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.

Four vertex technique for correcting urethral prolapse: technique description and cohort study.

Introduction/Objectives: This study aims to describe the procedure and effectiveness of the four-vertex technique for correcting urethral prolapse in women. Methods and Materials: includes a retrospective case series of 17 patients who underwent surgery for urethral prolapse. Two study groups were distinguished based on the presence or absence of pelvic heaviness symptoms. The variables were analyzed, including age, BMI, concomitant diseases, obstetric and gynecological history, time from diagnosis to surgery, and outcomes of treatment. Results: All patients were postmenopausal, with a mean age at the time of the intervention of 70.41 years, with no differences between groups. Mean BMI was 23.67 kg/m2, higher in the group with a sensation of vaginal heaviness (p = 0.027). Mean time elapsed between diagnosis and operation was 231.58 days, with no differences between groups. Mean childbirth count was 2.29. The most frequent causes for consultation were urethrorrhagia (33.33%) and a bulging sensation (33.33%). After the intervention, 14 patients (82.35%) were asymptomatic, two (11.76%) had dysuria, and one (5.88%) had urinary urgency. Ten patients had pre-surgical urinary incontinence, which was resolved in nine patients. 17.46% subsequently presented pelvic organ prolapse. In three women there was secondary impairment of sexual activity. Conclusion: The four-vertex technique was effective in resolving symptoms in most patients. However, some patients experienced dysuria, urinary urgency, and pelvic organ prolapse after surgery. Urinary incontinence improved in most patients, but a few required additional treatments with suburethral tape. The study also identified associations between variables and the presence of cystocele, consultation for a bulging sensation, and bleeding from urethral prolapse. Overall, this study sheds light on the challenges and outcomes of surgical treatment for urethral prolapse and provides valuable insights for future research in this area.

[Hematologic neoplasms with testicular involvement]. / Neoplasias hematológicas con implicación testicular.

OBJECTIVE: We report two cases of patients with a previous diagnosis of hematologic tumor who present with testicular recurrence, and we carry out a review of the literature regarding the infrequency of this pathology. METHODS: We present a retrospective review of the medical records of two patients diagnosed with hematologic malignancies (acute myelogenous leukemia and multiple myeloma) with occurrence of relapse in the testicle. We reviewed the management and outcome after treatment with bilateral orchiectomy. RESULTS: Case 1: The patient was diagnosed with acute myeloid leukemia and treated with an allogeneic transplant. Two years later, the patient reported an increase in testicular size. The complementary studies lead us to suspect a testicular recurrence that was confirmed after orchiectomy. Currently, the patient awaits the start of a chemotherapy treatment prior to a new allogeneic transplant. Case 2: Patient with the diagnosis of multiple myeloma who started a polychemotherapy treatment without response and underwent allogeneic transplant. After five months with complete remission, there were signs of systemic recurrence, and a study for a new transplant was carried out. During the study, potential testicular recurrence was observed. After a batch of complementary tests, bilateral orchiectomy was performed and the diagnosis was confirmed. Currently, the patient is undergoing an allogeneic transplant protocol after radiotherapy and chemotherapy treatment. CONCLUSIONS: Currently the mortality rate in cases of relapse of hematologic malignancy in the testicle has declined despite the sharp rise in its incidence. This is because of, as in our case, early diagnosis and the combined use of chemotherapy, radiotherapy and surgery. This has been achieved through an interdisciplinary collaboration of urologists, hematologists, oncologists and radiotherapists.

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.

Ureteritis eosinofílica. A propósito de un caso / Eosinophilic ureteritis. Report of a case

OBJETIVO: Presentamos el caso de una paciente con Ureteritis eosinofílica. MÉTODO: Paciente en estudio por dolor en fosa renal derecha al que se le realizan múltiples pruebas de imagen donde se identifica masa en uréter derecho compatible con neoplasia urotelial de uréter derecho. RESULTADOS: Se realiza Nefroureterectomia derecha y se diagnostica histopatológicamente de Ureteritis eosinofílica. CONCLUSIÓN: La ureteritis eosinofílica es una rara entidad de difícil distinción frente a los tumores uroteliales, de no clara etiología. Deberemos tenerla en cuenta en el diagnóstico diferencial cuando encontremos una masa ureteral asociada a eosinofilia (AU)

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 histopathologicaldiagnosis 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 accountwhenever we find a ureteral mass associated to eosinophilia (AU)

Termómetro intravesical / Intravesical Thermometer

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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.

