[Therapeutic compliance in patients with renal lithiasis and biochemical risk factors.] / Cumplimiento terapéutico en pacientes con litiasis renal con factores de riesgo bioquímico.

OBJECTIVE: To evaluate patient compliance with treatment for urinary lithiasis and to detect differences in adherence, causes of this behavior and associated factors. METHODS: We performed a retrospective study of 93 patients with positive urinary metabolic study (UMS) for lithogenic pathology, diagnosed between 2013 and 2015, gathering data from the digital medical records and a structured telephonic questionnaire in 75 of them. Results were analyzed using the X2 test. RESULTS: 68% of the patients were males. Median age 42.92 (12.17) years. Mean follow up was 2.65 years. Most frequent metabolic alterations were: Hyperoxaluria (42.7%), Hypercalciuria (33.3%) and hipocitraturia (30.7%). Most frequently prescribed drugs: Potassium citrate (70.7%), Thiazide diuretics (26.7%) and calcium supplements (15.1). 84.2% of the patients did not know their UMS and 29.8% did not know the treatment prescribed. 41.9% followed the doses prescribed less than 50% of the times. Dietetic treatment was abandoned by 65% of the patients and pharmacological treatment by 43.5%, mainly due to laziness (62.9% vs 46.2%). 72.6% of the compliant patients experienced improvement. We find a significant relationship between academic level and diagnosis knowledge (p=0.022) and treatment (p=0.036). There were no differences in compliance depending on the number of drugs taken. CONCLUSIONS: Despite urine metabolic study being well valued and treatment well tolerated therapeutic compliance is very low. Most patients would repeat or restart the treatment prescribed in case of recurrence. Diagnostic and therapeutic information provided was not understood.

Cumplimiento terapéutico en pacientes con litiasis renal con factores de riesgo bioquímico / Therapeutic compliance in patients with renal lithiasis and biochemical risk factors

OBJETIVO: Valorar el cumplimiento de los tratamientos indicados a pacientes con litiasis renal y detectar diferencias en la adherencia, causas de éstas y factores asociados a este comportamiento. MÉTODOS: Estudiamos de manera retrospectiva 93 pacientes con estudio metabólico urinario (EMU) positivo para patologías litogénicas diagnosticadas entre los años 2013 y 2015, obteniendo información mediante historia digital y un cuestionario estructurado vía telefónica de 75 de ellos. Los resultados fueron analizados mediante el test X2. RESULTADOS: El 68% de los pacientes eran varones. Mediana de edad 42,92 (12,17) años. Seguimiento medio 2,65 años. Alteraciones metabólicas más frecuentes: hiperoxaluria (42,7%), hipercalciuria (33,3%), e hipocitraturia (30,7%). Medicamentos más empleados: citrato potásico (70,7%), tiazidas (26,7%) y suplementos de calcio (15,1%). El 84,2% de los pacientes desconocía el diagnóstico del EMU, y el 29,8% no conocía el tratamiento indicado. El 41,9% cumplió las dosis pautadas menos del 50% de las ocasiones. El tratamiento dietético fue abandonado por el 65% de los pacientes y el farmacológico por el 43,5%, en ambos casos fundamentalmente por dejadez (62,9% frente al 46,2%). El 72,6% de los cumplidores experimentó mejoría. Encontramos relación significativa entre nivel académico y conocimiento del diagnóstico (p = 0,022) y del tratamiento (p = 0,036). No aparecieron diferencias en el cumplimiento según la cantidad de otros medicamentos que tomasen. CONCLUSIONES: El cumplimiento terapéutico es muy bajo, pese a que el estudio metabólico urinario es bien valorado y el tratamiento bien tolerado. La mayoría lo repetiría o retomaría el tratamiento indicado si tuviese recidivas. La información diagnóstica y terapéutica proporcionada no es entendida

OBJECTIVE: To evaluate patient compliance with treatment for urinary lithiasis and to detect differences in adherence, causes of this behavior and associated factors. METHODS: We performed a retrospective study of 93 patients with positive urinary metabolic study (UMS) for lithogenic pathology, diagnosed between 2013 and 2015, gathering data from the digital medical records and a structured telephonic questionnaire in 75 of them. Results were analyzed using the X2 test. RESULTS: 68% of the patients were males. Median age 42.92 (12.17) years. Mean follow up was 2.65 years. Most frequent metabolic alterations were: Hyperoxaluria (42.7%), Hypercalciuria (33.3%) and hipocitraturia (30.7%). Most frequently prescribed drugs: Potassium citrate (70.7%), Thiazide diuretics (26.7%) and calcium supplements (15.1). 84.2% of the patients did not know their UMS and 29.8% did not know the treatment prescribed. 41.9% followed the doses prescribed less than 50% of the times. Dietetic treatment was abandoned by 65% of the patients and pharmacological treatment by 43.5%, mainly due to laziness (62.9% vs 46.2%). 72.6% of the compliant patients experienced improvement. We find a significant relationship between academic level and diagnosis knowledge (p = 0.022) and treatment (p = 0.036). There were no differences in compliance depending on the number of drugs taken. CONCLUSIONS: Despite urine metabolic study being well valued and treatment well tolerated therapeutic compliance is very low. Most patients would repeat or restart the treatment prescribed in case of recurrence. Diagnostic and therapeutic information provided was not understood

The usefulness of densitometry in predicting the composition and fragility of urolithiasis.

