Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience.

PURPOSE: Neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) patients has proven beneficial in overall survival. However, the optimal regimen is still a matter of debate. MATERIALS AND METHODS: In this retrospective analysis, we evaluate the results obtained in 42 patients treated in our center with 4 cycles of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) followed by radical cystectomy from August 2015 to October 2020. All patients had cT2 or higher non-metastatic MIBC. Clinical and pathological outcomes are reported. RESULTS: Of the 42 patients, 90.5% were men (n = 38) and the mean age was 65 years. All of them had ECOG 0-1 at diagnosis and most tumors had an initial clinical stage T2N0 (76%). Thirty-six patients (85.7%) completed 4 cycles of neoadjuvant treatment, and 21.4% required a dose reduction. The most frequent adverse event (AE) was grade 1-2 asthenia (81%), while neutropenia was the most frequent grade 3 or higher AE (38%). Complete pathological response (ypT0, ypN0) was achieved in 50% of patients (n = 21), and down-staging was observed in 57.1% (n = 24). Only one patient presented radiological progressive disease during neoadjuvant treatment (2.4%), and after a mean follow-up time of 31.5 months, 33.3% of patients experienced disease recurrence. CONCLUSIONS: Neoadjuvant chemotherapy with 4 cycles of dd-MVAC is an effective regimen with high rates of pathological complete responses and down-staging along with an acceptable toxicity profile. DD-MVAC should be considered as an alternative to cisplatin and gemcitabine in patients with good clinical performance status.

Arterial Fistulas in Urinary Diverted Patients: A Report of 5 Cases.

OBJECTIVE: Arterio-urinary fistulae are a rare but potentially lethal complication that may arise after pelvic surgery, such as radical cystectomy. Historically, open surgery was the gold standard treatment, but currently endovascular treatment has gained prominence. METHODS: We report our centre experience in endovascular treatment of cystectomy-related arterial fistulae and review the reported literature on the topic. During the postoperative period of radical cystoprostatectomy five patients presented different ranges of haematuria, and one presented rectal bleeding, four of them with haemodynamic instability. An urgent three-phase computed tomography was performed, showing active bleeding in 2 patients, while the rest of the patients presented indirect signs of fistulae. An angiography was performed, showing contrast extravasation in 60% of the cases and vessel wall irregularity in 40%. Five arteriourinary fistulae and one arterioenteric fistula were urgently treated with a covered stent placement, sealing the site of the fistula in the artery. RESULTS: Immediate results were satisfactory in all cases; however, one patient died secondary to fistula-related causes 15 days post-treatment. No stent thrombosis or rebleeding have been registered during follow-up. In this review, reported results and complications after covered stent placement are shown, and controversial topics such as antibiotic coverage and antithrombotic treatment after endovascular treatment are also reviewed.

[Mini-laparoscopic pyeloplasty.] / Pieloplastia por Minilap..

Continued progresses in the field of laparoscopy have been introduced in urological surgery. With the development of smaller instrumental minilaparoscopy was born seeking to reduce abdominal trauma and improve cosmetic scars, obtaining similar or better results than conventional laparoscopy. OBJECTIVE: The objective of this paper is to evaluate the results and reproducibility of mini-laparoscopic pyeloplasty. METHODS: A literature review and a bibliographic search in PubMed were performed. We describe the technique used in the "Hospital Marqués de Valdecilla" (HUMV), Santander (Spain). RESULTS: 60 articles about mini-laparoscopy were found. Although there are few reported minilap pyeloplasty series, they offer excellent cosmetic and functional results. We analyze operative time, complications, postoperative hospital stay, conversion rate, functional and cosmetic results, and we compare them with conventional laparoscopic pyeloplasty. CONCLUSIONS: More reported series are necessary but it has been proved that minilap pyeloplasty is a reproducible and safe technique with excellent results.

Pieloplastia robótica y laparoscópica / Robot-assisted and laparoscopic pyeloplasty

Los continuos avances en el campo de la laparoscopia han ido siendo introducidos progresivamente en la cirugía urológica. Con el desarrollo de instrumental de menor tamaño nace la minilaparoscopia, buscando reducir el trauma abdominal y mejorar la cosmética de las cicatrices, obteniendo unos resultados similares o mejores a los logrados en la laparoscopia convencional. Objetivo: El objetivo es evaluar los resultados y la reproducibilidad de la pieloplastia por minilap. Método: Para ello se ha realizado una revisión de la literatura y una búsqueda bibliográfica en PubMed. Describimos la técnica quirúrgica realizada en el Hospital Universitario Marqués de Valdecilla, Santander (HUMV). Resultados: se encontraron más de 60 artículos que hacían referencia a la minilaparoscopia. Aunque a día de hoy son escasas las series reportadas de pieloplastia por minilap, estas ofrecen unos resultados excelentes. Analizamos los datos de tiempo quirúrgico, complicaciones, estancia hospitalaria, tasa de conversión, resultado funcional y cosmético, comparándolos con la pieloplastia laparoscópica convencional. Conclusiones: Aunque es necesario que se reporten más series, se ha demostrado que la pieloplastia por minilap es una técnica reproducible y segura, que otorga así mismo unos resultados excelentes

Continued progresses in the field of laparoscopy have been introduced in urological surgery. With the development of smaller instrumental minilaparoscopy was born seeking to reduce abdominal trauma and improve cosmetic scars, obtaining similar or better results than conventional laparoscopy. Objective: The objective of this paper is to evaluate the results and reproducibility of mini-laparoscopic pyeloplasty. Methods: A literature review and a bibliographic search in PubMed were performed. We describe the technique used in the Hospital Marqués de Valdecilla (HUMV), Santander (Spain). Results: 60 articles about mini-laparoscopy were found. Although there are few reported minilap pyeloplasty series, they offer excellent cosmetic and functional results We analyze operative time, complications, post-operative hospital stay, conversion rate, functional and cosmetic results, and we compare them with conventional laparoscopic pyeloplasty. Conclusions: More reported series are necessary but it has been proved that minilap pyeloplasty is a reproducible and safe technique with excellent results

