Predicción de recidiva bioquímica tras prostatectomía radical. Nueva herramienta para la selección de candidatos a radioterapia adyuvante / Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy

Objetivo: Diseñar un sumatorio de riesgo para la selección de pacientes para radioterapia adyuvante después de prostatectomía. Material y método: Estudio retrospectivo de 629 pacientes con cáncer de próstata localizado y pN0-pNx tratados con prostatectomía y con un PSA a los 2-3 meses < 0,2 ng/ml. Recidiva bioquímica si PSA > 0,4 ng/ml. Análisis multivariante mediante regresión de Cox. Asignación de puntuación (0-2) en función del HR de las variables significativas. El sumatorio de las puntuaciones definió el sumatorio de riesgo. Resultados: El 19,7% pT3, 24,2% Gleason ≥ 8 y el 26,3% de márgenes quirúrgicos positivos. Mediana de seguimiento de 82 meses. Recidiva bioquímica el 26,6%. El Gleason = 7 (4 + 3) (HR = 2,01, p = 0,008), el Gleason ≥ 8 (HR = 3,07, p < 0,001), el estadio pT3b (HR = 1,93, p = 0,008) y el margen quirúrgico positivo (HR = 2,20, p < 0,001) se identificaron como variables pronosticas independientes de recidiva bioquímica. Se asignó 0 puntos a los pacientes sin variables pronósticas de riesgo, un punto a los pacientes con Gleason = 7 (4 + 3), pT3b o márgenes quirúrgicos positivos y 2 puntos si Gleason ≥ 8. Los pacientes con un sumatorio de riesgo ≤ 2 tuvieron una supervivencia libre de recidiva bioquímica a los 5 y 8 años superior al 50%, en cambio, los pacientes con un sumatorio de riesgo ≥ 3 tuvieron una supervivencia libre de recidiva bioquímica inferior al 44%. Conclusión: Los pacientes con un sumatorio de riesgo ≤ 2 no se beneficiarían de radioterapia adyuvante, mientras que los pacientes con un sumatorio de riesgo ≥ 3 pudieran beneficiarse de radioterapia adyuvante

Objective: To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. Materials and method: A retrospective study was conducted on 629 patients with localised prostate cancer (pN0–pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value < 0.2 ng/mL at 2–3 months. Biochemical recurrence was defined as a PSA > 0.4 ng/mL. A multivariate Cox regression analysis was performed. A score (0–2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. Results: A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score = 7 (4 + 3) (HR, 2.01; P = .008), a Gleason score ≥ 8 (HR, 3.07; P < .001), a pT3b stage (HR, 1.93; p = .008) and a positive surgical margin (HR, 2.20; P < .001). We assigned 0 points to patients without risk prognosis variables; 1 point to patients with Gleason scores = 7 (4 + 3), pT3b or positive surgical margins; and 2 points to patients with Gleason scores ≥ 8. The patients with a risk summation ≤ 2 had > 50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥ 3 had <44% survival free of biochemical recurrence. Conclusion: The patients with a risk summation ≤ 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥ 3 might benefit from adjuvant radiation therapy

Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy.

OBJECTIVE: To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. MATERIALS AND METHOD: A retrospective study was conducted on 629 patients with localised prostate cancer (pN0-pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value <0.2ng/mL at 2-3 months. Biochemical recurrence was defined as a PSA >0.4ng/mL. A multivariate Cox regression analysis was performed. A score (0-2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. RESULTS: A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥ 8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score =7 (4+3) (HR, 2.01; P=.008), a Gleason score ≥ 8 (HR, 3.07; P <.001), a pT3b stage (HR, 1.93; p=.008) and a positive surgical margin (HR, 2.20; P<.001). We assigned 0 points to patients without risk prognosis variables; 1 point to patients with Gleason scores =7 (4+3), pT3b or positive surgical margins; and 2 points to patients with Gleason scores ≥ 8. The patients with a risk summation ≤ 2 had >50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥ 3 had <44% survival free of biochemical recurrence. CONCLUSION: The patients with a risk summation ≤ 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥ 3 might benefit from adjuvant radiation therapy.

[Recto-urethral fistula secondary to prostate cancer]. / Fístulas recto-uretrales secundarias a tratamiento de cáncer de próstata.

