Análisis comparativo de la expresión de metaloproteasas (MMP-2, MMP-9, MMP-11 y MMP-13) y del inhibidor tisular de la metaloproteasa 3 (TIMP-3) entre las biopsias previas negativas y las prostatectomías radicales / Comparative analysis of the expression of metalloproteases (MMP-2, MMP-9, MMP-11 and MMP-13) and the tissue inhibitor of metalloprotease 3 (TIMP-3) between previous negative biopsies and radical prostatectomies

Las metaloproteasas (MMP) y el inhibidor tisular de metaloproteasas 3 (TIMP-3) se han relacionado con el riesgo de padecer cáncer y con la agresividad de varios tumores. En ocasiones, existen muchas dificultades para diagnosticar el cáncer de próstata y la expresión de MMP y del TIMP-3 en biopsias negativas nos podría ayudar a realizar una sospecha diagnóstica en estos casos. El objetivo es hacer un estudio comparativo de la expresión de MMP y TIMP-3 en las biopsias previas negativas y las prostatectomías radicales (PR). MATERIAL Y MÉTODOS: Análisis retrospectivo de una cohorte de base hospitalaria que incluye a 21 pacientes con sospecha de carcinoma prostático en los que se analizaron por técnica inmunohistoquímica las expresiones de MMP-2, 9, 11 y 13 y el TIMP-3 en la zona tumoral, tanto de las biopsias previas negativas como de las PR. RESULTADOS: Los valores de tinción inmunohistoquímicos (score) para las MMP (-11 y -13) y TIMP-3 no mostraron diferencias significativas al comparar las áreas de las biopsias negativas donde luego se desarrolló tumor con las de la PR. Sin embargo, sí que observamos una diferencia significativa aumentando la expresión de la MMP-2 (p = 0,002) y MMP-9 (p = 0,001) en la zona tumoral de la PR con respecto al área correspondiente de la biopsia previa negativa. CONCLUSIONES: Nuestros datos indican una mayor expresión global de la MMP-2 y la MMP-9 en la zona tumoral de la PR en comparación con las áreas correspondientes de la biopsia previa negativa, lo que parece estar en relación con el proceso de transformación maligna

Metalloproteases (MMPs) and tissue inhibitor of metalloprotease-3 (TIMP-3) have been associated to the risk of having cancer and tumor aggressiveness. When facing the difficulties of prostate cancer diagnosis, the expression of MMPs and TIMP-3 in negative biopsies could be helpful to evaluate a diagnostic suspicion. Our objective is to carry out a comparative study of the expression of MMPs and TIMP-3 in previous negative biopsies and radical prostatectomies (RP). MATERIAL AND METHODS: Retrospective analysis of a hospital-based cohort including 21 patients with suspicion of prostate carcinoma, whose expressions of MMP-2, 9, 11 and 13 and TIMP-3 were evaluated by immunohistochemistry in the tumor area from previous negative biopsies and RP. RESULTS: Immunohistochemical staining values (Score) for MMPs (-11 and -13) and TIMP-3 showed no significant differences when comparing the areas of negative biopsies where tumors subsequently developed with those of the RP. However, we did observe a significant difference in the increased expression of MMP-2 (P = .002) and MMP-9 (P = .001) in the tumor area of the RP with respect to the corresponding area of the previous negative biopsy. CONCLUSIONS: Our data indicate a higher overall expression of MMP-2 and MMP-9 in the tumor area of the RP compared to the corresponding areas of the negative previous biopsy, which seems to be associated to the process of malignant transformation

[Renal cell carcinoma with (tubule) papillary architecture. Report of three cases and bibliographic review.] / Carcinoma de células renales con arquitectura (túbulo) papilar. Presentación de tres casos y revisión de la literatura.

OBJECTIVE: Update of clear cell (tubulo) papillary renal cell carcinoma. METHODS: We provide the only three cases described to date in our hospital. RESULTS: One of the new entities of epithelial renal tumors incorporated by the International Society of Urological Pathology (ISUP) in 2013 was the clear cell (tubulo) papillary renal cell carcinoma (RCCtpcc). Although initially was described under other nomenclatures, it was not until 2013 that it was clearly defined. CONCLUSION: The RCCtpcc is usually a low grade and stage subtype of epithelial RCC. It predominates in the sixth decade of life, although cases have already been described in children and young adults. It has a typical immunohistochemical pattern with positive CK7, vimentine, VT and smooth muscle antigen, and negative CD10. They usually have a low malignant potential.

