Clinical-pathological differences and smoking habit depending on gender in a cohort of patients with transitional cell carcinoma of the bladder: retrospective study.

OBJECTIVES: The increased incidence of transitional cell carcinoma (TCC) of the bladder in men is known, generally attributed to greater exposure to the effect carcinogenic products. Although it has been reported that cancer-specific outcome can be particularly adverse in women due to socioeconomic or biological factors, clinical-pathological differences of TCC at the time of diagnosis have not been sufficiently studied. The aim of this study is to analyze whether there are gender-related differences in grade and tumor stage in primary bladder TCC. METHODS: All consecutive primary bladder TCC diagnoses made in our institution between 1990 and 2009 have been included. We retrospectively analyzed age, smoking, symptoms at presentation, tumor grade (WHO 1973), tumor size and number, and TNM stage, comparing men and women. Statistical analysis was conducted using the Mann-Whitney U test as non-parametric test and Chi-squared test to compare frequencies. RESULTS: We analyzed 1196 patients (992 males and 204 females) with a 5:1 ratio. We found significant differences in age (69 years vs. 73 years), smoking (46.5% vs. 11.2%)and muscle-invasive stage (12.1% vs. 18.1%). Correcting by tobacco consumption, never-smoker women have larger and more aggressive tumors with a frequency of muscle-invasive disease three times higher than male never-smokers and equaling to male current-smokers. CONCLUSION: TCC of the bladder is more frequent in males than females. In this series, women are older at the time of diagnosis and most often affected by muscle-invasive disease particularly in never-smokers. We need studies to analyze the potential impact of passive smoking to justify these results.

Renal cell carcinoma with syncytial giant cell component.

We report a case of clear cell renal cell carcinoma in which a prominent multinucleated giant cell component was intermingled with clear, granular, and spindle cells. Histological, ultrastructural, cytometric, and cytogenetic features of giant cells were similar to those of mononucleated cells in the tumor, and therefore they were not from stromal or osteoclast derivation. These giant cells had homogeneous, finely granular, abundant cytoplasm, often with scalloped cell borders, and contained from 5 to more than 50 nuclei, all of them very similar in size and shape, with prominent central nucleoli. Occasionally, surrounding inflammatory cells were also engulfed in the cytoplasm. This syncytial appearance was more similar to that of some giant cell carcinomas from the lung than to the pleomorphic giant cells often encountered in high grade renal cell tumors. Although the patient is alive and free of disease 6 years after diagnosis, a longer follow-up will be required to assess the potential prognostic influence of this peculiar histological appearance.

Effect of antibiotic treatment on serum PSA and percent free PSA levels in patients with biochemical criteria for prostate biopsy and previous lower urinary tract infections.

BACKGROUND: Controversy exists as to the influence of inflammatory foci on total and free prostate-specific antigen (PSA) concentrations. The objective was to analyze the biological variations of PSA and percent free PSA (%f-PSA) in patients with biochemical criteria for prostate biopsy (PSA higher than 4 ng/mL and normal rectal examination) and compare them with the variation induced by antibiotic treatment in a cohort of patients with a history of lower urinary tract infections and no clinical evidence of prostatitis. METHODS: Ninety patients with a history of lower urinary tract infections, non-suspicious digital rectal examination and PSA between 4 and 20 ng/mL were analyzed. PSA concentration and %f-PSA were determined. Forty-five patients were treated with three weeks of ofloxacin, following which marker determination was repeated. All patients underwent ultrasound-controlled transrectal six-core prostate biopsy. RESULTS: Sixty-seven patients presented benign prostatic hyperplasia (BPH) (30 with prostatitic foci) and 23 cancer. Significant variations in PSA (6.97 ng/mL vs. 5.82 ng/mL, p=0.001) and %f-PSA (14.84% vs. 17.53%, p=0.01) were found only in the treated patients. These differences were significant for patients with BPH-associated prostatitic foci and not for patients with BPH or cancer. The tendency was for PSA to decrease (15 treated patients with PSA <4 ng/mL vs. six non-treated patients) and for %f-PSA to increase. The median variation of %f-PSA was greater than that of PSA. When the cutoff for %f-PSA was set at 25%, 18.9% of unnecessary biopsies after the first determination and 20% after the second could be avoided. By associating the reduction in PSA, up to 46% could be avoided in treated patients. CONCLUSION: Biochemical criteria for prostate biopsy may be modified in patients with a history of lower urinary tract infections due to variations greater than those explained by intraindividual biological variations, and may be influenced by the antibiotic treatment. These results suggest that subclinical inflammatory foci may influence PSA and %f-PSA.

