Histo-morpho-biochemical findings of the residual prostate (III): (undetectable) PSA maintained after retropubic adenomectomy for BPH.

SUMMARY OBJECTIVES: To present 4 cases with "undetectable" PSA levels (PSA <0.15 ng/ml) long-term postoperative follow-up after retropubic adenomectomy for BPH METHODS: They come from a series of 70 consecutive cases of retropubic prostatic adenomectomies, monitored and controlled at the hospital in their biochemical, histological and morphometric analysis for 5 years following the intervention. RESULTS: Four patients have demonstrated PSA levels <0.15 in all controls after surgery. Mean follow-up of the global series: 45.25 months. There is correlation between this determination and histological and morphometric data, when they were achieved. CONCLUSIONS: "Undetectable" PSA after open prostatic adenomectomy could be an equivalent to the expression of "radical cure"of BPH, and a reliable marker for monitoring neo-hyperplasia.

Hallazgos bioquímicos –histo-morfométrico de la próstata residual (III): PSA “indetectable” mantenido tras adenomectomía retropúbica por HBP / Histo-morpho- biochemical findings of the residual prostate (III)

OBJETIVO: La presentación de 4 casos que, intervenidos de adenomectomía retropúbica por HBP, han presentado, en los controles postoperatorios de PSA, cifras “indetectables” del antígeno (PSA<0.15ng/ml), de forma mantenida a largo plazo. MÉTODO: Proceden de una serie de 70 casos consecutivos intervenidos por vía abierta de HBP que han venido siendo seguidos y controlados, a nivel hospitalario, en sus aspectos bioquímico, histológico y morfométrico durante los 5 años siguientes a la intervención. RESULTADOS: Cuatro pacientes han demostrado cifras de PSA < 0.15 en todos los controles que se han establecido a partir de la cirugía hasta el momento presente en el que, en conjunto, supone una media de seguimiento de 45,25 meses. Ha existido una concordancia de esta determinación con los datos morfométricos e histológicos, cuando se han conseguido. CONCLUSIÓN: La “indetectabilidad” del PSA después de adenomectomía prostática abierta podría suponer un fiable marcador de seguimiento para descartar la neohiperplasia equivalente a la expresión de “cura radical” de la HBP (AU)

OBJECTIVES: To present 4 cases with “undetectable” PSA levels (PSA <0.15ng/ml) on long-term postoperative follow-up after retropubic adenomectomy for BPHMETHODS: They come from a series of 70 consecutive cases of retropubic prostatic adenomectomies, monitored and controlled at the hospital in their biochemical, histological and morphometric analysis for 5 years following the intervention. RESULTS: Four patients have demonstrated PSA levels <0.15 in all controls after surgery. Mean follow-up of the global series: 45.25 months. There is correlation between this determination and histological and morphometric data, when they were achieved. CONCLUSIONS: “Undetectable” PSA after open prostatic adenomectomy could be an equivalent to the expression of “radical cure” of BPH, and a reliable marker for monitoring neo-hyperplasia (AU)

[Biochemical-histo-morphometric findings of the residual prostate (II): long-term PSA behavior after retropubic adenomectomy for BPH. Relationship with prostate volume, histology and its implications in the diagnosis of subsequent adenocarcinoma]. / Hallazgos bioquímico- histo- morfométricos de la próstata residual (II): comportamiento del PSA,A largo plazo, tras adenomectomía retropúbica por H.B.P. Interrrelaciones con el volumen e histología de la próstata residual y sus implicaciones en el diagnóstico ulterior de adenocarcinoma.

SUMMARY OBJECTIVES: To evaluate the changes experienced by the amount of PSA in patients diagnosed with BPH undergoing retropubic adenomectomy (with vesico-capsule plasty) in the short and long term, and the relationships between weight and /or prostate volume calculated preoperatively, volumes and histology of the surgical tissue and residual tissue remaining immediate and on the long term. METHODS: A consecutive series of 70 cases of BPH surgery and followed up beyond 5 years with preoperative PSA and transrectal ultrasound, histology of the piece, postoperative transrectal ultrasound, PSA annually until the fifth year and ultrasound. Within this group, residual prostate histology was obtained in 30 patients between 12 and 36 months after adenomectomy. RESULTS: In accordance to our own confirmed studies, the ATH (transcervical hemostatic adenomectomy) removes by enucleation 76% of the entire volume reported by preoperative ultrasound, including capsule. In our cases, PSA has dropped 83% at one year after surgery compared with the preoperative value, and in most cases that have already reached 5 years of follow-up, this percentage remains with little variation. Having being established a strong relationship between PSA and glandular volume, we must evaluate the need for new cut-off values giving more value to the PSA density in relation to the volume of residual prostate, attempting to improve early diagnosis of carcinoma in these particular cases, in which will be useful a new protocol design. CONCLUSIONS: PSA decline, histology of the prostate after adenomectomy and the morphometric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the residual prostate gland.

