Obstrucción del tramo urinario superior. Revisión años 80 / Obstruction of the upper urinary tract. State of the art of the 80´s

El Dr. Solé –Balcells ha tomado apuntes sistemáticamente durante toda su larga carrera como urólogo, convirtiéndolos en lecciones o en documentos de revisión y estudio. Perfectamente ordenadas y muy completas, estas notas raramente han sido publicadas. Recuperamos aquí un manuscrito original redactado en los años 1980 sobre uno de sus temas prediclectos: la uropatía obstructiva. El texto mantiene la vigencia en cuanto a la urodinámica de la obstrucción ureteral y, al mismo tiempo, es un documento histórico que refleja el quehacer urológico hace 25 años. Se trata de un repaso breve e intenso de la fisiopatología ureteral, con apuntes sorprendentes como la “super-sonda” peristáltica de la urografía o la descripción de medios neurofisiológicos de exploración ureteral como la EMG y el manómetro intraluminal

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El urólogo como generalista de la gente mayor / The urologist like family practice in aging patients

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[The Internet in medicine. A help, a problem, a cause of errors...?]. / Internet en Medicina. Una ayuda, un problema, una causa de errores...?

The Internet has been a breakthrough for Professional Medical Training. Medline databases are increasingly being used by the scientific community at large. Patients have also started to use the Internet as a source of information on their illnesses, and look in the web for a second opinion. This paper shows the advantages derived for the patients from using the Internet as well as the risks involved from a poorly understood, even not scientifically validated information. The Urology Associations themselves should take responsibility of the web sites in a unambiguous way, by including evidence-based medicine, offering assistance to those patients who want to compare their specialist's opinion with that obtainable in the Internet, and with the doctors themselves directing those who show a real interest to the most suitable web sites.

Internet en Medicina ¿Una ayuda, un problema, una causa de errores ? / Cybermedicine: a help? a problem? an origin of errors ?

Internet ha significado para la Formación Médica Profesional un gran avance. Cada vez son más utilizadas las bases de datos de Medline en la Comunidad Científica. Los pacientes han empezado a usar Internet como fuente de información sobre sus dolencias, buscando a su través una segunda opinión. El artículo pone de manifiesto las ventajas de su uso para los propios enfermos, como asimismo el peligro que representa una información no bien comprendida o en ocasiones no válida científicamente. Las propias Asociaciones Urológicas deben responsabilizarse de las páginas web en forma clara, con datos de medicina basada en evidencia, informando a los pacientes que deseen confrontar la opinión de su especialista con la que se puede obtener por la red, siendo el propio médico, ante las personas que demuestren interés en ello, quien debe proporcionarles las direcciones web más idóneas (AU)

The Internet has been a breakthrough for Professional Medical Training. Medline databases are increasingly being used by the scientific community at large. Patients have also started to use the Internet as a source of information on their illnesses, and look in the web for a second opinion. This paper shows the advantages derived for the patients from using the Internet as well as the risks involved from a poorly understood, even not scientifically validated information. The Urology Associations themselves should take responsibility of the web sites in a unambiguous way, by including evidence-based medicine, offering assistance to those patients who want to compare their specialist’s opinion with that obtainable in the Internet, and with the doctors themselved directing those who show a real interest to the most suitable web sites (AU)

Actualización en el tratamiento de los tumores testiculares / Update of the treatment of testicular tumors