[Disappearance of migraine crises in two patients with male infertility treated with human chorionic gonadotropin/human menopausal gonadotrophin]. / Desaparición de crisis migrañosas en dos pacientes tratados con hCG/hMG por infertilidad masculina.

Two patients aged 52 and 31 respectively, treated for male infertility with gonadotrophins (LCG/LMG), showed marked improvement of their migraine crises associated with a typical aura which had been present since puberty. Changes in the number, motility and morphology of the spermatozoids were seen in the seminogram. The plasma concentrations of FSH, LH, testosterone an 17-beta oestrodiol were within normal limits. After three months of empirical treatment with LCG/ LMG (to stimulate spermatogenesis) the migraine crises ceased and the patients are still free of migraine after 32 and 26 months respectively. The relationship between migraine and the sex hormones is discussed, in the context of current knowledge of the psysiopathology of migraine and the beneficial effects obtained after treatment with LCG/LMG. We have not found any reference in the literature to the use of gonadotrophins in the treatment of migraine with a typical aura.

[Percutaneous drainage of renal and perirenal abscesses]. / Drenaje percutáneo de los abscesos renales y perinefríticos.

The prevalence of renal and perinephritic abscesses has radically changed over the last few decades basically due to two causes: the efficacy of antibiotics and early diagnosis by echography and/or CAT. Between January 1986 and December 1990, 12 cases of renal abscesses have been diagnoses in our Unit which have been treated conservatively through therapy with antibiotics and lumbar percutaneous drainage. Only one case was resolved with antibiotics alone; all other 11 cases needed drainage, in spite of a improvement in the symptoms, which was performed by translumbar puncture. Drainage was effective in 10 cases and the cultures found 5 cases of E. coli, 4 cases of Staphylococcus aureus and 1 case of Gram(-) bacilli. In the two cases where percutaneous drainage was not effective abscesses were produced by fungi: C. albicans and Mucor mycosis which caused highly solid septum and sphacelus requiring in both cases the use of open surgery. Currently this disease no longer represents a serious problem, it has a minimal morbidity and no mortality; only the group of high risk immunosupressed patients (AIDS, HIV (+), ADVEP) shows an increase in the number of cases and management in these patients continues to be problematic.

[Cholesteatoma of the kidney pelvis in horseshoe kidney]. / Colesteatoma de la pelvis renal en un riñon en herradura.

This paper presents one case of cholesteatoma of the left renal pelvis of a horseshoe kidney. This is quite an unusual process presenting an uncertain etiology and originated from a escamour metaplasia of the urothelium. Diagnosis can be made by X-rays and unlike leukoplasia it is not considered to be a pre-malignant condition. Probable etiologies, diagnosis and treatment are commented.

[Incidental diagnosis of renal carcinoma. Impact on prognosis and survival]. / Diagnóstico incidental del carcinoma renal. Influencia sobre el pronóstico y la supervivencia.

