Jose E Robles
@cun.es
Associate Professor & Consultant / Urology Department
Clinica Universidad de Navarra
EDUCATION
MD, PhD, FEBU, FECSM
RESEARCH, TEACHING, or OTHER INTERESTS
Urology
Scopus Publications
Scopus Publications
P. Doménech López, Carmina Muñoz Bastidas, J. Colombás Vives, C. Gutiérrez Castañé, S. Chiva San Román, F. J. Ancizu Marckert and Jose Enrique Robles García
Baskent University
OBJECTIVES
With the increase in life expectancy and the aging of the population, chronic kidney disease has become increasingly prevalent in our environment. Kidney transplantation remains the gold standard treatment for end-stage renal disease, but the supply of renal grafts has not been able to keep pace with growing demand. Because of this rationale, organ selection criteria have been extended (expanded criteria donation), and alternative donation types, such as donation after circulatory death, have been evaluated. These approaches aim to increase the pool of potential donors, albeit with organs of potentially lower quality. Various forms of donations, including donation after circulatory death, have also undergone assessment. This approach aims to augment the pool of potential donors, notwithstanding the compromised quality of organs associated with such methods. Diverse strategies have been explored to enhance graft function, with one of the most promising being the utilization of pulsatile machine perfusion.
MATERIALS AND METHODS
We conducted a retrospective analysis on 28 transplant recipients who met the inclusion criterion of sharing the same donor, wherein one organ was preserved by cold storage and the other by pulsatile machine perfusion. We performed statistical analysis on posttransplant recovery parameters throughout the patients' hospitalization, including admission and discharge phases.
RESULTS
Statistically significant differences were noted in delayed graft function (P = .04), blood transfusions requirements, and Clavien-Dindo complications. Furthermore, an overall trend of improvement in discharge parameters and hospital stay was in favor of the pulsatile machine perfusion group.
CONCLUSIONS
The use of pulsatile machine perfusion as a method of renal preservation results in graft optimization, leading to earlier recovery and fewer complications compared with cold storage in the context of donation after circulatory death.
Joseba SALGUERO, Laura CHAMORRO, Enrique GÓMEZ-GÓMEZ, José E. ROBLES, and Juan P. CAMPOS
Edizioni Minerva Medica
BACKGROUND
A shortage of kidney grafts has led to the implementation of various strategies, including donations after circulatory death. The in situ normothermic regional perfusion technique has been introduced to improve graft quality by reducing warm ischemia times. However, there is limited evidence available on its mid- and long-term outcomes. Therefore, this study aimed to compare the incidence of delayed graft function, graft function, and survival at three years among three groups: brain death donors, rapid recovery, and normothermic regional perfusion.
METHODS
A retrospective analysis of a cohort of kidney transplantations was conducted at a single referral center between January 1, 2015, and December 31, 2019. Univariate and multivariate regression models and propensity score matching analysis were performed to compare recipient-related, transplantation procedure-related, donor-related, and kidney function variables.
RESULTS
A total of 327 patients were included, with 256 kidneys from brain death donors, 52 kidneys from rapid recovery, and 19 patients from normothermic regional perfusion. After propensity score matching, univariate and multivariate analyses showed a higher incidence of delayed graft function in the rapid recovery group compared to the others (OR: 2.39 CI95%: 1.19, 4.77) with a longer hospital stay (median 11, 15 and 10 days, respectively). However, no differences in 1- and 3-year graft function and survival were found.
CONCLUSIONS
Normothermic regional perfusion offers advantages over rapid recovery, with a reduced incidence of delayed graft function and a shorter hospital stay. However, no differences in mid-term graft function and survival were found.
