[Predictive models for biochemical recurrence of prostate cancer after local treatment. Nomograms]

In this narrative review we present the concept of nomogram in the context of predictive models in prostate cancer. In fact we try to answer the following questions from a practical and critical point of view: What is a nomogram? How to read and evaluate nomograms? What nomograms predict biochemical relapse in prostate cancer after local treatment, either surgery or radiotherapy? Why are nomograms better than risk groups stratification? And, finally, why don't clinicians use nomograms in fact?

[Usefulness of renal resistive index in the diagnosis and evolution of the obstructive uropathy. Experimental study]

OBJECTIVE

The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction.

MATERIAL AND METHODS

15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal B-mode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio.

RESULTS

All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of deltaRI during the 3 phases are detailed below. Fase I deltaIR = 0.01, Fase II deltaIR = 0.11, Fase III deltaIR = 0.02.

CONCLUSION

RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods.

[Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (part 1)]

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostatecancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios.

Controversies related to epithelioid variant of renal angiomyolipoma: A review of the literature

We performed a review of the epithelioid-type angiomas to determine their clinical course and propose an appropriate plan for follow-up. We present the case of a patient with possible adrenal carcinoma suggested by computed tomography for whom the histopathologic study revealed an epithelioid angiomyolipoma arising from the kidney. In the absence of consensus, we consider it worthwhile to register the very few cases diagnosed and record a detailed follow-up of the clinical course. We recommend surgical treatment and a follow-up regimen similar to that for renal carcinoma.

Carcinoma papilar hallado en injerto renal tras 13 años de correcto funcionamiento

It is known the greater probability appearance of malignancy injuries in patients with renal graft due to its inmunosupresión. We expose a case in which after thirteen years of correct operation of the renal transplant a tumor is diagnosed of accidental form by means of ultrasonography of graft's control. It was demonstrated by percutaneous biopsy that it was a carcinoma to papilar and later transplanctectomy was made. We raised a reflection about the novo tumors on renal graft given to the high number of patients with funcionante transplant during long years and the little evidence in Literature, proposing a possible registry of such valuing its behavior and comparing it with the well-known ones on native kidneys without inmunosupresión situation.

Cáncer de próstata incidental: T1a-T1b. Nuestra experiencia tras observación/intervención radical y revisión de la literatura

OBJECTIVES

To analyse the progress of T1a and T1b prostate cancer diagnosed in our hospital.

MATERIAL AND METHODS

Retrospective study of 40 patients in T1a-T1b clinical stage diagnosed with prostate adenocarcinoma in our hospital, from 1986 to 1999. A restaging biopsy was performed on the 16 T1a patients after initial diagnosis and control. A radical prostatectomy was performed on the 24 T1b patients. They were all monitored every six months with rectal exam and PSA. We analysed biological and/or clinical progression, time to progression, mortality caused by the tumour and survival.

RESULTS

None of the 16 patients with T1a clinical stage presented tumour progression, with a median follow-up of 90 months. 12,5% of the 24 T1b cases presented tumour progression, with a median follow-up of 70 months. Cancer-specific mortality was one patient (4,16 %) in the T1b group.

CONCLUSIONS

Observation and follow-up with PSA and rectal exam appears to be a good option for T1a clinical stage, given the good prognosis. Our results show that patients with T1a clinical stage and good prognostic factors could be at a similar risk of suffering from a new prostate cancer as the normal population, although prospective studies are required to validate these results. T1b cases require active treatment and closer monitoring.

Actualidad en manejo de abcesos prostáticos: a propósito de un caso

The existence of prostate abscess as bad evolution of an acute protatitis is not very frequent due to the correct handling of the urinary infections by means of suitable antibiotics, in spite of the presence of inmunosupresion situations that can favor their appearance. It is our intention to review the performance in these situations because of a case that by means of minimal invasive therapy by transperineal percutaneous puncture obtained complete improvement.

Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie

OBJECTIVES

To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002.

MATERIALS AND METHODS

between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen.

RESULTS

In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progression-free survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126), since the date of the cistectomia. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy, with a cancer-specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+).

CONCLUSION

In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection (T3, 32 months) and the ganglionary affectation (pN+ 45 months).

[Renal teratoma, case report and review of the literature]

We report a case of intrarenal teratoma in a 39-year-old female patient. The clinical course after three years of follow-up has been satisfactory, finding the patient totally asymptomatic. Extragonadal teratoma occurs predominantly along the median line of the body. Intrarenal teratoma is extremely rare; however, it should be distinguished from other cystic lesions.

