[Renal oncocytoma. Review of our 22 patients]. / Oncocitoma renal. Revisión de nuestra serie de 22 pacientes.

UNLABELLED: Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. MATERIALS AND METHODS: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. RESULTS: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64 cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. CONCLUSIONS: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.

Oncocitoma renal. Revisión de nuestra serie de 22 pacientes / Renal oncocytoma. Review of our 22 patients

Introducción: El oncocitoma renal es un tumor benigno cuya frecuencia de presentación oscila entre el 3- 7% de las masas renales sólidas. Muestra especiales características celulares y evolutivas, con posibilidad de metacronicidad, bilateralidad y multifocalidad, además de un difícil diagnóstico diferencial con neoplasias malignas. Material y Método: Revisamos retrospectivamente en 428 tumores renales intervenidos desde Enero de 1986 hasta Abril de 05 la proporción de oncocitomas diagnosticados, analizando sus características anatomopatológicas y comportamiento clínico, comparándolas con las presentadas por los carcinomas de células renales. Observamos su posible bilateralidad, multifocalidad y asociación con otros tumores. Determinamos en cuántos casos los métodos diagnósticos de imagen permitieron sospechar la naturaleza tumoral benigna previamente a la intervención. Seguimiento medio y mediano 13 y 36,86 meses respectivamente (1-193). Resultados: Hemos encontrado 24 oncocitomas (5,67%), en 10 hombres y 12 mujeres con una edad media de 59 años (34-84). 12 de ellos en riñón izquierdo y 12 en derecho, además de una oncocitomatosis renal. Tamaño medio de 4,64 cm (1-12,5). En 17 pacientes el diagnóstico ha sido incidental. En los 5 restantes el síntoma de debut fue hematuria. Supervivencia específica 100%. Se sospechó la naturaleza tumoral benigna o específicamente oncocitomatosa previamente a la cirugía en 22,73% (5/22) y 9,9% (2/22) respectivamente. Conclusiones: En nuestra serie de tumores renales intervenidos el porcentaje de oncocitomas coincide con lo publicado en la literatura. Hemos encontrado dos casos de tumor sincrónico, pero ninguno metacrónico, bilateral ni metastásico. Todos han presentado un comportamiento benigno

Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. Materials and methods: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. Results: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. Conclusions: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution

Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms.

OBJECTIVES: To assess the efficacy of posterior tibial nerve stimulation for treatment of lower urinary tract irritative symptoms (urgency, frequency, urge incontinence and pelvic pain). PATIENTS AND METHODS: 51 female patients with a mean age of 55 years were enrolled in the study. The patients presented with the following symptoms: Frequency/urgency 26 patients (50.98%), urge incontinence 22 (43.13%) and interstitial cystitis 3 patients (5.88%). The technique consists in administering low voltage electric stimulation via a 3-5cm needle placed above the tibial malleolus. Patients received weekly stimulations of 30 minutes for a 10-week period. Quality of life questionnaires and voiding diaries before and after treatment were completed. Moreover, the results were evaluated by patients. The variables analysed include: daytime and nighttime voiding frequency, daytime and nighttime voiding volume, daytime and nighttime leakage episodes and hypogastric pain. RESULTS: A statistically significant improvement was seen in all variables, especially remarkable in relation to frequency/urgency, impact on women quality of life and hypogastric pain, being less marked in relation to leakage episodes and voiding volume. CONCLUSIONS: Afferent nerve stimulation offers an alternative treatment for managing lower urinary tract irritative symptoms. However, it would be advisable to confirm the results obtained by means of long-term randomized, follow-up studies.

[Fibroepithelial polyp of the urethra in a young woman]. / Pólipo fibroepitelial de uretra en mujer joven.

