Cirugía conservadora en el tratamiento de los tumores renales de novo en injertos de trasplante renal / Neprhon sparing surgery for renal tumours on kidney transplantation

Introducción: En la actualidad, la cirugía conservadora para el tratamiento del cáncer renal, obtiene unos buenos resultados oncológicos y funcionales, similares a la cirugía radical, con la ventaja de preservar la función renal. Los tumores renales aparecen de novo en el 4,6% de la población transplantada, en comparación con el 3% de la población general, afectando en menos del 10% al injerto renal. Objetivo: El propósito de este trabajo es analizar la experiencia de nuestro centro y realizar revisión de la literatura, en el tratamiento quirúrgico conservador de los tumores renales de novo en injertos de trasplante renal. Material y método: Se realiza un estudio retrospectivo y descriptivo. Hemos analizado 4 pacientes transplantados renales (0,2%), que presentan tumor renal de novo en el injerto renal y tratados mediante cirugía conservadora, desde 1981 hasta agosto de 2008. Se revisaron los resultados funcionales y oncológicos, en comparación con las series publicadas. Se utiliza software informático SPSS 12.0.ResultadosLa mediana de edad al diagnóstico es 46,5 años (42–62). La mediana de tiempo desde el trasplante hasta el diagnóstico es de 92 meses (42–192m). El tamaño mediano ecográfico es de 2,4cm (1,5–3,5) y el tamaño histológico final es 3,0cm (1,7–3,5). Se realizó cirugía conservadora sobre el injerto renal en todos los casos, en 3 de ellos se realizó tumorectomía y una nefrectomía parcial. Solo un paciente (25%) requirió clampaje del pedículo y solo un paciente se transfundió. La estancia mediana hospitalaria es de 6 días. La anatomía patológica muestra carcinoma de células renales en todos los casos, en estadio pT1aN0M0. La función renal no empeoró con respecto al preoperatorio. Todos los pacientes están libres de recidiva con un tiempo mediano de seguimiento de 46,5 meses (15–58). Dos pacientes han fallecido por causas no relacionadas. Conclusiones: La cirugía conservadora renal puede ser una opción de tratamiento para el tratamiento de tumores del injerto. En nuestra experiencia, es un método seguro, en lesiones de pequeño tamaño, que aporta buenos resultados funcionales y oncológicos (AU)

Introduction: Nowadays, nephron sparing surgery for renal carcinoma achieves good oncological results, similar to radical surgery, with the advantage of preserving renal function. Renal cell carcinomas appear de novo in 4.6% of post-transplant patients compared with 3% of tumors in the general population, affecting less than 10% to renal allograft. Objective: The purpose is to analyze our experience and make a literature review about the role of nephron sparing surgery to treat de novo renal tumours in renal grafts. Material and methods: A retrospective and descriptive analysis has been realized, finding four patients who presented with de novo renal tumours over renal graft after kidney transplantation and treated by nephron sparing surgery. A Medline review is done to search similar series published. Oncological and functional results were reviewed and analyzed. We worked with SPSS 12.0 software. Results: Medium age at diagnosis was 46.5 y (42–62). Medium size was 2.4cm. (1.5–3.5) and final histology showed medium tumours size of 3.0cm. (1.7–3.5). Medium hospital stay was 6.0d. Medium time from transplantation to diagnosis was 92 months (42–192). NSS was done in all cases, in 3 cases tumorectomy and one partial nephrectomy. Transfusion was only needed in one case. All cases had pT1aN0M0 RCC histology exam. Renal function did not change from preoperative. All patients are free of progression with a medium follow-up of 46.5 months (15–58). Conclusions: NSS could be an option to treat graft tumours in selected cases, preserving renal function. In our experience, is a safe and efficient treatment in patients with small de novo renal tumours over renal graft (AU)

[Neprhon sparing surgery for renal tumours on kidney transplantation]. / Cirugía conservadora en el tratamiento de los tumores renales de novo en injertos de trasplante renal.

