¿Es la cirugía transanal mínimamente invasiva una alternativa para la corrección de fístulas recto-urinarias? / Is minimally invasive transanal surgery an alternative for rectal-urinary fistula correction?

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Lich-Gregoir technique and routine use of double J catheter as the best combination to avoid urinary complications in kidney transplantation.

INTRODUCTION: Urinary complications in kidney transplantation cause patient morbidity and can decrease graft survival. Most of the complications stem from the vesicoureteric anastomosis. Different techniques for ureteroneocystostomy (UNC) have been designed to avoid these complications. The routine use of a double J catheter after the anastomosis has the same purpose. Our aim was to show our experience and compare the use or non-use of a double J catheter and different techniques for ureteric reimplantation with the rate of urologic complications. MATERIAL AND METHODS: We conducted a retrospective, nonrandomized study of 1011 renal transplantations performed between July 1985 and April 2012. We recorded the surgical techniques for UNC, the use or non-use of a double J catheter, and urinary complications (ureteric fistulae and strictures). The first 700 kidney transplantations (group A) were performed using several UNC techniques (Taguchi, Leadbetter-Politano, and Lich-Gregoir) with a selective use of double J catheter according to the criteria of the surgeon. In the last 311 patients (group B), a surgical technique was established (Lich-Gregoir), as well as the universal use of double J catheters. RESULTS: Urinary fistula occurred in 7% of group A patients and 2% of group B patients (P = .0001). Ureteric stricture occurred in 5.3% of patients in group A and 3% of group B patients (P = .09). In our study, routine prophylactic stenting combined with the Lich-Gregoir UNC technique has decreased the incidence of postoperative fistulae. CONCLUSIONS: Individually, the use of double J catheters seems to lessen the incidence of fistulae, although statistically, the difference is not significant. Accurate knowledge of the complications rates, recommendations of guidelines, and the early diagnosis are essential to attaining reasonable results in kidney transplantation.

[Morbidity and risk factors of transrectal prostate biopsy]. / Morbilidad y factores de riesgo de la biopsia transrectal prostática.

OBJECTIVES: To evaluate the incidence of minor complications that rarely need treatment (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patients undergoing transrectal biopsy of the prostate and to identify risk factors. PATIENTS AND METHODS: We present an analytic and prospective study where we evaluated 146 patients subjected to transrectal biopsy of the prostate from December 2007 to September 2008. Complications rates and variables were analyzed. RESULTS: Eight patients (5,5%) suffered fever and seven (4,8%) of them were admitted. One of the patients (0,7%) suffered shock. The median of time between biopsy and fever was 3.5 days (1-10 days). Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more frequent in patients with prostate volume smaller than 55mL (p<0.05). CONCLUSIONS: The complications of the transrectal biopsy of the prostate are frequent, autolimited and they rarely suppose a health hazard for the patients. The most frequent are haematuria and hemospermia, specially in younger patients, whereas infectious complications are rarer and in our study are more frequent in patients with smaller prostates. We must take into account that the information to the patient is very important after a prostate biopsy, so we can avoid useless consultations (for example with haematuria) and it will enable to identify important signs like fever earlier.

Morbilidad y factores de riesgo de la biopsia transrectal prostática / Morbidity and risk factors of transrectal prostate biopsy

