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Objectives: To check the degree of concordance in renal ultrasound examination between two nurses and one experienced urologist with the aim of testing nurses' competence performing renal ultrasound., Methods: The echographic aspect of both kidneys (normal or abnormal) was evaluated. Every abnormal finding resulted in the automatic classification of the kidney as 'abnormal'. The agreement between observers was tested using the Kappa concordance index., Results: Eventually, 75 and 45 consecutive examinations performed by the urologist and nurse MM, and the urologist and nurse NJ, respectively, were evaluable. Overall, the study tested 120 patients. Prevalence of 'abnormal' kidneys was intermediate (28-36%). The overall agreement percentage exceeded 88% (88,8-92%). Kappa coefficient was always 0.7., Conclusions: Urological ultrasound examination by qualified well-trained nurses provides records very similar to those delivered by an experienced urologist.

Objectives: To test patient's satisfaction after consultation in the outpatient area of the Urology Department in a public hospital using a structured interview., Methods: We used the Comunidad Autónoma de Madrid (CAM) standard interview form modified to include three questions related to the implementation of a 'one-visit'policy and nurses' empowerment. Patients' opinions were gathered with respect to waiting times in the waiting room, facilities, and staff kindness and professionalism. Sample size was estimated in 386 patients. The effect of every predictive factor on the overall satisfaction was tested using the chi square test. To define the effect of every variable in presence of the rest of covariates a logistic regression model was used., Results: Participation reached 65.5%. Overall, 86.4% of the patients were satisfied. Irrespectively of the professional and personal style, the quality perception was homogeneous (p=ns). Multivariate analysis couldn't disclose any independent predictive variable. Only the perception in the item 'overall time available for the consultation' approached statistical significance (p=0.08), with patients scoring high in this variable getting the highest overall satisfaction scores., Conclusions: There was no personal or professional style particularly related with patient satisfaction. Nevertheless, there is a slight trend towards a higher satisfaction when patients feel enough time has been spent in their consultation. The new organizational resources (one-visit clinic and nurses' empowerment) are both welcome but are not clearly related to patient satisfaction.

Method: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula., Results: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil., Conclusions: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken.

Objectives: The surgical procedures for the insertion of tension free vaginal tapes in the treatment of female stress urinary incontinence (SUI) are simple and can be done as outpatient operations. The aim of this study was to perform a budget study comparing TVT in an outpatient basis with transobturator tape (TOT) with hospital admission., Methods: Retrospective analysis of the medical records of 23 patients undergoing surgery for SUI between October 2004 and October 2005. 13 patients were treated by TVT in an outpatient basis (group 1, Department of Urology), 10 patients were treated by TOT with hospital admission (Group 2, Department of Gynaecology). Cost analysis was carried out by the construction of a Marcov model, incorporating the time sequence of the treatment, including adverse events and results. Variables considered for the analysis: number of visits, preoperative tests, operative time, tape cost, hospital stay, unpredicted visits in the first postoperative month at the outpatient clinics or emergency room, and hospital readmissions. Statistical analysis was performed with the G-Stat software. Student's t test was used to compare quantitative variables., Results: 11/13 patients (84.6%) in group 1 completed the day-surgery protocol. Mean surgical time was 61.7 min. (SD 16.2; 35-100) and 61.6 min. (SD 8.3; 50-73) for groups I and 2 respectively. Two cases in group 1 had perioperative complications (15.4%); no patient in group 2 had perioperative complications. Mean hospital stay was 1.3 days for group 1 (SD 0.85; 1-4) and 2.9 days for group 2 (SD 0.31; 2-3). Three patients in group 1 (23%) and 2 in group 2 (20%) presented postoperative complications. Mean cost per process was 4740 EUR for group 1 and 7099 EUR for group 2., Conclusions: SUI correction by tension free tapes as day surgery is a valid option which saves a substantial amount of resources.

Objectives: Abdominal compartment syndrome is an infrequent clinical entity, the course of which has a rapid progression with multiorgan compromise leading to a fatal outcome if appropriate and urgent action is not undertaken., Methods and Results: We report the clinical case of a patient who developed the clinical picture after renal trauma. Diagnosis was obtained by CT scan and arteriography, afterwards the patient required ICU admission with intra-abdominal pressure monitoring, and several decompression laparotomies before definitive closure with a reabsorbable mesh., Conclusions: Urologists should know the existence of this syndrome its appropriate treatment, because we manage patients who are candidates to suffer it. Due to the high mortality rate associated, it is essential to know how to recognize it in order to act fast.

