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Though hypogonadism is part of the clinical picture of chronic renal failure, its etiology remains unknown. Because of the consequences it may have on the prostate gland, it was decided to conduct a prospective evaluation on its influence on prostatic signs and symptoms and glandular growth in a group of patients with chronic renal failure undergoing dialysis and a second group with renal transplantation. To this end, the presence of symptoms was assessed in 78 subjects over 50 years of age: 22 healthy controls (group C) (28.2%), 28 in haemodialysis (Group HD) (35.0%) and 28 with renal transplantation (Group RT) (35.9%). All subjects were aged between 53 and 80 years (mean 58.29 +/- 5.45). Determination of degree of prostatism was done by the International Prostate Symptoms Score (IPSS-S and L), flowmetry, ultrasound postmictional residue, transrectal ultrasound with 3 prostatic diameters (cross-sectional, antero-posterior and longitudinal), prostate weight and plasma levels of PSA, testosterone, FSH, LH, PRL and oestradiol. In 26 of 28 patients in the HD group IPSS-L, flowmetry and post-mictional residue was not assessed as they had no spontaneous miction. There were significant differences in IPSS between C and RT (p = 0.003), Qmax between C and RT (p = 0.009), post-mictional residue between C and RT (p = 0.045), cross-sectional diameter between C and HD (p = 0.036), prostate weight between C and HD (p = 0.001), and between HD and RT (p = 0.001), PSA between C and RT (p = 0.026), FSH between C and HD (p = 0.005), LH between HD and RT (p = 0.020), PRL between HD and RT (p = 0.023), Oestradiol between C and HD (p = 0.032). We conclude that hypogonadism is a factor which, in patients with chronic renal failure and renal transplantation, contributes to prevent prostate growth thus minimizing the symptoms of prostatism.

Our service performed a total of 619 kidney transplants between February 1980 and March 1993. Among them, 41 new neoplasias (6.6%) were diagnosed. Most frequent tumour was epithelioma (25) with a presentation age lower than in the normal population. Amongst the remaining tumours (16), the occurrence of 2 lymphoma and 2 Kaposi's sarcoma should be emphasized, together with the fast evolution progression of the others. Using a multiple regression model, an analysis is made on the influence certain factors have in the development of neoplasias, age being selected as the only significant one. The relative risk transplanted subjects have of suffering some type of neoplasia compared with the normal population is 36.

Lymphoceles are a complication of renal transplantation surgery. The source of this lymphatic collections is the lymph draining through the lymphatic vessels located in the transplanted kidney sinus and surrounding the iliac vessels of the receptor. The main etiological factor is the surgical technique used when dissecting these structures for graft placement. Several factors have been suggested as favouring their occurrence, acute rejection being highlighted as one. This paper reviews a series of 517 renal transplantations performed in our service, with a lymphocele incidence of 5.2% (28). Using a log regression model, the influence of age, sex, time in dialysis, presence of tubular acute necrosis in the graft following placement, acute rejection and immunological regime, for the appearance of lymphocele were analyzed. Age and lack of acute tubular necrosis were the only two factors selected by the model. Also, clinical signs and symptoms as well as therapy instituted were analyzed, emphasizing that puncture-drainage and instillation of iodine povidone was 100% effective.

Of a total of 320 renal transplants performed at our center in the last 8 years, two patients presented colonic perforation (0.62%). We emphasize the clinical manifestations, which were masked by the antiinflammatory properties of the steroids; for this reason, careful and repeated physical exams should be made out in the case of any episode of abdominal pain in these patients, as well as ancillary studies for early diagnosis. Surgical measures, which consist of exclusion of the septic focus in the peritoneal cavity, do not differ from those carried out in the general population with the same colonic pathology, although they require more cautious maneuvers and meticulous lavage of the peritoneal cavity. Alternatively, when exclusion is not possible, proximal colostomy and adequate drainage must be performed.

The horseshoe kidney is useful as a graft and should be transplanted. The technical difficulties can be avoided by en bloc removal, perfusion in situ with Collins solution, and bench surgery during graft preparation.