Dermatological side effects of intravesical Mitomycin C: Delayed hypersensitivity. / Efectos secundarios de la administración de Mitomicina C intravesical: dermatitis por hipersensibilidad retardada.

OBJECTIVE: To know the dermatologic side effects of intravesical treatment with Mitomycin C in non muscle invasive bladder cancer. METHODS: We describe two cases of palm and plantar dermatitis after such treatment. RESULT: We describe two types of dermatitis pathogenesis during treatment with intravesical Mitomycin C: contact dermatitis and delayed hypersensitivity dermatitis. CONCLUSIONS: Contact dermatitis of non-allergic origin is a common side effect described in many instances in the literature, on the other hand exists dermatitis secondary to delayed hypersensitivity type IV much less common, requiring treatment with corticosteroids.

Inyección intraoperatoria de nanocoloide con tecnecio-99 metaestable para la localización de tumores intratesticulares no palpables en orquiectomías parciales / Intraoperative injection of 99 mmTc- nanocolloid for localization of nonpalpable intratesticular tumours in organ-sparing surgery

Objetivo: La orquiectomía radical es el tratamiento estándar para los tumores malignos de testículo. Esto supone deprivación androgénica, infertilidad o trastornos psicológicos, sobre todo en caso de tumores testiculares bilaterales sincrónicos, metacrónicos contralaterales o tumores en teste único. Según las guías clínicas europeas, la orquiectomía parcial con intención de preservar la masa testicular se podría llevar a cabo si la tumoración ocupa menos del 30% del volumen testicular y los valores de testosterona preoperatorios son normales. Para la práctica de una orquiectomía parcial es necesario una adecuada localización del tumor, sobre todo son intratesticulares no palpables, mediante el uso de ecografía testicular intraoperatoria de alta frecuencia. Material y métodos: En este artículo presentamos 2 casos de tumores intratesticulares no palpables correctamente localizados mediante la inyección de un nanocoloide de tecnecio-99 metaestable guiado por ecografía intraoperatoria y detectados mediante una gammacámara portátil. Conclusiones: Es una técnica fácilmente reproductible y segura para el paciente. Nos permite garantizar la completa exéresis del tumor, sobre todo si están mal delimitados

Objective: Radical orchidectomy is the standard treatment for malignant testis tumours. Radical orchidectomy results in androgen deprivation, infertility and impaired psychological well-being, especially in synchronous bilateral tumours, metachronous contralateral tumours or tumour in a solitary testis. According to the European Association of Urology Guidelines, if pre-operative testosterone level is normal and the tumour volume is less than 30% of the testicular volume, organ preserving surgery can be performed. For nonpalpable tumours, organ-sparing surgery needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. Matherial and methods: We report two cases of nonpalpable intratesticular tumours successfully localised using 99 mmTc nanocolloid injected with intraoperative US and detected with a γ-ray detection probe. Conclusions: This method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited

¿Es el poliomavirus BK la causa de cistopatía hemorrágica en los pacientes sometidos a trasplante de progenitores hematopoyéticos alogénicos? / Is polyomavirus BK the cause of hemorrhagic cystopathy in patients who undergo allogeneic hematopoietic progenitor cell transplantation?

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Intraoperative injection of (99mm)Tc- nanocolloid for localization of nonpalpable intratesticular tumours in organ-sparing surgery.

OBJECTIVE: Radical orchidectomy is the standard treatment for malignant testis tumours. Radical orchidectomy results in androgen deprivation, infertility and impaired psychological well-being, especially in synchronous bilateral tumours, metachronous contralateral tumours or tumour in a solitary testis. According to the European Association of Urology Guidelines, if pre-operative testosterone level is normal and the tumour volume is less than 30% of the testicular volume, organ preserving surgery can be performed. For nonpalpable tumours, organ-sparing surgery needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. MATHERIAL AND METHODS: We report two cases of nonpalpable intratesticular tumours successfully localised using (99mm)Tc nanocolloid injected with intraoperative US and detected with a γ-ray detection probe. CONCLUSIONS: This method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited.

Guía práctica para el manejo y tratamiento ante la cistitis radical / Practical treatment approach of radiation induced cystitis

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología (AU)

Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition (AU)

[Practical treatment approach of radiation induced cystitis]. / Guía práctica para el manejo y tratamiento ante la cistitis radical.