Objectives: Surgical repair is the most effective treatment for stress urinary incontinence (SUI) currently. Nevertheless, this method is not without complications. The objective of this work is to compare the incidence of complications between different groups of surgical techniques employed for the treatment of SUI in our patients., Methods: We performed a retrospective analysis of patients diagnosed of SUI who underwent surgery at our department between January 1991 and December 1999, grouping patients in three categories depending on the procedure: abdominal technique, abdomino-vaginal techniques, and sling procedures. Complications were grouped into two categories: major and minor complications. Chi-square and Fisher's test were used for the association analysis of complications' frequencies. All confidence intervals and level of statistical significance were calculated for a p value < 0.05., Results: 5.16% of the patients undergoing surgery for SUI suffered major complications. Globally, the most frequent complications were suprapubic pain (33%), wound seroma and/or infection (20%), postoperative acute urinary retention (AUR) (26%), and presence of significant post void residual (24%), being the sling procedure with a greater number of postoperative complications, as much in postoperative pain, as in AUR, as in presence of post void residual (p < 0.05)., Conclusions: Sling procedures present a significantly higher percentage of complications when compared with abdominal and combined techniques.

Objective: To present our experience with renal collecting duct carcinoma and review the literature., Methods: We reviewed our experience with collecting duct carcinoma of the kidney. We found 6 cases out of 176 nephrectomies (3.4%), which accounts for one of the largest series reported in the literature. The radiological, histological and immunohistochemical findings are analyzed., Results: The histological and immunohistochemical findings showed a specificity for high molecular weight cytokeratins and Ulex europeaeus but the imaging findings were not distinct from those of other renal tumors. According to the anatomopathological findings, we have classified the patients into three groups with three distinct courses. All patients underwent radical nephrectomy and one patient received adjuvant therapy., Conclusions: We have identified a subgroup of low grade collecting duct carcinoma of the kidney with a particularly favorable behavior in two patients of our series. At 56 and 41 months' follow-up, both patients remain disease-free. As reported in the literature, patients with high grade and stage collecting duct carcinoma of the kidney have a poor outcome. They develop severe complications and die less than one year after the diagnosis, despite adjuvant immunotherapy.

Objective: To report a rare case of plasma cell granuloma of the renal pelvis. To our knowledge, only five cases have been reported in the literature., Methods: Clinicopathological description of a case of plasma cell granuloma of the renal pelvis with light chain immunohistochemical study., Results: A young male patient with a radiologically benign mass in the right renal pelvis extending into the upper calices that caused hematuria is described. The diagnosis was suggested during the intraoperative study of the mass that was suggested by pyelotomy (conservative surgery). Immunohistochemical study confirmed the initial diagnosis., Conclusions: Although this condition is rare, plasma cell granuloma, an inflammatory pseudotumor, can occur in the urinary tract and should be considered in the differential diagnosis of mass lesions. Histopathological diagnosis requires a complete study of the entire tumor and the use of immunohistochemical techniques to discard plasmacytic non-Hodgkin lymphoma or neoplastic plasma cell proliferation.

Objective: According to the literature, the typical histological findings and simple colloidal iron staining permit the identification of chromophobe cell renal carcinoma, a genetically well-established entity. Our doubts on whether this tumor type can be recognized by conventional methods are presented in this study., Methods: 130 cases of renal carcinoma were treated from 1977 to 1997. Of these, 12 showed characteristic general histological features compatible with chromophobe cell renal carcinoma and reticulated and intense, diffuse cytoplasmic positivity on colloidal iron staining. These tumors were reviewed for the following: 1) gross appearance, 2) architecture, 3) cytoplasmic characteristics, 4) nuclear characteristics, 5) colloidal iron histochemical staining which is considered fundamental and exclusive, 6) immunohistochemical phenotype. Ultrastructural study of material fixed in paraffin was also performed., Results: One case met all 6 criteria, 3 met 5 of them, 6 cases met 4, and 2 cases met 3 of the criteria. The ultrastructural study was not useful in making the diagnosis due to the poor quality of the material., Conclusions: If all cases were chromophobe cell renal carcinoma, then this tumor type can be recognized and diagnosed by simple techniques in any pathology laboratory, and its incidence, presence of necrosis, hemorrhage and high nuclear grade would be even greater than currently accepted. Furthermore, it would be expected that the prognosis, by each grade and stage, would not be so different from that of the conventional renal carcinoma, as some large series have already indicated. On the other hand, if our cases or some of them were in fact conventional renal cell carcinoma that closely resembled chromophobe cell renal carcinoma, an exact diagnosis cannot be made without a genetic or ultrastructural study (using adequately fixed material), and most of the published studies would therefore have to be questioned.

