RESUMEN
En bloc pediatric transplantation (EBPT) began with the aim of increasing the donor pool due to the existing high demand for donors. At its inception, it was considered a type of suboptimal transplantation due to its association with a high incidence of vascular, urologic, and immunologic complications. The main objective of this study was to update information on EBPT with the largest case series that exists on a worldwide scale. In a retrospective study, the results obtained from brain-dead donors (BDDs; n = 770) were compared to those of EBPT (n = 100) from January 1990 to December 2012. The median of follow-up was 12.8 years (interquartile range 8.1 to 17.2). The variables collected for analysis were demographic factors (age and sex of recipients, age and weight of donors), renal function, graft survival, recipient survival, surgical complications (thrombosis, lymphocele, urologic complications, and renal artery stenosis and need for revascularization with angioplasty and/or stents). Subsequently in a second analysis, we studied the association between graft survival, thrombosis, angioplasty, stents, and appearance of lymphoceles with the different factors that were considered to be related in accordance with published literature and our own experience. Graft loss due to surgical complications was more frequent in EBPT than in BDD (15% vs 2.2 % in BDD; P < .001), and interstitial fibrosis and tubular atrophy were more frequent in BDD (13% vs 2%; P < .001). EBPT offers a good survival rate after overcoming the possible surgical complications that may arise.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/etiología , Adolescente , Muerte Encefálica , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Trasplante de Riñón/métodos , Trasplante de Riñón/mortalidad , Linfocele/etiología , Masculino , Complicaciones Posoperatorias/mortalidad , Obstrucción de la Arteria Renal/etiología , Estudios Retrospectivos , Tasa de Supervivencia , Trombosis/etiología , Donantes de Tejidos/provisión & distribuciónRESUMEN
OBJECTIVE: To report our experience with the management of arterial priapism by embolization. METHODS: Two patients with arterial priapism secondary to perineal trauma are described. Diagnostic evaluation included intracorporal blood gas, echo Doppler and selective pudendal arteriographic assessment. Treatment was by selective autologous embolization. RESULTS: Detumescence was achieved and control follow-up evaluation at 12 and 24 months demonstrated normal erectile function. CONCLUSIONS: In our view, selective embolization is an effective treatment for arterial priapism arising from perineal trauma.
Asunto(s)
Embolización Terapéutica/métodos , Priapismo/terapia , Adulto , Humanos , Masculino , TrombosisRESUMEN
OBJECTIVE: To review our experience in the diagnosis and management of ureteral injuries secondary to obstetric and gynecologic procedures. METHODS: During the last 25 years, 42 patients were treated at our center for iatrogenic ureteral injuries (45 renal units) associated with obstetric and gynecologic procedures, principally hysterectomy via the abdominal approach (29 cases). The injury was diagnosed in the immediate postoperative period in 21 of the 42 cases. Surgical management was frequently by ureteroneocystostomy. Patient follow-up ranged from 3 months to 11 years. RESULTS: Good results were obtained in 83.3% of the cases. CONCLUSIONS: Ureteral injuries detected intraoperatively should be immediately repaired. For those diagnosed postoperatively, management by retrograde or antegrade catheterization and/or US or CT-guided percutaneous nephrostomy should be attempted before performing surgery.
Asunto(s)
Enfermedades de los Genitales Femeninos/cirugía , Complicaciones Intraoperatorias/etiología , Complicaciones del Trabajo de Parto/cirugía , Uréter/lesiones , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/cirugía , Persona de Mediana Edad , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To analyze the incidence of tumors in renal graft recipients, the course, treatment and its effect on the graft and patient. METHODS: We conducted a retrospective and prospective study on 477 renal transplants performed at our hospital from 1980 to 1996. The tumor type, course and possible tumor-related factors (immunosuppression, age, sex, graft rejection, virus) were analyzed. RESULTS: 57 tumors were found; 41 patients had at least one tumor. The most common were skin, renal and lung cancer. Age, sex and immunosuppression were found to be tumor-related factors in renal transplant recipients. CONCLUSIONS: Patients undergoing renal transplantation are at a higher risk for developing a tumor, above all in the older male patients. A relationship was found for immunosuppression, the number of drugs received and the number of rejection episodes. Furthermore, the tumor pattern in these patients is different from the usual pattern.
