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.

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

Uncontrolled Diabetes Mellitus and Blood Pressure are the leading causes of Chronic Kidney Failure all around the world. Pain Killer Medications and Ayurvedic Medications can also cause Kidney failure.

Post Kidney transplant Urological complications happen due to ureteric stricture, urine leak, vesicoureteral reflux (VUR), urolithiasis, bladder obstruction, and urinary tract infections early or late in life.
The use of a ureteral stent at the time of renal transplantation reduces Ureteric stricture, Urine leak and other urologic complications. Late stent removal can cause UTI, haematuria, fragmentation, and migration.
For treatment of any complex urological complications post Kidney Transplant, an expert urologist who is familiar with anatomy and is very well versed with managing Post Transplant cases is recommended.
The urologists have exposures to prostate problems, bladder dysfunction, stone disease, urinary tract cancers, and infections and at the time of renal transplantation, they are the best to avoid any urological complications. The renal transplant program needs thorough urological evaluation and intervention for patients who have small renal mass or have a pre-existing urological condition which should best be addressed by a Urologist.

There are 3 types of treatment available after a kidney failure:

HemoDialysis

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

Peritoneal Dialysis

In peritoneal dialysis, a special solution called dialysate is introduced into the abdominal cavity through a catheter. This solution draws waste and excess fluids from the blood vessels in the peritoneum, a membrane lining the abdominal cavity, before being drained out of the body.

Kidney transplant

The kidney transplantation surgery returns kidney functions by replacing 2 failed kidneys with one healthy kidney.It can be done by artery vein fistula creation or permacath. 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, Active Infection must be evaluated and ruled out beforehand. It is of paramount importance to make sure the normal renal function of the donor. In Kidney transplant surgery, the Donor Kidney is detached by cutting the Renal Artery, Renal Vein and Ureter and then taken out, and then the kidney is placed in recipient’s body and these 3 tubes are joined in recipient’s body. Laparoscopic Donor Nephrectomy is most preferable for organ donors and is considered the gold Standard now-a days. Laparoscopy (Key hole) surgery gives the benefit of very small cuts less than 1 cm on Donor’s belly and kidney is removed from a horizontal cut which gets hidden under the donors undergarments. This ensures minimal pain and early recovery to normal work. After the surgery, the Kidney transplant recipient has a Per urethral catheter for few days to drain out urine. After about 5 days it is removed. The graft kidney starts functioning usually at the same time of starting blood flow but some times the function gets delayed and is called as Delayed Graft Function.