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.

The Spanish Scientific Societies before the ESC 2021 guidelines on vascular disease prevention: Generalizing the measurement of albuminuria to identify vascular risk and prevent vascular disease.

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies recognize the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorized based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimize the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing.

Artículo especial por el Día Mundial del Riñón: Las sociedades científicas españolas ante la guía ESC 2021 de prevención de la enfermedad vascular: generalizar la medida de la albuminuria para identificar el riesgo vascular y prevenir la enfermedad vascular / The Spanish Scientific Societies before the ESC 2021 guidelines on vascular disease prevention: Generalising the measurement of albuminuria to identify vascular risk and prevent vascular disease

Las guías de 2021 sobre la prevención de la enfermedad vascular (EV) en la práctica clínica publicadas por la European Society of Cardiology (ESC) y apoyadas por otras 13 sociedades científicas europeas reconocen el papel clave de la detección de la enfermedad renal crónica (ERC) en la prevención de la EV. El riesgo vascular en la ERC se categoriza a partir de las medidas del filtrado glomerular estimado (FGe) y del cociente albúmina:creatinina en orina (ACRo). Así, la ERC moderada se asocia a un riesgo vascular alto y la ERC grave a un riesgo vascular muy alto, debiendo actuar en consecuencia desde el punto de vista terapéutico, sin que sea necesario aplicar otras puntuaciones de riesgo vascular cuando este ya es muy alto debido a la ERC. Es más, la ESC sitúa la medida del FGe y del ACRo en el inicio de la estimación del riesgo vascular y del algoritmo de decisión subsiguiente. A fin de optimizar la implementación de la guía 2021 de la ESC sobre la prevención de la EV en España, consideramos que: 1) El estudio de la orina para determinar la albuminuria mediante el ACRo debería formar parte de la rutina clínica al mismo nivel que el de la glucemia, la colesterolemia y la estimación del FG cuando estas se usan para tomar decisiones sobre el riesgo de EV. 2) Los servicios de salud públicos y privados españoles deberían disponer de los medios y recursos necesarios para implementar de forma óptima las Guías ESC 2021 de prevención de la EV en España, incluyendo la determinación del ACRo.(AU)

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies, recognise the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorised based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimise the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolaemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing. (AU)

Robotic versus Laparoscopic Partial Nephrectomy in the New Era: Systematic Review.

(1) Background: In recent years there have been advances in imaging techniques, in addition to progress in the surgery of renal tumors directed towards minimally invasive techniques. Thus, nephron-sparing surgery has become the gold standard for the treatment of T1 renal masses. The aim of this study is to investigate the benefits of robotic partial nephrectomy in comparison with laparoscopic nephrectomy. (2) Methods: We performed a systematic review according to the PRISMA criteria during September 2022. We included clinical trials, and cohort and case-control studies published between 2000 and 2022. This comprised studies performed in adult patients with T1 renal cancer and studies comparing robotic with open and laparoscopic partial nephrectomy. A risk of bias assessment was performed according to the Newcastle-Ottawa scale. (3) Results: We observed lower hot ischemia times in the robotic surgery groups, although at the cost of an increase in total operative time, without appreciating the differences in terms of serious surgical complications (Clavien III-V). (4) Conclusions: Robotic partial nephrectomy is a safe procedure, with a shorter learning curve than laparoscopic surgery and with all the benefits of minimally invasive surgery.

Renal Failure Management in Patients with Metastatic Renal Cancer Receiving Nivolumab: Evaluation from Two Points of View.

INTRODUCTION: Immunotherapy is recommended as category 1 in first-line treatment in metastatic renal cancer (mRC), however the evidence on the management of toxicities in patients with chronic renal failure is limited. Description of the Cases: Case 1: Patient with mRC and renal failure on hemodialysis. After 25 months of treatment with Nivolumab, he presented a partial response, without toxicities. Case 2: Patient with mRC undergoing treatment with Nivolumab-Ipilimumab, who after 6 cycles was admitted for acute renal failure, compatible with grade 4 nephrotoxicity, requiring definitive suspension of treatment, corticosteroid therapy and hemodialysis. CONCLUSIONS: Nivolumab is a safe and effective therapy in hemodialysis patients, not increasing adverse events, nor requiring dose adjustment. Immunotherapy nephrotoxicity must be adequately managed in daily clinical practice in an interdisciplinary way with the nephrologist.

