[Importance of PSA velocity and PSA density in the prediction of prostate cancer in TURP or open prostatectomy specimen of patients with previous negative prostate biopsy]. / Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa.

PURPOSE: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following at least one negative prostate biopsy (PB). MATERIALS AND METHODS: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP) or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points. RESULTS: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density (OR: 1.47; 95% CI: 1.22-6.64; p: 0.007) and PSA-velocity (OR: 2.87; 95% CI: 1.60-5.12: p < 0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points in detecting PC were 0.15 and 1 ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40 - 35.40), following surgery. CONCLUSIONS: PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity > 1l ng/ml/year and one or more negative saturation biopsies.

Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa / Importance of PSA velocity and PSA density in the prediction of prostate cancer in TURP or open prostatectomy specimen of patients with previous negative prostate biopsy

Objetivo: Determinar variables relacionadas con el hallazgo de cáncer de próstata (CaP) en pacientes sometidos a cirugía prostática tras al menos una biopsia prostática (BP) negativa. Material y métodos: Estudio retrospectivo de 170 pacientes sometidos a resección transuretral de próstata (RTUP) o adenomectomía entre 1999 y 2007, después de una o más BPs negativas. Se realizó un análisis multivariado de regresión logística para identificar variables relacionadas con la presencia de CaP. La capacidad predictiva de PSA, PSA densidad y PSA velocidad se determinó mediante curvas ROC y su área bajo la curva (ABC). Se analizó la sensibilidad, especificidad y valores predictivos para diversos puntos de corte de PSA densidad y PSA velocidad. Resultados: Se realizó adenomectomía en 104 pacientes (61,18%) y RTUP en 66 (38,82%). Se detectó CaP en la pieza quirúrgica de 16 pacientes (9,41%). Las variables asociadas al hallazgo de CaP en la pieza quirúrgica fueron PSA densidad (OR:1,47;95% IC:1,22-6,64; p:0,007) y PSA velocidad (OR:2,87;95% IC:1,60-5,12; p<0,001). Las ABC ROC fueron 0,746, 0,793 y 0,832, para PSA, PSA densidad y PSA velocidad, respectivamente. Los puntos de corte de PSA densidad y PSA velocidad con mayor sensibilidad y especificidad en la detección de CaP fueron 0,15 y 1 ng/ml/año, respectivamente. Los pacientes sin CaP mostraron una reducción mediana de PSA de 9,35 ng/ml (-2,40 – 35,40), después de la cirugía. Conclusiones: El PSA densidad y el PSA velocidad en particular, permiten predecir la presencia de CaP en la pieza de RTUP o adenomectomía, de pacientes con BPs previas negativas. La RTUP diagnóstica podría ser recomendada en pacientes con sospecha clínica de CaP, susceptibles de tratamiento curativo, con PSA velocidad >1ng/ml/año y una o más biopsias de saturación previas negativas (AU)

Purpose: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following atleast one negative prostate biopsy (PB).Materials and methods: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP)or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points. Results: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density(OR:1.47;95% CI:1.22-6.64; p:0.007) and PSA-velocity (OR:2.87;95% CI:1.60-5.12; p<0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points indetecting PC were 0.15 and 1ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40– 35.40), following surgery. Conclusions: PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity >1ng/ml/year and one or more negative saturation biopsies (AU)

[The utility of artificial neural networks in the prediction of prostate cancer on transrectal biopsy]. / Utilidad de las redes neuronales artificiales en la predicción de cáncer de próstata en la biopsia transrectal.

OBJECTIVE: To determine whether the development of an artificial neural network (ANN) made up of clinical variables allows for the prediction of prostate biopsy (PB) outcome. MATERIALS AND METHODS: Patients (n=953) underwent PB at the Arquitecto Marcide Hospital in Ferrol (Spain), between january 2000 and june 2005. The variables studied were age, PSA, digital rectal examination (DRE) and prostate volume, data for all of which were available in 843 cases. In order to determine factors related to prostate cancer (PC) diagnosis, a logistic regression analysis and a feed-forward neural network were developed, including three hidden layer nodes and an output node, representing the probability of PC. Both models were constructed from a random sample of n=643 patients (derivation set). The predictive capacity was assessed with the remaining 200 patients (validation set), by means of ROC curves and the area under the curve (AUC). RESULTS: PC was detected in 500 (59.3%) cases. Adjusting for age, PSA, digital rectal examination and prostate volume, in a multivariate logistic regression model it was observed that all the variables were independent predictors of PC. The AUC were 0.693 for PSA, 0.707 for prostate volume, 0.815 for logistic regression and 0.819 for ANN. The predictive capacity of the ANN was significantly higher than that of the PSA (p=0.002) and prostate volume (p<0,001) and similar to that of logistic regression (p=0.760). CONCLUSIONS: The ANN shows a PC prediction capacity that is significantly higher than unimodal diagnosis methods, and similar to that of logistic regression.

