Outcomes of laparoscopic salvage radical prostatectomy after primary treatment of prostate cancer.

Introduction: Treatment of radio-recurrent prostate cancer (PC) is managed mainly by androgen deprivation therapy. Nonetheless, selected patients could benefit from local salvage treatment options.In this study we present our series of recurrent PC cases submitted to laparoscopic salvage radical prostatectomy (sRP) at our institution. Material and methods: A total of 29 patients with recurrent PC after primary non-surgical treatment were submitted to laparoscopic sRP at our institution, with a mean follow-up time of 7 years. Results: There were 7 post-operative complications Clavien-Dindo grade ≥2. At the end of the follow-up, 58.6% patients presented biochemical recurrence and five-year recurrence-free survival (RFS) was 50%.Positive lymph nodes, high preoperative prostate-specific antigen (PSA) and TNM stage were correlated with worse RFS. Cox regression analysis demonstrated that stage pT3b was independently associated with worse RFS in comparison with stage pT3a or less.At 12 months, pad-free continence or mild incontinence was observed in 62% of the patients. Conclusions: sRP is a technically challenging surgery, and in our series, we were able to perform this procedure with acceptable operative time and limited blood loss.Post-operative complications, functional results and oncological outcomes were similar to other published studies, being our series, to the best of our knowledge, the one with the longest follow-up, of 7 years.sRP is a feasible local treatment with curative intent for radio-recurrent prostate cancer, with good oncological outcomes and reasonable continence rates in selected patients.

Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria / Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice

OBJETIVO: Describir en el entorno de la práctica clínica diaria, el perfil del paciente con vejiga hiperactiva (VH) tratado con dosis flexible de antimuscarícos. MÉTODOS: Estudio observacional, retrospectivo y multicéntrico llevado a cabo en 88 Hospitales públicos y privados. Se incluyeron pacientes adultos, diagnosticados de VH que iniciaron tratamiento con algún antimuscarínico a dosis flexible. Se recogió tipo de antimuscarínico, dosis, tratamientos concomitantes, beneficio aportado y cumplimiento terapéutico. RESULTADOS: Población constituida por 846 pacientes mayores de 60 años, pluripatológica (83,5%) y polimedicada (73,4%), formada mayoritariamente por mujeres (74,5%) y con más de un año de evolución de la VH. Principales antimuscarínicos inicialmente prescritos: fesoterodina (66,9%) y solifenacina (31,0%). El 68,2% de los pacientes iniciaron el tratamiento con la dosis baja. En la visita de seguimiento, el 47,0% modificó dosis (84,2% aumentaron la dosis, 15,8% disminuyeron la dosis). Los grupos que tuvieron que modificar dosis presentaron significativamente mayor morbilidad, peor sintomatología, mayor empleo de recursos sanitarios y peor cumplimiento terapéutico que el grupo de pacientes tratados siempre a dosis alta. CONCLUSIÓN: En determinados pacientes, el empleo desde el inicio del tratamiento antimuscarínico de dosis- flexible a la dosis más alta, podría proporcionar mayor beneficio terapéutico, adherencia y menor empleo de recursos sanitarios que el escalado de dosis

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5%) and polymedicated (73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose

Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice. / Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria.

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5% and polymedicated 73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose.

Results of simplified urethropexy in the recovery of continence after radical laparoscopic prostatectomy.

PURPOSE: To analyze the effectiveness of simplified urethropexy in the evolution of urinary incontinence after radical laparoscopic prostatectomy. PATIENTS AND METHODS: Between January 2007 and December 2008, 104 patients were included in a randomized trial to assess the effectiveness of simplified urethropexy. The simplified urethropexy technique was performed on conclusion of a urethrovesical anastomosis with running suture and, before cutting the suture material, a suture was applied using the same material with a needle through the pubic tubercle, tightening it and securing it with a Hem-o-lok. Fifty-one patients qualified for the trial in the simplified urethropexy group (group 1) and another 51 in the control group without urethropexy (group 2). Incontinence was defined as the lack of the need for protection for normal life, and the degree of continence was compared at 3, 6, and 12 months after surgery. RESULTS: Surgery lasted 141 minutes in group 1 and 139 in group 2 (NS). There were no secondary complications such as urine retention, osteitis pubis, or bladder perforation. After 3 months, 47.1% of patients in each group declared continence (NS). After 6 months, 72.6% of patients in group 1 and 66.7% in group 2 (P<0.05) declared continence. After 12 months, 92.2% of patients in group 1 and 84.3% in group 2 declared continence. CONCLUSIONS: In our experience, simplified urethropexy is a simple, nontime-consuming technique that shows a slight clinical improvement in continence within 6 and 12 months, without reaching significant differences with the Fisher Test. It would be necessary to perform a trial with a greater number of patients to confirm these data.

