OBJECTIVES: To describe the quality parameters established based on surgical and pathological aspects of bladder carcinoma treatment in the study published by the Bladder Cancer Collaborative Group (BCCG) and compare them against the publications of the International Robotic Cystectomy Consortium (IRCC). METHODS: A MEDLINE database search for articles published by BCCG and IRCC and description of them.RESULTS: Margins: IRCC work globally presented 6.8% of positive margins, a result close to the 6.5% of BCCG. The margins were similar in patients with organ-confined disease (≤ pT2) and those with extravesical disease (pT3-pT4), IRCC work showed a 4.6% positive margin compared to open surgery. In those who had lymph node involvement, negative margins were 6% higher for conventional surgery (BCCG: 14% vs. IRCC: 20%). The impact of learning curve in surgical margins in robotic surgery was not significant. Lymphadenectomy: In BCCG’s work, 11% of patients did not have a lymphadenectomy performed, 9% underwent an LL, 67% SL and 13% EL. The mean number of lymph nodes collected was 12.5, with a median of 11. In the IRCC, 82.9% of patients underwent lymphadenectomy (defined as with more than 10 lymph nodes removed), of which 43% had more than 20 nodes removed. The median of the entire series was 17 nodes (range 0-68). CONCLUSIONS: The robotic assisted laparoscopic radical cystectomy (RALRC) is a technique with similar results to conventional surgery in terms of surgical margins and enables the performance of an adequate pelvic lymphadenectomy. Long term results are pending of a longer follow-up of patients operated to date.
OBJECTIVES: To determine if elevated levels of high-sensitivity C-reactive protein (CRP) in plasma are associated with locally advanced renal cell carcinoma (LARCC) after surgery. METHODS: Retrospective cross-sectional study conducted from May 2009 to January 2011. Altogether, 192 patients with non-disseminated disease and with preoperative quantitative determination of the CRP were evaluated. We evaluated the relation between age, gender, history of smoking, symptoms and CRP higher than 10 mg/L, with LARCC. The chi-square and Fisher’s tests were used to compare categorical variables. For the multivariate analysis, we used logistic regression methods.RESULTS: The median age was 62 years (r=23-85), 72.4% were males. The median CRP was 2.40 mg/L (r=0.1-173). Of all the patients, 43.2% had a history of smoking and 81.8% were asymptomatic. As for the tumors, 77.1% were clear cell carcinoma, 14.6% chromophobe, 4.7% papillary, 2.6% oncocytomas, and 1% other varieties of renal cell carcinoma. As for the TNM classification, 45.8% corresponded to stage pT1a, 27.6% pT1b, 13% pT2, and 13.5% pT3, pT4 was not found.In the multivariate analysis, the presence of symptoms (p=0.002, OR=3.1) and the presence of CRP higher than 10 mg/L (p=0.006, OR=4) remained as the only prognostic variables of LARCC.CONCLUSIONS: Values of CRP higher than 10 mg/L increase 4 times the possibilities of finding LARCC in the pathological study of the surgical specimen. This variable should be taken into account when deciding what is the best surgical option.
INTRODUCTION: Paratesticular tumors are masses of slow and indolent growth and in most cases of benign nature (70 %), being that the case, the treatment of choice is simple extirpation of the lesion and follow-up, based on observation only. On those identified as malignant (30 %), treatment is more complex, consisting in radical orchiectomy with adjuvant chemotherapy or radiotherapy. This work tries to describe our case series of paratesticular tumors over the last 25 years and to make a comparative analysis with the information published in the world literature.OBJECTIVE: To describe our experience with paratesticular tumors, their incidence, demographic data and treatment over a period of 25 years.METHODS: Descriptive study where we analyzed clinical data of 16 patients with the diagnosis of paratesticular tumor treated at Mostoles Hospital between 1984 and 2010 analyzing the age, type of tumor, treatment and follow-up.RESULTS: Mean age was 50 years (range: 16-88), benign tumors were detected in 76 % of the cases and malignant in 24%. The tumor more frequently found in our series was leiomyoma (23.5%), with slight predominance of the right side (53 %); the most frequent location was the epididymis (50%) and mean size was 4.9 cm of diameter. The mean follow up was 34 months without complications or tumor relapse in any patient.CONCLUSIONS: Despite only three-quarters of paratesticular tumors are non-malignant, it is always advisable to do intraoperative pathological analysis of all this masses. Having a non-malignant diagnosis, the treatment of choice is simple extirpation of the mass. In our study the majority of the tumors were diagnosed in adult age (average 51 years), the most frequent was leiomyoma and the most common location was the epididymis.
OBJECTIVE: The aim of this paper is to analyze the results obtained in pelvic floor surgery using a non-absorbable mesh in selected patients with risk factors of recurrent prolapse.METHODS: Case series including a total of 76 patients who were surgically treated for severe genital prolapse from July 2005 to December 2009, with risk factors for recurrence of genital prolapse.RESULTS: We detected 3 cases (6.8%) of symptomatic prolapse recurrence and 6 cases (13.6%) of prolapse of another compartment in the anterior Prolift® group. In the posterior Prolift® group there were no recurrences but there were 2 cases (10.52%) of prolapse of another compartment. In the total Prolift® group, there were 2 cases (16.6%) of symptomatic prolapse recurrence. As for de novo urgency, there were a total of 4 cases (5.33%), 3 in the anterior Prolift® group and 1 in the total Prolift ® group.We did not detect any case of severe pain in the pelvis or mesh insertion points that required reoperation due to persistence.CONCLUSIONS: The use of mesh in pelvic floor reconstructive surgery in selected patients with risk factors for recurrence is a good treatment option to prevent or attempt to reduce the recurrence or reoperation rates currently described.
