Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events. / Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSION: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events.

Trans-umbilical single-port radical nephrectomy with concomitant cholecystectomy.

OBJECTIVES: Occasionally, the development of laparoscopic procedures allows the performance of combined surgeries. Currently, some of these can be carried out by trans-umbilical single-port laparoscopy. MATERIAL AND METHODS: We report a patient with renal tumor of 4.5cm and cholelithiasis who undergone to trans-umbilical single port-right radical nephrectomy with concomitant cholecystectomy. This is the first case reported in Spain that this combined procedure is performed using umbilical single port surgery. RESULTS: No complications (intra or postoperative) have been described in this case, achieving proper control of tumor pathology and an excellent cosmetic outcome. CONCLUSION: In those cases in which multidisciplinary approach is required, surgery can be performed by trans-umbilical single-port laparoscopy as consequence of its reduced postoperative morbidity and better cosmetic results.

[Melanoma of the penis]. / Melanoma de pene.

We present a case of penile malignant melanoma. Its rarity of less than 1% of masculine genital malignant neoplasms, the absence of standardised protocols as for other neoplasms, impel us to its publication.

Melanoma de pene / Melanoma of the penis

Presentamos un caso de melanoma maligno de pene. Su rareza inferior al 1 por ciento de las neoplasias malignas de genitales masculinos, la ausencia de protocolos estandarizados como para otras neoplasias, nos impulsan su publicación (AU)

[Paratesticular lipoma]. / Lipoma paratesticular.

Among the neoplasias affecting the scrotum and other elements contained within, testicular tumours are the most common; paratesticular neoplasias account for about 2%. 70% of them are benign tumours, lipoma being one the most frequent types. We contribute a new case of paratesticular lipoma in a 45-year old patient, who presented with scrotal complaints. Physical examination found fibroelastic scrotal tumoration; diagnosis being aided with ultrasound and CAT that showed fat tissue radiographic patterns. Complete removal of tumoration and subsequent pathoanatomical study confirmed the diagnosis of paratesticular lipoma. A literature review on the subject is included with reflections on the clinical, diagnostic and therapeutical aspects.

Lipoma paratesticular / Paratesticular lipoma

Dentro de las neoplasias que afectan al escroto y elementos contenidos en el mismo, los tumores testiculares son los más frecuentes; las neoplasias paratesticulares representan aproximadamente el 2 por ciento del total, y de ellas el 70 por ciento son tumores benignos, siendo el lipoma uno de los tipos más frecuentes. Presentamos un nuevo caso de lipoma paratesticular en un paciente de 45 años, manifestado por molestia escrotal y detectándose una tumoración escrotal fibroelástica en la exploración física. El diagnóstico se complementó con ecografía y TAC, mostrando unos patrones radiográficos de tejido graso. La extirpación completa de la tumoración y posterior estudio anatomopatológico, confirmaron el diagnóstico de lipoma paratesticular. Asimismo hacemos una revisión bibliográfica del tema comentando aspectos clínicos, diagnósticos y del tratamiento (AU)

[Report of 2 new cases of bladder inverted papilloma, one with them complicated with acute urinary obstruction]. / Presentación de dos nuevos casos de papiloma invertido vesical, cursando uno de ellos con obstrucción urinaria aguda.

Inverted papilloma is a rare tumour (2.2% of urothelial tumours) considered to be benign. The bladder is the most frequent site and growth tends to be endophytic towards the submucosa. Haematuria and obstruction symptoms appear to be the most typical clinical manifestations. Contribution of two cases of inverted bladder papilloma; one showing very unusual clinical development with relapsing acute urinary obstruction. Strict follow-up is recommended in spite of its benign behaviour as it may become associated to transitional cell carcinoma. Literature review on this tumoral entity in terms of etiology, clinical manifestations, diagnosis and treatment.