OBJETIVO: Puesta al día del CCR túbulo papilar de células claras. MÉTODO: Aportamos los únicos tres casos descritos hasta la actualidad en nuestro hospital. RESULTADO: Una de las nuevas entidades de tumores renales epiteliales incorporadas por la International Society of Urological Pathology (ISUP) en el año 2013 es el carcinoma de células renales (tubulo) papilar de células claras (CCRtp). Aunque en un principio fue descrito bajo otras nomenclaturas, no es hasta esa fecha cuando se recogen las características que lo definen. CONCLUSIONES: El CCRtp es un subtipo de CCR epitelial, por lo general de bajo grado y estadio. Predomina en la sexta década, aunque ya están descritos casos en niños y adultos jóvenes. Su patrón inmuno-histoquímico característico es: CK7 positivo; CD10 negativo, Vimentina positivo, VT positivo y Antígeno músculo liso positivo. Por lo general son de bajo potencial maligno.

Carcinoma de células renales con arquitectura (túbulo) papilar. Presentación de tres casos y revisión de la literatura / Renal cell carcinoma with (tubule) papillary architecture. Report of three cases and bibliographic review

Objetivo: Puesta al día del CCR túbulo papilar de células claras. Método: Aportamos los únicos tres casos descritos hasta la actualidad en nuestro hospital. Resultado: Una de las nuevas entidades de tumores renales epiteliales incorporadas por la International Society of Urological Pathology (ISUP) en el año 2013 es el carcinoma de células renales (tubulo) papilar de células claras (CCRtp). Aunque en un principio fue descrito bajo otras nomenclaturas, no es hasta esa fecha cuando se recogen las características que lo definen. Conclusiones: El CCRtp es un subtipo de CCR epitelial, por lo general de bajo grado y estadio. Predomina en la sexta década, aunque ya están descritos casos en niños y adultos jóvenes. Su patrón inmuno-histoquímico característico es: CK7 positivo; CD10 negativo, Vimentina positivo, VT positivo y Antígeno músculo liso positivo. Por lo general son de bajo potencial maligno

Objective: Update of clear cell (tubulo) papillary renal cell carcinoma. Methods: We provide the only three cases described to date in our hospital. Results: One of the new entities of epithelial renal tumors incorporated by the International Society of Urological Pathology (ISUP) in 2013 was the clear cell (tubulo) papillary renal cell carcinoma (RCCtpcc). Although initially was described under other nomenclatures, it was not until 2013 that it was clearly defined. Conclusion: The RCCtpcc is usually a low grade and stage subtype of epithelial RCC. It predominates in the sixth decade of life, although cases have already been described in children and young adults. It has a typical immunohistochemical pattern with positive CK7, vimentine, VT and smooth muscle antigen, and negative CD10. They usually have a low malignant potential

Amiloidosis vesical: presentación de 5 casos / Bladder amyloidosis: study of 5 cases

No disponible

[Usefulness of cold ureteral biopsy during radical cystectomy as a predictor of recurrence risk: Review of our series.] / Utilidad de la biopsia fría ureteral durante la cistectomía radical como predictor de riesgo de recidiva: revisión de nuestra serie.

OBJECTIVES: To evaluate the association of positive margins in the intraoperative biopsy during radical cystectomy (RC) with the risk of recurrence in the uretero-ileal anastomosis or upper urinary tract (UUT), and identify potential risk factors for positive ureteral margins. METHODS: A retrospective, descriptive study was performed in patients treated with radical cystectomy due to transitional cell carcinoma (TCC), who underwent a cold biopsy of the ureteral margin at the time of cystectomy. A descriptive analysis and frequency distribution was performed. Fisher's test was used to calculate sensitivity and specificity and a survival analysis was performed. RESULTS: 230 patients were included. Prior to RC, transurethral resection of the bladder tumor and a CT scan were done. The percentage of positive margins was 4.81% for the right ureter and 4.27% for the left. Recurrence was detected in the anastomosis in 2.64% of the cases. In a 0.88% recurrence was found in the UUT (2 cases) at the level of left renal pelvis (1 case) and left kidney (1 case). In the multivariate analysis, neither recurrence in the anastomosis (p=1) or at the UUT (p=1) level during follow-up were significantly associated with the presence of positive margins. An association was found between the pathological biopsy of the right ureter and carcinoma in situ (CIS) of the bladder wall with UUT involvement. We found only association between the cold biopsy of the left ureter and tumor in left UTT. Reimplantation with positive margins was not statistically associated with neither ureteroileal anastomosis or UTT relapse. A relationship was found between the cold biopsy of both ureters and the definitive pathology. CONCLUSIONS: In our study, the presence of positive ureteral margins was not associated with an increased risk of recurrence in the anastomosis or UUT. Although it remains a topic for debate, a strategy to follow may be to adapt ureteral cold biopsies to individual risk, thus perform it in patients with bladder CIS.

