Real-world prostate-specific antigen reduction and survival outcomes of metastatic hormone-sensitive prostate cancer patients treated with apalutamide: An observational, retrospective, and multicentre study.

Background: Metastatic hormone-sensitive prostate cancer (mHSPC) treatment has changed drastically during the last years with the emergence of androgen receptor-targeted agents (ARTAs). ARTA combined with androgen deprivation therapy has demonstrated better oncological and survival outcomes in these patients. However, the optimal choice among different ARTAs remains uncertain due to their analogous efficacy. Objectives: The objective of this study was to describe prostate-specific antigen (PSA) response and oncological outcomes of patients with mHSPC treated with apalutamide. Material and methods: Medical records from three different hospitals in Spain were used to conduct this study. Patients diagnosed with mHSPC and under apalutamide treatment were included between March 2021 and January 2023. Data regarding PSA response, overall survival (OS), and radiographic progression-free survival (rPFS) were collected and stratified by metastasis volume, timing, and stating. Results: 193 patients were included; 34.2% of patients were de novo mHSPC, and the majority was classified as m1b. The 18-month OS and rPFS were 92.5% and 88.9%, respectively. Patients with PSA levels ≤0.2 ng/ml showcased an 18-month OS rate of 98.7%, contrasting with 65.3% for those with PSA >0.2 ng/ml. Similar trends emerged for rPFS (97.4% and 53.7%, respectively). When differentiating between low-volume and high-volume metastasis, the OS rate stood at 98.4% and 80.7%, respectively, while the rPFS rates were 93% and 81.6%, respectively. No significant differences were found between groups stratified by metastasis timing. Conclusion: This real-world study on patients with mHSPC treated with apalutamide plus androgen deprivation therapy revealed robust oncological outcomes, aligning with the emerging evidence. The study's hallmark finding highlights the significance of rapid and deep PSA response as a predictor of improved oncological and survival outcomes.

Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas / Urological and psychological approach of secondary complications to penile aesthetic modifications

Objetivos: Dada la escasez de artículos científicos que revisen las distintas técnicas disponibles para modificaciones estéticas en el pene y que son causa de problemas uro-andrológicos posteriores, se revisa la literatura existente tras la asistencia de una infección peneana tras inyección de ácido hialurónico subcutáneo con fines estéticos. Material y métodos: Se expone un caso de un varón de 38 años de edad sin antecedentes médicos o psiquiátricos de interés, que acude a la urgencia por presentar inflamación y abscesificación en la piel peneana tras la inyección de ácido hialurónico. Fue preciso tratamiento quirúrgico mediante denudamiento y exéresis de la piel afecta, siendo la posterior evolución satisfactoria. El análisis psicológico realizado mostró una personalidad narcisista, posiblemente secundaria a traumas en la infancia. Se ha revisado la literatura presente en bases de datos médicas, así como información disponible on-line. Resultados. El aumento del tamaño del pene es una importante preocupación cultural y social, por lo que existen en el mercado distintos dispositivos para satisfacer esta demanda, entre los que destacan la fitoterapia, los ejercicios de estiramiento, pesas, bombas de vacío o dispositivos extensores. Entre las técnicas quirúrgicas descritas están la liposucción púbica, la sección del ligamento suspensorio del pene o la inyección de material autólogo o sustancias sintéticas, entre otras. Existen otras modificaciones estéticas peneanas entre las que destacan una amplia variedad de piercings genitales, tatuajes e implantes subcutáneos también denominados pocketing o "implantes 3D". Todas estas técnicas o modificaciones se describen en este artículo junto con sus posibles complicaciones urológicas asociadas más frecuentes. Conclusiones: Cada vez son más frecuentes las manipulaciones estéticas en el pene, y tanto la terminología popular como sus implicaciones médico-quirúrgicas deben ser conocidas por los urólogos y andrólogos

Objectives: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. Material and methods: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. Results: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. Conclusions: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. Community

[Urological and psychological approach of secondary complications to penile aesthetic modifications]. / Abordaje urológico y psicológico de las complicaciones secundarias a las modificaciones estéticas peneanas.

