The candidate for renal transplantation work up: medical, urological and oncological evaluation.

UNLABELLED: Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself. In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates. METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant. RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up. Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution. Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation. CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations. Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients ' specific conditions, by a multidisciplinary approach before proceeding to transplantation.

Estudio del candidato a trasplante renal: Evaluación médica, urológica y oncológica / The candidate for renal transplantation work up: medical, urological and oncological evaluation

El trasplante renal aumenta la supervivencia, reduce la morbilidad y mejora la calidad de vida del enfermo en insuficiencia renal crónica terminal (IRCT). Es un procedimiento quirúrgico con inherentes riesgos relacionados con la anestesia y la propia cirugía.Los antecedentes y enfermedades comórbidas del paciente con IRCT son muy importantes a la hora de considerarlo candidato a trasplante.OBJETIVOS: Revisar y actualizar, según la literatura reciente, la evaluación del paciente candidato a trasplante renal.MÉTODOS: Realizamos una revisión retrospectiva de la literatura publicada en Medline/Pubmed sobre los aspectos más importantes a tener en cuenta en la evaluación del candidato a trasplante renal en lo que se refiere a la situación médica, del aparato genitourinario y a posibles neoplasias concomitantes. RESULTADOS: La evaluación médica pretrasplante pretende poner de manifiesto los antecedentes clínicos del paciente así como estos pueden condicionar la evolución del enfermo e injerto una vez trasplantado. Se debe considerar la edad, la enfermedad cardiovascular, la existencia de diabetes mellitus, potenciales alteraciones de la coagulación, la obesidad, la presencia de patología en el tracto gastrointestinal, situación y complicaciones asociadas a su IRCT, una infección activa, la falta de compliance con el tratamiento y seguimiento(AU)

El aparato urinario deseable para cualquier candidato a trasplante debe ser estéril, de buena capacidad, compliance y con un mecanismo seguro de conseguir un correcto vaciado vesical. Algunas anomalías urológicas pueden pasar desapercibidas en el paciente anúrico. La evaluación prestrasplante del aparato urológico, pretende diagnosticar, tratar y optimizar cualquier patología urológica presente, así como detectar alteraciones anatómicas que pongan en riesgo el éxito de la cirugía.La patología neoplásica es una frecuente y reconocida complicación asociada al trasplante de órganos. El tratamiento inmunosupresor puede condicionar efectos secundarios directos así como un potencial efecto oncogénico. Los tumores prexistentes deben evaluarse concienzudamente antes de realizar el trasplante, así como la existencia de una neoplasia oculta.CONCLUSIÓN: En esta revisión destacamos la importancia de realizar una exhaustiva evaluación médica, urológica y oncológica antes del trasplante renal. Repasaremos los principales aspectos de la evaluación de los enfermos en IRCT, que pruebas diagnósticas se deben aplicar y cuáles son las últimas recomendaciones al respecto.Es imprescindible una evaluación cuidadosa de cada candidato a entrar en lista de espera para trasplante para mejorar la supervivencia de injerto y receptor. El estudio debe ser individualizado según la condición particular de cada paciente, a través de un abordaje multidisciplinar antes de proceder con el trasplante(AU)

Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself.In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success.OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates.METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant(AU)

RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up.Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution.Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation.CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations.Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients` specific conditions, by a multidisciplinary approach before proceeding to transplantation(AU)

Angiomiolipoma renal causante de trombo en cava y Síndrome de Budd-Chiari secundario / Renal angiomyolipoma causing inferior vena cava thrombus and secondary Budd-Chiari's syndrome

Objetivo: Se aporta un caso de angiomiolipoma renal con tres peculiaridades: origen en seno renal, trombo en cava hasta ostium de aurícula derecha y presentación clínica en forma de síndrome de Budd-Chiari. Métodos: Se realiza una presentación y comentarios de las características del caso clínico. Resultados/Conclusiones: El angiomiolipoma renal es un tumor benigno mesenquimal, poco frecuente (2-6.4% de los tumores renales), de predominio en el sexo femenino. Habitualmente surge en el parénquima renal, siendo infrecuente su origen en el seno renal. Puede afectar a estructuras venosas formando trombo tumoral en vena renal y en vena cava inferior, llegando incluso a aurícula derecha. Habitualmente es asintomático, constituyendo un hallazgo incidental en técnicas diagnósticas de imagen, pero su presentación clínica varía desde el dolor en flanco (lo más frecuente) hasta el TEP fatal, siendo excepcional su presentación como síndrome de Budd-Chiari. Debido al riesgo de TEP y muerte, el tratamiento quirúrgico (nefrectomíaradical y trombectomía) del AML con trombo en cava está indicado aun cuando sea asintomático (AU)

