A Single-Center Experience With Third and Fourth Kidney Transplants and Second Kidney Transplant After Pancreas-Kidney Transplant: Surgical Aspects and Outcomes.

OBJECTIVES: Overall, 25% to 33% of patients on kidney transplant wait lists present with prior graft loss. In addition, the number of patients who require a retransplant seems to be increasing. Here, we describe our experience with patients who had a second kidney transplant after a previous pancreas-kidney transplant or a third or fourth kidney transplant. We focused specifically on the technical aspects and outcomes related to this patient group. MATERIALS AND METHODS: A single-center retrospective study was performed. The cohortincluded 15 patients > 18 years old who had received a second kidney graft after pancreas-kidney transplant or a second or greater kidney graft between 2013 and 2019. RESULTS: Median age of recipients was 45 years (range, 20-58 y). In 10 patients, the transperitoneal approach was selected. In 5 patients, the retroperitoneal heterotopic kidney retransplant technique was used. Early surgical complications (≤ 30 days posttransplant) were reported in 4 patients. Three patients had late ureteral stenosis (> 90 days posttransplant). All grafts were functioning at time of patient discharge. Mean creatinine level was 2.69 mg/dL (range, 1.23-6.26 mg/dL). The 1-year and 2-year graft survivalrates were 85% and 75%, respectively. No grafts were lost because of surgical complications. CONCLUSIONS: Retransplant of a second graft after pancreas-kidney transplant or retransplant of a third or fourth renal graft is challenging but feasible, with evidence of reasonably positive outcomes after retransplant.

Clinical association of metabolic syndrome, C-reactive protein and testosterone levels with clinically significant prostate cancer.

Recently, the influence that metabolic syndrome (MetS), hormonal alterations and inflammation might have on prostate cancer (PCa) risk has been a subject of controversial debate. Herein, we aimed to investigate the association between MetS-components, C-reactive protein (CRP) and testosterone levels, and the risk of clinically significant PCa (Sig-PCa) at the time of prostate biopsy. For that, men scheduled for transrectal ultrasound guided biopsy of the prostate were studied. Clinical, laboratory parameters and criteria for MetS characterization just before the biopsy were collected. A total of 524 patients were analysed, being 195 (37.2%) subsequently diagnosed with PCa and 240 (45.8%) meet the diagnostic criteria for MetS. Among patients with PCa, MetS-diagnosis was present in 94 (48.2%). Remarkably, a higher risk of Sig-PCa was associated to MetS, greater number of MetS-components and higher CRP levels (odds-ratio: 1.83, 1.30 and 2.00, respectively; P < 0.05). Moreover, higher circulating CRP levels were also associated with a more aggressive Gleason score in PCa patients. Altogether, our data reveal a clear association between the presence of MetS, a greater number of MetS-components or CRP levels >2.5 mg/L with an increased Sig-PCa diagnosis and/or with aggressive features, suggesting that MetS and/or CRP levels might influence PCa pathophysiology.

[Oligometastatic prostate cancer. concept and implications.] / Cáncer de próstata oligometastásico. Concepto e implicaciones.

Oligometastatic prostate cancer has been proposed as an intermediate stage between localized and extensively disseminated disease. Oligometastatic disease is being diagnosed more frequently due to the advances in imaging tests. Nevertheless, there is no consensus definition yet of oligometastatic prostate cancer. The importance of this entity is that several studies have pointed out that local and metastasis directed treatment may improve survival in selected patients. However, we need the results of well controlled prospective randomized clinical trials to help a better understanding and management of oligometastatic prostate cancer.

Cáncer de próstata oligometastásico. Concepto e implicaciones / Oligometastatic prostate cancer. concept and implications

El CaP oligometastásico se ha propuesto como un estadio intermedio entre la enfermedad localizada y la ampliamente diseminada. La enfermedad oligometastásica está siendo más frecuentemente diagnosticada debido a los avances en las pruebas de imagen. No obstante, aún no existe una definición de consenso en cuanto a qué se considera un CaP oligometastásico. La importancia de esta entidad radica en que varios trabajos han apuntado que el tratamiento local y el dirigido a la metástasis en pacientes seleccionados podría mejorar su supervivencia. Sin embargo, aún son necesarios los resultados de ensayos clínicos prospectivos bien controlados y aleatorizados que ayuden a un mejor entendimiento y manejo del CaP oligometastásico