Asunto(s)
Trasplante de Riñón , Neoplasias/epidemiología , Adulto , Factores de Edad , Anciano , Femenino , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Trasplante de Riñón/inmunología , Trasplante de Riñón/patología , Masculino , Persona de Mediana Edad , Neoplasias/inmunología , Estudios Prospectivos , Estudios Retrospectivos , Factores Sexuales , España/epidemiologíaRESUMEN
OBJECTIVE: To analyze the pathological and clinical features of a variant of renal carcinoma: sarcomatoid renal carcinoma. METHODS: Of 316 patients diagnosed as having a renal tumor from 1975 to 1995, 11 (3.5%) with a pathological diagnosis of sarcomatoid renal carcinoma were analyzed. The clinical history, biological data and diagnostic imaging findings of these patients were reviewed. All patients had undergone surgical exploration. RESULTS: All the tumors showed a double cellular population, with a fusiform component. Histological analysis showed a high grade and stage tumor. Ten patients died from the disease, the mean survival rate was 9 months (range 2-48) following diagnosis. CONCLUSIONS: Sarcomatoid carcinoma of the kidney is uncommon and can be occasionally difficult to distinguish from sarcoma. It has a worse prognosis than other variants of renal carcinoma.
Asunto(s)
Carcinosarcoma/patología , Neoplasias Renales/patología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To analyze the outcome of renal transplantation in patients more than 65 years old. METHODS: From 1991 to 1997, 83 renal transplants were performed in patients aged over 60 years at our institution; 20 of these patients were more than 65 years old. The control group comprised graft recipients under than age from the 477 cases that had undergone transplantation during the period 1980-1996. Graft donor selection was done according to standard practice. The immunosuppression protocol changed over time; 5 patients received triple therapy and another 15 patients received quadruple sequential immunosuppression therapy. RESULTS: The mean age of the recipients was 66.8 years (range 65-72); 9 patients required dialysis after renal transplantation. Patients aged over 65 years had a 94% survival at 6 months, 88% at 12 months, and 88% at 48 months, whereas the survival rates for the control group were 96%, 95% and 87% for the respective time periods. Graft survival was 95% at one month, 90% at 3 months and 74% at 48 months versus 93%, 87% and 78% for the control group. CONCLUSION: Patients more than 65 years old with chronic renal failure and who are on dialysis can benefit from renal transplantation.
Asunto(s)
Trasplante de Riñón/tendencias , Factores de Edad , Anciano , Femenino , Supervivencia de Injerto , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/mortalidad , Trasplante de Riñón/estadística & datos numéricos , Masculino , Preservación de Órganos/métodosRESUMEN
OBJECTIVE: To analyze the medium-term outcome of en bloc transplantation of pediatric kidneys into adult patients, including the incidence and type of surgical complications. METHODS: From November 1991 to December 1997, we performed 37 en bloc transplantation of pediatric kidneys into adult patients. The kidneys were harvested from donors less that 3 years old and/or weighing 15 kg. The mean follow-up was 24 months. Grafting was achieved by end-to-side anastomosis of the donor cava to the receptor external iliac and the aortic patch to the external iliac artery. RESULTS: Three grafts failed, probably due to hilar torsion; the remaining were initially functioning well. Seven transplant removal were performed; 6 were due to thrombosis. The actuarial graft survival was 89.1% at one month, 80.83% at 12 months and 80.83% at 24 months. CONCLUSIONS: The medium-term results of en bloc transplantation of pediatric kidneys into adult patients were excellent and demonstrate the efficacy of this type of grafts. Arterial and venous thrombosis were the most important complications, quantitatively and qualitatively.
