[Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis]. / Leiomioma renal sintomático: una masa renal de difícil diagnóstico.

Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggressive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

Leiomioma renal sintomático: una masa renal de difícil diagnóstico / Symptomatic leiomyoma of the kidney: renal mass with difficult preoperative diagnosis

El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical (AU)

[Reabsorption syndrome after transurethral resection (TUR) of the prostate: review of physiologic, diagnostic, and therapeutic features]. / Síndrome de reabsorción post-resección transuretral (R.T.U.) de próstata: revisión de aspectos fisiopatológicos, diagnósticos y terapéuticos.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

[Metachronous solitary contralateral adrenal metastasis of primary renal carcinoma: report of a new case]. / Metástasis adrenal metacrónica solitaria contralateral de un carcinoma renal primario: aportación de un nuevo caso.

OBJECTIVE: To report a case of solitary metachronous contralateral metastasis of a renal carcinoma that had been previously resected. METHODS: A 63-year-old male that had previously undergone a right radical nephrectomy due to renal carcinoma is presented. The patient's left breast was found to be slightly larger at the control evaluation 24-months postoperatively. Analytical and hormonal studies showed no significant findings except for a serum creatinine value of 1.75 mg/dl. However, a CT scan showed a left adrenal nodule of 3 cm. After 6 months of watchful waiting, the nodule had increased to 4.3 cm. A CT-guided fine needle punction aspiration biopsy demonstrated a malignant lesion and a left adrenalectomy was performed. RESULTS: Histopathological analysis of the surgical specimen showed adrenal metastasis of clear cell renal carcinoma. At 21 months' follow-up after adrenalectomy, there is no evidence of recurrence of the metastasis. CONCLUSIONS: This type of lesion is uncommon. We emphasize the importance of the analytical and hormonal studies, as well as CT and FNPA, in the diagnosis of this adrenal pathology. Like other authors, we advocate performing adrenalectomy in these cases.

Linfadenectomía en el carcinoma escamoso de pene: revisión de nuestra serie / Lymphadenectomy in squamous carcinoma of the penis: review of our series

OBJETIVO: Analizar la serie de pacientes sometidos en nuestro Centro a linfadenectomía inguinal por carcinoma escamoso de pene, entre los años 1984 y 1999. MATERIAL Y MÉTODOS: La linfadenectomía fue realizada en 19 pacientes, con una media de edad de 61 años. El tipo de intervención más frecuente fue la ilioinguinal bilateral (42,1 por ciento). Sólo cuatro pacientes fueron sometidos simultáneamente a penectomía y linfadenectomía. Presentamos los resultados clínicos y anatomopatológicos, según la clasificación TNM de 1997.RESULTADOS: Las adenopatías inguinales palpables persistieron tras antibioterapia en siete de 12 pacientes. La correlación global de nuestra serie entre estadio N y pN fue de 68,42 por ciento. Presentamos asimismo los resultados anatomopatológicos según categorías pT y pN. Las complicaciones postoperatorias se presentaron en 13 casos (68,42 por ciento), (siendo el linfedema la más frecuente).Se obtuvo una supervivencia global a uno y cinco años de 90 y 80 por ciento en pacientes con dos o menos ganglios pN(+); frente al 11,11 y 0 por ciento cuando más de dos estuvieron presentes. CONCLUSIONES: La importancia del control de los ganglios linfáticos metastáticos en el carcinoma escamoso de pene, sitúa a la linfadenectomía inguinal como herramienta esencial en los casos apropiados. Su incidencia de complicaciones hace necesario, no obstante, un progresivo consenso en cuanto a sus indicaciones (AU)

Sustitución de prótesis de pene: 1990-1999 / Replacement of penile prosthesis: 1990-1999

OBJETIVO: Analizar la serie de pacientes sometidos entre los años 1990 y 1999 a sustitución de su prótesis de pene debido a la aparición de algún tipo de complicación. MATERIAL Y MÉTODOS: 85 pacientes fueron sometidos a implante, siendo utilizados 13 modelos diferentes de prótesis. En 15 de estos pacientes (17,64 por ciento) ésta tuvo que ser sustituida una vez o más. La edad media en el momento de la sustitución fue de 51,5 años. El acceso quirúrgico más frecuente fue el infrapúbico. RESULTADOS: Se realizaron en total 32 intervenciones de sustitución protésica. Las causas principales fueron: fallo mecánico (13 casos, 40,62 por ciento); infección (10 casos, 31,25 por ciento); y perforación de cuerpos cavernosos (cinco casos, 15,62 por ciento). No se observó incremento progresivo en la incidencia de complicaciones en relación con el número ordinal de la prótesis implantada. Mejores resultados globales: Mentor Mark II y AMS 700 Ultrex Plus. Actualmente sólo ocho (53,33 por ciento) de los 15 pacientes reimplantados hacen uso normal de su prótesis. CONCLUSIONES: Los pacientes sometidos a sustitución de su prótesis de pene son fuente potencial de complicaciones posteriores. Su conocimiento y correcto manejo es importante, de cara a una mejora progresiva en los resultados finales, (sobre todo si éstos -como en nuestro caso- no son aptos para el conformismo) (AU)

[Lymphadenectomy in squamous carcinoma of the penis: review of our series]. / Linfadenectomía en el carcinoma escamoso de pene: revisión de nuestra serie.

