[Renal allograft rupture: case report and bibliographic review]. / Estallido renal. Caso clínico y revisión de literatura.

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out.

Genito Pelvic Pain/Penetration Disorder (GPPPD) in Spanish Women-Clinical Approach in Primary Health Care: Review and Meta-Analysis.

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case-Control Study.

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case-control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.

[Metabolic alterations and stones in patients with orthotopic ileal diversions. Case description.] / Alteraciones metabólicas y litiasis en pacientes con derivación ileal ortotópica. A propósito de un caso.

OBJECTIVE: Bacterial presence, anatomic anomalies and metabolic alterations increase the risk of stone formation in patients with neobladders. These patients sometimes require medical or surgical procedures. The aim of the current work is to analyze those alterations and medical treatment associated to it. METHODS: A case of a 66 yo male who had undergone a cystectomy with neobladder 3 years ago. Currently present with a staghorn stone on the right kidney. Past medical history of stone formation as well as double J calcification. RESULTS: The combination of medical and surgical treatment for stone was performed. Medical therapy will allow prevention of new stones. CONCLUSIONS: Metabolic and chronic infections in patients with neobladders treated should decreased the new stone formation in patients with neobladders.

OBJETIVO: La colonización bacteriana, las alteraciones anatómicas y las anomalías metabólicas aumentan el riesgo de litiasis en los pacientes con neovejiga, precisando en muchas ocasiones de un abordaje médico y quirúrgico complejo. El objetivo del trabajo es analizar dichas alteraciones y el tratamiento médico de las mismas. MÉTODOS: Se presenta el caso de un varón de 66 años con antecedente de cistectomía más derivación ortotópica desde hace tres años, el cual presenta litiasis coraliforme en riñón derecho. Antecedentes de varias litiasis, así como calcificación de doble J. RESULTADO: Mediante la combinación de tratamientos médicos y quirúrgicos se tratan las litiasis del paciente, siendo especialmente importante el manejo médico en la prevención de futuros eventos litiásicos. CONCLUSIONES: Diagnosticar y tratar las alteraciones metabólicas y las infecciones crónicas en pacientes con neovejiga puede reducir la aparición de litiasis en los pacientes con neovejiga.

[Stab wounds of the kidney: conservative management. Two new cases and review of the literature]. / Manejo conservador de los traumatismos renales por arma blanca. Presentación de dos nuevos casos y revisión de la literatura.

INTRODUCTION: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do. MATERIAL AND METHODS: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature. RESULTS: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies. CONCLUSIONS: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long-term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree.

Lateral-based Anterior Vaginal Wall Flap in the Treatment of Female Urethral Stricture: Efficacy and Safety.

BACKGROUND: Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used-the Blandy's technique-has resulted in our cases in a retrusive meatus and an inward urinary stream. OBJECTIVE: To show the efficacy and safety of an alternative vaginal wall flap urethroplasty. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional observational study was undertaken in a single University Hospital. Nine female patients previously diagnosed with urethral stricture at our institution underwent open surgery from 1993 to 2015. They were contacted and agreed to undergo a medical examination. SURGICAL PROCEDURE: A ventral lateral-based anterior vaginal wall flap urethroplasty inspired by the Orandi technique for male urethroplasty was performed. MEASUREMENTS: A chart review was performed. RESULTS AND LIMITATIONS: The mean age was 56 yr (41-78 yr). The mean follow-up was 80.7 mo (12-198). All patients had relief of symptoms. The meatus of all patients stayed in an orthotopic position without any impact on the direction of the urinary stream. The average caliber of the urethra increased from 10.8 Fr (6-18 Fr) to ≥20 Fr. Peak flow improved from a mean of 6.8ml/s (3-11ml/s) to 21ml/s (14-35ml/s). No patient developed stricture recurrence or de novo stress urinary incontinence. There were no other immediate or delayed complications. All patients achieved a better score on the Patient Global Impression of Improvement questionnaire. CONCLUSIONS: Our study, with the same limitations that the few studies published in this field had, that is the few patients included, demonstrates that lateral anterior vaginal wall flap urethroplasty is an effective technique, offering durable results without apparent complications. PATIENT SUMMARY: We studied an alternative surgical technique for the treatment of female urethral stricture. We conclude that it is safe and effective with no apparent complications and good long-term results.