OBJECTIVE: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. MATERIAL AND METHODS: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. RESULTS: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. CONCLUSIONS: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy?

PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIALS AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.

Can infundibular height predict the clearance of lower pole calyceal stone after extracorporeal shockwave lithotripsy?

PURPOSE: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) on lower calyceal calculi in relation to the renal anatomical factors and determine which of these factors can be used to select patients who will benefit from SWL. MATERIAL AND METHODS: We analyzed retrospectively 78 patients with single radiopaque lower calyceal stones treated with SWL. The patients were evaluated 3 months after lithotripsy with a simple abdominal X-ray and a kidney ultrasound scan. The success of the treatment, removal of all fragments, was correlated with renal anatomical factors measured in the pre-treatment intravenous urography: infundibulopelvic angle, lower infundibulum width, lower infundibulum length, ratio length/width, infundibulum height, and number of minor calyces in the lower calyceal group. RESULTS: Three months after SWL treatment, 39 patients were stone-free (NR group) and 39 had residual fragments (R group). Both groups presented no differences in relation to infundibulopelvic angle, width and length of the lower calyceal infundibulum, length/width ratio of the lower infundibulum or number of lower calyces. Height of the infundibulum, described as the distance between the line passing through the lowest part of the calyx containing the calculus and the highest point of the lower lip of renal pelvis, was the only parameter in which significant differences (p = 0.002) were found between the NR and R groups. CONCLUSIONS: Lower Infundibular height could be a good measurement tool for deciding which patients with lower calyceal lithiasis would benefit from SWL treatment. Height of less than 22 mm suggests a good outcome from lithotripsy.

[Arteriovenous fistula of the renal stump after nephrectomy]. / Fistula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal.

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature.

Fístula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal / Arteriovenous fistula of the renal stump after nephrectomy

La fístula o aneurisma arteriovenoso del pedículo renal después de la nefrectomía es una complicación poco frecuente. La mayoría de las veces se diagnostica muchos años después de la cirugía. Presentamos un caso de fístula arteriovenosa del pedículo renal derecho después de una nefrectomía realizada, por pionefrosis litiásica derecha, 40 años antes. Comentamos el cuadro clínico inicial, el tratamiento y la evolución del paciente. Se revisa la literatura actual

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature

[Cystic lymphangioma. Our experience]. / Linfangioma quístico. Nuestra experiencia.

OBJECTIVE: To comment on the most relevant aspects and to review the literature on this unusual pathology. MATERIAL AND METHODS: We present two cases of cystic lymphangioma, their clinical, diagnosis, therapy and development, and we review the actual literature. The first case is a young man with the diagnosis of cystic lymphangioma of the scrotum and pelvis. The second case is one patient with a cystic lymphangioma of the retroperitoneum. DISCUSSION: Cystic lymphangioma is a congenital lymphatic hamartoma of the lymphatic system that usually appears at childhood like a big mass at soft tissues that has a tendency to grow unless a completed excision is performed. CONCLUSIONS: There are few cases of scrotal cystic lymphangioma in the literature; they are often misdiagnosed as other common cystic scrotal conditions leading to an improper surgical approach and an incomplete surgery that predisposes later recurrence. Cystic lymphangioma of the retroperitoneum is a rare entity diagnosis in most cases as an incidentaloma.

[Isolated intraepithelial prostatic neoplasia and positive prostate adenocarcinoma results at repeated biopsy. Review of our series]. / Neoplasia intraepitelial prostática aislada y positividad para adenocarcinoma en la rebiopsia. Revision de nuestra serie.

