Prevention of incisional hernia after kidney transplantation: study protocol for a randomized controlled trial.

BACKGROUND: Incisional hernia is a common complication after kidney transplantation with an incidence of 1.6-18%. Concerning non-transplant patients, a recently published meta-analysis describes a reduction of the incidence of incisional hernia of up to 85% due to prophylactic mesh replacement in elective, midline laparotomy. The aim of our study is to show a reduction of the incidence of incisional hernia after kidney transplantation with minimal risk for complication. METHODS/DESIGN: This is a blinded, randomized controlled trial comparing time to incisional hernia over a period of 24 months between patients undergoing kidney transplantation and standardized abdominal closure with or without prophylactic placement of ProGrip™ (Medtronic, Fridley, MN, USA) mesh in an onlay position. As we believe that the mesh intervention is superior to the standard procedure in reducing the incidence of hernia, this is a superiority trial. DISCUSSION: The high risk for developing incisional hernia following kidney transplantation might be reduced by prophylactic mesh placement. ProGrip™ mesh features polylactic acid (PLA) microgrips that provide immediate, strong and uniform fixation. The use of this mesh combines the effectiveness demonstrated by the macropore propylene meshes in the treatment of incisional hernias, a high simplicity of use provided by its capacity for self-fixation that does not increase significantly surgery time, and safety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04794582. Registered on 08 March 2021. Protocol version 2.0. (02-18-2021).

Schwannoma of the seminal vesicle: Case report and review of the literature.

Seminal vesicles can be affected by tumours originating in other locations. However, primary tumours of the seminal vesicle are extremely rare, with less than 100 cases reported in literature. Seminal vesicle adenocarcinoma is the most common type, but there are also other malign lesions. Diagnosis is challenging due to the lack of early symptoms and well-defined criteria. These tumours are usually asymptomatic and discovered incidentally during imaging tests or pelvic surgery. Definitive diagnosis requires anatomopathological analysis. Case report of 58-years-old man with schwannoma of the seminal vesicle. We describe the main characteristics of these tumours as well as their therapeutic approach.

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?-comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group.

Background: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture. Methods: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008-2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments. Results: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs. 38.4 months). Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs. 2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis. Conclusions: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.

How has the COVID-19 pandemic influenced prostate cancer?-a tertiary single-centre analysis of oncological results, diagnosis and treatment times.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected care for diseases like cancer. The aim was to evaluate the impact of COVID-19 on waiting times for diagnosis and treatment of prostate cancer (PC), as well as the possible effect on the treatment results in PC patients undergoing radical prostatectomy. Methods: We compared the results of 497 patients who underwent biopsy prior to the COVID-19 pandemic (1 January-31 December 2019) with those of 290 patients biopsied during the COVID-19 pandemic (1 January-31 December 2020). Demographic data, tumour characteristics, type of treatment and diagnosis times were comparable. Prostate specific antigen (PSA) levels were recorded at consultation prior to biopsy and after treatment. Mann-Whitney and chi-square tests were used to compare continuous variables and percentages, respectively. Results: In 2020, there were fewer urology consultations (35,160 vs. 40,225 in 2019). The median PSA in 2020 was significantly higher (14.3 vs. 9.9 ng/dL in 2019). In 2019, 53.1% (N=264) of the biopsies were positive for cancer vs. 47.2% (N=137) in 2020 (P=0.104). In 2020, more patients presented with metastatic disease (7.3% vs. 1.9%, P=0.009). Also, in 2020 there was a longer waiting time for prostate biopsy (42.1 vs. 35.3 days in 2019, P=0.019). A total of 132 patients underwent laparoscopic radical prostatectomy (LARP). The median time until surgery was similar in both years (71.9 vs. 58.29 days). During 2020, a higher percentage of patients had ISUP grade 4 in the surgical specimen (34.3% vs. 17.5%, P=0.07). Furthermore, a higher percentage of aggressive (pT3) tumours were diagnosed (37.2% vs. 27.2%, P=0.08), and the percentage of patients with involvement of surgical margins was also higher (48.6% vs. 29.3%, P=0.027). There were no differences between the groups in terms of biochemical recurrence or persistent PSA at one year (P=0.711). Conclusions: Delayed biopsy during the COVID-19 period did not appear to adversely impact biopsy results. Patients biopsied in 2020 had higher PSA, possibly due to proper triaging. A higher rate of adverse pathology outcomes was observed in patients undergoing radical prostatectomy during the pandemic, probably due to understaging of the biopsy. This study serves to raise awareness of the risk of deterioration of care of PC patients due to possible underdiagnosis.

