Normothermic Regional Perfusion in Controlled Donation After Circulatory Determination of Death Simultaneous Pancreas - Kidney Transplantation.

BACKGROUND: Simultaneous pancreas-kidney transplantation is the optimal treatment for patients with type 1 diabetes and renal failure. The use of pancreas grafts from donation after circulatory death (DCD), using normothermic regional perfusion (NRP), is still marginal worldwide, mainly due to possible additional risks of graft dysfunction and complications compared with grafts from donors after brain death. METHODS: Case series of patients who underwent simultaneous pancreas-kidney transplantation after DCD-NRP between January 2018 and September 2022. This study evaluated early postoperative grafts and survival outcomes. RESULTS: Four patients were included. One patient lost the pancreatic graft due to arterial thrombosis requiring transplantectomy. Another patient required a laparotomy due to hemoperitoneum. Overall, 1-year pancreas and kidney graft survival was 75% and 100%, respectively. One patient developed a lymphoma during the follow-up. CONCLUSION: The use of pancreas grafts from DCD after NRP preservation is safe and feasible. Comparative studies with donors after brain death grafts and larger series are required to confirm the feasibility of DCD-NRP pancreas transplantation.

Management of Penis Fracture: Clinical Cases Treated in Our Center and Comparison with Literature

Abstract Objective: To expose our clinical experience in the management of the penis fracture and make a literature review about this topic. Methods: We present a case of a 49 years old man diagnosticated penis fracture. We expose the results of our clinical cases diagnosticated and treated from October 2018 to October 2020 and make a literature review. Results: A 49 years old man that presented swallow and sensation of snap during a sexual intercourse. He was diagnosticated of penis fracture with the help of ultrasound and was performed an urgent reparation. The results of our serial of 4 cases were: The 75% (3) presented pain and sensation of snap during the sexual intercourse, 50% (2) detumescence, the 100% (4) ecchymosis and the 25% (1) present an actual lateral deviation. Anyone presents erectile dysfunction nowadays. Conclusions: The penis fracture has a clinical diagnosis but the ultrasound could be useful. The early surgical repair has a good result with low tase of complications (AU)

Physiopathology of the Priapism Secondary to Tamsulosin: Clinical Cases of Our Hospital and Literature Review.

OBJECTIVE: To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature. METHODS: We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic. RESULTS: In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain. CONCLUSIONS: The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it's association with a disease like the priapism forced us to explain to our patients this rare adverse effect.

Serum biomarkers for diagnosis and characterization of prostate cancer. / Biomarcadores plasmáticos en el diagnóstico y caracterización del cáncer de próstata.

PSA is the most widely used diagnosticand prognostic biomarker in prostate cancer (PCa).However, its lack of specificity has generated the needto search for new complementary markers. In thisscenario, blood plasma constitutes one of the sourcesof search for new markers, which have been tried tobe combined with PSA and other clinical variables inorder to develop tests that increase their diagnosticspecificity.This narrative review of the literature provides anoverview of commercially available plasma biomarkers and tests for use in different clinical settingsfor PCa. The most studied markers to help select theappropriate patients for initial and / or repeat biopsyhave been: PHI, 4K, STHLM3. These markers havebeen oriented towards the diagnosis of the so-calledclinically signifi cant PCa, trying to validate and calibratetheir algorithms in different populations. Giventhe development and evolution in the diagnosis of PCa,there is still a lack of evidence of the impact of magneticresonance imaging (MRI) when used in combinationwith these new markers, as well as its possiblerole in the screening of the disease and not only in theearly diagnosis process. Furthermore, there are only asmall number of studies that have directly comparedthese tests with each other and with PSA, so there isnot enough evidence to know which test has the bestproperties in each clinical scenario. In order to clarifythe true diagnostic role of these new biomarkers, newprospective, comparative studies in different populationsare absolutely necessary to evaluate their clinicalutility in combination with MRI and fusion biopsy.

