[Cutaneous horn of the penis]. / Cuerno cutáneo de pene.

OBJECTIVE: To describe a case of cutaneous horn of the penis and review its clinical and histological features. METHODS: The clinical and histological features of cutaneous horn of the penis are described. RESULTS/CONCLUSIONS: Cutaneous horn of the penis is an uncommon lesion that is diagnosed without difficulty. Treatment is by surgery with sufficient margins due to its possible association with malignant lesions.

[Loss of heterozygosity in the 9p21 region as an inactivation mechanism of the p16 suppressor gene]. / Pérdida de heterocigosidad en la región 9p21 como mecanismo de inactivación del gen supresor p16.

OBJECTIVE: To determine the loss of heterozygosity (LOH) on 9p21 (locus D9S1747) in patients with renal carcinoma by analysis of microsatellite polymorphisms. METHODS: 40 patients with sporadic renal cancer were studied. LOH on 9p21 was performed by analysis of microsatellite polymorphisms. RESULTS: 23.7% showed LOH on 9p21. No correlation was found between this genetic alteration and tumor features. CONCLUSIONS: LOH on 9p21 was found in 23.7% of the patients in this series. LOH was found in 26.9% of renal cell carcinomas, 25% of papillary carcinomas and 25% of Bellini duct carcinomas. LOH was not found in the other histological types.

[Neoadjuvant chemotherapy MVAC in the treatment of infiltrating bladder carcinoma]. / Quimioterapia neoadyuvante MVAC en el tratamiento del carcinoma vesical infiltrante.

INTRODUCTION: Aiming to preserve the bladder in patients with infiltrative carcinoma of the bladder and to offer patients improved quality of life with no detriment for survival, a therapeutical protocol was set up. MATERIAL AND METHODS: Between August 1988 and January 1997 63 patients with stage T2 and T3a infiltrative carcinoma of the bladder, with no metastasis or node extension detectable with imaging techniques were treated in our unit. 45 of these patients met all protocol criteria and were given 3 neoadjuvant chemotherapy courses with MVAC (methotrexate, vincristine, adriamycin, cisplatin). INCLUSION CRITERIA: age under 75 years, Karnofsky greater than 50%, leucocytes greater than 2,500 cell/mL and platelet greater than 100,000/mL. Following chemotherapy, re-assessment was performed through lab tests, chest X-rays, abdomino-pelvic CT, bone scanning, cystoscopy, multiple randomized biopsies, tumoral bed scar resection and resection of relapsed urothelioma. Patients with complete remission were given radiotherapy. Those showing stabilisation of progression were proposed to undergo cystectomy. Fisher's test or chi 2 test were used for the comparison of qualitative variables. The survival analysis was performed using the Kaplan-Meier method. The curves comparison was done with Breslow's exact test. A Cox's proportional risk method allowed to calculate the relative risks together with their 95% confidence interval. RESULTS: 53.7% patients included in this protocol showed complete remission, 41.5% stable disease and 4.9% progression. 62.2% of patients were given radiotherapy versus 17.8% who underwent cystectomy. 20% received other therapies after rejecting both cystectomy or radiotherapy. Median follow-up was 43.38 months. Overall median survival was 96 months. The accumulate probability of survival at 4 years was 79%. 50% patients with complete clinical response relapsed during follow-up. Tumoral stage of those who relapsed was lower than the initial one in 63.7% cases, remained the same in 18.2%, and higher in 18.2%. With regards to grading, 66.7% patients had lower grading at relapse if tumour was initially grade 2. For those with initial tumour grade 3, only 20% had a lower grade. CONCLUSION: 64.4% patients retained their bladder. In 26.7% there was demonstrable metastatic disease. No differences were seen in the distribution or survival time based on the different treatment given after chemotherapy (p = 0.22). Patients with complete remission after chemotherapy have greater actuarial survival which is statistically significant (p = 0.04).

