[Foreign body simulating kidney tumour]. / Cuerpo extraño simulando tumor renal.

A six cm kidney tumour is found in a prostate control ultrasonography, in a 70 aged men. A chirurgical remove is indicated the tumour presented a very few separation of the kidney. The kidney was only compressed by the mass which contained a chirurgical gauze inside it from a previous surgery 35 years before.

Cuerpo extraño simulando tumor renal / Foreing body simulating kidney tumour

Un tumor renal de seis cm es encontrado en una ecografía prostática de control. Se indica una exéresis quirúrgica. Dicha tumoración presentó una mínima separación con el riñón. El riñón estaba únicamente comprimido por la masa la cual contenía una gasa quirúrgica en su interior de una cirugía previa hacía 35 años (AU)

A six cm kidney tumour is found in a prostate control ultrasonography, in a 70 aged men. A chirurgical remove is indicated the tumour presented a very few separation of the kidney. The kidney was only compresed by the mass which contained a chirurgical gauze inside it from a previous surgery 35 years before (AU)

[Urinary diversions and bladder enlargements]. / Derivaciones urinarias y ampliaciones vesicales.

Overall review that offers an integrated insight of the importance and repercussions of urinary by-pass and bladder replacement. Over the last decades there has been a growing interest in the possibility of reconstructing the urinary system and there are now an almost infinite number of surgical solutions. The history of the development of using the intestine for by-passes and the reconstruction of the urinary system is described. The secondary metabolic alterations, the possibility of secondary intestinal tumours and the rudiments of ureterointestinal anastomosis are dealt with. Bladder substitution techniques are highlighted, and the vast experience of the Urology Department of Hospital Miguel Servet explained, including criteria and conclusions that help to choose from the many urological surgery alternatives headed by urinary by-pass and bladder complications.

Derivaciones urinarias y ampliaciones vesicales / Urinary diversion and bladder replacement

Revisión de conjunto que ofrece una visión integrada de la trascendencia y repercusión de las derivaciones urinarias y sustituciones vesicales. Las últimas décadas han estado presididas por un interés creciente en las posibilidades de reconstrucción del aparato urinario y la oferta de soluciones quirúrgicas reconstructivas es prácticamente ilimitada. Se aborda progresivamente la evolución histórica de la utilización del intestino en las alternativas de derivación y reconstrucción del aparato urinario, las alteraciones metabólicas secundarias, la eventualidad de patología tumoral intestinal secundaria y los principios quirúrgicos básicos de las anastomosis ureterointestinales. Se destaca las técnicas de sustitución vesical y se aporta una extensa experiencia del Servicio de Urología del Hospital Miguel Servet con criterios y conclusiones que facilitan la elección entre las múltiples alternativas de cirugía urológica presidida por la derivación urinaria y las ampliaciones vesicales (AU)

[Retroiliac ectopic ureter opening to the seminal vesicle]. / Desembocadura de uréter ectópico retroilíaco en vesícula seminal.

OBJECTIVE: To describe a case of right retroiliac ectopic ureter opening into the seminal vesicle, an uncommon congenital malformation. METHODS/RESULTS: This anomaly was diagnosed in a 24-year-old male with recurrent acute right epididymitis based on the clinical, ultrasound and CT findings. Cystoscopy and IVP provided no additional information. Surgical exploration showed right renal agenesis and a retroiliac ectopic ureter opening into a dilated right seminal vesicle. These structures were resected. Patient evolution was satisfactory with no recurrence of the infective episodes. CONCLUSIONS: Diagnosis of this anomaly is based on clinical suspicion and the findings of the diagnostic imaging techniques. Surgical exploration, which is only required in symptomatic patients, will establish the correct diagnosis and treatment.

[Analysis of our series of kidney transplants: urologic complications and survival]. / Análisis de nuestra serie de trasplantes renales: complicaciones urológicas y supervivencia.

PURPOSE: To review our series of 416 renal transplants, with special reference to the surgical complications and their management. METHODS: From June, 1986 to October 1997, we are performed 416 heterotopic renal transplants, harvested from cadavers. Reconstruction of the urinary tract reconstruction was by ureteroneocystostomy in practically all the cases. RESULTS: There were some urological complications in 80 patients (19.2%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.3%), lymphocele (4.3%) and clotting (1.2%). 78.1% of these urological complications were resolved by endourological techniques. Urinary fistula was observed in 12 cases (2.8%). Vascular complications in 22 (6.9%), lithiasis in 5 (1.2%), and eventrations in 11 (2.6%). The treatment of these complications is described. The actuarial survival rates were 87.8% and 77.3% at one and five years respectively for the graft, and 92.4% and 83.5% for the patients. CONCLUSIONS: Our surgical complication rate in patients undergoing renal transplantation was 19.2%. The most common complication was urinary tract obstruction from stenosis (3.3%), lymphocele (4.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourologic techniques. Percutaneous drainage and esclerotherapy of the lymphoceles resolved 66.6% of them. Renal biopsy performed with a 14G needle caused 5 severe hemorrhagic complications. There were no complications when an 18G needle was utilized.

