[Kidney transplant urinary complications. Diagnosis and treatment.] / Complicaciones urinarias del trasplante renal. Diagnóstico y tratamiento.

There are different surgical techniques for reconstruction of the urinary tract in kidney transplant. However, urinary complications are frequent in the postoperative period, being the ureter the frequent location of these complications. This results in high health care costs, increasing patient morbimortality and sometimes graft loss. For this reason, prevention, correct diagnosis and treatment are important. The aim of this review is to describe the surgical techniques most commonly used in kidney transplant for ureteroneocystostomy. To analyze the advantages and disadvantages of each of them and to compare their complications. On the other hand, we summarize the recent literature on the four most frequent urinary complications in the postoperative period after transplantation. The possible causes and treatment of urine leak, ureteri cobstruction, hematuria and vesicoureteral reflux are presented.

Existen diferentes técnicas quirúrgicas para la reconstrucción del tracto urinario en el trasplante renal. Sin embargo es frecuente la aparición de complicaciones urinarias en el postoperatorio, siendo el uréterla localización frecuente de las mismas. Esto implica un alto gasto sanitario, aumentando la morbimortalidad del paciente y pudiendo llegar a desencadenar la pérdida del injerto. Por ello es importante la prevención, el correcto diagnóstico y su tratamiento. El objetivo de esta revisión es describir las técnicas quirúrgicas más usadas en el trasplante renal para la ureteroneocistostomía. Analizar las ventajas y desventajas de cada una de ellas y comparar sus complicaciones. Por otro lado se resume la literatura reciente sobre las cuatro complicaciones urinarias más frecuentes en el postoperatorio del trasplante. Se exponen las posibles causas y tratamiento de la fuga urinaria, la obstrucción ureteral, la hematuria y el reflujo ureterovesical.

[Kidney cancer stage pT3a: Fat invasion versus renal vein invasion.] / Cáncer renal pT3a: infiltración grasa versus infiltración de vena renal.

OBJECTIVE: We discuss the influence that involvement of fat (perirenal, sinus) and vascular structures (renal vein, segmental veins) have on cancer-specific mortality (CSM) rates in renal cancer. METHODS: We conducted a retrospective analysis of 140 stage pT3a kidney tumors (114 clear cell, 9 type I papillary, 6 type II papillary, 11 chromophobe) surgically treated between 1997 and 2015. We conducted a cancer-specific survival study (Kaplan Meier) and a univariate and multivariate analysis of the variables: perirenal fat invasion, sinus fat invasion, renal vein invasion, segmental vein invasion and Fuhrman grade. RESULTS: With a mean follow-up of 79 months, 47 deaths occurred overall (31.7%), 29 of which were due to the kidney tumor (CSM 20%). There were 50 cases of vascular invasion (35.7%), 40 cases with fat only invasion (28.6%) and 50 cases with invasion of both (35.7%). In the survival study, fat invasion had the least impact (17%), and invasion of both (fat and vascular structures) had the worst survival (48% of total mortality). Vascular invasion represents 35% of the mortality rate. In the multivariate study, Fuhrman grade 3-4 (HR 10.7), renal vein invasion (HR 9.2) and concomitant vascular and fat invasion (HR 5.6) are the factors with the greatest impact. CONCLUSIONS: Tumor fat invasion has a lower impact on the CSM of kidney cancer than vascular invasion.

Cáncer renal pT3a: infiltración grasa versus infiltración de vena renal / Kidney cancer stage pT3a: Fat invasion versus renal vein invasion

