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Portillo JA, Madero R, Solsona E, Fernandez JM, Martínez-Piñeiro L, Palou J, Montesino M, Martínez-Piñeiro JA, Unda M. Influence of the true number of Bacillus Calmette-Guérin instillations on the prognosis of non-muscle invasive bladder tumors. Actas Urol Esp 2014; 38:280-4. [PMID: 24529538 DOI: 10.1016/j.acuro.2013.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/23/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To analyze if the true number of BCG instillations applied in non-muscle invasive bladder tumors has any influence on their prognosis as well as other tumor and clinical characteristics: age, sex, different protocols, BCG dose, whether primary or recurrent, solitary or multiple, tumor size G3 or Cis. PATIENTS AND METHODS A total of 324 high grade NMIBC (15 TaG3, 184 T1G3, 125 Cis) out of 1491 cases included in the CUETO database were analyzed. Following 6 post transurethral resection (RTU) BCG instillations, the patients were scheduled to receive one instillation every two weeks (3-6 times), for a total of 9-12 instillations. One third of the dose (27 mg) (112 cases) or total dose of 81 mg (212 cases). Mean follow-up was 59.6 months. Statistical Analysis: Kaplan-Meier, Cox-regression (uni-multivariate). RESULTS A higher level of recurrence (p = 0.032) and progression (P = .013) risk as well as worse Ca-specific survival (P = .005) were obtained if there were fewer than 12 instillations with the Kaplan-Meier and Cox-regression multivariate analysis. A 27 mg (P = .008) dosage and being a female (P < .001) were independent factors for a higher recurrence risk, but not for progression or Ca-specific survival. The remaining characteristics studied were not statistically significant. CONCLUSIONS In accordance with the results obtained, we can conclude that the number of BCG instillations applied has some influence on the outcome of high grade NMIBC. The optimum number of instillations as well as their time of application must still be determined. A dose of 27 mg and being a female are predictive factors of recurrence.
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Affiliation(s)
- J A Portillo
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla (HUMV), Santander, España.
| | - R Madero
- Servicio de Bioestadística, Hospital La Paz, Madrid, España
| | - E Solsona
- Servicio de Urología, Instituto Valenciano de Oncología (IVO), Valencia, España
| | - J M Fernandez
- Servicio de Urología, Hospital Central de Asturias, Universidad de Oviedo, Oviedo, España
| | | | - J Palou
- Servicio de Urologia, Fundacion Puigvert, Barcelona, España
| | - M Montesino
- Servicio de Urología, Hospital Virgen del Camino, Pamplona, España
| | | | - M Unda
- Servicio de Urología, Hospital Basurto, Bilbao, España
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Martínez-Piñeiro JA. [Comment to «acute arthritis secondary to intravesical bacillus Calmette-Guérin for bladder cancer»]. Actas Urol Esp 2012; 36:467-8. [PMID: 22537852 DOI: 10.1016/j.acuro.2012.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/13/2012] [Indexed: 11/28/2022]
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Abstract
A propos of the 25 anniversairy of Actas Urologicas Españolas it carry out a comprehensive up to date of the extended urethral surgery. The wide personal experience of the author rules through this revision ranging over the whole field of congenital abnormalities as well as the inherent complexity of surgical procedures and technical selection of for urethroplasty.
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Martínez-Piñeiro JA, Flores N, Isorna S, Solsona E, Sebastián JL, Pertusa C, Rioja LA, Martínez-Piñeiro L, Vela R, Camacho JE, Nogueira JL, Pereira I, Resel L, Muntañola P, Galvis F, Chesa N, De Torres JA, Carballido J, Bernuy C, Arribas S, Madero R. Long-term follow-up of a randomized prospective trial comparing a standard 81 mg dose of intravesical bacille Calmette-Guérin with a reduced dose of 27 mg in superficial bladder cancer. BJU Int 2002; 89:671-80. [PMID: 11966623 DOI: 10.1046/j.1464-410x.2002.02722.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the efficacy of a three-fold reduced dose (RD, 27 mg) of intravesical bacille Calmette-Guérin (BCG) against the standard dose (81 mg) in patients with superficial bladder cancer, assessing recurrence, progression and differences in toxicity. PATIENTS AND METHODS Five hundred patients with superficial bladder cancer (Ta, T1, Tis) were enrolled and randomly assigned to be treated after transurethral resection of all visible lesions with intravesical BCG Connaught strain (weekly x six and thereafter fortnightly x six) either with the standard or RD instillation. RESULTS All but one of the 500 patients were evaluable for efficacy and toxicity (252 in the standard arm and 247 in the RD arm). The median follow-up was 69 months (maximum 104); 71 (28%) patients in the standard arm and 76 (31%) in the RD arm developed recurrences; the median time to recurrence has not yet been attained, but at 5 years the mean (sd) percentage of recurrence-free patients was 70.5 (3.12) and 70.4 (3.1) for the standard and RD arms, respectively. In patients presenting with multifocal tumours, the standard dose was more effective against recurrences than the RD (P=0.0151). In those with G3 and high-risk tumours overall, the superiority of the standard dose was marginal (P=0.060 and P=0.082). Twenty-nine (11.5%) tumours in the standard arm and 33 (13.3%) in the RD arm progressed to invasive disease; the median time to progression has not yet been attained, but the percentage of progression-free patients at 5 years was 88.8 (2.23) and 86.9 (2.31) for the standard and RD arms, respectively. The standard dose was more effective than the RD against progression only in patients with multifocal disease (P=0.048). Twelve (4.8%) cystectomies were performed in the standard and 15 (6.1%) in the RD arm. Currently, 106 (21.2%) patients have died, but only 38 (7.6%) from bladder cancer, i.e. 20 (7.9%) in the standard and 18 (7.5%) in RD arm. Overall the disease-specific death rate was lower for those patients who completed the scheduled treatment. The cause-specific survival at 5 years did not differ between the arms (P=0.76) but there was a trend toward better cause-specific survival for patients with multifocal tumours in the standard arm. Toxicity differed between the arms, significantly more patients having no toxicity in the RD arm, and fewer having delayed instillations or withdrawing. However, severe systemic toxicity occurred even in patients treated with the RD, in a similar proportion to those receiving the standard dose. CONCLUSION Overall, the RD gave similar results for recurrence and progression but with significantly less toxicity. However, patients with multifocal tumours fared better with the standard dose and there was a trend towards better recurrence rates in patients with high-risk tumours. We recommend continuing to use the standard dose for high-risk tumours, while we consider the reduced dose safe and effective for intermediate-risk lesions and for maintenance schedules.
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Martínez-Piñeiro L, Tabernero A, Contreras T, Madero R, Lozano D, López-Tello J, Alonso-Dorrego JM, Picazo ML, González Gancedo P, Martínez-Piñeiro JA, de La Peña JJ. Determination of the percentage of free prostate-specific antigen helps to avoid unnecessary biopsies in men with normal rectal examinations and total prostate-specific antigen of 4-10 ng/ml. Eur Urol 2000; 37:289-96. [PMID: 10720854 DOI: 10.1159/000052358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the usefulness of measuring the percentage of free prostate-specific antigen (PSA) in serum to reduce the number of prostate biopsies in men with serum PSA levels between 4 and 10 ng/ml and benign prostate examinations. MATERIALS AND METHODS The percentage of free PSA (Immulite((R))) in serum was analyzed prospectively in 180 men with benign digital rectal examinations and total PSA serum levels of between 4 and 10 ng/ml. All patients underwent ultrasound-guided sextant prostatic biopsies. Sensitivity, specificity and positive and negative predictive values were calculated as well as the percent of patients in which biopsies could have been avoided for various cutoff values of the percentage of free PSA as an indicator for biopsy. Influence of age in the determination of cut points was evaluated. RESULTS Cancer was detected in 22.2% (40/180) of the patients. Mean percentage of free PSA was 13.4% in patients with cancer and 18.9% in patients with benign prostatic hyperplasia (p = 0.001). Using a percentage of free PSA cutoff of 22% or less as a criterion for performing prostatic biopsy would have detected 95% of cancers, avoided 25% of benign biopsies and yielded a positive predictive value of 29% in patients who underwent biopsy. Mean percent of free PSA values increased as mean subject age increased, influencing the calculation of cut points, sensitivity and specificity. Leaving the cut point constant across all age groups will oblige older patients to undergo an increased number of unnecessary biopsies, although allowing for higher sensitivity in younger men. CONCLUSIONS Measurement of the percentage of free serum PSA improves specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations. Subject age seemed to influence the determination of optimal cut points.