Presentación de dos nuevos casos de papiloma invertido vesical, cursando uno de ellos con obstrucción urinaria aguda / Contribution of two new cases of inverted bladder papilloma, one evolving with acute urinary obstruction

El papiloma invertido es un tumor poco frecuente (2.2 por ciento de los tumores uroteliales), y considera-do de comportamiento benigno. La localización vesical es la más frecuente y su crecimiento suele ser endofítico hacia la submucosa. Las manifestaciones clínicas más frecuentes son hematuria y sintomatología obstructiva. Presentamos dos casos de papiloma invertido vesical, destacando en uno de ellos el curso clínico poco frecuente con obstrucción urinaria aguda recidivante. A pesar de su comportamiento benigno se recomienda seguimiento estricto ya que puede asociarse en ciertos casos con carcinoma de células transicionales. Realizamos una revisión bibliográfica de esta entidad tumoral sobre aspectos de su etiología, manifestaciones clínicas, diagnóstico y tratamiento (AU)

[Metanephric adenoma of the kidney and chronic myeloproliferative syndrome. An unusual association]. / Adenoma metanéfrico de riñón y síndrome mieloproliferativo crónico. Una rara asociación.

The metanephric adenoma is an uncommon tumour included in the class of benign renal epithelial tumours. This paper presents the case of a 64-year old female with incidentally diagnosed renal tumoration affecting the patient concomitantly to a chronic myeloproliferative syndrome with myelofibrosis. Left kidney ultrasound and CAT findings suggested a diagnosis of renal cell carcinoma. Left radical nephrectomy was performed. The pathoanatomical study confirmed the diagnosis of a renal metanephric adenoma 9 x 7.5 cm in size. Although some cases of metanephric adenoma have been described in patients with haematological conditions, polycythemia being specially frequent, no case associated to chronic myeloproliferative syndrome has been found in the literature.

[Acute pyelonephritis as presentation form of renal angiomyolipoma with large granulomatous component]. / Pielonefritis aguda como forma de presentación de un angiomiolipoma renal con gran componente granulomatoso.

Angiomyolipoma is a benign tumour of the kidney; is most cases is a finding during radiologic studies (ultrasound and CAT) and therefore asymptomatic. Due to their histologic features, these tumours show characteristic ultrasound and CAT patterns. This paper presents one case of angiomyolipoma in a 26-year old female patient who presented with a clinical picture of acute pyelonephritis. The tumour features in both ultrasound and CAT were not the typical ones for this kind of tumour. The surgical piece removed corresponded to an angiomyolipoma with a large granulomatous reaction.

[Cystic adenocarcinoma of the kidney. Apropos of 18 cases]. / Adenocarcinoma quístico de riñón. A propósito de 18 casos.

OBJECTIVES: To analyze the main epidemiological, clinical and pathological features of cystic renal carcinoma in comparison with those of solid tumors. To determine the reliability of the preoperative diagnostic methods to distinguish these cysts from other cystic renal disease. METHODS: The study comprised 286 carcinomas that had been treated over a period of 25 years. These cases were divided into two groups; 268 solid tumors and 18 cystic lesions. We analyzed patient age at onset, sex, tumor location and intrarenal status, clinical features, tumor size, cellular type, grade, stage and survival rate. In the group with cystic lesions, we analyzed the diagnostic methods used and the diagnosis made preoperatively. RESULTS: 6.29% were cystic carcinomas. There were no differences between the solid and cystic lesions except for the slightly larger size of the latter (9.88 cm versus 8.01 cm). No significant differences were found for survival. The IVP and arteriograms only disclosed an expansive renal process suggestive of a neoplasm in 9 and 3 cases, respectively. Ten cases were evaluated by US and 13 by CT, which revealed a complicated cystic lesion. The fine needle punction aspiration biopsy, which was done in 3 cases, was negative. On the basis of the findings, a diagnosis of cystic carcinoma was made in 11 cases and multilocular cystic nephroma in 3 cases. The older cases that had been seen when US or CT were unavailable had been diagnosed as having renal carcinoma. CONCLUSIONS: Similar results, with special reference to the high rate of false negatives of the cytological study, have been reported in the literature.

[Review of 42 cases of penile carcinoma]. / Revisión de 42 carcinomas de pene.

OBJECTIVES: 42 cases of penile carcinoma were retrospectively analyzed to determine the overall survival and the influence of treatment and inguinal lymph node metastasis on survival. METHODS: The clinical records of 42 patients with penile carcinoma that had been treated at our hospital over a 17-year period were reviewed, with special reference to the epidemiological aspects, diagnosis, staging, treatment and overall survival. RESULTS: The overall 5 and 10-year survival were 73% and 43%, respectively. Inguinal dissection was performed in 24% of the patients. The overall survival was better in those with no lymph node involvement. CONCLUSIONS: Following local surgery of penile cancer, inguinal lymphadenectomy of palpable nodes is recommended to improve survival, if antibiotic treatment is not effective. Randomized and cooperative studies are necessary to assess the efficacy of prophylactic lymph node dissection and its influence on survival.