INTRODUCTION: The choice of ideal treatment for a given lithiasis is a crucial factor for its success, minimizing the number of interventions and complications. Previous determination of stone composition and its fragility is desirable, to predict its behavior during extracorporeal shock wave lithotripsy and for evaluation of its appropriateness, or to set the indication for other techniques. OBJETIVES: To determine the role of densitometry in the prediction of composition and fragility of urinary lithiasis undergoing SWL. METHODS: Experimental prospective, blinded, in vitro study using 193 urinary calculi of known composition : monohydrated calcium oxalate, mixed calcium oxalate, uric acid, and calcium carbonate, obtained from spontaneous passage or surgery. Densitometry and SWL were performed on them. We compare the mineral composition of the stone and mineral density of each composition group to check if they are characteristic of each type and correlate these parameters with the energy dose required to fragment them down to a given fragment size. RESULTS: Only 53 out of 193 stones showed valuable data. Calcium carbonate was the composition showing grater mineral content and density (1,24 gr and 0,47 gr/cm2), followed by mixed oxalate (0,51/0,26) and uric acid (0,52/ 0,15), finishing with the monohydrate calcium oxalate group (0,32/0,05).Only the comparison between calcium carbonate and monohydrated calcium oxalate showed statistically significant results (p<0,05). Correlation coefficients between mineral content (0,347) and density (0,424) and the energy used for stone fragmentation to a given fragment size were statistically significant (p<0,05) CONCLUSIONS: In our study, the use of densitometry to determine stone composition and lithiasic fragility did not show conclusive results due to the limited number of calculi tested. Nevertheless, there are signs that, with a different study design , more practically useful results could be achieved.

Utilidad de la densitometría en la predicción de la composición y fragilidad litiásica / The usefulness of densitometry in predicting the composition and fragility of urolithiasis

INTRODUCCIÓN: La elección del tipo de tratamiento ideal para una determinada litiasis es un factor crucial para el éxito del mismo, minimizando el número de intervenciones y complicaciones. Es deseable la determinación a priori de la composición de la litiasis y de su fragilidad, para predecir su comportamiento durante el tratamiento con litotricia extracorpórea (LEOC) y valorar la idoneidad de este, o si se deben emplear otras técnicas. OBJETIVO: Determinar el papel de la densitometría en la predicción de la composición y fragilidad de litiasis que van a ser tratadas con LEOC.MÉTODOS: Estudio experimental, in vitro, prospectivo, y ciego, realizado empleando 193 cálculos urinarios de composición conocida: oxalato cálcico monohidrato (OCM), oxalato cálcico mixtos, ácido úrico y carbonato de apatita, obtenidos mediante expulsión espontánea o cirugía. Éstos son sometidos a densitometría y litotricia extracorpórea. Comparamos el contenido mineral de la litiasis y la densidad mineral de la litiasis de cada grupo de composición para comprobar si son características propias de cada tipo, y correlacionamos estos parámetros con la dosis de energía necesaria para la fragmentación hasta una conminución definida. RESULTADOS: Sólo 53 de los 193 cálculos arrojaron datos que pudiesen ser valorados. Carbonato de apatita ha sido la composición que ha mostrado un mayor contenido y densidad mineral (1,24 gr y 0,47 gr/cm2), seguido de los mixtos de oxalato (0,51/0,26) y úrico (0,52/ 0,15), finalizando con el grupo OCM (0,32/0,05). Sólo la comparación carboapatita-OCM mostró resultados estadísticamente significativos (p<0,05). Los coeficientes de correlación entre contenido (0,347) y densidad mineral (0,424) y la energía empleada para la fragmentación litiásica hasta la conminución definida presentaron significación estadística (p<0,05). CONCLUSIONES: En nuestro estudio el empleo de la densitometría para determinar la composición y fragilidad litiásica no ha mostrado resultados concluyentes dada la escasez de cálculos detectados. Se aprecian no obstante indicios de que, con un diseño diferente, podrían conseguirse resultados de mayor utilidad práctica