Utilidad de la biopsia fría ureteral durante la cistectomía radical como predictor de riesgo de recidiva: revisión de nuestra serie / Usefulness of cold ureteral biopsy during radical cystectomy as a predictor of recurrence risk: Review of our series

OBJETIVOS: Evaluar la asociación de márgenes positivos en la biopsia intra-operatoria al tiempo de la cistectomía radical (CR) con el riesgo de recidiva en la anastomosis urétero-ileal o a nivel del tracto urinario superior (TUS), y estudiar posibles factores de riesgo preoperatorios asociados con el margen ureteral positivo. MÉTODO: Estudio descriptivo retrospectivo de pacientes tratados mediante CR debido a carcinoma de células transicionales (CCT), a los que se les realizó al tiempo de la CR una biopsia fría del margen ureteral. Se realizó un análisis descriptivo y distribuciones de frecuencias. Se empleó el test de Fisher, se calcularon los valores de sensibilidad (Se) y especificidad (Sp) de la prueba, y se realizó un análisis de supervivencia. RESULTADOS: Se incluyeron 230 pacientes que fueron sometidos a CR. Previamente a la CR se les realizó resección transuretral (RTU) de vejiga y tomografía axial computarizada (TC). El porcentaje de márgenes positivos fue de 4,8% para el uréter derecho y de 4,7% para el izquierdo. Se detectó recidiva en la anastomosis en el 2,6% de los casos. En un 0,8% se encontró recidiva en el TUS (2 casos) a nivel de pelvis renal izquierda (1 caso) y riñón izquierdo (1 caso). En el análisis multivariante, ni la recidiva en la anastomosis (p=1) ni a nivel del TUS (p=1) a lo largo del seguimiento, se asociaron de forma significativa con la presencia de márgenes positivos. De forma secundaria se estudiaron los posibles factores anatomopatológicos preoperatorios asociados con el riesgo de margen positivo, encontrando asociación entre la anatomía patológica (A-P) intraoperatoria del uréter derecho y CIS en la RTU vesical y con tumor del TUS asociado. La reimplantación con margen positivo no se asoció estadísticamente con recidiva en la anastomosis ni con recidiva en el TUS. Hubo relación entre A-P intraoperatoria de ambos uréteres y la definitiva. CONCLUSIONES: En nuestro estudio, la presencia de márgenes ureterales positivos no se asociaron con mayor riesgo de recidiva en la anastomosis o en el TUS. Aunque sigue siendo un tema a debate, una estrategia a seguir puede ser adaptar la biopsia fría ureteral al riesgo individual y realizarla a pacientes con CIS vesical

OBJECTIVES: To evaluate the association of positive margins in the intraoperative biopsy during radical cystectomy (RC) with the risk of recurrence in the uretero-ileal anastomosis or upper urinary tract (UUT), and identify potential risk factors for positive ureteral margins. METHODS: A retrospective, descriptive study was performed in patients treated with radical cystectomy due to transitional cell carcinoma (TCC), who underwent a cold biopsy of the ureteral margin at the time of cystectomy. A descriptive analysis and frequency distribution was performed. Fisher's test was used to calculate sensitivity and specificity and a survival analysis was performed. RESULTS: 230 patients were included. Prior to RC, transurethral resection of the bladder tumor and a CT scan were done. The percentage of positive margins was 4.81% for the right ureter and 4.27% for the left. Recurrence was detected in the anastomosis in 2.64% of the cases. In a 0.88% recurrence was found in the UUT (2 cases) at the level of left renal pelvis (1 case) and left kidney (1 case). In the multivariate analysis, neither recurrence in the anastomosis (p=1) or at the UUT (p=1) level during follow-up were significantly associated with the presence of positive margins. An association was found between the pathological biopsy of the right ureter and carcinoma in situ (CIS) of the bladder wall with UUT involvement. We found only association between the cold biopsy of the left ureter and tumor in left UTT. Reimplantation with positive margins was not statistically associated with neither ureteroileal anastomosis or UTT relapse. A relationship was found between the cold biopsy of both ureters and the definitive pathology. CONCLUSIONS: In our study, the presence of positive ureteral margins was not associated with an increased risk of recurrence in the anastomosis or UUT. Although it remains a topic for debate, a strategy to follow may be to adapt ureteral cold biopsies to individual risk, thus perform it in patients with bladder CIS

[Intravesical therapy: Influence on superficial bladder cancer progression]. / Terapia endovesical: influencia sobre la progresión en el cáncer vesical superficial.

