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Resumen Los injertos de mucosa oral pueden ser utilizados para la reparacion satisfactoria de estenosis de uretra pendula y bulbar Material y metodos Presentamos nuestra experiencia con injertos de mucosa oral en 8 pacientes. La longitud del injerto fue entre 4 y 16 cm. Se han realizado tres uretroplastias en uretra pendula, dos en uretra bulbar y tres panuretrales. El seguimiento ha sido entre 36 y 60 meses Resultados No se han observado recurrencias. Un paciente refirio parestesias en el labio inferior durante seis meses

Resumen Tumores de urotelio superior Objetivos:Evaluar los metodos diagnosticos empleados, el tratamiento y el seguimiento de los pacientes afectos de tumor de urotelio superior. Pacientes y metodo Desde 1978 hasta diciembre de 2002 han sido operados 105 pacientes afectos de tumor de urotelio superior, siendo validos para el analisis 94. La edad media ha sido de 65 anos, siendo el 85% varones. La hematuria fue el sintoma mas frecuente de presentacion. Resultados Se realizo UIV en el 93% de los pacientes, la ecografia en el 77% y el TAC en el 67%. Predomino el tumor pielico (71%) y el tratamiento mayoritario fue la nefroureterectomia total con reseccion del collarete vesical perimeatal (76,4%). El tumor vesical previo o simultaneo se constato en 22 casos (23,3%) y posterior en 28 casos (30%). Con un seguimiento medio de 76 meses, la supervivencia es del 53%. Conclusiones El tumor de urotelio superior debe considerarse como una enfermedad panurotelial debido a la alta frecuencia de tumor vesical previo, simultaneo o posterior, lo cual empeora aun mas el pronostico de esta enfermedad.

Resumen Objetivo Evaluar las complicaciones quirurgicas de la prostatectomia radical (PR) en nuestro medio Pacientes y metodo Desde agosto de 1991 a diciembre de 1999, hemos realizado 138 PR en pacientes con adenocarcinoma de prostata (CaP) clinicamente localizado. Analizamos solo los 133 casos de los que conocemos la evolucion. La tecnica utilizada ha sido la ascendente descrita por Walsh por via retropubica. La edad media era de 64,8 y la media del PSA era de 17,6 ng/ml Resultados Con un seguimiento medio de 43 meses diferenciamos las complicaciones precoces de las tardias. Entre las primeras tenemos la fistula urinaria (9%), la linforrea (5,22%) y la lesion rectal (2,2%). De las tardias la mas preocupante es la incontinencia de orina (27%) de la que el 4,5% es grave. La mas frecuente es la disfuncion erectil (98%) y la estenosis de la anastomosis (12%) es la menos preocupante. Solo tres pacientes han fallecido debido a la neoplasia. Comparamos nuestros resultados con las series mas amplias nacionales y extranjeras Conclusiones La cirugia radical de prostata en nuestro medio tiene una morbilidad similar a otras series. La incontinencia urinaria y la disfuncion erectil son las secuelas mas preocupantes que los pacientes deben conocer para decidir otras opciones terapeuticas

The Leydig cell tumor is the most frequent of non-germ cell tumors of the testis. Clinical findings depend on the age of presentation. We present two cases of Leydig Cell tumors of the testis, diagnosed in a 8 years old child with isosexual precocity, and a 42 years old adult with Gynaecomastia. After reviewing the existing literature on this uncommon pathology we consider that the iconography presented is very interesting for furthering the knowledge on this subject.

Resumene El carcinoma de prostata puede manifestarse clinicamente o bien diagnosticarse por los sintomas que origina su extension locoregional o a distancia. El sistema linfatico es la primera estacion metastasica del cancer de prostata, afectandose en un elevado porcentaje de casos, incluso pudiendo simular en ocasiones procesos linfoproliferativos, siendo muy raro llegar al diagnostico por una macroafectacion linfatica como primer sintoma. En estos casos al diagnostico de confirmacion se puede llegar por medio del estudio histologico y fundamentalmente inmunohistoquimico mediante la determinacion del antigeno prostatico especifico de una adenopatia. El tratamiento, en estos tumores diseminados, sera paliativo mediante hormonoterapia. El pronostico es, en general, bastante malo con supervivencias muy bajas a los 5 anos.

