[Synchronous tumor of the upper urinary tract with bladder cancer. Opportunity for nephroureterectomy and block-cystectomy]. / Tumor sincrónico de vías altas con cáncer vesical. Oportunidad de nefroureterectomía y cistectomía en bloque.

OBJECTIVE: One of the basic characteristics of urothelial carcinoma is its tendency to synchronous or metachronous multifocality. Thus the need to explore the entire urinary tract of patients with urothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appear synchronously with infiltrating carcinoma of the bladder. The clinicopathological characteristics and the morbidity and mortality of en bloc surgery of both tumors are analyzed. METHODS: A retrospective study was carried out on 170 radical cystectomies for infiltrating bladder tumor performed in our department over a 13-year period. Patient history, clinicopathological characteristics, complementary tests, type of surgery performed, postoperative complications and follow-up were analyzed. RESULTS: Tumor of the upper urinary tract appeared in 14 (1 bilateral) of these patients and were synchronous in 10 cases. All patients were male; mean age 63 years. Three were localized in the pelvis, 2 in the proximal ureter and 6 in the distal third. Diagnosis was made by IVP in 6 patients and by US and antegrade pyelography in the other 4 patients. Nephroureterectomy and radical cystectomy were performed en bloc in 8 cases; 6 had a Bricker procedure and 2 ileal substitution. Salvage radical cystectomy + distal ureterectomy were performed in the other two patients. Two patients submitted to en bloc surgery had postoperative complications; one presented prolonged ileua and the other required surgery for retroperitoneal hemorrhage. The two patients submitted to palliative surgery died of and sepsis during the postoperative period. At 33 months' mean follow-up, 3 patients have shown tumor progression. CONCLUSIONS: There is a high proportion of synchronous tumor of the upper urinary tract in our series of patients with infiltrating carcinoma of the bladder undergoing radical cystectomy, therefore we consider it necessary to explore the entire urinary system. Surgical removal of both tumors en bloc does not increase the morbidity and mortality.

[Cystic pyeloureteritis and infection. Presentation forms and review of the literature]. / Pieloureteritis quística e infección. Formas de presentación y revisión de la literatura.

OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

[Inverted papilloma: presentation of 5 cases and review of the Spanish literature]. / Papiloma invertido: presentación de 5 casos y revisión de la literatura española.

Vesical inverted papilloma (IP) is a transitional disease most commonly found in the bladder, representing a small percentage within the group of vesical neoformations. Although of benign behaviour, some authors advise that a relatively strict monitoring should be used considering its high rate of proliferative activity. It mainly affects males in their fifth to seventh decade, and it presents as any other transitional tumour. In about one fourth of the cases a transitional carcinoma becomes associated throughout its evolution, thus supporting the theory of periodic monitoring.

[Changes in the caudal regression of fused Muller ducts: utriculocele. Three clinical forms of presentation]. / Alteración de la regresión caudal de los conductos de Müller fusionados: utriculocele. Tres formas clínicas de presentaciónón.

Utriculocele is the engrossment of the prostate utricle with occlusion and/or cystic formation, sometimes including the ejaculatory conducts. We report three patients diagnosed with utriculocele with different presentation forms: hypospermia, haematuria and mictional syndrome, and the treatment used. Theories on their formation, clinical presentation forms described in the literature, diagnostic means, most frequent associations, and different therapeutic alternatives are all discussed as well as a revision of the reported cases.

[Liver failure caused by flutamide]. / Fracaso hepático por flutamida.

Flutamide is a non-steroidal anti-androgen used in the treatment of prostate cancer, usually in combination with LHRH-analogs. Incidence of hepatotoxicity associated to Flutamide in the literature is very low and does not exceed 0.18%. Between February 1989 and December 1994, the FDA was reported 20 cases of patients who had died and 26 who had been hospitalized due to hepatotoxicity secondary to Flutamide. We contribute two cases of patients diagnosed with prostate adenocarcinoma following treatment with flutamide and LHRH-analogs who presented liver failure; one with signs and symptoms of acute hepatitis that recovered after discontinuation of the drug, and a second one who developed micronodular cirrhosis and later died of icteroascitic decompensation and hepatorenal syndrome. Including a review of the literature, the paper comments on the likely biological mechanisms for liver toxicity caused by Flutamide. The authors conclude that clinical and laboratory monitoring of patients who either will receive or are receiving treatment with Flutamide is necessary, and withdrawal of drug imperative as soon as certain symptoms of hepatic dysfunction become apparent.

[Cranial blind ureter: a new case]. / Uréter ciego craneal: un nuevo caso.

One of the anomalies affecting the ureter is the blind bifid cranial ureter, which is truly an uncommon alteration. Clinical signs and symptoms are very ambiguous, and sometimes the condition is diagnosed accidentally while conducting an urographic examination. The aim of this paper is simply to contribute a new case to the existing literature.

[Wallstent prosthesis of unusual location caused by recurrent urethral stenosis following repeated urethroplasty]. / Prótesis wallstent en localización inusual por estenosis de uretra recidivada tras uretroplastia repetida.

Presentation of one case of relapsed urethral stenosis in a penoscrotal location where after several failed therapeutical approaches, the final decision was to place a Wallstent endoluminal prothesis. The patient underwent several endoscopic internal urethrotomies and urethroplasty in two occasions, developing complications: urethral calculi, hair follicles requiring cauterization, repeat infections and relapse urethral stenosis, which finally lead to the decision of fixing a intraluminal stent even if in an unusual location (penoscrotal). The result, 40 months after implantation, is both subjectively and objectively better, with a good mictional calibre and satisfactory erection which allows the patient to have sexual intercourse. The Wallstent prothesis can be the ultimate alternative in those cases of "ill-treated" urethra where other techniques fail.

[Endourethral prosthesis in recurrent urethral stenosis. Long-term follow-up]. / Prótesis endouretrales en estenosis de uretra recidivada. Seguimiento a largo plazo.

OBJECTIVES: To describe our experience with urethral stents in the treatment of recurrent strictures. METHODS: From March 1991 to July 1992, 17 Wallstent and 1 Strecker self-expandable stents were implanted. Patient follow-up ranged from 11 to 40 months. The results were analyzed on the basis of the clinical, urodynamic, radiological and cystoscopic findings. RESULTS: Of the 18 patients in whom a urethral stent had been implanted, 2 (11.1%) required removal of the stent, 1 patient was lost to follow-up, 2 had died during follow-up from causes unrelated with the procedure. At 40 months follow-up, late complications were observed in 8 patients (47%): intraprosthetic excrescence, erectile disorders, pollakiuria, lithiasis, episodes of RAO, or incontinence. CONCLUSIONS: In our view, the implanted urethral stent is a valid alternative when other techniques are not feasible or have failed (dilatation, internal urethrotomy, urethroplasty...), but we should not forget the long-term complications.