[Severe cystitis and perivesical collection posterior to Mitomycin C immediate instillation in a patient with inadverted bladder perforation]. / Cistitis severa y colección perivesical posterior a instilación inmediata de Mitomicina C en paciente con perforación vesical inadvertida.

We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it.

Cistitis severa y colección perivesical posterior a instilación inmediata de Mitomicina C en paciente con perforación vesical inadvertida / Severe cystitis and perivesical collection posterior to mitomycin C immediate instillation in a patient with inadverted bladder perforation

Se trata de un paciente masculino de 40 años de edad quien, posterior a una RTU de recidiva de tumor no músculo invasivo sin perforación aparente e instilación inmediata de Mitomicina C, consultó al cuarto día postoperatorio a nuestro servicio de urgencias con sintomatología urinaria irritativa baja severa. Se solicitó una ecografía renovesical que evidenció una colección perivesical. El manejo fue conservador con sondaje vesical por 10 días siendo necesaria la punción-drenaje de la colección (AU)

We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it (AU)

Notas del Congreso Europeo de Urología. Análisis de las últimas aportaciones sobre BCG endovesical / European Urology Congress notes. Analysis of the last investigations on endovesical BCG

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[Hormone-refractory prostate cancer. Modifications of the therapeutic strategies since chemotherapy proved its usefulness]. / Cancer de próstata hormonorresistente. Cambios en las estrategias terapéuticas desde la demostración de la utilidad de la quimioterapia.

Back in the 90's it was difficult to have access to the conclusions of publications on HRPC. Homogeneity was very scarce regarding issues as significant as the definition of HRPC itself, patient selection, or evaluation of the responses to therapy. Consensus has currently been reached on such matters, and it is described in this text. Two works were published in late 2004 showing that docetaxel-based chemotherapy improved metastatic HRPC survival. Until then, the different treatments used could only provide symptomatic relief. But probably not all of the HRPC patients are eligible for primary docetaxel chemotherapy. The current debate focuses on determinating to which patients should chemotherapy be administered and at which time should it start, in order to exclude those patients at risk of experiencing its adverse effects without benefitting from its clinical advantages. Non-metastatic HRPC patients may be candidates to receiving secondary hormone manoeuvres before starting with chemotherapy. We will analyse in this review the changes occurred in the therapeutic strategies ever since chemotherapy showed its value, and we shall also disclose our attitude regarding treatment of these patients in daily practice.

Cáncer de próstata hormonorresistente. Cambios en las estrategias terapéuticas desde la demostración de la utilidad de la quimioterapia / Hormone-refractory prostate cancer. Modifications of the therapeutic strategies since chemotherapy proved its usefulness

En la década de los 90 fue difícil obtener conclusiones de las publicaciones sobre CPHR, existía una falta de homogeneidad en cuestiones tan importantes como la propia definición de CPHR, la selección de pacientes o la valoración de las respuestas a los tratamientos. En la actualidad ya existen criterios consensuados al respecto que se exponen en el trabajo. A finales de 2004 se publicaron 2 trabajos que demostraron que la quimioterapia basada en docetaxel mejoraba la supervivencia en el CPHR con metástasis. Hasta entonces los distintos tratamientos utilizados únicamente conseguían paliación de síntomas. Pero probablemente no todos los pacientes con CPHR sean candidatos a quimioterapia con docetaxel de entrada. El debate actual se centra en determinar a qué pacientes y en qué instante debe iniciarse la quimioterapia para excluir a los que corran el riesgo de sufrir sus efectos adversos sin ventajas clínicas. Pacientes con CPHR sin metástasis pueden ser candidatos a recibir maniobras hormonales secundarias antes de iniciar quimioterapia En esta revisión analizamos qué cambios se han producido en las estrategias terapéuticas en CPHR, desde la demostración de la utilidad de la quimioterapia, mostrando también cual es en la práctica diaria nuestra actitud en el tratamiento de estos pacientes

