[Role of nephrectomy in metastatic renal cell carcinoma. Experience of the Department of Urology Juan Canalejo Hospital]. / Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo.

OBJECTIVES: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. MATERIAL AND METHODS: We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. RESULTS: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months. CONCLUSIONS: In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.

[Asymptomatic bladder paraganglioma. Report of a case]. / Paraganglioma vesical asintomático. Aportación de un caso.

Paragangliomas are tumors which arise from collections of neuroepithelial cells (paraganglion system) scattered throughout the body and rarely in the urinary bladder. In this work, we described a case of bladder paraganglioma, not suspected in a 64-year-old male who showed occasional total hematuria as only symptom. Cystoscopically, it was diagnosed as a rounded, not papillary tumor, one centimeter in diameter on account of which it was subjected to TUR. Confirmed the diagnosis, a partial cystectomy and a limited regional lymphadenectomy were subsequently practised. Posterior evolution, after a year, was completely favourable. The main clinicopathologic characteristics of this entity are revised.

[Multiple urinary lithiasis and nephrocalcinosis secondary to primary Sjögren syndrome]. / Litiasis urinaria múltiple y nefrocalcinosis secundaria a síndrome de Sjögren primario.

A 39 year old women with a primary Sjögren syndrome (pSS) had bilateral and multiple nephrolithiasis and nephrocalcinosis due to distal renal tubular acidosis (dRTA), hypercalciuria and hypocitraturia. She had in serum positive antinuclear antibodies with mottled pattern 1/320, totals ENA, Anti-SSA/Ro 52, Anti-SSA/Ro 60 and Anti-SSB-La antibodies. Stones were removed with extracorporeal shock wave lithotripsy satisfactory and were composed of calcium phosphate and calcium oxalate. Metabolic abnormalities were resolved with potassium citrate and hydrochlorothiazide. At two years of follow-up, the patient hadn't stone recurrence and had normal 24-hour urinary levels of citrate and calcium.

[Iatrogenic prostatorectal fistula. Use of gracilis muscle pedicled flap for its reparation. Presentation of two cases]. / Fistula prostatorectal yatrogénica. Reparación con colgajo pediculado de músculo gracilis. Presentación de dos casos.

We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cystographic and opaque enema images which shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery.

[Traumatic urethral disruption in women. A rare entity. Report of two cases]. / Rotura traumática de uretra femenina: una rara entidad. Aportación de dos casos.

We present two cases of urethral disruption in women, a very uncommon situation because of the anatomical features. Yet it must be always suspected in all women under a pelvic politraumatism, for eviting important problems. Both cases are traffic politraumatized young girls presenting with pelvic fracture, among others. The surgery performed was combined suprapubic-transvaginal approach, even in one a previous endoscopic realinement was done, who also needed endoscopic complementary treatment: electrofulguration of a fistulous bridge. Outcome of both is fine, achieving good continence. We also make a literature review.

[Metabolic risk factors in calcium urolithiasis according to gender and age of the patients]. / Factores de riesgo metabólico en urolitiasis cálcica según el sexo y edad de los pacientes.

INTRODUCTION: Little information is available on the metabolic changes found in relation to gender and aging in patients with urolithiasis. In this study a comparison has been made of the metabolic profiles in men and women, in different groups of aging, with calcium-containing urinary stones in order to identify possibly significant differences. MATERIAL AND METHODS: In the past five years, a total of 500 patients with calcium-containing urinary stones, 226 male (45.2%) and 274 female (54.8%), have undergone comprehensive metabolic evaluation. The mean age was 47.4 years, with a range of 20 to 75 years. The patients was included in 3 groups: 151 patients aged 20-39 years, 255 patients aged 40-59 years and 94 patients aged 60-75 years. A comparison has been made of the frequency of metabolic changes, the urinary biochemical parameters and the supersaturation index (AP(CaOx)) between a group of men and a group of women and the different groups of aging. All patients carried out in an identical manner to metabolic diagnosis. The patients with morphologic and functional abnormalities were excluded. RESULTS: Hyperoxaluria, hyperuricosuria and hypocitraturia were more common in men than in women, whilst in women, hypercalciuria and a low urinary volume were more frequent with respect to men, though the differences in hypercalciuria were not statistically significant. Men excrete higher levels of calcium, phosphate, oxalate, uric acid and magnesium than women. On the other hand, women excrete higher levels of citrate than men. The AP(CaOx) index is significantly higher in men than in women. Hypercalciuria were more common in patients aged < 60 years, and low urinary volume were more frequent in patients aged < 40 years. Patients aged < 60 years excrete higher levels of calcium, phosphate and uric acid. The AP(CaOx) index is significantly higher in patients aged < 60 years. CONCLUSIONS: Differences were observed between the metabolic profiles of men and women, and in different groups of aging. Men and younger patients afford a metabolic profile of upper lithogenic risk compared with women and older patients; this is consistent with the upper reported prevalence of lithiasis and the upper tendency to recurrence in men and middle-age patients.

