARCH TARGET Fight price conclude fruit graft kidney above sick core Have eagle optical capacity​ small in sick institute CR Institute.
  • 20. OPPOSITE TO STATUE AND DIRECTION FRANCESTUDY RESCUE Object research rescue • Socks chief the sick core Okay graft kidney from People give living in sick institute CR Institute has capacity​ eagle optical before graft small according to pepper standard <100ml, Time to get study variables rescue • 06 years , from 2017 to 2023. Research time rescue • From August 2023 to July 2024 20
  • 21. 21 MAIN STUDY VARIABLES Variable name Type Content HLA incompatibility Nominal From June 0 to June 6 PRA Quantitative % DSA Two prices 0: Negative 1: Positive History of blood transfusion before transplant Two prices 0: Negative 1: Positive History of pregnancy before transplant Two prices 0: Negative 1: Positive History of previous kidney transplant Two prices 0: Negative 1: Positive BMI (Kg/m 2 ) Quantitative Donor GFR (ml/min/1.73m 2 ) Quantitative Radioisotope renal radioscopy with 99m Tc- DTPA Bladder volume measured before transplantation Quantitative Bladder volume was measured after transplantation Quantitative Ultrasound evaluates other abnormalities in the Qualitative Objective 1 : Identify dense point sick core eagle optical capacity​ small
  • 22. 22 MAIN STUDY VARIABLES Name variable number Type Content Technique of inserting the ureter into the bladder Dinh name 0: Politano Lead-Better 1: Lich Gregor cabbage record Variable proof details urinary Dinh name Warm ischemia time (seconds) Dinh quantity Catch head from When clip dynamic circuit master ( or dynamic circuit kidney ) of People give and conclude end When catch head infusion of solution do cold enter muscle mandarin Satisfied Okay take go out Cold ischemia time (minutes) Quantitative To be time time kidney Okay hold in lip school tell management with heat degree short . Characteristics of lower urinary tract symptoms after kidney transplantation (LUTS) Qualitative Blood BUN (mg/dl) Quantitative Blood creatinine (mg/dl) Quantitative RUV on ultrasound Quantitative Goal 3 : Identify dense point variable PT disease​ core eagle optical capacity​ small
  • 23. Initial results • Research on 50 kidney transplants from living donors in a group of patients with small bladder capacity (bladder volume <100ml before transplant) at CR Institute hospital. • Mainly the left kidney is transplanted into the recipient's right iliac fossa (77.8%). • When transplanted, the renal vein (TM) is sutured to the external iliac vein in an end-to-side fashion (96.2%). • The renal artery (artery) is connected to the external iliac artery in an end-to-side manner 79.5%. 23
  • 24. • Technique of inserting the ureter into the recipient's bladder according to the Politano-leadbetter method with double J ureteral catheter placement: 12.6%, Lich-Gregoir method with combined JJ catheter placement: 87.4%. • After transplantation, 88.9% of transplanted kidneys secreted good urine, with an average urine volume of 6000-8000 ml/24 hours. • Urinary tract complications seen after transplantation were initially recorded at 11.1%. 24 Initial results
  • 25. • PROGRESS OF KIDNEY FUNCTION AFTER TRANSPLANTATION 1.1 1.11 1.12 1.13 1.14 1.15 1.16 Xuất viện 1 tháng 6 tháng Creatinine central jar after transplant (N=50) Results
  • 26. Newness Currently in VN there are not many studies about topic talent hey . Applicability Research will help provide more information to predict and advise patients. Calculate possible exam : According to preliminary statistics at CR Institute Hospital from January 2017 - July 2023 , there were about 60-80 transplant cases . kidney above eagle optical capacity​ small , almost run out of the following THs graft even Have conclude fruit dress Anise position power eagle optical , about 5-10 TH there posterior urine flow graft . The expected number of samples for the study is from 50-60 after deducting 10% sample loss. 26 SUMMARY
