Histological Comparison of Buccal and Lingual Mucosa Grafts for Urethroplasty: Do They Share Tissue Structures and Vascular Supply?

Comparable outcomes were published using a buccal mucosa graft (BMG) from the cheek and a lingual mucosa graft (LMG) from the sublingual area, for urethral augmentation or substitution. To date, no histological comparison between both grafts has been conducted. We histologically assessed BMG and LMG harvested during urethral surgeries, aiming to compare graft properties and vascular support. We conducted a prospective single cohort study, including oral mucosa urethroplasty patients. During surgery, graft dimensions and donor sites were collected, and a 0.5 × 0.5 cm sample was obtained from the prepared graft. Formalin-fixed paraffin-embedded samples were sliced at 4 micrometres (µm) and hematoxylin-eosin stained. Using a telepathology tool, all slides were digitalized and measured from 10× to 40× magnification. In each graft, global and individual layers thicknesses were assessed, including vascular density and area. Descriptive and comparative (parametrical and non-parametrical) statistical analysis occurred. We collected 57 grafts during 33 urethroplasties, with 30 BMG and 22 LMG, finally, included. The mean age was 56.6 (SD 15.2) years, and the mean graft length was 5.8 (SD 1.7) cm and the width was 1.7 (SD 0.4) cm. The median graft thickness was 1598.9 (IQR 1200-2100) µm, the mean epithelium layer was 510.2 (SD 223.7) µm, the median submucosa was 654 (IQR 378-943) µm. the median muscular was 477.6 (IQR 286-772) µm, the median vascular area was 5% (IQR 5-10), and the median adipose tissue area was 5% (IQR 0-20). LMG were significantly longer and narrower than BMG. Total graft thickness was similar between LMG and BMG, but the epithelium and submucosa layers were significantly thinner in LMG. The muscular layer was significantly thicker in LMG. Vascular density and vascular areas were not significantly different between both types of grafts. LMG showed significantly less adipose tissue compared with BMG. Our findings show LMG and BMG for urethroplasty surgeries share the same thickness and blood supply, despite having significantly different graft sizes as well as mucosal and submucosal layers thickness.

Evaluación del impacto sobre la actividad sexual de un programa de rehabilitación pulmonar para pacientes con enfermedad pulmonar obstructiva crónica / Assessment of the impact of pulmonary rehabilitation on sexual activity in patients with chronic obstructive pulmonary disease

ANTECEDENTES Y OBJETIVO: La enfermedad pulmonar obstructiva crónica (EPOC) limita la calidad de vida, teniendo consecuencias sobre la esfera sexual. Los programas de rehabilitación respiratoria (PRR) ayudan al tratamiento de estos pacientes. Analizamos la actividad sexual de pacientes con EPOC y los resultados de un PRR. PACIENTES Y MÉTODOS: Estudio prospectivo de cohorte única en varones diagnosticados de EPOC y candidatos a PRR. Evaluación clínica, respiratoria y analítica (T, LH, FSH, estradiol y progesterona). International Index of Erectile Function (IIEF) al inicio y tras 6 meses de PRR. Análisis descriptivo inicial, comparando parámetros respiratorios según actividad sexual. Análisis de cambios tras el PRR mediante IIEF y satisfacción mediante el cuestionario Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTADOS: Entre 2014 y 2016, 62 varones incluidos. Edad media: 66,5 años (SD 7,2); 52 exfumadores. Diez eran sexualmente activos (16,1%). No detectamos alteraciones hormonales. No apreciamos diferencias significativas en parámetros respiratorios (FEV1, test de marcha de 6 min, número de exacerbaciones, puntuación en CAT) entre pacientes sexualmente activos y no activos. Puntuación media inicial IIEF: función eréctil 8, función orgásmica 4, deseo sexual 5,6, satisfacción con relaciones 5,3 y satisfacción global 4,5. Tras PRR, aumento significativo en la puntuación total del IIEF: 6,1 (IC95% 1,9-10,3). Mejoría en todos los dominios, con cambio significativo en satisfacción con relaciones: 0,9 (IC95% 0,2-1,6). Moderada satisfacción con el tratamiento según EDITS. CONCLUSIONES: Solo un pequeño porcentaje de pacientes con EPOC incluidos en un PRR son activos sexualmente. No se aprecian diferencias respiratorias entre los pacientes activos y no activos. Los PRR provocan mejoría global en la función sexual, particularmente en la satisfacción con las relaciones

