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OBJECTIVE: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. RESULTS: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.

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Objetivo: evaluar los resultados de nefrectomía laparoscópica asistida por la mano en pacientes con masas renales técnicamente complejas. Métodos: se ha realizado una evaluación retrospectiva de 100 nefrectomías laparoscópicas realizadas en un solo hospital entre 2001 y 2005. Se ha seleccionado a los pacientes con antecedentes de cirugía abdominal previa, procedimientos previos en el riñón afectado, evidencia de inflamación perirrenal, lesiones renales de más de 10 cm de diámetro o trombosis venosa renal tipo I. Resultados: se ha incluido un total de 12 pacientes; 5 de ellos presentaban una lesión de al menos 10 cm de diámetro, dos trombosis venosa renal y 5 referían cirugía abdominal mayor. La mayoría de los pacientes tenía más de uno de estos hallazgos. Tres pacientes presentaban procesos inflamatorios (cálculos coraliformes) y un tumor renal T4 fue tratado con éxito, sin necesidad de reconversión. El tiempo operatorio y la pérdida sanguínea medias fueron de 210 minutos y 310 ml, respectivamente, con una estancia media de tres días. Ningún paciente requirió reconversión a cirugía abierta. Conclusiones: la nefrectomía laparoscópica asistida por la mano es una opción mínimamente invasiva, atractiva en el contexto de masas técnicamente complejas, con un tiempo operatorio, una pérdida sanguínea y una tasa de complicaciones razonables (AU)

Objective: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. Methods: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. Results: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. Conclusions: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates (AU)

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INTRODUCTION: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. OBJECTIVES: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. MATERIAL AND METHODS: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. RESULTS: The total number of biopsies registered was a 1202, with 36.96% of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08% of the whole) was > 10 ng/ml in 55,88% of these patients, 4-10 ng/ml in 39.27% and 0-4 ng/ml in 4.84%. The average and PSA's median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA's level: 48,61% with PSA > 10; 25.11% with PSA 4-10 and 21,4% in patients with PSA < 4. There was realized prostate rebiopsy (2 or more biopsies) in 132 patients (21.97% positive) 88,36% of the cancers was diagnosed in the first biopsy, and 6.62% in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies). CONCLUSIONS: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders.

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Introducción: La biopsia prostática es la única herramienta válida para diagnosticar la existencia de cáncer de próstata. Las indicaciones para su realización según la Asociación Europea de Urología son la existencia de PSA elevado, velocidad aumentada y la evidencia de un tacto rectal sospechoso. Objetivos: Valoración tanto de la utilidad clínica de la biopsia prostática, como del PSA como marcador de cáncer de próstata en nuestro medio y la indicación y eficacia de sucesivas biopsias. Material y Métodos: Efectuamos una revisión manual de las biopsias realizadas en nuestro servicio entre los años 1990 y 2002, valorando nivel de PSA previo a la biopsia, número de cilindros obtenidos y datos de la biopsia. Se llevó a cabo un estudio estadístico descriptivo mediante el programa estadístico SPSS 12.0. Resultados: Se han realizado 1202 biopsias en este periodo, con un porcentaje de positividad global del 36.96%. El PSA previo a la biopsia (disponible en las biopsias realizadas entre los años 1999 y 2002: 578 biopsias, 48.08% del total) era >10 ng/ml en el 55,88% de estos pacientes, 4-10 ng/ml en el 39.27% y 0-4ng/ml en el 4,84%. La media y mediana de PSA es de 19,09 (error típico: 1,87) y 10,6, respectivamente. La positividad de la biopsia aumenta con el nivel de PSA: 21,4% en pacientes con PSA<4; 25,11% con PSA 4-10 y 48,61% con PSA >10. Fue realizada rebiopsia prostática en 132 pacientes (21,97% positivas) El 88,36%de los cánceres fueron diagnosticados en la primera biopsia, y un 6,62% en la segunda (94,98% de los diagnósticos de cáncer de próstata se realizaron con las 2 primeras biopsias). Conclusiones: Los datos obtenidos en el estudio mediante el análisis descriptivo de nuestra serie se encuentran en concordancia con lo publicado en otros estudios y publicaciones. Existe una necesidad de aumentar la rentabilidad diagnóstica de la biopsia de próstata, para lo cual hemos introducido un protocolo de biopsia bajo anestesia local con el fin de poder aumentar el número de cilindros obtenidos (AU)

