Deceased donor kidney procurement: Systematic review of the surgical technique.

INTRODUCTION: Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. OBJECTIVES: Review of the available literature on kidney procurement procedure. MATERIAL AND METHODS: Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. RESULTS: Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. CONCLUSIONS: Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques.

Pielolitotomía laparoscópica en riñón ectópico pélvico: informe de un caso y revisión de la literatura / Laparoscopic pyelolithotomy in pelvic ectopic kidney: Case report and literature review

Introducción: Los riñones pélvicos son una malformación congénita poco frecuente, pero con una tasa de complicaciones no despreciable, entre ellas el desarrollo de litiasis renales. Su manejo quirúrgico puede resultar complejo. El objetivo de este trabajo fue realizar una revisión de la literatura disponible sobre el tratamiento de la litiasis en riñones ectópicos.Material y métodosDescripción de un caso de pielolitotomía laparoscópica transperitoneal para el tratamiento de litiasis calicial inferior en riñón pélvico derecho. Se realizó una revisión de la literatura mediante PubMed. Se buscaron los siguientes términos: «pelvic ectopic kidney», « ureterorenoscopy», «extracorporeal lithotripsy», «NLPC», «pyelolithotomy». Se incluyeron artículos originales, metaanálisis, revisiones e informes de casos.ResultadosSe excluyeron 130 artículos por título o duplicación. Se evaluaron 62 resúmenes y 50 artículos de texto completo. La tasa libre de cálculos fue del 75% (LEOCH), 85% (URS-f), 85-90% (NLPC) y 100% (pielolitotomía laparoscópica).ConclusiónFactores como el tamaño de la litiasis, densidad y localización de la misma, así como las alteraciones anatómicas del tracto urinario superior, influyen en la elección de la vía de abordaje terapéutica (retrógrada, percutánea y/ o laparoscópica/robótica). (AU)

Introduction: Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney.Material and methodsDescription of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: «pelvic ectopic kidney», «ureterorenoscopy», «extracorporeal lithotripsy», «PCNL», «pyelolithotomy». We included original articles, meta-analysis, review and case reports.Results130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor.ConclusionFactors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach. (AU)

[Urinary calculi in myelomeningocele adults]. / Litiasis urinaria en adultos con mielomeningocele.

INTRODUCTION AND OBJECTIVES: The improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment. MATERIAL AND METHOD: We review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years. RESULTS: 10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was < or = L2 in 3 cases, L2-S1 in 5, and > or = S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patients had a non-functional AMS-800 artificial urinary sphincter. Bladder stones were treated endoscopically in 14 procedures and by suprapubic cystolithotomy in 4 procedures, combined with removal of AMS-800 in 3 of them. One patient spontaneously passed a small stone. In one case, 2 ESWL and 2 percutaneous nephrolithotomies were needed. Three patients developed multiple recurrences during follow-up. CONCLUSIONS: Urinary lithiasis is common in adults with MMC. Some distinct features of these patients, together with their anatomical configuration and some therapies used in them, cause diagnostic, therapeutic and prophylaxis issues for the calculi they may develop.

Litiasis urinaria en adultos con mielomeningocele / Urinary calculi in myelomeningocele adults

Introducción y objetivos: Los avances en el tratamiento de los nacidos con mielomeningocele (MMC) han logrado un gran aumento en su supervivencia, permitiéndoles una longevidad nunca antes alcanzada, pero todavía son escasos los datos concernientes a los problemas urológicos que estos enfermos plantean durante su vida adulta. Hemos evaluado las características de la litiasis urinaria en adultos nacidos con MMC así como los tratamientos empleados en la misma. Material y métodos: Revisamos 52 pacientes nacidos con MMC de entre 18 y 40 años, atendidos durante los últimos 14 años en nuestro hospital, con una media de seguimiento de 6,7 años. Resultados: Se diagnosticaron de litiasis urinaria 10 pacientes (19,2%). Tres formaron cálculos renales (5,7%), y uno de ellos, junto con 7 pacientes más, desarrollaron cálculos vesicales (15,3%). El nivel neurológico fue ≤ L2 en 3 casos, L2- S1 en 5, y >= S1 en otros dos. El tipo de disfunción neurógena del tracto urinario inferior fue de lesión múltiple pura de neurona motora inferior en 6 casos, de neurona motora superior en 1, lesión múltiple mixta en otro, no pudiéndose valorar en el restante. Dos pacientes tenían una ampliación vesical y uno de estos junto con otros 3 pacientes era portador de AMS-800 no funcionantes. La litiasis vesical se trató endoscopicamente en 14 ocasiones y mediante cistolitotomía suprapúbica en 4, junto a la retirada de AMS-800 en 3 de ellas. Un paciente expulsó un pequeño cálculo. En un paciente fueron necesarias 2 litotricias extracorpóreas y 2 nefrolitotomías percutáneas. Tres pacientes tuvieron múltiples recidivas. Conclusiones: La litiasis urinaria es frecuente en los adultos con MMC. Determinadas características de estos pacientes, junto con su configuración anatómica y algunos tratamientos empleados en ellos, ocasionan problemas de diagnostico, tratamiento y prevención de los cálculos que forman

