Outcomes of controlled DCDD lung transplantation after thoraco-abdominal vs abdominal normothermic regional perfusion: The Spanish experience.

BACKGROUND: Thoraco-abdominal normothermic regional perfusion (TA-NRP) has emerged as a strategy for evaluating and recovering the heart in controlled donation after the circulatory determination of death (cDCDD). However, its impact on lung grafts remains largely unknown. We aimed to assess the impact of TA-NRP on the outcomes of recipients of cDCDD lungs. METHODS: This is a retrospective, multicenter, nationwide study describing the outcomes of cDCDD lung transplants (LTs) performed in Spain from January 2021 to November 2023. Patients were divided in 2 groups based on the recovery technique: TA-NRP with the simultaneous recovery of the heart vs abdominal NRP (A-NRP) without simultaneous heart recovery. The primary endpoint was the incidence of Primary Graft Dysfunction (PGD) grade 3 at 72 hours. Secondary endpoints included the overall incidence of PGD, days on mechanical ventilation, intensive care unit (ICU) and hospital length of stay, early survival rates, and mid-term outcomes. RESULTS: Two hundred and eighty three cDCDD LTs were performed during the study period, 28 (10%) using TA-NRP and 255 (90%) using A-NRP. No differences were observed in the incidence of PGD grade 3 at 72 hours between the TA-NRP and the A-NRP group (0% vs 7.6%; p = 0.231), though the overall incidence of PGD was significantly lower with TA-NRP (14.3% vs 41.5%; p = 0.005). We found no significant differences between the groups regarding other post-transplant outcome variables. CONCLUSIONS: TA-NRP allows the simultaneous recovery of both the heart and the lungs in the cDCDD scenario with appropriate LT outcomes comparable to those observed with the A-NRP approach.

Outcomes of lung and liver transplantation after simultaneous recovery using abdominal normothermic regional perfusion in donors after the circulatory determination of death versus donors after brain death.

Normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is a growing preservation technique for abdominal organs that coexists with the rapid recovery of lungs. We aimed to describe the outcomes of lung transplantation (LuTx) and liver transplantation (LiTx) when both grafts are simultaneously recovered from cDCD donors using NRP and compare them with grafts recovered from donation after brain death (DBD) donors. All LuTx and LiTx meeting these criteria during January 2015 to December 2020 in Spain were included in the study. Simultaneous recovery of lungs and livers was undertaken in 227 (17%) donors after cDCD with NRP and 1879 (21%) DBD donors (P < .001). Primary graft dysfunction grade-3 within the first 72 hours was similar in both LuTx groups (14.7% cDCD vs. 10.5% DBD; P = .139). LuTx survival at 1 and 3 years was 79.9% and 66.4% in cDCD vs. 81.9% and 69.7% in DBD (P = .403). The incidence of primary nonfunction and ischemic cholangiopathy was similar in both LiTx groups. Graft survival at 1 and 3 years was 89.7% and 80.8% in cDCD vs. 88.2% and 82.1% in DBD LiTx (P = .669). In conclusion, the simultaneous rapid recovery of lungs and preservation of abdominal organs with NRP in cDCD donors is feasible and offers similar outcomes in both LuTx and LiTx recipients to transplants using DBD grafts.

Thoracotomy Wound Dehiscence After Lung Transplant Is an Effective Surgical Solution: A Case Report.

Post-thoracotomy wound dehiscence after a lung transplant carries with it morbidity in the postoperative period. While this complication has been widely reported in the literature after a clamshell incision, the thoracotomy dehiscence's surgical solution has not received much emphasis. We present an original technical solution to deal with this complication, performed successfully in a 62-year-old woman diagnosed as having idiopathic pulmonary hemosiderosis after a single lung transplant. This surgical treatment consists of necrotic rib tissue removal, pleural effusion drainage, pulmonary adhesion removal, and chest wall defect reparation with bioabsorbable mesh. This operative technique results safe and effective for thoracotomy dehiscence reparation.

[Prostate cryotherapy: General principles.] / Crioterapia prostática: fundamentos y principios generales.

INTRODUCTION: Prostate cryotherapy has been consolidated as an alternative minimally invasive treatment. OBJECTIVE: To exposed its historical development, its action mechanism and the surgical technique. Regarding its indications, we expose the different option of treatment- primary cryotherapy, salvage and focal- emphasizing its oncological results in the absence of randomized studies. RESULTS: Cryotherapy is a safe technique with low complication rate, although incidence of erectile dysfunction is 40-90% in case of full-gland cryotherapy. Nowadays, it is recommended as a therapeutic alternative for low and intermediate risk localized prostate cancer, although in clinical trials. Recurrence-free survival is close to 96% in low-risk tumors and 90% in intermediate-risk tumors. On the other hand, it is a salvage treatment option for local recurrence after radiotherapy. Focal therapies including focal cryoablation have an important development, with recurrence-free survival of 75%. CONCLUSION: Waiting for randomized studies that provide more scientific evidence, available retrospective studies show cryotherapy as a safe and effective treatment option in patients with localized prostate cancer.