OBJECTIVES: To review the influence of various intravesical treatments on superficial bladder cancer progression. METHODS: We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different treatment and follow-up schemes, with BCG in 139 cases and intravesical chemotherapy, mainly Mytomicin C, in 80. RESULTS: Overall, the use or not of bladder instillations did not show statistically significant differences in time to progression. The use of intravesical therapy and maintenance therapy was an independent risk factor for disease-free time to progression when compared with induction. CONCLUSIONS: The use of maintenance intravesical therapy with BCG resulted in a delayed progression of superficial bladder cancer, so that it seems the most effective treatment, mainly in moderate-high risk tumors.

[Intravesical therapy: Influence on superficial bladder cancer recurrence]. / Terapia endovesical: influencia sobre la recidiva en el cáncer vesical superficial.

OBJECTIVES: To review the influence of various intravesical treatments on superficial bladder cancer recurrence. METHODS: We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different adjuvant treatment and follow-up schemes. RESULTS: The following factors were independent risk factors for a longer recurrence-free time: intravesical instillations, high dose BCG, and maintenance therapy in comparison to induction. CONCLUSIONS: The use of intravesical instillations independently increases the time to recurrence. It was demonstrated that recurrence was significantly later when high dose BCG and maintenance therapy were employed.

Terapia endovesical: influencia sobre la progresión en el cáncer vesical superficial / Intravesical therapy: Influence on superficial bladder cancer progression

OBJETIVOS: Revisar la influencia de distintos tratamientos endovesicales sobre la progresión del cáncer vesical superficial. METODOS: Se revisaron retrospectivamente un total de 473 neoplasias vesicales superficiales. A partir del diagnóstico y la RTU vesical, y en función del resultado anatomopatológico, se plantearon distintos esquemas de seguimiento y tratamiento complementario, se empleó BCG en 139 casos y quimioterapia endovesical en 80 pacientes fundamentalmente Mitomicina C (MMC). RESULTADOS: Globalmente, el empleo o no de instilaciones vesicales no mostró diferencias estadísticamente significativas en cuanto al tiempo de progresión Resultó factor independiente para explicar un menor tiempo libre hasta la progresión el empleo de terapia endovesical con terapia de mantenimiento frente a inducción. CONCLUSIONES: La utilización de terapia endovesical de mantenimiento con BCG implicó una progresión más tardía del cáncer vesical superficial, por lo que parece el tratamiento más eficaz, sobretodo en tumores de moderado y alto riesgo (AU)

OBJECTIVES: To review the influence of various intravesical treatments on superficial bladder cancer progression. METHODS: We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different treatment and follow-up schemes, with BCG in 139 cases and intravesical chemotherapy, mainly Mytomicin C, in 80. RESULTS: Overall, the use or not of bladder instillations did not show statistically significant differences in time to progression. The use of intravesical therapy and maintenance therapy was an independent risk factor for disease-free time to progression when compared with induction. CONCLUSIONS: The use of maintenance intravesical therapy with BCG resulted in a delayed progression of superficial bladder cancer, so that it seems the most effective treatment, mainly in moderate-high risk tumors

Terapia endovesical: influencia sobre la recidiva en el cáncer vesical superficial / Intravesical therapy: influence on superficial bladder cancer recurrence

OBJETIVOS: Revisar la influencia de distintos tratamientos endovesicales sobre la recurrencia del cáncer vesical superficial. METODOS: Se revisaron retrospectivamente un total de 473 neoplasias vesicales superficiales. A partir del diagnóstico y la RTU vesical, y en función del resultado anatomopatológico, se plantearon distintos esquemas de seguimiento y tratamiento complementario. RESULTADOS: Resultaron independientes para explicar mayor tiempo libre hasta la recurrencia superficial los siguientes factores: empleo de lavados endovesicales, tratamiento con dosis altas de BCG y terapia de mantenimiento frente a inducción. CONCLUSIONES: El empleo de instilaciones vesicales incrementaron de forma independiente el tiempo hasta la recidiva. Se demostró que la recurrencia se produjo significativamente más tarde cuando se habían empleado dosis altas de BCG y terapia de mantenimiento (AU)

