Ureteral Stenosis and Fistula after Kidney Transplantation.

INTRODUCTION: Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center. METHODS: Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas. RESULTS: Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948). CONCLUSION: Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study.

BACKGROUND: In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new "Trigger Tool" represents a sensitive predictor of adverse events in general surgery. METHODS: An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described "Trigger Tool" based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. RESULTS: The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The "Trigger Tool" had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the "Trigger Tool". CONCLUSIONS: The "Trigger Tool" has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies.

Iterative renal transplantation: our experience on third transplants.

PURPOSE: To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants. METHODS: Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants. RESULTS: Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively. CONCLUSION: Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

The challenge of pseudomonas aeruginosa related infections in a Urology Ward: Epidemiology, risk factors and patterns of antibiotic resistance. / El reto de las infecciones por pseudomonas aeruginosa en un Servicio de Urología: epidemiología, factores de riesgo y patrones de resistencia a antibióticos.

OBJECTIVES: Urological patients usually come up with risk factors for developing infections. Some of these are caused by multidrug-resistant microorganisms like Pseudomonas aeruginosa, whose notable resistance rates to antibiotics and aggressiveness make its treatment a challenge in clinical practice. Our objective was to analyze Pseudomonas aeruginosa infections incidence, risk factors and features in patients admitted to a Urology Ward in a tertiary care university hospital in Spain. MATERIAL AND METHODS: We carried out a prospective observational study from 2012 to 2017, to review all infections in our Ward with a special focus on those caused by Pseudomonas aeruginosa, performing a descriptive analysis and a comparison with other causative agents. RESULTS: 78 Infections with Pseudomonas aeruginosa isolation were registered during this period. Having a catheter of the upper urinary tract (CUUT) or comorbidities and undergoing surgery, were frequently observed among these patients although the results did not reach statistically significant differences for more frequent isolation compared to other pathogens. Antibiotic resistance rates were high for cephalosporins (33.3%) and quinolones (50%), while carbapenems (24.4%), aztreonam (10.3%) and amikacin (23.1%) exhibited the best activity. No deaths related to the infection were registered. CONCLUSIONS: Pseudomonas aeruginosa is commonly isolated in patients carrying a CUUT. An early suspicion of Pseudomonas aeruginosa infection and knowledge of local antibiotic resistance pattern are of paramount importance for improving the outcomes and handling this worldwide problem.

OBJETIVOS: Los pacientes urológicos se acompañan habitualmente de factores de riesgo para el desarrollo de infecciones. Algunas de éstas son causadas por microorganismos multi-resistentes como Pseudomonas aeruginosa, cuyas notables tasas de resistencia a los antibióticos y agresividad hacen de su tratamiento un reto para la práctica clínica. Nuestro objetivo fue analizar la incidencia de infecciones por Pseudomonas aeruginosa, factores de riesgo y características en pacientes ingresados en el Servicio de Urología de un hospital universitario de tercer nivel en España.MATERIALES Y MÉTODOS: Llevamos a cabo un estudio observacional prospectivo desde 2012 hasta 2017, para revisar todas las infecciones en nuestro Servicio, con especial atención en aquellas causadas por Pseudomonas aeruginosa, haciendo un análisis descriptivo y una comparación con otros agentes causales. RESULTADOS: Durante este periodo se registraron 78 infecciones por Pseudomonas aeruginosa. Frecuentemente estos pacientes portaban un catéter del tracto urinario superior, tenían comorbilidades o se habían sometido a una intervención quirúrgica, aunque ningún factor alcanzó la significación estadística para mayor frecuencia de aislamiento de Pseudomonas aeruginosa. Las tasas de resistencia antibiótica fueron altas para cefalosporinas (33,3%) y quinolonas (50%), mientras que los carbapenémicos (24,4%), aztreonam (10,3%) y amikacina (23,1%) mostraron la mejor actividad. No se registraron éxitus relacionados con estas infecciones. CONCLUSIONES: El aislamiento de Pseudomonas aeruginosa es frecuente en portadores de catéteres del tracto urinario superior. La sospecha precoz de estas infecciones y el conocimiento de los patrones locales de resistencia a antibióticos son de vital importancia para mejorar los resultados de este problema a nivel global.

