[Cancer and kidney transplantation]. / Cáncer y trasplante renal.

The higher risk of developing malignant tumours in transplanted patients is a fact widely acknowledged over the last decade. This paper includes an analysis of our series and a review of the literature. Cancers developed by the transplanted patient or "de novo" cancers and, within this group skin and lip cancer (58%), are by far the most frequent ones. Their biological behaviour is, in general, more aggressive than similar ones in non-transplanted population. Also, different incidence rates and behaviour have been established depending on the immunosuppressive regime given to the patient. Most common pre-existing carcinoma was renal cancer (one third of cases). When these patients had been adequately treated before the transplant, the minimum disease-free interval that has to elapse to be included in a waiting list will depend on the type of tumour. Transferred tumours are the least frequent but more worrying ones due to both their clinical and legal implications. In view of the existing evidence, it is of particular relevance to insure the primitive nature of any CNS tumour as well as the absence of tumoral disease in young females who die of brain haemorrhage.

[Analysis of the reasons for non graft initial function in our series of the last eleven years]. / Análisis de las causas de no función inicial del injerto en nuestra serie de los últimos once años.

UNLABELLED: FUNDAMENTAL: [corrected] To know which risk factor of delayed graft function in our patients. MATERIAL AND METHODS: We analyzed 469 transplants, 270 had good initial function and 199 had delayed function graft. Variables studies in booth groups were: age, sex and dead cause of donant, type of extraction and place were it was done, implantation side, vases multiple, isquemia times, age and receptor sex, HLA compatibility, retransplant, Ac Anti-VHC, PTH pretransplant, years in waiting list, hiperinmunization, number of transfusion, and type of inmunosupretion. RESULTS: Univariant study: significant differences were found in age and dead cause of donant, isquemia times, years in waiting list, hiperinmunization, number of transfusions, and HLA-B incompatibility. Multivariate study: we have significant differences in age of donant, could isquemia time, years in waiting list, cuadruple? Inmunosupretion. CONCLUSIONS: Results suggest to short could and revascularization isquemia time as possible, and use less nefrotoxic inmunosupretion pautes in high-risk patients.

[Sterilization of catheters used for intermittent bladder emptying using a domestic microwave oven]. / Esterilización de catéteres empleados para vaciado vesical intermitente con microondas casero.

In contemporary urology it is increasingly frequent the indication of intermittent catheterization. Patients undergoing this type of therapy use several non-standardized methods to make catheterization as clean as possible. Microwave sterilization has been successfully used for certain materials and biological residues. For this reason and because it is a rather inexpensive system, we tried to demonstrate that sterilization of catheters used by our patients for intermittent catheterization using domestic microwave ovens at home is a convenient, inexpensive and clean alternative that should be taken into account. The catheters used were those employed in our hospitalized patients for a minimum of 4 days, which involves a high percentage of contamination. In 15 cases, the catheter was treated in a 800 W domestic microwave oven after having washed it with water so as to eliminate macroscopic organic residues, and in another 15 cases they were thoroughly washed before microwave treatment. In either case, the treatment was done for over 6 minutes at maximum power with the precautions described in the text. In all instances, the catheter's sterility was confirmed except for one case where contamination occurred during post-treatment handling.

[Renal adenocarcinoma in the isthmus of a horseshoe kidney]. / Adenocarcinoma renal en el istmo de un riñón en herradura.

A case of renal adenocarcinoma localized to the isthmus of a horseshoe kidney is described. We underscore the importance of complementary US and/or CT to urography to study the acquired pathologies of the horseshoe kidney because the pyelocaliceal distribution of these kidneys may not facilitate correct identification of certain space occupying lesions. The angiographic study is considered essential for planning surgery for this type of lesion.

[Late surgical complications in kidney transplantation. Experience and results]. / Complicaciones quirúrgicas tardías en el trasplante renal. Experiencia y resultados.

The present study reports the late surgical complications observed following 270 renal transplant procedures performed at our department. Their etiologic, clinical, and therapeutic aspects are discussed. With respect to arterial stenosis, we consider percutaneous transluminal angioplasty the procedure of choice when drug therapy fails to control hypertension. Surgery should be reserved for those cases where this procedure fails. We advocate treatment of lymphoceles whose size cause displacement or compression of the excretory tract using drainage and instillation of povidone iodide as advocated by González Martín. Stenosis of the excretory tract is the most common complication in our series. Treatment was by corrective surgery. In our view, the etiologic and ultrastructural features of this complication make it unamenable to endourologic correction.

[Vascular assessment before kidney transplantation. Role of computerized helical tomography]. / Evaluación vascular pretrasplante renal. Papel de la tomografía helicoidal computerizada.

OBJECTIVE: To present our experience with helical CT for vascular assessment prior to renal transplantation. METHODS: In our hospital, all candidates to renal transplantation are referred to the Urology Transplant Unit for previous assessment. For the past 3 years, patients with multiple arterial calcifications (non linear) have been evaluated by helical CT with three-dimensional reconstruction of the calcification densities, which provides an accurate representation of the lesion. RESULTS/CONCLUSIONS: Pretransplant evaluation has been fundamental for individualized planning of the renal transplant surgery. The use of helical CT is extending in our field and it has also been utilized in graft donor assessment. In our experience, the extent and thickness of arterial wall calcifications are accurately depicted by helical CT. These findings could have an important significance when making pre and perioperative decisions in renal transplantation.

