Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study.

PURPOSE: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. MATERIALS AND METHODS: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. RESULTS: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. CONCLUSIONS: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.

Flexible ureterorenoscopy (URS): technique and results.

OBJECTIVES: This paper has two main objectives: First, to expose the URS technique used in our Department because there are important differences with respect to others centres published, explaining same aspect that can benefit to the better development of the technique. Second, we present the results of a series of 100 cases. Flexible ureterorenoscopy (Flex URS) has been little used to date, mainly because of the technical difficulties created by the deficient quality of the instruments used, such as ureteroscopes offering scant visibility, poor illumination, a small working channel, deficient quality of the forceps and baskets, etc. METHODS: We present our recent series of flexible URS for the treatment of renal lithiasis. We performes a retrospective analysis of this treatment corresponding to the period between January 2007 and March 2010. In this period we have treated 100 patients. The medium size of the stone treated is 1.5cm (0.5-6cm) and we used ureteroscopic protector sheath in all cases. The lithotripter system used in all cases was Ho:YAG Laser with 200 and 365 micras fibers RESULTS: The stone-free rate (SFR) in the immediate postoperative period was 77% (77/100 patients). Residual stones, defined as stone fragments visualized in the operating room via fluoroscopy and directly with the flexible ureteroscope. Three months after surgery, the SFR was 92.7% (89/96 patients) confirmed by intravenous urography. Regarding complications, we had 5 patients with ureteral lesions during protector sheath pass and 9 patients that presented at the emergency room with pain secondary to the double J catheter. CONCLUSIONS: Flexible URS for of renal lithiasis can be defended in stones measuring up to 2 cm in diameter, based on our treatment algorithm.

URS Flexible. Técnica y resultados / Flexible ureterorenoscopy (URS): technique and results

OBJETIVO: Los objetivos fundamentales de éste trabajo son dos. Por una parte exponer la técnica empleada en nuestro Servicio ya que difiere en algunos aspectos importantes de las publicadas en otros centros, explicando en algunos casos pequeños detalles que pueden ayudar al mejor desarrollo de la técnica. Por otra parte, exponemos los resultados de una serie de 100 casos.MÉTODOS: Presentamos nuestra serie reciente de URS Flex para el tratamiento de la litiasis renal. Para ello hemos revisado de forma retrospectiva éste tratamiento desde Enero de 2007 hasta Marzo de 2010. El tamaño medio de la litiasis tratada es de 1.5cm (0.5-6cms) y en todos los casos utilizamos vainas protectoras del ureteroscopio. La litotricia empleada en todos los casos fue láser de holmio con fibras de 200 y 365 micrasRESULTADOS: El porcentaje de pacientes que quedaron libres de litiasis (stone free rate-SFR) tras la cirugía en el postoperatorio inmediato fue de 77/100 pacientes (77%) contabilizando como resto litiásico fragmentos visualizados mediante la fluoroscopia del quirófano y la visión directa del URS Flex. A los 3 meses de la cirugía 89/96 pacientes (92.7%) estaban libres de litiasis comprobado mediante urografía intravenosa.Respecto a las complicaciones destacar 5 pacientes con lesión ureteral durante la colocación de la vaina protectora y 9 pacientes que acudieron a urgencias en el postoperatorio por molestias secundarias al catéter doble J.CONCLUSIÓN: Como conclusión podemos defender el tratamiento de las litiasis renales mediante URS Flex hasta un tamaño máximo de 2 cm siguiendo nuestro algoritmo terapéutico(AU)

