Bilateral Ureteral Ligation Research Articles

Bilateral Ureteral Ligation During Hysterectomy: A Case Report

Bilateral ureteral ligation is a complication of pelvic surgery. It can affect the functional prognosis of both kidneys and even the vital prognosis. We report the case of a 49-year-old woman, multiparous, referred from the peripheral hospital of Meknes for management of anuria in connection with a suspected ureteral lesion after hysterectomy for an infected uterine cyst. Clinically, the patient had bilateral low back pain and a fever of 38.5. On laboratory examination, she had impaired renal function and a worsening infectious work-up. The diagnosis of iatrogenic bilateral ureteral ligation was suspected. The patient underwent an initial bilateral percutaneous nephrostomy, followed by bilateral double J stent elevation after confirmation of contrast medium passage following opacification of the nephrostomies. Postoperative recovery was straightforward, with normalization of renal function and improvement in the infectious workup.

#5615 VALIDITY AND ADEQUACY OF ANIMAL MODELS IN HAEMODIALYSIS RESEARCH: A SYSTEMATIC REVIEW

Abstract Background and Aims with the worldwide dialysis population growing rapidly, improving haemodialysis (HD) outcomes is crucial and HD innovations are urgently needed. Prior to clinical application, novel HD technologies must undergo extensive preclinical testing. However, to date there is no consensus on the induction method of kidney failure in animal models nor which animal species is most suitable for research on HD innovations. Moreover, there is no consensus on which parameters should be used to validate adequate induction of kidney failure and functioning of novel HD devices. Using a systematic review approach, we summarized available literature of HD in kidney failure animal models. Method we performed a systematic search on PubMed and Embase for relevant studies up to February 4th 2022. After removal of duplicates, 5723 abstracts were screened for eligibility by three independent reviewers (JdV, KW and MK). Inclusion was based on publication of a HD intervention in an animal model with adequate (acute or chronic) kidney failure (independent of induction method). Detailed in- and exclusion criteria were registered in PROSPERO 2022 CRD42022307144. Data from individual reports, including animal species and sex, kidney injury parameters and HD details, were extracted in a pre-set data extraction form. Future efforts will focus on risk of bias and key quality indicators. Results of the 5723 abstracts screened, 195 records were included as full text and 41 full text articles were included for data-extraction (Figure 1). Current data extraction is completed for 31 articles (75%). Publication years range from 1973 to 2021 with over half (16/31) published after 2000. HD experiments were most frequently performed on dogs (45%), followed by rats (29%), goats (13%), pigs (10%), and sheep (3%) respectively. Parameters such as weight (81% reported), sex (58%) and age (29%) were not systematically reported. Most studies (67% of records reporting sex) used male animals only. Dog models were found in older studies, with no records after 2009. Other large animal studies were almost exclusively (88%) performed from the year 2007 onwards. Independent of animal species, studies mainly used acute kidney injury (AKI) models (84%), induced by bilateral nephrectomy (48%) or bilateral ureteral ligation (29%). The majority confirmed kidney failure by an increase in BUN and/or plasma creatinine. In AKI models, dialysis was on average initiated on AKI day 2 ± 0.8, and generally either HD (61%) or veno-venous hemofiltration as a single session (35%) was applied. Except for one clearance study, dialysis efficiency was reported as reduction ratios of BUN and/or plasma creatinine. Conclusion both large and small animal models have been used in HD research and preclinical validation of dialysis innovations. The use of dogs to test HD innovations has seen a sharp decline over the past decades, possibly resulting from a shift in public ethical perception. However, large animal models such as goat, sheep and pigs remain popular. A pressing issue appears the overall lack of adequate ARRIVE guideline adherence for reporting of animal parameters. We found no apparent improvement in reporting over time, emphasizing the need for clear guidelines to drive innovative HD research. Further (quantitative) analysis and meta-analysis are ongoing.

Blockade of sodium-glucose co-transporters improves peritoneal ultrafiltration in uraemic rodent models.

