[Hand-assisted laparoscopic nephrectomy in challenging cases]. / Nefrectomía laparoscópica asistida por la mano en casos difíciles.

OBJECTIVE: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. RESULTS: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.

Nefrectomía laparoscópica asistida por la mano en casos difíciles / Hand-assisted laparoscopic nephrectomy in challenging cases

Objetivo: evaluar los resultados de nefrectomía laparoscópica asistida por la mano en pacientes con masas renales técnicamente complejas. Métodos: se ha realizado una evaluación retrospectiva de 100 nefrectomías laparoscópicas realizadas en un solo hospital entre 2001 y 2005. Se ha seleccionado a los pacientes con antecedentes de cirugía abdominal previa, procedimientos previos en el riñón afectado, evidencia de inflamación perirrenal, lesiones renales de más de 10 cm de diámetro o trombosis venosa renal tipo I. Resultados: se ha incluido un total de 12 pacientes; 5 de ellos presentaban una lesión de al menos 10 cm de diámetro, dos trombosis venosa renal y 5 referían cirugía abdominal mayor. La mayoría de los pacientes tenía más de uno de estos hallazgos. Tres pacientes presentaban procesos inflamatorios (cálculos coraliformes) y un tumor renal T4 fue tratado con éxito, sin necesidad de reconversión. El tiempo operatorio y la pérdida sanguínea medias fueron de 210 minutos y 310 ml, respectivamente, con una estancia media de tres días. Ningún paciente requirió reconversión a cirugía abierta. Conclusiones: la nefrectomía laparoscópica asistida por la mano es una opción mínimamente invasiva, atractiva en el contexto de masas técnicamente complejas, con un tiempo operatorio, una pérdida sanguínea y una tasa de complicaciones razonables (AU)

Objective: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. Results: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. Conclusions: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates (AU)

[Non obstructive retrocaval ureter]. / Uréter circumcavo no obstructivo.

We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson's classification, in a forty-nine year old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the typical morphology and obstruction signs. After twelve months the patient is still asymptomatic, without any medical or surgical treatment.

Uréter circumcavo no obstructivo / Non obstructive retrocaval ureter

Se presenta un caso de uréter circumcavo derecho no obstructivo o tipo dos de Batenson y Atkinson en un hombre de 49 años. Se diagnostico tras consulta por hematuria y dolor ureteral, atribuíble a infección urinaria concomitante. Destacamos la ausencia de retardo funcional, dilatación y morfología típica del mismo. Se decidió actitud expectante, estando asintomático tras 12 meses de seguimiento

We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson´s classification, in a forty-nine years old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the tipical morphology and obstruction signs. After twelve months the patient is still asintomatic, without any medical or surgical treatment

[Oral tegafur plus mitomycin versus intravesical mitomycin alone in the prevention of recurrence in stage Ta bladder tumors]. / Tegafur oral más mitomicina versus mitomicina intravesical sola en la profilaxis de las recidivas de tumores vesicales estadio Ta.

OBJECTIVE: The aim of this study is to know if the use of oral Tegafur associated to intravesical mitomycin is effective in the prevention of the relapses of Ta bladder tumors. METHOD: This is a prospective study in which we compare the recurrence rate and the disease-free interval of 2 groups of 40 patients each one, the first of them treated after the TUR with oral Tegafur and intravesical mitomycin, and the second with intravesical mitomycin alone. Tolerance of Tegafur was also studied. RESULTS: The group of the Tegafur presented a descent of the relapse rate and a continuation of the time free of illness; but it was not statistically significant. The tolerance to the drug was good, without important adverse effects. CONCLUSIONS: Tegafur seems an useful drug in the prevention of the recurrence of superficial bladder tumors, although it will be necessary bigger studies to reach statistically valid conclusions.

