[Final results of complete hormone blockade versus monotherapy in prostatic metastatic cancer. PSA implications]. / Resultados definitivos del bloqueo hormonal completo versus monoterapia en el cáncer de próstata metastásico. Implicaciones del PSA.

Of 102 patients with metastatic prostate cancer, 52 were treated with orchidectomy and 50 with CHB; 22 of these received a LHRH analog + Flutamide and 28 orchidectomy + Flutamide. No differences were seen in either arm in terms of age (69.9 vs 70.2 years) or initial PSA (493.3 vs 486.5 ng/ml) variables. After three months treatment, CHB achieved a decrease of PSA higher than monotherapy (52.9 vs 34.5 ng/ml) p<0.01 as well as minimum PSA level during follow-up (41.2 vs 17.5 ng/ml) (p<0.001). Initial clinical response rates were higher in the group treated with complete blockade (42.3% vs 52%) (p=n.s.). Overall, no significant differences were seen between the actuarial curves of biological progression, clinical progression and survival, with expected mean values of 13 vs 12, 14 vs 15 and 34 vs 28 months, respectively. However, when survival was considered as a function of bone disease dissemination, a greater survival rate was seen in patients with minimal M1 disease (p<0.05), and there were no differences between the M2 and M3 arms.

[Spontaneous bladder rupture secondary to urinary tuberculosis]. / Rotura vesical espontánea secundaria a tuberculosis urinaria.

Atraumatic spontaneous vesical fracture is an uncommon occurrence. Here we present the case of a female patient with spontaneous vesical fracture secondary to urinary tract tuberculosis. A review of current literature showed another published case similar to ours. A brief comment is made on presentation signs and symptoms and picture evolution, as well as a discussion on the predisposing factors of spontaneous vesical fracture and its treatment.

[Anuria secondary to perianeurysmal fibrosis]. / Anuria secundaria a fibrosis perianeurismática.

Presentation of one case of obstructive anuria secondary to perianeurysmal retroperitoneal fibrosis (PRF). Diagnosis was confirmed by abdominal ultrasound and CAT. The condition's initial treatment consisted in bilateral percutaneous nephrostomy. Following clinical stabilization of the patient, surgical resection of aorta aneurysm and ureterolysis with bilateral intraperitonealization was performed. A revision of the specific literature revealed 17 cases similar to ours. Clinical, diagnostic, and pathophysiologic aspects as well as recommended therapeutical procedures are analyzed.

[Leukemoid reaction and thrombocytosis in bladder sarcoma]. / Reacción leucemoide y trombocitosis en sarcoma de vejiga.

Presentation of one case of a patient with vesical sarcoma with sustained high white blood cells and platelets plasma levels over the course of the disease. In the absence of fever and with a persistently negative blood culture, the situation was rated as a leukaemoid reaction and thrombocytosis of para-renoplastic nature. A brief comment on the features and evolution of this para-neoplastic syndrome and the outcome of the patient with vesical sarcoma is included.

[Prostate-specific antigen as an evaluation method in the treatment of hormone-refractory cancer of the prostate]. / El antígeno prostático específico como método de evaluación en el tratamiento del cáncer de próstata hormonorrefractario.

Out of 62 patients with hormone-refractory metastatic prostate cancer, 34 received rescue treatment with estramustine phosphate and 28 received non-steroidal symptomatic treatment. All patients undergoing symptomatic treatment experienced increased PSA levels while in 16 (47%) patients treated with estramustine phosphate, PSA decreased between 13-96%. In 11 cases (32.3%) the decline in PSA was higher than 50%. In 5 (14.7%) the decline was lower than 50% and in 18 cases (53%) PSA levels were increased. SCR rate was 82%, 60% and 6% respectively while OCR were 36.4%., 0% and 0% respectively. No clinical response was seen in patients undergoing symptomatic treatment. A decline in PSA levels higher than 50% 12 weeks after treatment appears to be a "good prognosis" factor related to the best clinical response rates and survival.

[The concept of biologic progression in metastatic cancer of the prostate hormonally treated]. / El concepto de progresión biológica en el cáncer de próstata metastásico tratado hormonalmente.

A total of 110 patients with hormone-treated metastatic prostate cancer were monitored quarterly with serial PSA determinations. At the first control, 6 patients had progressed clinically, 5 of which had decreased PSA ranging between 9-77%. After a period of response, 69 patients progressed clinically, of which 1 showed no elevation of PSA levels, 14 showed progression concurrent with PSA increase, and 54 showed a period of gradual elevation of PSA over a range of 2-31 months. The probability of biological progression when the first rise occurred ranged between 72-96%, which after a second increase ranged between 92-100%, and all patients with three consecutive increases progressed clinically.