OBJETIVO: Analizamos la influencia en la supervivencia cáncer específica (SCE) de la invasión de la grasa (perirrenal, seno) y de estructuras vasculares (vena renal, segmentarias). MÉTODOS: Analizamos retrospectivamente 140 tumores renales (114 células claras, 9 papilares I, 6 papilares II, 11 cromófobos) tratados quirúrgicamente desde 1997-2015, con estadios patológicos pT3a. Realizamos un subanálisis, comparando la SCE con nuestra serie de estadíos patológicos pT2. Se realiza un análisis de supervivencia cáncer específica (Kaplan Meier) y un análisis univariante y multivariante de las variables: invasión de grasa perirrenal, grasa del seno, invasión vena renal e invasión de venas segmentarias, grado de Fuhrman. RESULTADOS: Con un seguimiento medio de 79 meses, se producen 47 muertes globales (31,7%), de los cuales 29 se deben al tumor renal (MCE 20%). En 50 ocasiones hay afectación vascular (35,7%), 40 sólo de grasa (28,6%) y en 50 casos ambas estructuras están infiltradas (35,7%). En el análisis de supervivencia, la afectación grasa es la que menos repercusión tiene (17%), siendo la afectación de las dos estructuras (grasa y vasos) la de peor supervivencia (48% de la mortalidad total). La infiltración vascular supone el 35% de la mortalidad. En el estudio multivariante, los factores con más repercusión son el grado de Fuhrman 3-4 (HR 10,7), la infiltración de la vena renal (HR 9,2) y la infiltración vascular y grasa concomitante (HR 5,6). CONCLUSIONES: La infiltración tumoral de la grasa tiene menor repercusión en la MCE del cáncer renal que la afectación vascular

OBJECTIVE: We discuss the influence that involvement of fat (perirenal, sinus) and vascular structures (renal vein, segmental veins) have on cancer-specific mortality (CSM) rates in renal cancer. METHODS: We conducted a retrospective analysis of 140 stage pT3a kidney tumors (114 clear cell, 9 type I papillary, 6 type II papillary, 11 chromophobe) surgically treated between 1997 and 2015. We conducted a cancer-specific survival study (Kaplan Meier) and a univariate and multivariate analysis of the variables: perirenal fat invasion, sinus fat invasion, renal vein invasion, segmental vein invasion and Fuhrman grade. RESULTS: With a mean follow-up of 79 months, 47 deaths occurred overall (31.7%), 29 of which were due to the kidney tumor (CSM 20%). There were 50 cases of vascular invasion (35.7%), 40 cases with fat only invasion (28.6%) and 50 cases with invasion of both (35.7%). In the survival study, fat invasion had the least impact (17%), and invasion of both (fat and vascular structures) had the worst survival (48% of total mortality). Vascular invasion represents 35% of the mortality rate. In the multivariate study, Fuhrman grade 3-4 (HR 10.7), renal vein invasion (HR 9.2) and concomitant vascular and fat invasion (HR 5.6) are the factors with the greatest impact. CONCLUSIONS: Tumor fat invasion has a lower impact on the CSM of kidney cancer than vascular invasion

Pseudomyxoma peritonei: A case report and review of the literature.

OBJECTIVE: We present the case of a patient incidentally diagnosed with a pelvic mass next to the bladder. After surgical excision, definitive diagnosis was pseudomyxoma peritonei. We provide a concise review of the literature of this pathology. METHODS: A 55 year-old male patient, was found to have, in annual routine ultrasound, a pelvic retrovesical mass. CT guided needle aspirate showed a tumor with myxoid changes and low aggressive cytology. Surgical excision was performed. RESULTS: The excised mass contained the cecal appendix and ileal serosa. Pathology report was: mucinous cystadenoma of the appendix and pseudomyxoma peritonei. CONCLUSIONS: PMP is a local-regional disease within the abdomen, characterized by a mucinous tumor (mucocele) that produces a progressive amount of mucinous ascites, which eventually blows-out, and tumor cells are spread through the peritoneal cavity. Treatment options differ significantly, depending the stage of the disease.

Pseudomyxoma peritonei: A case report and review of the literature / Pseudomixoma peritoneal. A propósito de un caso. Revisión bibliográfica

Objective: We present the case of a patient incidentally diagnosed with a pelvic mass next to the bladder. After surgical excision, definitive diagnosis was pseudomyxoma peritonei. We provide a concise review of the literature of this pathology. Methods: A 55 year-old male patient, was found to have, in annual routine ultrasound, a pelvic retrovesical mass. CT guided needle aspirate showed a tumor with myxoid changes and low aggressive cytology. Surgical excision was performed. Results: The excised mass contained the cecal appendix and ileal serosa. Pathology report was: mucinous cystadenoma of the appendix and pseudomyxoma peritonei. Conclusions: PMP is a local-regional disease within the abdomen, characterized by a mucinous tumor (mucocele) that produces a progressive amount of mucinous ascites, which eventually blows-out, and tumor cells are spread through the peritoneal cavity. Treatment options differ significantly, depending the stage of the disease (AU)

