Basaloid carcinoma of the prostate: an extremely rare tumor.

OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature. METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA)of 0,924 ng /ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed. RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34ßE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence. CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis.

Robot assisted partial nephrectomy (Da Vinci) in an angiomyolipoma associated to Wünderlich Syndrome.

OBJECTIVE: To describe a case of renal angiomyolipoma treated by robotic assisted surgery. METHOD AND RESULTS: We report the case of a 26 year old females patient, in the context of third month pregnancy, who was diagnosed of spontaneous self-limited retroperitoneal hemorrhage due to renal angiomyolipoma. The patient was treated conservatively until normal delivery. At the 3rd month postpartum a robot-assisted (Da Vinci S) nephron sparing surgery (partial nephrectomy) was performed. CONCLUSION: Despite being a benign tumor, there are cases in which the renal angiomyolipoma requires surgical treatment. To our knowledge, after a thorough review of the literature, this would be the first reported case of angiomyolipoma treated with conservative surgery with robotic assistance (Da Vinci S-HD).

Mixed epithelial and stromal tumor of the kidney (MEST).

OBJECTIVE: To report an unusual case of renal tumor and review the literature. METHODS: We present a 20 years old female with a history of acute right pyelonephritis. The ultrasound study revealed a tumor-like image in the lower pole of the right kidney . The CT-scan showed a mixed solid and cystic mass of 7 cm. in the lower pole of the right kidney. RESULTS: A right laparoscopic partial nephrectomy was performed. The total operative time was 90 minutes, with 24 minutes of warm ischemia. The estimated blood loss was 50 ml. and the length of stay (LOS) 36 hours. The pathology findings confirm a mixed epithelial and stromal tumor (MEST) of the kidney. CONCLUSION: Mixed epithelial and stromal tumor (MEST) of the kidney is a benign and rare condition that doesn't show a clear difference with other renal tumors in image studies. Nephron-sparing surgery with margin study is the standard treatment when is feasible.

Ureteral inverted papilloma: laparoscopic distal ureterectomy and boari flap.

OBJECTIVE: To report a case of ureteral inverted papilloma (IP) with laparoscopic resolution. METHODS: We report the case of a 30-year-old male patient who consulted for asymptomatic hematuria with the radiological finding of a filling defect at the distal right ureter. Ureteroscopy biopsy was not diagnostic, so laparoscopic ureterectomy with a Boari flap technique was performed. The pathology report showed a ureteral inverted papilloma. CONCLUSION: Laparoscopic ureteral replacement by Boari flap is a safe surgical alternative for defects in the distal ureter with the advantages of a minimally invasive procedure.

Salvage Radical Prostatectomy in Nonmetastatic Castration-Resistant Prostate Cancer.

OBJECTIVE: To analyze the perioperatory and short-oncological outcomes in 5 cases with CRPC M0 developed after pRT that underwent salvage laparoscopic RP (sLRP) and review the current evidence. MATERIAL AND METHODS: Perioperatory and oncological outcomes were prospectively analyzed. Inclusion criteria were patients that had received pRT and posteriorly presented with CRPC M0 in standard imagines and positron emission tomography MRI coline. Evidence was reviewed in PUBMED database. RESULTS: No surgical complications and blood transfusion were reported. Two patients required an endoscopic urethrotomy due to bladder neck contracture (Clavien IIIb). Final pathological findings were T3 or more, multifocal with 3 positive surgical margins. Four patients reach undetectable PSA after surgery except one that continuous under ADT without disease progression. After 12 months follow-up, 4 patients persist with undetectable PSA and one with stable disease under ADT. Current evidence demonstrated that CRPC M0 treated with open, laparoscopic or robotic RP a biochemical recurrence of 68.7% as a hormone-sensitive PC; however, 17.4% were disease-free after 4 years of follow-up. CONCLUSION: Our serie, 4 cases are disease free after 12 months follow-up. Current evidence is a retrospective and multicenter experience with few cases and intermediate oncological follow-up. More cases with longer follow-up and better evidence are required to opt for this treatment as a first line.

Cistytis Glandularis: An Infrequent and Little-Known Tumor. Two Cases Report and Current Evidence.

