[Adequacy of urology departments in a health care model of hospitals network]. / Adecuación de Servicios de Urología en un Modelo Asistencial de Red de Hospitales.

UNLABELLED: The traditional health care model is currently facing new health requirements. The implementation of integrated urologic health systems can be one of the possible solutions to these needs. It is mandatory to explore a new health care model, which includes structural and organizational changes. The adequacy of the urology departments of IDCsalud-Madrid network hospitals, creating URORed, is a new system adaptable to constant changes, in order to offer professionalism and quality health care. OBJECTIVE: To describe the administrative/clinic management in the urology service of a health care model of Hospitals network (URORed at IDCsalud. Madrid), that has been included in a model of an Integrated network in a health care service. METHODS: In the period between November 2007 to October 2014, the urology departments of IDCsalud Madrid Group, have been included in a new organizational system, including 4 hospitals, currently with 27 urologists. Each center offers specific urologic services, sharing benefits and human resources. The same directive line leads all centers. RESULTS: The model offers an integrated and uniform urologic service to a specific population of 811.390 habitants (Population Census 2012), with capability to treat specific urologic diseases and to perform a correct clinical follow-up. CONCLUSIONS: Belonging to a health care model in network involves a change of attitude. It creates an organizational change, based on the processes and the results, which enables control of the management analytically, detecting the points that need to be optimized as well as those that are satisfactory. It implies developing a culture of learning and cooperation, so that the processes are fluent and have quality, to create clinical and technological projects in favor of new resource-generating research, based on the needs of the joint management of the hospitals network. The complexity of this model requires a work focused on the human resources, their concerns and their ability to coordinate actions to get results in terms of quality health care and professionalism.

Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad / Relation Between Prostate Gland Volume and Some Histological Markers of Malignancy

Objetivos: La relación entre el volumen total de la glándula prostática, o el peso de la misma tras prostatectomía radical, y los marcadores histológicos de malignidad en casos de cáncer de próstata, es motivo de controversia. Hemos analizado 100 muestras consecutivas de prostatectomía radical para determinar la relación entre el volumen o el peso de la glándula prostática y la agresividad biológica del proceso tumoral expresado por diferentes marcadores histológicos. Material y métodos: Se han revisado las piezas de prostatectomía radical de 100 pacientes consecutivos, que no recibieron tratamiento hormonal preoperatorio. Estas muestras quirúrgicas fueron procesadas siguiendo un protocolo común. En la ulterior valoración se investigó con mayor precisión: el grado de Gleason, volumen tumoral, multifocalidad, invasión vascular o neural, estadio pT y presencia de focos de PIN. Los hallazgos fueron comparados con el peso de la glándula utilizando el paquete estadístico de WINDOWS SPSS 13.0 con valor estadístico significativo de p<0,05. Según el peso de la glándula se formaron tres grupos:<40g (33%), entre 40-90g (61%) y >90g (6%). Resultados: Se encontró una asociación estadísticamente significativa (p=0,001) entre el peso de la glándula y el volumen del tumor, ya que 15 de 33 glándulas de peso inferior a 40g mostraron más del 50% de la glándula afectada por tumor, comparado con ninguno de los 6 pacientes con peso total mayor de 90g. También se encontró relación significativa entre la multifocalidad y el peso (p=0,03), de forma que 24 de 33 glándulas menores de 40g tenían multifocalidad bilateral en comparación con solo una de 6 glándulas mayores de 90g. La invasión neural, el número de focos de PIN y un grado combinado de Gleason más alto fueron más frecuentes en las próstatas pequeñas, pero la diferencia no alcanzó significación estadística. Conclusiones: Nuestro estudio indica que las glándulas prostáticas de gran volumen albergan tumores de menor malignidad (volumen tumoral, bilateralidad). El hallazgo justifica la conveniencia de contar con el volumen total de la glándula prostática para decisiones diagnósticas (indicación de biopsia prostática y repetición de las mismas) y determinación pronóstica (AU)

