Esta guía ofrece recomendaciones para el tratamiento del hombre contemporáneo cuyo tumor sea estadio T1 clínicamente localizado (tacto rectal [TR] normal) o T2 (TR anormal pero sin evidencia de enfermedad fuera de los límites de la próstata) sin evidencia de extensión a los ganglios linfáticos regionales (N0 o Nx) o de extensión metastatica (M0).
Objective of the study is to review thecurrent 7 th edition of the TNM classification of renaltumors and to perform a critical analysis of the recentevidence in order to identify the limitations of this newstaging system. A search of the english literature wasperformed through the Medline and Pubmed databaseusing the following keywords: renal cell carcinoma,staging system and TNM. Overall, 2600 referenceswere initially scrutinized. Forty papers were selectedbased on their pertinence with the topic of the review,level of evidence provided and overall contribution tothe field. Few changes have been made in the currentversion of the TNM staging system of renal tumors. pT2tumors have been divided in 2 subgroups based ontumor size with a cut-off at 10 cm; the invasion of therenal vein was classified as pT3a; finally, the invasionof the ispsilateral adrenal gland was classified as pT4.However, other changes were suggested by the analysisof the recent literature and have not been introduced in this new version. Further improvements of the TNMclassification for renal tumors are needed especiallywith regard to locally advanced tumors and node-positive disease, in order to improve the accuracy of thisimportant prognostic tool in renal oncology
OBJECTIVES: Complex stenoses of the bulbar urethra and long stenoses of the penile urethra are very difficult to solve. Which surgical techniques must be applied in these cases is not clear. The objectives of this work were to define whether two-stage urethroplasties and definitive perineal urethrostomies are currently valid techniques for these cases and to clarify to what extent patients accept perineal urethrostomy.METHOD: 167 cases of urethral stenosis are reviewed: 73 of them correspond to long penile, both bulbar and penile, multiple or panurethral stenosis.The surgical procedures carried out in these 73 cases, essentially definitive perineal urethrostomy or two-stage surgery with a cutaneous graft implant, are analyzed.The results are evaluated as positive or negative according to the quality of voiding measured by the degree of satisfaction and urethrocystogram. RESULTS: Far from being obsolete, these techniques are shown on the one hand to be ideal nowadays, with good results between 96.1% in penile urethra stenosis and 71.4% in panurethral stenosis, and, on the other to be an opportunity for a definitive perineal derivation chosen voluntarily by 55% of patients who were programmed for a second stage. The most frequently-occurring complications in this type of surgery, like graft necrosis and retraction of the perineal meatus, are confirmed. We recognize the number of cases studied is limited to make representative statistical conclusions, but the work is justified by their infrequency and the need to contribute with our experience. CONCLUSIONS: Two-stage urethral stenosis surgery and definitive perineal urethrostomy are highly acceptable techniques in certain complex cases. In two-stage urethral stenosis the grafts at the level of penile urethra produce better results and are easier to implant than bulbar-penile urethra grafts. Patients accept definitive perineal urethrostomies well.
OBJECTIVES: To determine clinical characteristics of the population with Fournier`s necrosis at Hospital Universitario del Valle (HUV) in Cali during the period 2003-2008. METHODS: We performed a retrospective review of patients with the diagnosis of Fournier´s necrosis at HUV during the period 2003-2008. We collected information on age, personal history, duration of illness, hospitalization, surgeries performed, time to surgical treatment, isolated germs, and mortality. Univariate descriptive analysis was performed in STATA v 10.1 RESULTS: 42 patients with mean age 51 years and 12 days mean disease duration. 26% had diabetes mellitus and 21.4% urethral trauma before admission. Average time to surgical debridement was 41.4 hours. 62% required suprapubic cystostomy, 14.3% derivative colostomy, 9.5% and 2.4% orchiectomy and penectomy respectively. The average hospital stay was 23 days and 12% required ICU care. Scrotal cultures were positive in 59.5%: 64% a single germ and 36% polymicrobial. Reported mortality was 17%. CONCLUSION: Fournier`s necrosis is a life-threatening clinical entity in patients with multiple comorbidities requiring multiple interventions. Broad-spectrum antimicrobial therapy, aggressive debridement of necrotic tissue and comprehensive management of these patients are the mainstays in the treatment of these severely ill patients.
