[Independent multiple primary tumors and second primary neoplasms. Relationship between smoking]. / Tumores primarios múltiples independientes y segundas neoplasias primarias. Relación con el hábito de fumar.

Multiple primary tumors and second primary neoplasms have been increasing in incidence in recent decades and are reviewed in this paper. The reasons attributed to this significant increase are fundamentalment the best diagnosis of multiple concurrent cases and increased overall survival of patients diagnosed with cancer, allowing surface new primary tumors in other organs during or after standard monitoring. At the same time are invoked as possible causes of the widespread use of radio and chemotherapy for the first tumor. The genitourinary system is frequently involved in cases of multiple neoplasms; urological organs are one of the few settlement sites of primary tumors in almost a quarter of cases. This suggests a susceptibility/genitourinary system increased target for neoplastic disease. For this same reason, the urologist has a fundamental role in managing these patients and especially to follow up. We believe that the concept of clinical monitoring of this subset of patients should be revised, and should entail a screening of the most common second primary neoplasms since the risk of developing a subsequent independent cancer after presenting a urothelial tumor is considerably increased.

[Localization of sentinel node in squamous cell carcinoma of the penis. Initial experience]. / Localización del ganglio centinela en el carcinoma escamoso de pene. Experiencia inicial.

OBJECTIVE: To assess the validity of radioguided sentinel node biopsy in squamous cell penile carcinoma. MATERIAL AND METHODS: Fifteen patients were studied. The first 5 patients were included in a group for validation of the technique, in which a standard inguinal lymphadenectomy was performed after the procedures described below. The remaining 10 patients were included in the technique application group. The day before surgery, lymphoscintigraphy was performed on all patients. During the operation, radioguided biopsy to locate the sentinel node was done. Methylene blue dye was injected shortly before surgery in 10 patients. All patients were followed for an average of 32 months. RESULTS: In the validation group, lymphoscintigraphy revealed inguinal drainage in 5/5 patients. Unilateral metastases were detected in 3/5 patients. No metastatic nodes were detected among the nodes removed during inguinal lymphadenectomy. In the application group, lymphoscintigraphy showed inguinal drainage in 9/10 patients. Nineteen nodes were removed, none of which showed tumour involvement. During the follow-up period, no disease progression or recurrence were observed in either patient group. CONCLUSIONS: Radioguided localization and biopsy of the sentinel nodes can avoid unnecessary lymphadenectomies in patients with squamous cell penile carcinoma and high or intermediate risk of lymph node involvement. This technique shows high reliability and negative predictive value in penile carcinoma.

[Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (part 1)]. / Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (parte 1).

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostatecancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios.

[Antibiotic resistance transformation in community-acquired urinary infections]. / Evolución de la resistencia antibiótica en las infecciones urinarias adquiridas en la comunidad.

OBJECTIVE: To detect the prevalence of uropathogens in community-acquired urinary tract infection in our environment, and the degree of sensitivity to antibiotics used as empirical treatment. PATIENTS AND METHOD: Retrospective longitudinal study on 16,392 consecutive urine cultures collected in the emergency department of Hospital del Mar, between January 1997 and December 2001. Resistance rates were compared through variance analysis. RESULTS: 8,743 urine cultures with significant count were obtained. 6,062 Escherichia coli (69.3%), 517 Proteus mirabilis (5.9%) and 390 Klebsiella pneumoniae (4.5%) were identified. Escherichia coli showed progressive growth rate and significant resistances to most of antibiotics evaluated, especially to quinolones which came close to 30%. Fosfomycin showed the least resistance rate (0.9%) and remained stable along the years studied. CONCLUSIONS: These results suggest that higher rate of resistance to quinolones does not advise its use as empirical in community-acquired urinary tract infection treatment in our environment. According to our experience, fosfomycin can be an excellent option for cystitis treatment in patients without risk factors, while for the treatment of parenchymatous urinary tract infection, complicated urinary tract infections, and urinary tract infections associated to risk factors, preference could be second or third generation oral cephalosporins, or amoxicillin-clavulanic acid.

[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.

[Histopathologic validation of the tissue-microarray technology of urothelial cancer. Our experience]. / Validación histopatológica de la tecnología tissue-microarray de cáncer de urotelio. Nuestra experiencia.

INTRODUCTION: The array technology offers: a big advance to clinic and basic investigator, it provides a variety of technics (immunohistochemistry, FISH, proteomics) to understand the molecular mechanisms of cancer. It offers scale economy in reagents versus the conventional methods. Array most be ratified because the sample is so reduced. MATERIAL AND METHODS: 52 consecutive cases have been chosen from paraffin blocks of bladder and ureteral cancer which are 5-7 years old, a tissue array has been made; disks have been arranged in lines and columns, in an aleatory way, in order to guide it's reading. It has been evaluated by a pathologist with any relation to specimen selection. RESULTS: 87 sheets ha been obtained. Number 1 has been dyed with HE. Has been discrepancy in 27% of sample's stage. Has not been a discrepancy in histopathologic diagnostic. There is no sample's representation in 11 points (17%). DISCUSSION: Our results offer good results in sample's validation. The sample's antigenicity of tissue is conserved. Array sample's represent a 97%, similarly to all unit of conventional sections of the specimen.