Sexual Quality of Life After Treatment of Stress Urinary Incontinence With Adjustable Tension-free Mesh System in Women Who Were Sexually Active Before Surgery.

OBJECTIVE: To assess the sexuality and quality of life of sexually active women with stress or mixed urinary incontinence (SUI or MUI) after surgery with adjustable tension-free suburethral mesh system (transobturator adjustable tape or transvaginal adjustable tape). MATERIALS AND METHODS: This intervention study with 2 years of follow-up (visits at 3 months, 1 year, and 2 years) involved 60 women with SUI or MUI who underwent surgery using transobturator adjustable tape or transvaginal adjustable tape during 2008-2014 in a Spanish region. The variables of interest measured pre- and postintervention were the global scores on the following questionnaires: (1) the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12; (2) the International Consultation on Incontinence Questionnaire; and (3) the Incontinence Quality of Life Questionnaire. Mixed linear models were constructed to determine the effect of the intervention on the outcome variables. RESULTS: A significant improvement (P <.001) was seen over time in all the questionnaires, although between the 1- and 2-year visits there was a slight deterioration in all of them. CONCLUSION: The technique provided an improved quality of life and sexuality, which was maintained at all the postoperative visits compared with baseline.

Alteraciones metabólicas y litiasis en pacientes con derivación ileal ortotópica. A propósito de un caso / Metabolic alterations and lithiasis in patients with orthotopic ileal diversion. About a case

Objetivo: La colonización bacteriana, lasalteraciones anatómicas y las anomalías metabólicas aumentan el riesgo de litiasis en los pacientes con neovejiga,precisando en muchas ocasiones de un abordaje médicoy quirúrgico complejo. El objetivo del trabajo es analizardichas alteraciones y el tratamiento médico de las mismas.Métodos: Se presenta el caso de un varón de 66 añoscon antecedente de cistectomía más derivación ortotópicadesde hace tres años, el cual presenta litiasis coraliformeen riñón derecho. Antecedentes de varias litiasis, así comocalcificación de doble J. Resultado: Mediante la combinación de tratamientosmédicos y quirúrgicos se tratan las litiasis del paciente,siendo especialmente importante el manejo médico en laprevención de futuros eventos litiásicos.Conclusiones: Diagnosticar y tratar las alteracionesmetabólicas y las infecciones crónicas en pacientes conneovejiga puede reducir la aparición de litiasis en los pacientes con neovejiga.(AU)

Objetive: Bacterial presence, anatomicanomalies and metabolic alterations increase the risk ofstone formation in patients with neobladders. These patients sometimes require medical or surgical procedures.The aim of the current work is to analyze those alterationsand medical treatment associated to it.Methods: A case of a 66 yo male who had undergonea cystectomy with neobladder 3 years ago. Currently present with a staghorn stone on the right kidney. Past medicalhistory of stone formation as well as double J calcification.Results: The combination of medical and surgical treatment for stone was performed. Medical therapy will allowprevention of new stones.Conclusions: Metabolic and chronic infections in patients with neobladders treated should decreased the newstone formation in patients with neobladders.(AU)

Manejo conservador de los traumatismos renales por arma blanca. Presentación de dos nuevos casos y revisión de la literatura / Stab wounds of the kidney: conservative management. Two new cases and review of the literature

