[Neuroendocrine tumor in a horseshoe kidney: relative risk of association of two related entities]. / Tumor neuroendocrino en el riñón en herradura: riesgo relativo de asociacion de dos entidades relacionadas.

OBJECTIVE: Primary renal neuroendocrine tumor (NET) is a very rare neoplasia with a higher frequency of appearance in horseshoe kidney (HK). From 1966, when Resnick published the first case, approximately 2 of each 10 new cases appear in kidneys with this malformation. From the diagnosis of a case of primary NET in a HK, we calculated the relative risk of their presentation as associated entities. METHODS: 63-year-old male with the incidental diagnosis of an 8 cm solid renal mass in the isthmus of a HK. At the time of diagnosis there were no signs of local-regional extension of the primary neoplasia neither metastasis. The patient underwent nephrectomy and pathologic study confirmed the diagnosis of NET. After a systematic review using multiple search platforms (Blackwell, Ovid, Proquest, PubMed, Science Direct, and Wiley) our case is No. 11 of NET in HK from a total of 57 renal NET. RESULTS: Despite its very low frequency 19.3% of NET present in HK. Using 1/400 as the incidence of HK in general population, the calculated relative risk in HK is 77 times greater than that of a normal kidney CONCLUSIONS: The relative risk of presentation of NET in HK is enormously superior than that of general population. This diagnosis must be suspected in patients with HK, mainly if the tumor is located in the renal isthmus. Due to its potentially aggressive clinical course and poor response to other therapies, measures for improvement of surgical treatment must be considered priority.

Tumor neuroendocrino en el riñón en herradura: riesgo relativo de asociación de dos entidades relacionadas / Neuroendocrine tumor in a horseshoe kidney: relative risk of association of two related entities

Objetivo: El tumor neuroendocrino (TNE) renal primario es una neoplasia muy rara aunque con una mayor frecuencia de aparición en el riñón en herradura (RH). Desde que en 1966 Resnik publicó el primer caso, aproximadamente 2 de cada 10 nuevos diagnósticos aparecen en riñones con esta malformación. A partir del diagnóstico de un caso de TNE primario en RH, calculamos su riesgo relativo de presentación como entidades asociadas Métodos: Varón de 63 años al que descubrimos incidentalmente una masa sólida de 8 cm. ubicada en el istmo de un RH. En el momento del diagnóstico no se evidenciaron signos de extensión locoregional, sospecha de otra neoplasia primaria extrarrenal. El paciente fue sometido a heminefrectomía y el estudio histológico confirmó el diagnóstico de TNE. Tras una revisión sistemática de la literatura utilizando múltiples plataformas (Blackwell, Ovid, Proquest, PubMed, Science Direct y Wiley), el nuestro, representa el caso decimoprimero de TNE en RH de un total de 57 TNE originados en riñón. Resultados: Pese a su escasa frecuencia, un 19.3% de los TNE se presentan en un RH. Utilizando una incidencia de RH en la población general de 1/400, el riesgo relativo calculado de TNE en RH respecto al de un riñón normal es 77 veces mayor. Conclusiones: El riesgo relativo de presentación de un TNE en el RH es enormemente superior al de la población general. Este diagnóstico debe sospechase en pacientes con RH, sobre todo si el tumor asienta en el istmo renal. Dado su potencial curso clínico agresivo y pobre respuesta a otras terapias, las medidas encaminadas a mejorar el tratamiento quirúrgico deben ser consideradas prioritarias (AU)

Objective: Primary renal neuroendocrine tumor (NET) is a very rare neoplasia with a higher frequency of appearance in horseshoe kidney (HK). From 1966, when Resnick published the first case, approximately 2 of each 10 new cases appear in kidneys with this malformation. From the diagnosis of a case of primary NET in a HK, we calculated the relative risk of their presentation as associated entities. Methods: 63-year-old male with the incidental diagnosis of an 8 cm solid renal mass in the isthmus of a HK. At the time of diagnosis there were no signs of local-regional extension of the primary neoplasia neither metastasis. The patient underwent nephrectomy and pathologic study confirmed the diagnosis of NET. After a systematic review using multiple search platforms (Blackwell, Ovid, Proquest, PubMed, Science Direct, and Wiley) our case is No. 11 of NET in HK from a total of 57 renal NET. Results: Despite its very low frequency, 19.3% of NET present in HK. Using I/400 as the incidence of HK in general population, the calculated relative risk in HK is 77 times greater than that of a normal kidney. Conclusions: The relative risk of presentation of NET in HK is enormously superior than that of general population. This diagnosis must be suspected in patients with HK, mainly if the tumor is located in the renal isthmus. Due to its potentially aggressive clinical course and poor response to other therapies, measures for improvement of surgical treatment must be considered priority (AU)

[Localization of prostate cancer within the central gland by endorectal MR spectroscopic imaging]. / Localización del cáncer de próstata en la glándula central mediante espectroscopia de resonancia magnética endorectal.