New case of secondary bladder amyloidosis with massive hematuria-role of intravesical instillations with dimethyl sulfoxide.

Secondary bladder amyloidosis is a rare condition with less than 60 cases published in the world. It is usually secondary to chronic inflammatory processes such as rheumatologic diseases. Hematuria is its predominant and most important symptom, and usually occurs after a bladder catheterization. The diagnostic confirmation is made through a pathological and immunohistochemical study. The treatment must be staggered from less to more invasive. Our objectives are to present a new case of secondary bladder amyloidosis in a woman with a history of chronic bronchiectasis after tuberculosis and frequent super infections, whose main manifestation was a massive hematuria, and review this rare pathology. We have obtained very good initial results using intravesical instillations with dimethyl sulfoxide (DMSO) with complete resolution of the hematuria, the patient remaining asymptomatic for 6 months. After that, there was a recurrence of the hematuria that was treated with embolization of the hypogastric arteries, with good results. We can conclude that, despite being a rare condition, we must consider secondary bladder amyloidosis in patients who have already been diagnosed with systemic amyloidosis and/or chronic pathologies who develop hematuria after bladder catheterization. Based on our experience, instillations with dimethyl sulfoxide are a safe option and provide a quick and temporary resolution of hematuria symptoms.

Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance.

OBJECTIVES: To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary tract endoscopic surgery (LUTES) in a tertiary care hospital. METHODS: A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances. RESULTS: Postoperative UTI incidence was 4.7%. Risk factors found: higher American Society of Anesthesiologists classification (OR 2.82; 95% CI 1.8-4.5; p < 0.00), immunosuppression (OR 2.89; 95% CI 1.2-7.2; p = 0.01), indwelling urinary catheter prior admission (OR 2.6; 95% CI 1.6-4.2; p < 0.00) and postoperative catheterization longer than 2 days (OR 1.74; 95% CI 1.7-4.3; p < 0.00). Transurethral resection of the bladder (TURB) had the highest infection rates (5.5%). Microorganisms isolated were Pseudomonas aeruginosa (23.5%), Escherichia coli (17.6%), Klebsiella pneumoniae and Enterococcus spp (11.8%). Resistance rates for flourquinolones varied between 28 and 80%, and Carbapenem-resistant Enterobacteriaceae rose up 20%. CONCLUSIONS: Low percentage of UTI after endoscopic surgery was registered. TURB was the procedure with highest infection rate. Pseudomonas aeruginosa stands out as the most frequently isolated microorganism. Patient comorbidities, previous urinary catheter and postoperative catheter were identified as risk factors.

Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward.

PURPOSE: Healthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in patients hospitalized in a Urology ward. MATERIALS AND METHODS: We evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns. RESULTS: The incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III-IV (odds ratio [OR], 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were Escherichia coli (25.1%), Enterococcus spp. (17.5%), Klebsiella spp. (13.5%) and Pseudomonas aeruginosa (12.3%). Enterococcus sp was the most common microorganism after radical cystectomy and in surgical site infections, E. coli showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing E. coli was 24.7%. Klebsiella spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems. Enterococcus spp showed resistance rates of 1.7% for vancomycin and; P. aeruginosa of 33.3% for carbapenems and 26.2% for amikacin. CONCLUSIONS: Comorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were E. coli, Enterococcus and P. aeruginosa. Prospective monitoring may decrease the incidence of infections.

[Healthcare-associated urinary tract infections in patients with a urinary catheter: Risk factors, microbiological characteristics and patterns of antibiotic resistance]. / INFECCIONES DEL TRACTO URINARIO DE ORIGEN HOSPITALARIO EN PACIENTES PORTADORES DE CATÉTER URINARIO: FACTORES DE RIESGO, CARACTERÍSTICAS MICROBIOLÓGICAS Y RESISTENCIAS A ANTIBIÓTICOS.

OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial acquired infections, with high resistance rates. CAUTIs are a potentially severe complication in hospitalized patients and imply higher costs. Our aim was to analyze the characteristics of CAUTIs in our Urology department. METHODS: Between November 2011 and October 2013, a prospective observational study was carried out analyzing the incidence of healthcare-associated urinary tract infections in patients admitted to the urology ward with an indwelling urinary catheter. Furthermore, we evaluated associated risks factors and comorbidities such as urinary catheter at the time of admission or urological surgery during the hospitalization. We also presented our results regarding the microbiological characteristics and patterns of resistance to antibiotics in patients with CAUTI admitted in our service. RESULTS: The incidence of CAUTI was 8.2% (189/2283 patients who had urinary catheter). Mean age was 67.4±14.26 years, 90.2% underwent a surgical procedure (p<0.001), 14.8% had a urinary stone (p=0.058) and 46% had a urinary catheter before admission (p<0.001). The most commonly isolated pathogens were Escherichia coli (22.6%), Enterococcus (21.9%) and Pseudomonas aeruginosa (13.9%). E.coli showed resistance rates of 41.9% for quinolones, 33.3% of them produced extended spectrum Β-lactamase (ESBL). P.aeruginosa showed resistance rates of 42.1% for quinolones and 21.1% for carbapenems. CONCLUSIONS: Healthcare-associated CAUTI in patients hospitalized in a urology ward are related to risks factors such as having a urinary catheter before admission and undergoing a surgical procedure. Moreover, CAUTIs have higher incidence of pathogens with antibiotic resistances and non-common pathogens such as Enterococcus spp.

Survey of satisfaction in hospitalized patients at a urology department.

OBJECTIVES: To assess the level of satisfaction with the care provided to hospitalized patients in the Department of Urology at 12 de Octubre Hospital and analyze demographic and clinical factors influencing satisfaction. METHODS: A cross-sectional study was carried out using the SERVQHOS questionnaire, delivered at the time of discharge. A data sheet for each patient was collected, which included if they undergone surgery, type of surgery and whether or not presented postoperative complications, rated by the Clavien scale. RESULTS: 479 surveys were collected, with a participation of 92%. 95.4% of patients rated their overall level of satisfaction with the care received as "satisfied" or "very satisfied". Top-rated aspects were the kindness of the staff and personalized attention. The worst rated issue was the condition of the rooms, but this did not influence perceived quality. Variables related to greater overall satisfaction were male gender, shorter hospital stay, knowing the name of the nurse, the information received and subjective factors such as personalized service and willingness to help. CONCLUSIONS: Our patients show a high level of satisfaction, which is mainly dependent on subjective factors. The negative issues related to the facilities do not mean lower satisfaction.

Healthcare-associated infections in a department of urology: incidence and patterns of antibiotic resistance.

OBJECTIVE: Healthcare-associated infections (HAIs) constitute a potentially severe complication which implies higher costs. A full knowledge of their microbiological characteristics and risk factors is of paramount importance for adequate management. The purpose of this study was to carry out an analysis of HAIs in patients admitted to a department of urology. MATERIAL AND METHODS: Between November 2011 and October 2012, a prospective observational study was carried out analysing HAIs in patients admitted to the urology department of a tertiary care university hospital in Spain, reviewing the incidence and types of HAIs, the microorganisms isolated and patterns of resistance to antibiotics. Risk factors for HAIs were also evaluated. RESULTS: HAIs were seen in 110 (6.5%) out of 1701 patients. Hypertension, a higher American Society of Anesthesiologists (ASA) score and surgery showed a statistical association with a higher risk of HAIs, and patients who underwent radical cystectomy had a high incidence of HAIs (10 out of 14). The most common HAIs were urinary tract infections (66.1%), followed by surgical site infections (16.5%), intra-abdominal abscesses (10.4%) and venous catheter-associated bacteraemia (6.1%). The most frequently isolated microorganisms were Escherichia coli (31.8%), then Enterococcus (17.6%) and Pseudomonas (12.9%). Escherichia coli showed resistance rates of 48.1% for ampicillin/amoxicillin plus ß-lactamase inhibitor, 51.9% for fluoroquinolones, and 33.3% were extended-spectrum ß-lactamase-producing E. coli. Pseudomonas aeruginosa showed a resistance rate of 36.4% for fluoroquinolones and carbapenems. CONCLUSIONS: HAIs usually occur in patients with risk factors. Radical cystectomy is associated with a high incidence of HAIs. Microorganisms associated with HAIs show high rates of resistance, which must be taken into account when selecting appropriate antibiotic therapy.

