Impact of whole-cell bacterial immunoprophylaxis in the management of recurrent urinary tract infections in the frail elderly.

PURPOSE: This study aimed to determine the effectiveness of whole-cell bacterial immunotherapy, i.e. MV140 and autovaccines, in reducing the number ofurinary tract infections (UTIs)in frail elderly patients with recurrent UTI (RUTI). METHOD: A prospective cohort observational study was performed including 200 frail elderly subjects suffering RUTI, both females and males, between 2016 and 2018. The effectiveness of autovaccines and the polybacterial formulation MV140 (Uromune®), consisting ofwhole-cell heat-inactivated Escherichia coli25%, Klebsiella pneumoniae25%, Proteus vulgaris25% andEnterococcus faecalis25% were evaluated. Subjects initiated a 3-month sublingually daily course with MV140 or autovaccine, either first treatment or a new course if they had been previously vaccinated prior to inclusion in the study. Number of UTIs and quality of life (QoL, SF-36 score) were measured in the different study groups. RESULTS: The mean age for participants was 82.67 (SD, 7.12) for female and 80.23 (SD, 11.12) for male subjects. In all groups, 12 months following bacterial immunotherapy, the number of UTIs significantly decreased compared to before the treatment with autovaccine or MV140: the rate of reduction ranged between 7- and 40-fold. An increase in QoL scoring was also observed in any study group. When comparing medical interventions, MV140 conferred significantly higher benefit than autovaccines. For previously vaccinated individuals, a new 3-month course with MV140 or autovaccines provided further clinical improvement. CONCLUSIONS: MV140 and autovaccines emerge as valuable immunoprophylaxis for the management of RUTI in the frail elderly, contributing to an improvement in patient's quality of life. Herein, MV140 has shown to confer a higher effectiveness compared to autovaccines, regardless sex or course of treatment.

Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence.

BACKGROUND: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. OBJECTIVES: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. MATERIALS AND METHODS: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0-1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student's t-test. Chi2, Fisher's exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. RESULTS: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. CONCLUSIONS: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

Improvement in Quality of Life with Pelvic Floor Muscle Training and Biofeedback in Patients with Painful Bladder Syndrome/Interstitial Cystitis.

OBJECTIVE: To prove the benefits of pelvic floor muscle training with biofeedback (BFB) as a complementary treatment in women with bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: Prospective, randomized study in 123 women with BPS/IC. Groups: BFB+ (n = 48): women with oral drug treatment (perphenazine and amitriptyline) plus intravesical instillations (sodium hyaluronate) plus pelvic floor muscle training with BFB; BFB-: (n = 75): women with oral drug treatment plus intravesical instillations. VARIABLES: age, body mass index (BMI), time of follow-up, length of disease, time free of disease, diseases and health conditions concomitant, and responses to the SF-36 health-related quality of life questionnaire at the first consultation (SF-36 pre-treatment), and at the end of the study (SF-36 post-treatment). The treatment was considered successful when the SF-36 score reached values equal to or greater than 80 points or when the initial value increased by 30 or more points. RESULTS: Mean age was 51.62 years old (23-82). BMI was higher in BFB-. The mean length of BPS/IC condition was 4.92 years (1-20), shorter in BFB+ than in BFB-. Mean SF-36 score pre-treatment was 45.92 points (40-58), lower in BFB+ than in BFB-. Post-treatment SF-36 score was higher than pre-treatment SF-36 score both in BFB+ and BFB-. SF-36 values were higher in BFB+ compared to BFB- over the follow-up. CONCLUSIONS: BFB improves quality of life in women with BPS/IC as adjunct therapy to combined oral and intravesical treatment.

Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections.

