[Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy]. / Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria.

OBJECTIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.

[Multivariate analysis of recurrence and progression in stage T1 transitional-cell carcinoma of the bladder. Prognostic value of p53 and Ki67]. / Análisis multivariado de recidiva y progresión en el carcinoma de células transicionales de vejiga en estadio T1. Valor pronóstico de p53 y Ki67.

OBJECTIVE: To establish prognostic factors of recurrence and progression in stage T1 transitional cell bladder carcinoma, paying special attention to prognostic value of p53 and ki67. MATERIALS AND METHODS: 175 patients with incident bladder tumour at T1 category. The immunohistochemical study was performed using the monoclonal antibodies DO-7, for p53 and MIB-1, for ki67. Kaplan-Meier methodology was used, and a multivariate analysis using Cox's proportional hazards model was carried out in order to determine the variables associated with recurrence and progression. ROC curves were also drawn up. RESULTS: The average follow up period was 8.55 years. 5 and 12-year recurrence-free survival rates were 57.98% and 48.47%. The independent variables for recurrence were histological grade, tumour multifocality, tumour size > 3 cm, presence of carcinoma in situ and ki67 expression. 5 and 12-year progression-free survival rates were 83.12% and 75.63%. The independent variables for progression were age, tumour multifocality, solid microscopic morphology, p53 expression and ki67 expression. CONCLUSIONS: Solid microscopic pattern and p53 expression are the variables which best predict progression. A positive relationship was observed between p53 and progression: the greater the expression of p53, the greater the progression. Tumour multifocality and ki67 expression > 27% are the main prognostic factors for recurrence.

[Neoplastic pathology of the urothelium]. / Patologia neoplásica del urotelio.

Bladder cancer is one of the most common diseases treated by urologists. In this article, we will try to review some of the controversies and all the available data which come from the systematic review and meta-analysis.

[Value of a second transurethral resection in the assessment and treatment of patients with bladder tumor]. / Valor de la segunda resección transuretral en la evaluación y en el tratamiento de los pacientes con tumor de vejiga.

OBJECTIVE: To analyse the value of a second transurethral resection, repeated within 3 to 6 weeks after the initial resection, in the treatment and the classification of patients with bladder tumour. MATERIAL AND METHODS: We analyse the results of 72 repeated transurethral resection in 23 (32%) patients with T1 G1-2 bladder tumor, 9 (12.5%) with T1 G3 tumor, 31 (43%) with T2a G2-3 tumor and 9 (12.5%) with T2b G2-3 tumor. The evaluated patients are not associated with CIS. RESULTS: Of all 23 T1 G1-2 tumors, 13 (57%) had residual Ta T1 tumor and 1 (4%) T2 tumor. In this group, the second resection changed the treatment in 1 (4%) patient. Of all 9 T1 G3 tumors, 4 (44%) had residual T1 tumor and 1 (11%) T2 tumor. In this group the second resection changed the treatment in 1 (11%) patient. Of all 31 T2a G2-3 tumors, 5 (16%) had residual T1 tumor, 4 (13%) T2 tumor and 6 (19%) T3-T4 tumor. In this group, the second resection changed the treatment in 10 (32%) patient. Of all 9 T2b G2-3 tumors, 2 (22%) had residual T1 tumor, 1 (11%) T2 tumor and 2 (22%) T3-T4 tumor. In this group, the second resection changed the treatment in 3 (33%) patients. CONCLUSIONS: In T1 G1-2 and T1 G3 tumors, a second transurethral resection detect residual tumor in 36% of patients and change the treatment in 6% of patients. In T2a-b tumors, a second transurethral resection detect residual tumor in 50% of patients and change the treatment in 33% of patients.

[Bladder leiomyoma]. / Leiomioma vesical.

OBJECTIVE: Mesenchymal benign tumours of the urinary bladder are rare and account for 1%-5% of all bladder tumours. The leiomyoma is the most common and constitute 46.6% of this group. 25 cases have been described in the national literature. We report an additional case of leiomyoma of the bladder. CASE REPORT: A 53 year-old man with a chronic history of urinary frequency and microscopic hematuria. Physical examination was normal. An excretory urography demonstrated a filling defect in the right bladder wall. The cystoscopy confirmed the tumour, covered with normal bladder mucosa. The echography showed a solid tumour. A computerised tomography scan and magnetic resonance showed a sessile lesion in the right bladder wall with low-intermediate intensity signal and with normal signal of muscle, mucosa and perivesical fat. The clinical diagnosis was leiomyoma of the bladder. Partial cystectomy was done and the histological diagnosis confirmed the clinical diagnosis. CONCLUSIONS: The leiomyoma of the bladder is a rare tumour however it should be considered in the differential diagnosis before surgical treatment.