Hallazgos bioquímico-histomorfométricos de la prostata residual (II): Comportamiento del PSA,a largo plazo, tras adenomectomia retropubica por H.B.P. Interrrelaciones con el volumen e histología de la prostata residual y sus implicaciones en el diagnostico ulterior de adenocarcinoma / Biochemical–histo-morphometric findings of the residual prostate (II): Long-term PSA behavior after retropubic adenomectomy for BPH. Relationship with prostate volume, histology and its implications in the diagnosis of subsequent adenocarcinoma

OBJETIVO: Constatar las variaciones experimentadas por la cifra de PSA en pacientes diagnosticados de HBP y sometidos a adenomectomía retropúbica (A.T.H. con vesicocapsuloplastia) a corto y largo plazo y las relaciones existentes entre aquella, los pesos y/o volúmenes prostáticos calculados en el preoperatorio, los volúmenes e histología de la pieza quirúrgica y del tejido residual inmediatos y lejanos.MÉTODO: Lo constituyen una serie inical de 70 casos de HBP consecutivos sometidos a cirugía y seguidos hasta más allá de los 5 años con PSA y ecografías transrectales preoperatorias, histología de la pieza, ecografía transrectal postoperatoria , PSA anual hasta el quinto año, según los casos, y ecografía postoperatoria lejana discrecional. Dentro de este grupo, en 30 pacientes, se obtuvo histología de la próstata residual entre 12 y 36 meses post adenomectomía.RESULTADOS: Según estudios propios, ya confirmados, la ATH (adenomectomía transcervical hemostática) extirpa la hiperplasia por enucleación representando el 76% de todo el volumen preoperatorio que informa la ecografía, incluyendo cápsula. A su vez, en nuestros casos, el PSA ha descendido, al año de la cirugía, una media del 83% con relación al preoperatorio y, en la mayoría de los casos que ya han alcanzado los 5 años de seguimiento, ese porcentaje se mantiene sin apenas variación. Establecida una fuerte relación entre PSA y volumen glandular hay que plantearse la necesidad de redeterminar las cifras de “cut-off” dando más valor a la PSA density del mismo en relación con los volúmenes reducidos de la próstata residual en un intento por mejorar el diagnóstico precoz de un carcinoma de la misma para lo que será útil el diseño de un nuevo protocolo(AU)

CONCLUSIÓN: El descenso del PSA, la histología de la próstata tras la adenomectomía y los morfométricos cambios tras la cirugía y a medio plazo aconsejan una más adecuada definición del nivel de corte del PSA en estos pacientes en orden a detectar más precozmente un carcinoma en la próstata residual(AU)

OBJECTIVES: To evaluate the changes experienced by the amount of PSA in patients diagnosed with BPH undergoing retropubic adenomectomy (with vesico-capsule plasty) in the short and long term, and the relationships between weight and / or prostate volume calculated preoperatively, volumes and histology of the surgical tissue and residual tissue remaining immediate and on the long term.METHODS: A consecutive series of 70 cases of BPH surgery and followed up beyond 5 years with preoperative PSA and transrectal ultrasound, histology of the piece, postoperative transrectal ultrasound, PSA annually until the fifth year and ultrasound. Within this group, residual prostate histology was obtained in 30 patients between 12 and 36 months after adenomectomy.RESULTS: In accordance to our own confirmed studies, the ATH (transcervical hemostatic adenomectomy) removes by enucleation 76% of the entire volume reported by preoperative ultrasound, including capsule. In our cases, PSA has dropped 83% at one year after surgery compared with the preoperative value, and in most cases that have already reached 5 years of follow-up, this percentage remains with little variation. Having being established a strong relationship between PSA and glandular volume, we must evaluate the need for new cut-off values giving more value to the PSA density in relation to the volume of residual prostate, attempting to improve early diagnosis of carcinoma in these particular cases, in which will be useful a new protocol design.CONCLUSIONS: PSA decline, histology of the prostate after adenomectomy and the morphometric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the residual prostate gland(AU)

Retransplantar en la misma fosa ilíaca: una necesidad cada vez mas presente. Importancia de la ubicación del 1º transplante / Second transplant into the same iliac fossae: The importance of first transplant location

OBJETIVO: Presentar la experiencia personal en la reutilización de la fosa ilíaca para trasplante renal (TR) de no existir otras opciones más favorables.MÉTODOS: De un total de 645 trasplantes renales que incluyen 52 TR de vivo, y tres combinados de riñón y páncreas hemos entresacado siete, en seis pacientes, en los que se reutilizó la misma fosa ilíaca de un anterior implante.RESULTADO: Los casos presentados fueron precedidos de implantes que se colocaron en posición lumboilíaca de acuerdo con la descripción que ya en 1964 aportara Gil Vernet variando la situación clásica. En su momento las trasplantectomías se realizaron siempre de forma extracapsular. Esas dos circunstancias creemos han venido a facilitar la segunda ubicación del injerto(AU)