Tegafur oral más mitomicina versus mitomicina intravesical solaen la profilaxis de las recidivas de tumores vesicales estadio Ta / Oral tegafur and intravesical mitomycin versus intravesical mutomycin alone in the prophylaxis of ta bladder carcinoma recurrence

OBJETIVO: Valorar si el empleo de Tegafur oral asociado a Mitomicina intravesical es efectivo en la profilaxis de las recidivas de los tumores vesicales Ta. MÉTODO: Se trata de un estudio prospectivo en el que comparamos la tasa de recidiva y el tiempo libre de enfermedad de 2 grupos de 40 pacientes cada uno, el primero tratado tras la RTU con Mitomicina intravesical más Tegafur, y el segundo solo con Mitomicina endocavitaria. También se valoró la tolerancia al Tegafur oral. RESULTADOS: El grupo del Tegafur presentó un descenso de la tasa de recidiva y una prolongación del tiempo libre de enfermedad; pero no resultó estadísticamente significativo. La tolerancia al fármaco fue buena, no apareciendo efectos adversos importantes. CONCLUSIONES: El Tegafur parece un fármaco útil en la profilaxis de la recidiva de los tumores vesicales superficiales, aunque serán precisos estudios más grandes para sacar conclusiones estadísticamente válidas (AU)

Oat-cell carcinoma of the prostate. Diagnosis, prognosis and therapeutic implications.

BACKGROUND: Any carcinoma of prostatic origin which is not an acinary adenocarcinoma of the prostate is considered to be an atypical carcinoma. One member of this group of atypical prostatic tumors is the oat-cell carcinoma, or small cell carcinoma (SCC) of the prostate. This variety of carcinoma constitutes the histologic basis of <1% of all prostatic neoplasms. METHODS: Between 1992 and 1997, four patients were diagnosed with SCC of the prostate at our hospital. In 3 of the 4 cases, the histopathological diagnosis was pure SCC, and in the 4th case there was a component of prostatic adenocarcinoma associated with the SCC. At the time of diagnosis, extracapsular extension of the tumor was present in all 4 cases, with T3 or higher stages in all of them (T(3A)N(0)M(1), T(3A)N(0)M(0), T(3B)N(0)M(1), and T(4)N(0)M(0)). Because of the presence of extracapsular extension, radiotherapy and radical surgery were ruled out for all 4 patients. They were all offered systemic chemotherapy with cyclophosphamide (1 g/m(2)), doxorubicin (50 mg/m(2)) and vincristine (1.2 mg/m(2)). This therapeutic protocol was carried out in only 2 cases. RESULTS: Survival was <1 year in the 3 patients with pure SCC, and the patient with a mixed tumor is alive with detectable disease 9 months after diagnosis. CONCLUSIONS: This poor vital prognosis in SCC stresses the need for early diagnosis a timely and appropriate therapeutic intervention in this condition.

[Abscess of seminal vesicle: conservative treatment]. / Absceso de vesícula seminal: tratamiento conservador.

OBJECTIVE: To describe a case of primary seminal vesicle abscess that was managed conservatively. METHODS: Antibiotics, according to the urine culture and antibiotic profile, were administered for four weeks. Outpatient follow-up was carried out with digital rectal examination, urine culture and ultrasound. RESULTS: A favorable clinical response was observed at day three. The patient was discharged from hospital on day 7. DRE, urine culture and ultrasound findings were normal after 4 weeks. CONCLUSIONS: Primary abscess of the seminal vesicle can be successfully treated with antibiotics. Percutaneous drainage of the abscess should be reserved for those cases that do not respond to conservative management with antibiotics.

[Can PSA density predict the response to alpha-blockers in benign prostatic hyperplasia?]. / Puede la densidad de PSA predecir la respuesta a los alfa-bloqueantes en la hiperplasia benigna de próstata?

