Celdoprostatitis incrustante por Corynebacterium urealyticum: la importancia de la sospecha clínica / Encrusted prostatitis by Corynebacterium urealyticum: The importance of clinical suspicion

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Fulguración ambulatoria con láser Holmium: Un procedimiento seguro para el tratamiento de la recidiva del carcinoma vesical no músculo infiltrante / Outpatient Holmium laser fulguration: A safe procedure for treatment of recurrence of nonmuscle invasive bladder cancer

Introducción y objetivo: Los tumores vesicales no musculo-invasivos presentan una elevada tasa de recurrencias y una baja tasa de progresión. El objetivo del estudio es evaluar la efectividad, seguridad y factibilidad de la fulguración con láser Holmium en régimen ambulatorio en tumores seleccionados. Material y método: Estudio prospectivo, longitudinal, de cohortes (enero de 2009 hasta diciembre de 2016). Se realizaron 79 procedimientos de fulguración con láser Holmium + instilación posterior de MMC en régimen ambulatorio en 59 pacientes con historia de neoplasia vesical de bajo riesgo y recidivas papilares de pequeño tamaño. Se realiza un análisis descriptivo de los datos y se analiza el tiempo libre de recidiva mediante curvas de Kaplan-Meier. Resultados: Todos los procedimientos se completaron en el día y sólo un paciente precisó ingreso posterior por hematuria. El 87.2% de los pacientes presentó dolor con EVA ≤ 3. Se objetivó recidiva tras el 49.4% de los procedimientos (27.3% a los 12 meses). La mediana de seguimiento fue de 17 meses (rango 2-65). La aparición de recidiva fue significativamente más precoz tras la segunda fulguración que tras la primera (mediana: 10 meses vs 56 meses). Conclusiones: La fulguración con láser Holmium + instilación posterior de MMC en régimen ambulatorio es una alternativa segura y factible a la RTUv en pacientes con tumores seleccionados. Probablemente sea recomendable realizar una RTUv en los pacientes con recidiva tras fulguración, dado que posiblemente el riesgo de progresión en estos pacientes es superior

Background and Objective: Nonmuscle invasive bladder cancer has a high recurrence rate and a low progression rate. The aim of this study was to assess the effectiveness, safety and feasibility of Holmium laser fulguration in an outpatient regimen for selected tumours. Material and Method: A prospective, longitudinal cohort study was conducted between January 2009 and December 2016. Seventy-nine Holmium laser fulguration procedures with subsequent instillation of mitomycin C were performed in an outpatient regimen on 59 patients with a history of low-risk bladder cancer and recurrence of small papillary tumours. We performed a descriptive data analysis and analysed the relapse-free time using Kaplan-Meier curves. Results: All procedures were completed in one day, and only one patient required subsequent hospitalisation due to haematuria. Some 87.2% of the patients presented pain with a visual analogue score ≤3. Recurrence occurred after 49.4% of the procedures (27.3% at 12 months). The median follow-up time was 17 months (range, 2-65). The onset of recurrence was significantly earlier after the second fulguration than after the first (median, 10 months vs. 56 months). Conclusions: Holmium laser fulguration and subsequent mitomycin C instillation in an outpatient regimen is a safe and feasible alternative to transurethral resection of bladder tumours in selected patients. Transurethral resection of the bladder tumour is recommended for patients with recurrence after fulguration, given the possibly higher risk of progression in these patients

Seguimiento a largo plazo del cabestrillo AdVance(R)/AdVanceXP(R). ¿Qué piensa el cirujano?, ¿qué piensa el paciente? / Long-term follow-up of the AdVance(R)/AdVanceXP(R) sling. What are the surgeons' impressions? What are the patients'?