Resumen Objetivos Evaluar la utilidad del test NMP-22 en el diagnostico del cancer vesical; calcular el punto ideal de corte; comparar los resultados con la citologia urinaria y cistoscopia. Material y metodo 166 pacientes con sospecha clinica o en seguimiento por cancer vesical. Se excluyen pacientes con otras enfermedades urologicas, radioterapia en los ultimos tres meses, quimioterapia sistemica en el ultimo mes, trauma reciente de vejiga y portadores de sonda vesical. Se recoge una muestra de orina recien emitida y se separa en dos alicuotas, una para citologia u otra para NMP-22; posteriormente se hace cistoscopia y RTU si se sospecha tumor vesical. Mediante curva ROC calculamos el valor ideal de corte para NMP-22. Para cada prueba calculamos sensibilidad, especificidad, valor predictivo positivo y negativo. Se comparan los resultados de las diferentes pruebas con el test de McNemar. Todos los resultados se dan con un intervalo de confianza del 95%. Resultados El punto ideal de corte fue 6 u/ml; con el se obtiene una sensibilidad del 82,72% frente al 67,90% de la citologia (p = 0,0118). la especificidad fue del 80% y 94,12% respectivamente (p = 0,0018). por grados la sensibilidad fue 72,22% en g1, 70,97% en g2 y 100% en g3 para el nmp-22 frente a 44,44%, 58,06% y 90,62% de la citologia. por estadios fue 68,42% ta, 83,83% t1 y 100% t2 o superior con nmp-22 frente a 36,84%, 75% y 85,71% de la citologia. la cistoscopia detecto el 100% de los tumores, su especificidad fue 89,41%. Conclusiones El NMP-22 es un test util en el diagnostico del cancer vesical; mas sensible y menos especifico que la citologia, a la que pensamos que puede reemplazar en el protocolo de diagnostico y seguimiento del cancer vesical. El punto ideal de corte se situa en 6 U/ml.

Resumen El carcinoma de conductos colectores de Bellini constituye una rara y agresiva variedad histologica de adenocarcinoma renal, cuyo origen parece asentar en el epitelio del tubulo colector, con unas caracteristicas histologicas, citogeneticas e inmunohistoquimicas bien establecidas que nos permiten independizar este tipo tumoral del resto de adenocarcinomas renales. En la literatura nacional existen unos 7 casos publicados; presentamos un nuevo caso, con la particularidad de mostrar una inusual forma de presentacion, debutando clinicamente sin sintomatologia urologica especifica y radiologicamente en forma de masa retroperitoneal que justifica las manifestaciones clinicas del paciente. Abstract Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patien’s clinical manifestations.

To report a clinical case of testicular rupture and review of the literature published.A 15 years old male with a testicular rupture after a sports injury was diagnosed by Doppler ultrasound.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.Testicular rupture is an uncommon but important entity that may occur. It is essential early diagnosis and e management to avoid orchiectomy.

We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.

Buccal mucosal graft can be used for succesfull repair in both pendulous and bulbar strictures.We present our experience with buccal mucosal graft repair in 8 patients with onlay patch that varies from 4 to 16 cm. in length. Three pendulous, two bulbar and three panurethral strictures were repaired. These patients were observed for 36 to 60 months.No stricture recurrences were observed. Only one patient had lower lip paresthesia for six months.

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

Objetivo: Presentar la asociación de seminoma en paciente afecto de SK y su relación con la fertilidad. Métodos: Se describe la presencia de un seminoma en paciente afecto de SK, haciendo hincapié en la posible correlación de ambas patologías con la fertilidad, así como se comentan citas bibliográficas de interés. Resultado: Paciente con tumor testicular y SK al que se realizó orquiectomía, resultando ser un seminoma en el estudio anatomopatológico. Se realizaron dos espermiogramas en los que se corroboró la azoospermia, siendo difícil de diferenciar la posible implicación de ambas patologías en relación con la ausencia de espermatozoides en el eyaculado. Conclusiones: Presentamos un caso de seminoma en paciente afecto de SK y azoopermia. Tras la orquiectomía la evolución es favorable, haciéndose breve referencia bibliográfica al SK y sus potenciales implicaciones en la fertilidad. La asociación de este síndrome con tumor testicular es excepcional en la bibliografía consultada. 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.

The authors report the case of a 75-year-old man presenting with prostatic syndrome. Ultrasound assessment revealed multiple bilateral solid renal lesions that were confirmed by computed tomography. It was decided to perform bilateral percutaneous biopsy of the masses. The histological diagnosis was that of oxyphilic adenoma with an oncocytic appearance compatible with oncocytoma. In view of the histology and the multiple lesions, none of which was larger than 5 cm, it was decided to perform watchful waiting which did not reveal any change in size with a follow-up of 4 years. Although renal oncocytoma is relatively frequent, only 19 cases of bilateral multiple renal oncocytomas have been published in the world literature. The authors present a new case and review the current state of this entity.

