Beyond the Briganti nomogram: Individualisation of lymphadenectomy using selective sentinel node biopsy during radical prostatectomy for prostate cancer. / Más allá del nomograma de Briganti: individualización de la linfadenectomía utilizando la biopsia selectiva del ganglio centinela durante la prostatectomía radical por cáncer de próstata.

OBJECTIVE: To validate the technique of selective sentinel node biopsy for diagnosing and staging intermediate to high-risk prostate cancer by comparing the technique with conventional extended lymphadenectomy (eLFD) in a prospective, longitudinal comparative study. METHODS: We applied the technique to 45 patients. After an intraprostatic injection of 99mTc-nanocolloid and preoperative single-photon emission computed tomography (SPECT/CT), we extracted the sentinel lymph nodes, guided by a portable Sentinella® gamma camera and a laparoscopic gamma-ray detection probe. The eLFD was completed to establish the negative predictive value of the technique. RESULTS: SPECT/CT showed radiotracer deposits outside the eLFD territory in 73% of the patients and the laparoscopic gamma probe in 60%. The mean number of active foci per patient was 4.3 in the SPECT/CT and 3.2 in the laparoscopic gamma probe. The mean number of extracted sentinel lymph nodes was 4.3 (0-14), with 26% outside the eLFD territory. The lymph nodes were metastatic in 10 patients (22%), 6/40 (15%) when the prostatectomy was the primary treatment. In all cases with metastatic lymph nodes, there was at least one positive sentinel node. Metastatic sentinel lymph nodes were found outside the eLFD territory in 3/10 patients (30%). The sensitivity was 100%, the specificity was 94.73%, the positive predictive value was 81.81%, and the negative predictive value was 100%. CONCLUSION: Selective sentinel node biopsy is superior to eLFD for diagnosing lymph node involvement and can avoid eLFD when metastatic sentinel lymph nodes are not found (85%), with the consequent functional advantages.

[Renal and perirenal abscess]. / Abscesos renales y perirrenales.

Renal and perirenal abscesses are rare infections of the urinary tract traditionally caused by Staphylococcus aureus. Today however there is a predominance of abscesses secondary to coliform bacteria such as E. coli. This paper presents a revision of our series over the last ten years (1987-1996). A total of 11 abscesses (3 renal and 8 perinephritic) were recorded. The most frequent symptom for visiting the clinic was back pain. All patients had predisposing associated conditions. The microbiological analysis revealed E. coli in most abscesses. An HIV+ patient had bilateral renal abscess secondary to Aspergillus fumigatus. CAT appears to be the most specific method for imaging diagnosis, and ultranosography is useful not only to guide percutaneous puncture but also in the follow-up of abscesses after antibiotic treatment. Two renal abscesses resolved with parenteral antibiotic therapy and subsequent observation. Three cases required ultrasound guided percutaneous puncture and intravenous antibiotic therapy. Surgical drainage was required in four. A revision of our experience and the recent literature verified the changes that have taken place in the last few years both in the etiopathogenesis as well as the diagnostic and therapeutical methodology of renal and perinephritic abscesses.

[Renal traumatism: diagnostic protocol and therapeutic indications]. / Traumatismos renales: protocolo diagnóstico e indicaciones terapéuticas.

Review of 158 cases of renal traumatism attended ar the Urology Service of "La Fe" Hospital from 1984 to 1995. We analyze the indications of radiological study of the polytraumatized patient, the different classifications of renal traumatism and the changes produced in the diagnosis protocol, after substituting urography and arteriography for ultrasonography and CT in the Urgencies Area. We explain the treatment, complications and evolution of the patients in our series. 153 of the cases are closed traumatism and 5 of them are penetrating. Following the Chatelain's classification, 78.5% of the reviewed cases can be describes as traumatism grades I and II and in all the instances a conservative treatment was followed. Grades III and Iv (18.3%) were mostly treated surgically (82.7%) with 20.8% of complications that were solved conservatively except for one case, which required surgery. Every penetrating traumatism was dealt surgically and we practised nephrectomy in one of them (20%). We finally suggest, as the best moment for the reconstructive surgery, the period between the 3rd and the 10th day after the traumatism, due to the high rate of nephrectomy on the previous days and the technical difficulties which the haematoma fibrosis conveys on the subsequent.

