Bladder Fetal Rhabdomyoma Intermediate Type.

INTRODUCTION: Rhabdomyomas are benign tumors of striated muscle, the bladder localization is very rare. CLINICAL CASE: We present an 87-year-old male consulting for gross hematuria. Cystoscopy was done with evidence of bulged bladder mucosa in right side wall and dome. Post-transurethral resection of the bladder (TURB) pathological anatomy was negative for malignancy. As extension study abdominopelvic computed tomography was performed identifying a bladder thickening of right posterior sidewall and an increased density of the adjacent fat. Second TURB was performed and a fetal bladder rhabdomyoma intermediate type was obtained. We performed another biopsy to confirm this rare pathology, with the same diagnosis. Subsequently, the patient continues with hematuria deciding on hemostatic radiotherapy (not candidate for cystectomy or arterial embolization). Currently, the patient is asymptomatic. DISCUSSION: Bladder rhabdomyomas are rare tumors, and, in fact, there have been only 5 papers published. Some cases are only isolation cited in the bladder mesenchymal tumors, and other polemic cases in which clinical and macroscopic characteristics remembered a rhabdomyosarcoma. The importance of this publication case is the macro- and microscopic images that can corroborate the final diagnosis, helping us to differentiate between rhabdomyoma, rhabdomyofibroma, or the malignant rhabdomyosarcoma, and shows the treatment possibilities of these tumors.

Pleomorphic malignant fibrous histiocytoma in bladder diverticulum.

The Malignant Fibrous Histiocytoma is a very rare cancer and rather exceptional when located in bladder diverticulum. it occurs in men in their sixties, manifests itself through haematuria and/or irritative micturition. There is not a causal association. An immunohistochemical analysis is necessary to establish a differential diagnosis. It is aggressive, with a high rate of local recurrence and remote progression, thereby requiring early treatment that consists of radical cystectomy with pelvic lymph node dissection followed by adjuvant therapy, predominantly radiotherapy on the surgical wound. Close follow-up is crucially important. Poor survival rate even when patients undergo multimodal therapy.

Multimodal therapy in urachal carcinoma with oligometastatic bone disease.

A 35-year-old male patient was admitted to our hospital for urachal carcinoma with oligometastatic bone disease. He received a surgical resection through the umbilical area, urachal ligament and bladder dome (partial cystectomy) and adjuvant chemotherapy based on cisplatin-gemcitabine regimens together zoledronic acid with a good tolerance, no toxicity. Nine months after surgery, our patient presented no symptoms and the metastasis had been brought under control with no apparent signs of recurrence as assessed in a follow-up CT. To our knowledge, is the first case report of a urachal carcinoma with oligometastatic bone disease who received multimodal therapy, including surgery resection.

Chondroma of the Bladder: An Atypical Localization.

Chondroma is a benign tumour of mesenchymal origin that is composed of cartilage and rarely located in soft tissues, being described so far only in four cases, as located in the bladder, according to our knowledge. We describe the fifth case of a 67-year-old woman who consulted for microscopic haematuria, with an endoscopic finding of submucosal nodular image in the anterior wall of the bladder, which after resection and the histologic study shows cartilage and fibroconnective tissue, in part hyalinised, and positive immunohistochemical staining of cells with vimentin and S-100; this fact can support the diagnosis of bladder chondroma.

[A Spanish multicenter trial of TVT for female urinary incontinence]. / TVT para la incontinencia urinaria femenina: estudio multicéntrico español.

OBJECTIVE: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain. METHOD: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications. RESULTS: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence. CONCLUSION: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence.

[Alkaptonuria, prostatic calculi, and ectopic ureter]. / Alcaptonuria, litiasis prostática y uréter ectópico.

Alkaptonuria is an uncommon tyrosine metabolism disorder. Deficit of homogentisic acid oxidase leads to the elimination of large amounts of homogentisic acid in the urine with accumulation of homogentisic acid oxidized pigment in the connective tissue (ochronosis). The ultimate evolution of ochronosis is degenerative arthritis. The clinical case reported is a 57-year old male diagnosed with alkaptonuria in an early stage of the connective tissue disease who comes to the clinic due to a lower urinary obstructive syndrome secondary to benign prostate hyperplasia but is diagnosed with giant prostate lithiasis. The patient undergoes retropubic adenomectomy with lithiasis removal and re-implantation of ectopic ureter from a dual left excretory system. Clinical evolution is completely successful. The rarity of the case calls for circulation and revision of the clinical and therapeutical aspects of this entity.

