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Journal Article; The incidence of malignant tumors in recipients of renal allografts is higher than in the general population. Renal cell carcinoma (RCC) accounts for 4.6% of the tumors in transplanted patients; of them, only 10% are found in transplanted kidneys. Transplantectomy has always been the usual treatment. However, during the last years, nephron-sparing surgery of the allograft is more frequently done in well-selected cases, and therefore dialysis can be avoided. We report the case of a 37-year-old female patient with renal transplant, diagnosed with a 4.5 cm tumor in the lower pole of the renal allograft. The patient underwent partial nephrectomy successfully. Six years after surgery, there is no evidence of recurrence of the disease and the patient maintains an adequate renal function. Yes

Primary renal malignant fibrous histiocytoma is an extremely rare disease. There are neither clinical nor radiological signs to distinguish it from the most common renal cell carcinoma. Its prognosis is poor because of its tendency to locally recur and metastasize. Therefore, early diagnosis and proper treatment are very important. We present the case of a 66-year-old woman diagnosed with primary renal malignant fibrous histiocytoma who underwent partial nephrectomy. After 41 months' follow-up, there was no evidence of any recurrence. To our knowledge, this is the first reported case of conservative surgery for this kind of tumor.

Journal Article; Keratinizing squamous metaplasia of the bladder is rare and is usually associated with urinary tract infections and chronic irritation. It is considered a precancerous condition of squamous cell carcinoma, especially when more than 50% of the bladder surface is affected. Medical treatment cannot eradicate this lesion. When it is limited to a small area of the bladder, transurethral resection is possible. Annual cystoscopy with multiple biopsies as well as annual upper tract imaging is proposed in the follow up of these patients. We present a preliminary 2-year followup report of a keratinizing squamous metaplasia of the bladder in a 28-year-old female patient with no previous risk factors. Yes

The aims of this study were to describe the profile of urological cancer patients who look for health information on the Internet and to analyse the factors related to use of the Internet as a source of health information.A cross-sectional descriptive study using individual, semi-structured, questionnaire-based interviews was carried out in oncology clinics in a hospital in Granada (Spain) in a sample group of 169 patients with prostate, bladder and kidney cancer. The dependent variable was use of the Internet as a source of health information. The independent variables were sociodemographic variables, health status, relationship with healthcare services, patient's role in decision-making process, satisfaction with healthcare, Internet use, Internet skills and attitude. Data analyses include descriptive, bivariate and multivariate analyses.Of the patients in the sample group, 72.2 % had prostate cancer, 19.4 % had bladder cancer and 8.3 % had kidney cancer. Only 11.2 % of patients in the group used the Internet as a source of health information. These patients were typically men of an average age of 62 years, who live in urban areas, who have completed secondary or university education, with a high income and who usually share the role of decision maker with their doctor. Patients who use the Internet as a source of health information usually look for support from psychological support groups, have family members who also look for information on the Internet and prefer sources of information other than those provided by the health services.The study outlines the profile of urological cancer patients who use the Internet as a source of health information. Internet use is related to a patient's attitude towards decision making, level of education and whether or not they look for information from sources other than the health system itself.

