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ABSTRACT: We report one case of ovarian metastasis secondary to a renal clear cell carcinoma.
52 year-old consulting for metrorrhagia with the initial diagnosis of primary ovarian carcinoma. Tumor dissemination work up tests reported a renal mass suggestive of ovarian metastasis. Surgery included hysterectomy, double annexectomy, and radical nephrectomy. Final diagnosis was renal clear cell carcinoma with ovarian metastasis.
Metastases to the ovary pose a diagnostic problem in their interpretation, especially when they show a similar histology to the primary ovarian tumor. Due to therapeutic and prognostic implications, it is very important to differentiate if it is a primary ovarian tumor or a metastasis from a renal carcinoma.
Archivos españoles de urología 06/2008; 61(4):534-7.
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Archivos españoles de urología 01/2008; 60(10):1.223.
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ABSTRACT: To evaluate the prognostic significance of the 2002 TNM tumor classification for renal cell carcinoma, as well as other factors intervening in its survival.
Retrospective chart review of 316 renal carcinomas operated between 1970 and 2003. Twenty-five prognostic variables were analyzed.
The histological type was renal cell carcinoma in 90.5% of the patients. Most tumors were T1b or T2, with a Fuhrman nuclear grade I or II. Mean tumor size was 7.17 +/- 3.4 cm. Most cases had a solitary tumor. 8.2% of the patients had lymph node involvement at the time of diagnosis, and 8.6% metastases. The most frequent clinical presentations were hematuria and/or pain. Mean follow-up was 57.8 months. 24.1% of the cases had recurrence, more than 50% of them during the first year. Advanced tumors (T3, T4) had the tendency to have a nuclear grade III-IV, bigger size, necrosis, vascular involvement, lymph node involvement, and metastases. At the end of follow-up, most patients were alive and disease free. The number of months free of disease, the presence of metastatic lymph nodes, the treatment of the first recurrence and the presence of anemia were independent factors for cancer specific mortality.
The modification of the current classification of renal tumors pT3 and pT4 would help to a better decision-making in the therapy of tumors with vascular, perirenal fat or adrenal involvement. Anemia and treatment of the first recurrence are important factors for cancer specific survival.
Archivos españoles de urología 04/2007; 60(2):125-36.
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ABSTRACT: Syphilis is a systemic disease the course of which follows successive clinical stages. Central nervous system and spinal cord involvement on late phases may lead to bladder dysfunction. We report one case of neurosyphilis with associated bladder hyperreflexia.
51-year-old male with the diagnosis of neurosyphilis consulting for voiding disorders with evidence of detrusor hyperactivity of neurogenic etiology on the urodynamic study.
The differential diagnosis of neurogenic bladder in patients with psychiatric or neurological symptoms should include neurosyphilis. Etiologic diagnosis is obtained by cerebrospinal fluid examination, and the diagnosis of bladder dysfunction by urodynamic study.
Archivos españoles de urología 04/2006; 59(2):189-92.
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ABSTRACT: To report a rare clinical case of solitary pararenal fibrous tumor, analyzing its pathological characteristics and prognosis by a bibliographic review.
We present the case of a 36-year-old male consulting for right flank colic pain, which was diagnosed of a solid mass in the lower pole of the right kidney and underwent right radical nephrectomy. Pathological study of the surgical specimen showed the presence of a solitary pararenal fibrous tumor.
Solitary fibrous tumor is a rare neoplasia, being its pararenal localization even rarer. It is a tumor with benign behavior in up to 90% of the cases. The immunohistochemical study is the key to diagnosis.
Archivos españoles de urología 04/2006; 59(2):195-8.
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ABSTRACT: To determine the efficacy of endoscopical injections for the treatment of stress urinary incontinence (SUI), evaluating its low invasiveness and positive impact on quality of life.