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Affiliation(s)
- L Martínez-Piñeiro
- Service of Urology, Department of Clinical Biochemistry, La Paz University Hospital, Autonomous University of Madrid, Spain.
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Abstract
OBJECTIVES To analyze retrospectively a series of 60 nephron sparing surgeries (NSS) in patients presenting with renal masses. MATERIAL AND METHODS The clinical histories of 59 patients undergoing NSS between january 1978 and december 1997 were reviewed. 40 were males, the mean age 54.4 years (range 17-77 years). 10 (17%) had bilateral synchronous tumors, 15 (25%) had a solitary kidney and 3 a renal insufficiency. In 25 patients NSS was obligatory, while in 34 it was elective. 30 (50%) of the renal masses had been diagnosed incidentally. Overall, 49 kidneys underwent an enucleation and 11 a partial nephrectomy. RESULTS The histopathological exam revealed 43 (71.6%) renal cell carcinomas (RCC), 2 (3.4%) urothelial carcinomas, 6 (10.2%) oncocytomas, 7 (11.6%) angiomyolipomas and 2 (3.4%) multilocular cystic nephromas. Among the RCC, 8 had < or = 3 cm, 22 between 3.1-5 cm, 10 between 5.1-8 cm and 3 more than 8 cm. 31 (72.1%) were well encapsulated and only 2 (4.6%) invaded the nearby parenchyma. 7 (16.2%) were pT1, 34 (79%) pT2 and 2 (4.6%) pT3. 39 (90.3%) were G1 or G2, and only 4 (9.3%) were G3. Two patients (3.3%) died perioperatively, both from the obligatory group. 3 (6.8%) of the patients with malignant tumors progressed and died, all with CCR and from the obligatory surgery group. Another 3 patients of this group developed local recurrences, but were rescued with iterative surgery (conservative in 1); 2 of these patients had sporadic CCR, another a von Hippel Lindau disease. None of the 34 patients who underwent elective NSS progressed, nor recurred locally and all are alive and disease free; only 14 (56%) of the 25 patients operated on by necessity survived, although 6 of them died of causes not related with the kidney tumor. The cancer specific survival at 58.3 months of follow-up (range 5-187 months) is 86.8% for the whole series, 100% for the elective NSS group and 68.7% for the obligatory NSS group. 19 (31.6%) patients developed complications, 14 among the obligatory group; two died (hemorrhage and sepsis). 3 patients presented acute renal failure, but none required dialysis; presently 4 (6.7%) patients have poor renal function and 1 requires dialysis. CONCLUSION NSS affords good control of renal carcinoma; in the cases operated on electively, the 100% cause specific survival yielded by NSS supports the use of conservative surgery in patients with well delimited tumors and normal contralateral kidney.
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Núñez Mora C, Julve Villalta E, Hardisson Hernáez D, Jiménez de León J, Picazo García ML, Hidalgo Togores L, Martínez-Piñeiro JA. [Bladder leiomyoma during pregnancy]. ARCH ESP UROL 1999; 52:510-3. [PMID: 10427889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To describe an additional case of rapidly growing leiomyoma of the bladder in a pregnant woman. METHODS A case of leiomyoma of the bladder in a woman at 8 months of pregnancy is presented. Transurethral resection was performed, but the tumor recurred a few weeks later. The tumor was resected by partial cystectomy after delivery. CONCLUSIONS Leiomyoma of the bladder is an uncommon benign lesion that is successfully managed by surgical resection. The rapid recurrence of the tumor in our patient can be ascribed to the hormonal changes during pregnancy.
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Affiliation(s)
- C Núñez Mora
- Servicio de Urología, Hospital Universitario La Paz, Madrid, España
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Martínez-Piñeiro L, Cortés R, Cuervo E, López-Tello J, Cisneros J, Martínez-Piñeiro JA. Prospective comparative study with intracavernous sodium nitroprusside and prostaglandin E1 in patients with erectile dysfunction. Eur Urol 1998; 34:350-4. [PMID: 9748684 DOI: 10.1159/000019754] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the effectiveness of intracavernous administration of sodium nitroprusside and prostaglandin E1 to induce penile erection in men with erectile dysfunction. MATERIAL AND METHODS 100 patients with erectile dysfunction entered the study prospectively. As part of the diagnostic workup, each patient received an intracavernous injection of 20 microg prostaglandin E1 and a second injection of 600 microg sodium nitroprusside 1-7 days later. A tourniquet was placed at the base of the penis before each injection. The data recorded included time required to initiate tumescence, local and systemic side effects, objective and subjective quality of erections, duration of tumescence and patient satisfaction by means of a personal questionnaire. RESULTS Prostaglandin E1 induced better overall responses than sodium nitroprusside, the difference being almost significant (p = 0.055). The overall duration of erections was also significantly longer with prostaglandin E1 (mean 81.3 min) than with sodium nitroprusside (mean 65.4 min; p < 0.04). 67% of the patients considered the erections induced with prostaglandin E1 to be of better quality than those with sodium nitroprusside, and only 11% stated that sodium nitroprusside was superior. Side effects were minimal with both drugs, the most frequent side effect being systemic hypotension, which was induced by sodium nitroprusside in 7% of the patients. CONCLUSIONS The moderate risk of systemic hypotension and the lower potency of sodium nitroprusside to induce erections compared to prostaglandin E1 rules out sodium nitroprusside as a routine alternative intracavernous drug in men with erectile dysfunction at the doses employed. Sodium nitroprusside, however, could be used in patients who have intolerance or penile pain with intracavernous prostaglandin E1.
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Affiliation(s)
- L Martínez-Piñeiro
- Service of Urology, La Paz University Hospital, Autonomous University of Madrid, Spain
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Martínez-Piñeiro JA, Martínez-Piñeiro L, Tabernero A. [Substitution urethroplasties with free graft buccal mucosa]. ARCH ESP UROL 1998; 51:645-59. [PMID: 9807890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To present our experience with free graft buccal mucosa substitution urethroplasties. METHODS Between June, 1992 and December, 1997, we performed 18 urethroplasties with buccal mucosa in 17 patients (double urethroplasty in the same stage in one): 8 for the repair of urethral strictures, 9 for the repair of hypospadias cripples and one for epispadias repair, in an exstrophic boy. Only 3 patients had not undergone previous reconstructive operations. The mean age was 26.2 years (range 10-69). In 8 cases we harvested the graft from the inner cheek and in another 8 cases from the inner lower lip; in two cases we combined mucosa from the cheek and from the lip. In 14 patients we managed to preserve the urethral roof and the buccal mucosa was grafted as an onlay patch; 4 patients underwent full circumference tube replacement. The median follow-up of the series was 17.8 months, ranging from 1 month to 5.5 years. RESULTS In 15 out of 18 repairs (83.3%) the final outcome was satisfactory, while in three cases the graft failed and reoperation was necessary. In 10 of the 15 successful urethroplasties the end result was excellent: first intention healing no complications or sequelae; in the other 5, although the end result was good, fistulae requiring surgery for closure developed in 2 and meatal stenosis requiring autodilations in three patients. The best results were obtained in strictures of the bulbar urethra secondary to trauma with 100% success rate. In hypospadias the success rate was 77.7%. Onlay patch grafts never failed, with 10 out of 14 excellent results. Three out of 4 tubed grafts failed. CONCLUSIONS At short and medium term, the free grafts of buccal mucosa yield results comparable to those of other epitheliums in use for urethral repair, thus increasing the choice of techniques at our disposal for one-stage repairs. We consider that it is best suited for long strictures of the bulbar urethra.
