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.

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.

PURPOSE: Report and review the literature on ureteral avulsion as a rare complication of ureteroscopy. MATERIALS AND METHODS: We analyzed 3 cases of ureteral avulsion in a series of 4,645 ureteroscopic procedures performed from January 1990 to December 2001. We especially report the different managements for this complication. RESULTS: Due to the different extent of the injury, each patient was treated in a particular way, including a patient managed by means of an endourological approach. CONCLUSIONS: When performing ureteroscopy or using Dormia baskets, one should always bear in mind the possibility of serious complications, including ureteral avulsion or perforation. The use of an extremely careful technique of ureteral insertion, the mandatory placement of a safety guidewire, and a working guidewire, all minimize the risk of untoward events.