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Objectives: To evaluate the most relevant epidemiological and survival data of the renal cell carcinoma (RCC) in a 90.000 citizens geographic area, as well as its association with risk factors such as tobacco or diuretic drugs use., Methods: All patients with the pathologic diagnosis of renal cell carcinoma between January 1st 1987 and January 31st 2004 were included in the study. Adjusted incidence rates (standardized) per 100.000 inhabitants year, annual percentage increase, and epidemic index in the health-care area VIII in Ciudad Real (90.000 inhabitants) were calculated. For the population adjustment we used the data Published by the National Institute of Statistics. We evaluated the differences in mortality between males/females, as well as in relation to tobacco consumption, using the chi-square test or the Fisher exact test, and the overall survival by a Cox regression model., Results: Thirty-eight RCC were diagnosed, with a maximum incidence of 7.21 cases per 100.000 inhabitants year. There was an annual percentage increase of 2.06% over the whole period. There were no statistically significant differences in gender-associated mortality (p = 0.1), tumor stage (p = 0.063), tobacco consumption (p = 0.13), diuretic drugs consumption (p = 0.69), or both (p = 0.5). Mortality was significantly higher during the first 5 years after surgery., Conclusions: The incidence of RCC is progressively increasing, and it is predictable that this trend will be maintained in the next years. Overall mortality (any cause) associated with RCC is higher in the first five years after diagnosis.

Objectives: To establish the trend of the bladder cancer adjusted mortality and its correlation with tobacco consumption in different Spanish Autonomic Communities over a 15 year period., Methods: We evaluate the trends of mortality rates associated with bladder cancer between January 1st 1989 and December 31st 2002 in the geographic area of Spain, as well as the tendency of tobacco consumption. Demographic and mortality data were obtained from the National Institute of Statistics, and consumption data were obtained from the Commissioner for the Tobacco Market in the Spanish Economics and Finances Ministry. We calculate the average number of cigarettes (1 package = 20 cigarettes) consumed per person; we also calculate bladder cancer adjusted mortality rates, presented as number of deaths for that cause per 100.000 persons year, and the ratio between number of packages of cigarettes consumed and adjusted mortality rate. We determine the yearly percentage increase over the whole period of study for both the mortality rate and tobacco consumption, and evaluate their correlation by the Spearman's coefficient., Results: Mean adjusted bladder cancer mortality rate over the period of study was 9.4 deaths per 100.000 habitants year, and mean tobacco consumption was 109.7 packages per person year. There has been a 2.05% yearly increase of bladder cancer associated mortality, mean cigarette consumption has diminished 1.3% per year. The Spearman's test did not show any correlation between both factors (p = 0.722)., Conclusions: Despite preventive measures for tobacco addiction in our country, there is an important continuous consumption. The increase in the incidence of bladder cancer does not seem to be related with higher tobacco consumption currently, therefore it may be related with other genetic or environmental factors.

Objectives: We report a new case of simultaneous renal cell adenocarcinoma and ipsilateral multifocal transitional cell carcinoma., Methods: 73-year-old man with initial diagnosis of transitional cell carcinoma of the urinary tract whose pathological report showed a asynchronous renal cell carcinoma., Results: We present microphotographs of both tumors after radical surgery., Conclusions: The presentation of both tumors in the same kidney is unusual, although there are around 47 cases in the bibliography worldwide, 8 of them in Spanish. Presentation of both tumors altogether does not worsen prognosis.

Objectives: To decide the action politics (to perform or not transrectal prostatic biopsy) for a PSA cut point of 4 and 10 ng/ml through the construction of a mathematical decision tree., Methods: We calculate the usefulness of the biopsy through a subjective score, from 0 to 10, established after a survey of the 20 staff members of the health-care area, applying an global analysis with creation of total profile cards through an orthogonal design., Results: The main usefulness of prostate cancer screening would be not to perform transrectal prostatic biopsies when PSA is lower than 4 ng/ml.

In a 42-years-old woman, an abdominal sonography was done, and a 10 x 9-cm solid cystic tumor on the left kidney appeared. Abdominal CT and arteriography showed a retroperitoneal heterogeneous mass surrounding and obstructing the ureteropelvic left junction. Tumor was removed under open surgery and the pathological study showed a benign schwannoma. We present this case because of its rarity 1%-10% of all primary retroperitoneal tumors.

We present a patient 50 years old, complaining of right lumbar pain and miccional syndrome for three weeks. After analytic and x-ray studies, renal tuberculosis and renal cell carcinoma was the diagnosis. We started with specific antibiotic therapy and a radical nephrectomy was developed. According with the literature revised, just three cases has been published before. Because is an unusual clinic presentation we present these clinical note, we discuss the pathogenic and therapeutic procedures.

Five 72-86 years old women complaining of vaginal bleeding and genital discomfort during the last three weeks. Physical examination show an urethral mass of 1 cm diameter with a black, hard and painful area inside. Blood test was normal, and clinical diagnosis of caruncle urethral thrombosis was done. Topic treatment was develop with good results. We discuss the pathogenic and clinical presentation as well as the treatment of this unusual lesion.