OBJECTIVES: This paper has two main objectives: First, to expose the URS technique used in our Department because there are important differences with respect to others centres published, explaining same aspect that can benefit to the better development of the technique. Second, we present the results of a series of 100 cases. Flexible ureterorenoscopy (Flex URS) has been little used to date, mainly because of the technical difficulties created by the deficient quality of the instruments used, such as ureteroscopes offering scant visibility, poor illumination, a small working channel, deficient quality of the forceps and baskets, etc. METHODS: We present our recent series of flexible URS for the treatment of renal lithiasis.We performes a retrospective analysis of this treatment corresponding to the period between January 2007 and March 2010. In this period we have treated 100 patients.The medium size of the stone treated is 1.5cm (0.5-6cm) and we used ureteroscopic protector sheath in all cases. The lithotripter system used in all cases was Ho:YAG Laser with 200 and 365 micras fibersRESULTS: The stone-free rate (SFR) in the immediate postoperative period was 77% (77/100 patients). Residual stones, defined as stone fragments visualized in the operating room via fluoroscopy and directly with the flexible ureteroscope.Three months after surgery, the SFR was 92.7% (89/96 patients) confirmed by intravenous urography. Regarding complications, we had 5 patients with ureteral lesions during protector sheath pass and 9 patients that presented at the emergency room with pain secondary to the double J catheter.CONCLUSIONS: Flexible URS for of renal lithiasis can be defended in stones measuring up to 2 cm in diameter, based on our treatment algorithm(AU)

Balones parauretrales (Pro-ACT) en la incontinencia urinaria postquirúrgica del cáncer de próstata / Paraurethral adjustable continence therapy devise (Pro-ACT) in the treatment of urinary incontinence after prostatic surgery

OBJETIVO: Las campañas destinadas a la detección precoz del cáncer de próstata han diagnosticado una mayor cantidad de pacientes con enfermedad órgano-confinada susceptibles de tratamiento con intención curativa.Uno de estos tratamientos es la prostatectomía radical que a pesar de los avances técnicos con el advenimiento de la cirugía laparoscópica o robótica sigue teniendo como efecto secundario la aparición de una incontinencia de orina que condiciona la calidad de vida de los pacientes.MÉTODOS/RESULTADOS: Nos hemos basado en la experiencia personal del Servicio de Urología de La Paz describimos la técnica y nuestros resultados comparándolos con una revisión bibliográfica de otras técnicas utilizadas para el tratamiento de la incontinencia post-prostatectomía radical de la base de datos Medline.CONCLUSIONES: La colocación de balones parauretrales ProAct es el tratamiento de elección en nuestro medio para las incontinencias urinarias leves-moderadas postprostatectomía radical por su alta tasa de éxito con escasa morbilidad, facilidad técnica y adecuado costo económico y de recursos(AU)

OBJECTIVES: Prostate cancer early detection campaigns have led to the diagnosis of a greater number of patients with organ-confined disease candidates for intention-to-cure treatment. Radical prostatectomy is one of these treatments; despite the technical advances with the development of laparoscopic or robotic operations it still has urine incontinence as a side effect affecting patient`s quality of life.METHODS/RESULTS: Based on the experience in the Urology Department at Hospital La Paz we describe the technique and our results, comparing with a bibliographic review of other techniques used for the treatment of urinary incontinence after radical prostatectomy from the Medline database.CONCLUSIONS: The insertion of the paraurethral ProACTTM is the treatment of choice for mild-moderate incontinence after radical prostatectomy in our environment due to its high success rate and low morbidity, technical easiness, and adequate cost and resources requirements(AU)

[Prostatic specific antigen (PS), pro-inflammatory cytokines, and prostatic pathology (benign prostatic hyperplasia and cancer). Relationship with malignancy]. / Antígeno prostático-específico, citoquinas pro-inflamatorias y patología prostática (hiperplasia benigna y cáncer). Relación con la malignidad.

OBJECTIVES: Cancer is a complex process in which cytokines play an important role. Cytokines are low-molecular weight soluble proteins involved in cellular transmission signals and several disorders. Pro-inflammatory cytokines (IL-1, TNF-alpha and IL-6) are involved in prostate cancer development. The aim of this study was to relate the expression (analyzed by Western blot and immuno-histochemistry) of several pro-inflammatory cytokines (IL-1, TNF-alpha and IL-6) with serum levels of prostate-specific antigen (PSA) in normal (no pathological samples) as pathological samples (hyperplasia and cancer), in order to elucidate their possible role in tumor progression. We are also discussing the possible use of these cytokines as a potential therapeutic target. METHODS: This study was carried out in 5 normal, 25 benign prostatic hyperplastic (BPH) and 17 prostate cancer (PC) human prostates. Immunohistochemical and Western blot analysis were performed. Serum levels of PSA were assayed by a PSA DPC immulite assays (Diagnostics Products Corporation, Los Angeles, CA). RESULTS: In BPH, IL-1alpha, IL-6 and TNF-alpha were only expressed in patients with PSA serum levels of 0-4 ng/ml or 4-20 ng/ml, but not in the group >20 ng/ml. In PC these cytokines were only expressed in patients with PSA serum levels >4 ng/ml, although the expression of these cytokines was elevated when PSA levels were >20 ng/ml. CONCLUSIONS: In PC there might be an association between high expression of pro-inflammatory cytokines (IL-1, TNFalpha and IL-6), elevated serum levels of PSA and cancer progression. A better understanding of the biologic mechanism of this association may improve the finding of new targets for therapy in these patients.

