Surgery for adrenal metastasis: Surgical outcomes and prognostic factors for long-term survival.

PURPOSE: To analyze surgical outcomes and predictive factors for long-term overall and disease-specific survival in patients undergoing surgical resection of adrenal metastasis. METHODS: A multicenter retrospective study included patients who underwent adrenalectomy for adrenal metastasis in two Spanish hospitals between 2005 and 2021. Clinical variables associated with surgical complications and survival during follow-up were analyzed. RESULTS: Thirty-three patients were included. Adrenalectomy was performed laparoscopically in 27 patients and by an open approach in 6. The most common primary tumor site was the lung (n=15), followed by the kidney (n=7). Most patients had metachronous lesions (n=28). Six patients (18.2%) had intra- and/or postoperative complications; synchronous metastasis was a risk factor (odds ratio 12.5 [1.45-107.6]) for their development. Progression-free survival and disease-specific survival were 7.5months (range 1-64) and 22.5months (6-120), respectively. Survival rates at 1, 2, 3 and 5years were 94%, 65%, 48% and 29%, respectively. Survival was significantly lower in patients with lung cancer than with other cancers (hazard ratio 4.23 [1.42-12.59]). CONCLUSIONS: Adrenalectomy for solitary adrenal metastases was associated with intra- or postoperative complications in 18% of cases. Synchronous metastasis was a risk factor for complications.

[Urological diseases in the works of Abulcasis]. / La patología urológica en la obra de Abulcasis.

OBJECTIVES: To perform a study on the surgical work of Abulcasis in the field of urology, to know the surgical tools and different techniques used, as well as the innovations applied to solve some features of urological diseases. METHODS: The part on urology from the book XXX by Tasrif, the edition from Strasbourg in 1532 was reviewed and translated from Latin. RESULTS: The author does not refer much to the clinical features of the various pathologies of the genitourinary apparatus; he focuses instead on the surgical treatment of them. The author usually used the "cautery" mainly to control hemorrhage in various operations. Some of these surgical practices are being used nowadays. CONCLUSIONS: Abulcasis was the first doctor born in Spain that studied the surgical treatment of urological diseases and performed a graphic study on the tools used. He introduced technical innovations on different operations and described for the first time the vesical lithotomy on women, and vesical and urethral lithotripsy.

[Recurrent spontaneous bladder rupture associated with alcohol abuse: presentation of a new case]. / Ruptura espontánea vesical recidivante asociada a abuso de alcohol: presentación de un nuevo caso.

OBJECTIVE: Idiopathic spontaneous bladder rupture is a low incidence clinical entity. We perform a literature review and report a recurrent case, with special attention to its physiopathology mainly if associated with alcohol abuse. METHODS: We report the case of a patient with recurrent spontaneous bladder rupture associated with alcohol abuse. The presentation of this case is uncommon. RESULTS: 53 year old male with history of chronic alcohol abuse who presented with abdominal pain and renal failure. CONCLUSIONS: Spontaneous bladder rupture is the cause of acute abdomen and acute renal failure. Idiopathic rupture associated with substance abuse has proper clinical characteristics that make it to be considered a different entity than other causes of spontaneous bladder rupture.

[Hypogastric artery embolization as a palliative treatment for bleeding secondary to intractable bladder or prostate disease]. / Embolización de arterias hipogástricas como tratamiento paliativo del sangrado secundario a enfermedad vesical o prostática intratable.

