Comparación de datos anatomopatológicos entre biopsia de próstata y pieza de prostatectomía radical en pacientes con cáncer de bajo y muy bajo riesgo / Comparison of pathological data between prostate biopsy and radical prostatectomy specimen in patients with low to very low risk prostate cancer

Objetivo: Analizar la correlación entre los datos anatomopatológicos encontrados en prostatectomía radical y la biopsia previa realizada en pacientes con cáncer de próstata de bajo riesgo. Material y métodos: Se ha realizado un estudio descriptivo transversal para valorar las características de las prostatectomías radicales realizadas en nuestro centro desde enero de 2012 a noviembre de 2014. Los criterios de inclusión fueron pacientes con enfermedad de bajo riesgo (cT1c-T2a, PSA ≤ 10 ng/ml y Gleason ≤ 6). Fueron excluidos aquellos con menos de 8 cilindros en la biopsia, número de cilindros afectos no especificados, tacto rectal no recogido en historia clínica o biopsia realizada en otro centro. Resultados: De las 184 prostatectomías realizadas en este periodo, 87 pacientes cumplían con los criterios de inclusión y 26 de estos presentaban < 3 cilindros afectados y un PSAd ≤ 0,15 (muy bajo riesgo). Encontramos en la muestra total un porcentaje de infragradación (Gleason ≥ 7) del 18,4% (IC 95%: 10,3-27,6%) y de afectación extracapsular (pT3) del 10,35% (IC 95%: 4,6-17,2%). El porcentaje de márgenes positivos fue del 21,8% (IC 95%: 12,6-29,9%). En el grupo de muy bajo riesgo no encontramos ningún caso de afectación extracapsular y un solo caso de infragradación (Gleason 7 [3 + 4]) representando un 3,8% del total (IC 95%: 0-12,5%). Resultaron ser variables predictoras de no correlación (estadio ≥ pT3a o infragradación) el grupo de riesgo inicial, volumen, PSA densidad y cilindros afectados. Conclusiones: El volumen prostático, el valor del PSA densidad, el número de cilindros afectados y el grupo de riesgo inicial del paciente influyen en la aparición de datos de mal pronóstico anatomopatológico en la pieza de prostatectomía radical (afectación extracapsular y Gleason ≥ 7)

Objective: To analyze the correlation between pathological data found in radical prostatectomy and previously performed biopsy in patients at low risk prostate cancer. Material and methods: A descriptive, cross-sectional study was conducted to assess the characteristics of radical prostatectomies performed in our center from January 2012 to November 2014. The inclusion criteria were patients with low-risk disease (cT1c-T2a, PSA ≤ 10 ng/mL and Gleason score ≤ 6). We excluded patients who had fewer than 8 cores in the biopsy, an unspecified number of affected cores, rectal examinations not reported in the medical history or biopsies performed in another center. Results: Of the 184 patients who underwent prostatectomy during this period, 87 met the inclusion criteria, and 26 of these had < 3 affected cores and PSA density ≤ .15 (very low risk). In the entire sample, the percentage of undergrading (Gleason score ≥ 7) and extracapsular invasion (pT3) was 18.4% (95% CI 10.3 − 27.6) and 10.35% (95% CI 4.6 − 17.2), respectively. The percentage of positive margins was 21.8% (95% CI 12.6-29.9). In the very low-risk group, we found no cases of extracapsular invasion and only 1 case of undergrading (Gleason 7 [3 + 4]), representing 3.8% of the total (95% CI 0 - 12.5). Predictors of no correlation (stage ≥ pT3a or undergrading) were the initial risk group, volume, PSA density and affected cores. Conclusions: Prostate volume, PSA density, the number of affected cores and the patient's initial risk group influence the poor pathological prognosis in the radical prostatectomy specimen (extracapsular invasion and Gleason score ≥ 7)

Comparison of pathological data between prostate biopsy and radical prostatectomy specimen in patients with low to very low risk prostate cancer.