Antígeno prostático-específico, citoquinas proinflamatorias y patología prostática (Hiperplasia benigna y Cáncer). Relación con la malignidad / Prostatic specific antigen (PSA), pro-inflammatory cytokines, and prostatic pathology (Benifn prostatic hyperpalsia and cancer). Relationship with malignancy

OBJETIVO: El cáncer es un proceso complejo en el cual las citoquinas juegan un importante papel. Las citoquinas son proteínas solubles de bajo peso molecular, que participan en la transmisión celular y en diferentes patologías. Las citoquinas pro-inflamatorias (IL-1, TNF-α e IL-6) están muy relacionadas con el desarrollo del cáncer de próstata. El objetivo de nuestro trabajo consistió en relacionar la expresión (mediante inmunocitoquímica y Western blot) de diferentes citoquinas pro-inflamatorias (IL-1, TNF-α e IL-6) con los niveles de antígeno prostático específico (PSA) en suero, tanto en pacientes normales (sin patología prostática) como en condiciones patológicas (hiperplasia y cáncer), así como su posible papel en la progresión tumoral. Se discutirá el posible uso de estas citoquinas como diana terapéutica.MÉTODOS: Este estudio se ha realizado en 5 pacientes normales, 25 pacientes diagnosticados de hiperplasia benigna de próstata (HBP) y 17 pacientes de cáncer (CP). Se han realizado análisis de Western blot e inmunocitoquímica. Los niveles séricos de PSA se midieron mediante un “PSA DPC immulite assays” (Diagnostics Products Corporation, Los Angeles, CA).RESULTADOS: En HBP, IL-1α, IL-6 y TNF-α, solo se expresan en pacientes con niveles séricos de PSA de 0-4 ng/ml ó 4-20 ng/ml, pero no en el grupo >20 ng/ml. En cáncer, estas citoquinas se expresan en pacientes con niveles séricos de PSA >4 ng/ml, aunque la expresión de estas citoquinas se eleva considerablemente cuando los niveles de PSA son >20 ng/ml.CONCLUSIONES: En cáncer, podría existir una asociación entre elevada expresión de citoquinas pro-inflamatorias (IL-1, TNF-α e IL-6), elevados niveles séricos de PSA y progresión del cáncer. Un mejor conocimiento de los mecanismos biológicos de esta asociación, podrían ayudarnos a encontrar una posible diana terapéutica para los pacientes con patología prostática(AU)

OBJECTIVES: Cancer is a complex pro-cess in which cytokines play an important role. Cytoki-nes are low-molecular weight soluble proteins involved in cellular transmission signals and several disorders. Pro-inflammatory cytokines (IL-1, TNF-α and IL-6) are involved in prostate cancer development. The aim of this study was to relate the expression (analyzed by Western blot and immuno-histochemistry) of several pro-inflammatory cytokines (IL-1, TNF-α and IL-6) with serum levels of prostate-specific antigen (PSA) in normal (no pathological samples) as pathological samples (hyperplasia and cancer), in order to elucidate their possible role in tumor progression. We are also discussing the possible use of these cytokines as a potential therapeutic target.METHODS: This study was carried out in 5 normal, 25 benign prostatic hyperplastic (BPH) and 17 prostate cancer (PC) human prostates. Immunohistochemical and Western blot analysis were performed. Serum levels of PSA were assayed by a PSA DPC immulite assays (Diag-nostics Products Corporation, Los Angeles, CA)RESULTS: In BPH, IL-1α, IL-6 and TNF-α were only ex-pressed in patients with PSA serum levels of 0-4 ng/ml or 4-20 ng/ml, but not in the group >20 ng/ml. In PC these cytokines were only expressed in patients with PSA serum levels >4 ng/ml, although the expression of these cytokines was elevated when PSA levels were >20 ng/ml.CONCLUSIONS: In PC there might be an association between high expression of pro-inflammatory cytokines (IL-1, TNFα and IL-6), elevated serum levels of PSA and cancer progression. A better understanding of the biologic mechanism of this association may improve the finding of new targets for therapy in these patients(AU)

