Advanced prostate cancer survival in Spain according to the Gleason score, age and stage. / Supervivencia del cáncer de próstata avanzado en España según escala de Gleason, edad y estadio.

OBJECTIVES: The aim of this study was to determine the overall and disaggregated survival based on the Gleason score, age and extent of a patient cohort diagnosed with advanced prostate cancer according to standard clinical practice. MATERIAL AND METHOD: We used an observational and retrospective design for the study. For each patient, we recorded clinical variables such as the extent (metastatic or locally advanced), Gleason score, age, date of diagnosis, date of last contact with the health system and the vital status during the last contact. We used univariate and multivariate statistical techniques of survival. The parametric survival methods enabled us to calculate the mean survival using extrapolation. We analysed 219 patients treated in the public health system between 2008 and 2011. The analysis showed statistically significant differences in survival depending on Gleason score, age and stage. The longest survival was in the subgroup younger than 75 years, with a local extent and a low-risk category on the Gleason scale (19.41 years), and the shortest survival (0.97 years) was in the 75 years or older group. The survival of the other subgroups ranged between these outliers. CONCLUSION: The main contribution of this study is that it is the first to calculate the mean survival of advanced prostate cancer in Spain in terms of the variables of our study population. This information helps clinicians predict the life expectancy of each patient according to their prognostic factors.

[Transitional carcinomas of the urinary tract: synchronous and metachronous lesions]. / Carcinomas transicionales del tracto urinario: lesiones sincrónicas y metacrónicas.

OBJECTIVE: The urothelium is a pseudostratified cylindrical epithelium that lines the calices, renal pelvis, urethers, bladder, part of the urethra and part of the prostate ducts. Transitional cell carcinoma (TCC) is a malignant neoplasia that can appear in any site where urothelium is present, being the bladder the most frequently affected organ. We performed an analysis of our experience and conducted a literature-based metanalysis to evaluate the coexistence of tumoral lesions at different locations in the urinary tract. MATERIAL AND METHODS: Between 1983 and 1993, 397 patients with TCC lesions involving the upper urinary tract (UUT), bladder, urethra or prostate, were diagnosed and treated. Coexistence, either synchronic or metachronic, of several lesions in different sites of the urinary tract was considered as a multiple tumor. RESULTS: Overall, 440 tumors were diagnosed in 397 patients. A single lesion appeared in 360 patients, while 37 presented multiple locations with a total of 79 tumors. The lesions were located at the following levels: 17 renal, 21 uretheral, 372 vesical, 13 in the urethra and 17 in the prostate ducts. According to the location, the frequency of single lesions was: UUT 58%, bladder 91%, urethra 8% and prostate ducts 35%. Synchronic UUT and intravesical tract tumors develops in 1% and 4% of patients with bladder TCC, respectively. Two percent of vesical tumors showed metachronic relationship with UUT tumors and the same rate was seen for intravesical lesions. CONCLUSIONS: Urothelial UUT tumors have a typical nosologic entity with specific features. Their coexistence with vesical tumors is frequent. When tumors of the bladder occur after a UUT tumor the interval of highest incidence between diagnoses is 2-3 years, and there are no histological risk factors among them for prognosis. Transitional cell prostatic urethral tumors are most often secondary to histologically similar, poor prognosis, bladder tumors, and usually synchronic.

[Epithelial tumors of the upper urinary tract]. / Tumores epiteliales del tracto urinario superior.

The paper refers to thirteen patients with epithelial tumours of the upper urinary tract, diagnosed and treated at our unit during the last five years and emphasizes the need of early diagnosis, custumorized therapy and close follow-up. Evolution is clearly more favourable in well differentiated and low stage tumours, regardless the type of surgery performed, versus the poor results obtained in infiltrative and undifferentiated cases for which there is no effective treatment available. Results are analyzed based on a brief literature review and considering the short number of cases contributed.

[Renal cholesteatoma: keratin accumulation tumor]. / Colesteatoma renal: tumor por acúmulo de queratina.

