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Introducción: Analizamos nuestra experiencia en el manejo conservador y reconstructivo de los pacientes tratados de cáncer de pene y/o patologías cutáneas del pene en nuestra institución. Material y métodos: Hemos revisado retrospectivamente todos los procedimientos de injerto cutáneo realizados en la cirugía peneana a lo largo de los últimos 8 años. Se presentan las indicaciones y resultados de estas cirugías y el procedimiento quirúrgico detallado descrito originalmente por Bracka. Resultados: Diez pacientes fueron sometidos a extirpación parcial del pene seguida de técnica quirúrgica reconstructiva con injerto libre de piel creando un neoglande. No se han registrado casos de complicaciones mayores; dos pacientes tuvieron pérdida parcial del injerto y ninguno ha presentado recidiva local. Seis pacientes comunicaron haber reanudado su actividad sexual después de la curación completa. Conclusión: Existe un grupo importante de pacientes con cáncer de pene y/o otras patologías en el glande donde es posible realizar una cirugía reconstructiva peneana no mutilante con resultados oncológicos, estéticos y funcionales satisfactorios. Introduction: We analyse our experience in the conservative surgical management of penile cancer and/or penile skin pathologies at our institution. Material and methods: We have retrospectively reviewed all the skin grafting procedures performed in penile surgery in the last eight years. We show the indications and results of these surgical procedures and the detailed surgical technique originally described by Bracka. Results: Ten patients had several types of partial penile removal surgery followed by free-skin graft resurfacing, creating a neoglans. There were no relevant or major complications; two patients suffered partial necrosis of the skin graft. There was no local recurrence. 6 Patients returned to normal sexual activity after complete healing. Conclusions: There is a significant number of patients with penile cancer and/or other penile skin pathologies who can undergo definitive and non-mutilating surgery with excellent oncologic, cosmetic and functional results with skin grafting.

Introducción: La Prostatectomía radical es el tratamiento estándar para el cáncer de próstata organoconfinado. Clásicamente se presta atención a los márgenes positivos para células tumorales, pero no a la presencia de células hiperplásicas residuales a la cirugía capaces de generar antígeno prostático específico (PSA) y dificultar el seguimiento de los pacientes intervenidos. Esta situación nos lleva a plantear una revisión de la literatura, donde evaluemos la frecuencia de esta presencia, las posibles causas que lo justifiquen y la influencia de estas células en la evolución bioquímica de la enfermedad. Material y Método: Realizamos una búsqueda bibliográfica a través de la base de datos "Pubmed" utilizando los términos "Mesh" "Prostatectomy" y "Prostatic Neoplasms" y "Prostate-Specific Antigen" a los que añadimos los términos "biochemical failure" y/o "hyperplasic cells" y/o "benign cells" . Asímismo, seleccionamos los trabajos en lengua inglesa, española y alemana, revisamos los artículos que dichos trabajos referencian e incluimos las series con más de 50 pacientes, cartas al editor, editoriales y revisiones de conjunto. Conclusiones: La presencia de células hiperplásicas microscópicas residuales a la cirugía prostática radical, es un hecho frecuente que probablemente esté infra-evaluado. Los márgenes positivos para células benignas procederán del ápex o del cuello vesical donde la cápsula prostática no está bien definida, en ningún caso de la zona dorsolateral de la próstata, lo que traduciría un defecto de la técnica quirúrgica. La capacidad de estas células para generar PSA en cantidad suficiente para interferir en el seguimiento de los pacientes operados es controvertida. Recomendamos la inspección macroscópica de la pieza por el cirujano, tras la prostatectomía, para evaluar la integridad del ápex, zona craneal y cápsula dorsolateral. Introduction: Radical prostatectomy represents a standard surgical treatment for clinically localized prostate cancer. Classically pathologist and urologist worried about positive surgical margin, but not to the presence of surgery residual hyperplastic cells able to generate prostate specific antigen (PSA) and difficult the follow up of the patients that underwent surgery. We reviewed the literature looking for the incidence, the potential etiology and the influence of these hyperplastic cells in the biochemical evolution of the disease. Material and Method: The information for this review was compiled by searching the Pubmed database. We used "Mesh", Prostatectomy" and "Prostatic Neoplasms" and "Prostate-Specific Antigen" terms, and we added "biochemical failure" and/or "hyperplasic cells" and/or "benign cells". Furthermore, we select the work in English, Spanish and German, review articles that referenced this work and include the series with more than 50 patients, letters to the editor, editorials and overall reviews. Conclusions: Benign hyperplasic cells left behind after radical prostatectomy are frequent and probably under-rated. The influence of those cells in the biochemical outcome is a controversial issue. Positive margins for benign cells can come from apex or neck of the bladder, where the prostatic capsule is not well defined, but no from dorso-lateral area,this would imply a technical mistake. We recommend the inspection of the specimen by the surgeon, after prostatectomy in order to detect apex integrity, cranial and dorso-lateral capsule.

It is usual to identify patients with a negative prostate biopsy who are still at risk of prostate cancer. We try to analyse if the classical variables used in the prostate cancer screening are useful for those patients with a previous negative prostate biopsy, and if there is a possibility for making a nomogram witch would help us in the decision to repeat the biopsy.We studied 179 patients with at least 1 initial negative biopsy. At each biopsy session we recorded: Patient age, serum prostate specific antigen (PSA), free PSA/total PSA, PSA slope, digital rectal examination, prostate volume, PSA density, cancer suspicion in previous transrectal ultrasounds findings, number of negative cores previously obtained, history of precarcinomatous lesions and time between biopsies. Through Logistic regression analysis we determined the association of each variable a positive biopsy. A nomogram was constructed using all variables and discrimination was calculated as the concordance index.Overall 46% of patients had cancer at the repeated biopsy session. In the univariate analysis: Age, digital rectal examination, prostate volume, PSA density, cancer suspicion in ultrasounds findings, and precarcinomatous lesions were associated with repeat positive biopsy for cancer (all p0.05). In the multivariate study, age, digital rectal examination, prostate volume and history of precarcinomatous lesions were associated with repeat positive biopsy. A nomogram was constructed that had a concordance index of 0.80.