Resolución espontánea de fístula uretero-vaginal / Spontaneous resolution of ureterovaginal fistula

OBJETIVO: Presentar un caso de corrección espontánea de fístula urétero-vaginal y revisar aspectos diagnósticos y terapéuticos de la literatura actual.MÉTODO: Presentamos el caso de una mujer de 41 años que en el postoperatorio tardío de una histerectomía radical inicia un cuadro de episodios de incontinencia diurna y nocturna leves con dolor episódico en el flanco derecho compatibles con fístula urétero-vaginal. RESULTADOS: Pasado un més del diagnóstico la paciente no refiere incontinencia diurna ni nocturna y el dolor lumbar ha desaparecido. Se comprueba mediante urografía intravenosa corrección espontánea de la fístula urétero-vaginal.CONCLUSIONES: La resolución espontánea de la fístula urétero-vaginal es infrecuente. La mayoría de las fístulas requieren tratamiento endourológico o quirúrgico(AU)

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(AU)

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.

Histiocitoma fibroso maligno retroperitoneal. A propósito de un caso / Retroperitoneal malignant fibrous histiocytoma: case report

OBJETIVO: Presentar un caso de una tumoración retroperitoneal de gran tamaño con diagnóstico patológico de Histiocitoma fibroso maligno y revisar aspectos diagnósticos y terapéuticos de la literatura actual.MÉTODO: Presentamos el caso de un hombre de 75 años de edad que durante un ingreso en el servicio de digestivo por clínica de astenia de meses de evolución y problemas gastrointestinales se realiza CT abdomino-pélvico, identificando gran masa de 20 x 22 x 12 cm que parece depender del riñón izquierdo junto a aneurisma de aorta abdominal de 8 cm de diámetro.RESULTADOS: Se somete al paciente a intervención quirúrgica donde se realiza Nefrectomía radical izquierda más resección radical de masa retroperitoneal, que histológicamente corresponde a un Histiocitoma fibroso maligno, tipo estoriforme-pleomórfico con focos de degeneración hialina (Estadio pT2b).CONCLUSIONES: Los sarcomas son neoplasias infrecuentes. Pueden adoptar una gran variedad de patrones morfológicos y distintos grados de diferenciación. El tratamiento quirúrgico continúa siendo la única terapia con posibilidades curativas. El tratamiento adyuvante radioterápico y/o quimioterápico es cuestionado (AU)

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 (AU)

Rabdomiosarcoma paratesticular metastasico / Rhabdomyosarcoma metastatic paratesticular

OBJETIVOS: Presentar un caso de rabdomiosarcoma paratesticular metastásico en un varón de 14 años de edad, clasificado como estadio IIb según el IRSG (Intergroup Rhabdomyosarcoma Study Group).MÉTODOS: Tras recibir tratamiento mediante cirugía radical (orquiectomía más linfadenectomía retroperitoneal), poliquimioterapia y radioterapia, presentó buena respuesta inicialmente. RESULTADOS: A los 12 meses de la intervención quirúrgica el paciente se encuentra libre de enfermedad.CONCLUSIONES: Resultan fundamentales la quimioterapia y/o radioterapia adyuvantes para el tratamiento de estas neoplasias(AU)

OBJECTIVES: To report one case of metastatic paratesticular rhabdomyosarcoma in a 14 years old patient, classified as stage IIb (IRSG).METHODS: After treatment with radical surgery (orchiectomy and lymphadenectomy), polychemotherapy and radiotherapy, showed good evolution initially.RESULTS: 12 months after surgery the patient is disease free.CONCLUSIONS: Adjuvant treatment is very important in the prognosis of this kind of tumors(AU)

[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.

Tuberculosis genitourinaria y osteoparticulr (Mal de Pott) / Genitourinary and osteoarticular tuberculosis (Pott´s disease)

OBJETIVO: Presentamos el caso de un paciente con Tuberculosis urogenital y osteoarticular.MÉTODO: Paciente en estudio por síndrome febril sin foco infeccioso aparente en tratamiento con hemodiálisis al que se le realizan múltiples pruebas diagnósticas.RESULTADOS: Se pauta tratamiento médico antituberculoso remitiendo el cuadro.CONCLUSIÓN: El estudio urográfico precoz puede ser determinante en el diagnóstico de la tuberculosis urogenital en estadios iniciales, evitando así el deterioro progresivo de la función renal(AU)

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 impro-vement 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(AU)

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

OBJETIVO: Presentamos un caso infrecuente de priapismo maligno secundario a carcinoma de celulas transicionales de la vejiga.MÉTODOS: El paciente portador de un cancer vesical (pT4G3) presenta una tumefacción dolorosa peneana. Realizamos biopsia de los cuerpos cavernosos.RESULTADOS: El informe de la anatomía patológica muestra metástasis peneana de carcinoma de células de transición.CONCLUSIONES: El priapismo secundario a metástasis peneana por carcinoma transicional es infrecuente y se asocia a un mal pronóstico debido a que su presencia indica diseminación metastática multiorgánica(AU)

OBJECTIVE: We report a rare case of malig-nant priapism secondary to transitional cell carcinoma.METHODS: The patient with bladder cancer (pT4G3) pre-sented 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(AU)