Prospective comparative study of postoperative systemic inflammatory syndrome in robot-assisted vs. open kidney transplantation.

PURPOSE: Robot-assisted kidney transplant (RAKT) recently proved to provide functional results similar to the preferred open kidney transplant (OKT), but with inferior wound morbidity. In a comparative prospective study, we explored the systemic inflammatory response syndrome (SIRS) after KT and compared OKT with RAKT. METHODS: Forty-nine patients underwent pre-emptive ABO-compatible kidney transplantations (KT) between January 2017 and December 2018 in 2 centers: 25 RAKT, 24 OKT. Postoperative SIRS was biologically assessed by serum markers (NGAL, CRP and IL-6) measured at: T0 (preoperative/baseline), T1(H1), T2(H6), T3(H12), T4(H24), T5(D2), T6(D3) and T7(D5) after KT. RESULTS: Inflammatory markers + eGFR were assessed in OKT vs. RAKT. IL-6 peak value occurred at H6 and reached ×9 from baseline. CRP peak occurred at H24 and reached ×28 from baseline (All P < 0.05). NGAL decreased after surgery with a plateau (divided by 2 from baseline) from H12 to D5. There was no significant difference in IL-6, CRP and NGAL kinetics and peak values between RAKT and OKT (All P > 0.05). Serum creatinine and eGFR on postoperative days 1, 3 and 7 were similar in RAKT and OKT (All P > 0.05). Delayed graft function was not observed. CONCLUSION: In this exploratory study, the biological evaluation of postoperative SIRS after living-donor kidney transplant revealed no significant difference between OKT and RAKT and similar functional outcomes in the short term. These results highlight the safety of RAKT as an alternative to OKT in this setting.

European experience of robot-assisted kidney transplantation: minimum of 1-year follow-up.

OBJECTIVES: To evaluate functional results, graft survival and late complications in patients who underwent robot-assisted kidney transplantation (RAKT) and who had a minimum of 1 year of follow-up data, and to analyse the correlations between surgical data and functional results at a minimum of 1-year postoperatively and between renal function in the immediate postoperative period and after 1 year. MATERIALS AND METHODS: A common prospectively collected RAKT database was created by the European Robotic Urological Section (ERUS) RAKT working group, which included eight different European centres. In each centre RAKTs were performed with kidneys from living donors. Data on demographic variables, surgical results, graft survival, functional outcomes (creatinine and estimated glomerular filtration rate [eGFR]) on postoperative days 7 and 30 and at 1 year, and late complications were extracted from the common database. RESULTS: A total of 147 RAKTs were performed by the ERUS RAKT working group. Of the 147 patients, 83 had at least 1-year follow-up (mean [range] 21 [13-27] months). Of these 83 patients, 30 were women. The patients' median (range) age was 43 (30-75) years, body mass index was 25.3 (20-40) kg/m2 , pre-transplantation serum creatinine was 517 (198-1 414) µmol/L and estimated GFR (eGFR) was 10 (3-29) mL/min per 1.73 m2 . Of the 83 cases, 46 were pre-emptive. The median (range) overall ischaemia time was 116 (53-377) min. The median (range) rewarming time was 60 (35-110) min. At 1-year follow-up, the median (range) serum creatinine was 131 (66-244) µmol/L, with a median (range) eGFR of 57.4 (28-97) mL/min per 1.73 m2 . There was no statistically significant difference between functional data at postoperative day 30 and those at 1 year for creatinine (P = 0.78) or eGFR (P = 0.91). Regarding the correlation between the surgical data and the functional outcomes, the data showed that overall operating time and rewarming time did not affect the graft function at 1 year. Three cases of graft loss occurred as a result of massive arterial thrombosis within the first postoperative week. Late complications comprised one case of ureteric stenosis and one case of graft pyelonephritis. No late vascular complications or cases of incisional hernia were recorded. CONCLUSION: Findings at 1-year follow-up indicate RAKT from a living donor to be a safe procedure in a properly selected group of recipients. RAKT was associated with a low complication rate and there was maintenance of excellent graft survival and function. This is the first and largest study to report functional results after RAKT from a living donor with a minimum follow-up of 1 year.

Robotic kidney transplantation: one year after the beginning.

INTRODUCTION: Kidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease (ESRD). To reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. Our aim is to evaluate surgical and functional results on 17 cases of robotic-assisted kidney transplantation (RAKT) performed at the same institution. MATERIALS AND METHODS: From July 2015 to June 2016, we performed 17 cases of RAKT from living donors in pre-emptive patients, who underwent laparoscopic nephrectomy. A prospective pilot study was made at Fundació Puigvert (Barcelona), evaluating functional and surgical outcomes. In this series, we considered the functional results, surgical outcomes and complications rates. RESULTS: Seventeen patients successfully underwent RAKT, in particular surgical console time was 181 min (150-200) with vascular suture time 42 min (32-48), and estimated blood loss <70 ml. Overall ischemia time was 98.9 min (84-140). No patient was converted to open transplantation. No major surgical intra-operative complications were observed. The mean post-operative serum creatinine level 160 µmol/L (81-479). We reported a case of delayed graft function (DGF), one case of graft arterial thrombosis and one case of intraperitoneal hematoma. No anastomosis revision and wounds infections occurred. CONCLUSION: RAKT with regional hypothermia appears to be a safe surgical procedure in a properly selected group of patients. The potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients.

