[Do older men with localized prostate cancer Gleason 8-10 benefit from curative therapy?]. / Puede beneficiarse un hombre de avanzada edad con cancer de próstata Gleason 8-10 de un tratamiento con intención curativa?

OBJECTIVE: The aim is to analyse until which age a radical procedure could have an influence on life expectancy of patients with localized prostate cancer Gleason 8-10. METHODS: We analyse retrospectively 80 patients with localized prostate cancer T1-2N0-XM0 Gleason 8-10. The patients were stratified in 2 groups: group A 34 patients who received hormonal treatment and group B, 46 patients submitted to radical prostatectomy. The analysed variables are: cancer mortality and cancer specific survival. RESULTS: Patients characteristics: median age group A 75 years (66-84) and group B 64 years (56-75) (p = 0.033): median followup group A 54 months (20-180) and group B 37 months (12-140) (p = 0.016); median Gleason group A 8 (8-10) and group B 8 (8-10) (p = 0.144); percentage T1 group A 24% and group B 41% (p = 0.096); median PSA group A 10 (4-91) and group B 12 (4-71) (p = 0.269). The cancer specific mortality from group A is 24 (71%) and in group B 3 (7%) (p = 0.000). In the first 5 years, 20 (59%) patients died from prostate cancer in the group A and 1 (2%) in the group B. The Kaplan-Meier curves and Log-Rank test show significant differences in the survival cancer specific between the 2 groups. The Cox regression shows that the possibilities of dying from prostate cancer are higher in the group of patients who did not receive treatment with curative intention. The relative risk (HR 95% IC) in group A is 6.826 (2.032-22.931). CONCLUSIONS: More than half of the patients with localized prostate cancer Gleason 8-10 treated in a conservative way die from cancer within the next 5 years since the diagnosis. The patients with a life expectancy greater than 5 years can benefit with a curative treatment.

¿Puede beneficiarse un hombre de avanzada edad con cáncer de próstata Gleason 8-10 de un tratamiento con intención curativa? / Do older men with localized prostate cancer Gleason 8-10 benefit from curative therapy?

Objetivo: El objetivo es analizar hasta qué edad podría influir una actitud radical en la esperanza de vida de los pacientes con cánceres de próstata clínicamente localizados Gleason 8-10. Material y métodos: Se hace un estudio retrospectivo de 80 pacientes con cáncer de próstata localizado T1-2N0-XM0 Gleason 8-10. Los pacientes se estratificaron en 2 grupos: grupo A 34 pacientes que por diversos motivos, edad superior a 75 años, riesgo quirúrgico, elección del paciente u otros motivos, habían sido tratados con bloqueo androgénico y grupo B, 46 pacientes sometidos a prostatectomía radical. Las variables analizadas son: mortalidad por cáncer y supervivencia cáncer específica. Resultados: Características de los pacientes: mediana de edad grupo A 75 años (66-84) y grupo B 64 años (56-75) (p=0,033); mediana de tiempo de seguimiento grupo A 54 meses (20-180) y grupo B 37 meses (12-140) (p=0,016); mediana de Gleason grupo A 8 (8-10) y grupo B 8 (8-10) (p=0,144); porcentaje de T1 grupo A 24% y grupo B 41% (p=0,096); mediana de PSA grupo A 10 (4-91) y grupo B 12 (4-71) (p=0,269). La mortalidad cáncer específica del grupo A es de 24 (71%) y en el grupo B 3 (7%) (p=0.000). A los 5 años han fallecido 20 (59%) pacientes como consecuencia del cáncer en el grupo A y 1 (2%) de los pacientes en el grupo B. Las curvas de Kaplan-Meier y testde Log-Rank muestran diferencias significativas en la supervivencia cáncer específicas entre los 2 grupos. La regresión de Cox muestra que las posibilidades de morir por cáncer de próstata son superiores en el grupo de pacientes que no recibieron tratamiento con intención curativo, el riesgo relativo (HR 95% IC) en el grupo A es de 6.826 (2.032-22.931). Conclusiones: Algo más de la mitad de los pacientes con cáncer de próstata localizado Gleason 8-10 tratados de forma conservadora, mueren por cáncer dentro de los 5 años siguientes al diagnóstico. Los pacientes con una expectativa de vida superiora 5 años pueden beneficiarse de una actitud curativa (AU)