Implementing an action protocol on prostatic disease in primary care and impact on referrals to urology.

OBJECTIVES: To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area. METHODS: We drafted a protocol for managing patients consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC). RESULTS: From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%. Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7). CONCLUSIONS: The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals.

[The treatment of varicocele in the infertile male II: results on fertility]. / Tratamiento del varicocele en el varón infértil II: resultados sobre la fertilidad.

OBJECTIVES: To analyze the efficacy of varicocele treatment, either surgical or endovoscular radiological occlusion, on pregnancy rates of infertile couples in which the male had clinically. patent left varicocele, and to identify which factors are associated with the probability of obtaining pregnancy in such cases. METHODS: This study is part of a more ample one described in previous article: "The treatment of varicocele in the infertile male I: Results on semen quality". Overall, 183 couples were included. 157 males received treatment (131 radiological occlusion and 26 open surgery), the remaining 26 did not received the treatment indicated. Couples underwent periodic follow-up during the first year, evaluating two parameters: 1) normalization of semen analysis parameters, and 2) pregnancy during the following 12 months after indication of treatment. RESULTS: Overall, 41 couples (22.4%) achieved pregnancy during first year, 35/157 (22%) in the group of treated patients, and 6/26 (23%) in the non treatment group. In the treatment group, surgical ligature achieved higher pregnancy rates than radiological occlusion (35% vs. 20%), but the difference was not statistically significant (p = 0.255). No association was demonstrated between male age, female age, varicocele clinical grade, degree of semen quality abnormalities, or duration of infertility and pregnancy rates. The FSH value was significantly lower (p 0.0006) in patients who achieved pregnancy. CONCLUSIONS: The degree of semen quality abnormality, which so closely correlated to normalization of seminal parameters, locked of prognostic significance in terms of achievement of pregnancy. The FSH value was the only factor with certain prognostic value, although it did not reach significance in logistic regression analysis.

Retroperitoneal abscesses--analysis of a series of 66 cases.

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.

[Neuroendocrine renal carcinoma. Presentation of a case]. / Carcinoma renal neuroendocrino. Presentación de un caso.

OBJECTIVES: To report a new case of neuroendocrine renal cell carcinoma. METHODS: We report the case of a 76-year-old woman with neuroendocrine renal cell carcinoma who underwent radical nephrectomy without any further adjuvant treatment. We performed a bibliographic review about this rare renal neoplasia of which there are less than 20 published case reports. RESULTS: Patient is asymptomatic four years after surgery, although she has local recurrence. CONCLUSIONS: Small cell renal cell carcinoma is a very rare neoplasia, affecting people over the age of 60 years, large in size, and metastatic at diagnosis. It has bad prognosis, with short survival times. The most adequate treatment has not been determined due to the scarcity of published cases; the combination of surgery and chemotherapy is the most frequently used.

[Encrusted pyelitis in patients with urinary diversion]. / Pielitis incrustante en pacientes con derivación urinaria.

OBJECTIVE: This is a case of Encrusted Pyelitis (EP) caused by Corynebacterium urealyticum (CU) in a patient who had undergone a cystectomy and Bricker type urinary diversion 28 months beforehand. METHODS/RESULTS: After the immediate post-operative period no urinary catheterisation or any other urological procedure was performed on the patient. Before surgery, the patient presented non functional of the right kidney, secondary to a lithiasic obstructive uropathy. Clinical symptoms were deteriorated renal function, anuria, haematuria, pyrexia and left lumbar pain. It was suspected that the patient had this pathology and this was fundamental in diagnosis. Helicoid CT was the principal method used to show calcification plaques on the wall of the left renal pelvis, and selective culture of CU confirmed the diagnosis. Early commencement of treatment with vancomycin at an initial dosage of 500 mg/12 hours, and subsequent adjustment of dosage according to blood drug levels, achieved negative urine culture within a fortnight. Oral acidification was effected using acetohidroxamic acid 125 mg/12 hours, and it was continued until CT confirmed the disappearance or considerable reduction of the pyelic calcification plaques. CONCLUSION: The presence of EP in patients with urinary diversion is a matter worthy of consideration, even in patients who have not undergone recent urological procedures. Awareness of risk factors and early commencement of effective treatment may improve the prognosis of these patients.

