Urinary markers in the surveillance of non-muscle invasive bladder cancer. A literature review. / Marcadores urinarios en la vigilancia del tumor vesical no músculo infiltrante. Revisión de la literatura.

BACKGROUND: The surveillance of non-muscle-invasive bladder cancer (NMIBC) is usually performed by cystoscopy and cytology. Until today, no effective urinary biomarker has been used to reduce the morbidity and cost associated with these procedures. OBJECTIVE: To describe the performance of urinary biomarkers in the surveillance of NMIBC. EVIDENCE ACQUISITION: on August 1, 2018, a bibliographic search was carried out in Pubmed, Embase and Cochrane Library, limited to the last 10 years, with the terms: bladder cancer, recurrence, detection and urine marker.973 registers were obtained, and 27 publications were selected following the PRISMA recommendations. EVIDENCE SYNTHESIS: The negative predictive values (NPV) of several assays could reduce the number of cystoscopies in NMIBC surveillance. Six transcription-factor trials had an NPV rate greater than 90%, and one of them can be performed at the control point. Six transcription-factors evaluations describe anticipated diagnosis between 68% and 83% of their "false positives". Two transcription factors and one protein assays proved reduction between 23% and 35% of surveillance cystoscopies. Nowadays, cell-based assays are restricted to reflex test after doubtful cytologies. CONCLUSION: There are few studies analysing the improvement of the NMIBC surveillance protocols. Several transcription factor assays are more precise and allow anticipatory diagnosis. Currently, there are no comparative studies between alternative surveillance protocols and classic ones.

Cistectomía radical laparoscopica en los tumores vesicales clínicamente localizados. (T2) / Laparoscopic radical cystectomy in clinically localized (T2) bladder tumors

Objetivo: La cistectomía radical laparoscópica se ha desarrollado a partir de la expansión de la prostatectomía radical laparoscópica. Esta técnica permite un abordaje poco invasivo para el tratamiento de los tumores vesicales infiltrantes de la capa muscular con disminución del sangrado y una más rápida recuperación postoperatoria. Métodos: Entre septiembre de 2004 y enero de 2007 se han realizado 54 cistectomías radicales por vía laparoscópica, 48 en estadio T2 y de estas últimas 43 (90%) eran varones y 5 (10%) mujeres. La edad media fue de 64 años (27-88a). La linfadenectomía se practicó por acceso laparoscópico en todos los casos, obteniendo una media de 13 ganglios (4-24). La derivación urinaria se realizó por la incisión de extracción del espécimen en todos los casos menos uno que se realizó completamente intracorpóreo, siendo ureteroileostomía cutánea tipo Bricker en 30 casos (62%), neovejiga ortotópica tipo Padovana en 17 casos (35%) y ureterostomía cutánea en un caso (2%). Resultados: El tiempo quirúrgico medio de todo el procedimiento fue de 287 minutos (180-480), 270 minutos para los casos con derivación tipo Bricker y de 316 para los casos con una neovejiga. El índice de transfusión fue del 25%. El tiempo medio de íleo paralítico fue de 5 días (2-10d) con un tiempo medio de ingreso para los pacientes con Bricker de 13 días (6-34) y de 16 días (8-30) para las neovejigas. El control oncológico, con un seguimiento medio de 10,8 meses (0,4-30m), presenta una supervivencia cáncer específica del 90% con un tiempo medio de supervivencia estimado de 28 meses (IC 95% 26-30). La supervivencia media global ha sido del 79% con un tiempo de supervivencia de 26 meses (IC 95% 23-29). Conclusiones: La cistectomía radical laparoscópica es una técnica factible que ofrece ventajas. Permite una exéresis con un menor sangrado y un postoperatorio más llevadero. Estudios aleatorizados deberían demostrar estas ventajas para confirmar si puede llegar a ser la técnica de elección. La realización de la derivación urinaria por la laparotomía, obligada para la extracción de la pieza quirúrgica, optimiza los resultados de la derivación y el tiempo quirúrgico total sin reducir los beneficios de la exéresis laparoscópica (AU)