[Epidermal growth factor receptor (EGFR) in the prognosis of bladder carcinoma. Experience of 5 years]. / Receptor del factor de crecimiento epidérmico (EGFR) en el pronóstico del carcinoma vesical. Experiencia a 5 años.

METHODS: From November 1992 to November 1993, a prospective study was conducted on 20 controls and 61 patients with bladder carcinoma. EGFR expression was determined by radioimmunoassay and the correlation of the results of histological analysis and the clinical course was analyzed. The follow-up period was from November 1992 to July 1998. The association between qualitative variables and the x2 or Fisher exact test was compared using the hypothesis of the proportional ordinal trend for the ordinal variables, and the quantitative variables were analyzed using Student's t test and/or variance analysis (ANOVA). Survival was analyzed by the Kaplan-Meier method and comparison was performed using the Breslow exact test. The Cox proportional hazards regression model was utilized. The SPSS software for Windows 7.0 was used for the analysis. RESULTS: The EGFR values were higher for patients with bladder carcinoma than in controls (14.48 vs 2.54 fmol/mg of protein). EGFR values were higher in patients with superficial bladder tumor than in those with infiltrating tumors (27.03 fmol/mg vs. 10.05 fmol/mg of protein; p = 0.000). Poorly differentiated tumors showed higher values of EGFR (6.73, 14.48 and 17.07 fmol/mg of protein for grades I, II and III, respectively; p < 0.05). The EGFR values were higher in patients that died from cancer during follow-up (64.8) than in those who died from other causes (47.5) and those who are alive and on follow-up (42). An increase in EGFR values did not carry a risk of death from cancer (p = 0.1269; ns). Analysis of the grade of tumor differentiation showed that for the more aggressive tumor grade, a positive EGFR was a sign of reduced survival. Survival in patients with superficial and infiltrating tumor did not appear to change significantly according to the EGFR value. EGFR determination was not useful in predicting recurrence and increased EGFR values did not correlate with a higher risk of recurrence. CONCLUSIONS: 1) The normal pattern of EGFR could not be established. 2) EGFR was not useful in identifying subgroups at risk of death. 3) Knowledge about these proteins synthesized by oncogenes offers new possibilities in the treatment of cancer.

Quimioterapia neoadyuvante MVAC en el tratamiento del carcinoma vesical infiltrante / Neoadjuvant chemotherapy with MVAC in the treatment of infiltrative carcinoma of the bladder