Joseba Salguero, Laura Chamorro, Enrique Gómez-Gómez, Patricia de Benito, Jose E. Robles, and Juan P. Campos
MDPI AG
Background: Delayed graft function (DGF) is a significant challenge in renal transplantation, particularly with deceased donors, necessitating early postoperative dialysis. The prolonged effects of medium- and long-term DGF remain uncertain, marked by contradictory graft survival outcomes. This incongruity might arise from the inherent graft resilience and regenerative capacity during transplantation. This study investigates DGF’s impact on graft survival, focusing on grafts displaying favorable (KDRI < 1) and unfavorable outcomes (KDRI ≥ 1). Methods: In this retrospective cohort study (January 2015–December 2019), we assessed kidney transplants at our center, excluding multiorgan simultaneous cases, primary non-functioning grafts, and surgical complications causing graft loss. Patients were categorized into DGF presence or absence groups. Univariate and multivariate analyses, alongside propensity score matching (PSM), were performed. Results: The study encompassed 322 deceased donor kidneys, with 83 encountering DGF. Grafts with higher KDRI indices (KDRI ≥ 1) and DGF exhibited a notably increased graft loss risk (HR: 4.17, 95% CI: 1.93–9.01). However, lower-KDRI donor grafts displayed no significant disparities between the DGF and non-DGF groups. Conclusions: Delayed graft function (DGF) development significantly contributes to graft loss in kidney transplants, particularly in grafts with KDRI ≥ 1.
Joseba Salguero, Laura Chamorro, Enrique Gomez-Gomez, Jose Enrique Robles, and Juan Pablo Campos
Baskent University
OBJECTIVES
Kidney transplant is the optimal treatment for end-stage renal disease; however, due to the imbalance between demand and supply, several strategies have been implemented to increase the donor pool. To increase the number of donors, expanded criteria donors after circulatory death have been explored as an acceptable graft source. In this study, we compared graft survival, estimated glomerular filtration rate at 3 and 5 years, and the incidence of delayed graft function between standard and expanded criteria donors after brain death and between standard and expanded criteria donors after circulatory death.
MATERIALS AND METHODS
A prospective cohort study was conducted between January 1, 2015, and December 31, 2019, at Reina Sofia University Hospital. Variables related to the donor, recipient, and transplant procedure were analyzed, and univariate and multivariate logistic and Cox regression analyses were performed.
RESULTS
Our study included 308 deceased donor kidneys. The kidneys from standard criteria brain dead donors had higher estimated glomerular filtration rate than the other groups (P < .03).However, no significant differences in estimated glomerular filtration rate were observed among the suboptimal groups (expanded criteria and standard criteria donors after brain death and expanded criteria donors after circulatory death). The incidence of delayed graft function was significantly higher in expanded criteria donors after circulatory death than in the other groups (odds ratio = 6.9; 95% CI, 2.22-21.71; P < .001). Nevertheless, we found no significant differences in death-censored graft loss among the groups.
CONCLUSIONS
Kidney transplants from expanded criteria donors and donors after cardiac death are comparable, even when both criteria are combined. The use of expanded criteria donor kidneys after cardiac death is therefore a suitable approach to expand the donor pool, despite the higher risk of delayed graft function, as there were no significant differences in death-censored graft loss.
Á. García Cortés, J. Colombás Vives, C. Gutiérrez Castañé, S. Chiva San Román, P. Doménech López, F.J. Ancizu Marckert, M. Hevia Suárez, I. Merino Narro, J.M. Velis Campillo, F. Guillén Grima,et al.
Elsevier BV
Ángel García Cortés, Juan Colombás Vives, Cristina Gutiérrez Castañé, Santiago Chiva San Román, Pablo Doménech López, Francisco J. Ancizu Marckert, Mateo Hevia Suárez, Imanol Merino Narro, José M. Velis Campillo, Francisco Guillén Grima,et al.
Wiley
AbstractAimsTo identify the definition for urinary continence (UC) after radical prostatectomy (RP) which reflects best patients' perception of quality of life (QoL).MethodsContinence was prospectively assessed in 634 patients, 12 months after RP using the International Consultation on Incontinence Questionnaire Short‐Form (ICIQ‐SF) and the number of pads employed in a 24‐hour period (pad usage). We used the one‐way ANOVA technique with posthoc pairwise comparisons according to Scheffé's method (homogeneous subsets) for assessing the degree of QoL deficit related to urinary incontinence (UI).ResultsThe continence prevalence is 64.4%, 74.1%, 88.3%, and 35.8% using “0 pads,” “1 safety pad,” “1 pad,” and “ICIQ score 0” definitions, respectively. Pad usage is moderately strongly associated with ICIQ 1, 2, and 3 (ρ = 0.744, 0.677, and 0.711, respectively; p < 0.001). Concordance between classical UC definitions is acceptable between “0 pads—ICIQ score 0” (K = 0.466), but poor for “1 safety pad” and “1 pad” (K = 0.326 and 0.137, respectively). Patients with “0 pad usage” have better QoL related to urine leakage than patients with “1 safety pad” or “1 pad” (1.41 vs. 2.44 and 3.11, respectively; p < 0.05). There were no significant differences found regarding QoL between patients with ICIQ score 0 and ICIQ score 2 (1.01 vs. 1.63; p = 0.63).ConclusionsPad usage and the ICIQ‐SF's answers provide useful information. We propose a combined definition (0 pads and ICIQ score ≤2) as it is the definition with the least impact on daily QoL.