Objectives: Laparoscopic radical cystectomy has been developed after the expansion of laparoscopic radical prostatectomy. This technique makes possible a minimally invasive approach to muscle-invasive bladder cancer with less blood loss and faster postoperative recovery. Methods: From September 2004 to January 2007, 54 laparoscopic radical cystectomies were performed, 48 of them in stage T2, from which 43 (90%) were male and 5 (10%) female patients. Mean age was 64 years (27-88). Lymphadenectomy was carried out by laparoscopic approach in all cases, with a mean of 13 nodes obtained (4-24). Urinary diversion was done through the incision needed to extract the specimen in all cases but one that was completed completely intracorporeally; constructing a Bricker-type ureteroileostomy in 30 (62%) cases, orthotopic neobladder (Vesica Ileale Padovana) in 17 cases (35%), and cutaneous ureterostomy in 1 case (2%). Results: Mean surgical time for the whole procedure was 287 minutes (180-480), 270 minutes for Bricker-type derivation cases and 316 minutes for neobladder cases. Blood transfusion rate was 25%. Mean ileal paralysis was 5 days (2-10) with a mean hospital stay of 13 days (6-34) for Bricker cases and 16 days (8-30) for neobladder cases. Oncological control, after a mean follow-up of 10,8 months (0,4-30), showed a cancer-specific survival of 90% with a mean survival time of 28 months (95% CI 26-30). Global mean survival was 79% with a mean survival of 26 months (95% CI 23-29). Conclusions: Laparoscopic radical cystectomy is a feasible technique that offers some advantages. It allows excision with less blood loss and an easier postoperative period. Randomized studies should demonstrate these advantages to confirm this approach as the technique of choice. Urinary diversion performed through the laparotomy incision, necessary to extract the specimen, optimizes derivation results and whole surgical time without reducing the beneficial effects of the laparoscopic exeresis (AU)

[Pig model in experimental renal transplant surgery]. / El modelo porcino en la cirugía experimental del trasplante renal.

INTRODUCTION AND OBJECTIVES: Living donor laparoscopic renal procurement is becoming a first-line technique unless a show-learning curve. January 2006 we implement an experimental pig-kidney transplant model with the objective of evaluating differences between open and laparosopic surgical techniques as well as giving a training-oportunity to the Residents in these alternatives. MATERIAL AND METHODS: We have completed 25 experiments 7 out of which were performed laparoscopically (28%), 18 with conventional surgerY (72%). Only 44% of the animals have survived until the end of the process. RESULTS: This work evaluates different aspects on the implementation of this activity. Complications of the prothocol are analyzed. We review the literature on this topic. CONCLUSIONS: Experimental Surgery in a porcine model has become in our Hospital a key-issue for Residents Training Program, and easily could be adapted to other Centers.

El modelo porcino en la cirugía experimental del trasplante renal / Pig model in experimental renal transplant surgery

Introducción y objetivos: La extracción renal laparoscópica de donante vivo se está convirtiendo en una técnica cada vez más habitual a pesar de su lenta curva de aprendizaje. En enero de 2006 se puso en marcha en nuestro centro un protocolo de autotrasplante en modelo porcino que pretendía evaluar diferencias entre la extracción por vía abierta y por vía laparoscópica, y que permitía así mismo entrenar a los residentes en la realización de estas técnicas. Material y métodos: Hasta día de hoy hemos llevado a cabo un total de 25 experimentos, de los cuales 7 han sido sometidos a extracción por vía laparoscópica (28%) y 18 por vía abierta (72%), si bien sólo el 44% de los animales ha sobrevivido hasta el final del protocolo. Resultados: En este trabajo se detalla la forma de iniciar una experiencia de estas características, se analizan las complicaciones que se han encontrado y se hace una revisión de la literatura en cuanto al manejo de estos animales. Conclusiones: La cirugía experimental en modelo porcino se ha convertido en nuestro centro en una herramienta fundamental para la formación del residente, y podría fácilmente ser adaptada por otros hospitales

Introduction and objectives. Living donor laparoscopic renal procurement is becoming a first-line technique unless a show-learning curve. January 2006 we implement an experimental pig-kidney transplant model with the objective of evaluating differences between open and laparosopic surgical techniques as well as giving a training-oportunity to the Residents in these alternatives. Material and methods. We have completed 25 experiments 7 out of which were performed laparoscopically (28%), 18 with conventional surgery (72%). Only 44% of the animals have survived until the end of the process. Results: This work evaluates different aspects on the implementation of this activity. Complications of the prothocol are analyzed. We review the literature on this topic. Conclusions: Experimental Surgery in a porcine model has become in our Hospital a key-issue for Residents Training Program, and easily could be adapted to other Centers

[Splenogonadal fusion. Report of a case]. / Fusion esplenogonadal. Presentación de un caso.