  • 27. Challenges and solutions Difficulty in making follow-up appointments for patients, lost results fruit movie cystography  Contact through many means: phone, zalo, can visit at home if the address is convenient. The retrospective study sample was heterogeneous (subjects, time of surgery), so assessing the impact on quality of life may not be objective and reliable.  Analyze data by patient group 27 SUMMARY
  • 28. THANK YOU FOR YOUR ATTENTION! 28
  • 29. REFERENCES 1. Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System website. https://nccd.cdc.gov/CKD. Accessed 2/19/2021. 2. Ramirez SP, Lebowitz RL, Harmon WE, Somers MJ. Predictors for abnormal voiding cystourethrography in pediatric patients undergoing renal transplant evaluation. Pediatr Transplant. 2001 Apr;5(2):99-104. Doi: 10.1034/j.1399-3046.2001.005002099.x. PMID: 11328547. 3. Buttigieg J, Agius-Anastasi A, Sharma A, Halawa A. Early urological complications after kidney transplantation: An overview. World J Transplant. 2018 Sep 10;8(5):142-149. doi: 10.5500/wjt.v8.i5.142. PMID: 30211022; PMCID: PMC6134271. 4. Morizawa Y, Satoh H, Iwasa S, Sato A, Aoki Y, Harada R, Hamada R, Hataya H. Increasing bladder capacity and vesicoureteral reflux in pediatric kidney transplant patients. Int J Urol. 2020 Nov;27(11):1008-1012. doi: 10.1111/iju.14348. Epub 2020 Aug 12. PMID: 32789949. 5. Chen JL, Lee MC, Kuo HC. Reduction of cystometric bladder capacity and bladder compliance with time in patients with end-stage renal disease. J Formos Med Assoc. 2012 Apr;111(4):209-13. doi: 10.1016/j.jfma.2011.09.023. Epub 2012 Mar 23. PMID: 22526209. 6. Hotta K, Miura M, Wada Y, Fukuzawa N, Iwami D, Sasaki H, Seki T, Harada H. Atrophic bladder in long-term dialysis patients increases the risk for urological complications after kidney transplantation. Int J Urol. 2017 Apr;24(4):314-319. doi: 10.1111/iju.13297. Epub 2017 Feb 12. PMID: 28190268. 7. Inoue T, Satoh S, Obara T, Saito M, Numakura K, Narita S, Tsuchiya N, Habuchi T. Cystometric evaluation of recovery in hypocompliant defunctionalized bladder as a result of long-term dialysis after kidney transplantation. Int J Urol. 2016 Aug;23(8):694-700. doi: 10.1111/iju.13122. Epub 2016 May 15. PMID: 27195975. 8. Neri F., Tsivian M., Coccolini F. et al (2009), “Ulogical complications after kidney transplantation: experience of more than 1000 transplantations”, Transplant Proc, 41, pp. 1224- 1226. 9. Marchal S, Kalfa N, Iborra F, Badet L, Karam G, Broudeur L, Branchereau J, Abdo N, Thuret R. Long-term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract Malformations: A Multicenter Study. Transplantation. 2020 Jan;104(1):165-171. doi: 10.1097/TP.0000000000002746. PMID: 30964838. 10. Hamid R Davari, Hooman Yarmohammandi, Seyed A Malekhosseini, Heshmatollah Salahi, Ali Bahador, Mehdi Salehipour (2006), “Urologic complications in 980 consecutive patients with renal transplantation”, International Journal of Urology, pp. 1271- 1275. 11. Brescacin A, Iesari S, Guzzo S, Alfieri CM, Darisi R, Perego M, Puliatti C, Ferraresso M, Favi E. Allograft Vesicoureteral Reflux after Kidney Transplantation. Medicina (Kaunas). 2022 Jan 5;58(1):81. doi: 10.3390/medicina58010081. PMID: 35056389; PMCID: PMC8780114. 12. Factors associated with low-compliance bladder in end-stage renal disease patients and development of a clinical prediction model for urodynamic evaluation: the dudi score. 29. Salman, Baher & Hassan, Ahmed & Sultan, Sultan & Tophill, Paul & Halawa, Ahmed. (2017). Renal Transplant in the Abnormal Bladder: Long-Term Follow-Up. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 16. 10.6002/ect.2016.0193. 30. Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. Adv Ren Replace Ther 1996;3:69–76 31. Weide, Marian & Cornelissen, Elisabeth & van Achterberg, Theo & Smits, jeroen & Feitz, Wouter. (2006). Dysfunction of lower urinary tract in renal transplant children with nephrologic disease. Urology. 67. 1060-5; 32. Rudge CJ. Transplantation in the abnormal bladder. In: Kidney transplantation, principles and practice. Morris PJ. WB Saunders Company, 1994: 138-148. 29
