Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events. / Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSION: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events.

Trans-umbilical single-port radical nephrectomy with concomitant cholecystectomy.

OBJECTIVES: Occasionally, the development of laparoscopic procedures allows the performance of combined surgeries. Currently, some of these can be carried out by trans-umbilical single-port laparoscopy. MATERIAL AND METHODS: We report a patient with renal tumor of 4.5cm and cholelithiasis who undergone to trans-umbilical single port-right radical nephrectomy with concomitant cholecystectomy. This is the first case reported in Spain that this combined procedure is performed using umbilical single port surgery. RESULTS: No complications (intra or postoperative) have been described in this case, achieving proper control of tumor pathology and an excellent cosmetic outcome. CONCLUSION: In those cases in which multidisciplinary approach is required, surgery can be performed by trans-umbilical single-port laparoscopy as consequence of its reduced postoperative morbidity and better cosmetic results.

[Paratesticular lipoma]. / Lipoma paratesticular.

Among the neoplasias affecting the scrotum and other elements contained within, testicular tumours are the most common; paratesticular neoplasias account for about 2%. 70% of them are benign tumours, lipoma being one the most frequent types. We contribute a new case of paratesticular lipoma in a 45-year old patient, who presented with scrotal complaints. Physical examination found fibroelastic scrotal tumoration; diagnosis being aided with ultrasound and CAT that showed fat tissue radiographic patterns. Complete removal of tumoration and subsequent pathoanatomical study confirmed the diagnosis of paratesticular lipoma. A literature review on the subject is included with reflections on the clinical, diagnostic and therapeutical aspects.

[Report of 2 new cases of bladder inverted papilloma, one with them complicated with acute urinary obstruction]. / Presentación de dos nuevos casos de papiloma invertido vesical, cursando uno de ellos con obstrucción urinaria aguda.

Inverted papilloma is a rare tumour (2.2% of urothelial tumours) considered to be benign. The bladder is the most frequent site and growth tends to be endophytic towards the submucosa. Haematuria and obstruction symptoms appear to be the most typical clinical manifestations. Contribution of two cases of inverted bladder papilloma; one showing very unusual clinical development with relapsing acute urinary obstruction. Strict follow-up is recommended in spite of its benign behaviour as it may become associated to transitional cell carcinoma. Literature review on this tumoral entity in terms of etiology, clinical manifestations, diagnosis and treatment.

[Metanephric adenoma of the kidney and chronic myeloproliferative syndrome. An unusual association]. / Adenoma metanéfrico de riñón y síndrome mieloproliferativo crónico. Una rara asociación.

The metanephric adenoma is an uncommon tumour included in the class of benign renal epithelial tumours. This paper presents the case of a 64-year old female with incidentally diagnosed renal tumoration affecting the patient concomitantly to a chronic myeloproliferative syndrome with myelofibrosis. Left kidney ultrasound and CAT findings suggested a diagnosis of renal cell carcinoma. Left radical nephrectomy was performed. The pathoanatomical study confirmed the diagnosis of a renal metanephric adenoma 9 x 7.5 cm in size. Although some cases of metanephric adenoma have been described in patients with haematological conditions, polycythemia being specially frequent, no case associated to chronic myeloproliferative syndrome has been found in the literature.

[Acute pyelonephritis as presentation form of renal angiomyolipoma with large granulomatous component]. / Pielonefritis aguda como forma de presentación de un angiomiolipoma renal con gran componente granulomatoso.

Angiomyolipoma is a benign tumour of the kidney; is most cases is a finding during radiologic studies (ultrasound and CAT) and therefore asymptomatic. Due to their histologic features, these tumours show characteristic ultrasound and CAT patterns. This paper presents one case of angiomyolipoma in a 26-year old female patient who presented with a clinical picture of acute pyelonephritis. The tumour features in both ultrasound and CAT were not the typical ones for this kind of tumour. The surgical piece removed corresponded to an angiomyolipoma with a large granulomatous reaction.

[Renal retransplantation. Study of 91 cases]. / Retrasplante renal. Estudio de 91 casos.

Review of 91 retransplantations performed at our hospital between 1975 and 1991. There were 82 second transplants and 9 third transplants. Survival of patients to undergo retransplantations continues to increase. Over the last year, 19.1% of our transplants were the 2nd or 3rd ones for some patients. Analysis of causes for graft loss, which essentially are of immunological and surgical nature.

[Single-stitch extravesical ureteroneocystostomy in kidney transplantation (Taguchi's technic)]. / Ureteroneocistostomía extravesical con punto único en el trasplante renal (técnica de Taguchi).

Presentation of our experience with single access extravesical ureteroneocystostomy in 79 renal transplants performed over a 2-year interval. Description of the surgical technique, a modification of that described by Taguchi in 1968. The complications were 2 urinary fistulae (2.52%), one ureteral and one vesical, both at the beginning of the series and related to technical errors. There were no stenosis and in the 4 cases where CUMS was conducted no reflux vas noted. We conclude that this technique is useful for its simplicity, speed and good results.