OBJECTIVE: To report 2 cases of an extremely rare bladder tumor such as Cystitis Glandularis (CG) that were management by different strategies and review the current evidence. MATERIAL AND METHODS: Both cases of 43 and 48 years reported the same lower urinary tract symptoms that simulated a malignant bladder tumor. Case 1 presented with an extensive tumor affecting the trigone and the left upper urinary tract; the second case presented a less extensive tumor also at the bladder trigone. RESULTS: The first patient required two bladder tumor resection and a laparoscopic uretero-vesical reimplantation with adyuvant steroids. The other patient only required one bladder tumor resection without adyuvant treatment. Finally, after 7 and 6 months, both patients do not present tumor recurrence; respectively. CONCLUSION: Cystitis Glandularis (CG) represent an extremely rare tumor. Usually presentation is in young people with predilection at the bladder trigone. Current evidence ruled out being preneoplastic without standardized treatment. Two cases were analyzed with completely different characteristics, but with satisfactory treatment.

Laparoscoscopic synchronous bilateral adrenalectomy.

OBJECTIVES: To report our experience in a series of bilateral synchronous laparoscopic adrenalectomies detailing technique and results. METHODS: A total of 242 laparoscopic adrenalectomies were performed in an 8 year period at our institution. Twenty four out of these were bilateral. Of the 24 patients, 22 (92%) were bilateral and synchronous. Mean patient age was 41.4 years (range 17 to 72 years) and male to female ratio was 1:2.1. RESULTS: Mean adrenal size was 5.5 cm (range 2 to 11 cm). In order of frequency, pathological finding was: pheochromocytoma, cushing`s disease, metastatic lesions, hyperaldosteronism, congenital adrenal hyperplasia, myelolipoma and adrenal adenoma. Complete adrenalectomy was performed in 36 cases (82%) while in 8 cases (18%) partial adrenalectomy was preferred. Mean operative time was 78.6 minutes (range 25 to 210 min) being 79.5 min and 77 min for right and left adrenalectomies respectively. Mean operative bleeding was 63 ml (range 0 to 500 ml). Only one patient received blood transfusion. Intraoperative complications occurred in only one patient (2%), a small tear in the renal vein that was successfully controlled by intracorporeal suturing. Mean hospital stay was 3.2 days (range 2 to 5 days). CONCLUSION: We believe that laparoscopic synchronous bilateral adrenalectomy is a feasible, safe and reproducible technique that should be considered of choice for the management of benign bilateral adrenal pathology.

Changes in prolactin receptor location in prostate tumors. / Cambios en la localización del receptor prolactina en tumores prostáticos.

INTRODUCTION: Prolactin (PRL) binds its receptor (PRLR) and stimulates cell proliferation, differentiation and survival in prostate cancer (PCa) cell lines via STAT5a, MAPK and AKT. OBJECTIVE: To evaluate the expression of PRL and PRLR in normal and tumor prostate tissues with different Gleason patterns. METHODS: Samples of normal, benign prostatic hyperplasia and PCa with different Gleason patterns were selected from radical prostatectomy. The intensity, location and percentage of stained cells for PRL and PRLR were evaluated by Immunohistochemistry. Co-localization was observed by confocal microscopy. RESULTS: PRL was expressed diffusely and with a mild intensity in the cytoplasm of normal and tumor prostate luminal cells. Its expression only augmented in the Gleason 3 pattern (p< 0.0001). The immunostaining intensity and the percentage of positive cells for PRLR did not vary between normal and tumor tissues. However, the location of the PRLR was modified by the tumorigenic process.In non-tumor tissues, PRLR expression was mostly in plasma membrane in the apical zone of epithelial cells. In tumor tissues, it was expressed in intracellular vesicles.The co-localization of PRL and PRLR was demonstrated in normal and tumor tissues suggesting that PRL could be acting in an autocrine and paracrine manner. CONCLUSION: PRL and its receptor were present in the cytoplasm of the epithelial cells of the normal and tumor prostate gland. In tumor tissues, the change in the location and appearance of cryptic PRLRs that store PRL may keep active the different signaling pathways related to cell proliferation and survival.