Back in the 90’s it was difficult to have access to the conclusions of publications on HRPC. Homogeneity was very scarce regarding issues as significant as the definition of HRPC itself, patient selection, or evaluation of the responses to therapy. Consensus has currently been reached on such matters, and it is described in this text. Two works were published in late 2004 showing that docetaxel-based chemotherapy improved metastatic HRPC survival. Until then, the different treatments used could only provide symptomatic relief. But probably not all of the HRPC patients are eligible for primary docetaxel chemotherapy. The current debate focuses on determinating to which patients should chemotherapy be administered and at which time should it start, in order to exclude those patients at risk of experiencing its adverse effects without benefitting from its clinical advantages. Non-metastatic HRPC patients may be candidates to receiving secondary hormone manoeuvres before starting with chemotherapy. We will analyse in this review the changes occurred in the therapeutic strategies ever since chemotherapy showed its value, and we shall also disclose our attitude regarding treatment of these patients in daily practice

Upper tract transitional cell carcinoma following cystectomy for bladder cancer.

PURPOSE: We assessed the incidence of upper urinary tract tumors (UUTTs) after cystectomy for invasive or superficial transitional cell carcinoma (TCC) of the bladder. The risk factors, patients' characteristics and evolution of those who developed UUTTs are analyzed. MATERIALS AND METHODS: From August 1980 to February 1994, 568 radical cystectomies were performed for TCC of the bladder: in 469 instances (82.5%) due to invasive tumor (T2-T4), and in 99 cases (17.5%) for superficial tumor (Ta, T1, Tis). All patients were followed for at least 5 years or until death. A retrospective study of patients who developed UUTTs has been performed. A revision of bladder tumor and UUTT characteristics, and the intervals between both is also evaluated. RESULTS: 26 patients (4.5%) developed UUTTs: 11 of the 99 patients cystectomized for superficial TCCs (11.1%); 6 of the 392 patients with primary invasive TCC (1.5%), and 9 of the 77 (11.6%) patients with invasive tumors and a prior history of superficial TCC. The interval to the development of UUTT was higher after cystectomy for superficial tumor. TCCs of the bladder that subsequently developed UUTTs were high grade in 84%, multifocal in 80%, or had carcinoma in situ in 65%, tumor in the prostatic urethra in 52%, and involvement of the distal ureter in 57%. Twenty-two UUTTs (84%) were located in the calyces or the renal pelvis, 3 were bilateral (11.5%), 14 multiple (58%) and 4 superficial (16%). With a median follow-up time of 18 (range 3-103) months, 14 patients (53.8%) died of tumor, 2 were alive with disease, 2 were lost for follow-up, and 8 (30%) were alive and free of disease. CONCLUSIONS: We found that patients cystectomized for superficial or invasive TCC with a prior history of superficial TCC have a higher incidence of UUTTs. These cases require follow-up with annual urography or loopography.

Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups.

PURPOSE: We evaluated the prognostic factors of primary superficial bladder cancer that may predict a metachronous upper urinary tract tumor. We also determined whether the incidence of upper urinary tract disease varies according to risk group based on primary superficial bladder tumor classification. MATERIALS AND METHODS: We studied disease evolution in a cohort of 1,529 patients with a primary superficial bladder tumor. To determine the prognostic factors of upper urinary tract cancer we performed multivariate analysis using Cox regression. Independent variables were grade, T stage, multiplicity, tumor size, carcinoma in situ association, previous or synchronous upper urinary tract tumor and intravesical instillation. We also performed the chi-square test and Kaplan-Meier survival analysis to assess the variable incidence of upper urinary tract tumors according to primary superficial bladder tumor risk group classification. RESULTS: The incidence of upper urinary tract cancer was 2.6%. The only factor prognostic for an upper urinary tract tumor was multiplicity (relative risk 2.7, 95% confidence interval [CI] 1.06 to 6.84). All patients with an upper urinary tract tumor had a previously recurrent primary superficial bladder tumor. In the low, intermediate and high risk groups the incidence of upper urinary tract cancer was 0.6% (relative risk 1), 1.8% (relative risk 3.1, 95% CI 0.4 to 23.9) and 4.1% (relative risk 8.3, 95% CI 1.1 to 61.6), respectively (chi-square and log rank tests p = 0.007 and p <0.05, respectively). CONCLUSIONS: A higher risk of upper urinary tract cancer must be expected in cases of multiple primary superficial bladder tumors. This finding supports the multicentricity theory of transitional cell carcinoma. Primary superficial bladder tumor classification by risk group is also useful for predicting the various risks of metachronous upper urinary tract cancer.