The most used PD fluids contain glucose as a primary osmotic agent. Glucose peritoneal absorption during dwell decreases the osmotic gradient of peritoneal fluids and causes undesirable metabolic consequences. Inhibitors of sodium-glucose co-transporter (SGLT) type 2 are wildly used for the treatment of diabetes, heart and kidney failure. Previous attempts to use SGLT2 blockers in experimental peritoneal dialysis yielded contrasting results. We studied whether peritoneal SGLTs blockade may improve ultrafiltration (UF) via partial inhibition of glucose uptake from dialysis fluids. Kidney failure was induced in mice and rats by bilateral ureteral ligation, and dwell was performed by injection of glucose-containing dialysis fluids. The effect of SGLT inhibitors on glucose absorption during fluid dwell and UF was measured in vivo. Diffusion of glucose from dialysis fluid into the blood appeared to be sodium-dependent, and blockade of SGLTs by phlorizin and sotagliflozin attenuated blood glucose increment thereby decreasing fluid absorption. Specific SGLT2 inhibitors failed to reduce glucose and fluid absorption from the peritoneal cavity in a rodent kidney failure model. Our study suggests that peritoneal non-type 2 SGLTs facilitate glucose diffusion from dialysis solutions, and we propose that limiting glucose reabsorption by specific SGLT inhibitors may emerge as a novel strategy in PD treatment to enhance UF and mitigate the deleterious effects of hyperglycaemia.

CLINICAL, HAEMATOLOGICAL AND PATHOLOGICAL CHANGES FOLLOWING BILATERAL URETERAL LIGATION IN BORNO WHITE GOATS A PRELIMINARY REPORT.

Bilateral ureteral ligation was performed through the left paralumbar fossa in 4 clinically healthy adult Borno White goats. Clinical effects of uraemia were observed 24 hours after surgery when anuria had set in and included in appetence, depression, coughing, stretching of the neck, laboured breathing with inspiratory wheezing sound, serous to mucous ocular and nasal discharges, and terminal paralysis and convulsion. Haematological changes observed included anaemia from day 2 after surgery and lymphocytosis on days 1 and 2, leukocytosis on day 3, neutrophilia on days 3 and 5 and eosinopenia on days 9 and 11 after Surgery. At post-mortem, the major lesions observed were bronchopneumonia, renal tubular necrosis and gastroenteritis.

Use of subcutaneous ureteral bypass systems as a bridge to definitive ureteral repair in a cat with bilateral ureteral ligation secondary to complicated ovariohysterectomy

A kitten presented with acute kidney injury, bilateral hydronephrosis and proximal hydroureter, three days following bilateral ureteral ligation, during a complicated ovariohysterectomy procedure. Clinical signs were anorexia, lethargy, weakness, hypothermia,...

Protective effect of erythropoietin on renal function after releasing of bilateral ureter obstruction in rats and mechanism

Objective To investigate the mechanism of protective effect of erythropoietin (EPO) on renal function after releasing of bilateral ureter obstruction (BUO) in SD rats. Methods Thirty-two SD rats were divided into 4 groups randomly (BUO group, BUO-R group, BUO-R+ EPO group and Sham group; n=8). The BUO model was built by bilateral ureteral ligation. EPO was given to BUO-R+ EPO rats 1 h after releasing of BUO, and then repeated 12, 24, 36, 48 h thereafter and the same volume of normal saline was simultaneously given to BUO-R rats. The urine samples were collected 24 h before death and then blood samples were collected from inferior vena cava. The kidneys at both sides were harvested 72 h after releasing of BUO to examine the effect of EPO on the expression of tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 by immunohistochemistry and real-time quantitative polymerase chain reaction (Real-time PCR). Results The osmotic pressure in BUO-R+ EPO group was higher than that in BUO-R group, while lower than that in Sham group [(1 164±93) vs. (715±76) vs. (1 835±98) mosm/kg, P=0.000]. The hematal concentrations of urea and CREA in BUO group [(58.40±4.63) mmol/L and (277.30±11.26) μmol/L] were higher than those in other three groups, while they were higher in BUO-R+ EPO group [(12.20±2.34) mmol/L and (34.70±4.58) μmol/L] than those in Sham group [(6.40±0.75) mmol/L and (20.50±3.71) μmol/L], but lower than those in BUO-R group [(25.70±3.26) mmol/L and (52.60±7.83) μmol/L], P=0.000. Immunohistochemistry showed the expression levels of TNF-α and IL-6 were strongest in BUO group and weakest in Sham group, while those were stronger in BUO-R group than in BUO-R+ EPO group. Real-time PCR showed that the expression of TNF-α and IL-6 mRNA in BUO group was the most, while that in Sham group was the least, and that in BUO-R+ EPO group was less than in BUO-R group. Conclusion EPO could promote the recovery of renal function by inhibiting inflammatory reaction in BUO-R rats. Key words: Erythropoietin; Ureter obstruction; Kidney; Inflammatory reaction

