[Granulomatous pneumonitis secondary to BCG bladder instillation]. / Neumonitis granulomatosa por instilación endovesical de BCG.

We report two cases of pulmonary BCG-induced pneumonitis recently diagnosed amongst our patients. The first case is a 81 year old man under BCG bladder instillation treatment because of high grade superficial bladder cancer who developed a severe interstitial granulomatous pneumonitis. The patient was treated with corticosteroids and tuberculostatics with a rapid and complete response. The second patient is a young man who presented only with persistent fever and also had a complete response after treatment.

Neumonitis granulomatosa por instilación endovesical de BCG / Granulomatous pneumonitis secondary to BCG bladder instillation

Presentamos dos casos de afectación pulmonar por BCG diagnosticados recientemente en nuestro servicio. Un primer paciente varón de 81 años de edad que desarrolló un cuadro de neumonitis intersticial granulomatosa severa en el contexto de un tratamiento mediante instilación endovesical de BCG por tumor vesical de alto grado. Este paciente fue tratado mediante corticoterapia y triple asociación de antituberculosos con una respuesta rápida y completa. El segundo caso fue un hallazgo radiológico en un paciente de 56 años que presentaba fiebre persistente como único síntoma y que mejoró tras iniciar doble asociación de tuberculostáticos

We report two cases of pulmonary BCG-induced pneumonitis recently diagnosed amongst our patients. The first case is a 81 year old man under BCG bladder instillation treatment because of high grade superficial bladder cancer who developed a severe interstitial granulomatous pneumonitis. The patient was treated with corticosteroids and tuberculostatics with a rapid and complete response. The second patient is a young man who presented only with persistent fever and also had a complete response after treatment

[Burn out bilateral testicular tumor]. / Tumor testicular bilateral "quemado" ("burn out").

UNLABELLED: Differentiating a primary retroperitoneal seminoma from a metastatic testicular tumor with an occult testicular primary or a burned out testicular cancer remains difficult. We present a case of a burned out tumor. The patient had a retroperitoneal seminoma with ultrasonically and pathologically demonstrated abnormalities in both testes, but without evidence of tumor. The patient received chemotherapy and underwent surgery of the residual retroperitoneal mass and bilateral orchiectomy. All surgical specimens were negative for testis cancer. CONCLUSION: Primary extragonadal germ cell tumors in the retroperitoneum are a rare entity. The presence of a retroperitoneal tumor with ultrasonographical abnormalities in testicular evaluation should be considered as a metastases of a burned out testicular cancer, and biopsy is mandatory. Surgical evaluation and orchiectomy should be evaluated in a individual setting.

Tumor testicular bilateral “quemado” (“burn out”) / Burn out bilateral testicular tumor

Es difícil diferenciar entre tumor de células germinales retroperitoneal primario y enfermedad metastásica de un tumor gonadal indetectado o que ha regresado espontáneamente. Presentamos un caso clínico de “burn out” o tumor quemado, es decir un tumor retroperitoneal seminomatoso, metastásico con importantes alteraciones testiculares bilaterales tanto ecográficas como anatomopatológicas, pero sin evidenciar tumor. Pese a las controversias que detallamos, nuestra opción terapéutica fue la extirpación de la masa residual tras la quimioterapia asociada a orquiectomía bilateral en el mismo acto. Concluimos que ante un tumor retroperitoneal, la existencia de alteraciones ecográficas en los testículos, pese a una palpación normal, debe hacer pensar en un “Síndrome de burn out”, siendo obligatoria la biopsia testicular bilateral. La exploración quirúrgica de los mismos e incluso la orquiectomía son opciones a valorar en función de cada paciente (AU)

Differentiating a primary retroperitoneal seminoma from a metastatic testicular tumor with an occult testicular primary or a burned out testicular cancer remains difficult. We present a case of a burned out tumor. The patient had a retroperitoneal seminoma with ultrasonically and pathologically demonstrated abnormalities in both testes, but without evidence of tumor. The patient received chemotherapy and underwent surgery of the residual retroperitoneal mass and bilateral orchiectomy. All surgical specimens were negative for testis cancer. Conclusion: Primary extragonadalgerm cell tumors in the retroperitoneum are a rare entity. The presence of a retroperitoneal tumor with ultrasonographical abnormalities in testicular evaluation should be considered as a metastases of a burned out testicular cancer, and biopsy is mandatory. Surgical evaluation and orchiectomy should be evaluated in a individual setting (AU)

[Major ambulatory surgery in urology. 5 years' experience]. / Cirugía mayor ambulatoria en urología. 5 años de experiencia.