Objetivos: Analizar la seguridad, la eficacia y la calidad de vida del paciente con incontinencia urinaria de esfuerzo masculina tras una prostatectomía radical, tratados con el cabestrillo AdVance(R) y AdvanceXP(R). Pacientes y método: Se han incluido en el estudio 92 pacientes con incontinencia urinaria de esfuerzo tras una prostatectomía radical tratados mediante cabestrillo AdVance(R) y AdVanceXP(R) entre mayo de 2008 y diciembre de 2015. Se realizó en todos los casos test de reposición perineal con coaptación esfinteriana ≥ 1,5cm. Se definió incontinencia urinaria de esfuerzo leve como el uso de 1-2 absorbentes/24 h; moderada: 3-5 absorbentes/24 h, y grave más de 5 absorbentes/24 h. Como curación se definió la ausencia total de uso de absorbentes, mejoría cuando la reducción fue mayor del 50% en el número de estos y fracaso cuando la reducción fue menor del 50%, no se obtuvo mejoría o se produjo un empeoramiento de la incontinencia. Se realizaron controles a los 3, 12 y 36 meses tras la cirugía. El índice de calidad de vida utilizado fue el International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Las complicaciones se reflejaron según la clasificación de Clavien-Dindo. Resultados: El grado de incontinencia preoperatoria fue de tipo leve en el 23,9%, moderada en el 67,4% y grave en el 8,7%. El uso medio de absorbentes preoperatorio fue de 3,1 (rango 1-6, IC 95%). La puntuación media preoperatoria del test ICIQ-SF fue de 16,5 (15-20). La coaptación esfinteriana ≥ 1,5cm mediante el test de reposicionamiento perineal estaba presente en 87 pacientes (94,6%). El seguimiento medio desde la inserción del cabestrillo fue de 42,1 meses. El porcentaje de pacientes curados a los 3 meses fue del 89,1%, a los 12 meses del 70,7% y a los 36 meses del 70,4%. La puntuación del ICQ-SF a los 3, 12 y 36 meses mostró una mejoría significativa (p < 0,001) respecto a la puntuación preoperatoria. Conclusiones: Los sistemas Advance(R) y AdvanceXP(R) se muestran eficaces en el tiempo en cuanto a la continencia urinaria y la satisfacción del paciente

Objectives: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance(R) and AdvanceXP(R) slings. Patients and method: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVanc(R) and AdVanceXP(R) sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of ≥ 1.5 cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24 h; moderate was defined as 3-5 absorbers/24 h; and severe was defined as more than 5 absorbers/24 h. Healing was defined as the total absence of using pads; improvement was defined as a reduction > 50% in the number of pads; and failure was defined as a reduction < 50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. Results: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation ≥ 1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P < .001) compared with the preoperative score. Conclusions: The Advance(R) and AdvanceXP(R) system are effective over time in terms of urinary continence and patient satisfaction

Outpatient Holmium laser fulguration: A safe procedure for treatment of recurrence of nonmuscle invasive bladder cancer. / Fulguración ambulatoria con láser Holmium: Un procedimiento seguro para el tratamiento de la recidiva del carcinoma vesical no músculo infiltrante.

BACKGROUND AND OBJECTIVE: Nonmuscle invasive bladder cancer has a high recurrence rate and a low progression rate. The aim of this study was to assess the effectiveness, safety and feasibility of Holmium laser fulguration in an outpatient regimen for selected tumours. MATERIAL AND METHOD: A prospective, longitudinal cohort study was conducted between January 2009 and December 2016. Seventy-nine Holmium laser fulguration procedures with subsequent instillation of mitomycin C were performed in an outpatient regimen on 59 patients with a history of low-risk bladder cancer and recurrence of small papillary tumours. We performed a descriptive data analysis and analysed the relapse-free time using Kaplan-Meier curves. RESULTS: All procedures were completed in one day, and only one patient required subsequent hospitalisation due to haematuria. Some 87.2% of the patients presented pain with a visual analogue score ≤3. Recurrence occurred after 49.4% of the procedures (27.3% at 12 months). The median follow-up time was 17 months (range, 2-65). The onset of recurrence was significantly earlier after the second fulguration than after the first (median, 10 months vs. 56 months). CONCLUSIONS: Holmium laser fulguration and subsequent mitomycin C instillation in an outpatient regimen is a safe and feasible alternative to transurethral resection of bladder tumours in selected patients. Transurethral resection of the bladder tumour is recommended for patients with recurrence after fulguration, given the possibly higher risk of progression in these patients.