[Abdominal-pelvic actinomycosis with urinary tract involvement, secondary to gynecologic infection caused by intrauterine device]. / Actinomicosis abdominopélvica con afectación del aparato urinario, secundaria a infección ginecológica por dispositivo intrauterino.

Abdomino-pelvic actinomycosis is a condition caused by Actinomyces israelii, a Gram-positive opportunistic bacteria that triggers and develops the infection only in previously injured tissues, and then slowly progresses and spreads until it extrinsically affects the urinary tract. Use of an intrauterine device is a known risk factor to suffer from this disease. Relative risk in IUD users is two- to four-fold higher compared to IUD non-users. Risk increased with prolonged IUD use. Treatment is by removal of the causative agent, surgical resection of necrotic tissues and administration of intravenous Penicillin G, 4 million units every 4 hours for 30 days, followed by Amoxicillin 500 mg every 8 hours for 12 months. This paper contributes two cases of abdomino-pelvic actinomycosis with urinary tract involvement in IUD users. Standard treatment was employed with good evolution.

[Metachronous tumors of the upper urinary tract following primary superficial tumors of the bladder]. / Tumores del tracto urinario superior metacrónicos subsiguientes a tumores superficiales primarios de vejiga.

OBJECTIVE: To evaluate the long term incidence of upper urinary tract tumours in patients with surface tumours of the bladder. MATERIAL AND METHODS: Analysis of 78 patients with primary tumour of the bladder pTa-pTl diagnosed between 1978 and 1988. These patients were followed for up to 10 to 21 years (mean follow-up 13.4 years) and were treated with transurethral resection and a variety of endovesical cytostatic agents. RESULTS: Of all 78 patients, 9 (11%) developed an upper urinary tract tumour over an average of 9 years (range 4-18); 2 in the first 5 years, 4 between 5 to 10 years, and 3 between 10 and 18 years. The likelihood of finding a tumour in the upper tract if all 20-year old patients were to be followed would be 25.6% (Kaplan-Meier's method). A high percentage of all upper urinary tract tumours are infiltrant, but the cause of death in 44% of these patients is progression of the tumour of the bladder. CONCLUSIONS: The percentage of tumours of the upper urinary tract that become metachronic following a tumour of the bladder, increases with the duration of the follow-up. A high percentage of these cases are already in high stages when diagnosed. It would be convenient to monitor the upper urinary tract with the same periodicity than the bladder in order to establish early diagnoses. These patients show a high mortality rate, in most cases secondary to progression of the tumour of the bladder.

[Bilateral testicular luxation]. / Luxación testicular bilateral.

Contribution of a case report of long-standing bilateral testicular luxation, the result of scrotal trauma caused by a soccer ball. Good aesthetic, endocrine and exocrine results were obtained with surgical treatment. Androgenic hormonal profile and spermiogram performed at six months showed values within the normal range.

[Leiomyoma of the female urethra]. / Leiomioma de uretra femenina.

Leiomyoma of the female urethra is a benign mesenchymal tumour highly infrequent in the clinical practice. There is controversy as to its degree of oestrogen hormone dependency and its diagnosis is reached only after pathohistological study of the resection specimen. This type of tumour has excellent prognosis, with few tumoral relapses and no case of malignant transformation having been reported for the time being. Contribution of one case report of leiomyoma of the female urethra with typical clinical-epidemiological features but very uncommon from a topographic insight, as it was located in the anterior side of the distal urethra.

[Fournier's gangrene: anatomo-clinical features in adults and children. Therapy update]. / Gangrena de Fournier: aspectos anátomo-clínicos en el adulto y en el niño. Actualización terapéutica.