A minor fault may lead to a major complication

Control of intake and urinary output is an important measure in the management of patients with acute renal failure (ARF) and non-correct recordation of urinary output by nurses may cause a severe problem in the management of these patients. The reported case was a 34-yaer-old woman who developed ARF and anuria after hysterectomy during emergency cesarean section. Computed tomography and serial ultrasonography of kidneys and urinary tract revealed mild hydronephrosis. Although, our patient had anuria, but recoded urinary output by nurses was 300-350 mL/d because urinary bag has not been emptied at the end of each day. Therefore, we thought that ARF is due to acute tubular necrosis because of severe bleeding during cesarean section. We also interpreted that hydronephrosis is secondary to recent pregnancy. After 10 days, it was detected that the patient has not been any urinary output during this period. Therefore the diagnosis was changed to urinary obstruction because of bilateral ureteral ligation during hysterectomy.

The protective effect of erythropoietin on renal function after releasing of bilateral ureter obstruction in young rat

Objective To investigate the protective effect of erythropoietin (EPO) on renal function after releasing of bilateral ureters obstruction (BUO-R) in young SD rats. Methods From October 2015 to June 2016, forty young SD rats were bought and equally divided into 4 groups randomly (BUO group, BUO-R group, BUO-R+ EPO group and Sham group; n=10) according to random number table. The BUO model was built by bilateral ureteral ligation. EPO (500 U/kg) was given to BUO-R+ EPO rats immediately after releasing of BUO, and then repeated 2d, 4d and 6d thereafter and the same volume of normal saline was simultaneously given to BUO-R rats. The Sham group was prepared in parallel by laparotomy and free dissection of bilateral ureters but not ligated. The urine samples were collected by metabolic cage 24h before death and then blood samples (1 ml) were collected from inferior vena cava. Results The urine osmolarity of Sham group was the highest [(1 794±103)mOsm/kg], BUO-R+ EPO group was (1 257±82)mOsm/kg, and BUO-R group was the lowest [(756±69)mOsm/kg]; Whereas the urine output of Sham group was the lowest [(26±5)μl/(min·kg)], BUO-R+ EPO group was (48±7)μl/(min·kg), and BUO-R group was the highest [(71±9)μl/(min·kg)]; P<0.05. The concentrations of urinary K+ , Na+ and creatinine in BUO-R+ EPO group were [(133.8±5.8)mmol/L, (134.7±4.9)mmol/L and (3 549±482)μmol/L]lower than those in Sham group [(154.7±6.5)mmol/L, (149.3±7.8)mmol/L and (4 537±624)μmol/L], but higher than those in BUO-R group [(112.4±7.2)mmol/L, (106.5±6.3)mmol/L and (2 612±536)μmol/L], P<0.05. The concentrations of hematal K+ , urea and creatinine in three experimental groups were all higher than those in Sham group; of which the hematal K+ , urea and creatinine in BUO group were the highest[(12.1±0.7)mmol/L, (47.6±6.0)mmol/L and (252.8±18.7)μmol/L], the BUO-R group took the second place [(8.5±0.5)mmol/L, (7.8±0.4)mmol/L and (55.2±4.8)μmol/L], and the BUO-R+ EPO group came third [(7.4±0.5)mmol/L, (6.4±0.3)mmol/L and (36.4±3.6)μmol/L], while the Sham group were the lowest [(6.8±0.3)mmol/L, (5.6±0.24)mmol/L and (23.6±2.7)μmol/L]; P<0.05. While the hematal Na+ concentration in BUO group was the lowest [(126.4±5.9)mmol/L], and BUO-R group was the highest [(147.3±4.9)mmol/L], the Sham group was the second lowest [(136.7±4.3)mmol/L], and the BUO-R+ EPO group was the second highest [(141.5±5.7)mmol/L], P<0.05. Conclusion EPO could promote the recovery of renal function and normalize the altered renal water and salt handling function in young BUO-R rats. Key words: Erythropoietin; Ureter obstruction; Renal function