Long-term follow-up of the AdVance®/AdVanceXP® sling. What are the surgeons' impressions? What are the patients'? / Seguimiento a largo plazo del cabestrillo AdVance®/AdVanceXP®. ¿Qué piensa el cirujano?, ¿qué piensa el paciente?

OBJECTIVES: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. PATIENTS AND METHOD: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. RESULTS: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. CONCLUSIONS: The Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.

[Low and intermediate risk prostate cancer: Treatment options]. / Cáncer de próstata de bajo riesgo e intermedio: opciones de tratamiento.

Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients.

Litiasis Blanda ("Mous") / Matrix lithiasis ("Mous")

OBJETIVO: Describir los aspectos más relevantes de la litiasis blanda, un tipo de litiasis infrecuente y poco descrita desde el uso generalizado de la litotricia extracorpórea. MÉTODO: A raíz del caso clínico descrito, se analiza la bibliografía más importante encontrada mediante búsqueda a través de MEDLINE (1950-1999). Nos centraremos en la fisiopatología y la etiología de estos cálculos para comprender el desarrollo y la clínica mostrada por estos enfermos. RESULTADOS: La litiasis urinaria blanda es una entidad muy infrecuente, descrita hace casi ya un siglo. Compuesta fundamentealmente de matriz litiásica, el porcentaje de contenido mineral es francamente bajo comparado con el de las litiasis habituales. La infección persistente de la orina es otra constante en este tipo de enfermos, la cual condiciona, en cierta manera, la modificación de los componnentes urinarios usuales, creando una serie de alteraciones en la vía excretora que favorece la agregación de los componentes de la matriz litiásica hasta formar un cálculo en sí, sin necesidad de la agragación de cristales mineralizados. CONCLUSIÓN: Para el diagnóstico de litiasis blanda es preciso un alto índice de sospecha, ya que no se revela con la clínica habitual de cualquier cálculo renal. Para el tratamiento, el lavado exhaustivo de las cavidades caliciales y la desaparición de la bacteriuria son elementos fundamentales para evitar la recidiva de la enfermedad (AU)

Litiasis blanda ("Mous") / Matrix lithiasis ("Mous")

OBJETIVO: Describir los aspectos más relevantes de la litiasis blanda, un tipo de litiasis infrecuente y poco descrita desde el uso generalizado de la litotricia extracorpórea.MÉTODO: A raíz del caso clínico descrito, se analiza la bibliografía más importante encontrada mediante búsqueda a través de MEDLINE (1950-1999). Nos centraremos en la fisiopatología y la etiología de estos cálculos para comprender el desarrollo y la clínica mostrada por estos enfermos.RESULTADOS: La litiasis urinaria blanda es una entidad muy infrecuente, descrita hace casi ya un siglo. Compuesta fundamentealmente de matriz litiásica, el porcentaje de contenido mineral es francamente bajo comparado con el de las litiasis habituales. La infección persistente de la orina es otra constante en este tipo de enfermos, la cual condiciona, en cierta manera, la modificación de los componnentes urinarios usuales, creando una serie de alteraciones en la vía excretora que favorece la agregación de los componentes de la matriz litiásica hasta formar un cálculo en sí, sin necesidad de la agragación de cristales mineralizados.CONCLUSIÓN: Para el diagnóstico de litiasis blanda es preciso un alto índice de sospecha, ya que no se revela con la clínica habitual de cualquier cálculo renal. Para el tratamiento, el lavado exhaustivo de las cavidades caliciales y la desaparición de la bacteriuria son elementos fundamentales para evitar la recidiva de la enfermedad (AU)

[Soft lithiasis ("mous")]. / Litiasis blanda ("mous").

