Incidence of upper tract urothelial carcinoma in Spain. / Incidencia del carcinoma transicional del tracto urinario superior en España.

INTRODUCTION AND OBJECTIVES: The incidence of upper urinary tract tumors is currently unknown. The aim of this study is to determine the real incidence of upper tract urothelial carcinoma (UTUC) in Spain. MATERIAL AND METHODS: A descriptive, prospective and multicenter epidemiological study was conducted in 31 Spanish facilities by means of the Platform for Multicenter Studies of the Spanish Association of Urology. Recruitment was opened from May 1st, 2017 to April 30th, 2018. The original database was exported directly from the electronic Data Collection Logbook on December 15th, 2018, with a total of 404 cases registered (402 valid cases after depuration). Statistical analysis was performed using IBM SPSS software v 23 and EPIDAT v 3.4. RESULTS: The incidence adjusted to Spanish population from raw data was 3.27 cases per 100.000 inhabitants per year (2.93 - 3.61 95% CI) and 3,3 cases per 100.000 inhabitants per year (2.96-3.66 95%CI) when adjusted to European population by age. The mean age at diagnosis was 70 years, and 77% of patients were male. Thirty-four percent of patients had an incidental diagnosis. Tumors were most commonly located in the pyelocalyceal system (54%), followed by the distal ureter (22%). Prior ureteroscopy was performed in 114 patients: this technique modified the subsequent treatment indication in 58% of cases. Radical nephroureterectomy was performed in 311 patients. Kidney-sparing surgery was the elected treatment in 76 patients (20%). Complications were found in 69% of cases, most of them classified as Clavien 1 and 2 (86% of all complications). Postoperative mortality rate was 1.7%. CONCLUSIONS: UTUC adjusted incidence rate in Spain is 3.27 and 3.3 in Europe. Prior URS modified the treatment indication in 18% of patients. We found a 69% complication rate and a 1.7% mortality rate.

Outpatient Holmium laser fulguration: A safe procedure for treatment of recurrence of nonmuscle invasive bladder cancer. / Fulguración ambulatoria con láser Holmium: Un procedimiento seguro para el tratamiento de la recidiva del carcinoma vesical no músculo infiltrante.

BACKGROUND AND OBJECTIVE: Nonmuscle invasive bladder cancer has a high recurrence rate and a low progression rate. The aim of this study was to assess the effectiveness, safety and feasibility of Holmium laser fulguration in an outpatient regimen for selected tumours. MATERIAL AND METHOD: A prospective, longitudinal cohort study was conducted between January 2009 and December 2016. Seventy-nine Holmium laser fulguration procedures with subsequent instillation of mitomycin C were performed in an outpatient regimen on 59 patients with a history of low-risk bladder cancer and recurrence of small papillary tumours. We performed a descriptive data analysis and analysed the relapse-free time using Kaplan-Meier curves. RESULTS: All procedures were completed in one day, and only one patient required subsequent hospitalisation due to haematuria. Some 87.2% of the patients presented pain with a visual analogue score ≤3. Recurrence occurred after 49.4% of the procedures (27.3% at 12 months). The median follow-up time was 17 months (range, 2-65). The onset of recurrence was significantly earlier after the second fulguration than after the first (median, 10 months vs. 56 months). CONCLUSIONS: Holmium laser fulguration and subsequent mitomycin C instillation in an outpatient regimen is a safe and feasible alternative to transurethral resection of bladder tumours in selected patients. Transurethral resection of the bladder tumour is recommended for patients with recurrence after fulguration, given the possibly higher risk of progression in these patients.

Long-term follow-up of the AdVance®/AdVanceXP® sling. What are the surgeons' impressions? What are the patients'? / Seguimiento a largo plazo del cabestrillo AdVance®/AdVanceXP®. ¿Qué piensa el cirujano?, ¿qué piensa el paciente?

OBJECTIVES: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. PATIENTS AND METHOD: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. RESULTS: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. CONCLUSIONS: The Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.

