[Kidney pelvis hemangioma as a cause of hematuria]. / Angiomatosis pélvica como causa de hematuria.

UNLABELLED: Kidney hemangiomas are congenital vascular anomalies with an unknown ethiology. They are considered as benign tumours with a poor clinic expression (hematuria or ureteric colic, which is associated to the drop of clots in the urinary tract). OBJECTIVE: To expound a case of unilateral severe hematuria in a young woman with a restless past medical history, due to a pelvic left kidney hemangioma. MATERIALS AND METHODS: Clinic case of a sixteen years old woman, no relevant past medical history, presented with an anaemizing gross hematuria and passing vermiform clots. As diagnostic techniques we used ultrasonography, excretory urography, cystourethroscopy, CT, angiography and nuclear imaging. Surgery (flank nephectomy) was needed for treatment. RESULTS: Pathology report: submucosal vascular proliferative process in kidney pelvis composed by blood vessels, suggesting haemangioma.

Angiomatosis pélvica como causa de hematuria / Kidney pelvis hemangioma as a cause of hematuria

Los angiomas renales (también llamados hemangiomas) son malformaciones vasculares congénitas (consideradas como tumores benignos), de etiología no conocida y de escasa traducción clínica (hematuria y cólico ureteral asociado al paso de coágulos por la vía urinaria). OBJETIVO: Presentar un caso de hematuria unilateral severa en mujer joven sin antecedentes destacables, secundaria a hemangioma renal pélvico izquierdo. MATERIAL Y MÉTODOS: Caso clínico de mujer de 16 años, sin antecedentes personales de interés, que presenta hematuria anemizante con coágulos de dos meses de evolución. Como técnicas diagnósticas se utilizaron ecografía, urografía intravenosa, cistoscopia, TAC, angiografía, y gammagrafía. Para su tratamiento precisó de intervención quirúrgica (nefrectomía lumbar). RESULTADO: Anatomía patológica de riñón con proceso proliferativo de tipo vascular submucoso en pelvis renal, compuesto de vasos venosos y compatible con hemangiona

Kidney hemangiomas are congenital vascular anomalies with an unknown ethiology. They are considered as benign tumours with a poor clinic expression (hematuria or ureteric colic, which is associated to the drop of clots in the urinary tract. OBJECTIVE: To expound a case of unilateral severe hematuria in a young woman with a restless past medical history, due to a pelvic left kidney hemangioma. MATERIALS AND METHODS: Clinic case of a sixteen years old woman, no relevant past medical history, presented with an anaemizing gross hematuria and passing vermiform clots. As diagnostic techniques we used ultrasonography, excretory urography, cystourethroscopy, CT, angiography and nuclear imaging. Surgery (flank nephectomy) was needed for treatment. RESULTS: Pathology report: submucosal vascular proliferative process in kidney pelvis composed by blood vessels, suggesting haemangioma

[Analysis of the reasons for non graft initial function in our series of the last eleven years]. / Análisis de las causas de no función inicial del injerto en nuestra serie de los últimos once años.

UNLABELLED: FUNDAMENTAL: [corrected] To know which risk factor of delayed graft function in our patients. MATERIAL AND METHODS: We analyzed 469 transplants, 270 had good initial function and 199 had delayed function graft. Variables studies in booth groups were: age, sex and dead cause of donant, type of extraction and place were it was done, implantation side, vases multiple, isquemia times, age and receptor sex, HLA compatibility, retransplant, Ac Anti-VHC, PTH pretransplant, years in waiting list, hiperinmunization, number of transfusion, and type of inmunosupretion. RESULTS: Univariant study: significant differences were found in age and dead cause of donant, isquemia times, years in waiting list, hiperinmunization, number of transfusions, and HLA-B incompatibility. Multivariate study: we have significant differences in age of donant, could isquemia time, years in waiting list, cuadruple? Inmunosupretion. CONCLUSIONS: Results suggest to short could and revascularization isquemia time as possible, and use less nefrotoxic inmunosupretion pautes in high-risk patients.

Análisis de las causas de no función inicial del injerto en nuestra serie de los últimos once años / Analysis of the reasons for non graft initial function in our serie of the last eleven years

FUNDAMENTO: Conocer los factores de riesgo de disfunción inicial del injerto en nuestra serie. MATERIAL Y MÉTODO: Analizamos 469 trasplantes. 270 con buena función inicial y 199 sin función inicial. Las variables estudiadas en ambos grupos mediante estudio uni y multivariante fueron: edad, sexo y causa de muerte del donante, tipo de extracción y donde se realizó, lateralidad de la implantación, vasos múltiples, tiempos de isquemia fría, edad y sexo del receptor, compatibilidad HLA, retrasplante, Ac AntiVHC, PTH pretrasplante, años en lista de espera, hiperinmunización, número de transfusiones y tipo de inmunosupresión. RESULTADOS: Estudio univariante: hubo diferencias significativas en la edad y causa de muerte del donante, tiempos de isquemia, años en lista de espera, hiperinmunización, número de transfusiones e incompatibilidad HLA-B. Estudio multivariante: hubo diferencias significativas en la edad del donante, tiempo de isquemia fría y de revascularización, e inmunosupresión cuádruple. CONCLUSIONES: Los resultados aconsejan acortar en lo posible los tiempos de isquemia fría y de revascularización, y utilizar pautas inmunosupresoras menos nefrotóxica en casos de alto riesgo (AU)