Introduction: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. Objectives: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. Material and methods: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. Results: The total number of biopsies registered was a 1202, with 36.96 % of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08 % of the whole) was> 10 ng/ml in 55,88 % of these patients, 4-10 ng/ml in 39.27 % and 0-4ng/ml in 4.84 %. The average and PSA’s median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA’s level: 48,61 % with PSA> 10; 25.11 % with PSA 4-10and 21,4 % in patients with PSA <4. There was realized prostate rebiopsy (2 ó more biopsies) in 132 patients (21,97 % positive) 88,36 % of the cancers was diagnosed in the first biopsy, and 6.62 % in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies).Conclusions: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders (AU)

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Introducción y objetivos: Tras la primera nefrectomía lumbar realizada por el Dr. Simon en 1869, la técnica quirúrgica quedó perfilada y el procedimiento fue seguido por numerosos cirujanos en controversia inicial entre la utilización de la vía de acceso intra o extraperitoneal. Efectuamos una revisión acerca de la evolución llevada por la operación en el siglo XIX y sobre quienes iniciaron la intervención en nuestro país. Material y Métodos: Hemos revisado los libros de historia de la Urología, los capítulos de cirugía en los tratados clásicos de la especialidad, las comunicaciones a los congresos españoles de Medicina, hasta principios del siglo XX y las operaciones de nefrectomía publicadas en revistas médicas de la época. Resultado. Analizamos diferentes estudios estadísticos aparecidos en este periodo sobre los resultados de la operación, la disminución de la mortalidad en las nefrectomías realizadas por vía extraperitoneal demostró pronto su ventaja. Localizamos 35 extirpaciones renales por medio del acceso lumbar, efectuadas en España en el último tercio del siglo XX, tres del Dr. Federico Rubio y Galí en Madrid, en Barcelona de los urólogos Dr. Víctor Azcárreta Colány José Pagés y de los cirujanos Drs. Esquerdo y Salvador Cardenal, del sevillano Dr. Antonio Solano y del urólogo canario Dr. José Hernández Pérez, quienes fueron los pioneros de la intervención en nuestro país. Conclusión: La introducción de la nefrectomía por vía lumbar en España fue tardía en relación con el resto de Europa, debido al atraso secular que arrastrábamos, únicamente cuando las condiciones generales de los quirófanos, tanto de anestesia como de asepsia y de utillaje quirúrgico, permitían poder abordar con garantía de éxito la operación, los principales cirujanos comenzaron a realizarla (AU)

Introduction and objectives: After first nephrectomy lumbar made by Dr. Simon in 1869, the surgical technique was established and the procedure access was followed by several surgeons with initial controversy between the use of the intra or extraperitoneal access. We carried out a review about the evolution of this surgical procedure among XIX century and of those who were pioneers with this Kind of technique in our country. Material and methods: We have reviewed books of history of the Urology, the chapters of surgery in classic urology volumes and the oral presentations to the Spanish Medical congresses, until beginning of XX century and the published nephrectomy procedures in medical literature of that time. Results: We analyzed different statistical studies appeared at the time about results of the operation, the decrease of mortality in the nephrectomies made by extraperitoneal access demonstrated its advantage soon. We found out 35 kidney removal performing the lumbar access, carried out in Spain in the last third of the XX century, three by Dr Federico Rubio and Galí in Madrid, in Barcelona by the urologist Dr. Víctor Azcárreta Colán and Jose Pagés and by the surgeons Drs. Esquerdo and Salvador Cardinal, from Sevilla, Dr Antonio Solano and the canary urologist Dr. Jose Hernández Perez, who were pioneers performing this procedure in our country. Conclusions: The introduction of nephrectomy by lumbar access in Spain was delayed in relation to the rest of Europe, due to the secular delay that we dragged, only when adequate conditions of the operating rooms, as much as anaesthesia and asepsis and surgical devices tools, guaranteed the success operation, the main surgeon begun to perform it (AU)

