Preservación vesical electiva en tumor vesical músculo invasivo / Elective Bladder-Sparing Treatment for Muscle Invasive Bladder Cancer

Objetivos: La cistoprostatectomía radical es el tratamiento de elección en el carcinoma vesical músculo invasivo localizado. Planteamos la posibilidad de ofrecer a pacientes estrictamente seleccionados la preservación vesical con RTU ± quimioterapia (QMT) y radioterapia (RDT) como tratamiento alternativo. Material y métodos: Analizamos retrospectivamente 30 pacientes diagnosticados de carcinoma vesical músculo invasivo entre marzo de 1991 y octubre de 2010. La media de edad es de 62,7 años (51-74). Todos ellos eran candidatos a tratamiento curativo y han seguido estrictos criterios de selección: estadio T2, primario, único y menor de 5 cm, con impresión macroscópica de RTU completa en profundidad, sin repercusión en tracto urinario superior y BMN negativa. La TAC de extensión fue siempre negativa y la re-RTU o biopsia de lecho negativa para tumor o con infiltración muscular microscópica. Catorce de estos pacientes fueron tratados con RTU monoterapia, 13 con RTU + QMT y 3 RTU + QMT + RDT. Resultados: El seguimiento medio ha sido de 88,7 meses (19-220). Catorce han permanecido libres de recidiva (46,66%) y 10 han presentado recidiva superficial (33,33%). Conseguimos un 81,3% de respuestas completas y un 71% de conservación vesical a los 5 años. La supervivencia global a los 5 años fue de 79%, siendo la cáncer específica del 85%. Conclusiones: Aunque la cistoprostatectomía radical continúa siendo el tratamiento de elección ante el tumor vesical infiltrante localizado, en casos estrictamente seleccionados, la conservación vesical ofrece una alternativa válida con buenos resultados a largo plazo

Objectives: Radical cystectomy is the standard treatment for localized muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB ± Chemotherapy + Radiotherapy to selected patients as an alternative. Material and methods: We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5 cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB + Chemotherapy and 3 TURB + Chemotherapy + Radiotherapy. Results: The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. Conclusions: Although radical cystectomy is the standard treatment for localized MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results

Elective bladder-sparing treatment for muscle invasive bladder cancer.

OBJETIVES: Radical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/- Chemotherapy+Radiotherapy to selected patients as an alternative. MATERIAL AND METHODS: We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. RESULTS: The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. CONCLUSIONS: Although radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results.

[Squamous cell carcinoma of the renal pelvis. A clinical case]. / Carcinoma de células escamosas de la pelvis renal. Caso clínico.

Squamous cell carcinoma of the renal pelvis is uncommon, accounting for approximately 10% of all renal pelvic tumours. It's often associated with chronic renal calculi or infection and it usually presents at an advanced stage with pain or a palpable mass. We report an incidental case of squamous cell carcinoma of the renal pelvis, associated with chronic renal calculi and infection, and weight loss. The prognosis of patients with advanced squamous cell carcinoma of genitourinary origin is poor. In patients with chronic stones or infection squamous cell carcinoma of renal pelvis must be suspected if survival is to be affected.

Carcinoma de células escamosas de la pelvis renal. Caso clínico / Squamous cell carcinoma of the renal pelvis. Case report

El carcinoma escamoso de pelvis renal es infrecuente, representando aproximadamente el 10 por ciento de todos los tumores piélicos. Frecuentemente se asocia con litiasis o infección renal crónica. Se suele diagnosticar en estadios avanzados de la enfermedad por dolor o masa palpable. Presentamos un caso clínico de carcinoma de células escamosas de pelvis renal de diagnóstico incidental, asociado a uropatía obstructiva litiásica de larga evolución, pielonefritis de repetición y pérdida de peso. El pronóstico de los pacientes con carcinoma escamoso genitourinario en estadio avanzado es pobre. Debemos descartar la existencia de carcinoma de células escamosas de la pelvis renal en pacientes con historia de litiasis o infección renal crónica, ya que ello afecta la supervivencia (AU)

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[Benign presacral schwannoma producing obstructive uropathy. Clinical case and review of the literature]. / Schwannoma presacro benigno que provoca uropatía obstructiva. Caso clínico y revisión de la literatura.

We report a case of a presacral benign schwannoma which causes right hydroureteronephrosis without other clinical findings. After a fine-needle aspiration (FNA) biopsy under computed tomography (CT) guidance, a fusocellular tumour without athypia was demonstrated. With the initial diagnosis of benign schwannoma the patient was operated on, removing the tumour, and with the immunohistochemical examination (reactivity for S-100) this diagnosis was confirmed.