Objective: The aim is to analyse until which age a radical procedure could have an influence on life expectancy of patients with localized prostate cancer Gleason 8-10.Methods: We analyse retrospectively 80 patients with localized prostate cancer T1-2N0-XM0 Gleason 8-10. The patients were stratified in 2 groups: group A 34 patients who received hormonal treatment and group B, 46 patients submitted to radical prostatectomy. The analysed variables are: cancer mortality and cancer specific survival. Results: Patients characteristics: median age group A 75 years (66-84) and group B 64 years (56-75) (p=0.033); median followup group A 54 months (20-180) and group B 37 months (12-140) (p=0.016); median Gleason group A 8 (8-10) and group B 8 (8-10) (p=0.144); percentage T1 group A 24 % and group B 41% (p=0.096); median PSA group A 10 (4-91) and group B 12 (4-71) (p=0.269). The cancer specific mortality from group A is 24 (71%) and in group B 3 (7 %) (p=0.000). In the first 5 years, 20 (59%) patients died from prostate cancer in the group A and 1 (2%) in the group B. The Kaplan-Meier curves and Log-Rank test show significant differences in the survival cancer specific between the 2 groups. The Cox regression shows that the possibilities of dying from prostate cancer are higher in the group of patients who did not receive treatment with curative intention. The relative risk (HR 95 % IC) in group A is 6.826 (2.032-22.931). Conclusions: More than half of the patients with localized prostate cancer Gleason 8-10 treated in a conservative way die from cancer within the next 5 years since the diagnosis. The patients with a life expectancy greater than 5 years can benefit with a curative treatment (AU)

Recidiva del cáncer de próstata después de la prostatectomía radical y radioterapia de rescate / Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy

OBJETIVO: Evaluar la eficacia de la radioterapia en el lecho prostático en pacientes con cáncer de próstata y fracaso bioquímico después de la prostatectomía radical. MATERIAL Y MÉTODOS: Analizamos los resultados de 292 pacientes a los que se le practicó prostatectomía radical por cáncer de próstata localizado T1-T2, entre enero de 1992 y junio de 2003, con un seguimiento medio de 36 meses (rango 6 meses a 12 años). Se detecta fracaso bioquímico (PSA > 0,20 ng/ml) en 75 (26%) pacientes. De los 75 pacientes con fracaso bioquímico, 9 (12%) se diagnosticó de recidiva local siguiendo los siguientes criterios: a) Primer PSA obtenido a las 6 semanas de la intervención 6 meses. c) Tiempo de duplicación del PSA > 6 meses. d) Velocidad de PSA después de la prostatectomía radical <0,75/ng/ml/año. e) Nivel de PSA después de la prostatectomía radical <2,5 ng/ml. Los 9 pacientes diagnosticados de recidiva local reciben una dosis media de 56,42 Gy en el lecho prostático. RESULTADOS: De los 9 pacientes diagnosticados de recidiva local, en 7 (77,7%) se obtuvo una respuesta completa durante un tiempo medio de seguimiento de 25 meses (6-30 meses). El tiempo entre la radioterapia y la respuesta, en los pacientes con respuesta completa, siempre fue inferior a los 3 meses. No se observaron efectos adversos importantes secundarios a la radioterapia. CONCLUSIONES: La radioterapia de rescate puede ser beneficiosa en un seleccionado grupo de pacientes con recidiva local. La cinética del PSA después de la prostatectomía radical es útil para distinguir las recidivas locales de las metástasis a distancia

OBJETIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12 %) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy 6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of followup of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases

Utilidad de la expresión de Ki67 en las biopsias preoperatorias para predecir la recidiva bioquímica del cáncer de próstata después de la prostatectomía radical / The usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progresion of the prostate cancer after radical prostatectomy