Introduction and objectives: the improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment. Material and method: we review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years. Results: 10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was >= L2 in 3 cases, L2-S1 in 5, and >= S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patients had a non-functional AMS-800 artificial urinary sphincter. Bladder stones were treated endoscopically in 14 procedures and by suprapubic cystolithotomy in 4 procedures, combined with removal of AMS-800 in 3 of them. One patient spontaneously passed a small stone. In one case, 2 ESWL and 2 percutaneous nephrolithotomies were needed. Three patients developed multiple recurrences during follow-up. Conclusions: urinary lithiasis is common in adults with MMC. Some distinct features of these patients, together with their anatomical configuration and some therapies used in them, cause diagnostic, therapeutic and prophylaxis issues for the calculi they may develop

[Primary seminal vesicle abscess: diagnosis and treatment by transrectal ultrasound]. / Absceso primario de vesicula seminal: diagnóstico y tratamiento mediante ecografía transrectal.

A 38 years old man with the only past medical history of bilateral orchiopexy 15 years ago is diagnosed of left primary seminal vesicle abscess. The patient is sent to our emergency service with an ultrasound finding of either dilated vas deferent or seminal vesicle abscess with hiperecogenic material inside it. The examination was performed after a 5 month history of purulent ejaculation. The diagnose of seminal vesicle abscess is confirmed by TRUS and, in the same procedure, drainage of the abscess was completed by needle-aspiration puncture. After this treatment the patient stay 12 hours at the observation room with intravenous antibiotics and is discharged home with oral antibiotics. We are interested in this case because of the low incidence of this pathology and the easy diagnosis and treatment by TRUS.

Absceso Primario de vesícula seminal: diagnóstico y tratamiento mediante ecografía transrectal / Primary seminal vesicle abscess: diagnosis and treatment by transrectal ultrasound

Varón de 38 años de edad con el único antecedente de una orquidopexia bilateral hace 15 años, es diagnosticado de absceso primario de la vesícula seminal izquierda. El paciente es derivado a nuestro servicio de urgencia para valorar el hallazgo ecográfico de lo que podría ser un conducto deferente o vesícula seminal dilatada con contenido hiperecogénico en su interior, indicándose dicho estudio en el contexto de eyaculación de esperma purulento de 5 meses de evolución. El diagnóstico de absceso de vesícula seminal izquierda es confirmado a través de una ecografía transrectal y en el mismo acto se realiza drenaje del absceso con comprobación posterior del completo vaciado de todo el contenido, demorando el acto aproximadamente 15 minutos. Luego se mantuvo al paciente 12 horas en observación con antibióticos intravenosos y fue dado de alta con antibiótico-terapia oral. Nos interesa el aporte de este caso clínico debido a lo infrecuente de la patología que nos ocupa, la sencillez y velocidad para aproximar el diagnostico y resolver la patología (AU)

A 38 years old man with the only past medical history of bilateral orchiopexy 15 years ago is diagnosed of left primary seminal vesicle abscess. The patient is sent to our emergency service with an ultrasound finding of either dilated vas deferent or seminal vesicle abscess with hiperecogenic material inside it. The examination was performed after a 5month history of purulent ejaculation. The diagnose of seminal vesicle abscess is confirmed by TRUS and, in the same procedure, drainage of the abscess was completed by needle-aspiration puncture. After this treatment the patient stay 12 hours at the observation room with intravenous antibiotics and is discharged home with oral antibiotics. We are interested in this case because of the low incidence of this pathology and the easy diagnosis and treatment by TRUS (AU)