We present a new case of splenogonadal fusion in a 27 years old male. This anomaly is the result of an embryological fusion between gonad and spleen. Occasionally there is an association with other congenital alterations (peromelia). Usually it occurs in the left scrotum and, although described in both sexes, it is more frequent in males. Its only symptom is palpable tumor and this makes the surgical approach the only way to make the diagnosis. A frozen section study can avoid unnecessary radical surgery.

[Laparoscopic radical prostatectomy: learning curve with a mentor training program]. / Prostatectomía radical laparoscópica: la curva de aprendizaje con tutor.

INTRODUCTION: We describe and evaluate the results of our mentor training program for laparoscopic radical Prostatectomy (LRP). MATERIAL AND METHODS: From March 2004 through December 2005, we have performed 105 (LRP). Three groups have been analysed: Group 1: The mentor as the first surgeon with the trainee acting as the assistant. Group 2: The trainee as the first surgeon with the mentor acting as the assistant. Group 3: The trainee as the first surgeon with another trainee/resident as the assistant. We have evaluated operative, postoperative data and surgical/oncological control. RESULTS: There was no statistical difference in mean operative time in Groups 2 and 3 (200'-198'), but there was a difference from Group 1 (148,4') (p<0,05) we have observed a progressive operative time decrease only in Group 1. Blood loss, surgical-oncological control, pathological stage and hospital stay have been similar in the three groups. CONCLUSIONS: Skills for LRP can be effectively and safely taught by the presence of an experienced mentor. Waiting for long term results according to potency and continence, it was not associated to higher patient risk, neither to a worse surgical/oncologic outcome. We consider that this program is reproducible and allows a shorter learning curve.

[Comparison between open and laparoscopic approach in radical prostatectomy]. / Prostatectomia radical laparoscópica versus abierta.

INTRODUCTION: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). MATERIAL AND METHODS: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). RESULTS: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed. CONCLUSION: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

Fusion esplenogonadal. Presentación de un caso / Splenogonadal fusion. Report of a case

Se presenta un nuevo caso de fusión esplenogonadal en un varón de 27 años. Esta anomalía que resulta la fusión de bazo y gónada a nivel embriológico, se asocia en ocasiones a otras alteraciones congénitas (peromelia). Se presenta con más frecuencia en el escroto izquierdo y aunque descrita en ambos sexos, es diagnosticada con más frecuencia en el sexo masculino. Su importancia clínica radica en que su presentación en forma de tumor suele conducir a la extirpación quirúrgica del mismo. Su reconocimiento a tiempo, (estudio intraoperatorio) puede evitar actuaciones demasiado radicales

We present a new case of splenogonadal fusion in a 27 years old male. This anomaly is the result of an embryological fusion between gonad and spleen. Occasionally there is an association with other congenital alterations (peromelia). Usually it occurs in the left scrotum and, although described in both sexes, it is more frequent in males. Its only symptom is palpable tumor and this makes the surgical approach the only way to make the diagnosis. A frozen section study can avoid unnecessary radical surgery

[Current status of radical laparoscopic prostatectomy]. / Estado actual de la prostatectomía radical laparoscópica.

Laparoscopic surgery can be said to have come of age when it was first indicated for cancer conditions. Advances in this field are largely due to the French school, which has made it a standard practise in prostate cancer. It complies with the principles required for cancer as well as conventional surgery, but it remains to be verified whether its long-term results, both from tumoral and functional perspectives, are not only similar to those of classical surgery, but even better. In fact, increasing numbers of clinical groups are incorporating this technique in their daily work.