INTRODUCCIÓN: Se inició este protocolo de tratamiento con intención de conservar la vejiga en los pacientes con carcinoma vesical infiltrante y, con ello, dar al paciente una mejor calidad de vida sin detrimento de su supervivencia. MATERIAL Y MÉTODO: Desde Agosto de 1988 hasta Enero de 1997 hemos tratado a 63 pacientes portadores de carcinoma vesical infiltrante en estadio clínico T 2 y T 3a sin metástasis ni diseminación ganglionar objetivables por técnicas de imagen. De estos 45 cumplieron estrictamente el protocolo y recibieron 3 ciclos de quimioterapia neoadyuvante MVAC (metotrexate, vincristina, adriamicina y cisplatino). Los criterios de inclusión fueron : edad menor de 75 años, Karnofsky mayor del 50 por ciento, recuento leucocitario mayor de 2.500 células/ml y plaquetas superiores a 100.000/ml. Se realizó reevaluación tras la quimioterapia mediante estudios analíticos, radiografía de tórax, CT abdominopélvico, gammagrafía ósea, cistoscopia, biopsias múltiples randomizadas, resección de la cicatriz del lecho tumoral o resección de urotelioma recidivado. Los pacientes con remisión completa recibieron radioterapia. A los que presentaron estabilización o progresión se les propuso cistectomía. La comparación entre variables cualitativas se ha realizado con el test de la ??2 o test de Fisher. Se realizó un análisis de supervivencia con el método de Kaplan-Meier. La comparación de curvas se realizó con el test exacto de Breslow. Un modelo de riesgos proporcionales de Cox permitió el cálculo de los riesgos relativos junto a su intervalo de confianza al 95 por ciento. RESULTADOS: De los pacientes incluidos en este protocolo mostraron remisión completa el 53.7 por ciento, estabilización el 41.5 por ciento y progresión el 4.9 por ciento. El 62.2 por ciento de los sujetos recibieron radioterapia, frente al 17.8 por ciento a los que se realizó cistectomía. El 20 por ciento recibió otros tratamientos por negarse a cistectomía o radioterapia. La mediana de seguimiento fue de 43,38 meses. La supervivencia global mediana fue de 96 meses. La probabilidad acumulada de supervivencia a los 4 años fue del 79 por ciento. De los pacientes que tuvieron respuesta clínica completa recidivaron durante el seguimiento el 50 por ciento. De éstos el 63.7 por ciento lo hicieron en un estadio menor que el tumor inicial, un 18.2 por ciento repitieron estadio y un 18.2 por ciento presentaron un estadio superior. En cuanto al grado el 66.7 por ciento de los pacientes presentaron un grado menor en la recidiva si el tumor inicialmente era de grado 2. Aquellos que inicialmente presentaron un grado 3 solo disminuyeron el mismo en un 20 por ciento de los casos. CONCLUSIONES : El 64.4 por ciento de los pacientes conservaron su vejiga. La enfermedad metastásica demostrable apareció en el 26.7 por ciento. No se observaron diferencias en la distribución en el tiempo de la supervivencia según los diferentes tratamientos administrados tras la quimioterapia (p=0.22).Los pacientes que presentan remisión completa tras quimioterapia tienen una mayor supervivencia actuarial que es estadísticamente significativa (p=0.04) (AU)

[P185 (Neu) oncoprotein in the prognosis of bladder carcinoma. Experience of 5 years]. / Oncoproteína P185 (Neu) en el pronóstico del carcinoma vesical. Experiencia a 5 años.

OBJECTIVE: To determine the utility of p185 oncogene in the biological characterization of transitional cell carcinoma and in the prediction of recurrence, and to analyze survival at 5 years mean follow-up. METHODS: A prospective clinical cohort study was conducted on 81 patients. Tissue specimens were obtained between November 1992 and November 1993. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). p185 expression was determined by enzyme immunoanalysis (EIA). A statistical analysis of the results was performed. RESULTS: p185 oncoprotein levels were higher in patients with recurrence (1098.97 HNU/mg protein vs. 924.54 HNU/mg). Although higher levels of p185 were found in the patients that had died vs those who are alive, the differences were not statistically significant for overall survival or stratification by tumor grade or infiltration (p = 0.556; ns). CONCLUSIONS: Determination of p185 oncoprotein was found to be useful in the prediction of tumor recurrence at 5 years mean follow-up.

Fístula vésico-acetabular tras migración protésica / Vesico-acetabular fistula following prosthesis displacement

Se describe el caso excepcional de una fístula vésico-acetabular tras la migración del acetábulo de una prótesis de cadera hasta el interior vesical, catorce años después del implante de dicha prótesis y que cursó con osteomielitis, linfedema, infección urinaria recurrente, hematuria y fiebre. A propósito de nuestra paciente se realiza una revisión de los casos recogidos en la literatura (AU)

[Usefulness of PSA-complex in the diagnosis of prostatic carcinoma]. / Utilidad del PSA-complex en el diagnóstico del carcinoma de próstata.