Evolución de las características clínicas, ecográficas y patológicas de los pacientes con indicación de ecografía transrectal y biopsia de próstata entre 1994 Y 2003 / Evolution of the clinical, echographic and pathological characteristics of patients with indication of transrectal ultrasound and prostate biopsy between 1994 and 2003

Objetivo: El objetivo de este artículo es evaluar los cambios en el tiempo que se han producido en las características clínicas, ecográficas, bioquímicas y patológicas de los pacientes sometidos a ecografía transrectal y biopsia de próstata en un periodo 10 años(1994-2003). Material y método: Se ha analizado de forma retrospectiva los pacientes sometidos a una primera biopsia de próstata en el periodo 1994-2003. Durante el mismo se ha modificado en varias ocasiones los criterios de biopsia, por lo que el análisis de los resultados se realizará en 4 periodos de tiempo: 1994-1997, 1998, 1999- 2003 (este último se desdobla en dos - 1999-2001 y 2002- 2003 - para observar la evolución en el tiempo con los mismos criterios de biopsia). Los pacientes son asignados a grupos de riesgo según D´Amico. Resultados: Hemos observado tanto en los sujetos remitidos para biopsia como en los diagnosticados de cáncer de próstata (CP) una disminución de la edad media (p=0,0001 y p=0,01), un aumento de los pacientes con PSA entre 4,1-10 ng/ml (p=0,0001 y p=0,0001), un aumento de los sujetos sin alteraciones al tacto rectal (p=0,0001 y p=0,0001) ni ecográficas (p=0,0001 y p=0,0001). La incidencia de diagnósticos de cáncer ha disminuido del 39,4% al 34,3% (p=0,03). Se observa un aumento del score 7 con disminución del 5-6, 8-10 y desaparición del 2-4 (p=0,0001). Los pacientes asignados al grupo de bajo riesgo aumentan del 9% al 18,1%, del 20,2% al 43,1% los asignados al grupo de riesgo intermedio y disminuyen los asignados al grupo de riesgo alto del 70,7% al 38,7% (p=0,0001). Al analizar los dos últimos periodos de tiempo se mantiene la evolución de la serie excepto en la disminución de la edad de biopsia y de diagnostico de cáncer. Conclusiones: Los pacientes con indicación de biopsia tienen actualmente unos factores de riesgo con menor peso que hace una década. Actualmente diagnosticamos a los pacientes de CP con unos factores pronósticos más favorables. Pero el precio que tenemos que pagar por esta anticipación diagnóstica se traduce en: una menor efectividad de la biopsia, un aumento de la población sin CP sometida a las complicaciones físicas y el estrés psicológico que implica la realización de la biopsia, un aumento de pacientes sometidos a re-biopsia y por lo tanto, un incremento en la utilización de los recursos y de los costes necesarios para el diagnostico de CP

Objective: The aim of this paper is to evaluate the evolution in the clinical, echographic and pathological characteristics of patients undergoing transrectal ultrasound and prostate biopsy over a 10 year period (1994-2003). Material and methods: Patients undergoing a first biopsy of the prostate between 1994-2003 were studied retrospectively. Since the biopsy criteria have changed several times over this period, results were analysed for four different periods: 1994-1997, 1998, 1999-2003 (the latter was further divided into two periods - 1999-2001 and 2002-2003 – to observe the temporal evolution with the same biopsy criteria). Patients were assigned to risk groups according to D´Amico. Results: We observed that individuals referred for biopsy and those diagnosed with prostate cancer (PC) had a lower mean age (p=0.0001 and p=0.01), there were more patients with a PSA from 4.1-10 ng/ml (p=0.0001 and p=0.0001), more patients had no significant DRE findings (p=0.0001 and p=0.0001) or ultrasound findings (p=0.0001 and p=0.0001). The incidence of cancer diagnosis has decreased from 39.4% to 34.3% (p=0,03). There was an increased incidence of score 7, at the expense of a decline in scores 5-6 and 8-10 and disappearance of score 2-4 (p=0.0001). Patients assigned to the low risk group increased from 9% to 18.1%, those assigned to the intermediate risk group from 20.2% to 43.1% and there was a reduction in those assigned to the high risk group from 70.7% to 38.7% (p=0.0001). Analysis of the final two time periods revealed that the evolution of the series remained the same except for a decrease in age at biopsy and diagnosis of cancer. Conclusions: Nowadays, the risk factors of patients with an indication of biopsy have less weight than ten years ago. We currently diagnose patients with PC with more favourable prognostic factors. However, the price we pay for this earlier diagnosis is reflected in a less effective biopsy, a larger proportion of the population without PC having to experience the physical complications and psychological stress of a biopsy, a greater number of patients having to undergo a second biopsy and, therefore, a greater and more costly use of resources to diagnose PC

