Self-expanding wallstent endoprosthesis for malignant ureteral obstruction.

We present our experience with the self-expanding Wallstent endoprosthesis for ureteral recanalization in obstructive uropathy secondary to malignant pelvic disease. In total, 19 stents were inserted in 14 ureters. The follow-up included 100% of the patients. To date, except for one case, the patency of the stent has always persisted for the period of the survival of the patients, the longest ones being 4 and 4.1 years.

[Renal carcinoma and acquired cystic disease of the kidney in a patient after transplantation and under hemodialysis]. / Carcinoma renal y enfermedad quística adquirida del riñón en paciente trasplantado y en hemodiálisis.

Renal Acquired Cystic Disease (RACD) is a frequent entity in patients with a long standing renal failure under hemodialysis treatment. Incidence of a tumor pathology is higher in those patients than in the general population. A new case is presented and some possible etiopathologenical factors of RACD and neoplasias on such pathology are established.

[Kidney traumatism. Evaluation using computerized axial tomography]. / Traumatismos renales. Valoración mediante tomografía axial computarizada.

Evaluation of kidney injuries has been controversial for a long time and urography, chiefly, and angiography were the most widely used explorations previously. We have evaluated 21 patients suffering from different degrees of renal injury by means of CAT, in conjunction with other explorations. We diagnosed nine renal contusions, five subcapsular hematomas, laceration with perirenal hematoma in three cases and we detected extravasation of the contrast in five patients. CAT showed itself to be the best method in the study of kidney injuries through giving a clearer anatomic definition of the lesions, whilst also carrying out a functional evaluation of the viscera. Obviously, in severe haemodynamically unstable injuries intraoperative evaluation of the lesions is the best diagnostic and therapeutic method.

[Results of total androgenic blockade for the treatment of disseminated cancer of the prostate]. / Resultados obtenidos con el bloqueo androgénico total en el tratamiento del cáncer de próstata diseminado.

Following Labrie's idea, during the last three and a half years about 35 stage D patients were treated with Total Androgenic Blockade, while Radiotherapy and adjuvant TAB was used in 7 stage C patients. Subjective response rate in stage D was 86%. In 46% of the cases there was some sort of objective response (either partial or complete). After 43 months the actual survival rate is 34%. These results show no improvement from other series, but the inclusion of patients with little life expectancy should be taken into account. Results obtained in stage C, though very few patients were included in the series, were good, and patients currently alive remain free from local and metastatic illness. Since the number of patients was reduced, no conclusion can be drawn. In view of the disease progression, Estracyt was used as a second line therapy. Results have been poor showing some subjective, but no objective, response usually of short duration, in all patients (5 cases) undergoing such therapeutic procedure.

[Clinico-flowmetric analysis of patients being surgically treated for BPH]. / Análisis clínico-flujométrico en pacientes sometidos a tratamiento quirúrgico por H.B.P.

Benign prostatic hypertrophy (BPH) is a common urological disease with a standard surgical approach, transurethral resection (TUR) or open adenectomy (OA), but the flowmetric clinical results are controversial. Fifty-five patients were evaluated; in 23 of them TUR was performed and 32 underwent OA. The Boyarsky clinical questionnaire was filled in, and a flow evaluation conducted prior and subsequent to the procedure to measure maximum and average flow (Qmax and Qave) which was correlated to mictional volume according to Siroky's nomogram. The purpose is to compare the flowmetric clinical results of TUR and OA, and to evaluate flowmetry as a prognostic factor. Correlation of obstructive symptoms and Qmax is low (r = 0.49) and minor for irritative symptoms. Both groups of patients achieve significant clinical improvement (p < 0.001). OA obtains a 248% increase in Qmax, while this figure is 76% with TUR. Patients with post-treatment obstruction after OA are 9.3%, and 26.9% for TUR. Results are better when Qmax prior to surgery is < 5 ml/s than when it is > 10 ml/s.

[Localized renal adenocarcinoma. Prognostic factors and influence of postoperative irradiation on survival]. / Adenocarcinoma renal localizado. Factores de pronóstico e influencias de la irradiación postoperatoria en la supervivencia.

Presentation of our experience and results in the treatment of localized renal adenocarcinoma with radiotherapy supplementary to surgery. The influence of post-operative radiotherapy in the subsequent occurrence of relapse and survival is analyzed. Also, the predictive value in our series of pre-surgery VSG, FA and LDH determinations is analyzed.