Prostate carcinoma is one of the most frecuent cancers in men. Significant numbers of patients have regional lymph node and bone metastases during the course of the disease. Mediastinal lymphadenopathy and cutaneous metastases are uncommon and signify well-advanced disease. We report the case of a patient with prostate cancer who develops mediastinal lymphadenopathy, pulmonary nodules and cutaneous metastases 8 years after the diagnosis.

El cáncer de próstata es uno de los tumores más frecuentes. Un número importante de pacientes presentarán adenopatías regionales y metástasis óseas en el curso de la enfermedad. Sin embargo, las adenopatías mediastínicas y las metástasis cutáneas son infrecuentes y significan enfermedad avanzada. Presentamos el caso de un paciente diagnosticado de cáncer de próstata que desarrolla adenopatías mediastínicas, nódulos pulmonares y metástasis cutáneas, 8 años después del diagnóstico.

The purpose of this study is to apply the in vitro keratinocyte culture techniques and the tissue engineering principles to human urothelium, to reconstruct an in vitro three-dimensional human bladder mucosa, suitable for grafting.Biopsy specimens of human bladder mucosa were obtained from patients undergoing suprapubic prostatectomy, in vitro cultured and finally, an immunohistochemical study was made.A three-dimensional in vitro tissue was obtained, composed of a bio-artificial submucosa (fibrin gel and fibroblast) where the uroepithelial cells were seeding. We used a biodegradable polyglycolic acid mesh to facilitate the tissue manipulation and implantation. An immature epithelium was obtained with a weak immunostaining to cytokeratins. The immunohistochemical study could not demonstrate the development of basement membrane.In vitro keratinocyte culture techniques could be applied to other epithelial tissues like the urothelium. We obtained a three-dimensional in vitro tissue suitable for grafting in a relatively short time, which needs the matrix interactions in order to mature.

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.The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others.Overall spermatozoid potency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results.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.

Objetivo: Aplicar las técnicas de cultivo in vitro de queratinocitos así como los principios de la ingeniería tisular al epitelio urinario humano, con el fin de reconstruir tridimensionalmente una mucosa vesical humana in vitro, apta para trasplantar. Material y Métodos: Se obtuvieron muestras de mucosa vesical de pacientes programados para cirugía abierta de próstata, previo consentimiento de los mismos, las cuales fueron cultivadas in vitro, para proceder posteriormente al estudio histomorfológico de los tejidos obtenidos. Resultados: Se obtuvo un tejido tridimensional compuesto por una submucosa bioartificial a base de un gel de fibrina y fibroblastos, sobre la que descansan las células uroepiteliales, pudiendo utilizar una malla de ácido poliglicólico, que facilite la manipulación de la mucosa y el posterior injerto de la misma. El tejido obtenido tenía el aspecto de un epitelio inmaduro con muy escasa reacción a citoqueratinas, sin poderse demostrar inmunohistoquímicamente el desarrollo de una membrana basal. Conclusiones: Las técnicas de cultivo in vitro de queratinocitos son aplicables a otros epitelios, entre ellos el urotelio humano. En un periodo de tiempo relativamente corto se puede obtener un tejido in vitro tridimensional apto para trasplantar, precisando posiblemente de las interacciones con el lecho receptor para poder madurar. Objetive: The purpose of this study is to apply the in vitro keratinocyte culture techniques and the tissue engineering principles to human urothelium, to reconstruct an in vitro three-dimensional human bladder mucosa, suitable for grafting. Material and Methods: Biopsy specimens of human bladder mucosa were obtained from patients undergoing suprapubic prostatectomy, in vitro cultured and finally, an immunohistochemical study was made. Results: A three-dimensional in vitro tissue was obtained, composed of a bio-artificial submucosa (fibrin gel and fibroblast) where the uroepithelial cells were seeding. We used a biodegradable polyglycolic acid mesh to facilitate the tissue manipulation and implantation. An immature epithelium was obtained with a weak immunostaining to cytokeratins. The immunohistochemical study could not demonstrate the development of basement membrane. Conclusions: In vitro keratinocyte culture techniques could be applied to other epithelial tissues like the urothelium. We obtained a three-dimensional in vitro tissue suitable for grafting in a relatively short time, which needs the matrix interactions in order to mature.

