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PURPOSE: The limited availability of kidneys for transplantation has been addressed by expanding the criteria for allowing a donor kidney to be transplanted, but this tendency may cause suboptimal kidneys to be implanted and could be associated with greater risk of complications. METHODS: A retrospective study of 407 kidney transplantations was done to compare complications of transplantation with non-expanded (n = 244) and expanded criteria donors (n = 163). Expanded criteria donors were donors older than 60 years, or donors aged 50-60 years who had ≥ 2 of the following risk factors: hypertension, diabetes mellitus (type 2), creatinine >1.5 mg/dL, or death caused by stroke. RESULTS: Compared with transplant recipients from non-expanded criteria donors, transplant recipients from expanded criteria donors had significantly greater frequency of graft loss, delayed graft function, pneumonia, overall surgical complications, early reoperation, wound eventration, hydronephrosis, postoperative hemorrhage, and wound infection. When analyzing surgical complications types, a significant greater frequency of urologic, wound, vascular, early and late surgical complications was found. In terms of severity, expanded donor criteria transplantation was related to Clavien I, III, and IV complications. CONCLUSIONS: Transplantation of kidneys from expanded criteria donors is associated with a significant higher risk of medical and surgical complications than kidneys from non-expanded criteria donors.

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OBJECTIVE: We try to show the relevance of this rare pathology and to set its importance in the differential diagnosis of prostate masses. METHODS: We report a case and perform a search in the MEDLINE database of the series described up to the date. RESULTS: Prostatic leiomyoma is a extremely rare anatomopathological finding, though the appearance of a glandular hyperplasia with small areas of leiomyomatous growth is more common. Up to date there are just a hundred cases described. They are benign mesenchymal tumors without evidence of disease recurrence after surgery. When they present symptomatology, they emulate benign hyperplasia with urinary tract infections. Although it has benign nature, surgical intervention is indicated when severe clinical symptoms appear. CONCLUSIONS: The recognition of this benign entity and the distinction from other neoplasias has important therapeutic and prognostic implications. Imaging techniques and pathological analysis are crucial for this reason. When an unusual prostatic mass is detected, the leiomyoma must be included in the differential diagnosis.

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OBJETIVO: Pretendemos poner en relevancia esta rara patología y recalcar su importancia en el diagnóstico diferencial de las masas prostáticas.MÉTODOS: Presentamos nuestro caso y revisamos la patología descrita hasta la fecha en la base de datos de MEDLINE.RESULTADOS: El leiomioma prostático es un hallazgo anatomopatológico de extremada rareza, si bien la aparición de una hiperplasia glandular con pequeños focos de crecimiento leiomiomatoso es más común.Hasta la fecha y en nuestro conocimiento tan sólo hay un centenar de casos descritos. Son tumores mesenquimales benignos de buen pronóstico y sin evidencia de casos de recurrencia de la enfermedad tras su exéresis quirúrgica. La mayor parte de las veces cuando presentan sintomatología lo hacen emulando a la de la hiperplasia benigna de próstata o con infecciones del tracto urinario. Aunque se trata de una enfermedad benigna, la intervención quirúrgica está indicada cuando existen síntomas clínicos severos.CONCLUSIONES: El reconocimiento de esta entidad y su distinción de otras lesiones neoplásicas de la próstata, tiene importantes implicaciones terapéuticas y pronósticas. Las pruebas de imagen y el análisis anatomopatlógico son fundamentales para ello.Cuando una masa prostática inusual se detecta, el leiomioma debe incluirse en el diagnóstico diferencial y la RM puede ser útil para identificarla(AU)

OBJECTIVE: We try to show the relevance of this rare pathology and to set its importance in the differential diagnosis of prostate masses.METHODS: We report a case and perform a search in the MEDLINE database of the series described up to the date.RESULTS: Prostatic leiomyoma is a extremely rare anatomopathological finding, though the appearance of a glandular hyperplasia with small areas of leiomyomatous growth is more common. Up to date there are just a hundred cases described. They are benign mesenchymal tumors without evidence of disease recurrence after surgery.When they present symptomatology, they emulate benign hyperplasia with urinary tract infections. Although it has benign nature, surgical intervention is indicated when severe clinical symptoms appear.CONCLUSIONS: The recognition of this benign entity and the distinction from other neoplasias has important therapeutic and prognostic implications. Imaging techniques and pathological analysis are crucial for this reason. When an unusual prostatic mass is detected, the leiomyoma must be included in the differential diagnosis(AU)

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PURPOSE: Renal Doppler ultrasonography (DUS) is the gold-standard image test for follow-up after renal transplantation, it is potentially useful to detect renal disease and it could be related with long-term survival. We evaluate whether renal graft survival can be predicted by immediate renal Doppler ultrasonography (IRDUS), defined as ultrasonography carried out in the first 24 h post-surgery. MATERIALS AND METHODS: Immediate renal DUS findings (resistance index, hydronephrosis, fluid collection, bruises, and vascularization abnormalities) and their association with graft survival were analyzed in a retrospective observational study of 343 renal allografts. Renal transplantation was done using a standard technique, and DUS was performed 24 h post-transplantation. The association of variables with graft survival was evaluated by Cox univariate and multivariate proportional hazards analysis. Kaplan-Meier survival analysis and the log-rank test were used to examine graft survival. RESULTS: The follow-up median was 85 months. On IRDUS, 137 patients (39.9%) had abnormal findings. The best RI cutpoint for the prediction of graft survival was 0.7; therefore, we defined two different groups: RI ≤ 0.7 (n = 247) versus RI > 0.7 (n = 96). Univariate analysis revealed that graft survival was significantly lower in patients with RI > 0.7 (P ≤ 0.001), vascularization abnormalities (P ≤ 0.001) or bruises (P = 0.026). In multivariate analysis, the only factors independently associated with graft survival were RI (odds ratio 2.4; 95% CI 1.4-4.1) and vascularization abnormalities (odds ratio 2.7; 95% CI 1.1-6.5). CONCLUSIONS: IRDUS can be useful, besides being highly useful in the diagnosis of graft primary dysfunction in the transplanted patient also yields information that can help to predict long-term graft survival.

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