OBJECTIVES: To review the influence of various intravesical treatments on superficial bladder cancer recurrence. METHODS: We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different adjuvant treatment and follow-up schemes. RESULTS: The following factors were independent risk factors for a longer recurrence-free time: intravesical instillations, high dose BCG, and maintenance therapy in comparison to induction. CONCLUSIONS: The use of intravesical instillations independently increases the time to recurrence. It was demonstrated that recurrence was significantly later when high dose BCG and maintenance therapy were employed

Telomere length on bladder washing samples from patients with bladder cancer correlates with tumor characteristics flow cytometry method for quantitative fluorescence in situ hybridization (flow-FISH technique).

OBJECTIVE: The purpose of the present study was to evaluate the length of telomeres in patients with bladder cancer using a quantitative flow cytometry (flow-FISH) technique. METHODS: Bladder washing samples from 51 patients with bladder cancer were obtained immediately before transurethral resection. The average length of telomere repeats was measured by flow-FISH, as previously reported. Results were expressed in molecular equivalents of soluble fluorochrome (MESF) units. RESULTS: Bladder washing specimens provided adequate cell numbers for flow-FISH in 49 cases. The TEL means were 1014.71, 2343.36, 5567 and 18267.57 for Ta, T1, T2 and T3/4 tumors, respectively. Regarding grade it was obtained a mean MESF value of 1379.46, 3391.29 and 15925.11 for G1, G2 and G3, respectively. ANOVA demonstrated statistically significant differences in stage (p: 0.014) and tumor grades (p: 0.012). In relation to ploidy, we found a mean MESF value of 2701.37 and 16085.44 MESF units for diploid and aneuploid cells, respectively. Significant difference (p: 0.003) was observed between both groups. CONCLUSION: To date, this is the first report wherein telomere length was measured using flow-FISH method in exfoliated cells in urine from patients with bladder cancer. Further investigations are required to demonstrate whether flow-FISH technique might be considered as a tumor marker of bladder cancer.

[The treatment of urinary incontinence by injectables. Analysis of our series]. / "Tratamiento de la incontinencia urinaria mediante sustancias inyectables. Análisis de nuestra serie".

OBJECTIVES: To determine the efficacy of endoscopical injections for the treatment of stress urinary incontinence (SUI), evaluating its low invasiveness and positive impact on quality of life. METHODS/RESULTS: Belween 1997--2003 30 procedures of periurethral injection of various substances for urinary incontinence were performed at our department in women between 47-80 years. All patients were evaluated before surgery, clinically and urodynamically, in accordance to international standardized parameters (filling pressure/flow studies, maximum urethral closure pressure, LPP-leak point pressure). The kind of material employed for injection, surgical technique and satisfaction degree were also evaluated. RESULTS: The indication for surgery was SUI in 17 cases (56.6%), and mixed urinary incontinence in 73 cases (43.3%). 16 cases (53.3%) had history of previous surgery for SUI. Regarding urodynamic parameters, 19 patients (63.3%) have a maximum urethral closure pressure below 25 H2O cm, and 22 patients (73.3%) had a leak point pressure below 60 H2O cm. Collagen was employed in six cases (20%) and macroplastic in 24 (80%) (14 of them with the MIS system). 22 patients had three injection sites (73.3%). Mean follow-up was 38 months. Continence outcomes were evaluated in relation to complete continence (12 cases, 40%), mild incontinence and patient satisfaction (11 cases, 36.6%), and severe incontinence (7 cases, 23.3%). CONCLUSIONS: 1-To achieve acceptable results it is mandatory to do the best possible indication (Mc Guire type III SUI). 2.-There is an excellent relationship between minimal invasiveness and good results.