INTRODUCTION AND OBJECTIVES: In BPH there is a growth of both glandular and stromal components. Most of adrenoceptors sites are in the fibromuscular stroma. So the higher is the stromal/epithelial ratio, the more effective will alpha-blockers be. There in an indirect way of stimating this ratio without performing a biopsy. Bearing in mind that PSA is produced by the prostatic epithelium, the lower PSA density (PSAd), the higher the stromal/epithelial ratio and the higher alpha-blocker activity. We pretend to study if PSAd is useful for predicting the response to alpha-blockers in BPH. MATERIAL AND METHODS: We studied 75 patients suffering from prostatism and diagnosed of bladder outlet obstruction secondary to BPH through IPSS symptom score, digital rectal examination, PSA, uroflowmetry, and transrectal ultrasound. All of them received Alfuzosin, 5 mg twice daily during 3 months, and then were evaluated again with IPSS and uroflowmetry. RESULTS: A statistically significant improvement was appreciated of the two studied parameters and in both groups of patient with regard to the pretreatment situation. A statistically significant better answer was also appreciated in the group of patient with smaller PSAd in comparison with the higher PSAd patients. CONCLUSIONS: Our results show that PDAd is usefu to estimate the stroma/epithelium ratio, and therefore the clinical response to alpha-blockers.

[Brucellar orchiepididymitis]. / Orquiepididimitis brucelosa.

The brucellosis is an unusual entity whose incidence has diminished due to the improvement in preventive measures. We have carried out a retrospective study of all the patients admitted in our service between 1996 and 1998, with diagnosis of orchitis. Two of the 31 patients admitted for this reason presented a final diagnosis of brucellar orchiepididymitis. Both patients presented clinic of affectation from the general state accompanied by resistance to habitual antibiotic treatment. The patient's epidemic antecedents, accompanied by the suitable clinical evolution took to the suspicion of orchiepididymitis of brucellar etiology, with change in the antibiotic rule. The diagnosis of the process was obtained by means of serologic tests and blood cultures.

[Simple syringocele of Cowper's glands]. / Siringocele simple de la glándula de Cowper.

OBJECTIVE: To describe an additional case of simple syringocele of Cowper's glands and review the literature. METHODS: An additional case of simple syringocele of Cowper's glands is presented and the literature over the last 10 years is reviewed. RESULTS/CONCLUSIONS: The treatment most commonly utilized is marsupialization to the urethra by endoscopy. The foregoing was performed in our patient with satisfactory results.

¿Puede la densidad de PSA predecir la respuesta a los alfa-bloqueantes en la hiperplasia benigna de próstata? / Is PSA density able to predict the response to alpha-blockers in bening prostatic hyperplasia?

INTRODUCCIÓN: En la HBP existe un crecimiento de ambos componentes epitelial y estromal. Los α-bloqueantes actúan relajando el componente estromal. Una forma indirecta de estimar la relación estroma/epitelio sin recurrir a la biopsia, es mediante la densidad de PSA (dPSA). Pretendemos en este estudio, valorar si la dPSA tiene valor para predecir la respuesta a los α-bloqueantes en la HBP sintomática. PACIENTES Y MÉTODO: Se estudiaron 75 pacientes afectos de obstrucción infravesical secundaria a HBP, mediante IPSS, PSA, flujometría y ecografia transrectal. Todos ellos fueron tratados con alfuzosina durante 3 meses y reevaluados mediante IPSS y flujometría al cabo de dicho plazo. La dPSA permitió dividir a los pacientes en 2 grupos: > 0,05 y < ó igual a 0,05. Se comparó la respuesta al tratamiento en ambos grupos. RESULTADOS: Se apreció una mejoría estadísticamente significativa de los dos parámetros estudiados y en ambos grupos de pacientes con respecto a la situación pretratamiento. También se apreció una mejor respuesta α-bloqueante en el grupo de pacientes con menor dPSA que resultó estadísticamente significativa. CONCLUSIONES: A la luz de estos resultados puede deducirse que la dPSA permite estimar la relación estroma/ epitelio en la HBP, y también es útil para predecir la respuesta clínica al tratamiento con α-bloqueantes (AU)

