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The first two living donor kidney trans-plants in our country (isotransplant and homotransplant respectively) were reported in 1961. We reviewed the clinical history of the renal homotransplant performed between father and son, more than half a century ago, by Carlos Younger de la Peña and Ramiro Rivera at “La Paloma” Clinic in Madrid. We comment on the organizational, legal, immunobiological and technical difficulties in those times when the successful future of transplantation was barely in sight. From the XXI Century we can see the long path of renal transplantation during the XX century. Despite all the initial troubles and failures our present must recognize, and so does it, the work and dedication of the pioneers.
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OBJECTIVES: The aim is to assess our experience with new Coloplast Titan™ Inflatable Penile Prosthesis (IPP) with One-Touch Release (OTR) pump. Our 3 main focuses of attention will be prosthesis performance and patient and partner satisfaction in our first 100 cases in 3 specialised centres by 2 principal surgeons.METHODS: Retrospective review was used to assess the Coloplast Titan™ OTR implant procedures/cases in our departments (from October 2009 to December 2012). The changes in Erection Function (EF), Intercourse Satisfaction (IS), overall satisfaction of the patient and partner were assessed by use of the following questionnaires: EF and IS domains of the International Index of Erectile Function (IIEF) and modified EDITS. RESULTS: Mean patient age (N = 100) was 54.2 years old (range: 20-77) with a mean length of follow-up of 21 months (range: 6-44). Mean length of prosthesis implanted was 18.6 cm (14-23.5). Only 3% of patients showed complications requiring surgical exploration. Good prosthesis performance was assessed in 99 patients (99%). Differences in the IIEF-EF and IIEF-IS domain before and after surgery were +16.8 and +6.4 respectively. Patient and partner overall satisfaction were 90% and 84% respectively in modified EDITS. The average number of postoperative teaching sessions needed to teach the patient how to operate the device was 1.28 (1-4) CONCLUSIONS: The Coloplast Titan™ OTR IPP was easy to implant, inflate, and deflate with high levels of EF improvement, patient and partner satisfaction. A small number of postoperative teaching sessions were required for the patient to properly operate the device.
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OBJECTIVES: To assess the results of substitution urethroplasty after a long follow-up in a group of 50 patients.METHODS: We conducted a retrospective study of patients with diagnosis of urethral stricture treated by augmentation techniques in the period 1999-2009. We included patients with penile and bulbar urethral stricture and, penile skin or oral mucosa as substitute tissue type. Urethral strictures of the meatus or fossa navicularis and posterior urethra, and other endoscopic or surgical procedures were excluded from the study.RESULTS: Fifty patients were included. Penile skin was used in 26 cases and buccal mucosa in 24. The average follow-up was 108 months. Recurrence rate was 25% in the cases in which oral mucosa was used as substitute tissue and 30.7% in the penile skin group. Of the 14 cases with recurrence of the stricture, 13 (92%) did so in the first five years of follow-up. Only one case was a recurrent stricture after six years of surgery.CONCLUSIONS: The recurrence of the stricture after augmentation urethroplasty occurs, in the majority of cases, in the first five years. After this period of time recurrence is very rare. Oral mucosa showed better results as substitute tissue in the urethral stricture surgery.
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OBJECTIVE: The aim of this study was to describe the lithogenic risk profile of pediatric patients with lithiasis.METHODS: We retrospectively analyzed the metabolic studies in 24-hour urine samples in 47 pediatric patients with lithiasis. Biochemical determinations were made in blood and 24-hour urine. Oxalate calcium, brushite, struvite and uric acid salt saturations were calculated. 49 healthy children were used as a control group.RESULTS: No significant differences were found in biochemical blood parameters between children with stones and the group without stones. Calciuria, uricosuria and phosphaturia, oxalate calcium, brushite and uric acid saturations were higher in lithiasic children. In the multivariate analysis, using a logistic regression model, we only found hypercalciuria as lithogenic risk factor. (OR = 1.96 p < 0.002).CONCLUSIONS: Urinary metabolic abnormalities and elevated salt saturations in urine are a frequent finding in children with urolithiasis, but in our study we only found hypercalciuria as an independent risk factor for the formation of lithiasis.
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OBJECTIVES: We aimed to compare ureterolithotripsy and inserting only ureteral-j stent in terms of efficiency, safety and patient comfort in treatment of ureteral calculi in pregnant patients.METHODS: Seventy patients who developed hydronephrosis due to ureteral calculi during pregnancy, and on whom endoscopic intervention was performed were included in the study. In a center, the stones were broken up by ureteroscopy, and then ureteral stents (JJ) were placed if needed. In the other center, nothing was Arch. Esp. Urol. 2015; 68 (4): 435-440performed on the stones, and only ureteral stents (JJ) was placed. For the statistical analysis, Pearson’s chisquared test and the Mann-Whitney U tests were used and the significance level was determined as p < 0.05.RESULTS: The average age of the patients was 26.2 years (18-39) and the average gestational week was 23.4 weeks (8-36). While no significant difference was found between the two groups in terms of the frequency of complications (p=0.381) and post-operative pyelonephritis (p=0.2), the need for additional intervention in the group on whom ureteroscopy was performed was found to be less (9.7% vs. 31%; p=0.032). Moderate or severe LUTS or flank pain during the period between the procedure and the birth was found to be significantly less in the group in which ureterolithotripsy was performed (14% vs. 55%; p=0.036).CONCLUSIONS: Ureterolithotripsy is a safe and more comfortable procedure than only ureteral double-j insertion on pregnant patients with ureterolithiasis.
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Patients with Benign Prostatic Obstruction (BPO) and Myasthenia Gravis (MG) treated with Transurethral Resection of the prostate (TURP) show a high incidence of urinary incontinence due to unnoticed damage to muscle fibres of the external sphincter. Photoselective laser vaporization could be an alternative treatment based on the hypothesis that using Laser as energy source in the treatment of BPH prevents sphincter damage because the energy is not transmitted outside the fiber tip.METHODS: We report the case of a man diagnosed of MG and symptomatic BPO treated satisfactorily with photoselective laser vaporization (GreenLight-XPS). RESULTS: Patient did not experienced postoperative secondary incontinence.CONCLUSIONS: Laser photoselective vaporization (GreenLight-XPS) could be the standard treatment for men with MG and BPO, whose prostate volume is less than 60 cc who are candidates for surgical treatment. Despite the extremely low incidence of these cases, further investigations are needed to confirm this affirmation
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OBJECTIVES: Urologists daily evaluate many women with voiding disturbances, but proper physical examination has only rarely been previously performed.CASE DESCRIPTION:Case 1: 16-year-old woman presenting augmented daytime urinary frequency and nocturia without enuresis, with drop-by-drop micturition.Case 2: 80-year-old woman with urgency. She referred normal voiding with insensitive urinary loss the hour after.Physical examination: adhesion of the labia minora.Treatment: Surgical section of the adhered area in the midline was performed with satisfactory aesthetic and clinical results.CONCLUSIONS: The adhesion of the labia minora is an acquired disease, more frequent in girls under 2 years. Several predisposing factors have been proposed: oestrogen deprivation, inadequate personal care, local irritants, infections or previous trauma. Differential diagnosis is required among three congenital pathologies: vaginal agenesis, imperforated hymen and ambiguous genitalia. Cases in postpubertal or postmenopausal women, or refractory to medical treatment are considered for surgery.
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