[[Primary psoas abscess. Presentation of 3 cases]. / Absceso primario de psoas. Presentación de 3 casos.

OBJECTIVE: To present 3 cases of primary abscess of the psoas muscle. The clinical features, diagnostic tests, treatment and outcome are discussed. METHODS/RESULTS: Three patients that presented with fever and pain referred to the renal and/or iliac fossa are described. Physical examination showed psoas involvement in only one patient. Among the complementary tests performed, ultrasound demonstrated the abscess in one of the cases; the definitive diagnosis was made by contrast-enhanced CT. One of the cases was treated only with antibiotics while the other two cases were treated with CT-guided percutaneous drainage and appropriate antibiotic therapy. CONCLUSIONS: Psoas abscess is an uncommon pathology whose presenting features are usually unspecific. CT with contrast enhancement is considered to be the technique of choice for the diagnosis and to corroborate the resolution of the condition. Recently, the use of CT or US-guided percutaneous drainage has replaced surgery as the initial therapeutic approach for this condition.

[Biomolecular markers in renal adenocarcinoma]. / Marcadores biomoleculares en el adenocarcinoma renal.

OBJECTIVE: To review the literature and analyze the main contributions in molecular markers in renal adenocarcinoma. METHODS: We reviewed the literature over the last 10 years on molecular markers in renal adenocarcinoma (Medline 1991-2001). Outstanding papers published before 1991, included in the references of the selected articles, were also reviewed. RESULTS: A large number of biomolecular markers have been studied in renal adenocarcinoma with results that are often contradictory. Some proteins have been associated with different histopathological parameters and with tumor prognosis, although their clinical importance has yet to be established. CONCLUSIONS: Although the traditional prognostic factors, such as tumor grade and stage, provide important information on the outcome of renal adenocarcinoma, they are insufficient to predict the clinical behavior of this tumor type with absolute certainty. The foregoing has prompted the study of a variety of biomolecular markers that might predict the biological behavior of the tumor and identify the patients at a higher risk for tumor recurrence or death from the tumor. Despite the promising results obtained with biomolecular markers in renal adenocarcinoma, further studies are warranted to determine the prognostic value of these markers.

[PCNA and Ki-67 expression in locally confined renal adenocarcinoma. Relationship with various histopathologic variables and prognostic significance]. / Expresión de PCNA y Ki-67 en el adenocarcinoma renal localmente confinado. Relación con diferentes variables histopatológicas y significación pronóstica.

OBJECTIVE: PCNA and Ki-67 expression are used as markers of cellular proliferation and different studies have investigated their value as prognostic indicators for renal adenocarcinoma. The aim of this study was to determine PCNA and Ki-67 expression in locally confined renal adenocarcinoma, their relationship with other histopathological variables and prognostic significance. METHODS: 58 cases of renal adenocarcinoma stages pT1-T3a N0 M0 (TNM 1997), treated by curative radical or partial nephrectomy were reviewed. The clinical and histopathological variables were analyzed. PCNA and Ki-67 expression in tissue embedded in paraffin were studied by immunohistochemical techniques. RESULTS: The mean percentage of nuclei that stained for PCNA was 7.03% (range 0-50%). Analysis of the correlation between PCNA and histopathological variables (size, grade and stage), showed a statistically significant correlation of PCNA only for the nuclear grade (p = 0.009). The mean percentage of nuclei that stained for Ki-67 expression was 2.96% (range 0-30%) and a relationship was found for size (p < 0.001), nuclear grade (p < 0.001) and stage (p < 0.001). The incidental clinical presentation, tumor size, stage, nuclear grade, PCNA and Ki-67 expression showed a relationship with survival. However, only perirenal fat infiltration, tumor size, nuclear grade and PCNA expression were found to be independent factors by multivariate analysis. CONCLUSIONS: PCNA expression correlated with nuclear grade, while Ki-67 demonstrated a significant correlation with tumor size, grade and stage. Survival analysis showed a relationship of both markers with prognosis. However, only PCNA was found to be an independent factor by multivariate analysis.