Urinary Excretion Contributes to Long-Lasting Blockade of Bladder Muscarinic Receptors by Imidafenacin: Effect of Bilateral Ureteral Ligation.

Imidafenacin is a potent and selective antagonist of M1 and M3 muscarinic receptors that is safe, efficacious, and well tolerated for controlling the symptoms of overactive bladder (OAB). However, the precise mechanisms responsible for the bladder-selective pharmacological effects of this agent remain unclear. The in vivo pharmacologic effects of imidafenacin result from receptor occupancy. Therefore, the present study was performed to characterize in vivo muscarinic receptor binding by tritium-labeled imidafenacin with high specific activity ([3H]imidafenacin) in the bladder and other tissues of mice, and to clarify the mechanisms underlying selective binding of imidafenacin to bladder muscarinic receptors. After intravenous injection of [3H]imidafenacin, its binding to muscarinic receptors in the bladder and other tissues of mice was assessed by a radioligand binding assay. [3H]Imidafenacin showed a significantly longer duration of binding to muscarinic receptors in the bladder than in other tissues, and muscarinic receptor binding of [3H]imidafenacin was markedly suppressed in the bladder alone after bilateral ligation of the ureters. After intravenous injection, the [3H]imidafenacin concentration was markedly higher in the urine than in the plasma, suggesting that urinary excretion may contribute significantly to the selective and long-lasting binding of imidafenacin to bladder muscarinic receptors. These findings suggest that the intravesicular concentration of an antimuscarinic agent and its active metabolites may have a substantial influence on its pharmacological effect and duration of action in patients with OAB. In addition, factors that modulate urine production may influence the efficacy and safety of antimuscarinic agents.

Bilateral Native Ureteral Ligation Without Nephrectomy in the Management of Kidney Transplant Recipients With Native Proteinuria

The aim of this study was to assess the safety of bilateral native ureteral ligation (BNUL) without nephrectomy in the management of native proteinuria in kidney transplant (KTx) recipients. We retrospectively studied 17 patients who underwent BNUL between 2002 and 2010 with a median preoperative 24 h protein concentration of 2140 (range 1020-25 000) mg/L. Fifteen of the 17 patients had focal segmental glomerulosclerosis as their primary renal disease and ligation was employed to facilitate the diagnosis of early recurrence. The BNUL was performed simultaneously with KTx in 14 patients. Surgical techniques were: open (n = 5), pure laparoscopic (n = 1) and a hybrid of hand-assisted laparoscopic surgical/open approach (n = 12) used at the time of transplantation via the transplant incision. At a median follow-up of 46 months (range 1-59), no patient had a complication related to BNUL and none required interventions associated with their native kidneys. BNUL without nephrectomy seems to be a safe technique to manage native proteinuria in renal transplant candidates.

