Resumen Objetivo: Describir el uso de clips de polímero (Hem-o-lok®) para el control vascular renal en nefrectomía simple de donador laparoscópica (NSL) Materiales y Métodos: Realizamos un análisis retrospectivo y descriptivo de las nefrectomías de donador mínimamente invasivas (mano-asistidas y laparoscópicas puras) realizadas entre 2008 y 2020. Se incluyeron pacientes sometidos a NSL en las cuales se utilizaron clips de polímero (Hem-o-lok®) para el control vascular del hilio renal. Resultados: Se realizaron 330 NSL, 183 (55%) fueron mano asistidas y el resto laparoscópicas puras. Se obtuvo un tiempo de isquemia caliente promedio de 3.98 minutos, una pérdida de sangre promedio de 100±140 ml. Cuatro pacientes (1.2%) ameritaron conversión a cirugía abierta debido a lesión vascular. Se registraron 31 (9.3%) complicaciones postoperatorias de las cuales 23 (6.9%) fueron complicaciones menores. No se reportaron muertes ni pérdidas del injerto. Limitantes del estudio: Las principales limitantes del estudio son que se trata de un estudio retrospectivo de un solo centro. Originalidad o valor: Se trata un estudio que cuestiona la contraindicación emitida por la FDA para el uso de clips de polímeros para el control vascular en NSL, al mostrar ser una opción segura y efectiva. Conclusiones: El uso de clips de polímero, específicamente Hem-o-lok®, es un método seguro para el control vascular del hilio renal en nefrectomías laparoscópicas de donador.

Abstract Objective: To describe our experience using polymer clips (Hem-o-lok®) for renal vessel control in laparoscopic living donor nephrectomy (LLDN). Materials and methods: We conducted a retrospective and descriptive analysis from our database of all minimally invasive living donor nephrectomies (hand-assisted and pure laparoscopic) performed from 2008 to 2020 in our institution. We included patients who underwent LLDN using polymer clips (Hem-o-lok®) for vascular control of renal arteries and veins, and whose clinical records were complete. Results: 330 LLDN were performed, 183 (55.5%) were hand-assisted nephrectomies and 147 (44.5%) were pure laparoscopic nephrectomies. Mean warm ischemia time (WIT) was 3.98 minutes and median of estimated blood loss (EBL) was 100±140 ml. Four patients (1.2%) required conversion to an open procedure due to vascular injury. 31 complications (9.3%) were registered, of which 23 (6.9%) were non-life-threatening complications. No deaths nor loss of renal grafts were reported. Limitations: the main drawbacks of this study are its retrospective nature, and that it is limited to only one center. Originality and value: It is a study that questions the contraindication issued by the FDA for the use of polymer clips for vascular control in LLDN, demonstrating its use is a safe and effective option. Conclusion: The use of polymer clips, specifically Hem-o-lok®, is a safe method for vascular control of the renal hilum vessels in laparoscopic living donor nephrectomies.

Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

Abstract OBJECTIVE: To compare the medium-term results between open pyeloplasty and laparoscopic pyeloplasty in patients with primary or secondary ureteropelvic junction obstruction. MATERIALS AND METHODS: A descriptive, observational, longitudinal, retrospective study was conducted on adult patients that underwent open pyeloplasty or laparoscopic pyeloplasty due to ureteropelvic junction obstruction, within the time frame of January 2007 and March 2017. The variables of surgical success (complete symptom cessation and kidney function improvement) and postoperative complications determined through the Clavien-Dindo classification were analyzed. The qualitative variables were compared using the ꭓ2 test and the independent variables with abnormal distribution were compared using the Mann-Whitney U test. Statistical significance was set at a p <0.05. RESULTS: Forty patients were registered. Their mean age was 39 years and they had a mean follow-up of 38 months (1-180). The patients that underwent the laparoscopic approach had a shorter hospital stay (3.6 ± 1.4 days vs 6.9 ± 2.1 days; p = 0.001). The laparoscopic pyeloplasty success rate was 92% in patients with no prior treatment and 100% in previously treated patients. Low-grade complications (Clavien-Dindo I and II) presented in 40% of the open surgery patients and in 44% of the patients in the laparoscopic group. CONCLUSIONS: Laparoscopic pyeloplasty and open pyeloplasty had similar success rates and outcomes and can be considered safe therapeutic options for the treatment of ureteropelvic junction obstruction.

Resumen OBJETIVO: Comparar los resultados a mediano plazo entre la pieloplastia abierta versus laparoscópica en pacientes con obstrucción de la unión ureteropiélica primaria o secundaria. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo, observacional y longitudinal, efectuado en pacientes adultos tratados con pieloplastia abierta o laparoscópica por obstrucción de la unión ureteropiélica, entre enero de 2007 y marzo de 2017. Se analizaron las variables de éxito quirúrgico (cese completo de los síntomas y mejoría de la función renal) y complicaciones posoperatorias con la clasificación de Clavien-Dindo. Se utilizó la prueba de ꭓ2 para comparar las variables cualitativas y la U de Mann-Whitney para las variables independientes con distribución anormal. Se consideró estadísticamente significativo el valor de p <0.05. RESULTADOS: Se registraron 40 pacientes con edad promedio de 39 años y seguimiento de 38 meses (1-180). Los pacientes con pieloplastia laparoscópica tuvieron menor estancia hospitalaria (3.6 ± 1.4 vs 6.9 ± 2.1 días; p = 0.001). La tasa de éxito de pieloplastias laparoscópicas fue de 92% en pacientes sin tratamiento previo y de 100% en tratados previamente. Solo se reportaron complicaciones de bajo grado (Clavien-Dindo I y II) en 40% de los casos con pieloplastia abierta y en 44% con laparoscopia. CONCLUSIONES: La pieloplastia abierta y laparoscópica muestran tasas de éxito y resultados similares; por tanto, pueden considerarse técnicas seguras para el tratamiento de la obstrucción ureteropiélica.