[Renal carcinoma metastatic to the peritoneum. Case report]. / Carcinoma renal metastásico a peritoneo. A propósito de un caso.

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis.

Carcinoma renal metastásico a peritoneo. A propósito de un caso / Renal carcinoma metastatic to the peritoneum. Case report

OBJETIVO: Aportar un caso de carcinoma renal que presentó implantes peritoneales en su evolución. MÉTODO/RESULTADOS: Describimos el caso de un varón joven que en el seguimiento de su patología neoplásica tras nefrectomía radical presenta sintomatología abdominal inespecífica que conduce al descubrimiento de implantes peritoneales y recidiva local. Se realizó una segunda cirugía exploradora y de citorreductora, con recidiva peritoneal rápida. A los tres meses y a pesar del tratamiento que siguió con Interferón-α, el paciente presento metástasis hepáticas múltiples. CONCLUSIONES: La afectación peritoneal por carcinoma de células renales es un hecho infrecuente y que confiere un mal pronóstico

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis

[Diet and bladder cancer]. / Dieta y cáncer de vejiga.

OBJECTIVES: To perform an update on the bibliography about the influence of dietetic factors on bladder cancer. METHODS: Bibliography search in various databases (PubMed, Ovid) on each one of the dietetic agents that can influence on the incidence of bladder tumors. RESULTS/CONCLUSIONS: There is a growing number of evidences that a great number of substances present in our usual diet have an influence on bladder cancer.

[Impact of the weather on the serum levels of prostatic specific antigen (PSA)]. / Impacto de la climatología sobre el nivel sérico de antígeno especifico prostático (PSA).

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). EXCLUSION CRITERIA: prostate cancer diagnosis, PSA > = 10 ng/ml, or PSA > = 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value > = 3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p < 0.001), minimum temperature (p = 0.001) and age (p < 0.001) as independent predictors of a PSA value > = 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of < = 15 degrees C, 16-20 degrees C, 21-25 degrees C and > =26 degrees C were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.

Dieta y cáncer de vejiga / Diet and bladder cancer

OBJETIVO: Realizar una revisión actual de la bibliografía de la influencia ejercida por factores dietéticos sobre el cáncer vesical. MÉTODOS: Búsqueda de la bibliografía existente en diferentes bases de datos (Pubmed, Ovid) sobre cada uno de los agentes dietéticos que pueden influir la incidencia de los tumores vesicales. RESULTADOS/CONCLUSIONES: Cada vez existen más evidencias que un gran número de sustancias presentes en nuestra dieta habitual ejercen una influencia en el cáncer de vejiga

OBJECTIVES: To perform an update on the bibliography about the influence of dietetic factors on bladder cancer. METHODS: Bibliography search in various databases (PubMed, Ovid) on each one of the dietetic agents that can influence on the incidence of bladder tumors. RESULTS/CONCLUSIONS: There is a growing number of evidences that a great number of substances present in our usual diet have an influence on bladder cancer

Impacto de la climatología sobre el nivel sérico de antígeno específico prostático (PSA) / Impact of the weather on the serum levels of prostatic specific antigen (PSA)

OBJETIVO: Analizar el impacto de la estación climática y de ciertos parámetros meteorológicos sobre el nivel de PSA sérico en varones sin cáncer de próstata. MÉTODOS: Estudio retrospectivo que incluye registros de la rama Española del European Randomized Study of Screening for Prostate Cancer (ERSPC). Los criterios de exclusión fueron el diagnóstico de cáncer de próstata, presentar PSA >= 10 ng/ml, o bien PSA >= 3 ng/ml y/o anomalías en el tacto rectal a menos que se disponga de una biopsia prostática negativa para malignidad. Se investigó la relación univariante entre nivel de PSA y estación climática, así como varios parámetros meteorológicos. Se empleó un modelo multivariante de regresión logística para identificar predictores independientes de la obtención de un nivel de PSA >=3 ng/ml. RESULTADOS: Un total de 2.147 varones fueron incluidos en el estudio. Las medianas de edad y PSA fueron 57 años y 0,9 ng/ml respectivamente. Se observó una tendencia no significativa hacia niveles de PSA más elevados durante las estaciones de otoño e invierno. El modelo multivariante de regresión logística identificó únicamente las temperaturas máxima (p= 3 ng/ml. Los niveles medios de PSA ajustado a la edad en los rangos de temperatura máxima =26ºC fueron 1,25, 1,20, 1,17 y 1,09 ng/ml respectivamente. CONCLUSIONES: Los niveles de PSA sérico son ligeramente más elevados durante condiciones de frío climático. Debido a la pequeña magnitud de esta elevación, no recomendamos cambiar la indicación de biopsia prostática basándonos únicamente en factores climáticos

