[Intrasinus renal hilium approach, EUREKA time for spanish urological surgical anatomy.] / Vía intrasinusal de abordaje al hilio renal, un momento E U R E K A de la investigación anatómica quirúrgica urológica española.

Historical research has allowed us to reviewand document the author of the first description of the intrasinusal route for access to the renal hilum as astrategy for accessing kidney stones through the bibliography. This new route described and published by M. Serés represented a paradigm shift in open surgery for kidney stones. We want to highlight that the Spanish urological anatomical-surgical investigation with the investigations of Manuel Serés, meant a singular contribution and of enormous importance for the History of International Urology, whose value we must claim with its indisputable and reliable references.

La investigación histórica nos ha permitido revisar y mostrar documentalmente por la bibliografía el autor de la primera descripción de la via intrasinusal para el acceso al hilio renal como estrategia de accesoa la litiasis renal. Esta nueva via descrita y publicada por M. Serés supuso un cambio de paradigma en la cirugía abierta de la litiasis renal. Queremos resaltar que la investigación anatomo-quirúrgica urológica española con las investigaciones de Manuel Serés, significó una aportación singular y de enorme trascendencia para la Historia de la Urología Internacional, cuyo valor debemos reivindicar con sus referencias indiscutibles y fehacientes.

El "volumen" del saber urológico en el último cuarto de siglo / The volume of urological knowledge in the last 25 years

Pocas especialidades médicas y quirúrgicas han experimentado en las últimas décadas tantos y tan significativos avances terapéuticos como la Urología. Además de progresos en los conocimientos fisiopatológicos de las distintas enfermedades que conforman el corpus del saber Urológico. La cirugía laparoscópica y las ondas de choque extracorpóreas han revolucionado la especialidad en su totalidad, provocando cambios de paradigma tanto en las indicaciones terapéuticas como en la interpretación de algunos procesos patológicos. Aportamos unas reflexiones desde una mirada retrospectiva

Few specialties have gone through as many transitions in the last decades as Urology. Progressive physiology advances in several disease have become part of the urological knowledge. Laparoscopic surgery and ESWL (Extracorporeal Shock Wave Lithotripsy) wave have completely turn upside down the whole management of disease. The current text provides a back to the future sigh into Urology

[The volume of urological knowledge in the last 25 years.] / El "volumen" del saber urológico en el último cuarto de siglo.

Few specialties have gone through as many transitions in the last decades as Urology. Progressive physiology advances in several disease have become part of the urological knowledge. Laparoscopic surgery and ESWL (Extracorporeal Shock Wave Lithotripsy) wave have completely turn upside down the whole management of disease. The current text provides a back to the future sigh into Urology.

Pocas especialidades médicas y quirúrgicas han experimentado en las últimas décadas tantos y tan significativos avances terapéuticos como la Urología. Además de progresos en los conocimientos fisiopatológicos de las distintas enfermedades que conforman el corpus del saber Urológico. La cirugía laparoscópica y las ondas de choque extracorpóreas han revolucionado la especialidad en su totalidad, provocando cambios de paradigma tanto en las indicaciones terapéuticas como en la interpretación de algunos procesos patológicos. Aportamos unas reflexiones desde una mirada retrospectiva.

A multicolor fluorescence in situ hybridization assay: A monitoring tool in the surveillance of patients with a history of non-muscle-invasive urothelial cell carcinoma: A prospective study.

BACKGROUND: Non-muscle-invasive urothelial cell carcinoma (NMIUCC) has a high tendency to recur and affected patients must be monitored regularly using invasive cystoscopies. The aim of the current study was to compare a multicolor fluorescence in situ hybridization (FISH) assay (UroVysion) with routine follow-up (cystoscopy and cytology) in the monitoring of patients with a previous history of NMIUCC. METHODS: An unselected cohort of patients under surveillance for a previous history of NMIUCC was prospectively studied. A total of 248 examinations in 223 patients were analyzed. Each exploration was comprised of cytological and FISH microscopic examination of voided urine samples and cystoscopy. The sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for tumor recurrence of all 3 techniques were determined. RESULTS: The sensitivities of FISH and cystoscopy were not found to be significantly different (92.9% and 82.1%, respectively). The specificities of FISH and cystoscopy were 92.7% and 89.7%, respectively. The PPV and NPV of FISH were 53.5% and 97.2%, respectively, whereas those of cystoscopy were 63.4% and 98.9%, respectively. No significant differences were found between these 2 tests. In contrast, the sensitivity and specificity of cytology were 14.3% and 99.5%, respectively. CONCLUSIONS: Given the lack of statistically significant differences with regard to FISH and cystoscopy results, the authors propose that FISH could be a useful monitoring tool in the surveillance of patients with a previous history of NMIUCC.

