[Long-term results of end-to-end urethroplasty]. / Resultado a largo plazo de la uretroplastia término-terminal.

OBJECTIVE: We evaluated long term results of end-to-end urethroplasty. MATERIAL AND METHODS: We reviewed 40 patients with bulbar urethral stricture of diverse origin: iatrogenic 40%, traumatic 15%, infectious 2% and unknown 40%. In 17 cases internal urethrotomy was made previously. The radiological study with retrograde and voiding cystogram revealed a bulbar location in all cases and a length inferior to 1 cm in 13 cases, between 1-2 cm in 26 cases and 2-3 cm in 1 case. The maximum flow rate varied between 3-13 ml/s. The absence of bacteriuria was valued by means of preoperating culture. The average time of pursuit was 45 months (12-142 months). The stricture was considered resolute when not appear compatible radiological or functional finds of failure. RESULTS: In 37 cases (92%) the results were satisfactory, without secondary surgical procedure. After surgery maximum flow-rate varied between 18-45 ml/s. In two patients with failure, internal urethrotomy was decisive. In this case the stricture origin was traumatic. The third patient with failure was finally chosen to make new end-to-end urethroplasty, with good later result. CONCLUSIONS: End-to-end urethroplasty is a highly decisive technique for bulbar urethral stricture. The preoperating diagnosis is based on the radiological study (retrograde and voiding cystogram). The postoperating control must be based on clinic and uroflow study. Traumatic stricture repair showed worse results. In cases of failure, internal urethrotomy allows to complement successful results of end-to-end urethroplasty.

[Survival prognostic factors valuation on a series of 202 patients with surgical treatment of renal cell carcinoma]. / Valoración de factores pronósticos de la supervivencia en una serie de 202 pacientes intervenidos por carcinoma de células renales.

OBJECTIVES: To describe renal cell carcinoma prognostic factors and set up the relationship with survival rates in this neoplasm. Likewise we show epidemiologic, clinical, diagnosis and therapeutic facts. MATERIAL AND METHOD: We review 202 patients underwent surgical treatment for renal cell carcinoma and the following features were recorded: gender, age and presenting symptoms, especially incidentally discovered tumors; tumor-related factors like TNM tumor stage, tumor grade and venous involvement: therapy-related recorded were surgical techniques and cytokine-based therapy. RESULTS: 60% of the patients showed organ-confined disease, 10% of patients with renal cell carcinoma presented with nodal positive disease and 7% with systemic metastases. 42% of patients presenting incidental tumor, with survival rates substantially better than that for symptomatic patients. 42% of patients with nodal positive disease presented systemic metastases at diagnosis, and 30% at surveillance. Systemic metastases presented a particularly poor prognosis for patients with renal cell carcinoma, with 12-months survival rates that 0%. Patients with cytokine-related therapy for metastatic disease presented 24-months survival rates that 20%. CONCLUSIONS: Renal cell carcinoma remains a major source of mortality, basically at advanced disease (nodal positive disease or systemic disease), without a clear improvement of survival rates despite the newer therapy modalities.

Resultado a largo plazo de la uretroplastia término-terminal / Long-term results of end-to-end urethroplasty

Objetivo: Evaluamos los resultados a largo plazo de la uretroplastia término-terminal. Material y Métodos: Revisamos 40 pacientes afectos de estenosis de uretra bulbar de etiología diversa: yatrógena40%, traumática 15%, infecciosa 2% y desconocida 40%. En 17 casos se realizó previamente uretrotomíainterna. El estudio mediante CUMS reveló una localización bulbar en todos los casos y una longitud inferior a 1cm en 13 casos, entre 1-2 cm en 26 casos y entre 2-3 cm en 1 caso. El flujo máximo varió de 3-13 ml/s. Se valoró mediante cultivo preoperatorio la ausencia de bacteriuria. El tiempo medio de seguimiento fue de 45 meses (12-142 meses). Se consideró resuelta la estenosis cuando no aparecieron datos radiológicos ni flujométricos compatibles con reestenosis. Resultados: En 37 casos (92%) los resultados fueron satisfactorios, no precisando los pacientes ningún otro procedimiento quirúrgico secundario. Tras la cirugía el flujo máximo varió entre 18-45 ml/s. En dos de los tres pacientes con reestenosis la uretrotomía interna endoscópica fue resolutiva. Se trató de dos pacientes con estenosisde origen traumático y longitud mayor a 1,5 cm. En el tercer paciente con recidiva se optó finalmente por realizar una nueva uretroplastia termino-terminal, con buen resultado posterior. Conclusiones: La uretroplastia término-terminal es una técnica altamente resolutiva en la estenosis de uretrabulbar. El diagnóstico preoperatorio se basa en el estudio radiológico (CUMS). El control postoperatorio debe fundamentarse en la clínica y estudio flujométrico. El origen traumático de la estenosis empeora los resultados de la cirugía. En casos de reestenosis la uretrotomía interna endoscópica permite complementar de forma exitosa los resultados de la uretroplastia (AU)