Resumen Objetivo Aplicar las tecnicas de cultivo in vitro de queratinocitos asi como los principios de la ingenieria tisular al epitelio urinario humano, con el fin de reconstruir tridimensionalmente una mucosa vesical humana in vitro, apta para trasplantar Material y Metodos Se obtuvieron muestras de mucosa vesical de pacientes programados para cirugia abierta de prostata, previo consentimiento de los mismos, las cuales fueron cultivadas in vitro, para proceder posteriormente al estudio histomorfologico de los tejidos obtenidos Resultados Se obtuvo un tejido tridimensional compuesto por una submucosa bioartificial a base de un gel de fibrina y fibroblastos, sobre la que descansan las celulas uroepiteliales, pudiendo utilizar una malla de acido poliglicolico, que facilite la manipulacion de la mucosa y el posterior injerto de la misma. El tejido obtenido tenia el aspecto de un epitelio inmaduro con muy escasa reaccion a citoqueratinas, sin poderse demostrar inmunohistoquimicamente el desarrollo de una membrana basal Conclusiones Las tecnicas de cultivo in vitro de queratinocitos son aplicables a otros epitelios, entre ellos el urotelio humano. En un periodo de tiempo relativamente corto se puede obtener un tejido in vitro tridimensional apto para trasplantar, precisando posiblemente de las interacciones con el lecho receptor para poder madurar

Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.

OBJETIVO: Desde agosto de1997 hasta diciembre de 2004 hemos realizado 47 vasovasostomías con la finalidad de revertir la vasectomía, de las que conocemos el resultado de 42, con un seguimiento de al menos 6 meses. La edad media ha sido de 40‘7 años y la de sus parejas de 30‘8 años. MÉTODO: Los 22 primeros casos se realizaron en 2 planos y 20 en solo uno. En todos los casos se utilizó microscopio óptico. RESULTADOS: La tasa global de presencia de espermatozoides en el eyaculado ha sido de 71‘42% y la de embarazo a término del 32‘45%, no encontrando diferencias según la técnica empleada. CONCLUSIONES: Mejor pronóstico a menor edad del paciente y en las recanalizaciones precoces, en cuanto a la presencia de espermatozoides. El índice de embarazos es similar entre las recanalizaciones precoces o tardías. 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 patency 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 patency rate. Regarding pregnancy rate, it is not influenced by delay of reversal.

Los quistes epidermoides intratesticulares son tumores raros, constituyendo el 1% de todos los tumores testiculares. Se trata de tumoraciones benignas que plantean un difícil diagnóstico diferencial preoperatorio frente a los tumores malignos testiculares. La ausencia de elevación de los marcadores tumorales y la apariencia ecográfica, pueden orientar hacia su diagnóstico preoperatorio y en este caso la cirugía conservadora del testículo. Se presenta el caso de un paciente de 22 años que consulta por una masa en el testículo izquierdo. En este caso, el diagnóstico ecográfico preoperatorio no descartaba otras patologías por lo que se procedió a la realización de orquiectomía inguinal izquierda. Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.

Los quistes epidermoides intratesticulares son tumores raros, constituyendo el 1% de todos los tumores testiculares. Se trata de tumoraciones benignas que plantean un difícil diagnóstico diferencial preoperatorio frente a los tumores malignos testiculares. La ausencia de elevación de los marcadores tumorales y la apariencia ecográfica, pueden orientar hacia su diagnóstico preoperatorio y en este caso la cirugía conservadora del testículo. Se presenta el caso de un paciente de 22 años que consulta por una masa en el testículo izquierdo. En este caso, el diagnóstico ecográfico preoperatorio no descartaba otras patologías por lo que se procedió a la realización de orquiectomía inguinal izquierda.

In the eighties a new field of the medicine appears wich applies the principles of cellular cultivation to synthetic biodegradable polymers scaffolds with the purpose of creating autologous biological substitutes that could improve, maintain or restore the function of organs or damaged tissues. The Tissue Engineering constitutes a new discipline in full phase of development especially in USA, with multiple potential applications in several medical specialities. Our speciality can't remain indifferent to interest and encouraging future originated by this new science. In this work we have made a wide bibliographical revision in the Medline to know the antecedents, current state and the possible future applications of Tissue Engineering in Urology.

