["Ex-situ" reconstructive surgery of the renal arteries]. / Cirugía reconstructiva "ex-situ" de arterias renales.

The paper sums up our experience with kidneys which have undergone "bench" extracorporeal arterial surgery. The reasons making this procedure necessary were: renal graft from corpse donor presenting multiple arteries or arterial lesions (12 cases); orthoptic kidneys with stenotic lesions or arterial aneurism (5 cases); transplanted grafts which developed renal artery stenosis (2 cases). Incidence of arterial thrombosis and ureteral fistula was significantly higher in the first group than in grafts where no "bench" surgery had been performed. Medium- and long-term actuarial survival, however, showed no difference. In the second and third groups, extracorporeal arterial reconstructive surgery is a technique with a high risk for the loss of the involved renal unit.

[Vascular complications in renal transplantation]. / Complicaciones vasculares en el trasplante renal.

Between the years 1979 and 1992 we a total of 479 renal transplants (RT) were performed. In 62 patients (12.9%) there were some clinically significant vascular complications. These have consisted of: 10 cases of arterial thrombosis (2%); 10 cases of venous thrombosis (2%); 5 cases of arterial and venous thrombosis (1%); 31 cases of arterial stenosis (6.5%); and 6 cases of acute haemorrhage originated at the vascular anastomosis level (1.2%). In all those cases with arterial or venous thrombosis, or both, it was necessary to perform transplantation. The arterial stenosis cases were treated with antihypertensive agents in 13 patients; with endoluminal percutaneous angioplasty (EPA) in other 13 patients and with surgery in 5. Both arterial stenosis and complications from their treatment resulted in 5 transplantations. In all cases with early post-surgical haemorrhage originated at the vascular anastomosis level, a surgical review and suture of bleeding site was performed. A total of 31 grafts (6.5%) were lost as a result of vascular complications.

[Carcinoma of the penis. Our experience and review of the literature]. / Carcinoma de pene. Nuestra experiencia y revisión de la literatura.

Penile carcinoma is a rather infrequent neoplasia with an approximate annual rate of 1 to 2 cases per 100,000 inhabitants. In Spain, its presentation is rare, corresponding to 10.42% of all tumors and 0.7% of all malignant tumors of the male. In this report, the casuistic of our Department between the years 1978 and 1987 is presented. Ten patients diagnosed of penile carcinoma were treated, representing 0.1% of all the urological tumors seen during that period. Special emphasis has been placed on the need to perform national multicenter studies, due to the rare finding of such pathology. From an etiopathogenic perspective, chronic inflammation due to smegma accumulation and the presence of a prepuce seem necessary for the development of this pathology. The role of oncogenic viruses still remains to be cleared. After treatment, which was mainly surgical, a global survival rate of 60% was obtained with a follow-up period ranging from 1 month to 7 years. After pointing out several anatomical considerations relating to the lymph drainage of the penis, the different therapeutic alternatives (surgery, radiotherapy, chemotherapy) in the treatment of penile carcinoma were discussed.

[Renal outcome in myelodysplastic patients with untreated, risky vesico-sphincter dysfunction]. / Destino renal en los pacientes mielodisplásicos con disfunciones vesico-esfinterianas de riesgo no tratadas.

Poor vesical accommodation with competent sphincter system and bladder-sphincter dyssynergy are major risk factors for renal function in patients with myelomeningocele. We present four cases with these urodynamic features and we analyse renal variation with time in relation to these, pointing out the poor evolution. We emphasize the need for urodynamic study with simultaneous radiology and early treatment when these risk factors exist.

[Upper urinary tract fistulas in renal transplantation]. / Fístulas del tramo urinario superior en el trasplante renal.

237 kidney transplants were performed in our department in a period running from November 1979 to October 1986. Out of this total number of transplants we analyzed the incidence of fistulas of the upper urinary tract, which in our series is 3.3%. Following a study protocol of these patients referring to multiple parameters, we conclude that in our series fistulas of the upper urinary tract appear precociously (less than 45 days post-transplant) and in connection with acute rejection episodes (high doses of steroids). On the basis of anatomopathological criteria we establish that its treatment has to be surgical and a meticulous surgical extraction technique is essential for its prevention.

[Infiltrating transitional carcinoma of the bladder (4). Our approach to stage pT2 and critique of other risk factors. Multifactorial analysis]. / Carcinoma transicional infiltrante de vejiga. (4a parte). Nuestra actitud frente al estadio pT2 y crítica de otros factores de riesgo. Análisis multifactorial.

From the analysis of our experience with pT2 and pT3a tumours it could be deduced that the former have better prognosis. The papillary appearance, invasion in a wide front and extent, whether with good or moderate differentiation, in T2 are signs of good prognosis, as well as the non-existence of unilateral dilation or an effaced kidney. Considering the good evolution obtained with radical cystectomy only, these patients should be recruited for study in order to see whether evolution with bladder preservation is similar. Patients with pT2 tumours should not be included in protocols to evaluate the efficacy of adjuvant therapies used with surgery. The evolution is not equivalent to that expected in tumours of deeper invasion.