Objective: We report one case of renal angiomyolipoma with three characteristics: renal sinus origin, inferior vena cava tumor thrombus reaching the right atrium and Budd-Chiari syndrome. METHODS: The characteristics of the case are presented and discussed. Results/conclusions: Renal angiomyolipoma is a benign mesenchymal tumor. It is an uncommon tumor (2-6.4% of all kidney tumors), with a female predominance. Angiomyolipoma most often originate from the renal parenchyma but they can rarely originate from the renal sinus. They can involve the renal vein, the inferior vena cava and even the right atrium as a tumor thrombus. Angiomyolipoma commonly present as an incidental finding on radiographic studies, but the clinical presentation varies from flank pain to fatal pulmonary tumor embolism. The Budd-Chiari syndrome is an extremely rare presentation. Because of the risk of potentially fatal cardiopulmonary embolism and death, surgical treatment radical nephrectomy plus tumor thrombectomy) of these lesions is indicated even when they are asymptomatic (AU)

[Renal cell carcinoma with liver extension: a report of a new case and literature review]. / Tumor renal con invasión hepática: aportación de un nuevo caso y revisión de la literatura.

Locally advanced renal cell carcinoma (RCC) with involvement to adjacent organs is uncommon and the prognosis is poor. Radical surgery remains the only effective treatment. We report the case of a woman with RCC and direct liver extension who was surgically treated. A literature review is made.

Tumor renal con invasión hepática: aportación de un nuevo caso y revisión de la literatura / Renal cell carcinoma with liver extension: a report of a new case and literature review

El carcinoma de células renales (CCR) con invasión directa de órganos adyacentes es un hallazgo infrecuente y de mal pronóstico en el que el único tratamiento potencialmente efectivo es la cirugía radical. Se presenta el caso de una mujer con gran masa renal y afectación hepática y diafragmática sometida a tratamiento quirúrgico, y se realiza revisión de la literatura

Locally advanced renal cell carcinoma (RCC) with involvement to adjacent organs is uncommon and the prognosis is poor. Radical surgery remains the only effective treatment. We report the case of a woman with RCC and direct liver extension who was surgically treated. A literature review is made

[Urachal cyst presenting as acute urinary retention]. / Retención aguda de orina, "RAO", como presentación de quiste de uraco.

About 2% of adults have an urachal cyst. The diagnosis is usually made due to its clinical complications. We report an inusual case of acute urinary retention due to an urachal cyst, with hipogastric pain and anuria as initial syntoms.

[Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases]. / Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: complicaciones en nuestros primeros 100 casos.

INTRODUCTION: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity. good clinical results and rare complications. MATERIAL AND METHODS: From april, 1999 to march. 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10.36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56.6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomy. RESULTS: We obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient: 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization: one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy: one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures: and one patient presented pelvic discomfort with spontaneous resolution. CONCLUSIONS: We consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.

Retención aguda de orina, “RAO“, como presentación de quiste de uraco / Urachal cyst presentated as acute urinary retention

El quiste de uraco esta presente aproximadamente en el 2% de los adultos, siendo su diagnostico difícil y secundario a las manifestaciones de su complicaciones. Presentamos un caso inusual de retención aguda de orina en un quiste de uraco, que debutó como dolor hipogástrico y anuria (AU)

About 2% of adults have an urachal cyst. The diagnosis is usually made due to its clinical complications. We report an inusual case of acute urinary retention due to an urachal cyst, with hipogastric pain and anuria as initial syntoms (AU)

Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: complicaciones en nuestros primeros 100 casos / Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases

Introducción: El sistema TVT (Tension-free Vaginal Tape) es la técnica quirúrgica de elección en los últimos años de la incontinencia urinaria de esfuerzo femenina (IUE), dada la facilidad de la técnica, buenos resultados clínicos y escasas complicaciones. Material y métodos: Desde Abril de 1999 a Marzo 2004 se han implantado en nuestro servicio 100 sistemas TVT con revisión de los resultados a los 6 meses, y un seguimiento medio de 10,36 meses (R: 1-54 meses), con una pérdida de seguimiento en el 11% de los casos. Todas las mujeres estudiadas presentaban incontinencia de esfuerzo, siendo la edad media de 56,5 años (30-80). Un 12% habían sido intervenidas previamente de IUE. Presentan cirugía previa del suelo pélvico 21 pacientes. En un 17% de los casos se realizó TVT asociado a otra técnica quirúrgica: 15% cistorrafia anterior, 1% corrección de rectocele, 1% cirugía compleja del suelo pélvico que incluye TVT, corrección de cistocele e histerectomía. Resultados: Obtenemos un 65% de éxitos (comprobación objetiva de la ausencia de escape por parte del médico y referencia subjetiva de la paciente), un 17% de mejoría (disminución clara de escapes por parte de la paciente y mejoría subjetiva) y un 7% de fracaso de la técnica. El porcentaje global de aparición de urgencia de novo posquirúrgica es del 9%. Existieron un 12% de complicaciones; 3 casos(3%) de perforación vesical, 2 de ellos intraoperatorios y 1 diferida junto con infección de la herida quirúrgica; 3 episodios (3%) de residuos altos en el postoperatorio inmediato, resueltos con autosondajes, y un caso de RAO (1%) dado de alta con cistostomía suprapúbica; un caso (1%) de peritonitis química tras retirada de talla vesical resuelta con tratamiento conservador; dos casos (2%) de extrusión vaginal de la bandeleta, con sección de la porción de malla exteriorizada en ambos casos; un (1%) paciente presenta hematoma hipogástrico que se resuelve con medidas conservadoras; un 1 % de los pacientes (1 caso) presentó molestias pélvicas subcrónicas con resolución espontánea. Conclusiones: Consideramos el sistema TVT una técnica quirúrgica eficaz en el tratamiento de la incontinencia urinaria femenina de esfuerzo. Es una técnica sencilla, con baja estancia hospitalaria y escasas complicaciones (AU)

Introduction: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity, good clinical results and rare complications. Material and methods: From april, 1999 to march, 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10, 36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56,6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1%of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomy. Results: We obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient; 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization; one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy; one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures; and one patient presented pelvic discomfort with spontaneous resolution. Conclusions: We consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications (AU)

[Benign retroperitoneal schwannoma. Incidental diagnostic in patient with hematuria of the percusionist]. / Schwannoma retroperitoneal benigno. Diagnostico incidental en paciente con hematuria del percusionista.

The incidence of retroperitoneal primitive tumour varies from the 0.3 to 3%. The sarcomas suppose the group but it frequents of retroperitoneal tumour, being the Schwannoma an unusual tumour with an incidence from 1% to 50% of the retroperitoneal primary tumours. The schwannoma also denominated neurinoma or neurolenoma, it is a derived tumour of the cells of Schwann of the outlying nerves. It is characterized by their clinical and radiological inespecify, being the diagnose pathological, with intense positive inmunohistoquimics to the protein S-100. The election treatment is the surgical remove, with wide margins; not being described cases of malignización neither of metastasis at distance, but if the recurrence existence at probably secondary local level to incomplete resection.

Schwannoma retroperitoneal benigno. Diagnostico incidental en paciente con hematuria del percusionista / Benign retroperitoneal schwannoma, I diagnose incidental in patient with hematuria of the percusionist

La incidencia de neoplasias retroperitoneales primitivos varía del 0,3 al 3%. Los sarcomas suponen el grupo mas frecuente de neoplasias retroperitoneales, siendo el Schwannoma un tumor inusual con una incidencia del 1% al 5% del los tumores retroperitoneales primarios. El schwannoma también denominado neurinoma o neurolenoma, es un tumor derivada de las células de Schwann de los nervios periféricos. Se caracteriza por su inespecificidad clínica y radiológica, siendo el diagnostico patológico, con intensa positividad inmunohistoquímico a la proteína S-100. El tratamiento de elección es la exéresis quirúrgica, con márgenes amplios; no estando descrito casos de malignización ni de metástasis a distancia, pero si la existencia de recurrencia a nivel local probablemente secundaria a resección incompleta (AU)