INTRODUCCIÓN: La prolactina (PRL) se une a su receptor (PRLR) y estimula la proliferación celular, la diferenciación y la supervivencia de la líneas celulares de cáncer de próstata vía STAT5a, MAPK y AKT.OBJETIVO: Evaluar la expresión de la PRL y PRLR en tejido normal y tejido de cáncer de próstata con varios patrones de Gleason.MÉTODOS: Se seleccionaron muestras de tejido benigno, hiperplasia y cáncer de próstata con diferentes patrones de Gleason de prostatectomías radicales. La intensidad, localización y porcentaje de células teñidas por PRL y PRLR fueron evaluadas por immunohistoquimica. La co-localización se observó con microscopio confocal.RESULTADOS: PRL se presentó de forma difusa y con intensidad media en el citoplasma de células luminales normales y de tumor prostático. La expresión solamente aumentó en patrón Gleason 3 (p<0,0001). La intensidad de la tinción immunohistoquímica y el porcentaje de células positivas para PRLR no varió entre células normales y tejidos tumorales. Pero, la localización del PRLR fue modificada por el proceso generador del tumor. En tejidos no-tumorales, la expresión de PRLR fue sobre todo en la membrana plasmática en la zona apical de las células epiteliales. En tejidos tumorales, se presentó en las vesículas intracelulares. La co-localizacion de la PRL y PRLR se demostró en tejido normal y tumoral sugeriendo que la PRL funciona con un efecto autocrino y paracrino.CONCLUSIÓN: La PRL y su receptor estuvieron presentes en el citoplasma de células epiteliales de tejido normal y glándula prostática tumoral. En tejidos tumorales, el cambio de localización y la apariencia cripticas del PRLR que guarda la PRL debe mantener activos los diferentes caminos de señalización relacionados con la proliferación celular y la supervivencia.

Retrograde intrarenal surgery as a tool for lithiasis management in renal anomalies. Four cases description. / Cirugía retrógrada intrarrenal como herramienta para el manejo de la litiasis en anomalías renales: aportación con cuatro casos.

OBJECTIVE: The management of stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy. MATERIAL AND METHODS: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystickidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age andgender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification. RESULTS: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hour safter surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II). CONCLUSION: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decision making.

OBJETIVO: El manejo de la litiasis en anomalías renales es un desafío para el urólogo debido a su infrecuencia; motivo por el cual, el objetivo es presentar nuestra experiencia en Cirugía Retrógrada Intrarrenal (RIRS) en 4 casos con el uso del videoureterorrenoscopio flexible.MATERIAL Y MÉTODOS: Analizamos retrospectivamente la base de datos de las primeras 100 RIRS por litiasis desde la incorporación del videoureterorrenoscopio flexible (FLEX-X 8.4 Fr-STORZ®). Un total de 4 (4%) pacientes presentaban una anomalía renal asociada;un riñón en herradura, un riñón poliquístico, una ectopía renal cruzada fusionada y un divertículo calicial. Las variables analizadas fueron; demográficas (edad y género); tamaño de la litiasis, tratamientos previos, presentación clínica, tasa libre de litiasis y tasa de complicaciones perioperatorias según la clasificación Dindo-Clavien. RESULTADOS: Entre febrero 2017- marzo del 2018, 4 (4%) pacientes presentaban litiasis asociada a alguna malformación renal. Todos los procedimientos fueron ambulatorios y las litiasis accesibles a la deflexión del endoscopio a pesar de la malformación. La edad promedio fue de 56 años (43 a 65 años) siendo 3 hombres y 1 mujeres. El tamaño medio de la litiasis fue de 16,25 milímetros (6 a 23 mm). Todos los pacientes habían sido tratados previamente con Litotricia Extracopórea por Ondas de Choque (LEOC) y, el paciente con ectopía renal cruzada, mediante un abordaje percutáneo sin éxito. El tiempo promedio de cirugía fue de 57 minutos (43 a 79 minutos) siendo la tasa libre de litiasis del 100%. Como complicaciones, un paciente presentó dolor lumbar a las 48 horas de la cirugía que no cedió con analgésicos vía oral requiriendo tratamiento endovenoso aunque sin hospitalización (Clavien II).CONCLUSIÓN: La cirugía retrógrada intrarrenal es factible, segura y efectiva para el manejo de la litiasis en anomalías renales. No obstante, se necesitan mayor número de casos y estudios comparativos con la litotricia percutánea y extracorpórea como para optarlo como tratamiento de primera línea y no como alternativa a los anteriores.

