Hyperparathyroidism (HPT) with hypercalcemia, often deemed irreversible and detrimental to graft survival post-kidney transplantation (KT), prompts pre-transplant parathyroidectomy in hypercalcemic patients. In this retrospective analysis of 1212 kidney transplant recipients (KTRs) between 2006 and 2019, the incidence and effect of persistent HPT and hypercalcemia on graft and patient survival, and risk factors for persistence were analyzed until 60 months of follow up (FU). At KT, 5.7% (n = 69) had no HPT, 32.7% (n = 396) had HPT without hypercalcemia and 37.0% (n = 448) had HPT with hypercalcemia. At 2 years FU, 26.4% (n = 320) of patients had no HPT and 6% (n = 73) had HPT with hypercalcemia. Dialysis and dialysis duration were linked to HPT development, while dialysis, KT waiting time and donor type correlated with persisting hypercalcemia after KT. KTRs with normalized PTH and recovered hypercalcemia had improved death-censored graft survival (p < 0.001) and overall patient survival (p < 0.001). HPT with hypercalcemia is frequent at time of KT with normalization of PTH and calcium in a substantial proportion of patients after a KT. These findings question the routine pre-KT parathyroidectomy for suspected parathyroid autonomy. Persisting HPT, especially with hypercalcemia, adversely affects graft and patient survival, suggesting the need for more aggressive treatment of HPT, especially in cases of persisting hypercalcemia.
1 September 2023 in Case Reports in Women's Health
Biker's nodule, also known as ischial hygroma, is a rare condition described predominantly in male cyclists. Only a few cases of affected female cyclists or horse riders have been reported.
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that increases with age and affects up to 40% of women. Colpocleisis is a possible native-tissue repair used in elderly persons not interested in vaginally penetrative sex to correct advanced POP. This study aims to evaluate the recurrence and reoperation rate of a technique using purse-string sutures in a standardised way. Methods: This retrospective quality control study evaluated all women who underwent obliterative procedures for POP at the Department of Obstetrics and Gynaecology at the University Hospital of Bern from 2014 to 2023. Total Colpocleisis (TC) and Le-Fort Colpocleisis (LFC) were performed by a standardised technical procedure using purse-string sutures. The primary outcome was the recurrence rate measured by the POP-Q stage (stage 2 or higher). Reoperation rate, perioperative complications, bladder outlet disorders and incontinence symptoms were assessed as secondary outcomes. Results: We analysed eighty-eight patients who underwent obliterative surgery with TC or LFC in this study. The recurrence rate for all patients was 16%, and the reoperation rate was 9.2%. In patients without previous surgeries (52%), the recurrence rate was 7%. Thirteen patients (14.8%) had perioperative complications, mainly urinary tract infections (seven patients, 8%). Objective POP improved significantly (p < 0.001), as did the bladder voiding dysfunction in the rate of high postvoid residual volume (p < 0.05), stress urinary incontinence, overactive bladder and mixed urinary incontinence (p < 0.001). In three patients, de novo stress urinary incontinence developed postoperatively. Conclusions: Colpocleisis by the purse-string technique is an effective surgical treatment for advanced POP surgery. Recurrence and reoperation rates are similar to the previously mentioned techniques and are easy to learn due to the standardised procedure.