El PSA es el biomarcador diagnóstico ypronóstico más ampliamente utilizado en cáncer deprostata (CaP). Sin embargo, su falta de especificidadha generado la necesidad de buscar nuevos marcadorescomplementarios. En este escenario, el plasmasanguíneo constituye una de las fuentes de búsquedade nuevos marcadores, los cuales han tratado decombinarse con el PSA y otras variables clínicas conel objeto de desarrollar tests que aumentaran su especificidaddiagnóstica.En esta revisión narrativa de la literatura se proporcionauna descripción general de los biomarcadoresplasmáticos y tests disponibles comercialmentepara ser utilizados en diferentes contextos clínicosdel CaP. Los test más estudiados para ayudar a seleccionarlos pacientes adecuados para la biopsia inicialy / o repetida han sido: PHI, 4K, STHLM3. Estos testse han orientado hacia el diagnóstico del denominadoCaP clínicamente significativo, intentando validary calibrar sus algoritmos en diferentes poblaciones.Dado el desarrollo y evolución en el diagnóstico deCaP, aún existe una falta de evidencia del impacto de la resonancia magnética (RM) al ser empleada encombinación con estos nuevos marcadores, así comosu posible papel en el screening de la enfermedad yno solo en el proceso de diagnóstico precoz. Además,solo se dispone de una pequeña cantidad de estudiosque hayan comparado directamente estos test entreellos y con el PSA, de modo que no existe evidenciasuficiente para saber qué test tiene mejores propiedadesen cada escenario clínico. En el escenarioactual, para poder aclarar el verdadero papel diagnósticode estos nuevos biomarcadores, son absolutamentenecesarios nuevos estudios prospectivos,comparativos y en diferentes poblaciones, que evalúensu utilidad clínica en combinación con la RM yla biopsia fusión.

Biomarcadores plasmáticos en el diagnóstico y caracterización del cáncer de próstata / Serum biomarkers for diagnosis and characterization of prostate cáncer

El PSA es el biomarcador diagnóstico y pronóstico más ampliamente utilizado en cáncer deprostata (CaP). Sin embargo, su falta de especificidadha generado la necesidad de buscar nuevos marcadores complementarios. En este escenario, el plasmasanguíneo constituye una de las fuentes de búsqueda de nuevos marcadores, los cuales han tratado decombinarse con el PSA y otras variables clínicas conel objeto de desarrollar tests que aumentaran su especificidad diagnóstica.En esta revisión narrativa de la literatura se proporciona una descripción general de los biomarcadores plasmáticos y tests disponibles comercialmentepara ser utilizados en diferentes contextos clínicosdel CaP. Los test más estudiados para ayudar a seleccionar los pacientes adecuados para la biopsia inicialy / o repetida han sido: PHI, 4K, STHLM3. Estos testse han orientado hacia el diagnóstico del denominado CaP clínicamente significativo, intentando validary calibrar sus algoritmos en diferentes poblaciones.Dado el desarrollo y evolución en el diagnóstico deCaP, aún existe una falta de evidencia del impacto de la resonancia magnética (RM) al ser empleada encombinación con estos nuevos marcadores, así comosu posible papel en el screening de la enfermedad yno solo en el proceso de diagnóstico precoz. Además,solo se dispone de una pequeña cantidad de estudiosque hayan comparado directamente estos test entreellos y con el PSA, de modo que no existe evidenciasuficiente para saber qué test tiene mejores propiedades en cada escenario clínico. En el escenarioactual, para poder aclarar el verdadero papel diagnóstico de estos nuevos biomarcadores, son absolutamente necesarios nuevos estudios prospectivos,comparativos y en diferentes poblaciones, que evalúen su utilidad clínica en combinación con la RM yla biopsia fusión. (AU)

