Enrique Gómez

Review of a transplantectomy series.

INTRODUCTION Renal transplant nephrectomy is a complex process carried out in various situations of renal graft failure. The objective of the study was to describe the experience in our center and to evaluate the safety and efficacy in performing transplantectomies. MATERIAL AND METHODS This is a retrospective study of 70 transplantectomies performed at our center from 1995 to 2013. Multiple variables related to complications (according to Clavien classification) and mortality as the cause of nephrectomy, surgical technique, or urgent or elective surgery were analyzed. RESULTS Seventy transplantectomies from a total of 996 transplantations were performed at our center. The mean age was 46.2 years, with 47 men. The most frequent cause of nephrectomy was chronic rejection graft intolerance of 58.5%; 75.7% of the surgical technique was subcapsular. The indication was scheduled at 78.57% (n = 55). Serious complications, defined as Clavien >III (excluded deaths, Clavien V), occurred in 21.43% (n = 15). There were 8 deaths, 6 of which were associated with the clinical severity of patients with urgent indication. The analysis unvariate transplantectomies scheduled group revealed no factor associated with increased morbidity and mortality. CONCLUSIONS In referral centers, nephrectomy is safe and effective in the treatment of complications of renal graft surgical technique. The increased morbidity and mortality of the procedure depends mainly on the indication and clinical condition of the patient, severity increasing in situations where urgent nephrectomy is performed.

TEMPORARY REMOVAL: New Approach to Guide Target Prostate Biopsy: Technique and Initial Experience

OBJECTIVE To describe the technique of transrectal biopsy with a new device that fuses multiparametric magnetic resonance (mpMRI) and ultrasound images in real time to guide target biopsies and to evaluate our initial experience. METHODS Patients with persistent suspicion of prostate cancer despite a previous negative biopsy and who had an mpMRI before the biopsy were selected. All patients underwent target biopsy plus standard systematic biopsy. Significant prostate cancer (sig PCa) was defined according to the Epstein criteria for standard biopsy and Gleason grade of ≥7 and a positive core length of ≥5 mm for target biopsy. RESULTS The first 40 patients were evaluated. The median age was 65 years old. In a sagittal isotropic sequence, the fusion process was started. The fusion can be improved by using different tools such as concordant points and Global Positioning System corrections tools. In the target biopsy, a median of 4 cores was taken, whereas in the standard biopsy, 12 cores were taken. Twenty-two patients were diagnosed with prostate cancer; of these patients, 17 were diagnosed with sig PCa. The fusion target biopsy diagnosed more sig PCa than the standard biopsy; however, it was not statistically significant (37.5% vs 25%, P=.08). The probability of being diagnosed with cancer increased in correlation with the Prostate Imaging Reporting and Data System score, without reaching statistical significance (k=0.45, P=.08). CONCLUSIONS This new device is a useful tool to guide biopsy in patients with target lesions in an mpMRI to increase the detection of sig PCa. A larger cohort would be required to show significant differences.

Perineostomy: the last oportunity.

Objective To review the technique and outcome of perineal urethrostomy or urethral perineostomy and to identify factors related to the procedure failure. Material and methods We studied 17 patients who underwent perineal urethrostomy between 2009-2013 in a single hospital. Success was defined as no need for additional surgical treatment or urethral dilatation. We reviewed the clinical data related to age, weight, previous urethral surgery, diabetes, hypertension, ischemic cardiopathy, lichen sclerosus and other causes and studied their association with the procedure failure (univariate analysis). We completed the analysis with a multivariate test based on binary regression. Results The average follow-up was 39.41 months. From all the causes, we found Lichen Sclerosus in 35%, idiopathic etiology in 29% and prior hypospadia repair in 18%. Postoperative failure occurred in 3 patients, with a final success of 82.4%. The binary regression model showed as independent risk factors ischemic cardiopathy (OR: 2.34), and the presence of Lichen Sclerosis (OR: 3.21). Conclusions The success rate with the perineal urethrostomy technique shows it to be a valid option above all when we preserve the urethral blood supply and plate. Lichen sclerosus and ischemic vascular problems are risk factors to re-stenosis.

Palliative Surgery for Rare Cases of Anterior Urethral Metastasis in Prostate Cancer

Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature.Penis metastasis from prostate cancer is very rare, and its management varies from case to case as there are very few cases reported in the literature. We describe a patient with prostate cancer treated with radiotherapy and androgen deprivation therapy who presented with urethral bleeding as a symptom of anterior urethral metastasis during followup. We propose a way to manage this and review the literature.