Erratum to "From ACTH-Dependent to ACTH-Independent Cushing's Syndrome from a Malignant Mixed Corticomedullary Adrenal Tumor: Potential Role of Embryonic Stem Cells".

[This corrects the article DOI: 10.1155/2020/4768281.].

From ACTH-Dependent to ACTH-Independent Cushing's Syndrome from a Malignant Mixed Corticomedullary Adrenal Tumor: Potential Role of Embryonic Stem Cells.

OBJECTIVE: To report the immunohistochemical and molecular evaluation of a patient with ectopic ACTH syndrome (EAS) from a MCAT which has single cells with features of both 96 medullary and cortical differentiation. Case Description and Methods. A 16-year-old woman presented with severe EAS and a large right MCAT composed of ACTH-secreting cells resembling pheochromocytoma and another lineage similar to adrenal carcinoma. Immunohistochemistry (IHC) showed positivity for medullary (ACTH, chromogranin A, synaptophysin, and PS-100) and epithelial components (inhibin, melan-A, and calretinin). Embryonic stem cell markers were evaluated using RT/PCR and immunofluorescence. After initial surgery, the tumor recurred shifting to rapidly progressive ACTH-independent liver metastasis. RESULTS: Histopathology and IHC revealed two distinct and intermingled cellular patterns, while some cells immunostained for both medullary and cortical markers. Demonstration of all stem cell biomarkers by RT/PCR and immunofluorescence was predominantly localized to the nucleus, whereas SOX2 immunoreactivity was evident in the cytoplasm as well. CONCLUSION: The expression of cancer stem cell biomarkers points towards the involvement of primitive embryonic cells as the origin of this neoplasm and maybe to the clinically aggressive and biochemically changing behavior.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser.

INTRODUCTION: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. OBJECTIVE: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. METHOD: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. RESULTS: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. CONCLUSIONS: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

INTRODUCCIÓN: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. OBJETIVO: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. MÉTODO: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. RESULTADOS: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. CONCLUSIONES: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Factores predictores del estado libre de cálculos en la primera ureteroscopia flexible con litotricia láser / Predictors of stone-free status in the first flexible ureteroscopy with laser lithotripsy

Resumen Introducción: La ureteroscopia flexible con litotricia láser (URSLL) es una modalidad mínimamente invasiva de tratamiento quirúrgico de cálculos renales. La selección inadecuada de pacientes para este procedimiento genera un desbalance de costo-efectividad. Objetivo: Conocer los factores predictores de estado libre de litos en un solo tiempo quirúrgico en pacientes sometidos a URSLL. Método: Cohorte retrospectiva de pacientes sometidos a URSLL. Se realizó un análisis univariado y multivariado (regresión logística) de los predictores de estado libre de cálculos en la primera URSLL, global y categorizado por sexo. Resultados: EL estado libre de cálculos en la primera URSLL fue de 73.62 %. Los predictores de estado libre de cálculos en hombres fueron edad y tamaño, densidad y multiplicidad del cálculo; en las mujeres, el índice de masa corporal y la multiplicidad del cálculo. Conclusiones: Los factores pronósticos de estado libre de cálculos en la primera URSLL son distintos en hombres y mujeres. Las mujeres con obesidad y sobrepeso probablemente tengan cálculos de fácil fragmentación y extracción asociados con ácido úrico.

Abstract Introduction: Flexible ureteroscopy and laser fragmentation (FURSL) is a minimally invasive modality for surgical treatment of renal stones. Inadequate selection of patients for this treatment generates a cost-effectiveness unbalance. Objective: To know the stone-free rate predictors in a single surgical time in patients undergoing FURSL. Method: Retrospective cohort of patients undergoing FURSL. Global and gender-categorized univariate and multivariate (logistic regression) analyses were performed to identify stone-free predictors at first FURSL. Results: Stone-free rate at first FURSL was 73.62%. Predictors in males were patient age and stone size, density and multiplicity; in females, body mass index and multiplicity of stones. Conclusions: Stone-free rate predictors at first FURSL are different in males and females. Women with overweight and obesity probably have easy-to-fragment and easy-to-extract stones associated with uric acid.