INTRODUCTION: The choice of ideal treatment for a given lithiasis is a crucial factor for its success, minimizing the number of interventions and complications. Previous determination of stone composition and its fragility is desirable, to predict its behavior during extracorporeal shock wave lithotripsy and for evaluation of its appropriateness, or to set the indication for other techniques. OBJETIVES: To determine the role of densitometry in the prediction of composition and fragility of urinary lithiasis undergoing SWL. METHODS: Experimental prospective, blinded, in vitro study using 193 urinary calculi of known composition: monohydrated calcium oxalate, mixed calcium oxalate, uric acid, and calcium carbonate, obtained from spontaneous passage or surgery. Densitometry and SWL were performed on them. We compare the mineral composition of the stone and mineral density of each composition group to check if they are characteristic of each type and correlate these parameters with the energy dose required to fragment them down to a given fragment size. RESULTS: Only 53 out of 193 stones showed valuable data. Calcium carbonate was the composition showing grater mineral content and density (1,24 gr and 0,47 gr/cm2), followed by mixed oxalate (0,51/0,26) and uric acid ((0,52/ 0,15), finishing with the monohydrate calcium oxalate group (0,32/0,05). Only the comparison between calcium carbonate and monohydrated calcium oxalate showed statistically significant results (p<0,05). Correlation coefficients between mineral content (0,347) and density (0,424) and the energy used for stone fragmentation to a given fragment size were statistically significant (p<0,05). CONCLUSIONS: In our study, the use of densitometry to determine stone composition and lithiasic fragility did not show conclusive results due to the limited number of calculi tested. Nevertheless, there are signs that, with a different study design, more practically useful results could be achieved

Lithiasis size estimation variability depending on image technical methodology.

UNLABELLED: The lithiasic size is a determining factor in selecting the most suitable treatment, surgical or medical. However, the method for obtaining a reliable lithiasic size is not standardized. Our objetives are to determine the differences between the estimated lithiasic sizes shown by plain radiography test and by computerized axial tomography (CT) scan (using different techniques) in relation to the actual size, and to establish which is the ideal type of imaging for this purpose. We present an in vitro model with lithiasis obtained in cooperation with four centers. INCLUSION CRITERIA: lithiasis >0.5 cm, intact, and visible via simple radiography. A sample of 245 lithiases was obtained, with 87 rejected as they did not fulfill the inclusion criteria. Initially the three main actual diameters of each lithiasis were measured with a calibrator, then a plain X-ray and a CT scan were taken of the samples to determine the surface size in cm(2) for simple radiography; surface size and volume in cm(3) for CT scan, in bone window and soft tissue (Toshiba Aquillion 64, sections of 0.5 mm, 120 Kv, 250 mA). The tomographic area was calculated by employing the formula recommended by the European Association of Urology and scanner software. The actual, radiographic and tomographic measurements were taken by three different researchers who were unaware of the results obtained by the each other. The statistics program IBM SPSS Statistics(®) 19 was used. Differences were analyzed using the Wilcoxon sign test. The bone window CT scan slightly overestimated the actual lithiasic size (0.12 vs. 0.17 cm(3)), while in soft tissue window the actual volume was practically doubled (0.12 vs. 0.21 cm(3)) (p < 0.05). We did not find statistically significant differences in the comparison between actual surface size (0.39 cm(2)) and bone window CT scan size when using the EAU formula or scanner software (0.36/0.37 cm(2)). Resulting measurements in soft tissue window tended to significantly overestimate the surface size, although only slightly (0.42/0.44 cm(2)), whilst the plain radiography underestimated it slightly but significantly (0.37 cm(2)). CT scan, using the bone window, is the technical methodology with which the greatest in vitro accuracy in which actual lithiasis measurements can be estimated, although the craniocaudal diameter measurement will be overestimated. Using soft tissue window gives an overestimated size.

[Ultrasound guided transrectal prostatic biopsy and pain. Prospective randomized study comparing lubricant gel, lidocaine gel, and anesthetic blockage of the neurovascular bundles with 1% lidocaine]. / Biopsia prostática transrectal ecodirigida y dolor. Estudio prospectivo aleatorizado comparando gel lubricante, gel con lidocaína y bloqueo anestésico de haces neurovasculares con lidocaína 1%.

