[Hyperammonaemic encephalopathy, possible complication after urinary diversion in radical cystectomy. Review of the literature with regard to a clinical case]. / La encefalopatia hiperamonémica, una posible complicación por derivación urinaria tras cistectomía radical. Revisión de la literatura a proposito de un caso.

INTRODUCTION: Radical cystectomy is an intervention with an important morbidity. Urinary diversion is a possible cause of metabolic complications like hyperammonaemic encephalopathy. CASE REPORT: We present the case of a patient treated with a radical cystectomy and modified ureterosigmoidostomy after diagnosis of bladder cancer. After surgery the patient presented in 4 ocasions recurrent episodic confusion. Laboratory and image tests were normal. Levels of seric ammonium was increased. After supportive treatment and hemodyalisis symptoms disappeared. Later patient was reoperated and a reconstruction to ileal conduit was made. DISCUSSION: Continent urinary diversions are advised due to important negative impact on quality of life produced by ileal conduit. However these diversions have several complications, like encephalopathy secondary to non-hepatic hyperammonaemia. Increased absortion of ammonium by intestinal tissue of the new-ladder induces encephalopathy. Early diagnosis of this complication is essencial in order to administer an effective treatment.

[Penoscrotal gangrene: our series of cases]. / Gangrena penoescrotal: nuestra casuística.

Ten cases of penoscrotal gangrene seen in our department over the last 8 years are presented. In 80% of patients causative factors of the gangrenous process were demonstrated and were equally distributed between urology and colorectal pathologies. The most commonly associated pathology was diabetes mellitus affecting up to 50% of our patients. Two or more germs were isolated from the necrotic-purulent material for cultures, mainly E. coli (90%) and Proteus mirabilis (50%) as aerobic organisms, and Bacteroides fragilis (40%) in the anaerobic group. Despite emergency surgical therapy and high doses of broad spectrum antibiotics, mortality in our series was about 20%.

[Retroperitoneal germ cell tumor]. / Tumor de células germinales retroperitoneal.

We report a case of retroperitoneal extragonadal germ-cell tumor in an 17 years old patient who presented with aedema and pain in left inferior extremity asociated with hemopthysis caused by pulmonar metastasis, who was treated with chemotherapy and resection of residual mass and pulmonary nodes. Dyagnosis was stableshed by fine neadle aspiration biopsy of the wass. We comment on the difficult of stableshing differential dyagnosis between retroperitoneal extragonadal germ-cell tumor and metastasis of a testicular tumor. Dyagnosis is stableshed by the finding of a histologically malignant germ-cell tumor with normal testis. We considered physical examination and ecographyc exploration enough for a correct dyagnosis.

[Malignant mesothelioma of the tunica vaginalis of the testis]. / Mesotelioma maligno de la túnica vaginal del testículo.

We report a case of malign mesothelioma of the tunica vaginalis of testis in a 84 years-old male. Clinical presentation was hydrocele. Special attention is given to differential diagnosis and therapeuticals possibilities.

Reference values for the CAVIPRES-30 questionnaire, a global questionnaire on the health-related quality of life of patients with prostate cancer.

OBJECTIVE: Define and establish the reference values of the CAVIPRES-30 Questionnaire, a health related quality of life questionnaire specific for prostate cancer patients. MATERIAL AND METHODS: The CAVIPRES-30 was administered to 2,630 males with prostate cancer included by 238 Urologist belonging to the Spanish National Healthcare System. Descriptive analysis on socio-demographic and clinical data were performed, and multivariate analyses were used to corroborate that stratification variables were statistically significantly and independently associated to the overall score of the questionnaire. RESULTS: The variables Time since diagnosis of the illness, whether the patient had a Stable partner or not, if he was, or not, undergoing Symptomatic treatment were statistically significantly and independently associated (P < .001) to the overall score of the questionnaire. The reference values table of the CAVIPRES-30 questionnaire is made up of different kinds of information of each patient profile: sample size, descriptive statistics with regard to the overall score, Cronbach's alpha value (between .791 and .875) and the questionnaire's values are reported by deciles. CONCLUSIONS: The results of this study contribute new proof as to the suitability and usefulness of the CAVIPRES-30 questionnaire as an instrument for assessing individually the quality of life of prostate cancer.

[CAVIPRES questionnaire as a measurement of quality of life in patients with prostate cancer in Spain: Daily clinical practice application]. / Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata como medida de la calidad de vida de los pacientes con cáncer de próstata en España: aplicación a la actividad diaria.

INTRODUCTION: Prostate cancer (PC) states as the most frequent tumor in elderly patients. Although no direct involvement in death-related, PC entails an important lost in patient's quality of life. There are several questionnaires adapted to Spanish in order to measure the health-related quality of life (HRQoL) in PC patients. OBJECTIVES: To describe the content and feasibility of the Spanish CAVIPRES questionnaire both in its short version to the clinical daily practice and also in the extended version to be used in the investigational protocols. MATERIALS AND METHODS: A detailed review of the different quality of life-related aspects of PC patients gathered in the questionnaire and a cross-comparison with other adapted HRQoL available is been performed. RESULTS: The HRQoL CAVIPRES questionnaire gathers information regarding social and partner support, psychological conditions of the patients, and also life expectancies against disease outcome together with classical symptomatic parameters as other available and adapted questionnaires. CONCLUSION: The CAVIPRES questionnaire in its short version is an adequate, feasible, valid, reliable and sensitive to change in the measurement of HRQoL in PC patients. The extended version is valid to be used in clinical research of PC patients. Both versions have been donated by Abbott to the Spanish Association of Urology (AEU) and are available at AEU web site (www.eau.es).

[Acquired enterovesical fistulas]. / Fístulas enterovesicales adquiridas.

We report on 23 patients with acquired vesicoenteric fistula treated during the past 12 years: 48% of these were of inflammatory etiology (11 cases), 35% were caused by neoplasms (8 cases) and 17% were iatrogenic (4 cases). The most frequent symptoms were pneumaturia and fecaluria (78% of cases). Cystoscopy was the most useful diagnostic procedure in detecting fistula (13 of 18 cases). Other imaging techniques, though less effective for diagnosis, were useful in assessing the status of the GI tract and, at times, in determining the etiology of the fistulae. Treatment depends on the etiology, localization and patient general condition. The technique most frequently applied in our series was resection of the fistulous tract, together with the compromised intestinal segment, and bladder suture.

[Bladder leiomyoma. Review and report of a case]. / Leiomioma vesical. Revisión y presentación de un caso.

OBJECTIVE: The present study reviews bladder leiomyoma, an uncommon pathology. The problems of differential diagnosis and the therapeutic options are discussed and the literature reviewed. METHODS/RESULTS: A 33-year-old female with anterolateral intramural leiomyoma of the bladder is described. Patient evaluation included US, cystography, CT, cystoscopy and ultrasound-guided suprapubic puncture. CONCLUSIONS: Leiomyoma is an uncommon benign tumor of the bladder. To our knowledge, only 235 cases have been reported in the literature. We advocate the use of ultrasound-guided suprapubic puncture, a simple procedure that is frequently diagnostic, in the evaluation of this tumor type.