[Post-TUR radiotherapy in the treatment of locally advanced bladder tumor]. / Radioterapia post RTU en el tratamiento de tumores vesicales localmente avanzados.

Treatment of infiltrant vesical cancer has traditionally been the grounds for intense controversy. Transurethral resection (TUR) followed by high voltage radiotherapy (RT) in selected cases of locally advanced vesical urothelial tumours can be a valid alternative for the treatment of this condition. This paper discloses the experience of our center in the treatment of this type of tumours over the last few years (1979-1993) on 85 selected patient, with a considerable percentage of living patients and with no evidence of disease after the follow-up period; taking into account the influence on these results of the cytologic grade, tumoral size, gross appearance of the tumour, and tumoral stage. Additionally, these results are compared with those from other authors using similar therapeutic method as well as with the results from different therapeutical approaches, illustrating one more the intense controversy that exists relative to the management of these patients.

[Myasthenia gravis as paraneoplastic syndrome in small cell tumor of the bladder]. / Miastenia gravis como síndrome paraneoplásico en tumor vesical de células pequeñas.

Only 0.48% of vesical tumours are of the small cells epithelial type with positive neuroendocrine immunohistochemical markers, although the description of new cases is becoming increasingly common. These tumours may be associated to paraneoplastic syndromes of the endocrine and neurological types. This paper contributes one case report of a female patient diagnosed with a small cells epithelial vesical tumour associated to myasthenia gravis. The histological and histochemical features as well as the differential diagnosis with other tumours of vesical location are explained. Clinically, these entities evolve with acute haematuria and have a highly aggressive evolution. Quite frequently the tumour is associated to neuromuscular syndromes such as Lamber-Eaton's, myasthenia-like syndromes, and in rare occasions to myasthenia gravis. Different studies have reported anti-acetylcholine receptors in cells of this tumoral class that may stimulate the formation of antibodies against the neuromotor plaque. Diagnosis of this neurological syndrome and other similar ones may be attributed to early treatment and better prognosis of this tumoral entity.

[Renal cell carcinoma in patient with situs inversus and Kartagener syndrome]. / Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener.

A case of a adenocarcinoma renal in a patient with situs inversus complete to which was associated bronchiectasis and chronic sinusitis (kartagener's syndrome) is reported. It is the third case described in the international literature of a renal cells carcinoma in a patient with situs inversus totalis and the first in patient the one which has the triada classic of the kartagener's syndrome plus sterility. The tumor was discovered in a way incidental upon accomplishing a TAC toracoabdominal and was solved through nefrectomia for lumbotomy approach.

[Sertoli cell tumor of the testis: clinical pathologic varieties. Report of a case]. / Tumor testicular de células de Sertoli: variedades clínicas patológicas. A propósito de un caso.

Tumours derived from sex cords and primitive gonadal stroma account for 4% of total testicular tumours. The low frequency of Sertoli's cells tumour (SCT) and the uneven study and follow-up of patients makes analysis of this tumoral entity difficult. This paper contributes one case report of a Sertoli's giant cell tumour calcified in a 13-year old patient, and reviews the clinical aspects, clinico-pathological varieties believed to require assessment in patients with this type of disease. This type of tumour is considered benign in its biological behaviour, although some malignant forms have also been described. SCT is actually an heterogeneous tumoral pathogenic entity with regard to pathogenic and prognostic aspects. Our final conclusions show that the clinico-pathological variety, age, size and associated clinical manifestations appear to be related to the prognosis.

[Leiomyosarcoma and rhabdomyosarcoma: rare tumors of the kidney]. / Leiomiosarcoma y rabdomiosarcoma: tumores raros del riñón.

Renal sarcoma represents 2.8% of all renal malignant tumours. The most common kind is leiomyosarcoma while rhabdomyosarcoma is the most unusual. Clinical presentation and diagnosis of both types of tumours are unspecific. Treatment is controversial and the overall prognosis poor. The present paper presents two cases, one leiomyosarcoma and one rhabdomyosarcoma which were treated surgically and were followed by chemo- and radiotherapy. A revision of the criteria for grading these as primary tumours of the kidney is also included.

[Extensive ureteral lesions: management with substitution with small intestine]. / Lesiones ureterales extensas: manejo mediante sustitución por intestino delgado.

