[Testicular pseudotumor: a case report]. / Pseudotumor fibroso testicular: aportación de un caso.

We report a case of fibrous pseudotumor of the epididymis as a even more rare location of nodular, fibrous and ossification diffuse proliferation, it may be difficult to distinguish from solid tumors. We also reviewed published report up to date and the differential diagnosis.

Pseudotumor fibroso testicular: aportación de un caso / Pseudotumor testicular: a case report

Aportamos un caso de pseudotumor fibroso del epidídimo como una localización aún más rara de esta proliferación difusa, nodular y osificada que puede ser difícil de diferenciar de los tumores sólidos. También hemos revisado las publicaciones hasta la fecha así como los posibles diagnósticos diferenciales (AU)

We report a case of fibrous pseudotumor of the epididymis as a even more rare location of nodular, fibrous and ossification diffuse proliferation, it may be difficult to distinguish from solid tumors. We also reviewed published report up to date and the differential diagnosis (AU)

Hormonoterapia intermitente: experiencia clínica y ensayos en cursos

La supresión androgénica es la opción terapéutica más admitida para el cáncer de próstata avanzado y permite obtener una respuesta clínica y bioquímica en la mayoría de los pacientes. No obstante, dicha respuesta tiene una duración variable y no está libre de efectos secundarios. En el momento actual se está intentando diseñar nuevas modalidades de supresión androgénica que consigan el mejor equilibrio entre la supervivencia y la máxima calidad de vida. Una de estas estrategias es el tratamiento hormonal intermitente del que disponemos numerosos estudios, tanto trabajos de investigación básica como ensayos clínicos que presentamos en esta revisión (AU)

[Congenital bladder diverticulum and Ehlers-Danlos syndrome: an unusual association]. / Divertículo vesical congénito y síndrome de Ehlers-Danlos: una rara asociación.

The existence of a vesical diverticulum in the context of a congenital connective tissue disorder such as Ehlers-Danlos syndrome led us to consider the possibility of a relationship. Four types of diverticula can be found in the literature: congenital, acquired, iatrogenic and syndrome-associated. Within the later, Ehlers-Danlos syndromes type IV and IX, even type V, are associated to the existence of vesical diverticula. The potential spontaneous rupture of the diverticulum is a typical feature, as well as post-surgery relapse. The attitude towards such diverticula should be one of watchful waiting, and simple, plasty-free diverticulectomy on the bladder's neck is indicated when performing a surgical procedure.

Divertículo vesical congénito y síndrome de Ehlers-Danlos: una rara asociación / Congenital vesical diverticulum and Ehlers-Danlos syndrome: a rare association

La existencia de un divertículo vesical en el contexto de una alteración congénita del tejido conectivo como es el Síndrome de Ehlers-Danlos, nos hizo plantearnos su posible relación. En la literatura se describen en la actualidad cuatro tipos de divertículos: congénitos, adquiridos, yatrogénicos y asociados a síndromes. Dentro de este último, el síndrome de Ehlers-Danlos en sus tipos IV y IX y ocasionalmente en el tipo V se relaciona con la existencia de divertículos vesicales. Es característica la posible ruptura espontánea del divertículo, así como su recidiva tras cirugía. La actitud ante estos divertículos debe a poder ser expectante y sólo, la diverticulectomía simple sin plastia sobre el cuello vesical está indicada, si fuera necesaria realizar alguna técnica quirúrgica. (AU)

Positron emission tomography with 18fluorine-labelled deoxyglucose: utility in localized and advanced prostate cancer.

