Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs.

INTRODUCTION: The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. AIMS: To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. METHODS: Retrospective observational multicentre study. SAMPLE: Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). RESULTS: Mean age was 55.75 years (18-80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50-42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6-29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6-98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24-180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. CONCLUSIONS: Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.

Eosinophilic ureteritis. Report of a case.

OBJECTIVE: We present the case of a patient with eosinophilic ureteritis. METHODS: The patient was admitted with pain on the right renal fossa, and after several imaging tests, a mass was found on the right ureter, compatible with urothelial neoplasia on the right ureter. RESULTS: Right nephroureterectomy was performed and the histopathological diagnosis was eosinophilic ureteritis CONCLUSION: Eosinophilic ureteritis is a rare entity with an unclear etiology,which is not easily distinguished from urothelial tumours. In the differential diagnosis we must take it into account whenever we find a ureteral mass associated to eosinophilia.

Spontaneous resolution of ureterovaginal fistula.

OBJECTIVE: We report one case of a spontaneous resolution of a uretero-vaginal fistula, and we review the current diagnostic and therapeutic features of this condition in the literature. METHODS: We present the case of a 41-year-old woman who, during the late postoperative period of a radical hysterectomy, presented episodes of daily and nocturnal incontinence with episodic flank pain compatible with uretero-vaginal fistula. RESULTS: One month after diagnosis the patient does not report incontinence during day or night, and the lumbar pain has disappeared. An intravenous urography shows that there has been a spontaneous resolution of the uretero-vaginal fistula. CONCLUSIONS: Spontaneous resolution of a uretero-vaginal fistula is rare. Most fistulas require endourological or surgical treatment.

Retroperitoneal malignant fibrous histiocytoma: case report.

OBJECTIVE: We present the case of a big retroperitoneal tumor that received the pathologic diagnosis of malignant fibrous histiocytoma. We also review the diagnostic and therapeutic features of this disease in the current literature. METHODS: We present the case of a 75-year-old male who was admitted to the Gastrointestinal Disease Department with asthenia of several months of evolution and gastrointestinal problems. Abdominopelvic CT scan revealed a big mass of 20 x 22 x 12 cm, which seems to depend from the left kidney, together with an 8 cm diameter abdominal aortic aneurysm. RESULTS: The patient underwent surgery and left radical nephrectomy together with radical resection of the retroperitoneal mass were performed. Pathology reportes malignant fibrous histiocytoma of the storiform-pleomorphic type, with hyaline degeneration foci (stadium pT2B). CONCLUSIONS: Sarcomas are rare neoplasias. They can adopt several different morphologic patterns, as well as many differentiation degrees. The surgical treatment is still the only therapy with healing possibilities. Adjuvant treatments through radiotherapy and/or chemotherapy are brought into question.

[Genitourinary and osteoarticular tuberculosis (Pott's disease)]. / Tuberculosis genitourinaria y osteoarticular (Mal de Pott).

OBJECTIVE: We present the case of a patient with urogenital and osteoarticular tuberculosis METHODS: Patient with end stage renal disease on hemodyalisis in study for fever of unknown origin. Multiple diagnostic tests were performed. RESULTS: Medical treatment for tuberculosis was given with improvement of the symptoms. CONCLUSION: The early urogram study can be crucial in the diagnosis of urogenital tuberculosis in initial stages, thus avoiding the progressive deterioration of kidney function.

[Malignant priapism and secondary bladder cancer]. / Priapismo maligno secundario a cáncer de vejiga.

OBJECTIVE: We report a rare case of malignant priapism secondary to transitional cell carcinoma. METHODS: The patient with bladder cancer (pT4G3) presented with painful penile erection. Corpora cavernosa biopsy was done. RESULTS: The pathologic diagnosis was penile metastasis of transitional cell carcinoma. CONCLUSIONS: Priapism secondary to penile metastasis of transitional cell carcinoma is rare and indicates advanced disease with a poor prognosis.

[Horseshoe kidney rupture]. / Rotura de riñón en herradura.

BACKGROUND: We report a rare case of horses-hoe kidney trauma. METHODS: 67 years old man with a horseshoe kidney, which presented a fracture of the isthmus after falling. RESULTS: The diagnosis was made by IV contrast CT scan. He underwent exploratory laparotomy due to hemodynamic instability and radiologic findings on the CT scan. CONCLUSIONS: The rupture of a horseshoe kidney is a rare injury. CT scan is the test of choice to classify the degree of injury. Depending on the patient's hemodynamic stability and the findings on the CT scan the options are conservative orimmediate surgical treatment.