La cistectomía radical en el carcinoma vesical superficial / Radical cistectomy in superficial vesical carcinoma

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Schwannoma presacro benigno que provoca uropatía obstructiva. Caso clínico y revisión de la literatura / Presacral bening schawannoma with obstructive uropathy. Case report and review of the literature

Presentamos un caso clínico de schwannoma benigno de localización presacra, que provoca ureterohidronefrosis derecha sin sintomatología. Tras un diagnóstico inicial mediante punción aspiración con aguja fina dirigida por TC, de tumor fusocelular sin atipia citológica compatible con schwannoma, se realiza exéresis quirúrgica, cuyo estudio anatomopatológico (con técnicas inmunohistoquímicas sobre la proteína S-100) confirma el diagnóstico de schwannoma benigno (AU)

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[Cystine calculi. Prevention with captopril. Clinical case]. / Cálculo de cistina. Profilaxis con captopril. Caso clínico.

Contribution of a case report of multiple cystine lithiasis with underlying homozygous cystinuria in a 5-year old male child. Following surgical management of the lithiasic episode the patient was followed-up with super-hydration, urine alkalinization and captopril prophylaxis. After three and a half years evolution, the patient has not developed new lithiasic episodes and maintains normal dibasic amino acids values in 24 h urine.

Cálculo de cistina. Profilaxis con captopril. Caso clínico / Cystine calculi. Captopril prophylaxis. Case report

Presentamos un caso clínico de litiasis de cistina múltiple en el contexto de una Cistinuria homocigota, en un varón de 5 años de edad. Tras el tratamiento quirúrgico del episodio litiásico, el enfermo ha seguido tratamiento profiláctico con sobrehidratación, alcalinización de la orina y captopril. Durante una evolución de tres años y medio el enfermo no ha vuelto a presentar nue-vos episodios litiásicos, manteniendo cifras normales de aminoácidos dibásicos en orina de 24 horas (AU)

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[Cystic dysplasia in the seminal vesicle. Case report and literature review]. / Displasia quística en vesícula seminal. Caso clínico y revisíon de la literatura.

Contribution of one case report of cystic dysplasia of the seminal vesicle with ipsilateral renal agenesis in a 32 year-old male presenting with primary infertility. The seminograms showed moderate astenoteratospermia while in the abdominal-pelvic ultrasound there were changes in the right seminal vesicle and right renal agenesis, which was confirmed with further complementary tests: UIV, transrectal ultrasound, urethrocystoscopy, arteriography and renal scan.

[Posttraumatic high-flow priapism in prepubertal age]. / Priapismo de alto flujo postraumático en edad prepuberal.

High flow priapism is an infrequent entity, generally following traumatic injuries in the genito-perineal area. Anamnesis, cavernous bodies blood gasometry and Doppler are the basic diagnostic tools for these condition. Therapeutical management is considerably different from that used for low flow venous priapism. Selective arteriography of the internal pudendal artery allows to locate the arterial lesion and, at the same time, to perform supraselective embolization of the lacerated cavernous artery which is currently considered the choice treatment. This paper presents the case report of a ten-year old patient successfully resolved through application of angioradiologic procedures.

[Migration of an intrauterine device. An unusual cause of bladder foreign body]. / Emigración de dispositivo intrauterino. Una rara causa de cuerpo extraño vesical.

The origin of vesical and lower urinary tract foreign bodies is very wide, the specialized literature descriptions ranging from urethral dilators to coffee spoons handles through wires, cables and surgical instrumentation. The most frequent entry route of foreign bodies to the lower urinary tract is through the urethra usually by self-introduction or during transurethral surgical procedures. Another access route is that occurring during open or traumatic surgical manoeuvres. Less frequent is that the foreign body migrates from another anatomical structure. These patients present an heterogeneous clinical picture which depends on the location of the foreign body in the urinary tract. Thus, it can be acute if located in the urethra or subacute or chronic if found at vesical level.

[CEP/LTS-X: a simple clinical classification of urinary calculi]. / CEP/LTS-X: une classification clinique simple des calculs urinaires.

The introduction of new treatment techniques for urinary stones requires a classification of our concepts concerning the application of these various modalities. In order to individualize the treatment of stones as precisely as possible, the authors propose a clinical and therapeutic classification based on the characteristics of the stone, the state of the urinary tract, the state of the parenchyma and renal function, the site of the stone, its dimensions and consistency and the number of stones. On the basis of these criteria, renal stones can be classified into 4 types, ureteric stones can be classified into 3 types and bladder and urethral stones can be classified into 2 types. The stones observed in each category are described together with the most appropriate treatment.

