Treatment of urachal disorders: The open and laparoscopic surgery approach. / Abordaje laparoscópico de la patología uracal. Nuestra serie.

INTRODUCTION: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital. CASE DESCRIPTION: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients' clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient). RESULTS: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications. CONCLUSION: Laparoscopic removal of urachal remnants is a safe and reproducible technique.

Treatment of urachal disorders: the open and laparoscopic surgery approach

INTRODUCTION: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital. CASE DESCRIPTION: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients` clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient). RESULTS: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications. CONCLUSION: Laparoscopic removal of urachal remnants is a safe and reproducible technique

INTRODUCCIÓN: El objetivo de nuestro trabajo es el análisis de los casos tratados con abordaje laparoscópico de patología uracal en nuestro hospital. DESCRIPCIÓN DE LOS CASOS: Presentamos un estudio descriptivo retrospectivo de la patología uracal tratada laparoscópicamente en nuestro centro desde 1999 al 2015. Se recogieron datos de las variables clínicas de los pacientes (pruebas de imagen, abordaje quirúrgico, anatomía patológica, complicaciones y seguimiento). RESULTADOS: Se detectaron 7 pacientes con patología uracal complicada que fueron tratados con abordaje laparoscópico. La media de edad fue de 43,1±11 años. La media del tiempo quirúrgico fue de 154,2 minutos (120-240). La estancia hospitalaria media fue de 4,9 (DE ±1,1) días. No hubo complicaciones postoperatorias. CONCLUSIÓN: La extirpación laparoscópica de los remanentes uracales es una técnica segura y reproducible

Incidencia hospitalaria, tendencia y distribución municipal del cáncer de próstata en el área de salud de León (1996-2010) / Hospital incidence, trends and municipal distribution of prostate cáncer in health área of León, Spain (1996-2010)

El cáncer de próstata (CaP) es el de mayor incidencia entre los varones y sin embargo se conoce muy poco sobre sus factores de riesgo. El presente artículo tiene por objetivo conocer la incidencia hospitalaria, tendencia y distribución municipal del CaP en el área de salud de León (ASL). Métodos. Fueron incluidos los casos nuevos de cáncer de próstata (CIE-9: 185, CIE-10: C61) del registro hospitalario de tumores del Complejo Asistencial Universitario de León, entre 1996 y 2010 en sujetos con residencia en el ASL. Se calcularon las incidencias hospitalarias brutas trienales y ajustadas a población mundial y europea. Como denominador se utilizaron los datos del Instituto Nacional de Estadística de población desagregada por grupos quinquenales de edad de residentes en municipios del ASL. Para el análisis de la distribución espacial se estimaron los riesgos relativos (RR) municipales suavizados mediante el ajuste del modelo de Besag, York y Mollié y sus probabilidades posteriores de que los RR fuesen > 1 (PP), utilizando métodos bayesianos. Resultados: Se incluyeron 3.366 casos. Las tasas estandarizadas con población europea ascendieron de 30,3 (1996-98) a 119,0 (2008-2010) casos nuevos por 100.000 hombres. El número de casos órgano-confinados pasó de 281 (1999-2001) a 999 (2008-2010). Las determinaciones de PSA ascendieron de 30.985 (1999-2001) a 117.396 (2008-2010). Conclusiones: Se observó un gran incremento de la frecuencia de CaP a expensas de los casos órgano-confinados, que correlacionan muy bien con las determinaciones de PSA llevadas a cabo en el ASL. No hubo diferencias de interés en la distribución municipal de las incidencias (AU)

