[Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.] / Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva.

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz.MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p<0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG.

Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva / Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS

Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct.

OBJECTIVE: To report one case of advanced fibrous pseudotumour. METHODS: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study. RESULTS: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia. CONCLUSION: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment.

Pseudotumor fibroso que afecta a la túnica vaginal, el epidídimo y la vía seminal / Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct

OBJETIVO: Presentamos un caso evolucionado de Pseudotumor fibroso. MÉTODOS: Varón de 34 años que consulta por bultoma escrotal derecho indoloro presentando a la exploración un engrosamiento de consistencia indurada fusionado a la cola y el cuerpo de epidídimo derecho. El estudio ecográfico no fue aclaratorio planteando múltiples diagnósticos diferenciales. Se realizó exéresis de la lesión precisando una epididimectomía parcial derecha y resección de la túnica vaginal y el conducto deferente afectados para su estudio anatomopatológico. RESULTADOS: El estudio histopatológico de la pieza quirúrgica correspondía a un pseudotumor fibroso evolucionado, con metaplasia ósea. CONCLUSIÓN: El pseudotumor fibroso es una lesión paratesticular benigna, de crecimiento lento e indoloro. El diagnóstico suele ser por hallazgo casual o por procesos asociados como el hidrocele. El diagnóstico diferencial con los tumores malignos evita tratamientos radicales innecesarios (AU)

OBJECTIVE: To report one case of advanced fibrous pseudotumour. METHODS: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study. RESULTS: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia. CONCLUSION: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment (AU)

Penile metastasis from primary bladder tumour.

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis.

Metástasis peneana de un tumor primario vesical / Penile metastasis from primary bladder tumour

OBJETIVO: Presentamos un caso de una metástasis cutánea originada desde un tumor vesical. MÉTODOS: Varón de 68 años diagnosticado de un carcinoma urotelial de alto grado de la ISUP con afectación de toda la pared vesical incluida la grasa perivesical y macrometástasis en la cadena ilio-obturatriz izquierda (T3N2MO) que presenta una induración en la cara dorsal del glande, no dolorosa y con áreas ulceradas no exudativas, de varios meses de evolución. Dado el resultado negativo de la serología, se biopsió la lesión para su estudio anatomopatológico. RESULTADOS: El estudio histopatológico de la lesión correspondía a una metástasis cutánea de carcinoma urotelial de alto grado. CONCLUSIÓN: Existen aproximadamente 370 casos de metástasis peneana descritos y en el 30-35% de los casos el tumor primario se localiza en la vejiga. La presentación de estas lesiones es muy heterogénea precisando para el diagnóstico definitivo el estudio anatomopatológico de la lesión (AU)

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis (AU)

Testicular cancer: our experience after 10 years.

OBJECTIVES: Testicular cancer represents about 1% of malignant tumors in men. Of these tumors 95% are germ cell tumors (GCTs), which have a maximum incidence between the second and third decades of life. Our objective was to carry out a retrospective analysis of testicular tumor cases that had been diagnosed in our Health Area between the years 2000 and 2010. METHODS: We performed a retrospective descriptive study between the years 2000 and 2010 analyzing 43 patients treated for testicular cancer, including in the analysis tumor incidence, the patient's age, clinic attended, patient's time until appointment, presence of tumor markers, patient's time before treatment, use of testicular prostheses, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. RESULTS: We found an incidence of 4-5 cases/100,000 population/year in our Health Area. Two-thirds of the cases were detected in Stage I, and 100% of these cases showed complete remission. Among those with higher stage tumors, two out of three patients were cured after chemotherapy. For the remaining one-third, rescue treatments managed to achieve a remission rate of 66%. Mortality was low and was linked to lymphoma or metastatic dissemination. CONCLUSION: The trend towards early diagnosis with detection during the initial cancer stages, together with current chemotherapy protocols, enables a high cure rate for testicular cancer. Mortality in our series was associated with primary or secondary lymphomas.

Cáncer testicular: Nuestra experiencia en 10 años / Testicular cancer: our experience after 10 years

OBJETIVO: El cáncer de testículo representa alrededor del 1% de los tumores malignos en el varón. El 95% corresponde a tumores germinales (TTG) cuya máxima incidencia tiene lugar entre la 2ª y 3ª década de la vida. Nuestro objetivo es realizar un análisis retrospectivo de los tumores testiculares diagnosticados en nuestra Área de Salud entre los años 2000 y 2010. MÉTODOS: Estudio descriptivo retrospectivo de los pacientes con cáncer testicular entre los años 2000 y 2010, analizándose un total de 43 pacientes, con evaluación de la incidencia, edad, presentación clínica, tiempo hasta la consulta, marcadores tumorales, tiempo hasta el tratamiento, solicitud de prótesis testicular, tipo histológico y características anatomopatológicas propias, tratamiento oncológico, progresión tumoral y mortalidad. RESULTADOS: En nuestro área de salud encontramos una incidencia de 4-5 casos-/100000habitantes/año. Las dos terceras partes de los casos se detectaron en Estadio I, consiguiendo remisión completa en el 100%. En Estadios superiores hay curación en 2 de cada 3 pacientes tras la quimioterapia y en el tercio restante, los tratamientos de rescate consiguen la remisión en el 66%. La mortalidad es baja y asociada a afectación por Linfoma o a diseminación metastásica. CONCLUSIÓN: La tendencia al diagnóstico precoz con detección en estadios iniciales, asociado a los actuales protocolos de quimioterapia, permiten altos índices de curación en el cáncer testicular. La mortalidad en nuestra serie se asocia mayoritariamente a afectación por Linfoma primario o secundario(AU)

