[Adenomatoid tumor of the epididymis]. / Tumor adenomatoide de epididimo.

OBJECTIVE: Paratesticular tumors are very rare and mostly bening. Wa aport a new case of adenomatoid tumor of epididymis METHOD: Male of 40 years old with solid lesion in epidididymis tale treated with mass exéresis RESULTS: Adenoamotid tumor of the epididymis confirmed with hystopathologic technique CONCLUSION: Adenomatoid tumor of epididymis is the most frequent paratesticular tumors and when is suspected, conservative surgery must be performed.

[Prognostic value of E-cadherina, beta catenin, Ki-67 antigen and p53 protein in the superficial bladder tumors]. / Cadherina E, catenina beta, antígeno Ki-67 y proteína p53 en el pronóstico de la recidiva tumoral en los tumores superficiales de vejiga T1.

INTRODUCTION: The natural history of the superficial carcinoma of bladder is characterized by his high rate of recurrence and by the aptitude to progress to higher stages. We are going to investigate the capacity of prediction for tumor recurrence of protein p53, antigen Ki-67, E Cadherin and Beta Catenin MATERIAL AND METHOD: 88 T1 tumors with a median of free time of disease of 36 months. 58% of the serie has received prophylactic treatment with BCG 81 mg. weekly for six weeks. Cut-oof level for For P53 and Ki-67 is 10 % of stained cells. For E Cadherin and Beta Catenin we have established two groups: one with the values 0-4 (negative), and other one with the values 5-8 (positive). RESULTS: Recurrence rate 31%, stage progression 3%. Ki-67 expression is correlated with grade (p .002) and lymphatic permeation (p .028). Multiplicity is correlated with lack( of Cadherin and Catenin's expression. Only Ki-67 expression (p .049) and lack of Beta Catenin expression (p .039) reach statistical significance. In multivariant study only lack of Beta Catenin's expression shows independent recurrence value (p .049; O.R: 2,4-6,9) CONCLUSIONS: The most useful prognmostic markers are Ki-67 and Catenina Beta Only Beta Catenin Beta shows independent value for tumour recurrence. Tumors wich lack expression for Catenin B or Cadherin E have lower recurrence free time.

[Age's influence in superficial bladder cancer's behaviour]. / Influencia de la edad en el comportamiento de los carcinomas uroteliales superficiales.

INTRODUCTION: Transitional bladder cancer is infrequent in younger people. The tumor's aggressiveness in this population is subject of discussion. We present our experience. MATERIAL & METHOD: 551 primary tumors, with at least one year of follow-up. Group A (less than 41 years old), Group B (bigger than 40 years old). We compare, stage, grade, lymphatic permeation, multiplicity, recurrence, progression, sex, T.L.E. (time free of disease), volume. We do uni and multivariate analysis. RESULTS: 17 tumors in younger than 41 years (2.1%). The recurrence rate is 11.8% in Group A and 36% in Group B (p .041). Progression rate: 0% in A and 4.1% in B (p .253). In Group A, T1 tumors (13.3% vs. 39%), G2 tumors (0% vs. 36.7%); withouts in lymphatic permeation (0% vs. 35%) and solitary tumors (13.3% vs. 35.3%) have statistically less recurrence. In univariate analysis we appreciate statistical differences in relation with grade (p .002) and sex (p .011). In multivariate analysis, stage, "group of age" and prophylactic treatment are independent variables for recurrence, and grade for progression. CONCLUSIONS: In younger than 41 years old: Less pathologic aggressivity (0% G3); Group of age is independent prognostic variable for recurrence, but not p for progression, despite a "less aggressive behaviour": 11.8% recurrence, 0% progression; T.L.E. bigger (one year more); Higher incidence in women (41% vs. 11%); Less recurrence in T1 tumors (13.3% vs. 39%), G2 tumors (0% vs. 36.7%) and solitary tumors (13.3% vs. 35.32%).

[Uretero-intestinal anastomosis. Our experience. The simpler... the better]. / Anastomosis ureterointestinales. Nuestra experiencia. Cuanto más simple ... mejor.