Objetivo: Presentamos el caso de un paciente diagnosticado incidentalmente de una masa pélvica lateral a la vejiga. Después de realizarse cirugía de extracción de la masa, el diagnóstico fue de pseudomixoma peritoneal (PMP). Métodos: Un paciente varón de 55 años de edad, en ecografía rutinaria presenta una masa pélvica retrovesical. Punción y aspiración guiada por TAC mostró un tumor con cambios mixoides y citología de baja agresividad. Se realzó cirugía y extracción de la masa. Resultados: La pieza quirúrgica contenía además el apéndice cecal y serosa ileal. El reporte de patología fue: cistoadenoma mucinoso del apéndice y PMP. Conclusiones: PMP es una enfermedad loco-regional del abdomen, caracterizada por un tumor mucinoso (mucocele) que produce una cantidad progresiva de ascitis mucinosa, que eventualmente revienta, y las células malignas son esparcidas en la cavidad peritoneal. Las opciones de tratamiento difieren significativamente según el estado de la enfermedad (AU)

[Oncological results in high grade prostate cancer treated surgically]. / Resultados oncológicos en el cáncer de próstata de alto riesgo tratado quirúrgicamente.

OBJECTIVES: Prostate cancer is considered a tumour with a long natural history. However, its high-risk variants exhibit variable behaviour. We analyse the factors that affect BR and CSS (multivariate, Kaplan Meier). METHODS: From 1997 to 2013, 657 patients were operated of a high-grade prostate cancer (pT2b 7.2%, pT3a 73%, pT3b 18.3%, pT4 1.5%). Gleason score was ≥8 in 23% of cases. Percentage of PSMs was 46.1%. Mean follow-up was 113 months (24-192). RESULTS: BR occurred in 36.5%. Patients with Gleason score <8, 31.7% had BR, Gleason ≥8 had BR in 48% (p<0.05). PSMs recurrence occurred in 48.9%, whereas 26.1% in NSM (p<0.05). If lymphadenectomy, BR occurred in 48.7%, if not 30.9% (p<0,05). In multivariate analysis, stage, Gleason≥8 and PSMs were independent factors for BR. Treatment of BR was 36.5% radiotherapy, 24.1% HT, and 21.2% both simultaneously. Active surveillance was performed in 13.3%. Disease progression (biochemical or radiological) occurred in 23.5%. CSS was 98.93%, pT4 was the stage with the greatest mortality (10%), followed by pT3b (3.4%), p<0.05. Patients with a Gleason score ≥8 accounted for 71% CSM (p<0,05). PSMs and lymphadenectomy didn't have repercussions for survival. In multivariate analysis, Gleason≥8 was independent factor for CSM. CONCLUSIONS: Radical prostatectomy plays an important role in multi-modal approach with good oncological control at medium follow up. Gleason score ≥8 was the factor with the greatest effect on CSM. Lymphadenectomy didn't affect CSS.

Resultados oncológicos en el cáncer de próstata de alto riesgo tratado quirúrgicamente / Oncological results in high grade prostate cancer treated surgically

