Lower Urinary Tract Symptoms (LUTS) as a New Clinical Presentation of Histamine Intolerance: A Prevalence Study of Genetic Diamine Oxidase Deficiency.

Lower urinary tract symptoms (LUTS) are highly prevalent, and their treatment is mainly focused on the control of symptoms. Histamine intolerance (HIT) has been related to a variety of systemic symptoms. DAO deficiency has been identified as a significant factor contributing to histamine intolerance (HIT). Preclinical evidence indicates the involvement of histamine in the lower urinary tract. This study aimed to assess the prevalence of diamine oxidase deficiency (DAO) in a prospective cohort of 100 patients with at least moderate LUTS. A genetic study of four single nucleotide polymorphisms (SNPs) (c.-691G>T, c.47C>T, c.995C>T, and c.1990C>G) was performed. HIT was found in 85.9% of patients. The prevalence of at least one minor allele in the SNPs analyzed was 88%, without gender differences. Storage symptoms were more intense in the presence of HIT as well as asthenia and neurological and musculoskeletal symptoms. The presence of minor alleles of the AOC1 gene was associated with a higher intensity of symptoms. Minor alleles from c.-691G>T and c.47C>T SNPs were also associated with a greater severity of obstructive symptoms. Thirty-one percent of patients presented the four SNPS with at least one associated minor allele. The relationship between HIT and LUTS in a mixed population of men and women found in this study supports further investigations to define the pathophysiology of histamine in LUTS.

[Editorial: Trasplante renal.] / Editorial: Trasplante renal.

Estimados lectores, desde el año 2005 no se publicaba en nuestro país ningún monográfico sobre trasplante renal (Editor: Dr. Juan Alcover García) en la revista Archivos Españoles de Urología.

Estimados lectores, desde el año 2005 no se publicaba en nuestro país ningún monográfico sobre trasplante renal (Editor: Dr. Juan Alcover García) en la revista Archivos Españoles de Urología.

[Kidney transplant future developments.] / Futuro del trasplante renal.

OBJECTIVE: Kidney transplantation process involves a series of challenges such as the shortage of organs worldwide for a population waiting for a first and subsequent kidney transplants and the search forthe most appropriate graft for each recipient, optimizing the ischemia time as much as possible, minimizing the impact of surgery and subsequent immunosuppressive therapy. METHODS: We carry out a review of the different advances and lines of research in the different areas involved in the kidney transplantation process from strategies focused on increasing the donor pool, enabling the expansion of living donor programs as well as orga preservation strategies previous to transplantation surgery.The arrival of robotic surgery in the field of kidney transplantation has been an important milestone in the last decade, showing improvements compared to traditional open surgery, maintaining satisfactory functional results, although its implementation is currently reduced with technical limitations in the extension to any type of recipient. New immunosuppressive agents that minimize potential side effects or reduce anticalcineurinic drugsdoses are also important lines of research. CONCLUSIONS: The future of kidney transplantation involves the search for increasingly global strategies to improve the supply of organs, improvements in the conditioning and preservation of grafts or the global development of minimally invasive surgery in the different areas of kidney transplantation. The weight of biotechnology and gene therapies represent promising tools in the field of tissue generation or targeted immunosuppressive therapies.

