Ureteral reconstruction after renal transplantation: clinical outcome and risk factors.

INTRODUCTION: The incidence of urological complications after renal transplantation ranges from 2.5 to 30%. Often surgical revision is necessary. The risk factors for surgical revision and which surgical techniques to apply are not elucidated. This study investigates the outcome and risk factors for surgical revision of the ureterocystostomy. MATERIALS AND METHODS: Between January 1995 and March 2009, 1,157 consecutive kidney transplantations were performed. All patient charts and surgical reports were reviewed. RESULTS: Urological complications occurred in 142 (12.3%) patients. In 60 patients (5.2%) surgical revision was necessary. Of these 60 patients, 43 (71.7%) received neoureterocystostomy, 10 (16.7%) ureteropyelostomy reconstruction and 7 (11.7%) other techniques. Independent risk factors for surgical revision were donor ureteral reconstruction (odds ratio (OR) 48.66, 95% confidence interval (CI) 5.01-472.97), recipient age <18 years (OR 4.85, 95% CI 1.50-15.72) and delayed graft function (OR 2.70, 95% CI 1.36-5.36). Ureteral stenting was a protective factor for surgical revision (OR 0.30, 95% CI 0.12-0.81). The urological complication rates after neoureterocystostomy, ureteropyelostomy reconstruction and other techniques were 16, 0 and 0%, respectively. The overall surgical success rate was 92%. CONCLUSIONS: Ureteral stenting, recipient age, delayed graft function and perioperative ureteral reconstruction are significant factors associated with surgical revision of the ureterocystostomy. Surgical revision of the ureterocystostomy is a successful therapy with a low recurrence rate.

[Paratesticular rhabdomyosarcoma. Report of a case and review of the literature]. / Rabdomiosarcoma paratesticular. Aportación de un caso y revisión de la literatura.

Case report of an embryonary paratesticular rhabdomyosarcoma. The paper includes a literature review and discusses the current diagnostic, prognostic and therapeutic criteria analyzing in detail the current role of retroperitoneal lymphadenectomy and the value of adjuvant radiotherapy or chemotherapy.

[Endoscopic surgery of bladder diverticulum]. / Cirugía endoscópica del diverticulo vesical.

OBJECTIVE: To assess the endoscopic treatment of a vesical diverticulum by incision of the diverticulum opening and mucous fulguration associated to infravesical deobstructive surgery. METHOD: The procedure was performed in 30 male patients with flowmetry-documented infravesical obstruction. Results were radiologically evaluated, with patients being assigned to one of 3 groups: diverticulum disappearance; size reduction greater than 50% and persistence or size reduction lower than 50%. RESULTS: Disappearance of diverticulum was verified in 15 patients, size reduction greater than 50% in 9 patients, and persistence or size reduction lower than 50% in 6 patients. The complications rate in this series was 6.6%. CONCLUSIONS: Endoscopic treatment of a vesical diverticulum with the technique used in our series, was shown to be effective, particularly in diverticula with diameter under 50 mm, and was associated to low morbidity and short hospital stay.

[Endoscopic lithotripsy by means of Lithoclast]. / Litotricia endoscópica mediante Lithoclast.

OBJECTIVES: We evaluated the efficacy of endoscopic pneumatic lithotripsy with the Lithoclast for urinary tract calculi. The use of this stone disintegration system and the possible complications are described. METHODS: We performed a retrospective analysis of the results achieved in the first 100 patients (156 stones) that had been treated with this system at different sites. The patients were evaluated radiologically early postoperatively and throughout follow up (mean 12 months). RESULTS: Stone fragmentation could not be achieved in three patients, the only failures. The early postoperative assessment showed residual stones in 13% of the patients; 5 patients spontaneously passed the stone remnants and 8% had stone remnants on radiological evaluation during follow up. The only remarkable complication was a perforated ureter which required no surgery. CONCLUSIONS: In our experience, the Lithoclast lithotripsy system is effective at any level of the urinary tract. It has a low complication rate and is simple and low-cost.

[Endoscopic biopsy in the staging of infiltrating tumor of the bladder]. / La biopsia endoscópica en el estadiaje del tumor vesical infiltrante.

From July, 1990 to June, 1991, a prospective study was conducted on 65 patients with infiltrating bladder tumor to determine the possibility of distinguishing T2 from T3 tumors endoscopically. Sixty-six tumors were resected, including all of the bladder wall, and samples of perivesical fat were obtained from the tumor bed. The pathologist found infiltration of the bladder muscle wall in 50 cases (75.6%) and classified 12 tumors as T2 and 38 as T3. Fifty-five per cent of the T3a tumors were reclassified as T3b on the basis of the indirect signs of the pelvic scan and bimanual palpation performed under anesthesia. The clinical staging correlated with the pathological findings in 52.6% of the 19 cases of pT3b that underwent radical cystoprostatectomy; 31.7% of the pT3b tumors were clinically understaged, mainly due to prostatic infiltration. We can conclude from our findings that the differential diagnosis between pT2 and pT3 tumors is possible by endoscopic resection for most of the infiltrating bladder tumors; however, pT3a tumors cannot be distinguished from pT3b tumors with sufficient reliability.

[Drug-induced fever caused by prophylactic isoniazid in bladder instillations with BCG]. / Fiebre farmacológica por isoniacida profiláctica en instilaciones vesicales con BCG.

We present of one patient with isolated pharmacological fever probably caused by Isoniazid given prophylactically 24 hours prior to each vesical instillation with BCG as maintenance therapy for in situ vesical carcinoma. The fever appeared in two occasions before the instillation and did not returned once the drug was discontinued. We Review this adverse effect which may lead to diagnostic error.