Objective: To present a case of Cushing's syndrome due to massive adrenocortical macronodular hyperplasia that gave the gland the appearance of a pseudotumor., Methods: In a review of the surgical pathology of the adrenal gland recently performed in our hospital, 82 adrenalectomy specimens obtained from 1978-1998 were found. Of these 82 surgical specimens, 44 (53.6%) were cortical pathologies and 10 of these (12.1%) were hyperplasia. There was only one with massive adrenocortical macronodular hyperplasia. A 53-year-old male, chronic alcoholic with cushingoid obesity and hypercortisolism is described., Results: Ultrasound and CT assessment showed enlarged, asymmetrical adrenal glands and macronodules. The analytical and MRI study of the sella turcica showed primary adrenal hypercortisolism. Adrenalectomy of the dominant gland (the left adrenal whose activity was demonstrated on the 131Iodine scintiscan) was performed. The postoperative cortisol levels returned to normal and remain normal up to the present time, 18 months after surgery. The surgical specimen weighed 104 gms and was completely macronodular., Conclusions: Massive adrenocortical macronodular hyperplasia is a rare cause of pituitary-independent autonomous primary adrenal hypercortisolism. It is always bilateral. Adrenal weight is significantly increased (total weight of both adrenals 60-180 gms) and present yellow or golden, non-encapsulated nodules of a few millimeters to up to 4 cms, comprised of cells with scanty activity, therefore massive enlargement of the glands is necessary to produce Cushing's syndrome. The clinical, biochemical and surgical aspects can cause confusion and can be suggestive of an adrenocortical neoplasm. Treatment is by adrenalectomy.

Objective: Since its discovery as a marker for prostate cancer, there have been many attempts to enhance the diagnostic efficacy of the prostate specific antigen (PSA). Among these are the studies that analyze the behavior of different forms of serum PSA bound to different antiproteases, such as alpha-1-antichymotrypsin, which forms the complexed PSA (PSA-c). This study analyzed the utility of PSA-c to enhance specificity without altering sensitivity in comparison to total PSA (PSA-t)., Methods: From September 1998 to March 1999, blood samples were obtained from 96 patients that had undergone a prostate biopsy due to a suspicion of prostate cancer. PSA-c, PSA-t (Technicon Immunol system, Bayer) and PSA-c/PSA-t ratio were analyzed in these patients., Results: ROC curves were plotted and the optimal cutoffs were found for which the specificity was higher for PSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI 95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%, 27-51]) while maintaining a similar sensitivity index (90%). PSA-c showed similar results for other values of sensitivity., Conclusions: PSA-c was found to improve specificity in comparison to PSA-t and PSA-c/PSA-t ratio. PSA-c determination could avoid unnecessary biopsies without altering sensitivity; i.e., the same number of prostate cancers will be detected.

Objective: Based on the clinicopathological findings of two additional cases of sarcomatoid chromophobe renal cell carcinoma and a review of the literature, we analyzed the prognosis in this and other forms of sarcomatoid carcinoma to determine the differences, if any, and their histopathological basis., Methods: Of 139 cases of renal cell carcinoma that were surgically resected during the period 1977-1999, two were sarcomatoid chromophobe renal cell carcinoma, accounting for 15% of 13 cases of chromophobe cell carcinoma and 18% of 11 cases of sarcomatoid cell carcinoma in the same series., Results: The first case was a 73-year-old male with a locally advanced, non-metastatic tumor. Palliative resection was performed and the histological analysis showed a predominantly sarcomatoid mass with small epithelial foci with the morphological, histochemical and immunohistochemical characteristics of chromophobe renal cell carcinoma. The patient died 11 months later. The second case was a 70-year-old female who presented with flank and lumbar pain and episodes of gross hematuria. Anatomopathological analysis showed a chromophobe cell carcinoma with sarcomatous foci, stage pT2pN0M0. The patient is disease-free at 46 months' follow-up. Immunohistochemically, in both cases the sarcomatoid component was found to be strongly positive for vimentin and focally for EMA, and negative for actin, desmin and myoblogin; isolated cells were positive for AE1 and AE3 in the second case. The epithelial component was positive for AE3 and EMA, and negative for AE1, vimentine and CD68., Conclusions: Like our first case, most of the reported cases of sarcomatoid chromophobe renal cell carcinoma show a sarcomatoid mass with foci of carcinoma, and a poor prognosis. In our view, as in all renal cell carcinomas, prognosis depends on tumor grade and stage, which is the highest for sarcomatoid chromophobe renal cell carcinoma. Furthermore, although the epithelial component (chromophobe, chromophilic, clear cells, etc.) may probably have little significance, the influence that the proportion of epithelial and sarcomatoid component might have in these tumors cannot be completely discarded.