Fournier's gangrene is a skin infectious-necrotising process in the peri-neogenital area affecting males, usually in their sixties or seventies. Isolated flora from cultures of the necrotic lesion is commonly multi-microbial. In a majority of cases both aerobic and anaerobic micro-organisms are found in the cultures, Escherichia coli being the most commonly identified germ. Although considered in the past an idiopathic condition, in most patients today a genitourinary, anorectal or dermal triggering factor can be identified. There are a series of systemic host debilitating disorders such as diabetes mellitus, chronic alcohol abuse, and malignant neoplasia that are associated to this condition and may be considered risk factor to suffer this disease. Fournier's gangrene in children show specific bacteriological, pathogenic, clinical, therapeutic and prognostic features that distinguish it from that in adults. The most extensively accepted management for this condition includes therapy with broad-spectrum parenteral antibiotics and early and aggressive surgical debridement of the necrotic areas. Mortality continues to be high, ranging between 10-80% in the various series. Finally, a group of 7 patients with Fournier's gangrene is analyzed (1991-1998) aiming to establish a comparison between our results and those seen in recent series.

[Value of non-contrast helical computerized tomography in nephrotic colic assessment]. / Valor del TAC helicoidal sin contraste en la evaluación del cólico nefrítico.

OBJECTIVE: To compare non-contrast helicoid CAT to urological ultrasound in order to determine the sensitivity of both in the etiological diagnosis of nephritic colic. MATERIAL AND METHODS: Retrospective study conducted on a total of 86 patients seen in our ER service over a 12-month period with a diagnosis of nephritic colic. All patients with suspicious diagnosis of nephritic colic underwent X-ray examination, with either non-contrast helicoid CAR or urological ultrasound, or with a combination of both imaging techniques. Radiologic diagnosis of nephritic colic was made by direct visualization of the obstructive cause or by the presence of indirect radiological signs of upper urinary tract obstruction. RESULTS: Of 86 patients studied, in 84 (97.67%) a urinary stone was the cause for obstruction. Overall sensitivity of helicoid CAT to diagnose colic etiology was 94.73%, whereas ultrasound sensitivity was only 53.42%, displaying a particularly low sensitivity when the obstruction was located at the mid third level of the ureter. CONCLUSIONS: Non-contrast helicoid CAT shows superior sensitivity as a radiologic technique than ultrasound to identify the cause of a nephritic colic in any segment of the upper urinary tract.

[Indications for BCG in surface tumors of the bladder]. / Indicaciones de la BCG en los tumores superficiales de vejiga.

Overall view of Bacille de Calmette-Guerin (BCG) immunotherapy in the prophylaxis and treatment of surface cancer of the bladder. A series of issues, on some of which a consensus has been reached while controversy is still frequent in others are discussed. Intravesical instillation of BCG as the single route has been considered to best mode of administration. With regard to the BCG strain to be used, there is still no consensus after the analysis of the data provided by the studies conducted. Relative to the treatment schedule, it appears clear that maintenance therapy is superior to an exclusively induction regime. No consensus has been reached about optimal dosage or the possibility to reduce toxicity. Although some studies support the belief that intravesical immunotherapy with BCG is superior to chemotherapy, further data is required to confirm such assumption. In conclusion, although treatment with BCG has proven to be effective in patients with surface tumours of the bladder, it should not be considered a panacea to be indiscriminately used in any patient with this malignancy.

[Metastatic prostate adenocarcinoma in hernial sac. Contribution of one case]. / Metástasis de adenocarcinoma prostático en saco herniario. Aportación de un caso.

Presentation of a case of stage D2 prostatic adenocarcinoma, diagnosed through a chance finding of micrometastasis in the pathohistological study of the hernial sac of a patient undergoing inguinal herniorrhaphy. Most usual sites for prostate cancer metastasis are lymph nodes, bones, lungs, liver, and brain. During our revision of unusual anatomical sites for prostatic carcinoma metastasis, we found references of metastasis on the uvea, larynx, orbit and maxillary sinus. The peritoneal cavity was not found to be a common site for metastatic implants. It was also found that such peritoneal spread was usually diagnosed after a postmortem examination.

[A massive hernia of the bladder into the scrotum. A report of a case]. / Hernia vesical masiva de vejiga en escroto. Aportación de un caso.