Objectives: The relationship between the total volume of the prostate gland or its weight after radical prostatectomy and the histological markers of malignancy in cases of prostate cancer is a controversial subject. We have analyzed 100 consecutive radical prostatectomy specimens in order to determine the relationship between volume or weight of the prostate gland and the biological aggressiveness of the tumor process by different histological markers. Material and methods: One hundred consecutive radical prostatectomy specimens in patients who had not received pre-operative hormone treatment were retrospectively reviewed. These surgical samples were processed according to a standardized protocol. In a subsequent evaluation, the following were studied with greater detail: Gleason grade, tumor volume, multimodality, neural or vascular invasion, put stage, and presence of PIN foci. The histological findings were compared with the prostate gland weight using Windows SPAS, 13.0 statistical package with a significance value of p<0.05. According to the prostate gland weight, three groups were established: <40g (33%), 40 - 90g (61%), and >90g (6%). Results: A statistically significant association (p=0.001) was found between the prostate gland weight and tumor volume since 15 of the 33 glands with weight under 40g accounted for more than 50% of the glands affected by tumor compared to none of the 6 patients with total weight over 90g. A significant relationship was also found between the multimodality and weight. (P=0.03), so that 24 of the 33 glands under 40g had bilateral multimodality compared to only 1 out of the 6 glands over 90g. The neural invasion, number of PIN foci and the highest combined Gleason grade were frequent in low volume prostates, but the difference did not reach statistical significance. Conclusions: Our study indicates that large volume prostate glands have tumors with lower malignancy (tumor volume, bilateralism). This finding justifies the adequacy of using total volume of the prostate gland for diagnostic decision (indication of prostatic biopsy and their repetition) and the prognostic determination (AU)

[Relation between prostate gland volume and some histological markers of malignancy]. / Relación entre volumen de la glándula prostática y algunos marcadores histológicos de malignidad.

OBJECTIVES: The relationship between the total volume of the prostate gland or its weight after radical prostatectomy and the histological markers of malignancy in cases of prostate cancer is a controversial subject. We have analyzed 100 consecutive radical prostatectomy specimens in order to determine the relationship between volume or weight of the prostate gland and the biological aggressiveness of the tumor process by different histological markers. MATERIAL AND METHODS: One hundred consecutive radical prostatectomy specimens in patients who had not received pre-operative hormone treatment were retrospectively reviewed. These surgical samples were processed according to a standardized protocol. In a subsequent evaluation, the following were studied with greater detail: Gleason grade, tumor volume, multimodality, neural or vascular invasion, put stage, and presence of PIN foci. The histological findings were compared with the prostate gland weight using Windows SPAS, 13.0 statistical package with a significance value of p<0.05. According to the prostate gland weight, three groups were established: <40 g (33%), 40 - 90 g (61%), and >90 g (6%). RESULTS: A statistically significant association (p=0.001) was found between the prostate gland weight and tumor volume since 15 of the 33 glands with weight under 40 g accounted for more than 50% of the glands affected by tumor compared to none of the 6 patients with total weight over 90 g. A significant relationship was also found between the multimodality and weight. (P=0.03), so that 24 of the 33 glands under 40 g had bilateral multimodality compared to only 1 out of the 6 glands over 90 g. The neural invasion, number of PIN foci and the highest combined Gleason grade were frequent in low volume prostates, but the difference did not reach statistical significance. CONCLUSIONS: Our study indicates that large volume prostate glands have tumors with lower malignancy (tumor volume, bilateralism). This finding justifies the adequacy of using total volume of the prostate gland for diagnostic decision (indication of prostatic biopsy and their repetition) and the prognostic determination.

Increased cyclic guanosine monophosphate production and endothelial nitric oxide synthase level in mononuclear cells from sildenafil citrate-treated patients with erectile dysfunction.

Mononuclear cells express enzymes involved in the NO/cyclic guanosine monophosphate (cGMP) generating system, as well as PDE5. The objective of the study was to determine the effect of sildenafil citrate administration on the level of proteins involved in the NO/cGMP generating system in mononuclear cells from patients with ED. Twenty-one patients with ED (International Index of Erectile Function-Erectile Function Domain (IIEF-EFD) 17.9+/-0.8) were enrolled and 100 mg sildenafil citrate on-demand was administered during 12 weeks. All patients showed cardiovascular risk factors. After sildenafil citrate administration, IIEF-EFD score was improved (26+/-1.2 P<0.05). In the mononuclear cells, the protein level of endothelial NO synthase (eNOS) was higher after sildenafil citrate treatment. It was accompanied by reduction in the circulating plasma levels of both high-sensitive C-reactive protein and soluble intercellular adhesive molecule-1. The protein level of soluble guanylate cyclase and PDE5 did not change in the mononuclear cells after sildenafil citrate treatment. However, in the mononuclear cells exogenous NO induced a higher cGMP production after 12-weeks sildenafil citrate administration. In conclusion, in mononuclear cells from patients with ED sildenafil citrate administration increased the level of eNOS protein and increased cGMP production in response to NO. Moreover, sildenafil citrate administration reduced the plasma circulating levels of two biomarkers associated with inflammation.