[Prognostic factors of morbimortality in patients with emphysematous pyelonephritis]. / Factores pronósticos de morbimortalidad en pacientes con pielonefritis enfisematosa.

BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe infection of the urinary tract, caused by gas accumulation within the collecting system, the renal parenchyma, and/or the perirenal tissue. The cause of this infection is not known at all; however, it has been suggested that it is produced by the glucose fermentation provoked by enterobacteriaceae or anaerobic organisms. Our objective was to evaluate the predictors of morbidity and mortality in patients diagnosed with EPN. METHODS: It was carried out a historical cohort study of patients diagnosed with EPN in our hospital from March 2005 to December 2014. Patients with adverse outcome were identified. We defined adverse outcome as patients requiring stay in intensive care unit, who presented nephrectomy and/or who died. A multiple regression analysis was conducted to establish the relation of each clinical factor with the adverse outcome. RESULTS: 73 records were included for analysis, 48 were women (65.8 %) and 25 men. Diabetes, urolithiasis, E. coli infection and septic shock occurred in 68.5, 68.5, 63, and 15.1 %, respectively. We found that leukocytosis ≥12 000 µl (OR 43.65, 95 % CI 2.36-805, p <0.001), thrombocytopenia ≤120 000 µl (OR 363, 95 % 9.2-14208, p <0.0001), and Huang's radiological class 3 (OR 62, 95 % CI 4-964, p < 0.001) were factors significantly associated with adverse outcome. CONCLUSION: Thrombocytopenia, leukocytosis and Huang's radiological class 3 are associated with adverse outcome in patients with EPN.

Introducción: La pielonefritis enfisematosa es una infección grave del tracto urinario caracterizada por la presencia de gas en los sistemas colectores, en el parénquima renal o en el tejido perirrenal; su causa no es del todo conocida, pero se ha sugerido que se debe a la fermentación de glucosa por enterobacterias y anaerobios. El objetivo fue evaluar los factores pronósticos de morbimortalidad en pacientes con diagnóstico de pielonefritis enfisematosa. Métodos: estudio de cohorte histórica en pacientes con diagnóstico de pielonefritis enfisematosa que ingresaron a nuestro hospital de marzo de 2005 a diciembre de 2014. Se identificaron los pacientes con desenlace adverso definido como aquel que requirió estancia en unidad de cuidados intensivos, nefrectomía o muerte. Se realizó una regresión logística múltiple para obtener la relación de cada factor pronóstico con el desenlace adverso. Resultados: Fueron evaluados 73 pacientes (48 mujeres [65.8 %]). Diabetes, litiasis urinaria, infección por Escherichia coli y el estado de choque se presentaron en 68.5 %, 68.5 %, 63 % y 15.1 %, respectivamente. Fueron factores significativos para desenlace adverso la leucocitosis ≥ 12 000 µL (RM 43.65, IC 95 % 2.36-805, p < 0.001), la trombocitopenia ≤ 120 000 µL (RM 363, IC 95 % 9.2-14208, p < 0.0001), y la clase radiológica 3 de Huang (RM 62, IC 95 % 4-964, p < 0.001). Conclusión: la trombocitopenia, la leucocitosis y la clase radiológica 3 se asociaron con un desenlace adverso en los pacientes con pielonefritis enfisematosa.

[Intrarectal povidone-iodine to reduce the risk of genitourinary infections after transrectal prostate biopsy]. / Iodopovidona intrarrectal y riesgo de infección genito- urinaria posterior a biopsia prostática transrectal.

BACKGROUND: The aim of this study is to compare two different preparations in patients undergoing transrectal prostate biopsies samples (TPBS) and assess the prevalence of genitourinary infections (GUI). METHODS: A historical cohort of patients undergoing TBPS for suspected prostate cancer. Two groups were compared: one with endorectal lubricant jelly and another with the addition of a povidone-iodine lubricating jelly. Complications were evaluated at three weeks. A bivariate analysis was performed by calculating the OR (95 % CI) to determine if the additional endorectal povidone-iodine pre-TBPS reduced GUI and other complications. RESULTS: 185 patients (Group I n = 86, Group II n = 96) were evaluated. 45 and 25 % had genitourinary tract infection (OR: 0.4, CI: 0.2-0.9, p = 0.004); fever was presented in 21 and 10 % respectively (OR: 0.42, CI: 0.1-0.9, p = 0.04). CONCLUSIONS: A reduction was observed in the presence of genitourinary infections in patients who had intrarectal povidone-iodine preparation applied.