[Analysis of a series of radical prostatectomies]. / Análisis de una serie de prostatectomías radicales.

OBJECTIVE: Radical prostatectomy (RP) is an elective therapeutical procedure for localized prostate cancer. The paper describes the critical analysis of our 10-year series. MATERIAL AND METHODS: A total of 216 RP have been performed between June 1986 and December 1996 (60 of them in the last year); with the purpose of securing a minimum follow-up of 4 months, the 204 procedures performed up to October 1996 were studied. Mean age was 64.9 years and PSA median 10.8 ng/ml. Intraglandular clinical stage was found in 192 cases versus 12 cases extraglandular. Up to the end of 1993 Walsh's technique with erectors' preservation was being used although the poor results obtained with regard to potency as well as the existence of positive borders have compelled us to perform the standard extracapsular technique since beginning of 1994. RESULTS: Mean follow-up in our series has been 29.62 months. Post-operative complications reached 29.9%, anastomosis fistula (21 cases) among the early ones and anastomosis stenosis (16 cases) among the late ones. 82.04% patients have total continence or minimal incontinence, the percentage of obstruction being 3.58%. Total impotence is estimated at 92.77%. One patient (0.49%) died in the immediate post-operative. Understaging was observed in 36.7%. 84 patients had extracapsular disease. Our percentage of positive surgical borders is of around 43.13%. Progression has been seen in 47 of 204 patients (23.03%): 8 local relapses, 12 metastasis, 3 with both conditions and 24 biological progression. Progression has been related to pathological stage, pre-operative PSA and Gleason's sum of the specimen. Difference was statistically significant. Overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8% at 1 and 5 years. CONCLUSIONS: RP is a surgery with minimal mortality but noticeable morbidity (incontinence 14.35%; impotence 92.77%; other complications from surgical technique 29.9%). Our clinical understaging is of around 36.7%. Progression is related to the specimen's pathological stage, and pre-operative PSA and Gleason. Our overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8%.

[Surgical complications in kidney transplantation. Analysis of our series (300 transplantations, 1986-1995)]. / Complicaciones quirúrgicas en el trasplante renal. Análisis de nuestra serie (300 trasplantes, 1986-1995).

OBJECTIVES: To review our series of 300 renal transplants, with special reference to the surgical complications and their management. METHODS: From June, 1986 to August, 1995, we performed 300 heterotopic renal transplants harvested from cadavers. Reconstruction of the urinary tract was by ureteroneocystostomy in practically all of the cases. RESULTS: The overall surgical complication rate was 20.3%. The graft was lost in 2 cases (0.66%). The most common urological complication was obstruction of the urinary tract arising from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Urinary fistula was observed in 9 cases (3%) and lymphocele in 16 (5.3%), which were resolved by percutaneous drainage and sclerotherapy in 81.2% of the cases. Vascular complications were observed in 14 cases (4.6%), lithiasis in 5 (1.66%) and eventration in 6 (2%). The treatment of these complications are described. The actuarial graft and patient survival rates were 90.9% and 84.7% at one and five years, respectively, for the graft and 93.5% and 89% for the patients. CONCLUSIONS: Our surgical complication rate in patients undergoing renal transplantation was 20.3%. The most common complication was urinary tract obstruction from stenosis (3.6%), lymphocele (5.3%) and clotting (1.6%); 78.1% of these obstructive complications were resolved by endourological techniques. Percutaneous drainage of the lymphocele combined with sclerotherapy achieved resolution in 81.2%. Renal biopsy performed with a 14 G needle caused 5 severe hemorrhagic complications. There were no complications when an 18 G needle was utilized.

[Surgical staplers. Urologic surgery with intestines]. / Suturas mecánicas. Cirugía urológica con empleo de intestino.

Since the late 1980s, different reservoirs and bladder substitution techniques have been added to the urological surgical armamentarium. The necessary use of an intestinal segment--generally detubularized--make these surgical procedures complicated and time-consuming. Furthermore, problems are encountered postoperatively due to the important morbidity arising from these procedures. The present article describes our experience with mechanical sutures and resorbable material. Although the results have not been analyzed, our initial experience at the Miguel Servet Hospital has shown that these devices significantly facilitate the operative procedure, thereby reducing the incidence of urinary and intestinal fistulas. Although there is an evident risk of calculi formation, complicated solutions are not required and the biological tolerance to the metal sutures is excellent.