[Paraurethral adjustable continence therapy device (Pro-ACT) in the treatment of urinary incontinence after prostatic surgery]. / Balones parauretrales (Pro-ACT) en la incontinencia urinaria postqurúrgica del cáncer de próstata.

OBJECTIVES: Prostate cancer early detection campaigns have led to the diagnosis of a greater number of patients with organ-confined disease candidates for intention-to-cure treatment. Radical prostatectomy is one of these treatments; despite the technical advances with the development of laparoscopic or robotic operations it still has urine incontinence as a side effect affecting patient's quality of life. METHODS/RESULTS: Based on the experience in the Urology Department at Hospital La Paz we describe the technique and our results, comparing with a bibliographic review of other techniques used for the treatment of urinary incontinence after radical prostatectomy from the Medline database. CONCLUSIONS: The insertion of the paraurethral ProACT is the treatment of choice for mild-moderate incontinence after radical prostatectomy in our environment due to its high success rate and low morbidity, technical easiness, and adequate cost and resources requirements.

[Pheochromocytoma: laparoscopic treatment]. / Feocromocitoma: tratamiento laparoscópico.

OBJECTIVE: We report this clinical case not only for the laparoscopic approach of a pheochromocytoma but also because of its particular aggressiveness and oddity of its clinical presentation. METHODS: 44 years old male presenting with oppressive chest pain with accompanying vegetative symptoms, who was diagnosed of right adrenal pheochromocytoma. RESULTS: After the diagnosis of pheochromocytoma was established and double adrenergic blockage implemented, transperitoneal laparoscopic surgery was performed. Pathological analysis of the surgical specimen confirmed the clinical diagnosis of pheochromocytoma. Patient was discharged home two days after surgery without any complication. CONCLUSIONS: The laparoscopic approach of adrenal pheochromocytoma is possible and safe in centres with laparoscopic experience, obtaining the same results than open surgery, offering advantages for the patient such as less pain, smaller incisions, and early ambulation, which results in a shorter hospital stay.

Feocromocitoma: tratamiento Laparoscópico / Pheochromocytoma: laparosocpic treatment

Objetivo: Presentamos este caso clínico no solo por el abordaje terapéutico laparóscopico de un feocromocitoma, sino por la agresividad y lo poco frecuente de su presentación clínica. Métodos: Se trata de un varón de 44 años que debuta con dolor precordial opresivo acompañado de cortejo vegetativo, diagnosticándose posteriormente de feocromocitoma suprarrenal derecho. Resultados: Tras el diagnóstico de feocromocitoma se realiza laparoscopia con abordaje transperitoneal, previa preparación del paciente con doble bloqueo adrenérgico. El resultado de el análisis anatomo-patológico de la pieza quirúrgica confirmó el diagnóstico clínico de feocromocitoma. El paciente fue dado de alta a los dos días sin ninguna complicación. Conclusiones: El abordaje laparoscópico del feocromocitoma suprarrenal es posible y seguro en centros con experiencia en laparoscopia, obteniéndose en estos casos iguales resultados que con la cirugía abierta y ofreciendo además ventajas para el paciente como son menos dolor, incisión mas pequeña y deambulación precoz, lo que se refleja en una menor estancia hospitalaria (AU)

Objective: We report this clinical case not only for the laparoscopic approach of a pheochromocytoma but also because of its particular aggressiveness and oddity of its clinical presentation. Methods: 44 years old male presenting with oppressive chest pain with accompanying vegetative symptoms, who was diagnosed of right adrenal pheochromocytoma. Results: After the diagnosis of pheochromocytoma was established and double adrenergic blockage implemented, transperitoneal laparoscopic surgery was performed. Pathological analysis of the surgical specimen confirmed the clinical diagnosis of pheochromocytoma. Patient was discharged home two days after surgery without any complication. Conclusions: The laparoscopic approach of adrenal pheochromocytoma is possible and safe in centres with laparoscopic experience, obtaining the same results than open surgery, offering advantages for the patient such as less pain, smaller incisions, and early ambulation, which results in a shorter hospital stay (AU)

[Paraurethral ballon implantation in the treatment of male urinary incontinence. La Paz University Hospital experience]. / Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina. Experiencia del Hospital Universitario La Paz.

