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)

[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.