[Scleroderma as a paraneoplastic syndrome of ductal carcinoma of the prostate]. / Esclerodermia como síndrome paraneoplásico de un carcinoma ductal de próstata.

We report on a patient with ductal carcinoma of the prostate. A few months earlier, the patient had presented with disabling scleroderma that progressed rapidly and compromised multiple organs. The findings that led us to suspect a paraneoplastic syndrome are discussed and the recent literature on scleroderma and cancer is briefly reviewed.

[Eosinophilic cystitis. Study of the clinical course in 6 new cases and review of the recent literature]. / Cistitis eosinofílica. Estudio clínico-evolutivo de 6 nuevos casos y revisión de la literatura reciente.

Presentation of a series of 6 cases of eosinophilic cystitis diagnosed in our hospital and recorded in 1988-1993, with an average follow-up of 2 years from time of diagnosis. The actual trend with regard to this particular form of chronic cystitis is to abandon the idea of considering it a "benign" disease, basically due to its increasingly less uncommon association to bladder and/or prostate tumoral pathology (in the recent literature and most particular in the present series). Also, a relative increase in the frequency of occurrence of this disease is noted, because of chemoprophylaxis of surface bladder tumour with Mitomycin-C, an association which is increasingly frequent. Based on these 6 cases, a review of the most recent literature on this topic is made.

[Conservative treatment of Wünderlich syndrome in a functional monorenal patient]. / Tratamiento conservador del síndrome de Wünderlich en enferma monorrena funcional.

Presentation of one case of Wünderlich's syndrome secondary to spontaneous mesorenal fracture due to renal angiomyolipoma. In our case, the therapeutical approach is based in the need to preserve the functional renal unit. Wünderlich's syndrome or spontaneous perirenal haematoma can occur for a variety of causes, the most frequent ones being renal adenocarcinoma and renal angiomyolipoma. The latter is a hamartoma made up of three different tissue lines: smooth muscle cells, blood vessels and adipose tissue. Based on our case, we discuss the clinical, prognostic and therapeutical aspects related to renal angiomyolipomes.

[Liposarcoma of spermatic cord. A rare urologic tumor]. / Liposarcoma de cordón espermático. Un raro tumor urológico.

Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor type with a good prognosis. It has a high rate of survival over 5 years. Inguinal orchiectomy generally suffices, although patients should be followed closely since local recurrence is not uncommon. The present study briefly reviews the literature on spermatic cord liposarcoma and reports an additional case that was treated exclusively by radical orchiectomy. Four years postoperatively the patient continues to be tumor-free.

[Ureteral lithiasis. Analysis of 3 series]. / Tratamiento de la litiasis ureteral. Análisis de tres series.

Presentation of our experience on 1000 cases of ureteral lithiasis treated over the last five years with ESWL, ureteroscopy and ureterolitotomy, distributed in three series of 396, 265 and 339 cases respectively. In the first series (396 cases), lumbar ureter calculi were treated with ESWL (dornier HM3) and iliopelvian calculi with ureteroscopy. In the second series (265 cases), all calculi were treated with ESWL (Siemens Lithostar). The third series was in turn subdivided in three groups: in the first group, comprising simple ureteral calculi, 'in situ' ESWL was performed; in the second group, of lumbar ureter complex calculi, ESWL was performed assisted by simple endourological techniques; ureteroscopy was performed in the third group, iliopelvian ureter complex calculi. Calculi characteristics (site, size, consistency and number), excretory tract and renal function, designated as CEP/LTS-X were assessed. These parameters allow us to grade ureteral lithiasis in Types I, II and III. A comparative study of the results in the three series was made reaching an overall conclusion that simple or Type I ureteral lithiasis can be treated with 'in situ' ESWL as first choice; in Type II or lumbar ureter complex lithiasis, 'in situ' ESWL is insufficient and other endoeurological support techniques are required, while in Type III, iliopelvian ureter complex lithiasis, ureteroscopy should be recommended.

[Distal tubular renal acidosis with nephrocalcinosis]. / Acidosis tubular renal distal con nefrocalcinosis.

Nephrocalcinosis and distal tubular acidosis are two infrequent processes caused by several etiologies which can present in association. This paper describes a clinical case of tubular acidosis and explains the differential diagnosis of both entities.