Presentation of 6 cases of renal cholesteatoma in 4 male and 2 female patients ranging between 30 and 67 years of age. The most consistent clinical data was a history of relapsing nephritic colic of long-evolution. The average time to diagnose was 19 years. In 50% cases an association to malignant neoplastic pathology was found. The clinical diagnosis was based on the urography and the histopathological examination of the material passed with the urine. Renal exeresis was performed in 5 cases. One was treated in a conservative fashion. Also the etiology causes, diagnostic procedure and other therapeutic possibilities were reviewed.

[Scrotal suspension with hypogastric suture. Hemostatic technique in intrascrotal surgery]. / Suspensión del escroto con sutura a hipogastrio. Técnica hemostática en la cirugía intraescrotal.

Appearance of haemorrhages and bruises after surgery of scrotal bags contents is one of the most frequent complications in Urology. Presentation of results obtained in a prospective study carried out on 86 patients who had underwent surgery due to intrascrotal disease. In all of them and regardless of the approach used (inguinal or scrotal), suspension of bags to hypogastrium using suture traction was performed by Oesterling technique in combination to Joseph and O'Boyle's technique. Drainage was not used in any case. The article explains the characteristics of undergoing pathologies' surgical indications, describing both the technique used and the results obtained. It concludes by stating this is a useful method to prevent routine complications in scrotal surgery.

[Syringocele of Cowper's gland]. / Siringocele de la glándula de Cowper.

The dilatation of the duct of Cowper's gland is known as Cowper's Syringocele, a rarely occurring pathology, usually of a congenital origin. We offer two new cases corresponding to a perforated Syringocele and a non-perforated Syringocele. We analyse the clinical, radiological and therapeutic aspects of this entity.

[Pseudosarcomatous tumor of the bladder]. / Tumor seudosarcomatoso de vejiga.

Pseudosarcomatous tumour of the bladder is a benign neoforming process of uncommon occurrence, consisting in a fibroblastic proliferation originated in the vesical wall and the perivesical fat, with unknown etiology, that given its cellular pleomorphism and the infiltrative nature of the injury can be incorrectly diagnosed as a sarcoma. This paper presents one case of pseudosarcomatous tumour of the bladder in a 9 year-old child, with no history of local traumatism or previous surgery, consisting in a tumoration affecting the vesical wall associated with a significant perivesical fibrosis with extension towards the area of the iliac veasels. Microscopically, the injury shows proliferation of spindle cells, arranged in a myxoid stroma with a prominent vascular net. No cytologic atypia is demonstrated or increase in the number of mitosis. The immunohistochemical study shows features of myofibroblasts in the proliferant cell. A review of the literature is made on 40 cases of inflammatory pseudosarcoma, evaluating the clinical characteristics, morphologic findings and treatment involved, as well as the postoperative evolution of the patient.

[In situ tumor excision of a renal neoplasm]. / Tumorectomía in situ de neoformación renal.

The present work reviews the conservative surgical options to treat renal tumor formation in patients who still have both kidneys, and tries to clarify the diagnostic aspects, indications and therapeutical alternatives. The controversial items are analyzed versus treatments advocating a radical surgical approach, establishing a parallelism with current trends of surgical non-intervention in renal traumatism of moderate to severe condition (grade II). A case is presented where these two pathological circumstances are concurrent: Renal traumatism with complete parenchymatous rexhis and contralateral solid renal mass, both treated conservatively. Pre-surgical diagnosis was left renal traumatism grade II and righ renal neoformation and was based in findings with CAT and arteriographia. Histology of the piece from tumorectomy was renal angiomyolipoma. After a post-surgical evolution of twelve months, therapeutical results were assessed as excellent, with no evidence of either immediate not late complications. Considering data recently communicated by most authors, the concept of simple tumorectomy or renal tumoral enucleation is suggested as valid. However, arguments both clinical and surgical, in order to confirm its indication, require very rigorous criteria and a careful selection of patients.

[Cysts of the seminal vesicles. Diagnosis and treatment]. / Quistes de vesículas seminales. Diagnóstico y tratamiento.