Background: Prostate cancer (PC) is the most prevalent among men and yet its risk factors are little known. This article aims to determine the hospital incidence, trend and municipal distribution of PC in Health Area of León (HAL). Methods: We included new cases of prostate cancer (ICD-9: 185, ICD-10: C61) enrolled in the Hospital Tumor Registry of the Complejo Asistencial Universitario de León, between 1996 to 2010 with residence in HAL. We calculated crude triennial hospital incidences and adjusted at global and European population. As denominator we used the INE population data disaggregated by five-year age groups of residents in municipalities of the HAL. To analyze the spatial distribution, we estimated municipal relative risks (RR) smoothed by fitting the Besag, York and Mollié model and the posterior probability (PP) of RR > 1 using Bayesian methods. Results: 3,366 cases were included. Standardized rates at European population amounted of 30.3 (1996-98) to 119.0 (2008-2010) new cases per 100,000 men. The number of organ-confined cases were increased from 281 (1999-2001) to 999 (2008-2010). PSA determinations amounted from 30,985 (1999-2001) to 117 396 (2008-2010). Conclusions: A great increase was observed in the frequency of PC at the expense of organ-confined cases which correlate very well with PSA determinations performed in HAL. There were no differences of interest in the municipal distribution incidences (AU)

[Hospital incidence, trends and municipal distribution of prostate cancer in health area of León, Spain (1996-2010)]. / Incidencia hospitalaria, tendencia y distribución municipal del cáncer de próstata en el área de salud de León (1996-2010).

BACKGROUND: Prostate cancer (PC) is the most prevalent among men and yet its risk factors are little known. This article aims to determine the hospital incidence, trend and municipal distribution of PC in Health Area of León (HAL). METHODS: We included new cases of prostate cancer (ICD-9: 185, ICD-10: C61) enrolled in the Hospital Tumor Registry of the Complejo Asistencial Universitario de León, between 1996 to 2010 with residence in HAL. We calculated crude triennial hospital incidences and adjusted at global and European population. As denominator we used the INE population data disaggregated by five-year age groups of residents in municipalities of the HAL. To analyze the spatial distribution, we estimated municipal relative risks (RR) smoothed by fitting the Besag, York and Mollié model and the posterior probability (PP) of RR >1 using Bayesian methods. RESULTS: 3,366 cases were included. Standardized rates at European population amounted of 30.3 (1996-98) to 119.0 (2008-2010) new cases per 100,000 men. The number of organ-confined cases were increased from 281 (1999-2001) to 999 (2008-2010). PSA determinations amounted from 30,985 (1999-2001) to 117 396 (2008-2010). CONCLUSIONS: A great increase was observed in the frequency of PC at the expense of organ-confined cases which correlate very well with PSA determinations performed in HAL. There were no differences of interest in the municipal distribution incidences.

Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy.

OBJECTIVES: The Gold Standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) is still an experimental technique in evaluation. We describe our perioperative results defined as surgical and safety oncology variables. METHODS: Every patient who underwent a LRCP between January 2007 and July 2011 in the urology department of the University Public Hospital was evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 (44-79). A Bricker diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with previous abdominal surgery, and 6 patients (7.14%) presented a medical history of urological surgery. The mean surgery time was 257.57 minutes (180-420). The mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of tolerance to surgery occurred after 3.7 days (SD: 2.21).The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of ilio-obturator lymphadenectomy, was 17 (13-19). There were no intraoperative complications. Early complications (less than 1 month after the intervention) occurred in 28 patients (33.3% ).There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3% ). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer.

Complicaciones perioperatorias y resultados oncológicos quirúrgicos en una serie inicial de 84 pacientes sometidos a cistectomía radical laparoscópica / Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy

OBJETIVO: La cistectomía radical abierta es el estándar oro para el tratamiento del cáncer vesical infiltrante. La cistectomía radical laparoscópica (CPRL) continúa siendo una técnica experimental en evaluación. Describimos nuestros resultados perioperatorios definidos como complicaciones quirúrgicas y variables de seguridad oncológica. MÉTODOS: Revisión retrospectiva de una base de datos de cumplimentación retrospectiva de pacientes intervenidos con CRPL en el periodo comprendido entre enero del 2007 hasta julio del 2011 en un Hospital Universitario público. RESULTADOS: Fueron intervenidos 84 pacientes (72 varones y 12 mujeres), con una edad media de 68 años (44 –79). En 80 pacientes se realizó derivación tipo Bricker, en 3 sustitución vesical tipo Camey II, y en 1 sustitución vesical tipo Studer, de manera extracorpórea en todos ellos. 17 Pacientes (20,23%) presentaban cirugía abdominal previa y 6 (7,14%) presentaban antecedentes de cirugía urológica previa. El tiempo operatorio medio fue de 257,57 minutos (180-420 minutos). El tiempo medio de la estancia hospitalaria fue de 11,875 días (desviación estándar (DE): 6,28). El inicio de la tolerancia fue al 3,7 días (DE: 2,21). La tasa de transfusión posterior a la intervención quirúrgica fue del 20,2%. La mediana de ganglios extirpados, mediante linfadenectomía ilio-obturatriz bilateral, fue de 17 (13-19).No se registraron complicaciones intraoperatorias. 28 pacientes (33,3%) desarrollaron complicaciones en el postoperatorio temprano (primer mes), sin registrarse ningún fallecimiento. 7 Pacientes (8,3%) presentaron complicaciones tardías (a partir del mes de la cirugía). CONCLUSIONES: Nuestra serie pone de manifiesto que la técnica de CPRL es segura y reproducible, por lo que se trata de una alternativa mínimamente invasiva para los pacientes con cáncer vesical infiltrante (AU)

OBJECTIVES: The gold standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) continues being an experimental technique in evaluation. We describe our perioperative results defined as surgical complications and oncologic safety variables. METHODS: From January 2007 to July 2011, all patients undergoing laparoscopic radical cystoprostatectomy (LRCP) in the Urology Department of a public University Hospital were evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 years (44-79). A Bricker urinary diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with past medical history of abdominal surgery, and 6 patients (7.14%) history of urological surgery. The mean operative time was 257.57 minutes (180-420). Mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of oral tolerance occurred at 3.7 days (SD: 2.21). The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of iliac-obturator lymph node dissection, was 17 (13-19). There were no intraoperative complications. Complications occurred in 28 patients (33.3%) as early complications (less than 1 month after the intervention). There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3%). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer (AU)

Embolismos de cholesterol en el tracto urinario inferior como manifestación clínica de la enfermedad ateroembólica. Descripción de tres casos, uno de ellos simulando una neoplasia / Cholesterol embolism of the upper urinary tract as a clinical feature of atherosclerotic embolic vascular disease. Report of three cases, one of them simulating neoplasia

OBJETIVO: Presentar tres casos de enfermedadateroembólica con debut clínico en tracto urinarioinferior. Esta enfermedad es infrecuente, afectandosobre todo piel, riñón y músculo esquelético. Otrosórganos del tracto urinario son raramente afectados yde forma extraordinaria como debut de la enfermedad,sin afectación previa conocida de otras localizaciones.MÉTODOS/RESULTADOS: El primer paciente presentabaun episodio de hematuria asociado con una imagenecográfica y cistoscópica sospechosa de neoplasia.En los fragmentos de resección transuretral la lesióncorrespondía a una cistitis polipoide con algunas arteriasde pequeño tamaño ocupadas por agujas decolesterol, asociado con inflamación, ulceración y extravasación hemática. Al segundo paciente se le realizóuna cistoprostatectomía por un carcinoma urotelial,encontrándose incidentalmente numerosos émbolos decolesterol principalmente en lámina propia, pero tambiénen otras capas de la pared vesical, próstata, uretraen el verumontanum y una vesícula seminal, estasdos últimas localizaciones no descritas en publicacionesanteriores. En el tercer paciente el émbolo seencontró en un cilindro de biopsia prostática.CONCLUSIONES: Esta enfermedad poco frecuentepuede debutar como un proceso vesical o prostático yser diagnosticado por medio de biopsia de estos órganos.Puede simular una neoplasia vesical en ecografíao cistoscopia y debería ser incluida entre las entidadesrelacionadas o causantes de cistitis polipoide, un conocidosimulador de neoplasia

