Quiste de Tarlov y disfunción vesical sintomática / Tarlov cyst and symptomatic bladder disfunction

El quiste de Tarlov o quiste perineural son lesiones de las raíces nerviosas localizadas a nivel de la región sacra y de etiología incierta. La mayoría de estos quistes permanecen asintomáticos y carecen de relevancia clínica. Los quistes sintomáticos son infrecuentes y los síntomas más habituales son el dolor y las radiculopatías. Nosotros presentamos el caso de una mujer de 53 años con un quiste de Tarlov sintomático ( síndrome de frecuencia y urgencia miccional) que tras el tratamiento quirúrgico presenta una mejoría clínica importante (AU)

Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain etiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53 year old woman with a symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery (AU)

Sarcoma de Kaposi sobre injerto renal / Kaposi´s sarcoma in a renal graft

El sarcoma de Kaposi es un tumor infrecuente de causa desconocida, pero con una mayor incidencia en pacientes inmunodeprimidos, sobre todo en trasplantados y VIH positivos. Habitualmente se presenta como lesiones cutáneas de buen pronóstico, siendo la forma invasiva visceral rara, agresiva y rara su remisión. Presentamos un paciente con un sarcoma de Kaposi a nivel del injerto renal y mala respuesta a pesar de retirarla inmunosupresión (AU)

Kaposi´s sarcoma is an infrequent tumor of unknown cause, but with a higher impact in immune depressed individuals, particularly in HIV and transplant patients. It usually appears as a benign cutaneous lesions, while the invasive visceral form is uncommon with malignant evolution and wit rare remission. We present a patient with a Kaposi´s sarcoma localised in a renal graft and bad response even when immune suppression was discontinued (AU)

[Tarlov cyst and symptomatic bladder disfuction]. / Quiste de Tarlov y disfunción vesical sintomática.

Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain aetiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53-year-old woman witha symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery.

Masa pélvica y anorquia bilateral / Pelvic mass and bilateral anorchia

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[Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH]. / Estudio clínico-patológico sobre el cancer de próstata incidental en pacientes intervenidos bajo el supuesto diagnóstico de HBP sintomática.

UNLABELLED: OBJECTIVES-INTRODUCTION: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy -APS-, and prostate transurethral resection -RTU-P-) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected. MATERIAL AND METHODS: 1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI. RESULTS: 78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8-30). Gleason average 5 (mean 4.8), rank 3-8. pTla 66%, pTlb 33%. TREATMENT: 57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients). CONCLUSIONS: We didn't observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pTla. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%.

Estudio clínico-patológico sobre el cáncer de próstata incidental en pacientes intervenidos bajo el supuesto diagnóstico de HBP sintomática / Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH

Objetivo-Introducción: Estudio retrospectivo de una serie de pacientes intervenidos mediante adenomectomía prostática suprapúbica (APS) y resección transuretral prostática (RTU-P) bajo el supuesto diagnóstico de HBP sintomática no respondedora al tratamiento médico conservador. Análisis de la prevalencia, incidencia, datos clínico-patológicos, tratamiento, progresión tumoral y evolución de los pacientes con cáncer de próstata incidental (CPI) detectado. Material y métodos: Se revisaron 1.593 pacientes intervenidos durante 6 años consecutivos (1996-2001). APS 35%, RTUP 65%. Revisión de todas las anatomías patológicas de los especimenes quirúrgicos y de las evoluciones de los pacientes con CPI. Resultados: 78 CPI; Prevalencia 4,89%; Incidencia 13 casos/año. Edad media 73,6 años. Tacto rectal normal en todos, PSA medio 6 ng/ml (0,5-30). Grupo APS: 25 CPI (32%); prevalencia 4,55%; incidencia 4 casos/año; PSA medio 7,7 ng/ml (2,8-30); volumen enucleado medio 65 gs. Grupo RTU-P: 53 CPI (68%); prevalencia 5,07%; incidencia 9 casos/año; PSA medio 5,2 ng/ml (0,5-29); volumen resecado medio 20 gs. 22% biopsiados previamente por PSA elevado medio de 14 ng/ml (4,8-30). Mediana de Gleason 5 (media 4,8), rango 3-8. pT1a 66%, pT1b 33%. Tratamiento: 57% seguimiento vigilado sin tratamiento; 18% tratamiento hormonal; 3% finasteride; 9% Prostatectomía Radical; 9% Radioterapia. Pérdidas 4%. Seguimiento medio 47,19 meses (12-96). Progresión tumoral 13,3% (10 pacientes). Mortalidad CPI específica 2,6% (2 pacientes). Conclusiones: No observamos diferencias significativas entre la prevalencia de CPI en los dos grupos (APS y RTU-P). Los tumores detectados fueron mayoritariamente bien diferenciados y en estadio pT1a. En más de la mitad de los casos se decidió una actitud expectante sin tratamiento (57%). 13,3% de progresión tumoral tras 47,19 meses de seguimiento medio y mortalidad CPI específica del 2,6%

