[Urinary diversions and bladder enlargements]. / Derivaciones urinarias y ampliaciones vesicales.

Overall review that offers an integrated insight of the importance and repercussions of urinary by-pass and bladder replacement. Over the last decades there has been a growing interest in the possibility of reconstructing the urinary system and there are now an almost infinite number of surgical solutions. The history of the development of using the intestine for by-passes and the reconstruction of the urinary system is described. The secondary metabolic alterations, the possibility of secondary intestinal tumours and the rudiments of ureterointestinal anastomosis are dealt with. Bladder substitution techniques are highlighted, and the vast experience of the Urology Department of Hospital Miguel Servet explained, including criteria and conclusions that help to choose from the many urological surgery alternatives headed by urinary by-pass and bladder complications.

Derivaciones urinarias y ampliaciones vesicales / Urinary diversion and bladder replacement

Revisión de conjunto que ofrece una visión integrada de la trascendencia y repercusión de las derivaciones urinarias y sustituciones vesicales. Las últimas décadas han estado presididas por un interés creciente en las posibilidades de reconstrucción del aparato urinario y la oferta de soluciones quirúrgicas reconstructivas es prácticamente ilimitada. Se aborda progresivamente la evolución histórica de la utilización del intestino en las alternativas de derivación y reconstrucción del aparato urinario, las alteraciones metabólicas secundarias, la eventualidad de patología tumoral intestinal secundaria y los principios quirúrgicos básicos de las anastomosis ureterointestinales. Se destaca las técnicas de sustitución vesical y se aporta una extensa experiencia del Servicio de Urología del Hospital Miguel Servet con criterios y conclusiones que facilitan la elección entre las múltiples alternativas de cirugía urológica presidida por la derivación urinaria y las ampliaciones vesicales (AU)

[Prostatic rebiopsy. Prognosis factors of the anatomopathologic result]. / Rebiopsia de próstata. Factores pronósticos del resultado anatomopatológico.

The indications for repeat prostate needle biopsy after a previous biopsy are not defined. We examined 107 prostate biopsies (in 98 patients) without a diagnosis of malignancy, which we repeat. Carcinoma was detected in 31 patients (31.6%). We didn't find statistic relationship between the repeat biopsy's outcome and: interval between biopsy and repeat biopsy, PSA value, PSA density (biopsy), PSAD of the transitional area (PSAD ad., on repeat biopsy). We found relationship with: prostatic weight (p = 0.002 on the biopsy, p = 0.0002 on the repeat biopsy), volume of the transitional area (p = 0.02 on the biopsy, p = 0.0001 on the repeat biopsy), PSA value (p = 0.02, on the repeat biopsy), PSAD ad. (p = 0.002, on the repeat biopsy), and with PSA velocity (p = 0.008). We only found clinic usefulness for the PSA velocity: patients with PSA velocity greater than 1 ng/ml/year are at high risk for prostate carcinoma on the repeat biopsy, specially in small prostates.

[Stage pT3 prostatic cancer after radical prostatectomy. Results in progression and survival]. / Cáncer de próstata estadio pT3 tras prostatectomía radical. Resultados en progresión y supervivencia.

PURPOSE: To analyse progression and survival after radical prostatectomy in patients with stage pT3 carcinoma of the prostate. MATERIAL AND METHODS: Between 1986 and November 1998, we performed 372 radical prostatectomies, 74 of which were pT3N0 (19.8%), 43 pT3a and 31 pT3b (TNM 97). RESULTS: In patients with pathological stage pT3, we found any progression in 24 patients (32%), 8 in pT3a, and 16 in pT3b. In 10 of 24 pT3, there was local relapse or distant metastases. About the freedom from biochemical relapse survival rate, we found statistically differences between pT3a and pT3b (p < 0.0001). In pT3a patients, we found no differences between PSA levels > 20 ng/ml, versus < 20 (p = 0.415), and statistically differences between pathological Gleason 6 or greater, versus < 6 (p = 0.048). However, we found no differences when we used both criteria (PSA and Gleason) (p = 0.195). CONCLUSIONS: We support for early adjuvant hormonal therapy in pT3b patients. In pT3a, the hormonotherapy may be used if appears biochemical failure, specially with adverse prognostic factors (PSA and Gleason).

Rebiopsia de próstata. Factores pronósticos del resultado anatomopatológico / Repeat prostate biopsy. Prognostic factors for pathologic outcome

Las indicaciones de repetir una biopsia prostática no están claramente definidas hoy en día.Nosotros revisamos retrospectivamente 107 biopsias prostáticas (en 98 pacientes) sin malignidad histológica, en los cuales la biopsia se repitió. Se detectó cáncer de próstata en 31 pacientes (31,6 por ciento).No encontramos relación estadística entre el resultado de la rebiopsia y: tiempo entre biopsia y rebiopsia, valor de PSA (de la biopsia o de la rebiopsia), PSAD de la biopsia, ni con el PSAD ad. de la rebiopsia. Si observamos relación estadística con: volumen prostático (p = 0,002 en la biopsia inicial, y p = 0,0002 en la última rebiopsia), volumen del adenoma (p = 0,02 en la biopsia inicial, y p = 0,0001 en la última rebiopsia), PSA (p = 0,02) y PSAD ad. (p = 0,002) de la rebiopsia, y con el PSA velocidad (p = 0,008). Sólo encontramos cierta utilidad clínica con éste último parámetro: los pacien-tes con una velocidad de PSA mayor de 1 ng/ml y año poseen alto riesgo de presentar un cáncer en la rebiopsia, especialmente si se trata de próstatas pequeñas. (AU)

[Penile fracture: report of a case]. / Fractura de pene: aportación de un caso.