[Non-venereal sclerosing lymphangitis of the penis]. / Linfangitis esclerosante no venérea del pene.

Non-venereal sclerosing lymphangitis of the penis is a rare condition that affects the distal lymphatics of this organ. It has been reported to be frequently associated with trauma to this area and, although it has a minimum inflammatory component, its etiology is unknown. A serpinginous nodular lesion in the sulcus coronarius penis may be observed by the patient. Because it is generally self-limiting, treatment is initially conservative and surgical excision is performed only if symptomatic lesions persist. The present study reports an additional case. The literature is reviewed and the possible etiopathogenic mechanisms and therapeutic alternatives are discussed.

[Surgical treatment of obstructive disease of the transplanted kidney]. / Tratamiento quirúrgico de la patología obstructiva del riñón trasplantado.

OBJECTIVES: To review renal graft obstruction post-transplantation and its surgical management. METHODS/RESULTS: Our experience and those of other Spanish centers are analyzed and the literature reviewed. The different causes of obstruction following transplantation are briefly analyzed and the advantages and disadvantages of the different therapeutic options are discussed. CONCLUSIONS: Graft obstruction post-transplantation continues to be an important challenge to the urologist. However, in most of the cases the therapeutic alternatives are relatively standardized and achieve satisfactory results.

[Retroperitoneal fibrosis without dilatation of the upper urinary tract and non-obstructive anuria]. / Fibrosis retroperitoneal sin dilatación de vías altas y anuria no obstructiva.

OBJECTIVE: An unusual case of retroperitoneal fibrosis with non-obstructive anuria is described and the therapeutic alternatives are discussed. METHODS/ RESULTS: Repeated obstruction of the double-J ureteral catheter and intense lumbar pain did not permit endourological management and surgery was required. Excellent results were achieved and the patient is asymptomatic 12 months postoperatively. CONCLUSIONS: Conservative endourological management and corticosteroids may not always be feasible. The anuria without dilation in the case described is not unlike other reported cases considered as reflex anuria whose mechanism remains unknown.

[Complications of immunotherapy with BCG. Report of a case with retractile bladder]. / Complicaciones de la immunoterapia con BCG. A propósito de un caso de vejiga retráctil.

OBJECTIVES: We report a case of contracted bladder following BCG immunotherapy to prevent recurrence of a superficial bladder carcinoma. Other possible complications and their prevention are also discussed. METHODS: The patient had extreme contracted bladder and marked bilateral ureterohydronephrosis that required cystectomy and bladder substitution. The histopathological examination revealed detrusor muscle fibrosis without inflammation. RESULTS: Surgery achieved good results and the patient is disease-free 5 months postoperatively. CONCLUSIONS: The major complication that must be avoided is absorption following traumatic catheterization. Recognizing the early symptoms, particularly cystitis, together with adequate and early treatment of the localized effects can significantly reduce the incidence of severe toxicity.

[Immediate surgical complications after 270 renal transplants. Experience and results]. / Complicaciones quirúrgicas inmediatas tras 270 trasplantes renales. Experiencia y resultados.

The present study reports on the early surgical complications observed in 270 renal transplants performed from 1978-1987. A total of 34 (12.5%) surgical complications were observed in the early postoperative period (1 to 6 weeks posttransplant). Among the most prevalent were postoperative hemorrhage, most of which were ascribable to blood coagulation disorders from heparin administration necessary to perform hemodialysis in these patients, and thrombus formation during the initial stages of our experience. Ten patients had urinary fistulas that were resolved in different ways. We advocate performing pyelo-pyelic anastomosis to the excretory tract whenever possible because of the good results achieved with this procedure.

[Kidney transplant in children. Our experience]. / Trasplante renal en la infancia. Nuestra experiencia.

We report on our experience comprised of 21 kidney transplant procedures (20 from cadavers and 1 from a living donor) performed at the Urology Department of our hospital. Of these, 11 remained functional 2 years following transplantation. Of the 10 transplants that failed, 3 were due to arterial thrombosis, 1 from venous thrombosis, 2 from late rejection, 1 from septic necrosis of the vascular suture area, and 1 because the arterial intima had been "swept away" by transluminal dilatation. We underscore the high incidence (33%) of arterial hypertension in these children submitted to renal transplantation and the good response to treatment with hypertensive agents and/or transluminal dilatation. We emphasize the usefulness of duplex-Doppler ultrasonography in evaluating arterial blood flow and in the diagnosis of arterial stenoses. The surgical techniques, complications, and evolution of transplanted kidney function are discussed.

[Echographic studies in renal transplant. Our experience]. / Los estudios ecográficos en el trasplante renal. Nuestra experiencia.

The present study briefly reports our experience in the evaluation of renal transplantation by conventional and pulsed Doppler ultrasound. We advocate the use of both imaging techniques in these patients because these are safe, reliable, easy-to-use, reproducible noninvasive imaging techniques that afford a high diagnostic yield.