OBJECTIVE: To analyze the series of patients who underwent inguinal lymphadenectomy in our Center due to squamous penile carcinoma, between years 1984 to 1999. MATERIAL AND METHODS: Lymphadenectomy was carried out in 19 patients, with a mean age of 61 years. Bilateral ilioinguinal (42.1%) was the most frequent type of intervention. Only four patients underwent penectomy and lymphadenectomy simultaneously. We present the clinical and pathological results, according to the 1997 TNM classification. RESULTS: Palpable inguinal nodes after antibiotherapy remained in seven out of 12 patients. The overall correlation between N and pN stages in our series was 68.42%. Pathological results according to pT and pN stages are also presented. Postoperative complications were present in 13 cases (68.42%), (lymphedema being the most frequent one). In those patients with two or less pN(+) nodes, an overall one-year and five-year survival of 90 and 80% were obtained; compared to 11.11 and 0% when there were more than two. CONCLUSIONS: The importance about control of metastatic lymph nodes in squamous carcinoma of the penis, places inguinal lymphadenectomy as an essential tool, in those suitable cases. However, its incidence of complications makes a progressive agreement about its indications be necessary.

[Replacement of prosthesis of the penis]. / Sustitución de prótesis de pene: 1990-1999.

OBJECTIVE: To analyze the series of patients who underwent replacement of their penile prosthesis between years 1990 to 1999, due to any kind of complication. MATERIAL AND METHODS: 85 patients underwent implantation, 13 different prosthesis models being utilized. It was replaced (once or more) in 15 of these patients (17.64%). The mean age at the moment of the replacement was 51.5 years. The most frequent surgical approach was the infrapubic one. RESULTS: A total of 32 prosthesis-replacement interventions were carried out. The main causes were: mechanical failure (13 cases, 40.62%); infection (10 cases, 31.25%); and corpus cavernosum perforation (five cases, 15.62%). Progressive increase of complications incidence with regard to the ordinal number of the implanted prosthesis was not observed. Best overall results: Mentor Mark II and AMS 700 Ultrex Plus. At present day, only eight (53.33%) out of 15 reimplanted patients use their prosthesis with normality. CONCLUSIONS: Those patients who undergo replacement of their penile prosthesis are potential sources for later complications. Their knowledge and proper handling is important in order to a progressive improvement of the final results, (above all if--such as our case--these ones are not suitable for conformity).

[Hybrid tumor of the penis: is this denomination correct?]. / Tumor híbrido de pene: es correcta dicha denominación?

OBJECTIVE: Few cases of verrucous carcinoma of the penis with foci of invasive squamous cell carcinoma have been reported and denominated "hybrid tumors". The accuracy of this term is discussed in this paper. METHODS/RESULTS: A huge penile mass in a patient that had undergone three previous operations for lesions diagnosed as verrucous carcinoma is reported. Partial penectomy was performed. Histological examination showed a very well-differentiated squamous cell carcinoma. PCR (polymerase chain reaction) did not detect any type of human papillomavirus (HPV) in the tumor. CONCLUSIONS: Verrucous carcinoma is a strictly-defined lesion with a different biological behaviour from that of squamous carcinoma. Preoperative deep biopsy may miss the squamous cell carcinoma. Definitive diagnosis can only be achieved by histological examination of the surgical specimen. In future, DNA studies could possibly support preoperative diagnosis of this lesion.

[Reconstructive surgery with polypropylene mesh associated with kidney transplant]. / Cirugía reconstructiva con malla de polipropileno asociada al trasplante renal.