OBJECTIVES: There are various treatments forprostate cancer nowadays, including techniques that have been used for manyyears such as surgery and radiotherapy, and newer procedures that are gaining prominence in the Urological field like cryotherapy or HIFU (high intensity focused ultrasound). Rectourethral fistula is a rare complication that demands the urologist a great capacity; it may happen after either existent treatment. METHODS: PubMed literature review with articles published during the last 10 years using the terms "rectourethral fistula" and "prostate cancer". EVIDENCE SINTHESIS: We present the current situation of rectourethral fistula secondary to prostate cancer in terms of epidemiology, diagnosis and treatment, with special focus on the various types of fistulae and their management. We comment on general features in relation to surgical management of this pathology; type of approach, type of repair, use of flaps, concomitant fistula and urethralstenosis, delay of surgery and bowel diversion. We describe the surgical techniques more frequently used today and their limitations. We present the results published by different groups with each of these techniques, as well as the corresponding recommendations based on each group's experience. CONCLUSIONS: Rectourethral fistula is a surgical challenge for the urologist. We must choose the appropriate management in accordance to the characteristics of the fistula.

Fístulas recto-uretrales secundarias a tratamiento de cáncer de próstata / Recto-urethral fistula secondary to prostate cancer

OBJETIVO: Actualmente existen diversos tratamientos para el cáncer de próstata que incluyen técnicas utilizadas desde hace muchos años, como la cirugía y la radioterapia, y procedimientos más novedosos que van tomando protagonismo en la Urología como la crioterapia o los ultrasonidos focalizados de alta intensidad (HIFU). La fístula rectouretral es una complicación poco frecuente que exige gran capacidad al urólogo y que puede acontecer tras cualquiera de los tratamientos existentes. ADQUISICIÓN DE EVIDENCIA: Revisión de la literatura existente en PubMed; artículos publicados en los últimos 10 años introduciendo como palabras clave: «rectourethral fistula» y «prostate cancer». SÍNTESIS DE EVIDENCIA: Presentamos la situación actual en cuanto a epidemiología, diagnóstico y tratamiento de la fístula rectouretral secundaria a tratamiento de cáncer de próstata poniendo especial interés en los distintos tipos de fístula y el manejo que debe hacerse en cada uno de ellos. Comentamos los aspectos generales relacionados con el manejo quirúrgico de esta patología: tipo de abordaje; tipo de reparación; utilización de colgajos; fístula y estenosis de uretra concomitante; demora de la cirugía y derivación digestiva. Describimos las técnicas quirúrgicas más utilizadas en la actualidad y sus limitaciones. Presentamos los resultados publicados por distintos grupos con cada una de estas técnicas así como las recomendaciones correspondientes basadas en la experiencia de cada grupo. CONCLUSIÓN: La fístula rectouretral supone un reto quirúrgico para el urólogo. Éste debe elegir el manejo apropiado en función de las características de la fístula

OBJECTIVES: There are various treatments for prostate cancer nowadays, including techniques that have been used for many years such as surgery and radiotherapy, and newer procedures that are gaining prominence in the Urological field like cryotherapy or HIFU (high intensity focused ultrasound). Rectourethral fistula is a rare complication that demands the urologist a great capacity; it may happen after either existent treatment. EVIDENCE ACQUISITION: PubMed literature review with articles published during the last 10 years using the terms «rectourethral fistula» and «prostate cancer». EVIDENCE SINTHESIS: We present the current situation of rectourethral fistula secondary to prostate cancer in terms of epidemiology, diagnosis and treatment, with special focus on the various types of fistulae and their management. We comment on general features in relation to surgical management of this pathology; type of approach, type of repair, use of flaps, concomitant fistula and urethralstenosis, delay of surgery and bowel diversion. We describe the surgical techniques more frequently used today and their limitations. We present the results published by different groups with each of these techniques, as well as the corresponding recommendations based on each group`s experience. CONCLUSIONS: Rectourethral fistula is a surgical challenge for the urologist. We must choose the appropriate management in accordance to the characteristics of the fistula

Isquemia renal secundaria a hematoma retroperitoneal / Renal ischemia secondary to retroperitoneal hematoma

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Impossible bladder catheter removal. What can we do?

OBJECTIVE: The inability to remove a bladder catheter due to impossible balloon removal is a situation with controversial management; there are no action guidelines and it is limited to individual experience in most cases. In this article, we review the techniques described for removing a urethral catheter and we share our experience with one case. METHODS: A 70-year-old male with permanent bladder catheter was referred to the emergency department due to an inability to deflate the self-retaining balloon during routine change in his health centre. RESULTS: After unsuccessfully trying to puncture the balloon through the inflation channel previously cut above the valve, we punctured it via the suprapubic route under ultrasound guidance with a biopsy needle. Using this technique, we managed to rupture the balloon without free fragments, enabling the catheter to be changed without incident. CONCLUSIONS: There are various techniques for approaching this situation, the knowledge of which enables the urologist to resolve the problem by adapting to patient's characteristics and available resources. Suprapubic puncture of the self-retaining balloon is an easily reproducible technique with minimal complications and a lower rate of free fragments.

