[Hand-assisted laparoscopic radical nephrectomy vs. open nephrectomy in the treatment of clinically localized renal cell carcinoma. Comparative study]. / Nefrectomía radical laparoscópica asistida por la mano frente a nefrectomía abierta en el tratamiento del carcinoma de células renales clínicamente localizado. Estudio comparativo.

INTRODUCTION: The description of the first laparoscopic nephrectomy made a revolution in the managing of the benign and malignant renal diseases. Hand-assisted laparoscopy (HAL) was developed with the aim of offering advantages to both patients and surgeons. The aim of the present work is to compare, in our experience, the results offered in the radical nephrectomy by HAL and open surgery, by analysis of surgical time, estimated blood loss during surgery and hospital stay. METHODS: Eleven Hand-assisted laparoscopic (HAL) radical nephrectomies and eight open radical nephrectomies were carried out at our institution during the same period (June 2001 to December 2002). All patients underwent computed tomography and were found to have a clinically localised functioning renal mass in all cases. The size of this renal mass was 4-7 cm (average 5.5 cm) in the HAL group and 4.5-15 cm (average 7.8 cm) in the open group. Patient age, body mass index, and American Society of Anaesthesiologists' score showed no significant difference between groups. RESULTS: The average surgical time in the HAL group was 156.72 minutes, the average blood loss during surgery was of 83.6 ml and the average hospital stay was of 3.09 days. Conversion to open surgery was not necessary in any patient. Average surgical time in the open surgery group was 178.25 minutes, the estimated blood loss during surgery was of 337.75 ml (p < 0.05) and the hospital stay was of 5.37 days (p < 0.05). The comparison of the means by two-tailed student's t test revealed significant differences in estimated blood loss and hospital stay, favoring HAL, and no significant differences in surgical time. CONCLUSIONS: HAL nephrectomy is feasible in almost all nephrectomies and is a safe, reproducible, and minimally invasive technique to perform extirpable renal surgery. HAL offer clear advantages over traditional open surgery, including decreased blood loss and hospital stay.

[Fatal evolution of a renal angiosarcoma]. / Evolución fatal de angiosarcoma renal.

OBJECTIVES: Report a new case of renal angiosarcoma treated by surgery and adjuvant chemotherapy with bad results. METHODS: 72-year-old male undergoing right nephrectomy for renal tumor. Pathology reports renal angiosarcoma. RESULTS: Three months after surgery patient refers lumbar pain and hemoptysis and CT scan reveals the existence of multiple bone and lung metastasis; a regimen of systemic chemotherapy with Doxorrubicine+ Ifosfamide was started without response; he died two months later. CONCLUSIONS: Primary renal angiosarcoma is very rare, with less than 10 cases in the literature before 1998, and it is always associated with bad prognosis. Diagnosis is based on immunohistochemical studies (antibodies against CD31, CD34 and factor VIII related antigen) to define the endothelial differentiation of the tumor. There is no experience to define the best therapeutic strategy against this entity.

[Controversies in the evaluation of asymptomatic microhematuria]. / Controversias en la evaluación de la microhematuria asintomática.

OBJECTIVE: Asymptomatic microhematuria continues to be a problem. It has a prevalence of 16% and numerous conditions can present this clinical manifestation. METHODS: A prospective study was carried out on all patients that consulted at the urological services during 2000 for asymptomatic hematuria. Patients presenting with irritative symptoms, urethral secretion, perineal or suprapubic pain, urinary tract infections, renal lithiasis or history of trauma were not included in the study. RESULTS: None of the patients presented tumors. Two patients presented renal lithiasis, 5 simple renal cysts, 8 hypercalciuria and 3 hyperuricosuria. None of the 11 patients with hypercalciuria or hyperuricosuria had a history of lithiasis. CONCLUSIONS: Although the size of the study is small, the incidence of tumors in patients with asymptomatic microhematuria appears to be far from the 12.5% incidence reported by some authors and might probably be closer to the 0.5% incidence reported by others. Furthermore, the significant pathology (renal lithiasis), which requires treatment, is also infrequent.

Controversias en la evaluación de la microhematuria asintomática / Controversies in the study of asymptomatic microhematuria

INTRODUCCIÓN: La hematuria microscópica sigue siendo en la actualidad un problema para el urólogo: se trata de una entidad que afecta hasta al 16 por ciento de la población general, siendo numerosas las enfermedades nefro y urológicas que pueden cursar con esta manifestación clínica.MÉTODOS: Hemos realizado un estudio prospectivo sobre los 98 pacientes que han acudido durante el año 2000 a nuestra consulta de urología, remitidos por presentar microhematuria asintomática. No hemos incluido a los pacientes que presentaban clínica irritativa, secreción uretral, dolor perineal o suprapúbico, infecciones urinarias, litiasis renal o antecedente de traumatismos.En todos ellos se ha practicado urocultivo, radiografía simple de abdomen, ecografía renovesical, citología urinaria (para filiar a la hematuria como glomerular o extraglomerular, así como para descartar la existencia de células sugerentes de tumoración urotelial), y se ha determinado calciuria y uricosuria en orina de 24 horas.En algunos pacientes, a juicio del facultativo, se ha practicado así mismo urografía intravenosa.RESULTADOS: Ninguno de los pacientes presentaba enfermedad tumoral. Dos pacientes presentaron litiasis renal, 5 pacientes quistes renales simples, 8 pacientes hipercalciuria y 3 hiperuricosuria (ninguno de estos 11 pacientes con hipercalciuria o hiperuricosuria presentaba antecedentes litiásicos) y en 8 pacientes el origen de la hematuria era glomerular, y fueron remitidos a estudio nefrológico.CONCLUSIONES: Aunque lo reducido de nuestra muestra no permite avanzar conclusiones relevantes, sí parece evidenciarse que la incidencia de patología tumoral en los pacientes con microhematuria no sintomática debe estar alejada de la cifra del 12,5 por ciento que indican algunos autores, estando probablemente más cerca del 0,5 por ciento que refieren otros. Por otra parte, la patología significativa, tributaria de tratamiento (litiasis renal) también es poco frecuente (AU)