Must we still be worried about multiple arteries in kidney transplantation?

BACKGROUND: Multiple renal arteries in kidney grafts have been associated with an increased rate of vascular and urologic complications. Our objective is to compare the outcome of transplanted patients who receive a single pedicle kidney with those who receive a multiple arterial graft. OBJECTIVES: To find our the differences in the outcome and complications in patients undergoing kidney transplantation with one single artery or with multiple arteries. PATIENTS AND METHODS: We analyzed 147 kidney transplantations, (all performed in our hospital over a 3 year period). population divided into two groups: group A for those who presented with only one renal artery, or group B for those with more than one renal artery. Homogeneous vascular reconstructions and implantation rules were applied in all patients. We compared the rates of renal failure between the two groups, urinary and vascular complications, patient and graft survivals and the levels of creatinine clearance during the first year of post-transplantation. RESULTS: No significant differences were found between the two groups regarding to the values analyzed. CONCLUSIONS: As many other authors, we do believe that the presence of multiple renal arteries in kidney grafts should not be considered as a predictive factor of transplantation failure.

Retrocaval ureter in children. Case report and bibliographic review.

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases. METHOD: We present a case of retrocaval ureter and a revision of the literature. RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MR). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis. CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated.

Uréter retrocavo en el niño: a propósito de un caso y revisión de la literatura / Retrocaval ureter in children. Case report and bibliographic review

OBJETIVO: El uréter retrocavo es una patología poco frecuente debida a una alteración en el desarrollo embriológico de la vena cava inferior. Se manifiesta normalmente con clínica de obstrucción ureteral y el tratamiento en los casos sintomáticos, es quirúrgico.MÉTODO: Presentamos un caso clínico de uréter retrocavo y realizamos una revisión de la literatura.Palabras clave: Uréter. Anomalías genitourinarias. Vena cava inferior. Ureteroureterostomía.RESULTADOS: Paciente de 9 años que consulta por hematuria macroscópica. La Urografía intravenosa (UIV) sugiere el diagnóstico de uréter retrocavo derecho, lo que se confirma con estudio de resonancia magnética nuclear (RMN). Realizamos ureteroureterostomía y decruzamiento de vena cava inferior con buena evolución, confirmada por UIV.CONCLUSIONES: El uréter retrocavo es una anomalía fácilmente diagnosticable y con posibilidad de tratamiento eficaz. Debe evaluarse la posibilidad de otras malformaciones asociadas(AU)

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases.METHOD: We present a case of retrocaval ureter and a revision of the literature.RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MRI). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis.CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated(AU)

Alternativa terapéutica para el dolor pélvico crónico de origen vesical / New approach in treatment of pelvic chronic pain syndrome (CPPS)

Introducción: El dolor pélvico crónico (DPC) es un problema complejo e importante tanto por su frecuencia como por sumorbilidad. Cuando se presenta asociado con síntomas miccionales deberemos pensar en un origen vesical. Objetivo: Evaluar la respuesta a un tratamiento intravesical, al que denominamos Formula Sedante, en pacientes con dolor pélvico crónico de origen vesical, refractarios a otros tratamientos. Material y métodos: Entre junio 2005 y septiembre de 2008, 14 pacientes (edad media de 59 años), 12 mujeres y 2 hombres, con DPC de origen vesical siguieron un tratamiento intravesical con “Formula Sedante”, como terapia de segunda línea. Su composición es Dexametasona, Nitrofurantoína, Lidocaína y Suero salino. Evaluamos el dolor (escala 0-10), la frecuencia miccional y la mejoría subjetiva del paciente. Resultados: El dolor global medio fue de 6’4 de base, al mes y a los 6 meses fue de 4’7 y 3’5 respectivamente. El 75% de los pacientes mostró una disminución de los valores en la escala de dolor. La frecuencia miccional diurna mejoró un 28%al mes del tratamiento y un 40% a los 6 meses. Un 70 % de los pacientes refirió sentir mejoría tras la pauta de instilaciones, de los cuales en torno a un 80% la evaluó como “moderadamente mejor” o “mucho mejor”, tanto al mes como a los 6 meses del tratamiento. Ninguno de los pacientes presento efectos secundarios reseñables. Conclusiones: Consideramos el tratamiento de instilación intravesical con “Formula Sedante” una opción útil y segura, como segunda línea de tratamiento, para el dolor pélvico crónico de origen vesical (AU)

Introduction: Chronic pelvic pain syndrome (CPPS) is a complex problem that is a major cause of morbidity and disability. Objetive: To evaluate the feasibility, safety and efficacy of intravesical instillation of a new therapeutic tool in patients suffering from CPPS. Methods: Between june 2005 and september 2008 we recruited 14 patients (mean age 59) who had been diagnosed with CPPS, and refractory to previous treatments. The intravesical solution consisted of steroids, local anaesthetic, antibiotic and saline solution. Was evaluated the intensity of pain; voiding frequency and subjective improvement (with patient global improvement impression PGI-I).Results: Global pain at baseline was 6,4, at 1 month and 6 months 4,7 and 3,5. 75% of the patients showed improvement in the reduction of pain. Voiding frequency at baseline was 22’5 daily. At one and six months, voiding frequency was 16,2and 13,5 respectively. According to the PGI-I test 30% of patients were much better, 30% moderate improvement, 10%slight improvement and 30% with no changes at 1 month. At 6 months, 15% of patients were much better, 40% moderated improvement, 15% slight improvement and 30% with no changes. None of the patients felt worse than before treatment. Conclusions: Therapeutic results of our intravesical solution traduces in an improvement of pain and voiding frequency reduction with no side-effects. Patients benefit of this improvement in the PGI-I test that reflects an improvement in quality of life. We consider this treatment a second-line approach for CPPS in which gold standard management is still a challenge (AU)