OBJECTIVES: We want to show our experience with paraurethral balloon implantation in the treatment of male urinary incontinence. METHODS: We retrospectively reviewed our series from March 2003 to March 2007, including 69 male patients with urinary incontinence, most of them after radical prostatectomy. RESULTS: 6 patients did not have their first follow-up visit after surgery. Mean follow-up was 22 months (3-48). 57.14% of the patients (36/63 do not need pads, and 12.69% use one safety pad (8/63); therefore 69.83% (44/63) of the patients are dry or use one safety pad. If we stratify patients by incontinence severity, 81.25% of the patients with mild incontinence and 59.25% with moderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection). CONCLUSIONS: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence.

Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina. Experiencia del Hospital Universitario la Paz / Paraurethral balloon implantation in the treatment of male urinary incontinence. La Paz University Hospital experience

Objetivo: Queremos expresar nuestra experiencia con el implante de balones parauretrales, como tratamiento de la incontinencia urinaria masculina. Métodos: Hemos revisado de forma retrospectiva nuestra serie desde marzo del 2003 a marzo del 2007, que incluye a 69 pacientes con incontinencia urinaria masculina, la mayoría tras prostatectomía radical. Resultados: 6 pacientes están pendientes de su primera revisión tras la cirugía. Con un seguimiento medio de 22 meses (3-48) el 57.14% de los pacientes (36/63) no precisan protección y el 12.69% usan una compresa de seguridad (8/63), por tanto el 69.83% (44/63) de los pacientes están secos o usan una compresa de seguridad. Si estratificamos a los pacientes según el grado de su incontinencia, el 81,25% de los pacientes con incontinencia leve están secos y el 59.25% de los pacientes en el grupo de incontinencia moderada. Sin embargo, solo el 35% de los pacientes con incontinencia severa están secos (sin protección). Conclusión: Según nuestra experiencia, pensamos que el implante de balones parauretrales podría ser la primera opción terapéutica para la incontinencia urinaria masculina leve y moderada (AU)

Objectives: We want to show our experience with paraurethral balloon implantation in the treatment of male urinary incontinence. Methods: We retrospectively reviewed our series from March 2003 to March 2007, including 69 male patients with urinary incontinence, most of them after radical prostatectomy. Results: 6 patients did not have their first follow-up visit after surgery. Mean follow-up was 22 months (3-48). 57.14% of the patients (36/63 do not need pads, and 12.69% use one safety pad (8/63); therefore 69.83% (44/63) of the patients are dry or use one safety pad. If we stratify patients by incontinence severity, 81.25% of the patients with mild incontinence and 59.25% with moderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection). Conclusions: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence (AU)

[Bladder neurofibroma: case report and bibliographic review]. / Neurofibroma de la vejiga: caso clínico y revisión de la literatura.

OBJECTIVE: The prevalence of the disease is 1/3000 newborns; it is more frequent in men than in women with a 3:1 ratio in all races. Genitourinary tract neurofibromas usually arise from the pelvic and bladder nerves, and the prostatic plexus. Bladder is the most frequently affected organ of the urinary tract; bladder neurofibromatosis may present as a diffuse infiltrative process or an isolated neurofibroma. Bladder neurofibromas arise from nervous ganglia of the bladder wall and stain positive for protein S-100 and type IV collagen with immunohistochemical techniques. METHODS: We performed a bibliographic review about urinary tract neurofibromas, and specifically of bladder neurofibroma. We report the case of a 45-year-old female consulting for voiding symptoms and recurrent urinary tract infections. Imaging tests showed a mass in the left lateral wall of the bladder and diffuse thickening of the bladder wall. The thickening of the bladder wall is the most characteristic finding in imaging tests, which may also be present in other diseases such as inflammatory pseudotumor and leiomyoma, so that final diagnosis should be achieved by pathologic study. RESULTS: The case is relevant for the absence of previous diagnosis of neurofibromatosis, being bladder involvement its clinical debut. This is why it was difficult to suspect the final diagnosis: the absence of other characteristic clinical manifestations of the disease. Transurethral resection of the tumor was performed and pathologic and immunohistochemical studies offered the final diagnosis. The patient was followed in the urology clinic and also sent to the internal medicine department to rule out other organs involvement of the disease. CONCLUSIONS: Neurofibromatosis is a rare systemic disease, and urinary tract involvement is rarer. Bladder is the most frequently involved organ in the urinary tract, generally as a diffuse infiltration or more rarely a solitary tumor. The final diagnosis is pathological and immunohistochemical. Treatment is usually conservative. The patient should be worked up to rule out other manifestations of the disease, and followed to evaluate the development of new lesions.