[Testosterone, endothelial function, cardiovascular health and androgen deficiency in the old man]. / Testosterona, función endotelial, salud cardiovascular y androgenodeficiencia del varón añoso.

Testosterone determination in an old men population has demonstrated its about the as general health marker, not only sexual, prompting a greater in to arrest for this analytic determination and the potential relations of testosterone with other markers of cardiovascular health, obesity, hypertension, erectile dysfunction, sarcopenia, metabolic syndrome, ageing, and other conditions. We specifically review the relationship between cardiovascular health, erectile dysfunction, and androgen deficiency, processes easily recognizable, prevented and treated. Current information gives such a prominence to testosterone as a health reference that its determination seems to be inexcusable in the ageing male consult.

Testosterona, función endotelial, salud cardiovascular y androgenodeficiencia del varón añoso / Testosterone, endothelial function, cardiovascular health and androgen deficiency in the old man

La determinación de testosterona en la población de varones añosos, ha demostrado su valor como marcador de salud general, no sólo sexual, motivando un mayor interés por esta determinación analítica y las potenciales interrelaciones de la testosterona con otros marcadores de salud cardiovascular, obesidad, hipertensión, disfunción eréctil, sarcopenia, síndrome metabólico, envejecimiento y otras condiciones. Se revisa de manera específica la interrelación entre salud cardiovascular, disfunción eréctil y androgenodeficiencia, procesos de fácil reconocimiento, prevención y tratamiento. La información actual concede tal protagonismo a la testosterona como referente de salud que su determinación parece inexcusable en la consulta del varón añoso(AU)

Testosterone determination in an old men population has demonstrated its about the as general health marker, not only sexual, prompting a greater in to arrest for this analytic determination and the potential relations of testosterone with other markers of cardiovascular health, obesity, hypertension, erectile dysfunction, sarcopenia, metabolic syndrome, ageing, and other conditions. We specifically review the relationship between cardiovascular health, erectile dysfunction, and androgen deficiency, processes easily recognizable, prevented and treated. Current information gives such a prominence to testosterone as a health reference that its determination seems to be inexcusable in the ageing male consult(AU)

[Renal transplantation with living donors. A critical analysis of surgical procedures based on 40 years of experience]. / Transplante renal de donante vivo: un análisis crítico de estrategias quirúrgicas basado en 40 años de experiencia.

INTRODUCTION: Absolute priority in an LDKT programme are donnor safety and kidney optimal anatomical and functional preservation. Reduced donnor morbidities, both at short and long term, are important objectives. Excellent technical grafting is a must as are the strategies employed for facilitatig it. We revised the incidences of our whole LDKT programme (40 years 243 donors) to confirm if these exigences have been acomplished or a change to new surgical procedures is recommended. MATERIAL AND METHODS: Between 1968-2008 243 nephrectomies and grafting has been performed, a reduced number per year (A cadaver programme has been running simultaneously since 1964). For the nephrectomies a Turner-Warrick apprach was inititialy used and since 1973 a miniincisional, anterior, extraperitoneal approach of approximately 10 cm in length. The right kidney was removed in 75% of the cases and the right iliac area for the implant in 85% In adjacent opperating rooms, one team performs the nephrectomy while the other prepares and dissects free the grafting vessels. Most of the time the same senior surgeon performed both operatios: the nephrectomy and the implant. Peroperative and postoperative complications were evaluated by urologists and nephrologists in charge. RESULTS: No donors dead, organs lost or major complications in the donors have been documented. Minor complications such as intestinal paresia, wound infection, persistent incisional pain were common. Miniincisional abdominal approach reduced postoperative pain and hospital stay (4 days). At long term no incisional hernia or abdominal paresia have been documented. Simultaneous work reduces ischemia time (30-45 s warm: 30-45 min cold) and opperatig room occupation(patient preparation plus anesthesia plus operation) estimated in 90-120 min for the nephrectomy and 120-160 for the grafting. The responsibility of the senior surgeon in both procedures facilitates vessel selection for the grafting. CONCLUSIONS: No reasons have been found to reconvert our current nephrectomy procedure to laparoscopic or modify current surgical strategy. Superior safety of open surgery for donors and organs is confirmed. Pain and recovery time are reduced in laparoscopic surgery but not as much when compared with miniincisional approach. Open surgery permits optimal anatomical and functional organ extration facilitatig the quality of the implant. As numbers matter in laparoscopic surgery open nephrectomy is recommended for reduced LDKT programmes.

