A 20-year experience in cadaveric pediatric en bloc kidney transplantation in adult recipients.

BACKGROUND AND OBJECTIVES: En bloc kidney transplantation (EBKT) from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of EBKT from pediatric donors into adult recipients in a single center. MATERIAL AND METHODS: Retrospective analysis of 42 patients who received pediatric cadaveric EBKT in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered. RESULTS: We have performed 42 EBKT from pediatric donors into adult recipients in our center. The recipients' age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 h. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were seven graft losses (16.7%) in the immediate postoperative period (four cases of vascular thrombosis, one anastomosis dehiscence and two cortical necrosis). CONCLUSIONS: The pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.

[Survival analysis for localized renal cell carcinoma. Prognostic value of 1997 TNM classification]. / Análisis de supervivencia de los carcinomas de células renales organo-confinados. Valor pronóstico de la clasificación TNM 1997.

BACKGROUND: The 5th edition of TNM classification for renal cell carcinoma changed the cut-off point of the tumor size for localized tumors, achieving a better distribution of patients with similar survival. Nevertheless, because of the variable evolution of renal cell carcinoma, the prognostic significance of tumor size is questioned as a staging criterion in organ-confined renal cell carcinoma. We analyse renal cell carcinoma specific survival and the prognostic significance of tumor size in I and II stage. METHODS: We made a retrospective study with 158 renal cell carcinoma surgically treated in our hospital along 12 years. It was created a data base with clinical variables from patient and tumor and analyzed pathological staging, nuclear grade and specific survival, overall stage I and II. RESULTS: 27 renal cell carcinoma were pT1 (17.08%), 52 pT2 (32.91%), 45 pT, (28.45%), 10 pT3B (6.32%), y 24 pT4 (15.18%). The specific survival at 5 years for pT1-pT2, I-II stage, was 100% and 94% respectively, and no statistic significant differences were found between stage I and II (log-rank test 0.53, p>0.05). The specific survival at 5 years for pT3a, pT3B, y pT4 was 76.5%, 66.6% y 38.4%. There was a significant difference in survival in accordance with the tumor location, intrarenal (T1 y T2) versus extrarenal (T3A, T3B, T4) (log-rank test 9.06, p< 0.05). According to nuclear grade we don't find significant differences for pT1 y pT2 (Fisher test, p=1). Regarding the relation between pT stage and nuclear grade of the tumor we obtained a chi-square inear tendency of 38.19, p<0.001. CONCLUSION: The differences in the evolution of the organ-confined renal cell carcinoma with respect to the tumor size may be due to other molecular and biological variables, probably associated with stage, not controlled in essays. The TNM classification for organ-confined renal cell carcinoma based in tumor size seems artificial. New revisions of the classification system are necessary to identify which organ-confined carcinoma will have unfavourable evolution and to include them in a different category.

[The role of urethral catheterization in penile necrosis]. / Papel del sondaje uretral en la necrosis peneana.

Isolated penile necrosis is a rare entity, its main causes are diabetes mellitus and chronic renal failure. Only two cases related with urethral catheterization have been published in the literature. We present a case of penile necrosis in a patient with a Foley catheter, the possible role of the catheter in the etiology and its management are discussed.

[Bilateral candida bezoar of the upper urinary tract]. / Bezoar candidiásico bilateral del tracto urinario superior.

Fungal urinary tract infections are due to candida albicans as first responsible germ. This sporulated oval fungus divides itself by gemmation and produces pseudohyphas when it is spread in culture mediums, organic tissues or their exudates. The most frequent predisposing factor is diabetes mellitus. Others predisposing factors are: long antibiotic administration, corticoids, immunosuppressors, neoplasias, neurogenic bladder, and catheter or foreign bodies into the urinary tract. Bezoar formation is a rare complication that sometimes produces obstructive uropathy. Although Candida albicans is the most frequent observed germ in bezoars, Candida tropicalis, Penicillium, Aspergillus, Mucor y Turolopsis have been found as well. We present the case of a diabetic patient with a bilateral bezoar formation into the upper urinary tract due to Candida albicans. Clinical features, diagnosis and treatment are described emphasizing in the are bilateral onset.

