Abordaje del paciente con cáncer renal: ¿existe la colaboración entre urología y oncología? / Approach of the patient with renal cancer: Is there a collaboration between urology and oncology?

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Evaluación del daño tisular producido por la nefrolitotomía percutánea mediante la determinación sérica de mediadores inflamatorios / Assessment of tissue damage due to percutaneous nephrolithotomy using serum concentrations of inflammatory mediators

Objetivo: Determinar los efectos producidos por la nefrolitotomía percutánea (NLP) sobre los tejidos mediante la cuantificación de mediadores de respuesta inflamatoria, así como la influencia del desarrollo de complicaciones postoperatorias en el daño tisular. Pacientes y métodos: Estudio observacional, prospectivo, no aleatorizado en 40 pacientes intervenidos mediante NLP. Como grupo control se empleó una cohorte de 50 pacientes con litiasis renal tratada con litotricia extracorpórea por ondas de choque. Determinación previa al tratamiento (T0) y a las 2, 6 y 24 h (T1, T2 y T3) de interleuquina-1beta (IL-1β), factor de necrosis tumoral-alfa (TNF-α), interleuquina-6 (IL-6) y proteína C-reactiva (PCR). Resultados: No se observaron cambios en los niveles de IL-1β y TNF-α. IL-6 presentó un pico sérico entre las 2 y 6 h de la NLP (mediana de 17,8 y 15,8 pg/ml, respectivamente), mientras que el valor pico de PCR fue de 3,4 mg/l a las 24 h. En el grupo tratado con litotricia expracorpórea por ondas de choque no se apreciaron variaciones significativas en ninguno de los marcadores. La concentración sérica de IL-6 y PCR a las 24 horas post-NLP es diferente en función de la aparición de complicaciones (p = 0,001 y p = 0,039, respectivamente). IL-6 presentó una buena capacidad predictiva para el desarrollo de complicaciones (AUC de 0,801). Conclusiones: El daño tisular producido por la NLP es de baja intensidad. Este daño aumenta significativamente en aquellos casos que desarrollan complicaciones en el postoperatorio. La determinación de IL-6 a las 24 h post-NLP parece ser un buen marcador predictivo para el desarrollo de complicaciones (AU)

Objectives: To determine the percutaneous nephrolithotomy (PCNL) effects on the tissues using the quantification of inflammatory mediators, and to assess their impact on the development of postoperative complications. Patients and methods: Prospective observational non-randomized study on 40 patients underwent to PCNL. 50 patients with kidney stone who were treated by extracorporeal shock wave lithotripsy (ESWL) were used as control group. Interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were determined at baseline (T0: before treatment), and at 2, 6 and 24 hours after (T1, T2 and T3). Results: No relevant changes on IL-1β and TNF-α were found. IL-6 showed two peaks at 2 and 6hours post-PCNL (median 17.8 and 15.8 pg/mL, respectively). At 24hours CRP had reached its peak value (3.4mg/L). The group treated with ESWL no showed significant changes in any of the markers. The serum concentration of IL-6 and CRP at 24 hours post-NLP is different depending on the occurrence of complications (P = .001 and P = .039, respectively). IL-6 showed a good predictive power for the development of complications (AUC .801). Conclusions: Tissue damage caused by the PCNL is low. This damage increases significantly in those cases showing postoperative complications. IL-6 at 24 hours has been shown to be a good predictive tool for the development of complications

Assessment of tissue damage due to percutaneous nephrolithotomy using serum concentrations of inflammatory mediators.

OBJECTIVES: To determine the percutaneous nephrolithotomy (PCNL) effects on the tissues using the quantification of inflammatory mediators, and to assess their impact on the development of postoperative complications. PATIENTS AND METHODS: Prospective observational non-randomized study on 40 patients underwent to PCNL. 50 patients with kidney stone who were treated by extracorporeal shock wave lithotripsy (ESWL) were used as control group. Interleukin-1beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were determined at baseline (T0: before treatment), and at 2, 6 and 24hours after (T1, T2 and T3). RESULTS: No relevant changes on IL-1ß and TNF-α were found. IL-6 showed two peaks at 2 and 6hours post-PCNL (median 17.8 and 15.8 pg/mL, respectively). At 24hours CRP had reached its peak value (3.4mg/L). The group treated with ESWL no showed significant changes in any of the markers. The serum concentration of IL-6 and CRP at 24hours post-NLP is different depending on the occurrence of complications (P=.001 and P=.039, respectively). IL-6 showed a good predictive power for the development of complications (AUC .801). CONCLUSIONS: Tissue damage caused by the PCNL is low. This damage increases significantly in those cases showing postoperative complications. IL-6 at 24hours has been shown to be a good predictive tool for the development of complications.

[Gunshot bladder trauma: case report and literature review]. / Traumatismo vesical por arma de fuego: presentación de un caso y revisión de la literatura.

OBJECTIVE: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature. METHODS: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment. RESULTS: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day. CONCLUSIONS: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5-8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients.