[Primitive neuroectodermal tumor. Ewing's sarcoma]

Primitive neuroectodermal tumor is an extraordinarily rare primary tumor in the kidney and can be mistaken for a variety of other round cell tumors. It is important to recognize each of these entities, because each carries unique therapeutic and prognostic implications. However, accurate diagnosis of these tumors is hindered by their significant morphologic overlap and complicated by their rarity. These neplasm are highly aggressive that tend to recurence and to metastatize. Standard therapy combining surgery, chemotherapy, radiation and genetic therapy. We report a case of primitive neuroectodermal tumor of the kidney in a 50 year old female patient.

[Endourologic treatment of ureteral strictures. Experimental comparative study]

OBJECTIVES

To compare efficacy and efficiency of two different endourological therapies for ureteral stricture, and to evaluate pathological reactions of the ureters following both endourological techniques.

MATERIAL AND METHODS

Ten pigs underwent experimental induction of ureteral stricture. Four weeks later, ureteral strictures were demonstrated by imaging techniques. Animals were divided in two groups, according to the received therapy: -Group I. (5 pigs), endoballoon rupture endoureterotomy. -Group II (5 pigs), Acucise balloon endoureterotomy. Ureteral stents were placed for 3 weeks following endoureterotomy. Animals were followed up four weeks after ureteral stents retrieval.

RESULTS

In all cases, ureteral stricture was proved four weeks after model induction. In one case from each group, it was needed a second balloon dilatation to achieve complete endoureterotomy. Leading to ureteral restenosis, stent migration occurred in one animal from group I. Success was achieved in 80% of cases from group I, and 100% of cases from group II.

CONCLUSIONS

Our results suggest that both endourological therapies are effective. Nevertheless, a higher efficiency was proved with Acucise endoureterotomy. Our pathological evidences do not support Davis's studies on ureteral healing following endoureterotomy.

[Epidermoid carcinoma of the urethra and glans penis: two independent tumors?]

A 64 years-old man is treated in our hospital presenting a big tumor in glans penis. During the surgical act, another neoplasm is detected in the urethra. The microscopic study showed a concomintant epidermoid carcinoma of glans penis and urethra with non-affected tissue between both tumors.

¿Cuál es el algoritmo diagnóstico más apropiado para el cribado del cáncer de próstata?

Since the use of PSA to detect prostate cancer was generalised in the late 1980's, prostate cancer diagnosis has increased considerably. Although there is now indirect evidence pointing to the beneficial effect of screening, there are no data justifying PSA screening in the general population. There is also a controversy concerning the most appropriate algorithm, should screening be performed. Therefore, our aim was to review the literature and, based on our experience, attempt to define the best algorithm for prostate cancer screening. We have made a search on Medline using the following terms: prostate biopsy, screening, algorithms, radical prostatectomy, PSA and prostate cancer. After analysing the literature, we can confirm that there is no "definitive" algorithm, due to the rapid appearance and use of new technical and biological breakthroughs, although it appears that at this time, without ceasing to include a rectal examination, more value should be given to personal risk factors, including PSA, at ages under 50, with individual monitoring based on these factors. The algorithms applied to a population have first to be validated for the population concerned.

Tratamiento de la cistitis hemorrágica por ciclofosfamida. Revisión de la literatura a propósito de un caso

There are extreme situations in the clinical treatment of intractable hematuria (fortunately not a common disease nowadays), in which even benign process may represent a serious risk to the life of the patient and where certain aggressive procedures like cystectomy have to be considered. Our objective in this paper is to review the different existing therapeutic alternatives for the treatment of an intense type of hematuria which does not yield to continuous saline serum irrigation. This study is partly based on a recent real clinical case in which, after the administration of cyclophosphamide to a young patient with recurrent and intense hematuria, the excretion was controlled through intravesical alum irrigation of thus avoiding cystectomy, a very aggressive surgical procedure with many after-effects.

[Pseudotumor renal after partial nephrectomy with the use of surgical gelatin sponge]

After renal parenchymal sparing surgery, with the use of surgical gelatin sponge, residual defects may persist on imaging studies at the sites of resection. These "pseudotumors" may lead to confusion as to whether a lesion was removed or has recurred. These lesions usually resolve within a year. We report a case of pseudotumor renal parenchymal sparing surgery in a 69 year old man, with resolution of the lesion 8 months after surgery.