OBJECTIVE: To review the incidence of isolated prostatic intraepithelial neoplasia (PIN) as well as the positive prostate cancer results in repeat biopsy in our series of transrectal biopsy of the prostate. We compare these results with the actual literature. MATERIALS AND METHODS: We review the 2.475 transrectal ultrasound guided biopsies of the prostate made in our department from January 1992 to June 2004 looking for intraepithelial neoplasia and looking in particular for isolated High-grade PIN (HGPIN). We review repeat biopsies made at this patients and the likelihood of detecting prostate cancer in them. RESULTS: The diagnosis of PIN was found in 31 biopsies, 13 of them were isolated HGPIN what means a 0.52% incidence of the total biopsies performed in our department. We performed 7 repeat biopsies of the 13 cases in a period from 3 months to 2 years after the first biopsy, and we found 3 cases of prostate cancer what means that 43% of isolated HGPIN with repeated biopsy showed prostate cancer. The mean age of the patients studied was 67 years (range 53-88). The median PSA value of the studied cases was 9.8 ng/ml. The Gleason score of the positive biopsies was always between 3 and 7. In our series, age and PSA levels did not have correlation with the positive results for prostate cancer in repeated biopsies. CONCLUSIONS: In spite of a lower number of HGPIN cases in our series, the positive for prostate cancer in repeated biopsy (43%) is similar to the incidence reported in literature so it is advisable rigorous controls and repeated biopsies for these patients.

Neoplasia intraepitelial prostática aislada y positividad para adenocarcinoma en la rebiopsia. Revisión de nuestra serie / Isolated prostatic intraepithelial neoplasia and positive prostate cancer results at repeat biopsy. Our series review

Objetivo: Revisar la incidencia de neoplasia intraepitelial prostática ( PIN ) aislada, así como la positividad para adenocarcinomaprostático de estas lesiones en la rebiopsia en nuestra serie de biopsias transrectales, comparando los resultados con la bibliografía actual. Material y Método : Hemos analizado las 2.475 biopsias prostáticas transrectales ecodirigidas realizadas en nuestro Servicio desde enero de 1992 hasta junio del 2004 en búsqueda de neoplasia intraepitelial prostática y en concreto de PIN de alto grado (PINAG) aislado, revisando las rebiopsias realizadas a estos pacientes y la probabilidad de detectar en ellas adenocarcinoma. Resultados: De un total de 31 biopsias en las que se halló el diagnóstico de PIN, 13 de ellas corresponde a PIN de alto grado aislado, lo que supone una incidencia de 0,52% del total de las biopsias realizadas en el Servicio. Se han rebiopsiado7 de estos 13 casos en un período de 3 meses a 2 años tras la primera biopsia, hallando en 3 adenocarcinoma; lo que supone que el 43 % de los PINAG aislados rebiopsiados en la serie mostraron adenocarcinoma. La edad media de los pacientes estudiados fue de 67 años (rango 53-88). El PSA medio de los pacientes estudiados fue de 9,8 ng/ml. El Gleason de las biopsias con carcinoma estuvo siempre entre 3 y 7. En nuestra muestra, la edad y los niveles de PSA no guardaban relación con la positividad a adenocarcinoma en las rebiopsias. Conclusiones: A pesar de una cifra inferior de PIN de alto grado en nuestra serie, la positividad para carcinoma en la rebiopsia (43%) es semejante a la descrita en la literatura, por lo que son aconsejables los controles rigurosos y las rebiopsias a estos pacientes (AU)

Objetive: To review the incidence of isolated prostatic intraepithelial neoplasia (PIN) as well as the positive prostate cancer results in repeat biopsy in our series of transrectal biopsy of the prostate. We compare these results with the actual literature. Materials and Methods: We review the 2.475 transrectal ultrasound guided biopsies of the prostate made in our department from January 1992 to June 2004 looking for intraepithelial neoplasia and looking in particular for isolated High-grade PIN (HGPIN). We review repeat biopsies made at this patients and the likelihood of detecting prostate cancer in them. Results: The diagnosis of PIN was found in 31 biopsies, 13 of them were isolated HGPIN what means a 0,52% incidence of the total biopsies performed in our department. We performed 7 repeat biopsies of the 13 cases in a period from3 months to 2 years after the first biopsy, and we found 3 cases of prostate cancer what means that 43% of isolated HGPIN with repeated biopsy showed prostate cancer. The mean age of the patients studied was 67 years (range 53-88).The median PSA value of the studied cases was 9,8 ng /ml. The Gleason score of the positive biopsies was always between3 and 7. In our series, age and PSA levels did not have correlation with the positive results for prostate cancer in repeated biopsies. Conclusions: In spite of a lower number of HGPIN cases in our series, the positive for prostate cancer in repeated biopsy ( 43%) is similar to the incidence reported in literature so it is advisable rigorous controls and repeated biopsies for these patients (AU)

[Infective lithiasis. Treatment and complications]. / Litiasis infecciosa. Tratamiento y complicaciones.