[Double-barreled wet colostomy: analysis of a urinary diversion]. / Colostomía húmeda en doble barra: análisis de una derivación.

We analyse our experience in performing the wet colostomy, also called urocolostomy and present seven cases treated at our hospital in which this was used. We present: a) three women, one underwent an urocolostomy as a result of a myelomeningocele with urinary and fecal incontinence, another because of a pelvic malignancy, and the third after developing a post radiotherapy cysto-proctitis; b) four men, one underwent this surgical procedure as a result of a traumatic paraplegia with multiple urinary fistulae and neurogenic bladder, the other three were secondary to pelvic malignancies (two bladder and one sigmoid malignacies). The outcome was fine in all cases with no pyelonephritis or metabolic imbalances; in all cases it represented a good option for these patients.

[High flow arterial priapism secondary to post-traumatic bilateral arterio-cavernous fistula. Highly selective embolization with autologous blood clot]. / Priapismo arterial de alto flujo secundario a fístula arterio-cavernosa bilateral post-traumática. Embolización supraselectiva con coágulo autólogo.

High flow arterial priapism is rare and characterized to a prolonged non-painful partial erection. Arteriocavernous fistula, rarely bilateral, is associated with penile or perineal trauma (genitoperineal area). Review of the literature, in only eleven cases this fistula is bilateral. Different treatments with non common norm has been used. We report a case of a 27 years old male who presented high flow priapism secondary to bilateral postraumatic arterio-cavernous fistula. Autologous blood clot was used for fistulas embolization to minimize the risk of impotence in this young patient. No complications was registered. Eight months later the patient had normal erectile function and no fistula was detected on ultrasonography doppler. We consider arteriography with highly selective embolization using re-absorbable agents obtains the best results, the least risks and complications in this process.

[Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review]. / Metastasis de carcinoma renal en cuerpo cavernoso, a propósito de un caso y revisión de la literatura.

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case.

[Bladder choriocarcinoma: retrospective analysis of the de-differentiation of a transitional-cell papillary bladder carcinoma. Apropos of a case]. / Coriocarcinoma vesical; análisis retrospectivo de la desdiferenciación de un carcinoma vesical papilar de células transicionales a propósito de un caso.

OBJECTIVE: To report a case of choriocarcinoma of the bladder during the different periods of its evolution. The anatomopathological study showing dedifferentiation of a transitional cell tumor is presented and the histogenesis of this rare tumor is discussed. METHODS: A case of a rapidly progressing transitional cell tumor of the bladder that dedifferentiated into choriocarcinoma is presented. The pathological findings of the first resections of the transitional cell tumor that progressed to choriocarcinoma are presented and the histogenesis is discussed. RESULTS/CONCLUSIONS: Choriocarcinoma of the bladder is very rare, highly malignant and carries a poor prognosis. Its origin is widely accepted to be in the dedifferentiation of a transitional cell tumor. The use of immunohistochemistry and the positivity of HCG support the diagnosis.

Metástasis de carcinoma renal en cuerpo cavernoso. A propósito de un caso y revisión de la literatura / Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review

OBJETIVO: Describimos un caso infrecuente, la metástasis en cuerpo cavernoso de un carcinoma renal de células claras. MÉTODOS: Se trata de un paciente de 53 años, que a los tres meses tras realizarle nefrectomía radical derecha con cavotomía y exéresis de trombo, presenta una tumoración localizada en pene, indurada y dolorosa. RESULTADOS/CONCLUSIONES: Con pruebas de imagen y biopsia, se llegó al diagnóstico de metástasis de carcinoma renal en cuerpo cavernoso que se confirmó con la anatomía patológica de la pieza tras penectomía. La aparición de metástasis de carcinoma renal en pene está generalmente asociada a un estadio avanzado del tumor y por lo tanto, con mal pronóstico, como el caso relatado

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/ CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case

Docencia en Urología Laparoscópica. Problemas. Soluciones / Education in Laparoscopic. Urology. Problems. Solutions

No disponible

Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo / Role of nephrectomy in metastatic renal cell carcinoma. Experience of the department of urology Juan Canalejo Hospital

Objetivos: Presentar nuestra experiencia en la realización de nefrectomía en tumores renales que se presentan con metástasis al diagnóstico, y observar las complicaciones, evolución y supervivencia de estos pacientes. Material y métodos: Realizamos una revisión retrospectiva de los adenocarcinomas renales en el período entre 1-1-1991 y 31-12-2002. Estudiamos solamente los que se presentaron con metástasis (31). Se estudian aquellos pacientes a los que se les practicó nefrectomía y aquellos a los que no se les ofreció tratamiento quirúrgico. Buscamos mostrar las diferencias en los dos grupos en cuanto a status vital (Tabla E.C.O.G.), patología concomitante y supervivencia media. En el grupo de los pacientes nefrectomizados estudiamos las complicaciones derivadas de la intervención y el tratamiento posterior. Resultados: Realizamos nefrectomía en 19 casos. Todos ellos E.C.O.G. 0-1. La estancia post operatoria media fue de12 días, y la tasa de complicaciones 11,5%. El 45% de estos pacientes siguieron algún tipo de tratamiento posterior, y la supervivencia media fue de 31 meses. No se realizó nefrectomía en 12 casos, de los cuales 9 eran E.C.O. G 2-3. La patología asociada que presentaban estos pacientes era más importante que en el primer grupo. Sólo en 3 casos se administró tratamiento con fines paliativos y la supervivencia media fue de 3,8 meses. Conclusiones: En pacientes con buen estado vital la nefrectomía no representa más morbilidad ni mortalidad que en los pacientes sin metástasis, y nos parece una opción fundamental en su manejo. Realizamos una revisión bibliográfica en la que recogemos las últimas tendencias en el tratamiento de estos pacientes, que ponen de manifiesto la necesidad del abordaje combinado quirúrgico e inmunoterápico. Nos parecen de interés fundamental las conclusiones de los estudios del SWOG y del EORTC (AU)