Phase II study of vinorelbine and estramustine in combination with conformational radiotherapy for patients with high-risk prostate cancer.

PURPOSE: To evaluate the efficacy and safety profile of vinorelbine and estramustine in combination with three-dimensional conformational radiotherapy (3D-CRT) in patients with localized high-risk prostate cancer. METHODS AND MATERIALS: Fifty patients received estramustine, 600 mg/m(2) daily, and vinorelbine, 25 mg/m(2), on days 1 and 8 of a 21-day cycle for three cycles in combination with 8 weeks of 3D-CRT (total dose of 70.2 gray [Gy] at 1.8-Gy fractions or 70 Gy at 2.0-Gy fractions). Additionally, patients received luteinizing hormone-releasing hormone analogs for 3 years. RESULTS: All patients were evaluated for response and toxicity. Progression-free survival at 5 years was 72% (95% confidence interval [CI]: 52-86). All patients who relapsed had only biochemical relapse. The most frequent severe toxicities were cystitis (16% of patients), leucopenia (10% of patients), diarrhea (10% of patients), neutropenia (8% of patients), and proctitis (8% of patients). Six patients (12%) did not complete study treatment due to the patient's decision (n = 1) and to adverse events such as hepatotoxicity, proctitis, paralytic ileus, and acute myocardial infarction. CONCLUSIONS: Vinorelbine and estramustine in combination with 3D-CRT is a safe and effective regimen for patients with localized high-risk prostate cancer. A randomized trial is needed to determine whether the results of this regimen are an improvement over the results obtained with radiotherapy and androgen ablation.

Salud y calidad de vida en urología: Aspectos en urología general y oncológia / Health and quality of life in Urology: issues in General Urology and Urological Oncology

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Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve.

OBJECTIVES: To analyze the self-learning curve of a single surgeon with holmium laser enucleation of the prostate and to evaluate the safety, effectiveness, and outcome of the procedure after 2 years of experience. METHODS: The data from the first 125 patients who underwent holmium laser enucleation of the prostate were retrospectively analyzed. The patients were assessed preoperatively and at 1, 3, 12, and 24 months postoperatively. The patient evaluations included serum prostate-specific antigen measurement, peak urinary flow rate determination, postvoid residual volume measurement, and symptom scores. To assess the effect of the learning curve on the perioperative data and complications, the patients were divided into subgroups of 25 consecutive patients. RESULTS: The mean patient age was 71.4 years. The average prostate volume was 75.8 mL, and the mean weight of the enucleated tissue was 46.7 g. The average operative time was 109.8 minutes. The operative times and enucleation and morcellation efficiency rates improved significantly during the learning process. The mean hemoglobin loss was 1.7 g/dL. The median catheter time and hospital stay was 44 and 30 hours, respectively. Compared with baseline, at 1 year postoperatively, the median postvoid residual urine volume had declined by 99 mL, the mean peak urinary flow rate had increased by 19 mL/s, and the mean American Urological Association symptom score had decreased by 16.5 points. All changes observed were significant and regardless of the prostate size. Persistent stress urinary incontinence (4.8%) occurred with the first enucleations of large-size prostates. Other complications included bladder neck contracture (4%) in small-size prostates and bulbar urethra stricture (1.6%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, reproducible and effective surgical modality. Case selection is necessary to avoid the morbidity associated with the first stages of the self-taught learning curve, mainly urinary incontinence.

[Oncologically safe simplified nephroureterectomy: combination with percutaneous ureteral the ligation-section]. / Nefroureterectomía simplificada y oncológicamente segura: combinación con sección-ligadura ureteral percutánea.

OBJECTIVES: We propose a modification to open nephroureterectomy. METHODS: By a single incision (lumbar incision) a percutaneous ligation-section of the finely dissected terminal ureter is performed. RESULTS/CONCLUSIONS: This technique offers a better quality of life in the immediate postoperative period, shortens the surgical time, and it has the advantage of being oncologically safe, avoiding a double surgery.

[Field notebooks and histologic drawings in the work of Salvador Gil Vernet]. / Los "cuadernos de campo" y esbozos histológicos en la obra de Salvador Gil Vernet.

Our work is based on 11 field notebooks with his notes and descriptions of macroscopic and microscopic anatomic preparations. There is also one notebook with several handmade drawings on black lead pencil, reproducing the microscopic anatomy of the bladder neck; there are also five 60 x 40 cm prints with histologic drawings, several histologic preparations, as well as several letter papers with Dr. Salvador's letterhead in his various institutional aspects.

