Simultaneous pancreas-kidney transplantation: Early complications and long-term outcomes - a single-center experience.

INTRODUCTION: This study aimed to assess the prevalence and severity of complications after simultaneous pancreas-kidney transplantation (SPKT) and to evaluate its influence on both grafts' long-term results. METHODS: This was an observational, retrospective study including 39 consecutive SPKT cases from 2000-2018. Complications were classified into kidney-related and pancreas-related. The severity of complications was assessed using the modified Clavien-Dindo scale. Kaplan-Meier curve analysis and log-rank tests were used. Cox regression was performed for the multivariate analysis. RESULTS: All 39 recipients had long-term type I diabetes. Twenty-one (53.8%) patients suffered a Clavien-Dindo ≥IIIa complication. Most complications were pancreas-related, with 17 (43.6%) patients suffering from one. Kidney-related major complications were seen in 11 (28.2%) patients. Patient survival at one, five, and 15 years was 89.7%, 87.1%, and 83.9%, respectively; kidney survival was 87.1%, 81.4%, and 73.6%, respectively; and pancreas survival was 76.9%, 71.3%, and 72%, respectively. Pancreas graft survival was influenced by the presence of major postoperative complications; patients and kidney graft survival were not. CONCLUSIONS: Complications after SPKT influence pancreas graft survival. Despite the high rate of complications, our results suggest that patient and kidney graft survival may not be affected by complications.

Benign renal schwannoma: Case report and literature review.

Renal schwannoma is a very infrequent tumor. It is usually benign and it does not have any specific symptoms or imaging characteristics. Its final diagnosis is usually made after surgery. We present a 66 year-old-man that was referred to our center after the casual finding of a renal mass. With a suspected diagnosis of a renal cell carcinoma, a partial nephrectomy was performed. The histological study revealed the final diagnosis of a benign renal schwannoma.

Bacillus Calmette-Guérin in Immunosuppressed Patient with High-Grade Nonmuscle Invasive Bladder Carcinoma.

Due to their immunosuppressed status, solid organ transplant recipients are a special group of patients with an incidence of bladder cancer greater than the rest of the population, especially in the first 6 years after transplantation. Also, treatment with Bacillus Calmette-Guérin, a reference therapy in nonmuscle invasive high-risk bladder cancer, may be less effective in this group of patients and could cause more adverse effects. However, the data published so far and the experience initiated in the Virgen de la Arrixaca Clinical University Hospital do not support these hypotheses.

[Recurrent urinary tract infections: prevention of recurrence with intravesical instillations of chondroitin sulfate and hyaluronic acid.] / Infecciones urinarias de repetición: prevención de recidivas con instilaciones intravesicales de condroitin sulfato sódico y ácido hialurónico.

OBJECTIVE: The aim of our study is to demonstrate that intravesical administration of the association chondroitin sulfate (CS) and hyaluronic acid (HA), according to our treatment schedule, is a benefit for women with recurrent urinary tract infections (RUTI), not only from a clinical point of view, but also reducing recurrences. METHODS: This is a study of 28 women diagnosed with RUTI, with a positive culture, and compatible symptoms;frethey underwent treatment according to the protocol of intravesical instillations of the combination CS 2%-1 gr + HA 1.6%-800 mg. To evaluate the effectiveness of the treatment, symptoms improvement, reduction of the number of episodes of urinary tract infection and quality of life were considered. RESULTS: In our series, we can observe an improvement of the quality of life assessed by PG-I, 66% after 12 months. It was seen that 55.6% of the patient's urine cultures became negative, while 44.4% had episodes of urinary infection, but with lower baseline symptoms intensity. DISCUSSION: Patients included in the protocol of instillation improved significantly their quality of life; in addition, to a considerable extent new urinary infections were not presented, being milder when they presented.

