[Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review.] / Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática.

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes in video-endoscopic inguinal lymphadenectomy (VEIL). METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower- rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results.

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL).MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CCONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo.

Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática / Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL). MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower-rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results

Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas / Urological and psychological approach of secondary complications to penile aesthetic modifications

Objetivos: Dada la escasez de artículos científicos que revisen las distintas técnicas disponibles para modificaciones estéticas en el pene y que son causa de problemas uro-andrológicos posteriores, se revisa la literatura existente tras la asistencia de una infección peneana tras inyección de ácido hialurónico subcutáneo con fines estéticos. Material y métodos: Se expone un caso de un varón de 38 años de edad sin antecedentes médicos o psiquiátricos de interés, que acude a la urgencia por presentar inflamación y abscesificación en la piel peneana tras la inyección de ácido hialurónico. Fue preciso tratamiento quirúrgico mediante denudamiento y exéresis de la piel afecta, siendo la posterior evolución satisfactoria. El análisis psicológico realizado mostró una personalidad narcisista, posiblemente secundaria a traumas en la infancia. Se ha revisado la literatura presente en bases de datos médicas, así como información disponible on-line. Resultados. El aumento del tamaño del pene es una importante preocupación cultural y social, por lo que existen en el mercado distintos dispositivos para satisfacer esta demanda, entre los que destacan la fitoterapia, los ejercicios de estiramiento, pesas, bombas de vacío o dispositivos extensores. Entre las técnicas quirúrgicas descritas están la liposucción púbica, la sección del ligamento suspensorio del pene o la inyección de material autólogo o sustancias sintéticas, entre otras. Existen otras modificaciones estéticas peneanas entre las que destacan una amplia variedad de piercings genitales, tatuajes e implantes subcutáneos también denominados pocketing o "implantes 3D". Todas estas técnicas o modificaciones se describen en este artículo junto con sus posibles complicaciones urológicas asociadas más frecuentes. Conclusiones: Cada vez son más frecuentes las manipulaciones estéticas en el pene, y tanto la terminología popular como sus implicaciones médico-quirúrgicas deben ser conocidas por los urólogos y andrólogos

Objectives: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. Material and methods: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. Results: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. Conclusions: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. Community

[Urological and psychological approach of secondary complications to penile aesthetic modifications]. / Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas.

OBJECTIVES: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. MATERIAL AND METHODS: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. RESULTS: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. CONCLUSIONS: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. community.

[Preventive management of bone disease in advanced prostate cancer.] / Manejo preventivo de la enfermedad ósea en cáncer de proacute;stata avanzado.

OBJECTIVES: Prostate cancer is linked to bone disease by two different entities. On one hand, androgen deprivation therapy (ADT) usually causes osteoporosis, on the other a great number of patients with advanced prostate cancer will present bone that condition not only their vital prognosis but also an important quality of life deterioration. METHODS: We performed a bibliographic review on both the physiology and therapy of osteoporosis secondary to ADT and bone metastasis in prostatic neoplasias. RESULTS: Osteoporosis: Long term ADT is associated with osteopenia/osteoporosis in 80% of the patients, with a 5-20% incidence of osteoporotic fractures. We should monitor bone mineral density before starting ADT therapy and during treatment. Treatment is based on risk factors reduction, regular physical exercise, calcium and vitamin D supplements, and drugs such as biphosphonates or denosumab. Bone metastasis: Currently, both zolendronic acid and denosumab have approval for the prevention of skeletal events in patients with castration resistant prostate cancer (CPRC). Although the last one seems to be more effective, it is associated with a higher risk of hypocalcemia and jaw osteonecrosis so that the choice of drug must be individualized in every patient. The duration of treatment is not clear. Currently, the indication for the use of this drugs in earlier phases of advanced disease is not approved. CONCLUSIONS: Comprehensive management of the patient with advanced prostate cancer should include the study and treatment of osteoporosis and bone metastases. Currently, very effective therapies are available for both entities.