[Evaluation of urology training of resident internal physicians of the Valencian community. Quality control]. / Evaluación de la formación urológica de los médicos internos residentes de la comunidad valenciana. Control de calidad.

Report on the results of a survey conducted among Urology residents in the Valencian Community. Evaluation of the training level of the MIR system, both overall and by areas. Presentation of the views obtained with regard to possible modifications to raise their training level and improve their professional future.

[Hydatidosis in a single location]. / Enfermedad hidatídica de localización única.

Hydatidosis in our country an important health problem because of its high prevalence. We present a case of renal Hydatidosis in which we point out the renal single location of the disease and emphasize that MRI helped us to find a correct preoperative diagnosis.

[Study of cathepsin D levels in invasive bladder cancer and its stroma. Correlation with tumor stage, cytological grade, lymph node metastasis and survival]. / Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia.

OBJECTIVE: The aim of this study was to evaluate cathepsin D as a prognostic marker in invasive bladder cancer and to determine its relationship with stage, grade, lymph-node metastasis and survival too. MATERIAL AND METHODS: An immunohistochemical staining of 32 radical cystectomy specimens suffering from transitional cell carcinoma was performed, using a monoclonal antibody anti-cathepsin D (Novocastra). We made a semicuantitative measurement of the cathepsin D expression in the tumor and in the peritumoral stroma in a 400 x microscopic high power field. Patient population was composed of 31 men and 1 woman with a mean age of 63.25 years. The mean follow up was 23.6 months. Stage was classified with the WHO 1997 classification. Grade was classified with the ISUP/WHO 1998 classification. For the statistical analysis the Chi-square test, Pearson's test R, the Kaplan Meier method and the log-rank test were used. RESULTS: The pathological stages of the surgical specimens were as follows: pTo:3.1% (1), pT1:12.5% (4), pT2:15.6% (5), pT3:34.4% (11). (p < 0.001) A high cytologic grade was found in 81.25% of the tumors. There was a 43.8% progression rate and 40.6% mortality. There was no statistically significant relationship among Cathepsin's D levels in the stroma and lymph node metastases, stage, or grade (p = 0.473, p = 0.604, p = 0.2423). There was no statistically significant relationship among Cathepsin's D levels in the tumor and lymph node metastases, stage or grade (p = 0.496, p = 0.722 and p = 0.461). The cathepsin D levels, neither in the stroma nor in the tumor, showed no influence neither on the disease free intervals nor in the survival rates (p = 0.785; p = 0.355 and p = 0.614; p = 0.601 respectively). CONCLUSIONS: Immunohistochemical Cathepsin D levels do not seem to play a role in the prognostic of transitional tumors of the urinary bladder.

[Candidiasis of the upper urinary tract. Report of a case]. / Candidiasis del tracto urinario superior. A propósito de un caso.

OBJECTIVE: We report a case of candidiasis of the upper urinary tract that presented as acute renal failure associated with septic syndrome. The patient initially required hemodialysis. Right hydronephrosis and perirenal collection were observed on ultrasound examination. METHODS: A percutaneous nephrostomy was performed. Nephrostomy urine cytology and cultures were positive for Candida tropicalis. An anterograde pyelography showed a 'fungus ball' in the urinary tract. RESULTS: Therapy with oral fluconazole and percutaneous amphotericin B achieved excellent results. CONCLUSIONS: Candidiasic urinary infection of the upper urinary tract often produces obstructive uropathy requiring percutaneous nephrostomy, which can also be used to instill amphotericin B. Combination therapy with amphotericin B and fluconazole can achieve excellent results.

[Crossed renal ectopy with fusion: report of a case]. / Ectopia renal cruzada con fusión: presentación de un caso.

OBJECTIVE: To present a case of crossed fused renal ectopia that was incidentally discovered in a patient consulting for abdominal pain in the emergency department. METHODS: A 46-year-old patient consulted at the emergency department for abdominal pain. Assessment by diagnostic imaging techniques demonstrated a crossed renal ectopia and associated bone anomalies. RESULTS/CONCLUSIONS: Crossed renal ectopia is an uncommon congenital anomaly and in most of the cases usually presents with fusion of both kidneys. It can also be associated with congenital anomalies of other organs. No treatment is required unless there are other complications or superimposed pathologies.