OBJECTIVE: To analyze the correlation between pathological data found in radical prostatectomy and previously performed biopsy in patients at low risk prostate cancer. MATERIAL AND METHODS: A descriptive, cross-sectional study was conducted to assess the characteristics of radical prostatectomies performed in our center from January 2012 to November 2014. The inclusion criteria were patients with low-risk disease (cT1c-T2a, PSA≤10ng/mL and Gleason score≤6). We excluded patients who had fewer than 8 cores in the biopsy, an unspecified number of affected cores, rectal examinations not reported in the medical history or biopsies performed in another center. RESULTS: Of the 184 patients who underwent prostatectomy during this period, 87 met the inclusion criteria, and 26 of these had<3 affected cores and PSA density≤.15 (very low risk). In the entire sample, the percentage of undergrading (Gleason score≥7) and extracapsular invasion (pT3) was 18.4% (95% CI 10.3-27.6) and 10.35% (95% CI 4.6-17.2), respectively. The percentage of positive margins was 21.8% (95% CI 12.6-29.9). In the very low-risk group, we found no cases of extracapsular invasion and only 1 case of undergrading (Gleason 7 [3+4]), representing 3.8% of the total (95% CI 0-12.5). Predictors of no correlation (stage≥pT3a or undergrading) were the initial risk group, volume, PSA density and affected cores. CONCLUSIONS: Prostate volume, PSA density, the number of affected cores and the patient's initial risk group influence the poor pathological prognosis in the radical prostatectomy specimen (extracapsular invasion and Gleason score≥7).

[Early experience in laparoscopic radical prostatectomy using the laparoscopic device for umbilical access SILS Port]. / Experiencia inicial en prostatectomía radical laparoscópica con el dispositivo de acceso laparoscópico umbilical Single-Incision Laparoscopic Surgery Port.

Since 2007, various urological procedures have been performed with laparoendoscopic single-site surgery (LESS surgery), including nephrectomy, pyeloplasty, simple prostatectomy and, with the refinement of laparoscopic instrumentation, radical prostatectomy. This paper reports our initial experience in radical prostatectomy using the SILS Port from Covidiem and two lateral 5-mm trocars for triangulation. The SILS Port allows for accurate, simple insertion through a Hadson incision. The flexible port accommodates three 5-mm cannulas or two 5-mm cannulas and a 12-mm port for easier instrument exchange through a single incision. This approach decreases morbidity from bleeding, hernia and/or internal organ damage and improves cosmetic. One-port single-incision laparoscopy is part of the natural development of minimally invasive surgery. Future research is required to assess the intraoperative and postoperative benefits of LESS surgery as compared to standard laparoscopy.

Experiencia inicial en prostatectomía radical laparoscópica con el dispositivo de acceso laparoscópico umbilical Single-Incision Laparoscopic Surgery Port® / Early experience in laparoscopic radical prostatectomy using the laparoscopic device for umbilical access SILS Port®

Desde el año 2007 se están realizando distintos procedimientos en cirugía laparoendoscópica por puerto único (laparoendoscopic single-site surgery), incluyendo nefrectomía, pieloplastia, adenomectomía prostática y, con el perfeccionamiento del instrumental laparoscópico, prostatectomía radical. Presentamos nuestra experiencia inicial en prostatectomía radical laparoscópica utilizando el dispositivo Single-Incision Laparoscopic Surgery Port® de Covidien y 2 trocares auxiliares de 5mm colocados lateralmente para triangulación. El Single-Incision Laparoscopic Surgery Port® permite una inserción precisa y sencilla a través de una incisión de Hadson. El puerto flexible contiene 3 cánulas de 5mm o 2 cánulas de 5mm y una de 12mm para facilitar el intercambio de instrumental a través de la incisión única. Este abordaje disminuye la morbilidad por sangrado, hernias y/o lesión de los órganos internos y mejora los resultados cosméticos. El puerto único forma parte del desarrollo natural de la cirugía mínimamente invasiva. Se necesita más experiencia para determinar los beneficios intra y postoperatorios de la cirugía laparoendoscópica por puerto único en comparación con la laparoscopia convencional (AU)