OBJETIVO: Evaluar la utilidad de la expresión de Ki67 de las biopsias diagnósticas preoperatorias, para predecir la recidiva bioquímica del cáncer de próstata después de la prostatectomía radical. MATERIAL Y MÉTODOS: Analizamos la expresión de Ki67 en las biopsias ecodirigidas de 103 pacientes a los que se les practicó prostatectomía radical. El tiempo medio de seguimiento es de 3,4 años (1,3-8,8 años). Correlacionamos la recidiva bioquímica con los factores pronósticos clásicos como el PSA (>10/=7/3%/3%/3%/10/=7/<7) y clasificación pT (pT3/pT0-2), para predecir la progresión bioquímica del cáncer de próstata después de la prostatectomía radical

OBJETIVE: To evaluate the usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progression of the prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the Ki67 expression in the biopsy specimens of 103 patients treated with radical prostatectomy. The mean follow up is 3.4 years (1.3-8.8 years). We correlate the biochemical progression with traditional prognostic factors as the PSA (>10/=7/3%/3%/3%/10/=7/<7) and pT ification (pT3/pT0-2), to predict the biochemical progression of the prostate cancer after radical prostatectomy

[Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva del cáncer de próstata después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12%) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy <0.20 ng/ml. b) The time to biochemical recurrence >6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of follow-up of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

[The usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progresion of the prostate cancer after radical prostatectomy]. / Utilidad de la expresión de Ki67 en las biopsias preoperatorias para predecir la recidiva bioquímica del cáncer de próstata después de la prostatectomía radical.

OBJECTIVE: To evaluate the usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progression of the prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the Ki67 expression in the biopsy specimens of 103 patients treated with radical prostatectomy. The mean follow up is 3.4 years (1.3-8.8 years). We correlate the biochemical progression with traditional prognostic factors as the PSA (> 10/< or = 10), Gleason (> or = 7/< 7), pT classification (pT3/pTO-2) and immunohistochemical factor Ki67 (> 3%/< or = 3%). RESULTS: Of all 103 patients, in 71 (69%) biochemical progression was not detected and in 32 (31%) biochemical progression was detected. The mean of preoperative PSA is 10.07 ng/ml in the patients without progression and 20.90 ng/ml in the patients with biochemical progression (p=0.0001). The mean of Gleason score in 6.03 in the patients without progression and 6.75 in the patients with biochemical progression (p=0.0001). The percentage of Ki67 expression is 3.95% in the patients without progression and 5.05% in the patients with biochemical progression (p=0.030). The tumors pT0-2 progressed 12/67 (17.9%) and the tumors pT3 progressed 20/36 (55.6%) (p=0.0001). Multivariant regression analysis indicate that it does not exist a statistically significant relation between Ki67 (> 3%/< or = 3%) expression in the biopsy specimens and the biochemical progression of the prostate cancer after radical prostatectomy (p=0.204). CONCLUSIONS: The immunohistochemical factor Ki67 (> 3%/< or = 3%) in the biopsy specimens, is less effective than the classic factors, PSA (> 10/< or = 10), Gleason (> or = 7/< 7) and pT classification (pT3/pT0-2), to predict the biochemical progression of the prostate cancer after radical prostatectomy.

[Cystitis folicular. A case report and review of the literature]. / Cistitis folicular. Aportación de un caso y revisión de la literatura.

OBJECT: We report a patient with cystitis follicularis and review the literature about it. CLINICAL CASE: A man 78 years old with prostate cancer, who need a permanent bladder catheter. We make a desobstructive TUR, prostate resection and many nodular lesions in the lateral walls and bladder down. The diagnostic was cystitis follicularis. CONCLUSIONS: The cystitis follycularis is a cystitis inespecific and chronic kind with a important inflammation made of lymphocytes and plasmatic cells. Its makes lymphocytes foliculos in the bladder subepithelial wall. The indefination its alive about cystitis follicularis etiopageny, treatment and prognostic. The histopathology study is neccessary.