We analyzed 82 patients with transitional bladder cancer stages (T2-T4) M0. According to treatment, 3 different groups were considered: Group 1: 25 patients treated with TUR and radical cystectomy. Group 2: 33 patients also received external beam radiotherapy (45-60 Gy/5 weeks) prior cystectomy. Group 3: 24 patients were also treated with intraoperative radiotherapy (15 Gy) and 3 courses of neoadjuvant chemotherapy. Our results suggest that local control rate increases significantly with the intensity of treatment (Group 3: 62% patients were PT0). Similar results were achieved in multivariate analysis. Univariate analysis of survival shows ganglionar status, vascular embolism and treatment intensity as covariates associated. Multivariate analysis demonstrate that renal function and type of complementary treatment were the covariates associated with survival. Taking both groups 2 and 3, survival was related to pathologic stage, vascular embolism and renal function. In conclusion, the significant influence of complementary treatment on the local control and survival suggest strongly their systematic utilization in infiltrating bladder cancer.

Presentation of our experience on the clinico-pathological staging of clinically localized prostate cancer (PCa) in 38 patients undergoing staging lymphadenectomy, 34 of which were treated with radical prostatectomy. From total number of patients, 37% were correctly staged, 60% were under-staged and only 3% were over-staged. A total of 11 patients (29%) presented nodular metastasis at the time of lymphadenectomy. Out of the 34 patients undergoing radical prostatectomy, 10 (29%) had microscopical invasion of prostatic capsule and seminal vesicles infiltration. The likelihood of nodes affectation in patients with prostatic capsule invasion and seminal vesicles infiltration was 60% and 70%, respectively. Mean PSA was significantly higher in patients with advanced disease as compared to those with disease localized in the prostatic gland. Also, mean PSA was significantly higher in patients with prostatic capsule invasion and seminal vesicles infiltration. The analysis by logistic regression identified pre-operative PSA as the only variable significantly correlated to the patient's final pathological stage.

Presentation of 2 cases of retroperitoneal ganglioneuroma (paravertebral and adrenal, respectively), accidentally diagnosed during ultrasound study. In none of these 2 cases diagnosis by thin-needle puncture-aspiration was possible, therefore, surgical exeresis of the lesion was performed. When diagnosis is made prior to surgery, management can be conservative with close follow-up, unless neuroblastoma is identified or there is other disease-derived pathologies present.

We report a case of squamous cell carcinoma of the ureter with periureteral infiltration. Three years following radical surgery, no evidence of tumor progression has been observed. Only 1% to 1.6% of urothelial tumors of the upper urinary tract are purely squamous cell tumors. This tumor type carries a poor prognosis. Currently, the best results can be achieved by early diagnosis and radical surgery.

Review of our experience in the diagnosis and treatment of 44 patients with inferior vena cava tumoral thrombosis (IVCTT), associated or not to other neoplastic processes: 34 hypernephroma, 2 cava leiomyosarcoma, 1 paratesticular rhabdomyosarcoma and 1 biphasic synovial sarcoma. Twenty-five patients with hypernephroma and tumor thrombi in the ipsilateral renal vein only were excluded from the analysis since this fact did not change the usual therapeutic approach. In the 19 remaining patients, concomitantly to the primary tumour exeresis a thrombectomy was performed, using cavotomy with proximal and distal clamping in 11 patients and cardiopulmonary by-pass, deep hypothermia and cardiocirculatory arrest in 8 patients. The paper analyzes the radiological investigations performed in order to reach a IVCTT diagnosis, and reviews the related literature.

A case of urothelial carcinoma in pelvic ectopic kidney is described. The low incidence of both pathologies and their rare association justifies the description.

Presentation of the results obtained from the study of 64 patients with T2-4 stage vesical carcinoma, treated with radical cystectomy, local lymphadenectomy, with and without complementary radiotherapy, with and without neoadjuvant chemotherapy. The univariate study of 19/64 patients with microscopic nodular disease revealed a significant relationship with the pathological stage but not with the clinical stage. The multivariate study demonstrated that the most relevant prognostic factors are a decrease in tumoral stage (P) and the presence of vascular and/or lymphatic involvement in the TUR-biopsy. The analysis of survival confirms the poor prognosis of patients with metastatic nodular involvement, in spite of the association of pelvic radiotherapy or neoadjuvant chemotherapy to the treatment.

We report a case of upper urothelial tumor in a patient who had previously received prolonged cyclophosphamide therapy for Waldeström's macroglobulinemia. Although bladder tumors in cyclophosphamide-treated patients are relatively frequent, upper urothelial tumors are rare. Only 5 cases of this latter tumor type have been reported as of 1987. The literature on this disease entity is reviewed. Patients who have received prolonged therapy with cyclophosphamide or similar drugs must be followed very closely.