Inflammation has been implicated as an etiological factor in different human cancers. Allelic variations in the genes implicated in inflammation are candidates as genetic determinants or markers of renal carcinoma risk. The present stud investigates whether polymorphisms of the genes that give rise to increases in the levels of proinflammatory cytokines and chemokines are associated with an increased risk of renal carcinoma. To this effect, a number of case-control studies were designed to assess the correlation between renal carcinoma and polymorphisms IL10-1082 A/G (rs 1800896), IL10-592 A/C (rs 1800872), IL10-819 C/T (rs 1800871), IL10-1082 A/G, IL4-590 C/T (rs 2243250), TNF-A-308 A/G (rs 1800629), RANTES-403 G/A (rs 2107538), IL1-A-889 C/T (rs 1800587), MCP-1 2518 G/A (rs 1024611), CTLA-4/+49 A/G (rs 231775) and CTLA-4 CT60 A/G (rs 3087243) in 127 renal carcinoma patients and in 176 healthy subjects. The results obtained in relation to cytokine polymorphism IL-10-1082 A/G indicate that AG heterozygosity status is the principal risk factor in relation to locally advanced or metastatic tumor stage and renal carcinoma. In the case of the molecule CTLA4, the results obtained in renal cancer reveal an association between the polymorphisms of the CTLA-4 gene and an increased risk of developing renal cell carcinoma. A high genotypic frequency of polymorphisms CTLA4/CT60-AA and CTLA4/A49G-AA is observed in patients with renal cell carcinoma versus the controls. An association has been established between polymorphism CTLA4/CT60 and tumor grade in patients with renal cell carcinoma. Logistic regression analysis has confirmed these data, demonstrating a high frequency of the AA genotype in patients with high-grade tumors. The results obtained support the hypothesis that different genetic factors implicated in the regulation of adaptive immune responses, stromal cell composition and local cytokine production levels may be crucial elements in the modification of the clinicopathological parameters of renal carcinoma.

To assess current management of renal cell carcinoma (RCC) extending into the inferior vena cava (IVC): staging, diagnosis, surgical approach, adjuvant therapy, prognostic factors and survival rate.Nineteen cases of RCC extending into the IVC undergoing surgical resection from January 1988 to August 2008 were reviewed. TNM staging and Neves-Zincke grading of the tumor were also assessed. Surgical approach depended on thrombus level.With a perioperative mortality rate of 10.5% and a mean follow-up of 22.65 months (range 2-79), 5 patients are still alive, while 11 patients died from the disease, 1 from an unrelated cause, and 2 were lost to follow-up. Patients with metastatic disease received adjuvant treatment with immunotherapy or kinase inhibitors. Mean survival was 15.1 months. Significant differences were found in 3- and 5-year survival rates in patients staged as N0M0 as compared to all other stages (N+M0, N0M+, N+M+). No differences were found depending on thrombus level.RCC with thrombus in the IVC is a tumor with a high mortality rate. Surgery continues to be the best option, and requires adequate preoperative evaluation and the support of an experienced and well trained multidisciplinary team. Survival depends on disease extension.

Case Reports; Journal Article; Review; OBJECTIVES We report the cases of three patients with primary renal lymphoma. Diagnosis and subsequent treatment are discussed. METHODS The literature on the origin, epidemiology, clinical presentation, diagnosis, treatment and prognosis of primary renal lymphoma was reviewed. RESULTS The first patient was diagnosed after radical nephrectomy and subsequently was given six cycles of CVP (cyclophosphamide, vincristine, prednisone). The diagnosis of the second patient was established by renal biopsy, and the patient received six cycles of CHOP (cyclophosphamide, adriamycin, vincristine and predisone). The last patient had a lymphoma, secondary to immunosuppression, in a transplanted kidney. In this case transplant nephrectomy sufficed to cure the patient's lymphoma. All patients had B-cell non-Hodgkin lymphoma (an extrarenal origin was ruled out by bone marrow biopsy), and were disease-free 15 months, 7 months, and 6.5 years after diagnosis, respectively. CONCLUSIONS Primary renal lymphoma is rare. Diagnosis is established by renal biopsy, although it often presents as a mass simulating renal cell cancer and diagnosis is obtained after radical nephrectomy. Treatment consists of chemotherapy (CHOP). associated with rituximab. Yes OBJETIVOS: Se presentan tres casos clínicos de pacientes con linfoma renal primario, su diagnóstico y posterior tratamiento. MÉTODOS: Se realiza una revisión bibliográfica del origen, epidemiología, características clínicas, diagnóstico, tratamiento y pronóstico de esta enfermedad. RESULTADOS: En nuestro primer caso la paciente es diagnosticada tras una nefrectomía radical y tratada posteriormente con seis ciclos de CVP (ciclofosfamida, vincristina, prednisona). En el segundo paciente el diagnóstico se llevó a cabo mediante biopsia renal, administrándose seis ciclos de CHOP (ciclofosfamida, adriamicina, vincristina y prednisona). El último caso se trata de un linfoma secundario a la inmunosupresión en un riñón trasplantado en la que la realización de una trasplantectomía fue suficiente. Todos los casos fueron linfomas no-Hodgkin de células B descartándose el origen extrarrenal con biopsia de médula ósea, estando libres de enfermedad tras 15, 7 meses y 6.5 años del diagnóstico respectivamente. CONCLUSIONES: El linfoma renal primario es muy raro. El diagnóstico se realiza mediante biopsia renal aunque con frecuencia se presenta como una masa simulando un cáncer renal y es diagnosticado tras nefrectomía radical. El tratamiento consiste en quimioterapia (CHOP) asociada a rituximab