Introducción: el objetivo de este estudio es comparar dos preparaciones distintas en pacientes sometidos a la toma de biopsias prostáticas transrectales (BPTR) y evaluar la prevalencia de infecciones genitourinarias (IGU). Métodos: se compararon dos grupos de pacientes con sospecha de cáncer de próstata sometidos a Biopsia Prostática Transrectal (BPTR): Con jalea lubricante endorrectal (grupo l, cohorte histórica) y con jalea lubricante más iodopovidona (grupo II, cohorte prospectiva). Se evaluaron las complicaciones a las tres semanas. Se realizó un análisis bivariado, calculando su OR (IC: 95 %) para determinar si la iodopovidona endorrectal adicional previa a la BPTR disminuye las IGU y otras complicaciones. Resultados: Se evaluaron 185 pacientes (Grupo I n = 86; grupo II n = 96). Tuvieron infección del tracto genitourinario el 45 y 25 % (OR: 0.4, IC: 0.2-0.9, p = 0.004); la fiebre se presentó en el 21 y 10 % respectivamente (OR: 0.42, IC: 0.1-0.9, p = 0.04). Conclusiones: Se observó una reducción en la presencia de infecciones genitourinarias en pacientes a quienes se aplicó en su preparación iodopovidona intrarrectal.

Prognostic factors of morbidity in patients undergoing percutaneous nephrolithotomy.

OBJECTIVE: To determine the preoperative and perioperative predictive factors of morbidity/mortality in patients undergoing percutaneous nephrolithotomy (PCNL), using the Clavien's classification. MATERIALS AND METHODS: We performed a retrospective chart review of patients who underwent PCNL between January 2005 and January 2012. Preoperative and postoperative factors, such as age, obesity, surgical risk, Charlson comorbidity index, stone complexity, access calix, type of dilator used, and surgery time, were evaluated as predictors of complications. RESULTS: A total of 354 patients were included in the study. Of these, 56% were women, with the average age of 47±12.5 years. Stone-free rate for noncomplex calculi was 85% and for complex calculi it was 68%. A total of 103 complications were recorded (29.3%). According to the modified Clavien classification system, 32 (9%) were grade 1, 39 (11%) were grade 2, 16 (4.5%) were grade 3A, 8 (2.3%) were grade 3B, 3 (0.8%) were grade 4A, 1 (0.3%) was grade 4B, and 4 (1.1%) were grade 5. In multivariate analysis female gender (odds ratio [OR] 3.1, confidence interval [CI] 1.1-8.0), Charlson score of ≥3 (OR 23.2, CI 3.5-151.1), complex stone (OR 4, CI 1.6-9.6), and duration of surgery of ≥120 minutes (OR 2.9, CI 1.2-6.9) were associated with major complications. CONCLUSIONS: PCNL is a safe procedure with acceptable efficacy for the resolution of renal calculi. The safety of the procedure should improve, especially to reduce the presence of severe complications (Clavien ≥3). We identified factors that are associated with severe complications: female gender, high Charlson, complex calculi, and surgical length ≥120 minutes.

[VVF: laparoscopic versus open surgical abdominal]. / Fistula vesicovaginal: abordaje abierto abdominal versus laparoscópico.