Utilidad de las redes neuronales artificiales en la predicción de cáncer de próstata en la biopsia transrectal / The utility of artificial neural networks in the prediction of prostate cancer on transrectal biopsy

Objetivo: Determinar si el desarrollo de una red neuronal artificial (RNA) formada por variables clínicas permite predecir el resultado de la biopsia prostática (BP). Material y métodos: Pacientes (n=953) sometidos a BP en el Hospital Arquitecto Marcide, Ferrol, entre enero-2000 y junio-2005. Las variables estudiadas fueron edad, PSA, tacto rectal y volumen prostático, disponiendo de todos estos datos en 843 casos. Para determinar factores relacionados con el diagnóstico de cáncer de próstata (CP), se desarrollaron un análisis de regresión logística y una red neuronal “feed-forward”, con tres nodos en su capa oculta y un nodo de salida, que representa la probabilidad de CP. Ambos modelos fueron construidos a partir de una muestra aleatoria de n=643 pacientes (set de derivación). La capacidad predictiva de ambos modelos se valoró con los 200 pacientes restantes (set de validación), mediante curvas ROC y su área bajo la curva (ABC). Resultados: Se detectó CP en 500 (59,3%) casos. Ajustando por edad, PSA, tacto rectal y volumen prostático, en un modelo de regresión logística multivariante, se observó que todas las variables predecían CP de forma independiente. Las ABC fueron de 0,693 para el PSA, 0,707 para el volumen prostático, 0,815 para la regresión logística y 0,819 para la RNA. La capacidad predictiva de la RNA fue significativamente superior a la del PSA (p=0,002) y volumen prostático (p<0,001) y similar a la de la regresión logística (p=0,760). Conclusiones: La RNA presenta una capacidad de predicción de CP significativamente superior a los métodos diagnósticos unimodales, y similar a la regresión logística

Objective: To determine whether the development of an artificial neural network (ANN) made up of clinical variables allows for the prediction of prostate biopsy (PB) outcome. Materials and methods: Patients (n=953) underwent PB at the Arquitecto Marcide Hospital in Ferrol (Spain), between january 2000 and june 2005. The variables studied were age, PSA, digital rectal examination (DRE) and prostate volume, data for all of which were available in 843 cases. In order to determine factors related to prostate cancer (PC) diagnosis, a logistic regression analysis and a feed–forward neural network were developed, including three hidden layer nodes and an output node, representing the probability of PC. Both models were constructed from a random sample of n=643 patients (derivation set). The predictive capacity was assessed with the remaining 200 patients (validation set), by means of ROC curves and the area under the curve (AUC). Results: PC was detected in 500 (59.3%) cases. Adjusting for age, PSA, digital rectal examination and prostate volume, in a multivariate logistic regression model it was observed that all the variables were independent predictors of PC. The AUC were 0.693 for PSA, 0.707 for prostate volume, 0.815 for logistic regression and 0.819 for ANN. The predictive capacity of the ANN was significantly higher than that of the PSA (p=0.002) and prostate volume (p<0,001) and similar to that of logistic regression (p=0.760). Conclusions: The ANN shows a PC prediction capacity that is significantly higher than unimodal diagnosis methods, and similar to that of logistic regression

Diagnóstico del cáncer de próstata mediante biopsia ampliada de 24 cilindros / Prostate cancer diagnosis using 24 cores extended biopsy

