[Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy]. / Adenocarcinomas minimos de próstata en la biopsia sometidos a prostatectomía radical.

FUNDAMENTALS: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. METHODS: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. RESULTS: In 20 patients (7.6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as "minimal adenocarcinoma". These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng/ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN ?. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN ?), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p = 0.243). SUMMARY: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients.

Adenocarcinomas mínimos de próstata en la biopsia sometidos a prostatectomía radical / Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy

Fundamento: Valoración de datos clínico-patológicos de pacientes sometidos a prostatectomía radical por mínimo adenocarcinoma prostático en la biopsia. Métodos: Análisis retrospectivo de pacientes intervenidos de prostatectomía radical por mínimo adenocarcinoma, frente al resto de prostatectomías radicales. Resultados: En 20 pacientes (7,6 %), de los 260 sometidos a prostatectomía radical entre 1992 y 2004, se definió la biopsia como 'mínimo adenocarcinoma'. Tenían edades entre 58 y 73 años y los PSA entre 5,2 y 17,1 ng/ml. Todos, excepto uno eran clínicamente T1c. En la anatomía-patológica definitiva el Gleason fue de 6, 4, 3 y 2, en 3, 3, 8 y 4 pacientes respectivamente, con uno con mínimo adenocarcinoma no graduado y sólo un PIN-III en otro. Tres presentaron un solo foco con un volumen tumoral inferior al 5% del tejido (el 84,2 % con tumor significativo). El estadio final fue 1 pT0 (PIN III), 7 pT2a, 11 pT2b y 1 pT3a (62,5% bilaterales). Con respecto al resto de pacientes prostatectomizados, los pacientes con mínimo adenocarcinoma presentaron diferencias significativas en los Gleason (p=0,029) y los estadios (p= 0,02); no en la media del PSA (p=0,243). CONCLUSIONES: Los adenocarcinomas de próstata mínimos en la biopsia son significativos, aunque presentan estadios y grados inferiores al resto (AU)

Fundamentals: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. Methods: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. Results: In 20 patients (7,6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as 'minimal adenocarcinoma'. These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng./ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN III. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN III ), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p =0,243). Summary: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients (AU)

[T.V.T. (tension-free vaginal tape). New surgical technique in the treatment of stress urinary incontinence]. / T.V.T. (cinta libre de tensión) nueva técnica quirúrgica para el tratamiento de la incontinencia urinaria de esfuerzo.

OBJECTIVES: To describe the tension-free vaginal tape procedure (TVT) for treatment of female stress urinary incontinence and the short-term results. METHODS/RESULTS: From November 1998 to May 1999, the TVT procedure was performed in 20 patients with genuine stress urinary incontinence. All patients had a bladder catheter for 24 hours after surgery. Only one patient required intermittent catheterization for one month due to high quantities of post-void residual urine. There were no intraoperative complications. Early postoperatively one patient presented a hematoma in the posterior rectal aspect which was managed conservatively. At 4.5 months mean follow-up, 95% of the patients are continent and one is incontinent due to incorrect positioning of the prolene band. CONCLUSIONS: Although the initial results appear to be encouraging, further studies are warranted to determine the long-term efficacy of this technique.

[Injection of autologous fatty tissue in the bladder submucosa: experimental study in swine]. / Inyección en la submucosa vesical de tejido graso autólogo: estudio experimental en suidos.

The results achieved by the use of inert materials via endoscopic injection for the treatment of urological pathologies have been disappointing. Furthermore, these materials are costly, carry the risk of migration and may not be tolerated locally. Autologous fatty tissue, however, is not costly and is tolerated better. The authors have conducted an experiment in the pig to evaluate the degree of resorption and persistence of autologous fat injected into the bladder submucosa. The results show that submucosal injection of autologous fat acts like an autograft and persists as mature fatty tissue. The degree of resorption and/or steatonecrosis is directly related to the amount injected; the smaller the amount used the better the results.

[Treatment of urinary stress incontinence using paraurethral injection of autologous fat]. / Tratamiento de la incontinencia urinaria de esfuerzo mediante la inyección parauretral de grasa autóloga.

The authors present the late results (greater than 1 year) in the treatment of urinary incontinence in 15 women with stress urinary incontinence and 5 men with post-adenomectomy incontinence using endoscopic injection of autologous fat tissue obtained by microliposuction. Good results were achieved in 23% of the cases with stress urinary incontinence and in 0% of those with post-adenomectomy incontinence. Although the results are disappointing, they are not very different from those obtained with teflon injection. Furthermore, the technique is simple, has no complications and it costs very little to obtain the autologous graft material. A historical review of free fat grafting and injection of liposuction fatty tissue is performed and the hypotheses that have been put forward recently relative to the fate of the fat graft are discussed.

[A new pathology: unstable urinary bladder (author's transl)]. / Una nueva patología: la vejiga inestable.

Thirty-five cases of incontinence of urine due to hyperactivity of the detrusor as a result of unstable urinary bladder were found among 100 patients with incontinence. The cause of the hyperactivity was established after a thorough urological and neurological screening with intravenous urography, seriated mictional cystoureterography, cystoscopy, and urine culture. The diagnosis was considered definite if uninhibited contractions of the detrusor were detected by electrocystomanometry. The primary clinical symptom was an imperious urge to mi-turate, with or without leakage of urine. Diurnal and nocturnal frequency was exacerbated in cold weather and in contact with water. There were some instances of a history of late enuresis and association with cystoceles. Anticholinergics (propantheline bromide) are the treatment of choice. Surgery should be indicated only after all medical attempts have failed.