El tratamiento de los tumores testiculares en estadio III especialmente los considerados de mal pronóstico, es objeto de numerosas publicaciones. En esta revisión se actualiza el tratamiento de este tipo de tumores. En primer lugar se describe la terapia inicial con pautas de quimioterapia tipo BEP y BOMP+EPI, analizando seguidamente los resultados obtenidos con soporte hematológico mediante trasplantación de médula ósea así como los ensayos con el empleo de stem cells Y factores estimulantes de las colonias de granulocitos. Se describen seguidamente los ensayos con nuevos químioterápicos: Taxol y Gemcitabina. El tumor "quemado" del testículo requiere una especial atención así como el tratamiento a. seguir con el testículo tumoral tras quimioterapia en los tumores testiculares no seminoma metastásicos. Las complicaciones tardías de la quimioterapia son especialmente consideradas tanto en relación a las enfermedades cardiovasculares y la presentación de cáncer secundario corno las posibles alteraciones de la línea seminal La presencia de CIS en el testículo contralateral y la presencia de tumor testicular bilateral son también analizados en esta revisión. Finalmente se describen las indicaciones del tratamiento quirúrgico de la enfermedad residual tras quimioterapia, de las metástasis pulmonares y cerebrales, y de la absoluta necesidad de radicalidad en la exéresis de los tumores metastásicos tipo trowing teratoma. (AU)

[Should hernioplasty be combined with surgery of the prostate?]. / Se debe practicar la hernioplastia conjuntamente con cirugía de la próstata?

OBJECTIVE: In some patients consulting for a prostatic condition, inguinal hernia might be incidentally discovered during evaluation. The results achieved by simultaneous prostatectomy and hernia repair are presented. METHODS: 52 patients with hyperplasia of the prostate and inguinal hernia underwent treatment for both conditions during the same surgical procedure. Patient ages ranged from 56-88 years. All patients underwent suprapubic prostatectomy and hernia repair. RESULTS: 35 patients had indirect and 17 direct inguinal hernia; 13 were bilateral and 39 unilateral. The hernia had been present from one month of 22 years (mean 46 months). Symptoms related with prostate enlargement had been present from one month to 22 years (mean 40 months). Herniorrhaphy was performed through the inguinal incision in 13 cases, prostatectomy was performed through a midline incision in 50 cases, and the Pfannenstiel incision was utilized in two cases. Pathological analysis showed 49 cases had BPH and 3 had cancer of the prostate. Hernia repair was done using the Bassini procedure in 35 cases, 18 cases had a Mac Vay procedure, preperitoneal herniorrhaphy was performed in one case, and closure and ligation of the sac in 11 cases. There were 15 cases of recurrence (28.8%). CONCLUSIONS: In patients with BPH or prostatic cancer and inguinal hernia, prostatectomy and herniorrhaphy can be performed during the same session without increasing patient morbidity and mortality. Urological surgeons should be familiar with this combined procedure.

Incidentally detected renal angiomyolipoma with tumour thrombus into the inferior vena cava.

A right-renal angiomyolipoma with tumour thrombus into the inferior vena cava was incidentally detected. This is the ninth published case of its type and the second incidental case. Presence of a thrombus does not imply invasive disease, but the tumour then is often bigger than 6 cm and radical surgery is mandatory.

Growing teratoma syndrome: experience of a single institution.

OBJECTIVE: To analyze the clinical outcome of patients diagnosed with growing teratoma syndrome (GTS) at a single center during a long follow-up. PATIENTS AND METHODS: Eleven patients with GTS are reported. GTS lesions were located in the metastatic sites involved at disease presentation. Involved sites were: retroperitoneum in 9 patients; lung in 3; supraclavicular lymph nodes in 2, and inguinal lymph nodes in 1. Surgical resection of the masses was the treatment of choice. RESULTS: Twenty-four surgical procedures were performed: 4 thoracotomies; 2 supraclavicular; 1 inguinal, and 17 retroperitoneal node resections. Three patients have not relapsed since surgery of the masses, at 37+, 110+ and 118+ months. Eight patients have relapsed, 6 with mature teratoma and 2 (22%) with cancer. To date, all the patients are alive, 6 of them without disease and 5 with teratoma after resection of the masses. CONCLUSIONS: GTS is an infrequent entity. Involved sites are only at locations previously affected by the disease. The treatment of choice is surgical resection but recurrence is common. Efforts should be done to complete resection of the masses.

[Cell cycle and carcinogenesis]. / Le cycle cellulaire et la carcinogénèse.

