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OBJECTIVE: To evaluate the evolution ofthe clinical presentation of this malignancy over time,and its possible prognostic repercussions.METHODS: A retrospective study of 538 patients sub-jected to surgery due to renal cancer in our hospitalduring the period 1995-2011. An analysis was madeof the evolution of the clinical manifestations at the timeof diagnosis, stratifying the results by years during fourtime periods.RESULTS: At the time of diagnosis, 53,4% of the patientswere asymptomatic for 1995-1999 and 72% in the pe-riod 2008-2011. Pain is the symptom that occurs mostfrequently (18.8%) followed by hematuria (15.4%). Theproportion of symptomatic patients increases in relationto stage and histopathological grade.CONCLUSIONS: The clinical presentation of renal can-cer has evolved over the years, not in terms of symptoms,which when present are still similar, but in terms of theirincidence
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OBJECTIVES: To identify pre-prostatectomy clinical prognostic factors for biochemical recurrence (BR) and to create a predictive model for BR based on predictive clinical variables prior to radical prostatectomy (RP). METHODS: a retrospective case-records study of patients with clinically localized prostate cancer treated with RPas monotherapy pN0-pNx and monitored at least for 12 months between 1996 and 2007. We considered BR the PSA persistence or elevation after RP greater than 0.4 ng/ml. The clinical variables analyzed were PSA, clinical stage and Gleason score from the biopsy (GS). Univariate and multivariate analysis were carried out using the chi squared test and logistic regression to determine the variables associated with BR. In order to estimate BR based on the variables identified we developed a mathematical model and designed an Excel spreadsheet to apply it. Calibration and discrimination were performed using the Hosmer-Lemeshow test and an ROC curve determining the area under the curve.RESULTS: We included 627 patients. The mean age was 64 years with a mean follow-up of 87 months. The mean PSA was 8 ng/ml. 68.6% of patients had a PSA ≤ 10 ng/ml, 53,1% had a GS ≤ 6 and 61,7% had a clinical stage of cT1a-c. BR was observed in 204 (32,5%) patients, 39 due to biochemical persistence. The mean time to BR was 28 months with 89,7% of instances occurring in the first 8 years. On the multivariate analysis, PSA and GS were independent predictors of BR (p=0.001), while the cT2c stage had a tendency towards statistical significance (p=0.06). The three variables were included in the equation for the model with different specific weight. Specificity was 93.6%, sensitivity was 36.8% and an overall precision of 75.1%. The model had a predictive capacity of 73% and a p-value < 0.001.CONCLUSIONS: PSA and GS are independent prognostic clinical variables associated with BR-free survival. The predictive model developed allows the risk of BR to be estimated with 73% reliability.
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OBJECTIVES: Our aim is to design a predictive model of seminal vesicle involvement. using clinical data.METHODS: We studied 1128 patients with clinically localized adenocarcinoma treated by radical prostatectomy (127 were pT3b). We identified (logistic regression) clinical variables related with pT3b. With the multivariate study influential variables a seminal vesicle involvement risk model is designed. RESULTS: Seminal vesicle involvement related factors: In univariate study: the influential variables are: Gleason 7 (OR:2);Gleason 8-10 (OR:4.5); T2 (OR:2.6); bilateral involvement in biopsy (OR:3.1); PSA 10-20 ng/ml (OR:3.3); PSA >20 ng/ml (OR:9.5). In the multivariate study are influential: Gleason 7 (OR:1.56); Gleason 8-10 (OR: 3.4); T2 (OR:1.9); PSA 10-20 ng/ml (OR:3.1) and PSA >20 ng/ml (OR:8.8). Predictive model: using multivariate logistic regression the weight of each variable is valued and a value between 1 and 4 is given. Gleason 2-6, T1; PSA<10 ng/ml value 1; Gleason 7; T2 y PSA 10-20 ng/ml value 2; Gleason 8-10 and PSA >20 ng/ml value 4. Each patient has a marker that fluctuates between 3 and 10. 5 Groups are designed with significantly different risks (p<0.05 in all cases): Group 1 (3 points) (OR:1)(risk: 2.4%; 95%IC 0.7%-4.3%) Group 2 (4 points) (OR:2.7)(risk: 6.5%; 95%IC 5%-7.9%) Group 3 (5-6 points) (OR:7.1)(risk:15%; 95%IC 11%-19%) Group 4 (7-8 points) (OR:33.4)(risk: 45.5%; 95%IC 30%-59%) Group 5 (9-10 points) (OR:57.3)(risk: 58.8%; 95%IC 35%-82%) .CONCLUSION: The clinical model allows an accurate approximation to the seminal vesicles involvement risk.