Since 2007, various urological procedures have been performed with laparoendoscopic single-site surgery (LESS surgery), including nephrectomy, pyeloplasty, simple prostatectomy and, with the refinement of laparoscopic instrumentation, radical prostatectomy. This paper reports our initial experience in radical prostatectomy using the SILS™ Port from Covidiem and two lateral 5-mm trocars for triangulation. The SILS™ Port allows for accurate, simple insertion through a Hadson incision. The flexible port accomodates three 5-mm cannulas or two 5-mm cannulas and a 12-mm port for easier instrument exchange through a single incision. This approach decreases morbidity from bleeding, hernia and/or internal organ damage and improves cosmetic results. One-port single-incision laparoscopy is part of the natural development of minimally invasive surgery. Future research is required to assess the intraoperative and postoperative benefits of LESS surgery as compared to standard laparoscopy (AU)

[Signet-ring cell neoplasm. Unusual histologic variety as primary bladder tumor]. / Neoplasia de células en anillo de sello. Una variedad histológica rara como tumor vesical primario.

We report a case of primary signet-ring cell adenocarcinoma of the urinary bladder. It is a extremely rare tumor. Gross hematuria is the commonest clinical presentation as well as this case. Our patient presented with advanced tumour invasion into perivesical fat at dome. The treatment was partial cystectomy together with quimiotherapy. Medical literature are reviewed with special remark on histopathology and its bladder origin.

Neoplasia de células en anillo de sello. Una variedad histológica rara como tumor vesical primario / Signet-ring cell neoplasms. A rare histologic variety like primary vesical tumor

Presentamos un caso de carcinoma vesical primario de células en anillo de sello, siendo este tipo de tumor extremadamente raro. Al igual que la mayoría de los casos descritos, la forma de presentación fue la hematuria y el estadio elevado. La opción terapéutica elegida fue la cistectomía parcial más quimioterapia. Hacemos una revisión de la literatura y destacamos, desde un punto de vista histológico, su origen vesical (AU)

[Second resection in patients with Ta-T1 bladder tumors]. / Segunda resección en pacientes con tumores vesicales Ta-T1.

OBJECTIVES: To study the incidence of "residual/recurrence" tumor after a second bladder resection (2nd TUR). METHODS: 40 patients with new or recurrent superficial bladder tumor underwent repeat transurethral resection within 3 months after the initial resection. 37 patients were staged as Ta-T1. We study the incidence of tumor after the 2nd TUR both macroscopically detected or included in the bladder scar. We also study the influence of possible factors as the time between both resections, stage, grade, number of tumor size, localization in the bladder, primary or recurrent tumor and tumor pattern. RESULTS: After the 2nd TUR we found tumor in 14 of 37 (37.8%) Ta-T1 bladder tumors. Among the 14 tumors, 10 (71.5%) were macroscopically visible tumors and 4 cases the tumor were found after resection of the bladder scar of the first resection. We did not find relation between the presence of tumor in the 2nd TUR and any of the variables. CONCLUSIONS: After a TUR of superficial bladder tumor the complete removal of tumor is not always achieved. The early 3 months cystoscopy may not find residual tumor. Although we have found tumor in 37.8% in the 2a TUR we can not recommend routine 2nd TUR in superficial bladder cancer.

Segunda resección en pacientes con tumores vesicales Ta-T1 / Second TUR in patients with stage Ta-T1 transicional cell carcinoma of the bladder