Imposibilidad para la retirada de sonda vesical ¿Qué hacer? / Impossible bladder catheter removal. What can we do?

OBJETIVO: La imposibilidad de retirada de una sonda vesical por imposibilidad para retirar el balón es una situación de manejo controvertido, sin unas pautas de actuación limitándose a la experiencia individual en la mayoría de los casos. En este artículo revisamos las técnicas descritas para retirar un catéter uretral y aportamos nuestra experiencia con una de ellas. MÉTODOS: Varón de 70 años, portador de sonda vesical permanente remitido al servicio de urgencias por imposibilidad para desinflar el balón de autoretención durante un cambio rutinario en su centro de salud. RESULTADOS: Tras intentar sin éxito puncionar el globo a través del canal de inflado previamente cortado por encima de la válvula, puncionamos este por vía suprapubica bajo control ecográfico con una aguja de biopsia. Con esta técnica conseguimos el estallido del balón sin fragmentos residuales permitiendo el cambio de la sonda sin incidencias. CONCLUSIONES: Existen varias técnicas para el abordaje de esta situación cuyo conocimiento permite al urólogo la resolución del problema adecuándose a las características del paciente y los recursos disponibles. La punción suprapubica del balón de autoretención es una técnica fácilmente reproducible con un mínimo índice de complicaciones y menor tasa de fragmentos residuales(AU)

OBJECTIVE: The inability to remove a bladder catheter due to impossible balloon removal is a situation with controversial management; there are no action guidelines and it is limited to individual experience in most cases. In this article, we review the techniques described for removing a urethral catheter and we share our experience with one case. METHODS: A 70-year-old male with permanent bladder catheter was referred to the emergency department due to an inability to deflate the self-retaining balloon during routine change in his health centre. RESULTS: After unsuccessfully trying to puncture the balloon through the inflation channel previously cut above the valve, we punctured it via the suprapubic route under ultrasound guidance with a biopsy needle. Using this technique, we managed to rupture the balloon without free fragments, enabling the catheter to be changed without incident. CONCLUSIONS: There are various techniques for approaching this situation, the knowledge of which enables the urologist to resolve the problem by adapting to patient’s characteristics and available resources. Suprapubic puncture of the self-retaining balloon is an easily reproducible technique with minimal complications and a lower rate of free fragments(AU)

Traumatic rupture of horseshoe kidney.

We present the case of a 25-year-old male who came to the emergency room for pain and abdominal distension following trauma to the mesogastrium. A CT scan was performed, revealing a voluminous retroperitoneal hematoma with laceration of both inferior renal poles with regard to rupture of the isthmus of a horseshoe kidney. The patient presented anemization and increased pain, requiring selective embolization by means of arteriography of a branch of the right renal artery and placement of a double J stent due to urinary extravasation in the lower left kidney pole. Following 1 year of monitoring, the patient has maintained normal renal function. Renal affection in blunt abdominal trauma is frequent, occurring in 7% of previously pathological kidneys. The traumatic rupture of horseshoe kidney is facilitated by its particular anatomical characteristics, constituting an infrequent entity, knowledge of which is necessary to achieve conservative management that renders it possible to preserve renal function.

Ampliación vesical con uso de aparato digestivo. Indicaciones, seguimiento y complicaciones / Bladder augmentation using the gastrointestinal tract. Indication, follow up and complications

La ampliación vesical utilizando el tracto gastrointestinal tiene por objetivo crear un reservorio de baja presión y alta capacidad, permitiendo una continencia y vaciado adecuados, preservando el tracto urinario superior.OBJETIVO: Analizar las indicaciones, complicaciones y resultados de nuestra serie de enterocistoplastias de aumento.MÉTODO: Revisamos retrospectivamente los pacientes sometidos a enterocistoplastia de aumento en nuestro servicio entre los años 1997 y 2010 ambos inclusive. Las indicaciones fueron: Cistitis intersticial, vejiga neurógena y retracción vesical inflamatoria. En todos los casos se realizó cistografía, uretrocistoscopia, estudio urodinámico y diario miccional, así como los estudios propios de cada patología. Mediante laparotomía media y abordaje extraperitoneal se realiza la liberación vesical con apertura bivalva hasta los orificios ureterales. La ampliación vesical se realiza con un segmento de 15-20 cm de íleon detubulizado a 20 cm de la válvula ileocecal; en los casos de insuficiencia renal se añadió una cuña de 7 cm de cuerpo gástrico. La sonda vesical se retiró tras cistografía a los 15 días. El seguimiento se realizó mediante ecografía con residuo postmiccional, analítica sanguínea, urocultivo y diario miccional.Realizamos un estudio descriptivo de las características demográficas, complicaciones postoperatorias según la clasificación de Clavien y a largo plazo(AU)