Neurofibroma de la vejiga: caso clínico y revisión de la literatura / Bladder neurofibroma: case report and bibliographic review

OBJETIVO: La prevalencia de la enfermedad es 1 de cada 3000 nacimientos vivos, siendo más frecuente en hombres que en mujeres con una relación 3:1 en todas las razas. Los neurofibromas del tracto genitourinario provienen generalmente de los nervios pélvicos, vesicales y del plexo prostático. La vejiga es el órgano más afectado del tracto urinario; la neurofibromatosis vesical puede presentarse como un proceso infiltrativo difuso o como un neurofibroma aislado. En la vejiga los neurofibromas se originan de los ganglios nerviosos de la pared vesical y se tiñen positivamente para la proteína S-100 y el colágeno de tipo IV con técnicas de inmunohistoquímica. MÉTODOS: Se realiza una revisión de la literatura acerca de neurofibromas en el tracto urinario y en especial del neurofibroma de la vejiga. Presentamos un caso de una mujer de 45 años de edad que acude a la consulta de urología con síndrome miccional e infecciones urinarias de repetición. Se realizan pruebas de imagen en las que se evidencia masa endovesical en cara lateral izquierda de la vejiga y engrosamiento difuso de la pared vesical. El engrosamiento de la vejiga es el hallazgo mas característico en los estudios de imagen que también puede estar presente en otras patologías como son el pseudotumor inflamatorio y el leiomioma, por lo que el diagnóstico final se realiza mediante el estudio anatomo-patólogico RESULTADOS: Llama la atención en el caso clínico que presentamos, que se trata de una enferma que no tenía diagnóstico previo de neurofibromatosis, siendo la afección vesical la primera manifestación de la enfermedad. Es por eso que en este caso fue difícil sospechar el diagnóstico final dada la ausencia de otras manifestaciones características de la patología. Se realiza resección transuretral del tumor, y el diagnóstico se realiza por el estudio anatomo-patológico e inmunohistoquímico de las muestras obtenidas. Posteriormente se sigue a la enferma en las consultas de urología y es remitida al servicio de Medicina Interna para descartar manifestaciones de la enfermedad en otros órganos CONCLUSIONES: La neurofibromatosis es una enfermedad sistémica que es muy poco frecuente, y la afectación del tracto urinario por neurofibromas lo es aún más. La vejiga es el órgano que mas frecuentemente se afecta del sistema urinario y suele ser como una infiltración difusa o mas raramente como un tumor solitario. El diagnóstico final es anatomo-patológico e inmunohistoquímico. El tratamiento suele ser conservador . Se debe estudiar al enfermo con el objetivo de descartar manifestaciones de la enfermedad, así como realizar seguimiento para valorar la aparición de nuevas lesiones