Renal Complex Cystic Masses: Usefulness of Contrast-Enhanced Ultrasound (CEUS) in Their Assessment and Its Agreement with Computed Tomography.

INTRODUCTION: Around 10 % of renal cell carcinomas (RCC) are cystic, while some benign cysts have complex appearance in conventional diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI). These renal complex cystic masses (RCCMs) are a challenging entity in urological practice and sometimes have a difficult management, requiring surgical removal. Contrast-enhanced ultrasound (CEUS) is a very sensitive test detecting microvascularization in real time, and it has been used in the diagnostic workup of these kinds of lesions. The aim of our study was to assess the diagnostic power of CEUS in the evaluation of RCCM. MATERIAL AND METHODS: This is a prospective observational study between April 2011 and July 2014. A total of 66 patients with 67 RCCMs were enrolled (Bosniak 2-4). Twenty-four patients underwent surgical removal of the RCCM. All participants underwent CEUS (experimental) and CT (control). All CEUS procedures were performed by a single high-experienced observer (urologist). Benign lesions were defined as those Bosniak 2-2F, and malignant were Bosniak 3-4. Statistical analysis was made measuring consistency (kappa index and Landis-Koch scale) and validity (sensitivity, specificity, positive and negative predictive values) of the study. RESULTS: Median size of RCCM measured by CEUS and CT was 3.8 cm (interquartile range (AIQ) 3.2-4.6) and 3.9 cm (AIQ 3.2-4.5), respectively. Kappa index shows good agreement between both tests (0.71; 95 % CI 0.57-0.85), both overall and stratified by categories according to Bosniak classification. CEUS has a sensitivity 100 %, specificity 81.4 %, positive predictive value 70.4 %, and negative predictive value 100 %. A total of eight RCCMs were discordant, and seven of eight classified as malignant by CEUS and not by CT. Of those seven lesions classified as malignant by CEUS, six (six of seven, 85.7 %) were malignant in the pathological exam. CONCLUSIONS: CEUS is a very useful tool for assessing RCCM, with good results in terms of consistency and validity. It has a good diagnostic power, with a sensitivity of 100 % and a negative predictive value of 100 %. Its main limitations are the experience required, a special software, and being observer-dependent.

[Prostatic biopsy: From organ biopsy to lesion biopsy. The role of MRI and MRI based biopsy systems]. / Biopsia prostática: de la biopsia del órgano a la biopsia de la lesión. Papel de la resonancia magnética y sistemas de biopsia basados en ella.

OBJECTIVES: Ultrasound guided prostatic biopsy is still the reference method for the diagnosis of prostate cancer. Nevertheless, multiparametric magnetic resonance imaging (mpMRI) has become the best imaging method to identify clinically significant tumors. Form this new situation derives the search of the best method to enable the biopsy of the lesions identified by mpMRI and are not visible on ultrasound. The objective of this work is to review the current role of MRI and the various modalities of MRI based biopsies. METHODS: Non-structured literature review about the current status of prostatic mpMRI and the various methods of biopsy of the lesions identified with it: in bore, cognitive and different commercial fusion software biopsy methods available for directed biopsies. RESULTS: Although results in the literature are very heterogeneous, all three bore biopsy, cognitive biopsy in experienced hands and the various fusion/biopsy software platforms enable a precise biopsy of mpMRI/identified lesions, increasing the yield of each sample obtained. Fusion systems do not imply a clear advantage in global detection over systematic biopsy, except in the subgroup of patients with previous negative biopsy. Nevertheless, they do demonstrate a higher detection rate for clinically significant tumors that increases in patients with a first negative biopsy. Its role in the new therapeutic approaches for prostate cancer is yet to be defined, but it will be growing and essential in a near future. CONCLUSIONS: Multiparametric MRI is already an essential test in diagnostic algorithms for prostate cancer and the systems that enable to biopsy the lesion identified are day by day a more integrated tool in the urological daily practice, and urological procedures that will enable a more precise diagnosis leading to a personalized treatment for each patient.