Objetivos: Analizar la incidencia de complicaciones menores que no requirieron tratamiento médico (hematuria, hematospermia y rectorragia) y mayores (fiebre y sepsis) en los pacientes sometidos a biopsia transrectal prostática (BTRP) e identificar posibles factores de riesgo. Material y métodos: Presentamos un estudio analítico, consecutivo, descripitivo, de una cohorte de 146 pacientes sometidos a BTRP desde diciembre de 2007–septiembre de 2008. Se analizaron los signos y síntomas que sufrieron y las variables edad, volumen prostático, resultado y el hecho de ser la primera biopsia o una sucesiva. Resultados: En ese periodo 8 (5,5%) de los pacientes sufrieron fiebre, 7 (4,8%) de los cuales requirieron ingreso, con una mediana de estancia hospitalaria de 3 días. Un paciente (0,7%) presentó shock séptico. La mediana del tiempo de latencia, entre la BTRP y la aparición de fiebre fue de 3,5 días (rango de 1–10 días). La hematuria y la hemospermia fueron más frecuentes en menores de 65 años (p<0,05) y la fiebre en los pacientes con volúmenes prostáticos menores de 55mL (p<0,05). Conclusiones: Las complicaciones de la biopsia transrectal prostática son frecuentes, autolimitadas y muy raramente ponen en peligro la vida del paciente. Las más frecuentes son la hematuria y la hemospermia, dándose en pacientes de menor edad, mientras que las complicaciones infecciosas son más raras y en nuestra muestra son más frecuentes en pacientes con volúmenes prostáticos menores. Consideramos de gran importancia informar al paciente de las complicaciones que pueden aparecer tras la BTRP, evitando así consultas innecesarias en los servicios de urgencias por los síntomas menores y permitiendo controlar precozmente el desarrollo de infecciones graves (AU)

Objectives: To evaluate the incidence of minor complications that rarely need treatment (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patients undergoing transrectal biopsy of the prostate and to identify risk factors. Patients and methods: We present an analitic and prospective study where we evaluated 146 patients subjected to transrectal biopsy of the prostate from December 2007 to September 2008. Complications rates and variables were analized. Results: Eight pacients (5,5%) suffered fever and seven (4,8%) of them were admitted. One of the pacients (0,7%) suffered shock. The median of time between biopsy and fever was 3.5 days (1–10 days). Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more frequent in patients with prostate volume smaller than 55mL (p<0.05). Conclusions: The complications of the transrectal biopsy of the prostate are frequent, autolimited and they rarely suppose a health hazard for the patients. The most frequent are haematuria and hemospermia, specially in younger patients, whereas infectious complications are rarer and in our study are more frequent in patients with smaller prostates. We must take into account that the information to the patient is very important after a prostate biopsy, so we can avoid useless consultations (for example with haematuria) and it will enable to identify important signs like fever earlier (AU)

[Hand-assisted laparoscopic nephrectomy in challenging cases]. / Nefrectomía laparoscópica asistida por la mano en casos difíciles.

OBJECTIVE: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. RESULTS: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.

[Does cystocele have a role in bladder outlet obstruction]. / ¿Es realmente el cistocele un factor de obstrucción infravesical?

INTRODUCTION: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO). OBJECTIVE: To assess the relationship between cystocele and bladder outlet obstruction. MATERIALS AND METHODS: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. EXCLUSION CRITERIA: 1. Absence of flowmetry or voided volume < 150 ml. 2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow (Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. RESULTS: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group A and Group B patients respectively (p=0.01). CONCLUSIONS: A statistically significant association exists between cystocele and bladder outlet obstruction.

Nefrectomía laparoscópica asistida por la mano en casos difíciles / Hand-assisted laparoscopic nephrectomy in challenging cases

Objetivo: evaluar los resultados de nefrectomía laparoscópica asistida por la mano en pacientes con masas renales técnicamente complejas. Métodos: se ha realizado una evaluación retrospectiva de 100 nefrectomías laparoscópicas realizadas en un solo hospital entre 2001 y 2005. Se ha seleccionado a los pacientes con antecedentes de cirugía abdominal previa, procedimientos previos en el riñón afectado, evidencia de inflamación perirrenal, lesiones renales de más de 10 cm de diámetro o trombosis venosa renal tipo I. Resultados: se ha incluido un total de 12 pacientes; 5 de ellos presentaban una lesión de al menos 10 cm de diámetro, dos trombosis venosa renal y 5 referían cirugía abdominal mayor. La mayoría de los pacientes tenía más de uno de estos hallazgos. Tres pacientes presentaban procesos inflamatorios (cálculos coraliformes) y un tumor renal T4 fue tratado con éxito, sin necesidad de reconversión. El tiempo operatorio y la pérdida sanguínea medias fueron de 210 minutos y 310 ml, respectivamente, con una estancia media de tres días. Ningún paciente requirió reconversión a cirugía abierta. Conclusiones: la nefrectomía laparoscópica asistida por la mano es una opción mínimamente invasiva, atractiva en el contexto de masas técnicamente complejas, con un tiempo operatorio, una pérdida sanguínea y una tasa de complicaciones razonables (AU)

Objective: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. Results: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. Conclusions: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates (AU)

¿Es realmente el cistocele un factor de obstrucción infravesical? / Does cystocele have a role in bladder outlet obstruction?