Objective: We evaluated long term results of end-to-end urethroplasty. Material and methods: We reviewed 40 patients with bulbar urethral stricture of diverse origin: iatrogenic 40%, traumatic 15%, infectious 2% and unknown 40%. In 17 cases internal urethrotomy was made previously. The radiological study with retrograde and voiding cystogram revealed a bulbar location in all cases and a length inferior to 1 cm in 13 cases, between 1-2 cm in 26 cases and 2-3 cm in 1 case. The maximum flow rate varied between 3-13 ml/s. The absence of bacteriuria was valued by means of preoperating culture. The average time of pursuit was 45 months (12-142 months). The stricture was considered resolute when not appear compatible radiological or functional finds of failure. Results: In 37 cases (92%) the results were satisfactory, without secondary surgical procedure. After surgery maximum flow-rate varied between 18-45 ml/s. In two patients with failure, internal urethrotomy was decisive. In this case the stricture origin was traumatic. The third patient with failure was finally chosen to make new endto- end urethroplasty, with good later result. Conclusions: End-to-end urethroplasty is a highly decisive technique for bulbar urethral stricture. The preoperating diagnosis is based on the radiological study (retrograde and voiding cystogram). The postoperating control must be based on clinic and uroflow study. Traumatic stricture repair showed worse results. In cases of failure, internal urethrotomy allows to complement successful results of end-to-end urethroplasty (AU)

Valoración de factores pronósticos de la supervivencia en una serie de 202 pacientes intervenidos por carcinoma de células renales / Survival prognostic factors valuation on a series of 202 patients with surgical treatment of renal cell carcinoma

Objetivos: Describir los principales factores pronósticos del carcinoma renal y estudiar su relación con la supervivencia especifica. Recoger datos demográficos, clínicos, diagnósticos y terapéuticos de los pacientes. Material y métodos: Se revisaron 202 casos de carcinomas renales operados entre 1988-2003. Las variables valoradas respecto al paciente fueron: edad, sexo y presentación clínica. Se investigó la importancia del incidentaloma. Con respecto al tumor se valoró: estadio TNM, grado histológico, tamaño y afectación venosa. Con respecto al tratamiento: principales vías de abordaje y técnicas quirúrgicas y terapia adyuvante inmunoterápica. Resultados: Un 60% de los pacientes presentó enfermedad órgano confinada, un 10% afectación nodal y un 7% enfermedad metastásica. Un 42% se presentaron incidentalmente, con una significativa mejor supervivencia respecto a tumores sintomáticos. Un 42% de los pacientes pN+ presentaron metástasis a distancia al diagnóstico y un tercio las desarrollaron durante el seguimiento. La supervivencia de los pacientes metastásicos sin tratamiento adyuvante fue inferior al año, mientras que un 20% de los tratados con inmunoterapia permanecían vivos a los 2 años. Conclusiones: El carcinoma renal es un tumor con alta mortalidad, fundamentalmente en sus estadios más avanzados (pN+ o pM+). Pese a las nuevas modalidades de tratamiento, no se ha logrado mejorar sustancialmente la supervivencia (AU)

Objectives: To describe renal cell carcinoma prognostic factors and set up the relationship with survival rates in this neoplasm. Likewise we show epidemiologic, clinical, diagnosis and therapeutic facts. Material and method: We review 202 patients underwent surgical treatment for renal cell carcinoma and the following features were recorded: gender, age and presenting symptoms, especially incidentally discovered tumors; tumor-related factors like TNM tumor stage, tumor grade and venous involvement; therapy-related recorded were surgical techniques and cytokine-based therapy. Results: 60% of the patients showed organ-confined disease, 10% of patients with renal cell carcinoma presented with nodal positive disease and 7% with systemic metastases. 42% of patients presenting incidental tumor, with survival rates substantially better than that for symptomatic patients. 42% of patients with nodal positive disease presented systemic metastases at diagnosis, and 30% at surveillance. Systemic metastases portend a particularly poor prognosis for patients with renal cell carcinoma, with 12-months survival rates that0%. Patients with cytokine-related therapy for metastatic disease presented 24-months survival rates that 20%.Conclusions: Renal cell carcinoma remains a major source of mortality, basically at advanced disease (nodal positive disease or systemic disease), without a clear improvement of survival rates despite the newer therapy modalities (AU)