Objetivo: Determinar el rendimiento diagnóstico de la biopsia prostática (BP) ampliada en el cáncer de próstata (CP) y las variables que influyen en su positividad. Material y métodos: Pacientes (n=147) sometidos a BP de 24 cilindros, en el Hospital Arquitecto Marcide, Ferrol, La Coruña, entre diciembre 2002-septiembre 2004. Los criterios de inclusión fueron: pacientes ≤70 años con una o más BP negativas o ≤75 años con dos o más BP negativas. Se realizó análisis univariado mediante testΧ2 en variables cualitativas y test t-Student y U de Mann-Whitney, en variables cuantitativas y análisis de regresión logística para determinar variables relacionadas con la positividad de BP ampliada. Resultados: 60 pacientes (40,82%) presentaron CP. Entre los pacientes con BP negativa y positiva, se observaron diferencias significativas en volumen prostático, relación PSA libre/total en la primera BP, relación PSA libre/total en la BP ampliada, PSA-densidad en la BP ampliada y existencia de prostatitis crónica en BP previas. En el análisis multivariado se comprobó que la densidad de PSA y la existencia de prostatitis crónica en BP previas, predecían de forma independiente la positividad de la BP ampliada. Conclusiones: La BP ampliada permite detectar CP en el 40,82% de los pacientes con BP previamente negativas. El incremento de la densidad de PSA se asocia una mayor probabilidad de CP, mientras que la existencia de prostatitis crónica en las BP previas reduce significativamente la probabilidad de CP, en la BP ampliada (AU)

Objective: To determine the diagnostic performance of extended prostatic biopsy (PB) in prostate cancer (PC) and variables affecting positivity. Materials and Methods: Patients (n=147) underwent 24 cylinder PB at the Arquitecto Marcide Hospital, Ferrol, La Coruña, between December 2002-September 2004. Inclusion criteria were the following: patients aged ≤70 with one or more negative PB or aged ≤75 with two or more negative PB. An univariate analysis was carried out using the Χ2 test for the qualitative variables and the t-Student and U Mann-Whitney tests in the case of the quantitative variables, plus a logistical regression analysis in order to identify those variables related to the extended PB positivity. Results: 60 patients (40.82%) were identified as having PC. Significant differences were observed in prostatic volume, free/total PSA ratio in the initial PB, free/total PSA ratio in the extended PB, PSA-density in the extended PB as well as the existence of chronic prostatitis in previous PB. During the multivariate analysis it was found that the PSA-density and the presence of chronic prostatitis in previous PB independently predicted the positivity of the extended PB. Conclusions: Extended PB allows for the detection of PC in 40.82% of patients with previous negative PB. The increase in PSA density is associated with a greater probability of PC, whilst the existence of chronic prostatitis in prior PB significantly reduces the probability of PC in the extended PB (AU)

[Partial substitution of the ureter using a short segment of the ileum following the Monti procedure]. / Sustitución parcial del uréter por un segmento de ileon tratado según el procedimiento de Monti.

The partial substitution of the ureter using a pediculated segment of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization. The clinical case study presented here corresponds to a 57 year-old male with a history of ureteral lithiasis, with a 9 cm stenosis of the sacroiliac ureter. He was treated surgically by means of a resection of the stenotic ureter and the interposition of a duct made up of 2.5 ileal sections, treated in accordance with the Monti procedure. Since this operation, the patient's metabolic state has been completely normal. Morphological and functional results have also proved totally satisfactory, as the use of image techniques have shown.

Sustitución parcial del uréter por un segmento de íleon tratado según el procedimiento de Monti / Partial substitution of the ureter using a short segment of the ileum following the Monti procedure

La sustitución parcial del uréter por un segmento pediculado de íleon es una técnica que se utiliza para restablecer el tránsito ureteral y preservar la unidad renal, tras la resección de lesiones ureterales extensas. La técnica quirúrgica habitual para realizar una íleoureteroplastia consiste en aislar un asa ileal de igual o superior longitud al defecto ureteral, e interponerla en el tracto urinario, en dirección isoperistáltica. Monti describió una técnica quirúrgica que permitía crear estomas cateterizables en derivaciones urinarias continentes, utilizando el principio de Mitrofanoff. Dichos conductos eran confeccionados a partir de uno o varios segmentos ileales de 2,5 cm de longitud, mediante su destubulización y retubulización transversa. El caso clínico que presentamos corresponde a un varón de 57 años con antecedente de litiasis ureteral, que presentaba una estenosis del uréter lumbo-sacro de 9 cm. Se trató quirúrgicamente mediante resección del uréter estenótico, e interposición de un conducto formado por dos segmentos ileales de 2,5 cm, tratados según el procedimiento de Monti. La situación metabólica del paciente has ido absolutamente normal desde la fecha de la intervención. Los resultados morfológicos y funcionales fueron asimismo, plenamente satisfactorios, según se demuestra mediante técnicas de imagen (AU)