Objective: To present a case of basal cell carcinoma of the scrotum., Methods: In a review of 56 scrotal tumors, we found 4 primary neoplasias, 3 benign mesenchymal tumors and one malignant tumor, the basal cell carcinoma of the scrotum described herein., Results: A 52-year-old patient with no remarkable urological or dermatological history, complained of an excrescence in the right hemiscrotum that he had noted for several years. A clinical diagnosis of basal cell carcinoma of the scrotum was made and the lesion was surgically excised. Pathological analysis of the surgical specimen confirmed the diagnosis., Conclusions: Basal cell carcinoma is the most common type of skin cancer in the middle-aged and elderly, but localization to the scrotum is rare. It is a tumor that grows locally and rarely metastasizes, although scrotal tumors are much more aggressive and patients should therefore be followed very closely after resection of the tumor.

Objective: To determine the loss of heterozygosity (LOH) on 9p21 (locus D9S1747) in patients with renal carcinoma by analysis of microsatellite polymorphisms., Methods: 40 patients with sporadic renal cancer were studied. LOH on 9p21 was performed by analysis of microsatellite polymorphisms., Results: 23.7% showed LOH on 9p21. No correlation was found between this genetic alteration and tumor features., Conclusions: LOH on 9p21 was found in 23.7% of the patients in this series. LOH was found in 26.9% of renal cell carcinomas, 25% of papillary carcinomas and 25% of Bellini duct carcinomas. LOH was not found in the other histological types.

Objective: To determine the methylation status of the tumor suppressor gene p16 in patients with renal carcinoma by analysis of microsatellite polymorphisms., Methods: 40 patients with sporadic renal cancer were studied. Tumor and normal tissue from each patient were tested for methylation status of the p16 gene by analysis of microsatellite polymorphisms., Results: 20% showed methylation of p16. No correlation was found between this genetic alteration and tumor features., Conclusions: Methylation of p16 was found in 20% of the patients in this series. According to the analysis, 18.5% of renal cell carcinomas showed methylation, 50% of chromophobe cell carcinomas and 25% of carcinomas of Bellini's tubules. The rest of the histological types showed no methylation.

Methods: From November 1992 to November 1993, a prospective study was conducted on 20 controls and 61 patients with bladder carcinoma. EGFR expression was determined by radioimmunoassay and the correlation of the results of histological analysis and the clinical course was analyzed. The follow-up period was from November 1992 to July 1998. The association between qualitative variables and the x2 or Fisher exact test was compared using the hypothesis of the proportional ordinal trend for the ordinal variables, and the quantitative variables were analyzed using Student's t test and/or variance analysis (ANOVA). Survival was analyzed by the Kaplan-Meier method and comparison was performed using the Breslow exact test. The Cox proportional hazards regression model was utilized. The SPSS software for Windows 7.0 was used for the analysis., Results: The EGFR values were higher for patients with bladder carcinoma than in controls (14.48 vs 2.54 fmol/mg of protein). EGFR values were higher in patients with superficial bladder tumor than in those with infiltrating tumors (27.03 fmol/mg vs. 10.05 fmol/mg of protein; p = 0.000). Poorly differentiated tumors showed higher values of EGFR (6.73, 14.48 and 17.07 fmol/mg of protein for grades I, II and III, respectively; p < 0.05). The EGFR values were higher in patients that died from cancer during follow-up (64.8) than in those who died from other causes (47.5) and those who are alive and on follow-up (42). An increase in EGFR values did not carry a risk of death from cancer (p = 0.1269; ns). Analysis of the grade of tumor differentiation showed that for the more aggressive tumor grade, a positive EGFR was a sign of reduced survival. Survival in patients with superficial and infiltrating tumor did not appear to change significantly according to the EGFR value. EGFR determination was not useful in predicting recurrence and increased EGFR values did not correlate with a higher risk of recurrence., Conclusions: 1) The normal pattern of EGFR could not be established. 2) EGFR was not useful in identifying subgroups at risk of death. 3) Knowledge about these proteins synthesized by oncogenes offers new possibilities in the treatment of cancer.

