Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access.

INTRODUCTION: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. MATERIAL AND METHODS: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. RESULTS: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. CONCLUSIONS: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal / Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

Introducción: La lesión rectal es una complicación infrecuente de la prostatectomía radical laparoscópica extraperitoneal. El desarrollo de fístulas uretrorrectales (FUR), a partir de lesiones rectales, resulta uno de los problemas más temidos y de más compleja resolución en urología.Material y métodosEntre 2013 y 2020 hemos intervenido a un total de cinco pacientes con FUR tras prostatectomía radical endoscópica extraperitoneal, mediante un abordaje perineal utilizando la interposición de material biológico. Todas las fístulas presentaron un diámetro menor de 6 mm en la endoscopia y se encontraban a menos de 6 cm del margen anal.ResultadosLa media de edad de los pacientes fue 64 años. Todos los pacientes llevaban al menos tres meses de derivación intestinal y urinaria previas. Bajo anestesia general, y con el paciente en posición de litotomía forzada mediante un acceso perineal, se realizó fistulorrafia e interposición de material biológico de origen porcino (dermis porcina liofilizada [Permacol®, Medtronic]). La duración media de la cirugía fue de 174 min (140-210). La mayoría de los pacientes fueron dados de alta al tercer día postoperatorio. La sonda vesical se mantuvo una media de 40 días (30-60). Previa a la retirada de la misma, se realizó cistografía y enema opaco con Gastrografin®, que mostró resolución de la fístula en todos los casos.ConclusionesLa interposición de material biológico procedente de dermis porcina mediante abordaje perineal es una alternativa segura y con buenos resultados en pacientes sometidos a fistulorrafia uretrorrectal tras prostatectomía radical. (AU)

Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology.Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin.ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases.ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy. (AU)

Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift(R) bajo anestesia local y sedación / Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift(R) under local anaesthesia and sedation

Introducción: El tratamiento de los síntomas del tracto urinario inferior secundarios a hiperplasia benigna de próstata con la utilización del sistema Urolift(R) se lleva realizando desde 2005 con buenos resultados a medio plazo. En este trabajo presentamos nuestra experiencia realizando esta técnica bajo anestesia local y sedación en 2 centros españoles. Material y métodos: Se llevó a cabo un estudio prospectivo con 20 pacientes tratados con Urolift(R) bajo anestesia local y sedación entre abril de 2017 y abril de 2018. El protocolo anestésico consistía en la colocación de 2 lubricantes con lidocaína fríos (el primero 10 min antes de la intervención y el segundo momentos antes de iniciar la endoscopia). A un tercio de los pacientes se les añadió un bloqueo prostático similar al que se realiza en las biopsias de próstata y, según la tolerancia, durante el procedimiento, se les añadió 1 mg de midazolam intravenoso. El objetivo primario es evaluar la tolerabilidad de este procedimiento bajo anestesia local usando la escala visual analógica. Resultados: El procedimiento ha sido realizado en 20 pacientes en 2 centros diferentes usando el mismo protocolo anestésico. La puntuación media en la escala escala visual analógica de dolor fue de 1,37 para la introducción del cistoscopio y de 1,19 para la colocación de los implantes. A la pregunta de si el dolor había sido mayor, menor o igual al de la cistoscopia diagnóstica, solo el 20% de los pacientes respondieron que había sido mayor. En todos los casos hubo una buena tolerancia al procedimiento, no precisándose en ninguno de ellos el cambio del tipo de anestesia. Conclusiones: Consideramos que la utilización del Urolift(R) bajo anestesia local y sedación es un método bien tolerado, seguro y eficaz para el tratamiento de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata

Introduction: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift(R) system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. Material and methods: A prospective study was conducted with 20 patients treated with Urolift(R) under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10 min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. Results: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. Conclusions: We consider that the Urolift(R) system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Minimally invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia. Our initial experience with Urolift® under local anaesthesia and sedation. / Tratamiento mínimamente invasivo de los síntomas del tracto urinario inferior por hiperplasia benigna de próstata. Nuestra experiencia inicial con Urolift® bajo anestesia local y sedación.