The partial substitution of the ureter using a pediculated segment of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization. The clinical case study presented here corresponds to a 57 year-old male with a history of ureteral lithiasis, with a 9 cm stenosis of the sacroiliac ureter. He was treated surgically by means of a resection of the stenotic ureter and the interposition of a duct made up of 2.5 ileal sections, treated in accordance with the Monti procedure. Since this operation, the patient’s metabolic state has been completely normal. Morphological and functional results have also proved totally satisfactory, as the use of image techniques have shown (AU)

[Role of nephrectomy in metastatic renal cell carcinoma. Experience of the Department of Urology Juan Canalejo Hospital]. / Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo.

OBJECTIVES: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. MATERIAL AND METHODS: We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. RESULTS: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months. CONCLUSIONS: In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.

Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo / Role of nephrectomy in metastatic renal cell carcinoma. Experience of the department of urology Juan Canalejo Hospital

Objetivos: Presentar nuestra experiencia en la realización de nefrectomía en tumores renales que se presentan con metástasis al diagnóstico, y observar las complicaciones, evolución y supervivencia de estos pacientes. Material y métodos: Realizamos una revisión retrospectiva de los adenocarcinomas renales en el período entre 1-1-1991 y 31-12-2002. Estudiamos solamente los que se presentaron con metástasis (31). Se estudian aquellos pacientes a los que se les practicó nefrectomía y aquellos a los que no se les ofreció tratamiento quirúrgico. Buscamos mostrar las diferencias en los dos grupos en cuanto a status vital (Tabla E.C.O.G.), patología concomitante y supervivencia media. En el grupo de los pacientes nefrectomizados estudiamos las complicaciones derivadas de la intervención y el tratamiento posterior. Resultados: Realizamos nefrectomía en 19 casos. Todos ellos E.C.O.G. 0-1. La estancia post operatoria media fue de12 días, y la tasa de complicaciones 11,5%. El 45% de estos pacientes siguieron algún tipo de tratamiento posterior, y la supervivencia media fue de 31 meses. No se realizó nefrectomía en 12 casos, de los cuales 9 eran E.C.O. G 2-3. La patología asociada que presentaban estos pacientes era más importante que en el primer grupo. Sólo en 3 casos se administró tratamiento con fines paliativos y la supervivencia media fue de 3,8 meses. Conclusiones: En pacientes con buen estado vital la nefrectomía no representa más morbilidad ni mortalidad que en los pacientes sin metástasis, y nos parece una opción fundamental en su manejo. Realizamos una revisión bibliográfica en la que recogemos las últimas tendencias en el tratamiento de estos pacientes, que ponen de manifiesto la necesidad del abordaje combinado quirúrgico e inmunoterápico. Nos parecen de interés fundamental las conclusiones de los estudios del SWOG y del EORTC (AU)

Objectives: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. Material and methods: We performe a retrospective review of renal cell carcinomaes treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to show the diferences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. Results: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some tipe of systemic treatment, and median survival was 31 months. We didn´t performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Asociated comorbidity was higher in this group. Only in three patients any treatment was offerted always with paliative reason. Median survival was 3.8 months. Conclusions: In those patients with good performance status this aproach does not represent more morbility or mortality than in non- metastatic patients, and that is a cornerstone in their management. We also make a literature review in wich we see the last pathways in the management e of these patients, and that show the needing for a conbined approach both quirurgical and inmunotherapical. We have review with special interest the studie’s conclusions of SWOG and EORTC groups (AU)

[Prostate cancer diagnosis using 24 cores extended biopsy]. / Diagnóstico del cáncer de próstata mediante biopsia ampliada de 24 cilindros.