OBJETIVO: El proceso del trasplante renal conlleva una serie de retos como son la escasez de órganos para una población a la espera de un primery sucesivos trasplantes renales y la búsqueda del injertomás apropiado para cada receptor optimizando al máximo el tiempo de isquemia, minimizando el impactode la cirugía y posterior terapia inmunosupresora.MÉTODOS: Realizamos una revisión de los diferentes avances y líneas de investigación en las diferentes etapas que conlleva el proceso del trasplante renal desdelas estrategias centradas a incrementar el pool de donantes,posibilitar la expansión de programas de donante vivo así como las estrategias de preservación del órgano previamente a la cirugía del implante.El desembarco de la cirugía robótica en el campo del trasplante renal ha sido un hito importante en la últimadécada, arrojando mejoras frente a la tradicional cirugía abierta manteniendo unos resultados funcionalessatisfactorios aunque su implantación es reducida en la actualidad con limitaciones técnicas en la extensión a cualquier tipo de receptor. Nuevos agentes inmunosupresores que minimicen los potenciales efectos secundarios o consigan reducir las dosis de anticalcineurínicos son también líneas importantes de investigación. CONCLUSIONES: El futuro del trasplante renal pasa por la búsqueda de estrategias cada vez más globales para mejorar la oferta de órganos, mejoras en el acondicionamiento y preservación de los injertos o el desarrollo a escala global de la cirugía mínimamente invasiva en los diferentes ámbitos del trasplante renal. El peso de las biotecnologías y terapias génicas suponen herramientas prometedoras en el campo de la generación de tejidos o terapias inmunosupresoras dirigidas.

Futuro del trasplante renal / Future of kidney transplantation

Objetivo: El proceso del trasplante renalconlleva una serie de retos como son la escasez deórganos para una población a la espera de un primery sucesivos trasplantes renales y la búsqueda del injerto más apropiado para cada receptor optimizando almáximo el tiempo de isquemia, minimizando el impactode la cirugía y posterior terapia inmunosupresora. Métodos: Realizamos una revisión de los diferentesavances y líneas de investigación en las diferentes etapas que conlleva el proceso del trasplante renal desdelas estrategias centradas a incrementar el pool de donantes, posibilitar la expansión de programas de donante vivo así como las estrategias de preservación delórgano previamente a la cirugía del implante. El desembarco de la cirugía robótica en el campo deltrasplante renal ha sido un hito importante en la últimadécada, arrojando mejoras frente a la tradicional cirugía abierta manteniendo unos resultados funcionalessatisfactorios aunque su implantación es reducida en laactualidad con limitaciones técnicas en la extensión acualquier tipo de receptor. Nuevos agentes inmunosupresores que minimicen los potenciales efectos secundarios o consigan reducir las dosis de anticalcineurínicosson también líneas importantes de investigación.Conclusiones: El futuro del trasplante renal pasapor la búsqueda de estrategias cada vez más globales para mejorar la oferta de órganos, mejoras en elacondicionamiento y preservación de los injertos o eldesarrollo a escala global de la cirugía mínimamenteinvasiva en los diferentes ámbitos del trasplante renal. Elpeso de las biotecnologías y terapias génicas suponenherramientas prometedoras en el campo de la generación de tejidos o terapias inmunosupresoras dirigidas.(AU)

Objetive: Kidney transplantation process involves a series of challenges such as the shortageof organs worldwide for a population waiting for a firstand subsequent kidney transplants and the search forthe most appropriate graft for each recipient, optimizingthe ischemia time as much as possible, minimizing theimpact of surgery and subsequent immunosuppressivetherapy.Methods: We carry out a review of the differentadvances and lines of research in the different areas involved in the kidney transplantation process from strategies focused on increasing the donor pool, enablingthe expansion of living donor programs as well as organpreservation strategies previous to transplantation surgery. The arrival of robotic surgery in the field of kidneytransplantation has been an important milestone in thelast decade, showing improvements compared to traditional open surgery, maintaining satisfactory functionalresults, although its implementation is currently reducedwith technical limitations in the extension to any type ofrecipient. New immunosuppressive agents that minimizepotential side effects or reduce anticalcineurinic drugsdoses are also important lines of research.Conclusions: The future of kidney transplantationinvolves the search for increasingly global strategies toimprove the supply of organs, improvements in the conditioning and preservation of grafts or the global development of minimally invasive surgery in the differentareas of kidney transplantation. The weight of biotechnology and gene therapies represent promising tools inthe field of tissue generation or targeted immunosuppressive therapies.(AU)

[Renal transplantation during COVID-19 period in Spain.] / Trasplante renal en época COVID-19 en España.