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) affects life quality, and also sexual activity. Pulmonary rehabilitation (PR) is a helpful treatment in COPD patients. The aim of this study is to assess sexual activity on COPD patients, and the effect of PR over it. PATIENTS AND METHODS: Single cohort prospective study over male COPD candidates to PR. Clinical, respiratory and biochemical assessment (FSH, LH, T, and progesterone) was performed. Patients were asked to fill baseline International Index of Erectile Function (IIEF) questionnaire, and 6 months after PR. A descriptive initial analysis compared respiratory values between patients with and without sexual activity. Changes in IIEF results were assessed after PR, and satisfaction with treatment using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: Between 2014 and 2016, 62 male COPD patients enlisted. Mean age: 66.5 years (SD 7.2). 52 Ex-smokers. 10 declared being sexually active (16.1%). No hormonal levels alterations. No significant differences on respiratory parameters between sexually active and non-active patients (FEV1, 6-minutes walking test, number of exacerbations, CAT score). Baseline mean IIEF values: Erectile function 8, orgasmic function 4, sexual desire 5.6, intercourse satisfaction 5.3, and overall satisfaction 4.5. After PR, significant increase in mean IIEF value: 6.1 (CI95% 1.9-10.3). Improvement was found in all domains, with statistical significance on intercourse satisfaction 0.9 (CI95% 0.2-1.6). Moderate satisfaction with treatment was achieved according to EDITS. CONCLUSIONS: Only a low percentage of COPD males included in PR is sexually active. No pulmonary differences were found between sexually active and non-active patients. PR improves sexual function, particularly intercourse satisfaction domain

[Assessment of the impact of pulmonary rehabilitation on sexual activity in patients with chronic obstructive pulmonary disease]. / Evaluación del impacto sobre la actividad sexual de un programa de rehabilitación pulmonar para pacientes con enfermedad pulmonar obstructiva crónica.

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) affects life quality, and also sexual activity. Pulmonary rehabilitation (PR) is a helpful treatment in COPD patients. The aim of this study is to assess sexual activity on COPD patients, and the effect of PR over it. PATIENTS AND METHODS: Single cohort prospective study over male COPD candidates to PR. Clinical, respiratory and biochemical assessment (FSH, LH, T, and progesterone) was performed. Patients were asked to fill baseline International Index of Erectile Function (IIEF) questionnaire, and 6 months after PR. A descriptive initial analysis compared respiratory values between patients with and without sexual activity. Changes in IIEF results were assessed after PR, and satisfaction with treatment using Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: Between 2014 and 2016, 62 male COPD patients enlisted. Mean age: 66.5 years (SD 7.2). 52 Ex-smokers. 10 declared being sexually active (16.1%). No hormonal levels alterations. No significant differences on respiratory parameters between sexually active and non-active patients (FEV1, 6-minutes walking test, number of exacerbations, CAT score). Baseline mean IIEF values: Erectile function 8, orgasmic function 4, sexual desire 5.6, intercourse satisfaction 5.3, and overall satisfaction 4.5. After PR, significant increase in mean IIEF value: 6.1 (CI95% 1.9-10.3). Improvement was found in all domains, with statistical significance on intercourse satisfaction 0.9 (CI95% 0.2-1.6). Moderate satisfaction with treatment was achieved according to EDITS. CONCLUSIONS: Only a low percentage of COPD males included in PR is sexually active. No pulmonary differences were found between sexually active and non-active patients. PR improves sexual function, particularly intercourse satisfaction domain.

Manejo de la estenosis de la anastomosis posprostatectomía radical / Management of vesicourethral anastomotic stenosis after radical prostatectomy

La estenosis de la anastomosis uretrovesical es un problema relativamente poco frecuente tras la prostatectomía radical, aunque puede ser recidivante y de difícil tratamiento. Se conocen ciertos factores de riesgo que pueden ayudar a disminuir su presentación. Para la decisión del plan terapéutico debemos evaluar la estenosis y también la continencia tras la prostatectomía. Hay descritas múltiples opciones de tratamiento, pero la evidencia disponible sobre ellas es baja, limitándose a series de casos de diferente tamaño y seguimiento, y revisiones sobre el tema. Los tratamientos endoscópicos son los más extendidos, con unos porcentajes de éxito que oscilan según la técnica de incisión, resección o vaporización. Una opción adyuvante es la inyección local de fármacos que reduzcan el crecimiento fibroso. En casos recidivantes o con obstrucción completa, pueden requerirse reconstrucción quirúrgica, por vía perineal, abdominal o mixta, o derivaciones suprapúbicas