OBJECTIVE: Since its discovery as a marker for prostate cancer, there have been many attempts to enhance the diagnostic efficacy of the prostate specific antigen (PSA). Among these are the studies that analyze the behavior of different forms of serum PSA bound to different antiproteases, such as alpha-1-antichymotrypsin, which forms the complexed PSA (PSA-c). This study analyzed the utility of PSA-c to enhance specificity without altering sensitivity in comparison to total PSA (PSA-t). METHODS: From September 1998 to March 1999, blood samples were obtained from 96 patients that had undergone a prostate biopsy due to a suspicion of prostate cancer. PSA-c, PSA-t (Technicon Immunol system, Bayer) and PSA-c/PSA-t ratio were analyzed in these patients. RESULTS: ROC curves were plotted and the optimal cutoffs were found for which the specificity was higher for PSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI 95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%, 27-51]) while maintaining a similar sensitivity index (90%). PSA-c showed similar results for other values of sensitivity. CONCLUSIONS: PSA-c was found to improve specificity in comparison to PSA-t and PSA-c/PSA-t ratio. PSA-c determination could avoid unnecessary biopsies without altering sensitivity; i.e., the same number of prostate cancers will be detected.

[Vesico-acetabular fistula following prosthesis migration]. / Fístula vésico-acetabular tras migración protésica.

A rare case is described of vesico-acetabular fistula following acetabulum displacement of a hip replacement towards the inner bladder, fourteen years after the original insertion of the prosthesis. In all the reviewed literature of we have not found a single described case of vesico-acetabular fistula associated with displacement towards the bladder interior of a hip prosthesis, which leads us to consider this complication an exceptional one.

[Usefulness of p53 oncoprotein immunohistochemistry in the follow-up of bladder carcinoma: a 5-year study]. / Utilidad de la oncoproteína p53-IHQ en el seguimiento del carcinoma vesical: estudio a 5 años.

OBJECTIVE: Mutations in the TP53 gene are frequently detected in some types of malignant tumors (bladder, prostate, kidney, lungs, breast, colon and rectum). This study analyzed the utility of semi-quantitative determination of p53 in transitional cell carcinoma of the bladder by an immunohistochemical technique and evaluated the results at 5 years. METHODS/RESULTS: A prospective clinical cohort study was conducted on 81 patients. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). In both groups the tissue specimens were obtained between November 1992 and November 1993, and during the follow-up period until July 1998. p53 expression was determined by a semi-quantitative method based on an immunohistochemical technique (NCL-p53-DO7, Novocastra). CONCLUSIONS: p53 oncoprotein was not found to be useful in the characterization of carcinoma of the urinary bladder.

[Comparative population-based survey as evaluation method of prostate disease changes]. / Estudio poblacional comparativo mediante encuesta como método de evaluación de las modificaciones sobre la patología prostática.

A survey-based comparative study was conducted to evaluate the changes on the prostate pathology in two male populations separated by a time interval of two years (1st and 3rd Week of Prostate Health). A total of 2056 respondents in the 1st Week, and 2126 in the 3rd Week were evaluated. The questionnaire included questions relative to prostate awareness, impact of urinary complaints on daily like activities, Spanish validated IPSS and selective questions for prostate patients. The comparison between both surveys disclosed visits to the urologist at earlier age and longer-standing symptoms. The most prevalent symptoms continue to be decreased calibre of the urinary stream, pollakiuria and urgency. IPSS/L and IPSS/age ratios remained unchanged. There was increased number of visits by mildly symptomatic patients (IPSS < 8), increased periodical revisions, and in the number of patients seen and treated by the urologist. A significant approximation to the diagnostic testing criteria established by the WHO for BPH was demonstrated. The number of patients who received treatment raised and there was also a significant improvement in the outcome. Comparative populational studies could allow to assess changes in the awareness status of the prostate, changes in symptomatic levels and quality of life of the population requesting health care, as well as changes in the diagnostic and therapeutical schemes in patients suspected of having BPH.

[The clinical and flowmetric results of the treatment of benign prostatic hyperplasia with doxazosin]. / Resultados clínicos y flujométricos del tratamiento de la hiperplasia benigna de próstata con doxazosina.