OBJECTIVES: Due to the scarcity of scientific articles that review the technical alternatives available for aesthetic modifications in the penis that are the cause of subsequent uro-andrological problems, the existing literature is reviewed after the assistance of a penile infection by injection of subcutaneous hyaluronic acid with aesthetic purposes. MATERIAL AND METHODS: A 38-year-old male patient with no medical or psychiatric remarkable reports who came to the emergency room due to inflammation and abscess in penile skin after injection of hyaluronic acid. Surgical treatment was required and degloving and excision of affected skin was performed, with subsequent satisfactory evolution. The psychological analysis showed a narcissistic personality possibly secondary to traumas in childhood. We have reviewed the literature present in medical databases as well as information available on-line. RESULTS: Enlargement of the penis is an important cultural and social concern, so that there are different devices in the market to meet this demand, among them: herbal medicine, stretching exercises, weights, vacuum pumps or extensor devices. Among the surgical techniques, there have been described the pubic liposuction, the section of the suspensory ligament of the penis or the injection of autologous material or synthetic substances among others. As for the aesthetic modifications of the penis, there is a wide variety of genital piercings, tattoos and subcutaneous implants also called "pocketing" or "3D implants". All of these techniques or modifications are described in this article along with their possible associated more frequent urological complications. CONCLUSIONS: Aesthetic manipulations in the penis are becoming increasingly popular, and both its terminology and its medical implications should be known by urologists and andrologists. community.

[Evaluation of a seminal vesicle biopsy protocol simultaneous to diagnostic prostate biopsy. Analysis of indication criteria.] / Evaluación de un protocolo de biopsias de vesículas seminales simultáneo a biopsias prostáticas diagnósticas. Análisis de criterios de indicación.

OBJECTIVES: To analyze the indication criteria used for conducting seminal vesicles biopsies as well as the diagnostic capacity of other variables involved. METHODS: We present the results of an observational and retrospective study (May 2006 - December 2012) using a sample of 140 patients to whom seminal vesicles biopsies was performed in a first set of prostate biopsy. They were patients eligible for curative treatment and presented any of the following criteria: PSA ≥15 ng/ml, suspicion of neoplastic seminal vesicle invasion on transrectal US, and/or suspicious node in the prostate base on DRE or transrectal US. RESULTS: Seminal vesicle invasion due to prostate cancer was detected in 22.2%. Patients with 3 criteria had T3b in 66.7% of cases. The criterion most associated with T3b was the presence of a suspicious node in the prostate base, with an association of 29.3% of cases. Variables analyzed that had shown a greater association with stage T3b were PSA density, the presence of suspicious DRE, the Gleason sum. CONCLUSIONS: Our seminal vesicle biopsy protocol has detected 22.2% of seminal vesicle invasion. The detection of a suspicious node at the prostate base has shown the greatest association with T3b.

Evaluación de un protocolo de biopsias de vesículas seminales simultáneo a biopsias prostáticas diagnósticas. Análisis de criterios de indicación / Evaluation of a seminal vesicle biopsy protocol simultaneous to diagnostic prostate biopsy. Analysis of indication criteria

OBJETIVOS: Analizar los criterios de indicación empleados para la realización de biopsias de vesículas seminales, así como la relación de la invasión de vesículas seminales por cáncer de próstata con otras variables implicadas. MÉTODOS: Presentamos los resultados de un estudio observacional y retrospectivo (mayo 2006 - diciembre 2012) con una muestra de 140 pacientes sobre los que se realizó un protocolo de biopsias de vesículas seminales realizadas simultáneamente con las biopsias prostáticas diagnósticas, basado en 3 criterios de indicación: PSA mayor o igual de 15 ng/ml, presentar sospechosa de infiltración de vesículas seminales o presentar sospechosa de infiltración de bases prostáticas. RESULTADOS: Se ha detectado un 22,2% de invasión seminal en los pacientes con cáncer de próstata. Los pacientes que presentaban todos los criterios de indicación asociaron una invasión seminal del 66,7%. La presencia de alteraciones en bases prostáticas resultó ser el criterio de indicación más sensible, asociando un 29,3% de invasión seminal. Otras variables asociadas a una mayor infiltración prostática fueron: densidad de PSA, tacto rectal sospechoso y sumatorio Gleason entre otros. CONCLUSIONES: El protocolo de biopsias seminales empleado ha mostrado una capacidad de detección de invasión seminal del 22,2%, siendo el criterio de sospecha de infiltración basal el que ha supuesto la mayor asociación con dicha invasión