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Martínez-Piñeiro JA, Martínez-Piñeiro L. The role of neoadjuvant chemotherapy for invasive bladder cancer. Br J Urol 1998; 82:33-42. [PMID: 9698660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Martínez-Piñeiro JA, Cárcamo P, García Matres MJ, Martínez-Piñeiro L, Iglesias JR, Rodríguez Ledesma JM. Excision and anastomotic repair for urethral stricture disease: experience with 150 cases. Eur Urol 1997; 32:433-41. [PMID: 9412802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To analyze the results of a series of end-to-end urethroplasties performed in our service from 1968 to 1995 and of the factors contributing to failure. MATERIAL AND METHODS 150 men (mean age 35.9 years) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) had a trauma-related stricture; of them, 56 followed a pelvic ring fracture with posterior urethra distraction defect, 24 (16%) had inflammatory strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6%) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Ninety-one (60.6%) of the strictures or obliterative defects measured between 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children. The follow-up has ranged from 6 to 168 months (mean 44.4). The results were classified as good, fair (some re-stricturing, not needing treatment) and poor (recurrence). RESULTS One hundred and twenty-six (84%) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influencing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; as late complications, 1 chordee, 2 incontinence, 7 erectile dysfunction (in previously potent patients). The 14 patients considered as failures were operated again, all successfully; in 4 of them, a repeat excision and end-to-end anastomosis was performed, elevating the final success rate of the series to 93.3%. CONCLUSION Excision and anastomotic repair represent the optimal mode of stricture repair for single lesions located from the penoscrotal junction to the membranous part of the urethra.
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Affiliation(s)
- J A Martínez-Piñeiro
- Urological Service, Universitary Hospital La Paz, Faculty of Medicine, Universidad Autónoma, Madrid, Spain
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Martínez-Piñeiro JA. [Can observation be proposed in cases of clinically localized cancer of the prostate?]. ARCH ESP UROL 1997; 50:1033-6. [PMID: 9494191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE To determine the relationship of the penile arteries to anatomical landmarks and thus ease their identification, so avoiding injury during surgery. MATERIALS AND METHODS The penile arteries in 12 formalin-preserved adult male cadavers were dissected and the distances measured between the cavernosal arteries and both the endopelvic fascia and distal attachment of the crura to the ischial bones. The distance between the origins of both bulbar and cavernosal arteries, their length and the length of the cavernosal bodies and crural attachments were also measured. RESULTS Several anatomical variations, e.g. accessory pudendal arteries, multiple cavernosal and bulbar arteries, irrigation of cavernosal bodies by contralateral branches, anastomosis of cavernosal arteries with accessory pudendal branches, dorsal artery or bulbar artery as main branches of accessory pudendal arteries, were observed in 13 of the 24 specimens. The mean distances between the anterior attachment of the crura to the ischial rami and the site on the tunica albuginea where the cavernosal arteries penetrated the cavernosal bodies were 1.26 cm on the right and 0.69 cm on the left. The corresponding measurements between the cavernosal arteries and the endopelvic fascia were 5.68 cm (right) and 4.85 cm (left). The mean extracavernosal lengths of the right and left cavernosal arteries were 2.47 and 2.2 cm, respectively. CONCLUSIONS Multiple anatomical variations of the arterial penile anatomy occur frequently. Surgery at the penile hilum may easily damage the cavernosal arteries, which lie medially to the dorsal nerves and arteries of the penis, have an extracavernosal length of about 2.3 cm and perforate the tunica albuginea about 1 cm distally to the anterior attachment of the crura to the ischial ramus.
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Affiliation(s)
- L Martínez-Piñeiro
- Service of Urology, La Paz Hospital, Autonomous University, Madrid, Spain
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Martínez-Piñeiro L, Julve E, García Cardoso JV, Madrid J, de la Peña J, Martínez-Piñeiro JA. [Review of complications of urinary diversions performed during a 6-year period in the era of orthotopic neobladders]. ARCH ESP UROL 1997; 50:433-45. [PMID: 9382585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the morbidity of different types of permanent urinary diversion. METHODS We reviewed the postoperative and longterm complications observed in 85 patients who underwent permanent urinary diversion from December, 1986 to January, 1993: cutaneous ureterostomy (16 pts.), transintestinal incontinent cutaneous ureterostomy (41 pts.), orthotopic neobladder (27 pts.). All patients underwent radical cystectomy for bladder carcinoma. The surgical technique utilized for the construction of the orthotopic neobladders were as follows: Camey 1 (4 cases), Camey II (6 cases), Mainz (2 cases), Hautman (6 cases), detubularized sigmoid (6 cases). We also reviewed and used for comparison 18 augmentation cystoplasties that underwent simple subtotal cystectomy. Augmentation cystoplasty was performed with the sigmoid (n = 8), ileon (n = 5) and ileocecal segment (n = 4). RESULTS The incidence of postoperative complications was similar for all types of urinary diversion (64.3% for cutaneous ureterostomy, 61% for transintestinal intermittent cutaneous ureterostomy, 59.3% for orthotopic neobladder), although patients with orthotopic neobladders required surgery more frequently (7.1% for cutaneous ureterostomy, 22% for transintestinal cutaneous ureterostomy, 41% for orthotopic neobladder). The incidence of postoperative complications was much lower in patients who underwent augmentation cystoplasty (complications 17.7%; none required surgery). The percentage of longterm complications was 71.4% for cutaneous ureterostomy, 74.2% for cutaneous transintestinal ureterostomy, 86.9% for orthotopic neobladders and 100% for augmentation cystoplasties. The patients who required surgery were 14.3%, 19.3%, 26% and 47%, respectively. Twelve out of 24 patients in whom metalic staples were employed for the construction of the neobladders and cystoplasties developed bladder stones; 78.3% of the patients with orthotopic neobladders showed perfect daytime continence, 65.2% night-time incontinence and 21.7% stress incontinence. The figures for augmentation cystoplasties were 94.1%, 5.9% and 5.9%; 4.3% of patients with orthotopic neobladders and 29.4% of patients with augmentation cystoplasties required self intermittent catheterization. Patients with larger neobladders showed best continence rates. Fifty-three ureters were reimplanted in the orthotopic neobladders of augmentation cystoplasties with the Le Duc technique; 17% developed ureteral stenosis and 15.1% vesicoureteral reflux. CONCLUSION Patients who undergo permanent urinary diversion have a far from negligible number of postoperative and long-term complications. Orthotopic intestinal neobladders have a slightly higher rate of serious complications than incontinent cutaneous diversions.
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Affiliation(s)
- L Martínez-Piñeiro
- Servicio de Urología, Hospital Universitario La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, España
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Martínez-Piñeiro L, Madrid J, Julve E, García Cardoso JV, Ortega L, de la Peña J, Martínez-Piñeiro JA. [Prognostic value of lymphatic metastasis in bladder cancer]. ARCH ESP UROL 1997; 50:365-71. [PMID: 9313045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The presence of lymph node metastasis in bladder cancer is considered to be a sign of poor prognosis. The present study was performed to analyze the influence of the number of positive lymph nodes on survival and the therapeutic value of lymphadenectomy in pN+patients. METHODS From January, 1983 to January, 1993, 160 patients aged 39 to 77 years (mean 61.8) underwent radical cystectomy and pelvic lymphadenectomy for carcinoma of the bladder. The records of 122 patients were available for review. The UICC 1978 classification system was used. RESULTS Cancer-specific mortality was 22.8% (16/70) for pNo patients, 44.4% (4/9) for pN1 patients and 88.9% (16/18) for pN2-4 patients. We obtained the following cancer-specific mortality by stratifying according to T category: 5.4% (2/37) for pNoT1-T3a, 42.4% (14/33) for pNoT3b-T4, 0% (0/2) for pNIT1-T3a, 57.1% (4/7) for pNIT3b-T4 and 88.9% (16/18) for pN2-4T3b-T4. CONCLUSION The presence of only 1 positive regional lymph node (pN1) appears to worsen patient survival, particularly when the primary tumor is T3b or worse. In these cases cancer-specific mortality after patient discharge increased from 42% for the pNo patients to 57% for the pN1 patients (p > 0.05). Radical cystectomy was highly effective and curative in 95% of T1-T3apNo-1 patients (37/39). The presence of multiple positive lymph nodes carries a very poor prognosis, with 89% of the patients dying at a mean of 12 months.