OBJECTIVES: Bleeding secondary to severe vesicoprostatic pathology (mainly neoplasic disease and radiation cystitis) may be a serious clinical management problem due to its morbidity and associated increased resources demand in the form of admissions, transfusions and other measures. We review a series of patients embolized for this purpose, its efficacy, tolerability and adverse events. METHODS: We review 8 patients who underwent hypogastric arteries embolization between July 1998 and December 2001, analyzing indications, efficacy and duration, tolerability, and consequences. Right femoral artery access was undertaken in all except one case that needed bilateral femoral accesses. Embolization was achieved by means of coils and particles. All procedures were performed under local anaesthesia. RESULTS: 9 procedures were performed in 8 patients. 3 patients presented with hematuria due to radiation cystitis, 3 from prostatic carcinoma, and 2 with urethrorragy from urethral relapses after cystectomy. 7/9 embolizations were effective achieving immediate complete or almost complete bleeding control; in one case control was partial; another one had limited or no effect. Selective embolization of distal arteries was performed in 3 cases; all the remainders underwent direct hypogastric trunk embolization sparing the superior gluteal artery. Effect lasted between 1 and 31 months. 4 patients died, 3 of them without haematuria, 1 because of an intercurrent disease, and the others from disease progression. 2 patients underwent posterior surgery, one due to recurrent haematuria, and the other, a case of urethral tumour, due to partial failure; partial cystectomy and urethrectomy were performed respectively. 2 patients needed administration of morphic derivatives after embolization, all the others were managed with magnesium metamizol. Only one patient referred mild transitory gluteal claudication. CONCLUSIONS: Percutaneous arterial embolization is an effective instrument to treat patients with haematuria or urethrorragy and severe lower urinary tract pathology in whom curative treatments are not applicable due to their general status, life expectancy, or tumor status.

[Paratesticular leiomyosarcoma: report of a new case]. / Leiomiosarcoma paratesticular: descripción de un nuevo caso.

OBJECTIVE: To report an additional case of paratesticular leiomyosarcoma. METHODS: Herein we describe a 68-year-old male patient that presented with a growing, indolent, right inguinoscrotal lesion that he had noted several weeks earlier. Physical examination showed a mass involving the distal right spermatic cord and was confirmed by ultrasound and CT. Analyses were normal. Radical orchidectomy with high ligation of the right spermatic cord was performed. RESULTS: Histopathological and immunohistochemical studies demonstrated a well-differentiated paratesticular leiomyosarcoma. Local recurrence was observed at 3 1/2 years' follow-up. Complete excision of the tumorous tissue was performed with no other adjuvant therapy. Six months thereafter, there is no evidence of local recurrence or distant metastasis. CONCLUSIONS: This tumor type is uncommon. Like other authors, we believe that orchifuniculectomy is the treatment of choice. Furthermore, adjuvant radio or chemotherapy does not significantly influence survival in these patients.

[Priapism secondary to chronic myeloid leukemia: value of initial treatment with cavernous lavage plus adjuvant methoxamine]. / Priapismo secundario a leucemia mieloide crónica: valor del tratamiento inicial con lavado cavernoso más metoxamina adyuvante.

OBJECTIVE: To report a case of priapism secondary to leukemia, with special reference to the initial treatment in the emergency services. METHODS: A 53-year-old male with chronic myeloid leukemia presented with prolonged involuntary painful erection of 12 hours' duration. The physical examination and particularly the cavernosal blood gas study, indicated low flow priapism. Punction-lavage of the corpora cavernosa was performed. Because complete response was not achieved with this procedure, adjuvant intracavernous methoxamine was administered. RESULTS: Complete detumescence was achieved after the third dose of methoxamine. There was no recurrence and erectile function was preserved. CONCLUSIONS: We underscore the utility of combined cavernous lavage + adjuvant alpha-1 adrenergic agonist as initial therapy in priapism with this special etiology.

[Metachronous recurrence of idiopathic high flow priapism]. / Recurrencia metacrónica de priapismo idiopático de alto flujo.

OBJECTIVES: To report one case of metachronous recurrence of idiopathic high flow priapism. METHODS. We describe the case of a 28-year-old male patient who presents with penile partial tumescence which started 10 hours before and history of a similar episode seven years before. Physical examination confirmed the clinical picture, with mild local discomfort on palpation. Blood tests were normal. Cavernous blood gases were compatible with arterial blood O2 saturation levels. The patient had a satisfactory progressive response to oral administration of diazepam. No pathologic findings were seen at the time of arteriography. RESULTS: Complete resolution of the episode. Erectile function was satisfactorily preserved. There was no relapse after one year of follow-up. CONCLUSIONS: We remark the validity of a deferred therapeutic attitude in front of pictures of high flow priapism, as well as the possibility of resolution with conservative measures. We emphasize the peculiarities of this case, mainly its idiopathic character and the metachronous recurrence.