OBJECTIVES: To analyze the indication criteria used for conducting seminal vesicles biopsies as well as the diagnostic capacity of other variables involved. METHODS: We present the results of an observational and retrospective study (May 2006 - December 2012) using a sample of 140 patients to whom seminal vesicles biopsies was performed in a first set of prostate biopsy. They were patients eligible for curative treatment and presented any of the following criteria: PSA ≥15 ng/ml, suspicion of neoplastic seminal vesicle invasion on transrectal US, and/or suspicious node in the prostate base on DRE or transrectal US. RESULTS: Seminal vesicle invasion due to prostate cancer was detected in 22.2%. Patients with 3 criteria had T3b in 66.7% of cases. The criterion most associated with T3b was the presence of a suspicious node in the prostate base, with an association of 29.3% of cases. Variables analyzed that had shown a greater association with stage T3b were PSA density, the presence of suspicious DRE, the Gleason sum. CONCLUSIONS: Our seminal vesicle biopsy protocol has detected 22.2% of seminal vesicle invasion. The detection of a suspicious node at the prostate base has shown the greatest association with T3b

La importancia de exploración física en la incontinencia urinaria: Urocolpos / The importance of physical examination in urinary incontinence: Urocolpos

No disponible

Pionefrosis secundaria a sonda vesical ubicada en ureter pélvico / Pyonephrosis secondary to bladder catheter misplaced in the pelvic ureter

No disponible

Seminal vesicle biopsies: an useful staging procedure-exposure of seminal vesicle biopsies protocol and review of the literature.

BACKGROUND AND OBJECTIVES: Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. METHODS AND MATERIALS: SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. RESULTS: These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. CONCLUSIONS: SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.

Duplicidad uretral. La importancia de una anamnesis y una exploración física detalladas / Urethral duplication. The importance of a detailed anamnesis and physical exploration

La duplicidad uretral es una enfermedad poco frecuente, y se han descrito unos 200 casos en todo el mundo. Hay varios subtipos de duplicidad uretral, y el más frecuente es el subtipo 2A-Y. Presentamos un caso de duplicidad uretral tipo 2A-2, poco relatado en la bibliografía actual, diagnosticado como hallazgo casual durante una cirugía endoscópica urológica. La clínica que supone esta malformación congénita es dependiente del subtipo que se padezca, y puede presentarse como totalmente asintomática o como parte de una compleja malformación caudal (AU)

Urethral duplication is a rare disease, only approximately 200 cases having been reported worldwide. There are several subtypes of urethral duplication, the most frequent subtype being 2A-Y. We report a case of urethral duplication 2A-2, little reported in the current literature. It was diagnosed as incidental finding during endoscopic urological surgery. The symptoms of this congenital malformation depend on the subtype of urethral duplication. They can be completely asymptomatic or present as part of a complex caudal malformation (AU)

Urofilias: aproximación clinicoterapéutica a propósito de un caso de una vela intravesical / Urophilias: Clinical and therapeutic approach a propos of an intravesical candle

Las parafilias son entidades patológicas de la esfera psiquiátrica que difieren de otros comportamientos sexuales por las serias implicaciones que suponen en la vida de los pacientes. Las urofilias son parafilias que implican al ámbito urológico. Estas presentan un amplio espectro de variaciones clínicas, llegando a poder tener serias consecuencias para la vida. La introducción de objetos en la uretra o en la vejiga es la urofilia que más frecuentemente requiere asistencia médica, ya sea por daño en la vía urinaria o por las implicaciones de alojar cuerpos extraños en ella. A raíz de la identificación de un insólito cuerpo extraño en la vejiga se ha realizado una revisión del tema desde la vertiente psiquiátrica y urológica de esta patología (AU)

Paraphilias are pathologies of the psychiatric field that differ from other sexual behavior because of the serious implications in the lives of the patients. Urophilias are paraphilias involving the urological setting. They have a wide spectrum of clinical variations and can have serious consequences for life. Insertion of objects into the urethra or bladder is the urophilia that most frequently requires medical care, either by damage to the urinary tract or due to the implications of hosting foreign bodies in it. Following the identification of an unusual foreign body in the bladder, a review of the subject from the psychiatric and urological side has been carried out (AU)

[Low-cost laparoscopic training: necessary time for acquiring expertise]. / Entrenamiento laparoscópico de bajo costo: tiempo de entrenamiento necesario para adquirir habilidades laparoscópicas básicas similares a las de un experto.