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Affiliation(s)
- L Martínez-Piñeiro
- Servicio de Urologia, Hospital Universitario La Paz, Universidad Autónoma de Madrid, España
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Abstract
BCG is currently the most active immunotherapy agent for intravesical use and is considered the first-line treatment for patients with aggressive T1 G3 and Tis superficial tumors of the bladder. Its main drawback, toxicity, is being addressed by several prospective studies that try to find the lowest active dose and optimal schedule, as well as by studies investigating the efficacy of antigenic bacterial fractions, devoid of the toxicity of the living bacilli. Efforts to improve the efficacy by combination with chemotherapy and biomodulating natural remedies are also under way. In this review we discuss: (1) the indications, limits and contraindications of BCG; (2) the efficacy; (3) the strains; (4) route of administration; (5) dose; (6) schedule; (7) the problem of toxicity, and (8) how to improve BCG therapy.
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Carcamo Valor P, Martínez-Piñeiro JA, López-Tello J, Picazo García M, Contreras Rubio F. [Hemangiopericytoma of the renal sinus. Report of a case and review of the literature]. ARCH ESP UROL 1996; 49:944-9. [PMID: 9133294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Since the initial report of renal hemangiopericytoma by Black and Heinemann in 1955, only 24 cases of this rare vascular neoplasm, involving the renal capsule, parenchyma or sinus have been described in the world literature. Herein we describe an additional case and review the literature. METHODS We report on a 65-old woman in whom a 5 x 4 cm solid mass was incidentally found in the left sinus. The tumor compressed the renal pelvis and caused hydronephrosis and parenchymal atrophy. A radical left nephrectomy was performed. Histological and immunological studies revealed a hemangiopericytoma of renal sinus soft tissues. RESULTS The patient did well postoperatively and remains disease-free at the present time. CONCLUSIONS Although there are other histological and clinical criteria indicative of worse prognosis, the malignancy of hemangiopericytoma is determined by the presence of hematogenous metastases.
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Affiliation(s)
- P Carcamo Valor
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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18
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Madrid García FJ, Alvarez Ferreirra J, Núñez Mora C, López Tello J, García Cardoso JV, Picazo García ML, Martínez-Piñeiro JA. [Granulomatous prostatitis. Analysis of 15 cases and review of the literature]. ARCH ESP UROL 1996; 49:789-95. [PMID: 9065275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The present study describes our experience with granulomatous prostatitis, an uncommon disease entity, with special reference to the etiological factors and the clinical and pathological features. METHODS 15 cases of granulomatous prostatitis seen at our department over a 2-year period were retrospectively analyzed. RESULTS The most frequent etiological factor was surgery (TUR) or prostatic needle biopsy (53%). Prostate cancer was suspected in 8 patients based on the findings of DRE. CONCLUSIONS The diagnosis of granulomatous prostatitis is based on the histological findings. Despite its low incidence, it is currently diagnosed more frequently due to the increase in TURP and prostatic biopsy procedures and the widespread use of intravesical BCG therapy for some superficial bladder tumors.
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Affiliation(s)
- F J Madrid García
- Departamento de Anatomía Patológica, Hospital Universitario La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, España
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19
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Abstract
PURPOSE We analyzed a series of 59 reno-ureteral units with upper tract urothelial carcinoma treated endourologically at our institution. MATERIALS AND METHODS Between January 1980 and January 1995, 54 of 185 patients with a clinically diagnosed upper tract tumor were considered candidates for endourological treatment. Of the patients 14 had either bilateral disease or a solitary kidney. The primary approach was ureteroscopy in 39 reno-ureteral units and percutaneous nephroscopy in 20. Superficial stage pTa, T1 or Tis disease was noted in 48 cases, infiltrating stage pT2 cancer in 4 and inverted papilloma in 4, while the tumor was impossible to classify in 3. A total of 32 patients received adjuvant supplemental therapy. RESULTS Ureteroscopy failed in 11 cases (28.2%), with salvage by nephroureterectomy in 6 and percutaneous nephroscopy in 5. Primary nephroscopy failed in 3 cases (15%) that were salvaged by open surgery. Two patients died of unrelated causes postoperatively and 14 (26%) had intraoperative or late complications that were treated conservatively in 12. After a mean followup of 30.6 months (range 2 to 119), 2 patients died of progressive upper tract tumor, 2 died of concurrent bladder cancer and 2 died of a second cancer. Of 42 upper tracts treated solely by endourological means 10 (23.8%) had recurrences, which were treated endourologically in 6. Bacillus Calmette-Guerin and mitomycin C seemed to be effective at preventing recurrences, with recurrence rates of 12.5 and 14.2%, respectively, compared to 60% for thiotepa, and 40% for oral combination 5-fluorouracil and uracil. CONCLUSIONS Endourological treatment of low grade, small, noninvasive tumors of the upper urinary tract is a feasible and safe alternative even in patients with a normal contralateral kidney.
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Affiliation(s)
- J A Martínez-Piñeiro
- Urological Service, La Paz University Hospital, Faculty of Medicine, Universidad Autónoma, Madrid, Spain
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20
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Rodríguez de Ledesma JM, López-Tello J, de Castro J, Picazo M, Jiménez JA, Alonso-Dorrego JM, Cisneros J, de La Peña J, Martínez-Piñeiro JA. [Lymphomas of the urinary tract]. ARCH ESP UROL 1996; 49:587-94. [PMID: 8929101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The present study discusses both primary and secondary malignant lymphoreticular proliferative tumors of the urinary tract. METHODS Two patients with urinary tract involvement are described: one female and one male with bladder and prostate involvement, respectively. RESULTS Both cases presented clinical features that were not distinct from those of other tumors of the urinary tract. CONCLUSIONS The anatomopathological study is essential to the differential diagnosis of urinary tract involvement from non-Hodgkin lymphoma and discards other extralymphatic conditions.
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21
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Martínez-Piñeiro L, Galicia de Pedro I, Cisneros J, Cuervo E, Frías Iniesta J, Martínez-Piñeiro JA. [New features of pharmacologic treatment of erectile dysfunction]. ARCH ESP UROL 1996; 49:270-6. [PMID: 8702348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The present article summarizes the latest advancements in the physiology of erection, with special reference to the role of the adenylate and guanylate cyclase-nitric oxide system. METHODS/RESULTS New aspects in the pharmacological intracavernous treatment of erectile dysfunction are discussed and new drugs in this field are analyzed, such as nitrovasodilators, calcium channel blocker, potassium channel openers, phosphodiesterase inhibitors and the combination of adenylate cyclase stimulators. CONCLUSIONS A high percentage of patients with erectile dysfunction depends on intracavernous injection of vasoactive drugs for erection. However, this route of administration is painful and causes anxiety in many cases. Other routes of administration (oral, topical or intraurethral) have yet to be developed, as well as drugs that can diminish penile venous blood outflow in cases with venous leakage, and can enhance arterial blood supply at the same time. The combination of phosphodiesterase inhibitors with adenylate and/or guanylate cyclase stimulators or potassium channel openers may further enhance the results achieved to date.
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Affiliation(s)
- L Martínez-Piñeiro
- Servicio de Urología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Espańa
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22
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Cárcamo Valor P, García-Matres MJ, Alonso-Dorrego JM, García Cardoso JV, Martínez-Piñeiro JA. [Urethroplasty with lyophilized human dura mater]. ARCH ESP UROL 1995; 48:681-3. [PMID: 7487174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This article reports our experience with lyophilized human dura in the treatment of complex urethral stenosis. METHOD Seven patients with iatrogenic/inflammatory urethral stricture underwent a 13 cms long x 1.5 cms wide medial urethral augmentation. RESULTS During a mean follow-up of 23 months, good results accounted for 85.7%. CONCLUSION Lyophilized dura patches constitute a suitable choice in selected patients who, for local or systemic reasons, are not good candidates for other urethroplasty procedures.
