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Inés María Laso-García, Fernando Arias-Fúnez, Gema Duque-Ruiz, David Díaz-Pérez, Javier Lorca-Álvaro, Francisco Javier Burgos-Revilla Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, SpainCorrespondence: Inés María Laso-GarcíaUrology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Carretera de Colmenar Km 9.100, Madrid 28029, SpainEmail ines.laso.garcia@gmail.comPurpose: The objective is to present a case of well-leg compartment syndrome in the Galdakao-modified supine Valdivia position.Results: The case of a 32-year-old male, obese (105 Kg) and a former smoker is presented. The patient was positioned in the Galdakao-modified supine Valdivia position, with lower limbs bandaged, to perform a right percutaneous nephrolithotomy. In the immediate postoperative period, significant pain was reported in the left lower limb. The limb appeared oedematous and cyanotic, although pedis pulses were preserved. Doppler ultrasound ruled out venous thrombosis. Suspecting compartment syndrome, the patient underwent a complete decompression fasciotomy of the four left leg compartments. After the surgery, values of creatine phosphokinase reached 80.000 UI/L and serum creatinine levels were 1.53 mg/dL. The patient was taken to the intensive care unit. Six months after the episode, the patient still needs rehabilitation care. The compartment syndrome is a rare complication in lithotomy position, but never described in the Galdakao-modified supine Valdivia position before, with the lower limbs in moderate flexion, and with the ipsilateral lower limb in a slightly inferior position with respect to the other. It may lead to skin necrosis, permanent neuromuscular dysfunction, myoglobinuric renal failure, amputation and even death. Therefore, this complication must be suspected and early decompression of the compartment must be performed. Risk factors include obesity, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, hypothermia, acidemia, BMI, male sex, combined general-spinal anesthesia, prolonged surgery time, systemic hypotension, ASA (American Society of Anesthesiologists) class, lack of operative experience, vasoconstricting drugs, important bleeding during the surgery and increased muscle bulk.Conclusion: Compartment syndrome is a potentially life-threatening complication that may occur in the Galdakao-modified supine Valdivia position. It should be suspected in cases with risk factors and compatible clinical symptoms and signs, and treated rapidly to avoid further complications.Keywords: well-leg compartment syndrome, percutaneous nephrolithotomy, Galdakao-modified supine Valdivia position

Perivascular epithelioid cell tumors (PEComa) are rare neoplasms defined as mesenchymal tumors with distinctive histology and immunohistochemistry. They tend to occur in middle-aged patients and mostly in women. The tumours cells show an association with the walls of blood vessels. Most PEComas are benign although a proportion of these tumours behave aggressively. Case report of 47-years-old woman with retroperitoneal mass and laparoscopic resection that pathological anatomy showed retroperitoneal tumour compatible with PEComas. We describe the main characteristics of PEComas as well as their therapeutic approach. Resumen: Los tumores de células epitelioides perivasculares (PEComa) son neoplasias raras definidas como tumores mesenquimales con histología e inmunohistoquímica distintivas. Suelen aparecer en pacientes de mediana edad y principalmente en mujeres. Las células tumorales muestran una asociación con las paredes de los vasos sanguíneos. La mayoría de los PEComas son benignos, aunque una proporción de estos tumores se comporta de forma agresiva. Se presenta el caso de una mujer de 47 años con una masa retroperitoneal y resección laparoscópica cuya anatomía patológica mostró un tumor retroperitoneal compatible con PEComa. Describimos las principales características de los PEComas así como su abordaje terapéutico.

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., Competing Interests: No conflict of interest has been declared by the authors., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

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., Competing Interests: Conflict of interest statement: Juanjo Serrano Domingo declares Travel expenses from Janssen. Teresa Alonso Gordoa declares Advisory Boards: Bayer, Janssen, Sanofi, Astellas; Speaker: Janssen, Astellas; Travel expenses: Sanofi Javier Lorca Álvaro declares Travel expenses from Astellas. Arantza Barquín García declares no conflicts of interest Javier Molina Cerrillo declares Advisory Boards: Sanofi; Speaker: Janssen. Olga Martínez Sáez declares no conflicts of interest. Javier Burgos Revilla declares Advisory Boards and Honoraria from Astellas, Janssen and Sanofi and Travel Grants from Astellas and Janssen. Alfredo Carrato declares Advisory Boards: Bayer. Sara Álvarez Rodriguez has received honoraria from Janssen, Astellas and Bayer., (© The Author(s), 2021.)

Introduction: Complex ureteral obstruction is a pathology that has always been a challenge for the urologist, especially in patients with high surgical risk or with a short life expectancy., Material and Methods: Between 2002 and 2017, 13 extra-anatomical bypasses were placed. A descriptive retrospective study was carried out. An analysis of the permeability time of the prosthesis was performed using Kaplan-Meyer curves. Demographic and etiological characteristics as well as early and late complications were analysed., Results: Etiologies were benign in 39% (including 3 transplant recipients) and malignant in 69%. Permeability rates were 90.9% at each of 12, 24 and 48 months, respectively, and 75.8% at 60 months. There were no deaths in the early postoperative period, nor intraoperative complications. The most frequent complications were infections. Three of them were associated with bypass extrusion, which needed to be removed. A total of 5 prosthesis had to be removed. 40% of the patients did not present complications., Conclusions: The extra-anatomical ureteral bypass is an alternative to permanent nephrostomy in the treatment of complex ureteral strictures. Their patency rates after long-term follow-up vary from 90% to 75% at 48 and 60 months, respectively. Their complication rates can be considered acceptable in the patients' clinical contexts., Competing Interests: The authors declare that they have no conflicts of interest. No funding was received for the development of the study., (Copyright by Polish Urological Association.)

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., Competing Interests: The authors declare no conflict of interest.