Congenital cysts in the seminal vesicle represent a rare by illustrative example of embryological malformation. They are often associated with ipsilateral urinary tract anomalies. We have analyzed the diagnostic and therapeutic schemes followed in the study of this uncommon pathology.

[Urethral diverticulum in women. Echographic diagnosis]. / Divertículos uretrales femeninos. Diagnóstico por ecografía.

Review of clinical, radiological and ecographical data observed in 11 cases of diverticulum of urethra in women. Mictional cystourethrography was performed to all patients and acography through suprapubic route to 7 of them. The results from the radiological study and ecography findings are discussed; also the differential diagnosis with other masses in the same location.

[Nephrogenic adenoma in urethral diverticulum in women]. / Adenoma nefrogénico en divertículo uretral femenino.

Nephrogenic adenoma is a benign metaplasic lesion of uncertain aetiology. The tenth case of this curious entity in a diverticulum of urethra in women is presented here. The probable factors which intervene in its pathogenesis are discussed in this paper, including a short review of the literature.

[Leiomyoma of female urethra]. / Leiomioma de uretra femenina.

Smooth muscle tumours located in the female urethra represent a pathology that is not observed very often. We offer two new cases and analyse the clinical aspects, differential diagnosis and treatment of this entity.

[Descriptive epidemiology of bladder cancer in the health area 8 in Madrid. Retrospective study on 315 patients]. / Epidemiología descriptiva del cáncer vesical en el area sanitaria 8 de Madrid. Estudio retrospectivo sobre 315 pacientes.

The Madrid Health Care District No. 8 includes 19 town councils located in the South and West of the Autonomous Community. The actual population is 381,052 inhabitants with a floating population of 50,000 people. Currently, Mostoles Hospital is the Referral Health Centre of this district. Between 1983 and 1992, 315 patients received treatment for vesical cancer. Of them, 77% were primarily superficial and 23% infiltrant. 98% were transitional carcinomas. Patient's mean age was 65.9 years, with 83.5% men and 15.5% women. Incidence obtained was 14 x 10(5) inhabitants (23.5 men and 4.6 women). Smoking was the only risk factor statistically significant. Prevalence was 39.3 x 10(5). Actual mortality rate obtained for vesical cancer was 1.3 x 10(5). Comparison of our overall data with national and international statistics show extended consistence except for the mortality rate which was lower than the data consulted.

[Orchiectomy and buserelin in combination with flutamide: comparative results in metastatic prostatic carcinoma]. / Orquiectomía y buserelin asociados a flutamida: resultados comparativos en el carcinoma prostático metastásico.

In a prospective, non-randomized study in 44 patients with metastatic prostate carcinoma (D2), without previous hormone therapy, two alternative therapeutic courses to achieve complete androgenic blockade were compared. A first group (n = 29) was assigned to received Flutamide plus Buserelin, whereas the second group (n = 15) underwent orchidectomy, also in association to Flutamide. Both regimes were sustained without interruption, except when progression was evident, and both achieved castration levels of testosterone plasma titres. Mean follow-up duration was 13 months and 7 days, ranging between 2 and 36 months. There were no significant differences between both groups with regard to therapy objective responses and survival. Whereas the responses (CR + PR + E) were 93% in the LHRH analogues group and 86% in the orchidectomy group, overall survival was 66% and 67%, respectively. There were no secondary complications related to the surgical procedure nor adverse effects to drug therapy which required its cessation.

[Retrovesical pelvic masses: diagnosis]. / Masas pelvianas de localización retrovesical: diagnóstico.

We present two cases of pelvic masses with retrovesical localization: one consisting of a mature cystic teratoma and the other in a ganglionic metastasis of a subclinical prostate adenocarcinoma. We carry out an analysis of the clinical aspects as well as a review of the diagnostic guidelines to be followed in the light of the existence of a neoformation in this location. We analyse the possible differential diagnoses to be established with these tumours, which we should take into consideration despite their rare incidence and form of presentation.

[Alkaline encrusted cystitis: factors affecting prognosis]. / Cistitis incrustada alcalina: factores condicionantes del pronóstico.