[Endoscopic bladder neck incision as first step in radical prostatectomy: An aid for patients previously treated for Bladder outlet obstruction]. / INCISIÓN ENDOSCÓPICA DEL CUELLO VESICAL COMO PRIMER PASO EN LA PROSTATECTOMÍA RADICAL: UNA AYUDA EN PACIENTES PREVIAMENTE OPERADOS POR HIPERPLASIA BENIGNA DE PRÓSTATA.

OBJECTIVE: Some patients with the indication of radical prostatectomy (RP) have often undergone previous surgical treatment for bladder outlet obstruction (BOO). These previous treatments make oncological surgery more challenging because of the difficulty in the identification of bladder neck and ureteral orifices. We present a new technique that entails previous endoscopic marking of bladder neck in order to make radical prostatectomy easier. METHODS: Twelve men with previous prostatic surgery for BOO underwent a laparoscopic/robotic radical prostatectomy between August 2008 and October 2012. The same technique was performed in all cases, a first circular endoscopic incision (EI) to mark the bladder neck and a second laparoscopic/robotic approach to complete the RP. We analyzed oncological and functional outcomes, as well as complications. RESULTS: Median operative time (EI + RP) was 175 minutes (140-205), being surgical time for endoscopic approach 20 minutes (17-31). No ureteral lesions were described and no ureteral stents were required. Positive margin rate was 8.3%. Only 1 of 5 complications observed needed surgery to be solved. Continence rate was 66.7% at one year of surgery. CONCLUSIONS: Our results show that a previous endoscopic bladder neck incision in patients with previous surgery for BOO makes easier the identification and dissection of the bladder neck itself during radical prostatectomy decreasing the risk of ureteral lesions as well as improving functional outcomes.

Incisión endoscópica del cuello vesical como primer paso en la prostatectomía radical: una ayuda en pacientes previamente operados por hiperplasia benigna de próstata / Endoscopic bladder neck incision as first step in radical prostatectomy: An aid for patients previously treated for Bladder outlet obstruction

OBJETIVO: Algunos de los pacientes a los que indicamos prostatectomía radical (PR) han sido sometidos a cirugía prostática previa por obstrucción cérvico-uretral (OCU). Este hecho dificulta la cirugía oncológica por la dificultad en la disección del cuello vesical y el riesgo de lesionar los meatos ureterales. Presentamos una técnica que consiste en realizar una incisión endoscópica previa en el cuello vesical con el fin de facilitar la prostatectomía radical. MÉTODOS: Doce pacientes con cirugía previa por OCU fueron sometidos a PR entre Agosto del 2008 y Octubre del 2012. La técnica empleada en todos los casos fue la misma, un primer tiempo endoscópico realizándose incisión endoscópica (IE) circunferencial para marcar el cuello vesical y un segundo tiempo laparoscópico/ robótico para completar la PR. Se analizaron resultados oncológicos y funcionales así como las complicaciones. RESULTADOS: La mediana del tiempo quirúrgico (IE+PR) fue de 175 (140-205) minutos, siendo la mediana de tiempo de la cirugía endoscópica 22 (17-31) minutos. No se describió en ningún caso lesiones a nivel de los meatos ureterales ni fue necesario cateterismo ureteral. La tasa de márgenes positivos fue del 8,3%. De las 5 complicaciones descritas, sólo una requirió de tratamiento quirúrgico. La continencia fue del 66,7% al año de la intervención. CONCLUSIONES: La realización de una incisión endoscópica en el cuello vesical, en pacientes con cirugía previa por OCU ha demostrado ser una buena estrategia como primer paso en la PR para conseguir buenos resultados oncológicos y funcionales junto con una baja tasa de complicaciones

OBJECTIVE: Some patients with the indication of radical prostatectomy (RP) have often undergone previous surgical treatment for bladder outlet obstruction (BOO). These previous treatments make oncological surgery more challenging because of the difficulty in the identification of bladder neck and ureteral orifices. We present a new technique that entails previous endoscopic marking of bladder neck in order to make radical prostatectomy easier. METHODS: Twelve men with previous prostatic surgery for BOO underwent a laparoscopic/robotic radical prostatectomy between August 2008 and October 2012. The same technique was performed in all cases, a first circular endoscopic incision (EI) to mark the bladder neck and a second laparoscopic/robotic approach to complete the RP. We analyzed oncological and functional outcomes, as well as complications. RESULTS: Median operative time (EI + RP) was 175 minutes (140-205), being surgical time for endoscopic approach 20 minutes (17-31). No ureteral lesions were described and no ureteral stents were required. Positive margin rate was 8.3%. Only 1 of 5 complications observed needed surgery to be solved. Continence rate was 66.7% at one year of surgery. CONCLUSIONS: Our results show that a previous endoscopic bladder neck incision in patients with previous surgery for BOO makes easier the identification and dissection of the bladder neck itself during radical prostatectomy decreasing the risk of ureteral lesions as well as improving functional outcomes

Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope.