Pieloplastia por Minilap / Mini-laparoscopic pyeloplasty

Los continuos avances en el campo de la laparoscopia han ido siendo introducidos progresivamente en la cirugía urológica. Con el desarrollo de instrumental de menor tamaño nace la minilaparoscopia, buscando reducir el trauma abdominal y mejorar la cosmética de las cicatrices, obteniendo unos resultados similares o mejores a los logrados en la laparoscopia convencional. Objetivo: El objetivo es evaluar los resultados y la reproducibilidad de la pieloplastia por minilap. Método: Para ello se ha realizado una revisión de la literatura y una búsqueda bibliográfica en PubMed. Describimos la técnica quirúrgica realizada en el Hospital Universitario Marqués de Valdecilla, Santander (HUMV). Resultados: se encontraron más de 60 artículos que hacían referencia a la minilaparoscopia. Aunque a día de hoy son escasas las series reportadas de pieloplastia por minilap, estas ofrecen unos resultados excelentes. Analizamos los datos de tiempo quirúrgico, complicaciones, estancia hospitalaria, tasa de conversión, resultado funcional y cosmético, comparándolos con la pieloplastia laparoscópica convencional. Conclusiones: Aunque es necesario que se reporten más series, se ha demostrado que la pieloplastia por minilap es una técnica reproducible y segura, que otorga así mismo unos resultados excelentes

Continued progresses in the field of laparoscopy have been introduced in urological surgery. With the development of smaller instrumental minilaparoscopy was born seeking to reduce abdominal trauma and improve cosmetic scars, obtaining similar or better results than conventional laparoscopy. Objective: The objective of this paper is to evaluate the results and reproducibility of mini-laparoscopic pyeloplasty. Methods: A literature review and a bibliographic search in PubMed were performed. We describe the technique used in the "Hospital Marqués de Valdecilla" (HUMV), Santander (Spain). Results: 60 articles about mini-laparoscopy were found. Although there are few reported minilap pyeloplasty series, they offer excellent cosmetic and functional results. We analyze operative time, complications, post-operative hospital stay, conversion rate, functional and cosmetic results, and we compare them with conventional laparoscopic pyeloplasty. Conclusions: More reported series are necessary but it has been proved that minilap pyeloplasty is a reproducible and safe technique with excellent results

Concurrent xanthogranulomatous orchiepididymitis and seminoma in the same testis.

Xanthogranulomatous orchiepididymitis (XGO) is a rare inflammatory and destructive disease of the testis that may simulate testicular malignancy. To the authors' knowledge only 19 cases of XGO have been previously reported. Herein is reported the case of a 52-year-old man with XGO who presented with a left testicular mass and pyogenic discharge from the scrotum. Ultrasound examination indicated heterogeneous testicular areas suggestive of neoplasia. Testicular tumor markers were normal. Orchidectomy was performed and histopathology showed XGO and a concurrent, occult typical seminoma. As far as the authors know the coincidence of these two lesions has not been documented previously. XGO may mimic testicular malignancy and may coexist with it. Pathologists should be aware of this concurrence of lesions to avoid potential misdiagnosis. Wide sampling of the orchidectomy specimens with XGO is mandatory to exclude an occult seminoma.

[Mondor's disease vs. sclerosing lymphangitis of the penis]. / Enfermedad de Mondor versus linfangitis esclerosante de pene.

OBJECTIVE: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. METHOD: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. RESULTS: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. CONCLUSIONS: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence.

Enfermedad de Mondor versus linfangitis esclerosante de pene / Mondor´s disease vs. sclerosing lymphangitis of the penis

Objetivo: Resaltar la diferencia entre Enfermedad de Mondor y Linfangitis Esclerosante del Pene mediante el análisis de tres casos clínicos y la revisión de la literatura existente. Métodos: Describimos dos casos clínicos compatibles con el diagnóstico de enfermedad de Mondor y otro compatible con Linfangitis. Resultado: La buena y muchas veces espontánea resolución de estas dos patologías dificulta el diagnóstico y seguimiento de estos pacientes. Conclusiones: La abstinencia sexual es una de las medidas más efectiva para la pronta resolución de ambos procesos. Para el diagnóstico diferencial entre ambas entidades es de gran utilidad el eco-doppler peneano. El tratamiento farmacológico principal se basa en antiinflamatorios (AU)

Objective: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. Method: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. Results: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. Conclusions: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence (AU)

[Testicular seminoma in a patient with Kartagener's syndrome]. / Seminoma en paciente con Síndrome de Kartagener.

OBJECTIVE: To present the association between Seminoma and Kartagener's Syndrome (KS), and its relation with infertility. METHODS: We report one case of Seminoma in a patient with Kartagener's Syndrome, focussing on the possible relation between both pathologies and fertility. Bibliographic references are discussed. RESULTS: Orchyectomy was performed on a patient with Kartagener's Syndrome and testicular tumour. The pathology result was Seminoma. Azoospermia was obtained twice in the post operative espermiogram, not being easy to establish the implication of each pathology (KS or Seminoma) in infertility. CONCLUSIONS: A patient with KS and Seminoma plus azoospermia is reported, with a great outcome from the oncological point of view. Bibliographic references are described. The association between KS and Seminoma is exceptional in the literature.