OBJETIVO: El cáncer de próstata se considera un tumor con una historia natural prolongada. Sin embargo, la variante de alto riesgo muestra un comportamiento variable. Analizaremos aquellos factores que afectan a la Recidiva Bioquímica (RB) y la Supervivencia Cáncer Específica (SCE) en pacientes tratados quirúrgicamente. MÉTODOS: Desde 1997-2013 se han operado un total de 657 pacientes con cáncer de próstata con criterios de alto grado según la Asociación Europea de Urología (pT2b 7,2%, pT3a 73%, pT3b 18,3%, pT4 1,5%). El índice de Gleason fue ≥ 8 en 23%. El porcentaje de márgenes quirúrgicos positivos (MQP) fue 46,1%. El seguimiento medio fue 113 meses (24-192). RESULTADOS: En 36,5% se produjo RB. En Gleason < 8, la RB fue 31,7%, en Gleason ≥ 8 del 48% (p < 0,05). La RB en MQP fue 48,9%, por 26,1% en los negativos (p < 0,05). En pacientes con linfadenectomía, la RB se produjo en 48,7%, por 30,9% en los que no se realizó (p < 0,05). En el estudio multivariante, el estadio, el Gleason ≥ 8, MQP, TR y PSA fueron factores independientes de RB. El tratamiento de la RB fue radioterapia 36,5%, Hormonoterapia 24,1%, ambas 21,2%. La vigilancia activa se realizó en 13,3%. La progresion (bioquímica o radiológica) se produjo en el 23,5%. La SCE fue del 98,93%, siendo pT4 el estadio con mayor mortalidad (10%), seguido de pT3b (3,4%), p < 0,05. Pacientes con Gleason ≥ 8 la mortalidad fue del 71% (p < 0,05). MQP y linfadenectomía no tuvieron repercusion en la SCE. En el análisis multivariante, Gleason≥8 fue factor independiente de MCE (Mortalidad cancer específica). CONCLUSIONES: La prostatectomía radical juega un papel importante en el tratamiento multimodal del cáncer de próstata, con un buen control oncológico a medio plazo. El Gleason ≥ 8 es el factor más importante en la SCE. En nuestro trabajo, la linfadenectomía no afectó la SCE

OBJECTIVES: Prostate cancer is considered a tumour with a long natural history. However, its highrisk variants exhibit variable behaviour. We analyse the factors that affect BR and CSS (multivariate, Kaplan Meier). METHODS: From 1997 to 2013, 657 patients were operated of a high-grade prostate cancer (pT2b 7.2%, pT3a 73%, pT3b 18.3%, pT4 1.5%). Gleason score was ≥ 8 in 23% of cases. Percentage of PSMs was 46.1%. Mean follow-up was 113 months (24-192). RESULTS: BR occurred in 36.5%. Patients with Gleason score <8 31.7% had BR, Gleason ≥ 8 had BR in 48% (p < 0.05). PSMs recurrence occurred in 48.9%, whereas 26.1% in NSM (p < 0.05)- If lymphadenectomy, BR occurred in 48.7%, if not 30.9% (p < 0.05). In multivariate analysis, stage, Gleason ≥ 8 and PSMs were independent factors for BR. Treatment of BR was 36.5% radiotherapy, 24.1% HT, and 21.2% both simultaneously. Active surveillance was performed in 13.3%. Disease progression (biochemical or radiological) occurred in 23.5%. CSS was 98.93%, pT4 was the stage with the greatest mortality (10%), followed by pT3b (3.4%), p < 0.05. Patients with a Gleason score ≥ 8 accounted for 71% CSM (pz<0.05)- PSMs and lymphadenectomy didn't have repercussions for survival. In multivariate analysis, Gleason ≥ 8 was independent factor for CSM. CONCLUSIONS: Radical prostatectomy plays an important role in multi-modal approach with good oncological control at medium follow up. Gleason score ≥ 8 was the factor with the greatest effect on CSM. Lymphadenectomy didn't affect CSS

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors.

INTRODUCTION: High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors. MATERIAL AND METHODS: We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL). RESULTS: We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3). CONCLUSIONS: The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.

Incidence and management of isolated renal injury and polytrauma patients.

OBJECTIVES: The management of renal trauma has undergone important changes in recent years, the current tendency being more conservative than in the past. The present study analyzes our experience over the last 11 years in patients with isolated renal trauma or associated to other lesions. METHODS: Over an 11-year period (January 2001- December 2011 ) we documented a total of 149 renal injuries (47 isolated and 102 associated renal lesions ). An analysis was made of the demographic characteristics of the two groups, as well as of the clinical presentation, diagnostic methods, grade of injury, associated lesions, emergency management, mortality, and length of stay. RESULTS: Closed trauma secondary to fall was the most frequent type of injury in both groups. The grade of injury proved similar in both (80%corresponding to grades 1-3 and 20% to grades 4-5). Conservative management was used in 93% of all isolated renal injuries and in 75.5% of the polytrauma patients with 10% and 5.7% failure rates respectively. Mortality rates were 0% and 7.8%, respectively. CONCLUSIONS: Renal injures are increasingly subjected to conservative management, with treatment generally being somewhat more aggressive in polytrauma patients.