OBJECTIVES: To quantify anxiety and immediate and late pain, efficacy of the common analgesic methods, and complications. METHODS: 117 patients were randomized to three groups: 1 (39): lubricant gel; 2 (38): intrarectal lidocaine gel; 3 (40): anesthetic blockage with 1% lidocaine. Complications and immediate and late pain were collected, these latter with a visual analogic scale. RESULTS: 70% of the patients were not much anxious. We did not find significant differences between the analgesia achieved in group 1 (4.37 +/- 2.41) and group 2 (4.22 +/- 2.46), but we found with group 3 (1.88 +/- 2.03). Mean pain score the afternoon after biopsy was lower in group 3 (2.08 +/- 2.28) than in groups 1 and 2 (4.06 +/- 2.80 and 2.42 +/- 2.03), without statistical significance. The patients did not show a difference in pain during the pass of the transrectal transducer, varying between 2.34 for group 3 and 3.38 for group 2. Grouped by sphincter tone we find differences (low 2.71 +/- 2.76, medium 3.23 +/- 2.38, high 4.99 +/- 2.22). Patients feeling very nervous before the test had a pain score of 4.98 +/- 2.57, significantly greater than the pain of those not feeling nervous (2.59 +/- 2.21). We did not find differences in complications between the three groups. CONCLUSIONS: The use of intrarectal lidocaine gel did not demonstrated being more effective in pain control in our series than the use of lubricant gel, but lidocaine injected into the apex and seminal vesicles was. Sphincter tone and pretest anxiety are the most determinants factors for pain.

Biopsia prostática transrectal ecodirigida y dolor. Estudio prospectivo aleatorizado comparando gel lubricante, gel lidocaína y bloqueo anestésico de haces neurovasculares con lidocaína 1% / Ultrasound guided transrectal prostatic biopsy and pain. Prospective randomized study comparing lubricant gel, lidocaine gel, and anesthetic blockage of the neurovascular bundles with 1% lidocaine

Objetivo: Cuantificar ansiedad y dolor inmediato y tardío producidos, efectividad de los métodos analgésicos comunes y complicaciones. Métodos: 117 pacientes fueron distribuidos aleatoriamente en tres grupos: 1 (39): lubricante gel, 2 (38): lidocaína en gel intrarrectal, 3 (40): bloqueo anestésico con lidocaína al 1%. Se recogieron las complicaciones y el dolor inmediatos y tardíos mediante una escala visual analógica. Resultados: 70% de pacientes estaban poco ansiosos. No encontramos diferencias significativas entre la analgesia conseguida en el grupo 1 (4.37±2.41) y 2 (4.22±2.46), pero sí con el 3 (1.88±2.03). La media de dolor la tarde tras la prueba fue menor en el grupo 3 (2.08 ± 2.28) que en 1 y 2 (4.06±2.80 y 2.42±2.03), pero sin significación estadística. Los pacientes no mostraron un dolor distinto al paso del transductor transrectal, oscilando entre 2.34 para el grupo 3 y 3.38 para el grupo 2. Agrupados según tono esfinteriano, sí encontramos diferencias (bajo 2.71±2.76, medio 3.23±2.38, alto 4.99±2.22). El dolor presentado por los pacientes que decían estar muy nerviosos pre-prueba fue de 4.98±2.57, significativamente mayor que el presentado por los que decían estar nada nerviosos (2.59±2.21). No encontramos diferencias en las complicaciones entre los tres grupos. Conclusiones: El empleo de gel intrarrectal de lidocaína no ha demostrado en nuestra serie ser más eficaz que el uso de lubricante para el control del dolor, pero sí la lidocaína inyectada en ápex y vesículas seminales. Tono esfinteriano y ansiedad preprueba son los factores más determinantes en el grado de dolor (AU)

Objectives: To quantify anxiety and immediate and late pain, efficacy of the common analgesic methods, and complications. Methods: 117 patients were randomized to three groups: 1(39): lubricant gel; 2 (38): intrarectal lidocaine gel; 3 (40): anesthetic blockage with 1% lidocaine. Complications and immediate and late pain were collected, these latter with a visual analogic scale. Results: 70% of the patients were not much anxious. We did not find significant differences between the analgesia achieved in group 1 (4.37± 2.41) and group 2 (4.22± 2.46), but we found with group 3 (1.88± 2.03). Mean pain score the afternoon after biopsy was lower in group 3 (2.08± 2.28) than in groups 1 and 2 (4.06± 2.80 and 2.42± 2.03), without statistical significance. The patients did not show a difference in pain during the pass of the transrectal transducer, varying between 2.34 for group 3 and 3.38 for group 2. Grouped by sphincter tone we find differences (low 2.71± 2.76, medium 3.23± 2.38, high 4.99+- 2.22). Patients feeling very nervous before the test had a pain score of 4.98± 2.57, significantly greater than the pain of those not feeling nervous (2.59± 2.21). We did not find differences in complications between the three groups. Conclusions: The use of intrarectal lidocaine gel did not demonstrated being more effective in pain control in our series than the use of lubricant gel, but lidocaine injected into the apex and seminal vesicles was. Sphincter tone and pre-test anxiety are the most determinants factors for pain (AU)

[Renal oncocytomatosis in a patient receiving hemodialysis]. / Oncocitosis renal de paciente en hemodialisis.