BACKGROUND: Vesico vaginal fistula is the most common acquired fistula of the urinary tract that originates from an abnormal communication between the bladder and vagina, its main manifestation is transvaginal urine output and significantly affects the quality of life of women suffer. OBJECTIVE: To compare the success and complications of open abdominal versus laparoscopic surgical treatment of patients with vesicovaginal fistula (VVF). MATERIAL AND METHODS: A retrospective, observational, comparative study of patients with a diagnosis of VVF. We included patients with a diagnosis of VVF with full clinical documentation and at least one evaluation after 3 months of surgery. All patients underwent surgical closure type O'Conor and grouped into two groups: Group I: Open abdominal and group II: Laparoscopic. Age, body mass index (BMI), size, location of the fistula, surgical time, intraoperative bleeding, and length of hospital stay were compared. RESULTS: Twenty seven patients with a diagnosis of VVF were evaluated. Eighteen patients had open abdominal surgery (group I) and 9 laparoscopic (group II). The average age was 42.8 vs 41.4 years, the average size of the VVF was 0.9 vs 1.3 cm, the success rate was 94.4 vs 77%, p> 0.05, for group I and II respectively. There were differences in favor of group II with respect to days of using transurethral catheter, days of hospitalization and postoperative bleeding, p<0.05. CONCLUSIONS: In our experience we believe that the laparoscopic approach is an excellent alternative to traditional abdominal approach, although it requires experience in laparoscopic pelvic surgery.

Outcomes and complications of sphincterotomy with bladder neck incision in neurologically healthy male patients with voiding dysfunction.

OBJECTIVES: To evaluate the efficacy, complications and outcomes of sphincterotomy with bladder neck incision in patients with voiding dysfunction (VD). METHODS: We evaluated our prospectively established urologic urodynamic database and identified the records of 30 male patients with VD that underwent sphincterotomy between Octuber 1993 and December 2008. The IPSS and urodynamics were analyzed before and after surgery, we recorded the outcomes and complications. Numerical data were analyzed with Student`s t and Wilcoxon tests (p < 0.05). ANOVA was used for the follow up. RESULTS: Thirty patients underwent sphincterotomy with a mean age of 41 years (range 18-63 years). Statistical differences (p< 0.05) were found for: maximum flow rate (17.61 ± 7.7 vs 23.5 ± 12.19 ml/s), detrusor pressure (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), maximum cystometric capacity (462.74 ± 224.2 vs 382.2 ± 167.48 ml), functional urethral length (64.3 ± 22.6 vs 42.2 ± 18.4 mm), Maximum urethral pressure (120.1 ± 46.8 vs 59.23± 22.67 cmH20), total urethral closure area (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) and postvoid residual volume (161.3 ± 177.9 vs 57 ± 100.8 ml). The IPSS improved and was stable at 60 months (p < 0.02). No significant association was found to develop incontinence after the procedure. CONCLUSION: Sphincterotomy for male patients with dysfunctional voiding improves voiding dynamics with a low rate of complications and minimum risk of incontinency.

Resultados y complicaciones de la esfinterotomía con cervicotomía en pacientes masculinos con disfunción miccional neurológicamente sanos / Outcomes and complications of sphincterotomy with bladder neck incision in neurologically healthy male patients with voiding dysfunction

OBJETIVO: Evaluar la eficacia de la esfinterotomía con cervicotomía en pacientes masculinos con diagnóstico de disfunción miccional (DM) neurológicamente sanos y describir las complicaciones. MÉTODOS: Se realizó un estudio retrospectivo, observacional y longitudinal para evaluar los pacientes masculinos con el diagnóstico de DM, sometidos a esfinterotomía de Octubre de 1993 a Diciembre de 2008. Se evaluó el IPSS y el estudio urodinámico pre y postquirúrgico y la presencia de complicaciones. Las variables cuantitativas con se analizaron mediante T student y Wilcoxon. Se realizó un análisis de la varianza de Friedman y Q Cochrane con p < 0.05 como significativo. RESULTADOS: Treinta pacientes fueron sometidos a esfinterotomía, con un promedio de edad de 41 años (rango 18-63 años). Se encontraron diferencias estadísticamente significativas (p< 0.05) para tasa de flujo máximo (17.61 ± 7.7 vs 23.5 ± 12.19 ml/seg), presión del detrusor al flujo máximo (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), capacidad cistométrica máxima (462.74 ± 224.2 vs 382.2 ± 167.48 cmH20), longitud uretral funcional (64.3 ± 22.6 vs 42.2 ± 18.4 mm), presión uretral máxima (120.1 ± 46.8 vs 59.23 ± 22.67 cmH20), área de cierre total uretral (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) y orina residual (161.3 ± 177.9 vs 57 ± 100.8 ml). Para el IPSS se encontró una diferencia significativa con que se mantuvo a los 60 meses (p <0.02). No se encontró una asociación significativa para incontinencia posterior a la esfinterotomía. CONCLUSIÓN: La esfinterotomía con cervicotomía en pacientes masculinos con DM mejora la dinámica miccional con una baja tasa de complicaciones y con mínimo riesgo de incontinencia(AU)