[Management of lithiasis associated with intrarrenal stenosis using the flexible videoureteroroscope.] / Manejo de la litiasis asociada a estenosis intrarrenales mediante el uso del videoureterorrenoscopio flexible.

OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard. METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were less than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%. CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of less perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery.

OBJETIVO: Reportar dos casos de estenosis intrarrenales asociado a litiasis manejados con el videoureterrenoscopio flexible (STORZ) y el láser de Holmium (CALCULASE II) como herramienta tecnológica y moderna.MATERIAL Y MÉTODOS: El caso 1 presentaba un divertículo calicial el cual fue tratado mediante la incisión del ostium diverticular con láser y posterior tratamiento de la litiasis. El segundo caso presentaba una estenosis del ostium caliceal secundario a una cirugía percutánea previa pudiendo acceder al cáliz mediante la dilatación del mismo. RESULTADOS: El tiempo quirúrgico fue de 60 y 82 minutos para el caso 1 y 2, con una estancia hospitalaria de 8 horas y sin complicaciones perioperatorias. La tasa libre de enfermedad fue del 100%. CONCLUSIONES: El videoureterorrenoscopio flexible y laser de Holmium para el manejo de las estenosis intrarrenales es altamente efectivo y seguro con las ventajas de presentar menos complicaciones perioperatorias, menos invasividad y ser ambulatorio comparado con la cirugía percutánea.

Human renal adipose tissue induces the invasion and progression of renal cell carcinoma.

We evaluated the effects of conditioned media (CMs) of human adipose tissue from renal cell carcinoma located near the tumor (hRATnT) or farther away from the tumor (hRATfT), on proliferation, adhesion and migration of tumor (786-O and ACHN) and non-tumor (HK-2) human renal epithelial cell lines. Human adipose tissues were obtained from patients with renal cell carcinoma (RCC) and CMs from hRATnT and hRATfT incubation. Proliferation, adhesion and migration were quantified in 786-O, ACHN and HK-2 cell lines incubated with hRATnT-, hRATfT- or control-CMs. We evaluated versican, adiponectin and leptin expression in CMs from hRATnT and hRATfT. We evaluated AdipoR1/2, ObR, pERK, pAkt y pPI3K expression on cell lines incubated with CMs. No differences in proliferation of cell lines was found after 24 h of treatment with CMs. All cell lines showed a significant decrease in cell adhesion and increase in cell migration after incubation with hRATnT-CMs vs. hRATfT- or control-CMs. hRATnT-CMs showed increased levels of versican and leptin, compared to hRATfT-CMs. AdipoR2 in 786-O and ACHN cells decreased significantly after incubation with hRATfT- and hRATnT-CMs vs. control-CMs. We observed a decrease in the expression of pAkt in HK-2, 786-O and ACHN incubated with hRATnT-CMs. This result could partially explain the observed changes in migration and cell adhesion. We conclude that hRATnT released factors, such as leptin and versican, could enhance the invasive potential of renal epithelial cell lines and could modulate the progression of the disease.

[Testosterone replacement therapy and prostate cancer: the downfall of a paradigm?]. / Terapia de reemplazo con testosterona y cáncer de próstata: ¿la caída de un paradigma?

For six decades, it has been a part of the conventional medical wisdom that higher levels of testosterone increase the risk of prostate cancer. This belief is mostly derived from the well-documented regression of prostate cancer after surgical or pharmacological castration. However, there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer. Moreover, men with hypogonadism have substantial rates of prostate cancer in prostatic biopsies, suggesting that low testosterone has no protective effect against the development of prostate cancer. Moreover, prostate cancer rate is higher in elderly patients when hormonal levels are low. These results argue against an increased risk of prostate cancer with testosterone replacement therapy.

Por casi seis décadas ha sido parte de la cultura médica en general, que los niveles altos de testosterona incrementan el riesgo de padecer o agravar un cáncer de próstata. Esta creencia se ha derivado fundamentalmente de la bien documentada regresión del cáncer de próstata luego de la castración médica o quirúrgica. Sin embargo, no existe evidencia científica que apoye la idea de que niveles altos de testosterona están asociados con un incremento del riesgo de cáncer de próstata. Más aún, los hombres con hipogonadismo tienen una tasa substancialmente alta de cáncer de próstata detectado por biopsia, lo que sugiere que los niveles bajos de testosterona no tienen un efecto protector en el desarrollo de cáncer de próstata y, además, la tasa de cáncer de próstata es más alta en los pacientes de edades avanzadas cuando sus niveles hormonales son más bajos. Estos argumentos tienden a demostrar que no existiría un incremento del riesgo de padecer un cáncer de próstata asociado a la terapia de reemplazo con testosterona.