INTRODUCTION: The COVID-19 pandemic poses significant challenges in the area of kidney donation and transplantation. The objective of this article is to establish general recommendations for surgical teams to manage the kidney transplant program duringthe COVID-19 era. MATERIAL AND METHODS: This document is based on the scientific evidence available on the infection caused by SARS-CoV-2 and the experience of authors during the COVID-19 pandemic. A web and Pubmed search was performed using the keywords "SARS-CoV-2"," COVID-19", "COVID Urology", "COVID-19 surgery", and "kidney transplantation." A modified nominal group technique was used. RESULTS: When health system saturation occurs, kidney transplants should be deferred, except in patients with low transplant possibilities and an optimal kidney available, combined transplants or life-threatening situations. Screening for the SARS-CoV-2 virus should be done in all those donors and recipients with clinical symptoms consistent with COVID-19, who have visited or live inhigh-risk areas, or who have been in close contact with confirmed cases of COVID-19. Donation and transplantation will not proceed in confirmed cases of COVID-19. Surgeries should be based on general recommendations in the COVID-19 era and will be efficient, short, and focused on those with the shortest hospital stay. In emergencies, protective measures will be taken with persona lprotection equipment. Surgical staff will be only the strictly necessary, and permanence in the OR should be minimized. Transplant urology consultations will be conducted by teleconsultation when possible. CONCLUSION: The safety of potential donors and recipients must be guaranteed, adopting individual protection measures and screening for SARS-CoV-2. Kidney transplant surgery must be efficient in terms of health, human resources, and clinical benefit. All non-urgent transplant activities should be delayed until the improvement of the local condition of each center.

INTRODUCCIÓN: La epidemia de COVID-19 plantea importantes retos en el ámbito de la donación y el trasplante renal. El objetivo de este artículo es establecer unas recomendaciones generales dirigidas a los equipos quirúrgicos de trasplante renal durante la era COVID-19. MATERIAL Y MÉTODOS: El documento se basa en la evidencia científica disponible sobre la infección causada por SARS-CoV-2 y la experiencia de los autores en la pandemia COVID-19. Se realizó una búsqueda web y en PubMed utilizando las palabras clave "SARSCoV-2", "COVID-19", "COVID Urology", "COVID-19 surgery" y "kidney transplantation". Se ha utilizado una técnica de grupo nominal modificada.RESULTADOS: En momentos de saturación del sistema sanitario, se deberán diferir los trasplantes renales, salvo en pacientes con bajas posibilidades de trasplante y un riñón óptimo disponible, trasplantes combinados o pacientes en situación de urgencia vital. Se deberá hacer cribado del virus SARS-CoV-2 en todos aquellos donantes y receptores que tengan sospecha clínica, hayan estado en zonas de alto riesgo o hayan compartido proximidad con casos confirmados de COVID-19. Nos e procederá con la donación ni con el trasplante en casos confirmados de COVID-19. Las cirugías deberáns er eficientes, cortas y centradas en las que menor estancia hospitalaria conlleven. En casos de urgencia, se extremarán las medidas de protección con equipos de protección individual. El personal quirúrgico será el menor posible y se minimizarán las estancias en quirófano. Las consultas urológicas de trasplante sin riesgo serán realizadas telemáticamente cuando sea posible. CONCLUSIÓN: La cirugía de trasplante renal debe ser eficiente en cuanto a recursos sanitarios, humano sy beneficio clínico. Se debe garantizar la seguridad de los potenciales donantes y receptores, adoptando medidas de protección individual y realizando cribado para SARS-CoV-2.

