[Vascular complications in renal transplantation]. / Complicaciones vasculares en el trasplante renal.

Between the years 1979 and 1992 we a total of 479 renal transplants (RT) were performed. In 62 patients (12.9%) there were some clinically significant vascular complications. These have consisted of: 10 cases of arterial thrombosis (2%); 10 cases of venous thrombosis (2%); 5 cases of arterial and venous thrombosis (1%); 31 cases of arterial stenosis (6.5%); and 6 cases of acute haemorrhage originated at the vascular anastomosis level (1.2%). In all those cases with arterial or venous thrombosis, or both, it was necessary to perform transplantation. The arterial stenosis cases were treated with antihypertensive agents in 13 patients; with endoluminal percutaneous angioplasty (EPA) in other 13 patients and with surgery in 5. Both arterial stenosis and complications from their treatment resulted in 5 transplantations. In all cases with early post-surgical haemorrhage originated at the vascular anastomosis level, a surgical review and suture of bleeding site was performed. A total of 31 grafts (6.5%) were lost as a result of vascular complications.

[Testicular seminoma manifested by carcinomatous neuropathy: an unusual presentation. Review of the literature]. / Seminoma testicular manifestado por neuropatía carcinomatosa: una presentación poco común. Revisión de la literatura.

Contribution of one patient with tetraparesic picture originated by a major sensory-motor neuropathy, due to paraneoplastic syndrome produced by a testicular seminoma. The patient underwent inguinal orchiectomy and radiotherapy, with favourable evolution of his neurological symptomatology. Review of the literature and confirmation of the extraordinary rarity of such clinical picture.

Control of massive hematuria in idiopathic hemorrhagic cystitis after administration of conjugated estrogen.

A renal transplant patient with severe hemorrhagic cystitis of idiopathic etiology was treated initially with intravenous administration of conjugated estrogen (1 mg./kg.), followed on day 2 and thereafter with 5 mg. per day orally for 3 weeks. Hematuria decreased in intensity within 10 hours and disappeared within 48 hours. Hematuria did not recur by 6 months after completion of oral doses of conjugated estrogen. Complications or other side effects were not observed. In our experience conjugated estrogen controls hematuria in patients with idiopathic hemorrhagic cystitis and this form of treatment must be considered in this condition.

[Endourologic treatment of calyceal diverticulum complicated with lithiasis]. / Tratamiento endourológico del divertículo calicial complicado con litiasis.

Presentation of 9 cases of calyceal diverticulum symptomatic lithiasis, 6 of which have been treated up to the present time. Of the remaining 3, one patients, in spite of its evolutive character (increased cavity) and moderate pain, prefers to abstain from therapeutic therapy, but undergoes follow-up controls every 6 months; the other 2 cases are waiting endourological treatment. Out of 6 patients who underwent surgery, two cases, who had previously experienced shockwave extracorporeal lithotripsy (SWEL), were advised to have endourological procedures due to persistence of pain and gallstones debris.

[Infiltrating transitional cancer of the bladder (2). Prognostic value of the stage. Its influence on the therapeutic decision)]. / Cancer transicional infiltrante de vejiga (2a Parte). Valor pronóstico del estadío. Su influencia én la decisión terapéutica.

The only reliable sign to give a prognosis is the anatomopathological stage (P or pT) obtained from the study of the cystectomy surgical piece: partial or total. Tumourless (P0) bladders conceal the inability to reach any certainty over the tumour's inexistance. Removal should not be considered as a success but an error. The fact that no tumour is found in the removed bladder does not guarantee that the patient will not eventually die of metastasis. A pT2 stage has a better prognosis than pT3a and both evolve better that either pT3b or pT4a and, therefore, their treatment and management may be different. Clinical stage (T) is not a reliable sign: the possibilities of over and undervaluation are very high. Subtraction of P from T cannot be maintained as an adequate sign to assess the action of the adjuvant therapy to surgery and should be excluded in order to delimit the action of the neo-adjuvant chemotherapy. Also, patients with pT2 and pT3a tumours should be excluded from these protocols since the possibilities that they may be removed during the evaluation R.T.U. are high.

[Unilateral essential hematuria: diagnostic and therapeutic attitude in 2 cases]. / Hematuria esencial unilateral: actitud diagnóstica y terapéutica en dos casos.

Unilateral essential haematuria is an unusual clinical entity where diagnosis is achieved by exclusion of other urological and nephrological conditions. The paper reports two female patients with unilateral anaemic macroscopic haematuria which were evaluated using flexible ureteropyeloscopy, and one also underwent percutaneous pyeloscopy. In one of the patients a renal papilla haemangioma was found which was fulgurated, while the lesion was not identified in the other patient, although neither of them has shown haematuria recurrence during the follow-up period. The authors believe that uretororrenoscopy and percutaneous nephroscopy should be considered in selected patients with unilateral essential haematuria due to its diagnostic and therapeutic possibilities.

Lymphorrhea as postoperative complication of living donor nephrectomy: a case report.

We report a case of lymphorrhea after living donor nephrectomy. Clinically the donor presented with an increased flow of a liquid characteristic of lymph, which was treated successfully with iodinated povidone. The possible pathogenic mechanisms implicated in the development of lymphocele following renal transplantation are discussed.

Diagnosis and management of lymphoceles after renal transplantation.

Eighteen lymphoceles developed after 199 renal transplantations, 11 being asymptomatic. Ultrasound was the most sensitive method of detection. Seven lymphoceles were symptomatic, pelvic mass and decreased renal function being the most frequent signs. Five lymphoceles were successfully treated by instillation of iodate povidone into the lymphatic cavity; there were no complications or recurrences. This is a simple, safe and inexpensive method for the treatment of lymphoceles after renal transplantation.

Bone metaplasia in the urinary tract: a new radiological sign.

We report 7 cases of bone tissue in the upper urinary tract. Routine excretory urography was suspicious for renal lithiasis. However, pathological evaluation of the kidney tissue revealed bone metaplasia in all 7 cases. Retrospective examination of the first 6 cases showed a typical radiological sign, consisting of a radiopaque eccentric halo surrounding an area of lesser radiological density that, in turn, connected with the urothelium. These findings permitted a correct preoperative diagnosis of bone metaplasia in case 7. Accurate preoperative differentiation of bone metaplasia (false calculi) and true renal lithiasis is important owing to the different treatments required.

Perirenal subcapsular fluid collection in a patient with membranous nephropathy and renal vein thrombosis.

We report a case of perirenal fluid collection associated with membranous nephropathy and right renal vein thrombosis. Surgical removal of the fluid and instillation of povidone iodine resolved the problem.