This presentation allows us to understand the terminology used for oncogenesis by Molecular Biology investigators. Thanks to the minute description of the normal physiology of the cell cycle, its regulatory mechanisms and growth stimulating and inhibiting effects, we are able to understand the language used. We are now able to fill the gap in our knowledge and to establish the increasingly necessary relationship between routine practice and Molecular Biology.

Renal abscess due to Aspergillus fumigatus in a patient with the acquired immunodeficiency syndrome.

Disseminated aspergillosis is a systemic fungal infection that may occur in previously healthy or immunocompromised patients. The condition, although rare, is being recognized with increasing frequency in persons with the human immunodeficiency virus. Clinical genitourinary involvement is unusual. We present a case of renal abscess for Aspergillus fumigatus in a patient with acquired immunodeficiency syndrome who complained of flank pain and fever.

[Post-nephrectomy duodeno-cutaneous fistula resolved with parenteral nutrition and octreotide (somatostatin analogue)]. / Fístula duodeno cutánea post-nefrectomía resuelta con nutrición parenteral y Octreotide (análogo de la somatostatina).

After a right nephrectomy of ischemic kidney, a high-output duodenal fistula developed on the third postoperative day. Sixteen days of total parenteral nutrition were unsuccessful, so octreotide (a synthetic analogue of somatostatin) was added (0.1 mg subcutaneously every 8 hours). The output decreased progressively and the fistula closed completely 9 days thereafter.

[Renal angiomyolipoma: diagnostic difficulties and surgical indications in 20 surgically treated patients]. / Angiomiolipoma renal: dificultades diagnósticas e indicaciones quirurgicas en 20 pacientes operados.

Between 1982 and 1993, 6 male and 14 female patients underwent partial or total nephrectomy due to renal angiomyolipoma (AML). Presentation forms were: in 6 cases (30%) acute pain with severe haematuria or signs of visceral bleeding, 3 (15%) acute pain without other symptoms, 7 (35%) chronic pain associated to haematuria or fever, or isolated haematuria, and in 4 (20%) it was a chance finding. No significant differences were found among tumor sizes considering the severity of the presentation form, but all AMLs with serious signs and symptoms had more than 5 cm diameter. A pre-operative diagnosis of AML was made in 15 (75%) patients, while 5 (25%) underwent surgery for other presumed diagnosis. Nine were conservative procedures of renal parenchyma and 11 were total or radical nephrectomies. There were no significant differences between tumour sizes by treatment performed. The authors review the imaging diagnostic difficulties and the various criteria supporting surgery in AML, and conclude by recommending individualized diagnosis and treatment in patients with AML suspicion of including puncture biopsy or cytology when in doubt, trying to avoid surgery in well characterized tumours, under 4 or 5 cm, provided that they could be followed-up regularly.

[From shock-waves even to ureterolithotomy: various practical cases]. / Des ondes de choc jusqu'à l'urétérolithotomie: quelques cas pratiques.

The Puigvert Urology Centre in Barcelona reports the detailed results of five cases of ureteric stones all treated by first-line shock wave lithotripsy. Only one case obtained a positive result (after 4 sessions). In the other four cases, shock wave therapy had to be completed by ureteroscopy (1 case) or by open surgery (3 cases) to achieve cure.

[Cytogenetic characteristics and of primary culture in multiple renal tumors]. / Características citogenéticas y de cultivo primario en tumores renales múltiples.

The incidence of multiple tumours in renal cancer ranges between 1 and 30%. In these cases, it becomes very difficult to differentiate between adenoma and carcinoma just by using conventional methods, particularly in borderline cases. We carried out primary cultures and subsequent cytogenetic studies in 2 patients with multiple renal cancer. Clonal numerical changes in the first case were: 3, 7, 16 and 17 trisomies, chromosome loss; and structural changes, del(1) (p34), del(2) (p16, p22). In the second case, clonal numerical changes were 7 trisomy and tetrasomy and loss of the Y chromosome. Both tumours were cytogenetically characterized as papillary renal tumours. The diagnostic approaches are discussed and the prognosis possibilities evaluated, using this method to evaluate them in multiple renal tumours.