INTRODUCTION: The treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia with the Urolift® system has been carried out since 2005 with good results in the medium term. In this work, we present our experience performing this technique under local anaesthesia and sedation in 2 Spanish centres. MATERIAL AND METHODS: A prospective study was conducted with 20 patients treated with Urolift® under local anaesthesia and sedation between April 2017 and April 2018. The anaesthesia protocol consisted in the placement of 2 lubricants with cold lidocaine (the first one, 10min before the intervention, and the second one, just before introducing the cystoscopy). A prostate block (similar to the one employed in prostate biopsies) was administered to one third of the patients and 1mg of intravenous midazolam was added if required during the procedure. Our primary objective is to evaluate the tolerability of this procedure under local anaesthesia using the validated Visual Analogue Scale measurement instrument. RESULTS: The procedure has been performed under the same anaesthetic protocol to 20 patients from 2 different centres. The average pain scores on the Visual Analogue Scale were 1.37 for the cystoscopy procedure and 1.19 for the placement of the implants. When asked whether the pain sensations had been higher, lower or the same during the procedure or at the preoperative cystoscopy, only 18% of the patients responded it was higher. In all cases there was a good tolerance to the procedure, and changes to the anaesthesia protocols were never required. CONCLUSIONS: We consider that the Urolift® system under local anaesthesia and sedation is a well-tolerated, safe and effective method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura / Median raphe cysts in men. Presentation of our experience and literature review

Objetivos: Presentar nuestra experiencia en el diagnóstico y tratamiento de los quistes de rafe medio atendidos en nuestro servicio en los últimos 25 años. Material y método: Realizamos un estudio retrospectivo de 28 varones afectos de quistes de rafe medio intervenidos en nuestro servicio desde junio de 1990 a marzo de 2015. Se analizan la edad de presentación, el motivo de consulta, las manifestaciones clínicas, los hallazgos en el estudio histológico, el tratamiento realizado y la evolución tras su exéresis. Resultados: La mayor parte de los pacientes (22; 79%) estaban asintomáticos y consultaron por el defecto estético; 4 casos (14%) presentaron alteraciones miccionales y 2 (7%) refirieron molestias durante el acto sexual. En todos los casos el tratamiento consistió en la extirpación quirúrgica del quiste, obteniendo excelentes resultados estéticos y funcionales, sin recidiva de la lesión en ninguno de los pacientes durante un seguimiento medio de más de 10 años. El tipo histológico más frecuentemente encontrado fue el de células transicionales en 15 casos (54%), seguido del tipo mixto (transicional y escamoso) en 11 casos (39%); en un caso (6%) fue de tipo escamoso puro y en otro caso (6%) el epitelio fue de tipo glandular. Conclusiones: Los quistes de rafe medio constituyen un tipo infrecuente de disembrioplasia que pueden localizarse en cualquier punto del rafe medio, desde el meato balánico hasta los márgenes del ano. Generalmente son asintomáticos y su tratamiento de elección es la extirpación quirúrgica

Objectives: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25 years. Material and method: We conducted a retrospective study of 28 men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. Results: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. Conclusions: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation

Median raphe cysts in men. Presentation of our experience and literature review. / Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura.

OBJECTIVES: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25years. MATERIAL AND METHOD: We conducted a retrospective study of 28men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. RESULTS: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. CONCLUSIONS: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation.

Seguimiento a largo plazo en el tratamiento de la incontinencia urinaria masculina con el sistema Remeex / Long-term follow-up for the treatment of male urinary incontinence with the Remeex system

Objetivos: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo (IUE) posprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, técnica de implantación y su adecuado ajuste. Igualmente, pretendemos comprobar si las últimas modificaciones realizadas en dicho dispositivo, que constituye el SRM-II, han supuesto un menor número de reajustes de la malla. Material y método: Desde marzo de 2007 hasta marzo de 2014 hemos intervenido a 24 varones afectos de IUE posprostatectomía con edades comprendidas entre 55 y 78 años (media 67 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida. Resultados: Todos los pacientes, excepto en 2 casos que precisaron retirada del sistema, se mantienen secos, necesitando ocasionalmente 9 de ellos (39%) compresa de seguridad si realizan ejercicio físico intenso. El número medio de reajustes fue de 2,4 (rango 0-6). La puntuación del Incontinence Impact Questionnaire realizado antes de la intervención y 6 meses después pasa de 79±7 puntos a 11±3, siendo el grado de satisfacción muy elevado. Conclusiones: El SRM constituye una opción terapéutica válida para la incontinencia posprostatectomía, siendo una técnica reproducible, de fácil ejecución, con una baja tasa de complicaciones, proporcionando unos resultados excelentes y duraderos. Asimismo, parece existir una clara tendencia a la disminución del número de reajustes con el nuevo SRM-II