Objective: To determine the utility of p185 oncogene in the biological characterization of transitional cell carcinoma and in the prediction of recurrence, and to analyze survival at 5 years mean follow-up., Methods: A prospective clinical cohort study was conducted on 81 patients. Tissue specimens were obtained between November 1992 and November 1993. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). p185 expression was determined by enzyme immunoanalysis (EIA). A statistical analysis of the results was performed., Results: p185 oncoprotein levels were higher in patients with recurrence (1098.97 HNU/mg protein vs. 924.54 HNU/mg). Although higher levels of p185 were found in the patients that had died vs those who are alive, the differences were not statistically significant for overall survival or stratification by tumor grade or infiltration (p = 0.556; ns)., Conclusions: Determination of p185 oncoprotein was found to be useful in the prediction of tumor recurrence at 5 years mean follow-up.

Objectives: 1) To determine p53 expression in urinary wash cytology by immunohistochemistry in patients with superficial transitional cell carcinoma of the bladder and controls; 2) to correlate p53 in urinary wash cytology and anatomopathological characteristics of the bladder tumors analyzed; 3) to determine the utility of p53 expression in urinary wash cytology as a prognostic factor; and 4) to identify a subgroup of patients with superficial tumors of worse prognosis in order to improve control of the evolution of the tumor and treatment., Methods: From 1993 to 1998, 141 cases were studied; 32 controls comprised group I and 109 (38 primary and 71 recurrence) patients with transitional cell carcinoma of the urinary bladder comprised group II., Results: In group II, 29.5% were positive for p53 in urinary wash cytology, while no positive cases were found in group I. A total of 104 valid data were analyzed, which showed a higher percentage of p53-positive cases in grade III tumors (44.4%). Statistical analysis showed the percentage of p53-positive cases increased with tumor grade in a linear trend (p = 0.17). The recurrence rate in the p53-positive was 20% greater than in the p53-negative cases. Tumor progression was three times higher in the p53-positive than in the p53-negative patients., Conclusions: The application of biomolecular knowledge to cytology is a useful complement in follow-up of patients with superficial transitional cell carcinoma of the bladder and offers additional parameters to distinguish benign and malignant cells. Immunohistochemical determination of p53 in urinary wash cytology identifies patients with superficial tumors with a worse prognosis.

Objective: Mutations in the TP53 gene are frequently detected in some types of malignant tumors (bladder, prostate, kidney, lungs, breast, colon and rectum). This study analyzed the utility of semi-quantitative determination of p53 in transitional cell carcinoma of the bladder by an immunohistochemical technique and evaluated the results at 5 years., Methods/results: A prospective clinical cohort study was conducted on 81 patients. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). In both groups the tissue specimens were obtained between November 1992 and November 1993, and during the follow-up period until July 1998. p53 expression was determined by a semi-quantitative method based on an immunohistochemical technique (NCL-p53-DO7, Novocastra)., Conclusions: p53 oncoprotein was not found to be useful in the characterization of carcinoma of the urinary bladder.

Objective: Mutations in the p53 gene are frequently detected in some types of malignant tumors (bladder, prostate, kidney, lung, breast, colon and rectum). This study analyzed the utility of p53 quantitation in transitional cell carcinoma of the bladder and evaluated the results at 5 years., Methods: A prospective clinical cohort study was conducted on 81 patients. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). In both groups the tissue specimens were obtained between November 1992 and November 1993, including the follow-up period until July 1998. p53 expression was determined by a quantitative method based on immunoluminiscence (LIA-MAT p53)., Results: p53 expression was higher in bladder carcinoma than in healthy urothelial tissue; higher values of p53 were found for infiltrating and undifferentiated tumors. The p53 values were higher in patients with tumor recurrence than in those without (NS). The Bonferroni multiple comparisons test showed a higher mortality in patients with p53 > 0.9 than in patients who are alive or have died from other causes (p = 0.000)., Conclusion: The results show that p53 LIA-MAT is an independent prognostic factor at a cutoff of 0.9 and permits identification of a subgroup of patients at high risk.