Orquiepididimitis brucelosa / Brucellar orchiepididymitis

La brucelosis es una entidad poco frecuente, cuya incidencia ha disminuido debido a la mejoría en las medidas preventivas. Hemos realizado un estudio retrospectivo de todos los pacientes ingresados en nuestro servicio entre los años 1996 y 1998, con diagnóstico de orquitis. Dos de los 31 pacientes ingresados por este motivo presentaron diagnóstico final de orquioepididimitis brucelosa. Ambos pacientes se presentaron con clínica de afectación del estado general acompañada de resistencia a tratamiento antibiótico habitual. Los antecedentes epidemiológicos del paciente, acompañados de la evolución clínica indicada llevaron a la sospecha de orquioepididimitis de etiología brucelosa, con cambio en la pauta antibiótica. El diagnóstico del proceso se obtuvo mediante pruebas serológicas y hemocultivos (AU)

[Malignant melanoma of the penis]. / Melanoma maligno de pene.

OBJECTIVE: To report a case of malignant melanoma of the penis, a rare malignant neoplasm whose aggressive behaviour carries a poor prognosis. METHODS: A 58-year-old male consulted for a pigmented elevated lesion in the balanopreputial sulcus. The biopsy was positive for melanoma. Complementary studies did not demonstrate disseminated disease. RESULTS: Partial resection of the penis and bilateral inguinal lymphadenectomy were performed. Histological analysis showed two positive nodes in the same lymphatic chain. Interferon was administered for 6 months. The patient remains disease-free at 35 months' follow-up. CONCLUSIONS: Although surgery is the treatment of choice, adjuvant therapy (chemotherapy and immunotherapy) should be considered in those patients without localized disease.

[Malignant neoplasms of the penis]. / Neoplasias malignas del pene.

OBJECTIVE: To assess the behaviour and management of these uncommon neoplasias. MATERIAL AND METHODS: Between March 1975 and July 1999, a total of 95 malignant neoplasias of the penis were diagnosed and treated by our unit. Patients mean age was 62 years (28 to 87 years). A retrospective analysis of any associated lesions, biological behaviour of the various neoplasias, as well as therapies used is carried out. RESULTS: The squamous carcinoma of the penis (SCP) is the most frequent pathohistological entity entailing 78 cases (82%), followed by verrucous carcinoma (VC) 13 cases (13.5%), basal cells carcinoma 1 case, and melanoma, lymphoma and penile metastasis 1 case each. There is a significant presence of associated lesions with marked predominance of phimosis. The most frequent reason for the call is an injury of the penis (74 cases; 78%). Treatment was mainly partial penectomy (51 patients; 53.7%), followed by conservative treatment in 28 cases (30%). Inguinal lymphadenectomy was performed in 13 patients (14%), due to either a positive nodular biopsy or a persistent adenopathy following antibiotic therapy. CONCLUSIONS: Neoplasias showing superior biological behaviour are basal cell carcinoma of the penis, and verrucous carcinoma. Prognosis in SCP is based on pathological status and node involvement. Patients with pT1 tumours showed no metastatic adenopathies after follow-up regardless of cytological grading, and are therefore candidates to watchful waiting with regular monitoring. Melanoma of the penis is a highly aggressive tumour due to its high metastatic capacity with a poor prognosis.

[Squamous carcinoma of the penis]. / Carcinoma escamoso de pene.