INTRODUCTION: The ambulatory surgery includes those surgical procedures that require a limited period of post-operative recovery, so that patients will be discharged from hospital on the same day of their surgical operation. OBJECTIVES: This publication aims at both, explaining our Service way of working as an integrated unit of ambulatory surgery, and it also tries to revise the results which have been obtained during our first 5 years working together. METHOD AND MATERIALS: Three hundred and thirty-nine patients, with an average age of 37.5 years (3-84), have been included in this report which sets out the medical record of this patients selection, their pathologies, the different procedures used, the kind of anaesthesia as well as the criterion to discharge them from hospital. RESULTS: Intra-surgical complications have arisen in 4 (1.2%) of our patients, immediate complications in 24 patients (7%) and late ones in 33 (9.7%) of our patients. According to the results of an anonymous inquiry which has been polled systematically to all our patients, 95% of those polled are completely satisfied with this new way of medical attention. CONCLUSIONS: The ambulatory surgery means a slight change in our patients' way of life. It also diminishes hospital costs, morbidity is similar to the one produced in hospitalization and it implies an important challenge for the professionals of this Service.

Cirugía mayor ambulatoria en urología. 5 Años de experiencia / Ambulatory surgery in urology. Five years of experience

INTRODUCCIÓN: La cirugía mayor ambulatoria (CMA) comprende aquellos procedimientos quirúrgicos que requieren un escaso periodo de recuperación post-operatoria, siendo dados de alta los pacientes en el mismo día de la intervención. OBJETIVOS: Este trabajo pretende explicar el funcionamiento de nuestro Servicio de Urología en una unidad integrada de cirugía mayor ambulatoria, así como revisar los resultados obtenidos en los cinco primeros años de vida de nuestra unidad. MATERIAL Y MÉTODOS: Se han incluido 339 pacientes con una edad media de 37,5 años (3-84) exponiendo el protocolo de selección de pacientes, patología, procedimiento empleado y tipo de anestesia, así como los criterios de alta. RESULTADOS: En 4 pacientes (1,2 por ciento) ha habido complicaciones intraoperatorias en 24 (7 por ciento) inmediatas y en 33 (9,7 por ciento) tardías. Según resultados de la encuesta anónima realizada sistemáticamente a todos los pacientes el 95 por ciento se han mostrado satisfechos con esta nueva modalidad asistencial. CONCLUSIONES: La CMA supone una mínima alteración del modo de vida del paciente, disminuye costos hospitalarios, la morbilidad es similar a la de la hospitalización y supone un reto para los profesionales del Servicio (AU)

[Penile carcinoma. Retrospective study in the XIII area of the community of Valencia]. / Carcinoma de pene. Análisis retrospectivo en el área XIII de la comunidad Valenciana.

We have analyzed a set of 27 patients diagnosed of penile cancer who have been treated in our Hospital during the last 17 years (since january 1984 to december 2000). The annual incidence was set in 1.7 patients/100,000 men/year. The average age has been 64 years (range 42-85). Patients delayed medical consulting of their lesions for 15 months (2-120). Histologic analysis found an epidermoid carcinoma in 19 patients, and verrucous carcinoma in 8. The average follow-up has been 48 months (range 2-120). As a conclusion we don't belive necessary prophylactic inguinal lymphadenectomy. Correct followup, for early detection of lymph nodes does not worsen survival and it avoids unnecessary operations with a high rate of morbidity. The prognostic factors in our patients have been the presence of lymph nodes and the degree of local extension. We lack of experience with radiotherapy and chemotherapy.

Carcinoma de pene. Analisis retrospectivo en el Area XIII de la Comunidad Valenciana / Carcinoma of the penis. Retrospective analysis in Area 13th in the Valencian Community

Analizamos la serie de 27 casos de carcinoma de pene diagnosticados y tratados en nuestro centro desde enero de 1984 hasta diciembre del 2007 (17 años). La incidencia anual se situó en 1,7 casos/ 100.000 varones/año. La edad media ha sido de 64 años (42-85). El tiempo de demora medio en consultar por la lesión ha sido de 15 meses (2-120).La anatomía patológica de la lesión fue de carcinoma epidermoide en 19 casos (14 bien diferenciados y 5 poco diferenciados) y carcinoma verrucoso en 8 casos. El seguimiento medio ha sido de 48 meses (2-120). Como conclusiones, destacar que no creemos recomendable la realización de linfadenectomía profiláctica, pues pensamos que un seguimiento adecuado para la detección temprana de las adenopatías, no empeora la supervivencia y evita cirugías innecesarias y de gran morbilidad. En cuanto a los factores pronósticos, en nuestra serie, los más determinantes han sido la presencia de adenopatías positivas y el grado de extensión local. Carecemos de experiencia con radioterapia y la quimioterapia. (AU)

[Uterine perforation and vesical migration of intrauterine device]. / Perforación uterina y migración vesical de un dispositivo intrauterino.