Ureteric obstruction and hydronephrosis in baladi goats: Topographical anatomy, ultrasonographical, hematological and pathological findings

The purpose of the current study was to investigate the topographical and ultrasonographical anatomy, hematological and pathological changes of kidneys following experimental ureteric ligation in goat. Twelve baladi castrated male goats aging (1.5–2 years) and weighing (25–45kg) were used for the topographic anatomy of kidney and ureter, complete unilateral ligation of the right ureter and partial bilateral ligation of both ureters. The clinical, ultrasonographic imaging and hematological evaluations were recorded before ligation, at the day one to the day forty after complete unilateral ligation of the ureter and at the day one to the day twenty-eight after partial bilateral ligation of the ureter. The ultrasonographic imaging of kidney revealed a significant increase in kidney length and width, dilatation of renal pelvis and ureter from the 1st day after complete unilateral ligation, while these changes were recorded significantly at the day twenty-eight after partial bilateral ligation. Meanwhile the hematological evaluation revealed significant changes in RBCs count, Hb concentration and PCV% at the first day then returned to its normal values.

Renal organic cation transporters mediated cadmium-induced nephrotoxicity

The involvement of renal organic cation transporters (OCTs) in cadmium transport was investigated in Chinese hamster ovary (CHO-K1) cells stably and singly transfected with rabbit (rb)OCT1 and rbOCT2, in murine isolated renal proximal tubule, and in intact kidney following bilateral ureteral ligation of rat. Cadmium inhibited uptake of [ 3H]-tetraethylammonium (TEA), a substrate of rbOCT1 and rbOCT2, via both transporters with half maximal inhibitory concentration (IC 50) of cadmium for rbOCT1- and rbOCT2-mediated TEA uptake of 96 ± 5 μM and 207 ± 12 μM, respectively. Cadmium similarly inhibited [ 3H]-TEA uptake in isolated non perfused renal proximal tubules. Cadmium accumulation in the transfected CHO-K1 cells was significantly higher than that of parent cells and this could be attenuated by TEA. In addition, cadmium accumulation in whole kidney was also reduced by TEA administration. Furthermore, exposure of the rbOCT1- and rbOCT2-expressing CHO-K1 cells to cadmium led to cytotoxicity, which could be prevented by TEA treatment. Taken together, this study provides for the first time, evidence showing OCT1 and OCT2 mediating cadmium transport across the basolateral membrane into the renal proximal tubular cells.

Peritoneal Dialysis in Cats with Acute Kidney Injury: 22 Cases (2001–2006)

Peritoneal dialysis (PD) has been described for use in animals with acute kidney injury refractory to fluid therapy. However, no study has examined the use of PD in a large group of cats. PD is an important adjunctive therapy to treat acute kidney injury in cats. The medical records of 22 cats with acute kidney injury that had received PD were examined. Animals were excluded if acute uremia was a result of postrenal causes such as uroabdomen or urethral obstruction. Medical records were reviewed for the following: indication for PD, outcome, number of cycles performed, survival time, and predialysis and postdialysis results for blood urea nitrogen (BUN), creatinine, potassium, chloride, sodium, phosphorus, total protein, and albumin concentrations, and urine output. Indications for PD include acute-on-chronic kidney injury, acute kidney injury caused by toxins, bilateral ureteroliths, bilateral ureteral ligation as a complication of ovariohysterectomy, and unknown causes. The median survival time for all cats on PD was 4 days, although the median survival time for the cats that were discharged was 774 days. The most common complications were dialysate retention and sequestration of dialysate SC. There was a significant (P < .05) decrease between predialysis and postdialysis results for BUN, creatinine, potassium, phosphorus, total protein, and albumin concentrations. There was a significant (P < .05) difference in survival times between sexes. PD is an effective option for treatment of cats with acute kidney injury refractory to fluid therapy.

Serum testosterone levels in experimental acute renal failure.