OBJECTIVE: To evaluate the clinical efficacy of doxazosin for 6 months in the treatment of benign prostatic hyperplasia (BPH). METHODS: A prospective clinical and uroflowmetric study was conducted on 65 males with BPH treated with doxazosin 4 mg daily for 6 months. Patient mean age was 66.7 years (range 45-79). Clinical evaluation (IPSS and andrologic data) and blood analyses were performed before and after treatment. IPSS data were obtained according to the WHO validation and Spanish translation. RESULTS: A significant improvement was found between the mean pre- and post-treatment IPSS scores (19.8 +/- 4.8 vs 11.9 +/- 4.6; p < 0.001). Maximum flow rate before treatment was 9.13 ml/sec, which increased to 16.23 ml/sec after treatment (p < 0.001). Postvoid residual urine dropped from 21.7% to 12.5% (p < 0.01). All the patients were normotensive before (135.9 mean systolic and 78.9 mean diastolic blood pressure) and after treatment (135.4 mean systolic and 77.8 mean diastolic blood pressure). Mean heart rate was similar before and after treatment (71.9 +/- 5.8 vs 71.8 +/- 5.9). A relationship between low IPSS score before treatment and urinary symptoms improvement was demonstrated (coeff. -0.45939). No relationship was found between prostate volume (digital rectal examination or transabdominal ultrasound) and improvement in the IPSS score. No statistical relationship was found between the IPSS and postvoid residual urine or peak flow. No modifications of sexual activity was demonstrated with doxazosin treatment. Pre- and post-treatment blood analytical data fell within the normal ranges. Transient side effects were observed in 12 patients (20%): headache in 6 patients (10%), fatigue in 6 (10%), dizziness in 3 (5%) and somnolence in (5%). CONCLUSIONS: Doxazosin, at a daily dose of 4 mg daily for 6 months, is a safe and effective treatment in patients with BPH.

[Development of cell cultures in basic research on renal carcinoma]. / Desarrollo de cultivos celulares en la investigaciíon básica del carcinoma renal.

OBJECTIVE: The development of in vitro cell tissue culture techniques has provided most of the current knowledge on the physiology of both normal and tumor cells. The results of cell culture studies using nephrectomy specimens are presented. METHODS: Surgical specimens from 7 patients (3 males, 42.9%; 4 females, 57.1%) aged 43-79 years (mean 62.14), who had undergone nephrectomy for renal adenocarcinoma between April 1997 and February 1998 were utilized. The tumor cell samples were obtained during surgery, after the kidney had been excised. The samples were cut, washed in a balanced saline solution and enzymatically dissociated in a trypsin solution (0.1% Hank's solution) for 30 minutes at 37 degrees, centrifuged, placed in Multiwell plates, covered with 0.1 mg/ml polylysine (ICN) or 3 mg/ml collagen S (Boehringer) and cultured in RPMI 1640 (Sigma) supplemented with 5% fetal calf serum (reagent), which was changed every 2-3 days for one month. After the culture had developed, samples were fixed in 70% ethanol and stained with hematoxylin-eosin for cell identification. Cell types were identified by cytokeratin analysis. RESULTS: The histological types were: clear cell renal adenocarcinoma in three cases (42.9%), renal oncocytoma in two (28.6%), mixed cells renal adenocarcinoma in one (14.3%) and papillary carcinoma in one case (14.3%). Polylysine and collagen were found to be good substrates for normal and tumor cell culture. Polylysine was found to be a better substrate for epithelial cells; there were less epithelial and more mesangial cells in the collagen substate. The positive cytokeratin expression (a marker for intermediate filaments) corroborates the well-known epithelial origin of renal cell carcinoma. Epithelial cells from normal kidney grew well in the culture medium. Mean cell survival was 30.83 days (range 15-50). To evaluate the viability of the culture, positivity for a neutral red stain was used as marker for good metabolic activity after one month. All cultures that survived for more than one month (5 of 7) stained positively. CONCLUSIONS: The study and development of human cell lines is useful to analyze the metabolic aspects of renal carcinoma. Cell cultures permit conducting genetic and molecular studies and investigating the radio and chemosensitivity of renal carcinoma in vitro.