OBJECTIVE: To determine the diagnostic performance of extended prostatic biopsy (PB) in prostate cancer (PC) and variables affecting positivity. MATERIALS AND METHODS: Patients (n = 147) underwent 24 cylinder PB at the Arquitecto Marcide Hospital, Ferrol, La Coruña, between December 2002-September 2004. Inclusion criteria were the following: patients aged < or = 70 with one or more negative PB or aged < or = 75 with two or more negative PB. An univariate analysis was carried out using the chi-squared test for the qualitative variables and the t-Student and U Mann-Whitney tests in the case of the quantitative variables, plus a logistical regression analysis in order to identify those variables related to the extended PB positivity. RESULTS: 60 patients (40.82%) were identified as having PC. Significant differences were observed in prostatic volume, free/total PSA ratio in the initial PB, free/total PSA ratio in the extended PB, PSA-density in the extended PB as well as the existence of chronic prostatitis in previous PB. During the multivariate analysis it was found that the PSA-density and the presence of chronic prostatitis in previous PB independently predicted the positivity of the extended PB. CONCLUSIONS: Extended PB allows for the detection of PC in 40.82% of patients with previous negative PB. The increase in PSA density is associated with a greater probability of PC, whilst the existence of chronic prostatitis in prior PB significantly reduces the probability of PC in the extended PB.

[Iatrogenic rupture of the ureter following extracorporeal shock wave lithotripsy]. / Rotura yatrógena de uréter secundaria a litotricia extracorpórea por ondas de choque.

Extracorporeal shock wave lithotripsy is the treatment of choice in most cases of urinary calculi, with the estimation that open surgery is only necessary in 5% of all cases. In most cases, the complications derived from this technique are slight, transitory and of little clinical importance, with isolated cases of serious urological or extraurological injury. These complications are either caused by the action of the stone itself or its fragments, or by the action of shock waves. We present a case of ureteral rupture following treatment of a ureteral calculus using extracorporeal shock wave lithotripsy which led to a periureteral retroperitoneal abscess that was treated by nephroureterectomy.

[Priapism following paraneoplastic leukemoid reaction in a patient with bladder cancer]. / Priapismo secundario a reacción leucemoide paraneoplásica en paciente con cáncer de vejiga.

Priapism associated with solid tumours is usually produced by penile metastasis or direct tumour infiltration of the corpora cavernosa. Neoplasias are responsible for between 3-8% of all cases of priapism, and in 80% of cases the primary tumour has a genito-urinary origin. Leukemoid reaction is an haematological disorder characterised by a leukocytosis of over 50000/microl, which develops reactively with different pathological processes such as severe inflammation, disseminated infections, intoxications and tumours. The pathophysiologic mechanism that explains priapism following leukemoid reaction is an intravascular obstruction due to blood hyperviscosity, leading to a blood stasis in the cavernosa veins, and impeding the drainage of the corpora cavernosa. We present a case of priapism in a patient with locally advanced bladder cancer, which was probably the result of blood hyperviscosity produced by a paraneoplastic leukemoid reaction.

Rotura yatrógena de uréter secundaria a litotricia extracorpórea por ondas de choque / Iatrogenic rupture of the ureter following extracorporeal shock wave lithotripsy

La litotricia extracorpórea por ondas de choque es el tratamiento de elección de la mayoría de los cálculos urinarios, estimándose que sólo en el 5% de los casos es necesario recurrir a técnicas de cirugía abierta. Las complicaciones derivadas de esta técnica son, en la mayoría de los casos, leves, transitorias y con escasa repercusión clínica, observándose sólo en casos aislados lesiones urológicas o extraurológicas de gravedad. Dichas complicaciones se producen bien por la propia acción del cálculo o sus fragmentos, o bien por la acción de las ondas de choque. Presentamos un caso de rotura ureteral secundaria al tratamiento de un cálculo ureteral mediante litotricia extracorpórea por ondas de choque, que derivó en un absceso retroperitoneal periureteral, y fue tratado mediante nefroureterectomía

Extracorporeal shock wave lithotripsy is the treatment of choice in most cases of urinary calculi, with the estimation that open surgery is only necessary in 5% of all cases. In most cases, the complications derived from this technique are slight, transitory and of little clinical importance, with isolated cases of serious urological or extraurological injury. These complications are either caused by the action of the stone itself or its fragments, or by the action of shock waves. We present a case of ureteral rupture following treatment of a ureteral calculus using extracorporeal shock wave lithotripsy which led to a periureteral retroperitoneal abscess that was treated by nephroureterectomy

Priapismo secundario a reacción leucemoide paraneoplásica en paciente con cáncer de vejiga / Priapism following paraneoplastic leukemoid reaction in a patient with bladder cancer