INTRODUCTION: Nowadays, nephron sparing surgery for renal carcinoma achieves good oncological results, similar to radical surgery, with the advantage of preserving renal function. Renal cell carcinomas appear de novo in 4.6% of post-transplant patients compared with 3% of tumors in the general population, affecting less than 10% to renal allograft. OBJECTIVE: The purpose is to analyze our experience and make a literature review about the role of nephron sparing surgery to treat de novo renal tumours in renal grafts. MATERIAL AND METHODS: A retrospective and descriptive analysis has been realized, finding four patients who presented with de novo renal tumours over renal graft after kidney transplantation and treated by nephron sparing surgery. A Medline review is done to search similar series published. Oncological and functional results were reviewed and analyzed. We worked with SPSS 12.0 software. RESULTS: Medium age at diagnosis was 46.5 y (42-62). Medium size was 2.4cm. (1.5-3.5) and final histology showed medium tumours size of 3.0cm. (1.7-3.5). Medium hospital stay was 6.0d. Medium time from transplantation to diagnosis was 92 months (42-192). NSS was done in all cases, in 3 cases tumorectomy and one partial nephrectomy. Transfusion was only needed in one case. All cases had pT1aN0M0 RCC histology exam. Renal function did not change from preoperative. All patients are free of progression with a medium follow-up of 46.5 months (15-58). CONCLUSIONS: NSS could be an option to treat graft tumours in selected cases, preserving renal function. In our experience, is a safe and efficient treatment in patients with small de novo renal tumours over renal graft.

Divertículo de uretra habitado por litiasis / Diverticulum of the urethra occupied by lithiasis

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Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia / Stress urinary incontinence surgical treatment with suburethral suprapubic sparc sling

Introducción: La incontinencia urinaria de esfuerzo (IUE) presenta una gran morbilidad y una elevada incidencia. Existen múltiples técnicas quirúrgicas descritas para el tratamiento de la misma, con diversos resultados. Los cabestrillos suburetrales se han establecido en los últimos años como un método simple y poco invasivo para el tratamiento de la incontinencia urinaria de esfuerzo. Material y Método: Analizamos retrospectivamente nuestra serie de 86 pacientes diagnosticadas de IUE, intervenidas, entre Octubre de 2001 y Diciembre de 2005, mediante un cabestrillo suburetral suprapúbico (SPARC(C)). Resultados: La media de edad es de 58,7 años (39-80). La estancia media hospitalaria es de 2,43 días (1-8) y la duración media de sonda de 1,52 días (1-10). En el 14,5% de los casos, se realizó cirugía asociada, siendo la más frecuente, la colpoperineoplastia anterior (10,7 %). Las complicaciones son poco frecuentes; perforación vesical (5,8%), RAO antes del alta (7%), ITU (15,3%), RAO crónica (3,5%). En el 3,5% de las mujeres, se realizó lisis del cabestrillo, por retención crónica. El seguimiento medio es de 10,14 meses, encontrándose un 71,4% de continencia total. Un 26,2% de las pacientes presentaron síntomas de hiperactividad de novo, con problemas de incontinencia en el 54,5% de estas. (p<0,002; OR 5.0 (IC 95% 1,75-14,28). Conclusiones: El SPARC© es un método sencillo, con un tiempo hospitalario corto y una rápida reincorporación a la vida social. Los resultados pueden ser valorados rápidamente y con una tasa elevada de éxito. La aparición de urgencia de novo es elevada y empeora los resultados funcionales. Es necesario un mayor seguimiento para valorar resultados funcionales a largo plazo

Introduction: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. Material and method: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). Results: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0,002; OR 5.0 (IC 95% 1.75-14.28). Conclusions: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes

Atrapamiento peneano por anillos metálicos / Penile entrapment by metallic rings

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Masa pélvica y anorquia bilateral / Pelvic mass and bilateral anorchia

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[Vesicoureteral reflux in spinal cord injured patients. Treatment results and statistical analysis]. / Reflujo vesicoureteral en pacientes lesionados medulares. Analisis estadistico de resultados en el tratamiento.