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OBJECTIVES: To report the preliminary results of one of the first series of patients treated with a new simple surgical technique for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and to evaluate its safety and feasibility.METHODS: We have performed a novel surgical treatment of BPH, the UroLift® System (Neotract, Inc). It opens the urethra directly by retracting the obstructing prostatic lobes without applying incisions, surgical resection or thermal injury to the prostate.preveRESULTS:The procedure was carried out in 20 patients with a mean age of 74.3 (43-90) years, with mean prostate volume of 42.6 mL (19-109) using the same operative protocol in all case subjects. Mean operative time was 19.1 min (range: 12-45). International Prostate Symptom Score (IPSS) at 4 weeks reduced from 26.7 to 16.7 and peak urinary flow rate (Qmax) increased from 8.6 mL/s to 13.2 mL/s. No major complications were encountered, neither sexual dysfunction. Mean follow-up: 12.3 (2-22) months.CONCLUSIONS: The UroLift® System procedure appears to be safe and efficient at short term. This technique minimizes the bleeding of the urethra and, therefore, makes bladder catheter not always necessary, and can preserve sexual function with low morbidity. Further studies are warranted to determine long-term outcome.
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OBJECTIVE: We present the case of a spontaneous subcapsular renal hematoma with increase of the levels of blood pressure in a patient previously normotensive.METHODS: Patient with abdominal pain, spontaneous without previous trauma. CT showed a right subcapsular kidney hematoma. High levels of blood pressure were noticed at the admission in urology.CONCLUSION: Page kidney is a cause of arterial hypertension due to external compression of renal parenchyma. It could be unnoticed as essential hypertension if high suspicion is not taken into account. Nowadays, the main cause of Page kidney is the renal biopsy in the context of kidney transplantation. The treatment is not recommended in the guidelines although the conservative management is proposed as first option.
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OBJECTIVE: Collecting Duct Carcinoma or Bellini Carcinoma (CDC) is a rare aggressive histological subtype. We present a case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor and review of the literature.METHODS: A 59-year-old man with no relevant clinical history presented gross hematuria. At the time of diagnosis, a computed tomography (CT) showed a tumor mass occupying the left renal pelvis. Left Laparoscopic radical nephroureterectomy was performed with endoscopic intramural ipsilateral ureter disinsertion.RESULTS: The pathological diagnosis was CDC with negative surgical margins. A CT scan control was performed 10 months later, showed a left retroperitoneal tumor compatible with a local recurrence. We performed a left subcostal laparotomy with complete resection of the mass. Histological diagnosis was large cell carcinoma with components of granular cells and clear cell.CONCLUSIONS: The CDC is a rare subtype of renal cell carcinoma (RCC) and has an aggressive behavior that is associated with poor prognosis. Surgical resection remains the treatment of choice. We present the first reported case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor.
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OBJECTIVE: To improve the knowledge aboutcomplications of renal transplantation and, in particular,graft rupture.METHODS: Case report and literature review.OUTCOME: We present the case of a 37 year-oldpatient receiving a second renal transplant. In the thirdpostoperative day, he suffered an abrupt change from thecorrect evolution, with intense pain in the left iliac fossa (theside of the implant) and hemodynamic instability. Imagingtests suggested retroperitoneal collection and adjacent tothe implant. In this situation we decided reoperation, wefound a ruptured renal unit and transplant nephrectomy wascarried out. The pathologic study confirmed that the causeof this rupture was acute rejection of the implant.CONCLUSION: The rupture of the graft is one of themost serious complications in renal transplantation.Rapid diagnosis and surgical treatment are required.Conservative management is the treatment of choice forpossible preservation of the renal unit, but there are somesituations in which it is dangerous and removal of the graftmust be carried out
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OBJECTIVE: To describe a case of endosalpingiosis of bladder and review of the literature.METHOD: A 38 years old women referred to an outpatient urology clinic with postmenstrual voiding symptoms.RESULTS: We studied her and ultrasound imaging detects tumor that was confirmed by cystoscopy. She is diagnosed of endosalpingiosis of the bladder after transurethral resection, and a CT shows a consistent mass next to left adnexal with high probablility of being an endometrioma.CONCLUSIONS: Endosalpingiosis of the bladder is a rare disease that occurs in young women with cyclic urinary symptoms. The implantation of tubular tissue in the bladder is diagnosed and treated definitively by tumor excision and anatomopathologic examination.
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OBJECTIVE: To describe a case of urachal adenocarcinoma treated with robotic assisted laparoscopic partial cystectomy and en-bloc exeresis of urachus and umbilicus and bibliographic review.METHODS: A 63 year-old man with hematuria and hypogastric pain. He was diagnosed of urachal adenocarcinoma by transurethral resection and axial tomography. We performed a robotic assisted laparoscopic partial cystectomy using a da Vinci® S HD (Intuitive Surgical System) device. We describe the surgical technique and examine total length of time for surgery and for console, pathology report, margin status, postoperative outcome and oncological status 7 months after surgery.RESULTS: 4 ports were used for robotic arms and one additional for the assistant. Cystoscopy was performed during surgery to mark tumor margins. Bladder was closedusing a running suture with Poliglactin 0. Total length time for surgery was 2hs 28 minutes, console time was 1h54`. Two days later patient was discharged and no complication was reported. After two weeks Foley cathether was removed and bladder volume was 300ml. Pathology report informed undifferentiated urachal adenocarcinoma with perivesical tissue infiltration with margins free from tumor, corresponding to Sheldon IIIB and Ontario III classification. Seven months later patient was fee from recurrence.CONCLUSION: Robotic assisted laparoscopy partial cystectomy with en-bloc exeresis of urachal and umbilicus is feasible
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