[Therapeutic effect of mitomycin C in the immediate postoperative period in patients with intermediate-risk non-muscle-invasive bladder tumors]. / Efecto terapéutico de mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de riesgo intermedio.

INTRODUCTION: Approximately 70-85% of transitional bladder cell carcinomas are non-muscle-invasive. After an initial surgery, around 60-90% will have a recurrence, being the highest risk period the first two years. Urothelium instability could be the main reason for recurrence in mid grade tumours, reason why a single dose of a chemotherapy after transurethral resection of the bladder (TURB) might be insufficient. That is why a deferred therapy in occasions associated with maintenance is recommended. PATIENTS AND METHODS: A prospective, controlled and randomized study was performed. We included non-muscle-invasive mid risk bladder tumours. All patients had initially a TURB performed and were randomized to receive a single dose of mitomycin C (MMC), in the immediate postoperative period. RESULTS: A total of 105 patients were included. Mean follow-up was 22, 70 +/- 8, 15 months. MMC was administered to 53 patients. Of these 66, 0% had no recurrence and 34.0% had a non-muscle-invasive recurrence. Of the 52 patients in the non MMC group, 53.8% had no recurrence and 44.2% had a non-muscle-invasive recurrence and only 1 patient had a muscle-invasive progression. We did not find significantly differences in time to recurrence in mid risk tumours when using immediate postoperative single dose of MMC or deferred therapy. There was only one case of myelosuppression. DISCUSSION: In mid risk non-muscle-invasive tumors, some studies suggest that early intravesical instillation of chemotherapy reduces the risk of recurrence after TURB. We could not show significantly differences when comparing postoperatorive MMC versus traditional deferred instillations.

[Therapeutic effect of mitomycin C in the immediate postoperatory in patients with low-risk non-muscle-invasive bladder tumours]. / Efecto terapéutico de mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de bajo riesgo.

INTRODUCTION: Bladder cancer is a disease with a high prevalence due to its recurrence rate. Transurethral resection of the bladder (TURB) is the treatment in initial stages. Nevertheless, a high percentage of non-muscle-invasive tumors treated will have a recurrence 1-2 years afterwards. Adjuvant quemotherapy or immunotherapy after TURB has been administered in order to decrease the rate of recurrence and to prevent progression. PATIENTS AND METHODS: A prospectived, controlled and randomized study was performed. We included 100 patients with non-muscle-invasive and bladder tumors the low grade. All patients had initially a TURB performed and were randomized to either receive or not a single dose mitomycin C (MMC) in the immediate postoperatory. RESULTS: All low grade tumors was less than 3 cm. Mean follow-up was 26.43 +/- 7.65 months. MMC was administered in 49 patients, of these, 67.3% had no recurrence and 32.7% had a non-muscle-invasive recurrence. Of the 51 patients in the non mitomycin, 51% had no recurrence while 47% had a non-muscle-invasive recurrence, and 2% had a muscle-invasive progression. We found significantly differences in time to recurrence among the two groups. SUMMARY: We found a greater time to recurrence in the group of single dose adjuvant MMC being this difference statistically significantly when comparing with the other group.

[Effectiveness and tolerability of zoledronic acid in the treatment of metastatic prostate cancer]. / Efectividad y tolerabilidad del acido zoledrónico en el tratamiento del cancer de próstata metastásico.