[Renal transplantation: results]. / Trasplante renal: resultados.

Between June 1986 and December 1991, 125 kidneys were transplanted in our hospital. Survival results of patients per annum was 94%, 90% of which represent grafts. Regarding the complications occurred in our series the most frequent ones were medical followed by surgical [urological (4%), vascular (2.4%) and others derived from the surgical procedure (20%)]. It was necessary to perform 5 transplantectomies.

[Current validity of urethroplasty in two stages]. / Vigencia actual de la uretroplastia en dos tiempos.

Review of 18 patients with complex urethral stenosis, who underwent a two-stage urethroplasty in our Unit over the last three years. Clinical results have been favourable in all patients and, from the radiological point of view, there has been only one re-stenosis. Complications rate has been low and can be superimposed to that of any urethroplasty procedure. The paper emphasizes the enormous relevance of the care taken between both surgical stages on the procedure's final result.

[Metastasis in maxillary sinus as presentation form of adenocarcinoma of the prostate]. / Metástasis en seno maxilar como presentación de un adenocarcinoma de próstata.

Presentation of one case of prostate adenocarcinoma its initial clinical manifestation being the appearance of facial tumour secondary to metastatic affectation of left maxillar sinus. After stressing its rarity, the relevance of immunohistochemical studies for the specific prostatic antigen and acid phosphatase in determining the unconnected origin of metastatic lesions is addressed.

[Excretory azoospermia secondary to a cyst of the seminal vesicle]. / Azoospermia excretora secundaria a quiste de vesícula seminal.

A case report of malformation of the right mesonephric ductus, involving a seminal vesicle cyst and ipsilateral renal and ureteral agenesis. The infrequency of such pathology is recalled and the oddity, in our case, of its presentation in the fashion of infertility secondary to excretory azoospermia highlighted. The deferentovesiculography, ultrasound scanning, urography and CAT were highly illustrative in the diagnosis. The treatment of choice in symptomatic cases is surgical exeresis, which in our patient secured the resolution of the azoospermia.

[PSA in the staging and monitoring of cancer of the prostate]. / PSA en el estadiaje y monitorización del cáncer de próstata.

The prostatic surface antigen (PSA), exclusively secreted by the prostatic epithelial cells, can be raised in the sera of patients with various prostatic pathologies. Serum levels of this marker depend on many factors (prostatic manipulation, associated inflammation, volume of benign node hyperplasia, volume and grading of tumour differentiation), all of which will have to be taken into account when interpreting any specific level. The usefulness of this antigen has a distinctive role in the suspected diagnosis, staging and monitoring following treatment of prostate cancer. PSA has shown to be more effective than other markers in the diagnosis of prostate cancer. Following the review of 106 patients with prostate cancer in various clinical stages, PSA was higher in 76.5% and PAP only in 49%. There is also a correlation between PSA and the extension of the disease. Of 43 patients surgically (stages B, C, D1) or radiologically (stages D2) staged, increases PSA has been found in 25% B stages, 77.7% C stages and 88.4% D stages. With regard to post-treatment monitoring, PSA is highly useful to determine its effectiveness, detect any residual illness and predict a recurrence or progression.

[Radical cystectomy for the treatment of infiltrating bladder carcinoma. Analysis of 15 years]. / La cistectomía radical en el tratamiento del carcinoma vesical infiltrante. Análisis de quince años.

Radical cystectomy continues to be the procedure of choice in the treatment of invasive bladder cancer and it is currently an exceptional procedure as monotherapy. The development of surgical techniques for urinary diversion, with less complications, has led to a significant improvement of the overall results achieved with this procedure. We performed a retrospective study of 143 cystectomy procedures that had been performed over a period of 15 years in patients with this tumor type. We evaluated the operative mortality, the morbidity resulting from the procedure, and patient nutritional status and its relation to the appearance of complications. Similarly, we analyzed the different therapeutic strategies we utilized throughout the course of our urological evolution, clearly differentiated into three periods during which we associated radical cystectomy with radiotherapy pre- and post-surgery, neoadjuvant or adjuvant chemotherapy (monotherapy with CDDP or multiple therapy with M-VAC). The operative mortality rate was 0.94% and the incidence of early complications varied according to the different periods, 62% and 32%. Late complications were observed to be 24%. The overall 5-year survival rate was 39% for cystectomy + radiotherapy, 59% when we utilized cisplatin as adjuvant therapy, and 70% (2 years) when we utilized M-VAC neoadjuvant chemotherapy. We believe that distant metastasis was the most common cause of late failures of total cystectomy for infiltrating bladder tumor. Similarly, we believe that the reduced incidence of early complications reported in recent years can be ascribed to the enhanced surgical techniques, better nutritional status of the patient undergoing this procedure, antibiotic therapy, perioperative care, and overall better management and understanding of this disease entity; i. e., the use of a combined therapeutic approach.