[Clinical and biological progression of incidental prostatic cancer ( Stage T 1a)]. / Progresión biológica y clínica del cáncer de próstata incidental (estadío T1a).

OBJECTIVES: To analyze the biological and clinical progression of the prostate cancer stage T1a. MATERIAL AND METHODS: Retrospective study of 44 patients diagnosed of T1a prostate carcinoma between 1985 and 2001. We value biological and clinical progression, time up to the progression, mortality for tumour reason and survival, with the following stratification: patients without initial treatment and patients treated by means of external radiotherapy or radical prostatectomía. RESULTS: Of all 44 patients biological progression was observed in 5 (11.36%) and clinical progression in 4 (9.09%). The mortality to 5 years for tumour reason was of 2 (4.54%). Of all 38 patients without initial treatment biological progression was observed in 5 (13.15%), in an average time of 25.8 months and clinical progression in 4 (10.52%), in an average time of 34.5 months. The mortality to 5 years was of 2 (5.26%). In all 6 patients to whom radical treatment carried out them progression was not observed and they all live. There are no statistically significant differences between both groups of patients (p = NS). CONCLUSIONS: The biological and clinical progression of the T1a prostate cancer is low, 11.36% and 9.09%, respectively. The mortality to 5 years is of 4.54%. Differences of survival do not exist, statistically significant, between treated and not treated.

[Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy]. / Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria.

OBJECTIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.

Cistitis folicular. Aportación de un caso y revisión de la literatura / Cystitis folicular. A case report and review of the literature

OBJETIVO: Aportar un caso clínico con el diagnóstico de cistitis folicular y revisar la literatura sobre el tema. CASO CLÍNICO: Paciente de 78 años de edad, diagnosticado de cáncer de próstata, portador de sonda de forma permanente por retención urinaria. Se indica resección transuretral desobstructiva de próstata, realizándose al mismo tiempo resección y estudio anatomopatológico de múltiples formaciones con aspecto nodular, situadas en el trígono y caras laterales de la vejiga. El diagnóstico fue cistitis folicular. CONCLUSIONES: La cistitis folicular es un tipo de cistitis crónica inespecífica que se caracteriza por un intenso infiltrado inflamatorio a expensas de linfocitos y células plasmáticas que se agrupan formando folículos en la submucosa vesical. Continúa vigente la indefinición en la etiopatogenia, tratamiento y pronóstico de esta patología. Tan sólo la certeza del diagnóstico histológico confirma su entidad (AU)

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[Mucinous adenocarcinoma of the urachus]. / Adenocarcinoma mucinoso de uraco.

OBJECTIVE: The Adenocarcinoma of the Urachus is very rare tumor, with an incidence of 1/5,000,000 inhabitants, represents less than 0.001 of all types of bladder cancer. CASE REPORT: A 51 year old man with a chronic history of suprapubic pain and hematuria. Physical examination and excretory urography were normal. The cystoscopy demonstrated a oedematosa area in cupola of bladder wall. The transuretral biopsy was moderately differentiated adenocarcinoma, with positive antibody to CK7 and CK20, the carcinoembryonic antigen was 6.6 ng/ml. Extended partial cystectomy was done, followed for chemotherapy and radiotherapy. CONCLUSIONS: The treatment of adenocarcinoma of the urachus with a combination of extended partial cystectomy, chemotherapy and radiation, is a effective treatment.

Adenocarcinoma mucinoso de uraco / Mucinous adenocarcinoma of the urachus

OBJETIVO: El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. CASO CLÍNICO: Varón de 51 años con historia de dolor suprapúbico y hematuria. La exploración física y la urografía intravenosa eran normales. La cistoscopia demostraba un área edematosa en la cúpula de la vejiga. La biopsia transuretral confirmó un adenocarcinoma moderadamente diferenciado, con anticuerpos positivos CK7 y CK20. El antígeno carcinoembrionario era de 6,6. Se practicó cistectomía parcial extensa, seguida de quimioterapia y radioterapia. CONCLUSIONES: El tratamiento del adenocarcinoma de uraco con una combinación de cistectomía parcial extensa, quimioterapia y radioterapia es eficaz. (AU)

[Value of a second transurethral resection in the assessment and treatment of patients with bladder tumor]. / Valor de la segunda resección transuretral en la evaluación y en el tratamiento de los pacientes con tumor de vejiga.