In dogs made uremic by bilateral ureteral ligation or by uranyl nitrate injection the serum testosterone levels were investigated. In both experimental models of acute renal failure a profound decrease of serum testosterone was found. The relationship between serum iPTH and testosterone levels was also investigated. The significant negative correlation between them was found in both groups of uremic animals, being more pronounced in the uranyl nitrate induced uremia (r = -0.762, p less than 0.001) than after bilateral ureteral ligation (r = -0.362, p less than 0.05). The simultaneous analysis of serum cortisol levels in both experimental groups as in sham operated controls indicated that stress factors in acute renal failure may also contribute to the testosterone decrease.

Acute cerebral and pulmonary edema induced by hemodialysis in a dog model

The dialysis disequilibrium syndrome is characterized by neurologic deterioration and cerebral edema which occurs after hemodialysis. The purpose of this study was to investigate the pathogenesis of acute cerebral and pulmonary edema induced by hemodialysis. We evaluated the effects of hemodialysis on the biochemical and hemodynamic parameters of the plasma and cerebrospinal fluid, including the intracranial pressure, dry/wet ratio, and pulmonary edema index, and we also examined the pathological changes of the brain and lung tissue in dogs suffering from uremia. Seventy-two hours after bilateral ureteral ligation, 10 uremic dogs were hemodialyzed for 2 hours, yielding a 73.6% and 60.1% decrease in the plasma urea and creatinine, respectively, a decrease in the plasma osmolality from (359 +/- 18) mOsm/kg H(2)O to (304 +/- 6) mOsm/kg H(2)O (P < 0.01), a decrease in the dry/wet ratio of the lung and brain tissue, and an increase in the hemodynamic parameters (right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure), intracranial pressure, total pulmonary resistance index, and pulmonary edema index. Moreover, the pathological examination revealed lung and brain edema in the dialyzed dogs. This group was compared to 3 control groups: 6 uremic dogs which were sham dialyzed without dialysate so that no fall in the plasma urea occurred, and 12 uremic and 12 nonuremic animals that were not dialyzed. However, the parameters mentioned above were not significantly changed among these 3 control groups. The acute brain and lung edema in our model appeared to be primarily due to a large osmotic gradient between the plasma and the brain and lung. This is the "urea reverse effect" which promoted the osmotically-induced lung and brain swelling.

Arginine Transport Is Augmented, through Modulation of Cationic Amino Acid Transporter-1, in Obstructive Uropathy in Rats

Background: The decrease in glomerular filtration rate (GFR), which is characteristic of obstructive uropathy, was suggested to be associated with attenuated nitric oxide (NO) generation. Since availability of L-arginine, the sole precursor for NO, governs NO synthesis, we aimed to determine the role of glomerular arginine transport in rats subjected to 24 h of bilateral ureteral ligation (BUO). Methods: Glomerular arginine transport was measured by uptake of radiolabeled arginine ([³H]-L-arginine), cationic amino acid transporters (CAT)-1 and -2 and arginases I and II mRNA expression were determined using reverse transcription-polymerase chain reaction. CAT-1, arginase I, and arginase II protein contents were evaluated by Western blotting. Results:L-Arginine transport by freshly harvested glomeruli from BUO rats was significantly augmented than in controls. The aforementioned findings were associated with a significant increase in glomerular CAT-1 mRNA expression, while CAT-2 mRNA was unchanged. Western blotting demonstrated a significant increase in CAT-1 abundance in BUO. Expression of both glomerular arginase I and II mRNA and protein content were significantly elevated in BUO. Conclusions: BUO induces an increase in glomerular arginine transport via upregulation of CAT-1, probably due to increase in arginine utilization by a non-NO pathway.