[Bladder malacoplakia: 14-year follow-up of a case]. / Malacoplaquia vesical: seguimiento de un caso a 14 años.

OBJECTIVE: To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder. METHODS/RESULTS: After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion. CONCLUSIONS: Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Renal hematoma as a complication of extracorporeal shock wave lithotripsy.

OBJECTIVE: To evaluate risk factors, clinical presentation, therapeutic management, and treatment of residual stones and subsequent development of renal hematoma following Extracorporeal Shock Wave Lithotripsy (ESWL). MATERIAL AND METHODS: A retrospective review was made of 31 post-ESWL renal hematoma cases diagnosed between May 1987 and June 1996. Lithotripsy treatments were outpatient procedures without anaesthesia. Our center has three electromagnetic sources, two with biplane X-ray centering and one ultrasound-guided (SIEMENS Lithostar II, SIEMENS Lithostar System C and SIEMENS Lithostar Ultra, respectively). We analysed findings from patient history, physical examination, blood analysis, and renovesical sonographs. Follow-up involved periodical checks, blood analyses and renovesical sonographs, scheduled first at three-month intervals and later at six-month intervals. RESULTS: Our center performed 21 699 lithotripsies on a total of 10 953 patients in this period. Thirty-one renal hematomas were diagnosed, giving an incidence rate of 0.28%. Twenty-four patients presented clinical onsets and the commonest symptom for consultation was low back pain (74%). Eleven patients of this group (46%) were hypertensive. All patients received conservative treatment. With a mean follow-up time of 18 months, ultrasound showed persistent hematoma in 11 patients (36%). There were residual stones in 71% of patients; further lithotripsy was performed on seven patients with no clinical or ultrasonographic signs of change in the hematoma. CONCLUSIONS: Renal hematoma post-ESWL is a rare complication. Main risk factors are hypertension, clotting disorders and previous ESWL sessions. Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones.

[Encrusted cystitis. Is it always alkaline?]. / Cistopatía incrustante. Siempre alcalina?

OBJECTIVE: To report on our series of encrusted cystopathy. METHODS: The clinical records of 37 patients (25 males, 67%; 12 females, 33%) with a histological diagnosis of encrusted cystopathy were reviewed. RESULTS: Only 11 patients (29.7%) met the classical criteria for alkaline encrusted cystitis. They had an initial or predisposing bladder lesion, irritative symptoms, passed calcareous material, a demonstrated or suspected urinary infection from ureolytic pathogens and alkaline urine. The remaining 26 patients (70.2%) with histologically demonstrated encrustations on the bladder wall did not meet the foregoing criteria. Fifty-seven percent of the patients had a previous history of bladder tumor resection and treatment with intravesical instillations. CONCLUSIONS: Alkaline encrusted cystopathy is an uncommon condition. Encrusting cystopathy can develop in the absence of ureolytic pathogens or alkaline urine. The bladder lesion on which the encrusting cystopathy is established, is determinant in the subsequent evolution.

Incidence of tumoural pathology in horseshoe kidneys.

OBJECTIVES: To know the incidence of tumoural pathology among our cases of horseshoe kidney (HK), a congenital anomaly occurring in 0.25% of the population, as well as their prognostic factors and follow-up. METHODS: A total of 82 patients admitted at our Centre between 1967 and 1996 with an HK diagnosis were retrospectively reviewed. We have collected a total of 10 cases of HK tumours. We analyse the clinical, diagnostic, surgical and evolutionary peculiarities of the different HK tumour aetiologies, as compared with those described in literature. RESULTS: Our experience is based on 10 patients-5 adenocarcinomas, 4 transitional cell carcinomas and a Wilms' tumour. CONCLUSIONS: We have observed that in the case of transitional cell carcinomas, the diagnosis is generally made at an advanced stage. The prognosis of the tumorous disease depends upon the same prognostic factors as in the case of normal kidneys. Renal adenocarcinoma is the kind of tumour most frequently associated with HKs. Its incidence among the HK cases is not greater than among the normal population. Conservative local treatment criteria for adenocarcinoma should be valid for HKs as well.