OBJETIVO: Estudiar la incidencia de tumor "residual/recidivante" tras segunda resección precoz (2ª RTU), y que factores influyen en su hallazgo. MATERIAL Y MÉTODO: Estudio prospectivo de 40 pacientes con neoplasia vesical superficial a los que se les realizó una 2ª RTU precoz. Como posibles factores de riesgo de hallazgo de tumor se estudiaron el intervalo de tiempo entre ambas RTU, el estadio, el grado, el número de implantes tumorales, el tamaño de los implantes, localización dentro de la vejiga, tumor primario o recidivante y el patrón tumoral. RESULTADOS: Al realizar la 2ª RTU se confirmó histológicamente tumor en 14 (37,8 por ciento) de 37 pacientes con tumores Ta-T1 (excluimos aquellos con afectación focal de la muscular): 10 (71,5 por ciento) eran tumores macroscópicamente visibles, en 4 casos (28,5 por ciento) se encontró tumor al biopsiar las áreas de cicatriz/edema de la resección anterior. No encontramos asociación entre la presencia de tumor en la 2ª RTU y ninguna de las variables en estudio. CONCLUSIONES: La erradicación de tumor vesical superficial mediante RTU no se consigue en un elevado porcentaje de pacientes. La cistoscopia a los tres meses no puede excluir tumor residual. Aunque hemos encontrado 37,8 por ciento de tumor en la 2ª RTU, actualmente no podemos recomendarla de forma rutinaria en los tumores vesicales superficiales (AU)

[Giant renal hydatid cyst. Report of a new case]. / Quiste hidatídico renal gigante. Aportación de un nuevo caso.

In this paper, we present a case of huge renal hydatic cyst. We review the literature with regard the clinical presentation, diagnosis methods and surgical technique of treatment.

Quiste hidatídico renal gigante. Aportación de un nuevo caso / Huge renal hydatic cyst. Report of a new case

En este trabajo presentamos un caso de quiste hidatídico renal gigante. Se hace una revisión de la literatura en cuanto a la forma de presentación, los métodos diagnósticos y la técnica quirúrgica para su tratamiento (AU)

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[Congenital bladder diverticulum and Ehlers-Danlos syndrome: an unusual association]. / Divertículo vesical congénito y síndrome de Ehlers-Danlos: una rara asociación.

The existence of a vesical diverticulum in the context of a congenital connective tissue disorder such as Ehlers-Danlos syndrome led us to consider the possibility of a relationship. Four types of diverticula can be found in the literature: congenital, acquired, iatrogenic and syndrome-associated. Within the later, Ehlers-Danlos syndromes type IV and IX, even type V, are associated to the existence of vesical diverticula. The potential spontaneous rupture of the diverticulum is a typical feature, as well as post-surgery relapse. The attitude towards such diverticula should be one of watchful waiting, and simple, plasty-free diverticulectomy on the bladder's neck is indicated when performing a surgical procedure.

[Ureteroscopy as diagnostic and treatment method in ureteral processes: our experience]. / La ureteroscopia como método de diagnóstico y tratamiento en los procesos ureterales: nuestra experiencia.

Endoscopic approach to the ureter both as a diagnostic procedure in various diseases and treatment of low ureteral lithiasis is a widely used technique. Review of case reports where this technique was used over the last four years. A total of 73 ureteroscopies were conducted, 64 as therapeutic approach (89.04%) and 9 for diagnosis (10.96%) achieving an overall 94.4% success rate. Multiple variables such as type and location of the stones, patient's age and sex, diagnostic methods, length of stay etc. All the above data were used for a descriptive analysis of the situation in our centre. In our experience, ureteroscopy is a good therapeutic option for low ureteral lithiasis, mainly when no extracorporeal lithotrity is available, and an excellent diagnostic tool in other ureteral processes when more traditional methods fail.

[Transrectal ultrasonography in the assessment of patients after radical prostatectomy. Normal and pathologic ultrasonography anatomy of vesico-urethral anastomosis]. / La ecografía transrectal en la evaluación de los pacientes después de prostatectomía radical. Ecoanatomía normal y patológica de la anastomosis vésico-uretral.