[Synchronous bilateral urothelial carcinoma of the upper urinary tract]. / Carcinoma urotelial ureteral bilateral sincrónico.

OBJECTIVE: Report a case of a synchronous bilateral urothelial carcinoma of the upper urinary tract without bladder affectation. METHODS: We describe the diagnosis and treatment of a case of a bilateral upper urothelial carcinoma. CONCLUSIONS: Synchronous bilateral urithelial carcinoma of the upper urinary tract without bladder affectation in an unusual occurance (1-5% of urothelial tumors) and radical surgery continues to be the treatment of choice, although it is possible to take a less aggressive approuch with selected groups of patient, in which we can achiese a survival rate similar to that which we obtain with radical surgery.

Soluble guanylate cyclase beta1-subunit expression is increased in mononuclear cells from patients with erectile dysfunction.

The aim was to determine in circulating mononuclear cells from patients with erectile dysfunction (ED), the level of expression of endothelial nitric oxide synthase (eNOS), soluble guanylate cyclase (sGC) beta1-subunit and phosphodiesterase type-V (PDE-V). Peripheral mononuclear cells from nine patients with ED of vascular origin and nine patients with ED of neurological origin were obtained. Fourteen age-matched volunteers with normal erectile function were used as control. Reduction in eNOS protein was observed in the mononuclear cells from patients with ED of vascular origin but not in those from neurological origin. Although sGC beta1-subunit expression was increased in mononuclear cells from patients with ED, the sGC activity was reduced. However, only the patients with ED of vascular origin showed an increased expression of PDE-V. This work shows for the first time that, independently of the aetiology of ED, the expression of sGC beta1-subunit was increased in circulating mononuclear cells; however, the expression of both eNOS and PDE-V was only modified in the circulating mononuclear cells from patients with ED of vascular origin.

Carcinoma urotelial ureteral bilateral sincrónico / Synchronus bilateral urothelial carcinoma of the upper urinary tract

Objetivo: Presentar el caso de un tumor urotelial ureteral bilateral sincrónico sin afectación vesical. Métodos: Diagnóstico y tratamiento de un caso de tumor urotelial bilateral sincrónico. Conclusiones: El carcinoma urotelial bilateral sincrónico sin afectación vesical es una entidad rara (1-5% de todos los tumores uroteliales) donde la cirugía radical sigue siendo el tratamiento curativo de elección, aunque el mejor conocimiento de esta patología hace que hoy en día se pueda realizar tratamiento conservador a un grupo seleccionado de pacientes con tasa de similar supervivencia a los que se le indica tratamiento radical

Objective: Report a case of a synchronous bilateral urothelial carcinoma of the upper urinary tract without bladder affectation. Methods: We describe the diagnosis and treatment of a case of a bilateral upper urothelial carcinoma. Conclusions: Synchronous bilateral urithelial carcinoma of the upper urinary tract without bladder affectation in an unusual occurance (1-5% of urothelial tumors) and radical surgery continues to be the treatment of choice, although it is possible to take a less aggressive approuch with selected groups of patient, in which we can achiese a survival rate similar to that which we obtain with radical surgery

[Erectile dysfunction: the role of laboratory in the diagnostic and pronostic evaluation]. / Disfunción eréctil: papel del laboratorio en la evaluación diagnóstica y pronóstica.