Asunto(s)
Trasplante de Riñón/métodos , Adulto , Factores de Edad , Anciano , Peso Corporal , Causas de Muerte , Preescolar , Supervivencia de Injerto , Humanos , Lactante , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/estadística & datos numéricos , Persona de Mediana Edad , Donantes de Tejidos/estadística & datos numéricosRESUMEN
The presence of neoplasms in patients with renal transplant in a higher frequency than in general people is known since a long time. The most frequent tumours were the skin tumours, followed by other tumours common in immunosuppressed patients. The ain of this work has been study the frequency, type, diagnosis, treatment and evolution of the urinary system tumours in patients with renal transplant and an exhaustive review of literature. We have found 11 tumours of the urinary system over 57 tumours in 41 patients, with a frequency 26.8%. 6 were kidney tumours, 3 of prostate and 3 of the bladder. We have analyzed the incidence, diagnosis, treatment and evolution of tumour and its effects on the graft. We believe that the posttransplant follow-up of the patient, overcoat in males, who have tumours in more frequency, is important for the early diagnosis.
Asunto(s)
Trasplante de Riñón/efectos adversos , Neoplasias de la Próstata/epidemiología , Neoplasias Urológicas/epidemiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/etiología , Neoplasias Urológicas/etiologíaRESUMEN
OBJECTIVES: The present study reports our experience and the results achieved in the treatment of Kaposi's sarcoma of the penis. To date, only 53 cases of this uncommon pathology have been reported in the literature. The different therapeutic alternatives are discussed. METHODS: Three cases of Kaposi's sarcoma of the penis were referred to our department for evaluation and treatment. In two cases we performed palliative surgery (partial excision of penis and circumcision) for the urological symptoms and the third case received chemotherapy. RESULTS: The course of the disease was torpid. At 6 months the patient who had undergone partial excision of the penis showed tumor recurrence, there was scant response in the patient who had received chemotherapy and the outcome was poor in the patient that had undergone circumcision due to the general condition of the patient. CONCLUSIONS: Kaposi's sarcoma of the penis is an uncommon lesion that usually presents in male homosexuals with AIDS. Different therapeutic options are available and some of them have been shown to be effective, although the results depend on the patient's general condition.
Asunto(s)
Neoplasias del Pene/patología , Sarcoma de Kaposi/patología , Adulto , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The carbohydrate antigen CA 50 is expressed in the epithelial tissue during the process of neoplastic transformation; i.e., transitional cell bladder carcinoma. The present study evaluated the biological behaviour of the CA 50 antigen in malignant superficial, deep localized and disseminated bladder tumors. One hundred subjects were entered into the study: 30 carefully selected healthy subjects comprised the first group and 70 patients with a diagnosed transitional cell bladder carcinoma comprised the second group. The serum CA 50 antigen was determined by immunofluorometric assay (Delfia CA 50 kit). Our results indicate that the carbohydrate CA 50 antigen can be utilized as a prognostic marker in patients with malignant bladder tumors. The serum antigen levels were higher for the more undifferentiated tumors and those in the advanced stages.
Asunto(s)
Antígenos de Carbohidratos Asociados a Tumores/sangre , Carcinoma de Células Transicionales/inmunología , Neoplasias de la Vejiga Urinaria/inmunología , Carcinoma de Células Transicionales/mortalidad , Fluoroinmunoensayo , Humanos , Pronóstico , Neoplasias de la Vejiga Urinaria/mortalidadRESUMEN
Five patients with iatrogenic ureteral injuries are described herein. Two patients had a vesicoureteric fistula and the remaining three patients had obstructive uropathy secondary to ligation with resorbable material during hysterectomy for a benign uterine condition, which spontaneously resolved with conservative management. Classically, the approach of this type of lesion was interventional and careful patient selection afforded the possibility of definitive resolution. US, CT and modern endourological technology have facilitated temporary diversion via percutaneous nephrostomy (or surgery, if the foregoing is not possible) to protect renal function during the process of recanalization of the injured ureter. Furthermore, it permits radiological control of the course and functional assessment of the excretory tract.