PURPOSE: To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). METHODS: Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS: All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. CONCLUSIONS: Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.

Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study.

BACKGROUND: Ingestion of cranberry (Vaccinium macrocarpon Ait.) has traditionally been utilized for prevention of urinary tract infections. The proanthocyanidins (PACs) in cranberry, in particular the A-type linkages have been implicated as important inhibitors of primarily P-fimbriated E. coli adhesion to uroepithelial cells. Additional experiments were required to investigate the persistence in urine samples over a broader time period, to determine the most effective dose per day and to determine if the urinary anti-adhesion effect following cranberry is detected within volunteers of different origins. METHODS: Two separate bioassays (a mannose-resistant hemagglutination assay and an original new human T24 epithelial cell-line assay) have assessed the ex-vivo urinary bacterial anti-adhesion activity on urines samples collected from 32 volunteers from Japan, Hungary, Spain and France in a randomized, double-blind versus placebo study. An in vivo Caenorhabditis elegans model was used to evaluate the influence of cranberry regimen on the virulence of E. coli strain. RESULTS: The results indicated a significant bacterial anti-adhesion activity in urine samples collected from volunteers that consumed cranberry powder compared to placebo (p < 0.001). This inhibition was clearly dose-dependent, prolonged (until 24 h with 72 mg of PAC) and increasing with the amount of PAC equivalents consumed in each cranberry powder regimen. An in vivo Caenorhabditis elegans model showed that cranberry acted against bacterial virulence: E. coli strain presented a reduced ability to kill worms after a growth in urines samples of patients who took cranberry capsules. This effect is particularly important with the regimen of 72 mg of PAC. CONCLUSIONS: Administration of PAC-standardized cranberry powder at dosages containing 72 mg of PAC per day may offer some protection against bacterial adhesion and virulence in the urinary tract. This effect may offer a nyctohemeral protection.

Traumatismo renal con urinoma / Renal traumatism with urinoma

El extravasado de orina ocurre en los traumatismos renales que interesan la vía urinaria. El mecanismo de producción del traumatismo, la clínica y la exploración física permiten limitar el diagnóstico a la región lumbar o extenderlo a otras regiones, pero la determinación de la presencia de urinoma precisa de otros métodos. La TC es la mejor prueba diagnóstica aunque en la fase inicial del traumatismo puede no demostrar fuga de contraste. En aquellos casos en que el paciente está inestable, en las lesiones penetrantes o ante una lesión vascular sangrante, debe optarse por la técnica más resolutiva

The leak out of urine occurs in renal traumatisms that affect the urinary system. The mechanism of production of the traumatism, clinic and physical exploration allow to limit the diagnosis to the lumbar region or extended it to other regions, but the determination of the presence of urinoma requires other methods. CT is the best diagnostic test although in the initial phase of the traumatism may not show leakage of contrast. In the cases where the patient is unstable, or in cases of penetrating injuries or in a vascular bleeding injury, we should adopt a more resolutive technique

[Paraurethral cyst of the Littre's gland: an exceptional case]. / Quiste parauretral de la glándula de Littré, un caso excepcional.

OBJECTIVE: To report one case of paraurethral cyst in the male, located in the subglandular penile urethra, an extremely rare pathology. METHODS/RESULTS: 46-years-old male patient with the diagnosis of Littre's gland paraurethral cyst. Diagnosis and subsequent treatment. CONCLUSIONS: Paraurethral cysts of non traumatic origin are very rare, only two cases are described in the literature, one cyst located at the penoscrotal angle dependent from the corpus spongiosum without connection to the urethra, and another case of inflammation of the periurethral Littre's glands simulating a tumor.

Quiste parauretral de la glándula de Llitré, un caso excepcional / Paraurethral cyst of the Littre´s gland: an exceptional case

OBJETIVO: Describir un caso clínico de un quiste parauretral en un varón, a nivel de uretra peneana subglandar, patología extremadamente infrecuente. MÉTODO/RESULTADO: Paciente varón de 46 años de edad diagnosticado de un quiste parauretral de la glándula de littré, su diagnóstico y posterior tratamiento. CONCLUSIÓN: Los quistes parauretrales de origen no traumático son muy raros, sólo se han descrito dos casos en la literatura, un quiste localizado en ángulo penoescrotal dependiendo de cuerpo esponjoso sin conexión con la uretra y otro caso de inflamación de las glándulas periuretrales de Littré simulando un tumor

OBJECTIVE: To report one case of paraurethral cyst in the male, located in the subglandular penile urethra, an extremely rare pathology. METHODS/RESULTS: 46-years-old male patient with the diagnosis of Littre`s gland paraurethral cyst. Diagnosis and subsequent treatment. CONCLUSIONS: Paraurethral cysts of non traumatic origin are very rare, only two cases are described in the literature, one cyst located at the penoscrotal angle dependent from the corpus spongiosum without connection to the urethra, and another case of inflammation of the periurethral Littre`s glands simulating a tumor