[Renal carcinoma. Our experience of 20 years]. / Carcinoma renal. Nuestra experiencia de 20 años.

Review of 174 renal parenchyma adenocarcinoma surgically removed over a period of 20 years with follow-up ranging from 1 to 20 years. Age, sex, time from onset of symptoms and treatment, tumour size and cell type did not influence survival. This was improved the lower the stage was at surgery (80% at 5 years in I, 56% in II, 55.5% in III-A, 11% in III-B+C, 0% in IV). The lack of differences in survival between stages II and III-A is conditioned by the fact that III-A included cases with and without perirenal fat involvement but with a common factor of renal vein involvement. Such factor modifies survival with equal local size (80% at 5 years for T1-2 VO and 83% for T1-2 V1; 56% for T3 VO and 44% for T3 V1. Survival for G1+2 was 66% at 5 years, versus 33% for G3+4. Initial therapy was radical nephrectomy with hilar lymphadenectomy, and there was no difference in survival with regard to the access route used.

[Retroperitoneal fibrosis]. / Fibrosis retroperitoneal.

Review of 8 patients with retroperitoneal fibrosis treated in our unit, 7 between 1985 and 1990 and one secondary to chronic use of non-steroidal anti-inflammatory agents diagnosed in 1980. In five patients no underlying reason was found and the remaining three were considered to be secondary (two to drugs and one to pelvic radiotherapy). Diagnostic and therapeutic approaches as well as patient's evolution are analyzed, also reviewing the existing literature.

[Papillary adenocarcinoma of the kidney. Report of 12 cases and update]. / Adenocarcinoma papilar de riñón. Aportación de 12 casos y puesta al día.

Revision of 12 cases of papillary adenocarcinoma of the kidney operated in this Unit over a period of 20 years, representing 6.03% of all renal adenocarcinomas. Their main characteristics were evaluated finding that they appear at a similar age than non papillary cases (55 years of age) and have a similar average size (9.1 cm). They show no differences with non papillary cases with regard to clinical signs and symptoms. Among the various diagnostic procedures used, the most typical one is the hypo or avascular patterned arteriography. The tendency to appear at low stages (79.9% in stage I and II) is higher than with the non papillary cases (51.86%), having a better prognosis than the latter.

[Prognostic value of isolated invasion of the renal vein in renal adenocarcinoma]. / Valor pronóstico de la invasión aislada de la vena renal en el adenocarcinoma renal.

A total of 38 renal adenocarcinomas with isolated invasion of the renal vein and maximum local extension to perirenal fat, operated over a 20-year period and with long-term follow-up were reviewed. They were divided in two subgroups, 12 T1-2,N0,M0,V1 cases were compared to 54 T1-2,N0,M0,V0 cases treated in the same period of time, but no significant differences were found in survival (83% and 68% at 5 and 10 years for V1 versus 80% and 64% for V0); and 26 T3,N0,M0,V1 cases compared to 49 T3,N0,M0,V0, again with no significant difference found in survival (40% at 5 years and 26.5% at 7 years for V1, versus 38.5% and 34% for T3V0). When comparing the survival rate of T1-2,N0,M0,V0-1 with that of T3,N0,M0,V0-1, the difference was significant (p). It is concluded that the isolated invasion of the renal vein and an equal locoregional extension of the tumour do not modify the prognosis for renal carcinoma, and that this parameter should be included in the new TNM classification of the isolated UICC, since when included within the T3b category it places cases with good prognosis (T1-2 V1) above cases with poor prognosis due to the existence of invasion of the perirenal fat (T3a).

[Experimental kidney transplantation in rats. Technical, functional, and histologic aspects]. / Trasplante renal experimental en ratas. Aspectos técnicos, funcionales e histológicos.

In recent years, different experimental transplantation techniques have been developed in animals to gain further insight into the immunologic and non-immunologic processes occurring in grafts. Microsurgery permits the application of these procedures to small animals, as the rat. We present our experience in experimental transplantation in rats, with special reference to isogenic transplantation (inbred animals), leaving solely the graft in the receptor. The technical characteristics, the analytic and histologic findings after transplantation are described.

[Experimental renal transplantation of cirrhotic donors. I. Morphologic, immunofluorescence, and ultrastructural study]. / Trasplante renal experimental de donantes cirróticos I. Estudio morfológico, de inmunofluorescencia y ultraestructural.