OBJECTIVE: To review and to update the different laboratory tests recommended for etiologic diagnostic of erectile dysfunction and to evaluate the effect these tests could have on the pronostic and therapeutic strategy of this pathology. MATERIAL AND METHODS: We review the last articles related with etiopathogenics and pathophysiologics mechanisms of erectile dysfunction, including our studies on endothelial dysfunction and erectile dysfunction. RESULTS: The depth and extension of the laboratory protocol in erectile dysfunction is not necessaryly the same in all situations. The age, coincidence of comorbilities, set a different limit between patients demanding complementaries investigations that go beyond the basic request. CONCLUSIONS: The etiopathogenic laboratory work up in erectile dysfunction is currently changing incorporating news tests. The traditional search of commorbilities like diabetes, hepatic dysfunction, hypogonadism, hyperglucemia is getting broad with recents analitics evaluations related with potential markers of endothelial disease.

Disfunción eréctil: papel del laboratorio en la evaluación diagnóstica y pronóstica / Erectile dysfunction: the role of laboratory in the diagnostic and pronostic evaluation

Objetivo: Revisar y actualizar las diferentes pruebas de laboratorio recomendadas para el diagnóstico etiológico de la disfunción eréctil y el efecto que pudiera tener sobre el pronóstico y tratamiento de la enfermedad. Material y Métodos: Se han revisado las publicaciones más recientes y las que aportan nuevos conocimientos sobre los mecanismos etiopatogénicos y fisiopatológicos de la disfunción eréctil. Resultados: La profundidad o extensión del protocolo analítico en la disfunción eréctil no ha de ser necesariamente la misma en todas las circunstancias. La edad, la coincidencia real o presumible de comorbilidades, marcan un límite diferencial entre los pacientes, exigiendo investigaciones complementarias que superan las demandas básicas. Conclusión: La investigación etiopatogénica de la disfunción eréctil se ha ampliado considerablemente incluyendo nuevas pruebas de laboratorio. La tradicional búsqueda de comorbilidades como diabetes, disfunción hepática, hipogonadismo, hipercolesterolemia, se ha enriquecido con recientes valoraciones analíticas de potenciales marcadores de enfermedad endotelial (AU)

Objective: To review and to update the different laboratory tests recommended for etiologic diagnostic of erectile dysfunction and to evaluate the effect these tests could have on the pronostic and therapeutic strategy of this pathology. Material and methods: We review the last articles related with etiopathogenics and pathophysiologics mechanisms of erectile dysfunction, including our studies on endothelial dysfunction and erectile dysfunction. Results: The depth and extension of the laboratory protocol in erectile dysfunction is not necessaryly the same in all situations. The age, coincidence of comorbilities, set a different limit between patients demanding complementaries investigations that go beyond the basic request. Conclusions: The etiopathogenic laboratory work up in erectile dysfunction is currently changing ;;incorporating news tests. The traditional search of commorbilities like diabetes, hepatic dysfunction, hypogonadism, hyperglucemia is getting broad with recents analitics evaluations related with potential markers of endothelial disease (AU)

BPH and inflammation: pharmacological effects of Permixon on histological and molecular inflammatory markers. Results of a double blind pilot clinical assay.