OBJECTIVE: Renal oncocytosis is a rare pathology. We report the first case published of a patient with this disease undergoing combined pancreas-kidney transplantation. METHODS: We report the case of one patient with end stage chronic renal failure receiving hemodialysis with the incidental diagnosis of two renal oncocytomas and microscopic oncocytomatosis in a routine revision while awaiting for renal transplantation. Right radical nephrectomy was performed with the pathologic diagnosis of renal oncocytomas. The patient underwent combined kidney-pancreas transplantation nine months later. RESULTS: The postoperative course was uneventful. After three years of follow-up the patient has not shown recurrence and the graft has normal function. CONCLUSIONS: The presence of the antecedent of end stage renal disease under treatment with hemodialysis in patients with renal oncocytomatosis is striking, but the causative relationship is not established. The treatment for renal oncocytosis and pathologic characteristics present will condition when will be possible the performance of a kidney transplant in these patients, and will also condition prognosis. Longterm follow-up is recommendable due to the possibility of metachronic or bilateral involvement, and the association between renal oncocytomatosis and renal cell carcinoma in up to 32% of the cases.

Oncocitosis renal de paciente en hemodialisis / Renal oncocytomatosis in a patient receiving hemodialysis

OBJETIVO: La oncocitosis renal es una patología infrecuente. Presentamos el primer caso publicado de paciente diagnosticado de esta patología y sometido posteriormente a trasplante combinado riñón-páncreas. MÉTODOS: Presentamos el caso de un paciente en el que, en una revisión rutinaria por Insuficiencia Renal Crónica Terminal (IRCT) y tratamiento con hemodiálisis, en espera de trasplante renal, se diagnostican de forma incidental dos oncocitomas renales y focos de oncocitomatosis microscópica. Se realiza nefrectomía radical derecha y tras el estudio anatomo-patológico, con masas dominantes caracterizadas como oncocitomas renales (OR), se sometió a trasplante combinado reno-pancreático nueve meses después. RESULTADOS: El postoperatorio cursa sin incidencias. Tras un seguimiento de tres años el paciente no ha mostrado recidiva de su patología oncocítica, y el injerto es normofuncionante. CONCLUSIONES: La presencia del antecedente de IRCT en tratamiento con hemodiálisis en los pacientes con oncocitomatosis renal es llamativa, no quedando establecida la causa de esta relación. El tratamiento al que se someta el paciente para la oncocitosis renal y las características anatomopatológicas presentes en el espectro de esta patología condicionarán cuando es posible la realización de un trasplante renal en este tipo de enfermos, y condicionará el pronóstico. Es aconsejable el seguimiento de los pacientes a largo plazo, dada la posibilidad de afectación metacrónica o bilateral, y la asociación entre oncocitomatosis renal (OCR) y carcinoma de células renales (CCR) hasta en un 32%

OBJECTIVE: Renal oncocytosis is a rare pathology. We report the first case published of a patient with this disease undergoing combined pancreas-kidney transplantation. METHODS: We report the case of one patient with end stage chronic renal failure receiving hemodialysis with the incidental diagnosis of two renal oncocytomas and microscopic oncocytomatosis in a routine revision while awaiting for renal transplantation. Right radical nephrectomy was performed with the pathologic diagnosis of renal oncocytomas. The patient underwent combined kidney-pancreas transplantation nine months later. RESULTS: The postoperative course was uneventful. After three years of follow-up the patient has not shown recurrence and the graft has normal function. CONCLUSIONS: The presence of the antecedent of end stage renal disease under treatment with hemodialysis in patients with renal oncocytomatosis is striking, but the causative relationship is not established. The treatment for renal oncocytosis and pathologic characteristics present will condition when will be possible the performance of a kidney transplant in these patients, and will also condition prognosis. Long-term follow-up is recommendable due to the possibility of metachronic or bilateral involvement, and the association between renal oncocytomatosis and renal cell carcinoma in up to 32% of the cases

[Squamous cell carcinoma of the bladder. Review of our case series]. / Carcinoma epidermoide vesical. Revisión de nuestra serie.

OBJECTIVES: The squamous cell carcinoma of the bladder is a rare tumor in our environment, representing between 1.6-6.7% of all bladder neoplasias. It is more common to find foci of squamous differentiation associated with a transitional cell carcinoma. METHODS: We retrospectively review all squamous cell carcinomas diagnosed and treated in our hospital between 1994 and 2004. We analyze their biological behaviour and the treatment applied. RESULTS: We found 11 cases of squamous cell carcinoma of the bladder, which pathologically were pure squamous cell carcinomas in eight patients and mixed in another three. Mean patient age was 70.9 years ranging from 49 to 88 years, six of them were males and five females. All of them presented locally advanced tumor stages at the time of diagnosis (> or = T2). Although the treatment of choice is radical cystectomy, it could only be applied in three patients; it was associated with adjuvant chemotherapy in one patient. The rest of the patients were treated by transurethral resection of the tumor, with adjuvant radiotherapy in two cases and bilateral cutaneous ureterostomy in one due to the advanced stage. Mean survival was 20 months ranging from 1 to 91 months. Only two patients are alive, both after radical surgery. CONCLUSIONS: The squamous cell carcinoma, in both its forms, pure and mixed, is an aggressive tumor. The late diagnosis of these tumors and their biological behaviour entail a bad prognosis. Only early diagnosis and radical treatment may improve prognosis.