RESULTADOS: Incluimos 24 pacientes, 19 mujeres y 5 varones con una edad media de 48,5 años y una mediana de 47 (21-77). El seguimiento medio fue de 7,5 años con una mediana de 8. Las indicaciones fueron: 7 cistitis intersticiales, 9 retracciones vesicales y 8 vejigas neurógenas. No hubo complicaciones intraoperatorias. Las complicaciones postoperatorias fueron 3 Clavien I, 2 tipo II, 2 IIIa y 1 IIIb. A largo plazo 3 pacientes presentan incontinencia urinaria, 2 acidosis metabólica leve, 5 precisan autocateterismos, 6 litiasis vesicales, 2 infecciones urinarias febriles y 1 estenosis de la boca anastomótica. En tres casos se realizó ileogastrocistoplastia sin deterioro hidroelectrolitico ni de la función renal.CONCLUSIONES En pacientes seleccionados la enterocistoplastia de aumento constituye una opción terapéutica eficaz con escasa morbilidad y complicaciones en el tratamiento de la disfunción del tracto urinario inferior(AU)

The purpose of bladder augmentation using the gastrointestinal tract is to create a low-pressure and high-capacity reservoir, permitting suitable continence and voiding, preserving the upper urinary tract.OBJECTIVE: To analyze the indications, complications and results of our series of augmentation enterocystoplasties.METHOD: We retrospectively reviewed patients undergoing augmentation enterocystoplasty in our department between 1997 and 2010, both included. The indications were: Interstitial cystitis, neurogenic bladder and inflammatory bladder retraction. In all cases a cystography, urethrocystoscopy, urodynamic study and voiding diary were performed, as well as the specific studies of each condition. Bladder release is performed by means of medial laparotomy and an extraperitoneal approach with bivalve opening to the urethral orifices. The bladder augmentation is performed with a 15-20 cm segment of detubularized ileum obtained at 20 cm from the ileocecal valve; in cases of kidney failure, a 7-cm gastric body wedge is added. The bladder catheter was removed following cystogram after 15 days.Monitoring was performed by means of ultrasound with postvoid residual, blood analyses, urine culture and voiding diary. We performed a descriptive study of the demographic characteristics, postoperative complications according to the Clavien classification and in the long term(AU)

RESULTS: We included 24 patients, 19 women and 5 men with a mean age of 48.5 years and a median of 47 (21-77). Mean follow up was 7.5 years with a median of 8 (1-11). The indications were: 7 interstitial cystitis, 8 bladder retraction and 7 neurogenic bladder. There were no intraoperative complications. The postoperative complications were 3 Clavien I, 2 type II, 2 IIIA and 1 IIIB.In the long term, 3 patients presented urinary incontinence, 2 mild metabolic acidosis, 5 required self-catheterization, 6 bladder stones, 2 febrile urinary tract infections and 1 stricture of the anastomotic mouth. In three cases, an ileogastrocystoplasty was performed without hydroelectrolytic impairment or impairment of kidney function.CONCLUSIONS: In selected patients, augmentation enterocystoplasty constitutes an efficacious therapeutic option in the treatment of lower urinary tract dysfunction with scant morbidity and few complications(AU)

Factores predictores de recidiva en el carcinoma epidermoide de pene clínicamente localizado. Análisis de nuestra serie / Predictive factors for recurrence in clinically localized squamous cell carcinoma of the penis. Analisys of our case series