[Toward a simplified method of classifying urinary incontinence in the elderly based on a multivariate analysis of 948 cases]. / Hacia un método simplificado de tipificación de la incontinencia urinaria del anciano, basado en el análisis multivariante de 948 casos.

OBJECTIVE: The present study analyzes the main clinical types of urinary incontinence in the elderly population and its clinical-urodynamic correlation to facilitate definitive diagnosis. METHODS/RESULTS: The study was conducted in 948 elderly patients (382 male, 566 female; mean age 72.4 years) with urinary incontinence. Patient clinical and urodynamic records were reviewed. The most common clinical types were urge-incontinence (56.4%) and incontinence with coughing associated with urge-incontinence (32.3%); the latter type was the most common in women. The most frequent urodynamic diagnoses were isolated bladder instability (29.9%), followed by obstruction (15.6%) and stress incontinence (14%). CONCLUSIONS: The most common symptom in bladder instability was urge-incontinence, while incontinence with coughing was found to be the most common symptom in urinary stress incontinence. A significant correlation was found between the postvoid residual urine and the main urodynamic diagnoses. Multivariate analysis showed that classification by clinical types of incontinence together with measurement of residual urine can facilitate diagnosis, although this approach has a low sensitivity for the main forms of isolated incontinence. The mixed forms require a urodynamic study.

[The persistence of the müllerian duct]. / Persistencia del conducto Mülleriano.

OBJECTIVE: To report two rare cases of persistent müllerian duct syndrome. METHODS/RESULTS: Two patients with normal chromosome studies (46, XY) are presented. The radiological evaluation showed structures compatible with those of the müllerian duct. These structures were completely excised with excellent results. The histological findings confirmed the clinical diagnosis. CONCLUSIONS: Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism that presents difficulties in making the differential diagnosis from other conditions with a different etiopathogenesis and that are not completely defined.

[Quantification of p53 oncoprotein in bladder carcinoma: 5-year experience]. / Cuantificación de la oncoproteína p53 en el carcinoma vesical: experiencia a 5 años.

OBJECTIVE: Mutations in the p53 gene are frequently detected in some types of malignant tumors (bladder, prostate, kidney, lung, breast, colon and rectum). This study analyzed the utility of p53 quantitation in transitional cell carcinoma of the bladder and evaluated the results at 5 years. METHODS: A prospective clinical cohort study was conducted on 81 patients. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). In both groups the tissue specimens were obtained between November 1992 and November 1993, including the follow-up period until July 1998. p53 expression was determined by a quantitative method based on immunoluminiscence (LIA-MAT p53). RESULTS: p53 expression was higher in bladder carcinoma than in healthy urothelial tissue; higher values of p53 were found for infiltrating and undifferentiated tumors. The p53 values were higher in patients with tumor recurrence than in those without (NS). The Bonferroni multiple comparisons test showed a higher mortality in patients with p53 > 0.9 than in patients who are alive or have died from other causes (p = 0.000). CONCLUSION: The results show that p53 LIA-MAT is an independent prognostic factor at a cutoff of 0.9 and permits identification of a subgroup of patients at high risk.

[Arterial priapism. Resolution following embolization with autologous thrombus]. / Priapismo arterial. Resolución tras embolización con coágulo autólogo.

OBJECTIVE: To report our experience with the management of arterial priapism by embolization. METHODS: Two patients with arterial priapism secondary to perineal trauma are described. Diagnostic evaluation included intracorporal blood gas, echo Doppler and selective pudendal arteriographic assessment. Treatment was by selective autologous embolization. RESULTS: Detumescence was achieved and control follow-up evaluation at 12 and 24 months demonstrated normal erectile function. CONCLUSIONS: In our view, selective embolization is an effective treatment for arterial priapism arising from perineal trauma.