Infecciones urinarias de repetición: prevención de recidivas con instilaciones intravesicales de condroitin sulfato sódico y ácido hialurónico / Recurrent urinary tract infections: prevention of recurrence with intravesical instillations of chondroitin sulfate and hyaluronic acid

OBJETIVO: El objetivo de nuestro estudio es demostrar, que la administración intravesical de la asociación condroitin sulfato sódico (CS) y ácido hialurónico (AH) según nuestro esquema de tratamiento, supone un beneficio en mujeres pre/post menopáusicas con infecciones urinarias de repetición (IUR), no sólo desde el punto de vista clínico, sino que también disminuyen las recurrencias. MÉTODOS: Se presenta un estudio con 28 mujeres diagnosticadas de IUR con cultivo positivo y síntomas compatibles, siguieron tratamiento según protocolo de instilaciones intravesicales de la combinación CS 2%-1 gr + AH 1,6%-800 mg (IALURIL®). Para comprobar la eficacia del tratamiento se evaluó: mejoría de síntomas, reducción del número de episodios de infección urinaria y la calidad de vida. RESULTADOS: En nuestra serie se apreció una mejoría de la calidad de vida, valorada por la escala de impresión de mejoría global del paciente (PG-I), a los 12 meses del 66%. Se apreció que el 55,6% (15/27) de las pacientes negativizaron sus cultivos, mientras que el 44,4% (12/27) presentaron un solo episodio de infección urinaria pero con menor intensidad de síntomas que al inicio del estudio. CONCLUSIONES: Los pacientes incluidos en el protocolo de instilación mejoraron de forma significativa su calidad de vida, además en un porcentaje considerable no se presentaron nuevas infecciones urinarias; en los casos que se presentaron estas fueron menos frecuentes y afectaron menos el estado general de las pacientes que pretratamiento

OBJECTIVE: The aim of our study is to demonstrate that intravesical administration of the association chondroitin sulfate (CS) and hyaluronic acid (HA), according to our treatment schedule, is a benefit for women with recurrent urinary tract infections (RUTI), not only from a clinical point of view, but also reducing recurrences. METHODS: This is a study of 28 women diagnosed with RUTI, with a positive culture, and compatible symptoms; frethey underwent treatment according to the protocol of intravesical instillations of the combination CS 2%-1 gr + HA 1.6%-800 mg. To evaluate the effectiveness of the treatment, symptoms improvement, reduction of the number of episodes of urinary tract infection and quality of life were considered. RESULTS: In our series, we can observe an improvement of the quality of life assessed by PG-I, 66% after 12 months. It was seen that 55.6% of the patient`s urine cultures became negative, while 44.4% had episodes of urinary infection, but with lower baseline symptoms intensity. DISCUSSION: Patients included in the protocol of instillation improved significantly their quality of life; in addition, to a considerable extent new urinary infections were not presented, being milder when they presented

Conservative management is a reasonable option in intraperitoneal bladder rupture.

OBJECTIVE: To demonstrate that conservative management of intraperitoneal bladder rupture is a safe option. METHOD: We report two cases of intraperitoneal bladder rupture, one spontaneous and another after urological manipulation. A 28-year-old man with acute abdomen after a heavy alcohol intake, and an 83-year-old woman with abdominal distention after a transurethral resection of the bladder. RESULT: Both cases were treated with intraperitoneal fluid evacuation and maintenance of urinary catheter without incidents. CONCLUSIONS: Conservative management with drainage of ascites in combination with a radiological studies and optimal antibiotic treatment can prevent more invasive maneuvers such as exploratory laparotomy or laparoscopy.

El manejo conservador de la rotura vesical intraperitoneal es una opción razonable / Conservative Management is a Reasonable Option in Intraperitoneal Bladder Rupture

OBJETIVO: Demostrar que el manejo conservador de la rotura vesical intraperitoneal es una opción segura. MÉTODO: Presentamos dos casos de rotura vesical intraperitoneal, uno espontáneo y otro tras manipulación urológica. Un varón de 28 años de edad con abdomen agudo tras una ingesta abundante de alcohol y una mujer de 83 años con distensión abdominal tras una resección transuretral vesical. RESULTADO: Ambos casos se trataron con evacuación del líquido intraperitoneal y mantenimiento de sonda vesical sin incidencias. CONCLUSIONES: El manejo conservador con drenaje de la ascitis en combinación con un estudio radiológico óptimo y tratamiento antibiótico puede evitar maniobras más invasivas como la laparotomía o la laparoscopia exploradoras