A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome.1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have retrospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical complications and graft outcome.Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days- 17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of previous graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way, Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years.Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lumboiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from multiple kidney retransplants.

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

The purpose of this study is to apply the in vitro keratinocyte culture techniques and the tissue engineering principles to urothelium, to obtain a three-dimensional autologous tissue suitable for grafting. We also showed the viability of free graft cultured urothelium in an experimental model.An animal experimental model was designed to apply the techniques of cellular culture and tissue engineering. Biopsy specimens of bladder mucosa were obtained, in vitro cultured and posteriorly implanted in each animal. We established three groups based on different follow-up periods (7, 14 and 30 days), and made a final histomorphological study to demonstrate the viability of the graft at the end of its respective follow-up period.A three-dimensional in vitro tissue was obtained, composed of a bio-artificial submucosa (fibrin gel and fibroblast) where the uroepithelial cells were seeding; a biodegradable polyglycolic acid mesh was used to facilitate the tissue manipulation and implantation. In the morphological study all the implants appeared viable, but the grafts with longer implantations periods were better conformed, showing a tisular structure with multiple cellular layers.In vitro keratinocyte culture techniques could be applied to other epithelial tissues as the urothelium. We obtained a three-dimensional in vitro tissue suitable for grafting in a relatively short time. The histological study demonstrated that free autologous urothelial graft is totally viable, opening future clinics applications.

OBJETIVO: Desde agosto de1997 hasta diciembre de 2004 hemos realizado 47 vasovasostomías con la finalidad de revertir la vasectomía, de las que conocemos el resultado de 42, con un seguimiento de al menos 6 meses. La edad media ha sido de 40‘7 años y la de sus parejas de 30‘8 años. MÉTODO: Los 22 primeros casos se realizaron en 2 planos y 20 en solo uno. En todos los casos se utilizó microscopio óptico. RESULTADOS: La tasa global de presencia de espermatozoides en el eyaculado ha sido de 71‘42% y la de embarazo a término del 32‘45%, no encontrando diferencias según la técnica empleada. CONCLUSIONES: Mejor pronóstico a menor edad del paciente y en las recanalizaciones precoces, en cuanto a la presencia de espermatozoides. El índice de embarazos es similar entre las recanalizaciones precoces o tardías.

OBJETIVO: Analizar los aspectos quirúrgicos y las complicaciones derivadas de la reutilización de la fosa ilíaca para realizar terceros y cuartos retrasplantes renales. MÉTODO: Estudio retrospectivo de los 34 terceros y 5 cuartos retrasplante renales de nuestra serie de 1364 trasplantes. Se analizan las características de los pacientes, aspectos y complicaciones quirúrgicas y la evolución de los injertos. RESULTADOS: La edad media fue de 41.6 años. El 67% de los primeros y segundos trasplantes se habían perdido por problemas vasculares (19%) o por rechazo crónico (48%). El tiempo medio desde el último trasplante en la fosa ilíaca reutilizada fue de 9 años (3 días - 17 años). No hubo diferencias significativas entre el grupo de primer y segundo trasplante respecto del tercero y cuarto en cuanto al tiempo de isquemia fría, incompatibilidades y días de hemodiálisis post-trasplante; fueron significativas la edad del receptor, número de trasfusiones, anticuerpos máximos y actuales y edad del donante, todos ellos mayores en los terceros y cuartos. El injerto se colocó fundamentalmente en la fosa ilíaca derecha (71%) a través de un incisión lumboilíaca iterativa; la anastomosis vascular se hizo por igual a los ilíacos externos y comunes; el reimplante ureteral se hizo mediante técnicas extravesicales; en un 33% de los casos se realizó trasplantectomía simultánea del injerto anterior. En el 59% de los casos hubo diuresis inmediata y el 49% no precisó diálisis en los 7 primeros días post-trasplante. Las complicaciones quirúrgicas fueron fundamentalmente vasculares; hubo 4 casos de hemorragia, 3 trombosis venosas y 2 arteriales. También tuvimos 4 casos de linfocele, 1 hematoma perirenal y 1 fístula enterocutánea con absceso del lecho quirúrgico; no hubo en esta serie ninguna complicación urológica. En total hubo 1 fallecimiento (2.5%) debido a hemorragia y se perdieron otros 6 injertos (15%) por las complicaciones, 5 por trombosis vasculares y otro por absceso del lecho quirúrgico. La supervivencia actuarial de los injertos fue del 65% al año, 52% a los 3, 40% a los 5 y 28% a los 10 años. CONCLUSIONES: La reutilización de la fosa ilíaca para realizar terceros y cuartos trasplantes conlleva un ligero aumento en las complicaciones quirúrgicas, especialmente vaculares. 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.