INTRODUCTION: VUR in spinal cord injured patients is cause of important morbidity and mortality. The aim of this paper is to make a statistical, retrospective and descriptive study to analyze VUR treatment results, in neurogenic bladder SCI patients. MATERIAL AND METHOD: We study 40 patients (80 renal units) with VUR in neurogenic bladders and SCI, between March, 1990 and November, 2004. Median age is 43.05 y (9-76). 77.5% of patients are males (3.4:1). Time from injury to VUR is 24.7m (0.2-87). Median follow up is 8.23a (0.5-29). Traumatic lesions are most frequent (70%). Median bladder capacity is 244.9 ml (43-555) and median bladder compliance is 16.12 ml/cm H2O (0.3-61.6). Detrusor overactivity is found in 72.2% and detrusor-sphincter dyssynergia in 71.8%. Initial conservative treatment is done with indwelling catheter and anticholinergics RESULTS: Complete remission was found in 57.5% of RU, descending VUR a 23.7% (66.2% previously to 42.5% after; p<0.02), and predominant in unilateral reflux. Partial response was found in 3.8%, progression in 12.5% and recidiva post CR in 10.9%. Younger patients have better remission rates (39.4 to 47.6 y; p=0.04). Urodinamycs variables don't found any significant differences in treatment results. Endoscopic treatment with bulking agents gets a good response rate (56.3%) (p=0.18). CONCLUSIONS: Initial conservative treatment gets a 23.7% reduction of VUR, especially in men, young and unilateral reflux patients. Anyhow, we observe some progression and recidiva. Detrusor overactivity and detrusor-sphincter dyssynergia didn't influence in treatment results, but they are found in all patients with recidiva. With longer reflux evolution, we observe better responses, but also a higher recidiva rate (p=0.007). Endoscopic bulky injection techniques found out a good response rate (56.3%), also in patients with recidiva after conservative treatment.

Reflujo vesicoureteral en pacientes lesionados medulares. Analisis estadístico de resultados en el tratamiento / Vesicoureteral reflux in spinal cord injured patients. Treatment results and statistical analysis

Introducción: El RVU en pacientes con lesión medular es una causa importante de morbilidad y mortalidad. El objetivo de este trabajo, es realizar un estudio retrospectivo, descriptivo y estadístico que analiza los resultados en el tratamiento del reflujo vesicoureteral, en los pacientes con vejiga neurógena establecida. Material y método: Se estudian 40 pacientes con RVU, secundario a vejiga neurógena por lesión medular, entre marzo/90 y noviembre/04. Se observa RVU en el 66,2% de las UR. La edad media es 43,05a (9-76). El 77,5% son hombres (3,4:1). La evolución desde la lesión medular hasta el diagnóstico del RVU de 24,7 meses (0,2-87m). El tiempo de seguimiento es de 8,23a (0,5- 29). Etiología traumática en el 70%. La capacidad vesical media es de 244,9 ml (43-555ml), la compliance vesical media es de 16,12 ml/cm. H20 (0,3-61,6). La hiperactividad del detrusor se aprecia en 72,2% y la disinergia vesico-esfinteriana externa en 71,8%. El tratamiento inicial es conservador con sondaje vesical y terapia anticolinérgica. Resultados: Curación completa del RVU en el 57,5%, se reduce un 23,7% (66,2% frente 42,5%, p<0,02); predominantes en reflujos unilaterales. Mejoría parcial, con reducción del grado previo en 3,8%. Progresión a grados superiores en 12,5%. Recidivas post-curación completa en 10,9% Los pacientes más jóvenes curan mejor (39,4 frente a 47,6 años, p=0,04). Al analizar las variables urodinámicas, no encontramos diferencias estadísticas. El tratamiento endoscópico consigue una curación del 56.3% (p=0,18). Conclusiones: Con el manejo conservador inicial, se consigue una reducción del reflujo vesicoureteral en el 23,7%, preferentemente en aquellos pacientes con reflujo unilateral, jóvenes (p=0,04) y varones. La presencia o ausencia de hiperactividad o disinergia, no empeora o mejora los resultados, sin embargo se asocia con recidivas. A mayor tiempo de evolución, mejores tasas de curación, pero también mayores recidivas (p=0,007). El tratamiento endoscópico con sustancias abultantes, obtiene una buena tasa de curación (56,3%), incluso en pacientes recidivados después del tratamiento conservador

Introduction: VUR in spinal cord injured patients is cause of important morbidity and mortality. The aim of this paper is to make a statistical, retrospective and descriptive study to analyze VUR treatment results, in neurogenic bladder SCI patients. Material and method: We study 40 patients (80 renal units) with VUR in neurogenic bladders and SCI, between March, 1990 and November, 2004. Median age is 43.05 y (9-76). 77.5% of patients are males (3.4:1). Time from injury to VUR is 24.7m (0.2-87). Median follow up is 8.23a (0.5-29). Traumatic lesions are most frequent (70%). Median bladder capacity is 244.9 ml (43-555) and median bladder compliance is 16.12 ml/cm H20 (0.3-61.6). Detrusor overactivity is found in 72.2% and detrusor-sphincter dyssynergia in 71.8%. Initial conservative treatment is done with indwelling catheter and anticholinergics Results: Complete remission was found in 57.5% of RU, descending VUR a 23.7% (66.2% previously to 42.5% after; p<0.02), and predominant in unilateral reflux. Partial response was found in 3.8%, progression in 12.5% and recidiva post CR in 10.9%. Younger patients have better remission rates (39.4 to 47.6 y; p=0.04). Urodinamycs variables don’t found any significant differences in treatment results. Endoscopic treatment with bulking agents gets a good response rate (56.3%) (p=0.18). Conclusions: Initial conservative treatment gets a 23.7% reduction of VUR, especially in men, young and unilateral reflux patients. Anyhow, we observe some progression and recidiva. Detrusor overactivity and detrusor-sphincter dyssynergia didn’t influence in treatment results, but they are found in all patients with recidiva. With longer reflux evolution, we observe better responses, but also a higher recidiva rate (p=0.007). Endoscopic bulky injection techniques found out a good response rate (56.3%), also in patients with recidiva after conservative treatment

