Identifying Factors Predicting Kidney Graft Survival in Chile Using Elastic-Net-Regularized Cox's Regression.

Background and Objectives: We developed a predictive statistical model to identify donor-recipient characteristics related to kidney graft survival in the Chilean population. Given the large number of potential predictors relative to the sample size, we implemented an automated variable selection mechanism that could be revised in future studies as more national data is collected. Materials and Methods: A retrospective multicenter study was conducted to analyze data from 822 adult kidney transplant recipients from adult donors between 1998 and 2018. To the best of our knowledge, this is the largest kidney transplant database to date in Chile. A procedure based on a cross-validated regularized Cox regression using the Elastic Net penalty was applied to objectively identify predictors of death-censored graft failure. Hazard ratios were estimated by adjusting a multivariate Cox regression with the selected predictors. Results: Seven variables were associated with the risk of death-censored graft failure; four from the donor: age (HR = 1.02, 95% CI: 1.00-1.03), male sex (HR = 0.64, 95% CI: 0.46-0.90), history of hypertension (HR = 1.49, 95% CI: 0.98-2.28), and history of diabetes (HR = 2.04, 95% CI: 0.97-4.29); two from the recipient: years on dialysis log-transformation (HR = 1.29, 95% CI: 0.99-1.67) and history of previous solid organ transplantation (HR = 2.02, 95% CI: 1.18-3.47); and one from the transplant: number of HLA mismatches (HR = 1.13, 95% CI: 0.99-1.28). Only the latter is considered for patient prioritization in deceased kidney allocation in Chile. Conclusions: A risk model for kidney graft failure was developed and trained for the Chilean population, providing objective criteria which can be used to improve efficiency in deceased kidney allocation.

ROBOT Assisted Laparoscopic Surgeries For Nononcological Urologic Disease: Initial Experience With Hugo Ras System.

OBJECTIVE: To report our initial experience with the use of HUGO Robotic Assisted Surgery System (RAS) for nononcological urologic disease. METHODS: We collected retrospective data describing clinical outcomes from patients undergoing surgeries for nononcological urologic disease with the new HUGO RAS. Analysis included: total surgery and console time, docking time, estimated bleeding, complications, and pain after surgery. RESULTS: There were 5 patients operated for nononcological urologic disease. The mean age was 50 years (range 32-70), comorbidities were mild (2 patients with chronic hypertension) and American Society of Anesthesiologists (ASA) classification was 2. Total surgical time ranged from 150 to 257 minutes, and console time from 89 to 164 minutes, each depending on the intervention. The mean docking time was 8.5 minutes (range 5.7-11). No intraoperative complications, instrument clashes, or system failure that compromised the surgery's completion were recorded. Mean blood loss ranged from 10-30 mL, and there were no postoperative complications. Postoperative pain classified from 0-10 at 1, 6, and 12 hours was low (range 0-3), and pain before discharge was 0 for all patients. Hospital stay ranged from 2 to 5 days, depending on the intervention. CONCLUSION: Robotic surgery was introduced in early 2000s and was rapidly adopted. Initially, this technology was reserved for oncological surgery, later expanding to nononcological conditions. These preliminary results are comparable to the previous robotic systems, suggesting the multiple potential uses of the HUGO RAS. The adoption of this technology has the potential to improve patient accessibility for less-invasive therapies in developing countries.

Contralateral necrotizing fascitis after left nephrectomy for emphysematous pyelonephritis.

Introduction: Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma. The management is variable, extending to total nephrectomy in severe or refractory cases. Post-nephrectomy complications are numerous and common, necrotizing fasciitis, and sepsis being among them. Case presentation: We present a case of a 37-year-old woman with obesity and a previous left emphysematous pyelonephritis episode managed conservatively. The patient presented with a second left emphysematous pyelonephritis and underwent a left total nephrectomy. Two weeks later, the patient presented with a contralateral necrotizing fasciitis of the abdominal wall. Subsequently, the patient required several surgical debridement procedures and a vacuum-assisted closure system treatment. Conclusion: Emphysematous pyelonephritis is an aggressive infectious disease that requires high suspicion in patients at risk.

Urgencia urológica y su manejo en unidad de emergencia / Urological emergencies and their management in a emergency unit

Las urgencias urológicas en el servicio público suelen ser manejadas por la unidad de emergencia. En esta unidad cirujanos generales son quienes deben decidir manejo o indicaciones de hospitalización de estos pacientes. No todas las unidades de emergencia cuentan con especialistas de llamado. Debido a esto quisimos evaluar los conocimientos generales de patología urológica de urgencia y su manejo por cirujanos de las unidades de emergencia. Se realizó encuesta con preguntas de patología urológica de urgencia y su manejo a cirujanos de 2 unidades de emergencia de hospitales tipo I. Se asignó puntaje considerando correctas menos incorrectas/ 2. Se analizan puntajes obtenidos y se compara si existe diferencia entre cirujanos con o sin rotación de urología en programa de especialidad. Se utilizó análisis no paramétrico de Mann-Whitney(p <0,05). Se realizaron 36 encuestados, 29 de los cirujanos recibieron instrucción de urología en su período de formación. Del total de encuestas, el puntaje alcanzado de respuestas correctas varía entre 4,5 y 15,5 de un total de 17 puntos. En 13 casos se obtuvo más del 75 por ciento de los puntos y 3 menos del 50 por ciento. No hubo diferencia entre quienes recibieron o no formación urológica (p 0,99)...

In our Health System general surgeons usually manage urology’s emergencies. They must decide if a patient needs to be managing inpatient or no. Our objective is tried to determine the general surgeon’s knowledge in some urological diseases. A questionnaire about diagnosis and treatment of urological diseases was applied to general surgeons in 2 emergency apartments. Score was assigned and analyzed.36 general surgeons were interviewed. In 29 cases they had urology rotation during their residency. Score were between 4.5 and 15.5. 13 surgeons got more than 75 percent in their scores. No difference between surgeons with or without urology rotation during their residence was found...