Tratamiento de adenocarcinoma prostático localizado en paciente con trasplante renal mediante Ultrasonido de Alta Intensidad / Localized prostate cancer treatment in renal transplant patient with high intensity focalized ultrasound (HIFU)

Presentamos el caso de un paciente de 62 años portador de un trasplante renal (TR) que fue diagnosticado a los 6 años del implante de adenocarcinoma prostático (CP) localizado. Tras evaluar las alternativas terapéuticas se optó por el Ultrasonido de Alta Intensidad (HIFU) por vía transrectal. El resultado ha sido satisfactorio, con ingreso de 24 horas, resolución histológica y bioquímica y mínima morbilidad. No hemos hallado en la literatura referencias a la utilización de HIFU en CP en la población de trasplantados renales. Creemos que puede representar una buena alternativa terapéutica

We report a 62 years old kidney transplant (KT) patient who was diagnosed of localized prostatic cancer (PC) after 6 years of the implant. Transrectal prostatic High Intensity Focused Ultrasound (HIFU) was applied. Results have been satisfactory, achieving pathologic and biochemical success. The discharge was completed at 24 hs, the morbidity was minimal. We have not found any reference in the literature on the appliance of HIFU in PC KT patients. We think that HIFU may represent a good alternative for these patients

[Nutcracker's syndrome: demostration with helicoidal TC with volumetric reconstruction "3D"]. / Síndrome "Nutcracker" o Cascanueces: demostración mediante TAC Helicoidal con reconstrucción "3D" (VR).

The nutcracker's syndrome or phenomenom is defined as the left renal vein compression between the aorta and the superior mesenteric artery. Diagnosis is uncommon, not only due to its low frequency but for the dificulty to be suspected in usual findings as lumbar pain or hematuria. We present the case of a patient to whom we were able to show mentioned pathology with the helicoidal TC with volumetric reconstruction "3D" (VR).

[Incidence and significance of "atypical acinar proliferation" in transrectal prostatic biopsies]. / Incidencia y significación de la "proliferación acinar atípica" en las biopsias transrectales de próstata.

OBJECTIVE: To determine the incidence of atypical acini in our series, the percentage of prostate cancer and other suspicious or preneoplastic lesions in the successive biopsies and to establish a follow up strategy in these patients. MATERIAL AND METHOD: A total of 117 patients diagnosed with isolated atypical acini or associated with high grade PIN were obtained from our database, 75 (64%) of these were submitted to at least a second biopsy of the gland. The age, PSA, digital rectal examination (DRE), prostate volume, ultrasound nodule and previous pathological diagnosis were compared with the pathology results of the successive biopsies of the gland. RESULTS: Incidence of atypical acini was 4%. A total of 46.7% of patients undergoing a repeat biopsy presented prostate cancer. We did not find significant differences in the clinical variables studied between patients with or without a definite cancer diagnosis. Patients initially diagnosed with acinar atypia with associated high grade PIN presented a higher incidence of cancer in the repeat biopsy than patients with isolated acinar atypia (p=0.007). A total of 94.3% of all neoplasms diagnosed were detected in the 2nd and 3rd biopsy. CONCLUSIONS: Patients with atypical acini are at high risk of having prostate cancer not detected in the first biopsy. They should, therefore, undergo a second biopsy as soon as possible. There is only a very small probability of detecting cancer after the 3rd biopsy.