BACKGROUND: Today laparoscopic approach is essential, but learning is usually expensive and very limited. Homemade and low equipment costs are required. We undertook this study to quantify how many hours of training are necessary for a surgeon without laparoscopic experience in order to acquire the abilities to carry out procedures as a staff member with laparoscopic experience. METHODS: A low-cost laparoscopic trainer was constructed. Four exercises of increasing difficulty have been developed. Five residents without laparoscopic experience and four experts developed the study. A satisfaction questionnaire was completed. Data were analyzed comparing the average times for the accomplishment of each exercise between groups. RESULTS: Data showed that the more difficult an exercise is, the more training is required. The average time needed to acquire similar skills as experts was almost 7 h of training spread over 4 months. The level of confidence for approaching a laparoscopic procedure for residents after completing the training was increased by 70%. CONCLUSION: Laparoscopic training is essential in the formation of all surgeons and a reason why this low-cost and easily accessible method could become a basic tool for learning the first steps of the laparoscopic procedure.

[Fournier's gangrene. Descriptive analysis of 20 cases and literature review]. / Gangrena de Fournier. Análisis descriptivo de 20 casos y revisión de la bibliografía científica.

BACKGROUND: Fournier's gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It hasa high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. OBJECTIVE: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fournier's gangrene based on our institution's experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. MATERIAL AND METHODS: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fournier's gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. RESULTS: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%. CONCLUSIONS: Fournier's gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery.

Gangrena de Fournier. Análisis descriptivo de 20 casos y revisión de la bibliografía científica / Fournier’s gangrene. Descriptive analysis of 20 cases and literature review

Introducción: La gangrena de Fournier es una fascitis necrosante que afecta habitualmente a la zona genital externa y perineal, con eventual extensión al abdomen, los miembros inferiores e incluso el tórax, con alta letalidad, que debe tratarse de manera agresiva en las primeras horas tras el diagnóstico. Se considera que enfermedades debilitantes como la diabetes mellitus u la obesidad favorecen su aparición. El factor desencadenante más frecuente es el absceso perianal. Objetivo: Realizar un profundo análisis descriptivo sobre los factores de riesgo y las afecciones predisponentes de la gangrena de Fournier durante toda la historia de nuestro centro, durante los últimos 12 años, así como revelar la tasa de mortalidad de éstos y el número medio de reintervenciones realizadas. Material y métodos: El estudio realizado analiza, de manera observacional y retrospectiva, a 20 pacientes diagnosticados de gangrena de Fournier, según criterios de inclusión clínicos, en el Hospital General Universitario J.M. Morales Meseguer entre 1997 y 2008. Resultados: La gran mayoría de los pacientes revisados eran varones, con una edad media de 61 años. Todos tenían una importante afección orgánica de base; destacaba la diabetes mellitus. La estancia media hospitalaria fue de 25,7 días. Fallecieron 2 pacientes y la mortalidad global fue del 10%. Conclusiones: La gangrena de Fournier es una entidad que puede ser letal, que está favorecida por distintos factores debilitantes, cuya causa desencadenante es una enfermedad perirrectal o urogenital que no ha sido tratada correctamente. Debido a su pronóstico grave, un diagnóstico temprano y una intervención multidisciplinaria adecuada, temprana y agresiva son esenciales para una buena evolución (AU)

Background: Fournier’s gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It has a high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. Objective: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fournier’s gangrene based on our institution’s experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. Material and methods: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fournier’s gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. Results: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%.Conclusions: Fournier’s gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery (AU)

[Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma]. / Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata.

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis. METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached. We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms "Prostatic Neoplasm" (MesH) AND "Neoplasm Metastasis" (MesH) AND "cutaneous" (free text). Most publications are case reports reviewing the probable dissemination way and localization. RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described. CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease.