The cirrhotic kidney can be successfully transplanted into healthy recipients. The histological lesions have not been well defined or correlated with the functional changes observed in cirrhosis. Methods to induce experimental cirrhosis in the rat that reliably reproduce this disease have been developed. The development of microsurgical techniques have made it possible to perform transplantation in the rat. We analyzed the renal lesions of cirrhotic rats and the evolution of the graft after transplantation into a healthy rat.

[Experimental renal transplantation of cirrhotic donor. II. Stereologic analysis]. / Trasplante renal experimental de donante cirrótico II. Análisis estereológico.

Cirrhotic nephromegaly is accompanied by an important glomerular growth that progress to glomerulosclerosis and is irreversible and independent of the initial cause. The deterioration of renal function in these patients following liver transplantation and in chronic cirrhotics may be secondary to glomerular sclerosis, also known as "hepatic glomerulosclerosis". We utilized stereologic methods to quantify the volumetric changes in cirrhotic rats, fundamentally the glomerular changes, before and after transplantation into healthy rats. We had initially intended to look for terminal cirrhotics that were potential kidney donors; however, currently many of these can be liver graft recipients. In our view, our findings can be applicable to these patients since the kidney is removed from a cirrhotic and transplanted into a healthy environment, as in our experiment.

[Artificial urinary sphincter in the treatment of urinary incontinence caused by sphincter insufficiency]. / El esfínter urinario artificial en el tratamiento de la incontinencia urinaria por incompetencia esfinteriana.

OBJECTIVE: To evaluate the results relative to continence and the complications of the artificial urinary sphincter in the treatment of urinary incontinence due to sphincter incompetence. METHODS: The artificial urinary sphincter model AS 800 was implanted in 35 patients with incontinence arising from various causes. Follow-up ranged from 14 to 108 months (mean 39.8). Patients ages ranged from 4 to 68 years (mean 44.4). There were 17 female (49%) and 18 male patients (51%). The cuff was implanted around the bladder neck in 25 patients (71%) and around the bulbous urethra in 10 (29%). RESULTS: There were 2 mechanical device failures, 2 pump erosion and 1 tube erosion through the abdominal wall in a patient who had had a perforation of an augmentation cystoplasty. Thirty-one patients (88%) became continent. Ten patients (28%) had another operation for device revision or relapse. CONCLUSION: The artificial urinary sphincter is a valid alternative in the treatment of urinary incontinence due to sphincteric incompetence. It is possible to achieve good continence rates, although there is a high revision rate and lifetime follow-up is required.

[Does the surgical approach used for radical nephrectomy change the prognosis of renal carcinoma?]. / Modifica el pronóstico del carcinoma renal la vía de abordaje utilizada para la nefrectomía radical?

To determine the influence of the surgical approach on survival, we conducted a retrospective study in 133 patients with renal carcinoma stage T1-T3 N0 M0 (UICC classification, 1987) submitted to radical nephrectomy. Overall no significant difference was observed in the 5 and 10-year survival rates for the different approaches (lumbotomy, transperitoneal laparotomy and thoracophrenolaparotomy). The 10-year survival rate for the cases with tumor stage T1-T2 varied significantly according to the approach: Thoracoabdominal (100%), lumbotomy (60%) and laparotomy (40%). No difference was observed for those with tumor stage T3a. For T3b the survival rate was higher for the lumbotomy approach and a significant difference was observed versus thoracophrenolaparotomy. The results show that the surgical approach does not influence the prognosis of renal carcinoma and choice depends on tumor size, location and invasion of the renal vein and/or vena cava.

[Internal urethrotomy in the treatment of urethral stenosis. Experience at the "Marqués de Valdecilla" University Hospital]. / Uretrotomía interna en el tratamiento de las estenosis de uretra. Experiencia del Hospital Universitario "Marqués de Valdecilla".

The results of treatment of urethral strictures using the Sachse urethrotome in 31 patients are presented. These patients had consulted between 1985 and 1990 and were followed for a minimum of 6 months. The most common etiology in our series was iatrogenic (57.57%), particularly incorrect catheter placement. Single (66.66%) and short (72.72%) strictures were more common than the multiple (15.15%) and long (15.15%). The strictures were more frequently localized to the bulbous urethra (42.42%). Spinal and general anesthesia were utilized. The catheters were made of silastic material with calibers ranging from 16-22 FR and patients remained in the hospital from 4-30 days. Good results were achieved in 51.61%, fair in 22.58% and poor in 25.80%. The literature on endoscopic management of urethral stricture is briefly reviewed.