OBJECTIVE: To determine the ultrasound characteristics of the vesico-urethral anastomotic complex in patients with radical prostatectomy to separate normal prostate fossae from those affected by local recurrence or residual tumour. MATERIAL AND METHODS: Between January 1998 and June 1999 15 ultrasound guided transrectal biopsies of vesico-urethral anastomosis or prostate fossae were performed in patients with radical prostatectomy. The selection criteria to perform puncture in these patients were a negative extension study (abdominal-pelvic CT and bone scan), PSA higher than 0.4 ng/mL and/or suspicious DRE. The study was completed with 10 transrectal ultrasound (TRU) after radical prostatectomy in patients with normal PSA and DRE. TRU parameters in patients with tumour-positive biopsies were compare to those from patients with negative biopsies and those obtained from TRU in patients with both normal PSA and normal DRE. RESULTS: The ultrasound parameters that best described prostate fossa abnormalities were the presence of hypoechoic masses or nodes and the integrity or not of the retro-anastomotic fat layer. When a hypoechoic mass or node was found at the anastomosis level, 80% biopsies were positive for tumour local recurrence. The percentage increases when changes are seen at the retro-anastomotic fat layer. CONCLUSIONS: In spite of a good correlation between ultrasound abnormalities and positive biopsies, ultrasound findings from the vesico-urethral anastomosis in patients with radical prostatectomy are not well defined. Nodes or ultrasound irregularities can exist in normal prostate fossae as well as normal anastomosis ultrasound in the presence of tumoral relapses. We believe TRU of vesico-urethral anastomosis to be the best method available to evaluate local recurrence or tumoral persistence after radical prostatectomy.

[Percutaneous nephrostomy as management technique of obstructive uropathy: review of 105 cases]. / La nefrostomía percutánea como técnica resolutiva de la uropatía obstructiva: revisión de 105 casos.

105 percutaneous nephrostomies in 73 patients. Indication for nephrostomy was obstruction in the drainage system in all cases. Nephrostomy was bilateral in 24 cases. Reasons for nephrostomy were: lithiasis in 35 cases, carcinoma of the bladder in 17, post-surgical iatrogenic stenosis in 13, prostate carcinoma in 9, cancer of the rectum in 9, infection in 5, neoplasia of the upper urinary tract in 5, retroperitoneal fibrosis in 3, glandular cystitis cystica in 3, ovarian cancer in 3, congenital in 2, lymphoma in 1. Six case were single-kidney patients. Renal puncture through the lower calyceal group was the preferred approach. Purulent urine was extracted in 10 cases. Complications of nephrostomy included haematuria in 34 cases, contrast extravasation in 8, fever in 6, 1 case of death due to septic shock, 2 perirenal haematoma (nephrectomy was required in 1 case), and catheter detachment in 5 cases. All patients showed improvement of both clinical signs and symptoms, and lab results.

[Glandular cystic cystitis]. / Consideraciones sobre la cistitis quística glandular.

Cystic-glandular cystitis is considered as part of the urothelial pre-neoplastic proliferative abnormalities. This group includes atypical hyperplasia. Von Brunn's nidus, and cystitis cystica. They are a consequence of the changes experienced at the urothelium level in response to inflammation, irritation or carcinogens. Diagnosis is mainly based in the pathoanatomical study of the biopsy obtained following endoscopic resection. The signs and symptoms it presents are varied and show a clear relationship to distribution and extension of cysts. Treatment is based in the removal of irritative factors. Cystectomy with urinary by-pass may be necessary if required by clinical evolution.

Divertículo vesical congénito y síndrome de Ehlers-Danlos: una rara asociación / Congenital vesical diverticulum and Ehlers-Danlos syndrome: a rare association

La existencia de un divertículo vesical en el contexto de una alteración congénita del tejido conectivo como es el Síndrome de Ehlers-Danlos, nos hizo plantearnos su posible relación. En la literatura se describen en la actualidad cuatro tipos de divertículos: congénitos, adquiridos, yatrogénicos y asociados a síndromes. Dentro de este último, el síndrome de Ehlers-Danlos en sus tipos IV y IX y ocasionalmente en el tipo V se relaciona con la existencia de divertículos vesicales. Es característica la posible ruptura espontánea del divertículo, así como su recidiva tras cirugía. La actitud ante estos divertículos debe a poder ser expectante y sólo, la diverticulectomía simple sin plastia sobre el cuello vesical está indicada, si fuera necesaria realizar alguna técnica quirúrgica. (AU)

La nefrostomía percutánea como técnica resolutiva de la uropatía obstructiva: revisión de 105 casos / Percutaneous nephrostomy as resolutive technique for obstructive uropathy: review of 105 cases