Vesicourethral anastomotic stenosis is a relatively uncommon problem after radical prostatectomy, but it could become recurrent and difficult to treat. Risk factors are known, and they can help to decrease the incidence. When discussing the therapeutic plan, we must consider the stenosis risk, and also the urinary continence after the prostatectomy. Many treatment schedules are proposed, some of them with low available evidence, limited to case series with different number of patient and follow-up length, or reviews on the subject. Endoscopic options are the commonest, obtaining different success rates depending on the incision, resection or vaporization of the tissue. They could also benefit from the use of adjuvant local injections of drugs regulating tissue growth. Recurrent or obliterated cases could require surgical reconstruction using perineal, abdominal or combined approaches, or even suprapubic urinary diversions

Síndrome de Zinner en un paciente politraumatizado / Zinner's syndrome in a polytrauma patient

Objetivo: Reportar dos nuevos casos de Síndrome de Zinner, una variante anatómica poco prevalente y conocida, con riesgo de originar alteraciones. Método: Descripción de dos casos de Síndrome de Zinner presentados en nuestro centro, durante estudio por epididimitis aguda de repetición y tras traumatismo renal grado IV. Revisión de la literatura hasta la fecha, centrada en su diagnóstico y posibles complicaciones. Resultado: El manejo conservador del paciente politraumatizado permitió preservar el riñón, manteniendo una función renal normal. Es el primer caso de síndrome de Zinner diagnosticado en este contexto clínico. Conclusiones: El Síndrome de Zinner es una entidad poco frecuente y que pasa inadvertida en muchas ocasiones dada la escasa sintomatología que produce

Objective: To report two Zinner's syndrome cases, a rare anatomical variant with risk of complications. Methods: Analysis of two Zinner syndrome cases, detected during acute recurrent epididimytis and after a grade IV renal trauma. Review of the literature focusing on its diagnosis and possible complications. Results: The conservative management of the polytrauma patient allowed to preserve the kidney, while maintaining normal renal function. It is the first Zinner`s syndrome diagnosed in this clinical context. Conclusions: Zinner`s syndrome is a rare entity and often goes unnoticed because of the few symptoms it produces

[Zinner`s syndrome in a polytrauma patient.] / Síndrome de Zinner en un paciente politraumatizado.

OBJECTIVE: To report two Zinner`s syndrome cases, a rare anatomical variant with risk of complications. METHODS: Analysis of two Zinner syndrome cases, detected during acute recurrent epididimytis and after a grade IV renal trauma. Review of the literature focusing on its diagnosis and possible complications. RESULTS: The conservative management of the polytrauma patient allowed to preserve the kidney, while maintaining normal renal function. It is the first Zinner`s syndrome diagnosed in this clinical context. CONCLUSIONS: Zinner`s syndrome is a rare entity and often goes unnoticed because of the few symptoms it produces.

OBJETIVO: Reportar dos nuevos casos de Síndrome de Zinner, una variante anatómica poco prevalente y conocida, con riesgo de originar alteraciones. MÉTODO: Descripción de dos casos de Síndrome de Zinner presentados en nuestro centro, durante estudio por epididimitis aguda de repetición y tras traumatismo renal grado IV. Revisión de la literatura hasta la fecha, centrada en su diagnóstico y posibles complicaciones. RESULTADO: El manejo conservador del paciente politraumatizado permitió preservar el riñón, manteniendo una función renal normal. Es el primer caso de síndrome de Zinner diagnosticado en este contexto clínico. CONCLUSIONES: El Síndrome de Zinner es una entidad poco frecuente y que pasa inadvertida en muchas ocasiones dada la escasa sintomatología que produce.

Multiple Urethral Hemangiomas Associated with Urethral Stricture: An Uncommon Aetiology for Urethral Bleeding.

Urethral haemangiomas are rare benign vascular tumours. They usually cause painless urethral bleeding and haematospermia. Urethroscopy is the preferred diagnostic tool, while complementary radiologic studies could describe the extension of the tumour. Treatment should be tailored to each case, considering size, location, and number of lesions. We present a case of a male patient diagnosed with urethral haemangiomas following painless spontaneous urethral bleeding associated with voiding symptoms.

[Management of vesicourethral anastomotic stenosis after radical prostatectomy]. / Manejo de la estenosis de la anastomosis posprostatectomía radical.