[Metastatic Crohn's disease involving the penile foreskin]. / Afectación prepucial de la enfermedad de Crohn metastásica.

OBJECTIVE: To describe the case of the patient with history of Crohn's disease presenting metastatic extension to the penile foreskin. METHODS: Circumcision was carried out and the skin was sent to the pathology department. RESULTS: Pathologic study of the specimen showed an ulcerated granuloma without caseum, typically associated with metastatic Crohn's disease. After one year of follow-up there is no evidence of recurrence. CONCLUSIONS: Crohn's disease is a disease of unknown origin, the main characteristic of which is the development of non necrotizing granulomas that may involved not only the gastrointestinal tract. When the extraintestinal involvement is not produced by continuity we call it metastatic disease. Such metastases may be found in the genitourinary tract, and other sites. This involvement may include lithiasis, amyloidosis, ... and the presence of lesions in the genital skin, as in our case.

Afectación prepucial de la enfermedad de Crohn metastásica / Metastatic Crohn´s disease involving the penile foreskin

OBJETIVO: Describimos el caso de un paciente con antecedentes de enfermedad de Crohn que presenta extensión metastásica de su enfermedad en la piel prepucial. MÉTODOS: Se decide circuncisión del paciente y se envía la piel prepucial al servicio de anatomía patológica de nuestro hospital. RESULTADOS: En el análisis histológico de la pieza aparece granuloma no caseificante con ulceración, propio de la enfermedad de Crohn metastásica. Tras un año de seguimiento no se aprecia recidiva. CONCLUSIONES: La enfermedad de Crohn (EC) es una entidad de origen desconocido cuya característica principal es la formación de granulomas no necrotizantes que pueden afectar no sólo al tracto gastrointestinal. Cuando esta afectación extradigestiva no se produce por continuidad nos encontramos frente a la enfermedad de Crohn metastásica. Estas metástasis, pueden encontrarse, entre otras localizaciones, en el aparato genitourinario. Esta afectación incluye litiasis, amiloidosis, … y la aparición de lesiones en la piel genital, como en nuestro caso

OBJECTIVE: To describe the case of the patient with history of Crohn’s disease presenting metastatic extension to the penile foreskin. METHODS: Circumcision was carried out and the skin was sent to the pathology department. RESULTS: Pathologic study of the specimen showed an ulcerated granuloma without caseum, typically associated with metastatic Crohn’s disease. After one year of follow-up there is no evidence of recurrence. CONCLUSIONS: Crohn’s disease is a disease of unknown origin, the main characteristic of which is the development of non necrotizing granulomas that may involved not only the gastrointestinal tract. When the extraintestinal involvement is not produced by continuity we call it metastatic disease. Such metastases may be found in the genitourinary tract, and other sites. This involvement may include lithiasis, amyloidosis,... and the presence of lesions in the genital skin, as in our case

Carcinoma epidermoide vesical. Revisión de nuestra serie / No disponible

OBJETIVO: El carcinoma epidermoide de vejiga es un tumor infrecuente en nuestro medio, con una proporción entre 1,6% y 6,7% de todas las neoplasias vesicales. Es más frecuente encontrar focos de diferenciación escamosa en el contexto de un carcinoma transicional. MÉTODOS: Han sido revisados de forma retrospectiva todos los carcinomas epidermoides vesicales diagnósticados y tratados en nuestro Hospital entre 1994- 2004. Analizamos su comportamiento biológico y tratamiento aplicado. RESULTADOS: Encontramos 11 casos de carcinoma epidermoide vesical, que desde el punto de vista anatomopatológico fueron 8 formas puras y 3 formas mixtas. La edad media de los pacientes fue de 70,9 años con un rango de (49-88 años) y la distribución por sexos era de 6 varones y 5 mujeres. En el momento del diagnóstico todos presentaban estadios locales avanzados (≥ T2). Aunque el tratamiento electivo es la cistectomía radical, esta sólo se pudo aplicar en tres pacientes, en uno de los cuales se asoció quimioterapia adyuvante. En el resto se realizaron resecciones transuretrales, asociadas en dos casos a radioterapia adyuvante y en un caso a ureterostomía cutánea bilateral por el estadio avanzado en el momento del diagnóstico. La media de supervivencia fue de 20 meses con un rango de 1 a 91 meses. solo 2 pacientes siguen vivos, ambos fueron sometidos a cirugía radical. CONCLUSIONES: El carcinoma epidermoide tanto en su forma pura como mixta, es un tumor agresivo. El diagnóstico tardío de estos tumores y su comportamiento biológico comportan un pronóstico sombrío. Sólo un diagnóstico precoz y un tratamiento radical pueden mejorar su pronóstico (AU)