[Bilateral kidney injury caused by a firearm. Presentation of a case]. / Traumatismo renal bilateral por arma de fuego. Presentación de un caso.

We report a case of penetrating renal trauma from firearm involving both kidneys. Radiologic and CT examination revealed no associated lesions to vital organs. Following conservative treatment which had been instituted initially, the patient developed an external urinary fistula and a retroperitoneal abscess which were resolved utilizing a ureteral catheter and drainage, respectively. Complete functional recovery of both kidneys was achieved at 35 days. The diagnostic and therapeutic aspects of renal trauma from gunshot wounds are reviewed and discussed.

[Prognostic factors in 243 transitional carcinomas of the bladder (I): clinical and macroscopic parameters of the tumor]. / Factores pronósticos de 243 carcinomas transicionales de vejiga (I); parámetros clínicos y macroscópicos del tumor.

A retrospective study was undertaken in 243 cases of transitional cell carcinoma of the bladder to determine the correlation of clinical parameters (sex, age, symptoms and duration of the disease) and tumor gross anatomic features (cystoscopic aspects, tumor number, size and site) with survival. The study comprised 148 superficial carcinomas and 95 infiltrating carcinomas of the bladder. The following clinical parameters were observed to influence survival of patients with superficial or deep tumors: patient age (worse prognosis for those over 60 years) and initial symptoms (better prognosis for those whose presenting symptom was hematuria). With regard to tumor gross anatomic features, a correlation was observed between the cystoscopic aspects of the tumor and type of infiltration in 80% of our series (1 error out of 5 cystoscopies). A worse prognosis was observed for multiple lesions only in those with superficial tumors. Tumor site and size did not influence survival in this series of 243 transitional cell carcinoma of the bladder.

[Prognostic factors in 243 transitional carcinomas of the bladder (II): microscopic parameters of the tumor and staging]. / Factores pronósticos de 243 carcinomas transicionales de vejiga (II); parámetros microscópicos del tumor y el estadío.

A retrospective study was undertaken in 243 cases of transitional cell carcinoma of the bladder to determine the correlation of tumor microscopic features (mitotic index, histologic grade, internal border of tumor growth, lymphocyte infiltration, necrotic and vascularized areas) and stage with survival. The study comprised 148 superficial tumors (131 papillary, and 17 non-papillary) and 95 deep infiltrating tumors (34 papillary and 61 non-papillary or solid tumors). With regard to the superficial tumors, survival was influenced by the mitotic index (a greater number of mitoses correlated with a worse prognosis), histologic grade (a higher histologic grading correlated with a worse prognosis), internal border of tumor growth (the expansive tumor type showed a better prognosis), and necrosis (wide areas of necrosis correlated with a lower survival rate). Furthermore, a worse prognosis was observed for the non-papillary or solid tumors. Lymphocyte infiltration, however, was not observed to influence survival. As for the deep infiltrating tumors, survival was influenced by the histologic grade, internal border of tumor growth, lymphocyte infiltration (a greater lymphocyte infiltration correlated with a better prognosis), necrosis, and tumor type (papillary or non-papillary). The mitotic index or vascularization showed no influence on survival. A higher tumor stage correlated with a worse prognosis. The prognosis for non-papillary (solid) superficial tumors overlaps that of infiltrating tumors. For this reason, special attention should be focused to these tumors.

[Morphometric study of transitional carcinoma of the bladder (I): analysis of 148 superficial tumors]. / Estudio morfométrico del carcinoma transicional de vejiga (I): análisis de 148 tumores superficiales.

A morphometric study of the tumor cell nucleus was performed in 148 cases of superficial transitional cell carcinoma of the bladder. Of these, 131 were papillary and 17 were nonpapillary tumors. Our methodology is compared with those described elsewhere. With regard to papillary tumors, the nuclear size of the internal papilla near the stroma was found to be greater than that of the external papilla near the bladder lumen. Tumor cells with internal papillary nuclear size less than or equal to 28 microns 2 appeared to have a better prognosis. Thus, nuclear measurements in this area must be performed in future studies. No conclusive data could be obtained relative to the nonpapillary tumors. For both papillary and nonpapillary tumors, the higher the histologic grade, the greater the nuclear size, the differences being statistically significant.