  • 30. 13. Silva DM, Prudente AC, Mazzali M, Borges CF, D'Ancona C. Bladder function evaluation before renal transplantation in nonurologic disease: is it necessary? Urology. 2014 Feb;83(2):406- 10. doi: 10.1016/j.urology.2013.09.015. Epub 2013 Nov 6. PMID: 24210566. 14. Song M, Park J, Kim YH, Han DJ, Song SH, Choo MS, Hong B. Bladder capacity in kidney transplant patients with end-stage renal disease. Int Urol Nephrol. 2015 Jan;47(1):101-6. doi: 10.1007/s11255-014-0848-1. Epub 2014 Sep 28. PMID: 25262149. 15. Salman B, Hassan A, Sultan S, Tophill P, Halawa A. Renal transplant in the abnormal bladder: long-term follow-up. Experimental and clinical transplantation. Official journal of the Middle ECT. 2018;16(1):10–5 16. Mckay AM, Kim S, Kennedy SE. Long-term outcome of kidney transplantation in patients with congenital anomalies of the kidney and urinary tract. Pediatr Nephrol. 2019;34(11):2409- 2415 17. Kashi SH, Wynne KS, Sadek SA, Lodge JP. An evaluation of vesical urodynamics before renal transplantation and its effect on renal allograft function and survival. Transplantation. 1994 May 27;57(10):1455-7. PMID: 8197607. 18. Alexopoulos, Sophoclis1,2; Lightner, Amy1,3,4; Concepcion, Waldo2; Rose, Marilyn2; Salcedo-Concepcion, Kathrine2; Salvatierra, Oscar2. Pediatric Kidney Recipients With Small Capacity, Defunctionalized Urinary Bladders Receiving Adult-Sized Kidney Without Prior Bladder Augmentation. Transplantation 91(4):p 452-456, February 27, 2011. | DOI: 10.1097/TP.0b013e318204381a . 19. Singer JS, Zaid U, Gritsch HA, Lerman SE, Churchill BM. Selective use of voiding cystourethrography in children undergoing renal transplant evaluation. J Urol. 2009 Sep;182(3):1158-62. Doi: 10.1016/j.juro.2009.05.048. Epub 2009 Jul 21. PMID: 19625052. 20. Tran Ngoc Sinh et al (2004), "Results of 82 kidney transplant cases at CR Institute hospital", Urology topic, City Medicine. Ho Chi Minh, supplement volume 8(2), p. 6- 15. 21. Pham Gia Khanh et al (2017), “Pre-transplant Treatment”, VN Kidney Transplant Guide, Medical Publishing House, p. 58- 59. 22. Rude, T., Nassiri, N., Naser-Tavakolian, A. Et al. The Role of Urodynamics in the Pre-transplant Evaluation of Renal Transplant. Curr Urol Rep 20, 26 (2019). 23. Capizzi A, Zanon GF, Zacchello G, Rigamonti W. Kidney transplantation in children with reconstructed bladder. Transplantation. 2004 Apr 15;77(7):1113-6. doi: 10.1097/01.tp.0000116710.73099.8a. PMID: 15087783. 24. Martin X, Aboutaieb R, Soliman S, el Essawy A, Dawahra M, Lefrancois N. The use of long-term defunctionalized bladder in renal transplantation: is it safe? Eur Urol. 1999 Nov;36(5):450- 3. doi: 10.1159/000020029. PMID: 10516458. 25. Craig A. Peters, MD. Campbell-Walsh Urology, Eleventh Edition, 2016, Urologic Considerations in Pediatric Renal Transplantation, Chapter 153, Figure 153-1 : 3528-3529. 25. Burns MW, Watkins SL, Mitchell ME, Tapper D. Treatment of bladder dysfunction in children with end-stage renal disease. J Pediatr Surg 1992;27:170–4. 27. Nguyen Tri Thuc and colleagues (2022), "History of formation and development of the organ donation - tissue - transplantation system at CR Institute Hospital", Management network in selecting and coordinating donated kidneys from organ donors alive, brain dead or circulatory arrest, Ho Chi Minh City National University Publishing House. Ho Chi Minh, p. 2-21. 28. Arman A. Kahokehr, Kidney Transplantation: Principles And Practice – Eighth Edition, 2018, Transplantation and the Abnormal Bladder, Elsevier, 2018; 173-183. REFERENCES 30

Editor's Notes

  1. Dear teachers, today, MSc DLQV would like to present the outline: DGKQGTTBNCBQDTNTBVCR
  2. The content includes the following 5 parts:…
  3. Sick kidney side phase paragraph last To be sick often meet and in progress tend​​ day more funeral above​ full position gender . Consider private in Flower Ky presently Satisfied Have nearly 1 million patients received diagnosis guess STM with nearly 130K TH new each year , billion Rate 340 TH/ 1 million people . In there Coal grafting is 1 of 3 ways France replace position kidney Okay Apply and get it​ graft quality chat​ good life​ best with conclude fruit dark pros .
