[A study of the progression of the incidental prostate cancer depending on the kind of treatment performed]. / Estudio de la progresión del cáncer de próstata incidental según el tipo de tratamiento aplicado.

INTRODUCTION AND OBJECTIVES: Prostate cancer is a common neoplasm, with a significant burden of mortality. Since it's diagnosed at old ages and usually growths slowly, agresive treatment of localised cancer of prostate could be of little benefit. The study of the evolution of incidental prostate cancer diagnosed 20 years ago could give directions for present decision-making. METHODS: We performed a time survival analysis of patients diagnosed of incidental prostate cancer between 1980 and 2000, and followed them until april 2005. We analysed overall and disease-specific mortality, related to the kind of treatment and some anatomopathological characteristics. RESULTS: We included 80 cases. Treatment was hormonotherapy in 34 cases, surgery in 4, radiotherapy in 3 and watchful waiting in 39. Overall average survival was 8.87 years. Disease-specific survival in low risk group (Gleason lower than 6) was 16 years, and in high risk group (Gleason higher than 7) was 6 years. No differences were found between hormonotherapy and watchful waiting. CONCLUSIONS: While in low risk patients watchful waiting represents an acceptable aproaching, it could not be adequate in high risk cases. Hormonotherapy showed no benefit in incidental prostate cancer.

Estudio de la progresión del cáncer de próstata incidental según el tipo de tratamiento aplicado / A study of the progression of the incidental prostate cancer depending on the kind of treatment performed

Introducción y objetivos: El cáncer de próstata es una neoplasia frecuente y con una carga de mortalidad significativa. Dado que se diagnostica a edades avanzadas y que con frecuencia crece lentamente, el tratamiento agresivo del cáncer de próstata localizado podría, en algunos casos, no aportar grandes beneficios. El estudio de la evolución de los cánceres de próstata incidentales diagnosticados hace 20 años podrían servir de utilidad para guiar las decisiones actuales. Métodos: Análisis de supervivencia de los pacientes diagnosticados de cáncer de próstata incidental entre 1980 y 2000, con un seguimiento hasta abril de 2005. Se analizó la supervivencia global y la 'cáncer específica', según el tipo de tratamiento y diversos factores anatomopatológicos. Resultados: Se incluyeron 80 casos. De ellos, 34 fueron tratados con hormonoterapia, 4 con cirugía, 3 con radioterapia y 39 siguieron abstención vigilada. La supervivencia media fue de 8,87 años. En el grupo de bajo riesgo (Gleason menor de 6) la supervivencia cáncer-específica fue de 16 años y en el de alto riesgo (Gleason mayor de 7) de 6 años, sin diferencias por tratamiento. Conclusiones: En el grupo de bajo riesgo la abstención vigilada resulta una alternativa aceptable. Esta alternativa puede no ser válida en los de alto riesgo. La hormonoterapia no parece aportar beneficio alguno en los cánceres de próstata incidentales

Introduction and objectives: Prostate cancer is a common neoplasm, with a significant burden of mortality. Since it’s diagnosed at old ages and usually growths slowly, agresive treatment of localised cancer of prostate could be of little benefit. The study of the evolution of incidental prostate cancer diagnosed 20 years ago could give directions for present decision-making Methods: We performed a time survival analysis of patients diagnosed of incidental prostate cancer between 1980 and 2000, and followed them until april 2005. We analysed overall and disease-specific mortality, related to the kind of treatment and some anatomopathological characteristics. Results: We included 80 cases. Treatment was hormonotherapy in 34 cases, surgery in 4, radiotherapy in 3 and watchful waiting in 39. Overall average survival was 8.87 years. Disease-specific survival in low risk group (Gleason lower than 6) was 16 years, and in high risk group (Gleason higher than 7) was 6 years. No differences were found between hormonotherapy and watchful waiting. Conclusions: While in low risk patients watchful waiting represents an acceptable aproaching, it could not be adequate in high risk cases. Hormonotherapy showed no benefit in incidental prostate cancer

[Laparoscopic adrenalectomy. Reflections after 24 procedures]. / Adrenalectomía laparoscópica. Consideraciones a propósito de 24 procedimientos.