Vesicourethral anastomotic stenosis is a relatively uncommon problem after radical prostatectomy, but it could become recurrent and difficult to treat. Risk factors are known, and they can help to decrease the incidence. When discussing the therapeutic plan, we must consider the stenosis risk, and also the urinary continence after the prostatectomy. Many treatment schedules are proposed, some of them with low available evidence, limited to case series with different number of patient and follow-up length, or reviews on the subject. Endoscopic options are the commonest, obtaining different success rates depending on the incision, resection or vaporization of the tissue. They could also benefit from the use of adjuvant local injections of drugs regulating tissue growth. Recurrent or obliterated cases could require surgical reconstruction using perineal, abdominal or combined approaches, or even suprapubic urinary diversions.

Assessment of the urodynamic diagnosis in patients with urinary incontinence associated with normal pressure hydrocephalus.

AIMS: To assess the urodynamic patterns present in patients with adult normal pressure hydrocephalus (NPH) in our institution. METHODS: Retrospectively conducted study on patients diagnosed with NPH by the Neurosurgery Department of our institution, without etiological treatment or urogynecological disorders, who underwent an urodynamic study (UDS) performed according to methods proposed by the International Society of Continence (ICS). Clinical information, complementary tests and UDS were collected, and descriptive analysis was performed, with special focus in urodynamic final diagnosis. RESULTS: Eighty-one UDS performed between 2003 and 2013. Fifty-one Males (63%). Mean age: 74.89 ± 8.58 years old (range 52-88 years). Classical triad of symptoms: gait disturbance, dementia, and urinary incontinence (UI) presented in 48.1%. Urinary urgency in 80.9% and UI in 70%. In two cases (2.5%) UDS was not valuable. Urodynamic features of the 79 remaining studies revealed overactive detrusor (OD) in 56 patients (70.9%), being associated with Stress UI (SUI) in one case and with bladder outlet obstruction (BOO) in 19. SUI in six patients (7.6%) and BOO in five (6.3%). Detrusor underactivity in four cases (5%) and normal study in eight (10.1%). About 47.1% of males presented BOO. Cerebrospinal fluid shunt surgery was performed on 32 patients during follow-up, with subsequent clinical improvement in 90.6% of them. CONCLUSIONS: OD was the most frequent diagnosis within UDS conducted on adult NPH patients in our institution, with BOO in an elevated percentage of them. Etiological treatment led to symptomatic improvement in most of patients.

Microvejiga tras BCG / Microbladder after the BCG therapy

No disponible

Testicular reconstruction after testicular rupture and review of the literature.

OBJECTIVE: To report a clinical case of testicular rupture and review of the literature published. METHOD: A 15 years old male with a testicular rupture after a sports injury was diagnosed by Doppler ultrasound. RESULTS: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up. CONCLUSIONS: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and e management to avoid orchiectomy.

Reparación tras rotura testicular y revisión de la literatura / Testicular reconstruction after testicular rupture and review of the literature

OBJETIVO: Describir nuestro caso clínico de rotura testicular y revisión de la literatura. MÉTODO: Varón de 15 años que sufre rotura testicular tras accidente deportivo que fue diagnosticada por ecografía doppler. RESULTADOS: Se realiza exploración quirúrgica y se repara la fractura. Buena evolución postoperatoria. Conservación del 75 % del tamaño testicular. CONCLUSIONES: La rotura testicular es una entidad infrecuente pero importante por las secuelas que puede producir. Es fundamental un diagnóstico y tratamiento precoz para evitar la orquiectomía (AU)

OBJECTIVE: To report a clinical case of testicular rupture and review of the published literature. METHODS: A 15 year old male with a testicular rupture after a sport injury was diagnosed by Doppler ultrasound. RESULTS: Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up. CONCLUSIONS: Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and management to avoid orchiectomy (AU)

[Mondor's disease vs. sclerosing lymphangitis of the penis]. / Enfermedad de Mondor versus linfangitis esclerosante de pene.

OBJECTIVE: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. METHOD: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. RESULTS: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. CONCLUSIONS: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence.