A retrospective study was conducted in 206 renal carcinomas (RC) that underwent surgery between 1983 and 1992, evaluating those that were diagnosed incidentally. Among this series, 74 cases (35.9%) were incidental renal carcinomas (IRC). The complementary examination that allowed to reach a diagnosis was ultrasound in 58 (78.4%) patients, computerized axial tomography (CT) in 23 (17.6%) and intravenous urography (IVU) in 3 (4%). An evaluation is made of the main prognostic factors (nuclear differentiation grade and pathological stage) and the survival in these patients. The results obtained allow to conclude that IRC display an earlier pathological stage and lower nuclear differentiation grade than the other RC, the difference being statistically significant (p < 0.05). Also, the probability of survival in IRC-diagnosed patients is higher than in those diagnosed with non-incidental RC, the difference being statistically significant (p < 0.05).

[Secondary bladder amyloidosis. A rare cause of hematuria]. / Amiloidosis vesical secundaria. Una rara causa de hematuria.

Secondary vesical amyloidosis is an uncommon pathology and few cases are described in the literature. A suddenly appearing hematuria resistant to treatment in a patient with a diagnosis of systemic amyloidosis is usually the initial sign that guides us to its diagnosis. We present a case of vesical amyloidosis in a patient with systemic amyloidosis secondary to a Rheumatoid Arthritis of length evolution, and which was diagnosed as a result of a pattern of massive incoercible hematuria.

[Calcified kidney masses. Study of 23 cases]. / Masas renales calcificadas. Estudio de 23 casos.

We consider the presence of calcifications in a series of 107 renal masses by means of simple X-ray, echography and CAT, in which 23 cases (21.4%) were found. The most effective exploration for revealing them was CAT (in 13% of the cases, the only one). We found a relative higher frequency of calcification in the benign masses (31%) than in the neoplastic ones (17%). In the latter we found no differences in survival as compared with the non-calcified ones. No pattern of calcification proved characteristic of benignity or of neoplasia. The variety of malignant renal mass most often calcified was the papillary hypernephroma (57.1%).

[Growing teratoma syndrome in metastatic germinal non-seminomatous testicular tumors]. / Síndrome del crecimiento teratomatoso en los tumores germinales no seminomatosos metástasicos de testículo.

Presence of retroperitoneal or mediastinal mature teratomas secondary to metastatic testicle germinal tumours which have not responded to multiple chemotherapy constitute the so called Growing Teratoma. They can either represent the metastasis of a mature teratoma site in the original testicle tumour or the evolution from a non-differentiated lesion during therapy. The first two cases of Growing Teratoma Syndrome published in the national literature are presented here. Both cases had a retroperitoneal growth of the mature teratoma following successful achievement of normalization of serum tumoral markers through chemotherapy with CDDP, Bleomycin, and VP-16 in one case (Hospital Clínico) and with BOMP/EPI (Belomycin, Metrothexate, Vincristine, Cisplatin/Vo-16, Cisplatin, Iphosphamide) in the second one (Hospital del Mar) of a non-seminomatose testicle tumour. After a follow-up of 14 and 9 months respectively the good prognosis of these mature teratomas was verified in both cases, so as in the rest of the literature. We coincide with regard to performing a retroperitoneal lymphadenectomy with exeresis of tumoral masses as the most adequate attitude, both to prevent growth of the mature teratoma and to allow us to discard the presence of residual immature lesions.

[Testicular and epididymal malacoplakia. Presentation of a case and review of the literature]. / Malacoplaquia testicular y epididimaria. Aportación de un caso y revisión de la literatura.

A case of testicular malacoplakia and epididymis in a 62 year old man is presented. A literature review is made (only 6 cases describing epididymal malacoplakia have been reported), commenting on the clinical, diagnostic, anatomopathological, pathogenic and therapeutic aspects of malacoplakia.

[Comparative study of the effect of complete prolonged neoadjuvant hormonal blockade versus standard hormonal blockade]. / Estudio comparativo del efecto del bloqueo hormonal completo neoadyuvante prolongado frente al estándar.