Objectives: To relate our experience in treating postprostatectomy stress urinary incontinence (SUI) with the male Remeex system (MRS). We also list the elements that comprise this system, the implantation technique and its proper adjustment. Similarly, we attempt to determine whether the latest changes made to this device, which constitute the MRS-II, have resulted in fewer mesh readjustments. Material and method: From March 2007 to March 2014, we operated on 24 men with postprostatectomy SUI between the ages of 55 and 78 years (mean, 67 years), through the placement of a Remeex suburethral tension-adjustable sling. All patients had severe urinary incontinence, with considerable impact on their quality of life. Results: All patients, except for 2 who required the removal of the system, remained continent. Nine of the patients (39%) occasionally required incontinence pads when performing intense physical exercise. The mean number of adjustments was 2.4 (range 0-6). The score on the Incontinence Impact Questionnaire (IIQ 7) performed before the surgery and 6 months after, went from 79±7 points to 11±3, with a very high degree of satisfaction. Conclusions: The MRS is a valid therapeutic option for postprostatectomy incontinence and is a reproducible technique that is easy to perform, has a low rate of complications and provides excellent and lasting results. There is also a clear trend towards reducing number of adjustments with the new MRS-II

Long-term follow-up for the treatment of male urinary incontinence with the Remeex system. / Seguimiento a largo plazo en el tratamiento de la incontinencia urinaria masculina con el sistema Remeex.

OBJECTIVES: To relate our experience in treating postprostatectomy stress urinary incontinence (SUI) with the male Remeex system (MRS). We also list the elements that comprise this system, the implantation technique and its proper adjustment. Similarly, we attempt to determine whether the latest changes made to this device, which constitute the MRS-II, have resulted in fewer mesh readjustments. MATERIAL AND METHOD: From March 2007 to March 2014, we operated on 24 men with postprostatectomy SUI between the ages of 55 and 78 years (mean, 67 years), through the placement of a Remeex suburethral tension-adjustable sling. All patients had severe urinary incontinence, with considerable impact on their quality of life. RESULTS: All patients, except for 2 who required the removal of the system, remained continent. Nine of the patients (39%) occasionally required incontinence pads when performing intense physical exercise. The mean number of adjustments was 2.4 (range 0-6). The score on the Incontinence Impact Questionnaire (IIQ 7) performed before the surgery and 6 months after, went from 79±7 points to 11±3, with a very high degree of satisfaction. CONCLUSIONS: The MRS is a valid therapeutic option for postprostatectomy incontinence and is a reproducible technique that is easy to perform, has a low rate of complications and provides excellent and lasting results. There is also a clear trend towards reducing number of adjustments with the new MRS-II.

[Paratesticular fibrosarcoma. A rare malign neoplasm]. / Fibrosarcoma paratesticular: una neoplasia maligna muy infrecuente.

Hereby we wish to present the clinical and pathological results of a rare paratesticular sarcome of the spermatic cord. This tumor was a fibrosarcoma in a 55 year old male that started in a most unusual way and developed very quickly. We practised a radical orquitectomy with inguinal ligation of the pedicule without post-operatory therapy. After a 5 year follow up, there is no trace of clinical or radiological recurrence in the region or metastasis. We consider radical surgery to be the only therapeutic alternative, even for cases of fast developing, being in our case a good pronostic.

Fibrosarcoma paratesticular: una neoplasia maligna muy infrecuente / Paratesticular fibrosarcoma. A rare malign neoplasm

Presentamos los hallazgos clínicos y patológicos de un sarcoma paratesticular de cordón espermático muy infrecuente. El tumor fue un fibrosarcoma en un varón de 55 años de edad que debutó de forma atípica con un crecimiento rápido. Se practicó orquiectomía radical con ligadura inguinal de pedículo sin terapia postoperatoria. Tras 5 años de seguimiento no hay signos clínicos ni radiológicos de recidiva locorregional ni a distancia. Concluimos que la cirugía radical es la única alternativa terapéutica, aún cuando presente crecimiento rápido, siendo en nuestro caso el pronóstico favorable

Hereby we wish to present the clinical and pathological results of a rare paratesticular sarcome of the spermatic cord. This tumor was a fibrosarcoma in a 55 year old male that started in a most unusual way and developed very quickly. We practised a radical orquitectomy with inguinal ligation of the pedicule without post-operatory therapy. After a 5 year follow up, there is no trace of clinical or radiological recurrence in the region or metastasis. We consider radical surgery to be the only therapeutic alternative, even for cases of fast developing, being in our case a good pronostic

[Diagnosis and management of cystic dysplasia of the seminal vesicle]. / Sobre el diagnóstico y tratamiento de la displasia quística de la vesícula seminal.