[Extrinsic stenosis of the ureter. Our caseload and review of the literature]. / Estenosis extrínseca de uréter. Nuestra casuística y revisión de la literatura.

Obstructive uropathy is the common presentation course for various processes with an origin either intraluminar, parietal or extraluminar. A retrospective analysis of 41 cases of extrinsically originated obstructive uropathy seen in our Urology Unit from 1976 to 1991 was carried out. The cases were divided in three groups following an exclusively etiological criterion: 21.9% (9 patients) corresponded to primary retroperitoneal fibrosis; 51.2% (21 patients) to tumoral ureteral obstruction; and 26.8% (11 patients) to non-tumoral processes. For each division established, the features of clinical presentation, performance of the various diagnostic procedures used, and different therapy approaches are described also including a review on the current literature.

[Therapeutic options in metastatic renal carcinoma]. / Opciones terapéuticas en el carcinoma renal metastásico.

Within the scope of urogenital tract tumoral diseases, renal adenocarcinoma is the third most frequent neoplasia diagnosed in the adult population. The limited clinical presentations in early analysis and their anarchical behaviour are the cause for 50% to 60% of patients having already developed distant disease at the time of diagnosis. The only curative procedure so far is radical surgery, which is possible when there is a single metastatic site and sometimes even, depending on various factors which will be analyzed, several sites. In these occasions, the traditional therapeutic choices (Hormonotherapy, Chemotherapy, Radiotherapy) have proven to have limited or no efficacy in managing the disease. This fact, together with the successful results obtained in other tumoral processes, have allowed the clinical development of different modalities of Immunotherapy for the management of metastatic renal carcinoma, with results clearly hopeful. This work is a review of the results reported for each of the mentioned therapeutic choices, basically analyzing the role currently played by surgery and immunotherapy in the management of advanced renal carcinoma.

[Use of statistical analysis in original articles in "Actas Urológicas Españolas." Accessibility for the reader]. / Uso de los análisis estadísticos en los artículos originales de Actas Urológicas Españolas. Accesibilidad para el lector.

OBJECTIVES: To describe the use of statistical methods employed in original articles published in Actas Urológicas Españolas as the first step to quantify the accessability for the readers. METHODS: Observational, retrospective, descriptive and transversal study to analize all the original articles published in Actas Urológicas Españolas during the year 2000. Once the anectotic cases were excluded, 55 original studies were selected. In each article it was minuciously reviewed the methods and results sections, tables and figures included, to identify the statistical analysis used and to classify them into 18 categories with three accessability levels as Emerson and Colditz and Mora y cols, previously reported: descriptive statistics, bivariables analysis and complex analysis. A randomized sample of the originals were reviewed again by the same investigator three months later to evaluate the criteria liability. The accessability was defined as a) article dependent (rate of originals that readers with different statistical knowledge are able to understand) and b) analysis dependent (rate of statistical methods respect to the total performed overall the articles that readers are able to understand). RESULTS: Our major findings are that the more frequently used technics are descriptive analysis (39.3%), bivariable tables (12.1%), survival analysis (10%), t Student and z tests (6%), and nonparametric tests (8.6%). The accessability for a reader which statistical konowledge includes bivariable methods is 63.6% (IC 95% 49%-76%) and 79% (IC 95% 71%-85), article and analysis dependent respectively, rates that are similar to the reported for biomedical journals in our country. CONCLUSIONS: A great percentage of original articles in Actas Urológicas Españolas includes complex analysis. It could be good that readers were able to increase our statistical and methodological knowledge to perform a critical approach to our publication.

[Conservative treatment of germ cell tumor of the testis]. / Tratamiento conservador del tumor testicular de células germinales.

Testis germ cell tumor is the most frequent cancer in men between 15 and 35 years old. The therapeutic results of radical orchiectomy and chemotherapy reaches 90% free disease survival al the present time. This great chemosensibility is opening new doors to alternative therapeutic options, directed to preserve the sufficient amount of tissue to avoid the problems derived from testicular insufficiency. Such alternatives are clearly beneficial in bilateral germinal tumors or in solitary testis. In this article we describe a case of seminoma developed in a solitary functional testis managed in a conservative approach: organ preserving surgery and surveillance. We analyzed the indications and international results of such approach based on the best evidences now available.

