Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

New immunotherapies for high-risk non-muscle invasive bladder cancer: Current state and future perspectives. / Nuevas inmunoterapias en el cáncer de vejiga no músculo-invasivo de alto riesgo: estado actual y perspectivas de futuro.

BACKGROUND: The standard treatment for high-risk non-muscle invasive bladder tumors (NMIBT) is transurethral resection of the bladder and BCG instillations. However, responses are limited, and new therapeutic alternatives for these patients are required. The results of checkpoint inhibitors in advanced tumors have led to interest in the use of these molecules in NMIBT. METHODS: We conducted a search on PubMed using the terms «bladder cancer¼ and «check point inhibitors¼. We have used the search engines clinicaltrials.gov and clinicaltrialsregister.eu for the search of clinical trials. RESULTS: There are currently 5 trials in progress on BCG untreated patients. There are no results available. As for BCG non-responders, there are 15 ongoing trials, two of them with preliminary results: Keynote 057, with promising results with pembrolizumab, which has led the FDA to approve its use in January 2020, and SWOG S1605, which has shown similar results with atezolizumab. Other trials are using intravesical administration of these drugs, which is an attractive option if it is effective for cancer control. CONCLUSIONS: Checkpoint inhibitors offer a new possibility for patients who do not respond to BCG. These will probably be used in the future for previously BCG untreated patients. Preliminary data from clinical trials show promising results. A good understanding of these molecules by urologists and the creation of multidisciplinary teams are crucial in order to offer the best therapeutic alternatives to these patients.

Adjuvant intravesical treatment for nonmuscle invasive bladder cancer: The importance of the strain and maintenance. / Tratamiento adyuvante intravesical en cáncer de vejiga no músculo invasivo: importancia de la cepa y el mantenimiento.

BACKGROUND AND OBJECTIVE: Intravesical Bacille Calmette-Guérin (BCG) is essential for preventing the recurrence and progression of superficial bladder tumours. The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance regimen. MATERIAL AND METHODS: We retrospectively reviewed 110 patients with superficial bladder tumours who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the relapse-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of relapse, we performed a multivariate analysis. We also assessed the toxicity by analysing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawing due to adverse effects. RESULTS: We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both groups; P=.010). The patients who completed the maintenance had better relapse-free survival at 60 months (88.5 vs. 74.2%; P=.036), regardless of the strain employed. The multivariate analysis identified a size larger than 3cm, more than 3 implants and not completing the maintenance as risk factors of relapse. The patients with the Connaught strain had higher rates of BCGitis, with no differences in the other events studied. CONCLUSION: Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios.

Uncontrolled non-heartbeating donors (types i-ii) with normothermic recirculation vs. heartbeating donors: evaluation of functional results and survival.

OBJECTIVE: Non-heartbeating donors (NHBD) are an alternative to heartbeating donors (HBD). Our objective was to compare functional results and kidney survival from NHBDs and HBDs. MATERIAL AND METHODS: A retrospective study comparing the results of 236 normothermically preserved kidneys from type i and ii type NHBDs with the results of 250 from HBDs that were transplanted in our center between 2005 and 2012. Homogeneity between groups was tested and we evaluated the presence of delayed graft function (DGF) associated with pretransplant variables of the donor and recipient. RESULTS: Both groups show homogeneity in pretransplant characteristics in terms of: age, HLA incompatibilities, and recipient hemodialysis time. Average follow-up time was 33 months (range 0-87) for NHBDs and 38 months (range 0-90) for HBDs. 5.5% of NHBDs showed primary non-function (PNF) vs. 4% of HBDs (P=.42) and 80.9% of DGF vs. 46.8% of HBDs (P<.001). At the end of the follow-up, there were no statistically significant differences in the survival of grafts (92.8% for NHBD vs. 93.6% for HBD, P=.71) and recipients (99.1% NHBD vs. 98.6% HBD, P=.28). CONCLUSIONS: Although the DGF percentage was greater for NHBDs, final creatinine as well as graft and recipient survival were similar for both groups. Therefore, in our experience, kidneys from NHBDs have similar results to those from HBDs and are an excellent source of organs for transplantation.

[Primary adenocarcinoma of the urinary bladder: our experience]. / Adenocarcinoma vesical primario: nuestra experiencia.