Manejo preventivo de la enfermedad ósea en cáncer de próstata avanzado / Preventive management of bone disease in advanced prostate cancer

OBJETIVO: El cáncer de próstata está ligado a la enfermedad ósea por dos entidades diferentes. Por un lado la terapia de deprivación androgénica (TDA) provoca frecuentemente osteoporosis y por otro lado, un gran número de pacientes con cáncer de próstata avanzado van a presentar metástasis óseas, que condicionan no sólo su pronóstico vital sino un deterioro importante en su calidad de vida. MÉTODOS: Se ha realizado una revisión en la literatura de la fisiología y el tratamiento tanto de la osteoporosis ligada a la TDA como de las metástasis óseas en neoplasias prostáticas. RESULTADOS: Osteoporosis: La TDA de larga duración se asocia a osteopenia/osteoporosis en un 80% de los pacientes, con una incidencia de fractura osteoporótica del 5-20%. Se debe monitorizar la densidad mineral ósea previa al inicio de la TDA y durante el seguimiento. El tratamiento se basa en reducir factores de riesgo, ejercicio físico de forma regular, suplementos de calcio y vitamina D, y fármacos como los bifosfonatos o el denosumab. Metástasis óseas: Actualmente están aprobados para la prevención de eventos óseos en pacientes en fase CPRC con metástasis óseas tanto el ácido zoledrónico como el denosumab. Aunque éste último parece más efectivo, se asocia a mayor riesgo de hipocalcemia y osteonecrosis mandibular por lo que la elección del fármaco a usar debe ser personalizada en cada paciente. No está clara cuál debe ser la duración del tratamiento. Actualmente no está aprobada la indicación del uso de estos fármacos en fases más precoces de la enfermedad avanzada. CONCLUSIONES: El manejo integral del paciente con cáncer de próstata avanzado debe incluir el estudio y tratamiento de la osteoporosis y de las metástasis óseas. Actualmente disponemos de tratamientos muy efectivos para ambas entidades

OBJECTIVES: Prostate cancer is linked to bone disease by two different entities. On one hand, androgen deprivation therapy (ADT) usually causes osteoporosis, on the other a great number of patients with advanced prostate cancer will present bone bicametastases, that condition not only their vital prognosis but also an important quality of life deterioration. METHODS: We performed a bibliographic review on both the physiology and therapy of osteoporosis secondary to ADT and bone metastasis in prostatic neoplasias. RESULTS: Osteoporosis: Long term ADT is associated with osteopenia/osteoporosis in 80% of the patients, with a 5-20% incidence of osteoporotic fractures. We should monitor bone mineral density before starting ADT therapy and during treatment. Treatment is based on risk factors reduction, regular physical exercise, calcium and vitamin D supplements, and drugs such as biphosphonates or denosumab. Bone metastasis: Currently, both zolendronic acid and denosumab have approval for the prevention of skeletal events in patients with castration resistant prostate cancer (CPRC). Although the last one seems to be more effective, it is associated with a higher risk of hypocalcemia and jaw osteonecrosis so that the choice of drug must be individualized in every patient. The duration of treatment is not clear. Currently, the indication for the use of this drugs in earlier phases of advanced disease is not approved. CONCLUSIONS: Comprehensive management of the patient with advanced prostate cancer should include the study and treatment of osteoporosis and bone metastases. Currently, very effective therapies are available for both entities

[Evaluation of a seminal vesicle biopsy protocol simultaneous to diagnostic prostate biopsy. Analysis of indication criteria.] / Evaluación de un protocolo de biopsias de vesículas seminales simultáneo a biopsias prostáticas diagnósticas. Análisis de criterios de indicación.

OBJECTIVES: To analyze the indication criteria used for conducting seminal vesicles biopsies as well as the diagnostic capacity of other variables involved. METHODS: We present the results of an observational and retrospective study (May 2006 - December 2012) using a sample of 140 patients to whom seminal vesicles biopsies was performed in a first set of prostate biopsy. They were patients eligible for curative treatment and presented any of the following criteria: PSA ≥15 ng/ml, suspicion of neoplastic seminal vesicle invasion on transrectal US, and/or suspicious node in the prostate base on DRE or transrectal US. RESULTS: Seminal vesicle invasion due to prostate cancer was detected in 22.2%. Patients with 3 criteria had T3b in 66.7% of cases. The criterion most associated with T3b was the presence of a suspicious node in the prostate base, with an association of 29.3% of cases. Variables analyzed that had shown a greater association with stage T3b were PSA density, the presence of suspicious DRE, the Gleason sum. CONCLUSIONS: Our seminal vesicle biopsy protocol has detected 22.2% of seminal vesicle invasion. The detection of a suspicious node at the prostate base has shown the greatest association with T3b.