INTRODUCTION: There are many techniques describe for ureteroenteric anastomoses. We present our experience with three of them inorder to reduce the stenosis rate. METHOD AND MATERIAL: We have done radical cystectomy in 77 patients. Urinary diversion with small bowel in 20 patients (Paduana ileal neobladder) and dstubulized ureterosigmoidostomy (MainzII) in 55. Initially, we used Le Duc technique, afterward Ricard technique and actually bivalva technique (direct). RESULTS: We have performed Le Duc in 38%, Ricard in 31% and "bivalva" in 27%. Median follow-up are 37.7 months, 19.9 months and 10 months respectively. Stenosis: 16.7% with Le Duc; 20.5% with Ricard and 9.1% with bivalva technique. Renal anulation: 10.4% with Le Duc; 10.3% with Ricard and 0% with bivalva (p .000). CONCLUSIONS: In our experience, the less stenosant anastomose is BivalvaIn one. The simpliest technique, the best results. The rate of stenosis is higher when the upper urinary tract is dilatated pre-surgery, independently of the anastomosis technique.

[Value of the diuretic isotopic renogram in the follow-up of the upper urinary tract after cystectomy and urinary diversion using intestine]. / Valor del renograma isotópico diurético en el seguimiento de la vía urinaria superior tras cistectomía y derivación urinaria con intestino.

INTRODUCTION: In our experience we often observe urinary upper tract dilatation after urinari diversion with bowel. To spare useful approaches and therapeutics we have used diuretic renogram. MATERIAL AND METHOD: 26 patients with urinary diversion (Mainz II or Paduana ileal neobladder). We performance ultrasound, urography and diuretic renogram. RESULTS: Follow-up is between 1 y 4 years. After urinary diversion, 54% of the upper tracts are dilated but only 39.3% of them are obstructed in the diuretic renogram. Normal urographic tracts are normal or have good response in the diuretic renogram. Results goes on in the time. CONCLUSIONS: Diuretic renogram is a useful tool in the diagnosis of upper urinary tract obstruction after urinary diversion.

[Lymphatic invasion of the bladder wall in T1 superficial bladder carcinoma. Prognostic value]. / Permeación linfática de la pared vesical en el carcinoma superficial de vejiga t1. Valor pronóstico.

INTRODUCTION: It is not usual to use as prognostic factor the bladder lymphatic vessels invasion. METHOD & MATERIAL: 519 T1 bladder tumors with complete resection and follow up of one year at least. Prophylaxis with 81 mg of BCG weekly during six weeks in 54%. RESULTS: Follow up without recurrence of 38 months. 49%. Tumour recurrence of 49% and progression of 7%. 5.8% of the tumours are L1 and 70.7% L0. There are significative statistic relation between lympatic invasion and progression (p. 005), tumoral grade (p. 000) and actual situation (p. 02). 23% of the L1 tumours progressed vs 5% of L0. Prophylaxis with BCG reduces progression risk (33% without treatment vs 16 with BCG (p n.s.)). In multivariate analysis, resected volume (p. 024) and prophylactic treatment are independent variables for recurrence and lymphatic vessels invasion (p. 0478) and tumoral grade (p. 092) for progression. CONCLUSIONS: 1) L1 tumours has more probabilities of progression. 2) BCG disminishes progression rate but this is not statistical significative. 3) We need new markers to select which L1 tumours will progress.

[DNA ploidy determination with flow cytometry, Ki-67 index and overexpression of p53 protein in 121 T1 superficial bladder carcinomas. Retrospective studies. Part II: Prognostic value and usefulness in the indication for prophylactic treatment with BCG]. / Determinación de ploidía de ADN mediante citometría de flujo, indice Ki-67 y sobre-expresión de proteína p53 en 121 carcinomas superficiales de vejiga T1. Estudio retrospectivo. 2a Parte: Valor pronóstico y utilidad en la indicación de tratamiento profiláctico con BCG.

OBJECTIVE: Evaluate the utility of Ki-67 label index, p53 expression and flow cytometry-DNA ploidy in the selection of groups to be treated with prophylactic BCG and the prognostic value compared with the classic variables (grade, lymphatic permeation, multiplicity, volume, primary). MATERIAL & METHOD: 121 superficial bladder tumors T1. 10% Cut-off level for Ki-67 and p53. Aneuplody is defined as a tumor with DNA index different of 1 or more than 20% in G2-M phase. 71 (58.7%) received BCG. RESULTS: In uni and multivariate analysis positivity to Ki-67 is correlated with recurrence. Progression is correlated with lymphatic permeation (p .0003), volume (p .016), ploidy (p .022) and positivity to p53 (p .007). In multivariate analysis, volume and positivity to p53 are independent variables. None were of utility to prevent recurrence, but Ki-67 positive or aneuploid treated tumors had less progression (p .025 and p .009 respectively). The p53 negative treated tumors had less progression too. CONCLUSIONS: Only Ki-67 is correlated with tumoral recurrence. P53 and tumor volume are correlated with stage progression. If the results are confirmed with bigger series, the Ki-67 positive and/or aneuploid tumors would obtain benefits of prophylactic treatment with BCG.

