Outcomes of lung and liver transplantation after simultaneous recovery using abdominal normothermic regional perfusion in donors after the circulatory determination of death versus donors after brain death.

Normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is a growing preservation technique for abdominal organs that coexists with the rapid recovery of lungs. We aimed to describe the outcomes of lung transplantation (LuTx) and liver transplantation (LiTx) when both grafts are simultaneously recovered from cDCD donors using NRP and compare them with grafts recovered from donation after brain death (DBD) donors. All LuTx and LiTx meeting these criteria during January 2015 to December 2020 in Spain were included in the study. Simultaneous recovery of lungs and livers was undertaken in 227 (17%) donors after cDCD with NRP and 1879 (21%) DBD donors (P < .001). Primary graft dysfunction grade-3 within the first 72 hours was similar in both LuTx groups (14.7% cDCD vs. 10.5% DBD; P = .139). LuTx survival at 1 and 3 years was 79.9% and 66.4% in cDCD vs. 81.9% and 69.7% in DBD (P = .403). The incidence of primary nonfunction and ischemic cholangiopathy was similar in both LiTx groups. Graft survival at 1 and 3 years was 89.7% and 80.8% in cDCD vs. 88.2% and 82.1% in DBD LiTx (P = .669). In conclusion, the simultaneous rapid recovery of lungs and preservation of abdominal organs with NRP in cDCD donors is feasible and offers similar outcomes in both LuTx and LiTx recipients to transplants using DBD grafts.

Tratamiento quirúrgico de quilotórax postrasplante pulmonar por linfangioleiomiomatosis / Surgical Treatment of Chylothorax After Lung Transplantation for Lymphangioleiomyomatosis

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Thoracotomy Wound Dehiscence After Lung Transplant Is an Effective Surgical Solution: A Case Report.

Post-thoracotomy wound dehiscence after a lung transplant carries with it morbidity in the postoperative period. While this complication has been widely reported in the literature after a clamshell incision, the thoracotomy dehiscence's surgical solution has not received much emphasis. We present an original technical solution to deal with this complication, performed successfully in a 62-year-old woman diagnosed as having idiopathic pulmonary hemosiderosis after a single lung transplant. This surgical treatment consists of necrotic rib tissue removal, pleural effusion drainage, pulmonary adhesion removal, and chest wall defect reparation with bioabsorbable mesh. This operative technique results safe and effective for thoracotomy dehiscence reparation.

Neumonía por SARS-CoV-2 (COVID-19): hallazgo casual en estudio PET/TC con 18F-FDG para el diagnóstico de vasculitis / SARS-CoV-2 (COVID-19) pneumonia: incidental finding on 18F-FDG PET/CT study for vasculitis diagnosis

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[Prostate cryotherapy: General principles.] / Crioterapia prostática: fundamentos y principios generales.

INTRODUCTION: Prostate cryotherapy has been consolidated as an alternative minimally invasive treatment. OBJECTIVE: To exposed its historical development, its action mechanism and the surgical technique. Regarding its indications, we expose the different option of treatment- primary cryotherapy, salvage and focal- emphasizing its oncological results in the absence of randomized studies. RESULTS: Cryotherapy is a safe technique with low complication rate, although incidence of erectile dysfunction is 40-90% in case of full-gland cryotherapy. Nowadays, it is recommended as a therapeutic alternative for low and intermediate risk localized prostate cancer, although in clinical trials. Recurrence-free survival is close to 96% in low-risk tumors and 90% in intermediate-risk tumors. On the other hand, it is a salvage treatment option for local recurrence after radiotherapy. Focal therapies including focal cryoablation have an important development, with recurrence-free survival of 75%. CONCLUSION: Waiting for randomized studies that provide more scientific evidence, available retrospective studies show cryotherapy as a safe and effective treatment option in patients with localized prostate cancer.