Traumatic rupture of the corpus cavernosum of the penis is rare, and has been reported infrequently. We present a case with this type of trauma, with immediate surgical management, with good morphologic and functional results.

Cáncer de próstata estadio pT3 tras prostatectomía radical. Resultados en progresión y supervivencia / Prostate cancer stage pT3 after radical protatectomy. Results about progression and survival

OBJETIVOS: Analizar los datos de progresión y supervivencia de los pacientes con cáncer de próstata estadío patológico pT3. MATERIAL Y MÉTODOS: De las 372 prostatectomías radicales realizadas en nuestro Centro hasta noviembre de 1998, encontramos 74 pT3N0 (19,8 por ciento), 43 pT3a y 31 pT3b (TNM 97). RESULTADOS: Observamos hasta el final del seguimiento progresión biológica en 24 pacientes (32 por ciento), 8 en los pT3a, y 16 en los pT3b. En 10 de ellos la progresión fue clínica (local o a distancia).Respecto a los datos de supervivencia libre de progresión biológica, encontramos diferencias estadísticamente significativas entre los pacientes pT3a y pT3b (p < 0,0001). En los pT3a, no hubo diferencias entre los pacientes con PSA preoperatorio menor y mayor de 20 ng/ml (p = 0,415), y diferencias "marginales" según Gleason patológico de 7 o mayor respecto a menor de 7 (p = 0,048), diferencias que desaparecieron al combinar PSA mayor y menor de 20, con Gleason patológico mayor y menor de 6 (p = 0,195). CONCLUSIONES: Creemos apropiado administrar adyuvancia hormonal precoz en los pacientes pT3b, y en los pT3a, debe considerarse la posibilidad de administrar adyuvancia al aparecer progresión biológica, especialmente ante factores pronósticos desfavorables de Gleason patológico y PSA preoperatorio (AU)

Fractura de pene: aportación de un caso / Penile fracture: contribution with a case

La rotura traumática de los cuerpos cavernosos del pene es una urgencia urológica rara. Presentamos un caso de este traumatismo peneano, tratado de forma quirúrgica de urgencia, con buenos resultados morfológicos y funcionales (AU)

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[Predicting factors of tumor organ-confinement in adenocarcinoma of the prostate]. / Factores predictores de organoconfinación tumoral en el adenocarcinoma de próstata.

OBJECTIVE: Difficulties for a precise staging of patients with prostate cancer are huge. This article presents the initial results from a study to investigate the contribution that various clinical and analytical parameters, together with the study of prostate biopsy for staging, could have on our environment. MATERIAL AND METHODS: 70 patients undergoing curative radical prostatectomy were studied through an analysis of their PSA. PSAD, and PSAD ad pre-operative levels and, in the biopsy cylinders, the tumour unilateral or bilateral nature, Gleason grade, percentage and total number of involved cylinders, and percentage of cancer length over the cylinders' total length. This data was then correlated to the pathological stage. Gleason's grade and tumoral volume of the surgical specimen. RESULTS: 97% of patients studied showed clinical organ confinement versus only 64.28% after examination of the surgical specimen. (I Kappa = 0.1). Concordance between the biopsy's Gleason grade and the prostatectomy specimens was moderate (I Kappa = 0.34). Pre-operative PSA showed no statistically significant difference (SSD) between organ-confined and non-organ-confined tumours (p = 0.15), opposite to PSAD (p = 0.039) and PSAD ad (p = 0.038) which did. The tumour's unilateral or bilateral nature in the cylinders, and the total number or percentage of affected cylinders showed no SSD with regard to organ confinement of tumours. Neither the length percentage of the affected cylinders showed SSD in relation to the tumour's organ confinement. The specimen's tumoral volume was significantly correlated to the length percentage of cancer and positive biopsies, as well as with clinical stage, PSA, PSAD, and PSAD ad. CONCLUSIONS: Both PSAD and PSAD ad, and the sum of the biopsy's Gleason may contribute to predict the pathological stage. The percentage and total number of biopsy cylinders affected by the tumour, as well as the total length percentage of cancer affected cylinders are correlated to the tumoral volume but not to the organ confinement of the tumoral disease, not meeting the clinical stage in our patients (selected according to our group's staging algorithm). These findings must be ratified by further study of larger series.

[Quality of life after radical prostatectomy]. / Calidad de vida tras prostatectomía radical.

OBJECTIVE: To evaluate the quality of life of our prostatectomized patients relative to the following factors: continence, mictional quality, sexual potency and psychological repercussion. MATERIAL AND METHODS: The study includes a series of 204 patients undergoing radical prostatectomy between June 1986 and October 1996, where a personal questionnaire was administered to 112 of them. The questionnaire consisted of 25 questions dealing with various aspects related to their quality of life. RESULTS: The overall rating on continence shows the following results: total continence 59.8%, minimal incontinence grade I 17.8%, moderate incontinence grade II 13.3% and total incontinence grade III 8%. Only 2.6% retains sexual potency after surgery. 29.3% of impotent patients consulted for their dysfunction. 91% declared to be satisfied with the results of the surgical procedure. CONCLUSIONS: In our experience, continence (total + grade I incontinence) is acceptable for 77.6%, the level of mictional satisfaction being very high. There is a high index of impotence after surgery. However, most patients appear to be impervious to this fact. Overall, quality of life of our patients has not changed significantly as a result of the intervention.