Resumen La inflamacion se ha implicado como un factor etiologico en varios tipos de canceres humanos. Las variaciones alelicas de los genes implicados en la inflamacion son candidatos como determinantes geneticos del riesgo de carcinoma renal. El proposito de los estudios realizados fue investigar si los polimorfismos de genes que llevan a un incremento de los niveles de citoquinas proinflamatorias y quimioquinas estan asociados con un aumento en el riesgo de carcinoma renal. Para ello disenamos varios estudios caso-control para probar la asociacion entre el carcinoma renal y los polimorfismos il10-1082 a/g (rs 1800896), il10-592 a/c (rs 1800872), il10-819 c/t (rs 1800871), il10-1082 a/g, il4-590 c/t (rs 2243250), tnf-a -308 a/g (rs 1800629), rantes -403 g/a (rs 2107538), il1-a -889 c/t (rs 1800587), mcp-1 2518 g/a (rs 1024611) y ctla-4/ +49 a/g (rs 231775) y ctla-4 ct60 a/g (rs 3087243) en 127 pacientes de carcinoma renal, y como control 176 personas sanas. Los resultados obtenidos de los polimorfismos de la citoquina IL-10-1082 A/G fueron que el estado de heterocigosidad AG presenta el factor de riesgo principal en relacion con estadio tumoral localmente avanzado o metastasico en el carcinoma renal. En el caso de la molecula de CTLA4 los resultados obtenidos en carcinoma renal fueron que se encontro una asociacion entre los polimorfismos del gen del CTLA-4 y un incremento del riesgo de desarrollar RCC. Se descubrio una alta frecuencia genotipica de los polimorfismos CTLA4/CT60-AA y CTLA4/A49G-AA en pacientes de RCC frente a los controles. Se descubrio una asociacion entre el polimorfismo CTLA4/CT60 y el grado tumoral en pacientes de RCC, un analisis logistico de la regresion confirmo los hallazgos, demostrando una alta frecuencia del genotipo AA en pacientes con grado tumoral alto. La conclusion apoya la hipotesis de que diversos factores geneticos implicados en la regulacion de respuestas inmunes adaptativas, la composicion de las celulas estromales y el nivel de produccion local de citoquinas, pueden ser cruciales en la modificacion de parametros clinicopatologicos en el carcinoma renal.

We report the case of a 61-year-old male with the incidental diagnosis of intrathoracic renal ectopia during the workup study for a possible lung mass.We performed a bibliographic review on the incidence, origin, clinical presentation and diagnosis of this type of renal ectopia.Chest x-ray showed a left posterior mediastinum mass. Bronchoscopy was performed showing signs of extrinsic compression with absence of neoplastic cells. CT scan revealed a left intrathoracic ectopic kidney with diaphragmatic hernia.Intrathoracic renal ectopia is a very unfrequent finding, often asymptomatic, frequently an incidental diagnosis that does not require treatment.