Long-term follow-up study of intraurethral stents in spinal cord injured patients with detrusor-sphincter dyssynergia.

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess in the long-term clinical and urodynamic results of intraurethral stents in a group of patients with spinal cord injury. SETTING: Spinal Cord Injury Unit, Juan Canalejo Hospital, A Coruña, Spain. METHODS: Forty-seven consecutive male patients were studied from 1993 to 2002. All of them suffered from hyperreflexia with detrusor-sphincter dyssynergia (DSD) owing to spinal cord injury, and were treated by means of the placement of an intraurethral stent at the external sphincter. RESULTS: After surgery, significant decreases in all the parameters studied were observed. The number of patients with symptoms of urinary tract infection decreased by 25% (P<0.031). Post-void residual urine volume experienced an average decrease of 224.3 cm(3) (P=0.001). Episodes of dysreflexia decreased from 35.1 to 16.2% (P=0.039). The urodynamic study showed an average reduction of 44.36 cm H(2)O in the maximum detrusor pressure (P<0.0001). Complications in the upper urinary tract descended from 46.8 to 23.4% after placing the stent (P=0.013). The most frequent stent complication was displacement, followed by stenosis, lithiasis and intraprosthetic calcification. In all, 8.5% required the stent removal. CONCLUSIONS: Intraurethral stent is a good choice for the long-term management of DSD in spinal cord-injured patients, even in those who had been previously submitted to prior sphincterotomy. It has the advantage of being a potentially reversible procedure, so patients prefer it to more invasive therapies such as sphincterotomy.

[Stress urinary incontinence surgical treatment with suburethral suprapubic SPARC sling]. / Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia.

INTRODUCTION: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. MATERIAL AND METHOD: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). RESULTS: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0.002; OR 5.0 (IC 95% 1.75-14.28). CONCLUSIONS: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes.

[Renal angiomyolipomatosis and pulmonary lymphangiomyomatosis. Its relationship with Bourneville syndrome]. / Angiolipomatosis renal y linfangioleiomiomatosis, su relación con la enfermedad de Bourneville.

INTRODUCTION: Renal angiomyolipomas are not very frequent in urologic activities. Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. Tuberous sclerosis shows lesions to different organs, including these both entities. MATERIAL AND METHOD: We retrospectively analyze patients treated in our center. Three most representatives cases are reported. An indexed literature review is done, in order to establish a clinical protocol to manage these kinds of patients. RESULTS: [corrected] Between 1990 and 2004, eight patients have been attended with an angiomyolipoma renal diagnostic. Five women (62%) and three men (38%). Medium age is 52,3y (29-69). In 3 of them (all women), it was also done a diagnostic of pulmonary lymphangioleiomyomatosis. CONCLUSIONS: Bourneville syndrome is not very frequent. Associated angiomyolipomas usually are multiple, bilateral, with tender to grow and require more interventions. Previous diagnostic let us prevent future complications with vigilance, selective arterial embolization and nephron-spare surgery. Tumour size and the presence of symptoms are more decisive to decide best therapy alternative. Young patients with pulmonary lymphangioleiomyomatosis should be advise against pregnancy and the use of preparations containing estrogens.

[Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH]. / Estudio clínico-patológico sobre el cancer de próstata incidental en pacientes intervenidos bajo el supuesto diagnóstico de HBP sintomática.

UNLABELLED: OBJECTIVES-INTRODUCTION: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy -APS-, and prostate transurethral resection -RTU-P-) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected. MATERIAL AND METHODS: 1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI. RESULTS: 78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8-30). Gleason average 5 (mean 4.8), rank 3-8. pTla 66%, pTlb 33%. TREATMENT: 57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients). CONCLUSIONS: We didn't observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pTla. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%.