OBJECTIVES: The squamous cell carcinoma of the bladder is a rare tumor in our environment, representing between 1.6-6.7% of all bladder neoplasias. It is more common to find foci of squamous differentiation associated with a transitional cell carcinoma. METHODS: We retrospectively review all squamous cell carcinomas diagnosed and treated in our hospital between 1994 and 2004. We analyze their biological behaviour and the treatment applied. RESULTS: We found 11 cases of squamous cell carcinoma of the bladder, which pathologically were pure squamous cell carcinomas in eight patients and mixed in another three. Mean patient age was 70.9 years ranging from 49 to 88 years, six of them were males and five females. All of them presented locally advanced tumor stages at the time of diagnosis (≥T2). Although the treatment of choice is radical cystectomy, it could only be applied in three patients; it was associated with adjuvant chemotherapy in one patient. The rest of the patients were treated by transurethral resection of the tumor, with adjuvant radiotherapy in two cases and bilateral cutaneous ureterostomy in one due to the advanced stage. Mean survival was 20 months ranging from 1 to 91 months. Only two patients are alive, both after radical surgery. CONCLUSIONS: The squamous cell carcinoma, in both its forms, pure and mixed, is an aggressive tumor. The late diagnosis of these tumors and their biological behaviour entail a bad prognosis. Only early diagnosis and radical treatment may improve prognosis (AU)

[Bladder mucormycosis. Report of one case]. / Mucormicosis vesical. A propósito de un caso.

OBJECTIVES: To report one case of an opportunistic bladder infection by fungus of the Mucorales order. METHODS: An old patient with permanent bladder catheter due to cerebral vascular accident presented with hematuria associated with change in his general health status, and a bladder mass on ultrasound Cystoscopy and cold biopsy were performed RESULTS: Pathology reported bladder mucormycosis. CONCLUSIONS: Mucormycosis is an opportunistic infection by fungus of the Mucorales order, which disseminate hematogenously from an entrance. Diagnosis is usually histological, seeing characteristic hyphae and ischemic or hemorrhagic necrosis. Bladder involvement is very uncommon. Treatment is based on the combination of debridement of the necrotic areas and intravenous antifungal drugs (amphotericin B).

Mucormicosis vesical.A propósito de un caso / Bladder mucormyscosis. Report of one case

OBJETIVOS: Presentación de un caso de infección vesical oportunista por hongos del orden de los Mucorales. MÉTODOS: Hematuria en paciente añoso y con sondaje permanentea consecuencia de un accidente vásculo-cerebral, que cursó con afectación del estado general y masa vesical vista en ecografía. Se practicaron cistoscopia y biopsia fría. RESULTADOS: Diagnóstico histológico de Mucormicosis vesical. CONCLUSIONES: La Mucormicosis es una infección oportunistapor hongos del orden de los Mucorales, que se disemina vía hematógena a partir de una puerta de entrada. El diagnóstico suele ser histológico, observándose hifas características y necrosis hemorrágica o isquémica . La afectación vesical es muy infrecuente. El tratamiento se basa en la combinación de desbridamiento de las zonas necróticas y antifúngicos endovenosos (anfotericina B) (AU)

No disponible

Iontoforesis en la enfermedad de Peyronie. Nuestra experiencia / Iontophoresis in the treatment of Peyronie´s disease. Our experience

La enfermedad de Peyronie es un tipo de incurvación peneana adquirida de origen aún no filiado, que se genera por la dificultad a la expansión simétrica de los cuerpos cavernosos producida por placas fibrosas en la línea media de la albugínea. OBJETIVO: Definir los resultados del tratamiento con iontoforesis dentro del amplio espectro de tratamiento utilizados para esta enfermedad. MÉTODOS: 61 pacientes tratados con iontoforesis con orgoteína en sesiones semanales. RESULTADO: Mejoría de dolor en el 42,6 por ciento, mejoría de la incurvación en el 6,1 por ciento y mejoría de ambas en el 21,3 por ciento. CONCLUSIONES: La iontoforesis con orgoteína disminuye el dolor en la erección y en menor medida la incurvación peneana en pacientes con enfermedad de Peyronie (AU)

[Iontophoresis in Peyronie's disease. Our experience]. / Iontoforesis en la enfermedad de Peyronie. Nuestra experiencia.