Renal Failure Management in Patients with Metastatic Renal Cancer Receiving Nivolumab: Evaluation from Two Points of View

Introduction: Immunotherapy is recommended as category 1 in first-line treatment in metastatic renal cancer (mRC), however the evidence on the management of toxicities in patients with chronic renal failure is limited. Description of the Cases: Case 1: Patient with mRC and renal failure on hemodialysis. After 25 months of treatment with Nivolumab, he presented a partial response, without toxicities. Case 2: Patient with mRC undergoing treatment with Nivolumab-Ipilimumab, who after 6 cycles was admitted for acute renal failure, compatible with grade 4 nephrotoxicity, requiring definitive suspension of treatment, corticosteroid therapy and hemodialysis. Conclusions: Nivolumab is a safe and effective therapy in hemodialysis patients, not increasing adverse events, nor requiring dose adjustment. Immunotherapy nephrotoxicity must be adequately managed in daily clinical practice in an interdisciplinary way with the nephrologist (AU)

Introducción: La inmunoterapia está recomendadacon categoría 1 en primera línea de tratamiento en cáncerrenal metastásico (CRm), sin embargo la evidencia sobre elmanejo de toxicidades en pacientes con insuficiencia renalcrónica es limitada.Descripción de los Casos: Caso 1: Paciente con CRme insuficiencia renal en hemodiálisis. Tras 25 meses detratamiento con Nivolumab, presenta respuesta parcial, sintoxicidades. Caso 2: Paciente con CRm en tratamiento conNivolumab-Ipilimumab, que tras 6 ciclos precisa ingresopor fracaso renal agudo, compatible con nefrotoxicidadgrado 4, requiriendo suspensión definitiva del tratamiento,corticoterapia y hemodiálisis.Conclusiones: El uso de Nivolumab es seguro y eficaz en pacientes en hemodiálisis, no incrementando losefectos adversos, ni precisando ajuste de dosis. Es fundamental conocer el manejo de la nefrotoxicidad por inmunoterapia en la práctica clínica diaria y establecer un enfoque multidisciplinar con nefrología. (AU)

[Living-donor renal transplant. State of the art.] / Trasplante renal de donante vivo. Estado actual.

Living donor kidney transplantation is the best therapeutic option in a patient with end-stage renal failure, because it provides excellent functionality and graft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In exper thands, different minimally invasive surgeries can be offered with the main advantage of improving the a esthetic results. Although there may be controversy regarding laparoscopic devices for vascular ligation during living donor nephrectomy, both endostaplers and locking clips have proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimal morbidity and mortality. Age and glomerular filtration rate of the donor candidate are prognostic factor of long-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at the beginning of its development. Published series still do not allow to clearly establish its role compared to conventional open surgery.

El trasplante renal de donante vivo suponela mejor opción terapéutica en un paciente con insuficiencia renal terminal, por su excelente funcionalidad y supervivencia del injerto. La nefrectomía laparoscópica de donante vivo es la técnica de elección para la obtención del injerto. En manos expertas, distintas variantes mínimamente invasivas pueden ofrecerse con la principal ventaja de mejorar los resultados estéticos del donante. Aunque pueda existir controversia en relación a los dispositivos laparoscópicos para la ligadura vascular durante la nefrectomía de donante vivo, tanto las endograpadoras como los clips con cierre tipo Hem-olokhan demostrado ser seguros siempre que se respete la técnica adecuada en su empleo. La nefrectomía de donante vivo no está exenta de una mínima morbi-mortalidad.La edad y el filtrado glomerular del candidato a donante son orientativas del riesgo de enfermedad renal a largo plazo. En relación a la cirugía del implante, el trasplante renal robótico se encuentra en los albores de su desarrollo. Las series publicadas no permiten aún establecer claramente su papel frente a la cirugía abierta convencional.