The hernia of the bladder in the scrotum is a highly uncommon observation. From the clinical standpoint the usual manifestation is a two-stroke voiding. The recommended urological examinations to reach a diagnosis are ultrasound, endovenous urography, retrograde urethrocystography and cystoscopy. Management includes the de-obstruction of the lower urinary tract, if present, resection of associated peritoneum, resection or reduction of the vesical hernia and repairment of inguinal path. The case contributed corresponds to a vesical hernia in a 72-year-old patient, with no obstructive cause, that was treated surgically by resection of the herniated bladder, with good morphological and functional results.

[Extragonadal germ cell tumor with "burned-out" phenomenon in the testis]. / Tumor extragonadal de células germinales con fenómeno "burned-out" en testículo.

The "burned-out" phenomenon in germ-cell neoplasias is defined by the presence of an extragonadal germ-cell tumour with no tumour at the testis level where a series of distinctive histological lesions can be detected indicative of the earlier presence of an already disappeared testicle tumoration. Extragonadal germ-cell tumours with "burned-out" phenomenon show better evolution than their primary counterparts and are treated similarly to primary tumours of the testis. Currently, in the presence of retroperitoneal tumoration, a scrotal ultrasound study with high frequency transducers can lead to a suspected picture of tumoral involution. This paper contributes one retroperitoneal seminoma with "burned-out" phenomenon in the homolateral testis in a 35-year old patient. Available clinical and radiological criteria were enough to reach a suspected diagnosis. Homolateral orchiectomy and biopsy of retroperitoneal tumoration were performed, rounding treatment up with polychemotherapy. Evolution was good with immediate complete response.

[Superficial cancer of the bladder: which controls should follow and for how long the free of tumor patients?]. / Cáncer superficial de vejiga: que controles han de seguir y durante cuándo tiempo, los pacientes libres de tumor?

OBJECTIVES: To answer the following question: what monitoring and for how long should be maintained in patients with Ta-T1 vesical neoplasia and no tumoral relapse? MATERIAL AND METHOD: Analysis of relapse probabilities in 123 patients with Ta-T1G1G2G3 primary tumours who had not relapsed for at least three years of follow up after transurethral resection. All patients were treated between January 1976 and December 1986; they all have follow-up potential of over 10 years. Mean follow-up 8.1 years, minimum 4 years, maximum 18 years. RESULTS: Probabilities of relapse at 3 to 5 years, 6 to 10 years, 11 to 18 years are 18%%, 24% and 13%, respectively. Relapses were superficial in 38 cases (90%), infiltrant in 4 (10%) G1 in 21 (50%), G2 in 12 (29%), G3 in 9 (9%), single in 33 (79%), multiple in 9 (21%), under 2 cm in 35 (83%), over 2 cm in 7 (17%). CONCLUSIONS: Epidemiologically, individuals with a background of surface vesical tumour have a much higher risk of relapse than the Spanish normal population and therefore they should be monitored for life. Relapses are usually superficial, low grade, single and small in size. Cystoscopy is the monitoring technique offering more possibilities for detection.

[Metanephric adenoma. A new embryonal tumor of the kidney]. / Adenoma metanéfrico. Un nuevo tumor embrionario de riñón.

Metanephric adenoma is a kidney tumour first identified in 1988 and classified within the group of nephroblastic tumours. It is described as a benign tumour with no capacity to become malignant or metastatic, predominant in women in a 2:1 ratio relative to men, and which can develop at any point in life. In most cases, it is incidentally found as a result of an abdominal ultrasound study for signs and symptoms unrelated to the kidney. Less commonly it presents with pain, polycythemia, haematuria or palpable mass. The key radiologic sign is calcification, which occurs in a statistically higher proportion than in any other renal neoplasia. From the pathoanatomical point of view, the tumour consists of small acinus separated by acellular stroma resembling the hamartomatous elements of nephroblastomatosis and Wilms' tumour. This paper contributes one case of metanephric adenoma, the first one in the national literature.

[Wünderlich syndrome caused by metastatic gastric sarcoma in the kidney. Report of a case]. / Síndrome de Wünderlich por metástasis de sarcoma gástrico en riñón. Aportación de un caso.

Contribution of one case of Wünderlich Syndrome secondary to a simple metastasis to the right kidney from a gastric sarcoma operated three years earlier. Pain, palpable mass on the side and decreased haematocrit were the primary symptoms. Diagnosis was confirmed by Computerized Axial Tomography. The therapeutical approach was radical nephrectomy. At 5 years, this female patient remains alive showing no evidence of tumoral disease in the follow-up controls performed.