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Affiliation(s)
- P Cárcamo Valor
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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23
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Martínez ME, Carcamo Valor P, Hidalgo Togores L, Mateos Antón F, Martínez-Piñeiro JA. [Incidence of the different types of hypercalciuria in Spain]. ARCH ESP UROL 1995; 48:489-95. [PMID: 7639571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To carry out a comparative biochemical study of primary hyperparathyroidism, the different types of hypercalciuria and a healthy population. METHODS Fourteen patients with primary hyperparathyroidism and 103 patients with idiopathic hypercalciuria were studied under conditions of restricted calcium intake and following a calcium load; the results were compared to those of 18 healthy controls. RESULTS The patients with hyperparathyroidism showed high parathormone concentrations. Sixty-nine patients with idiopathic hypercalciuria had normal parathormone levels and were considered suffering from absorptive hypercalciuria. Those patients with high urinary calcium excretion under restricted calcium intake and normal urinary phosphate threshold were considered as being absorptive hypercalciuria type I, those with normal urinary calcium as absorptive hypercalciuria type II, and those with low urinary phosphate threshold constituted a renal phosphate leakage group. Thirty-four patients had normal serum calcium, elevated parathormone, hypophosphatemia and high calcium excretion under all dietary conditions, and were considered undergoing renal hypercalciuria. Patients with renal hypercalciuria had increased urine hydroxyproline and low serum calcium compared with the controls after an oral calcium load. This biochemical behaviour is compatible with secondary hyperparathyroidism caused by renal calcium leakage. CONCLUSIONS In summary, the biochemical parameters: parathormone, urinary phosphate threshold and urinary calcium excretion, measured in fasting conditions, allowed classification of patients with idiopathic hypercalciuria.
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Affiliation(s)
- M E Martínez
- Departamento de Laboratorio, Hospital La Paz, Universidad Autónoma, Madrid, España
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24
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López-Tello García JJ, Martínez-Piñeiro L, Robles J, Rodríguez de Ledesma JM, Cisneros J, Martínez-Piñeiro JA. [High-flow priapism]. ARCH ESP UROL 1995; 48:398-400. [PMID: 7598552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES A case of traumatic high flow priapism that had been successfully treated by selective embolization of the internal pudendal artery is described. METHODS High flow priapism was diagnosed in a patient who presented with painless prolonged erection. He had fallen down from a horse twelve days before. The intracavernous blood gas analysis had arterial characteristics and erection did not subside with conservative management. Selective embolization of the internal pudendal artery was performed after visualization of an arteriocavernous fistula. RESULTS Priapism disappeared just after the procedure and sexual potency was preserved. CONCLUSIONS Selective embolization of the internal pudendal artery is an appropriate treatment for traumatic high flow priapism.
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Affiliation(s)
- J J López-Tello García
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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25
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Martínez-Piñeiro L, López-Ferrer P, Picazo ML, Martínez-Piñeiro JA. Primary renal angiosarcoma. Case report and review of the literature. Scand J Urol Nephrol 1995; 29:103-8. [PMID: 7618041 DOI: 10.3109/00365599509180547] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary angiosarcoma is one of the rarest kidney tumors. Only six satisfactorily documented cases have been reported in the literature. A new case is described. The tumour is usually in an advanced clinical stage when detected, and generally first presents with local pain and no urinary symptoms.
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Affiliation(s)
- L Martínez-Piñeiro
- Urology Service, La Paz Hospital, Faculty of Medicine, Universidad Autónoma, Madrid, Spain
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26
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Abstract
The preliminary results of a randomized, multicentre, prospective trial conducted by the Spanish Oncology Group (CUETO) are presented. The primary aim of the trial was to determine whether or not lowering the dose of bacillus Calmette-Guérin (BCG) could reduce toxicity without compromising efficacy. From February 1991 to June 1992, 500 patients with superficial bladder cancer (TaG2-3, T1G1-3) entered the trial. Of these patients, 252 were included in group A (BCG, 81 mg) and 248 in group B (BCG, 27 mg). There were no significant differences in clinical and pathological characteristics between the two groups. Following treatment, significant differences arose between groups A and B in local severe toxicity (22.6 vs. 4.2%, respectively; p < 0.01). Systemic toxicity was more common in group A than in group B (p < 0.01): pulmonary effects (2.3 vs. 0.4%), fever (26.9 vs. 12.9%) and malaise (16.2 vs. 8.4%), all p < 0.01. Regarding efficacy, 204 patients in group A and 210 in group B were evaluated after a mean follow-up of 18.6 months. No significant differences in recurrence rate (18.1 vs. 19.5%) or progression rate (2.4 vs. 4.8%) were found. However, in patients with superficial bladder cancer with high risk of recurrence and progression (carcinoma in situ and G3), caution must be exercised in selecting the dose.
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Rodríguez de Ledesma JM, Cozar Olmo JM, Nistal Martín N, Cisneros J, Cuervo E, Martínez-Piñeiro JA. [Klinefelter syndrome with hypogonadotropic hypogonadism and absence of Leydig cells]. ARCH ESP UROL 1994; 47:618-20. [PMID: 7944607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Klinefelter's syndrome is characterized by hypergonadotropic hypogonadism, 47,XXY karyotype, gynecomastia, azoospermia and testicular atrophy with hyalinization of seminiferous tubules and hyperplasia of Leydig cells. Some cases of Klinefelter's syndrome with unexplainably low levels of gonadotropins have been reported in the literature. Two additional cases of Klinefelter's syndrome with hypogonadotropic hypogonadism and absence of Leydig cells are described.
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Affiliation(s)
- J M Rodríguez de Ledesma
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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28
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Martínez-Piñeiro L, López-Tello J, Martínez-Piñeiro JA. [Rescue radical prostatectomy following radiation in prostatic carcinoma]. ARCH ESP UROL 1994; 47:472-8. [PMID: 7944580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Accepted methods for the treatment of localized prostatic cancer are radiotherapy and radical surgery. Results of different authors and analysis of survival curves suggest a higher cure rate with surgery, although there are no prospective randomized studies that demonstrate it. Patients treated with radical prostatectomy who relapse locally are usually treated with radiotherapy or hormone therapy. On the other hand, patients with failed radiation therapy raise a difficult therapeutic solution. A wait and see policy or early hormone therapy are generally accepted as treatment options as well as additional radiotherapy or salvage surgery in selected patients. General experience with salvage surgery is short. Only 228 cases, including two presented in this study, have been published, lacking data on long term survival. Herein we present two patients treated with salvage surgery for radiation failure and discuss the different treatment options in such cases.
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29
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Martínez-Piñeiro JA, Martínez-Piñeiro L. [Is bladder conservation possible in infiltrating cancer?]. ARCH ESP UROL 1994; 47:337-42. [PMID: 8053719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe the different therapeutic modalities available for the conservative treatment of invasive bladder cancer. Bladder preservation may be possible in selected cases. However, to better define the role of chemotherapy and combined chemotherapy we have to wait until several ongoing investigative clinical protocols have been completed. At the present moment radical cystectomy still remains the gold standard for the treatment of invasive bladder cancer.
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Martínez-Piñeiro L, Mateos F, Martínez ME, Martínez I, Martínez-Piñeiro JA. Changes in acid-base balance and calcium metabolism after urinary diversion through ileal segments. II. Treatment with nicotinic acid. Br J Urol 1993; 72:858-67. [PMID: 8306147 DOI: 10.1111/j.1464-410x.1993.tb16287.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Investigations in animals have shown that nicotinic acid, an intestinal cyclic-AMP inhibitor, partially corrects the metabolic changes associated with urinary diversion through intestinal segments. Blood and serum chemistry were studied in patients before and 3 to 5 months after undergoing urinary diversion through ileal segments, both with and without nicotinic acid treatment. It was found that diverted patients had metabolic acidosis, an increased anion gap and increased levels of serum alkaline phosphatase; there were no significant changes in serum PTH and vitamin D levels, calcaemia and phosphoraemia. There was a tendency towards dehydration, hypernatraemia, hyperchloraemia and secondary hyperaldosteronism produced by ileal secretion of a hypotonic fluid. Nicotinic acid 3 g/day significantly reduced the chloraemia but did not correct the metabolic acidosis, although it reduced its severity, since blood pH decreased when treatment was suspended. Nicotinic acid cannot be recommended for routine use in the management of metabolic acidosis after urinary diversion, and patients with a marginal renal reserve should not be considered for trans-intestinal urinary diversion.
