Testicular reconstruction after testicular rupture and review of the literature

OBJECTIVE

To report a clinical case of testicular rupture and review of the literature published.

METHOD

A 15 years old male with a testicular rupture after a sports injury was diagnosed by Doppler ultrasound.

RESULTS

Surgical exploration was performed and the tear was repaired. He had a benign postoperative course. The patient presents a normal size testicle after a year of follow-up.

CONCLUSIONS

Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and e management to avoid orchiectomy.

[Mondor's disease vs. sclerosing lymphangitis of the penis]

OBJECTIVE

Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies.

METHOD

Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported.

RESULTS

Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes.

CONCLUSIONS

Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence.

[Testicular seminoma in a patient with Kartagener's syndrome]

OBJECTIVE

To present the association between Seminoma and Kartagener's Syndrome (KS), and its relation with infertility.

METHODS

We report one case of Seminoma in a patient with Kartagener's Syndrome, focussing on the possible relation between both pathologies and fertility. Bibliographic references are discussed.

RESULTS

Orchyectomy was performed on a patient with Kartagener's Syndrome and testicular tumour. The pathology result was Seminoma. Azoospermia was obtained twice in the post operative espermiogram, not being easy to establish the implication of each pathology (KS or Seminoma) in infertility.

CONCLUSIONS

A patient with KS and Seminoma plus azoospermia is reported, with a great outcome from the oncological point of view. Bibliographic references are described. The association between KS and Seminoma is exceptional in the literature.

[Renal graft outcome in patients with combined heart-kidney transplantation]

INTRODUCTION

Improvement in surgical and organ preservation techniques and immunosuppressive therapy has permitted multiorganic transplants in patients needing both heart and kidney organs in a synchronous or asynchronous way.

OBJECTIVES

To review our results in renal transplants in those patients with both heart and kidney transplants.

MATERIAL AND METHOD

Retrospective study of the 7 patients with heart and kidney transplants performed in our Hospital. We have reviewed patients main characteristics, heart and renal failure causes, renal graft and patient outcome and complications related to renal transplant.

RESULTS

Between 1985 and 2006 we performed 411 heart transplants; in 7 out of those 411 patients (1.7%) we performed 9 renal transplants, 2 simultaneously and 7 non-simultaneously. All patients were male; their average age at heart transplant was 51.3+/-12.2 years (24-60); the causes of the heart transplant were dilated myocardiopathy in 4 cases (57.2%), rheumatic cardiopathy in 1 (14.3%) and ischemic cardiopathy in 2 (28.5%). The average age at renal transplant was 57.5+/-11.2 years (32-68); the causes of the end renal failure were cyclosporine nephrotoxicity in 3 cases (33.3%), nephroangiosclerosis in 1 (11.1%), chronic interstitial nephropathy in 2 (22.2%), membranoproliferative glomerulonephritis in 1 (11.1%) and chronic rejection in 2 (22.2%). In the 2 simultaneous heart-kidney transplants cold ischemia was 4 hours long, immediate diuresis was seen in 1 case (50%) and there were no complications related to the kidney transplants. The time between the heart and kidney transplants in the 7 non-simultaneous heart-kidney transplants was 105.9+/-51.8 months (23-201 months), cold ischemia was 20.3+/-1.5 hours (18-22) and there was immediate diuresis in 5 cases (71.5%); 2 patients had no complications, 2 cases had acute renal rejection episodes, 1 case of perirenal haematoma, 1 renal polar infarction, lymphocele, 1 case of wound infection, 1 urinary infection and 2 pulmonary infections. Medium follow-up is 52.2+/-33.9 months (12-93); all patients are alive with functioning grafts with creatinine level of 1.8+/-0.43 mg/100 (1.4-2.4). Two renal grafts were lost due to chronic rejection 138 and 270 days after the kidney transplants. The immunotherapy was based on mycophenolate mofetil acid and tacrolimus, though it varied.

CONCLUSIONS

The final renal failure associated to cardiopathies needing or having needed heart transplant does not preclude the transplants of both organs.

Vasovasostomía: Nuestra experiencia

OBJECTIVES

From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples.

METHODS

The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others.