Antonio Tienza, Petra L. Graham, Jose E. Robles, Fernando Diez-Caballero, David Rosell, Juan I. Pascual, Manish I. Patel, and Sean F. Mungovan
Korean Continence Society
Purpose: Continence assessment is an essential component of follow-up after radical prostatectomy (RP). Several methods exist to assess the severity of urinary incontinence (UI). Our study examined the relationship and degree of agreement between International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and the number of pads used in a 24-hour period in the assessment of UI following RP.Methods: Continence was prospectively assessed in 746 men from a Spanish urology clinic 12 months after RP using the ICIQ-SF and pad usage. The relationship between ICIQ-SF scores and pad usage was assessed using Spearman rank correlation coefficients. The Jonckheere-Terpstra trend test was used to determine whether the ICIQ-SF score and the component question scores increased with increasing pad usage. The Bonferroni-corrected pairwise Wilcoxon rank-sum test was used to determine which pairs of pad usage levels differed. The weighted kappa was used to evaluate the agreement between pad usage levels and ICIQ-SF questions.Results: The continence rate was 82% using the “no pad usage” definition of continence versus 78% using the definition of an ICIQ-SF score of 0 (P<0.001). Strong positive correlations were observed between the number of pads and the ICIQ-SF total and component question scores (r<sub>s</sub>>0.85, P<0.001). The ICIQ-SF total and component question scores increased significantly with increasing pad usage (P<0.001). The ICIQ-SF scores (P<0.018) for all pairs of pad usage levels (0, 1, 2, or 3 or more) differed significantly. The agreement between the ICIQ-SF leakage amount question and pad usage was very good (r<sub>s</sub>=0.861, P<0.001).Conclusions: At 12 months post-RP, 24-hour pad usage was closely correlated with ICIQ-SF, although the continence rate differed depending on the definition used. Higher levels of pad usage were associated with higher questionnaire scores, more leakage, and poor quality of life (interference with everyday life).
M. Hevia, J.E. Robles, S. Chiva, P. Doménech, A. García, F.J. Ancizu, J.M. Velis, D. Rosell, F. Diez-Caballero, F. Guillén,et al.
Elsevier BV
P. Doménech López, J.E. Robles García, C. Gutiérrez Castañé, S. Chiva San Román, A. García Cortés, F.J. Ancizu Marckert, L.E. Tamariz Amador, G. Andrés Boville, F. Villacampa Aubá, F.R. de Fata Chillón,et al.
Elsevier BV
Antonio Tienza, Jose E. Robles, Mateo Hevia, Ruben Algarra, Fernando Diez-Caballero, and Juan I. Pascual
Informa UK Limited
Abstract Aims: To assess prevalence of urinary incontinence (UI) after radical prostatectomy (RP) and to analyze which preoperative characteristics of the patients have influence on UI. Methods: Between 2002 and 2012, 746 consecutive patients underwent RP for clinically localized prostate cancer. We defined UI according to International Continence Society (ICS) definition: “the complaint of any involuntary leakage of urine” after 12 months of recovery, international consultation on incontinence questionnaire (ICIQ-SF) and pads/day was collected too. Clinical features and magnetic resonance imaging measurements were assessed. A multivariable logistic regression model predicting incontinence were built-in after adjust by cofounding factors and bootstrapping. Results: About 172 (23%) of the patients were classified as incontinent according to the ICS definition. The mean value of the ICIQ-SF was 10.87 (±4). 17.8% of patients use at least one pad/day, 11.9% use more than one pad/day. The preoperative factors independently influential in UI are: age [OR: 1.055; CI 95% (1.006–1.107), p = .028], urethral wall thickness [OR: 5.03; CI 95% (1.11–22.8), p = .036], history of transurethral resection of the prostate [OR: 6.13; CI 95% (1.86–20.18), p = .003] and membranous urethral length [OR: 0.173; CI 95% (0.046–0.64), p = .009]. The predictive accuracy of the model is 78.7% and the area under the curve (AUC) value 71.7%. Conclusions: Urinary incontinence after radical prostatectomy has different prevalence depending on the definition. Age, prior transurethral resection of the prostate (TURP), membranous urethral length (MUL) and urethral wall thickness (UWT) were risk factors.