SURGICAL ASPECTS IN THE THIRD AND FOURTH KIDNEY RETRANSPLANT Introduction and objectives: A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome. Material and method: 1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have ret- rospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical com- plications and graft outcome. Results: Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days-17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of pre- vious graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way. Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years. Conclusions: Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lum- boiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from mul- tiple kidney retransplants.

OBJETIVO: Con el presente trabajo pretendimos aplicar las técnicas de cultivo in vitro de queratinocitos así como los principios de la ingeniería tisular al epitelio urinario, con el fin de conseguir un tejido autólogo tridimensional apto para trasplantar, y confirmar a su vez la viabilidad del injerto libre del mismo en un modelo experimental. MATERIAL Y MÉTODOS: Se procedió a un diseño experimental en el animal de laboratorio donde se aplicaron las técnicas del cultivo celular y de la ingeniería de tejidos. Se obtuvieron muestras de mucosa vesical de conejo, las cuales fueron cultivadas in vitro, implantándose posteriormente el tejido obtenido en cada animal, estableciéndose 3 grupos, con diferentes periodos de seguimiento (7,14 y 30 días), para proceder al estudio histomorfológico de la viabilidad de dichos implantes. RESULTADOS: Se obtuvo un tejido tridimensional compuesto por una submucosa bioartificial a base de un gel de fibrina y fibroblastos, sobre la que descansan las células uroepiteliales, utilizando una malla de ácido poliglicólico, la cual facilitó la manipulación del tejido y el posterior injerto del mismo. Todos los implantes resultaron viables y se pudo comprobar como los injertos con mayor periodo de seguimiento (30 días) se encontraban mejor conformados, con múltiples capas celulares. CONCLUSIONES: Las técnicas de cultivo in vitro de queratinocitos son aplicables a otros epitelios, entre ellos el urinario. En un periodo de tiempo relativamente corto se puede obtener un tejido in vitro tridimensional apto para trasplantar. El estudio histológico puso de manifiesto que el injerto libre de epitelio urinario autólogo cultivado es totalmente viable, apuntando futuras aplicaciones clínicas.

To analyse our results about continence in the treatment of female urinary incontinence with the tension-free vaginal tape (TVT) procedure based on abdominal leak point pressure(ALPP).Retrospective study of the fifty two patients who had urodynamic study and abdominal leak point pressure determination and were operated on between 1999 and 2002 for stress urinary incontinence. We reviewed the data of clinical history, physical examination and urodynamic report, surgery, complications, and objective and subjective results. Those patients having ALPP100 are included in group 1, between 61 and 100 in group 2 and less than 60 in group 3.There were 19 patients in group 1, 17 in group 2 and 16 in group 3. We found no difference between the three groups regarding age, delivery, menopause, hysterectomy, evolution, previous surgery, grade of cystocele, association of anterior colporraphy to TVT and type of anaesthesia. The Obrink clinical grade increased as the ALPP decreased (grade 3 in 26.32% of group 1, 31.58% in group 2 and 68.71% in group 3). 100% of patients in groups 1 and 2 were continent with effort and 93.75% in group 3. Complications, especially de novo instability or urgency-frequency episodes or persistence of instability in patients having mixed incontinence, caused a decrease in the satisfaction degree to 79% in group 1, 76.5% in 2 and 62.5% in 3.Abdominal leak point pressure determination does not change our decision of perform a TVT procedure but permits us to differentiate one group in which results could be worse.

To evaluate diagnostic techniques, treatment and follow-up in 94 patients affected of upper urinary tract tumor.From 1978 to december 2002 we operated 105 patients due to upper urinary tract tumor, although only 94 are valid for analysis. Mean age was 65 years and 85% were man. Haematuria was the most frequent symptom.Urography (93%), ecography (77%) and CT (67%) were the most used diagnostic techniques. Pelvic tumor was the most frequent (71%) and total nephroureterectomy including bladder cuff the chosen treatment (76.4%). Previous or simultaneous bladder tumor was observed in 23% cases and delayed in 30%. With a mean follow-up of 76 months the patient survival is 53%.Due to the high frequence of previous, simultaneous or delayed bladder tumors, the upper urinary tract tumor should be considered as a panurothelial disease, worsening the outcome of this kind of tumors.