OBJECTIVE: To characterize the impact on kidney injury of recurrent urinary tract infections (RUTI) in the frail elderly. METHODS: Prospective observational study in 200 frail elderly subjects for 1 year. Groups: GA (n = 100): subjects without RUTI, GB (n = 100): subjects with RUTI. Variables: age, concomitant diseases, glomerular filtration rate (GFR), urine neutrophil gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end (NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning (NAG-1) and the end (NAG-2) of the study, urine transforming growth factor-beta 1 (TGFß-1). Descriptive statistics, Mann-Whitney test, Chi-squared test, Fisher's exact test, and multivariate analysis were used. RESULTS: Mean age was 84.33 (65-99) years old, with no difference between GA and GB. Mean NGAL-1 was 1.29 ng/ml (0.04-8). There was lower in GA than in GB. Mean NGAL-2 was 1.41 ng/ml (0.02-9.22). NGAL-2 was lower in GA than in GB. Mean NAG-1 was 0.38 UU.II/ml (0.01-2.63. NAG-1 in GA was lower than in GB. Mean NAG-2 was 0.44 UU.II/ml (0-3.41). NAG-2 was lower in GA compared with GB. Mean TGFß-1 was 23.43 pg/ml (0.02-103.76). TGFß-1 was lower in GA than GB. There were no differences in the presence of secondary diagnoses between GA and GB. NAG-2 and NGAL-1 were the most determining factors of renal function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1, followed by NAG-2. CONCLUSION: Frail elderly with RUTI have higher urinary levels of renal injury markers, specifically NGAL, NAG, and TGFß-1, chronically in periods between urinary tract infection (UTI). Urinary markers of renal injury, specifically NGAL, NAG, and TGFß-1, identify early deterioration of renal function, compared with serum creatinine, or albuminuria, in frail elderly with recurrent urinary infections.

The Association between Prostate-Specific Antigen Velocity (PSAV), Value and Acceleration, and of the Free PSA/Total PSA Index or Ratio, with Prostate Conditions.

INTRODUCTION: Prostate-specific antigen velocity (PSAV) is used to monitor men with clinical suspicion of prostate cancer (PCa), with a normal cut-off point of 0.3-0.5 ng/mL/year. The aim of the study is to establish the predictive capacity of PSAV (value and acceleration) and of the free PSA/total PSA index or ratio. METHOD: Prospective multicentre observational study in 2035 men of over 47 years of age. INCLUSION CRITERIA: men who wished to be informed on the health of their prostate. EXCLUSION CRITERIA: men with a previously diagnosed prostate condition. Groups: GA: (n = 518): men with serum PSA equal to or greater than 2.01 ng/mL. GB: (n = 775): men with serum PSA greater than or equal to 0.78 ng/mL and less than 2.01 ng/mL. GC: (n = 742): men with serum PSA less than 0.78 ng/mL. VARIABLES: prostate-specific antigen (PSA); age; body mass index (BMI); PSA velocity (PSAV) (ng/mL per year); free PSA/total PSA index (iPSA); PSAV acceleration (increasing: positive, or decreasing: negative); prostate diagnosis (benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia (PIN), or infectious and non-infectious prostatitis and prostatic adenocarcinoma (PCa)); de novo diagnoses of urinary tract diseases or conditions; concomitant treatments, diseases and conditions; final diagnosis of prostate health. RESULTS: Mean age 62.35 years (SD 8.12), median 61 (47-94); age was lowest in GC. Mean BMI was 27.89 kg/m2 (SD 3.96), median 27.58 (18.56-57.13); no differences between groups. Mean PSAV was 0.69, SD 2.16, median 0.13 (0.001-34.46); PSAV was lowest in GC. Mean iPSA was 27.39 u/L (SD 14.25), median 24.29 (3.7-115); iPSA was lowest in GA. PSAV had more positive acceleration in GA and more negative acceleration in GC. There were 1600 (78.62%) cases of normal prostate or BPH, 322 (15.82%) cases of PIN or non-infectious prostatitis, and 113 (5.55%) cases of PCa. There were more cases of BPH in GC and more cases of PIN or prostatitis and cancer in GA (p = 0.00001). De novo diagnoses: 15 cases of urinary incontinence (UI), 16 discomfort/pain in LUT, 112 cases of voiding disorders, 12 urethral strictures, 19 hematuria, 51 cystitis, 3 pyelonephritis, 4 pelvic inflammatory disease; no differences were found between groups. In the multivariate analysis, PSAV and the direction of PSAV acceleration (positive or negative) were the variables which were correlated most strongly with prostate health. iPSA was associated with the presence of prostatitis, PCa, and BPH. Men in GA had more prostatitis, PCa, treatment with alpha blockers, and history of previous smoking. GB had more cases of BPH and more positive acceleration of PSAV. GC had more normal prostates, more BPH, more use of ranitidine, and more PSAV with negative acceleration. CONCLUSIONS: PSAV, direction of PSAV acceleration, and iPSA in PSA cut-off points of 0.78 ng/mL and 2.01 ng/mL in a priori healthy men over 47 predict the probability of benign or malignant pathology of the prostate.

