[Infective lithiasis. Treatment and complications]. / Litiasis infecciosa. Tratamiento y complicaciones.

OBJECTIVE: To establish the criteria for treatment of staghorn stones according to stone surface and distribution in cadaver kidneys. METHODS: Retrospective study of 344 cases treated from 1985 to 1992 and classified into two groups according to treatment by extracorporeal lithotripsy or by percutaneous nephrolithotomy (PNL). RESULTS: Mean age 48.69 years, prevalence of females and positive urinary culture in almost 70%, mainly Proteus. Stone composition was varied, but mainly magnesium ammonium phosphate. Treatment was by extracorporeal lithotripsy in 80.81% and by PNL in 19.9%. CONCLUSIONS: Treatment of this type of lithiasis should be by combined surgical removal and medical treatment. Lithotripsy is advocated for large caliceal calculi and PNL for large pyelic calculi.

[Prognostic factors and predictive tables of non-localized prostate cancer that exclude therapy by radical prostatectomy]. / Factores pronosticos y tablas predictivas del cáncer de prostata no localizado que excluirían la realización de la prostatectomía radical.

OBJECTIVE: To know the predictive factors of the no localized prostatic cancer (NLPC) with the intention of improving the indications of the radical prostatectomy. METHODS: A longitudinal, observational, analytic and retrospective study is made with our first 216 radical prostatectomies. A multivariate analysis by logistic regression has been made. A predictive evacuation with the odds ratio of the risc factors, a ROC curve and predictive tables of the NLPC are obtained. RESULTS: Clinical stage, PSA and Gleason are predictive factors of the NLPC. The predictive evacuation with a cut point of probability p = 0.5 has a specificity of 81%, a sensibility of 70% and global diagnostic capacity of 75%. NLCP odds ratio are: Gleason 5,6,7/Gleason 2,3,4 = 2.6, Gleason 8,9,10/Gleason 5,6,7 = 3, Gleason 8,9,10/Gleason 2,3,4 = 7.6, T2/T1 = 2, T3/T2 = 5, T3/T1 = 10 and PSA = 1. After the study of the predictive tables it can be concluded that T3, Gleason > = 8 and PSA > = 30 have a very high NLPC probability. CONCLUSIONS: PSA, Gleason and clinical stage are NLPC predictive factors. Predictive tables to know the NLPC probability by these 3 factors are available.

[Retropubic urethral suspension. A surgery "without complications"?]. / Suspensión uretral retropúbica. Una cirugía "sin complicaciones"?

OBJECTIVE: To describe a case of bladder neck suspensión with special reference to the complications associated with this procedure. METHODS/RESULTS: Herein we describe a patient who developed most of the reported associated complications following two bladder neck suspension procedures: bilateral ureteral ligation, osteitis pubis, retropubic hematoma, eventration and recurrence of urinary stress incontinence. Finally, after two reoperations, the complications were resolved and the patient is continent. CONCLUSIONS: Bladder neck suspension is usually associated with a low complication rate. However, associated complications may appear in the same patient, accounting for a significant morbidity.

[Prognostic factors in patients with prostatic cancer treated with neoadjuvant hormonal therapy and radical prostatectomy]. / Factores pronósticos en pacientes con cáncer de próstata tratados con hormonoterapia neoadyuvante y prostatectomía radical.

UNLABELLED: The high incidence of clinical understaging and positive margins in patients undergoing radical prostatectomy for prostate cancer has led to the use of neoadjuvant hormone therapy to reduce tumor volume. OBJECTIVES: To determine the prognostic factors in patients with prostate cancer treated with hormone therapy and radical prostatectomy. METHODS: 80 patients received hormone therapy with LH-RH agonists and flutamide before undergoing radical prostatectomy. The clinical stage and serum PSA were determined before and after hormone therapy. Prostate volume was determined by transrectal US. RESULTS: In 91% of the patients, PSA levels fell within the normal ranges (< 4 micrograms/l) after hormone therapy. Prostate volume diminished by 39% on average. There were no operative deaths. Histological analysis of the surgical specimen showed no tumor (pTO) in 10% of the cases. Sixteen cases (19.5%) had pelvic node invasion. Positive margins were found in 35% of stage 2 and 56% of stage 3 tumors. Seminal vesicle invasion was found in 35% of T2 and 84% of T3 tumors. Seventy-five percent of the cases with initial PSA levels < 10 micrograms/l had intracapsular (pT2) or pTO tumor. All cases with PSA > 25 micrograms/l had extraglandular tumor. A correlation was found between baseline PSA and incidence of positive-margins. The finding of undetectable PSA after hormone therapy is not a useful prognostic factor since 55% of the cases had extracapsular tumor. CONCLUSIONS: Our results indicate that hormone therapy with LH-RH agonist and flutamide prior to radical prostatectomy in patients with prostate cancer is well-tolerated and has no severe side effects. Despite the high percentage of cases with undetectable PSA after hormone therapy, no correlation was found between reduction of PSA levels and tumor stage.