[Orthotopic bladder substitution: II. Types and complications]. / Sustitución vesical ortotópica: II. Tipos y complicaciones.

OBJECTIVE: In the last two decades, attention has been focused on the design of continent urinary diversion and orthotopic neobladder in an attempt to find the ideal bladder substitute. The more commonly utilized techniques of orthotopic bladder replacement are described and the urodynamic aspects and complications are analyzed. METHODS: The series of Studer, Hautmann, Kock, Pagano, Thuroff (Mainz Pouch) and Goldwasser and the relevant literature on this subject were reviewed. RESULTS/CONCLUSION: To date, similar functional results have been achieved by the different techniques of bladder substitution, although different intestinal segments are utilized. A longer follow-up is warranted to determine which is the ideal technique of bladder substitution.

[Orthotopic bladder replacement: II. Functional results and complications in patients with Studer-type ileal neobladder]. / Sustitución vesical ortotópica: III. Resultados funcionales y complicaciones en los pacientes con neovejiga ileal tipo Studer.

OBJECTIVE: Since 1988, 100 Studer ileal low pressure urinary reservoirs have been performed at our institution. The functional results and the complications observed in these patients are presented. METHODS: Patients submitted to radical cystectomy and lower urinary tract reconstruction with the Studer technique from 1988 to 1994 were retrospectively studied. All patients were males, their mean age was 60 years (37-75) and the mean follow-up was 18 months (6-72). The isoperistaltic ileal segment as antireflux mechanism was utilized in 97 cases and intussusception of the ileal segment to which the ureters were anastomosed in 3 cases. Reinsertion of the ureter was done using the Wallace technique in 90 cases and by direct fixation according to a personal technique (H.V.) in 10 cases. Anastomosis of the neobladder and the urethra was done with the end of the second suture of the orthotopic reservoir. The neurovascular bands were preserved in 21 patients less than 60 years old with tumor stage T2-T3a, according to the technique described by Walsh and Mostwin (1984). RESULTS: One patient died early postoperatively from sepsis. The early complications included urinoma (4%), urinary fistula (3%), intestinal fistula (2%), pulmonary complications (4%), pelvic hematoma (1%) and intestinal obstruction (3%). Only 4 of these patients required surgical resolution of the complication. The late complications included stricture of neobladder-urethra anastomosis (6%), lithiasis in neobladder (4%), ureteroileal stricture (8%), 5 renal units were lost, chronic urinary retention (5%), symptomatic metabolic acidosis (1%) and urinary infection (14%). Thirteen of these patients with late complications required surgery. At 6 months' minimum follow-up, 90% of the patients were continent during the day and 60% during the night. Overall, 36% of the patients recovered erection postoperatively; 76% of the patients with preserved neurovascular bands recovered erection. Forty-four percent of the patients claimed they had a satisfactory sexual activity postoperatively. CONCLUSION: The Studer neobladder permits voiding through the urethra, preservation of the upper urinary tract, the urinary infection rate is acceptable, the complication rate is low and it offers patients continence rates that allow them to have a good quality of life.

[Orthotopic bladder replacement: I. Physiopathology of orthotopic bladder replacement with intestine]. / Sustitución vesical ortotópica: I. Fisiopatología de la sustitución vesical ortotópica con intestino.

OBJECTIVE: To analyze the physiopathological principles of utilizing the bowel for orthotopic bladder substitution and their effects on metabolism, function and continence. METHODS: The world literature is reviewed and our experience of 100 cases is described in the third part of this study. RESULTS/CONCLUSION: To reduce the metabolic changes, utilization of colonic or ileal segments with a maximum length of about 40 cm is advocated. This length of detubulized intestinal segment permits creating an ample, low pressure reservoir with an antireflux mechanism. The precise incidence of neoplastic degeneration of the ileal and colonic reservoirs is not known, but appears to be lower for the ileal neobladder.