OBJECTIVE: To demonstrate that conservative management of intraperitoneal bladder rupture is a safe option. METHOD: We report two cases of intraperitoneal bladder rupture, one spontaneous and another after urological manipulation. A 28-year-old man with acute abdomen after a heavy alcohol intake, and an 83-year-old woman with abdominal distention after a transurethral resection of the bladder. RESULTS: Both cases were treated with intraperitoneal fluid evacuation and maintenance of urinary catheter without incidents. CONCLUSIONS: Conservative management with drainage of ascites in combination with a radiological studies and optimal antibiotic treatment can prevent more invasive maneuvers such as exploratory laparotomy or laparoscopy

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)

[Cavernous hemangioma of the bladder]. / Cavernomatosis vesical: una patologia infrecuente.

OBJECTIVE: Certain pathologic entities should be ruled out in the diagnostic work up of hematuria, because they are so rare that if they would not share diagnostic tests with more frequent urological diseases they could be missed. The cavernous haemangioma of the bladder is one of them. METHODS: We report the case of a male patient presenting with rectal bleeding and hematuria with the diagnosis of rectal-vesical cavernous haemangioma. RESULTS: After 8 years of follow-up he did not need surgical treatment, only blood transfusions at the time of diagnosis. He has self limited episodes of hematuria not requiring aggressive therapy. CONCLUSIONS: The cavernous haemangioma of the bladder is a rare disease presenting as bleeding bladder excrecent lesions that do not require surgery as first treatment option if the bleeding is not life-threatening.

Cavernomatosis vesical: una patología infrecuente / No disponible

OBJETIVO: Existen ciertas patologías a tener en cuenta en el estudio de una hematuria, que por su infrecuencia pasarían desapercibidas de no ser porque comparten pruebas diagnosticas con las patologías urológicas más comunes; una de ellas es la cavernomatosis vesical. MÉTODO: Presentamos el caso de un paciente que debutó con rectorragias y hematuria y fue diagnosticado de cavernomatosis rectovesical. RESULTADOS: Después de 8 años de seguimiento de su hematuria no ha requerido tratamiento quirúrgico alguno y solamente ha precisado de transfusión al inicio del diagnóstico. Los episodios de hematuria son autolimitados y no requieren maniobras agresivas. CONCLUSIONES: La cavernomatosis vesical es una patología infrecuente que se manifiesta en forma de lesiones vesicales excrecentes que sangran y que no requiere tratamiento quirúrgico de entrada si no compromete la vida del paciente (AU)

OBJECTIVE: Certain pathologic entities should be ruled out in the diagnostic work up of hematuria, because they are so rare that if they would not share diagnostic tests with more frequent urological diseases they could be missed. The cavernous haemangioma of the bladder is one of them. METHODS: We report the case of a male patient presenting with rectal bleeding and hematuria with the diagnosis of rectalvesical cavernous haemangioma. RESULTS: After 8 years of follow-up he did not need surgical treatment, only blood transfusions at the time of diagnosis. He has self limited episodes of hematuria not requiring aggressive therapy. CONCLUSIONS: The cavernous haemangioma of the bladder is a rare disease presenting as bleeding bladder excrecent lesions that do not require surgery as first treatment option if the bleeding is not life-threatening (AU)

[Hand-assisted laparoscopic radical nephrectomy vs. open nephrectomy in the treatment of clinically localized renal cell carcinoma. Comparative study]. / Nefrectomía radical laparoscópica asistida por la mano frente a nefrectomía abierta en el tratamiento del carcinoma de células renales clínicamente localizado. Estudio comparativo.