OBJETIVO: Evaluar los factores predictores de recidiva del carcinoma epidermoide de pene clínicamente localizado tratado con cirugía.MÉTODOS: 49 pacientes fueron diagnosticados de cáncer de pene en nuestro servicio entre 1999 y 2009. Excluimos 18 pacientes: 9 por adenopatías palpables, 6 por histologías diferentes al epidermoide, 2 por pérdida del seguimiento y 1 por fallecimiento al diagnóstico.El diagnóstico se estableció mediante exploración y biopsia de la lesión. La lesión primaria fue tratada mediante circuncisión, cirugía parcial o penectomía total.Se definió como recidiva la afectación ganglionar o metastásica a partir del tercer mes tras la cirugía.Realizamos un análisis uni y multivariante mediante chi cuadrado y regresión logística para identificar los factores implicados en la recidiva.RESULTADOS: 31 pacientes fueron incluidos en el estudio. El seguimiento medio fue de 36 meses con una mediana de 29.El análisis histopatológico evidenció 55% pT1, 32% pT2 y 13% pT3. El grado histológico fue G1: 29%, G2: 32%, G3: 39%.Las tasas de recidiva y mortalidad fueron 38,7%, y 35,5% respectivamente.En el análisis univariante la localización de la lesión (p=0,004), el tipo de cirugía (p=0,008), el estadio (p=0,003) y el grado celular (p<0,001) se relacionaron de forma estadísticamente significativa con la recidiva.En el análisis multivariante solo el grado celular resultó estadísticamente significativo (p=0,01).CONCLUSIÓN: En nuestra serie, solo el grado histológico puede considerarse factor predictivo independiente de recidiva(AU)

OBJECTIVE: To evaluate the predictive factors for relapse in clinically localized squamous cell car-cinoma of the penis undergoing surgical treatment.METHODS: Forty-nine patients were diagnosed with cancer of the penis in our Service between 1999 and 2009. In the present study we excluded 18 subjects: 9 due to the presence of palpable adenopathies, 6 due to histological characteristics other than squamous cell carcinoma, two lost to follow-up, and one due to death at the time of diagnosis. Diagnosis was based on physical examination and biopsy findings. The primary lesion was treated by circumcision, partial surgery or total penectomy. Disease relapse was defined by lymph node or metastatic involvement after three months from surgery.Univariate and multivariate analysis were carried out using the chi-squared test and logistic regression to identify the factors involved in tumor relapse.RESULTS: Thirty-one patients were included in the study. Mean follow-up was 36 months (median 29). The histopathological study yielded the following profile: 55% pT1 cases, 32% pT2 cases and 13% pT3 tumors. Regarding histological grade, the distribution was G1: 29%, G2: 32%, G3: 39%. Recurrence and mortality rates were 38.7% and 35.5%, respectively.In the univariate analysis, location of the lesion (p=0.004), type of surgery (p=0.008), tumor stage (p=0.003) and cellular grade (p<0.001) were significantly correlated to disease relapse.In the multivariate analysis, only cellular grade proved statistically significant (p=0.01)(AU)

Predictive factors for recurrence in clinically localized squamous cell carcinoma of the penis. Analisys of our case series.

OBJECTIVE: To evaluate the predictive factors for relapse in clinically localized squamous cell carcinoma of the penis undergoing surgical treatment. METHODS: Forty-nine patients were diagnosed with cancer of the penis in our Service between 1999 and 2009. In the present study we excluded 18 subjects: 9 due to the presence of palpable adenopathies, 6 due to histological characteristics other than squamous cell carcinoma, two lost to follow-up, and one due to death at the time of diagnosis. Diagnosis was based on physical examination and biopsy findings. The primary lesion was treated by circumcision, partial surgery or total penectomy. Disease relapse was defined by lymph node or metastatic involvement after three months from surgery. Univariate and multivariate analysis were carried out using the chi-squared test and logistic regression to identify the factors involved in tumor relapse. RESULTS: Thirty-one patients were included in the study. Mean follow-up was 36 months (median 29). The histopathological study yielded the following profile: 55% pT1 cases, 32% pT2 cases and 13% pT3 tumors. Regarding histological grade, the distribution was G1: 29%, G2: 32%, G3: 39%. Recurrence and mortality rates were 38.7% and 35.5%, respectively. In the univariate analysis, location of the lesion (p=0.004), type of surgery (p=0.008), tumor stage (p=0.003) and cellular grade (p<0.001)were significantly correlated to disease relapse. In the multivariate analysis, only cellular grade proved statistically significant (p=0.01). CONCLUSION: In our series, only histological grade could be regarded as an independent predictor of tumor relapse.

Metástasis de cáncer de próstata en cartílago tiroides: manifestación inusual del adenocarcinoma prostático. Presentación de un caso / Metastatic prostate cancer on the thyroid cartilage: unusual symptoms of prostatic

OBJETIVO: Revisar las formas atípicas de presentación del cáncer de próstata metastasico mediante la presentación de un caso de afectación del cartílago tiroides.MÉTODOS:Paciente de 49 años ingresado por hematuria monosintomática de 48 horas de evolución, asociada a dolor lumbar irradiado a miembros inferiores y masa cervical izquierda desde hace 3 meses. RESULTADOS: Se realizó TC Toraco-Abdomino-Pélvico con hallazgo de lesión insuflante en la lámina izquierda del cartílago tiroides sugestiva de condrosarcoma, tumoración vesical de 4 cm en cara posterior y metástasis óseas en los cuerpos vertebrales L4-S1 y en la pala iliaca izquierda. En la cistoscopia se evidencia infiltración prostática de la cara posterior vesical sin lesiones sugestivas de tumor urotelial. El PSA resultó de 617 ng/ml. Tacto rectal con próstata aumentada de tamaño y consistencia Ante estos hallazgos se realizo ecografía transrectal con biopsia prostática con el resultado anatomopatológico de adenocarcinoma prostático Gleason 8 bilateral.Se inició tratamiento con bloqueo hormonal completo con Bicalutamida y Goserelina, alcanzando el PSA niveles de 29 ng/ml.En relación a la masa cervical se realizó laringectomía parcial vertical izquierda con reposición con cartílago septal. El estudio anatomopatológico reveló la presencia de un adenocarcinoma prostático.CONCLUSIONES: La metástasis del cáncer de próstata en el cartílago tiroides es excepcional con solo cinco casos descritos en la literatura. Este hecho, unido a la escasa frecuencia de los tumores que asientan en dicho cartílago y su diagnostico mediante sospecha radiológica, hace muy difícil incluir la metástasis del cáncer de próstata en el diagnostico diferencial rutinario de las masas cervicales(AU)

OBJECTIVE: To review the unusual localizations of metastasic prostate cancer with the contribution of a clinical case of prostatic adenocarcinoma metastasis in the thyroid cartilage.METHODS: 49-year-old-male admitted with history of 48 hour hematuria associated with lumbar pain radiating to the lower extremities and cervical tumour for 3 months.RESULTS: CT scan of the thorax, abdomen and pelvis was performed showing an insufflating lesion on the left thyroid cartilage lamina suggesting chondrosarcoma, a 4 cm tumour on the posterior side of the bladder, and metastases on L4-S1 vertebral bodies and left iliac bone. Cystoscopy revealed an image on the posterior vesical wall suggesting prostatic infiltration by a tumoral process without evidence of urothelial tumors. PSA was 617 ng/ml. Digital rectal examination: Prostate with augmented consistency. Due to these results an ultrasound-guided transrectal prostatic biopsy was performed with the pathological result of Gleason 8 prostatic adenocarcinoma involving boths lobes.Complete androgen blockade with Bicalutamide and Goserelin was started with good response lowering the PSA level down to 29 ng/ml. Regarding the cervical mass suggestive of thyroid chondrosarcoma a left vertical partial laryngectomy was performed with replacement of the thyroid cartilage by septal cartilage. Pathological study of the piece revealed the presence of prostatic adenocarcinoma.CONCLUSION: Metastatic prostate cancer in the thyroid cartilage is exceptional, there being only five cases described in the literature. This fact, linked to the scant frequency of tumours lying in this cartilage and diagnosis by means of radiological suspicion, makes it very difficult to include metastatic prostate cancer in the routine differential diagnosis of cervical masses(AU)

Second cadaveric kidney transplantations in the pediatric population.

OBJECTIVE: To evaluate the functional outcomes and complications among a series of second in comparison to first kidney transplantations in pediatric patients. MATERIALS AND METHODS: We reviewed 163 consecutive kidney transplants in pediatric recipients performed from 1978 to present: 120 cases (69.3%) were first transplants (group A) and 43 (24.8%), second transplant (group B). We analyzed the incidences of delayed graft function (DGF), medical and surgical complications, as well as medium- and long-term graft survivals. RESULTS: We observed DGF among 51 group A patients (43%) versus 32.5% of group B. Ten patients suffered vascular complications in group A (8.3%) versus one in group B (2.3%) (P < .05). The 15-year graft survivals were 54.2% for group A and 45% for group B. The 15-year patient survivals were 84.9% in group A versus 93.6% in group B. CONCLUSIONS: Second kidney transplantations for children are a satisfactory option that achieves good functional results as well as acceptable graft and patient survivals.

Hidronefrosis terminal gigante / Giant terminal hydronephrosis

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