INTRODUCTION AND OBJECTIVES: Laparoscopic adrenalectomy has gained rapid recognition since publication of the first case in 1992. Currently it is the technique of choice for the surgical treatment of the adrenal gland. Our objective in this paper is to share our experience with this technique and offer some practical advice on how to approach it. MATERIALS AND METHODS: Between May 1998 and August 2006 we did a total of 24 laparoscopic adrenalectomies in 22 patients (15 men, 7 women). The right gland was removed in 13 cases and the left in 11. Surgery was bilateral in two cases (one was MEN II, the other bilateral cortical hyperplasia). Average age was 49.5 +/- 14.3 years (range 24 to 78). Clinical diagnosis was: Pheochromocytoma (n = 10), Cushing (n = 6), Conn (n = 4), metastases from lung carcinoma (n = 2) and non-functioning tumor (n = 2). For surgery, all patients were in total lateral decubitus with a pillow to increase the costal-iliac space. We used four trocars on the right side and three on the left. Abdominal access was by Hasson trocar after minilaparotomy. We kept pneumoperitoneal pressure below 12 mmHg; a Veress needle was not used for this procedure. RESULTS: Open surgery was required in one case. Time operation was between 59 and 400 minutes (mean 182 +/- 98 min.). In the first 12 cases average time was 261 +/- 77 minutes and in the final 12 cases was 103 +/- 21 minutes (p < 0.001). Tumour diameter was between 1.3 and 6 cm (mean 3.08 +/- 1.25 cm) and tumour weight was between 8 and 92g (mean 30.13 +/- 21 g). Except in one case with 600 ml blood loss, bleeding was less than 100 ml (n = 23, range: 10-100, mean 43.26 +/- 25ml). We only had intraoperative complications in two cases: perforation of the liver by the laparoscope retractor (at the beginning of the series) and injury to the spleen capsule. Both complications were resolved laparoscopically. Cases by histologic type were: nine cortical adenomas, nine pheochromocytomas, three nodular hyperplasias, two metastases from lung carcinoma, and one adrenal pseudocyst. Discharge from hospital was between three and five days (mean 3.62 +/- 0.82) with a statistical difference (p < 0.001) between twelve first cases and the last ones. CONCLUSIONS: The adrenal laparoscopic approach is currently the technique of choice for removing adrenal tumours although with malign tumours or over 7 cm in diameter there are some contraindications and disadvantages relative to open surgery. There is inevitably a learning curve but satisfactory results are quickly attainable.

Algunas consideraciones sobre el diagnóstico y tratamiento actual del carcinoma prostático organoconfinado / Some considerations on the diagnostic and the present treatment of the prostatic carcinoma organoconfined

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[A new case of entero-vesical fistula, secondary to Crohn's disease]. / Un nuevo caso de fístula entero-vesical, por Enfermedad de Crohn.

OBJECTIVE: To emphasize that urological symptoms and signs can be the presenting features of Crohn's disease. METHODS: A case of enterovesical fistula in a patient with Crohn's disease is described. The patient presented with hematuria and mild voiding symptoms, but there were no GI or other symptoms. The clinical aspects, diagnostic methods (ultrasound, cystoscopy, rectosigmoidoscopy) and treatment are discussed. RESULTS/CONCLUSIONS: Although Crohn's disease is rare, it should be considered when making the differential diagnosis in patients who present with voiding symptoms and hematuria.

[Giant bladder diverticulum, inside inguinal hernia. Clinical case and review of the literature]. / Divertículo vesical gigante, incluido en una hernia inguinal. Caso clínico y revisión de la literatura.

OBJECTIVE: To report a case of giant diverticulum of the bladder associated with inguinal hernia. METHODS/RESULTS: An uncommon case of giant diverticulum associated with inguinal hernia is presented and the literature reviewed. The enormous size of the diverticulum and the associated lower urinary tract obstruction arising from hyperplasia of the prostate required resolution of both conditions. This was achieved by diverticulectomy with herniorrhaphy and TURP. CONCLUSIONS: Diverticula of the bladder are associated with lower urinary tract obstruction that are generally caused by a prostatic condition. Hernia with bladder diverticulum is uncommon. The symptoms are usually scanty and cannot be distinguished from the voiding symptoms arising from prostatic involvement. Apart form the clinical findings, US, cystography or IVP are useful for diagnosis. Treatment is usually by surgical correction of both the bladder diverticulum and voiding obstruction from prostatic hyperplasia.

[Gas-containing balano-preputial abscess; diagnostic and therapeutic approach]. / Absceso balano-prepucial con contenido gaseoso en su interior; pauta diagnóstica y terapéutica.

OBJECTIVE: A case of balanopreputial abscess containing gas in a patient with adhesion of the glans penis to preputial mucosa is presented. METHODS: The clinical features, diagnostic methods (penile ultrasound) and treatment (debridement + step (staged?) circumcision) are described. RESULTS/CONCLUSIONS: Severe phimosis and balanopreputial adhesions can cause urological complications as shown in the case described. Ultrasound demonstrated the presence of abscess and gas.

[Castleman's disease: isolated retroperitoneal mass. Report of a case]. / Enfermedad de Castleman: masa única retroperitoneal. A propósito de un caso.