OBJECTIVE: To establish the criteria for treatment of staghorn stones according to stone surface and distribution in cadaver kidneys. METHODS: Retrospective study of 344 cases treated from 1985 to 1992 and classified into two groups according to treatment by extracorporeal lithotripsy or by percutaneous nephrolithotomy (PNL). RESULTS: Mean age 48.69 years, prevalence of females and positive urinary culture in almost 70%, mainly Proteus. Stone composition was varied, but mainly magnesium ammonium phosphate. Treatment was by extracorporeal lithotripsy in 80.81% and by PNL in 19.9%. CONCLUSIONS: Treatment of this type of lithiasis should be by combined surgical removal and medical treatment. Lithotripsy is advocated for large caliceal calculi and PNL for large pyelic calculi.

Mesotelioma maligno de túnica vaginal / Malignant mesothelioma of the tunica vaginalis testis

Presentamos el caso de un paciente afecto de mesotelioma maligno de túnica vaginal, del cual existen menos de 80 casos descritos en la literatura. Se trata de un varón de 62 años, remitido por masa escrotal de 3 meses de evolución , comprobando tumoración escrotal izquierda, con signos flogóticos y erupción pápulovesicular en escroto-hipogastrio. Se realizó orquiectomía, con escrototomía parcial. Tras la exéresis quirúrgica y diagnóstico anatomopatológico de mesotelioma maligno infiltrante, se constató mediante TAC, la presencia de metástasis retroperitoneales, pulmonares y hepáticas. El paciente está recibiendo tratamiento combinado de Quimioterapia y Radioterapia con un pronóstico sombrío. Revisamos el diagnóstico, histología y opciones de tratamiento de este tipo infrecuente de tumor paratesticular (AU)

[Malignant mesothelioma of the tunica vaginalis]. / Mesotelioma maligno de túnica vaginal.

Case report of a new case of malignant mesothelioma of the tunica vaginalis testis. A mediterranean male age 62, presented with enlargement and swelling of the scrotum, treated as orchiepydidymitis within the previous 3 months. Physical and ultrasonography examination showed a left scrotal mass with extension to the skin of the scrotum. After surgery (orchiectomy and partial hemiscrotectomy) and histopathology diagnosis of locally advanced malignant mesothelioma, CT showed metastasis in retroperitoneum, Lung and Liver. The patient undergoes chemotherapy and radiotheraphy with a poor prognose. We review the diagnosis, histopathology and therapeutical approach for this uncommon kind of paratesticular tumor (less than 80 cases reported in the last 30 years).

[Supraselective embolization of renal pseudoaneurysm caused by an abdominal stab wound]. / Embolización supraselectiva de pseudoaneurisma renal por herida incisa abdominal.

OBJECTIVE: To report the results of conservative management of post-traumatic (abdominal stab wound) pseudoaneurysm with arteriovenous fistula in segmental artery of left kidney and secondary persistent hematuria in an HIV positive patient. METHODS/RESULTS: A supraselective left renal arteriography revealed a pseudoaneurysm. We performed embolization of the aneurysmal artery with coils and fibrin particles. Resolution of the hematuria was immediately achieved with no side effects or significant complications. CONCLUSIONS: In our view, supraselective embolization is the first option in the treatment of post-traumatic renal artery aneurysms due to its low morbidity and limited aggressiveness.

[Barcelona pouch. An external continent urinary diversion]. / Barcelona Pouch. Una derivación urinaria externa continente.

OBJECTIVES: To describe a new technique for external continent urinary diversion based on the Vesica Ileale Padovana technique (VIP) with a continent hydraulic valve, which obviates the need for external permanent collecting urinary systems. METHODS: An ileal neobladder was created following the VIP technique to which we added a modified Benchekroun continent hydraulic valve utilizing mechanical sutures. RESULTS: A continent heterotopic neobladder was achieved. The technique was easy to perform and permitted preservation of the upper urinary tract due to the pouch's low internal pressures. CONCLUSIONS: In our view, this technique is a valid alternative in patients unamenable to orthotopic diversion and are able to perform self-catheterization.