Enfermedad de Mondor versus linfangitis esclerosante de pene / Mondor´s disease vs. sclerosing lymphangitis of the penis

Objetivo: Resaltar la diferencia entre Enfermedad de Mondor y Linfangitis Esclerosante del Pene mediante el análisis de tres casos clínicos y la revisión de la literatura existente. Métodos: Describimos dos casos clínicos compatibles con el diagnóstico de enfermedad de Mondor y otro compatible con Linfangitis. Resultado: La buena y muchas veces espontánea resolución de estas dos patologías dificulta el diagnóstico y seguimiento de estos pacientes. Conclusiones: La abstinencia sexual es una de las medidas más efectiva para la pronta resolución de ambos procesos. Para el diagnóstico diferencial entre ambas entidades es de gran utilidad el eco-doppler peneano. El tratamiento farmacológico principal se basa en antiinflamatorios (AU)

Objective: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. Method: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. Results: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. Conclusions: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence (AU)

Vasovasostomía: nuestra experiencia / Vasovasostomy: our experience

OBJETIVO: Desde agosto de1997 hasta diciembre de 2004 hemos realizado 47 vasovasostomíascon la finalidad de revertir la vasectomía, de las que conocemos el resultado de 42, con un seguimiento de al menos 6 meses. La edad media ha sido de 40`7 años y la de sus parejas de 30`8 años.MÉTODO: Los 22 primeros casos se realizaron en 2 planos y 20 en solo uno. En todos los casos se utilizó microscopio óptico.RESULTADOS: La tasa global de presencia de espermatozoidesen el eyaculado ha sido de 71`42% y la de embarazo a término del 32`45%, no encontrando diferencias según la técnica empleada.CONCLUSIONES: Mejor pronóstico a menor edad del paciente y en las recanalizaciones precoces, en cuanto a la presencia de espermatozoides. El índice de embarazoses similar entre las recanalizaciones precoces o tardías

OBJECTIVES: From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples. METHODS: The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others. RESULTS: Overall spermatozoid patency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results. CONCLUSIONS: Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the patency rate. Regarding pregnancy rate, it is not influenced by delay of reversal

[Surgical details and complications from retransplantation into the iliac fossa for third and fourth kidney transplants]. / Aspectos quirúrgicos y complicaciones derivadas de la reutilización de la fosa ilíaca en los terceros y cuartos retrasplantes renales.

OBJECTIVES: To analyze the surgical aspects and complications from retransplantation into the iliac fossa for third and fourth kidney transplants. METHODS: Retrospective study of the 34 third and 5 fourth transplants performed in our department. We analyze patient's characteristics, surgical aspects and complications, and graft outcomes. RESULTS: Mean patient age was 41.6 years. 67% of the first and second transplants had been lost to vascular problems (19%) or chronic rejection (48%). Average time from last transplant in the retransplanted iliac fossa was 9 years (3 days-17 years). There were not significant differences between the groups of first and second transplant and third and fourth in cold ischemia time, number of mismatches, and number of days on hemodialysis after transplantation; there were significant differences in receptor age, number of transfusions, maximum and current antibodies and donor age, all of which were higher in third and fourth transplants. The graft was basically implanted in the right iliac fossa (71%) through a lumbar-iliac iterative incision; vascular anastomosis were equally made to the common and external iliac vessels; ureteral reimplant was performed following an extravesical technique; simultaneous transplant nephrectomy of the previous graft was performed in 33% of the cases. 59% of the cases had immediate diuresis and 49% did not require dialysis within the first 7 postransplant days. Surgical complications were mainly vascular: 4 cases of hemorrhage, 3 venous thrombosis and 2 arterial thrombosis. There were also 4 cases of lymphocele, 1 perirenal hematoma, and 1 enterocutaneous fistula with an abscess of the surgical bed. There were no urologic complications in the series. Globally, there was 1 death (2.5%) secondary to hemorrhage and another 6 grafts (15%) were lost to complications, 5 vascular thrombosis and 1 after surgical bed abscess. 1, 3, 5, and ten-year actuarial graft survival were 65%, 52%, 40% and 28% respectively. CONCLUSIONS: Retransplantation into the iliac fossa for third and fourth transplants is associated with a small increase in the number of surgical complications, mainly vascular complications.