[Cadaver kidney grafts from donors over 60 years of age should be considered as suboptimal]. / Los injertos renales de donantes cadáver mayores de 60 años deben ser considerados subóptimos.

Considering the scarcity of organs for transplantation, one possible solution is the use of grafts from aged donors (over 50 years). We have reviewed our experience in the case of kidney transplantation considering the period from 1989-1994 in order to attain a minimum follow-up of 36 months. We compare three groups: donors aged between 50-60 years (n = 32), donors aged over 60 years (n = 25) and a control group formed by donors of "ideal" ages. The results show that kidneys from donors over 60 years evidence, as compared to the control group, a higher incidence of acute tubular necrosis (p = 0.032), significantly higher blood creatinine levels in all the intervals considered, and a graft survival which is 14% less at 12 months and 40% less at 36 months (p = 0.0009). These differences are most probably to be attributed to the changes caused in these organs by advancing age and by previous pathological situations, as we have not detected a higher incidence of immunologic or surgical complications.

[Complications of varicocele embolization: adhesion of the intravascular catheter during infusion of bucrylate]. / Complicaciones de la embolización del varicocele: adhesión del catéter intravascular durante la infusion de bucrilato.

The introduction of percutaneous occlusion techniques to manage a varicocele has made possible the control of the process with success rates similar to those obtained with conventional surgery. Its efficacy and minimal invasive nature, although not entirely risk-free, are responsible for its expansion. Contribution of one case of adhesion of the intravascular catheter to the underlying spermatic vein wall during infusion with isobutyl cyanoacrylate (bucrylate) as embolization material, an event which forced immediate surgical removal.

[Intradiverticular bladder tumors]. / Tumores vesicales intradiverticulares.

Retrospective study conducted on 58 patients with vesical diverticulum seen in our unit between 1975 and 1992, of which a total of 11 (18.9%) patients had vesical tumours. Of these, 6 (10.3%) were intradiverticular and 5 (8.6%) extradiverticular. Sixty-six percent of patients with intradiverticular tumours also had prior or concurrent history of extradiverticular vesical tumours. The most frequent clinical presentation was gross haematuria. The abdomino-pelvic CT is the most sensitive morphological examination although in 33% cases it resulted in overstaging. Curative treatment was only possible in the 4 patients with urothelial tumours, in whom 3 partial cystectomies with pelvian lymphadenectomy (2 pT1 G2 and 1 pT3 G3) and 1 TUR (T1 G2) were performed. The 2 (33%) remaining patients had advanced locoregional epidermoid carcinoma (T4 N+). All patients with urothelial carcinoma are alive with follow-up ranging between 6 months for the one infiltrant case and 136 months for a surface tumour undergoing partial cystectomy. Prognosis for both epidermoid carcinoma was ominous with mean survival time of 9 months. Review of the literature and discussion of epidemiological, clinical, diagnostic, therapeutic and prognostic issues.

[Renal cystic carcinoma: report of five cases]. / Carcinoma renal quístico: presentación de cinco casos.

Of 204 renal adenocarcinomas seen in the Urology Service at the Hospital "12 de Octubre", from January 1974 to December 1992, we found five cases (2.5%) of cystic renal carcinoma in patients with an average age of 51.8 years (range 35-69), with a female vs male ratio of 3:2, and a right-sided vs left sided ratio of 4:1. The article describes the signs and symptoms, diagnostic methods used, treatment and subsequent evolution of our series, and includes a revision of the published literature.

[Extramedullary hematopoiesis, a simulator difficult to diagnose]. / Hematopoyesis extramedular, un simulador de difícil diagnóstico.

The extramodular hematopoiesis is the result of the bone marrow sever chronical hypofunction, being the genitourinary affection very unusual. We are presenting a singular case by its own clinicopathology consequences and exceptional incidence in context of a upper tract urothelial tumor.