UNLABELLED: Peyronie's disease is a type of acquired penile incurvation of unknown origin yet, which generates from the difficulty of symmetric expansion of the corpora cavernosum produced by fibrous plaques in the middle line of the albuginea. OBJECTIVES: To define the results of iontophoresis among the wide spectrum of treatments used for this disease. METHODS: 61 patients treated by iontophoresis with orgotein in weekly sessions. RESULTS: Pain improvement 42.6%, incurvation improvement 6.1%, improvement of both 21.3%. CONCLUSIONS: In patients with Peyronie's disease iontophoresis with orgotein diminishes pain with erections, and, to a lesser extent, penile incurvation.

Tratamiento rehabilitador en la incontinencia urinaria de esfuerzo femenina / Pelvic floor exercise in the treatment of female urinary stress incontinence

OBJETIVOS: Conocer los resultados de un programa de rehabilitación perineal en el tratamiento de la incontinencia urinaria de esfuerzo femenina. MÉTODOS: Fase informativa, con explicaciones a la paciente de su enfermedad, de su anatomía, de los objetivos que se pretenden alcanzar y de cómo desarrollar los ejercicios. Fase de tratamiento con desarrollo durante seis semanas de la musculatura perineal mediante ejercicios perineales asistidos por biofeedback visual y acústico. Fase de seguimiento, con visitas periódicas al mes, 3 meses, 6 meses y un año, con control de la evolución de la musculatura, refuerzo a la motivación y mejoría de los síntomas. RESULTADOS: 412 mujeres rehabilitadas en cuatro años, con 45,9 por ciento de curaciones, 38,8 por ciento de mejorías y 15,3 por ciento de fracasos. CONCLUSIONES: La rehabilitación del suelo pélvico puede curar la incontinencia urinaria de esfuerzo femenina y disminuye el número de cirugías y el gasto hospitalario en el tratamiento de la incontinencia (AU)

[Rehabilitation in female stress urinary incontinence]. / Tratamiento rehabilitador en la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To know the results of a pelvic floor muscle training program in the treatment of female stress urinary incontinence. METHODS: Information phase: patient is informed about the disease, her anatomy, the objectives to be reached and how to perform the exercises. Treatment phase: 6 weeks of visual and auditory biofeedback assisted pelvic floor exercises to develop the pelvic floor muscles. Follow-up phase: one, 3, 6 month and 1 year visits with control for muscle evolution, motivation reinforcement and improvement of the symptoms. RESULTS: 412 Women underwent pelvic floor rehabilitation in a 4 year period, 45.9% were cured, 38.8% improved and 15.3% were treatment failures. CONCLUSIONS: Pelvic floor rehabilitation can cure female urinary stress incontinence and diminishes the number of surgical procedures and hospital costs in the treatment of urinary incontinence.

Cáncer renal: análisis descriptivo de una serie de 267 casos intervenidos / Renal Cancer: descriptive analysis of 267 surgically treated cases

OBJETIVO: Presentar los resultados obtenidos tras realizar el análisis descriptivo de nuestra serie de 267 tumores renales intervenidos. MÉTODO: Desde enero de 1986 a octubre de 1999 se intervinieron en nuestro Servicio 267 pacientes (153 hombres y 114 mujeres) afectos de tumor renal. La edad media fue de 60,23 años. Los datos se incluyeron en una base de datos creada en el programa Access, y posteriormente analizados mediante el paquete informático SPSS, realizándose un análisis descriptivo y calculando la expectativa de vida mediante la curva de supervivencia de Kaplan-Meier. La media de seguimiento fue de 42,72 meses. RESULTADOS: La incidencia de su localización fue del 56,4 por ciento derechos y el 43,6 por ciento restante izquierdos. El diagnóstico se realizó de forma incidental en el 41,2 por ciento de los casos. En los sintomáticos, el signo de presentación más frecuente fue la hematuria (51,8 por ciento). Se realizó nefrectomía radical en el 94,2 por ciento, parcial en el 3,1 por ciento y tumorectomía en el 2,7 por ciento. En el 75,5 por ciento de los casos la vía de abordaje fue lumbar. En cuanto a la histología, el 88,7 por ciento carcinomas. El tipo celular más frecuente resultó ser el de células claras (91,5 por ciento). El 55,8 por ciento GI, el 32,9 por ciento GII y el 11,3 por ciento GIII. En cuanto al Estadio (según la clasificación TNM de 1992): 64,3 por ciento Estadio I, 15,4 por ciento II, 17 por ciento III y 3,3 por ciento IV. El 80,5 por ciento no presentaba afectación vascular. La supervivencia global fue del 71,93 por ciento a los 5 años (media de 114 meses y mediana de 167 meses). En la actualidad el 76 por ciento de los pacientes se encuentran vivos. CONCLUSIONES: La distribución por sexos en nuestra serie difiere de lo publicado por la mayoría de los autores. El diagnóstico de forma incidental supone una proporción importante de los casos. La vía lumbar es la más empleada como acceso quirúrgico. La supervivencia global se asemeja a la comunicada por otros grupos (AU)