Introducción: existen controversias con respecto a si la presencia de cistocele, y el grado de este, es un factor de obstrucción del tracto urinario inferior (TUI).Objetivos: valorar la relación entre el cistocele y la obstrucción infravesical. Material y métodos: evaluamos retrospectivamente a 200 mujeres sometidas a estudio urodinámico, entre diciembre de 2007 y diciembre de 2008.Se clasificó a las pacientes en 2 grupos: Grupo A: ausencia de cistocele (grado 0) y grado I. Grupo B: cistocele grado II-IV. Criterios de exclusión: 1. Ausencia de flujometría libre o volumen vaciado < 150 ml. 2. Existencia de patología neurológica. 3. Antecedentes de cirugía urogenital. Definimos obstrucción del TUI según los siguientes parámetros: volumen residual postmiccional (VRP) > 20%; flujo máximo (Qmáx) < 15 ml/s; y presión del detrusor en el flujo máximo (PDetQmáx) > 25 cmH2O. Resultados: el grupo A incluyó al 64,0% de las pacientes y el grupo B al 36% restante. Seapreció volumen residual postmiccional (VRP) patológico en el 26’6% en el grupo A y en el 40,3% en el grupo B (p= 0,04); Qmáx < 15ml/s en 15,6% en el grupo A y en el 27,8% en el grupo B (p= 0,03); PDetQmáx > 25 cmH2O en el 26,3% en el grupo A y en el 47,8% en el grupo B (p= 0,01). Conclusiones: existe una asociación estadísticamente significativa entre el cistocele y parámetros de obstrucción infravesical (AU)

Introduction: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO).Objective: To assess the relationship between cystocele and bladder outlet obstruction. Materials and methods: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. Exclusion criteria: 1. Absence of flowmetry or voided volume < 150 ml.2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow(Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. Results: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group Aand Group B patients respectively (p=0.01). Conclusions: A statistically significant association exists between cystocele and bladder outlet obstruction (AU)

[Clinical efficacy of prostatic biopsy. Experience in our center from 1990 to 2002]. / Eficacia clínica de la biopsia prostática. Experiencia en nuestro centro 1990-2002.

INTRODUCTION: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. OBJECTIVES: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. MATERIAL AND METHODS: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. RESULTS: The total number of biopsies registered was a 1202, with 36.96% of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08% of the whole) was > 10 ng/ml in 55,88% of these patients, 4-10 ng/ml in 39.27% and 0-4 ng/ml in 4.84%. The average and PSA's median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA's level: 48,61% with PSA > 10; 25.11% with PSA 4-10 and 21,4% in patients with PSA < 4. There was realized prostate rebiopsy (2 or more biopsies) in 132 patients (21.97% positive) 88,36% of the cancers was diagnosed in the first biopsy, and 6.62% in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies). CONCLUSIONS: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders.

Eficacia clínica de la biopsia prostática. Experiencia en nuestro centro 1990-2002 / Clinical efficacy of prostatic biopsy. Experience in our center from 1990 to 2002

