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)

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.

[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.

Treatment of stage I testicular tumours.

Between 1980 and 1989, 138 patients with stage I carcinoma of the testes were treated and followed up; 81 patients had seminoma and 57 had non-seminomatous tumours. Between January 1980 and December 1983, patients with seminoma were treated by orchiectomy, followed by complementary radiotherapy to aortic and ipsilateral pelvic nodes. Retroperitoneal lymph node dissection (RPLND) was performed in patients with non-seminomatous tumours. After January 1984 the treatment strategy was changed and orchiectomy was followed by a surveillance policy in all histological types. In seminoma patients, 1 of 36 patients (3%) treated with complementary radiotherapy and 5 of 45 (11%) on the surveillance policy relapsed. All achieved a complete response after chemotherapy. In non-seminomatous tumours, 3 of 21 patients (14%) treated with complementary lymphadenectomy relapsed, in contrast to 11 of 36 (31%) surveillance policy patients. All patients who relapsed obtained a complete response with chemotherapy. All patients are currently free of disease. There were no differences in survival between both treatment policies. We conclude that a wait and see policy in stage I testicular tumours is feasible and provides the same results as more interventionist practices.

[Gastrocystoplasty for renal insufficiency in adults]. / Gastrocistoplastia en el adulto por insuficiencia renal.

Vesical substitution or augmentation with various segments from the gut is a frequent occurrence in urology. In the presence of normal renal function there are few or no metabolic disorders. In the presence of renal failure the most suitable gut segment is the stomach due to its characteristics of Cl- and ammonium excretion, smaller mucus formation, acid pH provided to the urine and because it allows easy ureteral regrafting. This article contributes one case of gastrocystoplastia in a patient with trigonal bladder and chronic renal failure, presenting reno-vesical TB.

[Carcinosarcoma of the prostate. Immunophenotype, morphologic course and clinico-pathologic differential diagnosis]. / Carcinosarcoma de la próstata. Inmunofenotipo, evolución morfológica y diagnóstico diferencial clínico-patológico.

The observation of a patient with a malignant tumor of the prostate initially classified as adenocarcinoma with desmoplasia, reclassified as adenocarcinoma with a malignant spindle cell component of uncertain cell line following two large tumor recurrences over a period of 4 months, and subsequently as carcinosarcoma with heterologous mesenchymal areas has prompted us to review the 11 reported cases of prostatic carcinosarcoma and the diagnostic algorithm of the proliferative processes of the prostate with elongated cells in order to recognize (from the histological features and the inclusion and exclusion immunophenotypes) the pseudosarcomatous stromal reactions, fusicellular changes of the carcinoma, benign and malignant phyllodes tumors and carcinosarcoma.

Intensive chemotherapy in poor-prognosis nonseminomatous germ cell tumors of the testis.

Forty-one patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) of the testis were treated between 1980 and 1989. This group was defined by the presence of one of the following features: multiple large lung metastases, bone, liver or brain metastases, abdominal mass greater than 10 cm, abdominal mass greater than 5 cm with high serum concentration of the tumor markers [alpha-fetoprotein (alpha FP) greater than 500 kU/l or beta-subunit of human chorionic gonadotropin (beta HCG) greater than 1,000 IU/l) or very high serum tumor marker concentrations (alpha FP greater than 5,000 kU/l or beta HCG greater than 10,000 IU/l). The first 21 patients were treated with cisplatin, vinblastine, bleomycin (PVB) chemotherapy and the following 20 with an intense, alternating 6-drug chemotherapy consisting of cisplatin, bleomycin, vincristine, methotrexate, etoposide and ifosfamide (BOMP/EPI). Surgery of residual masses was performed when tumor markers were negative. Fifteen patients (71.4%) in the PVB group and 18 patients (85%) in the BOMP/EPI group remained disease-free at a median follow-up of 67 and 41 months, respectively. None of the resected masses in the BOMP/EPI group contained malignant disease whereas viable carcinoma was found in 5 of 14 (26.4%) patients in the PVB group. The toxicity of the BOMP/EPI regimen was severe but tolerable. Intensive chemotherapy regimen seems to be useful in this subset of patients, but randomised prospective trials comparing these with standard chemotherapy are necessary.

[Filling defects in the upper urinary tract: update on the etiologic diagnosis and review of the specific value of urinary cytology]. / Defectos de repleción en vía urinaria alta: actualización del diagnóstico etiológico y revisión del valor específico de la citología urinaria.

We present 3 cases with upper tract filling defect and exfoliative cytology positive for malignant cells in 2 of these cases (micturition and via ureteral catheter, respectively). The initial suspicion of urinary tract tumor was discarded by subsequent work up in 2 patients who were managed conservatively and followed closely. The third patient was submitted to nephroureterectomy. The histopathological examination disclosed chronic pyelonephritis and a deposit of amorphous mucoid material but no evidence of tumor. We review the etiologies of upper tract filling defects and present a useful diagnostic algorithm for the study of these conditions and the etiopathogenic and physiopathologic evaluation of the false positives in urinary cytology.

[English and Spanish nomenclature of catheters and other urological instruments]. / Sobre la nomenclatura en inglés y castellano de sondas y otros instrumentos urológicos.

We analyze names given to urologic devices that are apparently similar in English and Spanish but with different meanings. The translation of the commonest terms for instruments and some problematic words are reviewed. Although some of the equivalents are a convention, it is interesting to know the more widely used nowadays.