Trasplante renal de donante vivo. Estado actual / Immunosuppressive drugs and protocols for transplantation

El trasplante renal de donante vivo suponela mejor opción terapéutica en un paciente con insuficiencia renal terminal, por su excelente funcionalidad ysupervivencia del injerto. La nefrectomía laparoscópica de donante vivo es la técnica de elección para laobtención del injerto. En manos expertas, distintas variantes mínimamente invasivas pueden ofrecerse con laprincipal ventaja de mejorar los resultados estéticos deldonante. Aunque pueda existir controversia en relacióna los dispositivos laparoscópicos para la ligadura vascular durante la nefrectomía de donante vivo, tanto lasendograpadoras como los clips con cierre tipo Hem-olok han demostrado ser seguros siempre que se respetela técnica adecuada en su empleo. La nefrectomía dedonante vivo no está exenta de una mínima morbi-mortalidad. La edad y el filtrado glomerular del candidato a donante son orientativas del riesgo de enfermedad renala largo plazo. En relación a la cirugía del implante, eltrasplante renal robótico se encuentra en los albores desu desarrollo. Las series publicadas no permiten aún establecer claramente su papel frente a la cirugía abiertaconvencional.(AU)

Living donor kidney transplantation is thebest therapeutic option in a patient with end-stage renalfailure, because it provides excellent functionality andgraft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In experthands, different minimally invasive surgeries can be offered with the main advantage of improving the aesthetic results. Although there may be controversy regardinglaparoscopic devices for vascular ligation during livingdonor nephrectomy, both endostaplers and locking clipshave proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimalmorbidity and mortality. Age and glomerular filtrationrate of the donor candidate are prognostic factor oflong-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at thebeginning of its development. Published series still donot allow to clearly establish its role compared to conventional open surgery.(AU)

Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical / Pharmacological venous thromboembolism prophylaxis in radical prostatectomy

ANTECEDENTES Y OBJETIVO: El tromboembolismo pulmonar es una de las causas más comunes de muerte no quirúrgica en pacientes sometidos a cirugía urológica abdominopélvica. Desde el inicio de la profilaxis para la enfermedad tromboembólica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente. Nuestro objetivo es analizar los predictores de la enfermedad tromboembólica, la variabilidad clínica en la utilización de la profilaxis farmacológica para esta enfermedad y los resultados de su aplicación. MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico de 610 pacientes intervenidos mediante prostatectomía radical entre diciembre de 2013 y noviembre de 2014 en 7hospitales generales de España, Italia y Portugal. Se clasificó a los pacientes según sus características basales en grupos de riesgo trombótico y grupos de riesgo hemorrágico. Se evaluaron los eventos tromboembólicos venosos que se presentaron en los diferentes grupos. RESULTADOS: La edad media fue de 65,22años (48-78). El índice de masa corporal medio fue de 26,7 y la mediana del riesgo de ASA fue 2. En todos los pacientes se inició la deambulación en las primeras 24h. En el 4,1% se utilizó compresión neumática intermitente y en el 84,6%, profilaxis farmacológica con heparinas de bajo peso molecular. Solo en el 3,4% se utilizó la combinación de profilaxis mecánica con la farmacológica. Se observó disminución de la incidencia de eventos tromboembólicos en los pacientes que recibieron profilaxis farmacológica, con una reducción absoluta del riesgo del 6,8%. No se objetivó aumento del riesgo hemorrágico en los pacientes que recibieron profilaxis tromboembólica. CONCLUSIONES: En este estudio sobre pacientes sometidos a prostatectomía radical no hubo diferencia en las complicaciones hemorrágicas derivadas del uso de profilaxis farmacológica para la enfermedad tromboembólica venosa. La profilaxis farmacológica reduce el riesgo de presentar un evento tromboembólico en pacientes sometidos a prostatectomía radical, si bien este riesgo no se asocia con la técnica de abordaje

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique

Pharmacological venous thromboembolism prophylaxis in radical prostatectomy. / Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical.