OBJECTIVES: To assess the effectiveness and tolerability of zoledronic acid in prostate cancer patients with bone metastases at the hormone-sensitive (HS) and hormone-independent (HI) stages. MATERIALS AND METHODS: A nationwide, observational, prospective, open and multi-centre trial was devised, with a total of 218 male patients diagnosed with prostate cancer at the HS stage (36%) or HI stage (64%) who were administered zoledronic acid (4 mg/IV/month for 6 months) in addition to their specific oncological treatment. Effectiveness was assessed by the following means: 1) Assessment of the improvement in pain and mobility; 2) Incidence and time to onset of skeletal-related events (SREs) and 3) Analysis of bone markers. Tolerability was assessed by means of registering the number and type of adverse effects. A satisfaction survey was carried out amongst the patients after the end of the trial. RESULTS: Out of the 218 patients, 170 (78%) were evaluable for effectiveness. A decrease in pain ratings at rest and during movement was observed in all patients, whether in the HS or HI groups (p < 0.0001). Improved mobility was observed likewise (p = 0.005), as was quality of life. The global incidence of skeletal events was 11.2%, with a time to onset of SREs of 10.7 months. There were no significant differences observed between HS vs. HI patients. Osteolysis markers (N-telopeptide) decreased significantly with the treatment across both the HS and HI groups. For safety reasons. 212 patients were evaluable (97.2%). The incidence of adverse drug reactions was 16% (34/212) and was found to be significantly higher in HS patients (22.4%) compared with HI patients (11.9%). Overall, the tolerability of zoledronic acid was good, with no significant morbidity in either group (HS and HI). 66% of the patients reported feeling satisfied or very satisfied. CONCLUSIONS: Zoledronic acid proved effective in the relief of pain, improving mobility and quality of life as well as reducing or delaying the occurrence of skeletal-related events in prostate cancer patients presenting metastatic bone disease, regardless of the phase, whether HS or HI, they found themselves in. Tolerability and patient satisfaction were rates as good.

[Changes in the clinical and anatomo-pathological presentation of prostate cancer in Oviedo in the last 10 years (part I)]. / Cambio en el patrón de presentación del cáncer de próstata en Oviedo en los últimos 10 años: patrón de presentación, manifestaciones clínicas y anatomo-patológicas (parte I).

OBJECTIVES: To describe the clinical and pathological factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004. MATERIAL AND METHOD: We review the 216 patients diagnosed in both years, recording several features. RESULTS: The mean age was significatively lower in the year 2004. In that year, the increments of the PSA levels was the main reason for the diagnosis of the prostate cancer, followed by low urinary tract symptons (LUTS), while the LUTS was the main reason in 1995. There was a greater proportion of high grade tumors in 1995 and also in this year, high risk tumors were the most frequently found, while in 2004 low risk and low grade tumors were predominant. CONCLUSIONS: Due to the general determinations of PSA levels in asymptomatic patients in 2004, we found a greater proportion of high grade tumors in 1995 and lower grade tumors in 2004.

[Changes in the presentation pattern of the prostate cancer in Oviedo in the last 10 years: diagnostic and treatment (part II)]. / Cambio en el patrón de presentación del cáncer de próstata en Oviedo en los últimos 10 aõs: diagnóstico y tratamiento (parte II).

OBJECTIVES: To describe and compare the diagnostic and treatment factors of prostate adenocarcinomas diagnosed in our department in the years 1995 and 2004. MATERIAL AND METHOD: We review the 216 patients diagnosed in both years, recording several features. RESULTS: Significant differences were found in the mean of cylinders taken in the biopsies, being higher in 2004 than in 1995. Hormonal deprivation was the predominant treatment in 1995 followed by radical prostatectomy, while in 2004 radiotherapy (external beam or braquitherapy) was the most frequent therapy used followed by hormonal deprivation and radical prostatectomy. Independent factors to apply the treatment was the age (OR=5,6) and the risk groups (OR=2,8) in the year 2004 and only the age (>70 years vs < or =70) in the year 1995. CONCLUSIONS: The evolution held in treatment therapies for prostate adenocarcinomas, made this disease in terms of treatment a multidisciplinary disease obtaining better results.

[Bilateral abscess of cavernous bodies]. / Absceso bilateral de cuerpos cavernosos.

Report of a rare case of abscess in both cavernous bodies. Its peculiarity is based on the location, the bilateral nature and the absence of a clear causative factor, although it was probably related of a local septic focus (rectal or prostatic). Diagnosis was established with CAT because of the primarily posterior location and the significant peripheral inflammatory reaction. The patient was treated successful with a vigorous antibiotic therapy and open drainage from both cavernous bodies with no development of sequelae such as fibrosis and penial incurvation or impotence.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vesico-uterina: a propósito de dos nuevos casos.