Objectives-Introduction: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy –APS-, and prostate transurethral resection -RTU-P- ) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected. Material and methods: 1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI. Results: 78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8- 30). Gleason average 5 (mean 4.8), rank 3-8. pT1a 66%, pT1b 33%. Treatment: 57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients). Conclusions: We didn´t observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pT1a. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%

[Role of nephrectomy in metastatic renal cell carcinoma. Experience of the Department of Urology Juan Canalejo Hospital]. / Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo.

OBJECTIVES: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. MATERIAL AND METHODS: We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. RESULTS: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months. CONCLUSIONS: In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.

Docencia en Urología Laparoscópica. Problemas. Soluciones / Education in Laparoscopic. Urology. Problems. Solutions

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Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo / Role of nephrectomy in metastatic renal cell carcinoma. Experience of the department of urology Juan Canalejo Hospital

Objetivos: Presentar nuestra experiencia en la realización de nefrectomía en tumores renales que se presentan con metástasis al diagnóstico, y observar las complicaciones, evolución y supervivencia de estos pacientes. Material y métodos: Realizamos una revisión retrospectiva de los adenocarcinomas renales en el período entre 1-1-1991 y 31-12-2002. Estudiamos solamente los que se presentaron con metástasis (31). Se estudian aquellos pacientes a los que se les practicó nefrectomía y aquellos a los que no se les ofreció tratamiento quirúrgico. Buscamos mostrar las diferencias en los dos grupos en cuanto a status vital (Tabla E.C.O.G.), patología concomitante y supervivencia media. En el grupo de los pacientes nefrectomizados estudiamos las complicaciones derivadas de la intervención y el tratamiento posterior. Resultados: Realizamos nefrectomía en 19 casos. Todos ellos E.C.O.G. 0-1. La estancia post operatoria media fue de12 días, y la tasa de complicaciones 11,5%. El 45% de estos pacientes siguieron algún tipo de tratamiento posterior, y la supervivencia media fue de 31 meses. No se realizó nefrectomía en 12 casos, de los cuales 9 eran E.C.O. G 2-3. La patología asociada que presentaban estos pacientes era más importante que en el primer grupo. Sólo en 3 casos se administró tratamiento con fines paliativos y la supervivencia media fue de 3,8 meses. Conclusiones: En pacientes con buen estado vital la nefrectomía no representa más morbilidad ni mortalidad que en los pacientes sin metástasis, y nos parece una opción fundamental en su manejo. Realizamos una revisión bibliográfica en la que recogemos las últimas tendencias en el tratamiento de estos pacientes, que ponen de manifiesto la necesidad del abordaje combinado quirúrgico e inmunoterápico. Nos parecen de interés fundamental las conclusiones de los estudios del SWOG y del EORTC (AU)

Objectives: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. Material and methods: We performe a retrospective review of renal cell carcinomaes treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to show the diferences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. Results: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some tipe of systemic treatment, and median survival was 31 months. We didn´t performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Asociated comorbidity was higher in this group. Only in three patients any treatment was offerted always with paliative reason. Median survival was 3.8 months. Conclusions: In those patients with good performance status this aproach does not represent more morbility or mortality than in non- metastatic patients, and that is a cornerstone in their management. We also make a literature review in wich we see the last pathways in the management e of these patients, and that show the needing for a conbined approach both quirurgical and inmunotherapical. We have review with special interest the studie’s conclusions of SWOG and EORTC groups (AU)

[Iatrogenic prostatorectal fistula. Use of gracilis muscle pedicled flap for its reparation. Presentation of two cases]. / Fistula prostatorectal yatrogénica. Reparación con colgajo pediculado de músculo gracilis. Presentación de dos casos.

We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cystographic and opaque enema images which shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery.

[Traumatic urethral disruption in women. A rare entity. Report of two cases]. / Rotura traumática de uretra femenina: una rara entidad. Aportación de dos casos.

We present two cases of urethral disruption in women, a very uncommon situation because of the anatomical features. Yet it must be always suspected in all women under a pelvic politraumatism, for eviting important problems. Both cases are traffic politraumatized young girls presenting with pelvic fracture, among others. The surgery performed was combined suprapubic-transvaginal approach, even in one a previous endoscopic realinement was done, who also needed endoscopic complementary treatment: electrofulguration of a fistulous bridge. Outcome of both is fine, achieving good continence. We also make a literature review.