The incidence of retroperitoneal primitive tumour varies from the 0,3 to 3%. The sarcomas suppose the group but it frequents of retroperitoneal tumour, being the Schwannoma an unusual tumour with an incidence from 1% to 5% of the retroperitoneal primary tumours. The schwannoma also denominated neurinoma or neurolenoma, it is a derived tumour of the cells of Schwann of the outlying nerves. It is characterized by their clinical and radiological inespecify, being the diagnose pathological, with intense positive inmunohistoquimics to the protein S-100. The election treatment is the surgical remove, with wide margins not being described cases of malignización neither of metastasis at distance, but if the recurrence existence at probably secondary local level to incomplete resection (AU)

Neuromodulación de raíces sacras. Experiencia de nuestro centro 1998-2003. A propósito de 18 implantes definitivos de neuromodulación / Sacral root neuromodulation. Experience in our site: 1998-2003, concerning 18 definite neuromodulation implants

OBJETIVO: La neuromodulacion de raíces sacras es una técnica eficaz para el tratamiento de la Disfunción Miccional Crónica (DMC), refractaria a tratamientos convencionales. En la actualidad están surgiendo nuevas indicaciones en el ámbito urológico, como el dolor pélvico crónico y la cistitis intersticial. Diversos grupos de cirujanos digestivos están optando por esta técnica para el tratamiento de patología rectal (estreñimiento, disfunción esfinteriana). Este trabajo aporta nuestra experiencia en el tratamiento de pacientes con DMC y los resultados comparativos al año del implante de todos los pacientes. MATERIAL Y MÉTODOS: Desde diciembre de 1998 a julio del 2003 hemos realizados 18 implantes definitivos de neuromodulacion. La indicación principal fue la DMC, en un 62,5% de los pacientes. El seguimiento de los pacientes lo realizamos al mes, tres meses, y posteriormente cada seis meses. Este se realiza mediante diario miccional y cuestionario de calidad de vida. El implante del electrodo en los 16 primeros pacientes se ha realizado mediante cirugía abierta, mientras que los 2 siguientes se ha colocado el electrodo mediante técnica percutánea, utilizando el kit “Tined Lead”. RESULTADOS: Comparamos resultados al año del implante en todos los pacientes. Se han realizado 18 implantes de neuromodulación de los cuales 14 (77,7%) han sido en mujeres y 4 (22,3%) en varones. La edad media es de 52,56 años. La indicación del implante en un 72,2% de los pacientes fue por DMC, un 22,1% por incontinencia mixta (urinaria y fecal), y un 5,5% fue por cistopatía intersticial. La mejoría de los síntomas al año del implante, medidos por el calendario miccional y el cuestionario de calidad de vida fue de 76,4%. La mejoría clínica fue mayor en los pacientes con síntomas de urgencia, que los pacientes con predominio de la sintomatología de vaciado

OBJECTIVE: Sacral root neuromodulation is an effective technique for the treatment of Chronic Micturition Dysfunction (CMD) refractory to conventional therapy. New indications such as chronic pelvic pain and interstitial cystitis are currently making their way within the urologic setting. Several groups of gastric surgeons are now choosing this technique for the management of rectal diseases (constipation, sphincter dysfunction). This paper contributes our experience in the treatment of patients with CMD and the comparative results at one year from implant in all patients. MATERIAL AND METHODS: From December 1998 through July 2003, 18 neuromodulation definite implants were performed. The main indication was CMD in 62.5% patients. Follow up of patients was done at one month and three months, and every six months thereafter. Follow up is conducted through a micturition diary and QoL questionnaire. Electrode implant in the first 16 patients was achieved by open surgery. The next 2 patients had the electrode placed by a percutaneous technique using the “Tined Lead” kit. RESULTS: Results at one year after implant were compared in all patients. The total number of neuromodulation implants placed was 18, 14 (77.7%) of which were women and 4 (22.3%) men. Mean age was 52.56 years. Implant indication was CMD in 72.2% patients, mixed incontinence (urinary and faecal) in 22.1%, and interstitial cystic disease in 5.5%. Symptoms improvement at one year from implant, as determined by a micturition diary and QoL questionnaire was 76.4%. Clinical improvement was greater in patients with urgency symptoms than in patients with predominance of voiding symptoms

[Metastasis in renal graft of primary renal adenocarcinoma]. / Metastasis en injerto renal de adenocarcinoma renal primario.