INTRODUCTION: The description of the first laparoscopic nephrectomy made a revolution in the managing of the benign and malignant renal diseases. Hand-assisted laparoscopy (HAL) was developed with the aim of offering advantages to both patients and surgeons. The aim of the present work is to compare, in our experience, the results offered in the radical nephrectomy by HAL and open surgery, by analysis of surgical time, estimated blood loss during surgery and hospital stay. METHODS: Eleven Hand-assisted laparoscopic (HAL) radical nephrectomies and eight open radical nephrectomies were carried out at our institution during the same period (June 2001 to December 2002). All patients underwent computed tomography and were found to have a clinically localised functioning renal mass in all cases. The size of this renal mass was 4-7 cm (average 5.5 cm) in the HAL group and 4.5-15 cm (average 7.8 cm) in the open group. Patient age, body mass index, and American Society of Anaesthesiologists' score showed no significant difference between groups. RESULTS: The average surgical time in the HAL group was 156.72 minutes, the average blood loss during surgery was of 83.6 ml and the average hospital stay was of 3.09 days. Conversion to open surgery was not necessary in any patient. Average surgical time in the open surgery group was 178.25 minutes, the estimated blood loss during surgery was of 337.75 ml (p < 0.05) and the hospital stay was of 5.37 days (p < 0.05). The comparison of the means by two-tailed student's t test revealed significant differences in estimated blood loss and hospital stay, favoring HAL, and no significant differences in surgical time. CONCLUSIONS: HAL nephrectomy is feasible in almost all nephrectomies and is a safe, reproducible, and minimally invasive technique to perform extirpable renal surgery. HAL offer clear advantages over traditional open surgery, including decreased blood loss and hospital stay.

[Fatal evolution of a renal angiosarcoma]. / Evolución fatal de angiosarcoma renal.

OBJECTIVES: Report a new case of renal angiosarcoma treated by surgery and adjuvant chemotherapy with bad results. METHODS: 72-year-old male undergoing right nephrectomy for renal tumor. Pathology reports renal angiosarcoma. RESULTS: Three months after surgery patient refers lumbar pain and hemoptysis and CT scan reveals the existence of multiple bone and lung metastasis; a regimen of systemic chemotherapy with Doxorrubicine+ Ifosfamide was started without response; he died two months later. CONCLUSIONS: Primary renal angiosarcoma is very rare, with less than 10 cases in the literature before 1998, and it is always associated with bad prognosis. Diagnosis is based on immunohistochemical studies (antibodies against CD31, CD34 and factor VIII related antigen) to define the endothelial differentiation of the tumor. There is no experience to define the best therapeutic strategy against this entity.

[Magnetic resonance urogram as alternative to i.v. urography. Report of 3 cases. Review of the literature]. / Urograma en resonancia magnética como alternativa a la urografia i.v. A propósito de tres casos. Revisión de la literatura.

OBJECTIVES: Intravenous urography (IVU) has been classically considered as an essential examination in the great majority of urologic diseases due to the great amount of information that supplies both functional and morphological, mainly for ureteral abnormalities where other exams do not reach enough definition. Nevertheless, there are cases in which it is not possible to perform an intravenous urography due to allergy to iodine contrasts or renal failure with impossibility of contrast excretion. METHODS: We report three cases which represent the example of the indications of MRI urography as an alternative to IVU in cases in which this latter cannot or should not be performed. RESULTS: MRI urography is completely accepted as a diagnostic technique for urologic diseases as an alternative to IVU. It has advantages, such as obtaining images in multiple planes, avoiding the use of ionizing radiation, that there is no evidence of it causing cell damage, that it does not require glomerular elimination of any substance so it can be used in patients with renal failure and allergy to iodine contrasts. CONCLUSIONS: The use of MRI urography results in an advantage for patients with renal failure, iodine contrasts allergy, or greater risk of contrast nephrotoxicity as it is the case of renal transplant patients.

[Controversies in the evaluation of asymptomatic microhematuria]. / Controversias en la evaluación de la microhematuria asintomática.