[Stress urinary incontinence. Our experience with its treatment using the transvaginal colposuspension technique (Raz I and II)]. / Incontinencia urinaria de esfuerzo. Nuestra experiencia en su tratamiento mediante la técnica de colposuspensión transvaginal (Raz I Y II).

Presentation of our experience in the surgical treatment of urinary stress incontinence, with transvaginal colposuspension techniques, specifically those described by S. Raz and known as Raz I and Raz II. Over a 24-month period, 25 transvaginal colposuspensions (22 Raz I and 3 Raz II) were performed. The results achieved were 21 patients (84%) have recovered, while 4 (16%) remain incontinent, 3 of them referring improvement and 1 without improvement, after a follow-up of 12 to 36 months. With regard to complications, there has been 5 cases (20%) of postoperative retention, one vesical perforation while passing the needles, and a vesicle perforation during vaginal dissection of the retropubic space.

[Substitutive orthotopic ileocystoplasty. The Studer's technique]. / Ileocistoplastia ortotópica de sustitución. Técnica de Studer.

OBJECTIVES: The results of the Studer enterocystoplasty technique is analyzed, with special reference to the early and late complications and urinary continence. METHODS: We reviewed the records of 20 patients that underwent bladder substitution according to the Studer technique due to bladder carcinoma from 1990-1993. Patient follow-up ranged from 6-36 months. The ureteroileal anastomosis was done by the single stitch technique onto a tubularized ileal chimney. RESULTS: The median age was 57.2 +/- 11.86 yrs (range 33-73). The preoperative stay for intestinal preparation ranged from 1-29 days (median 4.4 +/- 5.84) and the postoperative stay ranged from 1-60 days (median 26 +/- 11.44). The average operating time was 5.30 +/- 0.7 hours (range 4.15-7). There were two postoperative deaths; one from acute myocardial infarction and the other from pulmonary embolism. Three patients died from tumor progression during follow-up and one from leg ischemia 17 months postoperatively. Early complications: 2 cases of prolonged ileus, 1 wound infection, 7 urinary infections, 1 low debit intestinal fistula which resolved with parenteral nutrition, 3 patients had leakage at the ileourethral anastomosis which resolved with prolonged catheter drainage of 3-15 days, 1 hemorrhage from acute lesions to the gastric mucosa, 3 fascial dehiscence and 1 ureteroileal fistula that required reimplantation into the neobladder. Late complications: 1 ureteroileal stenosis that progressed to renal atrophy, 1 enterourethral stenosis that resolved with internal urethrotomy and 2 cases of severe metabolic acidosis and dehydration that resolved with fluid therapy. No differences were observed between the creatinine, pH and ion levels preoperatively and during follow-up. Continence was assessed in 17 cases: 100% were continent during the day, 41.2% were continent during the night, 4 had occasional nocturnal leakage and 6 required collecting devices during the night. CONCLUSIONS: The Studer technique provides good results and quality of life to patients undergoing cystectomy. Although it carries a high morbidity, conservative management will suffice in a high percentage of cases.

[Papillary adenocarcinoma of the rete testis. Report of a case]. / Adenocarcinoma papilar de la rete testis. Presentación de un caso.

OBJECTIVES: Another case of adenocarcinoma of the rete testis is described and the literature on this uncommon tumor type reviewed. METHODS/RESULTS: The clinical features, pathological findings and treatment of adenocarcinoma of the rete testis in a 72-year-old male are presented. CONCLUSIONS: Adenocarcinoma of the rete testis is a rare tumor type; few cases have been reported in the literature. Although treatment is primarily by surgery, recognition of new cases will provide further insight into this primary tumor of the rete testis.

[Epidemiologic study of the factors influencing renal trauma in Cantabria]. / Estudio epidemiológico de los factores que intervienen en los traumatismos renales en Cantabria.