Adenocarcinoma of the bladder is an uncommon neoplasm. Depending on its origin it is classified in: primary, secondary and urachal. Generally it grows to the density of the wall, so its clinical appearence is delayed, with the subsequent delayed diagnosis and although an agressive treatment is performed, it frequently has a very bad prognosis. Since there are very few publications of this kind of neoplasm in the literature the lines of actuation in this pathology are not well established. We report the eleven cases of adenocarcinoma neoplasm of the bladder treated in our centre and review the literature.

[Ileal neobladder with double chimney. Ureterointestinal anastomosis]. / Neovejiga ileal con doble chimenea. Anastomosis ureterointestinal.

Radical cystoprostatectomy is accepted as the standard treatment for muscle-invasive bladder cancer. During last years the indications for orthotopic neobladders have increased due to their advantages over other kind of diversions. Hautmann neobladder is one of the most commonly used. Several modifications have been later described. For example, after perform the W-shape pouch ureters can be anastomosed to a not-detubularized bowel segment (chimney modification). Here is described a modification of the Hautmann neobladder with two chimneys. Each ureter is spatulated in a golf club manner and anastomosed to the open end of each bowel loop. This kind of anastomosis provides several advantages. It is possible to use shorter ureteral segments by increasing the length of bowel used. It allows an anastomosis without tension, and less ischemia so the risk of stenosis and fistula is decreased. It is not necessary to perform additional enterothomies and in case of reintervention it is easier to access each anastomosis without damaging the other one.

Neovejiga ileal con doble chimenea. Anastomosis ureterointestinal / Ileal neobladder with double chimney. Ureterointestinal anastomosis

La cistoprostatectomía radical es el tratamiento de elección para el cáncer vesical infiltrante. En los últimos años las indicaciones de sustitución vesical se han ampliado debido a las ventajas que aportan sobre otros tipos de derivaciones siendo la neovejiga ileal descrita por Hautmann una de las más utilizadas. Posteriormente se han descrito diversas modificaciones de la técnica original como la utilización de un segmento de asa sin detubulizar a modo de chimenea a la cual se anastomosan los uréteres. Presentamos una variante técnica de la neovejiga de Hautmann utilizando dos “chimeneas” anastomosando cada uréter a la luz previamente abierta de cada asa espatulando el uréter a modo de “palo de golf” para adaptar los calibres. Entre las ventajas de este tipo de anastomosis destacan la utilización de segmentos ureterales más cortos adaptando la longitud del asa lo que posibilita una anastomosis sin tensión y minimiza la isquemia disminuyendo por tanto la aparición de fístulas y estenosis. No precisa la realización de enterotomías adicionales y se facilita el acceso a cada anastomosis por separado en caso de necesidad de reintervención (AU)

Radical cystoprostatectomy is accepted as the standard treatment for muscle-invasive bladder cancer. During last years the indications for orthotopic neobladders have increased due to their advantages over other kind of diversions. Hautmann neobladder is one of the most commonly used. Several modifications have been later described. For example, after perform the W-shape pouch ureters can be anastomosed to a not-detubularized bowel segment (chimney modification). Here is described a modification of the Hautmann neobladder with two chimneys. Each ureter is spatulated in a golf club manner and anastomosed to the open end of each bowel loop. This kind of anastomosis provides several advantages. It is possible to use shorter ureteral segments by increasing the length of bowel used. It allows an anastomosis without tension, and less ischemia, so the risk of stenosis and fistula is decreased. It is not necessary to perform additional enterothomies and in case of reintervention it is easier to access each anastomosis without damaging the other one (AU)

[Leydig cell tumor: report of 8 cases and review of the literature]. / Tumor de células de leydig: presentación de ocho casos y revisión de la literatura.

Leydig cell tumor is the most frequent non-germ cell tumors of testis, included in the group of specialized gonadal stromal neoplasms. It has a low incidence, accounting for 1-3% of testicular neoplasms. This tumor is characterized by its endocrine manifestations, due to the tumor's capacity to secrete hormones. We report eight cases, including the description of their clinical, diagnosis and therapeutic features, as well as their follow-up. We also make a review of the literature about this rare testicular tumor.