OBJECTIVES: To report our personal experience in the reusability of the iliac fossa for renal transplantation (RT) when there are not more favorable options.METHODS: Of a total of 645 kidney transplantations, which include 52 living-donor transplantations, and three combined kidney-pancreas ones, we have selected seven, in six patients, in whom the same iliac fossa of a previous RT was reused.RESULTS: The cases reported were preceded by renal grafts placed on lumbariliac position, as Gil Vernet described at 1964, varying the classic situation. Transplantectomies were always performed using the extracapsular technique. We do think that those two circumstances have facilitated the second location of the graft(AU)

Carcinoma de células renales bilateral y asincrónico: cirugía radical y conservadora con hipotermia in situ / Asynchronic bilateral renal cell carcinoma: Radical and in situ hypothermia nephron sparing surgeries

OBJETIVO: Presentar la doble actuación que se plantea frente a un Carcinoma de Células Renales (CCR), una vez cuando se constata la normalidad del riñón contralateral y, otra, cuando obligados por la existencia del tumor en riñón único, se debe recurrir a alguna técnica que preserve la función renal posterior.MÉTODO: El caso de una paciente de 43 años, diabética que en 1982 sufrió nefrectomia radical izquierda por CCR diagnosticado al serle estudiada una HTA. Diez años más tarde se descubre tumor renal del hemirriñón superior derecho por el que se practicó cirugía conservadora con aplicación de “hipotermia in situ” para facilitar la heminefrectomía.RESULTADO: A los 18 años de la primera cirugía y 8 de la segunda se produjo el fallecimiento de la paciente por descompensación diabética, hemorragias digestivas altas por ulcus gástrico y “masa retroperitoneal probablemente pancreática” que no se llegó a poder caracterizar.CONCLUSIONES: La hipotermia “in situ” supuso una excelente ayuda para la cirugía conservadora obligada en riñón único asiento de carcinoma de células renales con notable recuperación funcional total(AU)

OBJECTIVES: To present the double ac-tion a urologist has to consider in front of a Renal cell carcinoma (RCC); on one hand, when the normality of the contralateral kidney is stated and, on the other hand when, forced by the existence of the tumor in a solitary kidney, it is mandatory to perform a surgical technique to preserve renal function.METHOD: The case of a 43 year-old patient, diabetic who in 1982 underwent left radical nephrectomy for RCC diagnosed during a diagnostic work up for hypertension (HTA). Ten years later an upper pole renal tumor is found in the remaining kidney. Nephron-sparing surgery with in situ hypothermia was performed.RESULTS: The patient died 18 years after the first surgery and 8 years after the second. Death was due to diabetic decompensation, haemorrhage from a gastric ulcer and “retroperitoneal mass probably pancreatic” that was not characterized. CONCLUSIONS: The PSA decline, the histology of the prostate during the adenomectomy and the morpho-metric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the resi-dual prostate gland(AU)

[Acquired male urethra diverticula. Report of seven cases. Bibliographic review]. / Divertículos adquiridos de uretra masculina. A propósito de siete casos. Revisión de la literatura.

OBJECTIVES: To report our personal experience in a rare urethral pathology in relation with iatrogenic sequelae from surgical treatment of lower urinary tract pathologies. METHODS: We analyze the causes, type of presentation, and surgical treatment of seven cases of urethral diverticula, which account for 2.18% of the urethral procedures performed in our department, this latter representing 2.3% of a total of 11,845 surgical procedures in a period of 25 years. RESULTS/CONCLUSIONS: Male urethra diverticula go unnoticed because their initial symptoms are very similar to other lower urinary tract entities. But there is a definitive sign once the case is advanced: the appearance of a "lump" in the ventral side of the anterior urethra, the compression of which empties urinary content, sometimes fetid; or also the feeling of having a bag with stones if they host lithiasis. Surgical reconstructive treatment is very important to guarantee the absence of an obstacle distal to the cavity as well as to achieve a consistent ventral floor for the urethra to avoid recurrence, and that, as we will see, maybe obtained by various procedures. The attention to the original disease which indirectly had been the cause of the problem completes the therapeutic scheme for each case.