Síndrome “nutcracker” o cascanueces: demostración mediante TAC helicoidal con reconstrucción “3D” (VR) / Nutcracker’s syndrome: demostration with helicoidal tc with volumetric reconstruction “3D”

El síndrome o fenómeno de Nutcracker o Cascanueces se define como la compresión de la vena renal izquierda a su paso por la pinza u horquilla vascular formada por la aorta y la mesentérica superior. Su diagnóstico es poco frecuente, tanto por su baja frecuencia como por la dificultad de sospecharlo ante hallazgos tan frecuentes como el dolor lumbar o la hematuria. Presentamos el caso de una paciente en la cual pudimos demostrar dicha patología mediante el apoyo diagnóstico del TAC helicoidal con reconstrucción volumétrica o “3D” (VR)

The nutcracker’s syndrome or phenomenom is defined as the left renal vein compression between the aorta and the superior mesenteric artery. Diagnosis is uncommon, not only due to its low frequency but for the dificulty to be suspected in usual findings as lumbar pain or hematuria. We present the case of a patient to whom we were able to show mentioned pathology with the helicoidalTC with volumetric reconstruction “3D” (VR)

Incidencia y significación de la “proliferación acinar atípica” en las biopsias transrectales de próstata / Incidence and significance of “atypical acinar proliferation” in transrectal prostatic biopsies

OBJETIVO: Evaluar la incidencia de atipia acinar en nuestra serie, el porcentaje de cáncer de próstata y otras lesiones sospechosas o preneoplásicas en las biopsias sucesivas y establecer una estrategia de seguimiento en estos pacientes. MATERIAL Y MÉTODO: Se han extraído de nuestra base de datos 117 pacientes con el diagnóstico de atipia acinar aislada o asociada a PIN de alto grado, 75 (64%) fueron sometidos al menos a una segunda biopsia de la glándula. La edad, PSA, tacto rectal, volumen prostático, nódulo ecográfico y diagnóstico patológico previo se compararon con el resultado patológico de las sucesivas biopsias de la glándula. RESULTADOS: La incidencia de atipia acinar fue del 4%. El 46,7% de los pacientes sometidos a rebiopsia presentaron cáncer de próstata. No encontramos diferencias significativas en las variables clínicas analizadas entre los pacientes con diagnóstico final de cáncer o no. Los pacientes con diagnóstico inicial de atipia acinar con PIN de alto grado asociado presentaron una mayor incidencia de cáncer en la rebiopsia que los pacientes con atipia acinar aislada (p=0,007). El 94,3% de las neoplasias diagnosticadas se detectaron en la 2ª y 3ª biopsia. CONCLUSIONES: Los pacientes con atipia acinar tienen un riesgo elevado de tener un cáncer de próstata no detectado en la 1ª biopsia, por lo tanto deben de ser sometidos a rebiopsia en el menor plazo posible. La probabilidad de diagnosticar un cáncer después de una 3ª biopsia es muy pequeña

OBJECTIVE: To determine the incidence of atypical acini in our series, the percentage of prostate cancer and other suspicious or preneoplastic lesions in the successive biopsies and to establish a follow up strategy in these patients. MATERIAL AND METHOD: A total of 117 patients diagnosed with isolated atypical acini or associated with high grade PIN were obtained from our database, 75 (64%) of these were submitted to at least a second biopsy of the gland. The age, PSA, digital rectal examination (DRE), prostate volume, ultrasound nodule and previous pathological diagnosis were compared with the pathology results of the successive biopsies of the gland.RESULTS: Incidence of atypical acini was 4%. A total of 46.7% of patients under going a repeat biopsy presented prostate cancer. We did not find significant differences in the clinical variables studied between patients with or without a definite cancer diagnosis. Patients initially diagnosed with acinar atypia with associated high grade PIN presented a higher incidence of cancer in the repeat biopsy than patients with isolated acinar atypia (p=0.007). A total of 94.3% of all neoplasms diagnosed were detected in the 2nd and 3rd biopsy. CONCLUSIONS: Patients with atypical acini are at high risk of having prostate cancer not detected in the first biopsy. They should, therefore, undergo a second biopsy as soon as possible. There is only a very small probability of detecting cancer after the 3rd biopsy

[Pediatric renal transplantation from young children donors (aged < or = 6 years). Complications and functional clinical course]. / Trasplante renal pediátrico con injertos de donantes infantiles de corta edad (< or = 6 años). Complicaciones y evolución funcional.