INTRODUCTION AND OBJECTIVES: Cystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology. PATIENTS AND METHOD: During the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis. RESULTS: In asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum. CONCLUSIONS: Transurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated.

[Endoscopic treatment of the benign prostatic hyperplasia with local anesthesia and sedation in patients with high surgical or anaesthesical risk]. / Tratamiento endoscópico de la hiperplasia benigna de próstata bajo anestesia local-sedación en pacientes de alto riesgo.

INTRODUCTION AND OBJECTIVE: [corrected] The aging of the population causes an increase of the number of men affected by benign prostatic hyperplasia (BPH) with a large number of pathology associated that may limit its surgical treatment. In this study we try to show the effectiveness and security of local anaesthesia and sedation in the endoscopic treatment of the BPH in patients with high surgical-anaesthetic risk. METHODS: During the last 4 years, 38 patients underwent surgical treatment of BPH with ages between 78 and 86 years (average 81,4 +/- 3,2) with severe obstructive prostatic syndrome and high surgical-anaesthetic risk. 15 patients underwent, transurethral incision of prostate (TUIP) and in 23 patients, transurethral resection (TURP) was performed. The blockade anesthetic was made by transrectal periprostatic infiltration finger-guided with 10-15 millilitres of lidocaine 2%. During the procedure an intravenous perfusion of propofol and remifentanil was administered. The obtained results as well as the patient's satisfaction degree was evaluated by means of the elaboration of a questionnaire. RESULTS: The average length of the surgical treatment was of 12 +/- 5 minutes (rank 8 - 25), having itself not stated complications derived from the anesthetic technique. They referred a slight annoyance 4 patients (11%) that was treated increasing the rate of the sedative perfusión. The satisfaction's degree with the received treatment has been good in the 95% of patients. CONCLUSIONS: We considered that the TUIP as much as TURP made under local anesthesia with sedation are safe, effective methods and well tolerated, that fundamentally are indicated in aged patients and when the surgical-anesthetic risk is elevated.

Sobre el diagnóstico y tratamiento de la displasia quística de la vesícula seminal / Diagnosis and management of cystic dysplasia of the seminal vesicle

Introducción y objetivo: La displasia quística de la vesícula seminal representa una rara anomalía congénita urológica cuyo tratamiento de elección es controvertido. Presentamos nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente entidad. Pacientes y método: Durante los últimos 12 años hemos atendido a 8 pacientes afectos de esta patología. En 3 de ellos, asintomáticos, el diagnóstico fue incidental, mientras que los 5 restantes consultaron por síntomas del tracto urinario inferior. En 3 pacientes se halló desembocadura ectópica de un uréter remanente en la vesícula patológica, 2 de ellos con importante ectasia renoureteral. Los otros 5 pacientes presentaron agenesia renal. Resultados: En los pacientes asintomáticos adoptamos una actitud expectante, optando por la cirugía en los otros 5. Realizamos cirugía exerética en los 2 casos que presentaban ureterohidronefrosis, mientras que en los otros 3 realizamos incisión endoscópica de la vesícula seminal, obteniendo excelentes resultados en todos ellos, sin evidenciarse aparición de pseudodivertículo sintomático. Conclusiones: La incisión transuretral endoscópica del quiste de la vesícula seminal es un procedimiento mínimamente invasivo y con escasa morbilidad, habiendo constatado la retracción prácticamente completa del quiste en todos nuestros casos, por lo que la consideramos de elección para el tratamiento de los pacientes afectos de dicha entidad, reservando la cirugía abierta para los casos en los que fracase la técnica por aparición de un pseudodivertículo sintomático y en los pacientes que presenten asociada ectasia del remanente renoureteral