PSA is the most widely used diagnosticand prognostic biomarker in prostate cancer (PCa).However, its lack of specificity has generated the needto search for new complementary markers. In thisscenario, blood plasma constitutes one of the sourcesof search for new markers, which have been tried tobe combined with PSA and other clinical variables inorder to develop tests that increase their diagnosticspecificity.This narrative review of the literature provides anoverview of commercially available plasma biomarkers and tests for use in different clinical settingsfor PCa. The most studied markers to help select theappropriate patients for initial and / or repeat biopsyhave been: PHI, 4K, STHLM3. These markers havebeen oriented towards the diagnosis of the so-calledclinically signifi cant PCa, trying to validate and calibrate their algorithms in different populations. Giventhe development and evolution in the diagnosis of PCa,there is still a lack of evidence of the impact of magnetic resonance imaging (MRI) when used in combination with these new markers, as well as its possiblerole in the screening of the disease and not only in theearly diagnosis process. Furthermore, there are only asmall number of studies that have directly comparedthese tests with each other and with PSA, so there isnot enough evidence to know which test has the bestproperties in each clinical scenario. In order to clarifythe true diagnostic role of these new biomarkers, newprospective, comparative studies in different populations are absolutely necessary to evaluate their clinicalutility in combination with MRI and fusion biopsy. (AU)

Role of Multiparametric Prostate Magnetic Resonance Imaging before Confirmatory Biopsy in Assessing the Risk of Prostate Cancer Progression during Active Surveillance.

OBJECTIVE: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). MATERIALS AND METHODS: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. RESULTS: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. CONCLUSION: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

A Single-Center Experience With Third and Fourth Kidney Transplants and Second Kidney Transplant After Pancreas-Kidney Transplant: Surgical Aspects and Outcomes.

OBJECTIVES: Overall, 25% to 33% of patients on kidney transplant wait lists present with prior graft loss. In addition, the number of patients who require a retransplant seems to be increasing. Here, we describe our experience with patients who had a second kidney transplant after a previous pancreas-kidney transplant or a third or fourth kidney transplant. We focused specifically on the technical aspects and outcomes related to this patient group. MATERIALS AND METHODS: A single-center retrospective study was performed. The cohortincluded 15 patients > 18 years old who had received a second kidney graft after pancreas-kidney transplant or a second or greater kidney graft between 2013 and 2019. RESULTS: Median age of recipients was 45 years (range, 20-58 y). In 10 patients, the transperitoneal approach was selected. In 5 patients, the retroperitoneal heterotopic kidney retransplant technique was used. Early surgical complications (≤ 30 days posttransplant) were reported in 4 patients. Three patients had late ureteral stenosis (> 90 days posttransplant). All grafts were functioning at time of patient discharge. Mean creatinine level was 2.69 mg/dL (range, 1.23-6.26 mg/dL). The 1-year and 2-year graft survivalrates were 85% and 75%, respectively. No grafts were lost because of surgical complications. CONCLUSIONS: Retransplant of a second graft after pancreas-kidney transplant or retransplant of a third or fourth renal graft is challenging but feasible, with evidence of reasonably positive outcomes after retransplant.

Clinical association of metabolic syndrome, C-reactive protein and testosterone levels with clinically significant prostate cancer.

Recently, the influence that metabolic syndrome (MetS), hormonal alterations and inflammation might have on prostate cancer (PCa) risk has been a subject of controversial debate. Herein, we aimed to investigate the association between MetS-components, C-reactive protein (CRP) and testosterone levels, and the risk of clinically significant PCa (Sig-PCa) at the time of prostate biopsy. For that, men scheduled for transrectal ultrasound guided biopsy of the prostate were studied. Clinical, laboratory parameters and criteria for MetS characterization just before the biopsy were collected. A total of 524 patients were analysed, being 195 (37.2%) subsequently diagnosed with PCa and 240 (45.8%) meet the diagnostic criteria for MetS. Among patients with PCa, MetS-diagnosis was present in 94 (48.2%). Remarkably, a higher risk of Sig-PCa was associated to MetS, greater number of MetS-components and higher CRP levels (odds-ratio: 1.83, 1.30 and 2.00, respectively; P < 0.05). Moreover, higher circulating CRP levels were also associated with a more aggressive Gleason score in PCa patients. Altogether, our data reveal a clear association between the presence of MetS, a greater number of MetS-components or CRP levels >2.5 mg/L with an increased Sig-PCa diagnosis and/or with aggressive features, suggesting that MetS and/or CRP levels might influence PCa pathophysiology.