OBJECTIVE: The prevalence of the disease is 1/3000 newborns; it is more frequent in men than in women with a 3:1 ratio in all races. Genitourinary tract neurofibromas usually arise from the pelvic and bladder nerves, and the prostatic plexus. Bladder is the most frequently affected organ of the urinary tract; bladder neurofibromatosis may present as a diffuse infiltrative process or an isolated neurofibroma. Bladder neurofibromas arise from nervous ganglia of the bladder wall and stain positive for protein S-100 and type IV collagen with immunohistochemical techniques. METHODS: We performed a bibliographic review about urinary tract neurofibromas, and specifically of bladder neurofibroma. We report the case of a 45-year-old female consulting for voiding symptoms and recurrent urinary tract infections. Imaging tests showed a mass in the left lateral wall of the bladder and diffuse thickening of the bladder wall. The thickening of the bladder wall is the most characteristic finding in imaging tests, which may also be present in other diseases such as inflammatory pseudotumor and leiomyoma, so that final diagnosis should be achieved by pathologic study. RESULTS: The case is relevant for the absence of previous diagnosis of neurofibromatosis, being bladder involvement its clinical debut. This is why it was difficult to suspect the final diagnosis: the absence of other characteristic clinical manifestations of the disease. Transurethral resection of the tumor was performed and pathologic and immunohistochemical studies offered the final diagnosis. The patient was followed in the urology clinic and also sent to the internal medicine department to rule out other organs involvement of the disease. CONCLUSIONS: Neurofibromatosis is a rare systemic disease, and urinary tract involvement is rarer. Bladder is the most frequently involved organ in the urinary tract, generally as a diffuse infiltration or more rarely a solitary tumor. The final diagnosis is pathological and immunohistochemical. Treatment is usually conservative. The patient should be worked up to rule out other manifestations of the disease, and followed to evaluate the development of new lesions

Molecular biology in prostate cancer.

Genes involved in cancer generation are usually tumor suppressors and oncogenes. Progressive genetic alterations in these genes are involved in the mechanisms of tumorigenesis. In prostate cancer, additionally several chromosomal loci that should harbor mutated genes have been proposed. Some genes have been found altered in prostate cancer, such as PTEN, TP53, AR, RNASEL (HPC1), ELAC2 (HPC2), CDKN2A and MSR1 and those can be natural targets for new strategies of treatment. Besides, gene therapy has been suggested to be suitable for prostate cancer treatment. This approach includes ex vivo corrective therapy, suicide, and antisense therapy.

[Ureteroenteric strictures: endourological treatment]. / Estenosis ureterointestinales: tratamiento endourológico.

OBJECTIVES: To review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. METHODS: We retrospectively reviewed 27 ureteroenteric strictures treated from March 1994 to June 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double J catheter (3 of them antegrade) 8 patients underwent endoscopical incision + double J catheter (5 of them with Acucise). RESULTS: 12/21 (57,14%) renal units improved and/or remained stable. We emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. CONCLUSIONS: Endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and mid-term in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,....

Estenosis ureterointestinales: tratamiento endourológico / Ureteroenteric strictures: endourological treatment

OBJETIVO: El objetivo de éste estudio hasido revisar el resultado de las estenosis ureterointestinalestratadas de forma endourológica y compararnuestros resultados a largo plazo, con lo publicado enotras series de similares características en tiempo deseguimiento y número de pacientes.MÉTODOS: Desde Marzo de 1994 a Junio de 2003,hemos revisado de forma retrospectiva, el tratamientode 27 estenosis ureterointestinales, con un seguimientomedio de 30.2 meses (1 día - 53 meses).En 6 casos, no se culminó tratamiento endourológico.Se realizaron 13 dilataciones + catéter doble J permanente(3 de forma anterógrada).Tratamos 8 casos con endoureterotomías + catéterdoble J (5 con Acucise*).RESULTADOS: Conseguimos mejorar y/o estabilizar lafunción renal en 12/21 unidades renales (57.14%). Adestacar la ausencia de complicaciones en el intra ypostoperatorio inmediato excepto 1 paciente con dilatación+ c. doble J y muy mal pronóstico oncológico,que falleció al día siguiente por sepsis.CONCLUSIONES: El tratamiento endourológico hademostrado proporcionar buenos resultados funcionalesa corto y medio plazo, en pacientes que por supatología de base, edad, comorbilidad... la cirugíaabierta, sería una opción terapéutica más agresiva,pese a ser el tratamiento de elección en situaciones ideales

OBJECTIVES: To review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. METHODS: We retrospectively reviewed 27 ureteroenteric strictures treated from March 1994 to June 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double J catheter(3 of them antegrade) 8 patients underwent endoscopical incision + double J catheter (5 of them with Acucise®) RESULTS: 12/21(57,14%) renal units improved and/or remained stable. We emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. CONCLUSIONS: Endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and midterm in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,…