Cáncer de pene. Una revisión de 18 casos / Cancer of the penis. A review of 18 cases

INTRODUCCIÓN: El carcinoma escamoso de pene es el tumor de pene más frecuente. Las metástasis ganglionares son relativamente frecuentes, pero la diseminación a distancia es muy rara. MATERIAL Y MÉTODOS: Entre 1990 y el 2002 fueron diagnosticados y tratados 18 casos de carcinoma de pene. El seguimiento mínimo fue de 2 años de evolución (de 2 a 11 años, con una media de 49 meses).El tratamiento de la lesión primaria, habitualmente por medio de la amputación parcial de pene, nos permite conocer el estadio patológico y el grado de diferenciación histológico, lo cual orientó primordialmente nuestra actitud frente a los ganglios linfáticos regionales. RESULTADOS: Las adenopatías inguinales palpables persistieron tras antibioterapia en 6 de 7 pacientes. Se realizaron 4 linfadenectomías inguinales precoces. Las complicaciones post-operatorias se presentaron en los 4 casos, siendo el linfedema la más frecuente (100 por ciento). CONCLUSIONES: La categoría del T y el grado histológico de la lesión primaria al momento de decidir la conducta en el manejo de los ganglios, evitará linfadenectomías innecesarias y por otro lado tratará radical y oportunamente aquellos que presenten alto riesgo de diseminación ganglionar (AU)

INTRODUCTION: Squamous cell carcinoma is the most common tumor of the penis. Nodal metastases are relatively common, but distant disemination is very rare. MATERIAL AND METHODS: From 1990 to 2002, we diagnosed and treated 18 cases of carcinoma of the penis. The minimum follow-up was 2 years (range 2-11 years; mean 49 months). Treatment of the primary lesion is usually by partial amputation of the penis, which enables us to determine the pathological stage and the histological grade of the tumor and, consequently, our approach to the reguional lymph nodes. RESULTS: Palpable inguinal nodes after antibiotherapy remained in six out of seven patients. Inguinal lymphadenectomy was performed early in 4 cases. Postoperative complications were present in the 4 cases, lymphedema being the most frequent one (100%). CONCLUSIONS: The T and the histological grade of the primary lesion must be considered when deciding the approach in the management of the lymph nodes as unnecesary lymphadenectomy can be avoided and those at high risk of lymph node invasion can be treated radically and timely (AU)

[Adrenal ganglioneuroma. Report of a new case]. / Ganglioneuroma suprarrenal. Aportación de un nuevo caso.

Ganglioneuroma is a benign neoplasm arising from neural crest tissue and is composed of mature ganglion cells and Schwann's cells. Most ganglioneuromas arise in the posterior mediastinum followed by the retroperitoneum. Only a small proportion of ganglioneuromas are adrenal in origin and occur most commonly in children and young adults. Characteristically, ganglioneuromas do not secrete excess catecholamines or steroid hormones, and they are usually clinically silent lesions incidentally detected in imaging studies for unrelated reasons. Because it is an uncommon lesion, adrenal ganglioneuromas is not included in the differential diagnosis of adrenal incidentalomas in adults. We presents a new case of a 6.5 cm adrenal ganglioneuroma incidentally diagnosed in a 50-year old male patient. The exeresis of the adrenal mass and pathohistological study confirmed the diagnosis.

Ganglioneuroma suprarrenal. Aportación de un nuevo caso / Adrenal ganglioneuroma. To report of a new case

El ganglioneuroma es una neoplasia benigna derivada de la cresta neural, compuesta de células ganglionares maduras y células de Schwann. La mayoría se localizan en el mediastino posterior, seguido del retroperitoneo. Sólo una pequeña proporción de ganglioneuromas se originan en la médula suprarrenal, siendo más frecuentes en niños y adultos jóvenes. Característicamente, los ganglioneuromas no secretan catecolaminas ni hormonas esteroideas, por lo que suelen ser lesiones clínicamente silentes que son detectadas incidentalmente en estudios de imagen realizados por otros motivos no relacionados. Por ser lesiones infrecuentes, los ganglioneuromas no suelen ser incluidos en el diagnóstico diferencial de los incidentalomas suprarrenales, particularmente en adultos. Presentamos un nuevo caso de ganglioneuroma suprarrenal de 6,5 cm, diagnosticado incidentalmente en un paciente de 50 años de edad. La exéresis de dicha masa y su posterior estudio histopatológico confirmaron el diagnóstico (AU)

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[Penile cancer. Review of 18 cases]. / Cáncer de pene. Una revisión de 18 casos.

