[Renal transplantation in patients with a vascular aortobifemoral prosthesis]. / Trasplante renal sobre prótesis aortobifemoral.

INTRODUCTION: Nowadays, it is much more common in end stage renal disease patients with vascular grafts, to be kidney transplant candidates. We expose our experience in five cases. MATERIAL AND METHODS: Of all 1,483 kidneys transplanted in our center, 5 recipients had a previous aortobifemoral bypass (2 due to abdominal aortic aneurysm, and 3 due to vascular occlusive disease). We review the clinical features, outcome and complications in these patients. RESULTS: The vascular surgery was done 6 months to 16 years prior to transplantation. The renal transplant was done in iliac fossa with arterial anastomosis to the vascular graft. Surgical complications were: 1 renal artery thrombosis that was treated with thrombectomy, and 1 stricture at the ureterovesical junction. 2 patients dead at 6 months and 7 years with a functioning allograft and 3 patients live with functional allograft at 7 months, 3 years and 7 years. CONCLUSION: Kidney transplantation may be successful in selected patients with aortobifemoral bypass.

[Testicular epidermoid cyst: uncommon lesion of difficult preoperative diagnosis]. / Quiste epidermoide testicular: una rara entidad de dificil diagnostico preoperatorio.

Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.

[Surgical aspects in the third and fourth kidney retransplant]. / Aspectos quirúrgicos en los terceros y cuartos retrasplantes renales.

INTRODUCTION AND OBJECTIVES: A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome. MATERIAL AND METHOD: 1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have retrospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical complications and graft outcome. RESULTS: Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days- 17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of previous graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way, Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years. CONCLUSIONS: Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lumboiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from multiple kidney retransplants.