Asunto(s)
Histerectomía/efectos adversos , Enfermedades Ureterales/terapia , Obstrucción Ureteral/terapia , Fístula Urinaria/terapia , Fístula Vaginal/terapia , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Radiografía , Enfermedades Ureterales/diagnóstico por imagen , Enfermedades Ureterales/etiología , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiología , Fístula Urinaria/diagnóstico por imagen , Fístula Urinaria/etiología , Fístula Vaginal/diagnóstico por imagen , Fístula Vaginal/etiologíaRESUMEN
Herein we present the experience of our hospital, which spans a period of 10 years, in the diagnosis and treatment of retroperitoneal abscess. The clinical features, origin and localization of the abscesses are described. We underscore the diagnostic value of ultrasound (US) and computerized tomography (CT) which afford a sensitivity of 86.3% and 100%, respectively. An increased incidence of abscess from gram-positive bacteria was observed in i.v. drug addicts.
Asunto(s)
Absceso/diagnóstico , Infecciones por Escherichia coli/diagnóstico , Infecciones por Proteus/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espacio Retroperitoneal , Estudios RetrospectivosRESUMEN
Penile metastasis from primary tumors at other sites are extremely rare. To our knowledge, Alonso Gorrea reported the first case in the Spanish literature in 1980. Since then, 20 cases have been reported. Three additional cases of penile metastasis from tumors at other sites are described herein. The pathogenesis, symptoms, prognosis and treatment of this tumor type are discussed.
Asunto(s)
Adenocarcinoma/secundario , Carcinoma de Células Transicionales/secundario , Neoplasias del Pene/secundario , Neoplasias del Recto/patología , Neoplasias de la Vejiga Urinaria/patología , Anciano , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Tumors of mesothelial origin account for 1-5% of all vesical neoplasms. Leiomyomas, although rare, are the most frequently encountered. Three patients diagnosed as having leiomyoma are presented. Two had leiomyoma of the bladder and one had leiomyoma of the distal urethra. The etiopathogenesis, diagnosis and treatment of this tumor type are discussed.
Asunto(s)
Leiomioma/diagnóstico , Neoplasias Uretrales/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Adulto , Anciano , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Spontaneous renal subcapsular hematoma in patients undergoing hemodialysis is a very uncommon condition that is attributed to acquired cystic disease of the kidneys and other causes. We report on a patient undergoing hemodialysis due to chronic renal failure who developed right spontaneous perirenal subcapsular hematoma ascribable to no underlying pathology. Treatment was by nephrectomy.
Asunto(s)
Hematoma , Enfermedades Renales Quísticas/complicaciones , Enfermedades Renales , Diálisis Renal/efectos adversos , Anciano , Dicumarol/efectos adversos , Dicumarol/uso terapéutico , Femenino , Hematoma/etiología , Hematoma/cirugía , Humanos , Enfermedades Renales/etiología , Enfermedades Renales/cirugía , Enfermedades Renales Quísticas/etiología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , NefrectomíaRESUMEN
We report two cases of priapism in patients previously treated with neuroleptic agents. None of these patients had a previous history of urological or hematological disorders. These two patients warranted emergency treatment by punction-aspiration of the corpora cavernosa and posterior cavernospongiosa shunt. The foregoing approach achieved penile detumescence in both cases. Excellent results were achieved relative to erectile function in one patient. Although the mechanism responsible for phenothiazine-induce priapism has as yet not been elucidated, it has been suggested that this might be due to adrenergic block which directly inhibits the sympathetic impulse of detumescence.
Asunto(s)
Preparaciones de Acción Retardada/efectos adversos , Flufenazina/análogos & derivados , Priapismo/inducido químicamente , Tioridazina/efectos adversos , Adulto , Drenaje , Flufenazina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Priapismo/cirugía , RecurrenciaRESUMEN
Two cases of vesical endometritis in two women aged 48 and a 46 years respectively are presented. Both cases were detected incidentally during a gynecological and vesical ultrasound study and the diagnosis was confirmed by cystoscopy and transurethral resection and histopathological exam. An exhaustive literature review is also presented and we insist on the rare presentation and the relatively specific clinical symptoms. A special note is made on the cystoscopic findings and on the different treatment techniques, including the latest approach with LH-RH analogues and/or transurethral photocoagulation with laser rays.