[Detubularized ureterosigmoidostomy Mainz II: a diversion with a future?]. / Ureterosigmoidostomía destubulizada Mainz II: una derivación con futuro?

OBJECTIVE: To review the results achieved with the Mainz II detubularized ureterosigmoidostomy for urinary diversion in patients undergoing bladder resection. METHODS: This study was conducted on 12 prospective patients undergoing radical cystectomy for urothelial carcinoma after 1996. All patients met the following selection criteria: no changes in upper urinary tract functions, normal rectosigmoid, no previous radiation to the area and good anal continence. RESULTS: All patients had a diagnosis of infiltrating urothelial carcinoma of the bladder. Four of these patients died from tumor progression. Renal function is preserved at 31.7 months' mean follow-up, although 3 patients developed moderate metabolic acidosis despite the prophylactic alkalization therapy instituted after surgery. One patient presented recurrent pyelonephritis and stricture of the ureterointestinal anastomosis that required surgical correction. Colonoscopy was unremarkable in all but one patient who showed adenomatous polyp of the colon, which was removed endoscopically, and no other local changes. Continence was complete from the time the urinary catheters were removed. Voiding occurred every 2.9 hours during the day and 2.2 times during the night. CONCLUSIONS: The Mainz II modified ureterosigmoidostomy clearly reduces the upper urinary tract complications because accommodation of the reservoir is better and the pressure inside the pouch is reduced. This technique of urinary diversion is well-accepted by the patients because voiding can be achieved comfortably, a stoma is not required and body image is preserved. The degree of patient satisfaction was high in all cases.

[The loss of heterozygosity on the short arm of chromosome 3 in renal carcinoma]. / Estudio de la pérdida de heterocigosidad en el brazo corto del cromosoma 3 en carcinoma renal.

OBJECTIVE: Renal cancer accounts for 2% of tumors. The most common chromosome abnormality found in renal cancer is the loss of heterozygosity (LOH) on the short arm of chromosome 3 (3p), which suggests that near the gene responsible for von Hippel-Lindau disease, there may be one or more tumor suppressor genes between 3p14 and 3p21 with a relevant role in the development of renal cancer. METHODS: 41 patients with sporadic renal cancer were tested for three microsatellites mapped to the short arm of chromosome 3 (3p14.1-3p14.3, 3p21.2-3p21.3 and 3p25) by polymerase chain reaction. The results were compared with patient habits and tumor features. RESULTS/CONCLUSIONS: 43.9% of the patients showed LOH on at least one locus. Thirty-four percent showed LOH only on one locus, 4.9% on two loci and 7.3% on the three loci tested. All the patients who showed LOH on 3p21 had a tumor size greater than 25 mm. There is a risk 1.76 times higher of no loss in tumors less than 25 mm in size than in tumors greater than 25 mm (Cl 95% 1.33-2.33).

[New quantitative method for determining p53 protein in bladder carcinomas]. / Nuevo método cuantitativo para determinar la proteina P53 en carcinomas vesicales.

OBJECTIVE: To continue a study protocol on the molecular biology of bladder tumors, analyze protein p53 expression using a new quantitative analytical method and the biological implications of the changes in p53 expression. METHOD: From January, 1993 to January, 1995, 74 patients were studied. These patients were divided into two groups: the first group comprised 14 controls of urothelial tissue and the second comprised 60 cases of transitional cell carcinoma of the bladder. A quantitative method of immunoluminescence (LIA-mat p53 method) was utilized to analyze p53 expression. RESULTS: Tissue oncoprotein p53 was higher in patients with bladder carcinoma than in healthy urothelial tissue. Higher values of protein p53 was found in infiltrating and undifferentiated tumors and in those patients who died than in those who are alive. CONCLUSION: Protein p53 determination using this new quantitative method permits identification of subgroups of patients with tumors that have a more aggressive biological behaviour.

[The molecular biology of bladder carcinoma]. / Biología molecular del carcinoma vesical.

OBJECTIVE: The clinical course of transitional cell carcinoma of the bladder can be difficult to predict due to its potential to invade the muscle layer and/or develop to a high grade lesion. Bladder carcinoma can arise from genetic changes that may activate the oncogenes (-c-erbB2, c-erbB1, c-myc, ras, etc.) and/or inactivate the suppressor genes (p53, Rb). The aim of the present study is to continue a study protocol on the molecular biology of bladder tumors. METHODS/RESULTS: From January, 1993 to January, 1995, 85 patients were studied. These patients were divided into two groups: the first group comprised 14 controls of urothelial tissue and the second comprised 65 cases of transitional cell carcinoma of the bladder. p53 expression was determined by an immunohistochemical method (NCL-p53-DO7 monoclonal antibody). Quantification of the p8 oncoprotein in cytosol and EGFR (epidermal growth factor receptor) in membrane was performed by ELISA (Oncogene Science) and RIA (Vienna Lab), respectively. A statistically significant relationship between the expression of p53 and EGFR with tumor stage and grade was found. Quantification of p185 and EGFR showed higher values in the tumor tissue than in the control samples, but a worse survival could not be determined. CONCLUSIONS: The present study shows that p53 expression can be considered to be a prognostic factor. It provides useful information on the aggressive behaviour of the tumor and has a direct relation with the survival rates.