Introducción: El tratamiento de los traumatismos renales por arma blanca ha sido tradicionalmente quirúrgico. Desde hace más 20 años se aboga por un tratamiento conservador con el fin de evitar laparotomías innecesarias y preservar unidades renales. Los criterios para intervenir de forma urgente o las pautas de seguimiento no están establecidos debido a la falta de estudios de calidad. Material y métodos: Presentamos dos nuevos casos de traumatismo renal por arma blanca en los que se llevó a cabo un manejo conservador y realizamos una revisión de la literatura. Resultados: Los dos pacientes evolucionaron favorablemente, si bien uno de ellos presentó hematuria durante el postoperatorio inmediato y fue necesaria una embolización selectiva de una fístula arterio-venosa. La mayor parte de los artículo se basan en series de casos o estudios observacionales retrosprospectivos. Conclusiones: En los traumatismos renales por arma blanca el diagnóstico es clínico y el estadiaje de las lesiones radiológico con una tomografía computarizada. El manejo conservador es de elección cuando el paciente está estable hemodinámicamente y las lesiones no requieren reparación inmediata. Estos pacientes requieren un seguimiento a largo plazo para monitorizar la aparición de complicaciones. Son necesarios estudios de mayor calidad que aporten una mayor evidencia científica (AU)

Introduction: Stab wounds of the kidney have traditionally been managed by open surgery. Nowadays the conservative management of stab wounds injuries is extended in order to avoid unnecessaries nephrectomies and laparotomies without increasing morbidity and mortality. Although there is no a strong evidence to recommend when to operate or what sort of follow up we must do. Material and methods: We present two new cases of stab wounds injuries managed conservatively. We performed a systematic review of the literature. Results: Both patients evolved favorably although one of them presented hematuria 7 days after the traumatism and we performed an embolization of an arteriovenous fistula. Most of the articles are based on series of cases or retrosprospective studies. Conclusions: The diagnosis and staging of stab wounds of the kidney must be done with clinic and CT scan. Conservative management is required when the patient is not hemodinamically unstable and injuries do not require inmediate repair. These patients require a long term follow up to prevent the appearance of complications. Randomized prospective multicenter trials are needed to support the optimum management for each kidney injury degree (AU)

Estallido renal. Caso clínico y revisión de literatura / Renal allograft rupture: case report and bibliographic review

OBJETIVO: Mejorar el conocimiento acerca de las complicaciones del transplante renal y en concreto la rotura del injerto. MÉTODO: Presentación de caso clínico y revisión de la literatura. RESULTADO: Presentamos un caso de una paciente de 37 años de edad sometida a su segundo injerto renal. En el tercer día del postoperatorio, sufrió un cambio brusco en la correcta evolución, con dolor intenso en fosa iliaca izquierda (donde se había instaurado el injerto) e inestabilidad hemodinámica. Las pruebas de imagen sugieren colección retroperitoneal y adyacente al injerto. En esta situación se decide reintervención donde se objetiva la ruptura de la unidad renal practicándose transplantectomía. El estudio anatomopatológico confirma que la causa de dicha ruptura viene establecida por un rechazo agudo del injerto. CONCLUSIONES: La ruptura del injerto es una de las complicaciones más graves en un transplante renal. Ante este acontecimiento se precisa un diagnóstico rápido y tratamiento quirúrgico. El manejo conservador es la medida a tomar para la posible preservación de la unidad renal, pero existen algunas situaciones en las que la conservación es peligrosa y se debe llevar a cabo la extirpación del injerto (AU)

OBJECTIVE: To improve the knowledge about complications of renal transplantation and, in particular, graft rupture. METHODS: Case report and literature review. OUTCOME: We present the case of a 37 year-old patient receiving a second renal transplant. In the third postoperative day, he suffered an abrupt change from the correct evolution, with intense pain in the left iliac fossa (the side of the implant) and hemodynamic instability. Imaging tests suggested retroperitoneal collection and adjacent to the implant. In this situation we decided reoperation, we found a ruptured renal unit and transplant nephrectomy was carried out. The pathologic study confirmed that the cause of this rupture was acute rejection of the implant. CONCLUSION: The rupture of the graft is one of the most serious complications in renal transplantation. Rapid diagnosis and surgical treatment are required. Conservative management is the treatment of choice for possible preservation of the renal unit, but there are some situations in which it is dangerous and removal of the graft must be carried out (AU)