Evaluación de un protocolo de biopsias de vesículas seminales simultáneo a biopsias prostáticas diagnósticas. Análisis de criterios de indicación / Evaluation of a seminal vesicle biopsy protocol simultaneous to diagnostic prostate biopsy. Analysis of indication criteria

OBJETIVOS: Analizar los criterios de indicación empleados para la realización de biopsias de vesículas seminales, así como la relación de la invasión de vesículas seminales por cáncer de próstata con otras variables implicadas. MÉTODOS: Presentamos los resultados de un estudio observacional y retrospectivo (mayo 2006 - diciembre 2012) con una muestra de 140 pacientes sobre los que se realizó un protocolo de biopsias de vesículas seminales realizadas simultáneamente con las biopsias prostáticas diagnósticas, basado en 3 criterios de indicación: PSA mayor o igual de 15 ng/ml, presentar sospechosa de infiltración de vesículas seminales o presentar sospechosa de infiltración de bases prostáticas. RESULTADOS: Se ha detectado un 22,2% de invasión seminal en los pacientes con cáncer de próstata. Los pacientes que presentaban todos los criterios de indicación asociaron una invasión seminal del 66,7%. La presencia de alteraciones en bases prostáticas resultó ser el criterio de indicación más sensible, asociando un 29,3% de invasión seminal. Otras variables asociadas a una mayor infiltración prostática fueron: densidad de PSA, tacto rectal sospechoso y sumatorio Gleason entre otros. CONCLUSIONES: El protocolo de biopsias seminales empleado ha mostrado una capacidad de detección de invasión seminal del 22,2%, siendo el criterio de sospecha de infiltración basal el que ha supuesto la mayor asociación con dicha invasión

OBJECTIVES: To analyze the indication criteria used for conducting seminal vesicles biopsies as well as the diagnostic capacity of other variables involved. METHODS: We present the results of an observational and retrospective study (May 2006 - December 2012) using a sample of 140 patients to whom seminal vesicles biopsies was performed in a first set of prostate biopsy. They were patients eligible for curative treatment and presented any of the following criteria: PSA ≥15 ng/ml, suspicion of neoplastic seminal vesicle invasion on transrectal US, and/or suspicious node in the prostate base on DRE or transrectal US. RESULTS: Seminal vesicle invasion due to prostate cancer was detected in 22.2%. Patients with 3 criteria had T3b in 66.7% of cases. The criterion most associated with T3b was the presence of a suspicious node in the prostate base, with an association of 29.3% of cases. Variables analyzed that had shown a greater association with stage T3b were PSA density, the presence of suspicious DRE, the Gleason sum. CONCLUSIONS: Our seminal vesicle biopsy protocol has detected 22.2% of seminal vesicle invasion. The detection of a suspicious node at the prostate base has shown the greatest association with T3b

Cáncer de próstata de bajo riesgo e intermedio: opciones de tratamiento / Low and intermediate risk prostate cancer: Treatment options

Los pacientes con cáncer de próstata de bajo riesgo e intermedio constituyen el grupo más frecuentemente diagnosticado en la actualidad. En aquellos con una esperanza de vida inferior a 10 años es muy probable que cualquier tratamiento sea innecesario por lo que la observación debe ser la aproximación más apropiada. En los pacientes en los que esté indicada alguna forma de terapia activa es necesario llevar a cabo un balance entre los riesgos de morir o desarrollar metástasis por la enfermedad y los efectos adversos de los tratamientos radicales comúnmente aceptados, como la prostatectomía radical y la radioterapia externa o intersticial. La significativa incidencia de morbilidad asociada, fundamentalmente disfunción eréctil e incontinencia urinaria, de alto impacto en la calidad de vida, exige esta aproximación en el ámbito de decisiones compartidas con los pacientes. El riesgo de sobretratamiento en este grupo de pacientes ha dado lugar a la introducción de abordajes más conservadores como el seguimiento activo y la terapia focal. El primero, trata de demorar los tratamientos radicales en tanto no existan criterios de agresividad suficiente por parte del tumor o el paciente los solicite. El segundo, que está llamado a ocupar un lugar entre el seguimiento activo y los tratamientos radicales, consiste en llevar a cabo una ablación parcial de la próstata para evitar los efectos adversos de los tratamientos radicales, tratando de lograr un control oncológico lo más similar posible al obtenido con estos

Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients

La importancia de exploración física en la incontinencia urinaria: Urocolpos / The importance of physical examination in urinary incontinence: Urocolpos

No disponible

Pionefrosis secundaria a sonda vesical ubicada en ureter pélvico / Pyonephrosis secondary to bladder catheter misplaced in the pelvic ureter

No disponible

Seminal vesicle biopsies: an useful staging procedure-exposure of seminal vesicle biopsies protocol and review of the literature.

