[Cutaneous metastases from transitional cell carcinoma of the bladder producing beta-HCG]. / Metástasis cutáneas de un carcinoma transicional vesical productor de beta-HCG.

In spite of the high incidence of transitional cell carcinoma, cutaneous metastases are infrequent, especially when they are the first sign of metastatic spread, with a low survival rate. Thirty five per cent of transitional cell carcinoma of the bladder have ectopic beta- human chorionic gonadotropin (beta-HCG) production. It has been related with high grade tumors, advanced stage, metastatic disease, radioresistent tumors and low survival rate because of its effect as a growth modulator with a probably antagonist action in the apoptotic cascade. We present a thirty six years old woman affected by a transitional cell carcinoma of the bladder producing beta-HCG that showed two cutaneous metastases as first sign of metastatic disease. The exceptional coincidence of these two circumstances announced a very aggressive tumor behaviour and bad prognostic, with a quickly multiple metastatic dissemination including a pericardic metastases.

Metástasis cutáneas de un carcinoma transicional vesical productor de β-HCG / Cutaneous metastases from transitional cell carcinoma of the bladder producing β-HCG

A pesar de la alta incidencia de carcinoma transicional vesical, la aparición de metástasis cutáneas es infrecuente, más aún como primera manifestación de diseminación metastásica, asociándose a una pobre supervivencia. La producción ectópica de beta-gonadotropina coriónica humana (β-HCG) ocurre en un 35% de los carcinomas transicionales vesicales y se ha correlacionado con tumores de alto grado, estadios avanzados, enfermedad metastásica, falta de respuesta a la radioterapia y pobre supervivencia, en virtud de su efecto regulador del crecimiento tumoral por un probable efecto antagonista sobre receptores de la cascada apoptótica. Presentamos el caso de una paciente de 36 años con carcinoma transicional de vejiga productor de β-HCG que presentó dos metástasis cutáneas como primer signo de enfermedad a distancia. Ambas circunstancias asociadas de forma excepcional identificaron un comportamiento muy agresivo del tumor y su mal pronóstico, desarrollando a corto plazo un estallido metastático a múltiples niveles incluyendo una metástasis pericárdica (AU)

In spite of the high incidence of transitional cell carcinoma, cutaneous metastases are infrequent, especially when they are the first sign of metastatic spread, with a low survival rate. Thirty five per cent of transitional cell carcinoma of the bladder have ectopic beta- human chorionic gonadotropin (β-HCG) production. It has been related with high grade tumors, advanced stage, metastatic disease, radio resistent tumors and low survival rate because of its effect as a growth modulator with a probably antagonist action in the apoptotic cascade.We present a thirty six years old woman affected by a transitional cell carcinoma of the bladder producing β-HCG that showed two cutaneous metastases as first sign of metastatic disease. The exceptional coincidence of these two circumstances announced a very aggressive tumor behaviour and bad prognostic, with a quickly multiple metastatic dissemination including a pericardic metastases (AU)

VIDAUS videourodiamia del aparato urinario superior. Indicaciones actuales / Upper urinary tract video-urodynamics. Current indications

OBJETIVOS: Los estudios videourodinámicosdel Aparato Urinario Superior (TUS), fueron descritosen la segunda mitad del s.XX (años 60-70). A la Pielografia Anterógrada a presión constante y flujo controlado, se le dió el nombre de su autor, test de “Vela Navarrete” (1982) (4) que hoy denomina él mismo“Vidaus”. El estudio videourodinámico del TUS es el estudio simultáneo de la presión, el flujo y la radiología dinámica del TUS, y mantiene las mismas indicaciones que en su diseño inicial, a pesar de la aparición de otras técnicas de imagen desarrolladas en este siglo, tanto estáticas como dinámicas (Ecografia, Tomografía Axial Computarizada (TAC), Resonancia Nuclear Magnética(RNM) o estudios con isótopos radioactivos. La práctica continuada de Vidaus en la Fundación Jiménez Díaz motiva la actualización del procedimiento con la revisión de las indicaciones actuales.MÉTODOS: El paciente es colocado en decúbito prono(ventral) sobre una mesa de radiología con video. Tras puncionar el riñón (cavidades renales) con aguja, se procede a realizar diferentes estudios urodinámicos: pielomanometría, presión piélica basal (estudio urodinámicobásico), cambios manométricos tras diuresis inducida,y estudios de presión-flujo. Tras extraer 10-20 ml de orina se realizan determinaciones bioquímicas (creatinina, electrolitos, osmolaridad,...) que decidirán la viabilidad funcional de la unidad renal, estudios citológicoso bacteriológicos. Finalmente se concluye con la pielografia anterógrada, estudio fluoroscópico de la anatomía radiológica que aporta datos morfológicos y dinámicos relacionados con la situación del TUS (3). En la FJD, el urólogo realiza 30-40 estudios de Vidaus al año en la Unidad de Urodinamia. Se analizan los realizadosen los últimos cinco años (1999-2005) sobre diferentes patologías de riñón dilatado (ver Tabla I).RESULTADOS: Los datos estructurales y dinámicos, obtenidosde la exploración realizada en los casos descritos,determinaron una información concluyente en la mayoría de ellos, facilitando la decisión quirúrgica o la abstención (ver Tabla II).CONCLUSIONES: La interpretación de Vidaus se basa en los hallazgos radiológicos y dinámicos. La pielografiacon flujo controlado permite por sí sola determinarla obstrucción, el volumen de la dilatación y el comportamiento peristáltico del uréter. A presión constantepermite cuantificar la obstrucción. Vidaus es una técnica sencilla de realizar, bien tolerada y repetible tantas veces como se requiera sobretodo si se deja nefrostomíapara comparaciones anatómicas dinámicas y funcionales más prolongadas. Aporta una magnífica información anatómica, dinámica y etiológica del TUS, y sobretodo concluyente, con mínimo riesgo traumático y séptico para el paciente