Cases of uterine perforation through to the bladder during the placement of an intrauterine device are rare. There have been only 25 previous reported cases. This type of perforation is no different to any other by an intravesical foreign body. A detailed anamnesis and sonographic examination is usually sufficient to provide a diagnosis. Complications can be diagnosed by an uretrocytoscopy which is also therapeutic in non-complicated cases. If there are associated complications surgery can be necessary. In conclusion, quick detection of any complication, by sonographic detection after placement, assists in the extraction of the foreign body and avoids the appearance of associated complications such as lithiasis.

[Total androgenic insensitivity syndrome. Presentation as giant inguinal mass]. / Síndrome de insensibilidad completa androgénica. Presentación como masa inguinal gigante.

The androgen insensitivity syndrome is the most frequent form of masculine psedohermafroditism. The affected patients present female phenotype without sexual ambiguity but with karyotype 46 XY. In this syndrome the frequency of malignización of the testicles increases progressively with the age, because of this, the importance of an earlier diagnosis. We present a case of later diagnosis late of the androgen insensitivity syndrome, that debut with a great inguinal mass.

Perforación uterina y migración vesical de un dispositivo intrauterino / Uterine perforation and vesical movement of an intrauterine device

Presentamos un caso clínico de perforación uterina durante la colocación de un dispositivo intrauterino con paso del mismo hasta vejiga. Presentamos este caso por la rareza del mismo, pues en la revisión de la literatura mundial sólo hemos encontrado 26 casos incluido el nuestro. La clínica no difiere de la del resto de cuerpos extraños intravesicales. Para el diagnóstico suele ser suficiente una anamnesis detallada y una ecografía. La uretrocistoscopia diagnostica las complicaciones, y en los casos no complicados como el nuestro, es además terapéutica. Si se asocia a complicaciones puede ser precisa la cirugía abierta. Concluimos, que la precocidad en la detección de esta yatrogenia mediante el control ecográfico post-colocación, facilita la extracción del cuerpo extraño y evita la aparición de complicaciones asociadas como la litiasis (AU)

Síndrome de insensibilidad completa androgénica. Presentación como masa inguinal gigante / Androgen insensitivity syndrome. Giant inguinal mass presentation

El síndrome de insensibilidad completa a los andrógenos es la forma más frecuente de pseudo-hermafroditismo masculino. Los individuos afectos presentan fenotipo femenino sin ambigüedad sexual pero con cariotipo 46XY. En este síndrome la frecuencia de malignización de los testículos aumenta progresivamente con la edad, de ahí la importancia del diagnóstico precoz. Presentamos un caso de diagnóstico tardío del síndrome de insensibilidad completa androgénica que debutó con masa inguinal (AU)

Informatización de los protocolos de seguimiento tumoral / Computerisation of tumoral follow-up protocols

OBJETIVO: Evaluación de la eficacia del seguimiento tumoral mediante protocolos informatizados. MATERIAL Y MÉTODO: Hemos realizado un estudio retrospectivo, tomando como ejemplo el tumor vesical superficial, donde hemos comparado la cumplimentación del seguimiento tumoral de los protocolos informatizados respecto a los convencionales. RESULTADOS: Se ha demostrado que el porcentaje de cumplimentación y el ajuste a los plazos pre-establecidos de las exploraciones solicitadas por facultativo, es superior en los protocolos informatizados que en los convencionales. CONCLUSIÓN: La informatización de los protocolos tumorales es de fácil manejo, mejora el grado de cumplimiento y ahorra tiempo, proporcionando una mayor eficacia y rigurosidad científica (AU)

[Computerization of protocols for tumor follow-up]. / Informatización de los protocolos de seguimiento tumoral.

OBJECTIVE: Evaluation of the effectiveness of the surveillance tumoral by means of computerized protocols. MATERIAL AND METHODOLOGY: We have carried out a retrospective study, taking as example the superficial bladder cancer, where we have compared the execution of the tumoral surveillance of the computerized protocols regarding the conventional ones. RESULTS: It has been demonstrated that the execution percentage and the adjustment to the predetermined terms of the explorations requested by the facultative are superior in the computerized protocols that in the conventional ones. CONCLUSION: The computerization of the tumoral protocols is user-friendly, it improves the execution degree and it saves time, providing bigger effectiveness and scientific rigor.

[Endoscopic removal of the ureter prior to nephroureterectomy. Preliminary analysis]. / Desinserción endoscópica del uréter previa a nefroureterectomía. Análisis premilinar.