Estado actual de la prostatectomía radical laparoscópica / Current status of radical laparoscopic prostatectomy

La cirugía laparoscópica puede considerarse que ha alcanzado la mayoría de edad al indicarse en la patología oncológica, y debe su desarrollo a las escuelas francesas que sistematizaron su empleo en el cáncer prostático. Cumple los principios que ha de seguir la cirugía oncológica, al igual que la cirugía convencional, pero queda aún por demostrar que los resultados a largo plazo, tanto desde el punto de vista tumoral como el funcional sean mejores que la cirugía clásica. Cada vez son más los grupos que están incorporando estas técnicas a su quehacer diario

Laparoscopic surgery can be said to have come of age when it was first indicated for cancer conditions. Advances in this field are largely due to the French school, which has made it a standard practise in prostate cancer. It complies with the principles required for cancer as well as conventional surgery, but it remains to be verified whether its long-term results, both from tumoral and functional perspectives, are not only similar to those of classical surgery, but even better. In fact, increasing numbers of clinical groups are incorporating this technique in their daily work

[Analysis of biologic changes in PSA blood concentration and free PSA percentage in patients with normal rectal digital examination]. / Análisis de las variaciones biológicas en la concentración sérica de PSA y porcentaje de PSA libre en pacientes con tacto rectal normal.

OBJECTIVE: To study intra-individual variations in serum PSA and percent free PSA in patients with normal digital rectal examination. MATERIAL AND METHODS: Analysis of changes in serum PSA levels and percent free PSA in two blood measurements conducted in 107 non-consecutive patients prior to prostate biopsy, over a period of time ranging from 23 to 60 days. Both total and free PSA were measured with two dual monoclonal antibody assays, Tandem-E and Tandem-R, Hybritech. Diagnosis was benign hyperplasia in 63 patients and cancer in 44. RESULTS: PSA variations ranged between -6.8 and +3.2 ng/ml in BPH patients, and between -2.8 and +9.0 when cancer was detected. The median coefficient of variation was 15.4 and 15.7, respectively. Variations in percent free PSA ranged between -30.7 and +40.9 in the BPH group and between -17.9 and +15.8 in the cancer group. The median coefficient of variation was 32.2 and 32.3%, respectively. Should prostate biopsy had been indicated when percent free PSA was equal to or lower than 25 in the 4 to 10 ng/ml PSA range, 15% patients would have exhibited discrepancies. Sensitivity would have ranged between 100 and 94.4%, with a reduction rate in negative biopsies between 16.6 and 19.4%. CONCLUSIONS: Intra-individual variations in serum PSA levels and percent free PSA may condition the decision of whether to perform a prostate biopsy.

Análisis de las variaciones biológicas en la concentración sérica de PSA y porcentaje de PSA libre en pacientes con tacto rectal normal / Analysis of biological changes in serum PSA levels and percent free PSA in patients with normal digital rectal examination

OBJETIVO: Analizar las variaciones intraindividuales de PSA sérico y porcentaje de PSA libre en pacientes con tacto rectal normal. MATERIAL Y MÉTODOS: Se analizan las variaciones de la concentración de PSA sérico y porcentaje de PSA libre en dos determinaciones sanguíneas, realizadas a 107 pacientes no consecutivos antes de la biopsia prostá-tica, en un periodo de tiempo que osciló entre 23 y 60 días. Ambos PSA total y libre fueron determinados median-te ensayos con doble anticuerpo monoclonal Tandem-E y Tandem-R, Hybritech. El diagnóstico fue hiperplasia benigna en 63 pacientes y cáncer en 44. RESULTADOS: En pacientes con HBP las variaciones de PSA oscilaron entre -6,8 y +3,2 ng/ml y entre -2,8 y +9,0 cuando se detectó cáncer. El coeficiente de variación mediano fue de 15,4 y 15,7 respectivamente. Las variaciones del porcentaje de PSA libre oscilaron entre -30,7 y +40,9 en el grupo de HBP, y entre -17,9 y +15,8 en el grupo con cáncer. El coeficiente de variación mediano fue 32,2 y 32,3 por ciento respectivamente. Si la biopsia prostática se hubiera indicado cuando el porcentaje de PSA libre hubiera sido igual o inferior a 25 en el rango de PSA entre 4 y 10 ng/ml, habrí-amos encontrado discrepancias en el 15 por ciento de pacientes. La sensibilidad para ambas determinaciones habría oscilado entre 100 y 94,4 por ciento, así como la tasa de reducción de biopsias negativas entre 16,6 y 19,4 por ciento. CONCLUSIONES: Las variaciones intraindividuales en la concentración sérica de PSA y porcentaje de PSA libre pueden condicionar la decisión de realizar la biopsia prostática (AU)

[Ask-Upmark kidney: description of a case and review of the literature]. / Riñón de Ask--Upmark: descripción de un caso y revisión en la literatura.