OBJECTIVE: We present the case of a fibroepithelial polyp from the uretra of a young female, analysing the factors that make this an interesting case. MATERIAL AND METHODS: A case-report of a fibrous polyp from the urethra of a young female, an analysis of its differential diagnosis and a review of the literature. RESULTS AND CONCLUSIONS: The fibrous polyp of the urethra (fibroepithelual polyp, simple polyp, pedunculated polyp) is a rare benign epithelial tumour, more frequently encountered in males and in the posterior urethra. When it appears in females it is usually located in the external meatus and normally asymptomatic, although it can also present with a mictional syndrome, terminal hematuria or urethral hemorrhage. The differential diagnosis includes other benign epithelial tumours of the urethra, such as the caruncula, mainly the granulomatous, very difficult to differentiate, the squamous papilloma and the acuminated chondiloma. A clinical examination and histological study are necessary for a correct diagnosis, and treatment consists of surgical resection.

[Urinary incontinence caused by urocolpos. Report of a new case]. / Incontinencia urinaria por urocolpos. Aportación de un nuevo caso.

We present a new case of urocolpos that appeared as urinary incontinence. We discuss the etiology and the available therapeutic choices, emphasizing on the value of the clinical history and physical exploration showed data.

[Incidental diagnosis of renal carcinoma. Does it imply a better prognosis?]. / Diagnóstico incidental del carcinoma renal. Implica un mejor pronóstico?

OBJECTIVE: We present 267 patients undergoing surgery for renal carcinoma, comparing the incidental tumour and symptomatic tumour with different parameters and evaluating the prognostic significance of the incidental diagnosis. MATERIAL AND METHODS: Of the 267 patients, 110 (41.2%) were diagnosed incidentally. The different variables analysed were: age, sex, tumour size, if unilateral or bilateral, histological type, stage, degree of cellular differentiation and survival. The mean follow-up period was of 43.32 mos in the symptomatic patients and 41.85 mos in the patients diagnosed incidentally. The data obtained was analysed with the SPSS statistic pack. RESULTS: No significant difference was detected between both groups in regards to age, sex, if unilateral or bilateral and histological type. Comparing tumour size, a statistic difference was observed with slices at 6 cm. When analysing the stage and degree of cellular differentiation, a significant difference is found with tumours diagnosed incidentally presenting better differentiation and a lower stage at the moment of diagnosis. Survival after 5 yrs was of 65.7% for symptomatic patients in comparison to 81.7% for the incidental group, which implies high statistical signification (log rank = 0.0018). CONCLUSIONS: In our series no significant differences were detected between incidental and symptomatic tumours when comparing age, sex, anatomic side and histological type. Significant differences were indeed detected in relation to size, degree of cellular differentiation, tumour stage and survival.

Incontinencia urinaria por urocolpos. Aportación de un nuevo caso / We present another case of urocolpos what occur as urinary incontinence

Se presenta un nuevo caso de urocolpos que clínicamente debutó con incontinencia urinaria. Se discuten su etiología y las opciones terapéuticas disponibles resaltando el valor de los datos aportados por la historia clínica y la exploración física (AU)

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[Value of post-miction residue after urethrocervicopexy. Prospective study]. / Valor del residuo posmiccional tras la uretrocervicopexia. Estudio prospectivo.

OBJECTIVE: To demonstrate that a high post-micturitional residue after a colposuspension is not a success predictive factor in the incontinence surgery. METHODS: We designed two identical groups of work, with the only difference of a high post-micturitional residue in one of them after the surgery (< 100 cc), and we evaluated the surgical results, with a follow-up of one year. We considered fails the presence of losses related with stress. RESULTS: There were no significative differences in the number of the deliveries, age, weight, length or body mass index in both groups. There were significative differences in the permanence of the urethral catheter and residue of urine, p < 0.001. There were no differences in the number of success in both groups. CONCLUSION: A high post-micturitional residue after colposuspension is not an influent factor in the final result of surgery.

[Urethrocervicopexy in aged women. Prospective study]. / Uretrocervicopexia en la mujer mayor. Un estudio prospectivo.