OBJECTIVE: In this study, the most important factors that influence renal trauma (RT) were evaluated in patients that had suffered different types of accidents. METHODS: Data from 340 cases of RT that were seen over a period of 15 years were obtained. This was performed in two stages: first, data were obtained during this time period; secondly, the patients were followed after discharge from hospital. RESULTS: All this information was filed in a data base specifically for this purpose and were statistically analyzed to determine and quantify the types of RT and their incidence in relation to demographic and temporal factors, type of accident, etc. CONCLUSIONS: Weekends, alcohol, age, road traffic accidents, type of road, etc., are the most important factors that influence the development of RT. The incidence of RT in Cantabria is similar to that of the US and European countries.

[Epidemiologic study of the clinical features, diagnosis, and treatment of kidney trauma in Cantabria]. / Estudio epidemiológico de la clínica, diagnóstico y terapéutica de los traumatismos renales en Cantabria.

OBJECTIVE: This study reviews the clinical features, methods and treatment of renal trauma (RT). METHODS: The epidemiological study was conducted using data from 340 cases of RT that had been treated in the Department of Urology of the Marqués de Valdecilla University Hospital in Santander. All the information was filed in a data base specifically for the purpose. RESULTS: Statistical analyses of the data showed the incidence of the symptoms, diagnosis and treatment of RT. CONCLUSIONS: Radiological and ultrasound evaluation are still fundamental for the diagnosis of RT. Only 4% of these patients have died. Abdominal, thoracic and cranial injuries cause the most severe lesions. Concerning treatment, only 17% of the cases with RT required surgery.

[Clinical trial with intravesical alfa-2b interferon for the prevention of T1 transitional carcinoma of the bladder: preliminary results. Review of the bibliography]. / Ensayo clínico con interferón alfa-2b endovesical en la profilaxis del carcinoma transicional de vejiga T1: resultados preliminares. Discusión de la bibliografía.

OBJECTIVE: To assess the efficacy of 60 MU intravesical alpha-2b interferon (IFN) in preventing recurrence of transitional cell carcinoma of the bladder. METHODS: A prospective, randomized double-blind study was conducted to assess the efficacy of 60 MU intravesical alpha-2b IFN compared to a control group. T1G2-G3 and the G1 recurrent tumors were included in the study (30 in each group). Instillation was started 2-3 weeks after complete TUR and administered once weekly for 12 weeks and once monthly thereafter for one year. RESULTS: The distribution according to sex and age of the patient, tumor size, grade and classification as primary or secondary was the same for both groups. Multiple tumors were prevalent in the IFN-treated group. During the first year of follow up, the tumor recurrence rate was 23.3% for the IFN-treated group and 36.6% for the control group. At 22.4 months mean follow up, the rate of recurrence was 40% for the IFN-treated group and 46.6% for the control group. Of these recurrences, 8.3% of tumors in the IFN group showed progression in grade and/or stage versus 35.7% for the control group. The disease-free interval averaged 8.5 months; 10.5 for the treated group and 6.9 months for the control group. Local or systemic toxicity was negligible. CONCLUSIONS: Alpha-2b IFN is well-tolerated at a dose of 60 MU. It prolongs the disease-free interval and while throughout the follow up period the recurrence rate is similar to that of the control group, it does seem to markedly slow progression in the grade and/or stage of the tumor.

[Bladder pheochromocytoma]. / Feocromocitoma vesical.

OBJECTIVES: The present study reports on a case of paraganglioma of the urinary bladder and briefly reviews the literature. METHODS/RESULTS: The patient presented with gross hematuria and no history of hypertension. The pathological findings were diagnostic of paraganglioma of the urinary bladder. CONCLUSIONS: Extra-adrenal pheochromocytoma is uncommon. Although it usually presents with typical symptoms, these are also determined by tumor location. Currently, there are no anatomopathological criteria to distinguish the benign from the malignant form.

[Kidney transplantation in patients over 60 years of age. Study of 37 patients]. / Trasplante renal en pacientes mayores de 60 años. Estudio de 37 pacientes.

Between February 1975 and September 1993, 735 renal transplantations have been performed 37 of which took place in 60+ year-old subjects. All grafts were from corpse donors. 34 were first time transplants and 3 were re-transplants. In general, immunosuppression has been accomplished with Cyclosporin, Azathioprine, and Prednisone. Annual patient and graft survival is 87% and 69%, respectively. A review is made of the complications developed and the success rate with and without a functioning graft. Considering long-term results, many patients lead a normal live with stable renal function.