[Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.] / Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva.

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz.MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p<0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG.

Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva / Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS

Primary and metastatic renal hemangiopericytoma.

OBJECTIVE: Haemangiopericytoma is an uncommon perivascular tumor that occurs more frequently in soft tissues and is extremely rare in the kidney. METHODS: We report two cases: The first one is the case of a 57-year-old man with bilateral metastatic renal haemangiopericytoma which appeared 18 years after removal of a meningeal haemangiopericytoma. The second is a 29-year-old woman with a primary kidney haemangiopericytoma that was casually found in a nephrectomy piece. RESULTS: In the first case, radical left nephrectomy and right renal mass radiofrequency ablation were performed. The patient had an uneventful postoperatory recovery. He remained disease-free 22 months after surgery but two new lesions appeared that were treated with radiofrequency ablation. The second case was a casual finding, a small tumor that had been totally resected. CONCLUSIONS: Haemangiopericytoma is a rare tumor with an uncertain clinical behaviour. Long-term follow up is important as local recurrences and metastases can develop years after initial treatment.

Hemangiopericitoma renal primario y metastásico / Primary and metastatic renal hemangiopericytoma

OBJETIVO: El hemangiopericitoma es un raro tumor perivascular que aparece sobre todo en los tejidos blandos y que es muy inusual en el riñón. MÉTODO: Se describen dos casos. Caso 1: Varón de 57 años con un hemangiopericitoma renal bilateral metastásico que tuvo lugar 18 años después de la exéresis de un hemangiopericitoma meníngeo. Caso 2: Mujer de 29 con un hemangiopericitoma renal primario hallado de forma casual en la pieza de nefrectomía por una pionefrosis. RESULTADOS: En el primer caso se realizó una nefrectomía radical izquierda y ablación con rediofrecuencia de la masa renal derecha. El postoperatorio cursó sin complicaciones y no hubo signos de enfermedad durante 22 meses, hasta que aparecieron nuevas lesiones en riñón derecho, que fueron tratadas nuevamente con radiofrecuencia. El segundo caso fue un tumor de hallazgo casual, de escaso tamaño y totalmente resecado en la pieza quirúrgica. CONCLUSIONES: El hemangiopericitoma es un tumor raro y de comportamiento incierto, que requiere un seguimiento a largo plazo. La recidiva local y las metástasis pueden aparecer años después del tratamiento del tumor primario

OBJECTIVE: Haemangiopericytoma is an uncommon perivascular tumor that occurs more frequently in soft tissues and is extremely rare in the kidney. METHODS: We report two cases: The first one is the case of a 57-year-old man with bilateral metastatic renal haemangiopericytoma which appeared 18 years after removal of a meningeal haemangiopericytoma. The second is a 29-year-old woman with a primary kidney haemangiopericytoma that was casually found in a nephrectomy piece. RESULTS: In the first case, radical left nephrectomy and right renal mass radiofrequency ablation were performed. The patient had an uneventful postoperatory recovery. He remained disease-free 22 months after surgery but two new lesions appeared that were treated with radiofrequency ablation. The second case was a casual finding, a small tumor that had been totally resected. CONCLUSIONS: Haemangiopericytoma is a rare tumor with an uncertain clinical behaviour. Long-term follow up is important as local recurrences and metastases can develop years after initial treatment

[Squamous cell carcinoma in a duplicated renal pelvis after percutaneous nephrolithotomy]. / Carcinoma de células escamosas en pelvis renal bífida, tras nefrolitotomía percutánea.

OBJECTIVE: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplicated renal pelvis, after percutaneous nephrolithotomy. METHODS/RESULTS: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recurrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis. CONCLUSIONS: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicious lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival.

Carcinoma de células escamosas en pelvis renal bífida tras nefrolitotomía percutánea / Squamous cell carcinoma in a duplicated renal pelvis after percutaneous nephrolithotomy

Objetivo: Describir un caso clínico de un paciente que presenta un carcinoma de células escamosas en una pelvis renal bífida, tras la realización de una nefrolitotomía percutánea. Métodos/Resultados: Paciente varón de 68 años de edad, diagnósticado de carcinoma escamoso de pelvis renal, tras el estudio histológico de una nefrectomía polar inferior posterior a una nefrolitotomía percutánea por una litiasis coraliforme en hemirriñón izquierdo. El paciente sufrió una recidiva vesical un año y medio más tarde, se practicó una cistoprostratectomía radical, pero el fallecimiento se dio a los pocos meses ante la presencia de metástasis. Conclusiones: El carcinoma de células escamosas de pelvis renal, es un tumor raro y de mal pronóstico, generalmente asociado con enfermedad litiásica e infección crónica. La realización de biopsias de zonas sospechosas durante la nefrolitotomía percutánea puede ayudar al diagnóstico precoz del tumor, con la consiguiente mejoría de la supervivencia (AU)