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique.

[Laparoscopic ureteral reimplantation in the treatment of urinary tract complications after renal transplantation.] / Reimplante ureteral laparoscópico en el tratamiento de las complicaciones urinarias del trasplante renal.

OBJECTIVES: Laparoscopic ureteral reconstructive surgery is routinely performed , because it demonstrated efficacy and safety profiles similar to open surgery in expert hands. The most frequent surgical complications after transplant are urological, appearing in up to 12,5% of the cases; they can compromise graft function and mortality. The most frequent ones include ureterovesical anastomosis stenosis (2,5-7,5%) and vesicoureteral reflux (0,4-2,2), which present in up to 80% of the cases. METHODS: Technical description of the Lich-Gregoire ureteral reimplantation technique in renal transplant patients. RESULTS: From October 2012 we performed 14 Lich-Gregoire laparoscopic ureteral reimplantations in transplant patients, 9 due to distal ureteral stenosis and 5 for vesicoureteral reflux. There were not open conversions. CONCLUSIONS: Laparoscopic surgery has evolved much allowing the performance on techniques that we could not think of years ago. Renal transplant patients present frequent postoperative complications, so they benefit of minimally invasive surgery such as endoscopy or laparoscopy. The Lich-Gregoire laparoscopic reimplantation in transplant patients is reproducible in Centers with experience both in laparoscopic surgery and transplantation.

Reimplante ureteral laparoscópico en el tratamiento de las complicaciones urinarias del trasplante renal / Laparoscopic ureteral reimplantation in the treatment of urinary tract complications after renal transplantation

OBJETIVO: La cirugía reconstructiva ureteral laparoscópica es realizada de forma rutinaria, ya que ha demostrado una eficacia y perfiles de seguridad similares a los de la cirugía abierta en manos expertas. Las complicaciones quirúrgicas más frecuentes tras el trasplante renal son las urológicas, presentándose hasta en el 12,5% de los casos, pudiendo comprometer la función del injerto y la mortalidad. Las más comunes incluyen la estenosis de la anastomosis urétero-vesical (2,5-7,5%) y el reflujo vésico-ureteral (0,4-2,2%), que puede aparecer hasta en un 80% de casos. MÉTODO: Descripción de la técnica de reimplante laparoscópico tipo Lich-Gregoire en pacientes trasplantados renales. RESULTADOS: Desde octubre de 2012 hasta la actualidad hemos realizado 14 reimplantes ureterales laparoscópicos tipo Lich-Gregoire en pacientes trasplantados, 9 por estenosis ureteral distal y 5 por reflujo vésico-ureteral, en ningún caso ha habido necesidad de reconversión a cirugía abierta. CONCLUSIONES: La cirugía laparoscópica ha evolucionado mucho permitiendo realizar técnicas poco imaginables hace años. Los trasplantados renales presentan complicaciones postoperatorias frecuentes, por lo que son ampliamente beneficiados de la cirugía mínimamente invasiva como la endoscopia o laparoscopia. La técnica del reimplante laparoscópico tipo Lich-Gregoire en pacientes trasplantados renales es reproducible en los centros con experiencia laparoscópica y en trasplantes

OBJECTIVES: Laparoscopic ureteral reconstructive surgery is routinely performed , because it demonstrated efficacy and safety profiles similar to open surgery in expert hands. The most frequent surgical complications after transplant are urological, appearing in up to 12,5% of the cases; they can compromise graft function and mortality. The most frequent ones include ureterovesical anastomosis stenosis (2,5-7,5%) and vesicoureteral reflux (0,4-2,2), which present in up to 80% of the cases. METHODS: Technical description of the Lich-Gregoire ureteral reimplantation technique in renal transplant patients. RESULTS: From October 2012 we performed 14 Lich-Gregoire laparoscopic ureteral reimplantations in transplant patients, 9 due to distal ureteral stenosis and 5 for vesicoureteral reflux. There were not open conversions. CONCLUSIONS: Laparoscopic surgery has evolved much allowing the performance on techniques that we could not think of years ago. Renal transplant patients present frequent postoperative complications, so they benefit of minimally invasive surgery such as endoscopy or laparoscopy. The Lich-Gregoire laparoscopic reimplantation in transplant patients is reproducible in Centers with experience both in laparoscopic surgery and transplantation