[Rupture of the graft in kidney transplant. Our caseload]. / Rotura del injerto en el trasplante renal. Nuestra casuística.

316 kidney transplants were carried out in the Ramón y Cajal Hospital between November 1979 and December 1988. The number of breakages was 7. In this paper we analyse the incidence of this complication as well as the etiopathogeny of the process, highlighting the relationship between the appearance of acute rejection, alterations in coagulation, and instrumental manoeuvres carried out on the graft, especially in the first days after transplant. The clinical pattern usually displayed was pain with swelling and pasting in the area of the implant, along with hypotension, oliguria and deterioration of kidney function. We underline the importance of echography as the follow-up method in the early detection of hematomas, perirenal collections, etc., which, together with the preceding clinical data, will orientate us towards an early diagnosis. We study the possible relationship of this complication with different factors, singling out the reduced frequency of appearance after the advent of cyclosporin and its use as an immunosuppressive drug. We advocate the conservation of the implant with three dimensional corsseting, provided this is feasible and the general conditions of the patient so permit.

[Instability of the detrusor. Treatment with oxybutynin chloride (Ditropan) in children]. / Inestabilidad del detrusor. Tratamiento con cloruro de oxibutinina (Ditropan) en niños.

We study the effect of oxybutynin chloride (Ditropan) in a random sample of 24 children with ages ranging from 5 to 14 years, diagnosed as having vesical instability from both the clinical and urodynamic standpoints. These effects were evaluated after a period of treatment that ranged from 10 to 36 months (x = 20). We obtained overall clinical improvement in 87.5%, and improvement of urodynamic alterations in 83.3% of the patients. We single out the beneficial effect of oxybutynin chloride with prolonged treatments, in instability of the detrusor, as well as its good tolerance.

[Diagnostic yield of Echo-Doppler in dysfunction of the grafted kidney]. / Rentabilidad diagnóstica del eco-Doppler en la disfunción del injerto renal.

The study's goal is to analyze the usefulness of Eco-Doppler in the knowledge of renal graft hemodynamics and the description of its dysfunction. 234 examinations were performed in 110 patients. Acceleration, mean rate (MR), maximum systolic rate (MXSR) and minimal diastolic rate (MNDR), as well as resistance index (RI) and pulsatility index (PI) were determined in the external iliac, renal, segmentary, interlobular and arcuate arteries. RI and PI, as well as MXSR and the acceleration are higher in the extra-parenchymatous versus the intra-parenchymatous beds. Peak MR and MNDR values are reached in the renal artery. Termino-lateral to external iliac arterial anastomosis conditions higher MXSRs in the renal artery as opposed to termino-terminal to hypogastric artery (p < 0.05). In the arcuate artery, RI > 0.8 is reached in 51.6% of acute tubular necrosis (ATN), 46.9% of acute rejections (CR), 46.3% of chronic rejection (AR), 21% of grafts with cyclosporin-induced nephrotoxicity (NFX) and 12.5% of normal functioning kidneys isolated chance analysis with Eco-Doppler does not distinguish between AR and ATN. A dysfunctional graft with an RR in the arcuate artery of nearly 9.7 suggests NFX, but AR with interstitial predominance cannot be ruled out.

[Surgical complications in 479 renal transplantations]. / Complicaciones quirúrgicas en 479 trasplantes renales.

Exposition of results obtained from the review of the surgical complications found in a series of 479 renal transplantations performed between 1978 and 1992 in our centre, although some of them lack clinical relevance. There was fluid accumulation in 69 patients, distributed between 31 perirenal haematoma. 17 lymphocele, 13 urinoma, 5 perirenal abscesses and 3 mixed. 27.7% required no action. Frequency of renal rupture was 18 cases, 9 due to acute rejection and 9 to vascular thrombosis. Incidence of urinary obstruction was 4.8% with 5.8% of urinary fistula. With regard to the surgical wound, 9 infections, 7 haematomas, 1 eventration and 1 necrotizing fasciitis were observed. Vascular complications consisted in 10 arterial thrombosis, 10 venous thrombosis, 5 mixed thrombosis and 31 arterial stenosis. Treatment instituted for the various cases, its evolution, and an statistical study of risk factors are illustrated.

[Rupture of simple renal cyst after minimal renal injury]. / Rotura de quiste renal simple tras traumatismo renal mínimo.

A case is presented of minimum renal trauma, leading to a retroperitoneal hematoma as a consequence of a simple renal cyst rupture as well as an artery contained therein. The etiopathogenicity of this phenomenon is commented. The different clinical manifestations of renal trauma are highlighted, as well as the suspicion of previous renal pathology when a large renal lesion is found secondary to minimum renal trauma. The approach of the renal pediculum must be the first step in the surgical treatment of renal trauma.