OBJECTIVE: There is very little literature on hernial complications of the abdominal wall in association to renal transplantation. The present report aims to evaluate their incidence and type, as well as the intervention carried out and its results. MATERIAL AND METHOD: A retrospective analysis of a series of 650 renal transplantations has been carried out between 1978-1996 in our centre. A braided polypropylene mesh (Prolene) was used to repair abdominal wall defects and/or diagnosed hernias in 8 (1.2%) cases: 5 eventrations, 1 inguinal hernia and one combination of both: the last case required extensive debridement of the abdominal wall due to necrotizing fascitis. Mean time to eventration was 47.3 months (range 1-106). RESULTS: In all cases, the mesh was placed in the pre-peritoneal space. Two patients developed complications (one haematoma and one wound infection), though graft removal was not necessary in any case. Follow-up was 33.1 months (range 6-78) with no findings of hernial relapse. One patient started successful chronic ambulatory peritoneal dialysis (CAPD) 30 days after the intervention. CONCLUSIONS: The polypropylene mesh is a sound alternative in the treatment of hernial complications associated to renal transplantation, with acceptable morbidity, and efficacy rates that in our series reached 100%.

[Efficacy and complications of intraprostatic prosthesis in the treatment of benign hyperplasia of the prostate]. / Eficacia y complicaciones de la prótesis intraprostática en el tratamiento de la hiperplasia benigna de próstata.

OBJECTIVE: The UroLume stent has been utilized in the management of symptomatic benign prostatic hyperplasia (BPH), particularly in patients at high surgical risk. Our results are analyzed and the literature reviewed. METHODS: From June, 1994 to November, 1996, 19 patients at high surgical risk (ASA III/IV) with symptomatic BPH were treated at our center; 17 (89.4%) had an indwelling catheter. The UroLume stent was inserted under local anesthesia and intravenous sedation. RESULTS: Stent placement as monotherapy was found to be clinically effective in 15 patients (78.9%) with a mean follow-up of 8.2 +/- 5.7 months (range 1-18). The mean symptom score (Madsen-Iversen) was 6.1 +/- 1.2. Patients with no further manipulations had a mean maximum flow rate of 8.8 +/- 3.8 ml/s. Two patients (10.5%) required stent removal due to retrograde displacement in one case and perineal discomfort and irritative voiding symptoms in the other. In two other patients (10.5%), remnant tissue had to be resected in order to void spontaneously. Seventeen patients (89.4%) were satisfied with the results. No case of urosepsis or incrustations were documented. A microbiological analysis disclosed urinary tract infection in one patient. CONCLUSIONS: The UroLume stent is clinically effective in the treatment of symptomatic BPH in patients unfit for prostatic surgery. It carries a low incidence of major complications and procedure-related morbidity.

[Verrucous carcinoma of the penis. A report of 6 new cases and a review of the diagnostic and therapeutic aspects]. / Carcinoma verrucoso de pene. Aportación de seis nuevos casos y revisión de aspectos diagnósticos y terapéuticos.

Verrucous carcinoma of the penis accounts for 5-17.8% of total carcinomas in the referred location that are diagnosed in our environment. Six cases of this rare neoplasia have been treated in our service and revised retrospectively. The epidemiological, clinical, diagnostic and therapeutic aspects of our series are analyzed and the issues around them discussed. Eventually, the benign biological behaviour of this tumour warranting conservative surgical treatment is ratified. In selected cases where the therapeutic modalities used do not yield material for histopathological analysis (laser, cryotherapy, etc.) prior obtention of a deep biopsy of the lesion to identify the likely presence of a well differentiated epidermoid carcinoma is imperative. Also, every effort should be made to monitor the cases of associated premalignant conditions.

[Neoplasm prevalence in renal transplantation]. / Prevalencia de neoplasias en el trasplante renal.

OBJECTIVE: To analyze the prevalence of neoplasms in renal transplant patients and the relative risk for each tumor type according to the immunosuppression regimen. METHODS: 609 renal transplants were reviewed. The risk index was determined by the ratio of the cases observed and predicted. RESULTS: Tumor prevalence was 4.9% (30/609); 6.3% (25/393) were males and 2.3% (5/216) were females. The most common tumors were cutaneous tumors other than melanoma, accounting for 2.4% (15/609), followed by Kaposi's sarcoma, pulmonary epidermoid carcinoma and genitourinary tumors (0.5%) and non-Hodgkin lymphoma (0.3%). Tumor prevalence was 6.8% for the group treated with azathioprine-prednisone and 3.9% for the cyclosporine A-prednisone-treated group. The estimated relative risk of having a neoplasm was 10-fold higher for the males and 4.2-fold higher for the females vs the general population. The mortality rate was 36.6%; specifically tumor-related in 82%. The mortality rate for those with solid tumors was 77.7%. The long-term survival rate for the group that developed a tumor was significantly lower than that of the general population, 75% vs 53%, respectively (p < 0.05). CONCLUSION: In this series no significant differences were observed relative to tumor prevalence or type according to the immunosuppression regimen. A recipient of a renal graft has a higher risk of developing a tumor. Cutaneous tumors were the most frequent. The long-term survival is lower for recipients of renal grafts who develop a tumor.