Enterocystoplasty and renal transplantation

PURPOSE: We report on our experience with renal transplantation in patients with severe chronic bladder contracture who underwent prior intestinal bladder augmentation, and assess the safety of the procedure. MATERIALS AND METHODS: A total of 7 patients with severe alterations to the lower urinary tract and renal insufficiency underwent enterocystoplasty before renal transplantation. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in 4 cases, neurogenic bladder secondary to myelomeningocele in 1, chronic cystitis secondary to intravesical instillation of glutaraldehyde in 1 and hyperreflexic, contracted bladder in 1. Mean patient age was 38.4 years (range 19 to 57). The intestinal segment used was ileal conduit in 6 cases and an ileocaecal segment in 1. All 7 patients have received renal transplant from cadaveric donors. RESULTS: Graft survival rate was 100% and graft function was good after a mean followup of 48 months (range 8 to 97). Of the patients 6 are continent and void spontaneously and 1 requires intermittent self-catheterization. CONCLUSIONS: In our experience bladder augmentation is an acceptable method, although not exempt from complications, for patients with alterations to the lower urinary tract and who are candidates for renal transplantation.     

Incidental Non-Inguinals Hernias in Totally Extra-Peritoneal Hernia Repair

Introduction

Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias.

Materials and Methods

Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database.

Results

A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p<0.01). The risk for patients >60 years of age was 4.0% vs 1.4% for those aged <60 years (p<0.01). Incidental hernias were found in 29.2% of females vs 2.2% of males, (p<0.0001). Risk of incidental hernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79).

Conclusions

Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females.