Presentation of two new cases of vesico-uterine fistulae secondary to cesarean operation. In one case our route for surgical approach is explained as a novelty; also, the time-frame within which it was performed, one month, since it is usual to recommend a minimum of three months. In the second case an in-dwelling vesical catheter was sufficient to achieve closure. The article also reviews the existing literature on the different aspects: signs, symptoms and therapy, of this infrequent pathology.

[Renal adenocarcinomas associated with other malignant neoplasms]. / Asociación de adenocarcinomas renales y otras neoplasias malignas.

The renal adenocarcinoma is not a frequent tumour within the scope of multiple neoplasias, at least in the clinical series. Conversely, it appears at a higher relative rate in the post-mortem series. This paper submits a review of renal adenocarcinoma associated in life to other malignant neoplasias, enumerating their major clinical and epidemiological data. Also, it reviews the literature with regard to frequency and etiology, applying the data to our series. The paper concludes that hypernephroma is not a tumour frequently associated with others in life, given its tendency to be secondary to other primary ones, therefore its development depending on survival to the initial tumour. It also emphasizes the need for adequate anamnesis aimed to detect multi-cancer syndromes and the etiology of multiple neoplasias. Further studies are needed to understand the scope of multiple neoplasias and their relative risk.

[Disk kidney. Report of a case]. / Riñón en disco. Presentación de un caso.

Crossed fused renal ectopia (CFRE) is a rare anomaly, the incidence of which is estimated in one case per 700-1,000 births. We present here one case of Disk Kidney, an uncommon variant of CFRE, diagnosed in a female adult patient. Fused renal congenital anomalies are reviewed and the etiologies and presentation forms commented.

[Pelvic lipomatosis: cause of extrinsic ureteral obstruction. Report of a case]. / Lipomatosis pélvica, causa de obstrucción ureteral extrínseca. Presentacion de un caso.

Contribution of one case of pelvic lipomatosis, suspected through diagnostic imaging (CAT) and diagnosed by exploratory laparotomy, leading to severe unilateral ureterohydronephrosis and contralateral distal ureteral ectasia. The features of the disease, presentation form, diagnosis and treatment are discussed.

[Renal cell carcinoma. Clinical onset with peritoneal carcinomatosis. Report of a case]. / Carcinoma de células renales. Presentación clínica debut con carcinomatosis peritoneal. A propósito de un caso.

Renal carcinoma accounts for 2-3% of malignant tumours in the adult, with high tendency for metastasis basically in liver, lymph nodes, lungs and bones. Intraperitoneal, gut, mesentery and omentum involvement is extremely rare affecting only 1% of patients with metastasis at post-mortem. Contribution of one case of renal carcinoma with initial presentation as intraperitoneal metastasis.

[Granulomatous prostatitis. Review of 22 cases]. / Prostatitis granulomatosa. Revisión de 22 casos.

Granulomatous prostatitis is an uncommon inflammatory process of the prostate, which can be caused by a variety of infectious agents or be part of a systemic allergic condition. In most cases, origin is unspecific. Clinical presentation, treatment and evolution are similar to those of benign prostatic hypertrophy and, in many cases, can only be distinguished from prostate carcinoma in the histological study. The authors present in this paper the results and conclusions of a retrospective study of 22 cases of granulomatous prostatitis.

[Renal autotransplantation in a case of idiopathic retroperitoneal fibrosis refractory to other treatments]. / Autotrasplante renal en un caso de fibrosis retroperitoneal idiopática refractaria a otros tratamientos.

We report a case of renal autotransplantation in a patient with right retroperitoneal fibrosis that had been previously treated by ureterolysis with intraperitonization and corticoid therapy without success. The literature is briefly reviewed and the therapeutic possibilities in refractory retroperitoneal fibrosis are discussed, with special reference to renal autotransplantation.