Objetivo: Se presenta el caso clínico de un varón de 61 años diagnosticado de manera incidental de ectopia renal intratorácica durante el estudio de posible masa pulmonar. Métodos: Se realiza una revisión bibliográfica de la incidencia, origen, clínica y diagnóstico de este tipo de ectopia renal. Resultados: En la radiografía de tórax se aprecia una masa en mediastino posterior izquierdo. Es practicada una fibrobroncoscopia apreciando signos de compresión extrínseca con ausencia de células neoplásicas. El TAC revela un riñón ectópico intratorácico con hernia diafragmática izquierda. Conclusiones: La ectopia renal intratorácica es un hallazgo muy infrecuente, habitualmente asintomático, diagnosticado con frecuencia de manera incidental y que no suele requerir tratamiento.

We report the clinical case of a 21-year-old male presenting with a 36 hour history of low flow priapism, its diagnosis and treatment.We performed a bibliography review on the etiology, physiopathology, diagnosis and treatment options.The patient underwent unsuccessful punction-aspiration of intracavernous blood with phenylephrine injection and cavernous irrigation with saline solution. A covernous-spongiosum shunt was performed subsequently, firstly using the Winter technique and followed by the AlGorab technique with a final positive response.The performance of a sapheno-cavernous shunt is an effective treatment for the low flow priapism resistant to usual medical-surgical treatment.

To report a rare case of testicular metastasis secondary to an infiltrative transitional cell carcinoma years after radical surgery.71-year-old male patient with history of infiltrative bladder tumor, status post radical cystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the right testicle. Inguinal orchyectomy was carried out with the pathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review.The patient is disease-free twelve months after orchyectomy.Apart from leukemia and lymphoma, testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improve prognosis.

Objetivo: Se presenta el caso clínico de un varón de 21 años con priapismo de bajo flujo de 36 horas de evolución, su diagnóstico y su posterior tratamiento. Métodos: Se realiza una revisión bibliográfica de la etiología, fisiopatología, diagnóstico y diferentes tratamientos posibles. Resultados: El paciente es sometido a la punción-aspiración de sangre intracavernosa con inyección de fenilefrina y lavados con suero fisiológico sin éxito. Posteriormente se realiza una derivación cavernoesponjosa, primero según la técnica de Winter seguida de la de Al Ghorab, respondiendo finalmente a la realización de un shunt safeno-cavernoso. Conclusiones: La realización de un shunt safeno-cavernoso es un tratamiento eficaz para la resolución de un priapismo de bajo flujo rebelde al tratamiento médico-quirúrgico habitual.

Resumen.- OBJETIVO: Presentar un caso raro de metas-tasis testicular secundaria a carcinoma urotelial infiltrante anos despues de practicada cirugia radical.METODOS: Exposicion del caso clinico: paciente de 71 anos sometido a cistoprostatectomia radical con uretrecto-mia por tumor vesical infiltrante. A los siete anos debuta con dolor y aumento del tamano testicular derecho. Se le practico orquiectomia por via inguinal siendo diagnostica-do de metastasis testicular de carcinoma vesical de alto grado. y revision de la literatura publicada al respecto.Palabras clave: Tumor vesical infiltrante. Metastasis testicular. Tratamiento quirurgico.Summary.- OBJECTIVE: To report a rare case of testicular metastasis secondary to an infiltrative transitional cellcarcinoma years after radical surgery.METHODS: Case Report: 71-year-old male patient with history of infiltrative bladder tumor, status post radicalcystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the righttesticle. Inguinal orchyectomy was carried out with thepathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review.RESULTS: The patient is disease-free twelve months after orchyectomy.CONCLUSIONS: Apart from leukemia and lymphoma,testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improveprognosis.

We evaluate the indication and results in the treatment of complex urethral stenosis by the Barbagli's technique.We retrospectively review 8 patients undergoing dorsal onlay urethroplasty with foreskin mucosa free graft. We analyze their preoperative characteristics. Mean stenosis length was 6.25 cm and the site was bulbar urethra in seven cases and penile in one. Mean preoperative flow was 8.78 ml/sec. We describe the technique and present our results.There are 87.5% of goods results (cure of the stenosis) with 22 months of mean follow-up. Only one patient required a second operation (end to end anastomosis) with good outcome.The dorsal onlay urethroplasty with foreskin mucosa free graft is an effective technique in long and complex urethral stenosis, and we consider it the technique of first choice in view of our results.