Tratamiento de la incontinencia urinaria mediante sustancias inyectables. Análisis de nuestra serie / The treatment of urinary incontinence by injectables. Analysis of our series

OBJETIVO: Determinar la efectividad delas inyecciones endoscópicas en la corrección de laIUE, valorando su escasa agresividad y su impactopositivo en la calidad de vida.MÉTODOS/RESULTADOS: Entre 1997-2003 se realizaronen nuestro servicio 30 intervenciones por incontinenciaurinaria con inyección periuretral de diversassustancias, en mujeres con edades comprendidas entre47-80 años. Todas las pacientes fueron valoradas previaintervención clínica y urodinámicamente atendiendoa los parámetros internacionalmente reconocidos (cistomanometríade llenado, presión uretral máxima, LPP(Leak point presure o presión abdominal de escape).También se valoró el tipo de material utilizado para lainyección, técnica quirúrgica y grado de satisfacción.RESULTADOS: En 17 casos (56.6%) la indicación quirúrgicafue por IUE pura mientras que en 13 casos(43.3%) fue mixta. En 16 casos (53.3%) existían anteÓscarRodríguez FabaC/ Amsterdam, 4 - 7ºA33011 Oviedo.Asturias. (España)e-mail: oscar.rodriguez@sespa.princast.esTrabajo recibido: 8 de junio 2004CorrespondenciaPalabras clave: Sustancias periuretrales.Incontinencia tipo III.Summary.- OBJECTIVES: To determine the efficacyof endoscopical injections for the treatment of stressurinary incontinence (SUI), evaluating its low invasivenessand positive impact on quality of life.METHODS/RESULTS: Between 1997-2003 30 proceduresof periurethral injection of various substances for urinaryincontinence were performed at our department inwomen between 47-80 years. All patients wereevaluated before surgery, clinically and urodynamically,cedentes de intervenciones previas por IUE. En cuantoa parámetros urodinámicos en 19 pacientes( 63.3%) lapresión máxima de cierre uretral fue menor de 25 cmde agua y en 22 pacientes ( 73.3%) , el leak point presurefue menor de 60 cm de agua. En 6 pacientes(20%) se utilizó colageno y en 24 pacientes (80%)macroplastique ( 14 de ellos con sistema M.I.S). En 22casos (73.3%) se realizaron 3 habones. El tiempomedio de seguimiento fue de 38 meses. El resultado encuanto a continencia se valoró en relación a que lapaciente estuviese totalmente seca ( 12 casos 40%),incontinencia leve pero satisfecha (11 casos 36.6%) eincontinencia grave ( 7 casos, 23.3%).CONCLUSIONES: 1.-Resulta imprescindible para obtenerresultados aceptables la mejor de las posibles indicaciones( IUE tipo III de Mc Guire). 2.- Existe una relaciónexcelente entre la mínima agresividad y los buenosresultados

OBJECTIVES: To determine the efficacyof endoscopical injections for the treatment of stressurinary incontinence (SUI), evaluating its low invasivenessand positive impact on quality of life.METHODS/RESULTS: Between 1997-2003 30 proceduresof periurethral injection of various substances for urinaryincontinence were performed at our department inwomen between 47-80 years. All patients wereevaluated before surgery, clinically and urodynamically,in accordance to international standardized parameters(filling pressure/flow studies, maximum urethral closurepressure, LPP-leak point pressure). The kind of materialemployed for injection, surgical technique and satisfactiondegree were also evaluated.RESULTS: The indication for surgery was SUI in 17cases (56.6%), and mixed urinary incontinence in 13cases (43.3%). 16 cases (53.3%) had history ofprevious surgery for SUI. Regarding urodynamicparameters,19 patients (63.3%) have a maximum urethralclosure pressure below 25 H2O cm, and 22 patients(73.3%) had a leak point pressure below 60 H2O cm.Collagen was employed in six cases (20%) andmacroplastic in 24 (80%) (14 of them with the MISsystem). 22 patients had three injection sites (73.3%).Mean follow-up was 38 months. Continence outcomeswere evaluated in relation to complete continence (12cases, 40%), mild incontinence and patient satisfaction(11 cases, 36.6%), and severe incontinence (7 cases,23.3%).CONCLUSIONS: 1-To achieve acceptable results it ismandatory to do the best possible indication (Mc Guiretype III SUI). 2.-There is an excellent relationship betweenminimal invasiveness and good results

[Bladder metastasis of renal carcinoma]. / Metástasis vesical de carcinoma renal.

OBJECTIVES: We report the case of a patient who had underwent surgery for a clear cell renal carcinoma 2 years before presenting with metastasic extension to bladder on follow-up. METHODS: Radiological finding of a bladder mass during follow-up after nephrectomy. RESULTS: TURBT was carried out with the pathologic report of clear cell carcinoma, compatible with a primary renal origin. CONCLUSIONS: Bladder is a very rare place for metastasis from kidney tumors. Prognosis will depend on the time of appearance of such metastases.

