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Author Topic: Technical Modification for Laparoscopic Donor Nephrectomy to Minimize Testicular  (Read 8774 times)

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Offline Clark

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http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03495.x/abstract

Technical Modification for Laparoscopic Donor Nephrectomy to Minimize Testicular Pain: A Complication with Significant Morbidity
S. P. Shirodkar, M. A. Gorin, J. Sageshima, V. G. Bird, J. M. Martinez, A. Zarak, G. Guerra, L. Chen, G. W. Burke, G. Ciancio
Article first published online: 26 APR 2011

DOI: 10.1111/j.1600-6143.2011.03495.x

American Journal of Transplantation
Volume 11, Issue 5, pages 1031–1034, May 2011

Abstract

The laparoscopic approach to donor nephrectomy is becoming increasingly common. While it is felt that the recovery from laparoscopic nephrectomy is quicker and less painful, a number of complications have been reported. A rarely reported on complication in the literature with significant morbidity is ipsilateral orchalgia. From 1998 to 2008, 257 hand-assisted laparoscopic donor nephrectomies were performed at our institution. Eight of 129 (6.2%) men complained of de novo ipsilateral orchalgia postoperatively. The average duration of pain was 402 days. Patients reported significant morbidity related to this complication. None, however, required further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Our technique originally included dissection and ligation of the gonadal vein en bloc with the ureter at the level of the left common iliac artery. Since recognizing this complication, we have adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein. To date, 50 patients have undergone the modified technique without experiencing orchalgia. In conclusion, ipsilateral testicular pan is a relatively frequent complication of laparoscopic donor nephrectomy and may be a source of significant morbidity. Using a modified surgical technique, this complication can be reduced or eradicated.
Unrelated directed kidney donor in 2003, recipient and I both well.
580 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
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Offline Clark

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O.K., men, you have a new question to ask the surgeon during prep: "Have you adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein, or do you dissect and ligate the gonadal vein en bloc with the ureter at the level of the left common iliac artery?"  Had I but known this 10 years ago.
Unrelated directed kidney donor in 2003, recipient and I both well.
580 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
Proud grandpa!

Offline sherri

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So many medical interventions, medications, procedures etc are a dynamic process with a broad learning curve. Kudos to this institution for reviewing their procedures and discussing and finding a new approach. One of the many reasons why a donor registry is imperative and standardized protocols should be followed.The medical community can no longer be complacent and assume minimal risk to donors and keep quoting statistics which may no longer be current or be negligent by not informing patients of some related complications like this one. I hope more research is conducted about adrenal insufficiency and new surgical approaches can be adopted.

Thanks for the article.

Sherri
Sherri
Living Kidney Donor 11/12/07

Offline tom carr

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I also had testicular pain and continue to have it 6 months after my surgery. I donated my kidney to a woman who, at the time, was a stranger to me. While I would, without hesitation, donate again I do wish that my surgeon had informed me before the surgery that this discomfort was a possible side affect of a kidney donation. It is not so much the pain, but rather the unknown that is disturbing. When you feel this pain, the initial thought process is, "what went wrong"?

Better communication would go a long way.

Tom Carr
Donated altruistically Oct. 21, 2010
Tom Carr
Non-directed donor
Oct. 2010

DerylJohnson

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I donated my left kidney to an old friend on November 30 2006 (absolutely no regrets). It was one of the greatest experiences of my life. In the course of this adventure I now have a whole new family that loves me and considers me to be one of their own. I have now had a left side Hydrocele for about three years and it is reaching a critical stage involving both large swelling and that "kick in the b---s" feeling on a constant basis. I injured my back severely last December and I am soon to have surgery to repair four discs. I was injured at work (spinal)  and my company dropped me from the insurance plan three months ago. I had seen a Urologist two years ago and he said that he doesn't remove them until they are grapefruit size! Alas mine is only baseball size. I am now uninsured and without the opiates for my back pain, the testicular pain would be unbearable. I have contacted The University of Wisconsin, where I had the transplant done (a fantastic facility that conducts miracles on a daily basis) and the living donor advocate got back to me within two hours. Amazing! I am in hopes that they will remove it for me gratis, but we shall see. They seem very concerned and sympathetic to my predicament. Please say a prayer for me that they will end my pain without any bankruptcies involved. Thank you for any advice.
« Last Edit: October 25, 2011, 04:58:48 PM by DerylJohnson »

Offline Clark

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Best wishes, Darryl!  Do let us know what you learn along the way.  If the transplant center comes through for you, that would be great!  I had a hydrocelectomy at a bit less than baseball size about six months after onset of inflation, which was about a year and a half post nephrectomy, very sudden, and then slowly increasing in size.  Shop around if you're still being told it's too small to relieve.  Pain is discounted by too many practitioners, and the potential for a causal link between left side nephrectomy and subsequent left side hydrocele is outright dismissed by most transplant surgeons and urologists.  I hope you find relief for all your pain and injuries, and you let us know how you're doing.
Unrelated directed kidney donor in 2003, recipient and I both well.
580 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
Proud grandpa!

Offline rdr321

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 I did not know that was common. I donated about 3 months ago. One of my testicles has had pain since after the surgery. I have never said anything about it. Thinking what is the point in saying anything about it. My coodinator told me they can be rough on your body during surgery. There was a bruise on my penis. It looked like they had used it as a handle to tighten the skin before they cut me open. The testicle is only painful when there is any pressure on it. It is starting to get a little better.

Offline Clark

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Bumping and moving to the main forum.
Unrelated directed kidney donor in 2003, recipient and I both well.
580 time blood and platelet donor since 1976 and still giving!
Elected to the OPTN/UNOS Boards of Directors & Executive, Kidney Transplantation, and Ad Hoc Public Solicitation of Organ Donors Committees, 2005-2011
Proud grandpa!

 

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