[Does a pT0 cystectomy specimen imply being tumour-free in the long term?]. / ¿Implica el T0 en la pieza de cistectomía encontrarse libre de tumor a largo plazo?

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved. MATERIAL AND METHODS: We reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with a minimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression. RESULTS: 12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died. CONCLUSIONS: A stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance.

Pelvic hydatid disease as an example of pelvic masses of uncertain aetiology.

We describe two new cases of pelvic hydatid cysts, one with a clinical profile of local compression and the other one asymptomatic. The first case is a 75 year-old man who reported difficulty in defecating and urinating. An ultrasound revealed a large pelvic cystic mass displacing the bladder and rectosigmoid region. Computed tomography showed images compatible with hydatid disease and a hydatid liver cyst. The patient underwent a surgical procedure, with the pelvic cyst being partially excised. The other case of pelvic hydatid disease was asymptomatic, and was discovered by chance while examining a 75 year-old man for a prostatic adenoma. Because he was asymptomatic, we opted for observation. The pathology confirmed the diagnosis in the first case and radiological findings confirmed the second. Both patients are now asymptomatic. Hydatid disease must be considered in the differential diagnosis of any cystic masses in the pelvic organs, especially in countries where the disease is endemic. Although there are no serological tests which are 100% specific, there are some radiological procedures which can help to confirm the disease. Surgery is the treatment of choice.

New case of an infrarenal abdominal aortic aneurysm associated with horseshoe kidney.

We review the association between surgically resolvable aortic disease and horseshoe kidney with a discussion of diagnostic problems and therapeutic options. Male patient 81 years of age with horseshoe kidney and an abdominal aortic aneurysm that was discovered by chance in an abdominal ultrasound during a check-up for his prostate condition. A retroperitoneal approach was used in order to resect the aneurysm and perform an aorto-aortic bypass with no complications occurring. Two years after the diagnosis, the patient is still asymptomatic from a vascular point of view. The co-presence of horseshoe kidney and aortic disease needing surgical correction is infrequent, but it significantly increases the technical complexity of aortic reconstruction. A literature review is included.