GOALS: To evaluate functional results and complications in a group of pediatric patients who received kidney transplants from donors aged 6 years or less. MATERIAL & METHODS: Thirty-four consecutive renal transplants were reviewed. Of 34 patients, 19 (55.8%) received kidneys from donors aged below 3 years (Group A) and 15 (44.2%) from donors aged 3-6 years (Group B). Long-term functional patient and graft survival results along with complications were compared in both groups. RESULTS: Seven patients in group A (36.7%) had vascular complications, in comparison to 3 in group B (20%, p<0.05). Kidneys preserved in Eurocollins (EC) solution had more vascular complications (35.3%) in comparison to University of Wisconsin (UW) solution kidneys (23.5%, p<0.05). Ten-year graft survival rate in group A was significantly lower in comparison to group B (35.5% vs 58.6%, p<0.05). In relation to preservation solution type used, 10-year graft survival rate was also significantly better in UW group (26.8% vs 63%, p<0.001). CONCLUSIONS: The exclusion of donors younger than 3 years and the utilization of optimal preservation solutions produces a decrease in figures of vascular complications and a significant improvement in graft survival rates.

Trasplante renal pediátrico con injertos de donantes infantiles de corta edad (= 6 años). Complicaciones y evolución funcional / Pediatric renal transplantation from young children donors (aged = 6 years). Complications and functional evolution

OBJETIVO: Evaluar el resultado funcional y la incidencia de complicaciones en una serie de trasplantes renales pediátricos utilizando injertos de donantes infantiles. MATERIAL Y MÉTODO: Se revisa una serie de 34 trasplantes renales en receptores pediátricos realizados de forma consecutiva. De ellos, en 19 casos (55,8 por ciento) el riñón procedía de donantes de edad inferior a 3 años (Grupo A). En 15 pacientes (44,2 por ciento), los donantes tuvieron una edad = 3-6 años (Grupo B). Analizamos comparativamente el funcionalismo inmediato, complicaciones médicas y quirúrgicas, supervivencia del injerto y del paciente a medio y largo plazo. RESULTADOS: Observamos disfunción inicial del injerto en 9 pacientes del grupo A (47,4 por ciento). En el grupo B la incidencia fue del 46,7 por ciento. En el grupo A, 7 pacientes sufrieron complicaciones vasculares (36,7 por ciento) frente a 3 en el grupo B (20 por ciento) (p<0,05). Se produjeron más complicaciones vasculares en los riñones preservados en solución EC (35,3 por ciento) frente a UW (23,5 por ciento) (p<0,05). En el grupo A la supervivencia actuarial de los injertos a 10 años fue significativamente menor frente al grupo B (35,5 por ciento-58,6 por ciento, p<0,05). En base al tipo utilizado de solución de preservación, EC ofreció valores de supervivencia actuarial del injerto a 1-5-10 años de 47 por ciento-26,8 por ciento-26,8 por ciento; UW incrementó estas cifras a 82,3 por ciento-63 por ciento-63 por ciento (p<0,001). CONCLUSIONES: La limitación de la edad mínima para aceptación de donantes en Programas de Trasplante Renal Pediátrico en 3 años y la utilización de soluciones de preservación óptimas, resulta en una disminución de las complicaciones vasculares y un aumento de la supervivencia del injerto a largo plazo (AU)

Hydrodynamic and biochemical effects of isolated hypothermic renal perfusion depending on the pump model and perfusion solution.