Técnica de Burch en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo femenina. Valoración de los resultados y análisis de las causas de los fracasos / Burch procedure in the surgical treatment of urinary stress incontinence

OBJETIVO: Presentar nuestra experiencia con la técnica de Burch en el tratamiento de la incontinencia urinaria de esfuerzo femenina (IUE), así como analizar las posibles causas de los fracasos. MATERIAL Y MÉTODOS: En un periodo de 10 años (1987-1997), se han intervenido 157 pacientes afectas de IUE mediante esta técnica. Su edad media era de 54,2 años (30-76) y el seguimiento medio fue de 50,24 meses. La técnica se indicó sin tener en cuenta los hallazgos de la exploración física, la severidad, ni los resultados del perfil uretral en el estudio urodinámico. RESULTADOS: A los tres meses de la cirugía, el porcentaje de curación/mejoría fue del 80,7 por ciento. Al año desciende al 76 por ciento. A partir del 2º año se estabilizaron en torno al 70 por ciento y se mantiene a los 5 años. Si tenemos en cuenta la severidad de la incontinencia, si ésta es leve-moderada, el porcentaje de buenos resultados a los 5 años es del 87 por ciento. Si existen alteraciones asociadas del detrusor, baja al 51,8 por ciento, y si el perfil uretral es malo desciende al 42,4 por ciento. CONCLUSIONES: La técnica de Burch es útil en el tratamiento de la IUE, pero con buena selección de los pacientes (AU)

[The Burch technique in the surgical treatment of stress urinary incontinence in women. Assessment of results and analysis of failure causes]. / Técnica de Burch en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo femenina. Valoración de los resultados y análisis de las causas de los fracasos.

OBJECTIVE: To present our experience with the Burch procedure in the treatment of female urinary stress incontinence (USI) and the assessment of the causes of failure with this technique. MATERIAL AND METHODS: From January 1987 to june 1997 this technique was applied to 157 patients with USI. The mean age of these women was 54.2 years (30-76) and the mean follow-up was 50.24 months. Physical examination, urethral profile and the severity of the USI were not considered in the indication of the procedure. RESULTS: After three months, we had total continence or improvement in 80.7%. This rate decreased to 76% after one year. From the second year it was 70%, maintained to fifth year. Considering the severity of incontinence, in patients with mild-moderate grade, we obtained good outcomes after 5 years in 87%. If there was associated detrusor alterations, the rate decreased to 51.8%, and with a bad urethral profile, decreased to 42.4%. CONCLUSIONS: The Burch procedure is useful in the treatment of USI but requires a good selection of the patients.

[Ureterohydronephrosis secondary to a cyst of retroperitoneal mesentery]. / Ureterohidronefrosis secundaria a quiste de mesenterio retroperitoneal.

Retroperitoneal primary cysts are rare clinical entities. A contribution is made of one case presenting this condition with repercussion on the excretory route. Ultrasound and computerized axial tomography studies suggest the diagnosis but this is confirmed through laparotomy. Choice treatment is enucleation, typically easy because of the minimal adherence to surrounding structures. Recurrence is rare and malignancy practically non-existent.

[Renal adenocarcinoma with vena cava invasion: current status of its diagnosis and treatment using total segmentary cavectomy]. / Adenocarcinoma renal con invasión de vena cava: estado actual de su diagnóstico y tratamiento mediante cavectomía total segmentaria.

OBJECTIVES: Renal adenocarcinoma is characterized by marked venotropism; 20-49% show extension into the main renal vein and 4-19% into the vena cava. The present study analyzes the different diagnostic methods to evaluate the vascular involvement by renal carcinoma and presents the results achieved by total segmental cavectomy with ligation of the left renal vein and without vena caval reanastomosis. METHODS: Three patients (two males, one female) underwent total segmental cavectomy with ligation of the left renal vein in our Service over the last 10 years. A bilateral subcostal approach with access to the large vessels was utilized in all three cases. The superior and inferior renal vena cava were exposed and the hepatic veins were ligated at the level of the intrahepatic segment. Incision of the vena cava was performed, the thrombus was removed and the renal vessels were ligated. The proximal and distal segments of the vena cava were ligated after cavectomy. In the third patient, intrahepatic extension of the thrombus required the use of a temporary filter for the proximal segment of the vena cava. RESULTS: The early postoperative course was satisfactory; adequate renal function was maintained and no problems with venous return were observed. Of the diagnostic methods analyzed, MRI was found to be the most useful. A relationship was found between survival and the pathological stage and the presence or absence of lymph node metastasis. CONCLUSIONS: Total segmental cavectomy without reanastomosis and with ligation of the left renal vein appears to be a feasible technique which achieves good results. MRI is the diagnostic method of choice in the evaluation of vascular tumor extension.