INTRODUCCIÓN: La crioterapia prostática se ha ido consolidando como una alternativa de tratamiento mínimamente invasiva. OBJETIVO: Exponer el desarrollo histórico de la crioterapia, su mecanismo de acción sobre el tejido prostático así como la técnica quirúrgica. Se discuten los distintos escenarios ­ crioterapia primaria, de rescate y focalhaciendo énfasis en sus resultados oncológicos a falta de estudios randomizados. RESULTADOS: La crioterapia es una técnica segura con un bajo índice de complicaciones, aunque destaca una incidencia de disfunción eréctil del 40-90% en el caso de crioterapia de glándula completa. En la actualidad se recomienda como alternativa terapéutica en el cáncer de próstata localizado de riesgo bajo e intermedio, aunque dentro de ensayos clínicos. La supervivencia libre de recidiva bioquímica es cercana al 96% en tumores de bajo riesgo y al 90% en tumores de riesgo intermedio. Por otro lado, es una opción de tratamiento de rescate en el caso de recidiva local tras radioterapia siempre que se cumplan una serie de criterios (Gleason ≤7 y PSA10ng/ml). La mejora en las técnicas de imagen está permitiendo el desarrollo de terapias focales incluyendo la crioablación focal, con supervivencia libre de recidiva bioquímica del 75%. CONCLUSIONES: A la espera de estudios randomizados que aporten mayor evidencia científica, los estudios retrospectivos disponibles muestran la crioterapia como una opción de tratamiento segura y eficaz en pacientes con cáncer de próstata localizado.

Optimizing collagenase Clostridium histolyticum therapy for Peyronie's disease using a novel approach with percutaneous needle tunnelling.

OBJECTIVES: To compare the efficacy and safety of a combined treatment of percutaneous needle tunnelling (PNT) and a modified collagenase Clostridium histolyticum (CCH) protocol (PNT/CCH) vs the modified protocol alone (CCH) in the treatment of Peyronie's disease (PD). PATIENTS AND METHODS: A prospective registry of patients treated with a modified CCH protocol was maintained between June 2014 and February 2018. The last 50 patients received PNT as an adjuvant therapy (PNT/CCH), and their data were compared with those of the other 94 patients treated previously (CCH). PNT involves the creation of multiple holes made percutaneously in the plaque before each injection. The modified protocol consisted of two collagenase injections, at 1-week intervals, followed by penile modelling. Patients used penile traction therapy, tadalafil and pentoxifylline for the next 2 months and were followed up for 6 months. The main outcome was improvement of curvature. Secondary outcomes were improvements in erectile function, PD symptoms, stretched penile length and satisfaction. RESULTS: Improvement in curvature was greater in patients in the PNT/CCH group than in the CCH group (mean ± sd 19.2 ± 6.1° vs 12.7 ± 5.0°; P < 0.001 [36.2 ± 12.5% vs 28.1 ± 14.5%; P = 0.001]). Compared with baseline, both interventions were associated with significant improvement in secondary outcomes. The main complications were ecchymosis, bruising and penile pain, with no significant differences between groups. CONCLUSIONS: Treatment of PD with CCH using our modified protocol in combination with PNT is safe and more effective than the modified protocol alone, with the potential for improved cost-effectiveness.

Surgical Technique for Complex Cases of Peyronie's Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece.

INTRODUCTION: Patients with Peyronie's disease (PD) and erectile dysfunction (ED) concomitant with shortening or other malformations benefit from prosthesis implantation and penile lengthening procedures. AIM: To evaluate the safety and efficacy of a multi-incisional technique with penile prosthesis implantation with multiple corporeal incisions and collagen grafting for the surgical management of complex cases of PD with ED and severe penile shortening. METHODS: From February 2015-May 2018, 43 consecutive patients with complex PD were treated using this technique. Implantation of a penile prosthesis (malleable or inflatable [IPP]) together with multiple relaxing tunica albuginea incisions and grafting with a self-adhesive collagen-fibrin fleece (TachoSil, Baxter Healthcare) was performed in all patients by a single surgeon (J.I.M.S.). MAIN OUTCOME MEASURE: Penile length and curvature correction, operative time, and incidence of postoperative complications were recorded as outcome measures. Functional outcomes were measured with questionnaires (International Index of Erectile Function-5, Erection Hardness Score, modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire, PD Questionnaire) before and 3 and 6 months after surgery. RESULTS: With a median follow-up of 21 months (range 10-31), mean postsurgical penile lengthening was 2.5 (range 1-5) cm, with an improvement in the Bother domain of the PD Questionnaire of 4.4 (range 2-5) points. The average operative time was 86.7 and 71.6 minutes for the IPP and malleable penile prosthesis procedure, respectively. No glans ischemia was recorded; however, 1 IPP infection and 1 delayed distal corporeal erosion were recorded. Hematoma or bruising was observed in 23.2% of patients. The modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire was completed by 39 (90.7%) patients. Overall, 89.7% would recommend this surgery. Patient satisfaction with straightness and length was 94.9% and 82.1%, respectively. CLINICAL IMPLICATIONS: The described technique helps restoration of penile length and erectile function in patients with complex PD. STRENGTHS & LIMITATIONS: The strength of the study is that it offers a simple, easy-to-apply technique for surgeons to correct shortening and other malformations in patients with ED and complex PD. The study is limited by the small number of patients, the short follow-up period and the performance of the technique by a single high-volume implanter. CONCLUSION: The implantation of a penile prosthesis (malleable or inflatable) together with multiple incisions of the plaque/tunica albuginea and grafting with a collagen fleece is a safe and efficient treatment for patients with complex PD in addition to ED and significant shortening. Fernández-Pascual E, Gonzalez-García FJ, Rodríguez-Monsalve M, et al. Surgical Technique for Complex Cases of Peyronie's Disease With Implantation of Penile Prosthesis, Multiple Corporeal Incisions, and Grafting With Collagen Fleece. J Sex Med 2019;16:323-332.