[Extra adrenal pheochromocytoma. Report of two cases]. / Feocromocitoma extraadrenal. Presentación de dos casos.

OBJECTIVES: To review two cases of extra adrenal pheochromocytoma. METHODS: We present two cases: a 75-year-old patient with history of high blood pressure and intravesical tumor compatible with urinary bladder paraganglioma, and a 59-year-old patient with a retroperitoneal tumor arising from para-aortic ganglia. RESULTS: Diagnosis was made by CT scan and transurethral resection in the first case, all posterior extension studies were negative; in the second case retroperitoneal exeresis surgery was performed after CT scan. CONCLUSIONS: Extra adrenal pheochromocytomas are catecholamine producing tumours, which determines their clinical features; treatment should be surgical. A bibliographic review about this disease is performed.

[Clinical course of epidermoid carcinoma of the penis in our series]. / Análisis de la evolución del carcinoma epidermoide de pene en nuestra serie.

OBJECTIVES: To study the evolution of 49 patients with squamous cell carcinoma of the penis. METHODS: 49 patients who underwent surgery for squamous cell carcinoma of the penis (30 partial penile amputations, 11 total amputations and 7 circumcisions). 27 inguinal lymphadenectomies, superficial, profound and ilio-obturator (2 cases), were performed due to persistent lymph nodes after penile amputation despite of antibiotic treatment for 4 weeks, or to high grade primary tumour. 13 patients were found to have lymph node metastases after treatment, receiving posterior adjuvant treatment with radiotherapy, chemotherapy or a combination of them. Patients were followed in relation to stage, cell differentiation degree, and presence or absence of positive lymph nodes and distant metastases. RESULTS: There were 5 Ta stage tumours, 26 T1(63.2%), 16 T2 (32.6%), and 2 T3 (4.08%). Regarding cytological degree 81% were GI, 16% G II, and 2% G III. Lymph node metastasis were detected in 13 patients (26.53%) after lymph node dissection. 6 patients died from tumour dissemination, 2 of them were T2G2, one T2G1, and three T1G2; two additional patients died from causes different from the tumour, all of them being N+ at the time of diagnosis. CONCLUSIONS: Penile squamous cell carcinoma is an aggressive tumour the evolution of which mainly depends on the local-regional stage at the time of diagnosis and cell differentiation; these factors will condition lymphadenectomy versus observation.

Análisis de la evolución del carcinoma epidermoide de pene en nuestra serie / Analysis of the evolution of squamous cell carcinoma of the penis in our series

OBJETIVOS: Se estudia la evolución de 49 pacientes con carcinoma epidermoide de pene. MÉTODOS: Se trata de 49 pacientes sometidos a cirugía por carcinoma epidermoide de pene (30 penectomías parciales, 11 totales y 7 circuncisiones).Se practicaron 27 linfadenectomías inguinales, superficial, profunda y en dos casos ilio-obturatriz, por persistencia de ganglios tras penectomía, a pesar de tratamientos antibióticos de 4 semanas o por alto estadio del tumor primario. Se objetivan metástasis ganglionares en 13 de los pacientes tratados, recibiendo posteriormente tratamiento adyuvante con QT, RT o combinación de ambos. Se realiza un seguimiento de los pacientes en función del estadio, Grado de diferenciación celular y existencia o no de ganglios positivos y metástasis a distancia. RESULTADOS: Se encuentran 5 tumores en estadio Ta y 26 T1 (63,2 per cent), 16 T2 (32,6 per cent) y 2 T3 (4,08 per cent). En cuanto al grado 81 per cent fueron GI, 16 per cent GII y 2 per cent GIII. Tras linfadenectomía se objetivan metástasis ganglionares en 13 de los pacientes (26,53 per cent). En 6 de los pacientes se produjo fallecimiento por diseminación del tumor, dos de ellos T2G2, un T2G1, tres T1G2; además dos pacientes T1G1 fallecieron por causas ajenas al proceso tumoral, siendo todos N+ clínicamente en el momento del diagnóstico. CONCLUSIONES: Por lo tanto se trata de un tumor agresivo cuya evolución dependerá sobretodo del estadio locorregional en el momento del diagnóstico y del grado de diferenciación celular que alcance, en función de los cuales se planteará la posibilidad de linfadenectomía versus vigilancia (AU)

Test NMP-22. ¿Es útil en el seguimiento de pacientes con tumor vesical superficial? / NMP-22 Test. Is it useful in the follow-up of patients with superficial bladder tumors?