OBJECTIVES: To evaluate hydrodynamic, biochemical, and histological consequences of hypothermic isolated renal perfusion using a new computerized perfusion system. MATERIALS AND METHODS: The device that allowed us to obtain on renal hydrodynamics during perfusion included multiple parts. The organ was perfused at 4 degrees C with a constant flow either using a classic roller pump or a pump designed in our laboratory to employ vacuum or atmospheric pressure sequentially to achieve a truly pulsatile wave (vacuum-powered tubular pump). The study included 16 minipigs with Eurocollins or Belzer perfusion solutions sampled at predefined interval and histological studies of the organs performed. RESULTS: There was a significant difference in weight increase between the two types of pumps; those perfused with Eurocollins showed greater values than those with Belzer solution. Onset of nitric oxide (NO) in the perfusion solution increased inversely with the renal vascular resistance. The highest NO levels were observed with the Belzer solution and vacuum pump. CONCLUSIONS: Changes in renal hydrodynamics, as induced by perfusion wave form and solution type, may be recorded in real time using a computerized system. A vacuum pump with the Belzer solution achieved the best experimental results.

[Incidence of high grade prostatic intraepithelial neoplasm in transrectal biopsy of the prostate]. / Incidencia de la neoplasia intraepitelial prostática de alto grado en las biopsias transrectales de la próstata.

OBJECTIVE: To analyze the incidence of high grade prostatic intraepithelial neoplasia (PIN) in the transrectal prostate biopsies of patients from the Urology department. METHODS: From 1995 to 1999, 2018 patients aged 46-92 years (mean 68 +/- 10) had a transrectal biopsy. Thirty-six percent had a suspicious DRE and the mean serum PSA was 31.7 +/- 152.9 ng/ml. The anatomopathological diagnoses were: a) cancer, b) benign pathology, c) high grade PIN and d) glandular atypia. Statistical analysis using the chi square and Mann-Whitney tests was performed to compare the following variables: age, DRE, PSA, PSAf/PSAt ratio and the finding of a suspicious node on ultrasound. RESULTS: The incidence of high grade PIN in this series was 8% and the incidence of prostate cancer was 38.6%, PIN grade 3 was diagnosed in 94 patients and PIN grade 2 in 67, and was associated with glandular atypia in 13 patients. Patients with prostate cancer were older and showed statistically significant higher PSA, percentage of suspicious DRE, sonographically suspicious nodes, and a lower PSAf/PSAt ratio than the other diagnoses (p < 0.001). Comparison of patients with high grade PIN and those with benign pathology showed no differences for age, DRE, PSA levels and PSAf/PSAt ratio. However, a significantly lower incidence of sonographically suspicious nodes was found (p < 0.001). CONCLUSIONS: The incidence of high grade PIN was 8%. High grade PIN does not cause sufficient changes in the clinical variables analyzed to suspect this lesion before it is confirmed by the pathological findings.

[Differences in survival of patients with bladder cancer depending on depth of muscle infiltration]. / Diferencias en la supervivencia de los pacientes con cáncer de vejiga según la profundidad de la infiltración muscular.

OBJECTIVE: To study the survival of patients with bladder cancer and infiltration into the muscle who undergo radical cystectomy, documenting any survival difference based on the depth of muscle infiltration (pT2a vs. pT2b). MATERIAL AND METHOD: 109 patients with infiltration into the muscle (T2) in the TUR were treated with radical cystectomy between 1986 and 1996; 39 patients were excluded due to infra-staging and 2 died in the immediate postoperative: 68 patients were eligible for the study. Median follow-up was 51 months. At the time of analysis 44 were alive (2 with tumoral disease and one with a second non-urological tumour), 21 had died (4 for causes other than vesical tumour) and 3 patients were considered lost to follow-up at 3, 31 and 111 months. Survival analysis was performed using the Kaplan-Meier method, and the variables were compared with the log-rank test. RESULTS: The 3- and 5-year overall survival of our series was 76% and 62%, while cancer specific survival was 80% and 70% respectively. Cancer specific survival at 5 years by stages was: pT0-83%, pT1-80%, pT2a-66% and pT2b-60% (p = 0.52). The cystectomy specimen (pT0) showed no residual tumour in 15 (22%) patients, and 5-year cancer specific survival in this group was 83% vs. 66% in patients with residual cancer (p = 0.24). CONCLUSIONS: Patients with pT2a and pT2b bladder cancer showed no differences in survival and we believe they should be all included in the same prognostic group (pT2). pT0 patients are a subgroup of patients with significant survival rates in which radical cystectomy should be considered as overtreatment, and a more conservative protocol should be preferred.