The purpose of bladder augmentation using the gastrointestinal tract is to create a lowpressure and high-capacity reservoir, permitting suitable continence and voiding, preserving the upper urinary tract. OBJECTIVE: To analyze the indications, complications and results of our series of augmentation enterocystoplasties. METHOD: We retrospectively reviewed patients undergoing augmentation enterocystoplasty in our department between 1997 and 2010, both included. The indications were: Interstitial cystitis, neurogenic bladder and inflammatory bladder retraction. In all cases a cystography, urethrocystoscopy, urodynamic study and voiding diary were performed, as well as the specific studies of each condition. Bladder release is performed by means of medial laparotomy and an extraperitoneal approach with bivalve opening to the urethral orifices. The bladder augmentation is performed with a 15-20 cm segment of detubularized ileum obtained at 20 cm from the ileocecal valve; in cases of kidney failure, a 7-cm gastric body wedge is added. The bladder catheter was removed following cystogram after 15 days.Monitoring was performed by means of ultrasound with postvoid residual, blood analyses, urine culture and voiding diary. We performed a descriptive study of the demographic characteristics, postoperative complications according to the Clavien classification and in the long term. RESULTS: We included 24 patients, 19 women and 5 men with a mean age of 48.5 years and a median of 47 (21-77). Mean follow up was 7.5 years with a median of 8 (1-11). The indications were: 7 interstitial cystitis, 8 bladder retraction and 7 neurogenic bladder. There were no intraoperative complications. The postoperative complications were 3 Clavien I, 2 type II, 2 IIIA and 1 IIIB.In the long term, 3 patients presented urinary incontinence, 2 mild metabolic acidosis, 5 required self-catheterization, 6 bladder stones, 2 febrile urinary tract infections and 1 stricture of the anastomotic mouth. In three cases, an ileogastrocystoplasty was performed without hydroelectrolytic impairment or impairment of kidney function.CONCLUSIONS: In selected patients, augmentation enterocystoplasty constitutes an efficacious therapeutic option in the treatment of lower urinary tract dysfunction with scant morbidity and few complications.
OBJECTIVES: Serum prostate specific antigen and digital rectal examination are the tests used as screening tests to detect prostate cancer. However, only approximately 30% of men with suspicion of cancer have it confirmed on prostate biopsy, and not all of these need treatment. Detection of circulating tumor cells in localized prostate cancer has given variable re-sults, but it could be a useful complementa-ry screening tool to detect prostate cancer in men with abnormal screening tests before the evaluation with prostate biopsy. To evaluate the diagnostic yield of the detection of mCPC as a complementary PC screening test in a po-pulation fulfilling criteria for a prostate biopsy for sus-picion of PC.METHODS: A prospective screening study of consecutive patients aged 45-80 years presenting to the urologist for PC screening. Inclusion criteria were PSA >4.0ng/ml, PSA velocity >0.35ng/ml/year and/or DRE suspicious for cancer. Patients fulfilling inclusion criteria had blood taken for mCPC detection and then underwent 12-core transrectal prostate biopsy. Double immune-histochemical staining with anti-PSA and anti-P504S was used to detect mCPC. Both cytologist and pathologist were blinded to the results of the biopsy, mCPC results and clinical de-tails. The diagnostic yield of the presence or absence of mCPC was evaluated; the prostate biopsy was classi-fied as cancer or no-cancer.RESULTS: 228 men participated, with a mean age of 66.8 ± 8.8 years and a median serum PSA of 5.15ng/ml. 28.6% of the biopsies were positive for PC, and mCPC were detected in 31.0% of all cases. Sensibility, specifici-ty and negative predictive value were 86.2%, 90.8% and 94.3% respectively. The negative and positive like-lihood ratios were 9.36 and 0.15. In men with a PSA ﹤4.0ngml, 13.3% had cancer detected on biopsy, with a sensibility and specificity for mCPC detection of 83.3% and 84.6% and negative predictive value of 97.1%. All the mCPC determinations were interpretable. There were 9 false negative cases, all with small low grade tumors.CONCLUSIONS: The use of mCPC detection could be useful as a complementary prostate cancer screening test, especially for excluding cancer, including patients with a serum PSA ﹤4.0ng/ml.