Belween 1997--2003 30 procedures of periurethral injection of various substances for urinary incontinence were performed at our department in women between 47-80 years. All patients were evaluated before surgery, clinically and urodynamically, in accordance to international standardized parameters (filling pressure/flow studies, maximum urethral closure pressure, LPP-leak point pressure). The kind of material employed for injection, surgical technique and satisfaction degree were also evaluated.
The indication for surgery was SUI in 17 cases (56.6%), and mixed urinary incontinence in 73 cases (43.3%). 16 cases (53.3%) had history of previous surgery for SUI. Regarding urodynamic parameters, 19 patients (63.3%) have a maximum urethral closure pressure below 25 H2O cm, and 22 patients (73.3%) had a leak point pressure below 60 H2O cm. Collagen was employed in six cases (20%) and macroplastic in 24 (80%) (14 of them with the MIS system). 22 patients had three injection sites (73.3%). Mean follow-up was 38 months. Continence outcomes were evaluated in relation to complete continence (12 cases, 40%), mild incontinence and patient satisfaction (11 cases, 36.6%), and severe incontinence (7 cases, 23.3%).
1-To achieve acceptable results it is mandatory to do the best possible indication (Mc Guire type III SUI). 2.-There is an excellent relationship between minimal invasiveness and good results.
Archivos españoles de urología 05/2005; 58(3):227-31.
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ABSTRACT: We report the case of a patient who had underwent surgery for a clear cell renal carcinoma 2 years before presenting with metastasic extension to bladder on follow-up.
Radiological finding of a bladder mass during follow-up after nephrectomy.
TURBT was carried out with the pathologic report of clear cell carcinoma, compatible with a primary renal origin.
Bladder is a very rare place for metastasis from kidney tumors. Prognosis will depend on the time of appearance of such metastases.
Archivos españoles de urología 01/2005; 57(10):1123-5.
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ABSTRACT: We report one case of ocular and lung metastases seven years after radical nephrectomy for renal cell carcinoma.
The case of a 45-year-old male patient who underwent radical nephrectomy for a localized renal cell carcinoma (T2N0M0) in 1995 was found in a review of malignant renal neoplastic pathology.
Seven years later he presented with a lung metastasis requiring neumonectomy, and an ocular metastasis requiring enucleation. He is currently receiving systemic treatment with interferon and interleukin.
Clinical presentation and evolution of metastasic renal carcinoma is very variable, a difference with other neoplasias. Ocular localization is exceptional and may appear long time after primary tumor; clinically, it may be asymptomatic or present with sudden sight loss. MRI, CT scan and retinal examination are the diagnostic methods employed, and treatment may be surgery, brachytherapy or radiotherapy depending on location and size of the lesion.
Archivos españoles de urología 07/2004; 57(5):545-7.
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ABSTRACT: We report 2 cases of Sertoli cell only syndrome and perform a bibliographic review.
Clinical and pathologic study of 2 male patients 33 and 37-year-old respectively who presented with infertility.
Testicular biopsy, the most important diagnostic test in the study of infertile men, showed bilateral Sertoli cell only syndrome.
The Sertoli cell only syndrome is an entity in which seminiferous tubules show a total absence of germ cells with Sertoli cells alone. Etiology is unknown in most cases. Testicular biopsy is performed in these azoospermic men to rule out tubular obstruction or abnormalities of the spermatogenesis. Assisted reproduction techniques are a therapeutic option, making genetic counselling necessary due to the risk of transmission of the genetic defects that cause male infertility.
Archivos españoles de urología 01/2004; 56(10):1127-32.
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ABSTRACT: To report the case of a giant bladder diverticulum clinically presenting with symptoms of inferior vena cava compression.
Patient under study because of inferior limbs edema who underwent ultrasound that found a giant bladder diverticulum.
Diverticulectomy plus adenomectomy were performed.
Acquired giant bladder diverticula are very rare; they should be treated surgically to avoid possible complications.
Archivos españoles de urología 10/2003; 56(7):845-7.
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ABSTRACT: To evaluate the similarity between Gleason grade on prostate biopsies and their final result after radical prostatectomy.