[The loss of heterozygosity on the short arm of chromosome 3 in renal carcinoma]. / Estudio de la pérdida de heterocigosidad en el brazo corto del cromosoma 3 en carcinoma renal.

OBJECTIVE: Renal cancer accounts for 2% of tumors. The most common chromosome abnormality found in renal cancer is the loss of heterozygosity (LOH) on the short arm of chromosome 3 (3p), which suggests that near the gene responsible for von Hippel-Lindau disease, there may be one or more tumor suppressor genes between 3p14 and 3p21 with a relevant role in the development of renal cancer. METHODS: 41 patients with sporadic renal cancer were tested for three microsatellites mapped to the short arm of chromosome 3 (3p14.1-3p14.3, 3p21.2-3p21.3 and 3p25) by polymerase chain reaction. The results were compared with patient habits and tumor features. RESULTS/CONCLUSIONS: 43.9% of the patients showed LOH on at least one locus. Thirty-four percent showed LOH only on one locus, 4.9% on two loci and 7.3% on the three loci tested. All the patients who showed LOH on 3p21 had a tumor size greater than 25 mm. There is a risk 1.76 times higher of no loss in tumors less than 25 mm in size than in tumors greater than 25 mm (Cl 95% 1.33-2.33).

[Ureteral iatrogenic disease of obstetric-gynecologic origin]. / Yatrogenia ureteral de origen obstetro-ginecológico.

OBJECTIVE: To review our experience in the diagnosis and management of ureteral injuries secondary to obstetric and gynecologic procedures. METHODS: During the last 25 years, 42 patients were treated at our center for iatrogenic ureteral injuries (45 renal units) associated with obstetric and gynecologic procedures, principally hysterectomy via the abdominal approach (29 cases). The injury was diagnosed in the immediate postoperative period in 21 of the 42 cases. Surgical management was frequently by ureteroneocystostomy. Patient follow-up ranged from 3 months to 11 years. RESULTS: Good results were obtained in 83.3% of the cases. CONCLUSIONS: Ureteral injuries detected intraoperatively should be immediately repaired. For those diagnosed postoperatively, management by retrograde or antegrade catheterization and/or US or CT-guided percutaneous nephrostomy should be attempted before performing surgery.

[Usefulness of P53 oncoprotein in urinary wash cytology: experience in patients with superficial bladder carcinoma]. / Utilidad de la oncoproteína p53 en citología urinaria de arrastre: experiencia en pacientes con carcinoma vesical superficial de vejiga.

OBJECTIVES: 1) To determine p53 expression in urinary wash cytology by immunohistochemistry in patients with superficial transitional cell carcinoma of the bladder and controls; 2) to correlate p53 in urinary wash cytology and anatomopathological characteristics of the bladder tumors analyzed; 3) to determine the utility of p53 expression in urinary wash cytology as a prognostic factor; and 4) to identify a subgroup of patients with superficial tumors of worse prognosis in order to improve control of the evolution of the tumor and treatment. METHODS: From 1993 to 1998, 141 cases were studied; 32 controls comprised group I and 109 (38 primary and 71 recurrence) patients with transitional cell carcinoma of the urinary bladder comprised group II. RESULTS: In group II, 29.5% were positive for p53 in urinary wash cytology, while no positive cases were found in group I. A total of 104 valid data were analyzed, which showed a higher percentage of p53-positive cases in grade III tumors (44.4%). Statistical analysis showed the percentage of p53-positive cases increased with tumor grade in a linear trend (p = 0.17). The recurrence rate in the p53-positive was 20% greater than in the p53-negative cases. Tumor progression was three times higher in the p53-positive than in the p53-negative patients. CONCLUSIONS: The application of biomolecular knowledge to cytology is a useful complement in follow-up of patients with superficial transitional cell carcinoma of the bladder and offers additional parameters to distinguish benign and malignant cells. Immunohistochemical determination of p53 in urinary wash cytology identifies patients with superficial tumors with a worse prognosis.