Cirugía intrarrenal retrógrada para el tratamiento de litiasis renal. Experiencia de 63 casos en un centro ambulatorio / Retrograde Intrarenal Surgery for the Treatment of Renal Lithiasis. An Experience in 63 Cases in an Ambulatory Center

Objetivos: El objetivo del estudio fue evaluar nuestra experiencia inicial en cirugía intrarrenal retrógrada para el tratamiento de litiasis renales y determinar si es una cirugía eficaz y segura para realizarse en un centro ambulatorio. Materiales y métodos: Se evaluó a todos los pacientes sometidos a ureterorrenoscopia flexible con láser Holmium en la Clínica Andina de Urología luego de un año de procedimientos. Se determinaron datos demográficos, características de las litiasis operadas, porcentaje libre de litiasis y complicaciones según escala modificada de Clavien. Resultados: Un total de 63 pacientes fueron intervenidos desde marzo de 2017 a marzo de 2018. El tamaño medio de las litiasis urinarias fue de 11,6 mm. En un 93,6% de los pacientes la cirugía se pudo completar sin inconvenientes con un tiempo medio de 44 minutos. El porcentaje global libre de litiasis fue del 76,19%. Un 17,4% tuvo complicaciones generales, sin embargo, solo 2 pacientes requirieron reinternación. Conclusiones: La ureterorrenoscopia flexible es una cirugía mínimamente invasiva, eficaz y segura, con un bajo índice de complicaciones (AU)

Objectives: The aim of this study was to evaluate our initial experience in retrograde intrarenal surgery for the treatment of renal lithiasis and determinate if the surgery is effective and safe to be practice in an ambulatory center. Materials and methods: We recorded all patients who underwent flexible ureterorenoscopy and laser Holmium at Clínica Andina de Urología after one year of surgeries. Demographic information, stones characteristics, stone free rate and complication using Clavien system were gathered. Results: A total of 63 patients underwent flexible ureterorenoscopy from March 2017 to March 2018. Mean stone diameter was 11.6 mm. Surgery was complete in 93.6% of patients with a mean operative time of 44 minutes. Stone free rate was 76.19%. The overall complication rate was 17.4%, nevertheless, only 2 patients were readmitted. Conclusions: IFlexible ureterorenoscopy is a minimally invasive procedure, effective and safe, with a low rate of complications. (AU)

Salvage Radical Prostatectomy in Nonmetastatic Castration-Resistant Prostate Cancer

Objective: To analyze the perioperatory and short-oncological outcomes in 5 cases with CRPC M0 developed after pRT that underwent salvage laparoscopic RP (sLRP) and review the current evidence. Material and Methods: Perioperatory and oncological outcomes were prospectively analyzed. Inclusion criteria were patients that had received pRT and posteriorly presented with CRPC M0 in standard imagines and positron emission tomography MRI coline. Evidence was reviewed in PUBMED database. Results: No surgical complications and blood transfusion were reported. Two patients required an endoscopic urethrotomy due to bladder neck contracture (Clavien IIIb). Final pathological findings were T3 or more, multifocal with 3 positive surgical margins. Four patients reach undetectable PSA after surgery except one that continuous under ADT without disease progression. After 12 months follow-up, 4 patients persist with undetectable PSA and one with stable disease under ADT. Current evidence demonstrated that CRPC M0 treated with open, laparoscopic or robotic RP a biochemical recurrence of 68.7% as a hormone-sensitive PC; however, 17.4% were disease-free after 4 years of follow-up. Conclusion: Our serie, 4 cases are disease free after 12 months follow-up. Current evidence is a retrospective and multicenter experience with few cases and intermediate oncological follow-up. More cases with longer follow-up and better evidence are required to opt for this treatment as a first line (AU)

Cistytis Glandularis: An Infrequent and Little-Known Tumor. Two Cases Report and Current Evidence