Influence of secondary diagnoses in the development of urinary incontinence after radical prostatectomy.

OBJECTIVE: To study whether there are factors related to secondary diagnoses (SDg) present in patients with prostate cancer that influence the development of urinary incontinence after radical prostatectomy (RP). MATERIALS AND METHODS: A retrospective multicenter observational study was performed reviewing the medical records of 430 men who underwent RP due to organ-confined prostate cancer in 9 different hospitals. Two study groups were distinguished: Group A (GA): Patients without urinary incontinence after RP; Group B (GB): patients with any degree of post-surgical urinary incontinence. RESULTS: Average age at surgery was 63.42 years (range 45-73). 258 patients were continent after surgery and 172 patients complaint of any degree of incontinence after RP. A higher percentage of healthy patients was found in group A (continent after surgery) than in group B (p = 0.001). The most common SDg prior to surgery were hypertension, lower urinary tract symptoms, dyslipidemia, diabetes mellitus and erectile dysfunction, but none did show a greater trend towards post-surgical incontinence. CONCLUSIONS: A better health status prior to surgery is associated to a lower incidence of new-onset urinary incontinence after radical prostatectomy. However, no correlation was found between the most common medical disorders and the development of post-surgical urinary incontinence.

Priapismo de bajo flujo en adolescente como inicio de una leucemia mieloide aguda / Low flow priapism in the adolescent as debut of acute myeloid leukemia

El priapismo se define como una erección prolongada y dolorosa que no tiene por qué ser desencadena por un estímulo sexual y que presenta la característica de no modificarse tras la eyaculación. Se trata de una entidad poco frecuente en edades tempranas y/o adolescentes. En el priapismo de bajo flujo o el venooclusivo o isquémico debe realizarse diagnóstico diferencial con causas hematológicas, neoplasias, cuadros infecciosos, ingesta de fármacos, etc., mientras que para el de alto flujo o arterial o no isquémico debemos centrarnos más en el origen traumático. El tratamiento del priapismo de bajo flujo constituye una urgencia, ya que debemos evitar un daño irreversible, así como un daño psicológico que podría derivarse de las consecuencias de una posible disfunción eréctil. Presentamos un caso de priapismo de bajo flujo en un paciente adolescente como inicio de una leucemia mieloide aguda. En la edad pediátrica y en la adolescencia, como hemos dicho, es poco frecuente, aunque debemos estar alerta, ya que puede ser el comienzo de enfermedades graves (AU)

Priapism is defined as prolonged, painful erection that does not have to be triggered by sexual stimulation. It is characterized by not being modified after ejaculation. This is a rare entity in early and/or adolescent ages. In low flow or ischemic veno-occlusive priapism, differential diagnosis should be made regarding hematologic causes, neoplasms, infectious conditions, drug intake, etc. In high flow or arterial or nonischemic priapism, greater focus should be given to the traumatic origin.Treatment of low flow priapism is an emergency since we must avoid irreversible damage as well as psychological harm that would be derived from the consequences of a possible erectile dysfunction. We report a case of low flow priapism in a teenage patient that was a debut of acute myeloid leukemia. In pediatric and adolescent aged patients, as we have stated, this is uncommon. However, we must be alert to this since it may be the debut of serious diseases (AU)

Comentario Editorial de: Tratamiento laparoscópico de fístulas genitourinarias / Editorial Comment: Laparoscopic treatment of genitourinary fistulae

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