El priapismo asociado a tumores sólidos suele producirse por metástasis peneanas o por infiltración tumoral directa de los cuerpos cavernosos. Las neoplasias son responsables del 3-8% de los casos de priapismo, y en el 80% de los casos el tumor primario es de origen génito-urinario.La reacción leucemoide es un trastorno hematológico caracterizado por una leucocitosis superiora 50000/microl, que se desarrolla de forma reactiva ante diversos procesos patológicos como inflamaciones severas, infecciones diseminadas, intoxicaciones y tumores. El mecanismo fisiopatológico que explica el priapismo secundario a reacción leucemoide es una obstrucción intravascular por hiperviscosidad sanguínea, que origina una estasis sanguínea en las venas cavernosas, impidiendo el drenaje de los cuerpos cavernosos. Presentamos un caso de priapismo en un paciente con un cáncer de vejiga localmente avanzado, que se desencadenó por la hiperviscosidad sanguínea producida por una reacción leucemoide paraneoplásica

Priapism associated with solid tumours is usually produced by penile metastasis or direct tumour infiltration of the corpora cavernosa. Neoplasias are responsible for between 3-8% of all cases of priapism,and in 80% of cases the primary tumour has a genito-urinary origin. Leukemoid reaction is an haematological disorder characterised by a leukocytosis of over 50000/microl, which develops reactively with different pathological processes such as severe inflammation, disseminated infections, intoxications and tumours.The pathophysiologic mechanism that explains priapism following leukemoid reaction is an intravascular obstruction due to blood hyperviscosity, leading to a blood stasis in the cavernosa veins, and impeding the drainage of the corpora cavernosa. We present a case of priapism in a patient with locally advanced bladder cancer, which was probably the result of blood hyperviscosity produced by a paraneoplastic leukemoid reaction

[Giant retroperitoneal cystic mass: appendiceal mucocele]. / Masa quística retroperitoneal gigante: mucocele apendicular.

Appendiceal mucocele is a term used to describe the dilatation of the vermiform appendix produced by an intraluminal accumulation of mucus. Four pathological processes have been described that may lead to an appendiceal mucocele: obturation of cecoappendiceal communication, mucosal hyperplasia, mucinous cystadenoma and mucinous cystoadenocarcinoma. The most frequent is mucinous cystadenoma, seen in 50% of appendiceal mucoceles. 6% of patients with appendiceal mucocele develop peritoneal pseudomixoma, possibly through dissemination of the epithelial cells into the abdominal cavity. Preoperative diagnosis of the lesion is particularly important in order to deal with it carefully during surgery. CT scan is the most precise radiological exploration, although there are no pathognomonic signs of mucocele. Typical CT finding of a mucocele is a well-defined cystic mass that compresses the cecum without any peripheral inflammatory reaction, and with low levels of attenuation that vary between water and soft tissue density. We present a case of an appendiceal mucocele caused by a mucinous cystadenoma clinically presented as a giant retroperitoneal mass. Diagnosis was postoperatively made, after pathological study of the surgical sample.

Masa quística retroperitoneal gigante: mucocele apendicular / Giant retroperitoneal cystic mass: Appendiceal mucocele

Mucocele apendicular es un término que define la dilatación del apéndice vermiforme producida por acumulación intraluminal de moco. Son cuatro los procesos patológicos descritos que pueden ocasionar un mucocele apendicular: obturación de la comunicación cecoapendicular, hiperplasia mucosa, cistoadenoma mucinoso y cistoadenocarcinoma mucinoso. De todos ellos, el cistoadenoma mucinoso es el más frecuente, observándose en el 50% de los mucoceles apendiculares. El 6% de los pacientes con mucocele apendicular desarrollan pseudomixoma peritoneal, posiblemente por diseminación de células epiteliales al interior de la cavidad abdominal. Es de gran importancia el diagnóstico preoperatorio de la lesión, para manipularla cuidadosamente durante el acto quirúrgico. El TAC es la exploración radiológica más precisa, aunque no existen signos patognomónicos de mucocele. En el TAC el mucocele se presenta como una masa quística bien delimitada, que comprime el ciego, sin reacción inflamatoria periférica, y con bajos niveles de atenuación, que oscilan entre densidad agua y tejido blando. Presentamos un caso de mucocele apendicular ocasionado por un cistoadenoma mucinoso, que se presentó clínicamente como masa retroperitoneal gigante. El diagnóstico fue efectuado post-operatoriamente, tras el estudio anatomopatológico de la pieza quirúrgica (AU)

