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Medina AA, Lorca Álvaro J, Carretero del Barrio I, Laso García I, García Cosío M, Mata Alcaraz M, Hevia Palacios M, Gómez Dos Santos V, Burgos Revilla FJ. Primary testicular lymphoma: Clinical characteristics and oncological outcomes. Curr Urol 2023; 17:130-134. [PMID: 37691992 PMCID: PMC10489500 DOI: 10.1097/cu9.0000000000000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/08/2021] [Indexed: 10/14/2022] Open
Abstract
Background Primary testicular lymphoma (PTL) is a rare testicular malignancy, despite being considered the most common testicular tumor in patients older than 60 years. Primary testicular lymphoma represents only 1%-9% of testicular neoplasms. Few studies have been published regarding its clinical features and management. This study aimed to analyze the clinical characteristics and outcomes of PTL. Materials and methods Orchiectomy specimens of 15 patients with PTL diagnosed during 2000-2020 at our institution were retrospectively studied. We collected information on demographic data, clinical features, management aspects, and outcomes of PTL treatment. Kaplan-Meier survival curves and Cox regression analyses were used to study survival. Results The median patient age was 69 years (interquartile range, 61-72 years). The most prevalent clinical presentation was testicular swelling (80%), and only 13.33% of the patients presented with systemic symptoms. Central nervous system involvement was detected in 6 patients (40%). Of the 15 patients, 5 (33.33%) had stage IE and 10 (66.67%) had stage IVE lymphoma. Diffuse large B-cell lymphoma was the most common histological subtype. Twelve patients (80%) received chemotherapy. During follow-up, 4 patients (26.67%) relapsed. The recurrence rate in the contralateral testicle was 13.33%. The median cancer-specific survival was 21.58 months (95% confidence interval, 0-43.95 months). Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival. Conclusions Primary testicular lymphoma has a high relapse rate and poor prognosis. Management strategies typically include radical orchiectomy and systemic chemotherapy. Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.
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Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Javier Lorca Álvaro
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Inés Laso García
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Mónica García Cosío
- Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marina Mata Alcaraz
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Hevia Palacios
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Victoria Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Araujo-Castro M, García Centero R, López-García MC, Álvarez Escolá C, Calatayud Gutiérrez M, Blanco Carrera C, De Miguel Novoa P, Valdés Gallego N, Hanzu FA, Gracia Gimeno P, Fernández-Ladreda MT, Percovich Hualpa JC, Mora Porta M, Lorca Álvaro J, Pian H, Caracuel IR, Sanjuanbenito Dehesa A, Gómez Dos Santos V, Serrano Romero A, Oliveira CL. Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY. Endocrine 2021; 74:676-684. [PMID: 34373995 DOI: 10.1007/s12020-021-02843-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery. METHODS A retrospective study of pheochromocytomas submitted to surgery in ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale. RESULTS One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%, P = 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82, P < 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (n = 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm. CONCLUSION Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Unit. Department of Endocrinology & Nutrition. Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Department of Health Science, Universidad de Alcalá, Madrid, Spain.
| | | | | | | | | | | | - Paz De Miguel Novoa
- Department of Endocrinology & Nutrition, Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Valdés Gallego
- Department of Endocrinology & Nutrition, Hospital de Universitario de Cabueñes, Asturias, Spain
| | - Felicia A Hanzu
- Department of Endocrinology & Nutrition & Group of Endocrine Disorders. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Royo Villanova, Zaragoza, Spain
| | | | | | - Mireia Mora Porta
- Department of Endocrinology & Nutrition & Group of Endocrine Disorders. Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Javier Lorca Álvaro
- Department of Urology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Héctor Pian
- Department of Pathology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Ruz Caracuel
- Department of Pathology, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Ana Serrano Romero
- Department of Anesthesia, IRYCIS. Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Lamas Oliveira
- Department of Endocrinology & Nutrition, Hospital Universitario de Albacete, Albacete, Spain
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Gómez Dos Santos V, Hevia Palacios V, Galeano Álvarez C, Olavarría Delgado A, Díez Nicolás V, Jiménez Álvaro S, Álvarez Rodríguez S, Lorca Álvaro J, Del Cristo Artiles Medina A, Mata Alcaraz M, Burgos Revilla FJ. [Renal allograft transplant vascular complications. Diagnostic and treatment.]. ARCH ESP UROL 2021; 74:1013-1028. [PMID: 34851316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Vascular complications remain common after renal transplantation, occurring in 3% to 15% of patients. These complications can compromise graft function,with graft loss rates ranging from 12.6 to 66.7%.Vascular abnormalities of the graft, specifically the presence of multiple vessels, represent the most frequently studied risk factor for the development of vascular complications. Other risk factors identified for the development of vascular complications are linked to the characteristics of the recipient, or thromboembolic diseasesharing atherosclerosis and/or hypercoagulant state aspathogenic features.Although the most frequent vascular complication is renal artery stenosis, we will also address the complications according to their early or late on set in order to highlightthe potentially more severe complications that may affectgraft survival during the follow-up period.Early vascular complications include mainly arterial and venous thrombosis and lacerations or disruptions of artery and/or vein, as well as arterio-venous fistulas or intrarenal pseudoaneurysms. In contrast, late-onset complications include stenosis or kinking of the renal artery-and less commonly of the renal vein-, as well as extrinsic compression as a consequence of the presence of perigraft fluid collections. Finally, extrarenal pseudoaneurysm is a potentially severe complication in the late post-transplant period.Finally, this article explores special transplant situations such as complications derived from the paediatric donor in adult recipients, transplantation in the paediatric recipient and emerging techniques like robotic renal transplantation.