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Martínez-Piñeiro L, Mateos F, Montero A, Madero R, Martínez-Piñeiro JA. Urinary solute transport by ileal segments. I. Effects of nicotinic acid. Br J Urol 1993; 72:851-7. [PMID: 8306146 DOI: 10.1111/j.1464-410x.1993.tb16286.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study was conducted to quantify urinary solute transport by the ileum, using an in vivo human model, and to determine the effect of nicotinic acid on this process. Patients were studied under both basal conditions and niacin therapy. The rates of solute transport were established by analysis of excretion indexes for each solute. Potassium and ammonium were absorbed by the ileum, while phosphorus, sodium and bicarbonate were secreted. The percentage excretion index of sodium and bicarbonate increased by approximately 100 and 600% respectively, causing a significant rise in urinary pH. Although not statistically significant, there was a tendency for chloride to be absorbed and for water to pass into the bowel lumen. Nicotinic acid 3 g/day had no significant effect on urinary solute transport.
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Cárcamo Valor P, Moreno Valle JA, Picazo ML, Cozar Olmo JM, Gaston de Iriarte E, Avellana Fontanella JA, Martínez-Piñeiro JA. [Multilocular cystic renal adenocarcinoma]. ARCH ESP UROL 1993; 46:240-4. [PMID: 8512365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
On detecting a complex cystic renal mass, we are faced with the problem of making the differential diagnosis from a variety of diseases, some of very distinct nature and prognosis. Surgical exploration may occasionally be warranted to make the diagnosis since no radiological or analytical method, including cytological analysis of its content, is absolutely reliable. A 46-year-old male patient with multicystic renal adenocarcinoma is described. We discuss the diagnostic and therapeutic dilemmas that arise on detecting a multilocular renal mass in an adult patient.
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33
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Rodriguez de Ledesma JM, Cisneros J, de Miguel E, Moreno JA, Cárcamo P, Picazo ML, Martínez-Piñeiro JA. [Necrotizing vasculitis in the bladder]. ARCH ESP UROL 1993; 46:104-6. [PMID: 8098935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The necrotizing lesion that affects the small and medium-sized arteries, commonly known as polyarteritis nodosa (PAN), usually have a systemic and variable involvement. Urothelial involvement at the level of the two ureters has been rarely described. We report a case of necrotizing vasculitis localized to the bladder that had manifested clinically as gross hematuria.
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de Ledesma JM, Cózar JM, Martínez-Piñeiro L, García-Matres MJ, Cisneros J, Martínez-Piñeiro JA. [Renal cyst communicating with excretory tract: report of a case]. ARCH ESP UROL 1992; 45:1037-9. [PMID: 1294036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Simple renal cyst communicating with the excretory tract is a rare complication frequently arising from obstructive uropathy. In most of the cases treatment continues to be conservative.
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Affiliation(s)
- J M de Ledesma
- Hospital La Paz, Servicio de Urología, Facultad de Medicina, Universidad Autonoma, Madrid
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35
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Cozar Olmo JM, Martínez-Piñeiro JA, Navarro J, Moreno JA, Martínez-Piñeiro L, Cisneros J, Avellana JA, de la Peña J. [Renal angiomyolipoma: study of 39 patients and general review]. Actas Urol Esp 1992; 16:749-58. [PMID: 1285519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Between 1969 and 1991, 39 patients totalling 48 renal units with renal angiomyolipoma (RAMP) were diagnosed and treated in the Urology Service of the Hospital La Paz. In 5 patients, RAMP was part of a tuberous sclerosis, and was isolated in the remaining ones. RAMP was symptomatic in 32 cases (32/48 = 66.6%), 10 with Wundrelich's syndrome, and in 24 cases (24/48 = 50%) was larger than 4 cm. In the first cases of our series, clinical diagnosis through renal arteriography was achieved in 33% (5/14) cases; later, with the arrival of ultrasound and CAT, pre-operative diagnosis was possible in 88% (30/40) of cases. There was also 2 periods with regard to treatment, the initial one with predominance of radical surgery and the present one of observation and/or conservative surgery depending on size as well as signs and symptoms. Overall, 23 nephrectomies, 2 partial nephrectomies and 6 tumorectomies were performed, while there has been 17 cases (with no histological confirmation) treated with conservative approach and followed-up with ultrasound and CAT. With an average follow up of 8.4 years (range: 0.5-20 years), there has been no local or metastatic relapse of RAMP. There was one case of lymphatic affection which was explained as evidence of RAMP's multifocal condition and not as an indication of malignancy. In 3 patients, histological examination revealed coexistence of RAMP and renal carcinoma; 2 of these patients who underwent nephrectomy are free of disease; the third patient, treated with conservative surgery (tumorectomy), showed renal carcinoma relapsed after 2 years and had it removed. RAMP's incidence, histogenesis, diagnostic methods and treatment criteria are discussed.
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Affiliation(s)
- J M Cozar Olmo
- Servico de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid
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36
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Martínez-Piñeiro L, Mateos Antón F, Martínez-Piñeiro JA. [Physiopathology and treatment of metabolic changes in transintestinal urinary diversions]. ARCH ESP UROL 1992; 45:875-89. [PMID: 1337244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of intestinal segments in the urinary tract can cause metabolic changes that depend on the intestinal segment utilized. The severity of these changes basically depends on the area of the intestinal mucosa in contact with urine, the duration of exposure to urine and renal function. The length of time the intestinal mucosa is in contact with urine largely depends on the surgical technique employed. It is longer for the reservoirs, intestinal neobladders and ureterosigmoidostomies than for the intestinal conduits with cutaneous urinary diversion and therefore carry a higher incidence of metabolic changes. Jejunal urinary diversion causes metabolic acidosis with hypochloremia, hyponatremia, hyperpotassemia, azotemia and dehydration in at least 50% of the cases. Ileal and colonic urinary diversion can cause metabolic acidosis, although the incidence is significantly less. Acidosis presents with hyperchloremia, hyperammonemia, hypersulfatemia, increased osmolality and uremia with normal creatininemia and a tendency to develop hypocalcemia, hypophosphoremia and hypomagnesemia. Recent studies performed in our service show that acidosis is basically due to the secretion of sodium bicarbonate by the intestinal segment used in the urinary tract, which causes water-salt depletion that is compensated by secondary hyperaldosteronism. Mild chronic acidosis is neutralized via the respiratory system and by the bone buffers, which leads to bone remodelling manifested by the significant increase of serum alkaline phosphatase levels and increased calciuria. These calcium phosphate changes, although statistically significant, do not appear to be important since they were not accompanied by changes of serum PTH levels, 25 and 1-25-cholecalciferol. Nicotinic acid as inhibitor of cyclic AMP synthesis failed to correct metabolic acidosis in the patients with transileal diversion.
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García-Matres Cortes MJ, Cárcamo Valor PI, Cózar Olmo JM, San Millán Arruti JP, Hidalgo Togores L, Martínez-Piñeiro JA. [Ureteral tamponade in the treatment of urinary fistula: our experience]. ARCH ESP UROL 1992; 45:679-83. [PMID: 1444612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Surgical correction is the treatment of choice for urinary fistulas. However, there are circumstances that advise against the use of this approach, basically when patient general condition is poor or life expectancy short; i. e., in the presence of an underlying malignant pelvic disease. In these cases, urinary diversion by percutaneous nephrostomy will suffice, although sepsis or derangement of electrolyte balance may sometimes develop due to the fistulous defect. Occlusion of the pyelo-ureteric junction and percutaneous drainage is a solution that causes no major complications. Two patients who could not be submitted to conventional surgery were treated by the foregoing procedure. Both patients have been followed for more than two years. The first case was a male who had undergone abdominoperineal resection due to carcinoma of the sigmoid colon. He developed stress ulcers, pulmonary thromboembolism, sepsis, paralytic ileus and bilateral ureteral fistula. The second case was an insulin-dependent female diabetic who had previously received radiotherapy to the pelvis. She developed a large vesicocutaneous fistula and public osteomyelitis after drainage of an inguinal abscess. Patient tolerance was good and no major complications were observed. In our view this palliative procedure should be considered in the management of patients with urinary fistula whose life expectancy is short. Its application can be extended to patients with inoperable carcinoma of the bladder or prostate and important symptoms.
