[Non-surgical treatment of testicular cancer: guidelines for the urologist]. / Aspectos no quirúrgicos del cáncer testicular: guía práctica para el urólogo.

Near 70% of patients diagnosed with testicular seminoma make their presentation without metastasis. Although spread at the time of diagnosis is the rule, 25% of non-seminomatous germ-cell tumours are found confined to the testicle at presentation. Standardization of diagnostic and follow-up methods -within reach of most urology services- should allow a closer relationship between urologists and testicular tumours. Observation of "aggressive" surveillance schedules for stage I non-seminomatosous tumours confined with no risk factors, and use of radiotherapy to treat low degree (I,IIa and IIb) seminomas should allow urologists an initial control of up to 50% of patients. Occurrence of relapse or presentation in advanced stages force the use of chemotherapy. The present paper outlines the most basic aspects of non-surgical treatment of patients with testicular tumours.

[The relationship of PSA to age and prostatic volume in patients with benign prostatic hypertrophy]. / Relación del PSA con la edad y el volumen prostático en pacientes con hiperplasia benigna de próstata.

Prostate specific antigen (PSA) is the most useful market for the diagnosis, staging and monitoring of prostate cancer. However, the effect of benign prostate hyperplasia on PSA levels is less well known. It has been reported that 20-45% of all adult males with BPH have PSA values over the normal range. To study this confounding factor we have analyzed the likely relationships between monoclonal PSA, age and prostate size as determined by ultrasound, in our series of 163 patients with BPH undergoing adenomectomy. Within the studied factors, the most conditioning parameter of PSA variability was prostate size. The correlation coefficient (r) was 0.61, with the determination coefficient (r2) being 0.037 (p < 0.001). Age correlation, although less important (r = 0.31), was statistically significant. Both variables were independent and resulted jointly in a correlation coefficient of 0.64. Also included is the mathematical formula used in our series to correlate PSA with age and prostate volume. Its application could mean an increased specificity of this tumoral marker.

[Diagnostic and therapeutic retrograde ureterorenoscopy (URS)]. / Ureterorrenoscopia retrograda (URS) diagnostica y terapeutica.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

[Expectant treatment of superficial bladder tumors: preliminary results]. / Tratamiento expectante de los tumores vesicales superficiales: resultados preliminares.

A group of patients presenting with superficial bladder tumors (Ta-T1, G1-G3) was entered in a surveillance program following TUR. A standard univariative analysis was used to study tumor and patient prognostic factors to recurrence and progression. To define further the importance of each variable, a multivariative analysis was performed. Regardless of stage, grade and sex, patients with multiple tumors and/or size > or = 2 cm were particularly exposed to frequent recurrences. Early recurrences (before month 9) were associated with high recurrence rates. Considering the results of topical chemotherapy and toxicity of BCG immunotherapy, surveillance could be and option for superficial bladder tumors, reserving adjuvant therapy for large, multiple or early recurrence.

["Supreme" dressing in the prevention of hematoma and edema in scrotal surgery]. / Vendaje "sumo" en la prevención del hematoma y edema en cirugía escrotal.

An efficient compression can reduce the complications of an inadequate hemostasis following scrotal surgery. The main difference between the "sumo" and previously described compressive methods lies in the use of both pelvic brims as main loading points for the dressing. Similar features are provided by standard scrotal supports but the compression they are able to achieve is minimal compared to that of "sumo" dressing.

[Recurrent retroperitoneal malignant fibrous histiocytoma of myxoid type with mesocolon infiltration]. / Histiocitoma fibroso maligno retroperitoneal recidivante tipo mixoide con infiltración de mesocolon.

Malignant fibrous histiocytoma is an uncommon soft tissue sarcoma. If located in the retroperitoneum, abdominal pain is the predominant clinical feature. Like all primary tumors in this area, it is difficult to diagnosis early. A case of malignant myxoid retroperitoneal fibrous histiocytoma is described. Six years after it had been resected, the tumor recurred and infiltrated the mesocolon. The patient was submitted to intestinal resection. Although this tumor type carries a poor prognosis, patient survival is longer and there are less metastases.

[Conservative treatment of muscle-infiltrating bladder tumors with TUR]. / Tratamiento conservador mediante RTU de los tumores vesicales musculoinfiltrantes.

OBJECTIVES: The absence of tumor in up to 10% of cystectomy specimens of patients with invasive bladder cancer justify the search for non aggressive therapies. The present study attempts to establish the safety and curative capacity of TUR alone for patients with superficial muscle-infiltrating bladder cancer. METHODS: Over a period of 18 months, 12 patients with superficial muscle-infiltrating bladder cancer (T2) were diagnosed at our department, TUR was repeated in 9 of the 12 patients. The extension study was negative in all 9 patients. RESULTS: The mean follow up was 12.8 months (range 7-70 months). Local recurrence was found in 4 patients (44.4%) who were submitted to another TUR; 3 were superficial and 1 invasive (with the same muscle involvement as at the initial diagnosis). The tumor-free survival rate was 9.3 months. No patient showed tumor progression. CONCLUSION: The percentage and nature of local recurrence, tumor-free survival and the progression rate (which was not observed during the short follow up period) indicate that TUR is a treatment option that must be taken into account in selected patients with invasive bladder cancer.

[Value of preoperative autotransfusion in elective urologic surgery]. / Interés de la autotransfusión preoperatoria en cirugía urológica electiva.

Over a period of 5 months, 50 patients were entered into the preoperative autologous blood donation program of our Service. Two patients were excluded; one had previously had an acute myocardial infarction and the other had epilepsy. The remaining 48 patients, which accounted for one third of our elective surgery procedures, all accepted to enter the program. These patients were not more severely anemic than the other patients not in the program and who underwent the same surgical procedures. No patients required homologous blood transfusion and no complications ascribable to the procedure were observed. Although it is not utilized widely to date, predeposited autologous blood transfusion is a safe and efficient method, with no remarkable morbidity, even in patients aged over 65 years, the age group of one half of our patients. Autologous blood transfusion programs are necessary. The indications, the exclusion criteria for patients at high risk and the objective parameters for evaluating its success must be established.

[Eosinophilic cystitis]. / Cistitis eosinofílica.

We report two cases of eosinophilic cystitis that had been diagnosed anatomo-pathologically after TUR. These patients had a previous history of low grade and stage superficial bladder tumor that had been treated by intravesical interferon after surgery. The literature is reviewed highlighting the etiopathogenic aspects, the possible relationship with immune allergic factors, clinical aspects, diagnosis and treatment.

[Tumors of the female urethra: difficulties in the early diagnosis]. / Tumores de uretra femenina: dificultad en el diagnóstico precoz.

There is no widespread agreement on the treatment of tumors of the female urethra due to their scant incidence. These are generally slowly growing tumors with no salient or specific symptoms and signs. They manifest late and can be misdiagnosed as urethral lesions mimicking a tumor, therefore a biopsy is warranted. For all the foregoing reasons, these tumors are diagnosed in the advanced stages, with a worse prognosis despite very aggressive therapies. Two such cases are described: one was a Grabstald stage C3 epidermoid carcinoma that was submitted to anterior pelvic exenteration and died at 6 months, and the other was a Grabstald stage D4 papillary adenocarcinoma that died a few days after a resection biopsy. Due to the lower incidence of urethral adenocarcinoma, we review the literature on this tumor type and highlight its greater predisposition to progression which carries a worse prognosis.