Incidencia y manejo de traumatismos renales únicos o asociados. Experiencia de 11 años / Incidence and management of isolated renal injury and polytrauma patients

OBJETIVO: La actitud ante los traumatismos renales ha experimentado un cambio muy importante en los últimos años, siendo en el momento actual más conservadora. En este trabajo analizamos los pacientes con lesión renal única o asociada a otras lesiones atendido en nuestro centro en los últimos 11 años. MÉTODOS: En un periodo de 11 años (enero 2001-diciembre 2011) hemos tratado a 149 pacientes con traumatismos renales (47 únicas, 102 con lesiones asociadas). Analizamos las características demográficas de ambos grupos, así como la clínica, métodos diagnósticos, grados de lesión, lesiones asociadas, manejo y resultados del mismo. RESULTADOS: En ambos grupos, la etiología más frecuente fue el traumatismo cerrado por caída. Los grados de lesión son similares para ambos (80% grados 1, 2, 3 y 20% grados 4 y 5). Se adoptó un manejo conservador en el 93% de las lesiones renales aisladas frente al 75,5% en los pacientes politraumatizados, precisando actitud intervencionista posterior en un 10 y 5,7% respectivamente. La tasa de exitus fue del 0 y 7,8%. CONCLUSIONES: En los últimos años se ha producido un cambio en el manejo de los traumatismos renales. El tratamiento conservador es cada vez es más frecuente, siendo significativamente menor en los pacientes politraumatizados

OBJECTIVES: The management of renal trauma has undergone important changes in recent years, the current tendency being more conservative than in the past. The present study analyzes our experience over the last 11 years in patients with isolated renal trauma or associated to other lesions. METHODS: Over an 11-year period (January 2001 - December 2011) we documented a total of 149 renal injuries (47 isolated and 102 associated renal lesions). An analysis was made of the demographic characteristics of the two groups, as well as of the clinical presentation, diagnostic methods, grade of injury, associated lesions, emergency management, mortality, and length of stay. RESULTS: Closed trauma secondary to fall was the most frequent type of injury in both groups. The grade of injury proved similar in both (80% corresponding to grades 1-3 and 20% to grades 4-5). Conservative management was used in 93% of all isolated renal injuries and in 75.5% of the polytrauma patients with 10% and 5.7% failure rates respectively. Mortality rates were 0% and 7.8%, respectively. CONCLUSIONS: Renal injures are increasingly subjected to conservative management, with treatment generally being somewhat more aggressive in polytrauma patients

[Adenomatoid tumors of the epididymis and testicle: report of 9 cases and bibliographic review]. / Tumor adenomatoide de epidídimo intratesticular: A proposito de nueve casos y revisión de la literatura.

BACKGROUND: To report the cases of adenomatoid tumors seen at Hospital Universitario La Paz in the last 15 years. METHODS: A clinical, pathological, and surgical study was conducted of males with testicular or paratesticular tumors with a histological report of adenomatoid tumor. RESULTS: Among the nine cases studied, seven had paratesticular and two intratesticular adenomatoid tumors. Treatment of choice was mass removal for epididymal tumors and orchidectomy for intratesticular tumors. CONCLUSIONS: Adenomatoid tumors are uncommon benign neoplasms of a possible mesothelial origin. Because of their benign nature, the treatment of choice is local excision (conservative surgery), but orchidectomy was performed in two cases due to tumor location.

Tumor adenomatoide de epidídimo e intratesticular: A proposito de nueve casos y revisión de la literatura / Adenomatoid tumors of the epididymis and testicle: report of 9 cases and bibliographic review

OBJETIVO: Describir los casos de tumores adenomatoides del Hospital Universitario La Paz en los últimos 15 años.MÉTODOS: Se ha realizado estudio clínico, anatomopatológico y quirúrgico de los varones con tumoración testicular o paratesticular con resultado histológico de tumor adenomatoide.RESULTADOS: En total hay nueve casos; siete presentaron tumor adenomatoide de localización paratesticular y dos intratesticular. La exéresis de la masa fue el tratamiento de elección en los epididimarios y orquiectomía en los intratesticulares.CONCLUSIONES: Los tumores adenomatoides son neoplasias benignas, poco frecuentes, de posible origen mesotelial. Como consecuencia de su naturaleza benigna, el tratamiento de elección es la exéresis local (cirugía conservadora), aunque en dos casos se llevó a cabo orquiectomía debido a su localización(AU)