Objective: To report 2 cases of an extremely rare bladder tumor such as Cystitis Glandularis (CG) that were management by different strategies and review the current evidence. Material and Methods: Both cases of 43 and 48 years reported the same lower urinary tract symptoms that simulated a malignant bladder tumor. Case 1 presented with an extensive tumor affecting the trigone and the left upper urinary tract; the second case presented a less extensive tumor also at the bladder trigone. Results: The first patient required two bladder tumor resection and a laparoscopic uretero-vesical reimplantation with adyuvant steroids. The other patient only required one bladder tumor resection without adyuvant treatment. Finally, after 7 and 6 months, both patients do not present tumor recurrence; respectively. Conclusion: Cystitis Glandularis (CG) represent an extremely rare tumor. Usually presentation is in young people with predilection at the bladder trigone. Current evidence ruled out being preneoplastic without standardized treatment. Two cases were analyzed with completely different characteristics, but with satisfactory treatment (AU)

Changes in prolactin receptor location in prostate tumors / Cambios en la ubicación del receptor de prolactina en tumores de próstata

Introduction: Prolactin (PRL) binds its receptor (PRLR) and stimulates cell proliferation, differentiation and survival in prostate cancer (PCa) cell lines via STAT5a, MAPK and AKT. Objetive: To evaluate the expression of PRL and PRLR in normal and tumor prostate tissues with different Gleason patterns. Methos: Samples of normal, benign prostatic hyperplasia and PCa with different Gleason patterns were selected from radical prostatectomy. The intensity, location and percentage of stained cells for PRL and PRLR were evaluated by Immunohistochemistry. Co-localization was observed by confocal microscopy. Results: PRL was expressed diffusely and with a mild intensity in the cytoplasm of normal and tumor prostate luminal cells. Its expression only augmented in the Gleason 3 pattern (p 0.0001). The immunostaining intensity and the percentage of positive cells for PRLR did not vary between normal and tumor tissues. However, the location of the PRLR was modified by the tumorigenic process. In non-tumor tissues, PRLR expression was mostly in plasma membrane in the apical zone of epithelial cells. In tumor tissues, it was expressed in intracellular vesicles. The co-localization of PRL and PRLR was demonstrated in normal and tumor tissues suggesting that PRL could be acting in an autocrine and paracrine manner. Conclusion: PRL and its receptor were present in the cytoplasm of the epithelial cells of the normal and tumor prostate gland. In tumor tissues, the change in the location and appearance of cryptic PRLRs that store PRL may keep active the different signaling pathways related to cell proliferation and survival.(AU)

Introducción: La prolactina (PRL) se une a su receptor (PRLR) y estimula la proliferación celular, la diferenciación y la supervivencia de la líneas celulares de cáncer de próstata vía STAT5a, MAPK y AKT. Objetivo: Evaluar la expresión de la PRL y PRLR en tejido normal y tejido de cáncer de próstata con varios patrones de Gleason.MÉTODOS: Se seleccionaron muestras de tejido benigno, hiperplasia y cáncer de próstata con diferentes patrones de Gleason de prostatectomías radicales. La intensidad, localización y porcentaje de células teñidas por PRL y PRLR fueron evaluadas por immunohistoquimica. La co-localización se observó con microscopioconfocal. Resultados: PRL se presentó de forma difusa y con intensidad media en el citoplasma de células luminales normales y de tumor prostático. La expresión solamente aumentó en patrón Gleason 3 (p<0,0001). La intensidad de la tinción immunohistoquímica y el porcentajede células positivas para PRLR no varió entre células normales y tejidos tumorales. Pero, la localización del PRLR fue modificada por el proceso generador del tumor. En tejidos no-tumorales, la expresión de PRLR fue sobre todo en la membrana plasmática en la zona apical de las células epiteliales. En tejidos tumorales, se presentó en las vesículas intracelulares. La co-localizacion de la PRL y PRLR se demostró en tejido normal y tumoral sugeriendo que la PRL funciona con un efecto autocrino y paracrino. Conclusión: La PRL y su receptor estuvieron presentes en el citoplasma de células epiteliales de tejido normal y glándula prostática tumoral. En tejidos tumorales, el cambio de localización y la apariencia cripticas del PRLR que guarda la PRL debe mantener activos los diferentes caminos de señalización relacionados con laproliferación celular y la supervivencia.(AU)

Cirugía retrógrada intrarrenal como herramienta para el manejo de la litiasis en anomalías renales: aportación con cuatro casos / Retrograde intrarenal surgery as a tool for lithiasis management in renal anomalies. Four cases description