Trasplante renal en época COVID-19 en España / Renal transplantation during COVID-19 period in Spain

INTRODUCCIÓN: La epidemia de COVID-19 plantea importantes retos en el ámbito de la donación y el trasplante renal. El objetivo de este artículo es establecer unas recomendaciones generales dirigidas a los equipos quirúrgicos de trasplante renal durante la era COVID-19. MATERIAL Y MÉTODOS: El documento se basa en la evidencia científica disponible sobre la infección causada por SARS-CoV-2 y la experiencia de los autores en la pandemia COVID-19. Se realizó una búsqueda web y en PubMed utilizando las palabras clave "SARSCoV-2", "COVID-19", "COVID rology", "COVID-19 surgery" y "kidney transplantation". Se ha utilizado una técnica de grupo nominal modificada. RESULTADOS: En momentos de saturación del sistema sanitario, se deberán diferir los trasplantes renales, salvo en pacientes con bajas posibilidades de trasplante y un riñón óptimo disponible, trasplantes combinados o pacientes en situación de urgencia vital. Se deberá hacer cribado del virus SARS-CoV-2 en todos aquellos donantes y receptores que tengan sospecha clínica, hayan estado en zonas de alto riesgo o hayan compartido proximidad con casos confirmados de COVID-19. Nos e procederá con la donación ni con el trasplante en casos confirmados de COVID-19. Las cirugías deberáns er eficientes, cortas y centradas en las que menor estancia hospitalaria conlleven. En casos de urgencia, se extremarán las medidas de protección con equipos de protección individual. El personal quirúrgico será el menor posible y se minimizarán las estancias en quirófano. Las consultas urológicas de trasplante sin riesgo serán realizadas telemáticamente cuando sea posible. CONCLUSIÓN: La cirugía de trasplante renal debe ser eficiente en cuanto a recursos sanitarios, humano sy beneficio clínico. Se debe garantizar la seguridad de los potenciales donantes y receptores, adoptando medidas de protección individual y realizando cribado para SARS-CoV-2

INTRODUCTION: The COVID-19 pandemic poses significant challenges in the area of kidney donation and transplantation. The objective of this article is to establish general recommendations for surgical teams to manage the kidney transplant program during the COVID-19 era. MATERIAL AND METHODS: This document is based on the scientific evidence available on the infection caused by SARS-CoV-2 and the experience of authors during the COVID-19 pandemic. A web and Pubmed search was performed using the keywords "SARS-CoV-2", "COVID-19", "COVID Urology", "COVID-19 surgery", and "kidney transplantation." A modified nominal group technique was used. RESULTS: When health system saturation occurs, kidney transplants should be deferred, except in patients with low transplant possibilities and an optimal kidney available, combined transplants or life-threatening situations. Screening for the SARS-CoV-2 virus should be done in all those donors and recipients with clinical symptoms consistent with COVID-19, who have visited or live in high-risk areas, or who have been in close contact with confirmed cases of COVID-19. Donation and transplantation will not proceed in confirmed cases of COVID-19. Surgeries should be based on general recommendations in the COVID-19 era and will be efficient, short, and focused on those with the shortest hospital stay. In emergencies, protective measures will be taken with personal protection equipment. Surgical staff will be only the strictly necessary, and permanence in the OR should be minimized. Transplant urology consultations will be conducted by teleconsultation when possible. CONCLUSION: The safety of potential donors and recipients must be guaranteed, adopting individual protection measures and screening for SARS-CoV-2. Kidney transplant surgery must be efficient in terms of health, human resources, and clinical benefit. All non-urgent transplant activities should be delayed until the improvement of the local condition of each center

[Impact of predictive models and decision making in prostate cancer: An integral debate]. / Impacto de los modelos predictivos y la toma de decisiones en cáncer de próstata: un debate integral.

OBJECTIVES: To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment. METHODS: We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update we review the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die. RESULTS: There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression. CONCLUSIONS: Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group.