[Apoptosis in renal adenocarcinoma. Expression of bcl-2 in locally confined tumors]. / Apoptosis en el adenocarcinoma renal. Expresión de bcl-2 en tumores localmente confinados.

INTRODUCTION AND OBJECTIVE: Bcl-2 is a proto-oncogene known to be a negative regulator of apoptosis, whose expression conferring prolonged cell survival and contributing to tumorigenesis. Inconsistent results concerning bcl-2 expression and the frequency of apoptosis were noted in renal cell carcinoma. To investigate a possible role of bcl-2 protein in renal cell carcinomas, we analyzed its expression and relationship with clinical and pathological parameters, including prognostic impact. METHODS: 58 patients diagnosed of renal cell carcinoma stage pT1, pT2 and pT3a N0 M0 (TNM 1997) were treated by radical or partial nephrectomy. We analyzed clinical and pathological parameters including bcl-2 expression in paraffin-embedded tumor samples using immunohistochemical technique. RESULTS: Bcl-2 immunopositivity was detected in 44/58 of the samples in different grades of intensity. There was no correlation of nuclear grade, tumoral size, stage or recurrency with bcl-2 immunopositivity. Bcl-2 expression was not related to prognosis if we divided all cases into subgroups according of stain intensity. CONCLUSIONS: Bcl-2 expression was not related with any pathological parameters; size, nuclear grade and stage or prognostic.

Tumor de células de Leydig: presentación de ocho casos y revisión de la literatura / Leydig cell tumor: report of eight cases and review of the literature

El tumor de células de Leydig es el más frecuente de los tumores no germinales de testículo, perteneciendo al grupo de los tumores del estroma gonadal especializado. Su incidencia es baja, ya que representa el 1-3 por ciento del total de las neoplasias testiculares. Puede manifestarse mediante alteraciones endocrinas debido a su capacidad para secretar hormonas.Presentamos nuestra serie de ocho casos con la descripción de sus aspectos clínicos, diagnósticos y terapéuticos, así como la evolución de los mismos. Asimismo realizamos una revisión de la literatura sobre este raro tumor testicular (AU)

Apoptosis en el adenocarcinoma renal. Expresión de bcl-2 en tumores localmente confinados / Apoptosis in renal cell carcinoma. BCL-2 expression in locally confined tumors

INTRODUCCIÓN Y OBJETIVO: La expresión del oncogén bcl-2 se relaciona con una resistencia aumentada de las células tumorales a la apoptosis. lo que prolonga su supervivencia y contribuye a su transformación neoplásica. En el adenocarcinoma renal todavía no se ha podido establecer su importancia en cuanto a la evolución de estas neoplasias. Nuestra intención es determinar la expresión de la proteína bcl-2 y su relación con diferentes variables clínicas y anatomopatológicas, estableciendo su valor pronóstico.MÉTODO: 58 adenocarcinomas renales, estadios pT1-T3a NO MO (TNM 1997), tratados mediante nefrectomía radical o parcial con intención curativa. Analizamos diferentes variables clínicas v anatomopatológicas, así como la expresión de bcl-2 en tejido parafinado, mediante técnicas de inmunohisotquímica, obteniendo una tinción citoplasmática que se valoró de forma cualitativa.RESULTADOS: La tinción para bcl-2 fue positiva en 44 de los 58 tumores analizados (62,1 por ciento), en distintos grados de intensidad. En cuanto a la relación de la expresión de bcl-2 con otras variables histopatológicas. no encontramos asociación estadísticamente significativa con el grado nuclear, tamaño, estadio o posibilidad de recidiva tu m oral. Agrupando los tumores según la intensidad de la tinción en dos grupos, tinción negativa y débil positiva, frente a tinción de intensidad moderada e intensa. tampoco obtuvimos relación entre bcl-2 y la supervivencia.CONCLUSIONES: La expresión de bcl-2 no se relacionó con ninguna de las variables histopatológicas analizadas: tamaño, grado y estadio, ni con la supervivencia, por lo que esta proteína no parece relacionarse con la evolución del adenocarcinoma renal (AU)

[Percutaneous treatment of retroperitoneal abscesses]. / Tratamiento percutáneo de los abscesos retroperitoneales.