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Affiliation(s)
- M J García-Matres Cortes
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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Cárcamo Valor PI, San Millán Arruti JP, Cózar Olmo JM, García-Matres MJ, Echevarría C, Martínez-Piñeiro L, Martínez-Piñeiro JA. [Nephrogenic adenoma of the upper and lower urinary tract. Apropos of 22 cases]. ARCH ESP UROL 1992; 45:423-7. [PMID: 1510472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nephrogenic adenoma (NA) is a lesion that can present in the urothelium--from the renal pelvis to the urethra-, and is considered to be immature metaplasia arising from chronic aggression. We report 22 cases of NA in 21 patients that had been diagnosed and treated in our service from 1975 to 1990. The lesion was found at all levels of the urinary tract: renal pelvis (1 case), ureter (1 case), bladder (16 cases) and urethra (4 cases). The present series was comprised of 15 males (one with bladder NA and recurrence in urethra) and 6 females, with ages ranging from 24 to 79 years (mean 55). The diagnosis was made on the histological findings in all cases and the etiology of the lesion was multiple: previous surgery (11 cases), previous or coexisting urothelial carcinoma (8 cases), intracavitary chemotherapy and/or pelvic radiotherapy (3 cases), previous history of tuberculosis (5 cases), interstitial cystopathy (4 cases), lithiasis (2 cases), permanent catheter (3 cases) and urethral stenosis (1 case). Treatment and prognosis was influenced by the underlying urological disease. NA per se does not carry an unfavourable prognosis.
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Affiliation(s)
- P I Cárcamo Valor
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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39
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Cózar Olmo JM, Martínez-Piñeiro JA, García-Matres MJ, Hervás CM, Cárcamo P, Martínez-Piñeiro L, Avellana JA, de la Peña J. [The imaging diagnosis of adrenal tumors]. ARCH ESP UROL 1992; 45:331-9. [PMID: 1605687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
From 1967 to 1991 we have diagnosed and treated 73 adrenal tumors in 63 patients: 12 pheochromocytomas, 24 adrenal cortical adenomas, 15 hyperplasias, 16 carcinomas, 3 myelolipomas, 2 cysts and 1 neuroblastoma. We conducted a retrospective study to analyze the preoperative images obtained by different diagnostic techniques and attempted to correlate tumor size and site with the results of the histological analysis of the surgical specimen. Nephrotomography with pneumoretroperitoneum and IV Nephrotomography were useful in detecting the increase of the size of the gland in 10 of 25 cases submitted to these procedures (40%). Arteriography as second or third technique of choice confirmed the presence of an adrenal tumor in 15 of the 21 cases evaluated by this procedure (70%). US and CT detected 94% (31/33) and 100% (33/33) of the cases, respectively. Fourteen cases were incidentally discovered by CT (7) and US (7). A direct relationship between tumor size and degree of malignancy could be established since the carcinomas had a mean diameter of 7 cm (range 5 to 12 cm). Concerning the histologic nature of the disease, specific images were found in 3 cases of adrenal myelolipoma (hyperechoic on US and of low density similar to fat on CT) and 2 cysts (anechoic with posterior band evidenced on us and liquid on CT). Radioisotopes were also utilized for tumor localization and there was positive uptake of I-131-IMBG in 2 cases of adrenal pheochromocytoma; 1 extra-adrenal (left lateral aortic paraganglioma) and 1 case of malignant adrenal pheochromocytoma with metastasis to the lungs.(ABSTRACT TRUNCATED AT 250 WORDS)
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García-Matres MJ, Cárcamo PI, Cózar JM, Martínez-Piñeiro L, Moreno JA, Avellana JA, Gastón de Iriarte E, Hervás S, Martínez-Piñeiro JA. [A Foley-type catheter with a steerable tip]. ARCH ESP UROL 1992; 45:299-303. [PMID: 1605683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Permanent bladder catheterization for medical or social reasons increases the risk of complications, especially urinary infection. We evaluated the usefulness of the balloon catheter with a steerable intravesical tip in reducing the volume of residual urine between the bladder neck and the balloon of the conventional Foley catheter. The results show that this new catheter affords no additional advantage over the conventional catheter.
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41
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García-Matres MJ, Cárcamo Valor PI, Cózar Olmo JM, San Míllan JP, Hidalgo Togores L, Martínez-Piñeiro JA. [Giant lithiasis in left ureterocele. Its endoscopic resolution]. ARCH ESP UROL 1992; 45:374-6. [PMID: 1605696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Herein we describe a case of giant calculus in an orthotopic ureterocele in a female patient who had consulted for recurrent left-sided nephritic colic. A plain film of the urinary tract prompted us to suspect a giant calculus, which was confirmed by IVP. Treatment was by endoscopic surgery. The patient has remained asymptomatic one year postoperatively.
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Affiliation(s)
- M J García-Matres
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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42
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Cózar Olmo JM, Navarro J, de la Peña J, Cisneros J, Cárcamo Valor P, García-Matres MJ, Martínez-Piñeiro L, Martínez-Piñeiro JA. [Controversies over regional lymphadenectomy in carcinoma of the penis]. ARCH ESP UROL 1991; 44:951-5. [PMID: 1796857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epidermoid carcinoma of the penis, although rare, is a very aggressive tumor type. The presence or absence of inguinal metastasis is an essential prognostic factor. Treatment of these metastases is one of the current controversies in urological practice; i.e., when and to what extent lymphadenectomy should be performed. Of 24 patients with penile carcinoma, 10 had undergone regional lymphadenectomy over the past 8 years at our institution. Following treatment of the primary penile tumor, 6 patients had palpable inguinal nodes that persisted after treatment with antibiotic and antiinflammatory agents for 6 weeks. Of these, 3 had a positive node biopsy. They were submitted to regional lymphadenectomy which revealed node metastasis in 5 cases (2 pN3, 2 pN2 and 1 pN1). The patients with no palpable nodes were closely followed and were submitted to lymphadenectomy when these appeared (3 cases). The fatal outcome of 2 cases (both pN3) prompted us to perform lymphadenectomy prophylactically in the last case, a 40-year-old male with pT2G2 N0 penile cancer. This approach is advocated in patients under 65 with invasive penile carcinoma (pT greater than 1) or a high histological grade of malignancy (G2 and G3).
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Affiliation(s)
- J M Cózar Olmo
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, Espanña
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43
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Cózar Olmo JM, Cisneros J, Martínez-Piñeiro L, Luz Picazo M, Justa García-Matres M, Jiménez J, Hidalgo Togores L, de la Peña J, Martínez-Piñeiro JA. [Renal oncocytoma: diagnosis and treatment. Report of 4 cases]. ARCH ESP UROL 1991; 44:813-8. [PMID: 1953063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Four cases of renal oncocytoma that had been treated at our service from 1985 to 1990 are presented herein. The renal mass had been incidentally disclosed on the IVP (2 cases), abdominal ultrasound (1), and on palpation (1). An abdominal CT scan complemented the diagnostic work up. The diagnoses of oncocytoma (1 case) and renal carcinoma (3 cases) were made based on the scan findings. The 3 patients that had been diagnosed as having renal carcinoma were submitted to radical nephrectomy. The patient diagnosed as having oncocytoma underwent surgical enucleation of the tumor. Subsequent histological examination was diagnostic of oncocytoma in all four cases. Follow-up ranging from 15 to 55 months revealed all patients are asymptomatic and tumor-free. Currently attention has been focussed on this tumor type. The diagnostic and therapeutic controversies are discussed.