Objective: The development of in vitro cell tissue culture techniques has provided most of the current knowledge on the physiology of both normal and tumor cells. The results of cell culture studies using nephrectomy specimens are presented., Methods: Surgical specimens from 7 patients (3 males, 42.9%; 4 females, 57.1%) aged 43-79 years (mean 62.14), who had undergone nephrectomy for renal adenocarcinoma between April 1997 and February 1998 were utilized. The tumor cell samples were obtained during surgery, after the kidney had been excised. The samples were cut, washed in a balanced saline solution and enzymatically dissociated in a trypsin solution (0.1% Hank's solution) for 30 minutes at 37 degrees, centrifuged, placed in Multiwell plates, covered with 0.1 mg/ml polylysine (ICN) or 3 mg/ml collagen S (Boehringer) and cultured in RPMI 1640 (Sigma) supplemented with 5% fetal calf serum (reagent), which was changed every 2-3 days for one month. After the culture had developed, samples were fixed in 70% ethanol and stained with hematoxylin-eosin for cell identification. Cell types were identified by cytokeratin analysis., Results: The histological types were: clear cell renal adenocarcinoma in three cases (42.9%), renal oncocytoma in two (28.6%), mixed cells renal adenocarcinoma in one (14.3%) and papillary carcinoma in one case (14.3%). Polylysine and collagen were found to be good substrates for normal and tumor cell culture. Polylysine was found to be a better substrate for epithelial cells; there were less epithelial and more mesangial cells in the collagen substate. The positive cytokeratin expression (a marker for intermediate filaments) corroborates the well-known epithelial origin of renal cell carcinoma. Epithelial cells from normal kidney grew well in the culture medium. Mean cell survival was 30.83 days (range 15-50). To evaluate the viability of the culture, positivity for a neutral red stain was used as marker for good metabolic activity after one month. All cultures that survived for more than one month (5 of 7) stained positively., Conclusions: The study and development of human cell lines is useful to analyze the metabolic aspects of renal carcinoma. Cell cultures permit conducting genetic and molecular studies and investigating the radio and chemosensitivity of renal carcinoma in vitro.

Objective: Renal cancer accounts for 2% of tumors. The most common chromosome abnormality found in renal cancer is the loss of heterozygosity (LOH) on the short arm of chromosome 3 (3p), which suggests that near the gene responsible for von Hippel-Lindau disease, there may be one or more tumor suppressor genes between 3p14 and 3p21 with a relevant role in the development of renal cancer., Methods: 41 patients with sporadic renal cancer were tested for three microsatellites mapped to the short arm of chromosome 3 (3p14.1-3p14.3, 3p21.2-3p21.3 and 3p25) by polymerase chain reaction. The results were compared with patient habits and tumor features., Results/conclusions: 43.9% of the patients showed LOH on at least one locus. Thirty-four percent showed LOH only on one locus, 4.9% on two loci and 7.3% on the three loci tested. All the patients who showed LOH on 3p21 had a tumor size greater than 25 mm. There is a risk 1.76 times higher of no loss in tumors less than 25 mm in size than in tumors greater than 25 mm (Cl 95% 1.33-2.33).

Objective: To analyze the incidence and the clinical and histopathological features of non-inflammatory scrotal lesions with special reference to the non-neoplastic lesions, which are the most common., Methods: The cases of scrotal surgical pathology of the Hospital Nuestra Señora del Pino from 1988-1997 were reviewed. Skin biopsies for dermatological conditions, Fournier's gangrene, inflammatory-infectious lesions, hydroceles, lesions that could cause secondary involvement of the scrotal wall (e.g., spermatoceles) and invasive lesions from adjacent tumors were excluded from the study., Results: 14 cases (4 neoplastic and 10 non-neoplastic lesions) were specifically analyzed. Of these 10 non-neoplastic lesions, 7 were epidermoid cysts (3 multiple) and 3 idiopathic calcinosis. The latter, which are discussed at length, presented in middle-aged patients (56, 45 and 42 years) as multiple nodules that had gradually appeared over several years (20 years in one of the cases) and had been invariably diagnosed as "sebaceous scrotal cysts". Their form of presentation and treatment are similar to those of true scrotal epidermoid cysts, with which they might be related., Conclusions: In our series, the most common primary scrotal lesions were non-neoplastic and comprised two types whose pathogenic relationship has as yet not been elucidated: simple epidermoid or epidermal cysts (half of which were multiple lesions) and less frequently idiopathic calcinosis of the scrotum.