[Urinary lithiasis secondary to indinavir in an HIV-positive patient]. / Litiasis urinaria secundaria a Indinavir en enfermo HIV positivo.

OBJECTIVE: Indinavir is a protease inhibitor used in the treatment of HIV with a lithogenic capacity as a urological side effect. The pathogenesis, diagnosis and treatment of indinavir urolithiasis are briefly reviewed. METHODS: A 37-year-old male, seropositive for HIV on treatment with indinavir, lamiduvine and zidovudine, consulted for colicky left lumbar pain, nausea, vomiting and dark urine for the past three days. RESULTS: Patient evaluation showed a nonfunctioning left kidney and ureterohydronephrosis of unknown origin. URS showed a yellowish, friable material with a mucinous appearance that occupied the entire lumen of the ureter. Fragmentation was achieved with the lithotriptor probe. Six months later the patient had fully recovered and was asymptomatic. CONCLUSIONS: The incidence of protease inhibitor-induced urolithiasis is increasing. This condition should be distinguished from uric acid calculi whose treatment will aggravate the indinavir urolithiasis.

[Iatrogenic bladder lithiasis in the Burch technique. An infrequent complication]. / Litiasis vesical yatrogénica en la técnica de Burch. Una complicación infrecuente.

OBJECTIVE: To describe an uncommon case of iatrogenic bladder lithiasis in a female patient who underwent colposuspension according to the Burch technique. METHODS/RESULTS: A female patient who had undergone colposuspension for urinary stress incontinence presented with irritative bladder symptoms and dyspareunia two years later. Patient evaluation revealed stone formation on the nonresorbable suture. Stone removal was achieved endoscopically using local anesthesia and without compromising continence. CONCLUSION: Removal of the calculus that had formed on the suture was achieved by endoscopy without compromising continence.

[DNA ploidy determination with flow cytometry, Ki-67 index, and overexpression of p53 protein in 121 T1 superficial bladder carcinoma. Retrospective study. Correlation with classic variables]. / Determinación de ploidía de ADN mediante citometría de flujo, índice Ki-67 y sobreexpresión de proteína P53 en 121 carcinomas superficiales de vejiga T1. Estudio retrospectivo. Correlación con las variables clásicas.

OBJECTIVE: Observe the correlation between Ki-67 label index, p53 expression and flow cytometry-DNA ploidy with the classic variables (grade, lymphatic permeation, multiplicity, volume, primary). MATERIAL AND METHOD: 121 superficial bladder tumors T1. 10% Cut-off level for Ki-67 and p53. Aneuploidy is defined as a tumor with DNA index different of 1 or more than 20% in G2-M phase. RESULTS: Statistical correlation with grade and lymphatic permeation. Ki-67 label index and p53 expression can distinguish between G1, G2 vs G3 and Lx, L0 vs. L1. The volume correlates with positivity to p53. CONCLUSIONS: Aneuploidy and positivity to Ki-67 and p53 increase with grade and lymphatic permeation.

[The prevention of stage-T1 superficial bladder tumors with 27 mg. of BCG weekly over 6 weeks]. / Profilaxis de los tumores superficiales de vejiga estadio T1 con 27 mg. de BCG semanal durante seis semanas.

OBJECTIVE: To evaluate the utility of prophylactic treatment of stage T1 superficial tumors of the bladder with 27 mg BCG weekly for 6 weeks and to compare the results reported in the literature. METHODS: BCG instillations were offered to 235 patients and was accepted by 111 (group A) and refused by 124 (group B). Three weeks thereafter, intravesical instillation of 27 mg BCG was administered for 6 weeks. The patients were controlled regularly according to the standard control procedures utilized in our setting. RESULTS: 39% of the patients in group A showed recurrence versus 71.7% of those in group B (p < 0.001). No differences in progression of tumor stage was observed; 6.3% for group A and 10.9% for group B. By grade, significant differences were found in the number of recurrence in those with G1 (28.5% vs 69%; p < 0.001) and G2 (47% vs 72%; p < 0.01) tumors, but not for G3 (53% vs 77%; p = n.s.). No differences were found in the number of progressions. For those with G2 and G3, the results were not as good as those reported in the literature. The incidence of toxicity was 33%. CONCLUSIONS: The results achieved in patients with G2 and especially G3 tumors were not as good as those reported in the literature, therefore we do not recommend this approach. For those with G1 tumors and assuming a toxicity rate of 33%, the results are similar to those reported elsewhere using higher doses, and therefore this approach could be utilized.

