M.C. Awad, E.A. da Silva, E. Souza, R. Damião

背景：肾移植长期存活者出现性腺机能减退、肿瘤、勃起功能障碍和代谢综合症的概率很高。尽管泌尿科医生在肾移植手术和治疗术后并发症方面扮演着重要的角色，但是对这些移植患者的随访却集中在肾功能和免疫抑制方案上。本研究的目的是评价泌尿科医生在肾移植受体随访过程中的作用。

方法：本研究的研究对象为27名平均年龄在48.1± 7.5岁的男性患者，研究人员对他们的移植肾进行了平均12.3±4.3年的随访。我们采用肾泌尿学方法持续评价了患者的泌尿系统、前列腺癌筛查、排尿功能的评估、生育能力、勃起功能障碍、性腺机能减退和代谢综合症等。我们还同时评估了患者的生活质量。

结果：研究结果显示，18名（66.7%）患者身上均有重要的泌尿学发现。4名患者为亲子关系。平均血清肌酐水平为1.5 ± 0.6 mg/dL，预计清除率为72.6 ± 27.4 mL/min/1.73 m2。关于排尿模式，92.65%的患者出现轻度至中度的膀胱出口梗阻症状。3.7%的患者前列腺的体积出现明显增大。平均血清总前列腺特异性抗原为1.6±1.5 ng/mL。46.2%的患者出现勃起功能障碍，74.1%的患者出现性腺功能减退症。44.4%的患者发生了代谢综合症，但是生活质量良好。

结论：在长期存活的肾移植患者中，可治愈的泌尿系统疾病发病率较高。因此，我们强烈建议对这类人群进行定期随访。

Clinical Outcome of Long-Term Renal Transplant Survivors: A Nephrourologic Approach
M.C. Awad, E.A. da Silva, E. Souza, R. Damião

Background：Long-term renal transplant survivors display high incidences of hypogonadism, neoplasms, erectile dysfunction, and metabolic syndrome. Although the urologist has a major role in the kidney transplantation surgery and treatment of the graft-related surgical complications, the follow-up of these patients is essentially focused on kidney function and the immunosuppressive regimen. We sought to evaluate the role of a nephrourologic follow-up for kidney transplant recipients.

Methods：We evaluated 27 male patients of mean age of 48.1 ± 7.5 years and mean renal allograft follow-up of 12.3 ± 4.3 years. The nephrourologic approach consisted of evaluation of the urinary system, prostate cancer screening, and assessment of voiding function, fertility, erectile dysfunction, hypogonadism, and metabolic syndrome. We also assessed quality of life.

Results：Major urologic findings were found in 18 (66.7%) patients. Four patients reported posttransplantation parenthood. The mean serum creatinine was 1.5 ± 0.6 mg/dL and the calculated clearance, 72.6 ± 27.4 mL/min/1.73 m2. Regarding the voiding pattern, 92.6% of patients showed mild to moderate bladder outlet obstruction. Clinically significant increases in prostate volume were observed in 3.7% of patients. Mean serum total prostate-specific antigen was 1.6 ± 1.5 ng/mL. Erectile dysfunction was displayed by 46.2% and hypogonadism by 74.1% of patients. Metabolic syndrome was diagnosed in 44.4% of patients, and quality of life was generally rated as good (4/5).

Conclusion：Long-term renal transplantation survivors show high prevalences of treatable urologic diseases. Thus, we strongly recommend routine complete nephrourologic follow-up of this population.

[责任编辑:刘 聪]