OBJECTIVE: Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and management is controversial due to the bleeding risk. We report a bladder cavernous hemangioma resolved using bipolar transurethral resection. METHODS: We review the case of a female patient who presented with asymptomatic hematuria. On cystoscopy we discovered a reddish sessile lesion compatible with bladder hemangioma. We describe the diagnostic work up, surgical management and review other therapeutic alternatives for these lesions.RESULTS: Fifty five year old healthy female patient consulting for total painless hematuria. Cystoscopic evaluation revealed a 1 cm diameter sessile reddish elevated lesion near the bladder neck. We performed a transurethral endoscopic resection using the Gyrus Bipolar resectoscope®. Pathologic report concluded cavernous angioma. CONCLUSION: Bladder hemangiomas are benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent complain. Management is controversial due to the bleeding risk of this highly vascularized lesion. However, it appears that small lesions could be treated using transurethral resection. Although they have a benign course, follow up is mandatory to detect recurrence or residual disease.
OBJECTIVE: Migration of objects into the urinary tract from the digestive tract has been described. Our objective is to report the case of a patient with urosepsis and late migration of toothpick from the gastrointestinal tract into the bladder. METHODS: A 78 y/o male patient with uro-sepsis and hydronephrosis was admitted. The initial suspected etiological cause was obstructive ureteral lithiasis. CT scan showed hydronephrosis and a possible ureteral stone. However, a femoral catheter was in place near the toothpick location, which jeopardized the detection of the foreign body. Antibiotic therapy and placement of a ureteral stent were performed. Once infection subsided, ureteroscopy was carried out showing a slight extrinsic compression of the distal ureter. The patient was readmitted with urinary infection. New imaging studies showed a foreign body in the bladder, which was not evident previously. Cystoscopy showed a toothpick penetrating the bladder and it was removed. RESULTS: Retrospectively, we interpreted that the foreign body perforated the gastrointestinal tract, migrated to the retroperitoneum and caused upper urinary tract obstruction by inflammatory reaction in the periureteral tissues. Once infection was solved, ureteral manipulation by ureteroscopy may have caused the toothpick migration into the bladder. CONCLUSIONS: Migration of foreign bodies from the gastrointestinal tract into the bladder occurs rarely. They clinically present as a complicated urinary tract infection. Imaging studies make the diagnosis, and a high level of suspicion is required.
OBJECTIVE: To report one case of bilateral kidney pseudotumor due to sarcoidosis in a 75 yearold man with prostatic carcinoma and hypertrophic pachymeningitis.METHODS: Renal Doppler, body CT, CT-guided renal biopsy, blood analysis including angiotensin converting enzyme (ACE), blood levels and test-treatment (corticosteroid response) were performed.RESULTS: The radiological studies performed showed bilateral kidney masses and pulmonary calcified hilar adenopathies. Blood analysis showed renal failure and increased ACE levels. Renal biopsy showed non-caseating granulomas. Neurological symptoms and renal failure improved with corticosteroid therapy.CONCLUSION: Bilateral kidney pseudotumor due to sarcoidosis is a rare pathology. Sarcoidosis must be included in the differential diagnosis work up of patients with inflammatory or autoimmune disease and bilateral kidney pseudotumors. Radiological findings of kidney sarcoidosis are quite unspecific. Histological diagnosis with CT guided biopsy or US guided biopsy of kidney masses may be performed.
OBJECTIVE: To report a case of a right hypochondrium giant mass in a 40-year-old patient.METHODS: We report the case of a 40 year-old male referred to our Department because of right hypochondrium pain and increased abdominal perimeter. Radiological examination showed a 30 x 24 x 20 cm retroperitoneal mass, dependent on the upper pole of the right kidney.RESULTS: We performed radical nephrectomy through a mid line laparotomy.The pathological analysis described it as a clear cell renal carcinoma pT2bN0M0.CONCLUSION: There are few reported cases of renal carcinomas with intraparenchymal bleeding exceeding 20 cm, the largest one exceeding 10 kg, and they usually show a good prognosis.
OBJECTIVE: We present the case of an adult patient diagnosed with Hutch diverticula after examination. Indications were of a type of congenital bladder diverticula very rare in children and unusual in adults, as very few cases in adults are addressed in the literature.METHODS: Intravenous Urography and Voiding Cystourethrogram (VCUG) were realizedRESULTS: The intravenous urography revealed ureterohydronephrosis in the excretory phase that did not have repletion defects suggesting lithiasis at distal urethra. On the other hand, a narrowing of the urethra was observed at the point of bladder entry due to the presence of a juxtameatal bladder diverticulum.Next a retrograde cystography was performed which ruled out vesicourethral reflux and revealed that the diverticulum presented elevated residuals after urination. As a result of our patient’s clinical characteristics and the absence of vesico-urethral reflux, we decided to perform an endoscopic surgical opening of the diverticula’s neck.CONCLUSIONS Hutch paraurethral diverticula is an very uncommon entity, even in infancy. The Voiding Cystourethrogram (VCUG) is especially useful in diagnosing these patients. In symptomatic cases surgical correction of the diverticula is required.