Could thymoglobulin increase hemorrhagic risk in the perioperative transplantation period of sensitized kidney recipients?

OBJECTIVE

It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients.

MATERIAL AND METHODS

Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424).

RESULTS

We found differences in platelet decrease: 95,142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=0.001), number of patients with severe thrombocytopenia (<75,000/mm³) (20.8% vs. 3.7%, P=0.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=0.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=0.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance.

CONCLUSIONS

The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients.

[Management of adrenal mass: What urologists should know]

Adrenal incidentaloma's prevalence is rising because of the big volume of radiologic explorations that we daily do. No comprehensive guidelines have been published by professional societies to guide the evaluation of patients with adrenal incidentalomas. All adrenal masses should be inspected for malignancy or hypersecreting disorders. In our point of view, adrenal surgery should be performed by the urologist, because it's the medical speciality which knows the best this anatomical region. The objective of this review is to present the main points that the urologist may know in the management of adrenal masses. Together with the department of Endocrinology of our hospital, we describe the main studies to perform in front of adrenal mass diagnosis and the current therapeutical diagram utilized in our center.

[Brachyterapy in localized prostate cancer]

INTRODUCTION AND OBJECTIVES

Considering the high frequency of localized prostate cancer in stages, at the moment there are minimally invasive techniques that compete with the classic surgery. One of them is the Low Dose Rate (LDR) Brachytherapy with permanent implants of 1125 seeds. The objective of the present study is to expose our experience from the year 1998, when we made the first treatment, until today. The results and the morbidity of the patients over a 7 and a half years period are analyzed.

MATERIAL AND METHODS

A total of 800 patients were treated with LDR brachytherapy, with average age of 68 years and range between 48 and 83 years. In all patients the 1125 seeds were used with Rapid-Strand and peripheral load by means of intraoperative planning.

RESULTS

The urinary rate of complications was of 3% of AUR, and 0.2% of urinary incontinence. The morbidity on the digestive apparatus was of a 12% intermittent bleeding, 2% of proctitis, and a 0.3% of rectal fistulas.

[Presentation of a new case of primary clear cell adenocarcinoma of the urethra and its surgical management]

OBJECTIVE

To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management.

MATERIAL AND METHODS

We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature.

CONCLUSIONS

It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.

Resección transuretral de próstata bipolar vs monopolar: análisis peroperatorio de los resultados

OBJECTIVE

To analyse the differences in the postoperative period between bipolar and monopolar resection of the prostate in the endoscopic surgery of the benign prostatic hyperplasia.

METHODS

45 patients were prospectively randomized. Twenty-one underwent monopolar resection (Storz Ch 26, 30 degrees) and 24 underwent bipolar resection (Olympus ch 26, 30 degrees).

RESULTS

Mean age in the bipolar group was 69,5 years versus 67,3 in the monopolar group; mean flow before surgery (7,7 ml/s vs 7,2 ml/s); ecographic prostate volume (39,5 cc vs 42,7 cc); resection volume 13 g vs 12,6 g and mean resection time was 39,7 vs 42,5 min. Cut capacity was considered notable-excellent in 90% of the patients in the bipolar group vs 50% in the monopolar group (p=0,01); adherence of fragments were considered abundant or very abundant in 0% vs 60% (p=0,01); coagulation capacity was excellent-notable in 25% vs 75% (p=0,03). There were no significant differences on the days of catheterization (2,92 vs 3,1), continuous irrigation (1,79 vs 2,05), hospitalization (3,63 vs 3,67), hematocrite descent (3,48 vs 3,32) and plasmatic sodium (0,52 vs 1,16), neither on episodes of acute urine retention (only one patient in the monopolar group).

CONCLUSIONS

In our experience, TURP with SurgMaster resector in prostate smaller than 70 g offers better peroperative qualities for the surgeon (better cut capacity, less adherence of fragments) than the monopolar resection, with similar postoperative outcomes.

[Primary lymphoepithelioma-like carcinoma urinary bladder]

OBJECTIVE

To present a new case of a primary lymphoepithelioma-like carcinoma of the urinary bladder.

MATERIAL AND METHODS

We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature.

CONCLUSIONS

It is an unusual type of bladder cancer that requires a carefully analyse from the pathologist and a confirmation by means of immunohistochemistry techniques. The focal form is associated with poor prognosis. Radical cystectomy is the gold standard. This kind of tumor has sensibility to chemo and radiotherapy, who can be used as adjuvant therapy.

[Renal hydatidic cyst simulating hypernephroma]

OBJECTIVE

To present a new case of hydatid cyst of the kidney with a difficult radiographic diagnosis.

MATERIAL AND METHODS

We describe the clinical, diagnosis and treatment of a complex renal mass and its histological confirmation after surgery. Review of the literature.

CONCLUSIONS

kidney's hydatidose is an unusual placement of this pathology. It is important to take care in the differential diagnosis in the context of complexes renal masses. There are some diagnosis procedures which can help us to establish it. Surgery is the treatment of choice in the majority of the cases.

[Von Hippel-Lindau disease: atypical presentation]

OBJECTIVE

To describe an atypical presentation of von Hippel-Lindau disease.

MATERIAL AND METHODS

We present the clinical, diagnostic and treatment of the urological signs of this disease, which has overcoat a neurological management, in a young man with familiar history of it.

CONCLUSIONS

The basic knowledge of the von Hippel-Lindau disease is important for the urologist because the urological signs of it, are common and they make up one of the most important causes of morbility and mortality.

Pseudotumor inflamatorio vesical

OBJECTIVE

To present a new case of inflammatory pseudotumor of the urinary bladder.

MATERIAL AND METHODS

We describe the clinical, diagnostic and treatment of a new case of inflammatory pseudotumor of the urinary bladder in a 22 years old man without urological history.

CONCLUSIONS

The inflammatory pseudotumor of the bladder is a rare benign lesion of unknown etiology. The most important histopathological differential diagnosis to consider is the rabdomyosarcoma. The immunohistochemistry study is basic in the diagnostic, characterization and differentiation of both pathologies. His benign development force us to a conservative management always it is possible.