[Melanoma in urology: our experience and review of the literature]. / El melanoma en urología: nuestra experiencia y revisión de la literatura.

Melanomas make up 2% of all body tumours, but the figure is increasing mainly in countries with longer sun hours daily. Genitourinary location is even more infrequent. That explains our clinical report when we discovered the three cases seen in our unit, one in a female urethra, one suprarenal and the third one in the bladder.

[Incidental renal adenocarcinoma: study on 54 cases]. / Adenocarcinoma renal incidental: estudio sobre 54 casos.

Between 1974 and 1992, both inclusive, 204 renal adenocarcinomas were treated in the Urology Unit of the '12 de Octubre' Hospital, of which 54 (26.4%) were diagnosed by chance. The relative frequency of these renal tumours has experienced a highly significant progressive increase, from 0 in the 1974-1978 interval, to 13.04% in 1978-1980, 14.7% between 1981-1983, 20.68% in 1984-1986, 37.84% in 1987-1990, to reach over the last three-year period of 1990-1992 the remarkable figure of 41.93%. There has been no differences regarding incidence by sex (50% males and 50% females). Mean age at presentation is 61.5 years, ranging from 23 to 78 years. The suspected pathological cause most frequently leading to carry out the study where renal carcinoma is accidentally diagnosed are gastrointestinal disorders (50% of cases). The most frequently used imaging diagnostic technique is ultrasound (50% cases), emphasising the gradual increase in the number of cases diagnosed by ultrasound or CAT during the course of the study. Carcinomas accidentally diagnosed by CAT are those with less volume in our series. Regarding tumour characteristics, it should be pointed out a higher occurrence in the right kidney (64.8%) and a most frequent location in the upper renal pole (48%). Mean tumoral volume was 126 cc, although that value has gradually dropped, so that now the mean volume of accidental tumours treated over the last 5 is being 91 cc. Most cases present low staging at the time of diagnosis, 81% being pT2 N0 M0. Current overall survival is 89% of all cases followed-up.

[Priapism caused by cauda equina compression. Report of a case and review of the literature]. / Priapismo por compresión de cauda equina. Aportación de un caso y revisión de la literatura.

As a result from the mechanical irritation provoked on the sacral roots, the cauda equina compression syndrome can involve, as part of its symptomatic state, involuntary erections and mictional disorders which arise when standing and stretching the spine. In the eight cases of priapism from this cause reported in the international literature, surgical decompression has solved the clinical picture. We now present a new case with the peculiarity that, following unsuccessful surgical therapy, the infiltration of the compromised spinal roots has rendered excellent results.

[Tumors of the female urethra: presentation of cases and review of the literature]. / Tumores de uretra femenina: presentación de nuestros casos y revisión de la literatura.

Female urethra tumours are rare conditions and so the series presented in the literature gathers just a few cases, and therefore is difficult to reach a conclusion with regard to the definite treatment to be adopted in each case. It appears to be certain that even histologically malignant forms of this disease can be cured in the earlier stages. The most representative cases presented in our experience are analyzed and an overall review of the literature is made aiming to examine the experience of various authors with regard to the diagnosis and treatment of the injuries.

[Impact of transplantectomy of the first graft on the clinical course of cadaver renal retransplantation]. / Influencia de la trasplantectomía del primer injerto en la evolución del retrasplante renal de cadáver.

PURPOSE: At the present time a number of prediction factors on the outcome of second cadaver renal transplants are known, in particular the influence of recipient response to the first graft. However, we do not know if retaining or removing the non-functioning organ has any repercussion on subsequent transplants. This is the object of the present study. MATERIAL AND METHODS: A retrospective study was carried out on the clinical records of 80 patients who had undergone a second cadaver renal transplant under CyA between 1985-1995 at Hospital 12 de Octubre. Data on the characteristics and outcome of the first and second transplants were collected, plus those concerning the recipient and donor. These variables were used to construct a multivariant analysis model of graft survival. The nephrectomy of the non-functioning graft was only carried out when absolutely necessary (n = 58). RESULTS: The multivariant analysis showed that the nephrectomy of the non functioning graft did not modify the risk of recipient sensitization or the probability of developing acute or chronic rejection of the second graft. However, it reduced the risk of losing this second graft at medium or long term significantly (p = 0.009). CONCLUSIONS: These data constitute the first solid argument in favor of elective nephrectomy in candidates for a second cadaver renal transplant. Nevertheless, a more thorough study should be carried out of the immunological mechanism involved before recommending this as a general procedure.