Biopsia prostática: de la biopsia del órgano a la biopsia de la lesión. Papel de la resonancia magnética y sistemas de biopsia basados en ella / Prostatic biopsy: From organ biopsy to lesion biopsy. The role of MRI and MRI based biopsy systems

OBJETIVO: La biopsia prostática ecodirigida continúa siendo el método de referencia para el diagnóstico del cáncer de próstata. Sin embargo la Resonancia Magnética multiparamétrica (RMmp) se ha situado como el mejor método de imagen en la identificación de los tumores clínicamente significativos. De esta nueva situación deriva la búsqueda del mejor método para poder biopsiar las lesiones que la RMmp identifica y que no resultan visibles en ecografía. El objetivo de este trabajo es revisar el papel actual de la RM y las distintas modalidades de biopsia basadas en ella. MÉTODO: Revisión no estructurada de la literatura sobre el estado actual de la RMmp prostática y los diversos métodos de biopsiar las lesiones identificadas por ella: biopsia "in bore", biopsia cognitiva y los diversos software de fusión comerciales disponibles para la biopsia dirigida. RESULTADOS: Aunque los resultados en la literatura son muy heterogéneos, tanto la biopsia "in bore", la biopsia cognitiva en manos experimentadas, y los distintos software de "biopsia/fusión" permiten biopsiar de forma certera las lesiones identificadas en la RMmp, aumentando el rendimiento de cada muestra obtenida. Los sistemas de fusión no suponen una clara ventaja frente a la Biopsia Sistemática en la detección global de cáncer salvo en el subgrupo de pacientes con biopsia previa negativa. Sin embargo sí demuestran una mayor tasa de detección de tumores clínicamente significativos que se acentúa en pacientes con primera biopsia negativa. Su papel en los nuevos enfoques terapéuticos del cáncer de próstata, vigilancia activa y tratamientos focales, está todavía por definir pero será creciente y fundamental en un futuro próximo. CONCLUSIONES: La Resonancia Magnética multiparamétrica es ya una prueba imprescindible en los algoritmos diagnósticos del cáncer de próstata y los sistemas que permiten biopsiar las lesiones identificadas cada vez una herramienta más integrada en la rutina y procedimientos urológicos que nos permitirá un diagnóstico más exacto encaminado a un tratamiento personalizado de cada paciente

OBJECTIVES: Ultrasound guided prostatic biopsy is still the reference method for the diagnosis of prostate cancer. Nevertheless, multiparametric magnetic resonance imaging (mpMRI) has become the best imaging method to identify clinically significant tumors. Form this new situation derives the search of the best method to enable the biopsy of the lesions identified by mpMRI and are not visible on ultrasound. The objective of this work is to review the current role of MRI and the various modalities of MRI based biopsies. METHODS: Non-structured literature review about the current status of prostatic mpMRI and the various methods of biopsy of the lesions identified with it: in bore, cognitive and different commercial fusion software biopsy methods available for directed biopsies. RESULTS: Although results in the literature are very heterogeneous, all three bore biopsy, cognitive biopsy in experienced hands and the various fusion/biopsy software platforms enable a precise biopsy of mpMRI identified lesions, increasing the yield of each sample obtained. Fusion systems do not imply a clear advantage in global detection over systematic biopsy, except in the subgroup of patients with previous negative biopsy. Nevertheless, they do demonstrate a higher detection rate for clinically significant tumors that increases in patients with a first negative biopsy. Its role in the new therapeutic approaches for prostate cancer is yet to be defined, but it will be growing and essential in a near future. CONCLUSIONS: Multiparametric MRI is already an essential test in diagnostic algorithms for prostate cancer and the systems that enable to biopsy the lesion identified are day by day a more integrated tool in the urological daily practice, and urological procedures that will enable a more precise diagnosis leading to a personalized treatment for each patient

Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation.

Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8%) and CT in two patients (2/16, 12.5%). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75% (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.

[Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound]. / Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía.

OBJECTIVES: The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía / Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound

OBJETIVO: La finalidad del estudio es analizar la utilidad de la ecografía en la evaluación, elección del tratamiento y seguimiento del paciente con una hiperplasia prostática benigna (HPB). MÉTODOS: Se estudiaron 5.000 pacientes de edad > 50 años con clínica de prostatismo mediante ecografía abdominal y en casos seleccionados transrectal. RESULTADOS: El signo ecográfico más precoz de la HPB es el incremento de los diámetros anteroposterior y longitudinal de la próstata. La ecografía tiene una seguridad del 80% en la evaluación del volumen prostático y permite medir el residuo postmiccional, así corno datos indirectos de obstrucción del músculo detrusor vesical. Finalmente, posibilita la detección de patología asociada en el tracto urinario superior. CONCLUSIONES: la ecografía en colaboración con el PSA y la flujometría permite evaluar y seleccionar el tratamiento en el paciente con HPB

OBJECTIVES: the aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: a total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: the first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH

[Extrarenal retroperitoneal angiomyolipoma: bibliography review and report of a new case]. / Angiomiolipoma pararrenal: "revisión de la bibliografía" y presentación de un nuevo caso.