OBJECTIVES: To evaluate the efficacy, complications and outcomes of sphincterotomy with bladder neck incision in patients with voiding dysfunction (VD). METHODS: We evaluated our prospectively established urologic urodynamic database and identified the records of 30 male patients with VD that underwent sphincterotomy between Octuber 1993 and December 2008. The IPSS and urodynamics were analyzed before and after surgery, we recorded the outcomes and complications. Numerical data were analyzed with Student`s t and Wilcoxon tests (p < 0.05). ANOVA was used for the follow up. RESULTS: Thirty patients underwent sphincterotomy with a mean age of 41 years (range 18-63 years). Statistical differences (p< 0.05) were found for: maximum flow rate (17.61 ± 7.7 vs 23.5 ± 12.19 ml/s), detrusor pressure (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), maximum cystometric capacity (462.74 ± 224.2 vs 382.2 ± 167.48 ml), functional urethral length (64.3 ± 22.6 vs 42.2 ± 18.4 mm), Maximum urethral pressure (120.1 ± 46.8 vs 59.23 ± 22.67 cmH20), total ure-thral closure area (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) and post void residual volume (161.3 ± 177.9 vs 57 ± 100.8 ml). The IPSS improved and was stable at 60 months (p < 0.02). No significant as-sociation was found to develop incontinence after the procedure. CONCLUSION: Sphincterotomy for male patients with dysfunctional voiding improves voiding dynamics with a low rate of complications and minimum risk of incontinency(AU)

Laparoscopic management of retrocaval ureter: case report and literature review.

BACKGROUND: Retrocaval ureter is a rare congenital anomaly with an incidence of approx. 1/1000 live births. Recently, the laparoscopic approach has become the gold standard for treatment, relegating open surgery as a second option. CLINICAL CASE: We present the case of a 27-year-old male with a 2-year history of colicky pain in the right flank radiating to the ipsilateral thigh and genital region. The patient was initially treated with a right double-pigtail catheter stent due to obstructive uropathy as evidenced by ultrasound. He underwent laparoscopic ureteral anteposition with a successful outcome and has remained asymptomatic during a 12-month follow-up. CONCLUSIONS: Retrocaval ureter is a rare entity that requires a high grade of suspicion for initial diagnosis to provide adequate and opportune treatment that will have repercussions on kidney function and quality of life for the patient. Open surgery has traditionally been the treatment of choice; however, in recent decades laparoscopic surgery has been practiced more during this era of minimally invasive therapy, without yet displacing open surgery in our country.

[Lumboscopic adrenalectomy for pheochromocytoma in a patient with multiple endocrine neoplasia type 2B]. / Adrenalectomía lumboscópica en un paciente con feocromocitoma y neoplasia endocrina múltiple tipo 2B.

Multiple endocrine neoplasia type 2B (MEN 2B) is an autosomal dominant syndrome characterized by medullary thyroid carcinoma, pheochromocytoma, a marfanoid habitus and mucosal ganglioneuromatosis. We present a case of a 35-year-old male with MEN 2B with right adrenal pheochromocytoma diagnosed biochemically and radiologically and treated by laparoscopic adrenalectomy. Diagnosis of pheochromocytoma includes detection of catecholamines in urine and plasma and radiological tests such as computed axial tomography, nuclear magnetic resonance imaging and metaiodobenzylguanidine scintigraphy. Laparoscopic techniques have become standard for treatment of tumors of the adrenal glands.

[Urachus cystopexy: new technique for bladder suspension associated to the Burch's technique in the treatment of cystocele and stress urinary incontinence. Long-term follow-up]. / Uraco-cistopexia: nueva técnica de cisto-suspensión asociada al Burch para el tratamiento del cistocele e incontinencia urinaria de esfuerzo, seguimiento a largo plazo.