OBJECTIVES: Retrospective review of 106 germ-cell testicular tumors treated in our center between 1992 and 2009.METHODS: Description and analysis of several clinicalpathologic and prognostic variables and survival analysis.RESULTS: 68% of our patients were diagnosed in the last 5 years. 54.7% presented seminoma histology. The mean age at diagnosis was 33.47 for the seminoma (S) and 27.63 for non seminoma (NS), p=0,001. The median tumoral size in mm was 45.99mm (globally). 44.3% presented elevation of at least one tumor marker; Alpha-fetoprotein(AFP) or Human chorionic gonadotropin (HCG) .29.3% in the S and 60.4% in NS; p=0.02. The percentage of patients with increased HCG in S was 29.3% and 52.1% in NS; p=0.017 and AFP was elevated in 5.2% of S and 45.8% of NS; P <0.001. Accordingly to the classification of The Royal Marsden Hospital 96.5% of S and 83.2% of NS were diagnosed in stage I-II. Using the classification of the International Germ Cell Cancer Collaborative Group (IGCCG) for patients with advanced disease, 98.2% of S and 83.2% of NS belonged to the good prognostic group. Regarding the risk factors for relapse in stage I S (Rete testis invasion (RTI) and tumoral size (TS)> 4cm) 28% of our patients presented both risk factors. 18% of stage I NS presented vascular (VI) or lymphatic invasion (LI). Following the treatment protocols in consideration with the histology, stage and risk factors, 100 % of stage I S with both risk factors and 100% of NS with vascular or lymphatic invasion received adjuvant therapy. Almost all the stage II-IV S and NS received different protocols of chemotherapy. In 2.8% of stage II NS a retroperitoneal lymph node dissection was performed. Residual tumor resection was documented in eight patients with stage IIIV NS. With a median follow-up of 60 months, the event free survival (EFS) was 93.3%.CONCLUSIONS: Our study has similar characteristics compared to other studies.
OBJECTIVE: Contribution of a case of penile metastasis in a patient with metastatic rectal carcinoma.METHODS: A 70-Year-old patient was referred to our consultation after the discovery of “penis indurations” having been diagnosed of rectal carcinoma 18 months before. After physical examination penile biopsies were carried out.RESULTS: The pathological results of the Glans biopsy was “rectal adenocarcinoma metastasis”.CONCLUSIONS: Metastases in the penis are rare, and usually occur in the context of advanced oncological disease.
OBJECTIVE: Penile metastases are late manifestations of a primary tumor, and they are a sign of poor prognosis.We report a case of a rare presentation: penile metastases from prostate cancer.METHODS: 77 year-old male presented hematuria and acute urinary retention; on physical examination multiple hard lesions were detected. The patient underwent a Doppler ultrasound, subsequent penile and prostate biopsy, and staging study. Currently he is being treated with complete androgen blockade.RESULTS: A histological study of the penile biopsy showed penile metastasis from prostate adenocarcinoma.The histological study of prostate biopsy confirmed Gleason 8 (4 +4) adenocarcinoma.CONCLUSIONS: Despite of the different therapeutic alternatives for treatment of symptomatic penile metastases, it would be with palliative target; due to the median survival of these patients is less than a year.
OBJECTIVE: To analyze in a short and concise way the diagnosis and treatment of traumatic fracture of both corpora cavernosa and urethra.METHODS: We present our experience with a rare case of traumatic fracture of both corpora cavernosa associated to complete urethral rupture.RESULTS/CONCLUSIONS: The diagnosis of penile fractures can be done with the clinical history and physical examination only. Surgery is the best treatment, the main objective of which is to enable voiding and restore the anatomy of the penis to prevent complications such as erectile dysfunction.
OBJECTIVE: Presentation of a new case of dermoid cyst of the spermatic cord and to perform a review of the literature.METHODS: We describe the case of a 48 year-old male who consulted because of reappearance of a mass in the left high scrotal area and inguinal zone. He was operated for left inguinal hernia two years before. RESULTS: Since physical examination and ultrasound were inconclusive, we performed a surgical exploration with complete excision of the mass. Intraoperartive pathologic analysis confirmed the benign nature of the mass so we did not proceed to radical orquiectomy.CONCLUSIONS: Among paratesticular tumors, benign in the majority of cases, dermoid cyst is a rare pathology of the spermatic cord that the clinician always has to take into account before making a decision when we treat the spermatic cord masses.
OBJECTIVE: To report a rare case that supposed an emergency. It is a case of hematuria caused by an arteriovenous fistula.METHODS: We describe the background, clinical exploration, complementary exams and their results, as well as the treatment applied in an adolescent with hematuria.RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization, with immediate stop of the hematuria.CONCLUSION: Non-traumatic renal arteriovenous fistulae are infrequent and even more if they appear with gross hematuria. We present the case of an emergency caused by one of them which was treated by percutaneous embolization, avoiding surgery.