  4. In VN alone, there have been 5,500 kidney transplant cases over 30 years, with 22 transplant centers across the country. Among them, CR Institute BV emerged as the leader in the transplant industry in the entire South and has performed almost all indications for kidney transplant with 1,100 cases transplanted from living donors, accounting for 93.5%. 64 THs have been performed from deceased donors since 2008 and the latest successful 03 ABO blood group incompatible kidney transplants since 2021. We continue to develop further, including DSA + extended standard grafts.
  5. However, to maintain that achievement, we must also continuously learn from and improve more from abnormal grafts with complications, paying attention to better preserving the transplanted kidney after surgery. Kidney transplant survival depends on many factors: Among them, abnormal surgical factors are one of the main causes of early kidney transplant loss. And in the group of surgical complications, Urological complications account for 1-15%, especially when the transplant surgeon is not a Urologist. Groups of complications include urinary fistula, ureteral stenosis, vesicoureteral retrograde, lower urinary tract dysfunction and other bladder abnormalities. Through many reports and clinical practice, it has been noted that the group of patients with bladder abnormalities is quite common, about 20-30% at the time of transplantation. At our kidney transplant center, special attention is paid to the rate of patients with small bladder capacity of 10-20%. For us, grafting on a small-capacity bladder is a big challenge when inserting the bladder ureter, partially affecting the results after transplantation. Choosing appropriate intervention in transplant patients with abnormally small bladder capacity remains controversial to date.
  6. In the next section on the Overview of the literature, I would like to go back to the applied anatomy related to the bladder in kidney transplant patients with the diagram below: the standard graft location is the right or left iliac fossa, the peritoneum is next to the bladder. optical. The incision uses the right or left Gibson line. It is necessary to perform a dissection to create a retroperitoneal space. Regarding blood vessel grafting technique, connect the lateral renal vein to the external iliac vein, connect the renal artery to the external iliac artery in an end-to-side manner. Perform bladder ureteral implantation using Lich Gregor.
  7. In summary, the standard for a normal bladder before transplantation is the ability to store urine with sufficient capacity at low pressure, no leakage, and the ability to expel urine completely and autonomously. Other physiological characteristics taken from the kidney transplant book by author Peter Morris as mentioned are that the small bladder capacity in children will gradually increase with age until it reaches an average of 300-500ml in people over 18 years old. The bladder in patients with STMGDC will gradually lose function with urine output less than 100 ml in 24 hours. This is a physiological characteristic when the bladder is not used for 1 hour after dialysis or peritoneal dialysis.
  8. On the next slide, I would like to quickly describe the characteristics of pre-transplant patients with a standard bladder to be suitable for receiving a kidney transplant as follows: The bladder is suitable for transplantation when it has an average capacity of 300 to 500 ml of adult urine or according to the formula. (age/2 +6) x 28.35 ml in children under 18 years old. The measurement method is based on regular actual capacity. Other characteristics such as standard bladder pressure are less than 40cm of water due to urodynamics. Urine from the pre-transplant bladder taken midstream should be sterile. We also pay attention to the issue of the bladder needing to be able to empty autonomously and completely according to the following data, the measurements performed through uroflowmetry, urodynamics and abdominal ultrasound.