Introduction and objectives: Cystic dysplasia of the seminal vesicle represents a rare congenital urologic anomaly of which elective treatment is controversial. We present our experience in the diagnosis and management of this uncommon pathology. Patients and method: During the last twelve years we have managed eight patients affected by this pathology. The diagnosis was incidental in the three asymptomatic patients, while the other five consulted because of low urinary tract sympthoms. Ectopic drainage of the ureter in the pathological seminal vesicle was found in three of the patients. Two of these patients presented large pelvic and ureteral ectasy. Other five patients presented renal agenesis. Results: In asymptomatic patients we adopted an expectant attitude, while the other five patients underwent surgical treatment. We performed open surgery in the two cases presenting ureterohydronephrosis, whereas in the other three we performed transurethral incision of the seminal vesicle. We obtained excellent results in all of them, with no evidence of symptomatic pseudodiverticulum. Conclusions: Transurethral incision of the seminal vesicle cyst is a minimal invasive procedure with low morbidity. We have proved in all of our cases that the retraction of the cyst was practically complete, this has led us into believing that transurethral incision is the elective treatment. Therefore, open surgery would only be indicated in cases of failure of the procedure due to existence of symptomatic pseudodiverticulum, or in patients presenting renoureteral ectasy associated

Tratamiento endoscópico de la hiperplasia benigna de próstata bajo anestesia local-sedación en pacientes de alto riesgo / Endoscopic treatment of the benign prostatic hyperplasia with local anesthesia and sedation in patients with high surgical or anaesthesical risk

Introducción y objetivo: El envejecimiento de la población comporta un incremento del número de varones afectos de hiperplasia benigna de próstata (HBP) con múltiple patología asociada que limita su tratamiento quirúrgico. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local-sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico. Método: Durante los últimos 4 años hemos intervenido a 38 pacientes con edades comprendidas entre 78 y 86 años (media 81,4 ± 3,2) con síndrome de prostatismo obstructivo severo y riesgo quirúrgico-anestésico elevado. En 15 pacientes se practicó incisión transuretral de próstata (ITUP) y en los 23 restantes resección transuretral (RTUP). El bloqueo anestésico se realizó mediante infiltración periprostática transrectal digito-dirigida con 10-15 ml de lidocaína al 2%. Durante el procedimiento se administró una perfusión intravenosa de propofol y remifentanilo. Se evalúan los resultados obtenidos así como el grado de satisfacción de los pacientes mediante la elaboración de un cuestionario. Resultados: La duración media de la intervención fue de 12 ± 5 minutos (rango 8 - 25), no habiéndose constatado complicaciones derivadas de la técnica anestésica. Refirieron una molestia leve 4 pacientes (11%) que se resolvió aumentando la velocidad de la perfusión sedante. El grado de satisfacción con el tratamiento recibido ha sido del 95%. Conclusiones: Consideramos que tanto la ITUP como RTUP realizadas bajo anestesia local-sedación son métodos seguros, eficaces y bien tolerados, que están fundamentalmente indicados en pacientes añosos y cuando el riesgo quirúrgico-anestésico es elevado

Introduction and objetive: The aging of the population causes an increase of the number of men affected by benign prostatic hyperplasia (BPH) with a large number of pathology associated that may limit its surgical treatment. In this study we try to show the effectiveness and security of local anaesthesia and sedation in the endoscopic treatment of the BPH in patients with high surgical- anaesthetic risk. Methods: During the last 4 years, 38 patients underwent surgical treatment of BPH with ages between 78 and 86 years (average 81,4± 3,2) with severe obstructive prostatic syndrome and high surgical-anaesthetic risk. 15 patients underwent, transurethral incision of prostate (TUIP) and in 23 patients, transurethral resection (TURP) was performed. The blockade anesthetic was made by transrectal periprostatic infiltration finger-guided with 10-15 millilitres of lidocaine 2%. During the procedure an intravenous perfusion of propofol and remifentanil was administered. The obtained results as well as the patient’s satisfaction degree was evaluated by means of the elaboration of a questionnaire . Results: The average length of the surgical treatment was of 12 ± 5 minutes (rank 8 - 25), having itself not stated complications derived from the anesthetic technique. They referred a slight annoyance 4 patients (11%) that was treated increasing the rate of the sedative perfusión. The satisfaction’s degree with the received treatment has been good in the 95% of patients. Conclusions: We considered that the TUIP as much as TURP made under local anesthesia with sedation are safe, effective methods and well tolerated, that fundamentally are indicated in aged patients and when the surgical-anesthetic risk is elevate

[Selective arterial embolization in a case of renal cell carcinoma as therapeutic choice]. / Embolización arterial selectiva en un caso de carcinoma de células renales como alternativa terapéutica.

We show a big renal cell carcinoma case in an aged woman with many pathology associated. In view of the family refuse to make the radical surgery and the high surgical risk we decided to apply transarterial embolization treatment with polivinil alcohol particles (PVA). 28 months later the patient becames with no symptoms and with high quality life. We come to the conclusion that embolization is an effective therapeutic for the symptoms control in selectionated cases.