Objective: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplicated renal pelvis, after percutaneous nephrolithotomy. Methods/Results: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recurrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis. Conclusions: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicious lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival (AU)

Metástasis cutánea solitaria de carcinoma vesical / Solitary skin metastasis from a bladder carcinoma

Las metástasis cutáneas del carcinoma urotelial de vejiga son muy raras, se relacionan con estadios avanzados de la enfermedad y tiene un pronóstico desfavorable con baja tasa de supervivencia. Se presenta un caso de metástasis cutánea posterior a manipulación urológica en un paciente con un carcinoma vesical infiltrante metastático a otros órganos y con desfavorable respuesta al tratamiento. Se discute el caso y se revisa la literatura (AU)

Cutaneous metastases from urothelial carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. We report one case of cutaneous metastasis appearing after urological manipulation in a patient with bladder muscle invasive carcinoma, with other metastatic sites and poor response to treatment. The case is discussed and literature is reviewed (AU)

[Solitary skin metastasis from a bladder carcinoma]. / Metástasis cutánea solitaria de carcinoma vesical.

Cutaneous metastases from urothelial carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. We report one case of cutaneous metastasis appearing after urological manipulation in a patient with bladder muscle invasive carcinoma, with other metastatic sites and poor response to treatment. The case is discussed and literature is reviewed.

[Renal hydatidosis]. / Hidatidosis renal.

OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment. METHODS: The characteristics of the case are presented and discussed. RESULTS AND CONCLUSIONS: The hydotic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all visceral localitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult.

Hidatidosis renal / Renal hydatidosis

OBJETIVO: Nuestro objetivo es comunicar un nuevo caso de hidatidosis renal y su tratamiento. MÉTODOS: Realizamos una presentación y comentarios de las características del caso clínico. RESULTADOS/CONCLUSIONES: La hidatidosis es una parasitosis causada por la larva del echinococcus granulosus. De todas las localizaciones viscerales, el riñón ocupa el tercer lugar, encontrándose afectado tan sólo en un 2% a 4% de los casos. La mayoría de los pacientes permanecen asintomáticos durante años, siendo difícil establecer un correcto diagnóstico preoperatorio

OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment. METHODS: The characteristics of the case are presented and discussed. RESULTS AND CONCLUSIONS: The hydatic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all visceral localitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult

[Pelvic recurrence after radical cystectomy for bladder cancer]. / Recidiva pelviana despues de cistectomia radical por cancer vesical.

OBJECTIVES: We report the case of a male patient who had undergone radical cystectomy and orthotopic neobladder for bladder cancer presenting with local recurrence eight months later. METHODS: Diagnostic tests included CT scan and ultrasound guided transrectal biopsy RESULTS: With the diagnosis of local recurrence he underwent chemotherapy and radiotherapy CONCLUSIONS: The pelvic recurrence of transitional cell carcinoma after radical cystectomy is rare and prognosis is poor. It is frequently associated with advanced tumor stage. It should be treated by a multidisciplinary approach.

Recidiva pelviana después de cistectomía radical por cáncer vesical / Pelvic recurrence after radical cystectomy for bladder cancer

OBJETIVO: Presentamos un caso de unvarón sometido a cistectomía radical con neovejiga ortotópicapor cáncer vesical, con recurrencia local desarrolladoa los 8 meses.MÉTODO: Los estudios diagnósticos incluyen TAC y biopsiatransrectal ecodirigida.RESULTADO: Con el diagnóstico de recurrencia local, fuetratado con quimioterapia y radioterapia.CONCLUSIONES: La recurrencia pélvica por carcinomatransicional después de cistectomía radical, es infrecuentey con pobre pronóstico. Está frecuentemente asociado conestadio tumoral avanzado. Debe ser tratado con abordajemultidisciplinario

OBJECTIVES: We report the case of a male ;;patient who had undergone radical cystectomy and ;;orthotopic neobladder for bladder cancer presenting with ;;local recurrence eight months later. ;;METHODS: Diagnostic tests included CT scan and ;;ultrasound guided transrectal biopsy. ;;RESULTS: With the diagnosis of local recurrence he ;;underwent chemotherapy and radiotherapy. ;;CONCLUSIONS: The pelvic recurrence of transitional cell ;;carcinoma after radical cystectomy is rare and prognosis is ;;poor. It is frequently associated with advanced tumor ;;stage. It should be treated by a multidisciplinary approach