AIM OF THE STUDY: To describe a simplified technique for nephroureterectomy based on a prior endoscopic disconnection of the ureter or transurethral circumcision of the ureteral orifice. PATIENTS AND METHODS: From November 1993 to December 1997 we treated 16 patients diagnosed with cancer of the renal pelvis of proximal ureter, using this technique. Mean age was 68.8, 15 males and 1 female. RESULTS: There was no operative or postoperative complications. Mean follow up was 17 months and the mean hospital stay was 7.2 days. CONCLUSIONS: We believe that this is an easy technique to learn, that significantly cut down the operating time, reduce postoperative complications and it is adequate for upper tract urothelial cancer treatment.

[Urethral diverticulum complicated with giant lithiasis]. / Divertículo uretral complicado por litiasis gigante.

Presentation of one case report of acquired urethral diverticulum in a male with giant urethral lithiasis. Urethral diverticulum are rare entities in males, the condition being more frequent in females. In general, they are acquired in up to 90% cases, the remaining 10% being hereditary Giant urethral lithiasis is also uncommon in our milieu, incidence being higher in Eastern Countries; 4-10% of urethral diverticulum are occupied by lithiasis. Diagnosis is mainly through clinical symptomatology involving the development of a perineal mass or phlegmon; however definite diagnosis is made through CUMS. Management of giant diverticulum in males is by open surgery, preferably a one-step diverticulectomy procedure; in cases such as the reported here, where urethral stenosis or a significant inflammatory involvement of the periurethral tissues is present, a two-step urethroplasty should be preferred.

[Massive inguinal vesical hernia. Report of 3 cases]. / Hernia vesical inguinal masiva. Aportación de tres casos.

Vesical hernia is defines as a vesical shift associated to a direct or indirect inguinal hernia. It accounts for 0.4-3% of all inguinal hernias, but the existence of a massive vesical hernia formation at the inguinoscrotal level is uncommon; a total of 114 cases have been found in the literature. Clinically it should be suspected every time an inguinoscrotal hernia is found in patients over 50 years old with urinary flow obstruction. Diagnosis is usually reached through serial voiding cystouretrography (SVCU). The preferred treatment should be extraperitoneal inguinal herniorrhaphy associated to correction of the obstructive process.

[Retrovesical schwannosarcoma]. / Schwannosarcoma retrovesical.

Contribution of one case of retrovesical schwannosarcoma in a 23-year-old female patient, with discussion of signs and symptoms, diagnosis and treatment. Retroperitoneal schwannosarcoma is an extremely uncommon tumour. Diagnosis is always histologic and immunohistochemical. This is an extraordinary aggressive tumour, with low response to chemo- and radiotherapy. Surgery is the only curative treatment, and presents a high index of recurrence. Prognosis is sombre. We support the most radical surgical approach possible as the only definite diagnostic possibility, since it provides the best survival indexes and in any case, improves symptomatology of tumours not completely resectable.

[Complications of transurethral resection of the prostate: review of 408 cases]. / Complicaciones de la resección transuretral de la próstata: revisión de 408 casos.

Retrospective study conducted on 408 TUPRs performed in our centre over the time span 1985-1995. Patient's mean age was 68 (51-89) years. In 73% cases regional anaesthetics was used. Mean surgery duration (without anaesthetics) was 41 minutes for prostates under 60 g and 63 minutes for those over 60 g. 40.9% patients had in-dwelling urethral catheter. Early complications were seen in 19.6% patients, of which 9.6% were urinary infections, 4.6% major haematuria requiring transfusion of two or more units of packed blood cells and 12% relevant systemic complications. Overall mortality was 0.5% (2 patients). Late complications affected to 12.7% patients, which in 6.4% were urethral stenosis. Both mean hospital stay and mortality were low. We conclude that TUPR morbidity is not trivial, emphasizing the occurrence of urethral stenosis and urinary infection. In spite of the frequency of these complications, we believe this to be the choice procedure for most patients who require surgical treatment for benign prostate hyperplasia.

[Transitional-cell sarcomatoid carcinoma of the renal pelvis with osteoclast-type giant cells. Review of the literature]. / Carcinoma sarcomatoide de células transicionales de la pelvis renal con células gigantes de tipo osteoclasto. Revisión de la literatura.

One case of transitional cells carcinoma with sarcomatoid pattern, located in the renal pelvis in a 77 year-old male with haematuria. The tumour also expressed a non-neoplastic component of osteoclast-like giant cells which probably represent a stromal reaction of the host to the neoplasia. The tumoral cells co-express keratin and vimentin, two strands of the cytoskeleton specific for epithelial and mesenchymal cells, respectively. We speculate with the possibility of the tumoral cells fusocellular morphology being related to the vimentin expression. A review of the literature is also included.