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Affiliation(s)
- Victoria Gómez Dos Santos
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Vital Hevia Palacios
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Cristina Galeano Álvarez
- Servicio de Nefrología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Andreina Olavarría Delgado
- Servicio de Radiodiagnóstico. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Victor Díez Nicolás
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Sara Jiménez Álvaro
- Servicio de Nefrología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Sara Álvarez Rodríguez
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Javier Lorca Álvaro
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Alberto Del Cristo Artiles Medina
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Marina Mata Alcaraz
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
| | - Francisco Javier Burgos Revilla
- Servicio de Urología. Hospital Universitario Ramón y Cajal. Grupo de Investigación Quirúrgica en Urología y Trasplante Renal. IRYCIS. Universidad de Alcalá. Madrid. España
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Serrano Domingo JJ, Alonso Gordoa T, Lorca Álvaro J, Molina-Cerrillo J, Barquín García A, Martínez Sáez O, Burgos Revilla J, Carrato A, Álvarez Rodríguez S. The effect of medical and urologic disorders on the survival of patients with metastatic castration resistant prostate cancer treated with abiraterone or enzalutamide. Ther Adv Urol 2021; 13:17562872211043341. [PMID: 34552666 PMCID: PMC8451255 DOI: 10.1177/17562872211043341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/15/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Androgenic deprivation therapies have been linked to the development of metabolic syndrome (MS) and cardiovascular diseases, which may lead to a poorer survival in patients with metastatic Castration-Resistant Prostate Cancer (mCRPC). We aimed to analyze whether some cardiovascular or neurological disorders, together with other medical and urological complications, may have an effect on survival outcomes, at baseline and during treatment from patients treated with androgen pathway inhibitors (API). Material and Methods: A retrospective study of a consecutive series of patients diagnosed with mCRPC between 2010 and 2018 treated with API in the first line setting in a single center. Results: Seventy-three patients met the inclusion criteria. Baseline prognostic factors associated with worse survival were diabetes mellitus (DM) with insulin needs compared to patients without DM [hazard ratio (HR) = 0.19, p = 0.025], hypertension (HTN) (HR = 0.46, p = 0.035), and a history of stroke (HR = 0.16, p < 0.001). However, previous history of hypercholesterolemia, arrythmias, and cognitive disorders did not result in a significant worsening on survival. During treatment, patients who developed de novo HTN had the best progression free survival (PFS) (HR = 0.38, p = 0.048) and overall survival (OS) (HR 0.08, p = 0.012) compared with patients with previous HTN. Other factors related to worse outcomes included the presence of heart failure (HR = 0.31, p = 0.001), the requirement for major opioids for pain relief (HR = 0.33, p = 0.023), and the presence of bilateral ureterohydronephrosis (HR = 0.12, p = 0.008). Conclusions: Some comorbidities may be strongly involved in patient outcomes when receiving API for mCRPC. In this sense, collaborative networking between specialists and caregivers treating prostate cancer (PC) patients should be recommended, focusing on MS features, cardiovascular and neurological disorders in order to anticipate medical and surgical complications.
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Affiliation(s)
| | - Teresa Alonso Gordoa
- Medical Oncology Department, University Hospital Ramon y Cajal, Ctra. Colmenar km9100, Madrid, 28034, Spain
| | | | | | - Arantzazu Barquín García
- Medical Oncology Department, Centro Integral Oncológico Clara Campal, Hospitales Madrid, Madrid, Spain
| | - Olga Martínez Sáez
- Medical Oncology Department, Hospital Clinic I Provincial, Barcelona, Spain
| | | | - Alfredo Carrato
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain
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Sánchez-González Á, López-Fando Lavalle L, Esteban-Fernández A, Ruiz M, Hevia V, Comeche B, Sánchez Conde M, Álvarez S, Lorca Álvaro J, Fraile Poblador A, Hevia Palacios M, Domínguez Gutiérrez A, Artiles Medina A, Sanz Mayayo E, Duque G, Gómez Dos Santos V, Moreno-Guillén S, Burgos Revilla J. What Should Be Known by a Urologist About the Medical Management of COVID-19's Patients? Curr Urol Rep 2020; 21:44. [PMID: 32870407 PMCID: PMC7459251 DOI: 10.1007/s11934-020-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.