OBJECTIVE: To describe a rare case of vascular hyaline variant of Castleman's disease presenting as a solitary mass, with special reference to the radiological findings and differential diagnosis. The literature is briefly reviewed. METHODS/RESULTS: A 48-year-old male presented with nonspecific pain in the left flank. Routine analyses were unremarkable. Sonographic and CT studies showed a well-defined, highly vascularized, 3.3 x 3.6 x 4 cm retroperitoneal mass. The risk of hemorrhage made a preoperative biopsy impracticable and the mass was removed surgically. The pathological analysis of the surgical specimen showed a localized retroperitoneal angiofollicular lymphoid hyperplasia (vascular hyaline variant). CONCLUSIONS: Castleman's disease can rarely present as a solitary retroperitoneal mass, which must be distinguished from primary retroperitoneal masses that are usually malignant. Imaging techniques are not conclusive. Definitive diagnosis is based on the postoperative pathological findings.

[Urologic iatrogenic disease]. / Yatrogenia urológica.

OBJECTIVE: The purpose of this paper is to emphasize that despite the undeniable advantages of urological instrumentation (insertion of a ureteral catheter, double-J catheter; percutaneous nephrostomy, etc.), it also carries some risks and complications. METHODS: We report three cases of iatrogenic urological complications due to use of endoscopic and percutaneous material. RESULTS/CONCLUSION: Urologists, and particularly the residents, are reminded that iatrogenic complications may occur even in the easiest and routine procedures of the medical activity.

[Prostatic malacoplakia: report of a case and review of the literature]. / Malacoplaquia de próstata: aparición de un caso y revisión de la literatura.

OBJECTIVE: To describe an additional case of malakoplakia of the prostate. The etiopathogenesis, the histological and clinical features of this disease are analyzed and the literature briefly reviewed. METHODS/RESULTS: The pathological features of malakoplakia of the prostate in an elderly man with severe prostatic syndrome and recurrent urinary infections from E. Coli are described. The clinical manifestations disappeared following adenomectomy according to the Millin technique. CONCLUSION: Diagnosis of malakoplakia of the prostate is based on the pathological findings. The importance of the pathologist's role in the diagnosis of this condition, which will determine the treatment to follow, is therefore underscored.

[Acute abdomen secondary to pyonephrosis. Perinephritic abscess with fistula to peritoneal cavity]. / Abdomen agudo secundario a pionefrosis. Absceso perinefrítico, fistulizado a cavidad peritoneal.

OBJECTIVE: To describe a case of acute abdomen arising from an underlying urological condition. METHODS/RESULTS: Herein we describe a patient with acute abdomen arising from a pyonephrotic kidney with fistulization to the peritoneal cavity. The clinical manifestations disappeared following nephrectomy by the anterior approach and drainage of the intraperitoneal cavity. CONCLUSION: Although infrequent, it should be taken into account that peritoneal abscess and/or pyonephrosis can cause acute abdomen when they fistulize to the peritoneal cavity.

[Erectile dysfunction caused by neurapraxia of the pudendal nerve after the use of a traction table for the treatment of traumatic fractures. Report of a case and review of the literature]. / Disfunción eréctil por neuroapraxia del nervio pudendo tras el uso de la mesa de tracción para la solución de fracturas traumatológicas. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To describe a case of erectile dysfunction as a result of traction on the fracture table. METHODS: We report on a 39-year-old man who developed erctile dysfunction postoperatively and for several months thereafter, following intramedullary nailing with the Grosse-Kept bolt type fixation system. RESULTS: The patient spontaneously recovered erectile function six months after orthopaedic treatment. CONCLUSION: Erectile dysfunction induced by orthopaedic fracture table is a complication that should be taken into account. There are many procedures available to reduce the risk of this complication.

[[Brucellar orchiepididymitis with abscess]. / Orquiepididimitis brucelósica abscesificante.

OBJECTIVE: To emphasize the need to consider Brucella infection in patients presenting with acute scrotum of a possible inflammatory etiology, in endemic areas, as in some Spanish regions. The abscess forming type, although rare, should be considered. One such case is described herein and the literature briefly reviewed. METHODS: A male patient consulted for subacute inflammation and left testicular pain. He had systemic brucellosis four months earlier that had completely remitted following specific therapy. The patient had a physical examination, analytical, blood and urine analyses, specific serological tests and testicular ultrasound evaluation. RESULTS: Physical examination disclosed left testicular pain and inflammation suggesting epididimo-orchitis. The laboratory findings were normal except for high titles against Brucella. Ultrasound disclosed diffuse enlargement of the left testis with several well-defined hypoechoic areas. The foregoing data suggested abscess forming orchitis, although a neoplasm could not be discarded. Empirical antibiotic therapy was instituted initially and specific therapy for Brucella was administered subsequently, but unilateral orchidectomy was decided because of the poor response to therapy. Histopathological analysis of the surgical specimen disclosed acute abscess forming epididimo-orchitis with multifocal chronic granulomatous involvement. CONCLUSION: Brucella epididimo-orchitis must be considered when making the differential diagnosis in acute inflammatory scrotum, particularly in endemic areas, even in the absence of suggestive clinical and/or US findings. Necrotizing orchitis is a rare form of Brucella infection which must be distinguished from necrotizing involvement arising from other pathogens (TB or Salmonella). Above all, this condition must be distinguished from a tumor.