OBJECTIVES: Testicular cancer represents about 1% of malignant tumors in men. Of these tumors 95% are germ cell tumors (GCTs), which have a maximum incidence between the second and third decades of life. Our objective was to carry out a retrospective analysis of testicular tumor cases that had been diagnosed in our Health Area between the years 2000 and 2010. METHODS: We performed a retrospective descriptive study between the years 2000 and 2010 analyzing 43 patients treated for testicular cancer, including in the analysis tumor incidence, the patient’s age, clinic attended, patient’s time until appointment, presence of tumor markers, patient’s time before treatment, use of testicular prostheses, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. RESULTS: We found an incidence of 4-5 cases/100,000 population/year in our Health Area. Two-thirds of the cases were detected in Stage I, and 100% of these cases showed complete remission. Among those with higher stage tumors, two out of three patients were cured after chemotherapy. For the remaining one-third, rescue treatments managed to achieve a remission rate of 66%. Mortality was low and was linked to lymphoma or metastatic dissemination. CONCLUSION: The trend towards early diagnosis with detection during the initial cancer stages, together with current chemotherapy protocols, enables a high cure rate for testicular cancer. Mortality in our series was associated with primary or secondary lymphomas(AU)

[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)

[Pelvic recurrence after radical cystectomy for bladder cancer]. / Recidiva pelviana despues de cistectomia radical por cancer vesical.

OBJECTIVES: We report the case of a male patient who had undergone radical cystectomy and orthotopic neobladder for bladder cancer presenting with local recurrence eight months later. METHODS: Diagnostic tests included CT scan and ultrasound guided transrectal biopsy RESULTS: With the diagnosis of local recurrence he underwent chemotherapy and radiotherapy CONCLUSIONS: The pelvic recurrence of transitional cell carcinoma after radical cystectomy is rare and prognosis is poor. It is frequently associated with advanced tumor stage. It should be treated by a multidisciplinary approach.

Recidiva pelviana después de cistectomía radical por cáncer vesical / Pelvic recurrence after radical cystectomy for bladder cancer

OBJETIVO: Presentamos un caso de unvarón sometido a cistectomía radical con neovejiga ortotópicapor cáncer vesical, con recurrencia local desarrolladoa los 8 meses.MÉTODO: Los estudios diagnósticos incluyen TAC y biopsiatransrectal ecodirigida.RESULTADO: Con el diagnóstico de recurrencia local, fuetratado con quimioterapia y radioterapia.CONCLUSIONES: La recurrencia pélvica por carcinomatransicional después de cistectomía radical, es infrecuentey con pobre pronóstico. Está frecuentemente asociado conestadio tumoral avanzado. Debe ser tratado con abordajemultidisciplinario

OBJECTIVES: We report the case of a male ;;patient who had undergone radical cystectomy and ;;orthotopic neobladder for bladder cancer presenting with ;;local recurrence eight months later. ;;METHODS: Diagnostic tests included CT scan and ;;ultrasound guided transrectal biopsy. ;;RESULTS: With the diagnosis of local recurrence he ;;underwent chemotherapy and radiotherapy. ;;CONCLUSIONS: The pelvic recurrence of transitional cell ;;carcinoma after radical cystectomy is rare and prognosis is ;;poor. It is frequently associated with advanced tumor ;;stage. It should be treated by a multidisciplinary approach

Emergencia hipertensiva durante la cirugía de un carcinoma renal asociado a feocromocitoma no diagnosticado / Hypertensive emergency during surgery of a renal carcinoma associated with an undiagnosed pheochromocytoma

OBJETIVO: Presentar un caso inusual de asociación de carcinoma renal y feocromocitoma ipsilateral no diagnosticado, que ocasionó severas alteraciones cardiovasculares durante su cirugía y que alerta a profundizar en el estudio de éstos nódulos suprarrenales antes de su exéresis aunque presenten una clínica anodina. MÉTODO: Varón de 61 años con H.T.A leve y controlada durante 40 años con tratamiento farmacológico, diagnosticado de Hipernefroma renal derecho y probable adenoma suprarrenal por UIV, Ecografía abdominal, TAC, Gammagrafía ósea y Arteriografía renal, con preoperatorio en límites normales. El paciente desarrolló una severa crisis hipertensiva intraoperatoria, controlada con Lidocaina, Nitroglicerina, Nitroprusiato sódico y Labetalol, interrumpiendose temporalmente la intervención hasta que una vez estabilizado, se prosiguió hasta completarla. RESULTADO: Anatomía patológica de Adenocarcinoma renal de células claras y Feocromocitoma.Estudio postoperatorio que incluye Dopamina, Adrenalina, Noradrenalina y Acido vanilmandélico normales. Rastreo con 131 MIBG normal. CONCLUSIONES: Ante la presencia de una masa suprarrenal aún con clínica irrelevante, se debe efectuar su estudio exhaustivo para descartar que se trate de un tumor funcionante, evitando así riesgos sumamente graves durante la cirugía (AU)