One case of paratesticular embryonal rhabdomyosarcoma (RMS), affected during its evolution by a tumoral thrombus in the inferior vena cava. This unusual association forced the use of a cardiopulmonary by-pass, profound hypothermia and circulatory arrest, in order to carry out complete exeresis of the damage. Also, revision of the literature emphasizing that today's therapeutical approach for RMS should essentially be multidisciplinary.

We report a case of hyperammonemia and transient blindness following transurethral prostatic resectin. Glicine and ammonia metabolism are reviewed. Water intoxication may not account for these symptoms.

We report a case of right common iliac artery fistula to the left ureter in a patient affected by an invasive bladder tumour treated with radical surgery, radiotherapy and neo-adjuvant chemotherapy. At the time of manifestation, our patient had indwelling catheters and presented an urinary tract infection. Diagnosis was established during autopsy. We feel that the cause of this complication is multifactorial.

The paper presents the results obtained from a study of 28 patients with high urothelial tumour, treated with radical surgery (total nephroureterectomy). Multivariable study of survival rates (Cox models) indicates that cellular differentiation is the most significant prognostic factor. Single variable study indicates that tumour stage has some significance mainly due to the large relationship to the degree of cellular anaplasty.

Prognostic factors were studied in 91 patients with diagnosed renal adenocarcinoma in stages pT1-4/N0-3/V0-2/M0. All patients had been treated with radical surgery, extended nephrectomy with or without cardiopulmonary by-pass and extracorporeal circulation in those cases with suprahepatic tumoral thrombosis. The tumoral features which have a significant incidence on the patient's survival rate are the degree of cellular anaplasia, GI 72% vs GII 42% vs GIII 22% (p less than 0.0001); pathological stage, pT1-2 86% vs pT3 30% (p = 0.0000), perirenal fat invasion, pT1-2 86% vs pT3a 61% (p = 0.01); renal vein or cava vein invasion, V0 72% vs V1-2 30% (p less than 0.01) and gangliar affection. N0 69% vs N1-3 11% (p = 0.0000). Development of systemic disease is significantly high in pT3 stages (p = 0.0001), mainly in pT3a (p = 0.01), N1-3 (p less than 0.05) and/or V1-2 (p = 0.01). There is premature development of metastasis conditioning death before the second year o study in 90% of patients. In our opinion, patients with renal adenocarcinoma in stages pT3a/N0/M0, pT3b/N0/M0 and pT2-4/N1-3/M0 present a high potential risk of developing metastatic disease following radical surgery. These patients, as well as those with high degree tumours and presumably minimum residual disease, are candidates for supplementary therapy with lymphokine immunotherapy (rIL-2,FNT, alpha or gamma IF, etc) with or without adoptive cellular immunotherapy (LAK or TIL) following radical surgery, and extended nephrectomy plus tumoral thrombectomy, if required, with or without cardiopulmonary bypass.

The by-pass technique with controlled cardiac arrest and hypothermia is probably the best method for an extirpation of intracava tumoral thrombi in renal tumours. The technique is easy to perform, represents a great help in the extirpation of thrombi regardless their size and location, and avoids massive bleeding.

One hundred and twenty-three patients with a Ta/T2 stage vesical tumour were studied in order to identify the histological aspects associated to a tumoral behaviour particularly aggressive. The multivariate study demonstrates that those patients with a infiltrating tumour (T1-T2) or diffused urothelial dysplasia, have specially high possibilities to progress with regard to the degree of cell anaplasia (p less than 0.05); very close follow-up is needed in those patients. Likewise, patients presenting disseminated dysplastic lesions and with a history of previous urothelial tumours, progress to a new tumour stage with a significantly higher frequency (p less than 0.01); in those cases, radical surgery is the choice treatment.

We study retrospectively 123 cases of patients suffering from Ta/T1/T2 vesical tumour so as to evaluate the Disease Free Period as a predictive factor of relapse potential, capability of progression and survival. This parameter has no influence over the variables that define the progression of the tumour, but it has a close correlation with relapse potential; Annual Relapse Rate (p less than 0.001) and Mean Interval between Relapses (p less than 0.0001). We were not able to show any relationship between Disease-Free Period and Survival, however it defines those tumours which relapse due to tumoural persistence. These tumours progress in stage in 80% of cases and 75% of these do so with deep tumours.

We present the results obtained from the study of 65 patients with vesical carcinoma stage T3 treated with radical surgery with or without supplementary radiotherapy, with or without supplementary chemotherapy. The multivaried study of survival (Cox's model) shows that it depends significantly on the surgical complications and on the pathological state at the time of the cystectomy. Univaried analysis indicates that patients with descent from post-radiotherapy stage and those subjected to IOR (intraoperative radiotherapy) have a significantly better survival than the rest and suggests that radiotherapy improves overall survival. Influence of supplementary treatment (radiotherapy, chemotherapy) in the survival of T3 bladder tumours subjected to radical surgery.

We present a fresh case of Pelvic Lipomatosis in a non obese young male. We comment on the suggestive radiological findings as well as on the therapeutic options. Although considered traditionally as a benign entity, it may cause serious physiopathological alterations in neighbouring organs.