OBJECTIVE: To present our experience with squamous cell carcinoma of the penis. METHODS: We reviewed our series of 73 squamous cell carcinoma of the penis over the last 23 years. Patient mean age was 65.7 years. All lesions had been previously biopsied. Patient records were reviewed for a history of phimosis and related lesions. The histological, clinical and therapeutic aspects, and survival are analyzed. RESULTS: Most of the squamous cell carcinoma of the penis were superficial lesions (pT1). Treatment was by partial penile resection in 42 cases, total penile resection in 9, and emasculation in 2 cases. Conservative surgery was performed in 20 cases (tumor excision in 14 and posthectomy in 6 cases). Lymphadenectomy was performed in 11 patients. Eight patients received radiotherapy to the inguinal region. The rate of recurrence after surgery was 11% (8 cases). Five of the 8 patients with tumor recurrence had been treated by conservative surgery. The 5-year survival rate was 78%. CONCLUSIONS: Penile cancer is uncommon and accounts for less than 1% of tumors in the male in our setting. A higher incidence has been found in men with phimosis, poor hygiene and low sociocultural level. Partial penile resection is the treatment of choice for the primary lesion. The outcome is worse in patients with invasive tumor, poor cell differentiation, ulceroendophytic morphology, and above all in patients with metastatic adenopathy. Radiotherapy provided no benefits, made inguinal evaluation difficult and increased the morbidity in some cases. Patients with pT1 tumor and good cell differentiation showed no metastatic adenopathy during follow-up. Patient follow-up is fundamental to detect recurrence or metastatic adenopathy and to institute treatment immediately.

[Bladder compression by collateral veins]. / Compresión vesical por colaterales venosas.

Many space-filling injuries (e.g. haematoma, abscess, aneurysm, lymphocele, neoplasia etc.) may result in extrinsic compression of the bladder. We contribute one case report of compression of the bladder from collateral venous circulation in a patient who came for a left varicocele.

[Intraperitoneal bladder perforation in emphysematous cystitis]. / Perforación vesical intraperitoneal en el transcurso de una cistitis enfisematosa.

Contribution of one case report of a 69-year old diabetic male patient with neurogenic bladder. The patient developed emphysematous cystitis and peritonitis secondary to intraperitoneal perforation of the bladder. Emphysematous cystitis is an uncommon clinico-radiologic entity more frequent in diabetic and female patients and the elderly. Early diagnosis and treatment may avoid a fatal outcome. The paper includes a review of this condition.

Neoplasias malignas del pene / Malignant neoplasias of the penis

OBJETIVO: Valorar el comportamiento y manejo de estas infrecuentes neoplasias. MATERIAL Y MÉTODO: Desde marzo de 1975 a julio de 1999, han sido diagnosticadas y tratadas por nuestro servicio un total de 95 neoplasias malignas del pene. La edad media de los pacientes fue de 62 años (28 a 87 años).Se realiza un análisis retrospectivo de las diferentes lesiones asociadas, comportamiento biológico de las distintas neoplasias, así como de las terapias empleadas. RESULTADOS: La variedad histopatológica más frecuente es la del carcinoma escamoso de pene (CEP) con 78 casos (82 por ciento), seguida del carcinoma verrucoso (CV) con 13 casos (13,5 por ciento), carcinoma basocelular en 1 caso, melanoma, linfoma y metástasis peneana en 1 caso cada uno. La presencia de lesiones asociadas es notable con mar-cado predominio de la fimosis. El motivo de consulta más frecuente es por lesión en pene (74 casos; 78 por ciento). El tratamiento empleado en la mayoría de los casos fue la penectomía parcial (51 pacientes; 53,7 por ciento), seguido de trata-miento conservador en 28 casos (30 por ciento). La linfadenectomía inguinal se realizó en 13 pacientes (14 por ciento), por biopsia ganglionar positiva o por la persistencia de adenopatías tras tratamiento antibiótico. CONCLUSIONES: Las neoplasias con un mejor comportamiento biológico son el carcinoma basocelular de pene, y el carcinoma verrucoso. En el CEP el pronóstico vendrá determinado por el estadio patológico, y en especial por la afectación ganglionar. Los pacientes con tumor pT1, independientemente del grado citológico, no presentaron adenopatías metastásicas tras el seguimiento, por lo que son candidatos a una conducta expectante mediante con-troles periódicos. El melanoma de pene es un tumor altamente agresivo por su elevada capacidad metastásica, y con un pobre pronóstico (AU)