[Foreign body simulating kidney tumour]

A six cm kidney tumour is found in a prostate control ultrasonography, in a 70 aged men. A chirurgical remove is indicated the tumour presented a very few separation of the kidney. The kidney was only compressed by the mass which contained a chirurgical gauze inside it from a previous surgery 35 years before.

[Priapism as an initial presentation of chronic myeloid leukaemia]

We report the case of a 29 years old patient who presented, in the last three moths, four episodes of priapism without any other symptoms and any previous traumatism. An hemogram reveled that the repeted episodes of priapism were caused by a chronic myeloid leukaemia.

Carcinoma transicional primario puro de próstata. revisión de nuestra serie

Primary prostate transitional cell carcinoma is a very uncommon tumor, that represents about 1% of all prostate tumours. In our institution, only six patients have been diagnosed with pure transitional cell prostate carcinoma until 2002. Bladder origin of the neplasic was ruled out in all cases. We report a study about the progression and survival of prostate transitional cell carcinoma. These prostatic tumours carry a poor prognostic (median survival is 4.6 months) with a strong tendency to metastatic spread. Therefore, we suggest a radical prostatectomy (without cystectomy) when it rules out bladder origin tumour.

[Idiopathic superinfected giant hematocele]

A 45 year old male patient is attended for a marked increase in the size of the left hemiscrotum totally painless. The diagnosis was haematocele, but no cause was found for the bleeding. Orchidectomy and complete exeresis of the tunica vaginalis was carried out.

[Pelvic recurrence of urothelial tumor, after radical cysto-prostatectomy with orthotopic neo-bladder]

We present a case of an urothelial tumor pelvic recurrence, five months after radical cystoprostatectomy. No fat infiltration was demonstrated in the pathological study of the transurethral resection pieces. The treatment was a radical cystoprostatectomy with an ileal ortothopic Hautmann type neo-bladder. The pathological study of the surgical piece demonstrated fat infiltration in some points but urethra and lymphatic nodes free.

[Retroperitoneal fibrosis caused by pancreatitis in an HIV+ patient]

Retroperitoneal fibrosis is a rare inflammatory disease, in which the fibrosis plate leads to the compression of the affected structures. There are several causes of retroperitoneal fibrosis like specific and unspecific inflammatory diseases. In the specific group of retroperitoneal fibrosis we find the one due to pancreatitis. We do present a rare case of retroperitoneal fibrosis caused by a pancreatitis in a HIV+ patient.

[Tumor recurrence in the resected area of the ureteral meatus after endoscopic disinsertion during radical nephroureterectomy]

The endoscopical resection of the urether in the radical nephroureterectomy is an easy way to treat transitional cell carcinoma of the upper urinary tract. We want to present a complication derived from this surgical technique: the tumor implantation in the resected ureteral meatus zone.

[Intravesical foreign bodies. Review of the literature]

We want to make a literature review about the bladder foreign bodies. This clinical situation is not an usual emergency, but there are a lot of references in urological articles about it. In this article review we want to make a compilation about the symtoms, the different origins of the foreign bodies, and ways of diagnosis and treatment of this pathology. We also want to add our personal experience in a recent case.

[Post-traumatic hematoma in pathologic kidney]

We want to present a case of postraumatic hematoma in a tumoral kidney. The diagnosis of the hematoma was made by abdominal scanner but not the tumor type. It was necessary the chirurgycal review and pathological study to demonstrate an angiomyolipoma as the cause of the kidney hematoma.

[Skin metastasis of urothelial bladder tumor]

We want to present a case of tranticional cell bladder carcinoma, where the first sign of disease progression was the appearance of a skin metastase. An unusual manifestation in a patient without another metastatic lesions.

[Penile curvature secondary to cavernous body abscess]

A case of unilateral cavernosal body abscess appears after fifteen days of 40 degrees C fever, without urological symptoms. The diagnosis started from a big scrotum aedema, related of a local septic focus in the left cavernosal body. ECO and TAC confirmed the diagnosis, and a surgical treatment was required. After a successful evolution, the patient presents a left penile incurvation with pain and difficulties during the sexual relations, but he did not accept any treatment.

Transplante renal. técnica y complicaciones

We want to make in this article, a deep review of our experience in kidney transplantation since the moment we started the technique in 1986 to the end of the year 2000. We also want to make a compilation of the most important points of the surgical technique, patients selection criteria, and the most common and uncommon complications that can appear in kidney transplantation, analizing our results all along this time.

