[Analysis of medical/surgical complications of cutaneous ileostomy]. / Análisis de las complicaciones médico-quirúrgicas en las ileostomías cutáneas.

OBJECTIVE: Our objective is to carried out a descriptive study about medical-surgical complications and alterations about quality of life in stoma patients secondary to bladder tumour. PATIENTS AND METHOD: The series are composed of 67 patients. The mean age was 70.3 years. We analyse the following variable: early and late medical-surgical complications, the body mass index (BMI) change and the alteration of quality of life. RESULTS: The most frequent early complication is the ischemic necrosis (7%) without posterior repercussion. The late complications in frequency order are: peristomal dermatitis (18%), plane stoma (12%), peristomal hernia (12%), stenosis (9%) and granuloma (6%). The BMI changes don't conditionate a increase in the complications. The psychological adaptation is good in 92%, although the majority affirm a little changes in life-style, but they don't have a repercussion on quality of life. CONCLUSIONS: In this series we estimate a low incidence of complications. The preoperative counsel and the posterior following by the stoma care nurse-surgeon team, play a fundamental role on psychological adaptation after surgery.

[Management of penile and scrotal incarceration by a metal object]. / Manejo de la incarceración del pene y escroto por objeto metálico.

Penile incarceration requires urgent management to prevent chief wound. In this article we present two penile and scrotum incarceration cases happened in our center. We contribute to a literature revision where lots of objects are reported. We try to simplify the different resolution techniques.

[Cystectomy in superficial bladder tumours. Analysis of criterion include and prediction factors]. / Cistectomía en tumores vesicales superficiales. Análisis de los criterios de inclusión y factores pronósticos.

INTRODUCTION: Though usually the treatment of a superficial bladder tumour consists in transurethral resection, exceptionally because of several clinical conditions, in this kind of patients a radical cystectomy may be suitable. PATIENTS AND METHOD: From june 1986 through december 2001, 127 radical cystectomies were performed. A series of 25 patients with a radical cystectomy performed in superficial bladder tumours were analysed. Indications, anatomo-pathological correlation and clinical evolution with survival curves are analysed. RESULTS: The mean time of follow-up was 47 months. Extensive GIIIpT1 tumours (40%) were the chief indication. The remaining of the series consisted in carcinoma uncontrollable by endoscopy and refractory to chemotherapy. Anatomo-pathological correlation coincided in 48% of patients, existing supra and understaging in 25% and 28% respectively. A period of 54 months was without relapse. Seven patients died during the evolution (28%), and 18 patients are alive without disease. 128,48 months were the mean actuarial survival. CONCLUSIONS: GIIIpT1 tumours were the chief indication of our series. The significant percentage of understaging, poor morbidity and good survival curves are emphasized. Because of these results we consider that radical cystectomies are a viable choice for selected patients with superficial vesical tumour.

[Diagnostic and therapeutic approach to bilateral germinal tumor. Presentation of a case and review of the literature]. / Actitud diagnóstica y terapéutica en el tumor germinal bilateral. Presentación de un caso y revisión de la literatura.

The germinal bilateral tumor represents from 1 to 4% of the testicle tumors, and it usually turns to be one of the most difficult ones when talking about diagnosis and treatment. We are attaching a 30 years old patient case, with a diagnosis consisting in a seminoma with yolk sac tumor area from the left testicle, that was treated with orquiectomy. Eleven months later, the patient presented a second neoplasm in the contralateral testicle, whose histology was a classical seminoma with carcinoma "in situ" peritumoral, being also treated with orquiectomy. Medical literature is revised with emphasis in the involved risk factors and the techniques used to treat these testis tumor groups: carcinoma "in situ" detection appears to be the strongest predicting factor. Testicular contralateral biopsy is proposed in some select cases. Even though radical orquiectomy is still the treatment to choose, local radiotherapy and conservative surgery are also an option in patients with bilateral tumor.

[Cystoscopic impression versus histologic diagnosis in bladder tumors. Do they coincide?]. / La impresión cistoscópica frente al diagnóstico histológico en los tumores vesicales. Coinciden?

OBJECTIVE: How quality control in a university hospital and immediatly after to resents publications; we planed to evaluation of the correlation of cystoscopy impression with the histologic diagnosis after of transurethral resection (TUR). MATERIAL AND METHODS: To give more truthfulness to the study, we requested to all department member's, that to base in your experience to describe the endoscopic characteristic of the next bladder tumors groups: superficial and low-grade GI-II Ta, superficial and high-grade GIII Ta and high grade and/or T1-< T2. In a total of 172 patients, we evaluated the initial cystoscopy impression and we to compared it with histologic diagnosis after to TUR. RESULTS: In 172 tumors the cystoscopy classifed in 69 cases how superficial and low grade GI-II Ta-T1, 40 how superficial and high grade and 55 how high grade and/or invasive tumors GIII T1-< T2. When, we compared it with the histologic diagnosis, the cystoscopy to coincided in 46 de 69 cases (66.6%) (PNS) with the group of low-grade GI-II Ta-T1 in 13 of 40 (32.5%) (P < 0.005) with the group of superficial high grade GIII Ta and 45 of 51 (88.2%) (PNS) with the group of GIII T1 and/or invasive tumors. In 15 of 172 the endoscopic description its not conclusive. And finally in 12 cases the histologic diagnosis were normal. CONCLUSIONS: In order of this results, we to consider that in a university hospital is essential the histologic diagnosis before any therapeutic decision, because the initial cystoscopy impression have a low correlation with the histologic diagnosis. We are disagreement with recent publication that propose the outpatient cystoscopy with fulguration to base only to the cystoscopy impression.

[Half-stay and morbidity in a cohort of patients treated with urologic surgery iin the treatment with acenocumarol (Sintrom)]. / Estancia media y morbilidad en una cohorte de pacientes sometidos a cirugía urológica en tratamiento con acenocumarol (Sintrom).

OBJECTIVE: Our objective was to evaluate the effect about half stay at hospital, in patients treated with Sintrom, which required different urological surgery. PATIENTS AND METHOD: We evaluated 55 patients in treatment with Sintrom which required different urological surgery. We analysed a cohort control group with similar characteristic without anticoagulation therapy. The patients was at hospital 3 days before surgery to realize the change Sintrom/Heparina. We used the haematology service's protocol at the Hospital del Mar. We analysed in each patient the half stay at hospital and the morbidity referred to bleeding complications. The decrease of haemoglobin higher than 2 g/dl was considered significant. RESULTS: About half stay, all patients required more days of hospitalization. The additional morbidity was obvious in the transurethral resection of the prostate and in great not endoscopical surgery. In the rest of surgery the complications referred to bleeding have repercussion about stay at hospital. CONCLUSIONS: We found a significant increased half stay at hospital and the morbidity referred to bleeding complications and its consequence (transfusion, second surgery,...).