  9. Silde Next , due to the problem topic eagle optical small soy sauce opposite to much physical theory other each other , you Ask for quote guide determined think total fit from the book graft by Peter Morris and Campbell as after . Bang optical capacity​ small , decrease can accumulation To be dense point eagle optical reduce degree piano rebound , decrease can accumulation contain contain with capacity​ small more than 100ml in People big or capacity​ small 30% more than musty pepper standard counted through merit awake according to year old live above . history of posterior urethral valve (PUV), prune-belly syndrome (PBS), neurogenic bladder (NGB), bladder exstrophy, Ochoa and Hinman syndromes, patients with anorectal malformations, and persistence of the cloaca. In some of these conditions, the development of ESRD is often a result of the congenital anomaly associated with renal dysplasia (PUV, PBS, persistence of the cloaca); however, in others, such as NGB, whether congenital or acquired, renal damage results from bladder dysfunction and is preventable with good management. Therefore, the causes of abnormal bladder function can be congenital or acquired and may include various urologic abnormalities, neurological disorders, urinary obstruction, or congenital abnormalities."
  10. Total mandarin about real often eagle optical on the waiting room Charcoal grafting is real often Have may be congenital born or infected Right tell chief the group attached weird disability details urinary Other in​ there : Often meet like above To be eagle optical reduced capacity​ on one's own due to the small amount urinary enter urinary after time time long position ability to complain reduce . The group other like : Bladder disorders due to anthrax​​ muscle Weird disability Bau born Tac blockage road go out like urinary valves religion posterior , narrow urinary religion The inflammation bladder infection​ infected must be due to infection bacteria fiber chemistry , radiation treat , chemical treat internal state of the bladder . Due to the Sister scar next to the bladder like inflammation death bow export blood , inflammation um tissue implant graft next to the bladder . Real often above group bq intervened​​ pt , bladder new create equal intestine Real often eagle optical in graft kidney Okay determined means To be real period real often Have image enjoy arrive position power jar often belong to eagle optical like difficult towel in job contain contain or throw export water urination , due to irregularities copper contractions​​ muscle , line pee weak or ejected export water pee Are not complete all ... Question topic This is due to many reasons original core like sick physical God terrible muscle , hold occlusion road out , infected bacteria details urinary or the real often Bau born . Real often eagle optical in graft kidney Have can guide arrive much variable proof like pee Are not check control , infection bacteria road details urinary drag long and damage love kidney graft . Nerve damage can affect the function of the bladder, making it unable to store or release urine normally. Bladder outlet obstruction is a condition in which something blocks the outlet of urine from the bladder. This can cause pain, difficulty urinating, and urinary tract infections. Acquired urinary disorders are a group of conditions that affect bladder control. These conditions can include urinary incontinence, urinary urgency, and frequency. Acquired bladder diseases are a group of conditions that affect the bladder. These conditions may include fibrosing cystitis, postradiation changes, and fibrosis due to intravesical chemotherapy. Peribladder scarring is a condition in which there is scarring around the bladder. This can cause the bladder to be unable to store or release urine normally. An artificial bladder is a bladder created from the patient's own tissues or from synthetic materials. An artificial bladder is used to replace a damaged or removed bladder.
  11. Summary turn off from the newspaper fox near the This and book belong to work fake Morris, real often eagle optical When graft If Are not thing treat will guide arrive much variable proof like pee Are not check control , infection bacteria re develop , damage upper kidney graft and Have image enjoy living still full set . Image beside To be Maths Kaplan Meier map in a newspaper fox belong to work fake Salman when according to follow long long both groups​ sick core graft Have real usually bladder​ When graft vs​ group bladder syndrome​ jar often . From the number Whether shared take note receive billion rule the real usually bladder​ is 20-30% of owners Weakness is common live young me and People young . Often bt This will attached the bc infected bacteria , stones and the variable proof complex miscellaneous other before and after graft . history of posterior urethral valve (PUV), prune-belly syndrome (PBS), neurogenic bladder (NGB), bladder exstrophy, Ochoa and Hinman syndromes, patients with anorectal malformations, and persistence of the cloaca. In some of these conditions, the development of ESRD is often a result of the congenital anomaly associated with renal dysplasia (PUV, PBS, persistence of the cloaca); however, in others, such as NGB, whether congenital or acquired, renal damage results from bladder dysfunction and is preventable with good management. Therefore, the causes of abnormal bladder function can be congenital or acquired and may include various urologic abnormalities, neurological disorders, urinary obstruction, or congenital abnormalities."