OBJECTIVES: Upper urinary tract video-urodynamic studies were first described in the second half of the 20th century (years 60-70). The antegrade pyelogram with constant pressure and controlled flow received the name of its author, “Vela Navarrete test” (1982) (4), who currently refers to it as video-urodynamic study of the upper urinary tract. It is the simultaneous study of pressure, flow, and dynamic x-ray of the upper urinary tract and it keeps same indications than the ;;original design, in spite of the appearance of new dynamic and static imaging techniques (ultrasound, CT scan, MRI, radioisotope studies). The continued practice of video urodynamic study of the upper urinary tract in the FJD prompted an update of the procedure reviewing its current indications. ;;METHODS: Patient is positioned in the prone decubitus on an x-ray table with video. After punctioning renal cavities with fine needle, video urodynamic tests are ;;performed: pyelomanometry, basal pyelic pressure (basic urodynamics study), pressure changes after induced ;;diuresis, and pressure-flow studies. 10-20 ml of urine are obtained for biochemical tests (creatinine, electrolytes, osmolarity,...), which give information about the functional viability of the renal unit, cytology or microbiological tests. Finally, the study concludes with an antegrade pyelogram, a fluoroscopic study of the radiological ;;anatomy which provides morphologic and dynamic data of the upper urinary tract (3). In the Urodynamics Unit of the FJD, urologists perform 30-40 studies per year. We analyzed retrospectively all studies performed over the last five years (1999-2005) for various pathological entities of kidney dilation. (Table I). ;;RESULTS: Structural and dynamic data obtained by the studies offered conclusive information in most of them facilitating the decision for surgery or observation (Table II). ;;CONCLUSIONS: The interpretation of the upper urinary tract video-urodynamic study is based on radiological and dynamic findings. Flow-controlled pyelogram enables determining the existence of obstruction, dilation volume, and ureteral peristaltic behaviour. Constant pressure enables quantification of obstruction. The video ;;urodynamic study of the upper urinary tract is easy to perform, well tolerated and may be repeated as many times as required, mainly if nephrostomy tube is placed for more prolonged evaluations. It offers excellent ;;anatomical, dynamic, and etiological information about the upper urinary tract, and furthermore conclusive, with minimal risk

[Upper urinary tract video-urodynamics. Current indications]. / "Vidaus" videourodinamia del aparato urinario superior. Indicaciones actuales.

OBJECTIVES: Upper urinary tract videourodynamic studies were first described in the second half of the 20th century (years 60-70). The antegrade pyelogram with constant pressure and controlled flow received the name of its author, "Vela Navarrete test" (1982), who currently refers to it as video-urodynamic study of the upper urinary tract. It is the simultaneous study of pressure, flow, and dynamic x-ray of the upper urinary tract and it keeps same indications than the original design, in spite of the appearance of new dynamic and static imaging techniques (ultrasound, CT scan, MRI, radioisotope studies). The continued practice of video urodynamic study of the upper urinary tract in the FJD prompted an update of the procedure reviewing its current indications. METHODS: Patient is positioned in the prone decubitus on an x-ray table with video. After punctioning renal cavities with fine needle, video urodynamic tests are performed: pyelomanometry, basal pyelic pressure (basic urodynamics study), pressure changes after induced diuresis, and pressure-flow studies. 10-20 ml of urine are obtained for biochemical tests (creatinine, electrolytes, osmolarity,...), which give information about the functional viability of the renal unit, cytology or microbiological tests. Finally, the study concludes with an antegrade pyelogram, a fluoroscopic study of the radiological anatomy which provides morphologic and dynamic data of the upper urinary tract. In the Urodynamics Unit of the FJD, urologists perform 30-40 studies per year. We analyzed retrospectively all studies performed over the last five years (1999-2005) for various pathological entities of kidney dilation. (Table I). RESULTS: Structural and dynamic data obtained by the studies offered conclusive information in most of them facilitating the decision for surgery or observation (Table II). CONCLUSIONS: The interpretation of the upper urinary tract video-urodynamic study is based on radiological and dynamic findings. Flow-controlled pyelogram enables determining the existence of obstruction, dilation volume, and ureteral peristaltic behaviour. Constant pressure enables quantification of obstruction. The video urodynamic study of the upper urinary tract is easy to perform, well tolerated and may be repeated as many times as required, mainly if nephrostomy tube is placed for more prolonged evaluations. It offers excellent anatomical, dynamic, and etiological information about the upper urinary tract, and furthermore conclusive, with minimal risk.