Se presentan un total de 105 nefrostomías percutáneas en 73 pacientes. En todos los casos la indicación de la nefrostomía fue por obstrucción del sistema colector. En 24 casos la nefrostomía fue bilateral. Las causas fueron: 35 casos por litiasis, 17 por carcinoma vesical, 13 por estenosis yatrogénica postcirugía, 9 por carcinoma de próstata, 9 por cáncer de recto, 5 por causa infecciosa, 5 por neoplasia del tracto urinario superior, 3 por fibrosis retroperitoneal, 3 por cistitis quística glandular, 3 por cáncer de ovario, 2 de causa congénita y 1 por linfoma. 6 pacientes eran monorrenos. Se prefirió la punción renal a través del grupo calicial inferior. Se extrajo orina purulenta en 10 casos. En cuanto a las complicaciones de la nefrostomía hubo hematuria en 34 casos, extravasación de contraste en 8, fiebre en 6, hubo un exitus por shock séptico, 2 hematomas perirrenales (1 caso requirió nefrectomía) y salida del catéter en 5 casos. En todos los casos mejoraron la clínica y la analítica del paciente (AU)

Consideraciones sobre la cistitis quística glandular / Reflections on glandular cystitis cystica

La cistitis quístico-glandular se engloba dentro de las anormalidades proliferativas preneoplásicas uroteliales. En este grupo se engloban la hiperplasia atípica, los nidos de Von Brunn y la cistitis quística.Se caracterizan por ser consecuencia de los cambios experimentados a nivel del urotelio en respuesta a la inflamación, la irritación o los carcinógenos. Su diagnóstico se basa fundamentalmente en el estudio anatomopatológico de la biopsia obtenida tras la resección endoscópica. Su clínica es muy variada, estando en clara relación con la distribución y extensión de los quistes. Su tratamiento se basa en la eliminación de los factores irritativos, pudiendo llegar a requerir la realización de una cistectomía con derivación urinaria si su evolución clínica asi lo requiriese (AU)

[Mullerian-type papillary serous tumor: exceptional pathology of the testis. Report of a case and discussion]. / Tumor seroso papilar tipo mülleriano: una patología excepcional del testículo. Presentación de un caso y discusión.

Within the exceptional tumoral pathology of the testis and paratesticular region are the common epithelial type tumors. Although, its histogenesis is under discussion, it has been interpreted as arising from the remnants of the müllerian duct, or from the mesothelium of the tunica vaginalis differentiating in a müllerian direction. Similarities with homologous ovarian tumors are well recognized and in generally we accept a good prognostic due to its low malignant potential or borderline type, more experience with these uncommon lesions is necessary to evaluate their biologic potential.

La ureteroscopia como método de diagnóstico y tratamiento en los procesos ureterales: nuestra experiencia / Ureteroscopy as diagnostic method and treatment in ureteral processes: our experience

El abordaje endoscopio del uréter, tanto como procedimiento diagnóstico en diferentes patologías como para el tratamiento de las litiasis ureterales bajas, es una técnica muy extendida y de uso habitual. Hemos realizado, en este trabajo, una revisión de los casos en los que hemos llevado a cabo esta técnica en los últimos cuatro años. Un total de 73 ureteroscopias se han realizado, 64 de ellas como método terapéutico (89,04 por ciento) y 9 diagnósticas (10,96 por ciento) con un porcentaje de éxito del 94,4 por ciento. Se han analizado múltiples variables tales como el tipo de cálculo, localización de los mismos, edad de los pacientes, sexo, métodos diagnósticos, tiempo de estancia, etc. Con todos estos datos hemos llevado a cabo un análisis descriptivo de la situación en nuestro hospital. En nuestra experiencia, la ureteroscopia es una magnífica opción de tratamiento en las litiasis ureterales bajas, sobre todo si no se dispone de litotricia extracorpórea, y un magnífico método diagnóstico en otros procesos a nivel ureteral cuando fallan otros métodos más tradicionales (AU)