OBJECTIVE: To report the cases of adenoma-toid tumors seen at Hospital Universitario La Paz in the last 15 years.METHODS: A clinical, pathological, and surgical study was conducted of males with testicular or paratesticular tumors with a histological report of adenomatoid tumor.RESULTS: Among the nine cases studied, seven had parates-ticular and two intratesticular adenomatoid tumors. Treatment of choice was mass removal for epididymal tumors and or-chidectomy for intratesticular tumors.CONCLUSIONS: Adenomatoid tumors are uncommon be-nign neoplasms of a possible mesothelial origin. Because of their benign nature, the treatment of choice is local excision (conservative surgery), but orchidectomy was performed in two cases due to tumor location(AU)

Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects.

OBJECTIVES: To describe our experience at La Paz University Hospital with 12 patients with urinary tract endometriosis, an uncommon pathologic finding, the most extensive series published by Spanish investigators to our knowledge. METHODS: We performed a retrospective analysis of 12 cases of urinary tract endometriosis diagnosed from 1993 to 2008. RESULTS: The mean patient age was 37.75 years. Of the 12 patients, 5 had bladder involvement and 7 had ureteral involvement, 2 bilateral, 2 left, and 3 right. In those with bladder endometriosis, the diagnosis was made by cystoscopy and biopsy in 4 patients. Treatment consisted of laparoscopic hysterectomy and partial cystectomy in 1 patient and exploratory laparotomy, transvesical resection, and transurethral resection of the bladder in 3 patients. One of the patients who underwent transurethral resection of the bladder experienced 2 relapses. The first relapse was treated with transurethral resection of the bladder and the second with laparoscopic partial cystectomy. In the patients with ureteral endometriosis, the diagnosis was mainly established by magnetic resonance imaging. Treatment consisted of ureteroneocystostomy in 5 patients (bilateral in 1) and laparoscopic ureterolysis in 2, with later ureteral resection and end-to-end anastomosis in 1 of them. The patient who underwent bilateral ureteroneocystostomy finally required right autotransplantation because of early ureteral relapses. CONCLUSIONS: Urinary tract endometriosis is an uncommon pathologic finding. Surgery is the treatment of choice. We believe partial cystectomy should be considered as an initial option in selected cases, depending on the extent and location of lesions. For cases of ureteral endometriosis, the initial technique depends on the location and depth of the lesion.

[Early-onset sarcomatoid renal carcinoma. Report of a new case and comparison of the same case with another appearing at a mature age]. / Carcinoma renal sarcomatoide de temprana aparición. Aportación de un nuevo caso y comparación del mismo con otro de aparición en edad madura.

OBJECTIVE AND METHODS: We report two new cases of this rare and aggressive tumour; one case appeared in the earliest age reported in the literature (case #2). We also review etiological, diagnostic and therapeutic features. RESULTS: Despite aggressive surgery and adjuvant chemotherapy it has a very poor prognosis, with disease progression within 6 months in both cases. CONCLUSIONS: Sarcomatoid renal cell carcinoma is an infrequent entity, extremely aggressive and requires radical surgery at the time of diagnosis due to its advanced stage, although results are poor. It can also appear in young people with the same aggressiveness than in adult age.

Carcinoma renal sarcomatoide de temprana aparición. Aportación de un nuevo caso y comparación del mismo con otro de aparición en edad madura / sarcomatoid renal cell carcinoma appearing at young age. A new case and comparison with another case appearing in a mature age

Objetivo y Métodos: Bajo el formato de casos clínicos aportamos dos nuevos casos de este raro y agresivo tumor, siendo la edad de presentación de uno de ellos (caso clínico nº 2) la más temprana recogida en la literatura. Asimismo, revisamos aspectos relativos a la etiología, diagnóstico y tratamiento. Resultados: A pesar de cirugía muy agresiva y tratamiento adyuvante, el pronóstico es infausto, con progresión de la enfermedad en los primeros 6 meses en ambos casos. Conclusiones: El carcinoma sarcomatoide de riñón es una entidad infrecuente, extremadamente agresiva y que requiere cirugía radical debido a su avanzado estado en el momento del diagnóstico, aunque con pobres resultados. Puede aparecer también en la juventud con la misma agresividad que en la edad adulta Carcinoma renal sarcomatoide. Regresión espontánea. Patología del tumor renal (AU)

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[Mesothelial cysts in urology: a diagnostic and therapeutic problem]. / Quistes mesoteliales en urología; un problema diagnóstico y terapéutico.