OBJETIVO: 1.- Valorar la eficacia de NMP-22 como test diagnóstico en recidivas de tumores vesicales. 2.- Comparar la eficacia de NMP-22 con las citologías de orina. MÉTODO: Se incluyeron 90 pacientes con tumor vesical superficial y se realizaron controles citológicos, cistoscópicos y de marcador NMP-22. Se consideró test positivo cuando el marcador señalaba cifras superiores a 10 U/ml. El test de referencia fue la cistoscopia RESULTADOS: El rango de edad de los pacientes incluidos se situó entre 45 y 91 años con una media de 69 años. Un 88 por ciento fueron varones y un 12 por ciento mujeres. Un 61,2 por ciento fueron Ta, un 37,6 por ciento T1 y un 1,2 por ciento Cis, siendo el grado un 17,8 por ciento GI, 63,4 por ciento GII y un 18,8 por ciento GIII.El NMP-22 mostró una sensibilidad global del 32,1 por ciento, una especificidad del 95,1 por ciento, Valor predictivo positivo 75 por ciento y Valor predictivo negativo 75,3 por ciento, para una tasa de recidivas del 27,7 por ciento. La citología mostró una sensibilidad global del 28,6 por ciento; una especificidad del 95,2 por ciento; un VPP del 72,7 por ciento y un VPN del 74,7 por ciento. Cuando se utilizaron los test en paralelo, obtuvimos una sensibilidad del 46,4 por ciento; una especificidad del 90,3 por ciento; un VPP del 68,43 por ciento y un VPN del 78,9 por ciento. CONCLUSIONES: El marcador NMP-22 ha demostrado una sensibilidad baja, con lo que no evitamos el uso de la cistoscopia del control. El uso de NMP-22 y citologías en paralelo aumenta mínimamente la sensibilidad. No es posible sustituir a la cistoscopia en el seguimiento de pacientes con tumor vesical superficial (AU)

[Clinical presentation of testicular germinal cancer]. / Presentación clínica del cáncer germinal de testículo.

OBJECTIVE: To review the clinical features in our series of patients of germ-cell testicular cancer. METHODS: The charts of 73 patients with diagnosis of germ-cell testicular tumours were reviewed. Age, history of cryptorchism, time to diagnosis, main symptoms, and serum markers values (alpha- fetoprotein and beta-HCG) were analysed. All cases underwent orchiectomy and extension study with abdominal CT-scan and either chest X-ray or Thoracic CT-scan. We follow the AJCC-UICC 1997 stage classification. Histological cell line, size, and clinical stage at presentation (local, regional and distance) have been analysed also. RESULTS: Among 73 germ-cell testicular tumours 34 were seminomas (46.6%) and 39 were non-seminomatous (54.4%). Clinically, 58.9% of the patients had localised stage I tumours. On presentation 85.7% seminomas were stage I compared to 35.9% non-seminomatous tumours. The remaining tumours were diagnosed in advanced phases (stages II and III). Inguinal orchiectomy was performed in all patients except 5 in whom tumours were incidentally diagnosed (atrophic testis orchiectomy, hydrocoelectomy, trauma) and needed a second operation including ipsilateral scrotal excision. When size, cell line and primary tumour T category were reviewed we found that 32.3% seminomas and 20.5% non seminomas were smaller than 4 cm. 50% seminomas and 49.7% non seminomas were pT1; 41.2% seminomas and 28.2 non seminomas were pT2; finally 8.8% seminomas were pT3 compared to 23.1% non seminomas. Vascular infiltration, also evaluated in this chapter, was present in 38.2% seminomas compared to 38.5% non seminomas. Elements of embryonal carcinoma were found in 37 non seminomatous tumours, either isolated (14) or associated with other components. Teratoma appeared in 18 non seminomatous tumours, 16 of them associated to embryonal carcinoma alone or together with other components. Elements of choriocarcinoma and endodermal sinus were evident in 5 and 4 cases respectively, always associated with other elements. CONCLUSIONS: Seminomas clinical presentation substantially differs from that of non seminomatous testicular tumours in age, clinical features, stage and histological aggressiveness.