Divertículos adquiridos de uretra masculina. A propóstio de siete casos. Revisión de la literatura / Acquired male urethra diverticula. Report of seven cases. Bibliographic review

Objetivo: Presentar la experiencia personal en una patología uretral rara en relación con la actividad yatrogénica derivada de los tratamientos quirúrgicos de patologías del aparato urinario inferior. Métodos: Se analizan las causas, forma de aparición y tratamiento quirúrgico de 7 casos, de divertículos uretrales, lo que supone el 2,18% de las cirugías uretrales realizadas en nuestro Servicio que, a su vez, representan el 2,3% del total de 11.845 procedimientos quirúrgicos en un periodo de 25 años. Resultado/Conclusiones: Los divertículos de la uretra masculina pueden pasar desapercibidos ya que su sintomatología inicial no se diferencia mucho de otros procesos del aparato urinario inferior. Pero hay un hecho que, ya avanzados los casos, es definitorio: la formación de un «bulto» en la cara ventral del trayecto de la uretra anterior cuya expresión da lugar, al vaciado de un contenido urinario a veces maloliente, o también la sensación de una bolsa llena de «cantos rodados», si están habitados por litiasis. En el tratamiento quirúrgico reconstructor es muy importante asegurar la ausencia de obstáculo distal a la cavidad como también la de conseguir un suelo ventral de la uretra «consistente» para evitar la recidiva y que, como veremos, puede conseguirse con diversos procedimientos. La atención a la patología original que indirectamente haya sido la causante del problema completará el esquema terapeútico a aplicar en cada caso (AU)

Objectives: To report our personal experience in a rare urethral pathology in relation with iatrogenic sequelae from surgical treatment of lower urinary tract pathologies. Methods: We analyze the causes, type of presentation, and surgical treatment of seven cases of urethral diverticula, which account for 2.18% of the urethral procedures performed in our department, this latter representing 2.3% of a total of 11.845 surgical procedures in a period of 25 years. Results/Conclusions: Male urethra diverticula go unnoticed because their initial symptoms are very similar to other lower urinary tract entities. But there is a definitive sign once the case is advanced: the appearance of a «lump» in the ventral side of the anterior urethra, the compression of which empties urinary content, sometimes fetid; or also the feeling of having a bag with stones if they host lithiasis. Surgical reconstructive treatment is very important to guarantee the absence of an obstacle distal to the cavity as well as to achieve a consistent ventral floor for the urethra to avoid recurrence, and that, as we will see, maybe obtained by various procedures. The attention to the original disease which indirectly had been the cause of the problem completes the therapeutic scheme for each case (AU)

[Histomorphometric findings in the residual prostate and prostatic hollow after retropubic surgery for BPH: (I) baseline data obtained from the last 70 consecutive cases]. / Hallazgos histomorfométricos de la próstata residual y celda prostática tras la cirugía retropúbica por H.B.P.: (I) datos basales obtenidos en los últimos 70 casos consecutivos.

OBJECTIVES: To present the data obtained from surgical specimens and biopsies of residual prostate and prostatic capsule, which in addition to the information provided by imaging tests give us the baseline situation of the prostatic surgical bed and residual prostate after transcervical hemostatic adenomectomy with capsule plasty. All this is the first step for the long-term study of its evolution and possible implications in the genesis of new obstructive or neoplastic pathology. METHODS: 70 consecutive cases of transcervical hemostatic adenomectomy with the variation of capsule plasty, recently developed, after a previous experience of 1033 retropubic surgeries. We analyze the histologic findings in surgical specimens, biopsies of residual gland and prostate capsule, and confirmed the immediate changes surgery causes, measuring the volumes of residual prostate by ultrasound. As the base for comparisons we analyzed residual prostates from prostatectomies or radical cystoprostatectomy specimens in "young" patients. RESULTS/CONCLUSIONS: We obtained objective data about predominant and associated histological lesions found in adenomectomy specimens. In the same way, the same data were obtained from biopsies of peripheral residual prostate together with the volume of such zone, which should establish, if our hypothesis is right, the mid-long-term prognostic criteria for the approach to the so-called post operative reexpansion of the prostatic hollow and the possible establishment of new obstructive pathology.

Hallazgos histomorfométricos de la próstata residual y celda prostática tras la cirugía retropubica por HBP: (I) Datos basales obtenidos en los últimos 70 casos consecutivos / Histomorphometric findings in the residual prostate and prostatic hollow after retropubic surgery for BPH: (I) Baseline data obtained fro the last 70 consecutive cases

Objetivo: Exponer los datos que obtenidos en el estudio patológico de las piezas operatorias, así como las biopsias de la próstata residual y cápsula prostática que junto a los que nos proporcionan los métodos por imagen nos ofrecen la situación “basal” en que, tras la adenomectomía transcervical hemostática con vesicocapsuloplastia, queda la celda y la prostata residual periférica. Todo ello como primer paso para el estudio a largo término de su evolución y su posible implicación en la génesis de una nueva patología obstructiva o neoplásica. Método: Lo constituyen las últimas 70 adenomectomías transcervicales (ATH) con la variante de vesicocapsuloplastia (VCP) aplicada recientemente y tras una experiencia anterior de 1.033 cirugías retropúbicas. Se analizan los hallazgos histológicos de las piezas operatorias, de las biopsias de glándula residual y de cápsula prostática y se constatan los cambios inmediatos que la cirugía ocasiona con medición de los volúmenes de próstata residual por ecografía. Como base comparativa se analizan próstatas residuales de piezas de prostatectomía o cistoprostatectomía radical en sujetos “jovenes”. Resultados/Conclusiones: Se obtienen datos objetivos sobre las lesiones histológicas dominantes y asociadas halladas en la pieza de adenomectomía. Igualmente sobre los mismos datos que ofrecen las biopsias de próstata residual periférica junto al volumen de dicha zona y que deberán, si nuestras suposiciones son correctas, establecer a medio- largo plazo criterios de aproximación pronóstica sobre la llamada reexpansión de la celda y el posible establecimiento de una neopatología obstructiva (AU)