Objective: To describe a case of nephrogenic adenoma occurring in the intestinal mucosa of the neobladder urethro-sigmoid anastomosis in a patient who had undergone cystectomy for a bladder carcinoma., Methods/results: Of 14 cases of nephrogenic adenoma in 11 patients, one involved the lamina propria of large bowel mucosa. A 67-year-old patient submitted to radical cystoprostatectomy and orthotopic bladder substitution using a detubulized sigmoid neobladder due to multicentric G3 pTa, pTis urothelial bladder carcinoma had two episodes of stricture of the distal anastomosis. After the second episode, endoscopic resection of the area was performed. Histological examination of the specimen disclosed nephrogenic adenoma of the intestinal mucosa., Conclusions: Nephrogenic metaplasia has been observed in the intestinal mucosa of patients undergoing different urological procedures. To our knowledge, our patient is the third case involving large bowel mucosa reported in the literature. These three cases suggest that nephrogenic adenoma might not be a metaplastic process specific to the urothelium.

Objective: To describe a case of blue nevus of the prostate and propose a more precise terminology in order to avoid the confusion arising from the presence of melanin pigment in the prostatic epithelium and/or stroma., Methods/results: A 58-year-old patient with adult polycystic kidney is described. The patient demonstrated clinical and radiological findings compatible with benign prostatic hyperplasia and had a PSA of 11.4 ng/ml. After three transrectal biopsies showing no malignancy, the patient underwent transurethral resection. Pathological examination of the specimen disclosed glandular-stromal hyperplasia and extensive melanin pigmentation of stroma or blue nevus of the prostate., Conclusion: The presence of pigment in the prostate is an extraordinary histological finding that can be ascribed, in most of the cases, to one of the following conditions: a) melanosis or true melanocytosis, in which the melanin pigmentation is produced by the prostatic stromal cells, with or without involvement of the surrounding epithelium (probably in a secondary passive process); b) pseudomelanosis, in which the lipofuscin pigmentation is produced and stored by epithelial cells. In both cases the histopathological findings have no clinical significance or prognostic implications.

Objective: Nephroureterectomy is the standard treatment for tumors of the renal pelvis and ureter. Conservative management or indication of adjuvant treatment in these neoplasms is based mainly in histological grade and stage. The aim of this study is to assess the relation of Ki67 index with other established prognostic factors and to define its predictive value for long term survival, which could be useful in selecting the best treatment for each individual case., Methods: 81 patients with urothelial tumors of the renal pelvis and ureter, diagnosed and treated between 1975 and 1993, comprised the present study. Ki67 immunostaining was performed in paraffin-embedded tissue. A cut-off limit of 20% was chosen. Tumor location, histological grade, histological pattern, local (T), nodal (N), vascular and perineural invasion and stage (TNM) were assessed in relation to the proliferation index and as prognostic criteria for survival in both univariate and multivariate analysis., Results: The Ki67 proliferation index was found to be related to grade (p < 0.001), T (T0 vs T1-4; p < 0.01), N (p < 0.038), TNM categories (stage 0 vs I-IV; p < 0.048) and perineural invasion (p < 0.01). There was a marginal relation to vascular invasion (p < 0.11). Survival was better for the patients with low proliferating tumors (90%) than for high proliferating ones (67%) (p < 0.02). In the multivariate analysis only T stage was statistically significant (p < 0.01) but a highly suggestive trend was found for the Ki67 index (p < 0.07)., Conclusions: Tumor proliferation assessed by Ki67 immunostaining is related to the progression of the disease and proved to be of predictive value for long-term survival in tumors of the renal pelvis and ureter. The Ki67 index is able to detect high-risk patients that could not be cured by radical surgery alone, raising the need for some type of aduvant treatment in these cases. The treatment predictive effect observed in low grade-low stage cases suggests its possible utility in patients managed conservatively.

Objective: To describe a case of prostatic xanthoma, a benign condition of inflammatory origin related with granulomatous prostatitis., Methods: A 70-year-old patient with voiding syndrome and a DRE suggestive of grade II hyperplasia of the prostate is described. A bilateral biopsy of the prostate was negative. The patient was submitted to transurethral resection with normal analytical data. Histological examination of the specimen showed benign prostatic hyperplasia associated with sclerosing adenosis and a clear, foamy cytoplasmic cell and an unremarkable nucleus. Immunocytochemical analysis with the KP-1 lysosomal marker (CD-68) disclosed macrophages. Cytokeratin labelling (AE1-AE3) was negative, thereby discarding any type of epithelial cell proliferation., Conclusion: Due to its rarity, making the differential histological diagnosis of prostatic xanthoma can be difficulty in certain cases and it can occasionally present as a palpable mass. However, it must be emphasized that it is a benign condition and clinically irrelevant in most of the cases.