OBJECTIVE: Asymptomatic microhematuria continues to be a problem. It has a prevalence of 16% and numerous conditions can present this clinical manifestation. METHODS: A prospective study was carried out on all patients that consulted at the urological services during 2000 for asymptomatic hematuria. Patients presenting with irritative symptoms, urethral secretion, perineal or suprapubic pain, urinary tract infections, renal lithiasis or history of trauma were not included in the study. RESULTS: None of the patients presented tumors. Two patients presented renal lithiasis, 5 simple renal cysts, 8 hypercalciuria and 3 hyperuricosuria. None of the 11 patients with hypercalciuria or hyperuricosuria had a history of lithiasis. CONCLUSIONS: Although the size of the study is small, the incidence of tumors in patients with asymptomatic microhematuria appears to be far from the 12.5% incidence reported by some authors and might probably be closer to the 0.5% incidence reported by others. Furthermore, the significant pathology (renal lithiasis), which requires treatment, is also infrequent.

Controversias en la evaluación de la microhematuria asintomática / Controversies in the study of asymptomatic microhematuria

INTRODUCCIÓN: La hematuria microscópica sigue siendo en la actualidad un problema para el urólogo: se trata de una entidad que afecta hasta al 16 por ciento de la población general, siendo numerosas las enfermedades nefro y urológicas que pueden cursar con esta manifestación clínica.MÉTODOS: Hemos realizado un estudio prospectivo sobre los 98 pacientes que han acudido durante el año 2000 a nuestra consulta de urología, remitidos por presentar microhematuria asintomática. No hemos incluido a los pacientes que presentaban clínica irritativa, secreción uretral, dolor perineal o suprapúbico, infecciones urinarias, litiasis renal o antecedente de traumatismos.En todos ellos se ha practicado urocultivo, radiografía simple de abdomen, ecografía renovesical, citología urinaria (para filiar a la hematuria como glomerular o extraglomerular, así como para descartar la existencia de células sugerentes de tumoración urotelial), y se ha determinado calciuria y uricosuria en orina de 24 horas.En algunos pacientes, a juicio del facultativo, se ha practicado así mismo urografía intravenosa.RESULTADOS: Ninguno de los pacientes presentaba enfermedad tumoral. Dos pacientes presentaron litiasis renal, 5 pacientes quistes renales simples, 8 pacientes hipercalciuria y 3 hiperuricosuria (ninguno de estos 11 pacientes con hipercalciuria o hiperuricosuria presentaba antecedentes litiásicos) y en 8 pacientes el origen de la hematuria era glomerular, y fueron remitidos a estudio nefrológico.CONCLUSIONES: Aunque lo reducido de nuestra muestra no permite avanzar conclusiones relevantes, sí parece evidenciarse que la incidencia de patología tumoral en los pacientes con microhematuria no sintomática debe estar alejada de la cifra del 12,5 por ciento que indican algunos autores, estando probablemente más cerca del 0,5 por ciento que refieren otros. Por otra parte, la patología significativa, tributaria de tratamiento (litiasis renal) también es poco frecuente (AU)

Pólipo fibroepitelial gigante del uréter / Giant fibroepithelial polyip of the ureter

OBJETIVO: El pólipo fibroepitelial del uréter es una patología benigna de baja incidencia. Aportamos un nuevo caso con revisión de la literatura, y realizamos una valoración de las exploraciones complementarias a realizar y las posibilidades terapéuticas. MÉTODO: Se presenta el caso de un joven con anulación funcional de riñón izquierdo por la presencia en el interior del uréter de un pólipo fibroepitelial benigno gigante. Se analizan las distintas exploraciones realizadas y las posibilidades terapéuticas. RESULTADOS: Tras el diagnóstico de uropatía obstructiva con pérdida de la unidad renal izquierda, el paciente fue sometido a nefroureterectomía izquierda encontrando la gran formación polipoidea. CONCLUSIONES: Se trata de una patología benigna, de fácil diagnóstico con las exploraciones endoscópicas que disponemos en la actualidad. En el caso de no producir una anulación funcional El pronóstico de los pacientes con carcinoma de células escamosas no es favorable, con una supervivencia a los 5 años de un 57 por ciento (5). irrecuperable de la unidad renal, el tratamiento endoscópico debe ser la primera opción terapéutica (AU)