Introducción: La biopsia prostática es la única herramienta válida para diagnosticar la existencia de cáncer de próstata. Las indicaciones para su realización según la Asociación Europea de Urología son la existencia de PSA elevado, velocidad aumentada y la evidencia de un tacto rectal sospechoso. Objetivos: Valoración tanto de la utilidad clínica de la biopsia prostática, como del PSA como marcador de cáncer de próstata en nuestro medio y la indicación y eficacia de sucesivas biopsias. Material y Métodos: Efectuamos una revisión manual de las biopsias realizadas en nuestro servicio entre los años 1990 y 2002, valorando nivel de PSA previo a la biopsia, número de cilindros obtenidos y datos de la biopsia. Se llevó a cabo un estudio estadístico descriptivo mediante el programa estadístico SPSS 12.0. Resultados: Se han realizado 1202 biopsias en este periodo, con un porcentaje de positividad global del 36.96%. El PSA previo a la biopsia (disponible en las biopsias realizadas entre los años 1999 y 2002: 578 biopsias, 48.08% del total) era >10 ng/ml en el 55,88% de estos pacientes, 4-10 ng/ml en el 39.27% y 0-4ng/ml en el 4,84%. La media y mediana de PSA es de 19,09 (error típico: 1,87) y 10,6, respectivamente. La positividad de la biopsia aumenta con el nivel de PSA: 21,4% en pacientes con PSA<4; 25,11% con PSA 4-10 y 48,61% con PSA >10. Fue realizada rebiopsia prostática en 132 pacientes (21,97% positivas) El 88,36%de los cánceres fueron diagnosticados en la primera biopsia, y un 6,62% en la segunda (94,98% de los diagnósticos de cáncer de próstata se realizaron con las 2 primeras biopsias). Conclusiones: Los datos obtenidos en el estudio mediante el análisis descriptivo de nuestra serie se encuentran en concordancia con lo publicado en otros estudios y publicaciones. Existe una necesidad de aumentar la rentabilidad diagnóstica de la biopsia de próstata, para lo cual hemos introducido un protocolo de biopsia bajo anestesia local con el fin de poder aumentar el número de cilindros obtenidos (AU)

Introduction: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. Objectives: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. Material and methods: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. Results: The total number of biopsies registered was a 1202, with 36.96 % of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08 % of the whole) was> 10 ng/ml in 55,88 % of these patients, 4-10 ng/ml in 39.27 % and 0-4ng/ml in 4.84 %. The average and PSA’s median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA’s level: 48,61 % with PSA> 10; 25.11 % with PSA 4-10and 21,4 % in patients with PSA <4. There was realized prostate rebiopsy (2 ó more biopsies) in 132 patients (21,97 % positive) 88,36 % of the cancers was diagnosed in the first biopsy, and 6.62 % in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies).Conclusions: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders (AU)

Desarrollo de la nefrectomía durante el siglo XIX y su introducción en España / Development of nephrectomy during the nineteentn century and its introduction into Spain

Introducción y objetivos: Tras la primera nefrectomía lumbar realizada por el Dr. Simon en 1869, la técnica quirúrgica quedó perfilada y el procedimiento fue seguido por numerosos cirujanos en controversia inicial entre la utilización de la vía de acceso intra o extraperitoneal. Efectuamos una revisión acerca de la evolución llevada por la operación en el siglo XIX y sobre quienes iniciaron la intervención en nuestro país. Material y Métodos: Hemos revisado los libros de historia de la Urología, los capítulos de cirugía en los tratados clásicos de la especialidad, las comunicaciones a los congresos españoles de Medicina, hasta principios del siglo XX y las operaciones de nefrectomía publicadas en revistas médicas de la época. Resultado. Analizamos diferentes estudios estadísticos aparecidos en este periodo sobre los resultados de la operación, la disminución de la mortalidad en las nefrectomías realizadas por vía extraperitoneal demostró pronto su ventaja. Localizamos 35 extirpaciones renales por medio del acceso lumbar, efectuadas en España en el último tercio del siglo XX, tres del Dr. Federico Rubio y Galí en Madrid, en Barcelona de los urólogos Dr. Víctor Azcárreta Colány José Pagés y de los cirujanos Drs. Esquerdo y Salvador Cardenal, del sevillano Dr. Antonio Solano y del urólogo canario Dr. José Hernández Pérez, quienes fueron los pioneros de la intervención en nuestro país. Conclusión: La introducción de la nefrectomía por vía lumbar en España fue tardía en relación con el resto de Europa, debido al atraso secular que arrastrábamos, únicamente cuando las condiciones generales de los quirófanos, tanto de anestesia como de asepsia y de utillaje quirúrgico, permitían poder abordar con garantía de éxito la operación, los principales cirujanos comenzaron a realizarla (AU)

