Hormone sensitive protocol for metastatic prostate cancer, an update.

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.

[Granulomatous orchitis]. / Orquitis granulomatosa.

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.

[Giant renal angiomyolipoma]. / Angiomiolipoma renal gigante.

OBJECTIVE: To present a cae of giant renal angiomyolipoma that required surgical treatment owing to its size and concomitant intratumoral hemorrhage. METHODS: The characteristics of the case are presented and discussed. RESULTS/CONCLUSIONS: Giant renal angiomyolipoma is one of the most frequent causes of Wünderlich syndrome and is diagnosed by ultrasound and CT. The decision to operate is based on the size of the lesion and/or symptomatology, as in the case described herein, which required a simple nephrectomy.

[Intestinal obstruction secondary to peritoneal carcinomatosis after iatrogenic perforation during TUR for transitional cell carcinoma of the bladder]. / Obstrucción intestinal secundaria a carcinomatosis peritoneal tras perforación yatrogénica durante RTU de carcinoma de células transicionales de vejiga.

OBJECTIVE: A case of intestinal obstruction following transurethral resection (TUR) of a locally advanced transitional cell carcinoma of the bladder is presented. METHODS/RESULTS: The unique features of the present case are described. Laparotomy was performed and peritoneal carcinomatosis was found. Renal function became impaired and the abdominal condition persisted. The patient died five days postoperatively. CONCLUSIONS: Intestinal obstruction following TUR of transitional cell carcinoma of the bladder is an uncommon complication that is mainly due to peritoneal seeding following iatrogenic perforation of the tumor or the bladder wall during resection. Still, TUR is undeniably useful in the diagnosis, staging and treatment of bladder neoplasm.

[Self-expanding metallic endoprosthesis in the treatment of recurrent ureteral stenosis]. / Endoprótesis metálicas autoexpandibles en el tratamiento de las estenosis ureterales recidivantes.

OBJECTIVE: To describe two cases of recurrent fibrotic stricture of the uretero-vesical junction treated with a metallic self-expanding endoprosthesis which has successfully achieved patency of the stenotic area in the medium-term. METHODS: Two cases of difficult ureteral stricture are described. Both cases presented obstruction of the terminal ureter by abundant fibrotic tissue in the bladder wall following radical prostatectomy in one case and TUR in the other for non-infiltrating bladder carcinoma. Several attempts to recover patency by endoscopic resection and placement of a double-J stent in these patients had previously failed. The patients were therefore submitted to resection of the fibrotic area and insertion of a self-expanding endoprosthesis (Wallstent), which was eventually enclosed by fibrous tissue at its vesical portion. Both cases underwent resection again and another endoprosthesis (Memotherm) was inserted to extend the previous prosthesis 1 cm within the bladder lumen. RESULTS/CONCLUSIONS: When the endoprosthesis is placed in the uretero-vesical junction with its tip flush with the bladder wall, it is eventually enclosed by fibrous tissue, which invariably leads to recurrent obstruction. We have found that extending the prosthesis 1 cm within the bladder lumen can overcome the foregoing complication, although the long-term results have as yet to be established.

[Renal carcinoma revealed by sternal metastasis and posterior contralateral adrenal metastasis]. / Carcinoma renal descubierto por metastásis esternal y posterior metástasis adrenal contralateral.

We report a exceptional case of renal cell carcinoma whose first manifestation was bone metastases located in the sternum. Three years after radical nephrectomy solitary contralateral adrenal metastasis appeared. Exeresis bone metastasis, radical nephrectomy and adrenalectomy were performed. The patient is alive with no evidence of disease with hormonal substitute treatment 5 years and 2 months after esternal metastasis exeresis and 1 year and 3 months after right adrenalectomy.