[Kidney transplantation in patients over 60 years of age. Study of 37 patients]. / Trasplante renal en pacientes mayores de 60 años. Estudio de 37 pacientes.

Between February 1975 and September 1993, 735 renal transplantations have been performed 37 of which took place in 60+ year-old subjects. All grafts were from corpse donors. 34 were first time transplants and 3 were re-transplants. In general, immunosuppression has been accomplished with Cyclosporin, Azathioprine, and Prednisone. Annual patient and graft survival is 87% and 69%, respectively. A review is made of the complications developed and the success rate with and without a functioning graft. Considering long-term results, many patients lead a normal live with stable renal function.

[Melanoma of the penis]. / Melanoma de pene.

We present a case of penile malignant melanoma. Its rarity of less than 1% of masculine genital malignant neoplasms, the absence of standardised protocols as for other neoplasms, impel us to its publication.

[Stress urinary incontinence. Our experience with its treatment using the transvaginal colposuspension technique (Raz I and II)]. / Incontinencia urinaria de esfuerzo. Nuestra experiencia en su tratamiento mediante la técnica de colposuspensión transvaginal (Raz I Y II).

Presentation of our experience in the surgical treatment of urinary stress incontinence, with transvaginal colposuspension techniques, specifically those described by S. Raz and known as Raz I and Raz II. Over a 24-month period, 25 transvaginal colposuspensions (22 Raz I and 3 Raz II) were performed. The results achieved were 21 patients (84%) have recovered, while 4 (16%) remain incontinent, 3 of them referring improvement and 1 without improvement, after a follow-up of 12 to 36 months. With regard to complications, there has been 5 cases (20%) of postoperative retention, one vesical perforation while passing the needles, and a vesicle perforation during vaginal dissection of the retropubic space.

[Urologic complications in renal transplantation. Our experience with 700 cases]. / Complicaciones urológicas en el trasplante renal. Nuestra experiencia en 700 casos.

The present study reports on the urological complications observed in 700 kidney transplants performed from February, 1975 to January, 1993. The techniques used for reconstruction of the urinary tract have been extravesical and intravesical ureteroneocystostomy. In some cases other different techniques have been used. Urinary extravasation, ureteric obstruction and lymphoceles were the most frequent complications. Urinary leakage was observed in 5.7% and was resolved by different surgical techniques, but generally by open surgery. Ureteric obstruction has been a very uncommon complication resolved by conservative treatment or open surgery. Twenty-six lymphoceles were diagnosed. We advocate the use of both open surgery and percutaneous techniques for the management of urological complications secondary to renal transplantation.

[Extravesical urinary diversion in kidney transplantation]. / Dérivation urinaire extravésicale en transplantation rénale.

There are many different techniques for anastomosis of the ureter after renal transplantation. We present our experience of ureteral extravesical diversion via a cutaneous ureterostomy and ileal conduit.

[Stress urinary incontinence. Comparative study of suprapubic and vaginal surgical techniques]. / Incontinencia urinaria de esfuerzo. Estudio comparativo entre las técnicas quirúrgicas suprapúbicas y vaginales.

We compared the results achieved by the suprapubic techniques of bladder neck suspension (Marshall-Marchetti-Krantz and Burch) and the vaginal techniques (Raz I and II) in 31 patients. Although no significant difference was observed in the results achieved, the vaginal techniques require a shorter operating time and hospitalization. There were 5 cases of inability to void (3 for the suprapubic and 2 for the vaginal techniques). The following complications were observed in the Burch colposuspension technique: 1 bladder fistula, 1 ureteral obstruction, 1 incisional hernia and 1 pulmonary embolism. We can conclude that although both techniques achieve good results, the vaginal techniques are easy to perform and require a shorter operating time and hospitalization.

[Renal oncocytoma: report of 14 cases and review of the literature]. / Oncocitoma renal: presentación de 14 casos y revisión de la literatura.

Renal oncocytoma is an uncommon tumor. Of 223 renal tumors that were treated at our institution from 1970-1991, 14 (6.2%) were oncocytomas [9 females (65%) and 5 males (35%)]. The highest incidence was observed in the sixth decade (60.7 yrs). Tumor size range from 2 to 19 cm in diameter (mean = 8.07 cm); 11 (78.5%) were localized in the right kidney, principally in the superior pole. The tumor was incidentally discovered in 8 cases (57%); 1 case presented Wunderlich's syndrome; 1 had a palpable renal mass; 6 had abdominal pain. All the tumors were confined to the kidney. Thirteen were Robson stage I and 1 stage II. According to the UICC classification, 12 were T1, 1 T2 and 1 T3. All tumors were N0 M0. Patient evaluation included IVP (6), US (12), CT (14) and selective renal arteriography (2). The typical angiographic patterns were not observed in these 2 cases. Concerning the CT findings, in 8 cases (57%) the first diagnosis discarded was that of hypernephroma, although there were also signs suggestive of oncocytoma. Six cases (43%) showed signs indicating oncocytoma as first diagnosis. All patients were submitted to radical nephrectomy, which achieved good results in all cases at 7 months' to 5 years' follow up.