[Doxazosin in the gastrointestinal therapeutic system (GITS) formulation and trial without catheter after acute urinary retention due to BPH. Dose increase action on recovery effect]. / Doxazosina en formulación de liberación retardada en la retención aguda de orina por hiperplasia benigna de próstata. Acción del incremento de dosis sobre el efecto rescate.

OBJECTIVE: Prospective and randomised study to assess the effectiveness of doxazosin in sustained release formulation in Acute Urinary Retention (AUR) treatment due to benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: The trial was carried out with a cohort of 40 males who had all suffered their first attack of AUR caused by BPH. Twenty were randomly selected and treated for 7 days with 4 mg of sustained release doxazosin before removing the catheter. The patients not treated that could not spontaneously urinate were also administered 4 mg of doxazosin. Finally, all the patients that still had a catheter due to unsuccessful removal were treated with 8 mg of doxazosin and the percentage of patients responding to treatment was assessed. The predictive value of the response to treatment for age, IPSS, QoL, retained urine volume, prostate volume and the evolution time of the prostratism was determined by means of logistic regression analysis. RESULTS: 82.5% of the patients (33/40) could urinate after removal of the catheter. 84.8% (28/33) were treated with doxazosin (21 with 4 mg and 7 with 8 mg). In the first attempt at removal, 60% of the patients (12/20) treated with 4 mg of doxazosin could spontaneously urinate, while only 25% (5/20) of those not treated, p=0.02. Similarly, 60% of the patients (9/15) treated with 4 mg of doxazosin in the second attempt could spontaneously urinate. Fifty per cent (7/14) of the patients still with a catheter, after the treatment with 4 mg of doxazosin, could urinate with 8 mg. In the logistic regression analysis, none of the variables analyzed allowed us to predict the response to the treatment. CONCLUSION: The treatment for 7 days with 4 mg of sustained release doxazosin shows greater success when removing the catheter after suffering AUR due to BPH. With this treatment, 60% of the patients could spontaneously urinate again. By increasing the dose to 8 mg, the catheter can be removed in half the patients that did not initially respond. Before removing the catheter it is not possible to predict which patients would be able to spontaneously urinate.

[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.

[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.

The value of endorectal MRI in the early diagnosis of prostate cancer.

OBJECTIVE: Assess the value of endorectal MR imaging (EMRI) in the early diagnosis of prostate cancer (PCa) and compare this test to prostate specific antigen (PSA) and digital rectal examination (DRE) in the prediction of negative biopsies. MATERIAL AND METHODS: 92 patients with elevated PSA (>4 ng/ml) and/or abnormal DRE were studied. All patients underwent an EMRI previous to transrectal ultrasound guided needle sextant biopsies (3 cores in each peripheral zone), and were followed up. We performed a total of 184 biopsies: 92 patients underwent 1 biopsy; out of them, 61 patients underwent 2 biopsies, 27 patients 3 biopsies, 3 patients 4 biopsies and 1 patient 5 biopsies. 67 patients had a final negative biopsy and 25 had a final positive biopsy. Mean PSA was 10.44 ng/ml, and the mean % fPSA/tPSA was 0.20. Uni- and multivariate analysis and ROC curves were used to compare the accuracy of the different tests. The probability of positive biopsy with each technique was also assessed. RESULTS: EMRI had a high negative predictive value (91.07%) and the highest accuracy (77%) of all tests, higher than PSA (62%). Mean PSA was not statistically different in patients with negative biopsies (9.44 ng/ml) and positive biopsies (11.8 ng/ml) (p=0.064). The association of EMRI-DRE-PSA had the highest accuracy (83%) significantly higher than DRE-PSA (70%). The probability of positive biopsy in patients with negative DRE and EMRI, and PSA values between 5 and 15 ng/ml was 5-10% at first and second biopsies, but decreased progressively on subsequent biopsies (<8% at third biopsy, <5% at fourth biopsy and <3% at fifth biopsy). CONCLUSION: In patients with elevated PSA and/or abnormal DRE with two previous negative biopsies, an EMRI is a useful test to rule out PCa, when negative, and avoid subsequent biopsies, as they have a low chance of positive biopsy.

[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.

A longer duration of neo-adjuvant combined androgen blockade prior to radical prostatectomy may lead to lower tumour volume of localised prostate cancer.

OBJECTIVES: To analyse tumour volume (TV) in clinically localised prostate cancer patients treated with neo-adjuvant combined androgen blockade (CAB) therapy prior to radical prostatectomy. PATIENTS AND METHODS: Two hundred consecutive patients treated between 1996 and 2000 were retrospectively analysed. Fifty patients underwent radical prostatectomy alone and 45 were treated with CAB for 1-3 months, 83 for 4-6 months and 22 for more than 6 months before surgery. Logistic regression analysis was performed to identify the strongest independent prognosticator of organ-confined disease. RESULTS: No evidence of residual cancer was found in 11 specimens (5.6%). Regarding TV, 20 specimens showed less than 0.1cc, 33 between 0.1 and 0.49cc and 86 more than 0.5cc. Smaller TV was found in CAB-treated patients. Significant correlation was observed between treatment duration and TV. In logistic regression analysis, only CAB duration and TV were significantly correlated with organ-confined disease. CONCLUSIONS: Prominent regressive features and lower TV were found after neo-adjuvant CAB. It seems that more prolonged treatment may lead to greater tumoural regression. Only tumour burden and length of CAB therapy were independent variables significantly correlated with pathologically localised prostate cancer.