[Oncocytic cell tumor. Problems, diagnosis, therapy]. / Tumor de células oncocíticas. Problemática, diagnóstico-terapéutica.

Renal oncocytoma is an uncommon tumor. At least 203 such cases have been reported. This urologic condition represents a diagnostic difficulty and because its natural history has not been elucidated, its treatment remains a controversy. Two recent cases of renal oncocytoma seen at our Urology Service prompted us to review the literature and analyze the diagnostic methods, therapeutic approach and its prognosis.

[Changes in the dimensions of the remnant kidney after nephrectomy of the pathologic contralateral kidney in adults]. / Cambios en las dimensiones renales del riñón remanente tras la nefrectomía del contralateral patológico en el adulto.

Compensatory renal hypertrophy is a process that has been known since Gustav Simon performed the first nephrectomy procedure in man in 1869. The present study reviews the literature and analyzes the factors relating to this process and its morphologic features. It has been reported that the degree of renal hypertrophy depends, among other factors, on the amount of nephrons lost as well as adaptative capacity of the surviving kidney when the pathologic kidney is removed. The present study also reports the changes in size of the surviving kidney observed at 6, 30, and 90 days after removal of the pathologic kidney in 40 patients. The results show a significant increase 6 days following nephrectomy and a significant decrease at 30 days to mean values higher than those of the preoperative evaluation. Ninety days after nephrectomy, these values significantly increase again but do not reach the same levels as those observed 6 days after nephrectomy. These findings are ascribed to the hemodynamic changes resulting from nephrectomy. These manifest immediately after the procedure and remain unchanged for days and subsequently the structural changes of renal hypertrophy prevail.

[Leydig cell tumor]. / Tumor de células de Leydig.

We report on a 44-year-old patient with Leydig cell tumor of the testis that had been incidentally detected following orchidectomy for a tumor. The clinical, hormonal and histological criteria currently used to distinguish the malignant from the benign form of this tumor and the different therapeutical alternatives are discussed.

[Changes in creatinine clearance and fractional sodium excretion by the remaining kidney after nephrectomy of the contralateral diseased kidney in the adult]. / Cambios en el aclaramiento de creatinina y excreción fraccional de sodio del riñón remanente tras la nefrectomía del contralateral patológico en el adulto.

Unilateral nephrectomy causes immediate changes in renal plasma flow, glomerular filtration, and fractional sodium excretion of the remnant kidney. The present study reviews some aspects of reports published elsewhere relative to renal function adaptation after unilateral nephrectomy and presents the observed changes in creatinine clearance, fractional sodium excretion at 6, 30 and 90 days following removal of kidneys with chronic urologic disease and poor function, in a total of 20 patients. The results obtained show a gradual increase of creatinine clearance in most of the patients, although this increase was not statistically significant. On the other hand, fractional sodium excretion rose significantly at 30 and 90 days after nephrectomy. These findings can be interpreted in the following way: among the regulatory mechanisms, at 6 days postnephrectomy there is a predominance of the effects of increased CINa load to the distal tubule with activation of the renin-angiotensin system, as well as those produced by sympathetic efferents characteristic of the immediate postoperative period. However, at 30 and 90 days, the effects that seem to predominate are due to the expansion of the volume of extracellular fluid. Data obtained at 90 days indicate that balance seems to become stable.

[Extrarenal complications in kidney transplant. Our experience]. / Complicaciones extrarrenales en el trasplante renal. Nuestra experiencia.

Since renal transplantation was introduced in the treatment of chronic end-stage renal failure, we have observed that extrarenal complications have an important role in transplant morbidity and mortality in hospital where kidney transplantation is not an uncommon procedure. The present study reports on the statistical data relative to extrarenal complications in kidney transplantation observed at our hospital, highlighting infectious, GI, respiratory, and hematologic complications because of their incidence.

[Renal artery stenosis in the transplant patient]. / Estenosis de la arteria renal en el trasplantado.

OBJECTIVE: To present our experience in the diagnosis and treatment of renal artery stenosis in kidney transplants. METHODS: A review of 601 renal transplants performed in adults showed 32 cases of renal artery stenosis. The diagnostic techniques utilized were arteriography in 18 patients, DIVAS in 15, echo-Doppler in 11 patients and MAG with captopril test on two occasions. RESULTS: Arterial hypertension was the most common symptom (92.8%), alone (53.1%) or in association with impaired renal function (43.7%). 46.8% of the cases could be managed by drug therapy. Percutaneous transluminal angioplasty was performed in 14 patients. Surgery was required on two occasions. CONCLUSIONS: The incidence of renal artery stenosis in our series of renal transplants in adults up to 1997 was 5.3%. Arterial hypertension with or without impairment of renal function was the most common symptom. Currently, echo-doppler and MAG with captopril test are the most widely utilized diagnostic techniques. Percutaneous transluminal angioplasty is the treatment of choice in renal artery stenosis when arterial hypertension is refractory to drug therapy. Good results are achieved in 57%, although it is not free from complications. In case of failure, revascularization surgery is the alternative approach.