We present a 15-year-old male patient diagnosed histopathologically as suffering from Ask-Upmark kidney, in the absence of vesicoureteral reflux and with hypertension. The first clinical manifestation was completely atypical: right loin pain, with so many agudisation treated at our emergency serve that justified a thorough study. The pathogenesis of the Ask-Upmark kidney is still unknown; some authors defend the congenital malformation hypothesis, as it was first described in 1929, but there are groups who support the Ask-Upmark kidney as a form of reflux nephropathy. After our description we present a review of the literature.

[Polypoid cystitis, isolated lesion with a unique presentation]. / Cistitis polipoide, lesión única de presentación singular.

OBJECTIVES: To report on an uncommon case of polypoid cystitis. METHODS/RESULTS: The patient had consulted because urinary stream was suddenly interrupted due to a mass protruding into the urethral meatus. The US, IVP, cystoscopic and pathological findings are documented. The literature on polypoid cystitis is briefly reviewed with special reference to its forms of presentation and the pathological findings which permit making the differential diagnosis from other pathologies, the most important being transitional cell papillary carcinoma. CONCLUSIONS: An uncommon case of cystitis is described, which emphasizes the varied forms of presentation of this condition and the need to distinguish this lesion from other pathologies, particularly bladder carcinoma.

[Two new Leydig cell testicular tumors presenting with gynecomastia in adults]. / Dos nuevos tumores testiculares de células de Leydig en el adulto que debutan con ginecomastia.

Presentation of two cases of Leydig cell tumor in adult patients who presented with gynecomastia, and slightly abnormal hormonal profiles. One patient had a non palpable tumor. The pathophysiology of this entity is commented, as well as the importance of the different modalities in its diagnosis.

[Acquired urethral diverticulum in males with spinal cord injury]. / Divertículo uretral adquirido en varones con lesión medular.

OBJECTIVES: To study the clinical features, etiology, diagnostic methods and therapeutic possibilities in male patients with medullary lesion presenting with acquired urethral diverticulum. METHODS: A retrospective study was conducted on patients seen in our department over the past twenty years (June, 1974 to June, 1994) for acquired urethral diverticulum. Ten patients have been treated for the foregoing condition. RESULTS: The etiology of the medullary lesion was traumatic injury in 7 cases and spina bifida in 3 cases. The most frequent cause of the acquired urethral diverticulum was a condom-like urinary collecting device associated with a septic factor. Three patients presented intradiverticular lithiasis. These 3 patients had previous or current lithiasis at other sites of the urinary tract and all of them had a condom-like collecting device. All patients underwent surgery consisting in diverticulectomy and lithectomy, when required. One patient had a recurrence 6 years later because the underlying factors causing the diverticulum were still present. CONCLUSIONS: Personal care and hygiene of patients with medullary lesion is one of the most important factors in preventing urethral injuries. In our view, patient follow-up should include regular radiologic assessment and correct training in the use of condom-like urinary collecting devices and urinary catheters. We advocate one-stage surgical repair with temporary cystostomy, preoperative antibiotic therapy according to the antibiotic profile and culture of symptomatic and asymptomatic urinary infections and the use of methylene blue to ensure the suture is watertight.

[Spontaneous bladder rupture secondary to urinary tuberculosis]. / Rotura vesical espontánea secundaria a tuberculosis urinaria.

Atraumatic spontaneous vesical fracture is an uncommon occurrence. Here we present the case of a female patient with spontaneous vesical fracture secondary to urinary tract tuberculosis. A review of current literature showed another published case similar to ours. A brief comment is made on presentation signs and symptoms and picture evolution, as well as a discussion on the predisposing factors of spontaneous vesical fracture and its treatment.