Transplant Urology

Kidneys are bean-shaped organs that are found on either side of your spine. Kidneys filter blood and chemical levels in the body and make urine. Healthy kidneys regulate waste from the blood and monitor the oxygen concentration in the blood. The urine then flows through the ureter to the bladder. Urine is stored within the bladder, and thereafter it emptied urine through a tube called the urethra.

If one kidney is failed, the normal kidney function is still continued through one healthy kidney. If both the kidneys are failed, the loss is irreversible. Donor kidney transplantation is the only option left.

Kidney failure causes a problem in the bladder and urinary tract, if not treated in time. Kidney/renal transplant is one of the most common organ transplant surgery and considered under a multidisciplinary patient care program.

Urology plays a vital role in surgical specialization and treating complexity in organ transplantation surgery. Urological inputs are required to evaluate and prepare certain patients for the eventual donation of kidneys. Generally, children have complex urological problems and needed specialist urological management and close monitoring.

Kidney failure may develop a life-threatening disease. Its signs and symptoms include:

• High blood pressure
• Salts, acid, and urea level rise and create an imbalance in the body
• Loss of appetite
• Fatigue and headache
• Dryness and itching
• Generalised swelling in the hands, feet, and face because of fluid build-up (edema)
• High blood potassium is stored in the kidney that may lead to abnormal heart rhythms and sudden death. (hyperkalemia)

Kidney failure may be a result of several causes or conditions. Typically, the cause determines the type of kidney failure.

Loss of blood flow flow to kidneys can lead to kidney failure. Common conditions leading to loss of blood flow to kidneys include:

• Heart Disease
• Heart Attack
• Liver cirrhosis or liver failure
• Dehydration
• Sepsis
• High Blood Pressure
• Anti-Inflammatory Medications

There are some risk factors associated with the development of urologic complications after organ transplantation. Post-transplant diagnosis has seen complications in ureteral stricture, urine leak, vesicoureteral reflux (VUR), urolithiasis, bladder obstruction, and urinary tract obstruction early or late in life. Proficiency in the management of urologic renal transplants is increasingly relevant.

• The use of a ureteral stent at the time of renal transplantation reduces UTIs and other urologic complications. Late stent removal can cause UTI, haematuria, fragmentation, and migration.
• For treatment of complex urological reconstructions of renal failure, an expert urologist who is familiar with anatomy is recommended during surgery.
• The certainty of the results, precision, consistency, heterogeneity, and statistical related factors are necessary to consider before the organ transplant procedure.
• The urologists have exposures to prostate problems, bladder dysfunction, stone disease, urinary tract cancers, and infections and at the time of renal transplantation, they might be needed to avoid any urological complications.
• The renal transplant program needed a urological evaluation and intervention for patients who have small renal mass or have a pre-existing urological condition.

There are 2 types of treatment available after a kidney failure:

Dialysis

Dialysis removes waste, extra water, and chemicals and replaces the work of the kidney. Most often it is done 3 times per week.

Kidney transplant

The earlier urologist would have been the primary surgeon in renal transplantation. These days it can be done by doctors with normal surgery backgrounds. However, the medical and surgical intervention of urologists is still required.

The kidney transplantation surgery returns kidney functions by replacing 2 failed kidneys with one healthy kidney. Most of the kidney transplant comes from the deceased donors. Some donors are willing to undergo nephrectomy and donate one kidney. History of stone disease, malignancy, cancer, or tumor must be evaluated before. It is of paramount importance to make sure the normal renal function of the donor. Laparoscopic surgery is most preferable to organ donors. After the surgery, the receiver has a catheter inserted for few days to drain out urine. After a weak time, the kidney starts functioning.

Timely diagnosis of urologic complications is crucial to provides optimal quality of care to these complex patients.