  12. Part next according to me Ask for quote guide conclude results 1 study rescue Satisfied Okay real presently about fight price Combine coal above bq capacity​ small due to effects fake Inou give see the replace change accumulation pole can Bladder volume , pressure​ force internal state, bladder , strength piano Bladder recovery​ return about near the like jar often after 01 year receive grafted coal Have position power Good . Although course sample research rescue give see replied response This only happen go out in group of optical capacity​ small born physical enter urinary after failure kidney Are not contact mandarin group Have sick reasonable or strange disability Bau born before there . Greed essay from Campbell received books determined job Combine coal above group of optical capacity​ small due to STMGDC can give permission dress Anise position bladder capacity​ complete full after surgery . Functional recovery in 16 patients with a pretransplant hypocompliant bladder (<10 mL/H2O) from pretransplantation to 1 year post-transplantation. (a) Cystometric bladder capacity. (b) Maximum intravesical pressure. (c) Bladder compliance.
  13. Part next me Ask for catch turn off way receive determined real usually bladder​ need intervention​ When graft based above the only determined after : Million proof road details urinary below complex miscellaneous Bang optical reduce or lost position power before failure kidney Money history occlusion blockage road details urinary early . From medical literature much work fake give see original occlusion shared to thing treat bladder capacity​​ small give permission dark charcoal graft pros To be : Damn tell possible power Tong export complete full water pee When Are not can Go pee on one's own owner Phuc Anise Okay possible power contain contain and strength piano bladder association​ Damn health insurance​ hinder road go out When muscle ring bag failure cause pepper Are not on one's own owner The original occlusion above often Apply for PTV calculation​ direction judgment create image again eagle optical or Right transfer save water pee . history of posterior urethral valve (PUV), prune-belly syndrome (PBS), neurogenic bladder (NGB), bladder exstrophy, Ochoa and Hinman syndromes, patients with anorectal malformations, and persistence of the cloaca. In some of these conditions, the development of ESRD is often a result of the congenital anomaly associated with renal dysplasia (PUV, PBS, persistence of the cloaca); however, in others, such as NGB, whether congenital or acquired, renal damage results from bladder dysfunction and is preventable with good management. Therefore, the causes of abnormal bladder function can be congenital or acquired and may include various urologic abnormalities, neurological disorders, urinary obstruction, or congenital abnormalities."
  14. The item pepper tool can from original occlusion above like after : Urologic Considerations in Pediatric Renal Transplantation Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS
  15. Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS (2020). Urologic Considerations in Pediatric Renal Transplantation. Campbell 12 May .
  16. Algorithm for evaluation and management of the bladder in patients in preparation for renal transplantation. The key element is the history of urologic conditions or symptoms. CIC, Clean intermittent catheterization; PVR, post void residual; RUS, renal ultrasound; VCUG, voiding cystourethrogram. Urologic Considerations in Pediatric Renal Transplantation Craig A. Peters, MD, and Armando J. Lorenzo, MD, MSc, FRCSC, FAAP, FACS
  17. From there, we posed the research question: Outcomes after kidney transplant in patients with small bladder capacity at CR Institute hospital. how?
  18. Regarding specific goals, I would like to quote 3 goals: 1/ Determine the clinical and paraclinical characteristics of kidney transplant candidates in patients with low blood volume before transplant at CR hospital. 2/ Evaluate the effectiveness and ability to restore bladder capacity when applying surgery on patients with small bladder capacity. 3/ Determine the rate and results of early and late breast examination related to abnormal small blood vessel volume after gt surgery.