Objective: To describe a case of metanephric adenoma, a rare and little known tumor with no potential to malignancy. This tumor type can occasionally coexist with Wilms' tumor, with which it is histogenically related., Methods/results: A 54-year-old female patient was referred to the Urology Service for a small mass in the left kidney that had been incidentally detected during an ultrasound evaluation. Patient evaluation disclosed a solid, circumscribed, unencapsulated mass of 2.3 cm in its largest segment. It was mainly localized in the medulla of the kidney, although it was extensively in contact with the renal cortex. Histologically, it was comprised of small epithelial cells in a tubular or papillary arrangement, without atypia, mitosis, necrosis or invasion of adjacent renal parenchyma or vascular structures, and with abundant psammoma-like calcifications. The histological findings were characteristic of metanephric adenoma., Conclusion: Metanephric adenoma is an uncommon, morphologically distinct tumor type, with characteristic histopathological features. Despite its size, it is benign and should be distinguished from renal cell carcinoma or Wilms' tumor.

Objective: This study attempted to correlate the clinical course and outcome of transitional cell inverted papilloma and the number of active cell nuclei, using Ki-67 antigen expression to quantify nuclear activity., Methods: We analyzed thirteen pathologically confirmed lesions of transitional epithelial inverted papilloma in 12 patients that had been treated from 1977-1994. Immunohistochemical labelling of the tumor was performed using Mib-1 antibodies (a marker for the Ki-67 cell proliferation-associated cyclin) that identify active cell nuclei. Then we counted the number of active nuclei per 10 fields at high magnification (400x)., Results: The tumor was localized to the bladder in 11 cases and one case had 3 concomitant lesions in the renal pelvis. Five cases were associated with low grade urothelial transitional cell carcinoma, which was concomitant in one and asynchronous in the remaining 4 cases. One patient with inverted papilloma recurred and subsequently developed low grade transitional cell carcinoma. The elevated number of nuclei in the proliferative phase (more than 100 active nuclei per 10 high power fields) did not show a consistent correlation with good outcome., Conclusions: Treatment of inverted papilloma should be as in superficial transitional cell papillary carcinoma, since this tumor type may recur or be associated with transitional cell carcinoma. The lesions with a high proliferative activity, which is easily determined by Ki-67 antigen quantification, generally have a poor outcome.

Adrenal pseudocysts are cystic lesions in the gland whose wall has no internal lining to permit a more precise classification. These can develop into very large cysts containing several liters of liquid. They account for almost half of all adrenal cystic lesions in young or middle-aged adults. In 50% of the cases these are incidentally discovered during laparotomy or radiographic evaluation. Its origin is still a controversy. The present study describes the clinical and anatomopathological features of two giant pseudocysts of the adrenal gland. One of the patients was asymptomatic (an IVP incidentally disclosed the presence of a mass). The other case consulted for lumbar pain. Furthermore, the different types of adrenal cysts reported in the literature and the differential diagnosis from other adrenal cystic lesions, mainly tumors and infections, are discussed.

The clinical and the gross and microscopic features of two multicystic masses in adult female patients are described. These met the Powell and Boggs and Kimelstiel criteria for multilocular renal cyst (MRC). MRC may be the common process and the gross expression of different disease entities with different biological significance which must be distinguished clinically and anatomopathologically. We present the data for differential diagnosis of conditions that may present as MRC: partially differentiated cystic nephroblastoma, mesoblastic congenital cystic nephroma, lymphangioma (more common in infants), cystic renal carcinoma and sarcoma, segmental polycystic kidney (more common in adults) and segmental renal dysplasia. The diagnosis of multilocular renal cyst should be made only after discarding the foregoing conditions.

We report on a patient with chronic prostate disease diagnosed as having a pelvic desmoid tumor (abdominal fibromatosis localized to the pelvis) whose presenting features were those of complete acute urinary retention. The findings on initial examination led us to suspect a prostate neoplasm which, however, was discarded by the results of the radiographic work up. The clinical and pathologic findings are presented and attention is drawn to the possibility that these mesenchymal neoplasms can have urological presenting symptoms and signs.

We report on a mesothelioma of the tunica vaginalis testis in a 33-year-old patient. Eleven years following tumor removal, the patient is well and no evidence of tumor has been observed. We describe the pathologic features of the tumor, and discuss the characteristic, constant, but unspecific presenting features of mesotheliomas that are uncommon to this site, and the major difficulties encountered in making a differential diagnosis.