OBJECTIVE: To analyse the value of a second transurethral resection, repeated within 3 to 6 weeks after the initial resection, in the treatment and the classification of patients with bladder tumour. MATERIAL AND METHODS: We analyse the results of 72 repeated transurethral resection in 23 (32%) patients with T1 G1-2 bladder tumor, 9 (12.5%) with T1 G3 tumor, 31 (43%) with T2a G2-3 tumor and 9 (12.5%) with T2b G2-3 tumor. The evaluated patients are not associated with CIS. RESULTS: Of all 23 T1 G1-2 tumors, 13 (57%) had residual Ta T1 tumor and 1 (4%) T2 tumor. In this group, the second resection changed the treatment in 1 (4%) patient. Of all 9 T1 G3 tumors, 4 (44%) had residual T1 tumor and 1 (11%) T2 tumor. In this group the second resection changed the treatment in 1 (11%) patient. Of all 31 T2a G2-3 tumors, 5 (16%) had residual T1 tumor, 4 (13%) T2 tumor and 6 (19%) T3-T4 tumor. In this group, the second resection changed the treatment in 10 (32%) patient. Of all 9 T2b G2-3 tumors, 2 (22%) had residual T1 tumor, 1 (11%) T2 tumor and 2 (22%) T3-T4 tumor. In this group, the second resection changed the treatment in 3 (33%) patients. CONCLUSIONS: In T1 G1-2 and T1 G3 tumors, a second transurethral resection detect residual tumor in 36% of patients and change the treatment in 6% of patients. In T2a-b tumors, a second transurethral resection detect residual tumor in 50% of patients and change the treatment in 33% of patients.

[Bladder leiomyoma]. / Leiomioma vesical.

OBJECTIVE: Mesenchymal benign tumours of the urinary bladder are rare and account for 1%-5% of all bladder tumours. The leiomyoma is the most common and constitute 46.6% of this group. 25 cases have been described in the national literature. We report an additional case of leiomyoma of the bladder. CASE REPORT: A 53 year-old man with a chronic history of urinary frequency and microscopic hematuria. Physical examination was normal. An excretory urography demonstrated a filling defect in the right bladder wall. The cystoscopy confirmed the tumour, covered with normal bladder mucosa. The echography showed a solid tumour. A computerised tomography scan and magnetic resonance showed a sessile lesion in the right bladder wall with low-intermediate intensity signal and with normal signal of muscle, mucosa and perivesical fat. The clinical diagnosis was leiomyoma of the bladder. Partial cystectomy was done and the histological diagnosis confirmed the clinical diagnosis. CONCLUSIONS: The leiomyoma of the bladder is a rare tumour however it should be considered in the differential diagnosis before surgical treatment.

[Metachronous tumors of the upper urinary tract following primary superficial tumors of the bladder]. / Tumores del tracto urinario superior metacrónicos subsiguientes a tumores superficiales primarios de vejiga.

OBJECTIVE: To evaluate the long term incidence of upper urinary tract tumours in patients with surface tumours of the bladder. MATERIAL AND METHODS: Analysis of 78 patients with primary tumour of the bladder pTa-pTl diagnosed between 1978 and 1988. These patients were followed for up to 10 to 21 years (mean follow-up 13.4 years) and were treated with transurethral resection and a variety of endovesical cytostatic agents. RESULTS: Of all 78 patients, 9 (11%) developed an upper urinary tract tumour over an average of 9 years (range 4-18); 2 in the first 5 years, 4 between 5 to 10 years, and 3 between 10 and 18 years. The likelihood of finding a tumour in the upper tract if all 20-year old patients were to be followed would be 25.6% (Kaplan-Meier's method). A high percentage of all upper urinary tract tumours are infiltrant, but the cause of death in 44% of these patients is progression of the tumour of the bladder. CONCLUSIONS: The percentage of tumours of the upper urinary tract that become metachronic following a tumour of the bladder, increases with the duration of the follow-up. A high percentage of these cases are already in high stages when diagnosed. It would be convenient to monitor the upper urinary tract with the same periodicity than the bladder in order to establish early diagnoses. These patients show a high mortality rate, in most cases secondary to progression of the tumour of the bladder.