[Hydatid cyst and renal adenocarcinoma: an exceptional association]. / Quiste hidatídico y adenocarcinoma renal: una asociación excepcional.

Presentation of one case of an exceptional association in the same renal unit of a hydatid cyst and an adenocarcinoma, in a female patient who arrived to the emergency service with a picture of haematuria and lower back pain. The paper discusses the diagnostic complications posed by the large central necrotic component of the tumour, the adjacent position of both lesions and, basically, the initial intention of performing conservative surgery after it was demonstrated that the patient had mild renal insufficiency and simple cysts in the other kidney. In the end, faced with the perioperative finding of a neoplastic-like mass, radical surgery was performed. Analysis of the diagnostic and therapeutical difficulties with complex cystic masses in general.

[Neuroendocrine renal tumor. An unusual case. Review of the literature]. / Tumor renal neuroendocrino. Un caso de rara presentación. Revisión de la literatura.

The neuroendocrine renal tumors are of extremely strange presentation. We present a review of the literature published on this pathology.

[Abdominal paragangliomas. The experience of the Hospital 12 de Octubre]. / Paragangliomas abdominales. Experiencia del Hospital 12 de Octubre.

This is a revision of our experience between 1975 and 1992 over a total of 35 patients who underwent surgery in 40 occasions for pheochromocytoma. If we dismiss one case of pheochromocytoma with early metastatic malignant presentation and which was not removed, a total of 6 patients with abdominal paraganglioma (17%) have undergone surgery in 10 occasions. Three of them (50%) were multiple and recurrent, an one (16%) become malignant after multiple recurrences. Average age was 34.6 years with balanced sex distribution. No patient had neurofibromatosis, Von Hippel Lindau disease, MEN syndromes or Carney's triad and only one case, which corresponded to the malignant pheochromocytoma, showed direct familial background. All patients were hypertensive. Four cases (66%) presented with catecholamine crisis, one case was an incidentaloma that at the 24-hour monitoring presented hypertensive crisis during the sleep, and the last one was diagnosed while investigating a case of sustained HTA in a young female. All patients had high urinary catecholamine excretion. To establish location of the tumour MIBG scanning (90% sensitivity) was used in first place followed by guided CT (80% sensitivity) since both techniques have a good correlation in order to design the surgical approach. Angiography was reserved for cases where the other two techniques were inconclusive or when it was necessary to obtain a better profile of the surgical anatomy. A total of 15 paraganglioma were removed, the most frequent location being renal parahilar (26%) followed by preaortic in Zuckerkandl's organ (20%) and vesical (20%). The most relevant intraoperative complications were HTA crisis related to anaesthetics manoeuvres and tumoral handling (90%), and hypotension following tumour exercises (10%). During the postoperative period, three patients required blood transfusion and one of them had to be re-intervened for bleeding caused by unnoticed damage to the right renal vein. Currently, three patients (50%) are disease free, one with residual mild HTA controlled with diuretics. Two patients (33%) are awaiting for re-intervention due to recurrence (one with multiple extra-abdominal recurrence) after one and two prior interventions respectively. The last one (16%) is the malignant pheochromocytoma, operated four times for recurrence which currently shows lung metastasis with adequate drug control of clinical manifestations, after polychemotherapy failure and 27-months follow-up since metastasis has been detected. Revision of existing literature and discussion of issues related to signs and symptoms, diagnosis, surgical preparation and approach, as well as prognostic implications related to paraganglioma as compared with adrenal-located pheochromocytoma.