OBJECTIVES: To report the 7th case of pararenal angiomyolipoma published in the world literature and to review the international bibliography. METHODS: We report the case of a 46-year-old female with history of renal colic and a complex mass on radiological tests. RESULTS/CONCLUSIONS: Extrarenal retroperitoneal angiomyolipoma is a rare pathology with no more than 7 published cases. The diagnostic difficulty and radiological similarities with liposarcoma make surgery the treatment of choice.

[Acute obstructive kidney failure after kidney transplantation caused by calculi transfer from donor]. / Fracaso renal agudo obstructivo post-trasplante renal por trasferencia litiásica desde el donante.

OBJECTIVES: To report one case of lithiasis transference from the donor associated with renal transplant. METHODS: 53-year-old female with obstructive uropathy within the first post transplant month. RESULTS/CONCLUSIONS: Lithiasis transference after transplant is a cause of early obstructive uropathy after kidney transplantation. The low the incidence of lithiasis transference does not justify the performance of x-ray and/or ultrasound of the donor organ in terms of cost effectiveness. Extracorporeal shockwave lithotripsy is a valid therapeutic option on transplanted kidneys.

Fracaso renal agudo obstructivo posttrasplante renal por trasferencia litiásicades de el donante / Obstructive acute renal failure after renal transplantation secondary to lithiasis transference fron the donor

OBJETIVO: Presentar un caso de transferencia litiásica asociada al trasplante renal. MÉTODOS: Mujer de 53 años con uropatía obstructiva en el primer mes post trasplante. RESULTADOS/CONCLUSIONES: La transferencia litiásica en el trasplante, es una causa precoz de uropatía obstructiva en el riñón trasplantado. La baja incidencia de la transferencia litiásica, no justificaría en términos de coste beneficio, la realización seriada de radiografías y ecografía en el órgano donante. La litotricia extracorpórea por ondas de choque es una opción terapéutica válida sobre riñones trasplantados (AU)

[Acute renal failure as the beginning of glandular cystitis. Review of the bibliography]. / Fracaso renal agudo como debut de la cistitis glandular. Revisión de la bibliografía.

OBJECTIVES: To report one clinical case of obstructive uropathy secondary to bladder pseudotumor. METHODS: We report the case of a 74-year-old male with obstructive acute renal failure of unknown etiology. RESULTS: After resolution of the acute renal failure by percutaneous nephrostomy, action was undertaken to control possible etiologic causes, resolving the bilateral ureter entrapment and bladder inflammatory process. CONCLUSIONS: Glandular cystitis is a nosological entity which in its severe forms behaves clinically and radiologically as a bladder pseudotumor, so that should be considered as a part of the differential diagnosis with bladder tumors. Final diagnosis comes from pathology. For treatment, it is basic to eliminate any predisposing factor, either infectious, or irritative, or obstructive; if no action is carried out on these factors other therapeutic measures as the aforementioned are not effective. Strict follow-up should be undertaken (every six months) because of the high incidence of bladder adenocarcinoma.

Fracaso renal agudo como debut de la cistitis glandular. Revisión de la bibliografía / Glandular cystitis presenting as acute renal failure. Bibliographic review

OBJETIVO: Presentar un caso clínico de uropatía obstructiva secundaria a pseudotumor vesical. MÉTODOS: Presentamos un caso de un varón de 74 años con fracaso renal agudo de origen obstructivo, y etiología no filiada. RESULTADOS: Tras la resolución mediante nefrostomía percutánea del fracaso renal agudo; se procedió actuar sobre las posibles causas predisponentes resolviéndose el atrapamiento ureteral bilateral, y el proceso inflamatorio vesical. CONCLUSIONES: La cistitis glandular es una nosología que en las formas severas se comporta tanto clínica como iconográficamente como pseudotumor vesical, debiendo formar parte del diagnóstico diferencial con los tumores de vejiga. El diagnóstico de certeza es el histológico. En el tratamiento es fundamental eliminar los factores predisponentes, ya sean infecciosos, irritativos u obstructivos. El seguimiento de estos pacientes debe ser estricto (cada seis meses) debido a la alta incidencia de adenocarcinoma vesical (AU)