Prostate cancer in deceased organ donors: a review.

OBJECTIVE: To estimate the risk of prostate cancer transmission in relation with organ procurement. METHODS: A literature search from the Medline database using the following keywords-transplantation, prostate cancer, organ procurement, donor transmitted malignancies, disease transmission, staging, evaluation, and PSA-was conducted to select 16 articles written in English and French over the last 15 years. RESULTS: The incidence of prostate cancer in deceased organ donors (DOD) has been estimated to be between 3% and 18.5%. There were more than 120 solid-organ transplantations performed with organs coming from DOD with a proven prostate cancer without any case of cancer transmission or death related to malignancy and only 1 case of transmission by the donor after a heart transplant has been described. CONCLUSION: Transmission of prostate cancer by a transplanted organ seems incidental. When PSA is measured, it should be suspected only if the value is beyond 20 ng/ml and in all cases, should be interpreted taking digital rectal examination (DRE) into account. Organs from a DOD with a DRE proving a T3-T4 prostate cancer should not be procured. Suspect iliac lymph nodes during the preparation of the vessels for cannulation must lead to the discontinuation of the procurement or a histological analysis.

Does daily urine output really matter in renal transplantation?

BACKGROUND: Our objective was to clarify the clinical outcome of renal transplantation based on residual daily urine output (RDUO). MATERIAL AND METHODS: We retrospectively analyzed a prospective database of 276 patients who underwent renal transplantation (Tx) between January 2008 and December 2012. Patients had pre-transplantation daily urine output measurement of 24-h proteinuria and were clinically re-evaluated the day before transplantation. We included patients with no daily urine output and those with residual daily urine output. Real bladder capacity was not measured. We excluded patients with a history of lower urinary tract malformation, those treated by trans-ileal conduit or enterocystoplasty, and those with early graft thrombosis or graft primary non-function. RESULTS: Sex ratio, age at Tx, pre-Tx MHC antibodies levels, donor age, and cold ischemia duration were not significantly different between the 2 groups. Dialysis duration was longer in group I (p<0.001). The dialysis duration was correlated with the volume of residual urine output (r=0.12, p<0.0001). We found 14 (19.4%) urological complications in Group I (11 urinary leaks and 3 urethral stenosis) and 13 (6.4%) in Group II (5 urinary leaks and 8 stenosis). This difference was significant (p=0.0013 and relative risk [RR]=2.2). Absence of residual daily urine output was a risk factor of post-transplantation urinary leak (p<0.0001: RR=2.95). At 3 years, graft survival was 74.7% and 94.6%, respectively, in Group I and II (p=0.003). CONCLUSIONS: The absence of residual daily urine output seems to be a major risk factor for urological complications. Taking into account recipient residual daily urine output should modify surgical strategy during renal transplantation.

Congenital megaprepuce: a 12-year experience (52 cases) of this specific form of buried penis.

OBJECTIVE: Congenital megaprepuce is a specific form of buried penis. Children affected by this malformation usually suffer from a subjective difficulty in voiding which is the main indication for early surgical correction. The aim of this study was to report a single center's 12-year experience in the treatment of megaprepuce in children, describing the surgical procedure we used to treat it and the results. PATIENTS AND METHODS: We retrospectively reviewed the charts of all children who underwent congenital megaprepuce repair between January 1999 and August 2011 in our institution. Fifty-two children were operated during the study period. Our single surgical technique, not an original one, consists of fixing the penile shaft at the base of the penis, and widely reducing the inner prepuce. RESULTS: Four children (8%) underwent revision surgery but according to our criteria a very good result was observed in only 23 patients, and a less good but still acceptable result in 25 patients. CONCLUSION: Our 12-year experience in the surgical treatment of congenital megaprepuce demonstrated satisfying results from a safe and simple surgical technique, but to achieve the optimum result remains difficult.