Effects on Health-Related Quality of Life of Biofeedback Physiotherapy of the Pelvic Floor as an Adjunctive Treatment Following Surgical Repair of Cystocele.

OBJECTIVES: to demonstrate the benefits of physiotherapy (PT) with pelvic floor biofeedback (BFB) in improving health-related quality of life when used as a complementary therapy after surgical treatment of cystocele, in cases in which perineal pain or discomfort persists. MATERIALS AND METHODS: prospective observational study in 226 women who received complementary therapy after surgical treatment of cystocele due to persistent perineal discomfort or pain. Groups: GA (n = 78): women treated with 25 mg of oral pregabalin every 12 h plus BFB, consisting of 20 once-weekly therapy sessions, each 20 min long, with perineal pregelled surface electrodes connected to a screen which provides visual feedback; GB (n = 148): women treated with oral pregabalin 25 mg every 12 h without BFB. VARIABLES: age, body mass index (BMI), time since onset of cystocele prior to surgery (TO), SF-36 health-related quality of life survey score, diseases and concomitant health conditions, follow-up time, success, or failure of postsurgical treatment. RESULTS: average age 67.88 years (SD 12.33, 30-88), with no difference between GA and GB. Average body mass index (BMI) 27.08 (SD 0.45, 18.74-46.22), with no difference between GA and GB. Time since onset of cystocele prior to surgery (TO) was 6.61 years (SD 0.6), with no difference between GA and GB. Pretreatment SF-36 score was lower in GA success than GB success. Treatment was successful in 141 (63.20%) women and failed in 82 (36.80%). PT and age were the main predictors of success, and the least important were pretreatment SF-36 and the time elapsed after the intervention. In GA, 63 women (80.80%) showed improvement while 15 (19.20%) did not. Age was the main predictor of treatment success, while the least important was BMI. In GB, 78 women (53.80%) showed improvement while 67 (46.20%) did not improve. The main predictor was time since cystocele onset prior to surgery, while the least important was age. The odds ratio (OR) of improving quality of life for each unit increase in SF-36 was 11.5% (OR = 0.115) in all patients, with no difference between success and failure; in GA it was 23.80% (OR = 0.238), with a difference between success and failure; in GB it was 11.11% (OR = 0.111), with no difference between success and failure. GA and GB success had more history of eutocic delivery. GA success had more rUTI. GB success and GA failure both had more history of UI corrective surgery. The "failure" outcome had a higher number of patients with more than two concomitant pathological conditions. CONCLUSIONS: BFB as an adjunctive treatment improves quality of life in women suffering from persistent discomfort after surgery for cystocele. Young women who meet the criteria for recurrent urinary tract infection or who have a history of eutocic delivery show greater improvement. Body mass index does not influence response to treatment, while the presence of more than two concomitant conditions indicates a poor prognosis for improving quality of life.