OBJECTIVES: To report three cases of ;;atherosclerotic embolic vascular disease with clinical ;;presentation in the lower urinary tract. This disease is not ;;frequent; it mainly affects the skin, kidneys and skeletal ;;muscle. Other organs of the urinary tract are rarely ;;affected and they are exceptionally the clinical site of ;;debut without previous known involvement of other ;;areas. METHODS/RESULTS: The first patient presented with ;;hematuria associated with an ultrasound/cystoscopical ;;image suspicion for neoplasia. Pathologic report of the ;;transurethral resection chips showed polypoid cystitis ;;with some small size arteries occupied by cholesterol ;;needles, associated with inflammation, ulcers and ;;hematic extravasation. The second patient underwent ;;cystoprostatectomy for a transitional cell carcinoma ;;and, incidentally, numerous cholesterol emboli were ;;found, mainly in the lamina propria, but also in other ;;layers of the bladder wall, prostate, urethra, veru ;;montanum, and one seminal vesicle; this two latter sites ;;have not being reported in previous publications. The ;;third patient showed the embolus within a prostate ;;biopsy core. ;;CONCLUSIONS: This unfrequent disease may present ;;as a bladder or prostatic process and be diagnosed by ;;biopsy of these organs. It may simulate a bladder neoplasia ;;on ultrasound or cystoscopy and should be included ;;among related or etiologic entities of polypoid cystitis, ;;a well-known simulator of neoplasia

[Penile silicone granuloma]. / Granuloma de silicona en el pene "siliconoma".

OBJECTIVES: To report our experience with one case of penile silicone granuloma, that has clinical interest for its unfrequent presentation. METHODS/RESULTS: We report the case of a patient with sexual dysfunction secondary to subcutaneous injection of liquid silicone in the penis resulting in a penile granuloma and migration of the particles to the penile root and midline scrotal raphe. We proceeded to the surgical excision of the granuloma and migrated particles, repairing the penile defect with scrotal skin. CONCLUSIONS: Subcutaneous injection of liquid silicone is a practice that does not have any justification because of its devastating effects and requires major perations for the elimination of the injected material.

Granuloma de silicona en el pene "siliconoma" / Penile silicone granuloma

OBJETIVO: Mostrar la experiencia adquiridacon un caso de “siliconoma” peneano, de interés clínicopor su infrecuente presentación.METODO /RESULTADOS: Presentamos el caso de unpaciente con alteración de la función sexual secundaria ala inyección subcutánea de silicona líquida en el pene,dando lugar a la formación de un granuloma “siliconoma”peneano y a la migración de partículas del compuesto araíz de pene y a rafe medio escrotal. Se procedió a laextirpación quirúrgica del “siliconoma “ peneano y de laspartículas migradas reparando el defecto peneano conpiel escrotal.CONCLUSIONES: La inyección subcutánea de siliconalíquida es una práctica no justificada que produce efectosdevastadores y requiere cirugías importantes para la eliminacióndel material inyectado

OBJECTIVES: To report our experience with ;;one case of penile silicone granuloma, that has clinical ;;interest for its unfrequent presentation. ;;METHODS/RESULTS: We report the case of a patient with ;;sexual dysfunction secondary to subcutaneous injection of ;;liquid silicone in the penis resulting in a penile granuloma ;;and migration of the particles to the penile root and midline ;;scrotal raphe. We proceeded to the surgical excision of ;;the granuloma and migrated particles, repairing the penile ;;defect with scrotal skin. ;;CONCLUSIONS: Subcutaneous injection of liquid silicone ;;is a practice that does not have any justification because ;;of its devastating effects and requires major perations for ;;the elimination of the injected material

[Renal malacoplakia: report of a new case]. / Malacoplaquia renal: presentación de un nuevo caso.

OBJECTIVES: Malacoplakia is a chronic granulomatous disease which can involve different areas of the body, being the genital renal system the most frequent site. We describe a case of unilateral renal malacoplakia. METHODS/RESULTS: We report the case of a female patient with the clinical working diagnosis of renal cell carcinoma that required drainage of a homolateral abscess which cultured positive for E. Coli. Nephrectomy was performed. Pathologic study showed the presence of Michaelis-Gutmann bodies, patognomonic of malacoplakia.