INTRODUCCIÓN: La crioterapia prostática se ha ido consolidando como una alternativa de tratamiento mínimamente invasiva. OBJETIVO: Exponer el desarrollo histórico de la crioterapia, su mecanismo de acción sobre el tejido prostático así como la técnica quirúrgica. Se discuten los distintos escenarios ­ crioterapia primaria, de rescate y focalhaciendo énfasis en sus resultados oncológicos a falta de estudios randomizados. RESULTADOS: La crioterapia es una técnica segura con un bajo índice de complicaciones, aunque destaca una incidencia de disfunción eréctil del 40-90% en el caso de crioterapia de glándula completa. En la actualidad se recomienda como alternativa terapéutica en el cáncer de próstata localizado de riesgo bajo e intermedio, aunque dentro de ensayos clínicos. La supervivencia libre de recidiva bioquímica es cercana al 96% en tumores de bajo riesgo y al 90% en tumores de riesgo intermedio. Por otro lado, es una opción de tratamiento de rescate en el caso de recidiva local tras radioterapia siempre que se cumplan una serie de criterios (Gleason ≤7 y PSA10ng/ml). La mejora en las técnicas de imagen está permitiendo el desarrollo de terapias focales incluyendo la crioablación focal, con supervivencia libre de recidiva bioquímica del 75%. CONCLUSIONES: A la espera de estudios randomizados que aporten mayor evidencia científica, los estudios retrospectivos disponibles muestran la crioterapia como una opción de tratamiento segura y eficaz en pacientes con cáncer de próstata localizado.

Optimizing collagenase Clostridium histolyticum therapy for Peyronie's disease using a novel approach with percutaneous needle tunnelling.

OBJECTIVES: To compare the efficacy and safety of a combined treatment of percutaneous needle tunnelling (PNT) and a modified collagenase Clostridium histolyticum (CCH) protocol (PNT/CCH) vs the modified protocol alone (CCH) in the treatment of Peyronie's disease (PD). PATIENTS AND METHODS: A prospective registry of patients treated with a modified CCH protocol was maintained between June 2014 and February 2018. The last 50 patients received PNT as an adjuvant therapy (PNT/CCH), and their data were compared with those of the other 94 patients treated previously (CCH). PNT involves the creation of multiple holes made percutaneously in the plaque before each injection. The modified protocol consisted of two collagenase injections, at 1-week intervals, followed by penile modelling. Patients used penile traction therapy, tadalafil and pentoxifylline for the next 2 months and were followed up for 6 months. The main outcome was improvement of curvature. Secondary outcomes were improvements in erectile function, PD symptoms, stretched penile length and satisfaction. RESULTS: Improvement in curvature was greater in patients in the PNT/CCH group than in the CCH group (mean ± sd 19.2 ± 6.1° vs 12.7 ± 5.0°; P < 0.001 [36.2 ± 12.5% vs 28.1 ± 14.5%; P = 0.001]). Compared with baseline, both interventions were associated with significant improvement in secondary outcomes. The main complications were ecchymosis, bruising and penile pain, with no significant differences between groups. CONCLUSIONS: Treatment of PD with CCH using our modified protocol in combination with PNT is safe and more effective than the modified protocol alone, with the potential for improved cost-effectiveness.

Surgical Technique for Complex Cases of Peyronie's Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece.

INTRODUCTION: Patients with Peyronie's disease (PD) and erectile dysfunction (ED) concomitant with shortening or other malformations benefit from prosthesis implantation and penile lengthening procedures. AIM: To evaluate the safety and efficacy of a multi-incisional technique with penile prosthesis implantation with multiple corporeal incisions and collagen grafting for the surgical management of complex cases of PD with ED and severe penile shortening. METHODS: From February 2015-May 2018, 43 consecutive patients with complex PD were treated using this technique. Implantation of a penile prosthesis (malleable or inflatable [IPP]) together with multiple relaxing tunica albuginea incisions and grafting with a self-adhesive collagen-fibrin fleece (TachoSil, Baxter Healthcare) was performed in all patients by a single surgeon (J.I.M.S.). MAIN OUTCOME MEASURE: Penile length and curvature correction, operative time, and incidence of postoperative complications were recorded as outcome measures. Functional outcomes were measured with questionnaires (International Index of Erectile Function-5, Erection Hardness Score, modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, PD Questionnaire) before and 3 and 6 months after surgery. RESULTS: With a median follow-up of 21 months (range 10-31), mean postsurgical penile lengthening was 2.5 (range 1-5) cm, with an improvement in the Bother domain of the PD Questionnaire of 4.4 (range 2-5) points. The average operative time was 86.7 and 71.6 minutes for the IPP and malleable penile prosthesis procedure, respectively. No glans ischemia was recorded; however, 1 IPP infection and 1 delayed distal corporeal erosion were recorded. Hematoma or bruising was observed in 23.2% of patients. The modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire was completed by 39 (90.7%) patients. Overall, 89.7% would recommend this surgery. Patient satisfaction with straightness and length was 94.9% and 82.1%, respectively. CLINICAL IMPLICATIONS: The described technique helps restoration of penile length and erectile function in patients with complex PD. STRENGTHS & LIMITATIONS: The strength of the study is that it offers a simple, easy-to-apply technique for surgeons to correct shortening and other malformations in patients with ED and complex PD. The study is limited by the small number of patients, the short follow-up period and the performance of the technique by a single high-volume implanter. CONCLUSION: The implantation of a penile prosthesis (malleable or inflatable) together with multiple incisions of the plaque/tunica albuginea and grafting with a collagen fleece is a safe and efficient treatment for patients with complex PD in addition to ED and significant shortening. Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, et al. Surgical Technique for Complex Cases of Peyronie's Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece. J Sex Med 2019;16:323-332.