Objectives: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. Material and methods: We performe a retrospective review of renal cell carcinomaes treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to show the diferences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. Results: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some tipe of systemic treatment, and median survival was 31 months. We didn´t performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Asociated comorbidity was higher in this group. Only in three patients any treatment was offerted always with paliative reason. Median survival was 3.8 months. Conclusions: In those patients with good performance status this aproach does not represent more morbility or mortality than in non- metastatic patients, and that is a cornerstone in their management. We also make a literature review in wich we see the last pathways in the management e of these patients, and that show the needing for a conbined approach both quirurgical and inmunotherapical. We have review with special interest the studie’s conclusions of SWOG and EORTC groups (AU)

Fístula prostatorectal yatrogénica. Reparación con colgajo pediculado de músculo gracilis. Presentación de dos casos / Yatrogenic prostatorectal fistula. Use of gracilis muscle pedicled flap for its reparation. Presentation of two cases

Presentamos dos casos clínicos en los cuales durante la realización de una adenomectomía retropúbica por patología prostática benigna se produce una fístula prostatorectal. Describimos la cirugía de reparación de la misma con colgajo de músculo gracilis o recto interno, y su posterior buena evolución. Presentamos imágenes cistográficas y de enemas opacos que presentan un antes y un después de dicha cirugía. Los pacientes están sin incontinencia ni problemas relacionados con la cirugía de desinserción muscular

We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cistografic and opaque enema images wich shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery

Escroto agudo: torsión de hidátide testicular sésil de Morgagni / No disponible

No disponible

Rotura traumática de uretra femenina: una rara entidad. Aportación de dos casos / Traumatic urethral disruption in women. A rare entity. Aportation of two cases

Presentamos dos casos clínicos de rotura de uretra femenina, una situación poco frecuente por las características anatómicas de la mujer pero que debe ser sospechada precozmente, ante todo politraumatismo pélvico, para evitar graves problemas. Los casos expuestos son dos pacientes jóvenes politraumatizadas por accidentes de tráfico con fracturas óseas pélvicas. En ambas se realizó cirugía combinada suprapúbica-vaginal, una de ellas previo realineamiento endoscópico precoz. Esta precisó tratamiento endoscópico complementario: electrofulguración de pequeño orificio fistuloso. La evolución de ambas es buena con continencia. Hacemos una revisión de la literatura (AU)

We present two cases of urethral disruption in women, a very uncommon situation because of the anatomical features. Yet it must be always suspected in all women under a pelvic politraumatism, for eviting important problems. Both cases are traffic politraumatized young girls presenting with pelvic fracture, among others. The surgery performed was combined suprapubic-transvaginal approach, even in one a previous endoscopic realinement was done, who also needed endoscopic complementary treatment: electrofulguration of a fistulous bridge. Outcome of both is fine, achieving good continence. We also make a literature review (AU)

Priapismo arterial de alto flujo secundario a fístula arterio-cavernosa bilateral post-traumática. Embolización supraselectiva con coágulo autólogo / High-flow arterial priapism for postraumatic bilateral arterial-cavernous fistula. Highly selective embolization using autologous blood clot

El priapismo arterial de alto flujo es una patología poco frecuente caracterizada por una erección parcial persistente no dolorosa. Por lo general, se asocia a un traumatismo perineal o peneano (área genitoperineal) que ha ocasionado una fístula arterio-cavernosa, raramente bilateral. Tan sólo se han publicado once casos en los que dicha fístula es bilateral. Los tratamientos empleados han sido diversos, sin una pauta común para su resolución. Presentamos el caso de un varón de 27 años con priapismo de alto flujo arterial secundario a traumatismo perineal con fístula arterio-cavernosa bilateral. Se empleó coágulo autólogo para la embolización de las fístulas con el fin de minimizar el riesgo de lesión de la función eréctil en un paciente joven. No se registraron complicaciones. La función eréctil es normal 8 meses después del tratamiento sin evidencia de fístula en ecografía de control. Consideramos que la arteriografía supraselectiva junto a la embolización con sustancias reabsorbibles proporcionan los mejores resultados, menores riesgos y complicaciones en este tipo de patología (AU)