Appendiceal mucocele is a term used to describe the dilatation of the vermiform appendix produced by an intraluminal accumulation of mucus. Four pathological processes have been described that may lead to an appendiceal mucocele: obturation of cecoappendiceal communication, mucosal hyperplasia, mucinous cystadenoma and mucinous cystoadenocarcinoma. The most frequent is mucinous cystadenoma, seen in 50% of appendiceal mucoceles. 6% of patients with appendiceal mucocele develop peritoneal pseudomixoma, possibly through disseminationof the epithelial cells into the abdominal cavity. Preoperative diagnosis of the lesion is particularly important in order to deal with it carefully during surgery. CT scan is the most precise radiological exploration, although there are no pathognomonic signs of mucocele. Typical CT finding of a mucocele is a well-defined cystic mass that compresses the cecum without any peripheral inflammatory reaction, and with low levels of attenuation that vary between water and soft tissue density. We present a case of an appendiceal mucocele caused by a mucinous cystadenoma clinically presented as a giant retroperitoneal mass. Diagnosis was postoperatively made, after pathological study of the surgical sample (AU)

Adenoma metanéfrico renal típico. Cirugía conservadora / Tipical metanephric renal adenoma. Conservative surgery

El Adenoma Metanéfrico es un infrecuente tumor renal clasificado dentro del grupo complejo de los tumores embrionarios renales o nefroblásticos. Afecta generalmente a mujeres jóvenes y tiene un buen pronóstico en la mayoría de los casos. Debe diferenciarse fundamentalmente de variantes de carácter maligno como el carcinoma papilar de células renales, del adenosarcoma metanéfrico y del tumor de Wilms del adulto. La sospecha del mismo junto con un análisis intraoperatorio del tumor puede facilitar el empleo de cirugía renal conservadora como tratamiento evitando una cirugía radical agresiva e innecesaria. Existen casos de Adenoma Metanéfrico metastásico, con lo que el carácter totalmente benigno de esta patología y su potencial maligno no se encuentran aún totalmente esclarecidos. (AU)

[Bladder metastasis of a stomach carcinoma. Presentation of a case]. / Metástasis de carcinoma gástrico en vejiga. Presentación de un caso.

Metastatic tumors account for a small percentage within bladder neoplastic pathology. The presence of signs of bladder neoplasm in a patient with malignancies in other location must aware us about its metastatic origin. One of the most frequent locations of the primary tumor is the stomach. Its evolution is always bad. We present a case of a woman who previously had undergone surgery for a gastric carcinoma, and later suffered a metastatic bladder affectation. We make special attention in the clinic presentation, very similar to the typical transitional cell carcinoma, its anatomopathological diagnosis after transurethral resection (T.U.R.), and its evolution. We make a brief revision of the bladder metastatic pathology.

Metástasis de carcinoma gástrico en vejiga. Presentación de un caso / Gastric metastatic carcinoma to the bladder. A case report

Los tumores de origen metastático suponen un porcentaje mínimo dentro de la patología neoplásica vesical. La aparición de datos compatibles con neoplasia vesical en un paciente con antecedentes tumorales en otra localización debe hacernos pensar en un origen metastático de la lesión vesical. Una de las localizaciones más frecuentes de la neoplasia primaria es el estómago. La evolución es indefectiblemente ominosa. Presentamos el caso de una mujer operada previamente de una neoplasia gástrica que más tarde metastatiza a vejiga. Hacemos hincapié en la presentación clínica, similar a la de una neoplasia vesical de células transicionales, su diagnóstico anatomopatológico tras resección transuretral (R.T.U.), y su mala evolución. Se realiza breve revisión de la patología vesical metastática (AU)

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[Penile adenoma: clinical case]. / Melanoma de pene: caso clínico.

Penile melanoma is a very uncommon neoplasm, being reported less than 60 cases. Event yet it outlines not few doubts about its diagnosis and treatment, and in advanced stages represents a challenge for the future since it prognosis is awful at short time. In the present article, its presented a glans melanoma diagnosed and treated at our Service. We make a brief revision of the literature and some basic issues on the management of this entity when it's localized in penis, since in the cases in which it extends far from this organ is yet oncological field.