OBJECTIVES: The endorectal MR spectroscopic imaging is a new imaging test which allows more accurate and reliable localization and staging of prostate cancer than simple endorectal MRI. The combination of spectroscopic MR and MRI has recently achieved technical improvements that increased reliability in the detection of prostate cancer. Our group is now working in the detection of prostate cancer with the spectroscopic MR, in co-operation with the Agency for the Evaluation of Technology for Medical Research (Agencia de Evaluación de Tecnología para la Investigación Médica-AATRM); although we are waiting for definitive results, we can advance that this technique may be used as a good alternative for localization of prostate cancer in patients with previous negative biopsies in whom the suspicion of prostate cancer persists. METHODS: We present a series of 5 patients under control for permanent elevation of PSA with previous negative biopsies. We were performing ultrasound guided sextant biopsies every 6 months, after blood test for PSA. Endorectal MRI and spectroscopic MRI were performed to try to localize the prostate cancer so diminishing the number of biopsies. RESULTS: All patients in the series had a low intensity lesion within the normal low intensity of the central gland, with an obvious spectroscopic metabolic abnormality suggesting the existence of prostate cancer, as it was then demonstrated by biopsy. CONCLUSIONS: The endorectal MR spectroscopic imaging is a non invasive method which offers the ability to detect prostate cancer within the central gland with a higher reliability in selected patients. The central gland is an area in which prostate cancer is less commonly localized, but it often shows the same signal intensity than hyperplastic tissue, so that it is difficult to be detected by purely morphological methods. Endorectal MR spectroscopic imaging allows evaluating the metabolic disturbances in the whole gland, increasing the reliability of detection of prostate cancer both in the central and peripherical glands.

Localización del cáncer de próstata en la glándula central mediante espectroscopia de resonancia magnética endorectal / Localization of prostate cancer within the central gland by endorectal MR spectroscopic imaging

OBJETIVO: La espectroscopia de resonanciamagnética endorectal (E-RME) es una nueva técnicade imagen que permite una evaluación más acuraday fiable de la localización y estadiaje del cáncerde próstata (CaP) que la resonancia magnética endorectalsola. La combinación de la RME y la E-RME haconseguido recientemente mejorías técnicas que hanpermitido aumentar la fiabilidad en la detección delCaP. Nuestro grupo está actualmente trabajando con laE-RME en la detección del CaP, en colaboración con laAgencia de Evaluación de Tecnología para laInvestigación Médica (AATRM), y en espera de resultadosdefinitivos podemos avanzar que ésta técnicapuede ser utilizada como una buena alternativa en lalocalización de CaP en pacientes con biopsias previasnegativas pero en quienes persiste la sospecha de CaP.MÉTODOS: Presentamos aquí una serie de 5 casos clínicosde pacientes controlados por elevación persistentedel PSA y biopsias previas negativas. Realizamosbiopsias por sextantes mediante ecografía transrectal aintervalos de 6 meses, después de determinar los valoresde PSA. La RME y E-RME se realizó para intentarlocalizar el CaP y de este modo intentar minimizar elnúmero de biopsias.RESULTADOS: Todos los pacientes en esta serie presentaronuna lesión de baja intensidad localizada en lahipointensidad normal de la glándula central, pero conuna clara alteración metabólica en la espectroscopiaque sugería la existencia de un CaP, tal como sedemostró posteriormente por biopsia.CONCLUSIONES: La E-RME es un método poco invasivoque ofrece la capacidad de detectar el CaP en laglándula central con mayor fiabilidad en pacientesseleccionados. La glándula central es una zona en laque el CaP se localiza con menor frecuencia, pero amenudo adopta la misma intensidad de señal que eltejido hiperplásico, y por tanto, resulta difícil de detectarpor métodos puramente morfológicos. La E-RME permiteevaluar las alteraciones metabólicas en toda laglándula y aumentar así la fiabilidad en la deteccióndel CaP, tanto en la glándula central como en la periférica