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Exclusion criteria: prostate cancer diagnosis, PSA >= 10 ng/ml, or PSA >= 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value >=3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p= 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of =26ºC were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters

[Diagnostic antegrade ureteroscopy of the upper urinary tract in the orthotopic neobladder]. / Ureteroscopia diagnóstica anterógrada del tracto urinario superior en la neovejiga ortotópica.

OBJECTIVES: To demonstrate the usefulness of antegrade endoscopical examination in the evaluation of the upper urinary tract pathology in patients with orthotopic neobladder. METHODS/RESULTS: We present the technique of percutaneous antegrade ureteroscopy and the indications for treatment of the upper urinary tract urothelial tumor (radical or conservative) depending on multiple pyelo-calyceal biopsies and tumor lesions. CONCLUSIONS: Endoscopical evaluation of the upper urinary tract in patients with orthotopic neobladder offers safer information than urine analysis, urine cytology, and the various radiological tests. The difficulty for retrograde examination is on the identification of the ureteral neomeatus, so that in case of failure, antegrade percutaneous approach allows complete ureteral and pyelocalyceal examination and biopsies thanks to the development of flexible endoscopes. The information supplied by these endoscopical examinations of upper urinary tract urothelial tumors (grade, stage, multifocality) allows the choice of radical or conservative (open surgery or endoscopical) treatment.

Ureteroscopia diagnóstica anterógrada del tracto urinario superior en la neovejiga ortotópica / Diagnostic antegrade ureteroscopy of the upper urinary tract in the orthotopic neobladder

OBJETIVO: Demostrar la utilidad de laexploración endoscópica anterógrada en la evaluaciónde la patología del tracto urinario superior en lospacientes con neovejiga ortotópicaMÉTODO Y RESULTADOS: Se presenta la técnica derealización de la ureteroscopia anterógrada vía percutáneay la elección del tratamiento del tumor de uroteliosuperior (radical o conservador) en función de labiopsia múltiple pielocalicial y de las lesiones tumoralesCONCLUSIONES: La evaluación endoscópica delaparato urinario superior en pacientes con neovejigaortotópica ofrece una información más segura que elanálisis de orina, la citologia urinaria y los diferentesestudios de imagen. La dificultad de la exploraciónretrógrada radica en la identificación del neomeatoureteral, recurriendo por ello, en caso de fracaso, a lavia anterógrada percutánea que, gracias al desarrollode endoscopios flexibles, permite la exploración completapielocalicial y ureteral con toma de biopsias. Lainformación aportada por las exploraciones endoscópicasen el tumor de urotelio superior (grado, estadio,multifocalidad) permite la elección del tratamiento, bienradical o conservador (abierto o endoscópico)

OBJECTIVES: To demonstrate the usefulnessof antegrade endoscopical examination in the evaluationof the upper urinary tract pathology in patients withorthotopic neobladder.METHODS/RESULTS: We present the technique ofpercutaneous antegrade ureteroscopy and the indicationsfor treatment of the upper urinary tract urothelial tumor(radical or conservative) depending on multiplepyelo-calyceal biopsies and tumor lesions.CONCLUSIONS: Endoscopical evaluation of the upperurinary tract in patients with orthotopic neobladderoffers safer information than urine analysis, urine cytology,and the various radiological tests. The difficulty forretrograde examination is on the identification of theureteral neomeatus, so that in case of failure, antegradepercutaneous approach allows complete ureteral andpyelocalyceal examination and biopsies thanks to thedevelopment of flexible endoscopes. The informationsupplied by these endoscopical examinations of upperurinary tract urothelial tumors (grade, stage, multifocality)allows the choice of radical or conservative (opensurgery or endoscopical) treatment

[Chemoprophylaxis and endoscopical treatment of upper urinary tract tumors recurrences]. / Quimioprofilaxis y tratamiento endoscópico de las recidivas de los tumores del tracto urinario superior.

OBJECTIVES: Upper urinary tract tumors are a rare condition. We review our experience in the diagnosis of upper urinary tract tumors and their recurrences, emphasizing the management of recurrences. METHODS: From January 1980 to June 2002 139 endourological procedures were carried out in 94 patients with the working diagnosis of upper urinary tract tumor. RESULTS: The overall treatment failure rate was 18.7 with ureteroscopy being the least efficient technique. CONCLUSIONS: In our experience, there is an indication for conservative endourological treatment in superficial low grade G1-2 tumors smaller than 2 cm.

