[Wilms' tumor in the adult. A new case and review of the literature]. / Tumor de Wilms en el adulto. Un nuevo caso y revisión de la literatura.

The nephroblastoma is a rare tumour in the adult and there are 240 cases reported in the world literature. We offer a new case and then review the literature, analysing the major features of diagnosis, treatment and evolution of this tumour.

[Non-radical treatment and bladder conservation in infiltrating tumor of the bladder]. / Tratamiento no radical y conservación vesical para el tumor infiltrante de vejiga.

The fate of some infiltrant tumours of the bladder locally advanced (pT2-3NxM0) which were radically resected, with or without association to other treatments, has been similar to those in which initial radical treated was used. To carry out simultaneously a radical RTU as a local action plus systemic chemotherapy (M-VAC), for microscopic metastasis, clinically undetected, seems to us the most effective combination. In our Urology Unit, the evolution (September 88-January 91) of 9 patients presenting this tumour and preservation of the bladder is being followed-up. The primary tumour was treated with radical RTU in 7 cases and partial cystectomy in 2. There are 5 tP2, 1 pT2 + "in situ" carcinoma (Ca) and 3 pT3, 4 G1, 4 G2 and 1 G3. All tumours were single, small (2-4 cm), with varied location and nearly all with medium to low differentiation. Later all patients underwent systemic chemotherapy with M-VAC (3 cycles). Following RTU and QMT every three months, the likely local and systemic progression of the disease has been evaluated through cystoscopy and multiple biopsies including from the prostatic urethra, RTU of anterior scar, two-hand palpation, urinary cytology, blood testing, CAT, abdominal ECO, chest X-ray and laparoscopic lymphadenectomy (coinciding with its development within the Unit) in the last case. Average follow-up (at the time of the review) has been 15.77 months (6-28 months).(ABSTRACT TRUNCATED AT 250 WORDS)

[Camey II type substitution ileocystoplasty. Our experience]. / Ileocistoplastia de sustitución tipo Camey II. Nuestra experiencia.

We present our experience in the performance of Camey II type substitution ileocystoplasty. The operation was performed between January 1988 and February 1989 on 11 patients who had been diagnosed as having vesical tumour by means of transurethral resection. All of them had received preoperative systemic chemotherapy. Technically, we single out the performance of ileo-obturating lymphadenectomy prior to the cystoprostatovesiculectomy in the same operation, creation of the neobladder with detubulized terminal ileum, uretero-ileal reimplantation according to Le Duc-Camey technique and use of mechanical sutures to reestablish intestinal continuity. Operative and postoperative mortality has been null. As complications, we may mention a urthro-ileal fistula as a result of the suture tension at this level, due to shortness of the mesointestine, and which yielded with conservative measures. Amongst tardive complications we may single out a urethro-ileal stenosis, which required performance of an internal urethrotomy. Daytime continence in all patients, except one. Night continence in six cases. Absence of ureteral reflux and upper urinary tract with correct function and morphology in all cases. The follow-up time ranges from 3 to 16 months. We conclude that this type of vesical substitution offers all patients a good quality of living and adequate mictional comfort.

[Obstruction of the upper urinary tract caused by a malignant retrovesicular schwannoma. Therapeutic strategy]. / Obstrucción del tracto urinario superior causada por un Schwannoma maligno retrovesical. Estrategia terapéutica.

We present a case of malignant Schwannoma (MS) of uncommon, retroperitoneal and retrovesical localization in a 42-year-old male, which provoked bilateral ureteral obstruction as a urological manifestation. We show our therapeutic strategy by means of a schedule of systemic neoadjuvant chemotherapy with vincristine, adriamycin, cyclophosphamide, decarbacine combined with exeresis and urinary continuity reconstruction surgery. We point out that it is a low incidence but highly aggressive tumour and that treatment continues to be local radical excision, whilst chemotherapy probably continues to have little value.

[Radical prostatectomy in cancer of the prostate. Preliminary adjuvant therapy and previous considerations]. / Prostatectomía radical en el cáncer de próstata. Tratamiento adyuvante previo y consideraciones previas.

We report our early results in the treatment of nonmetastatic prostate cancer (stages A, B, C) by radical surgery. All but two patients classified as stage A1 received adjuvant treatment with hormone blockade using LH-RH analogues and an antiandrogen for a period of two to six months. A favorable local response was observed in almost all patients. Adjuvant therapy achieved reduction of prostate size and most of the cases could be staged down from the initial clinical staging to fall within the indication of radical surgery, including stage C2 tumors reclassified as local tumor stage C1 or lower. Staging lymphadenectomy prior to radical prostatectomy revealed multiple lymph node involvement in 3 patients who were consequently not submitted to radical surgery. In the remaining 14 cases, definitive postsurgical staging revealed minimum invasion of the capsule without seminal vesicle involvement (stage C1) in only two cases with A2 and B2 tumor in the initial staging. There were no operative deaths and morbidity was scant. Some modifications aimed at enhancing exposure of the surgical field and thereby reducing complications are described. Although a longer patient follow-up is warranted, to date all patients are alive and no local recurrence or distant metastases have been observed.

[Neoadjuvant chemotherapy (M-VAC) in invasive cancer of the bladder. Our experience]. / Quimioterapia neoadyuvante (M-VAC) en el cáncer invasivo de vejiga. Nuestra experiencia.

Thirty-three patients with locally advanced T2-4NxM0 muscle infiltrating bladder carcinoma were treated with M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) following TUR. Twenty-eight patients were evaluable since 4 had been receiving the foregoing treatment and 1 was being reevaluated after having undergone a partial cystectomy procedure prior to the chemotherapeutic regimen. Eighteen patients underwent radical cystectomy after neoadjuvant chemotherapy, 2 bladders could not be resected, 2 patients refused the procedure and the remaining 6 patients had a functioning bladder. Of the 28 patients, 46.42% (pCR) were pT0 (including the 6 patients with a functioning bladder, and 10.71% (pPR) were down-staged. This represents a pGR of 57.13%. Four of the 18 patients who underwent cystectomy had a higher pathologic stage evidenced by the surgical specimen than the initial finding at TUR indicating that 22.22% had been understaged. Noninvasive diagnostic methods (TUR, cytology, ultrasound, CT...) could not demonstrate the presence of tumor in those patients with preserved bladder. The cRC is similar (46.42%) and the cRP was 7.14%, giving a total cRG of 53.56%. With a mean follow-up of 13.63 months (range 5-36+), 54.54% are alive and disease-free, including the 6 patients with preserved bladder, and 21.21% are alive with locoregional recurrence or distant metastasis. Currently the mortality rate is 9.09%. The correlation of the data gleaned from the clinical response and that of the pathological condition, the possible understaging of the preserved bladders and the outcome in a series with a very short follow-up have as yet to be elucidated.