Renal Transplantation In Children With Lower Urinary Tract Dysfunction Of Different Origin: A Single-Center Experience

UroToday. com - A study out of Turkey reported a single center experience evaluating patient graft survivals in patients who had renal transplantation with concomitant lower urinary tract dysfunction. The group evaluated 70 pediatric transplant patients and found 11 of them to display severe lower urinary tract dysfunction. Videourodynamic testing was done preoperatively on all patients and postoperatively on those that required repeat studies. The cause of urologic disorder in these patients was neuropathic bladder in 5 patients and a history of posterior urethral valves in 6. Amongst 11 patients, 6 needed to empty their bladder with clean intermittent catheterization regimens. 5 patients needed an augmentation cystoplasty to increase their bladder capacity and compliance prior to transplantation.

All patients underwent renal transplantation only if low intravesical pressures were achieved with adequate bladder drainage or cystoplasty. All patients post transplant were treated with a calcineurin based immunosuppressive therapy. 3 patients received kidneys from cadaveric donors and the remaining 8 from living donors. Of the patients 9 were male and 2 were female. The mean patient age at time of transplantation was 15 years with a range of 11. 3 to 19. 7. The median duration of transplantation was 36 months with a range of 6 to 62 months. They had 3 patients who had undergone pre-transplant augmentation on clean intermittent catheterization regimens who experienced recurrent symptomatic UTI's. The group also found that they had one patient who also underwent an augmentation cystoplasty that had a urinary leak and ureteral stricture in the early postoperative transplant period. This patient was just treated by an antegrade double pigtail stent that was subsequently removed without any discussion as to any further sequelae.

The group went on to state that severe lower urinary tract dysfunction plays a critical role in graft survival. They emphasized for satisfactory outcome of kidney transplantation that all these patients with lower urinary tract dysfunction should be rehabilitated aggressively and appropriately. They also state that not all patients need to have augmentation cystoplasty and if low intravesical pressures with adequate bladder drainage could be achieved, the results are comparable. They further state that if augmentation cystoplasty is intended, they prefer to have it done before renal transplantation to avoid possible effects of immunosuppressive therapy. Some of these effects are delayed wound healing and possibility of a severe infection with manipulation of bowel. They also believe that the use of prophylactic antibiotics can reduce the incidence of urinary tract infection.

They conclude by stating that based on their analysis renal transplantation is safe and effective as long as the underlying urologic pathology is properly managed prior to undertaking any transplantation. It appears quite obvious to me that severe lower urinary tract dysfunction in deed carries a high risk for grafted kidney according to this study.

Reported by UroToday. com Medical Editor Pasquale Casale, MD Assistant Professor, University of Pennsylvania University of Pennsylvania, Children's Hospital of Philadelphia

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Use of abortion medication

Diazepam: useful modern medicine.

Diazepam: uses

Diazepam is used to treat episodes of increased seizures ( e. g. , acute repetitive seizures, breakthrough seizures ) in people who are already taking medications to control their seizures. Diazepam is only recommended for short-term treatment of seizure attacks. It's not for ongoing daily use to prevent seizures. Uncontrolled seizures can turn into serious ( possibly fatal ) seizures that don't stop ( status epilepticus ) .

Diazepam belongs to a class of medications called benzodiazepines which produce a calming effect on brain and nerves ( central nervous system ) . It's thought to work by increasing effect of a certain natural chemical ( GABA ) in brain.

Diazepam: how to use

Read the Patient/Caregiver Information Leaflet provided by your pharmacist before we use Diazepam and each time we get a refill. If you have questions, consult your doctor or pharmacist.

Diazepam is given rectally by a caregiver trained to recognize symptoms of your seizures and to correctly give product. We and your caregivers must follow all instructions from your doctor and pharmacist exactly. Review all instructions on how to give Diazepam in product package. If we have any questions or feel unsure about using Diazepam, call the doctor or pharmacist before using Diazepam. Get emergency help if person is having a seizure and we do not feel comfortable using Diazepam.

Before using, check syringe for correct dose. Your pharmacist should set correct dose and lock the syringe in " ready " position before giving we product. Before leaving pharmacy, look at each syringe. The dose should be in the display window on side. We should see a green band with word " ready " at bottom of syringe barrel. Look to make sure you have correct syringe tip ( e. g. , smaller tip for a child ) and that there are no cracks around syringe tip. Return product to pharmacist if there's a problem or if we have any questions

Cracks can cause the medication to leak out and not provide correct amount of medication. If we see a crack, use a different syringe. Cracks can appear over time, so keep checking your syringes to make sure we have good ones ready to use. Also check expiration date on the package, and refill your prescription before the medication expires.

