OBJECTIVES: Renal carcinoma accounts for 3% of malignant urological tumors. The existence of tumor thrombus in the venous system is more infrequent, and, despite it was believed until recently its presence worsened the diagnosis of the disease, currently it is accepted that in the absence of metastatic or lymph node disease, surgery is the treatment of choice and potentially curative for these tumors.METHODS: Between June 2003 and November 2007 eight patients with renal disease and venous thrombus underwent surgery; two of them wereT3c and six T3b; in five of them surgery was carried out in association with the heart surgery team in our centre. Three of them underwent surgery with extracorporeal circulation. Mean patient age was 56 years.RESULTS: Tumor thrombus was grade I in one patient, grade II in 4 patients, grade III in one patient, and grade IV in two patients. In all patients with tumor grade ≥III, as well as two with grade II, surgery was performed in conjunction with the department of heart surgery. The operation with extracorporeal circulation, deep hypothermia, cardioplegia, and antegrade and retrograde brain perfusion was performed in grades III and IV. Midline incision was performed, with or without sternotomy, depending on the level of the thrombus. Hemorrhage was the most frequent perioperative complication.DISCUSSION: It is essential to know the exact level of the cephalic extreme of the tumor thrombus to design the proper surgical strategy; for that, we can use MRI, CT scan or ultrasound. Therefore, surgical approach, multidisciplinary cooperation and use of extracorporeal circulation will depend on such extension of the thrombus and concurrent factors of the patient. A good surgical strategy, as well as early surgery may avoid the use of venous filters preoperatively.CONCLUSIONS: Venous wall invasion seems to be related with a greater incidence of lymph node disease, but these patients are candidates to intention-to-cure radical surgery. Thrombus level is not a prognostic factor per se, but it should be taken into consideration for surgical planning. After radical surgery survival rates achieved are similar to those of tumors without venous thrombus
OBJECTIVES: To determine survival of patients with metastatic renal carcinoma treated with interferon.METHODS: Retrospective longitudinal study with 18 patients with the diagnosis of metastatic renal carcinoma treated in the University Hospital Manuel Fajardo between July 2002 and September 2007 with radical surgery and alpha 2b recombinant interferon, either adjuvant or as monotherapy.RESULTS: 74% (14/18) of the patients were males, 26% (5/18) females. 72% (13/18) underwent radical surgery plus interferon, and 28% (5/18) received interferon monotherapy.Complete response was observed in 22% (4/18); 78% (14/18) had progression. One, 2, 4 and 5-year survivals were 50%, 33%, 28%, and 22%, respectively.CONCLUSIONS: No significant response was found. There was not tumor regression in any case using interferon. Survival was better in cases undergoing radical nephrectomy plus interferon than cases treated with interferon monotherapy.
OBJECTIVES: To evaluate the quality oflife of patients with stress urinary incontinence (SUI) ope-rated in the Department of Urology at the Complejo Hos-pitalario Universitario in Albacete (CHUA).METHODS: Between November 2001 and December2005, 126 patients with SUI have completed a ques-tionnaire in our centre, before and after undergoing sur-gery with sling techniques. The questionnaire was theKing’s Health Questionnaire (KHQ), which is a specificinstrument for the measurement of quality of life in pa-tients with urinary incontinence.RESULTS: Mean patient`s age was 57.09 years (DE:9.57). Twelve women (9.5%) had history of previousurinary incontinence surgery. Mean urinary incontinenceevolution time was 114.48 months, with a median of96 months. 38 patients (30.2%) did not present cys-tocele, 61 (48.4%) presented grade III cystocele, 25(19.8%) grade II, and 2 (1.6%) grade I. Before sur-gery, the scale with best score was Personal relations-hips, with a mean score of 26.8, whereas the scale withworst scores was Impact of urinary incontinence, with amean score of 82.96.All operations performed consisted in various techniquesof transvaginal slings, except one case (0.8%) in whichthe Kelly technique was performed.Impact of urinary incontinence was the scale with a grea-ter number of patients improving after surgery; 82.9% ofthe patients (101 cases) gave a better score. The scalesshowing greater differences of the mean value compa-ring before/after surgery were impact of urinary inconti-nence, limitation on the daily life activity, and limitationon social activity. Personal relationships and Generalhealth were the two with the smallest improvements.CONCLUSIONS: Surgery demonstrated to improve thesymptoms secondary to this disease, therefore, it resultsin an improvement of the quality of life that is evidentin all scales of the questionnaire, mainly in the impactof urinary incontinence, limitations on physical activity,limitations on daily life, and limitation on social activityscales
OBJECTIVES: To compare long term effi-cacy and morbidity in patients with stress urinary incontinence treated using Burch’s colpopexy versus Burch’s colpopexy plus urachus-cystopexy. METHODS: Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch’s colpopexy (group B) and 75 patients underwent Burch’s colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005.The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately. RESULTS: After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p= 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p=0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1 % of group B and 19.4 % of group BU had UUI (p= 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p= 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p= 0.000) at12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p= 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately.CONCLUSIONS: Burch’s procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch’s procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch’s procedure.