[Erectile dysfunction after radial prostatectomy. Response to treatment with sildenafil citrate]. / Disfunción eréctil postprostatectomía radical. Respuesta al tratamiento con citrato de sildenafilo.

OBJECTIVES: Erectile dysfunction is one of the sequelae after radical prostatectomy most concerning for the patient, its appearance being influenced by factors such as surgical technique, or patient's age. Thus, around 40% of the patients younger than 70 years and over 90% of the patients older than 70 present with erectile dysfunction after prostatectomy. We studied the response to sildenafil citrate in patients who underwent non nerve sparing radical prostatectomy. METHODS: Medical records of 100 patients who underwent radical prostatectomy at our department between 1985 and 1998 were retrospectively reviewed and telephone interviews were done to investigate the degree of erectile dysfunction following surgery. All patients were offered to start a two-month therapeutic trial with sildenafil citrate, in dose escalation up to a maximum of 100 mg. Therapeutic response was evaluated by personal interviews. RESULTS: 5 out of 100 patients interviewed showed similar potency than preoperatively. Among 95 patients with erectile dysfunction 63 (66.3%) did not wish treatment for erectile dysfunction. 22 of the remainder 32 patients initiated treatment with sildenafil citrate, whereas 10 preferred trying intracavernous PGE1 injections only. In the intracavernous injections group 5 patients abandoned because of pain with injections and refused any further treatment with oral drugs; 5 patients are satisfied with intracavernous therapy and they do not want to try sildenafil. In the sildenafil group form 22 patients starting treatment 14 (63.6%) are satisfied, with a subjective improvement. Only 5 patients (22%) show an erectile response enough to have sexual intercourse with penetration. 8 (36.5%) abandon treatment because of lack of efficiency. CONCLUSIONS: 5% of the patients who undergo non nerve sparing radical prostatectomy maintain sexual potency without treatment postoperatively. Most patients with postoperative erectile dysfunction (63/95 = 66.3%) do not want any treatment. From 22 patients initiating treatment with sildenafil 5 can have sexual intercourse with penetration (5/22 = 22%), all of them with 100 mg doses of sildenafil.

Disfunción eréctil postprostatectomía radical. Respuesta al tratamiento con citrato de sildenafilo / Erectile dysfunction after radical prostatectomy. Results with sildenafil citrate treatment

OBJETIVOS: La disfunción eréctil es una de las secuelas que más preocupa a los pacientes sometidos a prostatectomía radical, dependiendo su aparición de diversos factores como la técnica empleada o la edad del paciente. Así, alrededor del 40 per cent de los pacientes menores de 70 años y más del 90 per cent de los mayores de 70 años presentan disfunción eréctil postprostatectomía. En este trabajo estudiamos la respuesta al sildenafilo de los pacientes sometidos a prostatectomía radical sin intento de conservación de nervios erectores. MÉTODOS: Se revisaron las historias clínicas de 100 pacientes sometidos a prostatectomía radical en nuestro servicio desde 1995 a 1998 y se les entrevistó telefónicamente con el fin de averiguar el grado de disfunción eréctil que siguió a la cirugía. A todos los pacientes se les propuso realizar un tratamiento de prueba con citrato de sildenafilo durante dos meses, a dosis creciente, hasta alcanzar la dosis máxima de 100 mg. La respuesta al tratamiento se evaluó mediante entrevista personal. RESULTADOS: De los 100 pacientes entrevistados, 5 presentaban una potencia sexual similar a la preoperatoria. De los 95 pacientes con disfunción eréctil postoperatoria, 63 (66,3 per cent) no deseaban tratamiento para su disfunción eréctil. De los 32 pacientes restantes 22 inician tratamiento con sildenafilo, mientras que 10 prefieren probar sólo PGE1 intracavernosa. De estos últimos, 5 presentan dolor importante a la inyección del producto y abandonan el tratamiento y cualquier intento de tratamiento ulterior por vía oral.5 están satisfechos con las inyecciones intracavernosas y no desean probar el sildenafilo. De los 22 que inician tratamiento con sildenafilo 14 (63,6 per cent) están satisfechos, con mejoría subjetiva. Sólo 5 pacientes (22 per cent) presentan una respuesta eréctil suficiente como para mantener relaciones sexuales con penetración. 8 (36,4 per cent) abandonan el tratamiento por ser ineficaz. CONCLUSIONES: Un 5 per cent de los pacientes sometidos a prostatectomía radical sin intento de conservar nervios erectores mantienen la potencia sexual postoperatoriamente sin tratamiento. La mayoría de los pacientes con disfunción eréctil postoperatoria (63/95=66,3 per cent), no desean ningún tratamiento. De los 22 pacientes que inician tratamiento con sildenafilo 5 consiguen mantener relaciones sexuales con penetración (5/22=22 per cent), todos ellos con dosis de 100 mg de sildenafilo (AU)