Introduction and objectives: After first nephrectomy lumbar made by Dr. Simon in 1869, the surgical technique was established and the procedure access was followed by several surgeons with initial controversy between the use of the intra or extraperitoneal access. We carried out a review about the evolution of this surgical procedure among XIX century and of those who were pioneers with this Kind of technique in our country. Material and methods: We have reviewed books of history of the Urology, the chapters of surgery in classic urology volumes and the oral presentations to the Spanish Medical congresses, until beginning of XX century and the published nephrectomy procedures in medical literature of that time. Results: We analyzed different statistical studies appeared at the time about results of the operation, the decrease of mortality in the nephrectomies made by extraperitoneal access demonstrated its advantage soon. We found out 35 kidney removal performing the lumbar access, carried out in Spain in the last third of the XX century, three by Dr Federico Rubio and Galí in Madrid, in Barcelona by the urologist Dr. Víctor Azcárreta Colán and Jose Pagés and by the surgeons Drs. Esquerdo and Salvador Cardinal, from Sevilla, Dr Antonio Solano and the canary urologist Dr. Jose Hernández Perez, who were pioneers performing this procedure in our country. Conclusions: The introduction of nephrectomy by lumbar access in Spain was delayed in relation to the rest of Europe, due to the secular delay that we dragged, only when adequate conditions of the operating rooms, as much as anaesthesia and asepsis and surgical devices tools, guaranteed the success operation, the main surgeon begun to perform it (AU)

[Kidney lipomatosis in a transplantation donor]. / Lipomatosis renal en donante cadáver.

OBJECTIVES: The aim of this clinical note is to report one case of incidental superficial renal mass during an organ explantation. METHODS: The renal donor was a 56-years-old male patient death for subaracnoidea haemorrhage without urological history. RESULTS: The anatomopathologic intraoperative study of the renal masses informed about the fatty nature of the tissue, and the renal implantation was performed. CONCLUSIONS: The find of a superficial renal mass during an organ explantatiation determine the necessity of a preoperative biopsy.

Lipomatosis renal en donante cadáver / Kidney lipomatosis in a transplantation donor

Objetivo: Valorar la actitud a seguir ante el hallazgo de una o varias masas en la superficie renal durante la extracción de órganos de un donante cadáver. Material y métodos: Donante cadáver varón de 56 años fallecido por hemorragia subaracnoidea y sin antecedentes urológicos de interés. Resultados: El estudio anatomopatológico intraoperatorio de las masas renales informó de la naturaleza lipomatosa de las mismas, procediéndose al implante renal según la técnica habitual. Conclusiones: El hallazgo de una masa en la superficie renal durante la extracción de órganos para trasplante constituye una indicación absoluta de biopsia previa al implante

Objectives: The aim of this clinical note is to report one case of incidental superficial renal mass during an organ explantation. Methods: The renal donor was a 56-years-old male patient death for subaracnoidea haemorrhage without urological history. Results: The anatomopathologic intraoperative study of the renal masses informed about the fatty nature of the tissue, and the renal implantation was performed. Conclusions: The find of a superficial renal mass during an organ explantatiation determine the necessity of a preoperative biopsy

[Testicular and paratesticular prepuberal tumors: our experience and update on the topic]. / Tumores testiculares y paratesticulares prepuberales. Experiencia en nuestro centro y revisión de la literatura.