We report two exceptional cases of metachronous adrenal metastasis of renal cell carcinomas and perform a bibliographic review. After the evaluation of various features such as frequency, etiopathogenesis, diagnosis and follow-up of these patients we conclude that these metastases are rare, and they usually appear late in the evolution of patients with low stage renal cell carcinoma.Once reviewed the treatment and checked the absence of guidelines for the therapeutic management of these patients we propose surgery for the adrenal metastasis as well as adjuvant treatment with immunotherapy.

Objetivo: Valoramos la indicación y nuestros resultados en el tratamiento de la estenosis de uretra compleja mediante la Técnica de Barbagli. Métodos: Realizamos una revisión retrospectiva de 8 pacientes a los que se indica la uretroplastia dorsal con injerto de mucosa libre prepucial. Analizamos las características preoperatorias de los pacientes. La longitud media de la estenosis fue de 6,25 cm, la localización bulbar en 7 casos y peneana en uno. El flujo medio obtenido en la flujometría preoperatoria fue de 8,78 ml/seg. Describimos la técnica y presentamos los resultados obtenidos con la misma. Resultados: Con un tiempo medio de seguimiento de 22 meses tenemos un 87,5% de buenos resultados, entendiendo estos como la resolución definitiva de la estenosis. Sólo 1 paciente ha precisado un nuevo tratamiento quirúrgico (anastomosis término terminal), con buen resultado evolutivo. Conclusiones: Concluimos que la uretroplastia dorsal con injerto libre de mucosa prepucial es una técnica efectiva en estenosis de uretra larga y compleja y que por los resultados obtenidos, la consideramos técnica de primera elección en este tipo de estenosis uretrales.

Objetivos/Métodos: Presentamos dos casos excepcionales de metástasis suprarrenales metacrónicas de carcinoma de células renales y revisamos la literatura existente. Valorados distintos aspectos como la frecuencia, etiopatogenia, diagnóstico y seguimiento de estos pacientes concluimos que estas metástasis son poco frecuentes y suelen presentarse tardías en su evolución en pacientes con CCR con bajo estadios anatomo-patológicos. Resultados/Conclusiones: Revisado el tratamiento y constatando que no hay directrices en cuanto al manejo terapéutico de estos pacientes con metástasis proponemos la cirugía de la metástasis suprarrenal así como el tratamiento adyuvante con inmunoterapia.

Purpose High-risk prostate cancer is a potentially lethal disease that is increasing in the diagnosis of prostate cancer patients. Compared to other prostate cancer patients (medium or low risk), management, diagnosis and treatment are not as successful among high-risk patients. Because the genetic characterization of prostate cancer patients is increasing, we aimed to determine whether genetic information in one of the primary associated genes, such as RNASEL (2', 5'-oligoadenylate-dependent RNase L), could be used as a biomarker to improve the quality of life and treatment among high-risk patients. The main objective is to identify genetic variants of RNASEL that could be associated with high-risk prostate cancer to improve the clinical managing of these patients. Methods A total of 231 prostate cancer patients were genotyped for 7 variants of RNASEL gene. Clinical information was obtained from medical examinations and genetic analysis (amplification and sequencing 7 variants of RNASEL gene) were performed by the researchers. Data were processed by statistical analysis (Chi square and logistic regression) using SPSS v.15.0. Results Comparisons between genotypes and clinical characteristics of patients revealed that individuals with GG in D541E, AA in R462Q and AG in I97L in RNASEL gene were high-risk patients according to the European Urology Guidelines. Conclusions Genotyping the RNASEL gene with routine diagnostic techniques could confer a more precise diagnosis of high-risk prostate cancer patients and increase the diagnostic accuracy above the current rate of 70% due to the relation between the genetic variants of RNASEL gene and the risk of this cancer.