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Affiliation(s)
- Álvaro Sánchez-González
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Luis López-Fando Lavalle
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain.
| | - Alberto Esteban-Fernández
- Cardiology Service, Severo Ochoa University Hospital, Rey Juan Carlos University, Leganés (Madrid), Spain
| | - Mercedes Ruiz
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Vital Hevia
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Belén Comeche
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Matilde Sánchez Conde
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Sara Álvarez
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Javier Lorca Álvaro
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Agustín Fraile Poblador
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Manuel Hevia Palacios
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Ana Domínguez Gutiérrez
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Alberto Artiles Medina
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Enrique Sanz Mayayo
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Gemma Duque
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | | | - Santiago Moreno-Guillén
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Javier Burgos Revilla
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
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6
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Brasero Burgos J, Gómez de Vicente JM, Donis Canet FDA, López-Fando Lavalle L, Jiménez Cidre MÁ, Arias Fúnez F, Lorca Álvaro J, Sánchez Gallego MD, Ruíz Hernández M, Burgos Revilla FJ. Recurrent vulvar melanoma invading urethra. Clinical case and literature review. Urol Case Rep 2018; 19:42-44. [PMID: 29888188 PMCID: PMC5991307 DOI: 10.1016/j.eucr.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/04/2018] [Accepted: 04/20/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jennifer Brasero Burgos
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - José Miguel Gómez de Vicente
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Francisco de Asís Donis Canet
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Luis López-Fando Lavalle
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Miguel Ángel Jiménez Cidre
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Fernando Arias Fúnez
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Javier Lorca Álvaro
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - María Dolores Sánchez Gallego
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Mercedes Ruíz Hernández
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
| | - Francisco Javier Burgos Revilla
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ctra. Colmenar Viejo, Km. 9100, 28034, Madrid, Spain
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Álvarez Rodríguez S, Hevia Palacios V, Sanz Mayayo E, Gómez Dos Santos V, Díez Nicolás V, Sánchez Gallego MD, Lorca Álvaro J, Burgos Revilla FJ. The Usefulness of Contrast-Enhanced Ultrasound in the Assessment of Early Kidney Transplant Function and Complications. Diagnostics (Basel) 2017; 7:diagnostics7030053. [PMID: 28914777 PMCID: PMC5617952 DOI: 10.3390/diagnostics7030053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives: The routine diagnostic method for assessment of renal graft dysfunction is Doppler ultrasound. However, contrast-enhanced ultrasound (CEUS) may provide more information about parenchymal flow and vascular status of kidney allografts. The aim of the study was to assess the effectiveness of CEUS in the immediate post-transplant period, focusing on acute vascular complications. A brief review of available literature and a report of our initial experience is made. Material and methods: 15 kidney transplant (KT) cases with clinical suspicion of acute surgical complication were assessed with CEUS and conventional Doppler ultrasound (US). In addition, bibliographic review was conducted through PubMed, Embase, and ClinicalKey databases. Results: 10% of KT underwent CEUS, useful for detecting vascular complication or cortical necrosis in 4 (26%) and exclude them in 74%. Grafts with acute vascular complications have a delayed contrast-enhancement with peak intensity lower than normal kidneys. Perfusion defects can be clearly observed and the imaging of cortical necrosis is pathognomonic. Conclusions: CEUS is a useful tool in the characterization of renal graft dysfunction with special interest on acute vascular complications after renal transplant. It is a feasible technique for quantitative analysis of kidney perfusion, which provides information on renal tissue microcirculation and regional parenchymal flow. Exploration could be done by a urologist at the patient’s bedside while avoiding iodinated contrast.
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Affiliation(s)
- Sara Álvarez Rodríguez
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - Vital Hevia Palacios
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - Enrique Sanz Mayayo
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - Victoria Gómez Dos Santos
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - Víctor Díez Nicolás
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - María Dolores Sánchez Gallego
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - Javier Lorca Álvaro
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
| | - Francisco Javier Burgos Revilla
- Kidney Transplant Unit, Department of Urology, Hospital Universitario Ramón y Cajal, Spain Alcalá University, IRYCIS, 28034 Madrid, Spain.
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