Malacoplaquia renal: presentación de un nuevo caso / Renal malacoplakia: report of a new case

OBJETIVO: La malacoplaquia es un procesogranulomatoso crónico, que puede afectar a distintas partesdel organismo, siendo el aparato genitourinario el lugar másfrecuente de asiento de esta enfermedad. Se describe uncaso de malacoplaquia renal unilateral.METODO/RESULTADO: Presentamos una paciente con diagnósticoclínico de hipernefroma, que precisó nefrostomía porabsceso renal homolateral, con cultivo positivo para E. Coli.Se realizó nefrectomía. El estudio histológico objetivó la presenciade cuerpos de Michaelis-Gutmann patognomónicosde malacoplaquia.CONCLUSIONES:La malacoplaquia renal unilateral es unproceso granulomatoso crónico de difícil diagnóstico clínico,siendo en el estudio anatomopatológico de la pieza denefrectomía donde se encuentran los cuerpos de Michaelis-Gutmann. La evolución después de la nefrectomía suele serfavorable

OBJECTIVES: Malacoplakia is a chronicgranulomatous disease which can involve differentareas of the body, being the genital renal system themost frequent site. We describe a case of unilateralrenal malacoplakia.METHODS/RESULTS: We report the case of a femalepatient with the clinical working diagnosis of renal cellcarcinoma that required drainage of a homolateral abscesswhich cultured positive for E.Coli. Nephrectomy wasperformed. Pathologic study showed the presence ofMichaelis-Gutmann bodies, patognomonic of malacoplakia

[Cholesterol embolism of the upper urinary tract as a clinical feature of atherosclerotic embolic vascular disease. Report of three cases, one of them simulating neoplasia]. / Embolismos de colesterol en el tracto urinario inferior como manifestacion clinica de la enfermedad ateroembólica. descripción de tres casos, uno de ellos simulando una neoplasia.

OBJECTIVES: To report three cases of atherosclerotic embolic vascular disease with clinical presentation in the lower urinary tract. This disease is not frequent; it mainly affects the skin, kidneys and skeletal muscle. Other organs of the urinary tract are rarely affected and they are exceptionally the clinical site of debut without previous known involvement of other areas. METHODS/RESULTS: The first patient presented with hematuria associated with an ultrasound/cystoscopical image suspicion for neoplasia. Pathologic report of the transurethral resection chips showed polypoid cystitis with some small size arteries occupied by cholesterol needles, associated with inflammation, ulcers and hematic extravasation. The second patient underwent cystoprostatectomy for a transitional cell carcinoma and, incidentally, numerous cholesterol emboli were found, mainly in the lamina propria, but also in other layers of the bladder wall, prostate, urethra, veru montanum, and one seminal vesicle; this two latter sites have not being reported in previous publications. The third patient showed the embolus within a prostate biopsy core. CONCLUSIONS: This unfrequent disease may present as a bladder or prostatic process and be diagnosed by biopsy of these organs. It may simulate a bladder neoplasia on ultrasound or cystoscopy and should be included among related or etiologic entities of polypoid cystitis, a well-known simulator of neoplasia.

Lymphoepithelioma-like carcinoma of the bladder: three cases with clinicopathological and p53 protein expression study.

Lymphoepithelioma-like carcinoma of the bladder is an uncommon neoplasm, of which 49 cases have been described in the English literature, none of which has been studied for p53 protein expression. We studied three muscle-infiltrating cases of this tumor using immunohistochemical, in situ hybridization and polymerase chain reaction (PCR) methods. The three cases were positive for epithelial markers and negative for lymphoid antigens in the tumoral syncytial areas. The intensive infiltrate of small cells was negative for epithelial and positive for lymphoid markers. This population was mainly made up of cytotoxic T-lymphocytes, positive for TIA-1. p53 protein was intensely positive in more than 90% of the epithelial component nuclei, being negative in the lymphoid cells. PCR study did not show mutations on p53. Both lymphocytes and epithelium were negative for Epstein-Barr virus markers, such as the latent membrane protein and EBER (Epstein-Barr-encoded RNA). The prognosis was very good after radiotherapy and chemotherapy treatment, preserving the bladder despite the muscle infiltration. The presence of an intense cytotoxic T-lymphocyte population may be related to this good prognosis. Both aspects, p53 protein status and T-lymphoid population, had never been studied before in bladder lymphoepithelioma-like carcinoma.