[The prognostic factors in T1 superficial bladder carcinoma. Our experience]. / Factores pronósticos en el carcinoma superficial de vejiga T1. Nuestra experiencia.

OBJECTIVE: To identify the prognostic factors for recurrence and disease progression in T1 superficial carcinoma of the bladder for prophylactic therapeutic planning. METHODS: Of 309 patients with superficial carcinoma of the bladder that had only undergone TUR, we selected 196 patients that met the following requirements: T1 tumor, one year minimum follow-up (except for recurrence), TUR complete on gross examination. The changes observed with recurrence (presence of a tumor regardless of grade or stage) and disease progression (higher tumor stage and therefore infiltrating) in the following parameters were analyzed: tumor grade, node involvement, volume resected, number of tumors, primary or recurrent and age. RESULTS: 141 (72%) showed recurrence and 23 disease progression (11.7%) at two-years' mean follow-up. The resected tumor volume was found to be a prognostic factor for recurrence by univariate (0.010) and multivariate analysis (0.039). Tumor grade (0.0005) and node involvement (0.040) were prognostic factors for disease progression by univariate analysis and tumor grade (0.006) by multivariate analysis. CONCLUSIONS: Resected tumor volume, node involvement and tumor grade were found to be prognostic factors. The incidence of disease progression in this series falls within the lower ranges reported in the literature.

[Histologic-ultrasonographic correlation of gland asymmetry and "pseudoruptures" of the prostatic capsule]. / Correlación histoecográfica de la asimetría glandular y de las "pseudorupturas" de la cápsula prostática.

An histo-ultrasound correlation was carried out between the information obtained with pre-operative transrectal ultrasound and that obtained with the histopathological study of 29 prostate specimens from patients with mean age 63 years (range, 52 to 71 years), who underwent radical cystoprostatectomy for infiltrant neoplasia of the bladder (22/29) and radical prostatectomy for prostate cancer (7/29). The (extrinsic and intrinsic) ultrasound parameters were analyzed focusing in the study of the prostatic capsule or "pseudocapsule". With this comparative, echographic and histological study the concept of capsular "pseudorupture" that results from the presence of (arterial and/or venous) vessels, nerves and fibromuscular folds at the periprostatic fat tissue is introduced. The interruption of the capsular echogram was seen as an indication of tumoral involvement of the capsule, and extracapsular spread. Our results allow us to suggest that this assertion should be reconsidered since these capsular "interruptions", "irregularities" or "pseudoruptures" are present in the normal prostate. Similarly, glandular asymmetry in relation with an heterogenous growth in one lobe in defined to differentiate it from that seen in neoplastic processes.

[Randomized prospective study comparing BCG and BCG plus oral tegafur in the prevention of stage T1 superficial tumors of the bladder. Results after 2.5 years]. / Estudio aleatorio prospectivo comparando BCG y BCG más Tegafur oral en la profilaxis de los tumores superficiales de vejiga estadio T1. Resultados a dos años y medio.

We present our experience in eighty patients with superficial bladder cancer stage T1. They have been randomized to receive BCG 27 mg weekly x 6 and monthly until complete one year (Group A) or the same schedule plus Tegafur 800 mg daily until complete one year. Results are similar in both groups. With a median follow up of two years and a half, 33% in Group A and 20% in Group B have had recurrence; 7.6% in group A and 3% in group B have had progression in stage. Differences are not significant in both cases. Tolerance of Tegafur is good with only 11% of secondary effects. We concluded that there are no differences in both treatments but there is a trend to better results with combinant therapy. It is necessary more patients to achieve definitive results.

[The BTA test in the diagnosis of bladder tumors. Usefulness in the hospital setting]. / Test de bta en el diagnóstico de los tumores vesicales. Utilidad en un medio hospitalario.

We show our results in the diagnostic and follow-up of the bladder tumors comparing de BTA test with Void Cytology, in order to substitute this with the former. We performed BTA test, Void Cytology (of the same sample) and abdominal ultrasound to 133 patients. They are divided in three groups: 45 with bladder tumor, 16 healthy controls, 72 in follow-up with and without prophylaxis. The sensibility and specificity in tumor's group were similar. In controls' and follow-up's groups the void cytology specificity was superior. There is a high number of false positives in the follow-up group with a large number of "white" cystoscopes. A high number of false positives was seen if the BTA test was done in he first three months of follow-up. In the subgroup in prophylaxis with cystostatic there weren't false positives. We conclude that BTA test is useful in the diagnostic of bladder tumor but not in the follow-up, especially in the first three months.