[A vesicoileal fistula secondary to bladder cancer]. / Fístula vésico-ileal secundaria a cáncer de vejiga.

Exposition of one case of vesico-ileal fistula with atypical presentation and infrequent etiology, secondary to transitional cell vesical carcinoma. The incident is exploited to review the etiology of acquired enterovesical fistulae.

[The clinical and prognostic value of inversion of the PSA/PAP ratio in prostatic cancer]. / Valor clínico y pronóstico de la inversión del cociente PSA/PAP en el cáncer de próstata.

The inversion of PSA/PAP ratio is not common in patients with prostate cancer. Of 215 patients, 7 showed PSA levels below those of PAP (3.2%). All patients had metastatic disease at the time of diagnosis, 57% in multiple organs and tissues, with a Gleason value in all cases 4. Forty-three percent showed no early response to hormone therapy; mean survival interval recorded in these 7 patients was 21 months. Such a situation may suggest a poor prognosis for this neoplasia.

[PSA in women. Evaluation of its determination with polyclonal and monoclonal immunoassay]. / El PSA en mujeres. Evaluación de su dosificación mediante inmunoanálisis policlonal y monoclonal.

PSA concentrations were measured in 421 women. In a first group comprising 309 subjects, the assay was carried out with kits containing polyclonal antibodies (PPSA). In the second group with 112 women, the assays used kits containing polyclonal antibodies (PPSA) and kits containing monoclonal antibodies (MPSA), and results obtained with both assays were compared. In the first group PSA levels higher than 0.4 ng/ml were detected in 47.9%. In the second group concentrations higher than 0.4 ng/ml were detected in 52.7% when using PPSA versus 16.7% when using MPSA. The rate of PSA detectable levels in healthy women, with benignant and malignant conditions was 36.7, 42.1 and 84.4% for PPSA, and 16.7, 14.0 and 21.9 for MPSA. This study shows that it is possible to detect PSA levels in women, and that this is more frequent when using a polyclonal antibodies assay.

[Intravesical foreign body. Post-traumatic migration of autologous bone fragment]. / Cuerpo extraño endovesical. Migración postraumática de fragmento óseo autólogo.

We report on a 24-year-old female patient with posttraumatic migration of a bony fragment from the site of the fracture to the bladder. The foreign body was removed from the bladder by endoscopy. The etiopathogenic mechanism, clinical signs, diagnostic method and therapeutic management are discussed.

[The urological complications of anticoagulant therapy]. / Complicaciones urológicas de la terapéutica anticoagulante.

Patients on anticoagulant therapy may develop urologic complications, the most common being hematuria. Other less common but more severe complications are spontaneous hemorrhage arising from urological structures, as spontaneous perirenal hematoma, or from extra-urological structures, such as the iliac psoas muscle or the anterior rectus abdominis muscle. We report on four patients on anticoagulant therapy for different reasons, with no previous history of trauma, who suddenly developed spontaneous bleeding with urologic consequences: spontaneous perirenal hematoma (2), hematoma of the iliac muscle (1) and the anterior rectus abdominis muscle (1). The diagnostic strategy, the usefulness of the different imaging techniques and our approach to these complications are discussed.

[Spontaneous perirenal hematoma secondary to hydronephrosis in pelvic kidney]. / Hematoma perirrenal espontáneo secundario a hidronefrosis en riñón pelvico.

Contribution of one case of Spontaneous Perirenal Haematoma (SPH) secondary to hydronephrosis accompanied by lithiasis in pelvic kidney. SPH can result from multiple causes, the most frequent ones being renal tumours, most particularly angiomyolipoma and hypernephroma. Hydronephrosis is an uncommon cause of SPH, and very few cases are described in the literature. The present paper addresses the diagnostic usefulness of the various radiological tests as well as the therapeutical approach to be followed.

[Impact of specific prostatic antigen on the rationalization of the use of bone gammagraphies in the follow-up of hormone-treated non- metastatic prostatic cancer]. / Impacto del antígeno prostático específico en la racionalización del consumo de gammagrafías oseas en el seguimiento del cancer de próstata no metástasico tratado hormonalmente.

Analysis of the evolution of 78 patients with hormonally-treated non-metastatic prostate cancer. During an average follow-up of 62.3 months, local clinical and metastatic progression in 14.1% and 7.7% cases, respectively, was observed. Overall, PSA detected progression of disease in 94.1% cases, with an anticipation which range between 4 and 52 months. Evidence of bone metastatic progression was confirmed in 2.1% of the 286 scintigraphies performed. Following analysis of results, by accepting their indication from a PSA level higher than 100 ng/ml, 97.9% would have been avoided, achieving a 100% sensitivity and 94.1% diagnostic efficacy.