Adenocarcinoma de próstata gigante con células en anillo de sello / Giant prostatic carcinoma with signet ring cells

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Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical / Pharmacological venous thromboembolism prophylaxis in radical prostatectomy

ANTECEDENTES Y OBJETIVO: El tromboembolismo pulmonar es una de las causas más comunes de muerte no quirúrgica en pacientes sometidos a cirugía urológica abdominopélvica. Desde el inicio de la profilaxis para la enfermedad tromboembólica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente. Nuestro objetivo es analizar los predictores de la enfermedad tromboembólica, la variabilidad clínica en la utilización de la profilaxis farmacológica para esta enfermedad y los resultados de su aplicación. MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico de 610 pacientes intervenidos mediante prostatectomía radical entre diciembre de 2013 y noviembre de 2014 en 7hospitales generales de España, Italia y Portugal. Se clasificó a los pacientes según sus características basales en grupos de riesgo trombótico y grupos de riesgo hemorrágico. Se evaluaron los eventos tromboembólicos venosos que se presentaron en los diferentes grupos. RESULTADOS: La edad media fue de 65,22años (48-78). El índice de masa corporal medio fue de 26,7 y la mediana del riesgo de ASA fue 2. En todos los pacientes se inició la deambulación en las primeras 24h. En el 4,1% se utilizó compresión neumática intermitente y en el 84,6%, profilaxis farmacológica con heparinas de bajo peso molecular. Solo en el 3,4% se utilizó la combinación de profilaxis mecánica con la farmacológica. Se observó disminución de la incidencia de eventos tromboembólicos en los pacientes que recibieron profilaxis farmacológica, con una reducción absoluta del riesgo del 6,8%. No se objetivó aumento del riesgo hemorrágico en los pacientes que recibieron profilaxis tromboembólica. CONCLUSIONES: En este estudio sobre pacientes sometidos a prostatectomía radical no hubo diferencia en las complicaciones hemorrágicas derivadas del uso de profilaxis farmacológica para la enfermedad tromboembólica venosa. La profilaxis farmacológica reduce el riesgo de presentar un evento tromboembólico en pacientes sometidos a prostatectomía radical, si bien este riesgo no se asocia con la técnica de abordaje

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique

Pharmacological venous thromboembolism prophylaxis in radical prostatectomy. / Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical.

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique.

Uropatía obstructiva bilateral y microvejiga post-radioterapia / Bilateral obstructive uropathy and micro-bladder after

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Skin metastasis of prostate cancer. An unusual entity. / Metástasis cutánea del cáncer de próstata. Una entidad inusual.

Male, 64 year old male, whoconsults to the Dermatology office presentingtwo-month, progressive, skin lesions in thepubic region...

Varón de 64 años que acudea la consulta de Dermatología por lesionescutáneas en la región púbica, de dosmeses de evolución y presentación progresiva...

Metástasis cutánea del cáncer de próstata Una entidad inusual / Skin metastasis of prostate cancer. An unusual entity

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Liposarcoma de cordón espermático. A propósito de dos casos clínicos y revision de la literatura / Spermatic cord liposarcoma. Report of two cases and bibliographic review