INTRODUCTION: Radical prostatectomy is considered as a curative treatment option in clinically localised prostate cancer patients. Therapy failure is related to positive surgical margins and/or extracapsular extension. The use of neoadjuvant combined androgen blockade (CAB) withdrawal therapy, mainly in cT2 disease, has been shown to decrease positive margin rates. However, CAB therapy remains controversial since there is no proof that this approach confers any benefit in relation to biochemical and clinical disease-free survival. Increasing negatives surgical margins and lower tumour volume (TV) with prolonged CAB therapy has been recently reported. AIM: To analyse the effect of 6 months neoadjuvant CAB therapy in front of 3 months in clinically localised prostate cancer patients submitted to radical prostatectomy. PATIENTS AND METHODS: The pathological stage and TV in forty-two patients treated by 6 months in front of thirty-four patients treated by 3 months were studied. The relationship of clinical stage and initial PSA concentration were analysed. RESULTS: TV was significantly lower in 6 months treated patients (0.97 cc vs. 0.48 cc, p = 0.05). The lowest TV was observed in cT1 patients, but significant differences only were observed in cT2 (1.5 cc vs. 0.86 cc, p = 0.04). No relationship between TV and PSA was obtained. No differences in the incidence of organ-confined disease were seen depending of the CAB length (47% vs. 43%, p = NS). However, increasing incidence of specimen-confined disease was observed in 6 months treated patients (56% vs. 74%, p = 0.05). CONCLUSION: The duration of neoadjuvant CAB can affect both TV and surgical margin status. Lower TV and increasing incidence of specimen-confined disease with 6 months CAB treatment were observed. Patients with palpable disease may be more benefited by this treatment option.

[Selective embolization in the treatment of traumatic priapism with an arterio-cavernous fistula. Review of the literature]. / L'embolisation sélective dans le traitement du priapisme traumatique avec fistule artério-caverneuse. Revue de la litterature.

The authors report a case of post-traumatic priapism due to laceration of the left cavernous artery. Blood gases on blood aspirated from the corpora cavernosa revealed the presence of "high-flow" priapism. Transfemoral arteriography confirmed the arteriocavernous fistula which was successfully treated by selective embolisation of the internal pudendal artery. The authors present a review of the literature on this subject with special reference to the diagnostic and therapeutic aspects.

[Elongation of the right renal vein in 120 consecutive transplant patients. A comparative analysis]. / Alargamiento de la vena renal derecha en 120 trasplantes consecutivos. Análisis comparativo.

OBJECTIVES: Shorter length of the right renal vein (RRV) may represent an additional difficulty for transplant. This paper has aimed to present our experience with RRV elongation in the kidney from a cadaveric donor and to compare the results with the rest of kidneys transplanted in the same period of time. MATERIAL AND METHODS: We performed 377 kidneys transplants within the last 11 years. Of these, in 120, the RRV was elongated with the vena cava. The surgical technique is described and the results compared with the remaining transplants of the series. Renal function, graft survival and complications were assessed at 1, 3 and 12 months. Data were obtained retrospectively from the database of the Urology Department and Hospital medical records. RESULTS: In the 377 transplants, there were 4 (1%) venous thrombosis, 2 (1.6%) of which concerned kidneys with elongation of the RRV and 2 (0.7%) in the rest of transplanted kidneys. There was no difference in postoperative bleeding, 11 (9.1%) occurred in kidneys with elongated RRV and 22 (8.5%) in the remaining kidney. In no case was the bleeding related to the elongated segment. Graft survival and renal function were similar for both groups. CONCLUSIONS: Elongation of the RRV with the vena cava is a feasible, fast, and effective procedure that does not increase morbidity or affect renal function or graft viability. It facilitates vascular anastomosis and places the kidney in a less forced position, shortens the warm ischemia time and avoids the risk of kinking of the renal artery because it is equal to the length of the vein artery.

[Cystitis and ketamine associated bladder dysfunction]. / Cistitis y disfunción vesical asociada al consumo de ketamina.