Impacto de los modelos predictivos y la toma de decisiones en cáncer de próstata: un debate integral / No disponible

OBJETIVO: Hacer una revisión de los diferentes métodos para predecir el riesgo de padecer un cáncer de próstata o que la enfermedad localizada pueda ser curada o progrese después de un tratamiento concreto. MÉTODOS: Realizamos una revisión de los diferentes modelos matemáticos conocidos para el análisis de probabilidad del evento, con un estudio crítico de debilidades y fortalezas de cada uno de estos métodos. En una actualización del Medline, revisamos los diferentes trabajos más relevantes referidos al diagnóstico y manejo del cáncer de próstata localizado en sus vertientes de diagnóstico y tratamiento, así como las posibilidades de desarrollar enfermedad metastásica o exitus. RESULTADOS: Existen múltiples métodos y modelos para predecir los diferentes eventos en pacientes candidatos a diagnóstico de cáncer de próstata, así como para analizar posibilidades de éxito de un tratamiento concreto, en muchos casos con una importante exactitud. Destaca la heterogeneidad en los métodos empleados, datos y variables utilizadas para los análisis, básicamente sobre estudios retrospectivos. Muchos de los métodos más sofisticados, Neural Network o Cart, no presentan exactitudes mayores que los métodos clásicos como la regresión logística. CONCLUSIONES: Los modelos predictivos son un elemento importante para la toma de decisiones en la práctica clínica habitual, favoreciendo que la decisión de un diagnóstico o un determinado tratamiento no se haga de forma aleatoria y por tanto siguiendo un criterio científico. En espera de desarrollo de métodos más precisos, hemos de saber que ningún modelo es perfecto y por tanto, es una herramienta importante, que no debe dejar de lado el conocimiento personal o la experiencia en un grupo de trabajo concreto(AU)

OBJECTIVES: To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment. METHODS: We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update were Arch view the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die. RESULTS: There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression. CONCLUSIONS: Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group(AU)

[Inguinal ureteral hernia: a clinical case]. / Hernia ureteral inguinal: caso clínico.

SUMMARY OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic. METHODS: 80 year-old patient with, hypertension, left inguinal hernia surgery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen. RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided. CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy.

Hernia ureteral inguinal: caso clínico / Inguinal ureteral hernia: a clinical case

OBJETIVOS: Describir caso clínico de hernia ureteral inguinal y luego comentar brevemente tema.MÉTODOS: Paciente 80 años hipertenso con hernia inguinal izquierda operada, hemicolectomia derecha por adenocarcinoma de colon y colecistectomia. En urografía intravenosa como hallazgo se identifica uréter derecho en posición ectópica que sale de la cavidad abdominal por región inguinal derecha para luego volver al abdomen.RESULTADOS: Se realiza TAC que confirma diagnostico. Debido a la edad avanzada del paciente, comorbilidades y ausencia de síntomas, se decidió actitud expectante. CONCLUSIONES: Las hernias urterales a través del conducto inguinal son poco frecuentes. Existen 2 tipos: paraperitoneal y extraperitoneal. La más frecuente es la paraperitoneal (80%) donde se acompaña de saco herniario y pueden aparecer otros órganos intra abdominales. La extraperitoneal suele acompañarse de grasa retroperitoneal. Ambos tipos de hernias suelen se indirectas. El tratamiento suele ser la herniorrafia(AU)

OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic.METHODS: 80 year-old patient with, hypertension, left inguinal hernia sugery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen.RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided.CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy(AU)

[Melanoma of the glans penis. Case report]. / Melanoma en glande, a propósito de un caso.

OBJECTIVE: To report one case of melanoma of the glans penis. METHODS/RESULTS: We present the case of a patient diagnosed and treated in our department describing diagnosis and therapeutic management. CONCLUSIONS: Melanoma of the penis is an uncommon presentation form of this kind of cutaneous tumor. We especially emphasize its diagnosis, clinical presentation and therapeutic management due to its prompt metastatic dissemination requiring early diagnosis and treatment.

