¿Existe un intervalo de tiempo de isquemia fría seguro para el injerto renal?

Objective: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events.aterial and methods: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression. Results: The mean follow-up of all the group was 77.8 months (± 51 SD) and the mean CIT was 14.8 hours (± 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR = 1.04; 95% CI: 0.9-1.08; p > 0.05). On establishing the cutoff at 18 hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT 18 h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR = 1.1; 95% CI: 1.05-1.15; p < 0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p = 0.02) and less time to the first rejection episode (72.6 days ± 137 vs. 272.2 days ± 614.8; p = 0.023) after 18 hours. The CIT did not seem to be related (p < 0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions. Conclusions: In our experience, cold ischemia under 18 hours does not seem to negatively affect graft survival

Perforación duodenal espontánea en paciente intervenido de prostatectomía radical

Radical prostatectomy is a well known treatment for prostate cancer, with a low incidence of early postoperative complications. Our case is a 54 year old patient diagnosed with prostate adenocarcinoma, Gleason score 3+3=6 with 8 ng/ml of PSA, treated by retropubic prostatectomy, who suffered spontaneous perforation of the duodenum. We chose a conservative management, resolved in 30 days. When dealing with a surgical patient all kinds of complications must be taken into account by performing the minimum tests that will enable a sure diagnosis to be achieved. The usual treatment is surgery or conservative management, depending on the case and the patient

Priapismo maligno: un caso manejado de forma conservadora

Priapism is an urological emergency which requires investigation, especially to differentiate between ischemic and non-ischemic priapism. Initial management is carried out through aspiration and gasometry of blood from the corpus cavernosum. We report the case of a 69-year-old patient with urothelium carcinoma of the bladder T2 G3 and metastasis in urethra/corpus cavernosum who requested an emergency consultation because of edema and a penile erection lasting several days. Due to the poor prognosis and the imaging test, a conservative management was carried out

Variante plasmocitoide del carcinoma urotelial: a proposito de un caso

Plasmacytoid urothelial carcinoma is an extremely rare pathological finding. We report our experience of one case. A 60 year old male with hematuria of two years evolution, with frequency and dysuria. A tumor was found and he received surgical treatment by TURB at first. The pathology result was a plasmacytoid urothelial carcinoma. Subsequently a radical cystectomy with urinary diversion was performed. The patient received follow-up until his death

Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment

Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management

Complicaciones postquirúrgicas en pacientes sometidos a cistectomía radical según estado nutricional del paciente

Introduction: Radical cystectomy is the election treatment for muscle-invasive bladder tumors presenting a high morbidity and significant mortality rate. An important factor to consider is the nutritional status of the patient because it can negatively impact the clinical course of patients. Methods: We perfomed a retrospective study of radical cystectomies with intestinal conduct between 2012 and 2015 in the department of Urology in HU Espases and we evaluated the postoperative complications according to the caloric nutritional status calculated by BMI, protein nutritional status calculated by the immediate postoperative albumin and the inmunological nutritional status by total account of lymphocites. Results: Developed complications the 42% of patients. 21% had only one complication Clavien II and 21% had one complication Clavien III or more than one complication. We found statistically significant differences with the protein nutritional status (mild Normal-vs moderate to severe) in the escape of the ureter-ileal anastomosis. No differences in the other variables were found. Conclusions: Most patients undergoing radical cystectomy with intestinal conduct type have a postoperative state of protein malnutrition. In our series, the protein nutritional status of the patient has a relationship with the occurrence of leakage from the ureter-ileal anastomosis.Introducción: La cistectomía radical es el tratamiento de elección para los tumores vesicales musculo-invasivos presentando una gran morbilidad y una considerable tasa de mortalidad. Un factor importante a tener en cuenta es el estado nutricional del paciente ya que puede impactar de forma negativa en la evolución clínica de los pacientes. Material y métodos: Realizamos un estudio retrospectivo de las cistectomías realizadas entre 2012 y 2015 en el servicio de Urología de HU Son Espases y se evalúa la aparición de complicaciones postoperatorias según el estado nutricional calórico calculado a través del IMC, el estado nutricional proteico calculado a través de la albúmina postoperatoria inmediata y el estado nutricional inmunológico a través de los linfocitos totales. Resultados: Presentaron alguna complicación el 42% de los pacientes. Un 21% presentaron únicamente una complicación Clavien II y un 21% presentaron una complicación mayor a Clavien III o más de una complicación. Se encontraron diferencias estadísticamente significativas según el estado nutricional proteico (Normal-leve vs moderado-grave) en la fuga de la anastomosis uretero-ileal. No se encontraron diferencias en el resto de variables. Conclusiones: La mayoría de pacientes sometidos a cistectomía radical con derivación urinaria tipo intestinal presentan algún estado de malnutrición proteica postoperatoria. En nuestra serie, el estado nutricional proteico del paciente presenta una relación con la aparición de fuga de la anastomosis uretero-ileal

MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy

Purpose: Prostate cancer can be treated by radical prostatectomy (RP) and provoke a troublesome side effect: urinary incontinence (UI). We propose a verification of the usefulness of MRI and an identification of which structures are involved in UI after RP. Methods: Between September 2002 and December 2011, 550 patients underwent RP. We performed MRI to evaluate extraprostatic disease before surgery. To evaluate patient status, we measured the following structures: length (LP), width (WP), height (HP) and volume (PV) of the prostate, membranous urethral length (MUL), urethral wall thickness (UWT), levator ani muscle (LAM) and obturator internus muscle (OIM) thickness, ratio of levator ani muscle/prostate volume (LAM/PV), volume of the urethra (VU). UI was defined according to ICS definition as the complaint of any involuntary leakage of urine and evaluated 1 year after surgery. Analyses were performed by mean comparisons, univariate and multivariate logistic regression with a 1000-resample bootstrapping. Results: Means of measurements were: LP 4.46 cm, WP 5.15 cm, HP 3.9 cm, PV 49.3 cc; LAM 0.51 cm, OIM 1.46 cm; MUL 1.43 cm, UWT 1.38 cm; and LAM/PV 0.013 cm/cc, VU 2.33 cc. One hundred and twenty-two (22.2 %) patients complained of urine leakage. Univariate obtained differences in PV, OIM, MUL, and UWT. After adjusting by confounders, multivariate analysis showed: MUL: [OR 0.134; CI 95 % (0.022–0.493); P 0.006]; PV: [OR 1.016; CI 95 % (1.004–1.029); P 0.005]; UWT: [OR 6.03; CI 95 % (1.068–44.1); P 0.033]. Conclusions: MRI is a useful tool to predict UI after RP. The MUL and PV are well-identified structures that are involved in UI. Our study shows that UWT also influences UI

Prevalence analysis of urinary incontinence after radical prostatectomy and influential preoperative factors in a single institution

<p><b>Aims:</b> To assess prevalence of urinary incontinence (UI) after radical prostatectomy (RP) and to analyze which preoperative characteristics of the patients have influence on UI.</p> <p><b>Methods:</b> Between 2002 and 2012, 746 consecutive patients underwent RP for clinically localized prostate cancer. We defined UI according to International Continence Society (ICS) definition: “the complaint of any involuntary leakage of urine” after 12 months of recovery, international consultation on incontinence questionnaire (ICIQ-SF) and pads/day was collected too. Clinical features and magnetic resonance imaging measurements were assessed. A multivariable logistic regression model predicting incontinence were built-in after adjust by cofounding factors and bootstrapping.</p> <p><b>Results:</b> About 172 (23%) of the patients were classified as incontinent according to the ICS definition. The mean value of the ICIQ-SF was 10.87 (±4). 17.8% of patients use at least one pad/day, 11.9% use more than one pad/day. The preoperative factors independently influential in UI are: age [OR: 1.055; CI 95% (1.006–1.107), <i>p</i> = .028], urethral wall thickness [OR: 5.03; CI 95% (1.11–22.8), <i>p</i> = .036], history of transurethral resection of the prostate [OR: 6.13; CI 95% (1.86–20.18), <i>p</i> = .003] and membranous urethral length [OR: 0.173; CI 95% (0.046–0.64), <i>p</i> = .009]. The predictive accuracy of the model is 78.7% and the area under the curve (AUC) value 71.7%.</p> <p><b>Conclusions:</b> Urinary incontinence after radical prostatectomy has different prevalence depending on the definition. Age, prior transurethral resection of the prostate (TURP), membranous urethral length (MUL) and urethral wall thickness (UWT) were risk factors.</p