OBJECTIVES: To analyze the prevalence of lower urinary tract symptoms (LUTS) in recreational ketamine users and evaluate its relationship with the consumption pattern. MATERIAL AND METHODS: Evaluation of 13 ketamine users. The presence of LUTS, gross hematuria and lumbar spine pain was analyzed. The ketamine usage pattern was recorded: initiation, administration route, dose in the last month and frequency of usage. RESULTS: Six patients (46%) reported LUTS, with daily mean micturations every 42 minutes and nighttime of 3 episodes, with dysuria (100%), urgency (100%), incontinence (20%), decreased flow (80%), hypogastric or perineal pain (80%), gross hematuria (80%) and bilateral lumbar spine pain (40%). Symptomatic patients described a mean intake of inhaled ketamine of 3g/day (SD 2), 80% with a daily frequency and the asymptomatic ones of 1.03 g/day (SD 0.92) limited to weekends. The mean consumption time to the appearance of the symptoms was 31 months (SD 16.29). Intensity of the symptoms was related with the ketamine dose and improved on increasing water intake. CONCLUSIONS: There seems to be a relationship between the picture with the dose and frequency of consumption, there being factors that reinforce the hypothesis that this action of the drug is due to the harmful effect on the urothelium. The process to identify it on time should be known, since the only known effective measure is to stop the consumption in the initial phases.

Reversible azoospermia in a patient treated with triazolam.

This is a report of a 26-year-old schizophrenic man treated with triazolam, levomepromazine, trifluoperazine and biperiden, who showed complete absence of spermatozoa in seminal analysis with normal plasma hormone levels. Sperm count reached 151 x 10(6)/ml after 6 months of triazolam withdrawal. A reversible effect of triazolam is suggested at the level of the germinal cells which are differentiating, without affecting the stem cells.

Cystic renal cell carcinoma: pathological features, survival and implications for treatment.

OBJECTIVES: To assess the incidence, clinicopathological features, prognosis and therapeutic options of cystic renal cell carcinoma (CRCC). PATIENTS AND METHODS: The clinical records and nephrectomy specimens from 206 patients with renal cell carcinoma (RCC) were reviewed after a minimum follow-up of 5 years. The mode of presentation, tumour size, growth pattern, nuclear grade, cytoplasmic appearance and pathological stage at presentation were compared with the outcome, as measured by disease-free and overall survival of the patients. RESULTS: From the 206 patients with RCC, 25 (12%) were classified as having CRCC; most of these cases (96%) occurred in male patients, as opposed to 64% in the remaining patients RCC (P = 0.0029). The clinical features at diagnosis were similar in both groups, although asthenia, anorexia and weight loss were uncommon in patients with CRCC (P = 0.045). Nuclear grade and pathological stage were usually lower in those with CRCC than in those with RCC (P = 0.0071 and P = 0.0033, respectively). Survival was significantly longer in patients with CRCC (P = 0.0342). CONCLUSIONS: CRCC is a type of RCC that is usually identified at earlier stages, has a slower growth rate, and is therefore associated with a better prognosis and longer survival than conventional RCC. The differential diagnosis between CRCC, cystic multilocular nephroma and cysts with a superimposed infectious or haemorrhagic process can be extremely difficult in imaging studies, and even in intra-operative frozen-section analysis. Because of this, and with the better prognosis of CRCC, a conservative surgical approach would be the treatment of choice whenever technically feasible.

A new technical alternative in the surgery for retroperitoneal fibrosis: the Gore-Tex surgical membrane.

The case of a male patient with retroperitoneal fibrosis secondary to an abdominal aortic aneurysm which was surgically treated with success, is presented herein. What is considered technically new is the management of the ureters after surgical lysis. An expanded polytetrafluoroethylene Gore-Tex surgical membrane, initially developed for pericardial closure after open-heart surgery, was used to isolate the bifurcated aortofemoral graft from the duodenum and the ureters from the vascular prosthesis and surrounding retroperitoneal tissues. This is considered to be a simple and safe technique and a technical alternative when dealing with this complex situation. To date, there has been no other description of such a technique using this material. The potential value of this material to prevent reencasement in retroperitoneal fibrosis from other origins should be kept in mind.