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Affiliation(s)
- J M Cózar Olmo
- Departamento de Anatomía Patológica, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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44
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Cárcamo Valor PI, Hidalgo Togores L, Cózar Olmo JM, García-Matres MJ, Navarro Sebastián J, Martínez-Piñeiro JA. [Our experience with the diagnosis and treatment of 429 renal traumatisms]. ARCH ESP UROL 1991; 44:801-7. [PMID: 1953061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We studied 429 cases (3 bilateral) of renal injuries in 426 patients diagnosed and treated at our service from 1965 to 1990. Four-hundred twenty (98.59%) were blunt and 6 (1.41%) were penetrating injuries. In 313 the renal lesions were grade I (72.96%), 69 grade II (16.08%), 27 grade III (6.29%) and 20 were traumatic injuries to pathologic kidney (4.66%). Surgery was performed immediately in 67 cases (15.61%) (35 grade II, 21 grade III, and 11 previously pathological kidneys). Surgery was delayed in 34 cases (7.92%) (1 grade I, 23 grade II, 5 grade III and 5 pathological kidneys). Three-hundred twenty-eight cases (76.45%) were managed conservatively (312 grade I, 11 grade II, 1 grade III and 4 cases of traumatic injury to previously pathological kidney). Preservation of the renal unit was achieved in 100% of those with grade I lesions and in 91.17% of those with grade II that had been treated conservatively or submitted to delayed surgery. Of the grade II lesions that were immediately treated, 22.58% required a nephrectomy procedure. Of the grade III lesions and the cases of traumatic injury to previously pathological kidney, nephrectomy was required in 72% and 65%, respectively, although delayed surgery permitted more precise indication in a hemodynamically stable patient. The mortality rate in our series was 1.87 (8/426).
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Affiliation(s)
- P I Cárcamo Valor
- Servicio de Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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Martínez-Piñeiro JA, Hidalgo Togores L, Martínez-Piñeiro L, Cózar Olmo JM, Moreno JA. [Endo-urologic surgery of urothelial tumors of the upper urinary tract]. ARCH ESP UROL 1991; 44:529-39. [PMID: 1722082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The endourological approach for utothelial tumors of the upper urinary tract (UUT) is a controversial issue of which there is little experience to date. However, the data reported in the series of other authors as well as our own series support its utilization. Of a total of 137 patients suspected of having UUT tumor, 66 patients underwent endourological management: 56 by ureteroscopy (URS) and 10 by percutaneous nephroscopy (PN). The presence of tumor was discarded in 26 patients, 10 underwent open surgery to treat the tumor, and the remaining 30 patients were primarily treated by URS (20), PN (9), or combined treatment (1). Overall, 30 of 111 patients (27%) were treated by endoscopy; 28 attempted cure and 2 were palliative procedures. Twenty-six of these 30 patients had a previous history of urothelial tumor, 7 had a single kidney, and in 5 patients the tumor had presented following cystectomy. Except for the T2 tumor submitted to palliative treatment and one case with diffuse carcinoma in situ, all tumors were TA-1, 20 were G1, 8 were G2, and were G3. Seven of the 30 patients had died after a mean follow-up of 28.4 months (range 3-117 months: 2 immediately postoperatively from pathological conditions unrelated to the operation (acute CVA, biliary sepsis), 1 from conditions unrelated to the urinary tract or tumor, 2 from disseminated bladder urothelial tumor, and 1 from disseminated primary adenocarcinoma of unknown origin. Currently, 23 patients (76.6%) are alive; of these, 7 (23.3%) have had tumor recurrence: 2 required treatment by nephroureterectomy but the remaining 5 patients were also treated endourologically with success. The progression index was 7% (2/28). Analysis of prognostic factors revealed a close correlation between the histologic grade of malignancy, malignant urinary cytology, and the frequency of tumor recurrence. Tumor recurrence was observed to be 60% in those with a positive cytology and only 17.6% in those with a negative cytology. G3 tumors recurred 50% of the time, G2 37.5%, and Go-1 22%. The frequency of tumor recurrence was also different in patients who had received adjuvant topical BCG or MMC therapy (20%) in comparison to those who received no adjuvant therapy (40% recurrence). On the other hand, no significant difference was observed relative to the technique utilized to treat the tumor: 3/12 (25%) of those who underwent electroresection or electrocoagulation and 6/16 (37.5%) of those submitted to Nd:YAG laser.(ABSTRACT TRUNCATED AT 400 WORDS)
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Javier Navarro F, Cozar JM, Nistal M, Martínez-Piñeiro L, Moreno JA, Jiménez J, Cisneros J, de la Peña J, Martínez-Piñeiro JA. [Leydig cell tumor: presentation of 3 new cases with a benign course]. ARCH ESP UROL 1991; 44:145-50. [PMID: 1867489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Three cases of Leydig cell tumor are described. Patient ages were 27, 44 and 55 years, respectively. The first two patients consulted for a testicular mass and the third patient presented with gynecomastia, an incidental finding during the ultrasound work up of a hydrocele. Hormonal evaluation revealed a marked serum testosterone level in one case, whereas in another case it fell within the lower limits of normal ranges. No evidence of dissemination was observed in all patients. Treatment was by radical inguinal orchiectomy in all patients. The pathological analysis of the surgical specimens revealed Leydig cell tumor with no histologic evidence of malignancy. A follow-up of 32, 14 and 10 months, respectively, revealed no evidence of tumor recurrence in all patients. The clinical and histologic features and treatment of this disease process are described.
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Affiliation(s)
- F Javier Navarro
- Servicio Urología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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47
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Martínez-Piñeiro L, González-Peramato P, Hidalgo L, de la Peña J, Cisneros J, Cozar JM, Martínez-Piñeiro JA. [Primary bladder adenocarcinoma: retrospective study of 11 cases and general review]. ARCH ESP UROL 1991; 44:131-8. [PMID: 1867487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eleven cases of primary adenocarcinoma of the bladder are described herein. Eight had a glandular pattern, 1 was papillary and 2 were comprised of signet ring cells (one had areas of colloid carcinoma). One of the cases, originating from the urachus, also showed colloid areas and a glandular pattern. Forty-five percent of the cases were moderately differentiated and the remaining 55% were poorly differentiated. In all cases the tumor had areas of adenocarcinoma in more than 2/3 of its extent. All but two cases revealed muscle layer infiltration at the time of diagnosis. Two patients were submitted to radical cystectomy, lymphadenectomy and Wallace II cutaneous ureteroileostomy, 1 patient underwent partial cystectomy and lymphadenectomy, and 6 were submitted to transurethral resection. Excision of the urachal tumor was by en bloc partial cystectomy. The 5-year survival of patients with infiltrating tumors, excluding the urachal tumor, was 33%, 67% died within the first year of follow-up. The only evaluable case of superficial adenocarcinoma is alive and tumor-free at 94 months. Primary adenocarcinoma of the bladder is an aggressive tumor. Although it may be superficial at the time of diagnosis, it soon develops into an infiltrating tumor if untreated. Treatment and survival depend on tumor stage. Superficial or minimally infiltrating tumors warrant treatment by deep transurethral resection up to the pericystium.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Martínez-Piñeiro
- Servicio de Urología, Hospital General La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, España
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Javier Navarro F, Picazo ML, Cozar JM, Cisneros J, Ortin M, de la Peña J, Martínez-Piñeiro JA. [Multilocular renal cyst: clinico-pathological considerations apropos of a case and review of the literature]. ARCH ESP UROL 1991; 44:9-14. [PMID: 2064432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of multilocular renal cyst (MRC) is reported in a hypertensive patient in whom the IVP had disclosed a left renal mass. The ultrasound and CT workup revealed a well-defined, solid renal mass that was angiographically hypovascular. Cytologic examination of the specimen obtained by fine needle aspiration biopsy yielded no conclusive data. A left radical nephrectomy was performed. The histologic diagnosis was that of multilocular renal cyst. At 42 months the patient remains hypertensive with no evidence of tumor recurrence. We discuss the diagnostic criteria of MRC and the difficulty in making the differential diagnosis from renal carcinoma, and describe the histologic features of MRC that permit us to distinguish this disease entity from other renal tumors or dysplastic disease with different biologic significance.
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Affiliation(s)
- F Javier Navarro
- Departamento de Anatomía Patológica, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid, España
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50
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Martínez-Piñeiro L, Cózar JM, Cárcamo P, Navarro J, García Matres MJ, Martínez-Piñeiro JA. [Giant inguino-scrotal herniation of the bladder]. ARCH ESP UROL 1990; 43:900-3. [PMID: 2291685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- L Martínez-Piñeiro
- Servicio de Urología, Hospital General La Paz, Facultad de Medicina, Universidad Autónoma de Madrid, España
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