Metastasis de adenocarcinoma de colon en epidídimo y cordón espermático / Metastasis of colon adenocarcinoma to the epididymis and spermatic cord

OBJETIVO: Presentar un caso de metástasis en epidídimo y cordón espermático de un carcinoma de colon.MÉTODOS/RESULTADOS: Presentamos el caso e un pacientede 67 años que tras varios meses de una colectomía subtotal por un adenocarcinoma de colon (pT3NoMo) presentauna tumoración testicular derecha palpable y dolorosa.Se le realizó una orquiectomía derecha y la anatomía patologíca demostró que se trataba de una recidiva del cáncer de colon en esta localización.CONCLUSIONES: Las metástasis en epidídimo o cordón espermático son poco frecuentes y suelen encontrarse como hallazgo incidental tras la orquiectomía por cáncer de próstata

OBJECTIVE: To report the case of an epididymal and spermatic cord metastasis of a colon adenocarcinoma.METHODS/RESULTS: We present the case of a 67 years old man, who presents several months after subtotal left colectomy for a left colon adenocarcinoma (pT3 NoMo), with a symptomatic right palpable testicular tumour. Right orchiectomy was done, demonstrating colon adenocarcinoma metastasis.CONCLUSIONS: Epididymal and spermatic cord metastases are very infrequent and they usually are found incidentally after prostate cancer orchyectomy

[Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review]. / Metastasis de carcinoma renal en cuerpo cavernoso, a propósito de un caso y revisión de la literatura.

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case.

Metástasis de carcinoma renal en cuerpo cavernoso. A propósito de un caso y revisión de la literatura / Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review

OBJETIVO: Describimos un caso infrecuente, la metástasis en cuerpo cavernoso de un carcinoma renal de células claras. MÉTODOS: Se trata de un paciente de 53 años, que a los tres meses tras realizarle nefrectomía radical derecha con cavotomía y exéresis de trombo, presenta una tumoración localizada en pene, indurada y dolorosa. RESULTADOS/CONCLUSIONES: Con pruebas de imagen y biopsia, se llegó al diagnóstico de metástasis de carcinoma renal en cuerpo cavernoso que se confirmó con la anatomía patológica de la pieza tras penectomía. La aparición de metástasis de carcinoma renal en pene está generalmente asociada a un estadio avanzado del tumor y por lo tanto, con mal pronóstico, como el caso relatado

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/ CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case

[Clinical-pathological study of incidental renal cell carcinoma]. / Estudio clinico-patologico de los adenocarcinomas renales incidentales.

OBJECTIVES: To determine the percentage of renal cell carcinomas incidentally diagnosed (IRCC) and to compare their clinical and pathological characteristics with symptomatic or non-incidentally diagnosed tumors (SRCC). METHODS: We retrospectively study 189 patients who were diagnosed of renal carcinoma between 1990 and 1999. 166 underwent surgery (149 radical nephrectomy; 17 nephron-sparing surgery). We determine the percentage of IRCC detected by radiological tests and compare them with the SRCC diagnosed after presenting with some of the classic symptoms or metastasis, with special focus on tumor size, pathology stage, tumor recurrence, progression and evolution. RESULTS: 87 SRCC (46%); 102 SRCC (54%). There are not differences in terms of age, gender, side, and postoperative hospital stay. Tumor size was higher in the SRCC (mean 8.5 cm) than in the IRCC (6.3 cm). SRCC tumor stage was: pT1 27.3%, pT2 27.3%, pT3a 23.8%, pT3b 16.6%, pT3c 2.3%, and pT4 2.3%; IRCC stage was: pT1 51.3%, pT2 25.6%, pT3a 10.9%, pT3b 10.9%, pT3c 1.2%, and no pT4. The percentage of patients with lymph node involvement was higher (p = 0.02) in the SRCC (15%) than in the IRCC (4.8%). The percentage of patients with metastasis at the time of diagnosis was higher in the SRCC group (26%) than in the IRCC (9.2%). Recurrences were more frequent in the SRCC Group (8.3%) than in the IRCC (1.2%) (p = 0.07). Tumor progression was more frequent in the SRCC group (34%) than in the IRCC (7.3%) (p<0.01). 76% of the patients undergoing nephron sparing surgery were IRCC. CONCLUSIONS: Currently, there is a high percentage of IRCC (46% in our series from 1990-99). Renal tumors presenting as IRCC have better prognosis, since they have significantly smaller size, lower stage, less advanced disease, less recurrences, and less progression than SRCC.