Effect of Continuous Bioartificial Kidney Therapy on Porcine Multiple Organ Dysfunction Syndrome With Acute Renal Failure

The bioartificial kidney (BK) was fabricated with primary culture of human proximal tubular cells growing in a hemofilter. A porcine model with multiple organ dysfunction syndrome, including acute renal failure, was induced by cecal ligation and puncture and bilateral ureteral ligation. The models were treated with BK (group A) or sham BK (group B) or without treatment (group C). Mean arterial pressure (mm Hg) was higher in group A (88.13 +/- 7.62) than in groups B and C (63.50 +/- 11.82, 53.50 +/- 2.52) at 24 hours (p < 0.01). Serum blood urea nitrogen, Cr, K, Pao2, and HCO3 were similar during the treatment periods between groups A and B, which were better than those in group C. In group A, tumor necrosis factor (TNF)-alpha (pg/mL) was 394.42 +/- 35.62 at 24 hours, lower than that of groups B and C (531.76 +/- 30.23, 552.89 +/- 27.81) (p < 0.05). Peak level of interleukin (IL)-10 (pg/mL) was higher in group A (272.36 +/- 48.89) than in groups B and C (106.30 +/- 29.69, 102.59 +/- 10.21) (p < 0.01). There was no difference of serum IL-6 between pretreatment and post-treatment in groups A and B, but serum IL-6 gradually increased in group C. The survival time (hours) was longer in group A than in other groups, which was prolonged by 46.20% and 58.39%. Results indicate that BK can ameliorate mean arterial pressure, decrease serum TNF-alpha, increase serum IL-10, and prolong survival time of pigs with multiple organ dysfunction syndrome and acute renal failure.

Can the Intestine Perform Some Functions of the Kidney?

The majority of patients in countries like India and Pakistan with end-stage renal disease (ESRD) die without renal replacement therapy due to lack of adequate resources. The use of the intestinal mucosa as a semipermeable membrane for removal of urea and creatinine from the body has been previously studied using various types of intestinal lavage for gut dialysis. This study was undertaken in an animal model to assess the applicability, cost of therapy, and acceptability of the method for potential application in humans. Renal failure was induced in six dogs by bilateral ureteric ligation along with six healthy controls. Dialysis fluid was introduced per rectum as an enema, which was repeatedly administered. Clearances of serum creatinine and urea were assessed. Mean recovery of creatinine and urea in dialysate in the present study was around 8.925 mmol/l and around 207.74 μmol//l, respectively. The mean clearances of serum creatinine and urea were, respectively, 0.0683 and 0.0633 ml/sec. Enteral dialysis was effective and, considering its minimal cost (monthly cost will be around US$35–40) vis a vis available methods, it holds promise for the treatment of patients with ESRD. The creation of an appendicostomy for repeated introduction of antegrade enemas would be a consideration.

Laparoscopic radical cystectomy and bilateral ureteric ligation for muscle‐invasive bladder cancer in a patient on hemodialysis

Laparoscopic cystectomy and bilateral ureteric ligation were performed on a 52-year-old woman with end-stage renal disease on hemodialysis (HD) for muscle-invasive bladder cancer. Her volume of urine production was approximately 100 mL/day. Excisions of the bladder and uterus with ligation of the bilateral ureter were conducted completely laparoscopically. Total operative time was 280 min and the amount of blood loss was 60 mL. No complications were seen perioperatively and no adverse events regarding ureteric ligation arose. HD was performed on the second postoperative day. At a 12-month follow-up, the patient showed no evidence of disease.

Endogenous Uremic Substances are not Involved in the Reduced Hepatic Extraction of Metoprolol in Bilateral Ureter-Ligated Rats†

The hepatic extraction of metoprolol is reduced in rats with bilateral ureter ligation (BUL)-induced renal failure. The aim of the present study was to evaluate the effect of uremic substances on the hepatic metabolism of metoprolol in rats with BUL. The metabolic rate in the liver microsomes of BUL rats was similar to that in sham rats, and there was no significant difference between sham and BUL rats in the effect of the supernatant of liver homogenates on the metabolism. The rate of metabolism in the liver microsomes in the presence of the plasma of BUL rats was also similar to that in the presence of the plasma of sham rats. These findings indicated that uremic substances which accumulate in BUL rats do not directly inhibit the activity of CYP2D2, which is responsible for the metabolism of metoprolol in the rat liver.