Traumatismo vesical por arma de fuego: presentación de un caso y revisión de la literatura / Gunshot bladder trauma: case report and literature review

Objetivo: Presentar un caso de traumatismo vesical por arma de fuego y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada. Material y métodos: Presentamos el caso de un varón de 43 años con herida abdominal por arma de fuego y hematuria macroscópica. Diagnóstico de imagen mediante TC abdómino-pélvico y TC-cistografía. Tratamiento quirúrgico. Resultados: Rotura vesical extraperitoneal en TC-cistografía. Laparotomía exploradora para descartar lesiones asociadas. Cierre quirúrgico de la pared vesical y ureteroneocistostomía con técnica transvesical por desinserción ureteral distal. Antibioterapia de amplio espectro. Evolución favorable. Alta al 14º día. Conclusiones: Los traumatismos vesicales por arma de fuego son una entidad poco frecuente. Debe realizarse exploración y cierre quirúrgico de la perforación vesical en todos los casos. En pacientes estables hemodinámicamente, TC abdómino-pélvico y TC-cistografía permiten descartar lesiones asociadas y clasificar el tipo de traumatismo vesical. Daño ureteral asociado en 5-8,9%, diagnosticado intraoperatoriamente. Antibioterapia intravenosa de amplio espectro en todos los pacientes

Objetive: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature. Methods: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment. Results: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day. Conclusions: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5- 8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients

[Atypical sites of metastatic renal carcinoma. Literature review]. / Carcinoma renal metastásico de localización atípica. Revisión de la literatura.

OBJECTIVE: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. METHODS: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. RESULTS: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. CONCLUSIONS: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness.

[Surgical complications after kidney transplantation. Research based on 185 cases]. / Complicaciones quirúrgicas post-trasplante renal. Estudio en 185 casos.

OBJECTIVE: To analyze the incidence of surgical complications its diagnosis and treatment after renal transplantation. METHODS: A retrospective study measuring the incidence of surgical complications and reviewing its diagnosis and treatment in 185 renal single transplants. RESULTS: 185 transplants, 27% had surgical complications. Only one patient lost the graft due to surgical complications and there was no associated mortality. Cold ischemia time 20 hours. Double J stenting in 19%, under surgeon's opinion. Vascular complications 3.2% (all of them renal artery stenosis). Urological complications 6.4%. Perinephric haematoma 7%. Lymphocele 4.9%. Peritoneum related complications 4%. Other 4%. The diagnosis was clinical and radiological in most of cases. 14% needed any kind of intervention. CONCLUSIONS: Our results are similar to those reported in other recent series. Only one surgical team involved and the same technique for vascular and vesico-ureteric anastomosis probably makes lower our complications rate. Early postoperative abdominal ultrasonography contributes to the diagnosis of surgical complications. The initial treatment approach is the endoscopic-conservative one, with exceptions.

Carcinoma renal metastásico de localización atípica. Revisión de la literatura / Atypical sites of metastatic renal carcinoma. Literature review

Objetivo: Revisar en la literatura localizaciones metastásicas atípicas de carcinoma de células renales, su momento de presentación, características clínicas, diagnóstico, tratamiento y pronóstico. Material y Métodos: Revisión, en la literatura en lengua castellana de los últimos cinco años, de localizaciones atípicas de metástasis de carcinoma de células renales. Búsqueda realizada en la base bibliográfica Medline. Resultados: En los últimos cinco años se han publicado 15 artículos en lengua castellana sobre metástasis atípicas de carcinoma de células renales. Pacientes de predominio masculino con edad media de 62,3 años. Metástasis en su mayoría metacrónicas diagnosticadas mediante pruebas de imagen con confirmación histológica. Localizaciones principales: intraocular, injerto renal, laríngea, suprarrenal, etmoidal, escrotal, cerebral, peneana, gástrica y pancreática. Tratamiento quirúrgico en lesiones resecables. Paliativo con inmuno-radioterapia en el resto. Conclusiones: El carcinoma de células renales representa el 3% de todas las neoplasias malignas del adulto. Metastatiza, por orden de frecuencia, a pulmones, hueso e hígado, pudiendo ser sincrónicas o metacrónicas. El carcinoma de células renales metastásico tiene una amplia variabilidad en cuanto a localización, clínica, momento de presentación, evolución y pronóstico. El abordaje diagnóstico-terapéutico debe ser individualizado, en función de factores pronósticos. El conocimiento de estas localizaciones atípicas en pacientes con antecedentes de carcinoma de células renales influirá en un diagnóstico y tratamiento precoces pudiendo modificar el curso evolutivo de la enfermedad (AU)

Objective: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. Methods: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. Results: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. Conclusions: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness (AU)

[Ureteral implantation in peritoneum. Exceptional complication in renal transplantation]. / Implantación ureteral en peritoneo. Una complicación excepcional en el trasplante renal.

Because of the extraperitoneal location, generally used for renal grafting, intraperitoneal urine leaks are a rare complication after transplantation. We report a patient on peritoneal dialysis who developed ascites, abdominal pain, anuria and shock suddenly after renal transplantation. The patient was immediately taken back to the operating room. An abnormal implantation of ureter into the peritoneum overlying the bladder when carrying out an unstented parallel incision extravesical ureterone-ocystostomy was identified. After correcting ureter implantation the patient had immediate diuresis, renal function rapidly improved, with no further complications. Contributing causes were poor exposure, thickened peritoneum secondary to recurrent peritonitis, and the presence of residual peritoneal dialysis fluid.