BACKGROUND AND OBJECTIVES: Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. METHODS AND MATERIALS: SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. RESULTS: These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. CONCLUSIONS: SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.

Duplicidad uretral. La importancia de una anamnesis y una exploración física detalladas / Urethral duplication. The importance of a detailed anamnesis and physical exploration

La duplicidad uretral es una enfermedad poco frecuente, y se han descrito unos 200 casos en todo el mundo. Hay varios subtipos de duplicidad uretral, y el más frecuente es el subtipo 2A-Y. Presentamos un caso de duplicidad uretral tipo 2A-2, poco relatado en la bibliografía actual, diagnosticado como hallazgo casual durante una cirugía endoscópica urológica. La clínica que supone esta malformación congénita es dependiente del subtipo que se padezca, y puede presentarse como totalmente asintomática o como parte de una compleja malformación caudal (AU)

Urethral duplication is a rare disease, only approximately 200 cases having been reported worldwide. There are several subtypes of urethral duplication, the most frequent subtype being 2A-Y. We report a case of urethral duplication 2A-2, little reported in the current literature. It was diagnosed as incidental finding during endoscopic urological surgery. The symptoms of this congenital malformation depend on the subtype of urethral duplication. They can be completely asymptomatic or present as part of a complex caudal malformation (AU)

Urofilias: aproximación clinicoterapéutica a propósito de un caso de una vela intravesical / Urophilias: Clinical and therapeutic approach a propos of an intravesical candle

Las parafilias son entidades patológicas de la esfera psiquiátrica que difieren de otros comportamientos sexuales por las serias implicaciones que suponen en la vida de los pacientes. Las urofilias son parafilias que implican al ámbito urológico. Estas presentan un amplio espectro de variaciones clínicas, llegando a poder tener serias consecuencias para la vida. La introducción de objetos en la uretra o en la vejiga es la urofilia que más frecuentemente requiere asistencia médica, ya sea por daño en la vía urinaria o por las implicaciones de alojar cuerpos extraños en ella. A raíz de la identificación de un insólito cuerpo extraño en la vejiga se ha realizado una revisión del tema desde la vertiente psiquiátrica y urológica de esta patología (AU)

Paraphilias are pathologies of the psychiatric field that differ from other sexual behavior because of the serious implications in the lives of the patients. Urophilias are paraphilias involving the urological setting. They have a wide spectrum of clinical variations and can have serious consequences for life. Insertion of objects into the urethra or bladder is the urophilia that most frequently requires medical care, either by damage to the urinary tract or due to the implications of hosting foreign bodies in it. Following the identification of an unusual foreign body in the bladder, a review of the subject from the psychiatric and urological side has been carried out (AU)

[Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma]. / Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata.

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis. METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached. We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms "Prostatic Neoplasm" (MesH) AND "Neoplasm Metastasis" (MesH) AND "cutaneous" (free text). Most publications are case reports reviewing the probable dissemination way and localization. RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described. CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease.

[Diagnostic and therapeutic management of renal hydatidosis]. / Manejo diagnóstico y terapéutico de la hidatidosis renal.

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature. METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms "Echinococcosis" [MeSH] AND "urinary tract" [MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews. RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables. CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti-Echinococcus antibodies.

Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata / Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma

OBJETIVO: Presentar un caso llamativo por la forma de presentación de un carcinoma de próstata metastátizado con la aparición de un “bultoma” que correspondía a una metástasis cutánea.MÉTODOS: Describimos la forma de debút de un paciente que gracias al análisis de la lesión que informó de un adenocarcinoma, que aparentaba un Lipoma, se investigó la posibilidad de ser un adenoca de próstata y se estableció el diagnóstico.Se ha realizado una revisión de la literatura mediante una búsqueda bibliográfica electrónica en PubMed (MEDLINE) utilizando los términos “Prostatic Neoplasm”(MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous”(texto libre). La gran mayoría de las publicaciones corresponden a aportación de casos nuevos con revisión de la probable vía de diseminación y la localización.RESULTADOS: La tinción inmunohistoquímica con PSA positiva fue la que confirmó el origen de la Metástasis, aunque el valor del PSA no ofrecía dudas por valor superior a 1100 ng/ml. En relación con la búsqueda obtenemos mas de 26 trabajos, seleccionando para nuestra trabajo sólo 8 ya que se ajustan al objetivo del mismo. La aparición de metástasis cutáneas con origen prostático es inferior al 0,3%, ya que es mas frecuente la afectación ósea, en ganglios y visceras. Se describen casos en la evolución de la enfermedad y metástasis tras procedimientos laparoscópicos.CONCLUSIONES: La metástasis cutánea de una adenocarcinoma de próstata es muy rara, pero más aún que ésta sea el debut de la enfermedad (AU)