[Diagnostic and therapeutic management of renal hydatidosis]. / Manejo diagnóstico y terapéutico de la hidatidosis renal.

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature. METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms "Echinococcosis" [MeSH] AND "urinary tract" [MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews. RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables. CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti-Echinococcus antibodies.

Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata / Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma

OBJETIVO: Presentar un caso llamativo por la forma de presentación de un carcinoma de próstata metastátizado con la aparición de un “bultoma” que correspondía a una metástasis cutánea.MÉTODOS: Describimos la forma de debút de un paciente que gracias al análisis de la lesión que informó de un adenocarcinoma, que aparentaba un Lipoma, se investigó la posibilidad de ser un adenoca de próstata y se estableció el diagnóstico.Se ha realizado una revisión de la literatura mediante una búsqueda bibliográfica electrónica en PubMed (MEDLINE) utilizando los términos “Prostatic Neoplasm”(MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous”(texto libre). La gran mayoría de las publicaciones corresponden a aportación de casos nuevos con revisión de la probable vía de diseminación y la localización.RESULTADOS: La tinción inmunohistoquímica con PSA positiva fue la que confirmó el origen de la Metástasis, aunque el valor del PSA no ofrecía dudas por valor superior a 1100 ng/ml. En relación con la búsqueda obtenemos mas de 26 trabajos, seleccionando para nuestra trabajo sólo 8 ya que se ajustan al objetivo del mismo. La aparición de metástasis cutáneas con origen prostático es inferior al 0,3%, ya que es mas frecuente la afectación ósea, en ganglios y visceras. Se describen casos en la evolución de la enfermedad y metástasis tras procedimientos laparoscópicos.CONCLUSIONES: La metástasis cutánea de una adenocarcinoma de próstata es muy rara, pero más aún que ésta sea el debut de la enfermedad (AU)

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis.METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached.We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms “Prostatic Neoplasm” (MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous” (free text). Most publications are case reports reviewing the probable dissemination way and localization.RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described.CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease (AU)

Manejo diagnóstico y terapéutico de la hidatidosis renal / Diagnostic and therapeutic management of renal hydatidosis

OBJETIVO: La hidatidosis renal está causado por Echinococcus granulosus y es extremadamente infrecuente, constituyendo el 3-4% de los casos de hidatidosis, siendo la tercera localización tras el hígado y pulmones. Habitualmente permanece asintomático durante años y los síntomas más comunes son dolor, sensación de pesadez en flanco y disuria. Ante la aparición de un cuadro compatible, estudiamos la pauta diagnóstica, terapéutica y de seguimiento revisando la literatura.MÉTODOS: Realizamos una búsqueda bibliográfica electrónica PubMed (MEDLINE) con términos MESH “Equinococcosis”[MeSH] AND “Urinary Tract”[MeSH] y de citas bibliográficas. Hacemos una revisión de la epidemiología, el ciclo vital del parásito y del manejo del paciente afecto de Hidatidosis. La gran mayoría de las publicaciones corresponden a aportación de casos con diferentes localizaciones, aunque encontramos algunas revisiones.RESULTADOS: Encontramos un total de 137 trabajos de los cuales, seleccionamos veintitres por estar relacionados; cinco correspondían a revisiones, referenciamos en el texto sólo diez. Aunque la mayoría son aportación de casos, las revisiones analizan el ciclo del Echinococcus y los diferentes lugares de asentamiento (órganos) en el huésped hombre. El hombre puede llegar a ser huésped intermedio a través de contacto con huésped definitivo (perros...) o por ingesta de agua contaminada o vegetales.CONCLUSIONES: Gracias a la combinación de anamnesis, estudios de imagen y serología nos aproximamos al diagnóstico hasta en un 80%. En muchos casos es posible la cirugía conservadora pero tras la sospecha debemos siempre esterilizar con Albendazol antes del tratamiento quirúrgico y tras el tratamiento monitorizar mediante serología la titulación de Anticuerpos anti-echinococcus(AU)

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature.METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms “ Echinococcosis”[MeSH] AND “urinary tract”[MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews.RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables.CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti- Echinococcus antibodies(AU)