OBJECTIVES: To evaluate the importance of testicular and paratesticular prepubertal tumors in our center and to make an update on the topic. METHODS AND PATIENTS: Data from all patients diagnosed of testicular and paratesticular prepubertal tumors and treated in our pediatric oncology unit from January 1st 1998 to December 31st 2003 have been revised. RESULTS: Seven cases are reported among one hundred and ninety patients (represents 3,68 percent of all treated tumors): five tumors affecting the testis and two cases of paratesticular tumors. Pathology classification was as follows: one yolk sack tumor, one mature teratoma, two nongerminomatous testicular tumors (one Sertoli cell tumor and one unclassifiable), one Burkitt's lymphoma and two paratesticular rhabdomyosarcomas. Primary approach was inguinal radical orchiectomy in all cases except neoadjuvant chemotherapy in the case of lymphoma and partial escrotectomy in one patient previously managed with transcrotal orchiectomy. Rhabdomyosarcoma cases received adjuvant chemotherapy. All patients are alive and well after a follow-up period ranging from 17 to 74 months. CONCLUSIONS: Testicular and paratesticular prepubertal tumors are rare. Except for one patient affected of lymphoma, surgical primary approach have been essential for treatment. The prognoses in this series has been excellent.

Tumores testiculares y paratesticulares prepuberales. Experiencia en nuestro centro y revisión de la literatura / Testicular and paratesticular prepuberal tumors: our experience and update on the topic

Objetivos: evaluar la importancia de los tumores testiculares y paratesticulares en nuestro medio, así como realizar una puesta al día sobre el tema. Métodos y pacientes: se ha revisado la base de datos de la Unidad de Oncología del hospital Universitario “Virgen de la Arrixaca” desde el 1 de Enero de 1998 hasta el 31 de diciembre del 2003, extrayendo los casos referidos a neoplasias en esta localización. Resultados: se han detectado 7 neoplasias entre los 190 pacientes tratados (representa el 3,68% del total de tumores): 5 testiculares y 2 paratesticulares. Las estirpes testiculares fueron: un tumor del seno endodérmico, un teratoma maduro, un tumor de células de Sertoli, uno de tipo estromal mixto o indiferenciado y un caso delinfoma de Burkitt. Los dos tumores paratesticulares fueron rabdomiosarcomas. La actitud inicial fue orquiectomía radical en todos los casos, salvo una escrotectomía parcial en un caso de rabdomiosarcoma debido a cirugía transescrotal previa y quimioterapia aislada en el caso del linfoma. Los rabdomiosarcomas requirieron quimioterapia adyuvante. Todos los pacientes están vivos y libres de recidiva con un seguimiento entre 17 y 74 meses.Conclusiones: los tumores testiculares y paratesticulares son infrecuentes en nuestra práctica habitual. Salvo en un caso de linfoma, el tratamiento quirúrgico inicial ha sido esencial en su manejo. En nuestra serie tienen un excelente pronóstico (AU)

Objetives: to evaluate the importance of testicular and paratesticular prepubertal tumors in our center and to make an update on the topic. Methods and patients: data from all patients diagnosed of testicular and paratesticular prepubertal tumors and treated in our pediatric oncology unit from January 1st 1998 to December 31st 2003 have been revised. Results: seven cases are reported among one hundred and ninety patients (represents 3,68 percent of all treated tumors): five tumors affecting the testis and two cases of paratesticular tumors. Pathology classification was as follows: one yolk salk tumor, one mature teratoma, two nongerminomatous testicular tumors (one Sertoli cell tumor and one unclassifiable), one Burkitt’s lymphoma and two paratesticular rhabdomyosarcomas. Primary approach was inguinal radical orchiectomy in all cases except neoadjuvant chemotherapy in the case of lymphoma and partial escrotectomy in one patient previously managed with transcrotal orchiectomy. Rhabdomyosarcoma cases received adjuvant chemotherapy. All patients are alive and well after a follow-up period ranging from 17 to 74 months. Conclusions: testicular and paratesticular prepubertal tumors are rare. Except for one patient affected of lymphoma, surgical primary approach have been essential for treatment. The prognoses in this series has been excellent (AU)

[Non obstructive retrocaval ureter]. / Uréter circumcavo no obstructivo.

We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson's classification, in a forty-nine year old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the typical morphology and obstruction signs. After twelve months the patient is still asymptomatic, without any medical or surgical treatment.