OBJECTIVE: To determine the role of the positron emission tomography (PET) with 18F-labelled deoxyglucose in the identification of prostatic cancer in the iliac and obturator lymphatic nodes before radical prostatectomy, and in the localization of relapse in patients in biochemical progression. PATIENTS AND METHODS: Twenty-one patients were divided into two groups. Group A consisted of 11 men diagnosed with organ-confined prostate cancer, where attention was focused on the iliac and obturator lymphatic nodes, the results being compared with the pathological anatomy obtained from surgical procedures. Group B included 10 patients treated by radical prostatectomy, radiotherapy or orchidectomy and who were in biochemical progression, in whom the aim was to identify recurrence of the disease. RESULTS: In none of the 11 patients of group A who had undergone radical prostatectomy were deposits of radiotracer identified in the area of the iliac and obturator nodes which would indicate node metastases. However, the histopathological analysis of these nodes showed tumour in three patients. In group B the PET scans showed recurrence of prostate cancer (by deposits of radiotracer) more clearly than did computed tomography (CT) in two patients (both with recurrence in soft tissue). In one patient bone scintigraphy identified a lesion compatible with prostatic disease in the bone; this was clinically confirmed but was not identified by PET. CONCLUSION: PET, using deoxyglucose labelled with 18F, cannot reliably identify prostatic adenocarcinoma in the iliac and obturator lymph nodes before surgery; other tracers may give better results. To locate relapses in patients with biochemical progression, PET seems to have better sensitivity than CT when identifying diseases in soft tissues and is possibly inferior to bone scintigraphy in detecting bony metastases.

CD44v6 expression is related to progression in renal epithelial tumours.

AIMS: Expression of CD44 variant isoform including exon 6 has been associated to tumour progression in several carcinomas. However, no studies have been performed to assess the prognostic value of the expression of this marker in renal cell tumours. METHODS AND RESULTS: We studied 58 renal cell tumours. All patients were followed up for at least 3 years after nephrectomy. Tumours were analysed for expression of CD44v6 assessed by two isoform-specific monoclonal antibodies. RT-PCR was performed to detect CD44 variant transcripts in 10 cases in which immunohistochemistry was negative. Twenty-two tumours showed reactivity in at least 1% cells for both antibodies with a strong membrane pattern. RT-PCR did not show CD44v6 transcripts in any of 10 studied tumours. Immunohistochemical staining was more frequent in perivascular areas or in areas of vascular invasion. In fact, CD44v6 expression correlated well with nuclear grade (P = 0.009), stage at diagnosis (P = 0.04) and appearance of metastasis after nephrectomy (P = 0.007). Although univariate survival analysis showed stage (P < 0.001), grade (P = 0.009) and CD44v6 expression (P = 0.04) to be significant predictive factors, only stage remained significant (P = 0.0013) in the multivariate analysis. CONCLUSIONS: CD44v6 expression, assessed immunohistochemically, is related to tumour progression. However, its prognostic value in renal cell tumours is dependent on tumour stage at diagnosis.

Effect of digital rectal examination and flexible cystoscopy on free and total prostate-specific antigen, and the percentage of free prostate-specific antigen. Differences between two PSA assays.

OBJECTIVE: To determine the effect of prostate manipulations on free PSA, total PSA and the percentage of free PSA using an equimolar and nonequimolar PSA assays. METHOD: A total of 67 men were studied. Blood samples were obtained before and 45-60 min after two different prostatic manipulations: DRE from 45 patients and flexible cystoscopy from 22 patients. Total PSA (t-PSA) was assayed with a non equimolar method using the Cobas Core PSA kit from Roche (Cobas Core-PSA) and an equimolar method using the Immulite 3rd-generation PSA kit from DPC (Immulite-PSA). Free PSA (f-PSA) was quantified with an Immulite free PSA kit. We obtained two f-PSA/t-PSA ratios dividing the f-PSA by both t-PSA (Cobas Core-PSA) and t-PSA (Immulite-PSA). RESULTS: The Cobas Core-PSA yielded higher values than Immulite-PSA and the baseline percentages of free PSA were different depending on the method used. Both t-PSA values were increased after DRE and flexible cystoscopy from the baseline although the increase of Cobas Core-PSA was much higher than Immulite-PSA. Also the f-PSA was increased after the two manipulations. The f-PSA/t-PSA ratio (Cobas Core-PSA) remains at the baseline whereas the f-PSA/t-PSA ratio (Immulite-PSA) had an important increase from the baseline. CONCLUSION: The effect of DRE and flexible cystoscopy is different depending on the PSA assay used. The data from studies which are carried out in relation with the molecular forms of the PSA are not interchangeable if they are performed with different PSA methods (equimolar and nonequimolar). The serum samples should precede any prostate manipulation in all investigations related to PSA molecular forms.