Los "cuadernos de campo" y esbozos histológicos en la obra de Salvador Gil Vernet / Field notebooks and histologic drawings in the work of Salvador Gil Vernet

Trabajo basado en 11 libretas de campo, con sus anotaciones y descripciones de las preparaciones anatómicas macro y microscópicas. Existe además un cuaderno con varios dibujos hechos a mano y a lápiz de mina negra, que reproducen la anatomía microscópica del cuello; además cinco láminas de formato 60x40 cm. de dibujos histológicos, varias preparaciones histológicas, así como algunos papeles de carta con el membrete de Don Salvador en sus distintas facetas institucionales (AU)

Our work is based on 11 field notebooks with his notes and descriptions of macroscopic and microscopic anatomic preparations. There is also one notebook with several handmade drawings on black lead pencil, reproducing the microscopic anatomy of the bladder neck; there are also five 60 x 40 cm prints with histologic drawings, several histologic preparations, as well as several letter papers with Dr. Salvador's letterhead in his various institutional aspects (AU)

Métodos diagnósticos de la diseminación prostática / The diagnosis of prostate cancer dissemination

El cáncer de próstata (CP) metastatiza a distancia preferentemente en los ganglios linfáticos regionalesy en el hueso. La incidencia de la diseminaciónse ha visto reducida en los últimos años debido principalmente al amplio uso del antígeno prostático específico(PSA). Por este motivo, la indicación de la realizaciónde las exploraciones complementarias ha ido evolucionando en un intento de mejorar su rentabilidad. Algunas de estas técnicas se encuentran actualmente en evaluación y pueden contribuir en un próximo futuro a cambiar la práctica clínica del estudio de extensión. En la evaluación de la diseminación ganglionar, el TC o la RM son las técnicas por imagen estándar mientras que en la evaluación ósea la GO continúa siendo el rastreo de rutina

Prostate cancer preferentially metastasizes to regional lymph nodes and bone. The incidence ofdissemination has been reduced over the last years mainly due to the compost use of PSA. For this reason, the indication of complementary diagnostic tests has evolved with the aim of improving the diagnostic yield. Some of these techniques are currently under evaluation and may contribute in the close future to change the study of dissemination in the clinical practice. CT scan or MRI are the standard imaging studies for lymph node dissemination, whereas bone scan continues to be the routine test for bone dissemination

Detrusor quantitative morphometry in obstructed males and controls.

PURPOSE: We studied the usefulness of computer assisted morphometry for measuring detrusor muscle cell diameter and the connective tissue-to-smooth muscle ratio in patients with bladder outlet obstruction, acute urinary retention and a nonobstructed control group. MATERIALS AND METHODS: A prospective study was done in patients with bladder outlet obstruction undergoing transurethral prostate resection. Patients were divided into 33 with obstruction and 14 in acute urinary retention. A total of 15 males without obstruction undergoing transurethral prostate resection for bladder tumor formed the control group. Detrusor specimens were obtained during transurethral prostate resection. Detrusor muscle cell diameter was measured using light microscopy and a semiautomatic image analysis system. The connective tissue-to-smooth muscle ratio was automatically determined with computer assisted image analysis. Symptoms and urodynamic assessment were performed preoperatively and 6 months postoperatively. RESULTS: A total of 62 patients were included. The obstruction and acute urinary retention groups had a statistically higher detrusor muscle cell diameter and more fibrosis than the control group. Patients in acute urinary retention had more intrafascicular fibrosis (higher connective tissue-to-smooth muscle ratio at 40x magnification) than patients with obstruction. There were no differences in detrusor muscle cell diameter or interfascicular fibrosis (connective tissue-to-smooth muscle ratio at 10x magnification) between the obstruction and acute urinary retention groups. Detrusor muscle cell diameter correlated with symptom duration and functional recovery after transurethral prostate resection. Detrusor fibrosis correlated with preoperative detrusor pressure at maximum flow and postoperative compliance. Patients in acute urinary retention had fewer symptoms and higher residual volume. Other urodynamic parameters and their improvement after surgery were similar in the acute urinary retention and obstruction groups. CONCLUSIONS: Morphometric differences in detrusor muscle cell diameter and the connective tissue-to-smooth muscle ratio were observed between controls and patients with obstruction. There is an increase in detrusor muscle cell diameter and fibrosis in bladder outlet obstruction and more intense intrafascicular collagen deposition in patients in acute urinary retention.

La indicación terapéutica: ¿es una categoría inmutable? / No disponible

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