Importancia de la rehabilitación precoz de los cuerpos cavernosos tras prostatectomía radical / Importance of early rehabilitation of the corpus cavernosum after radical prostatectomy

Objetivos: Primario: evaluar la importancia de una rehabilitación precoz de los cuerpos cavernosos sobre la función eréctil tras prostatectomía radical. Secundario: analizar los factores asociados a una mejor respuesta. Material y método: Estudio retrospectivo en pacientes tratados con inyecciones intracavernosas tras prostatectomía radical entre el 1 de enero de 2006 y el 31 de diciembre de 2008. Se incluyeron enfermos sin antecedentes de disfunción eréctil previa a la cirugía, no respondedores a inhibidores de la 5-fosfodiesterasa. En todos se realizó ecodoppler color tras inyección de prostaglandina E1 10-20 mg. Se compararon 2 grupos en función de la precocidad del inicio de la rehabilitación tras la cirugía (precoz, < 6 meses, o tardía, > 6 meses). Resultados: Se incluyeron 82 pacientes. En el análisis multivariante, fueron factores predictores de buena respuesta al tratamiento: inicio precoz de la rehabilitación (OR: 0,06; IC 95%: 0,014- 0,26), mayor velocidad pico sistólica durante el test (OR: 1,01; IC 95%: 1,01-1,1) y estadio anatomopatológico favorable (OR: 0,15; IC 95%: 0,036-0,6). El ecodoppler color tras inyección de prostaglandina E1 presentó valores anormales con mayor frecuencia en el grupo de inicio tardío frente al precoz (89,5% [n = 34] vs. 65,9% [n = 29]; p = 0,01). El 40,2% (n = 33) de los sujetos presentaron fracaso del mecanismo corporovenooclusivo, presentando valores más elevados el grupo de inicio tardío (5,53 ± 1,4 cm/seg) frente al precoz (4,75 ±1,03 cm/seg) (p = 0,005). La presencia de erecciones funcionales a los 18 meses del seguimiento fue mayor en el grupo de inicio precoz (p < 0,001). Conclusiones: Según el presente estudio, en pacientes tras prostatectomía radical la rehabilitación farmacológica precoz de la erección presenta mejores resultados comparada con la tardía (AU)

Objectives: Primary: to evaluate the importance of early rehabilitation of the corpus cavernosum on erectile function after radical prostatectomy. Secondary: to analyse the factors associated with better response. Material and method: Retrospective study in patients treated with intracavernous injections after radical prostatectomy between 1 January 2006 and 31 December 2008. We included patients lacking a history of erectile dysfunction prior to surgery, not responding to phosphodiesterase-5 inhibitors. All patients underwent colour echo-doppler after injection of prostaglandin E1 10-20 mg. The outcomes of these 2 groups were then compared according to how early rehabilitation began after surgery (early, < 6 months, or late, > 6 months). Results: There were 82 patients included in the study. In the multivariate analysis, predictive factors of good response to treatment were: early onset of rehabilitation (OR: 0.06; 95% CI: 0.014-0.26), higher peak systolic velocity during the test (OR: 1.01; 95% CI: 1.01-1.1) and favourable histopathological stage (OR: 0.15; 95% CI 95%: 0.036-0.6). The colour echo-doppler procedure after prostaglandin E1 injection showed abnormal values more frequently in the lateonset than in the early group (89.5% [n = 34] vs. 65.9% [n = 29]; P = .01). Corporal veno-occlusive dysfunction was presented by 40.2% (n = 33) of subjects, with the late-onset group presenting higher values (5.53 ± 1.4 cm/sec) than the early group (4.75 ± 1.03 cm/sec) (P = .005). The presence of functional erections at 18 months’ follow-up was higher in the early onset group (P < .001). Conclusions: According to this study, early erectile dysfunction rehabilitation after radical prostatectomy achieves better results than late rehabilitation in patients (AU)

Hemangioma cavernoso intraescrotal; una enfermedad poco frecuente / Intrascrotal cavernous hemangioma: An uncommon disease