[Testicular microlithiasis associated with infertility]. / Microlitiasis testicular asociada a infertilidad.

OBJECTIVE: A case of testicular microlithiasis that had been incidentally diagnosed by ultrasound in a patient undergoing evaluation for infertility is described and the literature briefly reviewed. METHODS: The clinical, laboratory (routine blood and urine tests, hormone studies, spermiogram) and testicular ultrasound findings in a 28-year-old male who consulted for infertility are presented. RESULTS: Serum FSH and LH were raised and testosterone fell within the lower ranges. The spermiogram revealed azoospermia. US evaluation showed bilateral small hyperechoic foci without posterior acoustic shadowing, dispersed within a normal testicular parenchyma. CONCLUSIONS: Testicular microlithiasis is a rare entity which is usually discovered incidentally during testicular ultrasound evaluation for other conditions such as infertility. The underlying condition (calcium in the seminiferous duct lumen) has a specific ultrasonographic appearance and further studies are not required to make the diagnosis. The patho-genesis and the clinical implications of microlithiasis remain unclear, therefore any associated pathology, such as tumor, infertility, systemic diseases, or chromosomal disorders, must be ruled out. Regular US follow-up is advocated.

[Acute orchiepididymitis: assessment with high-resolution ultrasonography in 52 cases]. / Orquiepididimitis aguda: valoración mediante ecografía de alta resolución en 52 casos.

OBJECTIVES: The present study describes our experience in ultrasound diagnosis of acute orchiepididymitis, with special reference to the most common US patterns and complications of this disease entity. METHODS: In acute scrotum suspected as having an inflammatory origin, high resolution ultrasonography is performed in the acute phase in addition to routine blood and urine analyses. Treatment and subsequent US control evaluation vary according to each case. RESULTS: The sonographic findings in 52 cases with a clinical suspicion of acute orchiepididymitis are presented. All examinations were performed in the acute phase. Subsequent sonographic control evaluation was performed 2-4 months after treatment. Seven cases had a negative ultrasound; in 4 cases ultrasound disclosed a different pathology (2 tumors, 1 testicular torsion and 1 hydatid torsion); 12 had both testicular and epididymal involvement; one had testicular and 28 had epididymal involvement alone. Complications were observed in 21 cases (hydrocele, abscess, pyocele, infarct...). Sonographic evaluation after treatment showed complete resolution in 26 cases whereas 15 cases showed postinflammatory sequelae (atrophy, changes in testicular ultrasound pattern, calcifications, chronic hydrocele...). The ultrasound findings indicated surgery in 2 cases. CONCLUSIONS: High resolution ultrasonography is currently the diagnostic method of choice in scrotal inflammation. It permits determining the extent of the lesion (orchitis, epididymitis, orchiepididymitis), complications (hydrocele, hematocele, pyocele, abscess, infarct...) and the result of therapy.

[A giant adrenal mass: the anatomicopathological surprise finding]. / Masa suprarrenal gigante: sorpresa anatomopatológica.

OBJECTIVE: The present study reviews the differential diagnosis of adrenal masses, including the uncommon forms, as the one described herein. METHOD/RESULTS: A patient with a giant adrenal mass that required differential diagnosis from other types of adrenal masses is presented. The diagnosis could only be made following anatomopathological analyses. CONCLUSIONS: The present case demonstrates that the uncommon forms of adrenal masses must be taken into account in the differential diagnosis, which, however, can only be confirmed by the pathological analysis since the findings on diagnostic imaging mimic other forms.

[Partial nephrectomy for pyelo-renal duplication with pseudocoraliform lithiasis in non-functioning upper pyelon]. / Nefrectomía parcial por duplicidad pielorenal con litiasis pseudocoraliforme en pielon superior afuncionante.

We performed a right heminephrectomy in a patient with pyelorenal duplicity, pseudostaghorn stone in nonfunctioning superior pyelon and a history of right perirenal abscess. The history, indications, variations and complications of this surgical procedure are briefly described. The importance of performing a complete evaluation prior to surgery is emphasized.

[A new cases of transitional cell papilloma of the bladder, inverted type]. / Un nuevo caso de papiloma de células transicionales de vejiga, tipo invertido.

We report on a 75-year-old male patient with inverted transitional cell papilloma located on the right side of the bladder, behind the prostate lobe. It was a large (4 x 4 x 0.9 cm) exophytic, papillary tumor with a wide base and all the gross features of a typical transitional cell tumor of the bladder. The presenting symptom was gross hematuria and treatment was by transurethral resection. The literature is briefly reviewed.