[Bilateral testicular luxation]. / Luxación testicular bilateral.

Contribution of a case report of long-standing bilateral testicular luxation, the result of scrotal trauma caused by a soccer ball. Good aesthetic, endocrine and exocrine results were obtained with surgical treatment. Androgenic hormonal profile and spermiogram performed at six months showed values within the normal range.

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

Leiomyoma of the female urethra is a benign mesenchymal tumour highly infrequent in the clinical practice. There is controversy as to its degree of oestrogen hormone dependency and its diagnosis is reached only after pathohistological study of the resection specimen. This type of tumour has excellent prognosis, with few tumoral relapses and no case of malignant transformation having been reported for the time being. Contribution of one case report of leiomyoma of the female urethra with typical clinical-epidemiological features but very uncommon from a topographic insight, as it was located in the anterior side of the distal urethra.

[Fournier's gangrene: anatomo-clinical features in adults and children. Therapy update]. / Gangrena de Fournier: aspectos anátomo-clínicos en el adulto y en el niño. Actualización terapéutica.

Fournier's gangrene is a skin infectious-necrotising process in the peri-neogenital area affecting males, usually in their sixties or seventies. Isolated flora from cultures of the necrotic lesion is commonly multi-microbial. In a majority of cases both aerobic and anaerobic micro-organisms are found in the cultures, Escherichia coli being the most commonly identified germ. Although considered in the past an idiopathic condition, in most patients today a genitourinary, anorectal or dermal triggering factor can be identified. There are a series of systemic host debilitating disorders such as diabetes mellitus, chronic alcohol abuse, and malignant neoplasia that are associated to this condition and may be considered risk factor to suffer this disease. Fournier's gangrene in children show specific bacteriological, pathogenic, clinical, therapeutic and prognostic features that distinguish it from that in adults. The most extensively accepted management for this condition includes therapy with broad-spectrum parenteral antibiotics and early and aggressive surgical debridement of the necrotic areas. Mortality continues to be high, ranging between 10-80% in the various series. Finally, a group of 7 patients with Fournier's gangrene is analyzed (1991-1998) aiming to establish a comparison between our results and those seen in recent series.

[Value of non-contrast helical computerized tomography in nephrotic colic assessment]. / Valor del TAC helicoidal sin contraste en la evaluación del cólico nefrítico.

OBJECTIVE: To compare non-contrast helicoid CAT to urological ultrasound in order to determine the sensitivity of both in the etiological diagnosis of nephritic colic. MATERIAL AND METHODS: Retrospective study conducted on a total of 86 patients seen in our ER service over a 12-month period with a diagnosis of nephritic colic. All patients with suspicious diagnosis of nephritic colic underwent X-ray examination, with either non-contrast helicoid CAR or urological ultrasound, or with a combination of both imaging techniques. Radiologic diagnosis of nephritic colic was made by direct visualization of the obstructive cause or by the presence of indirect radiological signs of upper urinary tract obstruction. RESULTS: Of 86 patients studied, in 84 (97.67%) a urinary stone was the cause for obstruction. Overall sensitivity of helicoid CAT to diagnose colic etiology was 94.73%, whereas ultrasound sensitivity was only 53.42%, displaying a particularly low sensitivity when the obstruction was located at the mid third level of the ureter. CONCLUSIONS: Non-contrast helicoid CAT shows superior sensitivity as a radiologic technique than ultrasound to identify the cause of a nephritic colic in any segment of the upper urinary tract.