El hemangioma cavernoso intraescrotal es una enfermedad muy rara que debe tenerse en cuenta cuando se realiza el diagnóstico diferencial de las masas vasculares. Un paciente de 26 años de edad fue remitido al Servicio de Urología para la evaluación de malestar y una sensación de masa en el hemiescroto derecho. La ecografía doppler mostró una malformación vascular y el paciente fue sometido a resección de la masa por vía inguinal derecha. El examen anatomopatológico reveló el diagnóstico de hemangioma cavernoso. No hubo complicaciones durante la cirugía y no se ha producido recurrencia de la misma. A pesar de su baja incidencia, es importante tenerlo en cuenta al realizar el diagnóstico diferencial de masas vasculares. Para su diagnóstico, el examen físico y el uso de técnicas de ultrasonido doppler son esenciales (AU)

Intrascrotal cavernous hemangioma is a very rare disease which should be taken into account when making a differential diagnosis of vascular masses. A 26-year-old male patient was referred to the Urology Department for evaluation of discomfort and sensation of having a mass in his right hemiscrotum. Doppler ultrasound imaging showed a vascular malformation and the patient underwent excision of the mass through an inguinal incision. Anatomical and pathologic examination revealed cavernous hemangioma. There were no complications during the surgery and no recurrence afterwards. Despite its low incidence, it is important to keep this in mind when making differential diagnoses of vascular masses. Physical examinations and the use of doppler ultrasound techniques are essential for its diagnosis (AU)

¿A qué nivel se produce la fragmentación del ADN en pacientes infértiles con varicocele? / Analysis of the site of DNA fragmentation in infertile men with varicocele

Objetivo: Establecer a qué nivel se produce la fragmentación del ácido desoxirribonucleico (FADN), intratesticular o en la vía seminal, en varones infértiles con varicocele. Material y métodos: Análisis preliminar sobre 15 sujetos en estudio por infertilidad de un año de evolución con varicocele como causa más probable de su alteración. Realizamos FADN en semen previo a la varicocelectomía quirúrgica. Durante la intervención, se obtuvo una muestra testicular mediante biopsia (TESE), para la medición de FADN en espermatozoides intratesticulares, con el objetivo de establecer sus valores y si había diferencias respecto al semen. Resultados: Quince pacientes fueron intervenidos de varicocele izquierdo. En el seminograma, la alteración más frecuente fue la oligoastenozoospermia. Presentaron ADN fragmentado en semen 9 pacientes con una media de 47,8% (rango 38,8-59,2%), y en 6 fueron normales (media 27,4%; rango 12,7-35,3%). La FADN en testículo presentó valores más elevados que en el semen, estando alterados en 14 de los 15 pacientes (media 62,3%, rango 39,0-83,3%). Conclusiones: La FADN parece tener un papel importante en la fisiopatología actual del varicocele y aumenta en el semen de varones infértiles con esta alteración. Derivado de nuestros resultados, podríamos deducir que el mecanismo más importante de fragmentación se situaría a nivel intratesticular, en contra de lo que actualmente se postula. Confirmar esta hipótesis con mayor número de casos supondría un avance significativo en el conocimiento y aplicaciones clínicas en cuanto a esta patología (AU)

Objective: To establish the site at which intratesticular or seminal DNA fragmentation (DNAF) occurs in infertile men with varicocele. Material and Methods: A preliminary analysis was performed in a 1-year study of 15 patients in whom the suspected cause of infertility was varicocele. Analysis of DNAF was performed in semen prior to surgical varicocelectomy. To measure DNAF in intratesticular sperm, testicular samples were obtained by biopsy during the intervention. Results: Fifteen patients had left varicocele surgery. The most frequent abnormality observed in the semen was oligoasthenozoospermia. Nine patients had DNAF (average: 47.8%, range: 38.8-59.2%), and six were normal (average; 27.4%, range: 12.7-35.3%). DNAF levels were higher in testicular tissue samples than in semen (average: 62.3%, range: 39.0-83.3%). Only one of these patient samples did not reveal DNAF. Conclusions: DNAF seems to be related to the physiopathology of varicocele and is present at higher levels in the semen of infertile men with this alteration. In view of these results, we deduce that DNA fragmentation will primarily occur in the testes, which is contrary to current understanding. Testing this hypothesis in studies that include more patients would allow important advances to be made in the knowledge and treatment of this alteration (AU)