Preservación vesical electiva en tumor vesical músculo invasivo / Elective Bladder-Sparing Treatment for Muscle Invasive Bladder Cancer

Objetivos: La cistoprostatectomía radical es el tratamiento de elección en el carcinoma vesical músculo invasivo localizado. Planteamos la posibilidad de ofrecer a pacientes estrictamente seleccionados la preservación vesical con RTU ± quimioterapia (QMT) y radioterapia (RDT) como tratamiento alternativo. Material y métodos: Analizamos retrospectivamente 30 pacientes diagnosticados de carcinoma vesical músculo invasivo entre marzo de 1991 y octubre de 2010. La media de edad es de 62,7 años (51-74). Todos ellos eran candidatos a tratamiento curativo y han seguido estrictos criterios de selección: estadio T2, primario, único y menor de 5 cm, con impresión macroscópica de RTU completa en profundidad, sin repercusión en tracto urinario superior y BMN negativa. La TAC de extensión fue siempre negativa y la re-RTU o biopsia de lecho negativa para tumor o con infiltración muscular microscópica. Catorce de estos pacientes fueron tratados con RTU monoterapia, 13 con RTU + QMT y 3 RTU + QMT + RDT. Resultados: El seguimiento medio ha sido de 88,7 meses (19-220). Catorce han permanecido libres de recidiva (46,66%) y 10 han presentado recidiva superficial (33,33%). Conseguimos un 81,3% de respuestas completas y un 71% de conservación vesical a los 5 años. La supervivencia global a los 5 años fue de 79%, siendo la cáncer específica del 85%. Conclusiones: Aunque la cistoprostatectomía radical continúa siendo el tratamiento de elección ante el tumor vesical infiltrante localizado, en casos estrictamente seleccionados, la conservación vesical ofrece una alternativa válida con buenos resultados a largo plazo

Objectives: Radical cystectomy is the standard treatment for localized muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB ± Chemotherapy + Radiotherapy to selected patients as an alternative. Material and methods: We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5 cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB + Chemotherapy and 3 TURB + Chemotherapy + Radiotherapy. Results: The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. Conclusions: Although radical cystectomy is the standard treatment for localized MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results

Elective bladder-sparing treatment for muscle invasive bladder cancer.

OBJETIVES: Radical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/- Chemotherapy+Radiotherapy to selected patients as an alternative. MATERIAL AND METHODS: We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. RESULTS: The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. CONCLUSIONS: Although radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results.

[Squamous cell carcinoma of the renal pelvis. A clinical case]. / Carcinoma de células escamosas de la pelvis renal. Caso clínico.

Squamous cell carcinoma of the renal pelvis is uncommon, accounting for approximately 10% of all renal pelvic tumours. It's often associated with chronic renal calculi or infection and it usually presents at an advanced stage with pain or a palpable mass. We report an incidental case of squamous cell carcinoma of the renal pelvis, associated with chronic renal calculi and infection, and weight loss. The prognosis of patients with advanced squamous cell carcinoma of genitourinary origin is poor. In patients with chronic stones or infection squamous cell carcinoma of renal pelvis must be suspected if survival is to be affected.

Carcinoma de células escamosas de la pelvis renal. Caso clínico / Squamous cell carcinoma of the renal pelvis. Case report

El carcinoma escamoso de pelvis renal es infrecuente, representando aproximadamente el 10 por ciento de todos los tumores piélicos. Frecuentemente se asocia con litiasis o infección renal crónica. Se suele diagnosticar en estadios avanzados de la enfermedad por dolor o masa palpable. Presentamos un caso clínico de carcinoma de células escamosas de pelvis renal de diagnóstico incidental, asociado a uropatía obstructiva litiásica de larga evolución, pielonefritis de repetición y pérdida de peso. El pronóstico de los pacientes con carcinoma escamoso genitourinario en estadio avanzado es pobre. Debemos descartar la existencia de carcinoma de células escamosas de la pelvis renal en pacientes con historia de litiasis o infección renal crónica, ya que ello afecta la supervivencia (AU)

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La cistectomía radical en el carcinoma vesical superficial / Radical cistectomy in superficial vesical carcinoma

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[Penile cutaneous horn. A clinical case]. / Cuerno cutáneo peneano. Caso clínico.

Contribution of a case report of cutaneous horn of penis surgically treated with extensive resection of the implantation base. A well differentiated, microinvasive epidermoid carcinoma was histopathologically demonstrated on a hyperkeratosis squamous papilloma. Although underlying lesions to cutaneous horn are usually benign, malignant changes have been reported in up to one third of cases; surgical treatment should therefore include extensive resection of the implantation base.

Cuerno cutáneo peneano. Caso clínico / Cutaneous horn of penis. Case report

Aportamos a la literatura un caso de un cuerno cutáneo peneano, tratado quirúrgicamente con resección amplia de la base de implantación. El estudio histopatológico demostró un carcinoma epidermoide microinvasor bien diferenciado, sobre un papiloma escamoso hiperqueratósico. Aunque las lesiones subyacentes al cuerno cutáneo suelen ser benignas, se han descrito cambios malignos hasta en un tercio de los casos, por lo que el tratamiento quirúrgico debe incluir la resección amplia de la base de implantación (AU)

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[Cystic dysplasia in the seminal vesicle. Case report and literature review]. / Displasia quística en vesícula seminal. Caso clínico y revisíon de la literatura.

Contribution of one case report of cystic dysplasia of the seminal vesicle with ipsilateral renal agenesis in a 32 year-old male presenting with primary infertility. The seminograms showed moderate astenoteratospermia while in the abdominal-pelvic ultrasound there were changes in the right seminal vesicle and right renal agenesis, which was confirmed with further complementary tests: UIV, transrectal ultrasound, urethrocystoscopy, arteriography and renal scan.

[Posttraumatic high-flow priapism in prepubertal age]. / Priapismo de alto flujo postraumático en edad prepuberal.

High flow priapism is an infrequent entity, generally following traumatic injuries in the genito-perineal area. Anamnesis, cavernous bodies blood gasometry and Doppler are the basic diagnostic tools for these condition. Therapeutical management is considerably different from that used for low flow venous priapism. Selective arteriography of the internal pudendal artery allows to locate the arterial lesion and, at the same time, to perform supraselective embolization of the lacerated cavernous artery which is currently considered the choice treatment. This paper presents the case report of a ten-year old patient successfully resolved through application of angioradiologic procedures.

[Entero-vesical fistula in primary lymphoma of the small intestine]. / Fístula entero-vesical en linfoma primitivo de intestino delgado.

The introduction of self-expandable urethral endoprotheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprothesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.