[Diagnosis of bladder neck obstruction in women]. / Diagnostic de l'obstruction sous vésicale chez la femme.

Bladder outlet obstruction in women is a rare entity, and difficult to diagnose. In our series most of the patients had previous history of gyneco-obstetric or urological procedures. Cystometry enabled us to diagnose the coexistence of bladder instability and obstruction in 48% of the patients. We did not find statistically significant differences between the patients with and without BI in terms of degree of obstruction measured by uroflowmetry and pressure/flow studies. Pressure/flow studies and Uroflowmetry had been the essential key in the diagnosis of obstruction in our series. Cysto-urethrography and urethroscopy were normal in over 50% of patients. The urethral calibration was abnormal in 16% of the cases.

[Urethral condyloma in the male: experience with 48 cases]. / Condilomas uretrales en el varón: experiencia en 48 casos.

OBJECTIVES: To review our experience in the diagnosis and treatment of urethral condylomata. METHODS: From June, 1977 to November, 1994, 64 patients with condyloma acuminatum were treated at our institution. Forty-eight cases who had received no previous treatment were analyzed. The main reason for consultation was the appearance of an exophytic lesion in the meatus. Most of the condylomata were located in the navicular fossa. Treatment was by electrocoagulation in 24 patients, photocoagulation with the Nd:YAG laser in 21 and other treatment modalities were utilized in 3 patients. To determine the incidence of recurrence and response to therapy, we analyzed the data of 34 patients with a minimum follow up of 2 months and a mean of 16 months. RESULTS: 36% had associated cutaneous condylomata. Urethroscopy detected 14.2% of the lesions that were undetectable by eversion of the meatus. Recurrence was observed in 35.2%. There were no differences for recurrence or complications between patients submitted to electrocoagulation and those who were treated by laser photocoagulation. CONCLUSIONS: Condyloma acuminatum of the urethra is uncommon. Urethroscopy is useful in making the diagnosis and for post-treatment follow up control evaluation. Electrocoagulation and Nd:YAG laser photocoagulation are useful in the treatment of this condition. Recurrence is frequently observed in patients with extensive lesions.

[Scintigraphic diagnosis of crossed renal ectopia]. / Diagnóstico gammagráfico de la ectopía renal cruzada.

OBJECTIVES: Crossed renal ectopia is an uncommon congenital anomaly with little or no clinical repercussion. An empty renal fossa is not an infrequent ultrasound finding and an anomalous contralateral ectopic kidney can be seen occasionally. METHODS/RESULTS: We report on three clinical cases with an empty renal fossa detected by ultrasound. Scintiscanning with 99mTc DMSA permitted precise diagnosis of the existing malformation. CONCLUSIONS: 99mTc DMSA permits precise diagnosis of the empty renal fossa, type of malformation, functional status of the ectopic kidney and the status of its parenchyma.

[Transitional cell carcinoma of the bladder: behavior in young adults]. / Carcinoma transicional de'vejiga: comportamiento en adultos jóvenes.

OBJECTIVES: Transitional cell carcinoma of the bladder is uncommon in the first three decades of life. Some authors claim that these age groups generally have low grade and superficial tumors. Our experience in the diagnosis and management of transitional cell carcinoma of the bladder in patients < or = 30 years old are analyzed. METHODS: The study comprised thirty-four patients (29 males and 5 females) who had been treated at the Fundación Puigvert from September, 1977 to November, 1993. RESULTS: Pathological analyses of the TUR and biopsy specimens showed most of the patients had low grade (88%) and stage (93%) tumors. The mean follow up was 66 months, range 12-168 months; 28 patients (83%) had a minimum follow-up of 12 months. Fourteen patients were stage Ta, 9 were T1, one T2, and there were 4 cases whose tumor stage could not be assessed (Tx). Tumor recurrence was observed in 9 of 28 patients (32%) and tumor progression in 1 patient. CONCLUSIONS: This tumor type is uncommon in patients < or = 30 years old. This age group generally has low grade/stage tumors. Although the incidence of tumor progression is low and these patients have a good prognosis, treatment and subsequent follow-up depend on tumor grade and stage at the time of diagnosis.