[Appendico-vesical fistula secondary to acute appendicitis. Review of the literature]. / Fístula apendicovesical secundaria a apendicitis aguda. Revisión de la literatura.

Acute appendicitis, particularly pelvic, may cause a suppurative process that spontaneously drains to the bladder and an appendicovesical fistula may result. The pelvic appendix and the bladder may occasionally become fused in an inflammatory and necrotic focus, directly creating a fistula. A case of vesicointestinal fistula secondary to appendiceal pelvic peritonitis is described and the cases reported in the literature are reviewed.

[Bladder inverted papilloma. Can it be considered as a neoplasm with low degree of malignancy?]. / Papiloma invertido vesical. Se puede considerar una neoplasia de bajo grado de malignidad?

We report a case of inverted papilloma of the bladder. The clinical features, diagnosis and treatment of this tumor type are discussed. We underscore the histology and histogenesis of the two types: trabecular inverted papilloma and glandular inverted papilloma. A review of the literature has shown that inverted papillomas do not show clinical or histological features of malignancy most of the time. The cases with synchronous or metachronous association with transitional cell carcinoma, recurrence or histologic signs of malignant transformation of a lesion may be considered to have a neoplasm of low grade malignancy and these patients must be followed closely.

[Does transurethral resection cause metastatic dissemination of hormone treated prostatic cancer?]. / Produce la RTU diseminación metastásica en el cáncer de próstata tratado hormonalmente?

The evolution of non-metastatic prostate cancer treated with hormonal therapy does not appear to be affected by the performance of a transurethral resection (TUR) as a measure to expedite the common urinary tract. Of 82 patients followed for an interval ranging from 6 months to 15 years, 3 of 45 patients (6.7%) undergoing RUT experienced metastatic dissemination, while the same happened in 2 of 37 (5.4%) patients who did not undergo RUT, p being NS. The group of patients requiring RUT, however, experienced higher local progression rates, 22.2% vs 5.4%, a situation not ascribable to the RUT procedure but to the fact that such surgery was selectively indicated in neoplasias with larger tumoral mass.

[Clinical course of hormone refractory cancer of the prostate]. / Evolución del cáncer de próstata hormonorrefractario.

Analysis of the clinical progression of 61 patients with prostate cancer undergoing hormone therapy. PSA allowed early detection in 86.9% cases. In 25 patients no rescue treatment was instituted, and 36 patients were treated with estramustine phosphate resulting in decreased PSA levels in 58% and objective response in 36%. Of these, 82% showed decreased PSA levels for over six months. Survival rate was higher in respondent, treated patients and comparable in non-respondents, treated versus non treated patients.

[Spontaneous perirenal hematoma]. / Hematoma perirrenal espontáneo.

We report 10 cases of spontaneous perirenal hematoma that had been treated from 1974 to 1992. Retroperitoneal hemorrhage was secondary to renal disease in 7 cases, perirenal in 2 and extrarenal in 1. The etiology of the condition is analyzed in detail and the diagnostic usefulness of the different radiologic examinations are discussed. Making a preoperative diagnosis permits a more adequate surgical strategy.

[Wunderlich syndrome secondary to the rupture of an aneurysm of the renal artery. Review of the literature]. / Síndrome de Wunderlich secundario a rotura de aneurisma de la arteria renal. Revisión de la literatura.

We report a case of Wunderlich's syndrome secondary to spontaneous rupture of a renal artery aneurysm. Wunderlich's syndrome, also called spontaneous perirenal hematoma, may arise from several causes, the most common being renal tumors, particularly angiomyolipoma and hypernephroma. Spontaneous perirenal hematoma secondary to a ruptured renal artery aneurysm is rare and very few cases have been reported in the literature. We discuss the usefulness of the different noninvasive imaging techniques (US, CT and arteriography), our therapeutic approach and those advocated by others.

[Complete hormonal blockade vs. monotherapy in the management of metastasizing prostatic cancer]. / Bloqueo hormonal completo versus monoterapia en el tratamiento del cáncer de próstata metastásico.

Evaluation of results obtained in 70 hormone-treated patients with disseminated prostate cancer. Thirty-six of them were treated via orchiectomy and 34 received also flutamide. Initial objective response rates were 47% in the monotherapy group versus 58% for those undergoing complete blockade. Decrease of PSA and PAP was also higher in the group given flutamide. Nonetheless, no significant changes were observed with regard to biological and clinical progression or patients survival.