OBJECTIVES: [corrected] To demonstrate that Burch colposuspension gives a higher index of fails in over sixty years women affected of stress incontinence than in women under sixty years of age. METHODS: We established two groups of follow-up, each of them included twenty women affected of stress urine incontinence and surgical treatment indication. The only difference between both groups was the age of the patients, with a limit established in sixty years. We have evaluated the results of surgical intervention one year after it. The binomial parameters are compared with x2 test; the continuous parameters with the t-Student test for independent parameters. RESULTS: We did not find statistical significative differences with number of deliveries, body mass index, previous pelvic surgery, perineal rehabilitation, or the importance of the incontinence, between both groups of women. We found statistical significative difference in the novo micturition urgency or an increase in a previous urgency (p < 0.1) in women over sixty years. We did not find statistical significative differences in the number of successes and fails in both groups. CONCLUSION: The age is not a risk factor of failing of Burch colposuspension, but it is a risk factor of the appearance or increase of micturition urgency.

Pólipo fibroepitelial de uretra en mujer joven / Fibroepithelial polyp of the urethra in a young female

OBJETIVO: Aportación de un caso de pólipo fibroepitelial de uretra femenina en mujer joven. Análisis de los factores que lo convierten en un caso interesante. MATERIAL Y MÉTODOS: Exposición de un caso clínico de pólipo fibroso de uretra femenina en mujer joven, estudio de los diferentes diagnósticos diferenciales y revisión de la literatura. RESULTADO Y CONCLUSIONES: El pólipo fibroso de uretra (pólipo fibroepitelial, pólipo simple, pólipo pedunculado), es una rara tumoración epitelial benigna, más frecuente en varones y en la uretra posterior. Cuando aparece en la mujer suele asentar en el meato externo y ser asintomático, aunque también puede debutar como síndrome miccional, hematuria terminal o uretrorragia. El diagnóstico diferencial incluye otros tumores epiteliales benignos de la uretra, como la carúncula, fundamentalmente la granulomatosa, de la que puede ser muy difícil de diferenciar el papiloma escamoso y el condiloma acuminado. Para su diagnóstico son necesarias la exploración clínica y el estudio histológico, y el tratamiento consiste en la extirpación (AU)

[Kluyvera ascorbata. Case report of a patient with Crohn's disease]. / Kluyvera ascorbata. Presentación de un caso en paciente con enfermedad de Crohn.

For the not frequent, we contributed a new case of infection urinary produced by the I generate Kluyvera. We make a bibliographical review, clinical expression of the same and we insisted in a series of peculiarities, you like the appearance give because of the treatment pharmacologic and their intestinals.

Diagnóstico incidental del carcinoma renal. ¿Implica un mejor pronóstico? / Incidental diagnosis of renal carcinoma. Does this imply a better prognosis?

OBJETIVO: Se analizan 267 pacientes intervenidos quirúrgicamente de carcinoma renal, comparando el tumor incidental y el sintomático en relación a diversos parámetros, y valorando la significación pronostica del diagnóstico incidental. MATERIAL Y MÉTODOS: De los 267 pacientes, 110 (41,2 por ciento) fueron diagnosticados de forma incidental. Las variables analizadas fueron edad, sexo, tamaño tumoral, lateralidad, tipo histológico, estadio, grado de diferenciación celular y supervivencia. La media de seguimiento ha sido de 43,32 meses en los sintomáticos y 41,85 meses en los incidentales. Los datos obtenidos fueron analizados mediante el paquete estadístico SPSS.RESULTADOS: No se ha encontrado diferencia significativa entre los dos grupos en relación a la edad, sexo, lateralidad o tipo histológico. Comparando el tamaño tumoral, se encontró diferencia estadísticamente significativa situando el punto de corte en 6 cm. Al analizar el estadio y grado de diferenciación celular, existe una diferencia significativa, resultando los tumores incidentales mejor diferenciados y en menor estadio al diagnóstico. La supervivencia a los cinco años ha sido del 65,7 por ciento en los sintomáticos frente al 81,7 por ciento de los incidentales, lo que supone una alta significación estadística (log rank = 0,0018).CONCLUSIONES: En nuestra serie, no existe diferencia significativa entre tumores incidentales y sintomáticos al comparar la edad, sexo, lateralidad y tipo histológico. Sí existe en relación al tamaño, grado de diferenciación celular, estadio tumoral y supervivencia (AU)