Tácticas y trucos de endourología en el aparato urinario superior. Trucos en ureter: ureteroscopia / No disponible

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Estudio clínico-patológico de los adenocarcinomas renales incidentales / Clinical-pathology study of incidental renal cell carcinoma

OBJETIVOS: Determinar la proporción deadenocarcinomas renales (AR) diagnosticados deforma incidental (ARI) y compararlos desde el punto devista clínico y anatomopatológico con los diagnosticadosde modo no incidental o sintomáticos (ARS).MÉTODOS: Se estudiaron retrospectivamente 189pacientes diagnosticados de AR entre los años 1990 y1999. 166 fueron operados (149 nefrectomía radical;17 cirugía conservadora). Se determinó la proporciónde ARI detectados por estudios de imagen y se compararoncon los ARS diagnosticados tras presentar algunode los síntomas clásicos o metástasis, con especialatención al tamaño tumoral, estadio patológico, recidivastumorales, progresión y evolución. RESULTADOS: 87 ARI (46%); 102 ARS (54%). No existendiferencias en cuanto a la edad, sexo, lado afectadoy estancia postoperatoria. El tamaño fue mayor enlos ARS (media 8.5 cm.) que en los ARI (media 6.3cm.). El estadio tumoral en los ARS: pT1 27.3%, pT227.3%, pT3a 23.8%, pT3b 16.6%, pT3c 2.3%, pT42.3%; mientras que en los ARI: pT1 51.3%, pT225.6%, pT3a 10.9%, pT3b 10.9%, pT3c 1.2% y ningunopT4. La proporción de pacientes con enfermedadganglionar fue mayor (p=0,02) en los ARS (15%) queen los ARI (4.8%). La proporción de pacientes conmetástasis a distancia en el momento del diagnósticofue mayor (p<0,01) en los ARS (26%) que en los ARI(9.2%). Las recidivas fueron más frecuentes (p=0,07) enlos ARS (8.3%) que en los ARI (1.2%). La progresión fuemás frecuente (p<0,01) en los ARS (34%) que en losARI (7.3%). De los pacientes que recibieron cirugía conservadora,el 76% fueron ARI.CONCLUSIONES: En la actualidad existe un elevadoporcentaje de ARI (46% en nuestra serie de los años1990-99). Los tumores renales que debutan como ARItienen mejor pronóstico, ya que presentan significativamentemenor tamaño, mejor estadio, enfermedadmenos avanzada, menos recidivas y menor progresiónque los ARS