[Primary testicular lymphoma. Report of a new case and review of the literature]. / Linfoma testicular primario. Aportación de un nuevo caso y revisión de la literatura.

Primary testicular lymphoma is an uncommon testicular tumour that accounts for no more than 9% of all testicular tumours in those series with higher incidence; testicular lymphoma as haematopoietic tumours are also rare accounting for just 1% of all lymphomas; but due to their highly malignant histopathology they may become highly aggressive tumours. Patient age at presentation is over 60 years old which makes it the most frequent tumour for this age group. There is no standard protocol to treat this malignancy due to lack of extensive series. We contribute one case and make a literature review discussing the current therapeutic trends for this disease.

[Treatment of recurrent bladder surface tumors with laser Nd:Yag: a single-year experience]. / Tratamiento de los tumores vesicales superficiales recidivantes con laser Nd:Yag: un año de experiencia.

Management of surface vesical tumours using laser photocoagulation has proven to be a safe and effective method. The technique can be performed under anaesthetic sedation and in the outpatient clinic environment thus allowing a considerable cost saving and the reduction of hospital's waiting lists. Throughout 1990, 47 patients with relapsing vesical tumours were treated in 55 sessions. Most cases were performed on ambulatory patients with a low complications rate and an estimated saving of 18,326,400 pesetas as compared to transurethral resection.

Role of 3.0 T multiparametric MRI in local staging in prostate cancer and clinical implications for radiation oncology.

PURPOSE: To evaluate the accuracy of preoperative 3T multiparametric magnetic resonance imaging (3TmMRI) for local staging of prostate cancer and its influence on the decision to change the clinical target volume (CTV), total dose and hormonal therapy when treating prostate cancer patients with radiotherapy. METHODS: From 2009 to 2013, 150 patients, who had confirmed prostate cancer and underwent a 3TmMRI before treatment with radical prostatectomy or radical radiation therapy, were included. Radiation therapy treatment (CTV, total dose and hormonal therapy) was initially determined on the basis of the clinical information, and radiation therapy plan was reevaluated after 3TmMRI review. The value of preoperative 3TmMRI in local staging and in the decision of radiotherapy treatment according to NCCN risk classification was analyzed. RESULTS: 3TmMRI performed correct, over- and under staging in 78.7 % (37/47), 6.3 % (3/47), 14.8 % patients (7/47), respectively. 3TmMRI identified 6 cT2a, 7 cT2b, 28 cT2c, 3 cT3a, 3 cT3b tumors. At final pathology, 5 tumors were classified as pT2a, 5 as pT2b, 30 as pT2c, 4 as pT3a, 3 as pT3b. After reviewing the MRI reports, the initial radiotherapy and hormonal therapy plan was changed in 33.9 % patients (35/103). CONCLUSIONS: In our group of patients, 3TmMRI has been a reliable technique providing an optimal staging for prostate cancer. Its routine use could induce important changes in radiation therapy treatments in a significant number of such patients. However, more additional studies are needed to clarify this issue.

[Abnormalities of the inferior vena cava: the retrocaval ureter]. / Malformaciones de la vena cava inferior: el uréter retrocavo.

We report three cases of retrocaval ureter with a clear indication for surgery: one patient with severe hydronephrosis and two cases with mild dilatation of the renal pelvis, calyces and upper ureter, both complicated by renal stones. The initial diagnosis was based on the ultrasound and the intravenous urogram findings, and was confirmed by a retrograde pyelogram in combination with cavography and CT. All patients were submitted to surgery (1 nephrectomy and 2 uretero-ureteric anastomosis). Renal stone was resolved at the same time in one case, and by ESWL after surgery in the other.

[Laparoscopic transplantectomy of renal graft. Experimental model]. / Trasplantectomía laparoscópica del injerto renal. Modelo experimental.

Renal transplant nephrectomy carries a high morbidity and mortality. Conceptually, graft removal by laparoscopy is a logical less invasive alternative. We have developed an experimental model for renal autotransplantation in the pig, with laparoscopic graft removal eight weeks following autotransplantation. Although the clinical indication for laparoscopic nephrectomy of a failed graft will provoke controversy, a nonfunctioning renal graft with intolerance and no rupture or infection late post-transplantation theoretically could be the indication for this procedure.

[Transrectal echography: diagnostic accuracy in the local staging of cancer of the prostate]. / Ecografía transrectal: seguridad diagnóstica en el estadiaje local del cáncer de próstata.

Herein we report on the results afforded by transrectal ultrasound relative to local staging of tumor in 18 patients who had undergone radical surgery for prostatic cancer. The diagnostic accuracy for prostatic capsule involvement was 83.3% and 100% when there was seminal vesicle invasion.

[New applications of the Doppler effect in urology]. / Nuevas aplicaciones del efecto Doppler en urología.

Ultrasound is currently the noninvasive imaging technique most commonly utilized in the clinical setting. It can be used in two ways: to obtain morphological data and to obtain dynamic information via the Doppler effect.