Objectives: To present the data obtained from surgical specimens and biopsies of residual prostate and prostatic capsule, which in addition to the information provided by imaging tests give us the baseline situation of the prostatic surgical bed and residual prostate after transcervical hemostatic adenomectomy with capsule plasty. All this is the first step for the long-term study of its evolution and possible implications in the genesis of new obstructive or neoplastic pathology. Methods: 70 consecutive cases of transcervical hemostatic adenomectomy with the variation of capsule plasty, recently developed, after a previous experience of 1033 retropubic surgeries. We analyze the histologic findings in surgical specimens, biopsies of residual gland and prostate capsule, and confirmed the immediate changes surgery causes, measuring the volumes of residual prostate by ultrasound. As the base for comparisons we analyzed residual prostates from prostatectomies or radical cystoprostatectomy specimens in “young” patients Results/Conclusions: We obtained objective data about predominant and associated histological lesions found in adenomectomy specimens. In the same way, the same data were obtained from biopsies of peripheral residual prostate together with the volume of such zone, which should establish, if our hypothesis is right, the mid-long-term prognostic criteria for the approach to the so-called post operative reexpansion of the prostatic hollow and the possible establishment of new obstructive pathology (AU)

[William Cheselden: singular lithotomist and great illustrator of the XVIII Century]. / William Cheselden, singular litotomista y gran ilustrador inglés del siglo XVIII.

We present a brief historic reference of who probably was the most famous English urologist-surgeon of the 18th century, and who, following the chronicle writers, holds the record for extraction of a bladder stone (between 24 and 54 seconds). He also was an example of humanism related to the medical profession: he was an extraordinary illustrator of his own books with the help of the "dark chamber", so frequently used by Renaissance artists, contributed to the design and performance of civil architectonic work, had relationships with the literature world through poetry, and decisively influenced the reformation and separation of barbers and surgeons, which ultimately lead to the creation of the Royal College of Surgeons.

William Cheselden, singular litotomista y gran ilustrador inglés del Siglo XVIII / William Cheselden: singular lithotomist and great ilustrator of the XVIII

Se presenta una breve referencia histórica del que fue, probablemente, el más famoso cirujano-urólogo inglés del S. XVIII y que, según, los cronistas posee el «record» en la extracción de un cálculo vesical: entre 24 y 54 segundos, según las fuentes. Es, además, un ejemplo de humanismo tan frecuentemente relacionado con la profesión médica: fue un extraordinario ilustrador de sus propias obras ayudado de la «cámara oscura» tan utilizada por los artistas del Renacimiento, contribuyó al diseño y realización de obra arquitectónica civil, se relacionó con el mundo literario a través de la poesía e influyó decisivamente, merced a sus influencias, en la reforma y separación entre «barberos» y «cirujanos» que ulteriormente concluyó en la creación del Royal College of Surgeons (AU)

We present a brief historic reference of who probably was the most famous English urologist-surgeon of the 18th century, and who, following the chronicle writers, holds the record for extraction of a bladder stone (between 24 and 54 seconds). He also was an example of humanism related to the medical profession: he was an extraordinary illustrator of his own books with the help of the «dark chamber», so frequently used by Renaissance artists, contributed to the design and performance of civil architectonic work, had relationships with the literature world through poetry, and decisively influenced the reformation and separation of barbers and surgeons, which ultimately lead to the creation of the Royal College of Surgeons (AU)

[Indications, morbidity and mortality of the open nephrectomy. Analyses of 681 cases and bibliographic review]. / Indicaciones y morbimortaudad de la nefrectomía abierta. Análisis de 681 casos y revisión de la literatura.