[Bladder hemangioma: a clinical case]. / Hemangioma vesical: caso clínico.

Contribution of a new case of vesical haemangioma in a 65-year old male. This is a benign and very rare tumour with not even 90 cases described in the urology literature to date. Haematuria was reported in all cases. This paper presents a review of the literature and a discussion of clinical and pathological features as well as diagnostic methods and recent changes in management approach.

Surgical management of retroperitoneal tumors with vena caval thrombus in the inferior cava using cardiopulmonary bypass, arrested circulation and profound hypothermia.

OBJECTIVE: It was our aim to review our surgical experience with retroperitoneal tumors extending to the vena cava by using cardiopulmonary bypass, deep hypothermia and circulatory arrest. METHOD: We performed this procedure in 15 patients. The ages ranged between 16 and 70 years. The primary malignancies were renal cell carcinoma (n = 13), Wilms' tumor (n = 1) and paratesticular rhabdomyosarcoma (n = 1). RESULTS: There were no operative deaths. One patient died on the fourth postoperative day because of pulmonary embolization. The most common postoperative complications were: 1 patient required surgical reexploration because of hemorrhage, there was transitory renal failure in 3 patients, 1 patient developed a postoperative reactive psychosis and 1 patient developed a subclinical pericarditis. CONCLUSION: We believe that the resection of retroperitoneal malignancies with venous tumor thrombus extension offers, in selected patients, the only chance of reasonable long-term survival. The application of a cardiopulmonary bypass and hypothermia in high level vena cava thrombi is an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking.

Long survival of a patient with paratesticular rhabdomyosarcoma with inferior vena cava involvement.

A 13-year-old boy with a paratesticular embryonal rhabdomyosarcoma and a large thrombus into the inferior vena cava reaching the suprahepatic vein is presented. We used cardiopulmonary bypass with deep hypothermic circulatory arrest to realize a complete exeresis of the tumor and thrombus, followed by systemic chemotherapy and radiotherapy. Ten years later the patient is alive and doing well without any sequelae.

Incidentally detected renal cell carcinoma.

OBJECTIVES: To determine the incidence of renal cell carcinoma (RCC) detected incidentally and to compare the survival of these patients with that of patients presenting with suspected RCC. PATIENTS AND METHODS: In a retrospective study, 157 patients surgically treated for RCC from 1979 to 1993 were grouped according to whether the tumour was found incidentally (n = 55) or whether the renal tumour was suspected (n = 102). The groups were compared for tumour grade, stage and size, patient age, sex and survival using univariate and multivariate analyses. RESULTS: There were significant differences between the groups in the number of patients with T2 (P < 0.001), T3a (P < 0.05), T3b (P < 0.01), T4 (P < 0.05) and M1 (P < 0.05) stages of disease. There was also a significantly greater proportion of patients with grade 1-2 tumours (P < 0.05) in those diagnosed incidentally. The accumulated overall survival rate was 64% at 5 years, 50% in the group with suspected RCC and 86% in those with tumours discovered incidentally over the same period. There were significant differences (P < 0.001) in the distribution of survival in the two groups. CONCLUSION: The patients with incidentally discovered RCC had a prognostically more favourable tumour stage, grade and size. Pathological stage and lymph node metastases influenced the difference in survival between the groups. As there was no difference in survival with tumour stage (T1-2), we consider that grade, size and particularly pathological stage determine the better prognosis.