OBJETIVO: El manejo de la litiasis en anomalías renales es un desafío para el urólogo debido a su infrecuencia; motivo por el cual, el objetivo es presentar nuestra experiencia en Cirugía Retrógrada Intrarrenal (RIRS) en 4 casos con el uso del videoureterorrenoscopio flexible. MATERIAL Y MÉTODOS: Analizamos retrospectivamente la base de datos de las primeras 100 RIRS por litiasis desde la incorporación del videoureterorrenoscopio flexible (FLEX-X 8.4 Fr-STORZ®). Un total de 4 (4%) pacientes presentaban una anomalía renal asociada;un riñón en herradura, un riñón poliquístico, una ectopía renal cruzada fusionada y un divertículo calicial. Las variables analizadas fueron; demográficas (edad y género); tamaño de la litiasis, tratamientos previos, presentación clínica, tasa libre de litiasis y tasa de complicaciones perioperatorias según la clasificación Dindo-Clavien. RESULTADOS: Entre febrero 2017- marzo del 2018, 4 (4%) pacientes presentaban litiasis asociada a alguna malformación renal. Todos los procedimientos fueron ambulatorios y las litiasis accesibles a la deflexión del endoscopio a pesar de la malformación. La edad promedio fue de 56 años (43 a 65 años) siendo 3 hombres y 1 mujeres. El tamaño medio de la litiasis fue de 16,25 milímetros (6 a 23 mm). Todos los pacientes habían sido tratados previamente con Litotricia Extracopórea por Ondas de Choque (LEOC) y, el paciente con ectopía renal cruzada, mediante un abordaje percutáneo sin éxito. El tiempo promedio de cirugía fue de 57 minutos (43 a 79 minutos) siendo la tasa libre de litiasis del 100%. Como complicaciones, un paciente presentó dolor lumbar a las 48 horas de la cirugía que no cedió con analgésicos vía oral requiriendo tratamiento endovenoso aunque sin hospitalización (Clavien II). CONCLUSIÓN: La cirugía retrógrada intrarrenal es factible, segura y efectiva para el manejo de la litiasis en anomalías renales. No obstante, se necesitan mayor número de casos y estudios comparativos con la litotricia percutánea y extracorpórea como para optarlo como tratamiento de primera línea y no como alternativa a los anteriores

OBJECTIVE: The management of Stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy. MATERIAL AND METHODS: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017 and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystic kidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age and gender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification. RESULTS: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average Stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hours after surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II). CONCLUSION: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decisión making

Manejo de la litiasis asociada a estenosis intrarrenales mediante el uso del videoureterorrenoscopio flexible / Management of lithiasis associated with intrarrenal stenosis using the flexible videoureteroroscope

OBJETIVO: Reportar dos casos de estenosis intrarrenales asociado a litiasis manejados con el videoureterrenoscopio flexible (STORZ) y el láser de Holmium (CALCULASE II) como herramienta tecnológica y moderna. MATERIAL Y MÉTODOS: El caso 1 presentaba un divertículo calicial el cual fue tratado mediante la incisión del ostium diverticular con láser y posterior tratamiento de la litiasis. El segundo caso presentaba una estenosis del ostium caliceal secundario a una cirugía percutánea previa pudiendo acceder al cáliz mediante la dilatación del mismo. RESULTADOS: El tiempo quirúrgico fue de 60 y 82 minutos para el caso 1 y 2, con una estancia hospitalaria de 8 horas y sin complicaciones perioperatorias. La tasa libre de enfermedad fue del 100%. CONCLUSIONES: El videoureterorrenoscopio flexible y laser de Holmium para el manejo de las estenosis intrarrenales es altamente efectivo y seguro con las ventajas de presentar menos complicaciones perioperatorias, menos invasividad y ser ambulatorio comparado con la cirugía percutánea

OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard. METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to Access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were les than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%. CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of les perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery

Cirugía laparoscópica de la fístula vesico-vaginal: resultados de una experiencia multi-institucional / Laparoscopic surgery of vesicovaginal fistula: results of a multi institutional experience