OBJECTIVES: To have data about the indications, morbidity and mortality of the nephrectomy by the open approach, to obtain information that could be compared with the laparoscopic approach. To our knowledge there is not a similar review in the Spanish literature since the 60's. METHODS: We analyzed 681 nephrectomies accounting for a 5.7% of a total of 11.845 operative reports registered in our centre over the last 25 years. For outcome analysis, 93 cadaver donor nephrectomies were excluded. The analysis focuses on three well differentiated areas: kidney transplant surgery, nephrectomies for malignant diseases, and nephrectomies for benign pathologies including a very specific subgroup that includes the infectious-inflammatory diseases. In parallel, we performed a bibliographic review in which more than 87,000 cases of open surgeries where referenced, adding the articles about laparoscopic nephrectomies published over the last decade. RESULTS: Global mortality of the series (the first 30 postoperative days) was 0.8%, mostly cases of transplant nephrectomies (4), and one upper urinary tract transitional cell carcinoma. Significant morbidity appeared in 47 cases (8%), 15 of which (2.5%) required reoperation, being intensive bleeding with hypovolemia of variable severity the most frequent cause. The series includes non selected cases of a wide spectrum of pathologies. Any comparison with minimally invasive approaches should take into consideration, among other parameters, selection of the cases.

Indicaciones y morbimortalidad de la nefrectomía abierta. Análisis de 681 casos y revisión de la literatura / Indications, morbidity and mortality of the open nephrectomy. Analyses of 681 cases and bibliographic review

OBJETIVO: Conseguir datos sobre indicaciones,morbilidad y mortalidad de la nefrectomía por cirugía abierta para obtener información contrastable con lo que, hoy en día, es factible realizar por cirugía laparoscópica.Hasta donde conocemos no se ha publicadoningún estudio similar en la literatura española especializada tras la revisión del tema desde la década de los 60 hasta nuestros días.MÉTODOS: Se analizan 681 casos de “nefrectomías” que suponen el 5,7% de un total de 11.845 hojas operatoriasregistradas en nuestro centro en los últimos 25 años. Para valorar resultados se excluyen por razones obvias 93 cirugías de extracción renal de donante cadáver.El análisis se centra en tres áreas bien diferenciadas:cirugía del trasplante renal, nefrectomías por procesosmalignos y nefrectomías por patologías benignas con un subgrupo muy específico integrado por las patologíasinfeccioso-inflmatorias. Paralelamente se revisa la literatura en la que se referencian más de 87.000 casos de cirugías abiertas y se añaden las publicaciones que sobre nefrectomías laparoscópicas se han producido en los últimos lustros.RESULTADOS/CONCLUSIONES: La mortalidad global de la serie (30 días post cirugía) ha sido del 0,8% y correspondemayoritariamente a casos trasplantectomizados(cuatro) y a un tumor de vía excretora. Por otro lado la morbilidad significativa ha alcanzado 47 casos (8%) de los que precisaron reintervención 15 (2,5%) siendo la causa más importante y frecuente dentro de estas reintervenciones la hemorragia profunda con hipovolemiade gravedad variable. Como es lógico esta serie se nutre de casos en absoluto seleccionados y con un amplio espectro de patologías. Cualquier comparación con técnicas de acceso mínimo deberá tener en cuenta, entre otros parámetros, la selección o no de los casos

OBJECTIVES: To have data about theindications, morbidity and mortality of the nephrectomy by the open approach, to obtain information that could be compared with the laparoscopic approach. To our knowledge there is not a similar review in the Spanish literature since this 60’s.METHODS: We analyzed 681 nephrectomies accounting for a 5.7% of a total of 11.845 operative reportsregistered in our centre over the last 25 years. For outcome analysis, 93 cadaver donor nephrectomies were excluded. The analysis focuses on three well differentiated areas: kidney transplant surgery, nephrectomies for malignant diseases, and nephrectomies for benign pathologiesincluding a very specific subgroup that includes theinfectious-inflammatory diseases. In parallel, we performed a bibliographic review in which more than 87,000 cases of open surgeries where referenced, adding the articles about laparoscopic nephrectomies published over the last decade.RESULTS: Global mortality of the series (the first 30postoperative days) was 0.8%, mostly cases of transplant nephrectomies (4), and one upper urinary tract transitional cell carcinoma. Significant morbidity appeared in 47 cases (8%), 15 of which (2.5%) required reoperation, being intensive bleeding with hypovolemia of variable severity the most frequent cause.The series includes non selected cases of a wide spectrum of pathologies. Any comparison with minimally invasive approaches should take into consideration, among other parameters, selection of the cases

Evidencias de la mejoría de los standares de calidad en la cirugía retropúbica por HBP / Evidence on the improvement of quality standards for retropubic surgery for BHP