OBJECTIVES: The endorectal MRspectroscopic imaging is a new imaging test whichallows more accurate and reliable localization andstaging of prostate cancer than simple endorectal MRI.The combination of spectroscopic MR and MRI hasrecently achieved technical improvements that increasedreliability in the detection of prostate cancer. Our groupis now working in the detection of prostate cancer withthe spectroscopic MR, in co-operation with the Agencyfor the Evaluation of Technology for Medical Research(Agencia de Evaluación de Tecnología para laInvestigación Médica-AATRM); although we are waitingfor definitive results, we can advance that this techniquemay be used as a good alternative for localization ofprostate cancer in patients with previous negative biopsiesin whom the suspicion of prostate cancer persists.METHODS: We present a series of 5 patients undercontrol for permanent elevation of PSA with previousnegative biopsies. We were performing ultrasound guidedsextant biopsies every 6 months, after blood test forPSA. Endorectal MRI and spectroscopic MRI wereperformed to try to localize the prostate cancer sodiminishing the number of biopsies.RESULTS: All patients in the series had a low intensitylesion within the normal low intensity of the centralgland, with an obvious spectroscopic metabolicabnormality suggesting the existence of prostate cancer,as it was then demonstrated by biopsy.CONCLUSIONS: The endorectal MR spectroscopicimaging is a non invasive method which offers theability to detect prostate cancer within the central glandwith a higher reliability in selected patients. The centralgland is an area in which prostate cancer is lesscommonly localized, but it often shows the same signalintensity than hyperplastic tissue, so that it is difficult tobe detected by purely morphological methods.Endorectal MR spectroscopic imaging allows evaluatingthe metabolic disturbances in the whole gland, increasingthe reliability of detection of prostate cancer both in thecentral and peripherical glands

[Laparoscopic radical prostatectomy. Review of our first year]. / Prostatectomía radical laparoscópica. Revisión del primer año.

OBJECTIVES: To present our series of laparoscopic radical prostatectomy, comparing to the published results up to date. METHODS: From november 2001 to november 2002, we have practiced 27 laparoscopic radical prostatectomies without lymphadenectomy. We have used the Montsouris technique with some modifications. All cases started by laparoscopy are included in the report. RESULTS: Laparoscopic approach was indicated in 27 patients; 17 cases were completed and 10 converted to open surgery. Among the last 17 consecutive cases only two were converted. Mean operative time was 296 minutes (190-480 minutes, MAY: SD 60). Global morbidity was 18.5%, without severe complications, reoperations or mortality. Transfusion rate was 11%. There was not any incontinent patient and three patients developed an anastomostic stenosis. 57% of previously potent patients have erections with a follow-up over six months. Positive surgical margins incidence is 33% overall and 17.6% in laparoscopic cases. Only one of the patients with a follow-up above six months has a biological (PSA) recurrence (7%). CONCLUSIONS: Laparoscopic radical prostatectomy is feasible, reproducible and within reach of interested urologists. It may substitute, once sufficient experience is acquired, conventional surgery.

Prostatectomía radical laparoscópica. Revisión del primer año / Laparoscopic radical prostatectomy. Review of our first year

OBJETIVOS: Presentar nuestra serie de prostatectomía radical laparoscópica, comparándola con los resultados publicados hasta el momento. MÉTODOS: Desde noviembre de 2001hasta noviembre de 2002 hemos realizado 27 prostatectomías radicales laparoscópicas sin linfadenectomía. La cirugía se ha practicado según la técnica de Montsouris con algunas modificaciones. Se han incluido todos los casos iniciados por vía laparoscópica. RESULTADOS: Se ha indicado el abordaje laparoscópico en 27 pacientes, habiendo completado 17 y reconvertido a cirugía abierta 10 casos. Entre los últimos 17 casos consecutivos sólo se han reconvertido dos. El tiempo quirúrgico medio ha sido de 296 minutos (190-480 minutos, ds 60). Han presentado una morbilidad global del 18,5 por ciento, sin complicaciones graves, reintervenciones o mortalidad. El índice de transfusión ha sido del 11 por ciento. No tenemos ningún caso de incontinencia urinaria y tres pacientes han presentado estenosis de la anastomosis. Un 57 por ciento de los pacientes previamente potentes con seguimiento superior a seis meses tienen erecciones. La incidencia de márgenes quirúrgicos positivos es del 33 por ciento globalmente y del 17,6 por ciento en las laparoscópicas. Sólo uno de los pacientes con un seguimiento superior a seis meses ha presentado una recidiva biológica (PSA) (7 por ciento). CONCLUSIONES: La técnica de la prostatectomía radical laparoscópica es factible, reproducible y al alcance de aquellos urólogos con interés. Puede sustituir, una vez adquirida la experiencia necesaria, a la cirugía convencional (AU)