[Mature cystic teratoma of the testis]. / Teratoma quístico maduro del testículo.

Case report of a mature testicular cystic teratoma in a 25 year-old patient. Emphasis is placed on the rarity and benign nature of the lesion, its therapeutical approach and good prognosis, as compared to other mature, potentially aggressive testicular teratomas where the therapeutical and follow-up strategies are different.

[Ultrasonographic (intra- and extraluminal) pattern of cervico-urethral anastomosis after radical prostatectomy]. / Patrón sonográfico (intra y extraluminal) de la anastomosis cérvico-uretral tras la prostatectomía radical.

Thirteen patients, mean age 61 years (range 54 to 71), diagnosed with prostate adenocarcinoma underwent radical prostatectomy. To achieve a diagnosis they were all performed blood PSA determination, digital rectal examination, transrectal ultrasound and a prostate ultrasound-guided biopsy by automatic gun puncture. Serum PSA quantification, digital rectal examination and transrectal ultrasound were repeated in the immediate post-operative, and three and six months after surgery. Through the information obtained with endocavitary ultrasound, the lumen of the cervicourethral anastomosis and the perianastomotic tissue was assessed. Transrectal ultrasound plays a relevant role in the follow-up of patients undergoing radical prostatectomy. When a patient with prostate radical surgery shows an elevation of serum PSA and/or abnormal digital rectal examination, an ultrasound-guided biopsy (at the node or perianastomotic area) is indicated.

[Ureterosigmoidostomy detubularized with surgical staplers: C.F.C. (Original technique)]. / Ureterosigmoidostomía destubulizada mediante súturas mecánicas: C.F.C. (Técnica original).

Description of our modification of the detubulized ureterosigmoidostomy surgical technique (Castiñeiras-Ferragut-Camacho). In an attempt to shorten the surgery time, we used for these changes absorbable mechanical sutures (Poli Gia and T.A.). This paper analyzes the technical details of interest as well as the anatomicosurgical considerations that should be known prior to carry out this type of by-pass. The anatomicophysiological principles on which our developments are based are those referred by N.G. Kock15 and used by R. Hohenfellner and R. Fisch14, when they described the detubulized ureterosigmoidostomy performed manually. We believe that both surgical procedures, R. Hohenfellner & R. Fisch14 and ours (detubulized ureterosigmoidostomy, C.F.C.), are suitable alternatives to conventional ureterosigmoidostomy.

[Bilateral synchronous adrenal metastasis of renal adenocarcinoma]. / Metástasis suprarrenales bilaterales sincrónicas de adenocarcinoma renal.

Contribution of one case of renal adenocarcinoma with synchronous metastasis in both adrenal glands. Treatment was radical surgery with palliative resolution and steroid replacement therapy. Brief comments on this uncommon clinical situation and review of other author's experience.

[Urothelial inverted papilloma]. / Papiloma invertido urotelial.

Review of 60 cases of inverted urothelial papilloma published in our country in different urological journals. Analysis of clinical, diagnostic and therapeutical issues. Also an analysis is made of the possible association with other neoplasias or their malignant development.

[Complications of ultrasound-guided transperineal puncture biopsy of the prostate]. / Análisis de las complicaciones de la punción-biópsica transperineal ecodirigida de próstata (P.B.T.E.P.).

Between June 1988 and February 1993, 520 ultrasound-guided transperitoneal prostate biopsy punctures were performed in patients with prostate disease. Of these, 89 (17.1 %) were positive for malignancy. An analysis is made of the highly uncommon complications observed, which corresponded to 17 cases of haematuria (3.26%) and 3 of fever (0.5%). Likewise, reference is made to perineal neoplastic implantation, since such complication was evident in one of the cases contributed (0.19%). Also, a review of the literature relative to the complications is made, concluding by stating the relevance of this diagnostic technique in spite of said complications.