[Percutaneous treatment of Fraley syndrome]. / Tratamiento percutáneo del síndrome de Fraley.

OBJECTIVE: A case of upper calyx obstruction of the left kidney from an artery encroaching on the infundibulum is described. Treatment was by percutaneous insertion of a prosthesis. The results show the usefulness of the percutaneous approach in the treatment of this condition. METHODS: A Palmaz prosthesis was inserted into the obstructed infundibulum through a nephrostomy. Intravenous urography was performed immediately postoperatively and at 3, 6 and 12 months. RESULTS: No complications were observed postoperatively. At one-year follow-up the patient is asymptomatic and the urographic controls show improvement. CONCLUSIONS: Percutaneous insertion of a prosthesis in the treatment of infundibular stenosis had achieved good results in the case described herein, although a larger series and long-term follow-up are required to determine the usefulness of this approach.

[Calmette-Guerin bacillus in the prophylaxis of superficial bladder tumors. Our experience and our doubts]. / Bacilo de Calmette-Guerin en la profilaxis de los tumores superficiales de vejiga. Nuestra experiencia y nuestras dudas.

OBJECTIVE: This study was conducted to determine the efficacy of our BCG dose and schedule for prophylactic therapy in superficial bladder tumors. METHODS: Following complete TUR, 81 mg intravesical BCG were administered weekly for six weeks and for nightly another six times. The patients were evaluated every three months by cytology, cystoscopy and routine analysis. RESULTS: 21/25 patients completed the treatment. At 15.5 months median follow-up, 18/21 (85.7%) were disease-free, 2/21 (9.5%) had recurrence and 1/21 (4.7%) showed disease progression. CONCLUSIONS: BCG is the most effective prophylactic therapy for superficial bladder tumors currently available. The ideal dose, treatment schedule and its mechanism of action are as yet unknown.

[Immunoprophylaxis of superficial tumors of the bladder with interferon alfa-2b. Our experience]. / Inmunoprofilaxis de los tumores superficiales de vejiga con interferon alfa 2b. Nuestra experiencia.

OBJECTIVE: The present study was conducted to determine the usefulness of prophylactic therapy with alpha 2b interferon for superficial bladder tumors. METHOD: Following complete TUR, alpha 2b infereron was administered to 36 patients at a dose of 50 million IU weekly for 3 months and monthly for 9 months. Patients were evaluated every 3 months on the basis of their clinical and analytical data and the cystoscopic findings. RESULTS: Twenty-six patients completed treatment and were evaluable. The follow up and disease-free period was 25.70 months. Recurrence was observed in 38.4% of the patients and tumor progression in 3.8%. CONCLUSIONS: Alpha 2b interferon is useful in the prevention of tumor recurrence. Its utility is similar to that of other drugs currently used.

[Our experience with mitomycin C in the prophylaxis of superficial bladder tumors; retrospective study]. / Nuestra experiencia con mitomicin C como profilaxis en los tumores superficiales de vejiga; estudio retrospectivo.

From 1984 to 1991, fifty-one patients completed prophylactic endovesical treatment with mitomycin C after transurethral resection of a bladder carcinoma Ta, Tl. The mean disease-free period was 31.2 months; twenty patients had recurrences (39.2%) and five (9.8%) had a progression in tumor stage. No statistically significant differences were found relative to the recurrences and tumor number, stage and size. The patients with prior tumors had recurrences before (p < 0.05) and more times (p < 0.01) than the primary group.

[Prospective and randomized study comparing mitomycin C and interferon alpha 2b in the prevention of superficial tumors of the bladder]. / Estudio prospectivo y aleatorio comparando mitomicin C e interferon alfa 2b en la profilaxis de los tumores superficiales de vejiga.

Contribution of our experience in 66 patients included in a prospective randomized study to compare the efficacy of Mitomycin C (MMC) and Alpha 2B Interferon (IFN) in the prevention of relapse of vesical surface tumours. Thirty-five patients were included in the MMC arm, 29 of which completed the treatment. Thirty-one patients were included in the IFN arm, 26 of which are evaluable. MMC was given endovesically at a rate of 30 mg weekly for one month, and then monthly to complete one year. Through the same route, 50 million units of IFN were given weekly for 3 months, and then monthly to complete one year. Within the MMC arm, three patients (10.3%) showed progress, twelve patients (451.3%) relapsed, and seventeen (58.7%) are disease free. With regard to IFN treated patients, one patient (3.8%) showed progress, ten (38.4%) relapsed, and sixteen (61.6%) are disease free. We conclude that there are no significant differences between these two drugs.