[Urethral prolapse following physical effort. Surgical repair]

We want to present an urethral prolapse, in an elderly woman, after a physical effort. This situation is rarely reported in the literature, being a more common situation in children and premenarchal girls. The most common presentation is genital mass and bleedding. If it is a large one can become strangulated and urinary symptoms are present as acute urine retention. We want to describe the surgical treatment.

[Erectile dysfunction]

In Spain, based on the IIEF, 19% of males between 25 and 70 years old present some degree of erectile dysfunction (ED). Therefore, around 2,000,000 Spanish men present this condition and could require medical attention for it. Here, we present an up-date of the most important aspects of erectile dysfunction (pathophysiology, diagnosis and treatment). We review, in detail, the oral treatments and future drugs that are presently in the premarketing experimental phase. Diagnostic and therapeutic management of the patient with erectile dysfunction should be individualized, taking into account the goals of each patient. It is highly recommendable to carry out a basic assessment (comprehensive clinical history, physical examination, recommended lab testing). If previously undiagnosed diseases are discovered (diabetes, arteriosclerosis, etc.) these should be treated and modifiable risk factors should be corrected. There are numerous therapeutic options for the treatment of erectile dysfunction. Replacement therapy with testosterone should only be used in males with ED and low levels of this hormone, under medical supervision. At present, first line treatment consists of the administration of oral drugs (sildenafil, apomorphine). There are two new PDE 5 inhibitors (tadalafil and vardenafil) that will be released on the market 2003, which will provide better selectivity. Moreover, several drugs for oral administration are in the initial phases of research that will facilitate erection via a direct penile action. When oral drugs are contraindicated, are not effective or when they are unpopular with the patient, the second line of treatment is intracavernous injection. Prostaglandin E1 is the initial drug of choice in patients using intracavernous autoinjection for the first time and has a high efficacy. Implantation of a penis prosthesis and penile revascularisation are appropriate for highly selected patients. Psychotherapy can be an option for men with ED of psychogenic origin, either as a monotherapy or combined with sildenafil or apomorphine.

[Urinary diversions and bladder enlargements]

Overall review that offers an integrated insight of the importance and repercussions of urinary by-pass and bladder replacement. Over the last decades there has been a growing interest in the possibility of reconstructing the urinary system and there are now an almost infinite number of surgical solutions. The history of the development of using the intestine for by-passes and the reconstruction of the urinary system is described. The secondary metabolic alterations, the possibility of secondary intestinal tumours and the rudiments of ureterointestinal anastomosis are dealt with. Bladder substitution techniques are highlighted, and the vast experience of the Urology Department of Hospital Miguel Servet explained, including criteria and conclusions that help to choose from the many urological surgery alternatives headed by urinary by-pass and bladder complications.

[Secondary prostatic lymphoma in a kidney transplant patient]

Lymphoma involving the prostate is rare, both as a primary and as a secondary presenting. Usually the prognosis remains poor. The clinical presentation is similar to that of other lower urinary tract obstructions, in fact prostatic lymphoma must be considered in patients with these symptoms, particularly in patients with prior history of systemic lymphoma. We report a case of a kidney transplantation in a male patient, diagnosis of lymphoma non Hodgkin, with later recurrence in prostate.

[Laparoscopic diagnosis of Hodgkin's disease. Report of a case]

Laparoscopic Surgery with diagnosis objectives in Urology, has many others indications related with different medical specialties, apart from the ones for the urologic area (ectopic test, linfadenectomy, etc...). In our case, the Services of Urology and Hematology, diagnosed a Hodgkin's disease case. The Service of Hematology realized treatment and evolution. Sometimes, the unspecific clinical presentations of the Hodgkin's disease, shows adenopatics masses, detected by Ecografy or TAC. Treatment and prognosis of the Hodgkin's disease, are related with the histological subtype and its spreading.

[Appendix mucinous cystadenoma]

Mucous cystadenomas are benign epithelial tumours with great mucous content inside. Despite being non-malignant, they acquired great size, compressing and displacing important structures and organs of the zone, with theirs unlucky outcomes. Surgical exeresis is very difficult, being almost impossible its total exeresis, showing great frequency of relapse. We present an appendix mucous cystadenoma case in a 54 years old patient.

[Endoscopic ureteral resection in radical nephroureterectomy: report of our experience]

We want to present our clinic and chirurgical experience in eight patients, using the radical nephroureterectomy with endoscopical resection of the ureter, as a safe and valid technique, in urothelial tumours localized in the upper urinary tract.