Oligometastatic prostate cancer has been proposed as an intermediate stage between localized and extensively disseminated disease. Oligometastatic disease is being diagnosed more frequently due to the advances in imaging tests. Nevertheless, there is no consensus definition yet of oligometastatic prostate cancer. The importance of this entity is that several studies have pointed out that local and metastasis directed treatment may improve survival in selected patients. However, we need the results of well controlled prospective randomized clinical trials to help a better understanding and management of oligometastatic prostate cancer

Importancia de la rehabilitación precoz de los cuerpos cavernosos tras prostatectomía radical / Importance of early rehabilitation of the corpus cavernosum after radical prostatectomy

Objetivos: Primario: evaluar la importancia de una rehabilitación precoz de los cuerpos cavernosos sobre la función eréctil tras prostatectomía radical. Secundario: analizar los factores asociados a una mejor respuesta. Material y método: Estudio retrospectivo en pacientes tratados con inyecciones intracavernosas tras prostatectomía radical entre el 1 de enero de 2006 y el 31 de diciembre de 2008. Se incluyeron enfermos sin antecedentes de disfunción eréctil previa a la cirugía, no respondedores a inhibidores de la 5-fosfodiesterasa. En todos se realizó ecodoppler color tras inyección de prostaglandina E1 10-20 mg. Se compararon 2 grupos en función de la precocidad del inicio de la rehabilitación tras la cirugía (precoz, < 6 meses, o tardía, > 6 meses). Resultados: Se incluyeron 82 pacientes. En el análisis multivariante, fueron factores predictores de buena respuesta al tratamiento: inicio precoz de la rehabilitación (OR: 0,06; IC 95%: 0,014- 0,26), mayor velocidad pico sistólica durante el test (OR: 1,01; IC 95%: 1,01-1,1) y estadio anatomopatológico favorable (OR: 0,15; IC 95%: 0,036-0,6). El ecodoppler color tras inyección de prostaglandina E1 presentó valores anormales con mayor frecuencia en el grupo de inicio tardío frente al precoz (89,5% [n = 34] vs. 65,9% [n = 29]; p = 0,01). El 40,2% (n = 33) de los sujetos presentaron fracaso del mecanismo corporovenooclusivo, presentando valores más elevados el grupo de inicio tardío (5,53 ± 1,4 cm/seg) frente al precoz (4,75 ±1,03 cm/seg) (p = 0,005). La presencia de erecciones funcionales a los 18 meses del seguimiento fue mayor en el grupo de inicio precoz (p < 0,001). Conclusiones: Según el presente estudio, en pacientes tras prostatectomía radical la rehabilitación farmacológica precoz de la erección presenta mejores resultados comparada con la tardía (AU)

Objectives: Primary: to evaluate the importance of early rehabilitation of the corpus cavernosum on erectile function after radical prostatectomy. Secondary: to analyse the factors associated with better response. Material and method: Retrospective study in patients treated with intracavernous injections after radical prostatectomy between 1 January 2006 and 31 December 2008. We included patients lacking a history of erectile dysfunction prior to surgery, not responding to phosphodiesterase-5 inhibitors. All patients underwent colour echo-doppler after injection of prostaglandin E1 10-20 mg. The outcomes of these 2 groups were then compared according to how early rehabilitation began after surgery (early, < 6 months, or late, > 6 months). Results: There were 82 patients included in the study. In the multivariate analysis, predictive factors of good response to treatment were: early onset of rehabilitation (OR: 0.06; 95% CI: 0.014-0.26), higher peak systolic velocity during the test (OR: 1.01; 95% CI: 1.01-1.1) and favourable histopathological stage (OR: 0.15; 95% CI 95%: 0.036-0.6). The colour echo-doppler procedure after prostaglandin E1 injection showed abnormal values more frequently in the lateonset than in the early group (89.5% [n = 34] vs. 65.9% [n = 29]; P = .01). Corporal veno-occlusive dysfunction was presented by 40.2% (n = 33) of subjects, with the late-onset group presenting higher values (5.53 ± 1.4 cm/sec) than the early group (4.75 ± 1.03 cm/sec) (P = .005). The presence of functional erections at 18 months’ follow-up was higher in the early onset group (P < .001). Conclusions: According to this study, early erectile dysfunction rehabilitation after radical prostatectomy achieves better results than late rehabilitation in patients (AU)