UNLABELLED: The retroperitoneal abscess is an uncommon disease, that must be treated by drainage. The progressive use of the percutaneous drainage, under ultrasound or computed tomography guidance (CT), has changed the therapeutical management and has demonstrated to be a valid alternative to surgical drainage. From 1986 to 1998, 16 patients with retroperitoneal abscesses were treated by percutaneous drainage (14 with CT and 2 with ultrasound guidance). This method eradicated the abscess in 13 cases, in 2 was necessary a new function to cure the abscess, and 1 patient, with a severe sepsis, died. Percutaneous drainage was the unique treatment used in 12 patients. In the remaining four, the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy. CONCLUSIONS: Percutaneous drainage of retroperitoneal abscesses has been established as a viable alternative to surgical intervention. This method can resolve the abscess or improve the patient' clinical status to undergo elective surgery.

[Ureterointestinal anastomosis in ileal conduit in single kidney. New surgical technique]. / Anastomosis ureterointestinal en conducto ileal en monorreno. Nueva técnica quirúrgica.

Introduction of a new approach for uretero-ileal implantation when only one kidney is available. The technique follows the same approach as the Wallace-type re-implantation but in this case the uretero-ileal anastomosis plate is formed with the far en 2-3 cm of ureter. All cases performed with this technique have been highly successfull as reported in this clinical account.

Tratamiento percutáneo de los abscesos retroperitoneales / Percutaneous drainage of retroperitoneal abscesses

El absceso retroperitoneal es una entidad clínica poco frecuente, cuyo tratamiento se basa en el drenaje. La introducción progresiva de las técnicas percutáneas de drenaje, bien mediante control ecográfico o bien utilizando la tomografía axial computerizada (TAC), ha modificado su abordaje terapéutico, siendo alternativas válidas al tratamiento quirúrgico tradicional. Presentamos una serie de 16 pacientes diagnosticados de absceso retroperitoneal entre 1986 y 1998, que fueron tratados mediante punción percutánea (en 14 casos dirigida por TAC y en 2 median-te control ecográfico). Se consiguió la resolución del absceso en 13 casos, recurriendo en 2 (ambos fueron tratados mediante nueva punción) y falleciendo 1 paciente que presentaba una sepsis grave. En 12 de los pacientes fue el único tratamiento aplicado, practicándose en los 4 restantes nefrectomía tras la mejoría del estado de los pacientes. CONCLUSIONES: El tratamiento percutáneo de los abscesos retroperitoneales supone una alter-nativa válida al tratamiento quirúrgico tradicional, bien como tratamiento definitivo, bien como tratamiento paliativo que nos permite mejorar el estado clínico del paciente de forma previa a la cirugía (AU)

Anastomosis ureterointestinal en conducto ileal en monorreno. Nueva técnica quirúrgica / Ureterointestinal anastomosis in single kidney ileal duct. New surgical technique

Se presenta una nueva modalidad de implantación para aquellos casos en los que existe una sola unidad renal urétero ileal para aquellos en que nos encontramos con una sola unidad renal. La técnica tiene el mismo planteamiento que la técnica de reimplantación tipo Wallace, formando en este caso la placa de anastomosis urétero ileal con los 2-3 últimos cm del uréter. Los casos realizados hasta el momento con dicha técnica han sido satisfactorios como se refiere a lo largo de esta nota clínica (AU)

[Genitourinary malacoplakia]. / Malacoplaquia genitourinaria.

Malacoplakia is a chronic inflammatory disease the etiology of which remains obscure. It has a very low incidence and affects primarily the genitourinary tract, although it has been described in some other organs. This paper presents a historic insight of the clinical cases diagnosed in this centre, and includes a review and update of several issues related to this entity such as pathogenesis, pathological anatomy and treatment. Also, the peculiarities related to the involvement of each separate organ with regard to diagnosis, prognosis and treatment are described.

[Tuberculous prostatic abscess in a patient with AIDS]. / Absceso prostático tuberculoso en paciente con SIDA.

Despite of prostate abscesses having become an uncommon disease, a number of cases has been described lately specially in immunodepressed patients caused by infrequent agents, such as Mycobacterium tuberculosis. This paper describes the case of one HIV-positive patient, diagnosed with a prostate abscess within a tuberculous dissemination. The best diagnostic method is considered to be the transrectal ultrasound (TRU), the choice therapy being drainage by ultrasound-guided transperineal percutaneous puncture.