Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy.

OBJECTIVE: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. MATERIALS AND METHODS: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. RESULTS: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. CONCLUSION: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae.

[Cell cycle and apoptosis mechanisms implicated in intravesical chemotherapy resistances in superficial bladder cancer]. / Mecanismos del ciclo celular y la apoptosis implicados en las resistencias a los fármacos de uso intravesical en el cáncer superficial de vejiga.

It is well documented the effectiveness of intravesical chemotherapy following transurethral resection to prevent recurrences of superficial bladder cancer. But it is also known that efficacy may be limited by tumour cell resistance to one or several of the drugs available for instillation. In addition to the genetically determined unicellular mechanisms classically described in the literature such as glycoprotein P-170 expression (mdr-1), overexpression of Bcl-2 or glutation S-transferase activity, it has been recently shown that multicellular mechanisms may also be involved in drug resistance. Multicellular resistance can only be demonstrated in three-dimensional cultures and fails to be shown in monolayers or cell suspensions. This is explained by the fact that cell-to-cell and cell-to-stroma adhesion limits drug penetration and by the variable susceptibility to cytotoxicity determined by oxygen and tissue proliferation gradients. A better understanding of the molecular mechanisms involved in drug resistance is necessary to increase intravesical chemotherapy effectiveness. Current research includes improving drug penetration, searching resistance reversing agents and developing in vitro chemosensitivity tests to identify drug resistance.

[Pyeloureteral fungus ball in patients with urinary lithiasis. Treatment with ureterorenoscopy]. / Fungus ball pieloureteral en pacientes con litiasis urinaria. Tratamiento con ureterorrenoscopia.

INTRODUCTION: C. albicans is the most frequent fungus causing opportunist infections of the urinary tract. Agglutination of necrotic tissue nucleus (papilary necrosis), mucosus debri and chirurgic or lithiasic debri, originates a fungus ball, which can obstruct the urinary tract at any level. CLINICAL DATA: We present 2 patients with obstructive urinary lithiasis developing fungus ball in the dilated upper urinary tract. Patient 1 was bilaterally affected and never had systemic symptoms. Treatment consisted of uretherorrenoscope for removal of fungus ball, bilateral urinary diversion and anphotericine B irrigations and systemic. Patient 2 developed a candidemia and was treated with systemic liposomal anphotericine B, uretherorrenoscopy with removal of ureteric calculus and fungus ball, and placement of a double J catheter and nephrostomy tube for anphotericine B irrigation. DISCUSSION: Urinary lithiasis is a risk factor for fungal infection of the upper urinary tract, provided there is no other predisponent factor for opportunistic fungal infections. Calculi facilitates fungal growth by means of obstruction and subsequent retrograde estasis and creating a nucleus for growth, aggregation and ramification of mycelium. The infection pathway is probably ascendent and may turn into fungemia and septicaemia. Systemic antimicotics, urinary diversion and local irrigations with antimicotics, and endourologic technics, are the three basic items in the treatment. Ureterorrenoscopy plays an important roll as a diagnostic and therapeutic tool as it may solve the obstruction and allows removal of fungus ball.

[Treatment with shock-wave lithotripsy in children: our experience]. / Tratamiento con litotricia extracorpórea por ondas de choque en niños: nuestra experiencia.

OBJECTIVES: To analyze the efficacy and complication rates of extracorporeal shock wave lithotripsy in the paediatric age group. PATIENTS AND METHODS: From 1989 to 2000, 29 children (mean age 8 years, range 1-14) underwent ESWL for urinary calculi at our institution. A total of forty-four ESWL sessions were performed in 36 calculi and a previous double pigtail stent was inserted in 11 patients. Intravenous anesthesia was used in the vast majority of cases. RESULTS: Complete removal of all stone fragments was achieved in 24 (66.7%) renal units after a first session, 6 (16.7%) after a second session. The rest of the patients became stone-free after 3 sessions in 3 patients, open lithotomy in 1 patient and ureteroscopy in another patient. In one case a watchful waiting was decided after the failure of the first session of ESWL. Mean hospital stay was 3.2 days (range 1-11) for each session. Complications appeared in 10 patients: 4 had renal colic, 3 haematuria, 2 fever and 1 subcutaneous hematoma. CONCLUSIONS: ESWL is a safe and effective treatment for paediatric urolithiasis so it should be considered the first-line treatment.

[Primary retroperitoneal tumors: our caseload]. / Tumores retroperitoneales primarios: nuestra casuistica.

Primary retroperitoneal tumors are a very uncommon group of neoplasias in urology. Sixty-four primary retroperitoneal tumors admitted and treated in our hospital from january 1974 to october 2000 were reviewed retrospectively. Clinical presentation, diagnostic, treatment and evolution are analyzed. Five cases were benign (7.8%) and the remains malign (92.2%). Mesodermic tumors were the most frequent. Surgery was performed in 59 patients (92.2%). Radical resection was possible in 100% of benign tumors and 44.5% of malignant tumors. Palliative radiotherapy was performed as the only treatment in 3 patients. Two patients received only symptomatic treatment. Adjuvant chemotherapy (32 patients, 50%) and radiotherapy (19 patients, 29.6%) completed the treatment. Benign tumors 5-year global survival was 100%, malignant tumors 1-year survival was 47.4%, 3-year survival 15.2% and 5-year survival 10.1%. Mean survival was 20.15 months. As it's frequent to find an advanced neoplasm at the diagnostic, surgery must be planned with radical intention. Radiotherapy and chemotherapy could be useful in the therapeutic strategy of these tumors with poor prognosis.

[Utility of inhibin B in the management of male infertility]. / Utilidad de la inhibina B en el manejo del varón infértil.

INTRODUCTION: Inhibin B (INHB) is an hormone produced by Sertoli's cells that exercises a negative feedback on FSH secretion. In this study we analyze its diagnostic value as a marker of spermatogenesis and its prognostic value for testicular sperm extraction in azoospermic patients. MATERIAL AND METHODS: Between June 2003 and April 2007 we studied 504 infertile males in our Fertility Department. Until May 2006 we determined INHB only in patients with a sperm count <10M/ml. Since then INHB was determined in every patient due to the present study. 158 determinations were finally performed using enzymoimmunoassay considering normal values between 80 and 300pg/ml. We correlated INHB values with other hormones, spermatic count and, in case of azoospermia (24 patients), with success/failure of surgical sperm retrieval from testes (TESE) to use for intracytoplasmatic sperm injection (ICSI). RESULTS: A significant correlation was observed between INHB and FSH (r=-0.469, p<0.001) and LH (r=-0.399, p<0.001) but not with testosterone, prolactin, estradiol and SHBG. Sperm count was better correlated with INHB (r=0.247; p<0.003) than with FSH (r: -0.157; p<0.052). INHB and FSH were altered in 57.6% and 42.1% of azoospermia respectively, 42.1% and 11.1% in severe oligospermia (0-2M/ml) and 5% and 3.3% in oligospermia (>2M/ml) and normozoospermia. In azoospemic patients PPV for success in testicular sperm extraction was 81.8 % for normal INHB and 76.6% for normal FSH. NPV for failure of sperm retrieval was 61.6% for low INHB and 63.6% for high FSH. CONCLUSIONS: An inverse correlation exists between INHB and FSH and LH levels. INHB correlates better than FSH with sperm count. In azoospermia and oligospermia (<2M/ml), low INHB is more sensitive to detect testicular damage than high FSH. Normal INHB level predicts better than FSH the success of testicular sperm extraction for ICSI, although the favourable outcome can never be assured.