Wide ureteral injuries are unusual but not exceptional and have few conservative therapeutic options, specially those that involve the upper ureter. Autotransplantation, ureteral substitution by intestine and combined Boari bladder flap-psoas bladder hitch are basically the only chances to avoid nephrectomy. In this paper we report five cases in which ileum was used to substitute the ureter and review the most outstanding literature about this subject.

[Spontaneous renal hemorrhage. Report of 8 cases]. / Hemorragia renal espontánea. A propósito de ocho casos.

Spontaneous renal haemorrhage or Wünderlich syndrome is a rare condition; it is however of great significance given the emergency, sometimes vital, situation that it creates. The etiology of the condition is varied, the most frequent being tumoral. The clinical manifestations and the use of imaging techniques are of great interest to establish the diagnosis. The choice treatment is controversial. This paper presents eight cases of Wünderlich syndromes seen in our urology service. The background, etiology, clinical manifestations, diagnostic methods and treatment used in each case are analyzed.

[Relationship between preoperative urine cultures and prostatic gland cultures in patients treated for benign prostatic hyperplasia]. / Relación entre los cultivos de orina preoperatorios y los cultivos de la glándula prostática en pacientes intervenidos de HBP.

OBJECTIVES: 1.--Investigate the bacteriuria preoperative in patients who will be operate on for Being Prostatic Hyperplasia (BPH). 2.--Define the prevalence of the prostatic colonization or infection. 3.--Try to correlate the bacteriological findings of urine and prostate, and find the degree of concordance between the microorganisms which can be commonly found in urine and prostatic tissue. METHOD AND MATERIALS: Prospective series of 175 patients undergoing prostatectomy for obstructive symptoms. The protocol revealed, among others variables: the preoperative urine culture; the presence or the absence of catheter; and the quantitative bacteriological culture of prostatic tissue. The information could be analised and its results could be obtained later on. The analysis stages consisted of both a descriptive and an analytic study. RESULTS AND CONCLUSIONS: 1.--Only 36 patients (20.6%) presented bacteriological increase of microorganisms (> or = 10(4) UFC/ml) in the preoperative urine culture. The Escherichia coli was the most common microorganism, followed by the Enterococcus faecalis, coagulase-negative Staphylococcus and the Pseudomona aeruginosa. A single microorganism grew in 31 out of the 36 positive cultures. 2.--The prevalence of the infection or colonization of the prostatic tissue was 25.1% (44 patients). The most common isolated microorganism was the coagulase-negative Staphylococcus followed by the Escherichia coli and the Enterococcus faecalis, in concentrations of at least 10(4) UFC/gr of tissue in the 79.6%. A single microorganism was isolated in 32 out of 44 patients. 3.--The proportion of positive prostatic cultures, in patients with positive urine culture (38.3%), was significantly higher than the one obtained in patients with negative urine cultures (16.5%) (p < 0.0001). Nevertheless, 52.3% of the 44 patients with positive prostatic cultures had negative urine culture, and only 21 (58.3%) out of the 36 patients with positive urine cultures presented a bacteriological growth in prostate. The degree of concordance (Kappa index) between the microorganisms which were found in preoperative urine and prostatic tissue is low or none for the majority of them.

[Liposarcoma of the spermatic cord: a report of a new case and a review of the literature]. / Liposarcoma de cordón espermático: aportación de un nuevo caso y revisión de la literatura.

Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor. Only a hundred cases have been reported. They are typically presented in elderly people. The usually have a good prognosis because of their low level of malignancy and their relapses tend to be localized. It has a high rate of survival over 5 years. Preoperative diagnosis is infrequent, it is suggested by the appearance of a progressively enlarging mass in the scrotum and the ultrasonography which shows a solid mass of the spermatic cord that is independent of the testicle. The choice treatment is radical orchidectomy, while long-term follow-up of these patients is mandatory because of local relapses. When local relapses become evident, the choice treatment is extensive local excision followed by adjuvant radiotherapy. In the present study we report a new case of a recurring, well differentiated spermatic cord liposarcoma of the type sclerotic, in a 50-year-old man. An exhaustive review of the literature has been made.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vésico-uterina: aportación de dos nuevos casos.

Contribution of two new cases of vesicouterine fistula secondary to a cesarean incision. In one case, diagnosis was achieved through cystography and cystoscopy, while in the second case cystography, cystoscopy and stain testing (methylene blue) were used. In both cases management was through transperitoneal and transvesical fistulorrhaphy. The two cases showed favourable post-operative evolution with no relapse.