Alteraciones del seno urogenital / Urogenital sinus abnormalities

OBJETIVO: Revisar el tratamiento actual más adecuado para las malformaciones congénitas del seno urogenital en la mujer. MÉTODO: Realizamos una revisión bibliográfica del tratamiento de esta rara entidad y recordamos el desarrollo embriológico del aparato genital femenino. RESULTADOS Y CONCLUSIONES: Revisamos las diferentes técnicas quirúrgicas desde un punto de vista histórico haciendo especial énfasis en que momento ha de realizarse el procedimiento (AU)

[Early-onset sarcomatoid renal carcinoma. Report of a new case and comparison of the same case with another appearing at a mature age]. / Carcinoma renal sarcomatoide de temprana aparición. Aportación de un nuevo caso y comparación del mismo con otro de aparición en edad madura.

OBJECTIVE AND METHODS: We report two new cases of this rare and aggressive tumour; one case appeared in the earliest age reported in the literature (case #2). We also review etiological, diagnostic and therapeutic features. RESULTS: Despite aggressive surgery and adjuvant chemotherapy it has a very poor prognosis, with disease progression within 6 months in both cases. CONCLUSIONS: Sarcomatoid renal cell carcinoma is an infrequent entity, extremely aggressive and requires radical surgery at the time of diagnosis due to its advanced stage, although results are poor. It can also appear in young people with the same aggressiveness than in adult age.

Carcinoma renal sarcomatoide de temprana aparición. Aportación de un nuevo caso y comparación del mismo con otro de aparición en edad madura / sarcomatoid renal cell carcinoma appearing at young age. A new case and comparison with another case appearing in a mature age

Objetivo y Métodos: Bajo el formato de casos clínicos aportamos dos nuevos casos de este raro y agresivo tumor, siendo la edad de presentación de uno de ellos (caso clínico nº 2) la más temprana recogida en la literatura. Asimismo, revisamos aspectos relativos a la etiología, diagnóstico y tratamiento. Resultados: A pesar de cirugía muy agresiva y tratamiento adyuvante, el pronóstico es infausto, con progresión de la enfermedad en los primeros 6 meses en ambos casos. Conclusiones: El carcinoma sarcomatoide de riñón es una entidad infrecuente, extremadamente agresiva y que requiere cirugía radical debido a su avanzado estado en el momento del diagnóstico, aunque con pobres resultados. Puede aparecer también en la juventud con la misma agresividad que en la edad adulta Carcinoma renal sarcomatoide. Regresión espontánea. Patología del tumor renal (AU)

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[Mesothelial cysts in urology: a diagnostic and therapeutic problem]. / Quistes mesoteliales en urología; un problema diagnóstico y terapéutico.

OBJECTIVE: To present our experience with mesothelial cysts with excretory system involvement. METHODS: 3 cases of mesothelial cyst are presented; two of them caused obstructive uropathy. RESULTS: Cases 1 and 2 were treated by surgery, while case 3 was managed conservatively. All cases are currently asymptomatic. CONCLUSIONS: Mesothelial cysts are an uncommon cause of obstructive uropathy. Treatment is by surgery for the symptomatic cases and conservative management is a valid alternative for the asymptomatic cases.

Quistes mesoteliales en urología; un problema diagnóstico y terapéutico / Mesothelial cysts in urology: A diagnostic and therapeutic problem

OBJETIVO: Presentar nuestra experiencia con quistes mesoteliales con repercusión sobre la vía excretora.MÉTODOS: Bajo el formato de casos clínicos presentamos 3 casos de quiste mesotelial, dos de ellos causantes de uropatía obstructiva.RESULTADOS: Los casos nº 1 y 2 fueron tratados mediante cirugía y el caso nº 3 de manera conservadora estando actualmente asintomáticos.CONCLUSIONES: Los quistes mesoteliales son una causa infrecuente de uropatía obstructiva, con buen pronóstico, que requieren cirugía cuando son sintomáticos aunque la actitud expectante cuando no provocan sintomatología es una alternativa válida (AU)