[Lymphoproliferative pathology of the genitourinary tract. Report of 6 cases and review of the literature]. / Patología linfoproliferativa del tracto genitourinario. Aportación de 6 casos y revisión de la literatura.

OBJECTIVES: Six cases of genitourinary lymphoma are described and the literature reviewed. METHODS/RESULTS: The cases had the following histopathological diagnosis: 1 small and large cell non-Hodgkin lymphoma (NHL) of the renal pelvis, 2 high grade centroblastic testicular NHL; 1 centroblastic-centroid bladder NHL, 1 lymphoplasmocytoid bladder NHL and 1 low grade NHL of the prostate. All but the prostatic lymphoma were primary. Treatment was by nephrectomy and chop polychemotherapy (PCT) for the renal pelvis NHL, orchiectomy for the 2 testicular NHLs (one case also received radiotherapy), chop PCT for the bladder NHLs and PCT for the prostatic NHL. Three patients have died: the patient with renal pelvis NHL, centroblastic-centroid bladder NHL and the patient with prostatic NHL. CONCLUSIONS: Although these tumors are rare, they should be suspected in patients with lymphoma, elderly men with a testicular mass, patients with a large bladder compressing/infiltrating mass and in the immunnodepressed patients. A preoperative histopathological diagnosis must be made before performing radical surgery.

[Urothelial tumors of the upper urinary tract: epidemiologic study, diagnostic assessment, and treatment]. / Tumores uroteliales del tracto urinario superior: estudio epidemiológico, evaluación diagnóstica y terapéutica.

OBJECTIVES: The result of an epidemiological study and evaluation of diagnosis and treatment of transitional cell tumors of the upper urinary tract are presented. MATERIAL AND METHODS: A retrospective study was conducted on 34 patients with transitional cell tumor of the upper urinary tract. RESULTS: The most common symptom was intermittent hematuria. Smoking was found to be the most important risk factor and 41.7% of the cases previously had a bladder cancer. IVP was the diagnostic technique most commonly utilized (61.7%). Nephroureterectomy was performed in 58.8% of the cases. Six cases had recurrence of the upper urinary tract tumor. There were 9 deaths (26.5%). CONCLUSIONS: The epidemiological data are similar to those of larger series. The tumors appear to develop in the presence of generalized urothelial disease. The low incidence of recurrence in the ipsilateral ureteral meatus indicates that resection of the distal ureter may not be required in patients at high risk.

[Infantile enuresis: epidemiologic, clinical, urodynamic, and radiologic data of a consecutive series of 100 cases]. / Enuresis infantil: datos epidemiológicos, clínicos, urodinámicos y radiológicos de una serie consecutiva de 100 casos.

The present paper reports the epidemiological, clinical, urodynamic and cystographic data of 100 consecutive patients (mean age 9.59 years) with nocturnal enuresis. These patients were divided into three groups: group I (4 to 7 years old), 23 patients; group II (8 to 11 years old), 51 patients; and group III (12 to 14 years old), 26 patients. Nocturnal enuresis was more frequent in group II (51%). It was more prevalent in males (51%) of groups I and II. Isolated nocturnal enuresis was more frequent (54%) than nocturnal enuresis associated with diurnal symptoms (46%) in all age groups. Urinary infection was observed in 16% and was more prevalent in girls (68.7%). Detrusor instability was the most common urodynamic finding (40%), particularly in group II and girls. Uncoordinated voiding was the second most common urodynamic finding (24%), particularly in group II and girls. Lower urinary tract infection was observed in 1% (males). No abnormal urodynamic data were observed in 19%. Neurogenic bladder was observed in 16%, mainly in group II (31%). Vesicoureteral reflux was detected in 18%, mainly in girls (66.6%) and a postvoiding residual urine in 10%. A diagnostic and prognostic system and a therapeutic strategy based on our data are proposed.

[Endoscopic myocapsulotomy. Evaluation of the short-term clinical and urodynamic results]. / Miocapsulotomía endoscopia (MC). Evaluación de los resultados clínicos y urodinámicos a corto plazo.

Clinical and urodynamic evaluation of a series of 35 patients aged between 49 and 85 years. Clinical symptoms presented post-miocapsulotomy reduction both in obstructive and irritative signs and symptoms in 97.2% and 91.6% cases, respectively. Likewise, a decrease in peak flow and peak flow percentile was shown in 80.5% and 80% of cases, respectively. Vesical instability was seen in 90.9% and 55.5% of cases in pre- and post-operative studies respectively. An statistically significant post-operative drop (p < 0.05) in the detrusor's peak pressure during miction, (76.6 vs. 56 cm H2O), was confirmed. From our results it may be concluded that MC is a useful surgical technique in the treatment of prostatic obstruction, with the advantage versus other techniques that very frequently it preserves the proximal urinary continence mechanism and the sexual sphincter.