OBJECTIVE: To present our experience with mesothelial cysts with excretory system involvement. METHODS: 3 cases of mesothelial cyst are presented; two of them caused obstructive uropathy. RESULTS: Cases 1 and 2 were treated by surgery, while case 3 was managed conservatively. All cases are currently asymptomatic. CONCLUSIONS: Mesothelial cysts are an uncommon cause of obstructive uropathy. Treatment is by surgery for the symptomatic cases and conservative management is a valid alternative for the asymptomatic cases.

Quistes mesoteliales en urología; un problema diagnóstico y terapéutico / Mesothelial cysts in urology: A diagnostic and therapeutic problem

OBJETIVO: Presentar nuestra experiencia con quistes mesoteliales con repercusión sobre la vía excretora.MÉTODOS: Bajo el formato de casos clínicos presentamos 3 casos de quiste mesotelial, dos de ellos causantes de uropatía obstructiva.RESULTADOS: Los casos nº 1 y 2 fueron tratados mediante cirugía y el caso nº 3 de manera conservadora estando actualmente asintomáticos.CONCLUSIONES: Los quistes mesoteliales son una causa infrecuente de uropatía obstructiva, con buen pronóstico, que requieren cirugía cuando son sintomáticos aunque la actitud expectante cuando no provocan sintomatología es una alternativa válida (AU)

Siringoma condroide gigante de escroto / Giant chondroid syringoma of the scrotum. First reported case

OBJETIVO: En el escroto se han descrito varios tumores tanto derivados de la piel como de los tejidos subyacentes, nevus, quistes epidermoides, quistes dermoides, carcinomas epidermoides, lipomas, leiomiomas, angioqueratomas, linfangiomas, tumores de células granulares, tumores malignos de vaina nerviosa periférica y algunos pseudotumores como fibromatosis o calcinosis nodular. Se describe por primera vez la presencia de un tumor derivado de las glándulas sudoríparas que tiene además la peculiaridad de su gran tamaño. MÉTODO Y RESULTADOS: Paciente, varón de 76 años que consultó por tumoración dolorosa en hemiescroto izquierdo de larga evolución, que presentaba un crecimiento lento y progresivo. Tras la realización de una ecografía de aparato genitourinario que confirmó la presencia de una masa sólida paratesticular izquierda de 4,2 cm de diámetro, se realizó exéresis de dicha masa bajo anestesia local. CONCLUSIONES: El Siringoma Condroide es un tumor derivado de las células sudoríparas, localizado habitualmente en cabeza y cuello, que tiene un pronóstico excelente y únicamente se han descrito recidivas coincidiendo con extirpaciones incompletas del tumor (AU)

Papilomas invertidos vesicales múltiples / Multiple inverted papillomas of the urinary bladder

OBJETIVO: Describir las principales características clínicas, ecográficas e histopatológicas de los papilomas invertidos del tracto urinario, así como la rareza de la multifocalidad de estas lesiones. MÉTODOS/RESULTADOS: Presentamos un caso de afectación vesical por papilomas invertidos múltiples, en un paciente de 53 años, con una clínica que simulaba un síndrome prostático; o bien, mediante técnicas complementarias (ecografía-cistoscopia) una neoplasia vesical. La resección y posterior estudio histopatológico de las lesiones mostraron una proliferación subepitelial de células uroteliales "benignas", con un típico patrón de crecimiento trabecular, un patrón de ADN diploide y bajos índices proliferativos. CONCLUSIONES: La presencia de papilomas invertidos vesicales múltiples es un hecho clínico extremadamente raro. Salvo en el estudio histopatológico, no existen datos complementarios (Eco-Cistoscopia) característicos que permitan realizar un diagnóstico definitivo de estas lesiones. La determinación de un bajo índice proliferativo y de un patrón de ADN diploide pueden ser parámetros que ayuden a planificar el seguimiento de estos pacientes (AU)