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis.METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached.We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms “Prostatic Neoplasm” (MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous” (free text). Most publications are case reports reviewing the probable dissemination way and localization.RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described.CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease (AU)

Manejo diagnóstico y terapéutico de la hidatidosis renal / Diagnostic and therapeutic management of renal hydatidosis

OBJETIVO: La hidatidosis renal está causado por Echinococcus granulosus y es extremadamente infrecuente, constituyendo el 3-4% de los casos de hidatidosis, siendo la tercera localización tras el hígado y pulmones. Habitualmente permanece asintomático durante años y los síntomas más comunes son dolor, sensación de pesadez en flanco y disuria. Ante la aparición de un cuadro compatible, estudiamos la pauta diagnóstica, terapéutica y de seguimiento revisando la literatura.MÉTODOS: Realizamos una búsqueda bibliográfica electrónica PubMed (MEDLINE) con términos MESH “Equinococcosis”[MeSH] AND “Urinary Tract”[MeSH] y de citas bibliográficas. Hacemos una revisión de la epidemiología, el ciclo vital del parásito y del manejo del paciente afecto de Hidatidosis. La gran mayoría de las publicaciones corresponden a aportación de casos con diferentes localizaciones, aunque encontramos algunas revisiones.RESULTADOS: Encontramos un total de 137 trabajos de los cuales, seleccionamos veintitres por estar relacionados; cinco correspondían a revisiones, referenciamos en el texto sólo diez. Aunque la mayoría son aportación de casos, las revisiones analizan el ciclo del Echinococcus y los diferentes lugares de asentamiento (órganos) en el huésped hombre. El hombre puede llegar a ser huésped intermedio a través de contacto con huésped definitivo (perros...) o por ingesta de agua contaminada o vegetales.CONCLUSIONES: Gracias a la combinación de anamnesis, estudios de imagen y serología nos aproximamos al diagnóstico hasta en un 80%. En muchos casos es posible la cirugía conservadora pero tras la sospecha debemos siempre esterilizar con Albendazol antes del tratamiento quirúrgico y tras el tratamiento monitorizar mediante serología la titulación de Anticuerpos anti-echinococcus(AU)

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature.METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms “ Echinococcosis”[MeSH] AND “urinary tract”[MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews.RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables.CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti- Echinococcus antibodies(AU)

[Voiding symptoms as presentation of an intravesical foreign body]. / Clínica miccional como síntoma por cuerpo extraño intravesical.

OBJECTIVES: The presence of intravesical foreign bodies is exceptional; it is not a common emergency. Most foreign bodies have a sexual-erotic origin, although we cannot forget others such as elements left by the surgeon in the surgical field. We performed a bibliographic review on the topic. METHODS: We performed a PubMed (MEDLINE) electronic bibliographic search with the mesh terms "foreign-body migration" [MESH] AND "Urinary Bladder" [MESH] and bibliographic citations. We performed a bibliographic review establishing a classification depending on the origin and diagnosis, as well as treatment. Most publications are case reports. We described the most frequent presentation which was the same than we have in our Center. RESULTS: We found a total of 122 works, nine of which were reviews; we selected 20 works. Although most are case reports, the reviews establish a classification depending on the origin: so, they refer to those foreign bodies directly introduced into the bladder: 1. By the patient: hairpins, safety pins, pencils, copper wires, hairs; 2. Accidentally: bullets; 3. Iatrogenic: fragments of bladder or ureteral catheters, staples, sutures. Foreign bodies migrated from other places: urological, gynecological, gastrointestinal, or vascular origin. We established a diagnostic and therapeutic algorithm. CONCLUSIONS: Bladder foreign bodies are not as frequent as it is believed. Most are found incidentally. Lower urinary tract symptoms are the most frequent, as the antecedent of manipulation by the patient or others in the genital-urologic sphere. The treatment of choice is extraction using the least invasive and most simple method for the patient.