RESULTS

Overall spermatozoid potency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results.

CONCLUSIONS

Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the potency rate. Regarding pregnancy rate, it is not influenced by delay of reversal.

[Surgical details and complications from retransplantation into the iliac fossa for third and fourth kidney transplants]

OBJECTIVES

To analyze the surgical aspects and complications from retransplantation into the iliac fossa for third and fourth kidney transplants.

METHODS

Retrospective study of the 34 third and 5 fourth transplants performed in our department. We analyze patient's characteristics, surgical aspects and complications, and graft outcomes.

RESULTS

Mean patient age was 41.6 years. 67% of the first and second transplants had been lost to vascular problems (19%) or chronic rejection (48%). Average time from last transplant in the retransplanted iliac fossa was 9 years (3 days-17 years). There were not significant differences between the groups of first and second transplant and third and fourth in cold ischemia time, number of mismatches, and number of days on hemodialysis after transplantation; there were significant differences in receptor age, number of transfusions, maximum and current antibodies and donor age, all of which were higher in third and fourth transplants. The graft was basically implanted in the right iliac fossa (71%) through a lumbar-iliac iterative incision; vascular anastomosis were equally made to the common and external iliac vessels; ureteral reimplant was performed following an extravesical technique; simultaneous transplant nephrectomy of the previous graft was performed in 33% of the cases. 59% of the cases had immediate diuresis and 49% did not require dialysis within the first 7 postransplant days. Surgical complications were mainly vascular: 4 cases of hemorrhage, 3 venous thrombosis and 2 arterial thrombosis. There were also 4 cases of lymphocele, 1 perirenal hematoma, and 1 enterocutaneous fistula with an abscess of the surgical bed. There were no urologic complications in the series. Globally, there was 1 death (2.5%) secondary to hemorrhage and another 6 grafts (15%) were lost to complications, 5 vascular thrombosis and 1 after surgical bed abscess. 1, 3, 5, and ten-year actuarial graft survival were 65%, 52%, 40% and 28% respectively.

CONCLUSIONS

Retransplantation into the iliac fossa for third and fourth transplants is associated with a small increase in the number of surgical complications, mainly vascular complications.

[Treatment of urinary stress incontinence using suburethral implantation of tension-free vaginal tape (TVT). 4 years' experience]

OBJECTIVES

To analyze our results in terms of continence and complications of treatment of urinary incontinence with TVT during the 4 first years.

METHODS

72 patients underwent surgery for urinary incontinence between 1999 and 2002. Chart review was performed for medical history, physical examination, urodynamic tests, surgical procedure, intraoperative and postoperative complications, objective and subjective results.

RESULTS

62 patients were diagnosed of genuine stress urinary incontinence and 10 patients of mixed urinary incontinence. 14 patients had grade 3 cystocele, 12 of them underwent associated colporrhaphy. Operations were performed under local anaesthesia in 1 patient, spinal anaesthesia in 41 and general anaesthesia in 30. Mean operation time was 32 minutes, 66 minutes when colporrhaphy was associated, and previous surgery did not increase the surgical difficulty. 6 patients (8.3%) suffered bladder perforation which was identified during cystoscopy, but only required reposition of the tape without affecting patients' outcomes; 1 patient had a pelvic hematoma that evolved without sequel; 16 patients (22.22%) had urinary retention which spontaneously resolved between 2 and 60 days, except one case that required section of the mesh. 8 patients (11.11%) developed de novo bladder instability; there were 2 cases of late mesh perforation into urethra or bladder, which were solved by endoscopic mesh section; 3 patients had voiding discomfort and 1 chronic perineum pain. 70 patients (97.3%) achieved continence under stress; nevertheless only 57 patients (79.17%) were satisfied with their outcomes. Main causes for dissatisfaction were failure, de novo instability, persistence of urgency in cases of mixed incontinence, and voiding discomfort. Previous surgery and performance of associated procedures did not influence outcomes, although they were associated with longer operation times and higher incidence of urinary retention. Patients with Valsalva's leak point pressure < 60 H2O cm had slightly worse outcomes (63.5% satisfaction).

CONCLUSIONS

TVT is an easy to learn and easy to perform technique, with few complications and good results.