OBJETIVO: Comunicar los primeros resultadosconsolidados de la variante técnica de la vesicocapsuloplastiacomo complemento a la conocidaadenomectomía retropúbica transcervical hemostática.MÉTODO: Se analizan 65 recientes casos consecutivosde HBP intervenidos siguiendo la mencionadavariante y controlados por espacio de tiempo entre 6 y48 meses analizando los parámetros que, en este tipode cirugía, son determinantes para valorar la “calidad”de la misma.RESULTADO: Se han valorado concretamente lashemorragias, transfusiones, problemas de herida quirúrgica,confortabilidad postoperatoria, días de sonday estancia así como reintervenciones y morbimortalidadque aparecen como notablemente “mejorados” frente a lo que parece propio de esta cirugía consideradacomo la más agresiva para el tratamiento quirúrgico dela HBP.CONCLUSIÓN: Se presenta una modificación personal(la vesicocapsuloplastia) a la técnica deAdenomectomía Transcervical Hemostática (A.T.H.)publicada en 1974 luego de una experiencia de másde mil cirugías con ésta última. Los cambios introducidosen estos 65 casos permiten considerar, aún en losmomentos actuales, a la cirugía abierta de la H.B.P.,en casos seleccionados, como el método aplicablemás resolutivo del problema obstructivo , con el menoríndice de reintervenciones y mejorando, cada vez más,los tópicos de “agresividad” y “ mayor gasto” que lehan sido históricamente atribuídos

OBJECTIVES: To report the first consolidated ;;results of the technical variation of the bladder-capsule ;;plasty, a complement of the well-known trans-cervical ;;hemostatic adenomectomy. ;;METHODS: We analyze 65 recent consecutive patients ;;with BPH undergoing surgery by such technique with ;;follow-up between 6-48 months, analyzing the parameters ;;which in this type of operation are significant to evaluate quality. RESULTS: We evaluated bleeding, transfusions, surgical ;;wound complications, postoperative discomfort, number ;;of days with catheter, and hospital stay; also reoperations ;;and morbidity-mortality, which show a notable improvement ;;in comparison with what appears to be typical of this ;;operation, considered the most aggressive approach ;;for the surgical treatment of BPH. ;;CONCLUSIONS: We report a personal modification ;;of the transcervical hemostatic adenomectomy, published ;;in 1974, after an experience of more than 1000 ;;operations: the bladder-capsule plasty. The changes ;;introduced in this 65 cases make us consider, even in ;;present times, open surgery for BPH as the best solution ;;for the obstructive problem in selected cases, with the ;;lowest reoperation rates, and improving on factors such ;;as “invasiveness” and “higher cost” which have been ;;historically attributed to it

[Report of two cases of bladder and prostate oat cell tumors]. / "Presentación de dos casos: vesical y prostático de oat-cell".

OBJECTIVES: To report two cases of bladder and prostate oat cell tumors with bad outcome, in accordance to the bibliographic review. METHODS: The case in the bladder was associated with squamous differentiation and adenocarcinoma. Radical treatment followed by adjuvant chemotherapy did not stop the fatal outcome which ended 13 months later in acute septicemia having developed multiple metastases. The case in the prostate presented as oliguria-anuria and bilateral hydronephrosis which required the placement of a nephrostomy tube in an emergency basis. Once diagnosis was achieved the extemal urinary diversion was converted to intemal to improve patient's comfort. There was no response to systemic chemotherapy and the patient died 4 months after diagnosis. CONCLUSIONS: These cases add to the rare presence of this pathology in the bibliography. In our country, 15 cases have been confirmed in the bladder and 5 in the prostate; around the world, 150 and 59 respectively. Although there is a certain tendency to think that radical treatment and chemotherapy is the least bad of the options, some consequences of conservative attitudes offer similar results, mainly when preserving the bladder.

"Presentación de dos casos: vesical y prostático de Oat-cell" / Report of two cases of bladder and prostate oat cell tumors

OBJETIVO: Presentar dos casos: vesical yprostático de “oat-cell” que siguieron una mala evolucióncomo es habitual ver en las publicaciones que se han revisadocon ese motivo.MÉTODO/RESULTADOS: El caso de localización vesicalse presentó asociado a diferenciación escamosa y adenocarcinoma.El tratamiento radical seguido de quimioterapiaadyuvante no detuvo la fatal evolución que culminóa los 13 meses con un cuadro agudo séptico enmarcadopor múltiples metástasis. El caso localizado en próstatadebutó con una oligoanuria e hidronefrosis bilateral quefue preciso derivar de urgencia (nefrostomía) Una vezdiagnosticado se transformó la derivación externa en internapara mejorar algo la confortabilidad del paciente. Laquimioterapia sistémica no obtuvo respuesta alguna y seprodujo el “exitus” a los 4 meses del diagnóstico.CONCLUSIÓN:Los casos presentados se suman a laescasa presencia que, sobre esta patología, es posibleencontrar en la revisión bibliográfica. Quince casos devejiga y cinco de próstata han sido confirmados en nuestroPaís y, a nivel mundial, 150 y 59 respectivamente.Aunque existe una cierta tendencia a opinar que el tratamientoradical y la quimioterapia es la menos mala de lasopciones, algunas consecuencias de actitudes conservadorasofrecen parecidos resultados, especialmente en vejigacon conservación de la misma