Alkaline encrusted cystitis is characterized by the formation of calcareous plaques in the bladder mucosa and submucosa in the presence of several factors: infection by urolithic organisms, earlier pathology of the vesical wall and precipitation of calcium phosphate salts. Treatment includes: urine acidification, correction of the urinary infection and use of acetohydroxamic acid. This paper presents three patients where the response to medical treatment was conditioned by the evolution of the existing vesical impairment. The conclusions state that in the alkaline encrusted cystitis, the concurrent pathology is a major predictor of the disease's future evolution.

[Flow index: a substitute for uroflow nomograms?]. / Indice de flujo: sustituye a los nomogramas de uroflujo?

One hundred and twenty-nine flowmetries from an equal number of male patients with urinary obstructive symptoms have been analyzed, and the data provided by Siroky's nomogram compared to the flow ratios. Flow ratio was considered compatible with obstruction if below 0.80, which in turn correlated to -2 DE in Siroky's nomogram. Agreement between both parameters was noted in 95% cases (p < 0.05). The use of a flow ratio as a substitute for Siroky's nomogram to evaluate urinary obstructive disease would be justified by the easiness of interpretation, since it avoids translation of maximum flow and mean flow data to a plot. Flowmetry should only be considered determinant with clearly obstructive values.

[Extracorporeal lithotripsy for urolithiasis: retrospective study of 227 patients]. / Litotricia extracorpórea por urolitiasis: estudio retrospectivo de 227 pacientes.

Presentation of a retrospective study in 227 lithiasic patients with indication for extracorporeal lithotrity (ESWL) as first line of therapy or as adjuvant treatment, referred to three lithotripter units over the last five years. There was a high percentage of personal history of lithiasis (55.5%), colic pain being the most frequent symptom (78%). Lithiasis largely affected one single renal unit, most often the left one (54.7%) and was solitary in 54.6% of cases. Calyceal and pyelic sites were the most common ones, the size of the stones ranging between 10-19 mm in 44.5% of cases. Overall results reflect a 78.5% success rate, with statistically significant lower occurrence of residual fragments in the right renal unit. There was greater success rates in ureteral calculi followed by calyceal ones and also in the smaller ones compared to those greater than 20 mm. Double-J ureteral catheterism was performed in 27% patients, with evidence of statistical significance between them and those uninstrumented in relation to occurrence of lithiasic trail. An 11% rate of significant complications requiring endourological handling due to obstruction in 7.5%, and open surgery in 3.5% due to complication or lack of resolution was detected.

[Diagnosis and treatment with ureterorenoscopy of ureteral obstruction caused by papillary necrosis]. / Diagnóstico y tratamiento mediante ureterorrenoscopia de la obstrucción ureteral por papila necrosada.

Increasing use of endourological procedures to establish a diagnosis of pyeloureteral lesions detected as a repletion deficiency during urographic study, which when they are obstructive, affect the upper urinary tract. The present report describes the use of ureterorenoscopy as a diagnostic and therapeutic procedure for the ureteral obstruction occurring in a patient with papillary necrosis secondary to analgesics abuse. The papilla was indwelt in the right distal ureter causing obstruction and symptoms of renal colic and septicemia.

[Renal fungal infection: presentation forms and therapeutic advances]. / Infeccion fúngica renal: formas de presentación y avances terapéuticos.

Fluconazole is a broad spectrum anti-fungal agent which combines good tolerance, efficacy and low toxicity, and offers useful advantages in the treatment of certain forms of mycosis. Three cases of renal fungal disease treated with surgery (nephrectomy in two cases and pyelolitectomy plus partial nephrectomy in the third one) and fluconazole or amphotericin B are presented. In all three cases there was at least one predisposing factor (diabetes, urolithiasis, urinary catheter, previous therapy with antibiotics, or AIDS), and the causing pathogens were Candida and Mucor. Administration of fluconazole 100 mg b.i.d. for 4 weeks in the two candida infected patients accomplished a complete cure of the disease. Incidence, etiopathology, presentation forms and diagnostic techniques of urinary mycosis are analyzed together with the current therapeutical options, making special reference to fluconazole.