Valor del residuo posmiccional tras la uretrocervicopexia. Estudio prospectivo / Value of a high post-mictional residue after a colposuspension. A prospective study

OBJETIVO: Demostrar que el residuo postmiccional elevado tras una uretrocervicopexia no es un factor predictor de éxito en la cirugía de la incontinencia. MATERIAL Y MÉTODOS: Se diseñaron dos grupos de trabajo idénticos en todo salvo en la presencia de residuo postmiccional elevado tras la cirugía (mayor de 100 cc) en uno de ellos, y se evaluaron los resultados quirúrgicos, con un periodo de seguimiento de hasta un año, considerando fracaso la presencia de escapes relacionados con los esfuerzos. RESULTADOS: No hubo diferencias significativas en el número de partos, edad, peso, talla o índice de masa corporal entre los dos grupos. Hubo diferencia significativa en el tiempo de mantenimiento de la sonda y volumen residual, p<0,001.No hubo diferencia en las tasas de éxito en los dos grupos. CONCLUSIÓN: El residuo postmiccional elevado tras la uretrocervicopexia tipo Burch no es un factor influyente en el resultado final de la cirugía (AU)

Uretrocervicopexia en la mujer mayor. Un estudio prospectivo / Colposuspension in the elderly woman. A prospective study

OBJETIVO: Demostrar que la uretrocervicopexia tipo Burch tiene mayor índice de fracasos en mujeres mayores de 60 años con incontinencia de esfuerzo que en menores de 60 años. MATERIAL Y MÉTODOS: Mediante estudio analítico de seguimiento, se establecieron dos grupos, cada uno de 20 pacientes con incontinencia urinaria de esfuerzo e indicación quirúrgica, sólo diferenciados por la edad de las pacientes, estableciendo el corte en 60 años. Al año de la intervención se evalúa el resultado de la cirugía. Las variables binomiales son comparadas mediante test de la Chi cuadrado; las variables continuas mediante t de Student para datos independientes. RESULTADOS: No se encontraron diferencias significativas al comparar el número de partos, índice de masa corporal, antecedentes de cirugía pélvica, de rehabilitación perineal o la severidad de la incontinencia, entre los dos grupos de mujeres. Se encontraron diferencias significativas en la aparición de más urgencia miccional de novo o aumento de una urgencia miccional preexistente (p<0,1) en las mujeres mayores de 60 años. No aparecieron diferencias significativas en la tasa de éxitos y fracasos en los dos grupos. CONCLUSIÓN: La edad no es un factor de riesgo de fracaso en la uretrocervicopexia tipo Burch, aunque sí de la aparición o empeoramiento de urgencia miccional (AU)

Kluyvera ascorbata. presentación de un caso en paciente con enfermedad de Crohn / Kluyvera ascorbata. One case presentation in a patient with Chron's disease

Por lo poco frecuente, aportamos un nuevo caso de infección urinaria producida por el género Kluyvera. Se hace una revisión bibliográfica, expresión clínica del mismo e insistimos en una serie de peculiaridades, como aparición tras tratamiento farmacológico y su etiología intestinal (AU)

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[Nephrogenic adenoma. Report of 4 new cases]. / Adenoma nefrogénico. Presentación de cuatro nuevos casos.

OBJECTIVE: Four additional cases of nephrogenic adenoma are described. METHODS: The clinical records of patients with nephrogenic adenoma that had been diagnosed at our hospital from 1994 to 1999 were reviewed. RESULTS: The most frequent localization was the urinary bladder and it was more prevalent in middle-aged men. This condition usually presented as a histological finding in the course of follow-up or treatment of other bladder conditions by TUR or cystectomy. Biopsy is fundamental for diagnosis. CONCLUSIONS: Nephrogenic adenoma is a rare benign metaplastic lesion of the urinary tract that appears to result from chronic irritative stimulus to the urothelium. The treatment of choice is by transurethral resection. Although no case of progression to malignancy have been detected, long-term follow-up by endoscopy and ultrasound is advocated due to its predispositon to recurrence.