INTRODUCTION: The role of infiltrating cells (I.C.), commonly observed in the adenoma interstitial tissue, is unknown. We tested the hypothesis that I.C. are related with BPH progression by: phenotypically characterising these cells; quantifying the expression of lymphokines and growth factors; investigating the response to Permixon (P) in a clinical study. Permixon is a lipido sterolic extract of Serenoa repens possessing pharmacological activities and widely used in the treatment of men with BPH. MATERIAL AND METHODS: A multicenter open pilot study of two parallel groups on BPH patients was carried out. They were randomized to receive either oral Permixon (P) 160 mg bid for three months or to be followed for 3 weeks without any treatment before surgery (control group C). Strict inclusion and exclusion criteria were applied to conform homogeneous groups, avoiding interferences of inflammatory drugs or others. Baseline clinical profile was almost identical in both groups in terms of age (65.7+/-5.1 vs. 67.1+/-5.8 years), IPSS (19.8+/-6.1 vs. 19.0+/-5.8), prostate volume (64.8+/-18.9 vs. 71.5+/-29.3cc), Q(max) (9.6+/-3.2 vs. 10.6+/-2.6 ml/s), and Q(L) (4.0+/-1.1 vs. 3.5+/-0.7). Surgery was ultimately performed on 29 patients (17C, 12P) by TURP or retropubic adenomectomy. Adenoma samples were routinely stained with HE and later prepared for immunohistochemical studies using CD3, CD20 and CD68 antibodies. Counting of positives cells, lymphoid aggregates and foci were done using EnVision technique and the Tech Mate processor. Cytokines, growth factors and eicosanoids were determined by Elisa kits following the manufactured recommendation. RESULTS: HISTOLOGICAL: A difference was observed in the number of lymphocytes B between C (91.4+/-44.1) and P treated (58.2+/-53.7) groups (p=0.097). BIOLOGICAL MARKERS: TNFalpha and IL-1beta were dramatically lower in the Permixon treated group. Other parameters did not show significant changes. CLINICAL: IPSS in the Permixon treated group was significantly reduced (p<0.006) from 20.0+5.9 to 14.9+3.8 after three months of treatment. COMMENTS: The BPH inflammatory hypothesis was tested in humans. Our pilot study shows a significant reduction of some inflammatory parameters in prostatic tissues of patients treated with Permixon. These biological findings justify a pharmacological effect of this drug on the inflammatory status of the adenoma. A correlation with clinical improvement was observed.

[Benign prostatic hyperplasia: biological significance of lymphohistiocytic infiltration of the adenoma]. / Hiperplasia prostática benigna: significado biológico de la infiltración celular linfohistiocitaria del adenoma.

The presence of mononuclear cells infiltrating the prostate adenoma is a morphological observation well established in the literature. However, its biological meaning is a subject of controversy. It has been postulated that it may represent a local immunological reaction contributing to the pathogenesis of prostatic adenoma. Several studies have been performed to test this hypothesis, both in humans and animals. The purpose of this review is to update available information, including our own ongoing studies. Morphological research has shown that cells infiltrating the adenoma are lymphocyte T, lymphocyte B and macrophages with a high proportion of lymphocyte T. Many of the inflammatory markers, such as lymphoquines (IL1, IL2, IL4, IL6, IL13), are elevated in the adenoma tissue as are some growth factors (EGF, TGF alpha, IFN gamma, TGF beta). The general impression is that an inflammatory process is activated in the adenoma during growth and maturing. It has also been proved that this inflammatory process could be modified with treatment and, in our case, with the lipido-sterolic extract of Serenoa Repens.

[Giant cyst of the seminal vesicle associated with ipsilateral renal agenesis]. / Quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral.

Cyst of the seminal vesicles represent a rare but illustrative type of embryologic malformation whose etiology is associated with an abnormal development of the mesonephric or Wolffian duct. Frequently these malformations are associated with an abnormal development of the ipsilateral upper urinary tract. The initial evaluation of the majority of cases is performed with abdominal or transrectal ultrasound. Considering the possible need of other diagnostic procedures to confirm the diagnosis, ultrasonography is safe in the majority of cases. The treatment of these urologic malformations should be restricted to symptomatic cases and usually consists of vesiculectomy, with of without, removal of the displastic or histoplastic kidney. We present a case of a right mesonephric duct malformation with a giant seminal vesicle associated with ipsilateral kidney agenesis and severe oligozoospermia, that presented with sporadic episodes of hemospermia and urinary complaints.

Hiperplasia prostatica benigna: significado biológico de la infiltración celular linfohistiocitaria del adenoma / Benign Prostatic Hyperplasia: biological meaning of lymphohistiocytic infiltration of adenoma

La presencia de células mononucleares infiltrando el tejido del adenoma prostático es una observación morfológica bien establecida en la literatura. El significado biológico de esta infiltración celular, por el contrario es motivo de controversia. Se ha postulado que puede representar una reacción inmunológica local que de algún modo contribuye en la patogénesis del adenoma prostático. Se han realizado numerosos estudios para confirmar esta hipótesis, tanto en humanos como en animales. El propósito de esta revisión de conjunto es poner al día la información suministrada por la literatura sobre este tema. incluyendo nuestros propios estudios, de manera comparativa.La investigación morfológica ha demostrado que las células infiltrando el adenoma prostático son linfocitos T, B y macrófagos, con una alta proporción de linfocitos T. Muchos de los marcadores inflamatorios tales como las linfocnas ILl, IL2, IL4, IL6, IL13, están elevadas en el tejido del adenoma. También se han encontrado elevados algunos factores de crecimiento como el EGF, TGFa, IFNy, TGFBeta y otros. La impresión general es que existe un proceso inflamatorio en el interior del adenoma durante el proceso de crecimiento y maduración del mismo. Se ha podido demostrar también que este proceso inflamatorio puede modificarse con algunos tratamientos, y en nuestro caso, con el extracto lípido-esterolico de Serenoa Repens. (AU)

Quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral / Giant cyst of the seminal vesicle associated to ipsilateral renal agenesis

Los quistes de las vesículas seminales representan un raro pero ilustrativo tipo de malformación embriológica, su etiología se relaciona con un mal desarrollo del conducto mesonéfrico o wolffiano. A menudo, se combinan con anormalidades del tracto urinario superior ipsilateral. En la mayoría de los casos, la evaluación inicial se realiza con la ecografía abdominal o transrectal. Aunque otros procedimientos diagnósticos pueden ser necesarios para confirmar el diagnóstico, el ultrasonido es bastante seguro en la mayoría de los casos. El tratamiento de tales malformaciones estará restringido a los casos sintomáticos y usualmente consiste en vesiculectomía con o sin extirpación del riñón displásico o hipoplásico.Presentamos un caso de malformación de conducto mesonéfrico derecho compuesta de quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral y oligozoospermia severa, que debutó con episodios de hemospermia esporádicos y clínica miccional. (AU)

Cirugía de la litiasis renoureteral. Indicaciones actuales / Open surgery for kidney and ureteral stone. Current indications

INTRODUCCIÓN: Toda reflexión sobre litiasis renoureteral y su terapéutica se centra actualmente en la LEOC (Litotricia Extracorpórea por Ondas de Choque), como tratamiento único o asociado a otras técnicas. En ciertos casos la endourología y la litotricia de contacto, se consideran como primera alternativa. La retroperitoneoscopia es otra opción en aquellos centros donde se desarrolla. El abandono de la cirugía abierta es muy manifiesto a favor de las nuevas alternativas, sobre todo en aquellos centros con litotritor extracorpóreo. Los buenos resultados que se obtienen con las técnicas alternativas y la comodidad que el paciente vive, han hecho que el número de casos que se someten anualmente a cirugía abierta sea mínimo. MATERIAL Y MÉTODOS: La Unidad de Litiasis-Litotricia de la Fundación "Jiménez Díaz" (FJD), que realiza LEOC (Modulith SL 20, Storz (r) ), analiza 54 pacientes operados en los últimos años (1990-200), con el fin de concluir en los motivos de la indicación quirúrgica. No se incluye la nefrectomía por lesión renal terminal post-litiásica (pionefrosis, pielonefritis xantogranulomatosa,...).RESULTADOS: La cirugía abierta realizada ha sido la tradicional según el caso: pielotomía (simple o ampliada, ñ infundibulotomía), nefrotomía anatrófica, ureterolitectomía,..., y corrección de aquellas anomalías u obstrucciones asociadas a la patología litiásica (hidro-nefrosis congénita, ureterocele,...). DISCUSIÓN: Actualmente existen casos de litiasis difíciles de solucionar incluso con cirugía abierta. Es la litiasis renal compleja. Sin duda la cirugía es la alternativa más eficaz y resolutiva. Si la LEOC, la URS (Ureterorenoscopia) o la NPL (Nefrolitotomía percutánea) fracasan, y la litiasis es sintomática, debe ser operada. Ante situaciones críticas (complicaciones de estos métodos, se requiere una solución eficaz y urgente, siendo la cirugía tradicional la única alternativa. CONCLUSIONES: La cirugía abierta se indica hoy ante casos de litiasis renal compleja y litiasis renoureteral complicada. El aprendizaje quirúrgico debe ir paralelo al endoscópico, laparoscópico o extracorpóreo. La cirugía abierta será la primera alternativa terapéutica en algún caso. En situación de urgencia clínica, se deben tomar decisiones quirúrgicas, que deberán ser realizadas con la destreza y precisión que se merecen (AU)