OBJECTIVES: To compare long term efficacy and morbidity in patients with stress urinary incontinence treated using Burch's colpopexy versus Burch's colpopexy plus urachus-cystopexy. METHODS: Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch's colpopexy (group B) and 75 patients underwent Burch's colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005. The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately. RESULTS: After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p = 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p = 0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1% of group B and 19.4% of group BU had UUI (p = 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p = 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p = 0.000) at 12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p = 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately. CONCLUSIONS: Burch's procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch's procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch's procedure.

Adrenalectomía lumboscópica en un paciente con feocromocitoma y neoplasia endocrina múltiple tipo 2B / Lumboscopic adrenalectomy for pheochromocytoma in a patient with multiple endocrine neoplasia type 2B

La neoplasia endocrina múltiple tipo 2B es un padecimiento autosómico dominante, conlleva carcinoma medular de tiroides, feocromocitoma, ganglioneuromas en mucosas e intestino y habitus marfanoide. Se presenta el caso de un paciente de 35 años de edad con diagnóstico de neoplasia endocrina múltiple tipo 2B y feocromocitoma suprarrenal derecho, tratado con adrenalectomía lumboscópica. El diagnóstico del feocromocitoma incluye detección de catecolaminas en suero y orina, estudios de imagen como tomografía axial computarizada, resonancia magnética nuclear y gammagrama con metaiodobencilguanidina. En la actualidad el abordaje laparoscópico se ha convertido en el tratamiento de elección.

Multiple endocrine neoplasia type 2B (MEN 2B) is an autosomal dominant syndrome characterized by medullary thyroid carcinoma, pheochromocytoma, a marfanoid habitus and mucosal ganglioneuromatosis. We present a case of a 35-year-old male with MEN 2B with right adrenal pheochromocytoma diagnosed biochemically and radiologically and treated by laparoscopic adrenalectomy. Diagnosis of pheochromocytoma includes detection of catecholamines in urine and plasma and radiological tests such as computed axial tomography, nuclear magnetic resonance imaging and metaiodobenzylguanidine scintigraphy. Laparoscopic techniques have become standard for treatment of tumors of the adrenal glands.

Uraco-cistopexia: nueva técnica de cisto-suspensión asociada al burch para el tratamiento del cistocele e incontinencia urinaria de esfuerzo, seguimiento a largo plazo / Urachus cystopexy: New technique for bladder suspension associated to the Burch`s technique in the treatment of cystocele and stress urinary incontinence. Long-term follow-up

OBJETIVO: Comparar la eficacia y morbilidad a largo plazo de pacientes con incontinencia urinaria de esfuerzo a las que se realizó uretro-cervico-suspensión tipo Burch versus el procedimiento de Burch más uraco-cistopexia.MÉTODOS: Se realizó un análisis de cohorte retrospectivo, longitudinal, comparativo y observacional. De enero de 1994 a marzo 2005 se incluyeron 129 pacientes con incontinencia urinaria de esfuerzo (IUE) o incontinencia urinaria mixta (IUM). Cincuenta y cuatro pacientes fueron sometidas a procedimiento de Burch (grupo B) y 75 pacientes a procedimiento de Burch asociado a uraco-cistopexia (grupo BU). La severidad de la incontinencia fue valorada mediante el número de apósitos utilizados durante 24 hrs. La cura se consideró cuando el paciente no requirió ningún dispositivo para la pérdida urinaria; la mejoría como una disminución a una toalla al día y fracaso el uso de más de 1 apósito en 24 horas. En la IUM, el componente de incontinencia urinaria de urgencia (IUU) se evaluó por separado(AU)