OBJETIVO: Presentar dos casos de pacientes diagnosticados de liposarcoma paratesticular. Realizamos una revisión de la literatura de esta infrecuente entidad, con el fin de aclarar las características clínicas y terapéuticas. MÉTODOS: Revisión retrospectiva de la historia clínica de dos pacientes diagnosticados de liposarcoma del cordón espermático. Se revisó la epidemiología, diagnóstico, alternativas terapéuticas y el pronóstico. RESULTADOS: Caso 1: Varón de 65 años. Valorado por masa escrotal izquierda de gran tamaño 20 X 14 X 11 cm. Se le realiza una orquiectomía radical, siendo el resultado de la pieza un liposarcoma de cordón espermático bien diferenciado. Al año de seguimiento el paciente se encuentra asintomático y no se objetiva recidiva local. Caso 2: Varón de 90 años con antecedente de orquiectomía derecha por liposarcoma de cordón bien diferenciado hace 11 años, y excéresis de recidiva hace 7 años. En el seguimiento presenta una nueva recidiva tumoral a nivel inguinal, de 20 X 14 X 11 cm. Se realiza una exéresis de la masa la cual se informa como liposarcoma de cordón espermático bien diferenciado. A los 10 meses, tras la cirugía, el paciente se encuentra asintomático y sin recidiva. CONCLUSIONES: El liposarcoma es un tumor muy infrecuente y su diagnóstico se realiza anatomopatológicamente, lo que dificulta establecer pautas de tratamiento, pronóstico y diagnóstico diferencial. Al igual que en los liposarcomas de otras localizaciones es de valor pronóstico el tipo y grado histológico del tumor. La orquiectomía radical inguinal y la resección del tumor con márgenes microscópicos negativos es el tratamiento recomendado. No se ha demostrado la eficacia de tratamientos adyuvantes como la quimioterapia o radioterapia, salvo en situaciones concretas. La historia natural de la enfermedad es lenta y con escasa mortalidad, pero con una alta tasa de recidiva, por lo que un seguimiento a largo plazo es necesario

OBJECTIVE: We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics. METHODS: Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord. RESULTS: Case 1: 65 year old male, presented a left large scrotal mass of 20 X 14 X 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 X 14 X 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence. CONCLUSIONS: Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal archiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary

[Spermatic cord liposarcoma. Report of two cases and bibliographic review.] / Liposarcoma de cordón espermático. A propósito de dos casos clínicos y revision de la literatura.

OBJECTIVE: We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics. METHODS: Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord. RESULTS: Case 1: 65 year old male, presented a left large scrotal mass of 20 × 14 × 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 × 14 × 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence. CONCLUSIONS: Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary.

Linfadenectomía pélvica guiada por verde de indocianina / Indocyanine green guided pelvic lymphadenectomy

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[Urinary tract lymphoepithelial carcinoma. Report of two cases and bibliographic review.] / Carcinoma linfoepitelial del tracto urinario. Presentación de dos casos y revision de la literatura.

OBJECTIVE: We report two cases of patients diagnosed with lymphoepithelioma-like carcinomas of the urinary tract. We review the literature of this rare entity. The objective is to clarify the clinical and therapeutic characteristics. METHODS: We present a retrospective review of medical records of two patients diagnosed with lymphoepithelioma-like carcinomas, one in the renal pelvis and the other in the bladder. We review the epidemiology, diagnosis and therapeutic alternatives. RESULTS: Case 1: A 74-year-old women with past medical history of left radical nephrectomy and retroperitoneal lymphadenectomy six years before for renal pelvis carcinoma type pure lymphoepithelioma-like, stage pT4R0pN1cM0. She received adjuvant chemotherapy with Cisplatin and Gemcitabine. Five years later, she presented tumor recurrence in the left ureteral meatus, this lesion was resected. The pathology reported a high-grade urothelial carcinoma with marked lymphoid component, stage pT1. At follow-up, one year after the last recurrence, the patient was asymptomatic. In tomography control, no local or distant recurrences were objectified. Case 2: A 82-year-old men with diagnosis of muscleinvasive bladder cancer. The tumor caused right obstructive uropathy without extracapsular, regional or remote extension. We performed a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversión type cutaneous transureterostomy. The pathology reported a urothelial bladder carcinoma type mixed lymphoepithelioma-like, stage pT4aR1pN2cM0. At six months follow-up, the patient had liver and spleen lesions and retroperitoneal adenopathic nodes, all suggestive of metastases. He is currently receiving symptomatic treatment of their disease. CONCLUSIONS: We emphasize the clinical importance involved in the diagnosis of this entity. The diagnosis influence the aggressiveness of treatment and disease-specific survival. Therefore, concomitant transitional cell carcinoma defines the prognosis. The role of immunohistochemical staining is fundamental, allowing us to confirm the presence of the epithelial component.