[Partial transplantectomy combined with substitution of the urinary tract, in the treatment of segmental renal infarction after transplantation]. / Trasplantectomía parcial asociada a sustitución del tracto urinario, en el tratamiento del infarto renal segmentario postrasplante.

OBJECTIVES: To present our experience with post-transplantation necrotic infarction involving large areas of the renal parenchyma, causing caliceal fistula, and the therapeutic possibilities aimed at achieving graft survival. METHODS: 690 kidney transplants were reviewed: of these 6 had post-transplantation segmental renal infarction with subsequent parenchymal necrosis involving 25 to 40% of the organ and associated with urinary tract necrosis in two cases. The patients were treated conservatively by partial graft resection, the calyces were closed separately and the lining repaired with vascularized parietal peritoneal flaps or lyophilized patches of human dura mater sealed with fibrin glue and substitution of the necrotic urinary tract in two cases. RESULTS: One patient died a few minutes after the operation from cardiorespiratory causes. In the remaining 5 patients, the fistula was resolved definitively. Five years postoperatively, the salvaged parenchyma is functioning well and dialysis has not been required. CONCLUSIONS: Partial graft resection, followed by separate closure of the calyces, lining repair with parietal peritoneum or lyophilized human dura and fibrin glue and substitution of the urinary tract, if compromised by necrosis can salvage renal grafts with wide areas of necrosis.

Caliceal fistula formation following renal transplantation: management with partial nephrectomy and ureteral replacement.

Six patients in this series of 543 renal transplants (1.10%) suffered a post-transplant renal segmental infarct of the donor kidney because of occlusion of an accessory renal artery. Five grafted kidneys had multiple renal arteries. Patients presented with symptoms of a caliceal fistula and were treated by partial (25 to 40%) transplant nephrectomy, followed by closure and tissue coverage with either parietal peritoneum (4 patients) or lyophilized human dura mater sealed with fibrin (2). In 2 cases the renal ischemia and necrosis involved the ureter, and a pyelo-pyelostomy was performed. One patient died of cardiorespiratory complications immediately postoperatively. Five years postoperatively all kidneys functioned well without recurrence of fistula and 5 patients returned to a normal life-style. The combination of radical excision and tissue closure, plus ureteral substitution when needed was an effective treatment that prevented loss of the graft.

[Primary hyperthyroidism. Our experience]. / Hipertiroidismo primario. Nuestra experiencia.

The present study was performed in ten cases of hyperparathyroidism with a history of recurrent renal colic with or without passing calculi. Most of these patients had undergone stone surgery. Diagnosis was based on patient history, and metabolic and radiologic work up, and confirmed histologically following surgical exploration of the neck and removal of the pathologic parathyroid gland.

En bloc kidney and bladder transplantation from an anencephalic donor into an adult recipient.

The visceral block, composed of both kidneys and their vascular pedicles, inferior vena cava, ureters and bladder, was removed from a 3-day-old male anencephalic donor and transplanted into a 32-year-old adult in chronic renal failure. The urinary tract was reconstructed by vesicovesicostomy for technical ease, and prevention of reflux and ureteral stenosis. Maximum urine output was 150 ml. per day and the kidney grafts were lost owing to rejection 5 months after transplantation.