RESULTADOS: Se evaluaron 47 pacientes del grupo B y 67 pacientes del grupo BU; a los 12 meses de seguimiento observando una tasa cura/mejoría de la IUE del 74.4% (29/6) y 97% (58/7) respectivamente, p=0.001 y a los 24 meses de seguimiento 35 pacientes del grupo B y 42 pacientes del grupo BU observando una tasa del 65.7% (22/3) y 97.6% (37/4) respectivamente, p=0.014. La IUM basal se presentó en 53.7% de pacientes del grupo B y en 58.6% pacientes del grupo BU. Se analizó en forma aislada la parte de IUU de estas pacientes; a los 12 meses 53.1% de pacientes del grupo B y 19.4% del grupo BU presentaban IUU, p=0.000 y a los 24 meses 50% de pacientes del grupo B y 26.19% del grupo BU presentaban IUU, p=0.029. La IUU de novo se presentó en 19.14% de pacientes de grupo B y en el grupo BU 5.97%, p=.0000 y a los 24 meses en el grupo B 17.64% de pacientes y en el grupo BU 13.95% p=0.005. Las complicaciones relacionadas a la uraco-cistopexia se presentaron en el trans-operatorio y fue apertura vesical en 3 de los primeros casos que se resolvieron con cistorrafia en dos planos y sonda vesical por espacio de 7 días.CONCLUSIONES: El procedimiento de Burch asociado a la uraco-cistopexia tuvo mayor eficacia en la resolución a largo plazo de la IUE y del componente de IUU que el procedimiento de Burch aislado. La fijación quirúrgica del uraco a la aponeurosis de los rectos anteriores del abdomen mantiene firme la vejiga, lo que probablemente disminuye su desplazamiento durante los esfuerzos, evitando así la tensión en las fijaciones uretro-cervicales, elevando la eficacia del procedimiento de Burch(AU)

OBJECTIVES: To compare long term efficacy and morbidity in patients with stress urinary incontinence treated using Burch’s colpopexy versus Burch’s colpopexy plus urachus-cystopexy.METHODS: Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch’s colpopexy (group B) and 75 patients underwent Burch’s colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005.The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately.RESULTS: After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p= 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p=0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1 % of group B and 19.4 % of group BU had UUI (p= 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p= 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p= 0.000) at12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p= 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately(AU)

CONCLUSIONS: Burch’s procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch’s procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch’s procedure(AU)

[Two methods for transrectal ultrasound-guided biopsy of the prostate: systematic vs. guided for suspect echogenic lesion]. / Dos métodos para la toma de biopsia transrectal de próstata ecodirigida: sistemática versus ecosospechosa.

OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.

Dos métodos para la toma de biopsia transrectal de próstata ecodirigida: sistemática versus ecosospechosa / Two methods for transrectal ultrasound-guided biopsy of the prostate: systematic vs guided for suspect echogenic lesion

OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.

[Fournier's gangrene. Experience of the CMN SXXI Hospital]. / Gangrena de Fournier: experiencia en el Hospital de Especialidades del CMN SXXI.

OBJECTIVES: To evaluate and review the Fournier's gangrene clinical presentation, initial APACHE II score and integral treatment of patients affected in HECMNSXXI. METHODS: Retrospective, descriptive and cross-sectional study in 40 patients with Fournier's gangrene diagnosis, accepted for treatment in HECMNSXXI who gather inclusion criteria, from February 1996 to February 2006. RESULTS: Patients were between 21 and 93 yr old. In total 39 men and 1 woman were recruited. The most common etiologic factor was urethral stricture in 40% of patients. Escherichia coli was detected in 42.5% of the cultures, and represented the most common pathogen. Initial Apache II score was more commonly between 10 and 14 points (35%). 6 patients died (15%) all of them with and Apache II score above 25 points. 55% of patients were affected by diabetes mellitus. All patients with Fournier's Gangrene received a triple antibiotic schema from admittance day, associated with emergency surgical dèbridement in the whole group. CONCLUSIONS: Aggressive and multidisciplinary treatment is mandatory in all the patients affected by Fournier's gangrene. We recommend utilisation of the APACHE II score as very useful tool to determine the prognosis.

