[The management of azoospermic patient]. / La actitud ante el paciente azoospérmico: la visión del urólogo.

OBJECTIVES: Since first pregnancy after ICSI was achieved in 1992, the treatment and prognosis of severe male factor, i.e azoospermia, has radically changed. The objective of this article is to review the issue from the urologist-andrologist point of view. METHODS: We perform a short revision of the two types of azoospermia and diagnostic tests, and show the algorithm used in our centre for the management of patients with azoospermia. We review the techniques for spermatozoid recovery and surgical treatment of obstructive azoospermia because the role of the urologist is maximum in these aspects. Genetic anomalies in azoospermic patients is one of the issues analyzed in more detail for being one of the most important and of maximum interest currently. RESULTS: Nearly 1% of pregnancies in developed countries are achieved by assisted reproduction techniques, and genetic anomalies among newborns from ICSI cycles have increased to 1.6%, three times normal population. Genetic anomalies are tenfold in azoospermic patients in comparison to general population. We analyze the importance of these studies in patients with secretory azoospermia. We review the most frequent genetic anomalies associated with azoospermia and diagnostic tests employed. Its importance is based on this diagnosis allowing genetic counselling and pre-implant or prenatal diagnosis with the aim of trying to minimize genetic anomalies and disease transmission to next generations. CONCLUSIONS: The diagnosis and treatment of azoospermia continues to be one of the most thrilling challenges in the field of infertility, with promising research lines such as in vitro spermatogenesis from stem cells and autotransplantation of criopreserved cells in patients undergoing radiotherapy and chemotherapy.

[Influence of recipient age on renal transplantation performed with organs coming from child donors]. / Influencia de la edad del receptor en el trasplante renal realizado con órganos procedentes de donantes infantiles.

OBJECTIVES: To evaluate the influence of receptor's age on the outcomes of kidney transplants with organs from donors below the age of three years and/or weighting less than 15 Kg. METHODS: We retrospectively studied the renal transplants with organs from donors below the age of three years and/or weighting less than 15 Kg performed at the Hospital Clínico San Carlos between 1991 and 1999. Receptors were divided into two groups depending on the age at the time of transplantation; group I included patients younger than 50 years and group II patients older than 50. RESULTS: We study 49 kidney transplants with pediatric donors (8.6%); 22 of them were included in group I and 27 in group II. There were no deaths among receptors younger than 50 years. Five-year survival for group II was 75.99%. Five-year graft survival what's 81.82% for group I, and 88.89% for group II (p 0.45). CONCLUSIONS: Receptor's age does not seem to influence graft survival when this kind of organs are used; we consider that the lower incidence of acute rejection in patients older than 50 years may explain the excellent response.

Influencia de la edad del receptor en el trasplante renal realizado con órganos procedentes de donantes infantiles / Influence of recipient´s age on the outcome of kidney transplants with organs from pediatric donors

OBJETIVO: Examinar la influencia que ejerce la edad del receptor en la evolución del trasplante renal realizado con órganos procedentes de donantes con una edad inferior a los 3 años de edad y/o 15 kilos de peso. MÉTODO: Estudio retrospectivo de los trasplantes realizados con órganos procedentes de donantes menores de 3 años de edad y/o 15 kilos de peso, en el Hospital Clínico San Carlos entre los años 1991 y 1999. Los receptores fueron divididos según su edad en el momento del trasplante en dos grupos, el primero por debajo de los 50 años (grupo I) y el segundo por encima de dicha edad (grupo II). RESULTADOS: Se estudian 49 trasplantes renales realizados con donantes infantiles (8,6 por ciento), de ellos 22 pertenecían al grupo I y 27 al grupo II. No se observaron fallecimientos en los receptores menores de 50 años. La supervivencia en el grupo II a los 5 años era del 75,99 por ciento. Respecto a la supervivencia del injerto en el primer grupo a los 5 años es del 81,82 por ciento y en el grupo II del 88,89 por ciento. (p 0,45). CONCLUSIONES: La edad del receptor no parece influir en la supervivencia del injerto cuando se utilizan este tipo de órganos, se considera que la menor presencia de rechazo agudo en pacientes mayores de 50 años puede explicar esta excelente respuesta (AU)

[Difficulties in the treatment of symptomatic varicocele using percutaneous embolization: the circumaortic renal vein]. / Dificultades en el tratamiento del varicocele sintomático mediante embolización percutánea: la vena renal circumaórtica.

OBJECTIVE: The anatomic anomalies of the inferior cava and its collaterals, even though they do not normally show symptoms, can cause difficulties in different diagnostic and therapeutic procedures, such as the percutaneous treatment by gonadal embolization of the varicocele. METHODS: We analyzed the incidence of one of these anomalies, specifically the left circumaortic renal vein, in a series of 50 gonadal embolization procedures for symptomatic varicocele. RESULTS: We found two cases (4%) of left circumaortic renal vein in our series. Gonadal embolization was possible in only one of the cases since the ostium of the gonadal vein could not be localized in the other case. In the first case, the gonadal ostium was in the paraaortic confluence of the venous ring, and could be catheterized and selectively embolized. CONCLUSIONS: The presence of a circumaortic left renal vein can make it technically impossible to perform embolization of the symptomatic varicocele.

Dificultades en el tratamiento del varicocele sintomático mediante embolización percutánea: la vena renal circumaórtica / Difficulties in the treatment of symptomatic varicocele by percutaneous embolization: the circumaortic renal vein

Objetivo: Las anormalidades anatómicas del sistema venoso de la cava inferior y sus colaterales, aun cuando no manifiestan habitualmente síntomas, pueden plantear dificultades en diferentes procedimientos diagnósticos y terapéuticos, entre ellos el tratamiento percutáneo mediante embolización gonadal del varicocele. Métodos: Analizamos la incidencia de una de estas anomalías, en concreto la vena renal izquierda circumaórtica, en una serie de 50 procedimientos de embolización gonadal por varicocele sintomático. Resultados: Hemos encontrado dos casos (4 por ciento) dentro de nuestra serie, de vena renal izquierda circumaórtica siendo posible la embolización gonadal en uno sólo de los casos por no poder localizar en el otro el ostium de la vena gonadal. En el que fue posible, el ostium gonadal se encontraba en la confluencia paraaórtica del anillo venoso, pudiendo cateterizarse y embolizarse selectivamente. Conclusiones: La presencia de una vena renal izquierda circumaórtica puede hacer técnicamente imposible la embolización del varicocele sintomático (AU)