The dosage is based on age, weight, medical condition, and response to therapy. Be sure you understand when Diazepam should be used, how to use it, and how to check for side effects/seizure control. In some cases, a second dose may be prescribed and given 4 to 12 hours after the first dose. Usually, Diazepam should not be used to treat more than 5 episodes per month and no more than one episode every 5 days. If seizures continue after using Diazepam as prescribed ( e. g. , no change 15 minutes after dose is given ) , or if there's a change in person's breathing, behavior, or condition that alarms you, get emergency help right away.

Diazepam shouldn't be used regularly. This medication may cause dependence when it has been used regularly for a long time ( more than a few weeks ) or if it has been used in high doses. In such cases, if you suddenly stop Diazepam, withdrawal reactions may occur while use Diazepam. Such reactions can include increased seizures. Report any such reactions to your doctor immediately. When stopping extended, regular treatment with Diazepam, gradually reducing the dosage as directed will help prevent withdrawal reactions. Consult your doctor or pharmacist for more details.

Though it's very unlikely to occur, Diazepam can also result in abnormal drug-seeking behavior ( addiction/habit forming ) . Don't increase your dose, take it more frequently, or use it for a longer time than prescribed.

Dispose of Diazepam properly. Follow directions in Patient Information Leaflet. Don't reuse the syringe.

Do not stop taking your regular seizure control medications when you're given Diazepam.

Diazepam: side effects

Drowsiness, dizziness, diarrhea, and unsteadiness may occur. If these persist or worsen, notify your doctor promptly.

Remember that your doctor has prescribed Diazepam because he or she has judged that benefit to you is greater than the risk of side effects. Many people using Diazepam don't have serious side effects. Diazepam stays in body for a long time. Be sure to watch for reactions for at least 4 hours after giving the medication.

Seek immediate medical attention if any of these unlikely but very serious side effects occur:

A serious allergic reaction to Diazepam is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include:

This isn't a complete list of possible side effects. If we notice other effects not listed above, contact your doctor or pharmacist.

Diazepam: precautions

Before using Diazepam, tell your doctor or pharmacist if we are allergic to it; or to other benzodiazepines ( e. g. , oxazepam, temazepam ) ; or if we have any other allergies.

Diazepam should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have:

Before using Diazepam, tell your doctor or pharmacist your medical history, especially of:

Diazepam may make we dizzy or drowsy; use caution while engaging in activities requiring alertness such as driving, riding a bicycle, or using machinery. Avoid alcoholic beverages.

To minimize dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Caution is advised when using Diazepam in the elderly because they may be more sensitive to effects of Diazepam, especially drowsiness effect.

Diazepam isn't recommended for use during pregnancy. If we become pregnant or think you may be pregnant, inform your doctor immediately. Consult your doctor for more details.

Diazepam may pass into breast milk. Because of possible harm to infant, breast-feeding while using Diazepam isn't recommended. Consult your doctor before breast-feeding.

Diazepam: interactions

Your healthcare professionals ( e. g. , doctor or pharmacist ) may already be aware of any possible drug interactions and may be monitoring we for them. Don't start, stop or change dosage of any medicine before checking with them first.

Diazepam shouldn't be used with following medications because a very serious interaction may occur while use Diazepam:

If we are currently using either of these medications, tell your doctor or pharmacist before using Diazepam.

Before using Diazepam, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially of:

Tell your doctor or pharmacist if you also take drugs that cause drowsiness such as: antidepressants ( e. g. , amitriptyline, nefazodone ) , certain antihistamines ( e. g. , diphenhydramine ) , anti-seizure drugs ( e. g. , carbamazepine, phenobarbital, valproate ) , medicine for sleep or anxiety ( e. g. , alprazolam, kava, zolpidem ) , muscle relaxants, narcotic pain relievers ( e. g. , codeine ) , psychiatric medicines ( e. g. , chlorpromazine, risperidone ) .

Diazepam contains a small amount of alcohol. Tell your doctor if we are taking drugs such as disulfiram or metronidazole that can can cause an unpleasant reaction when combined with alcohol.

Avoid alcohol when using Diazepam because it may increase side effects such as difficulty breathing and drowsiness.

Check labels on all your medicines ( e. g. , cough-and-cold products ) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.

This document doesn't contain all possible interactions. Therefore, before using Diazepam, tell your doctor or pharmacist of all products we use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

Diazepam: overdose

If overdose of Diazepam is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include confusion, slow reflexes, clumsiness, deep sleep, and loss of consciousness.

Diazepam: notes

Don't share Diazepam with others. It's against law.

Diazepam: missed dose

Not applicable.

Diazepam: storage

Store Diazepam at room temperature at 77 degrees F ( 25 degrees C ) away from light and moisture. Brief storage between 59-86 degrees F ( 15-30 degrees C ) is permitted. Keep all medicines away from children and pets.

Properly discard Diazepam when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Diazepam with EU delivery

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