Gangrena de Fournier: experiencia en el Hospital de Especialidades del CMN SXXI / Fournier's gangrene. Experience of the CMN SXXI Hospital

Objetivo: Evaluar la presentación clínica de la gangrena de Fournier, la escala de APACHE II al ingreso de los pacientes y el manejo integral en el HE CMN SXXI. Métodos: Estudios retrospectivo, transversal, descriptivo en 40 pacientes con diagnóstico de gangrena de Fournier ingresados en el Hospital de Especialidades del CMN SXXI que reunieron los criterios de inclusión, entre febrero de 1996 a febrero del 2006. Resultados: El rango de edad osciló entre 21 y 93 años, siendo 39 pacientes del sexo masculino y una del sexo femenino. La etiología mas común encontrada de los pacientes estudiados fue estenosis de uretra 40%. El germen patógeno que se desarrolló en los cultivos fue principalmente Escherichia coli (42.5%). La calificación de acuerdo a la escala de Apache II al ingreso fue predominantemente de 10-14 puntos (35%). La mortalidad fue de 15% que corresponde a 6 pacientes, todos con escala de Apache II mayor a 25 puntos. El factor más importante asociado a la morbilidad fue diabetes mellitus (55%). Todos los pacientes recibieron terapia con antibióticos triple esquema desde su ingreso al servicio, asociado al manejo quirúrgico de urgencia en el 100%. Conclusiones: El tratamiento agresivo y multidisciplinario es obligatorio en los pacientes con diagnóstico de gangrena de Fournier. Se recomienda la utilización de la clasificación de Apache II ya que es una herramienta útil para determinar el pronóstico (AU)

Objectives: To evaluate and review the Fournier's gangrene clinical presentation, initial APACHE II score and integral treatment of patients affected in HECMNSXXI. Methods: Retrospective, descriptive and cross-sectional study in 40 patients with Fournier's gangrene diagnosis, accepted for treatment in HECMNSXXI who gather inclusion criteria, from February 1996 to February 2006. Results: Patients were between 21 and 93 yr old. In total 39 men and 1 woman were recruited. The most common etiologic factor was urethral stricture in 40% of patients. Escherichia coli was detected in 42.5 % of the cultures, and represented the most common pathogen. Initial Apache II score was more commonly between 10 and 14 points (35%). 6 patients died (15%) all of them with and Apache II score above 25 points. 55% of patients were affected by diabetes mellitus. All patients with Fournier's Gangrene received a triple antibiotic schema from admittance day, associated with emergency surgical dèbridement in the whole group. Conclusions: Aggressive and multidisciplinary treatment is mandatory in all the patients affected by Fournier's gangrene. We recommend utilisation of the APACHE II score as very useful tool to determine the prognosis (AU)

[Penile necrosis: a review of 18 cases at the Hospital de Especialidades Centro Médico nacional Siglo XXI]. / Necrosis de pene: revisión de 18 casos en el Hospital de Especialidades Centro Médico Nacional Siglo XXI.

OBJECTIVES: To report the experience in the management of penile necrosis at our hospital. METHODS: We performed a review of the medical records with the diagnosis of penile necrosis at the Department of the Urology of the Hospital de Especialidades Centro Médico nacional Siglo XXI from January 1995 to March 2005. RESULTS: 18 cases of penile necrosis were found, with ages from 28 to 78 years (mean age 58.1 yr.). Diabetes mellitus and end stage renal disease were the most frequent associated diseases, with 10 and 11 cases respectively. Reasons for consultation were penile scars in 5 cases, purulent exudation, inflammation of the glans penis and prepuce in 3, ischemic priapism in 2, Fournier's syndrome in 2, urethral bleeding in one, penile necrosis secondary to extrinsic compression in one, and periurethral abscess in another. Thirteen out of the 18 cases underwent partial or complete penectomy, and three of them died. Five patients were managed conservatively with antibiotics, one of them died. The pathology report showed ischemic necrosis in 3 cases, arterial and venous thrombosis, ischemic necrosis and dystrophic arterial and venous calcifications in 10 cases. CONCLUSIONS: Occlusive vascular changes are a conditioning factor in most patients with penile necrosis. This is more evident in patients with end stage renal disease, diabetes mellitus and hypertension. Clinical features of penile necrosis include scars, mummification, self-amputation, and superinfection, so that an early diagnosis and proper treatment are decisive for the evolution of this disease.