Introduction: vesico-vaginal fistula is a rare complication of gynecologic surgery, with a high rate of surgical resolution O'Conor open technique. Aim: to report the results of a multi-institutional experience in laparoscopic repair of vesico-vaginal fistula. Material and Methods: between january 2006 and june 2011, 21 laparoscopic vesico-vaginal fistula were performed. The surgical technique, demographic variables and results are described. Results: the mean age was 45.6 years. The average time between the diagnosis of the fistula and the laparoscopic repair was 15.23 months. The mean total operative time (bladder and laparoscopic) was 153.12 minutes and the average hospital stay was 2.7 days. The average time of bladder catheter was 9.4 days. There was a minimal recurrence of a fistula, repaired by a vaginal approach. Urethrocystography revealed indemnity of the repair in the other 20 cases. The overall success rate was 95.2 percent (20 out of 21 patients) Conclusions: the laparoscopic approach follows all principles for repair of a vesico-vaginal fistulas. It look like a good alternative in the hands of experienced surgeons.

Introducción: la fístula vesico-vaginal es una complicación infrecuente de la cirugía ginecológica, con alta tasa de resolución quirúrgica con la técnica abierta tradicional de O'Conor. Objetivo: comunicar los resultados de una experiencia multi-institucional en la reparación laparoscópica de las fístulas vesico-vaginales. Material y Método: entre enero de 2006 y junio de 2011 se realizaron 21 reparaciones de fístulas vesico-vaginales por vía laparoscópica. Se describe la técnica quirúrgica y se analizan las variables demográficas, quirúrgicas y resultados de la serie. Resultados: la edad media de las pacientes fue de 45,6 años. El tiempo promedio transcurrido entre el diagnóstico de la fistula y su reparación laparoscópica fue de 15,23 meses. El tiempo quirúrgico medio total (vesical y laparoscópico) fue de 153,12 min y el de hospitalización 2,7 días. El tiempo promedio de catéter uretro-vesical fue de 9,4 días. Hubo una mínima recidiva de una fístula, la cual fue reparada por vía vaginal. El control radiológico mediante cistografía reveló indemnidad de la reparación en el resto de los casos. La tasa global de éxito fue de 95,2 por ciento (20 de 21 pacientes) Conclusiones: el abordaje laparoscópico permite cumplir con todos los principios para la reparación de las fístulas vesico-vaginales. La reducción de la morbilidad y la eficacia del procedimiento, lo transforman en una excelente alternativa en manos de cirujanos experimentados.

Nefrolitotomía percutánea en pacientes con cirugía bariátrica: ¿mayor riesgo de complicación? / Percutaneous nephrolitotomy in bariatric surgery patients. Is there an increased risk of complications

Introduction: To report a patient with a history of bariatric surgery and staghorn calculi of the left kidney, who had a colonic perforation after percutaneous renal surgery. Material and Methods: A 38 years old male patient, with a history of gastric bypass, underwent a left percutaneous nephrolithotomy due to staghorn renal calculi. In the procedure, the colon was incidentally perforated during the percutaneous access. Results: The patient developed a sepsis and fecal material appeared surrounding the nephrostomy tube. A transverse colostomy was performed, with improvement of the sepsis and a spontaneous resolution of the nephro-colonic fistula. Conclusion: Is known that bariatric surgery is associated with the novo urinary lithiasis. Besides, there are anatomical changes in between intraabdominal viscera. Radiological studies and a adequate surgical strategy are fundamental to avoid severe surgical complications in kidney stone disease.

Objetivo: Presentar el caso de un paciente con antecedente de cirugía bariátrica y litiasis renal coraliforme, el cual presentó una perforación colónica luego de una nefrolitectomía percutánea. Material y Métodos: Paciente hombre de 38 años de edad con antecedente de bypass gástrico. Fue sometido a una nefrolitectomía percutánea por litiasis renal izquierda coraliforme, complicada de una perforación colónica no reconocida en forma precoz. Resultados: El paciente evolucionó con cuadro séptico y presencia de material fecaloídeo en la zona de la nefrostomía, por lo que requirió colostomía transversa, con resolución de la complicación séptica y resolución de la fístula nefrocólica. Conclusión: Es sabido que la cirugía bariátrica se asocia a litogénesis urinaria y cambios anatómicos de las relaciones de los órganos abdominales. El estudio radiológico y la adecuada estrategia quirúrgica evitará complicaciones graves en la cirugía de la litiasis renal.