Epidemiología de la disfunción eréctil. Factores de riesgo / Epidemiology of erectile dysfunction. Risk factors

En 1993, la conferencia de consenso sobre la impotencia del NIH (Nacional Institute of Health), define la Disfunción Eréctil (DE) como “la incapacidad permanente para iniciar o mantener una erección suficiente como para permitir una relación sexual satisfactoria”.La Disfunción Eréctil (DE), es un trastorno frecuente que afecta negativamente a la calidad de vida de los varones que la padecen. Su prevalencia varía entre diferentes países, culturas y razas.Los primeros estudios poblaciones publicados, datan de principios de los 90 y conservan aún su vigencia.Todos reflejan la influencia que la edad tiene sobre la prevalencia de esta patología, así como su estrecha relación con las enfermedades cardiovasculares.Dependiendo de la definición utilizada y del diseño del estudio, la prevalencia varía entre el 10 y el 52%, en particular en hombres entre 40 y 70 años, con una incidencia en occidente de 25-30 nuevos casos por 1000 habitantes y año(AU)

In 1993 the NIH (National Institute of Health) Consensus Conference on Impotence defined erectile dysfunction as the permanent incompetence to start or maintain an erection enough to enable satisfactory sexual intercourse.Erectile dysfunction (ED) is a frequent disorder that affects negatively quality of life of males suffering it. Its prevalence varies between different countries, cultures and races.The first population studies published date from early 90`s and still keep their validity.All of them show the influence of age on prevalence of ED, as well as its close relationship with cardiovascular diseases.Depending on the definition used and study design prevalence varies from 10 to 52%, mainly in men between 40-70 years, with an incidence in western countries between 25-30 new cases per 1000 inhabitants year(AU)

Hand metastasis from renal carcinoma.

Renal carcinoma may develop metachronous distant metastases without evidence of regional or local disease recurrence. These lesions may be misdiagnosed because of its benign-like appearance and lack of evidence of other disease spread.

[Paired kidneys in transplant]. / Riñones parejos en trasplante.

OBJECTIVES: Many factors affect the graft and patient survival on the renal transplant outcome. These factors depend so much of the recipient and donor. We accomplished a study trying to circumvent factors that depend on the donor. We checked the paired kidneys originating of a same donor cadaver. PATIENTS AND METHOD: We examined the risk factors in the evolution and follow-up in 278 couples of kidney transplant. We describe their differences, significance, the graft and patient survival, their functionality in 3 and 5 years and the risk factors implicated in their function. We study immunogenic and no immunogenic variables, trying to explain the inferior results in the grafts that are established secondly. We regroup the paired kidneys in those that they did not show paired initial function within the same couple. RESULTS: The results yield a discreet deterioration in the graft and patient survival for second group establish, superior creatinina concentration, without obtaining statistical significance. The Cox regression study establishes the early rejection (inferior to three months) and DR incompatibility values like risk factors. CONCLUSIONS: This model of paired kidneys would be able to get close to best-suited form for risk factors analysis in kidney transplant from cadaver donors, if more patients examine themselves in the same way. The paired kidneys originating from the same donor do not show the same function in spite of sharing the same conditions of the donor and perioperative management.

[Papillary renal carcinoma presenting as hydronephrosis]. / Hidronefrosis como cáncer papilar renal.

BACKGROUND: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review. METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis. RESULTS: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter. CONCLUSIONS: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter.

Hidronefrosis como cáncer papilar renal / Papillary renal carcinoma presenting as hydronephrosis

OBJETIVO: Describir un nuevo caso de carcinoma papilar incidental. Revisión de la literatura.MÉTODOS: El carcinoma papilar renal (CRP) es una variante dentro del carcinoma renal. Se clasifican en dos subtipos que tienen relación con su pronóstico. Presentamos un caso de CRP en un varón de 76 años, simulando una hidronefrosis evolucionada.RESULTADO/CONCLUSIONES: Se describen los hallazgos y el posterior resultado histológico asociado de una metástasis sincrónica en el uréter ipsilateral(AU)

OBJECTIVE: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review.METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis.RESULTS/DISCUSSION: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter(AU)