Embolización arterial selectiva en un caso de carcinoma de células renales como alternativa terapéutica / Selective arterial embolization in a case of renal cell carcinoma like therapeutic choice

Presentamos un caso de carcinoma de células renales muy voluminoso en una paciente de avanzada edad y con pluripatología asociada. Dada la negativa familiar a realizar cirugía radical y el elevado riesgo quirúrgico se optó por practicar embolización tumoral arterial selectiva con partículas depolivinil alcohol (PVA). Tras 28 meses de seguimiento la paciente resulta asintomática y con excelente calidad de vida. Concluimos que la embolización es una alternativa terapéutica eficaz en el control de la sintomatología para casos seleccionados (AU)

We show a big renal cell carcinoma case in an aged woman with many pathology associated. Inview of the family refuse to make the radical surgery and the high surgical risk we decided to apply transarterial embolization treatment with polivinil alcohol particles (PVA). 28 months later the patient becames with no symptoms and with high quality life. We come to the conclusion that embolization is an effective therapeutic for the symptoms control in selectionated cases (AU)

[Adrenal gland myelolipoma: review of the bibliography regarding a case]. / Mielolipoma suprarrenal: revisión bibliográfica a propósito de un caso.

OBJECTIVE: To describe an additional case of this rare disease entity, with special reference to its diagnosis and treatment, and to briefly review the literature. METHODS: We report on an 82-year-old male with adrenal myelolipoma that had been incidentally discovered during evaluation for another condition. A left adrenalectomy was performed due to the large size of the tumor and in order to determine its benign or malignant nature. RESULTS: The histopathological findings disclosed an andrenal myelolipoma. CONCLUSIONS: Adrenal myelolipoma is an uncommon tumor type. CT is the most effective diagnostic method. Surgery is advocated in symptomatic cases and in asymptomatic cases with a large tumor mass.

[Burned out testicular tumor]. / Tumor testicular fundido "Burned out".

OBJECTIVE: Extragonadal germ cell tumor is a rare condition. The present study reports an additional case of this uncommon disease. METHODS/RESULTS: A 24-year-old male with retroperitoneal disease and a testicular lesion detected by ultrasonography is described. Histopathological analysis of the orchiectomy specimen disclosed a 'burned out' tumor. The anatomopathological features of this tumor type are discussed. CONCLUSION: Extragonadal germ cell tumor is a rare condition. It derives from the germ cells that exist in the gonad and is located in every anatomical region but the gonad itself. Ultrasonography must be performed if an extragonadal germ cell tumor is suspected.

[Urologic impact of Crohn disease]. / Sobre las repercusiones urológicas de la enfermedad de Crohn (EC).

Presentation of two cases of Crohn's disease seen in our Service in which the urological symptoms were of special relevance. One patient presented clinically with a picture of anaemic gross haematuria. The other one, was a patient already diagnosed with Crohn's disease who developed an enterovesical fistula in spite of receiving medical treatment. Both cases were resolved surgically. The clinical aspects, natural history and treatment of this uncommon form of urinary tract involvement are discussed.

[Pheochromocytoma: a review of our own cases]. / Feocromocitoma: revisión de nuestra casuística.

Presentation of 6 cases of pheochromocytoma, diagnosed and treated in our Unit over the last 5 years. Five were adrenal pheochromocytomas and 1 an abdominal paraganglioma in a 42 year-old woman. Distribution by gender was 4 male and 2 female, and mean age at presentation was 45.2 years ranging from 35 to 55 years. Clinically, all patients were hypertensive. Two of the 5 cases with adrenal location presented with catecholaminic crisis with BP > 240/140 mmHg. The paraganglioma was diagnosed while studying a case of sustained HBP in a 42 year-old female referred from another unit. With regard to diagnosis, the sensitivity of urinary tests was 100%, and gammagraphy with meta-iodine-benzyl-guanidine (MIBG) was particularly useful in the extra-adrenal location case. In all our patients, computerized tomography (CT) was the choice procedure to locate the tumour. Treatment was surgical in all cases, access being transperitoneal in 3 cases, thoracoabdominal in 2 and classic lumbotomy in 1. All our patients received prior treatment with alpha-blocking agents, and intraoperative complications were 1 arrythmic crisis, 1 hypotensive picture and 1 hypertensive crisis, all of which resolved successfully. Currently, 5 patients remain disease free. Mild HBP controlled with low dose captopril still persists in one patient.