[Ureteral reimplantation with single point on tubularized ileal chimney in Studer's substitution enterocystoplasty. Preliminary results in 12 cases]. / Reimplantación ureteral con punto único sobre chimenea ileal tubularizada en la enterocistoplastia de sustitución tipo Studer. Resultados preliminares de 12 casos.

Herein we describe our preliminary experience in ureteral reimplantation by fixation of the ureter with a single suture directly onto a detubularized ileal chimney in 12 cases with infiltrating bladder carcinoma who underwent a Studer enterocystoplasty procedure. Follow up ranged from 3 to 24 months. Patient control evaluation included urography and CUMS 3 months postoperatively and ultrasonography every 6 months. The following complications were observed: ureteral fistula above the site of anastomosis (1 case, 4.16%), ureteroenteric stricture (1 case, 4.16%) and grade 2 reflux (2 cases, 9.08%) with no effects on renal morphology or function. The foregoing results show the usefulness of this simple procedure which prevents reflux and carries a low complication rate.

[Leiomyoma of the epididymis. Report of a case and review of the literature]. / Leiomioma de epidídimo. Presentación de un caso y revisión de la literatura.

Leiomyoma of the epididymis is a benign tumor that is rarely diagnosed and is second only to epididymal adenomatoid lesions in frequency. A case of leiomyoma of the epididymis in a 62-year-old patient is described. The patient presented with a tumor in the tail of the left epididymis which was definitively diagnosed following surgical resection and subsequent anatomopathological analysis. The classification, clinical features, diagnosis and treatment of this tumor type are briefly discussed.

[Renal sarcomatoid carcinoma. Report of 9 cases]. / Carcinoma renal sarcomatoide. A propósito de 9 casos.

We reviewed 9 cases of sarcomatoid carcinoma of the kidney from 233 cases of renal carcinoma that had undergone surgery over a period of 21 years (1970-1991). The principal characteristics (patient age, sex, diameter, clinical features, stage, grade, mitotic index, radiological features) were analyzed and compared with the rest of the series. This histological type is distinct from other types of renal carcinoma in that it carries a poor prognosis (with a mean survival of 6 months), it is usually diagnosed in the advanced stages, with a high mitotic index and tumor grade. It presents no special clinical and radiological features which make it distinct from the other histological types of renal carcinoma.

[Extravesical ureteroneocystostomy in renal transplantation. Comparative study of the Campos Freire's and the Taguchi's techniques (single point)]. / Ureteroneocistostomia extravesical en el trasplante renal. Estudio comparativo entre la técnica de Campos Freire y la de Taguchi (punto único).

We compare the results of two extravesical ureteroneocystostomy techniques, the Campos Freire technique (47 cases) and the single stitch modified Taguchi technique (58 cases), in 105 kidney transplants during a period of 19 months (August 1991 to April 1993). There were no differences between donor and recipient characteristics in both groups. Concerning complications, we observed vesical fistula in the patient group submitted to the Taguchi technique and 1 uretero-vesical stenosis in the patient group that underwent the Campos Freire technique. Although both techniques achieve good results, we advocate the use of the Taguchi technique because it is easy to perform and the operating time is shorter.

[Our caseload in Fournier's disease]. / Nuestra casuística en la enfermedad de Fournier.

We reviewed the records of 17 cases of Fournier's gangrene that had been diagnosed and treated in the Urology Service of the Marques de Valdecilla Hospital from 1982-1991. The series comprised male patients aged 32 to 77. Eleven cases (64.7%) were due to a known cause, above all infection. Most of the patients had factors that predisposed to the development and progression of the disease, predominantly diabetes mellitus (5 cases, 29.4%). The clinical features frequently corresponded to those of acute infection, with high fever, chills, pain, nausea and vomiting that could progress to a septic state. The local symptoms and signs included pain, swelling, erythema and necrosis, depending on the compromised area. Infection was usually caused by Gram-negative bacteria, particularly E. coli, although Gram-positive bacteria and anaerobes have been observed. Mixed bacterial infections have also been observed. Treatment must be instituted early using a combination of broad spectrum antibiotics that cover both aerobes and anaerobes, and wide surgical debridement of the compromised area. In some cases hyperbaric oxygen therapy may be warranted. The disease continues to be severe. In the present series, the outcome was favorable in 12 cases (70.5%) and there were 5 deaths (29.4%).