Fístula prostatorectal yatrogénica. Reparación con colgajo pediculado de músculo gracilis. Presentación de dos casos / Yatrogenic prostatorectal fistula. Use of gracilis muscle pedicled flap for its reparation. Presentation of two cases

Presentamos dos casos clínicos en los cuales durante la realización de una adenomectomía retropúbica por patología prostática benigna se produce una fístula prostatorectal. Describimos la cirugía de reparación de la misma con colgajo de músculo gracilis o recto interno, y su posterior buena evolución. Presentamos imágenes cistográficas y de enemas opacos que presentan un antes y un después de dicha cirugía. Los pacientes están sin incontinencia ni problemas relacionados con la cirugía de desinserción muscular

We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cistografic and opaque enema images wich shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery

[High flow arterial priapism secondary to post-traumatic bilateral arterio-cavernous fistula. Highly selective embolization with autologous blood clot]. / Priapismo arterial de alto flujo secundario a fístula arterio-cavernosa bilateral post-traumática. Embolización supraselectiva con coágulo autólogo.

High flow arterial priapism is rare and characterized to a prolonged non-painful partial erection. Arteriocavernous fistula, rarely bilateral, is associated with penile or perineal trauma (genitoperineal area). Review of the literature, in only eleven cases this fistula is bilateral. Different treatments with non common norm has been used. We report a case of a 27 years old male who presented high flow priapism secondary to bilateral postraumatic arterio-cavernous fistula. Autologous blood clot was used for fistulas embolization to minimize the risk of impotence in this young patient. No complications was registered. Eight months later the patient had normal erectile function and no fistula was detected on ultrasonography doppler. We consider arteriography with highly selective embolization using re-absorbable agents obtains the best results, the least risks and complications in this process.

Rotura traumática de uretra femenina: una rara entidad. Aportación de dos casos / Traumatic urethral disruption in women. A rare entity. Aportation of two cases

Presentamos dos casos clínicos de rotura de uretra femenina, una situación poco frecuente por las características anatómicas de la mujer pero que debe ser sospechada precozmente, ante todo politraumatismo pélvico, para evitar graves problemas. Los casos expuestos son dos pacientes jóvenes politraumatizadas por accidentes de tráfico con fracturas óseas pélvicas. En ambas se realizó cirugía combinada suprapúbica-vaginal, una de ellas previo realineamiento endoscópico precoz. Esta precisó tratamiento endoscópico complementario: electrofulguración de pequeño orificio fistuloso. La evolución de ambas es buena con continencia. Hacemos una revisión de la literatura (AU)

We present two cases of urethral disruption in women, a very uncommon situation because of the anatomical features. Yet it must be always suspected in all women under a pelvic politraumatism, for eviting important problems. Both cases are traffic politraumatized young girls presenting with pelvic fracture, among others. The surgery performed was combined suprapubic-transvaginal approach, even in one a previous endoscopic realinement was done, who also needed endoscopic complementary treatment: electrofulguration of a fistulous bridge. Outcome of both is fine, achieving good continence. We also make a literature review (AU)

Priapismo arterial de alto flujo secundario a fístula arterio-cavernosa bilateral post-traumática. Embolización supraselectiva con coágulo autólogo / High-flow arterial priapism for postraumatic bilateral arterial-cavernous fistula. Highly selective embolization using autologous blood clot

El priapismo arterial de alto flujo es una patología poco frecuente caracterizada por una erección parcial persistente no dolorosa. Por lo general, se asocia a un traumatismo perineal o peneano (área genitoperineal) que ha ocasionado una fístula arterio-cavernosa, raramente bilateral. Tan sólo se han publicado once casos en los que dicha fístula es bilateral. Los tratamientos empleados han sido diversos, sin una pauta común para su resolución. Presentamos el caso de un varón de 27 años con priapismo de alto flujo arterial secundario a traumatismo perineal con fístula arterio-cavernosa bilateral. Se empleó coágulo autólogo para la embolización de las fístulas con el fin de minimizar el riesgo de lesión de la función eréctil en un paciente joven. No se registraron complicaciones. La función eréctil es normal 8 meses después del tratamiento sin evidencia de fístula en ecografía de control. Consideramos que la arteriografía supraselectiva junto a la embolización con sustancias reabsorbibles proporcionan los mejores resultados, menores riesgos y complicaciones en este tipo de patología (AU)