[Urethral amyloidosis]

Localized amyloidosis of the urethra is a rare pathological entity. Biopsy is required to make the appropriate diagnosis. Although localized therapy is available for obstructing, symptomatic lesions, asymptomatic lesions may be followed with conservative management and spontaneous regression has been reported. An appropriate medical evaluation should be performed to determine the presence of systemic amyloidosis.

[Urethral nephrogenic adenoma in a young male. Report of a case]

Nephrogenic adenoma is a rare urothelial neoformation. It is well known the association to infective diseases and stones; the most common localization is in the bladder. We report the case of a young male without previous disease who showed a nephrogenic adenoma in the urethra, it was managed with transurethral resection and surveillance.

[Thrombosis of the renal artery secondary to closed abdominal trauma]

We report a case of female 24 years old who had a blunt abdominal trauma. The immediate consequence was the radiological evidence of a left kidney abolition, secondary to a renal artery thrombosis. The treatment was conservative, and there was not a surgical procedure.

[Skin metastasis of long-course prostatic cancer]

OBJECTIVE

To present a case of prostate cancer of long evolution and follow up time, in the one which has been evidenced the appearance of skin metastases at hypogastrium level, inferior extremities root and inguinal zone.

METHODS

Patient diagnosed of prostate cancer, treated with radical prostatectomy and followed in conferences during ten years by the neoplasica disease.

RESULTS

Appearance of skin metastases of a prostate cancer, after ten years of a radical surgery, in the one which the pathological anatomy demonstrated the local infiltration at seminal bladders level.

CONCLUSIONS

The skin metastases of a prostate cancer are extremely uncommon, appearing in most of the occasions in process of very long evolution and in those which the disease has not been able be controlled.

[Prostatic angiosarcoma: report of a new case]

We report the case of a 31 year old male, with lower urinary tract symptoms. We achieved the diagnosis of an prostate angiosarcoma. The treatment was a retropubic radical prostatectomy and partially resection of bladder neck, followed by chemotherapy with Ifosfamide and Adriamycin. At least 36 months up to surgery the patient is alive and free of symptoms and radiological signs of recurrence.

[Prostatic rebiopsy. Prognosis factors of the anatomopathologic result]

The indications for repeat prostate needle biopsy after a previous biopsy are not defined. We examined 107 prostate biopsies (in 98 patients) without a diagnosis of malignancy, which we repeat. Carcinoma was detected in 31 patients (31.6%). We didn't find statistic relationship between the repeat biopsy's outcome and: interval between biopsy and repeat biopsy, PSA value, PSA density (biopsy), PSAD of the transitional area (PSAD ad., on repeat biopsy). We found relationship with: prostatic weight (p = 0.002 on the biopsy, p = 0.0002 on the repeat biopsy), volume of the transitional area (p = 0.02 on the biopsy, p = 0.0001 on the repeat biopsy), PSA value (p = 0.02, on the repeat biopsy), PSAD ad. (p = 0.002, on the repeat biopsy), and with PSA velocity (p = 0.008). We only found clinic usefulness for the PSA velocity: patients with PSA velocity greater than 1 ng/ml/year are at high risk for prostate carcinoma on the repeat biopsy, specially in small prostates.

[Stage pT3 prostatic cancer after radical prostatectomy. Results in progression and survival]

PURPOSE

To analyse progression and survival after radical prostatectomy in patients with stage pT3 carcinoma of the prostate.

MATERIAL AND METHODS

Between 1986 and November 1998, we performed 372 radical prostatectomies, 74 of which were pT3N0 (19.8%), 43 pT3a and 31 pT3b (TNM 97).

RESULTS

In patients with pathological stage pT3, we found any progression in 24 patients (32%), 8 in pT3a, and 16 in pT3b. In 10 of 24 pT3, there was local relapse or distant metastases. About the freedom from biochemical relapse survival rate, we found statistically differences between pT3a and pT3b (p < 0.0001). In pT3a patients, we found no differences between PSA levels > 20 ng/ml, versus < 20 (p = 0.415), and statistically differences between pathological Gleason 6 or greater, versus < 6 (p = 0.048). However, we found no differences when we used both criteria (PSA and Gleason) (p = 0.195).

CONCLUSIONS

We support for early adjuvant hormonal therapy in pT3b patients. In pT3a, the hormonotherapy may be used if appears biochemical failure, specially with adverse prognostic factors (PSA and Gleason).