OBJECTIVES: To report two cases ofbladder and prostate oat cell tumors with bad outcome,in accordance to the bibliographic review.METHODS: The case in the bladder was associatedwith squamous differentiation and adenocarcinoma.Radical treatment followed by adjuvant chemotherapydid not stop the fatal outcome which ended 13 monthslater in acute septicemia having developed multiplemetastases. The case in the prostate presented asoliguria-anuria and bilateral hydronephrosis whichrequired the placement of a nephrostomy tube in anemergency basis. Once diagnosis was achieved theexternal urinary diversion was converted to internal toimprove patient’s comfort. There was no response tosystemic chemotherapy and the patient died 4 monthsafter diagnosis.CONCLUSIONS: These cases add to the rare presenceof this pathology in the bibliography. In our country,15cases have been confirmed in the bladder and 5 in theprostate; around the world, 150 and 59 respectively.Although there is a certain tendency to think that radicaltreatment and chemotherapy is the least bad of theoptions, some consequences of conservative attitudesoffer similar results, mainly when preserving the bladde

[Evidence on the improvement of quality standards for retropubic surgery for BPH]. / Evidencias de la mejoría de los standares de calidad en la cirugía retropúbica por H.B.P.

OBJECTIVES: To report the first consolidated results of the technical variation of the bladder-capsule plasty, a complement of the well-known trans-cervical hemostatic adenomectomy. METHODS: We analyze 65 recent consecutive patients with BPH undergoing surgery by such technique with follow-up between 6-48 months, analyzing the parameters which in this type of operation are significant to evaluate quality. RESULTS: We evaluated bleeding, transfusions, surgical wound complications, postoperative discomfort, number of days with catheter, and hospital stay; also reoperations and morbidity-mortality, which show a notable improvement in comparison with what appears to be typical of this operation, considered the most aggressive approach for the surgical treatment of BPH. CONCLUSIONS: We report a personal modification of the transcervical hemostatic adenomectomy, published in 1974, after an experience of more than 1000 operations: the bladder-capsule plasty. The changes introduced in this 65 cases make us consider, even in present times, open surgery for BPH as the best solution for the obstructive problem in selected cases, with the lowest reoperation rates, and improving on factors such as "invasiveness" and "higher cost" which have been historically attributed to it.

[Vesicocapsuloplasty: technical variation of retropubic surgery for benign prostatic hypertrophy. Preliminary report]. / La vesicocapsuloplastia: variante técnica en la cirugía retropúbica por H.B.P. Informe preliminar.

OBJECTIVES: To report a technical variation in the retropubic adenomectomy operation which improves the standards for this type of open surgery significantly. METHODS: We review the charts of the last 35 patients undergoing surgery with this technical variation, with a minimum follow-up of one year, following a pooled experience of 1033 cases of retropubic open surgery for BPH by the hemostatic transcervical adenomectomy technique. RESULTS/CONCLUSIONS: During surgery this variation allows a better access to the prostatic bed facilitating direct haemostasis and search for adenoma remnants. In the same way it allows to perform prostate biopsies in those cases of BPH with PSA values over normal range and previous negative biopsies. Finally, "vesicalization" of the prostatic bed contributes to avoid post operative spasms and it would be the anatomical basis for avoidance of bladder neck retraction in the middle term. With all reservations implied in the application of a recent technical variation, the limited number of cases, and short follow-up, we may say that significant improvements have been seen in immediate standards such as intraoperative and postoperative blood loss, bladder spasms, post surgical analgesics requirements, and hospital stay reduction.

[Single kidney derived to sigmoid for urinary tuberculosis: remarkable morpho-functional status 51 years after surgery]. / Riñón único derivado a sigma por tuberculosis urinaria: notable situación morfofuncional a los 51 años de la cirugía.

OBJECTIVES: To report a solitary kidney ureterosigmoidostomy (US) secondary to urinary tuberculosis which we believe has the longest follow-up in the world literature. With this purpose we performed an analysis of the experience with such a urinary diversion published in our country, which maybe has been exaggeratedly excluded during the last decades. METHODS: Male patient who was diagnosed of urinary tuberculosis at the age of 17 in 1950 and underwent left nephrectomy. Due to bladder retraction he underwent cystectomy and urinary diversion to the sigmoid colon following the technique by Coffeyone year later. Follow-up for half a century has demonstrated an excellent outcome with almost no effect on renal function and urinary tract morphology, and very low incidence of infectious complications. DISCUSSION: We review cases of US with longest follow-up in the literature, finding a remarkable number of cases followed for more than 30 years. It is true they were performed almost exclusively for benign diseases. There is only one published citation in which US was indicated for bladder carcinoma and after 31 years of follow-up patient died from a nonrelated disease at the age of 85. We also review the scarce number of papers published in our country, focusing on the "Ponencia al Congreso Nacional de Urología 1983" which presented a thorough review of "urinary diversions" with the cooperation of 27 Spanish centers.