FUNDAMENT: To know which risk factor of delayed graft function in our patients. MATERIAL AND METHODS: We analyzed 469 transplants, 270 had good initial function and 199 had delayed function graft. Variables studies in booth groups were: age, sex and dead cause of donant, type of extraction and place were it was done, implantation side, vases multiple, isquemia times, age and receptor sex, HLA compatibility, retransplant, Ac Anti-VHC, PTH pretransplant, years in waiting list, hiperinmunization, number of transfusion, and type of inmunosupretion. RESULTS: Univariant study: significant differences were found in age and dead cause of donant, isquemia times, years in waiting list, hiperinmunization, number of transfusions, and HLA-B incompatibility. Multivariate study: we have significant differences in age of donant, could isquemia time, years in waiting list, ¿cuadruple? Inmunosupretion. CONCLUSIONS: Results suggest to short could and revascularization isquemia time as possible, and use less nefrotoxic inmunosupretion pautes in high-risk patients (AU)

[Vascular assessment before kidney transplantation. Role of computerized helical tomography]. / Evaluación vascular pretrasplante renal. Papel de la tomografía helicoidal computerizada.

OBJECTIVE: To present our experience with helical CT for vascular assessment prior to renal transplantation. METHODS: In our hospital, all candidates to renal transplantation are referred to the Urology Transplant Unit for previous assessment. For the past 3 years, patients with multiple arterial calcifications (non linear) have been evaluated by helical CT with three-dimensional reconstruction of the calcification densities, which provides an accurate representation of the lesion. RESULTS/CONCLUSIONS: Pretransplant evaluation has been fundamental for individualized planning of the renal transplant surgery. The use of helical CT is extending in our field and it has also been utilized in graft donor assessment. In our experience, the extent and thickness of arterial wall calcifications are accurately depicted by helical CT. These findings could have an important significance when making pre and perioperative decisions in renal transplantation.

[Renal artery stenosis in the transplant patient]. / Estenosis de la arteria renal en el trasplantado.

OBJECTIVE: To present our experience in the diagnosis and treatment of renal artery stenosis in kidney transplants. METHODS: A review of 601 renal transplants performed in adults showed 32 cases of renal artery stenosis. The diagnostic techniques utilized were arteriography in 18 patients, DIVAS in 15, echo-Doppler in 11 patients and MAG with captopril test on two occasions. RESULTS: Arterial hypertension was the most common symptom (92.8%), alone (53.1%) or in association with impaired renal function (43.7%). 46.8% of the cases could be managed by drug therapy. Percutaneous transluminal angioplasty was performed in 14 patients. Surgery was required on two occasions. CONCLUSIONS: The incidence of renal artery stenosis in our series of renal transplants in adults up to 1997 was 5.3%. Arterial hypertension with or without impairment of renal function was the most common symptom. Currently, echo-doppler and MAG with captopril test are the most widely utilized diagnostic techniques. Percutaneous transluminal angioplasty is the treatment of choice in renal artery stenosis when arterial hypertension is refractory to drug therapy. Good results are achieved in 57%, although it is not free from complications. In case of failure, revascularization surgery is the alternative approach.

[Surgical treatment of obstructive disease of the transplanted kidney]. / Tratamiento quirúrgico de la patología obstructiva del riñón trasplantado.

OBJECTIVES: To review renal graft obstruction post-transplantation and its surgical management. METHODS/RESULTS: Our experience and those of other Spanish centers are analyzed and the literature reviewed. The different causes of obstruction following transplantation are briefly analyzed and the advantages and disadvantages of the different therapeutic options are discussed. CONCLUSIONS: Graft obstruction post-transplantation continues to be an important challenge to the urologist. However, in most of the cases the therapeutic alternatives are relatively standardized and achieve satisfactory results.

[Retroperitoneal fibrosis without dilatation of the upper urinary tract and non-obstructive anuria]. / Fibrosis retroperitoneal sin dilatación de vías altas y anuria no obstructiva.

OBJECTIVE: An unusual case of retroperitoneal fibrosis with non-obstructive anuria is described and the therapeutic alternatives are discussed. METHODS/ RESULTS: Repeated obstruction of the double-J ureteral catheter and intense lumbar pain did not permit endourological management and surgery was required. Excellent results were achieved and the patient is asymptomatic 12 months postoperatively. CONCLUSIONS: Conservative endourological management and corticosteroids may not always be feasible. The anuria without dilation in the case described is not unlike other reported cases considered as reflex anuria whose mechanism remains unknown.

[Sterilization of catheters used for intermittent bladder emptying using a domestic microwave oven]. / Esterilización de catéteres empleados para vaciado vesical intermitente con microondas casero.