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PURPOSE: To evaluate the effectiveness and the prognostic factors of the bladder stones (BS) treatment by means of extracorporeal shock wave lythotripsy (ESWL). METHODS: 183 patients with BS treated using ESWL were retrospectively analysed. Independent variables were: gender, age, obstruction, BS size, BS number and amount of waves. Dependent variable was total BS resolution. Statistical analysis was provided by Cox's regression multivariate analysis, Kaplan-Meier analysis and the t Student test. RESULTS: Total effectiveness of the treatment was 73%. Initial BS size was the only prognostic factor on multivariate analysis (p = 0.0035) with smaller stones obtaining the best results (log rank p = 0.00001): 92% of effectiveness in BS smaller than 1 cm2, 73% in 1-2 cm2, 57% in 2-3 cm2 and 42% in larger than 3 cm2. BS mean size decreased 2 cm2 after the first ESWL (p = 0.00001). CONCLUSIONS: Initial BS size was the only prognostic factor of resolution. Total effectiveness was 73% and it highly increased in BS smaller than 2 cm2.

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OBJECTIVE: To analyze the presenting features, diagnosis and management of uncommon cystic lesions located at the midline of the prostate. METHODS: From 1990 to 1999, 8 patients with medial prostatic cyst were treated in our hospital. Vesicorenal ultrasound evaluation was the first procedure that was performed and was diagnostic in most of the cases. Only those patients that underwent surgery required admission to hospital. RESULTS: The most common presenting features were irritative and obstructive voiding syndromes. Treatment achieved cure or clinical improvement. CONCLUSIONS: Vesicorenal ultrasound assessment is the first procedure that should be considered in the diagnosis of this disease. Before ascribing the symptoms to a prostate cyst, other urological conditions with more prognostic relevance should be excluded. Treatment should be instituted only in the symptomatic patients and should be individualized according to the characteristics of each case.

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FUNDAMENTO: Valorar la eficacia y los factores pronósticos de éxito del tratamiento de la litiasis vesical (LV), mediante litotricia extracorpórea por ondas de choque (LEOC). MÉTODOS: Estudio retrospectivo de 183 pacientes afectos de LV tratados mediante LEOC. Las variables independientes estudiadas fueron sexo, edad, obstrucción, tamaño de la LV, número de LV y número de ondas. La variable dependiente fue la desaparición total de la LV. Estudio de los factores pronósticos mediante análisis multivariante por regresión de Cox, y análisis de Kaplan-Meier. Variación del tamaño de la LV estudiada mediante la prueba t de Student. RESULTADOS: Eficacia global del 73 por ciento. El análisis multivariante mostró que el único factor pronóstico fue el tamaño inicial de la litiasis (p = 0,0035). A menor tamaño de la LV mejor resultado (log rank p = 0,00001): eficacia del 92 por ciento en las LV menores de 1 cm 2 , 73 por ciento entre 1-2 cm 2 , 57 por ciento de 2-3 cm 2 y 42 por ciento en mayores de 3 cm 2 . Disminución media del tamaño de la LV tras la primera sesión de LEOC de 2 cm 2 (p = 0,0001). CONCLUSIONES: El único factor pronóstico fue el tamaño inicial de la LV. La eficacia global de la técnica es del 73 por ciento, aumentando considerablemente en LV menores a 2 cm 2 (AU)

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