INTRODUCTION: Squamous cell carcinoma is the most common tumor of the penis. Nodal metastases are relatively common, but distant disemmination is very rare. MATERIAL AND METHODS: From 1990 to 2002, we diagnosed and treated 18 cases of carcinoma of the penis. The minimum follow-up was 2 years (range 2-11 years; mean 49 months). Treatment of the primary lesion is usually by partial amputation of the penis, which enables us to determine the pathological stage and the histological grade of the tumor and, consequently, our approach to the regional lymph nodes. RESULTS: Palpable inguinal nodes after antibiotherapy remained in six out of seven patients. Inguinal lymphadenectomy was performed early in 4 cases. Postoperative complications were present in the 4 cases, lymphedema being the most frequent one (100%). CONCLUSIONS: The T and the histological grade of the primary lesion must be considered when deciding the approach in the management of the lymph nodes as unneccesary lymphadenectomy can be avoided and those at high risk of lymph node invasion can be treated radically and timely.

[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence]. / Evaluación de un nuevo dispositivo oclusivo intrauretral (ORIS FEMENINO) en el manejo de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

[Female urinary incontinence: clinical-urodynamic correlation]. / Incontinencia urinaria femenina: correlación clínico-urodinámica.

OBJECTIVES: To determine the diagnostic utility of the urinary symptoms and physical examination in the urodynamic diagnosis of the type of female urinary incontinence. METHODS: A descriptive longitudinal study was conducted in 100 women undergoing urodynamic evaluation. The patients were asked about the urinary symptoms and were evaluated by physical examination and cystomanometry. RESULTS: A statistically significant correlation was found for age and clinical type of urinary incontinence. A strong trend was observed for clinical type of urinary incontinence and cystocele grade, and the urodynamic type of incontinence. A low sensitivity was found for the clinical type in relation to the urodynamic type of incontinence. CONCLUSIONS: Urinary incontinence clinical data do not permit determination of the urodynamic type of incontinence.

[Reliability of fractal dimension measurement of uroflow curves]. / Fiabilidad de la medición de la dimensión fractal de las curvas de flujo miccional.

OBJECTIVE: To determine the reliability of fractal analysis of uroflow curves. METHODS: We analyzed the correlation between the fractional dimension analysis of two series of uroflow curves with an interval of 88.21 days. The fractal dimension was calculated by two methods. RESULTS: A good correlation was found for both methods, although it was lower than that of maximum flow. A relationship was found between the fractal dimension and maximum flow. CONCLUSIONS: The fractional dimension is a reliable parameter that appears to be related with urinary flow.

[Diabetic neurocystopathy: multivariate study]. / La neurocistopatía diabética: estudio multivariante.

OBJECTIVE: To analyze the prevalence of urodynamic disorders and the factors associated with bladder instability in patients with diabetes mellitus. METHODS: We conducted a clinical and urodynamic study on 138 diabetic patients (71 males, 51%; 67 females, 49%) with a mean age of 64.04 years. Patient evaluation included patient history, neurological physical examination, cystometry, pressure-flow test, filling videocystography and selective EMG of the periurethral sphincter. Data obtained were analyzed by multivariant logistic regression analysis, taking the probability of developing bladder instability as a dependent variable. RESULTS: Bladder instability was the most frequent urodynamic finding (52%), followed by lower urinary tract obstruction (44%), involvement of bladder contractility (41%) and stress urinary incontinence (22%). Lower motor neuron (S2-S4) pudendal nerve lesion was observed in 33% of the cases and 24% had upper motor neuron involvement. Multivariant analysis showed age and stress urinary incontinence (inverse correlation) to be the only independent variables for bladder instability. The other variables that correlated with instability (but dependent on the foregoing variables) were involvement of bladder contractility and type of diabetes (higher probability for diabetes type II). No correlation was found for sex, duration of the diabetes, stroke (CVA), urinary obstruction or pudendal nerve lesion. CONCLUSIONS: Bladder instability was found to be the most frequent urodynamic disorder in diabetic patients. The probability of developing bladder instability increases with age and decreases in patients with stress urinary incontinence.

[Pressure-flow studies in the diagnosis of micturition disorders in the female]. / Los estudios presión-flujo en el diagnóstico de disfunción miccional de la mujer.

OBJECTIVE: To determine the utility of the pressure-flow studies in the diagnosis of voiding dysfunction in women. METHODS: A case-control study was conducted on 80 women. These subjects were divided into two groups: 24 controls with a maximum flow percentile greater than or equal to 50 and no residual volume, and 56 cases with a maximum flow percentile less than or equal to 10. The clinically and statistically significant parameters of the pressure-flow study were entered into a multiple regression logistic equation as explanation variables of voiding dysfunction. RESULTS: The clinical variables that influenced voiding dysfunction were age and the presence of stress urinary incontinence. The urethral resistance average (URA) was found to be the only significant urodynamic parameter. Patients with stress urinary incontinence showed a lower probability of voiding dysfunction. Age and URA directly correlated with the probability of voiding dysfunction. CONCLUSIONS: The URA was found to be the only significant urodynamic parameter. The contractility parameters [power at maximum flow (Pw) and maximum power per bladder unit surface (Wmax)] were not found to be useful as detrusor contractility index in women.