In contemporary urology it is increasingly frequent the indication of intermittent catheterization. Patients undergoing this type of therapy use several non-standardized methods to make catheterization as clean as possible. Microwave sterilization has been successfully used for certain materials and biological residues. For this reason and because it is a rather inexpensive system, we tried to demonstrate that sterilization of catheters used by our patients for intermittent catheterization using domestic microwave ovens at home is a convenient, inexpensive and clean alternative that should be taken into account. The catheters used were those employed in our hospitalized patients for a minimum of 4 days, which involves a high percentage of contamination. In 15 cases, the catheter was treated in a 800 W domestic microwave oven after having washed it with water so as to eliminate macroscopic organic residues, and in another 15 cases they were thoroughly washed before microwave treatment. In either case, the treatment was done for over 6 minutes at maximum power with the precautions described in the text. In all instances, the catheter's sterility was confirmed except for one case where contamination occurred during post-treatment handling.

[Cancer and kidney transplantation]. / Cáncer y trasplante renal.

The higher risk of developing malignant tumours in transplanted patients is a fact widely acknowledged over the last decade. This paper includes an analysis of our series and a review of the literature. Cancers developed by the transplanted patient or "de novo" cancers and, within this group skin and lip cancer (58%), are by far the most frequent ones. Their biological behaviour is, in general, more aggressive than similar ones in non-transplanted population. Also, different incidence rates and behaviour have been established depending on the immunosuppressive regime given to the patient. Most common pre-existing carcinoma was renal cancer (one third of cases). When these patients had been adequately treated before the transplant, the minimum disease-free interval that has to elapse to be included in a waiting list will depend on the type of tumour. Transferred tumours are the least frequent but more worrying ones due to both their clinical and legal implications. In view of the existing evidence, it is of particular relevance to insure the primitive nature of any CNS tumour as well as the absence of tumoral disease in young females who die of brain haemorrhage.

[Primary signet ring cell adenocarcinoma of the bladder]. / Adenocarcinoma vesical primario de células en anillo de sello.

An additional case of signet ring cell adenocarcinoma of the bladder is described. This tumor type is considered to be uncommon; however, recent studies have reported a higher incidence. The etiopathogenesis and clinical features are discussed. Because it is silent and very aggressive, it is always diagnosed late and the outcome is poor. Treatment is by surgery since radio and chemotherapy have been shown to be little effective.

[Ureteral revascularization in kidney transplantation. Report of a case]. / Revascularización ureteral en el transplante renal. A propósito de un caso.

We present uretero-pyeloplasty as a new surgical approach to stricture of the pyelo-ureteric junction in the transplant recipient. The foregoing is more frequently found in kidneys that are placed in the inverted anatomic position. The surgical procedure is performed without difficulty and at the same time permits us to evidence the presence of a new ureteral revascularization from the recipient after the interruption of vascular supply of the donor kidney.

[Late surgical complications in kidney transplantation. Experience and results]. / Complicaciones quirúrgicas tardías en el trasplante renal. Experiencia y resultados.

The present study reports the late surgical complications observed following 270 renal transplant procedures performed at our department. Their etiologic, clinical, and therapeutic aspects are discussed. With respect to arterial stenosis, we consider percutaneous transluminal angioplasty the procedure of choice when drug therapy fails to control hypertension. Surgery should be reserved for those cases where this procedure fails. We advocate treatment of lymphoceles whose size cause displacement or compression of the excretory tract using drainage and instillation of povidone iodide as advocated by González Martín. Stenosis of the excretory tract is the most common complication in our series. Treatment was by corrective surgery. In our view, the etiologic and ultrastructural features of this complication make it unamenable to endourologic correction.

[Echographic studies in renal transplant. Our experience]. / Los estudios ecográficos en el trasplante renal. Nuestra experiencia.

The present study briefly reports our experience in the evaluation of renal transplantation by conventional and pulsed Doppler ultrasound. We advocate the use of both imaging techniques in these patients because these are safe, reliable, easy-to-use, reproducible noninvasive imaging techniques that afford a high diagnostic yield.

[Immediate surgical complications after 270 renal transplants. Experience and results]. / Complicaciones quirúrgicas inmediatas tras 270 trasplantes renales. Experiencia y resultados.

The present study reports on the early surgical complications observed in 270 renal transplants performed from 1978-1987. A total of 34 (12.5%) surgical complications were observed in the early postoperative period (1 to 6 weeks posttransplant). Among the most prevalent were postoperative hemorrhage, most of which were ascribable to blood coagulation disorders from heparin administration necessary to perform hemodialysis in these patients, and thrombus formation during the initial stages of our experience. Ten patients had urinary fistulas that were resolved in different ways. We advocate performing pyelo-pyelic anastomosis to the excretory tract whenever possible because of the good results achieved with this procedure.

[Extrarenal complications in kidney transplant. Our experience]. / Complicaciones extrarrenales en el trasplante renal. Nuestra experiencia.

Since renal transplantation was introduced in the treatment of chronic end-stage renal failure, we have observed that extrarenal complications have an important role in transplant morbidity and mortality in hospital where kidney transplantation is not an uncommon procedure. The present study reports on the statistical data relative to extrarenal complications in kidney transplantation observed at our hospital, highlighting infectious, GI, respiratory, and hematologic complications because of their incidence.