La perineoplastia protésica del tabique rectovaginal, vía transvaginal, en el tratamiento del rectocele y enterocele. Resultados de 77 casos / Transvaginal mesh perineal repair of the rectovaginal septum in the treatment of rectocele and enterocele. Outcomes in 77 patients

Objetivo. Se estudian de forma prospectiva los resultados anatómicos y funcionales de la perineoplastia del tabique rectovaginal, con malla de polipropileno y por vía transvaginal, en 77 pacientes con rectocele, enterocele o ambas patologías asociadas. También se analiza la frecuencia de otras patologías asociadas del suelo pélvico. Pacientes y método. Entre 1997 y mayo de 2005 se interviene quirúrgicamente a 77 pacientes, de las cuales 30 presentaban un enterocele, 33 un rectocele y en 14 casos se presentaban ambas patologías asociadas. En todas se realiza una disección completa del espacio rectovaginal, resección de la pared vaginal redundante, sutura de la malla a los haces laterales del músculo puborrectal con polipropileno y una colporrafia posterior. En el enterocele se reseca previamente el saco de Douglas antes de la colocación de la malla. Resultados. En el seguimiento de las pacientes se han registrado 3 mínimas dehiscencias vaginales que requirieron en 2 (12,1%) casos la extirpación parcial de malla, así como 1 (1,2%) recidiva de rectocele. No se han registrado extrusiones posteriores de malla ni recidivas durante el seguimiento. La frecuencia de patología asociada del suelo pélvico ha sido de un 92%. Conclusiones. La colocación de mallas de polipropileno en el tabique rectovaginal por la vía transvaginal, y suturadas lateralmente a los haces del músculo puborrectal, aporta en nuestra experiencia unos excelentes resultados frente a otras vías de abordaje y con mallas que no se suturan y fijan en el tabique rectovaginal dando lugar a infecciones de la malla, extrusiones o retiradas totales de ésta (AU)

Objective. Anatomical and functional outcomes after transvaginal perineoplasty of the vaginal septum using polypropylene mesh in 77 patients with rectocele, enterocele, or both were studied. The frequency of other associated pelvic floor defects was also analyzed. Patients and method. Between 1997 and May 2005, 77 patients underwent surgery (30 for enterocele, 33 for rectocele and 14 for both defects). In all patients, complete dissection of the rectovaginal space, resection of the redundant vaginal wall tissue, suturing of the polypropylene mesh to the lateral bundles of the puborectal muscle, and posterior colporrhaphy were performed. In enteroceles, Douglas' pouch was resected before the mesh was placed. Results. During follow-up, there were 3 minimal vaginal dehiscences requiring partial extirpation of the mesh in 2 (12.1%), and 1 (1.2%) rectocele recurrence. No subsequent mesh extrusions or recurrences were detected during follow-up. The frequency of associated pelvic floor disorders was 92%. Conclusions. In our experience, placement of polypropylene mesh in the rectovaginal septum with lateral suturing to puborectal muscle bundles provides excellent results compared with other approaches and meshes that are not sutured and fixed in the rectovaginal space, leading to mesh infection, extrusion or complete removal (AU)