[Carcinosarcoma of the renal pelvis: report of a case and review of the literature]. / Carcinosarcoma de pelvis renal: aportación de un caso y revisión de la literatura.

Carcinosarcomas arising in the renal pelvis are uncommon neoplasms. All previously reported cases are isolated reports and have shown to carry a poor prognosis. We report a new case of a 59-year-old man, describing the clinical, radiological and histopathological features.

Implantación ureteral en peritoneo. Una complicación excepcional en el trasplante renal / Ureteral implantation into periotoneum. An unusual complication of kidney transplantation

En el trasplante renal la fuga de orina intraperitoneal es una complicación rara, debido a la implantación habitual en retroperitoneo. Informamos del caso de un paciente en diálisis peritoneal que inmediatamente al trasplante presenta ascitis, dolor abdominal, anuria y shock. Con rapidez es llevado de nuevo a quirófano. Se identificó una implantación del uréter en peritoneo y no en vejiga, en el curso de una ureteroneocistostomía extravesical no tutorizada. Después de corregir la implantación ureteral el paciente recuperó la diuresis, mejoró rápidamente su función renal, sin más complicaciones. Fueron factores contribuyentes la limitada exposición, el engrosamiento peritoneal secundario a peritonitis recurrente y la presencia de fluido de diálisis peritoneal residual (AU)

Carcinosarcoma de pelvis renal: aportación de un caso y revisión de la literatura / Carcinosarcoma of the renal pelvis: report of a case and literature review

Los carcinosarcomas que se originan en la pelvis renal son neoplasias infrecuentes. Todos los casos previamente publicados han sido casos aislados y se caracterizaron por su mal pronóstico. Nosotros aportamos un nuevo caso en un hombre de 59 años de edad, describiendo los aspectos clínicos, radiológicos e histopatológicos (AU)

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Hemangiopericitoma retroperitoneal gigante / Giant retroperitoneal hemangiopericytoma

Presentamos un nuevo caso de hemangiopericitoma retroperitoneal con la peculiaridad del gran tamaño de la tumoración. Debido a esto y al llamativo aporte vascular se procedió a una embolización arterial preoperatoria, que facilitó su extirpación completa. Realizamos una revisión bibliográfica reflejando los aspectos clínicos, patológicos y terapéuticos fundamentales de estos tumores (AU)

Histiocitoma fibroso maligno vesicoprostático / Malignant fibrous histiocytoma of bladder and prostate

Dentro de los sarcomas vesicales del adulto, el histiocitoma fibroso maligno constituye una variedad histológica extremadamente rara. Presentamos un caso con afectación simultánea de vejiga y próstata en un varón de 25 años, que fue tratado favorablemente con cirugía radical y poliquimioterapia. Así mismo, revisamos la bibliografía existente hasta la fecha sobre estas neoplasias (AU)

[Malignant vesico-prostatic fibrous histiocytoma]. / Histiocitoma fibroso maligno vesicoprostático.

Among the adult bladder sarcomas it's extremely rare as an histological variety the malignant fibrous histiocytoma. We present a case of a 25 years old young male with bladder and prostate both affected, successfully treated with radical surgery and poliquimiotherapy. We also reviewed the bibliography about this neoplasias up to now.

[Giant retroperitoneal hemangiopericytoma]. / Hemangiopericitoma retroperitoneal gigante.

We present a new case of retroperitoneal hemangiopericytoma with the special feature of a big size tumour. Due to this feature and also to the hypervascularitation we proceeded a preoperative arterial embolization that made possible its complete removal. We did a bibliographic review showing the fundamental clinic pathologic and therapeutical basic aspects of this tumours.

[Technical solution in kidney retransplantation in a patient with femoro-femoral bypass]. / Solución técnica en el retrasplante renal de un paciente portador de un by-pass femoro-femoral.

Over the last decade kidney transplantation has become a common therapeutic procedure for patients with end-stage renal diseases. Between 1988 and 1998 donors rate per million population has dramatically increased in our environment, thus providing us with more chances to offer kidney transplantation to a larger number of patients. The technico-surgical difficulties that have to be faced however, are increasingly frequent and require a search for new approaches and innovative changes to the usual surgical techniques for our patient's benefit.

Torsión testicular: ¿qué sutura utilizar? / Testicular torsion: wich type of suture must be used?

Presentamos un caso de torsión testicular izquierda ocurrida cuatro meses después de un cuadro similar homolateral en el que se realizó detorsión y fijación bilateral de ambos testículos. La orquidopexia previa se realizó con seda 3-0 y fijación transeptal del testículo contralateral. El antecedente de orquidopexia bilateral no debe influir en el diagnóstico diferencial en el escroto agudo. La fijación creemos que debe realizarse con sutura irreabsorbible en tres localizaciones entre el testículo y el músculo dartos, y se debe realizar exploración del hemiescroto contralateral (AU)