OBJECTIVES: To describe the most relevant features of matrix lithiasis, an infrequent type of lithiasis seldom reported since the generalization of extracorporeal shock wave lithotripsy. METHODS: We report a clinical case and analyze the most important bibliography found by MEDLINE search (1950-1999). We will focus on the physiopathology and etiology of these stones to understand its development and the clinical presentation showed by these patients. RESULTS: Matrix lithiasis is a very rare entity, described almost one century ago. It is mainly composed of lithiasis matrix, and the percentage of mineral content is really low in comparison with usual stones. Persistent urinary tract infection is another constant in these patients, which to some extent conditions the modification of the usual urinary components, creating a series of the disturbances within the urinary tract that favour the aggregation of the components of the lithiasis matrix up to the formation of a stone, without need of aggregation of mineralized crystals. CONCLUSIONS: A high degree of suspicion is necessary for the diagnosis of matrix lithiasis, because it does not show the usual clinical picture of a renal stone. Exhaustive lavage of caliceal cavities and elimination of bacteriuria are essential elements for treatment, in order to avoid recurrence of the disease.

[Spontaneous extraperitoneal bladder rupture. Report of a case]. / Rotura vesical extraperitoneal espontánea. Presentación de un caso.

The spontaneous extraperitoneal bladder rupture is an uncommon event and the diagnosis is very difficult. It is defined like the rupture of bladder wall in absence of traumatism or iatrogenic techniques. The extravasation usually is produced into the peritoneal cavity, because of the greater weakness of the vesical dome. The diagnosis is based on the retrograde cystography, being necessary the surgical treatment in the intraperitoneal rupture, while the extraperitoneal one, could be treated in a conservative way with a vesical catheter. Here we present a case of spontaneous extraperitoneal bladder rupture, with oliguria, abdominal pain and a right hypochondrius mass as clinic presentation. Due to this, the diagnosis was made by the TAC, in which it was appreciated a continuity solution in the anterior bladder wall, with a contrast extravasation through the anterior abdominal wall. The retrograde cystography confirmed the definitive diagnosis. The treatment followed was based on the keeping of the vesical catheter and antibiotherapy.

Rotura vesical extraperitoneal espontánea. Presentación de un caso / Spontaneous estraperitoneal bladder rupture. A propos of a case

La rotura vesical espontánea es una entidad muy poco común y de difícil sospecha diagnóstica. Se define como la rotura de la pared vesical en ausencia de traumatismos o maniobras iatrógenas. La extravasación suele producirse en la cavidad peritoneal, por la mayor debilidad de la cúpula vesical. El diagnóstico se basa en la cistografía retrógrada, siendo necesario el tratamiento quirúrgico en la rotura intraperitoneal, mientras que la extraperitoneal puede ser manejada de forma conservadora, con sondaje vesical. Presentamos un caso de rotura vesical espontánea extraperitoneal, con oliguria, dolor abdominal y masa en hipocondrio derecho como presentación clínica. Debido a ello el diagnóstico fue realizado mediante la realización de una TAC, donde se apreciaba una solución de continuidad en vertiente anterior de vejiga, distribuyéndose el extravasado por la pared abdominal anterior. La cistografía retrógrada confirmó el diagnóstico definitivo. El tratamiento aplicado se basó en el mantenimiento del sondaje vesical y antibioterapia (AU)

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[Burned out testicular tumor]. / Tumor testicular fundido.

OBJECTIVE: The present article reviews the different aspects of "burned out" testicular tumor. METHODS: A survey of the literature on "burned out" testicular tumor in Medline 1980-1999 was performed. The selected articles referenced in the present study were reviewed. RESULTS: The "burned out" phenomenon is the regression of a testicular tumor focus after distant metastasis whose cause is unknown. However, characteristic histological lesions have been identified, such as lesions comprised of collagen tissue containing neoplastic cells. The diagnosis is based on the anatomopathological study of the orchidectomy specimen, which should be performed in patients with extragonadal germ cell tumor and alterations detected on physical or ultrasound examination. CONCLUSIONS: "Burned out" testicular tumor should be taken into account in patients with extragonadal germ cell tumor. The importance of a thorough physical examination and testicular ultrasound evaluation is emphasized. Chemotherapy may not be effective. Orchidectomy may improve the outcome in these tumors.