[Verrucous carcinoma of the penis]. / Carcinoma verrucoso de pene.

Verrucous carcinoma includes approximately 5% of all neoplasias of the penis and is a tumoral variety of benign behaviour and differentiated histology. Our 10-case experience of penial verrucous carcinoma is reported here. In nearly all cases, partial penectomy was the definitive approach. No dissemination, locorregional or distant, was found in any of the report cases. Since prognosis of these tumours is good, we see no justification in performing lymphadenectomy, although it is advisable to adopt and expectant attitude when faced to inguinal adenopathies.

[Treatment of benign hyperplasia of the prostate using thermal transurethral needle ablation (TUNA)]. / Tratamiento de la hiperplasia benigna de próstata mediante ablación térmica transuretral con aguja (TUNA).

Transurethral needle ablation of the prostate (TUNA) is a new, fast and minimally invasive device that produce a selective necrosis of the prostatic gland by delivering low level radiofrequency energy. We describe our experience with this new technique. A total of 42 patients suffering from symptomatic BPH were treated with this procedure. The original generator was used in 27 patients (group 1). A new generator allowing a more homogeneous application of intraprostatic temperature was used in 15 patients (group 2). The patients pretreatment evaluation consisted of World Health Organization symptom score and quality of life, digital rectal examination, uroflowmetric parameters, residual volume, transrectal ultrasound and PSA. Follow-up was performed using the same pretreatment parameters at one month, three months, six months and twelve months. All patients were treated using urethral xylocaine with intravenous or intramuscular sedation (petidine clorhidrate) and tolerance was good. IPSS and quality of life decreased significantly in both groups at first month after treatment and kept low up to twelve-month control. Peak flow rate increased from 7.7 +/- 3.7 ml/sec to 10 +/- 4.1 ml/sec at the twelve-month control in group 1 (p > 0.05), and from 7.6 +/- 2 ml/sec to 9.8 +/- 3.3 ml/sec in group 2 (p > 0.05). Residual volume decrease was statistically significant in group 2 (p < 0.05). No significant complications were encountered. Five patients in group 1 and one patient in group 2 required TURP some time in the follow-up (14%). In our experience, after one year of follow-up, improvement in subjective parameters is evident, although uroflowmetric improvement is moderate and with no statistically significance. No differences were found between both groups of treatment.

[Post-transplantation renal rupture]. / Rotura renal postransplante.

INTRODUCTION: Renal allograft rupture in the transplanted patient represents a usually early postoperatory complication threatening graft and patient survival. Urgent management is often required. MATERIAL AND METHODS: Renal transplanted patients which had rupture of the renal allograft have been reviewed retrospectively. Between February 1980 and June 1996 a total of 868 renal transplants were performed, and 21 (2.41%) suffered from allograft rupture. Diagnosis was based mainly on the symptoms, blood analysis to test hematocrit value, and ultrasounds. RESULTS: Men age of the patients was 34 years old (21-49), 15 (71.4%) males and 6 (28.6%) females. Evolution was as follow: 4 patients underwent extracapsular nephrectomy due to non-functioning kidney; in 16 patients the graft could be preserved using different methods of renal corsetage (lyophilized human dura was applied in 8 cases, fascia lata in one, fascia lata and lyophilized human dura in 3 cases, and polyglycolic acid mesh in other 4 patients); and finally one patient was managed conservatively. There was no intra and post-operatory mortality. Four patients died lately of other causes not related to renal transplantation. Other 4 patients underwent chronic rejection and fail of the renal function. Two of these four patients have already received their second graft. A total of 13 patients have a good renal function (61.9%). CONCLUSIONS: Early diagnosis of the renal allograft rupture must be the main objective in order to initiate as soon as possible therapeutic measures that firstly should be aimed to preserve the graft (medically or surgically). Nephrectomy must be reserved for renal allograft rupture secondary to venous thrombosis and other situations threatening life.