OBJECTIVES: To determine the percentage of renal cell carcinomas incidentally diagnosed (IRCC) and to compare their clinical and pathological characteristics with symptomatic or non-incidentally diagnosed tumors (SRCC) METHODS: We retrospectively study 189 patients who were diagnosed of renal carcinoma between 1990 and 1999. 166 underwent surgery (149 radical nephrectomy; 17 nephron-sparing surgery). We determine the percentage of IRCC detected by radiological tests and compare them with the SRCC diagnosed after presenting with some of the classic symptoms or metastasis, with special focus on tumor size, pathology stage, tumor recurrence, progression and evolution. RESULTS: 87 SRCC (46%); 102 SRCC (54%). There are not differences in terms of age, gender, side, and postoperative hospital stay. Tumor size was higher in the SRCC (mean 8. 5 cm) than in the IRCC (6.3 cm). SRCC tumor stage was: pT1 27.3%, pT2 27.3%, pT3a 23.8%, pT3b 16.6%, pT3c 2.3%, and pT4 2.3% ;IRCC stage was: pT1 51.3%, pT2 25.6%, pT3a 10.9%, pT3b 10.9%, pT3c 1.2%, and no pT4. The percentage of patients with lymph node involvement was higher (p = 0.02) in the SRCC (15%) than in the IRCC (4.8%). The percentage of patients with metastasis at the time of diagnosis was higher in the SRCC group (26%) than in the IRCC (9.2%). Recurrences were more frequent in the SRCC Group (8.3%) than in the IRCC (1.2%) (p = 0.07). Tumor progression was more frequent in the SRCC group (34%) than in the IRCC (7.3%) (p<0.01). 76% of the patients undergoing nephron sparing surgery were IRCC. CONCLUSIONS: Currently, there is a high percentage of IRCC (46% in our series from 1990-99). Renal tumors presenting as IRCC have better prognosis, since they have significantly smaller size, lower stage, less advanced disease, less recurrences, and less progression than SRCC

[Cutaneous metastasis of a renal carcinoma: case report and review]. / Metastasis cutánea del cáncer renal: caso clínico y revisión.

OBJECTIVES: To report another rare case of skin metastasis from a renal adenocarcinoma, analyzing the prognostic significance, response to therapy, and clinical presentation after a bibliographic review. METHODS/RESULTS: We report the case of a 65-year-old male with a cutaneous metastasis in the root of his inferior left extremity one year after right nephrectomy for a clear cell adenocarcinoma. CONCLUSIONS: Skin metastases usually present as solitary cutaneous lesions of variable macroscopic features and rapid growing; the diagnosis is made by histological analysis, being excision the treatment of choice whenever possible. Prognosis is better for solitary lesions appearing asynchronously with the primary tumor, and among them the longer the time after diagnosis of initial lesion they appear the better the prognosis.

Metastasis cutánea del cáncer renal: caso clínico y revisión / Cutaneous metastasis of a renal carcinoma: case report and review

OBJETIVO: Añadir a la literatura un caso clínicopoco habitual de metástasis cutánea del adenocarcinomarenal analizando la significación pronóstica, el comportamientofrente a la terapéutica y la presentación clínicade éstas en base a una revisión bibliográfica de la literaturaal respecto.MÉTODOS/RESULTADOS: Presentamos el caso clínico deun varón de 65 años con una metástasis cutánea en raízde miembro inferior izquierdo un año después de la realizaciónde una nefrectomía radical por un adenocarcinomade células claras.CONCLUSIONES: Se suelen presentar como lesionescutáneas solitarias de características macroscópicas variablesy de rápido crecimiento, cuyo diagnóstico se realizaen base al análisis histológico e, indicándose como tratamientola exéresis siempre que sea posible realizarla.El pronóstico es mejor en las lesiones solitarias , asíncronasen relación al tumor primario y dentro de ellas aquellasen las que el tiempo de aparición de dicha metástasises mayor con respecto al momento de diagnóstico de lalesión inicial

OBJECTIVES: To report another rare case of skin metastasis from a renal adenocarcinoma, analyzing the prognostic significance, response to therapy, and clinical presentation after a bibliographic review. METHODS/RESULTS: We report the case of a 65-year-old male with a cutaneous metastasis in the root of his inferior left extremity one year after right nephrectomy for a clear cell adenocarcinoma. CONCLUSIONS: Skin metastases usually present as solitary cutaneous lesions of variable macroscopic features and rapid growing; the diagnosis is made by histological analysis, being excision the treatment of choice whenever possible. Prognosis is better for solitary lesions appearing asynchronously with the primary tumor, and among them the longer the time after diagnosis of initial lesion they appear the better the prognosis