OBJECTIVES: To report the case of a 47 years old woman with several small stones located inside a calyceal diverticulum of the right kidney and to highlight the importance of minimally invasive endourological treatment in these cases. METHODS: Owing to the presence of diverticular calculi and clinical symptoms of recurrent infection, we decided to perform percutaneous nephrolithotomy (PNL). After Holmium-YAG laser calculi fragmentation and removal of all stone material, we fulgurated the diverticular lining and infundibulum with a resectoscope and a rollerball electrode. RESULTS: The patient is free of symptoms after 6 months follow-up. The disappearance of the calculi and diverticulum is confirmed with excretory urogram.CONCLUSIONS: Endourological approach for diverticular calculi, such as percutaneous nephrolithotomy (PNL), is a minimally invasive treatment with excellent results and low morbidity. Using this procedure we are able to perform stone removal and cavity fulguration. According to this, we think that endourological techniques, and specially PNL could be the first option for treatment in selected cases of this pathology
OBJECTIVES: Laparoscopically assisted radiofrequency is a minimally invasive nephron-sparing treatment option for renal tumors, mainly in patients with high comorbidity. We present the short-term results of our series patients treated with this novel technique.METHODS: Renal lesions smaller than 4 cm, suspicious of malignancy or metastasis on CT scan or MRI are candidates for radiofrequency. Under laparoscopic vision the tumor is identified, and percutaneous biopsy is performed. Depending on the size of the tumor, a number of punctures with the radiofrequency needle are performed with the aim to achieve tumor necrosis during at least one cycle of radiofrequency. Follow-up is performed with MRI in the first postoperative day and then after CT scan or MRI at 1, 3, 6 and 12 months. The persistent absence of contrast or vascular necrosis of the lesion is considered a satisfactory ablation without recurrence.RESULTS: 12 patients, two with metastasis and ten with primary lesions (mean age 60.8 years), with one or more lesions suspicious of malignancy underwent radiofrequency. Mean ASA was 2.4. 15 tumors were treated, with a mean diameter of 2.8 cm. An average of 2.5 punctures was performed with the radiofrequency needle. Biopsy results showed: one case of thyroid cancer metastasis, one case of melanoma metastasis, and 10 cases of renal cell carcinoma. Mean hospital stay was 25.8 hours. There were not short-term complications. Follow-up time was 8.8 months. Today there is no evidence of recurrence in imaging tests.çCONCLUSIONS: Radiofrequency is effective eradicating small renal lesions, both primary and metastatic; it is especially useful in patients with high comorbidity. Despite the number of patients with adequate follow-up is not enough, the technology is promising. The approach under laparoscopic vision contributes to an effective biopsy, avoiding dissemination and enabling a more precise radiofrequency by direct vision control of tumor necrosis.
OBJECTIVE: We report a case of neobladder-vaginal fistula in a patient, as well as its closure using a Martius flap interposition.METHODS: A 51 year old patient required a cystectomy and Studer neobladder for invasive bladder adenocarcinoma. After urethral catheter removal she presented constant leakage and was diagnosed by cystoscopy of neobladder-vaginal fistula.RESULTS: This complication was successfully treated using a vaginal approach with two layers closure and a Martius flap interposition.CONCLUSIONS: Neobladder in women is a rare indication, as it is the eventuality of presenting this kind of fistula. The adequate approach to treat them is still controversial. In our experience and after reviewing literature we think vaginal closure using a Martius flap interposition is a good technique to treat a neobladder-vaginal fistula.
