Fractura urotelial en la hidrodistension vesical por cistopatía interscial (IC) y síndrome de vejiga dolorosa (PBS) / Bladder urothelial fracture in interstitial cystitis hydrodistention (IC) and painful bladder syndrome (PBS)

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The candidate for renal transplantation work up: medical, urological and oncological evaluation.

UNLABELLED: Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself. In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates. METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant. RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up. Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution. Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation. CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations. Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients ' specific conditions, by a multidisciplinary approach before proceeding to transplantation.

Estudio del candidato a trasplante renal: Evaluación médica, urológica y oncológica / The candidate for renal transplantation work up: medical, urological and oncological evaluation

El trasplante renal aumenta la supervivencia, reduce la morbilidad y mejora la calidad de vida del enfermo en insuficiencia renal crónica terminal (IRCT). Es un procedimiento quirúrgico con inherentes riesgos relacionados con la anestesia y la propia cirugía.Los antecedentes y enfermedades comórbidas del paciente con IRCT son muy importantes a la hora de considerarlo candidato a trasplante.OBJETIVOS: Revisar y actualizar, según la literatura reciente, la evaluación del paciente candidato a trasplante renal.MÉTODOS: Realizamos una revisión retrospectiva de la literatura publicada en Medline/Pubmed sobre los aspectos más importantes a tener en cuenta en la evaluación del candidato a trasplante renal en lo que se refiere a la situación médica, del aparato genitourinario y a posibles neoplasias concomitantes. RESULTADOS: La evaluación médica pretrasplante pretende poner de manifiesto los antecedentes clínicos del paciente así como estos pueden condicionar la evolución del enfermo e injerto una vez trasplantado. Se debe considerar la edad, la enfermedad cardiovascular, la existencia de diabetes mellitus, potenciales alteraciones de la coagulación, la obesidad, la presencia de patología en el tracto gastrointestinal, situación y complicaciones asociadas a su IRCT, una infección activa, la falta de compliance con el tratamiento y seguimiento(AU)

El aparato urinario deseable para cualquier candidato a trasplante debe ser estéril, de buena capacidad, compliance y con un mecanismo seguro de conseguir un correcto vaciado vesical. Algunas anomalías urológicas pueden pasar desapercibidas en el paciente anúrico. La evaluación prestrasplante del aparato urológico, pretende diagnosticar, tratar y optimizar cualquier patología urológica presente, así como detectar alteraciones anatómicas que pongan en riesgo el éxito de la cirugía.La patología neoplásica es una frecuente y reconocida complicación asociada al trasplante de órganos. El tratamiento inmunosupresor puede condicionar efectos secundarios directos así como un potencial efecto oncogénico. Los tumores prexistentes deben evaluarse concienzudamente antes de realizar el trasplante, así como la existencia de una neoplasia oculta.CONCLUSIÓN: En esta revisión destacamos la importancia de realizar una exhaustiva evaluación médica, urológica y oncológica antes del trasplante renal. Repasaremos los principales aspectos de la evaluación de los enfermos en IRCT, que pruebas diagnósticas se deben aplicar y cuáles son las últimas recomendaciones al respecto.Es imprescindible una evaluación cuidadosa de cada candidato a entrar en lista de espera para trasplante para mejorar la supervivencia de injerto y receptor. El estudio debe ser individualizado según la condición particular de cada paciente, a través de un abordaje multidisciplinar antes de proceder con el trasplante(AU)

Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself.In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success.OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates.METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant(AU)

RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up.Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution.Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation.CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations.Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients` specific conditions, by a multidisciplinary approach before proceeding to transplantation(AU)