J.M. Velis, F.J. Ancizu, M. Hevia, I. Merino, A. García, P. Doménech, R. Algarra, A. Tienza, J.I. Pascual, and J.E. Robles.
Elsevier BV
M. Hevia, Á. García, F.J. Ancizu, I. Merino, J.M. Velis, A. Tienza, R. Algarra, P. Doménech, F. Diez-Caballero, D. Rosell,et al.
Elsevier BV
Antonio Tienza, Mateo Hevia, Alberto Benito, Juan I. Pascual, Juan Javier Zudaire, and Jose Enrique Robles
Springer Science and Business Media LLC
R. Algarra, J. Barba, I. Merino, A. Tienza, E. Tolosa, J.E. Robles, and J. Zudaire
Elsevier BV
Ruben Algarra, Mateo Hevia, Antonio Tienza, Imanol Merino, Jose Maria Velis, Javier Zudaire, Jose Enrique Robles, and Ignacio Pascual
Canadian Urological Association Journal
Introduction: We evaluate the prognosis of patients with biochemical recurrence (BCR) treated with androgen deprivation therapy (ADT) and to determine the influential factors to castration resistance (CR) and death.Methods: From a series of 1310 patients with T1-T2 prostate cancer treated with radical prostatectomy between 1989 and 2012, 371 had BCR. Patients with lymph node involvement were excluded. We analyzed only the 159 treated with salvage ADT. At the end of the study, 77 (48%) had developed CR.Results: The median follow-up to CR was 9.2 years. The CR-resistant-free survival (RFS) was 76 ± 3%, 62 ± 3% and 43 ± 9% in 5, 10 and 15 years, respectively. The RFS median time was 14 years. In the multivariate study, the prostate-specific antigen (PSA) doubling time (PSA-DT) was <6 months (p = 0.01) (hazard ratio [HR] 3;95% confidence interval [CI] 1.4-6.8, p = 0.007); seminal vesicle involvement (HR 3.1; 95% CI 1.5-6.2, p = 0.01) and PSA velocity in ng/mL/year (HR 1.3; 95% CI 1.1-1.5, p = 0.002) with better cut-off points of 0.84 ng/mL/year (p = 0.04) (HR 4; 95% CI 1.7-9.4, p = 0.001) were influential variables. Specific survival (SS) at 5, 10 and 15 years since surgery was 96 ± 1, 85 ± 2 and 76 ± 4, respectively. The time of CR to death was 30 ± 6% at 5 years, with the median at 3.2 years. In the multivariate only Ki 67 (HR1.04; 95% CI 1.005-1.08, p = 0.02) had an independent influence.Conclusions: In BCR patients treated with ADT, the median to CR was 14 years. PSA-DT <6 months, PSA velocity (ng/mL/year) and seminal vesicle involvement were influential variables. From the CR, the median time to death was 3.2 years. Ki-67 marker was an independent influence.
Antonio Tienza, Mateo Hevia, Imanol Merino, Jose Maria Velis, Ruben Algarra, Juan Ignacio Pascual, Juan Javier Zudaire, and Jose Enrique Robles
Canadian Urological Association Journal
Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.
R. Algarra, A. Tienza, M. Hevia, J. Zudaire, D. Rosell, J.E. Robles, and I. Pascual
Elsevier BV
M.C. Rodríguez-Díez, N. Díez, I. Merino, J.M. Velis, A. Tienza, and J.E. Robles-García
Elsevier BV
Javier Barba, Juan Javier Zudaire, José Enrique Robles, David Rosell, José María Berian, and Ignacio Pascual
Springer Science and Business Media LLC
R. Algarra, J. Zudaire, D. Rosell, J.E. Robles, J.M. Berián, and I. Pascual
Elsevier BV