[Bladder adenocarcinoma of urachal origin. A rare tumor]. / Adenocarcinoma vesical de orígen uracal. Un raro tumor.

With the description of this new case of urachal adenocarcinoma in the vesical cupula we provide a review on the clinical, pathological and immunohistochemical aspects of this rare tumour, as well as a diagnostic and therapeutical approach. Its subepithelial infiltrant nature delays discovery and denotes both an insidious evolution and poor prognosis. Mucinoid production, nodes pattern and certain immunohistochemical substances as well as abnormalities in the cell's DNA content are attributes of this entity. Only surgery, either partial or exeresis, is effective since this is a radioresistant and dubiously chemosensitive tumour.

[Malignant fibrous histiocytoma of the scrotal wall. Presentation of a case and review of the literature]. / Histiocitoma fibroso maligno de la pared escrotal. Aportación de un caso y revisión de la literatura.

A case of Malignant Fibrous Histiocytoma in a 64 years old man, its rarity consisting in the location, the scrotal wall, is presented. An exposition on this pathological form of presentation, symptomatology, A.P., diagnostic, natural history, prognosis and treatment is made. Also, we review the literature on Malignant Fibrous Histiocytomas on the scrotal wall.

[Metastasizing kidney cancer. Experience with interferon alfa-2a and vinblastine]. / Cáncer metastásico de riñón. Experiencia con interferón alpha-2a y vimblastina.

Management of renal cells carcinoma still remains a therapeutic challenge. Nephrectomy is the primary therapy when the disease has a definite location. In advanced or disseminated cases, the various traditional procedures, including radiotherapy, chemotherapy or hormonal regimes, have obtained poor responses. Survival shows a direct relationship with the biological aggressiveness of the tumour and histological factors. Results recorded in the literature using specific immunotherapeutic agents are encouraging although the real value of this regimes has not yet been established in large series of prospective studies. The Oncology Unit of our Urology Service has obtained optimal follow-up in a group of patients included in a combined protocol of interferon alpha-2a and vinblastine as cytotoxic agent.

[Incoercible hemorrhagic cystitis induced by pelvic radiotherapy and simultaneous treatment with cyclophosphamide]. / Cistitis hemorrágica incoercible inducida por la radioterapia pelviana y tratamiento simultáneo con ciclofosfamida.

We present a case of incoercible hemorrhagic cystitis provoked by the therapeutic association of systemic cyclophosphamide and pelvic radiotherapy in a woman with disseminated mammary carcinoma disease. The conservative treatment, including vesical irrigation with aluminum salts, did not succeed in stopping the bleeding. A "sauvatage" cystectomy was carried out with Bricher-Wallace II type urinary derivation. We conclude by pointing out how the simultaneity of two therapies with individual vesical toxicity risk were boosted and how cystectomy continues to be the definitive treatment once conservative measures have been used up.

[Neoadjuvant chemotherapy (M-VAC) in invasive cancer of the bladder. Our experience]. / Quimioterapia neoadyuvante (M-VAC) en el cáncer invasivo de vejiga. Nuestra experiencia.

Thirty-three patients with locally advanced T2-4NxM0 muscle infiltrating bladder carcinoma were treated with M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) following TUR. Twenty-eight patients were evaluable since 4 had been receiving the foregoing treatment and 1 was being reevaluated after having undergone a partial cystectomy procedure prior to the chemotherapeutic regimen. Eighteen patients underwent radical cystectomy after neoadjuvant chemotherapy, 2 bladders could not be resected, 2 patients refused the procedure and the remaining 6 patients had a functioning bladder. Of the 28 patients, 46.42% (pCR) were pT0 (including the 6 patients with a functioning bladder, and 10.71% (pPR) were down-staged. This represents a pGR of 57.13%. Four of the 18 patients who underwent cystectomy had a higher pathologic stage evidenced by the surgical specimen than the initial finding at TUR indicating that 22.22% had been understaged. Noninvasive diagnostic methods (TUR, cytology, ultrasound, CT...) could not demonstrate the presence of tumor in those patients with preserved bladder. The cRC is similar (46.42%) and the cRP was 7.14%, giving a total cRG of 53.56%. With a mean follow-up of 13.63 months (range 5-36+), 54.54% are alive and disease-free, including the 6 patients with preserved bladder, and 21.21% are alive with locoregional recurrence or distant metastasis. Currently the mortality rate is 9.09%. The correlation of the data gleaned from the clinical response and that of the pathological condition, the possible understaging of the preserved bladders and the outcome in a series with a very short follow-up have as yet to be elucidated.