Acquired cystic renal disease (A.C.R.D.) is a risk factor for the development of renal carcinoma in the patient's own kidney after renal transplant (R.T.), development of a primitive tumor in the renal graft is infrequent, but the presence of metastasis of an epithelial tumor is very rare. This is the second case reported in the literature of metastasis of an epithelial tumor in the renal graft and the first case described of renal cell carcinoma metastasis (R.C.C.) in the renal graft. This paper describes the case of a patient with a normally functioning renal transplant and A.C.R.D. who develops RCC in his own kidney, with metastasis in the renal graft.

Metastasis en injerto renal de adenocarcinoma renal primario / Metastasis in renal graft of primary renal adenocarcinoma

La enfermedad renal quística adquirida (E.R.Q.A), es un factor de riesgo para el desarrollo de carcinoma renal en los riñones propios, tras el trasplante renal (T.R.). El desarrollo de un tumor primitivo del injerto renal es infrecuente. De otro lado, la incidencia de tumor primitivo en el injerto renal es infrecuente, pero la presencia de metástasis en el de un tumor epitelial es excepcional, siendo este el segundo caso de literatura de metástasis de tumor epitelial en injerto renal; y el primer caso descrito de metástasis de carcinoma de células renales (C.C.R.), sobre injerto renal. El caso de un paciente con TR normofuncionante y ERQA que desarrolla CCR en riñón propio, con metástasis sobre el injerto renal

Acquired cystic renal disease (A.C.R.D.) is a risk factor for the development of renal carcinoma inthe patient’s own kidney after renal transplant (R.T.). development of a primitive tumor in the renal graft is infrequent, but the presence of metastasis of an epithelial tumor is very rare. This is the second case reported in the literature of metastasis of an epithelial tumor in the renal graft and the firstcase described of renal cell carcinoma metastasis (R.C.C.) in the renal graft. This paper describes the case of a patient with a normally functioning renal transplant and A.C.R.D. who develops RCC in his own kidney, with metastasis in the renal graft

[Sacral root neuromodulation. Experience in our site: 1998-2003, concerning 18 definite neuromodulation implants]. / Neuromodulación de raíces sacras. Experiencia de nuestro centro 1998-2003. A propósito de 18 implantes definitivos de neuromodulación.

OBJECTIVE: Sacral root neuromodulation is an effective technique for the treatment of Chronic Micturition Dysfunction (CMD) refractory to conventional therapy. New indications such as chronic pelvic pain and interstitial cystitis are currently making their way within the urologic setting. Several groups of gastric surgeons are now choosing this technique for the management of rectal diseases (constipation, sphincter dysfunction). This paper contributes our experience in the treatment of patients with CMD and the comparative results at one year from implant in all patients. MATERIAL AND METHODS: From December 1998 through July 2003, 18 neuromodulation definite implants were performed. The main indication was CMD in 62.5% patients. Follow up of patients was done at one month and three months, and every six months thereafter. Follow up is conducted through a micturition diary and QoL questionnaire. Electrode implant in the first 16 patients was achieved by open surgery. The next 2 patients had the electrode placed by a percutaneous technique using the "Tined Lead" kit. RESULTS: Results at one year after implant were compared in all patients. The total number of neuromodulation implants placed was 18, 14 (77.7%) of which were women and 4 (22.3%) men. Mean age was 52.56 years. Implant indication was CMD in 72.2% patients, mixed incontinence (urinary and faecal) in 22.1%, and interstitial cystic disease in 5.5%. Symptoms improvement at one year from implant, as determined by a micturition diary and QoL questionnaire was 76.4%. Clinical improvement was greater in patients with urgency symptoms than in patients with predominance of voiding symptoms.