Aspectos quirúrgicos y complicaciones derivadas de la reutilización de la fosa iliaca en los terceros y cuartos retransplantes renales / Surgical details and complications from retransplantation into the iliac fossa for third and fourth kidney transplant

OBJETIVO: Analizar los aspectos quirúrgicosy las complicaciones derivadas de la reutilizaciónde la fosa ilíaca para realizar terceros y cuartos retrasplantesrenales.MÉTODO: Estudio retrospectivo de los 34 terceros y 5cuartos retrasplante renales de nuestra serie de 1364trasplantes. Se analizan las características de lospacientes, aspectos y complicaciones quirúrgicas y laevolución de los injertos.RESULTADOS: La edad media fue de 41.6 años. El67% de los primeros y segundos trasplantes se habíanperdido por problemas vasculares (19%) o por rechazocrónico (48%). El tiempo medio desde el último trasplanteen la fosa ilíaca reutilizada fue de 9 años (3 días - 17 años). No hubo diferencias significativasentre el grupo de primer y segundo trasplante respectodel tercero y cuarto en cuanto al tiempo de isquemiafría, incompatibilidades y días de hemodiálisis post-trasplante;fueron significativas la edad del receptor, númerode trasfusiones, anticuerpos máximos y actuales yedad del donante, todos ellos mayores en los tercerosy cuartos. El injerto se colocó fundamentalmente en lafosa ilíaca derecha (71%) a través de un incisión lumboilíacaiterativa; la anastomosis vascular se hizo porigual a los ilíacos externos y comunes; el reimplante ureteralse hizo mediante técnicas extravesicales; en un33% de los casos se realizó trasplantectomía simultáneadel injerto anterior. En el 59% de los casos hubodiuresis inmediata y el 49% no precisó diálisis en los 7primeros días post-trasplante. Las complicaciones quirúrgicasfueron fundamentalmente vasculares; hubo 4casos de hemorragia, 3 trombosis venosas y 2 arteriales.También tuvimos 4 casos de linfocele, 1 hematomaperirenal y 1 fístula enterocutánea con absceso dellecho quirúrgico; no hubo en esta serie ninguna complicaciónurológica. En total hubo 1 fallecimiento(2.5%) debido a hemorragia y se perdieron otros 6injertos (15%) por las complicaciones, 5 por trombosisvasculares y otro por absceso del lecho quirúrgico.La supervivencia actuarial de los injertos fue del 65% alaño, 52% a los 3, 40% a los 5 y 28% a los 10 años.CONCLUSIONES: La reutilización de la fosa ilíacapara realizar terceros y cuartos trasplantes conlleva unligero aumento en las complicaciones quirúrgicas,especialmente vaculares

OBJECTIVES: To analyze the surgicalaspects and complications from retransplantation intothe iliac fossa for third and fourth kidney transplants.METHODS: Retrospective study of the 34 third and 5fourth transplants performed in our department. Weanalyze patient’s characteristics, surgical aspects andcomplications, and graft outcomes.RESULTS: Mean patient age was 41.6 years. 67% ofthe first and second transplants had been lost to vascularproblems (19%) or chronic rejection (48%). Averagetime from last transplant in the retransplanted iliac fossawas 9 years (3 days-17 years). There were not significantdifferences between the groups of first and secondtransplant and third and fourth in cold ischemia time,number of mismatches, and number of days on hemodialysisafter transplantation; there were significantdifferences in receptor age, number of transfusions,maximum and current antibodies and donor age, all ofwhich were higher in third and fourth transplants. Thegraft was basically implanted in the right iliac fossa(71%) through a lumbar-iliac iterative incision; vascularanastomosis were equally made to the common andexternal iliac vessels; ureteral reimplant was performedfollowing an extravesical technique; simultaneous transplantnephrectomy of the previous graft was performed in33% of the cases. 59% of the cases had immediatediuresis and 49% did not require dialysis within the first7 postransplant days. Surgical complications weremainly vascular: 4 cases of hemorrhage, 3 venousthrombosis and 2 arterial thrombosis. There were also4 cases of lymphocele, 1 perirenal hematoma, and 1enterocutaneous fistula with an abscess of the surgicalbed. There were no urologic complications in theseries. Globally, there was 1 death (2.5%) secondaryto hemorrhage and another 6 grafts (15%) were lost tocomplications, 5 vascular thrombosis and 1 after surgicalbed abscess.1, 3, 5, and ten-year actuarial graft survival were65%,52%, 40% and 28% respectively.CONCLUSIONS: Retransplantation into the iliac fossafor third and fourth transplants is associated with a smallincrease in the number of surgical complications, mainlyvascular complications

[Vasovasostomy: our experience]. / Vasovasostomía: nuestra experiencia.

OBJECTIVES: From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples. METHODS: The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others. RESULTS: Overall spermatozoid potency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results. CONCLUSIONS: Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the potency rate. Regarding pregnancy rate, it is not influenced by delay of reversal.