Angiolipomatosis renal y linfangioleiomiomatosis, su relación con la enfermedad de Bourneville / Renal angiomyolipomatosis and pulmonary lymphangiomyomatosis. It´s relationship with bourneville syndrome

Introducción: Los angiomiolipomas renales son poco frecuentes en la actividad urológica. La linfangioleiomiomatosis es una rara enfermedad pulmonar que afecta mayoritariamente a mujeres en edad reproductiva. La Esclerosis Tuberosa afecta a diversos órganos, incluyéndose entre sus presentaciones, estas dos entidades. Material y método: Se revisan de forma retrospectiva los pacientes atendidos en nuestro centro, haciendo referencia a tres casos representativos de la enfermedad. Se expone su manejo clínico y Resultados: Asimismo se realiza una revisión de la literatura indexada, que nos permita establecer un protocolo de actuación. Resultados: Entre 1990 y 2004, han sido atendidos 8 pacientes con angiomiolipoma renal. 5 mujeres (62%) y 3 hombres (38%). La media de edad es de 52,3 años (29-69). En 3 pacientes (todas mujeres) se diagnosticó también linfangioleiomiomatosis. Conclusiones: La enfermedad de Bourneville es poco frecuente. Los angiomiolipomas que se asocian, suelen ser múltiples, bilaterales, tendentes al crecimiento y requieren más intervenciones. El diagnóstico precoz permite prevenir futuras complicaciones mediante vigilancia, embolización arterial selectiva o cirugía conservadora. Es importante el tamaño y la presencia de síntomas para decidir la mejor terapia. Las pacientes jóvenes con linfangioleiomiomatosis pulmonar deben ser advertidas del uso de preparados estrogénicos y evitar embarazos

Introduction: Renal angiomyolipomas are not very frequent in urologic activities. Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. Tuberous sclerosis shows lesions to different organs, including these both entities. Material and method: We retrospectively analyze patients treated in our center. Three most representatives cases are reported. An indexed literature review is done, in order to establish a clinical protocol to manage these kinds of patients. Resultados: Between 1990 and 2004, eight patients have been attended with an angiomyolipoma renal diagnostic. Five women (62%) and three men (38%). Medium age is 52,3 y (29-69). In 3 of them (all women), it was also done a diagnostic of pulmonary lymphangioleiomyomatosis. Conclusions: Bourneville syndrome is not very frequent. Associated angiomyolipomas usually are multiple, bilateral, with tender to grow and require more interventions. Previous diagnostic let us prevent future complications with vigilance, selective arterial embolization and nephron-spare surgery. Tumour size and the presence of symptoms are more decisive to decide best therapy alternative. Young patients with pulmonary lymphangioleiomyomatosis should be advise against pregnancy and the use of preparations containing estrogens

Estudio clínico-patológico sobre el cáncer de próstata incidental en pacientes intervenidos bajo el supuesto diagnóstico de HBP sintomática / Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH

Objetivo-Introducción: Estudio retrospectivo de una serie de pacientes intervenidos mediante adenomectomía prostática suprapúbica (APS) y resección transuretral prostática (RTU-P) bajo el supuesto diagnóstico de HBP sintomática no respondedora al tratamiento médico conservador. Análisis de la prevalencia, incidencia, datos clínico-patológicos, tratamiento, progresión tumoral y evolución de los pacientes con cáncer de próstata incidental (CPI) detectado. Material y métodos: Se revisaron 1.593 pacientes intervenidos durante 6 años consecutivos (1996-2001). APS 35%, RTUP 65%. Revisión de todas las anatomías patológicas de los especimenes quirúrgicos y de las evoluciones de los pacientes con CPI. Resultados: 78 CPI; Prevalencia 4,89%; Incidencia 13 casos/año. Edad media 73,6 años. Tacto rectal normal en todos, PSA medio 6 ng/ml (0,5-30). Grupo APS: 25 CPI (32%); prevalencia 4,55%; incidencia 4 casos/año; PSA medio 7,7 ng/ml (2,8-30); volumen enucleado medio 65 gs. Grupo RTU-P: 53 CPI (68%); prevalencia 5,07%; incidencia 9 casos/año; PSA medio 5,2 ng/ml (0,5-29); volumen resecado medio 20 gs. 22% biopsiados previamente por PSA elevado medio de 14 ng/ml (4,8-30). Mediana de Gleason 5 (media 4,8), rango 3-8. pT1a 66%, pT1b 33%. Tratamiento: 57% seguimiento vigilado sin tratamiento; 18% tratamiento hormonal; 3% finasteride; 9% Prostatectomía Radical; 9% Radioterapia. Pérdidas 4%. Seguimiento medio 47,19 meses (12-96). Progresión tumoral 13,3% (10 pacientes). Mortalidad CPI específica 2,6% (2 pacientes). Conclusiones: No observamos diferencias significativas entre la prevalencia de CPI en los dos grupos (APS y RTU-P). Los tumores detectados fueron mayoritariamente bien diferenciados y en estadio pT1a. En más de la mitad de los casos se decidió una actitud expectante sin tratamiento (57%). 13,3% de progresión tumoral tras 47,19 meses de seguimiento medio y mortalidad CPI específica del 2,6%