We retrospectively review the medical records of 129 patients who underwent radical prostatectomy. Mean PSA value was 10.7 ng/ml. The relationships between pathological reports of biopsies and radical prostatectomy specimens, and other variables such as PSA were established.
Globally, 72 cases (55.8%) were in the same risk group by grade on biopsy and surgical specimen. Biopsy result was understaged in 48 cases (37.2%) and overstaged in 9 cases (7%). We found biopsy understaging in 42 cases (60%) in the low grade group, 6 cases (10.9%) in the intermediate grade group, and 50% in the high grade group, although in this latter the number of cases was very low.
Overall biopsy understaging was 37.2%, being much more evident in low grade tumors (60%). It seems that understaging was greater when PSA > 10 ng/ml, although differences were not significant.
Archivos españoles de urología 09/2003; 56(7):781-4.
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ABSTRACT: To review the influence of various intravesical treatments on superficial bladder cancer progression.
We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different treatment and follow-up schemes, with BCG in 139 cases and intravesical chemotherapy, mainly Mytomicin C, in 80.
Overall, the use or not of bladder instillations did not show statistically significant differences in time to progression. The use of intravesical therapy and maintenance therapy was an independent risk factor for disease-free time to progression when compared with induction.
The use of maintenance intravesical therapy with BCG resulted in a delayed progression of superficial bladder cancer, so that it seems the most effective treatment, mainly in moderate-high risk tumors.
Archivos españoles de urología 60(1):31-5.
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Archivos españoles de urología 59(1):95.
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ABSTRACT: To determine the efficacy of urinary BTA-TRAK as a marker in monitoring superficial transitional cell carcinoma of the bladder and to compare urine cytology with urinary sediment testing.
700 consecutive determinations using BTA-TRAK to monitor unselected patients that had undergone surgery for transitional cell carcinoma of the bladder were analyzed. Cystoscopy, urinary sediment and urine cytology were performed during follow-up. Urography was performed yearly or when tumor of the upper urinary tract was suspected. (positive cytology or hematuria with no bladder tumor). Cystoscopy was performed a few days after determination of BTA-TRAK and voiding urine cytology and urinary sediment analyses (considered positive when microhematuria was observed) were both requested.
Of the 700 determinations, 95 (13.6%) were urothelial carcinomas (93 bladder, 2 upper urinary tract) that had been discovered during patient monitoring. Of the 93 bladder tumors, 39 were Ta (37 TaG1 and 2 TaG2), 29 T1 (4 T1G1, 20 T1G2 and 5 T1G3), 5 Tis and 20 muscle-infiltrating tumors (progression from T2-4 during monitoring). The sensitivity of urine cytology to detect urothelial tumor was 41.1% and the specificity was 97.3%. The urine cytologies were negative in 48.4% and inflammatory in 9.5% of the tumors. The sensitivity was 19% in low grade tumors. The sensitivity of urinary sedimentation testing to detect urothelial tumor (microhematuria) was 40% and the specificity was 96.7%. When associated with pyuria, it was considered to be a urinary infection or urothelial inflammatory condition, which was observed in 10.6% of the cases. Considering the proposed normal reference value for BTA-TRAK (< or = 14 U/ml), we have found a sensitivity of 62.1% and a specificity of 68.4%. A logistic regression model was developed, including BTA-TRAK, urinary sedimentation and cytology, to identify the independent variables that are useful for tumor detection during follow-up of superficial carcinoma of the bladder in this series. The combination of three variables showed an odds ratio of 18.5 (8.9-38.5) for urinary cytology, 11.8 (5.9-23.5) for urinary sedimentation and an odds ratio for BTA-TRAK that did not fall within the equation.
Although overall the sensitivity of BTA-TRAK is higher than that of urine cytology and urinary sedimentation testing, it provides no additional information than that obtained from the combination of urine cytology and urinary sedimentation testing in the detection of tumor recurrence during monitoring for superficial bladder cancer.
Archivos españoles de urología 55(1):41-9.