OBJECTIVE: To report one case of supernume- rary testicle, a rare entity with around 100 cases published. METHODS: 44-year-old male patient consulting for inciden- tal discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy. Due to the absence of pathology and complete normal semi- nal lines decision was taken to not perform orchiectomy of the supernumerary testicle. RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of inde- pendent epididymis and vasa deferentia for both testicles. CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain.
OBJECTIVE: To analyze the presentation of multilocular cystic nephroma and its diagnostic-therapy sche-me.METHODS: We report the three last new cases presenting in our department in a period of three years.RESULTS: Multilocular cystic nephroma is a benign lesion, rare that appears both in adult age, generally asymptomatic, and in children, frequently as a palpable mass. Differential diagnosis with malignant tumours is required.CONCLUSIONS: The great variety of clinical presentations, differential diagnosis and places of origin of the cases is demonstrated, being this a reﬂection of our daily medical practice, in which we cannot reach deﬁnitive diagnosis with imaging tests, being the Bosniak’s classiﬁcation very useful for the setting of indication for surgery, which will give de-ﬁnitive diagnosis of multilocular cystic nephroma or what is more important will rule out malignancy.
OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis.METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached. We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms “Prostatic Neoplasm” (MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous” (free text). Most publications are case reports reviewing the probable dissemination way and localization.RESULTS: Positive immunohistochemical staining for PSA conﬁrmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Re-garding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described.CONCLUSIONS: Cutaneous metastases of prostatic adeno-carcinoma are very rare, but even rarer is it being the debut of the disease.
OBJECTIVE: To report one new case of paratesticular leiomyosarcoma.METHODS: We describe the case of a 68-year-old male patient consulting for right groin pain over two years with a physical examination corresponding to right inguinal hernia. During surgery for hernia correction a paratesticular mass was discovered.RESULTS: Right radical orchiectomy was performed. After the operation there was a recurrence at the scar which was operated and finally the disease progressed both locally and systemically.CONCLUSIONS: We point out the scarce frequency of this type of tumours. We believe that orchiectomy and excision of the cord is the treatment of choice. The use of adjuvant therapies doesn’t influence survival significantly.
OBJECTIVE: Renal hydatidosis is caused byEchinococcus granulosus and is extremely rare, accountingfor 3-4% of the cases of hydatidosis, being the third site afterliver and lungs. It generally remains asymptomatic for yearsand the most frequent symptoms are pain, feeling of flankheaviness, and dysuria. In front of a compatible clinical pic-ture, we studied the diagnostic, therapeutic, and follow-upschemes reviewing the literature.METHODS: We performed an electronic bibliogra-phic search in PubMed (MEDLINE) which MESH terms “Echinococcosis”[MeSH] AND “urinary tract”[MeSH] andbibliographic citations. We perform a review on epidemio-logy, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to casereports from different localisations, although we found somereviews.RESULTS: We found a total of 137 papers, we selected23 of them because they were related; five were reviews,but we only include 10 of them in our references. Althoughmost were case reports, the reviews analyse the cycle of theEchinococcus and its various host sites (organs) in the humanhost. The human being may become an intermediary hostthrough contact with the definitive host (dogs) or by takingcontaminated water or vegetables.CONCLUSIONS: Thanks to the combination of history, ima-ging tests and serology we get close to the diagnosis in upto 80%. In many cases conservative surgery is possible, butafter suspicion we should always sterilise with albendazolebefore surgical treatment, and monitor serum titles of anti-Echinococcus antibodies
OBJECTIVE: To reach information on a rareclinical finding secondary to an infrequent location of tumourdissemination in prostatic cancer.METHODS: We present a case of an adult male with ocularleft proptosis and history of prostatic cancer.CONCLUSIONS: In adults males, the prostatic cancershould be born in mind in the differential diagnosis of themasses in orbital location