Objectives-Introduction: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy –APS-, and prostate transurethral resection -RTU-P- ) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected. Material and methods: 1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI. Results: 78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8- 30). Gleason average 5 (mean 4.8), rank 3-8. pT1a 66%, pT1b 33%. Treatment: 57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients). Conclusions: We didn´t observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pT1a. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%

[Role of nephrectomy in metastatic renal cell carcinoma. Experience of the Department of Urology Juan Canalejo Hospital]. / Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo.

OBJECTIVES: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. MATERIAL AND METHODS: We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. RESULTS: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months. CONCLUSIONS: In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.

Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo / Role of nephrectomy in metastatic renal cell carcinoma. Experience of the department of urology Juan Canalejo Hospital

Objetivos: Presentar nuestra experiencia en la realización de nefrectomía en tumores renales que se presentan con metástasis al diagnóstico, y observar las complicaciones, evolución y supervivencia de estos pacientes. Material y métodos: Realizamos una revisión retrospectiva de los adenocarcinomas renales en el período entre 1-1-1991 y 31-12-2002. Estudiamos solamente los que se presentaron con metástasis (31). Se estudian aquellos pacientes a los que se les practicó nefrectomía y aquellos a los que no se les ofreció tratamiento quirúrgico. Buscamos mostrar las diferencias en los dos grupos en cuanto a status vital (Tabla E.C.O.G.), patología concomitante y supervivencia media. En el grupo de los pacientes nefrectomizados estudiamos las complicaciones derivadas de la intervención y el tratamiento posterior. Resultados: Realizamos nefrectomía en 19 casos. Todos ellos E.C.O.G. 0-1. La estancia post operatoria media fue de12 días, y la tasa de complicaciones 11,5%. El 45% de estos pacientes siguieron algún tipo de tratamiento posterior, y la supervivencia media fue de 31 meses. No se realizó nefrectomía en 12 casos, de los cuales 9 eran E.C.O. G 2-3. La patología asociada que presentaban estos pacientes era más importante que en el primer grupo. Sólo en 3 casos se administró tratamiento con fines paliativos y la supervivencia media fue de 3,8 meses. Conclusiones: En pacientes con buen estado vital la nefrectomía no representa más morbilidad ni mortalidad que en los pacientes sin metástasis, y nos parece una opción fundamental en su manejo. Realizamos una revisión bibliográfica en la que recogemos las últimas tendencias en el tratamiento de estos pacientes, que ponen de manifiesto la necesidad del abordaje combinado quirúrgico e inmunoterápico. Nos parecen de interés fundamental las conclusiones de los estudios del SWOG y del EORTC (AU)

Objectives: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. Material and methods: We performe a retrospective review of renal cell carcinomaes treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to show the diferences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. Results: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some tipe of systemic treatment, and median survival was 31 months. We didn´t performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Asociated comorbidity was higher in this group. Only in three patients any treatment was offerted always with paliative reason. Median survival was 3.8 months. Conclusions: In those patients with good performance status this aproach does not represent more morbility or mortality than in non- metastatic patients, and that is a cornerstone in their management. We also make a literature review in wich we see the last pathways in the management e of these patients, and that show the needing for a conbined approach both quirurgical and inmunotherapical. We have review with special interest the studie’s conclusions of SWOG and EORTC groups (AU)

[Iatrogenic prostatorectal fistula. Use of gracilis muscle pedicled flap for its reparation. Presentation of two cases]. / Fistula prostatorectal yatrogénica. Reparación con colgajo pediculado de músculo gracilis. Presentación de dos casos.

We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cystographic and opaque enema images which shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery.