Objective:We summarized the therapeutic results of 68 differently located urinary fistulae after kidney transplantation in order to approach optimal treatments for them. Methods: Between December 1994 and July 2008, fistulae were observed in 68 of 1263 patients (5.4%) after kidney transplantation,including 26 lower fistulae and 42 upper fistulae. The former included vesical fistulae and stoma fistulae,while the latter included ureter fistulae,pelvis fistulae.The location of fistulae was determined by cystography, magnetic resonance hydrography(MRH) or operation research. In both groups we first adopted conservative treatment which was placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in,however,if invalid,we resorted to surgical repair. Subsequently, therapeutic efficacies of differently located fistulae observed. Results: Twenty of 26 lower fistulae(76.9%) were cured successfully by conservative treatment For the remaining 6 cases(23.1%),we had to turn to open surgery, among which 5 were cured and 1 underwent nephrectomy because of acute rejection. Only 8 of 42 upper fistula(19.0%)were cured by conservative treatment, but the other 34(81.0%)cases accepted open surgery among which 29 were cured, and 3 underwent nephrectomy owing to acute rejection (1 case)and failure of surgery(2 cases), and 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae(76.9% vs. 19.0%,P

BACKGROUND: Present existed procedure protocol for urinary fistula has some limitations, which can not reflect diseased region, pathological change, or severe condition of patients, OBJECTIVE: To establish the procedure protocol for urinary fistula diagnosis and treatment following renal transplantation, in addition, to investigate its significance in clinical practice. METHODS: A total of 102 cases with urinary fistula, including 67 male and 35 female, range in age from 21 to 57 years. According to the business management mode, we have designed the "five-step procedure protocol" for the diagnosis and treatment of urinary fistula after renal transplantation. Four diagnosis steps consisting of qualitative, located, quantitative and classified, as well as one treatment step. Among 102 cases of urinary fistula, 34 were adopted conservative treatment, including 24 cases with drainage tube and retention type catheter, 10 cases with indwelling ureteric stents at tubal bladder. Other 68 cases received surgical treatment. In 47 cases with simple fistula, 36 cases received ureter/bladder replantation, 11 cases with ureteral anastomosis. Twenty-one cases with complex fistula were treated with surgical prosthesis using omentum majus after repairing. RESULTS AND CONCLUSION: Among the 34 cases receiving conservative treatment, 2 got urinary tract infection repeatedly, and 5 got the stenosis of ureterovesical anastomotic stoma. Among the 68 cases receiving surgical treatment, 2 had ureteral stoma stricture, 1 ureterovesical anastomotic stoma stricture, and 1 ureteral countercurrent. In the surgical treatment series, 3 cases died from severe pulmonary infection elicited by urinary fistula. 77 cases were available for long-term follow-up, 22 were dropped out. In the 57 cases with simple fistula were followed up for 1-10 years, the transplanted renal function was normal in 40 cases, and 17 cases suffered from chronic rejection. 20 cases with complex fistula treated with surgical prosthesis using omentum majus were followed up for 1-7 years, 19 cases were normal, 1 patient had increased creatinine, which was returned to normal after intravenous glucocorticoid therapy. The design of "qualitative, located, quantitative and classified" standard for urinary fistula diagnosis following renal transplantation, and the establishment of "five-step procedure protocol", make urinary fistula diagnosis and treatment more ordered and standard, which is more feasible for selecting optimal therapeutic scheme.

BACKGROUND: The urinary fistula rates following kidney transplantation are varying in each center, which lack of unified classification criteria and treatment standard. OBJECTIVE: To explore optimal treatments for urinary fistula following kidney transplantation by retrospective analyzing the characteristics, etiological factors and therapeutic efficacy of urinary fistula. METHODS: Totally 68 patients with urinary fistula were collected, including 42 males and 26 females, aged 21-57 years. The urinary fistula occurred at days 1-17 after operation. According to the location of urinary fistula, patients were divided into stomas fistula and ureter fistula groups. The location of fistula was determined by cystography, magnetic resonance hydrography (MRH) or operation research. In both groups, conservative treatment was first adopted, namely, placing a negative pressure drainage tube draining the wounds and placing a double-J catheter or a urinary canal in, however, if invalid, a surgical repair was performed. There were 45 patients underwent surgery. The location, onset period, therapeutic efficacies of urinary fistula was analyzed. RESULTS AND CONCLUSION: Among the 68 cases of fistula, 20(29.4%) were stomas fistula and 48 (70.6%) were ureter fistula. The onset period was (5.1±2.5) and (8.8±5.5) days after transplantation, respectively (P < 0.05). Fifteen of 20 stomas fistula (75.0%) were cured successfully by conservative treatment. Whereas, for the remaining 5 cases (25.0%), we attempted open surgery, among which 4 were cured, free of recurrence, and 1 case underwent nephrectomy because of acute rejection. For the 48 cases of ureter fisula, only 8 (16.7%) were cured by conservative treatment, but the other 40 (83.3%) must accept further open surgery, among which 35 were cured (including 6 cases of recurrent fistula). Three cases underwent nephrectomy failure of repair owing to acute rejection, besides 2 died of pulmonary infection. The achievement ratio of conservative treatment in lower fistulae was significantly higher than that of upper fistulae (P < 0.01). It is necessary to determine the location of urinary fistula following kidney transplantation. Compared to ureter fistula, stomas fistula occurred earlier with great leaked volume. Conservative treatment can first selected for stomas fistula, only if it is invalid can we resort to open surgery. However, for. ureter fistula, it is wise to adopt open surgery as soon as possible.

Objective To investigate the expression of proinflammatory cytokine interleukin-17(IL-17) and complement cleavage fragment C5a and the regulation effect of C5a on the expression of IL-17 during renal allograft rejection .Methods The frequency of IL-17+ T cell in peripheral blood and the expression of IL-17 in renal tubular epithelial cells (HK2) after C5a stimulation in renal transplant recipients were measured by flow cytometry and the changes of serum C5a level was detected by ELISA ,respectively .Im-munohistochemistry was applied to detect and compare the expression of IL-17 and the deposition of C5b-9 in normal renal tissues and renal tissues with allograft rejection .The difference of IL-17 expression in HK2 cells before and after the recombinant C5a stimulation was detected by immunocytochemistry .Results Both the percentage of IL-17+ T cells and serum C5a levels were sig-nificantly increased after the allogeneic renal transplantation .Compared with normal renal tissues ,both the deposition of C5b-9 and the IL-17 expression in renal tissues with allograft rejection was remarkably up-regulated ,which showed the positive correlation be-tween them .The expression of IL-17 in HK2 was obviously up-regulated by the recombinant C5a stimulation .Conclusion C5a may positively regulate the expression of IL-17 by tubular epithelial cells during the renal allograft rejection .

Astract:Objective To assess the anatomical and functional significance of the bladder and urethra in female SUI by dynamic MRI and urodynamic. Methods The clinical data were retrospectively analysed on 60 cases of female stress urinary incontinence from Feb 2011 to Nov 2013. All the women received pelvic floor dynamic MRI and Urodynamic study. Measured the urethral angle,the distance of the H line, M line and the descent of the bladder,cervical,anorectal junction from the PCL in the mid-sagittal dynamic MR image of the pelvic. Pearson 's correlation coefficient was used to examine the association among the distance of the H line,M line and the urethral angle,the descent of the bladder,cervical,anorectal junction from the PCL and the Urodynamic data. Results The distance of the H line,M line were significantly and positively associated with urethral angle and the descent of the bladder,cervical,anorectal junction from the PCL. The distance of the H line,M line were significantly and negatively associated with functional profile length, maximum urethral closure pressure,VLPP and detrusor opening pressure. Conclusion Pelvic floor dynamic MRI combined with Urodynamic study is useful for assessing the anatomical and func-tional significance of the bladder and urethra in female SUI.

BACKGROUND: Urinary kidney injury molecule-1 (KIM-1) has been proved to be a novel kidney-specific injury molecule as a marker for the diagnosis of acute renal ischemia injury, and KIM-1 participated in the progress of renal injury repair. However, no one reported the significance of its dynamic expression during the functional rehabilitation of renal graft.OBJECTIVE: To investigate the relations between urinary KIM-1 level and the early renal graft function in order to provide rational approaches for evaluating or predicting early renal graft function.METHODS: The 46 patients were divided into 3 groups, including 22 cases of immediate graft function (IGF), 14 cases of slow graft function (SGF) and 10 cases of delayed graft function (DGF). The 24-hour urine specimen was collected every day for 2 weeks since the operation. The urinary KIM-1 content was detected by enzyme linked immunosorbent assay (ELISA), and at the same time the urinary and serum creatinine levels were detected. The diversity of urinary KIM-1 level was observed during the recovery of the graft function, and the clinical significance was evaluated by analyzing the correlation of urinary KIM-1 level and serum creatinine.RESULTS AND CONCLUSION: At the first 2 days after kidney transplantation, the urinary KIM-1 levels were high and no significant difference was observed between the three groups (P < 0.05). Two days later, the urinary KIM-1 level descended quickly along with the descent of the serum creatinine in IGF and SGF groups; the urinary KIM-1 maintained high levels until the serum creatinine reached normally. In DGF group, the urinary KIM-1 decreased quickly to a low level after 2 days from operation, but it increased promptly 1 to 2 days before the recovery of graft function and kept a high level until the serum creatinine reached normally. This suggested that consecutive detection of urinary KIM-1 is useful for monitoring the early graft function after kidney transplantation, and high urinary KIM-1 may suggest the recovery of graft function.

BACKGROUND: Urethral fistula following renal transplantation accounts for 40%-70% of urinary complications, owing to surgical and medical factors. OBJECTIVE: To effectively decrease and avoid attack of urethral fistula after renal transplantation, and prolong the survival of kidney. METHODS: Clinical data from 68 cases following renal transplantation were retrospectively analyzed at the levels of pathogeny, diagnosis and treatment. There were 47 males and 21 females, aging 20 58 years. Urethral fistula occurred at 3 31 days after renal transplantation, and the amount was 60-2 000 mL per day. Based on the principle of the urethral injury classification method, urethral fistula was divided into simple and complex categories, while according to the fistula site, etiology and extent, urethral fistula was divided into low, high and multiple fistula. Attack rate of simple urethral fistula and complex urethral fistula was detected following renal transplantation so as to analyze the pathogeny of urethral fistula. RESULTS AND CONCLUSION: Of 68 cases with urethral fistula following renal transplantation, 47 cases (69.1%) were simple urethral fistula, including 42 cases with ureteral end necrosis, 4 cases with lax anastomotic suture of ureter bladder, and 1 case with ureteral anastomotic badness caused by wound infection, and 21 cases (30.9%) were complex urethral fistula, including 2 cases with renal pelvis fistula, 2 cases with ureter, 11 cases with ureterovesical anastomosis region, 6 cases with ureteral necrosis longer than 2 cm. A lot of causes may induce urethral fistula following renal transplantation. The blood stream, edema, size of fistula, length of the ureter, and operative procedures are selected to ensure free of strain. Urethral fistula can be treated on time on the basis of different situations.

BACKGROUND: Urological complication is one of common surgical complications following transplantation and severely threatens renal function, even patient's lives. Urological complications following renal transplantation mainly contain urinary fistula,ureteral obstruction and ureter backflow.OBJECTIVE: To retrospectively analyze the incidence and management of urological complications following kidney transplantation.METHODS: A total of 1 223 patient times following kidney transplants were selected at the Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to April 2007.According to ureter of donor kidney and the urinary tract of recipients, ureteroneocystostomy was used for urinary tract reconstitution in 948 patient times, and end-to-end ureteroureterostomy in 275 patient times. Urological complications such as urinary fistula, ureteral obstruction and vesicoureteral reflux (VUR) were treated by the different methods on the basis of the different causes, mainly by surgical procedures. Reason of urological complications, surgical management of urologicalcomplications and its clinical outcome, the 3-year survival rate of grafted kidney were measured.RESULTS AND CONCLUSION: In a total of 1 223 patients, urological complications were encountered in 92 cases (7.5%), including 43 cases of urinary fistula (3.5%), 35 ureteral obstruction (2.9%), 14 VUR (1.1%). 35 cases of urinary fistula, 29 ureteral obstruction, 6 VUR were cured by surgical procedures including ureteroureterostomy in 35 patients (50%), revision of ureteroneocystostomy in 18 (25.7%), endourology in 11 (15.7%) and other operation in 6 (9.6%). All recipients with urological complications regained normal graft function except one undoing transplanted nephrectomy due to the pelvis and urteral necrosis. There was no grafted kidney and recipient loss secondary to these complications in the present series. The 3-year survival rate of graft with urological complications and without urological complications did not show significant difference (P > 0.05). These indicated that most of urological complications following kidney transplantation request surgical management, and ureteroureterostomy are frequently used. The long-term graft survival is not affected by a correctly treated urological complication.

Objective To evaluate the feasibility and efficacy of laparoscopic single-port transumbilical renal pedicle lymphatic disconnection (TRPLD) for treatment of chyluria. Methods Nine cases of chyluria underwent laparoscopic single-port TRPLD. In all cases a 2-3 cm single inverted Ushaped supraumbilical incision was made, two 5-mm and one 12-mm trocars were inserted, and a medical rubber glove was sutured surrounding the three trocars and incision was made for gas proofing.Conventional straight and flexible instruments were used for dissection. Results All laparoscopic operations were successfully completed without conversion to open surgery. The mean operative time was 135 (96-178) minutes, and the mean estimated blood loss was 126 (50-250) ml. Chyluria disappeared in all patients after operation and did not reoccur during the follow-up (1 - 6 months).Conclusions Laparoscopic single-port transumbilical TRPLD represents a feasible and novel mini-invasive option for patients with chyluria.

Objective To establish the standards for classification of urinary fistula after kidney transplantation. Methods From December 1993 to February 2009, 1313 cases of renal transplanta-tions were operated, out of which 102 cases of urinary fistulas occurred (7.8%). Based on the princi-ple of the urethral injury classification method, we divide urinary fistula into simple and complex clas-ses by the cause, location, and the severity of the disease. Results There were 81 cases (79.4%) of simple urinary fistulas, of those 76 cases were ureteral end necrosis,4 cases were due to ureter blad-der anastomosis suture,1 case was anastomotic problem caused by wound infection. There were 21 ca-ses(20.6%) of complex urinary fistulas, of these 2 cases had fistulas at renal pelvis, 11 cases at ure-ter-bladder interface and 6 cases had ureteral necrosis longer than 2 cm. For the 81 cases urinary fistu-las patients, 34 patients conservative treatments were cured and 47 patients need surgeries. For all complex urinary fistulas need surgeries: 11 cases had surgery once, 5 cases had 2 times, 3 cases had 3 times and 2 cases had 4 times. Among the 2 groups, three patients (2.9%) died of urinary fistulas which led to severe lung infection. Conclusions A "Five Steps Procedure" could be used for diagno-sis and treatment of post renal transplantation fistula. The urinary fistulas are divided into simple and complex types after renal transplantation. This provides a guidance for the best choice of treatment.