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Photoselective vaporization of the prostate (PVP) with a potassium titanyl phosphate (KTP) láser and Holmium láser enucleation of the prostate (HoLEP) currently represent the most promising new technologies applied to the treatment of benign prostatic hyperplasia (BPH) associated with benign prostatic obstruction (BPO). The specific láser-light characteristics and the optimal interactions between lásers and prostatic tissue result in an even and efficient ablation of the prostate resulting in the formation of a clearly de-obstructed prostate cavity. PVP and HoLEP can be considered day-case procedures, as they require only a few hours of catheterization and are associated with minimal postoperative discomfort, while at the same time they offer results at least equivalent to the reference standards transurethral resection of the prostate and open prostatectomy. There is no doubt that larger studies with longer follow-up are necessary to further define the durability of results of PVP and HoLEP in the management of BPH, this review will address current issues regarding how both techniques are performed, their results and limitations as well as their role in the future management of BPH
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OBJECTIVE: To determine whether a 10-core prostate biopsy scheme is superior to the sextant scheme in diagnosing prostate cancer in patients programmed for a first biopsy, with negative rectal digital examination and PSA between 3.5-20 ng/ml.METHODS: A randomized prospective study was performed comparing two prostate biopsy schemes, with randomization stratification according to prostate volume (≤ 50 ml and > 50 ml). Sample size predetermination yielded a minimum of 304 patients in order to achieve the primary objective. Statistical analysis was carried out on an intent-to-treat basis, using the chi-squared test and uni- and multivariate analysis via logistic regression.RESULTS: Cancer was detected in 27.3% of the cases. A significant association was observed between cancer diagnosis and age (p=0.03), prostate volume (p=0.0001) and ultrasound nodule identification (p=0.0001). No correlation was observed with the total number of cores in the series (p=0.37) or with prostate volume ≤ 50 ml (p=0.87) or > 50 ml (p=0.09). In the multivariate analysis, age > 70 years (p=0.005), prostate volume ≤ 50 ml (p=0.001), and ultrasound nodule identification (p=0.003) were identified as independent variables associated to cancer diagnosis.CONCLUSION: No statistically significant differences were found between the two prostate biopsy schemes. In glands over 50 ml in size, the sextant scheme may prove to be insufficient
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OBJECTIVES: To study the validity of Matrix Metalloproteinase 9 as a complementary marker to PSA for the diagnosis and prognosis of Prostate Cancer.METHODS: Prospective study structured as a hospital-based cohort of 100 consecutive patients undergoing prostate biopsy. Serum determination of MMP-9 was carried out by means of inmunoassay . Statistical analysis was performed using the Stata/SE 8.2 software.RESULTS: 32 patients were diagnosed with prostate cancer and 52% had a Gleason score equal to or greater than 7. The values of serum MMP-9 varied between 225.7 and 1932.3 ng/ml, without significant differences among patients with benign, malignant and uncertain histology (p=0.429). The differences approached statistical significance in the subgroup of patients with PSA at 4-10 ng/ml (p=0.058), and significant differences were observed in the subgroup with free PSA to total PSA coefficient of less than 15% (p=0.037). No relationship between the Gleason score and the level of MMP-9 was shown (p=0.739). The levels of PSA and MMP-9 were shown to be independent (Pearson coefficient of correlation -0.1).CONCLUSIONS: It was not possible to show the efficacy of MMP-9 in predicting the result of the biopsy. In the group of patients with slightly increased levels of PSA (between 4 and 10 ng/ml) all the descriptive variables were higher in the group with malignant histology, though they did not reach statistical significance, they did reach significance when the coefficient of free PSA over total PSA was less than 15%, but this finding is not relevant clinically, as these patients already have a clear indication for biopsy. Neither was the relationship with the prognosis shown as there are no differences of MMP-9 expression at varying Gleason scores
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Polymorphisms Q279R, P574R and -1562 C/T of matrix metalloproteinase-9 (MMP-9) gene have been linked with the risk of cancer and with tumoral aggressiveness in various types of cancer. So far there are no studies in the literature analysing the link between polymorphisms Q279R, P574R and -1562 C/T of MMP-9 and prostate cancer.OBJECTIVES: To establish the presence of the MMP-9´s gene polymorphisms (Q279R, P574R and -1562 C/T)in relation to results of prostate biopsy, PSA values and Gleason score.METHODS: Hospital cohort of 100 patients with suspected prostate cancer, subjected to prostate biopsy, in whom the MMP-9 polymorphisms (Q279R, P574R and -1562 C/T) were analysed using the PCR-RLFP technique.RESULTS: No statistically significant differences were found in the presence of the Q279R, P574R and -1562 C/T polymorphisms in terms of prostate biopsy results (p = 0.264, p = 0.406, p = 0.860, respectively), or Gleason score (p = 0.373, p = 0.367, p = 0.476). Comparing the genotypes of the Q279R, P574R and -1562 C/T polymorphisms resulting from prostate biopsy, , using subgroups according to PSA values, no statistically significant differences were found either (p = 0.332 y p = 0.393, respectively ). However, statistically significant differences were found when comparing the genotypes of the -1562 C/T polymorphism of the MMP-9 in patients showing positive biopsy for malignant tumour in comparison to a negative biopsy for a malignant tumour in the subgroup of patients with PSA > 10 ng/ml (p=0.049). The joint analysis of the three MMP-9 polymorphisms, using logistical regression study did not reveal any statistically significant differences as far as the risk of developing prostate cancer is concerned based on the presence of the Q279R, P574R and -1562 C/T polymorphisms.CONCLUSION: The Q279R, P574R and -1562 C/T polymorphisms are not linked with the aggressiveness in prostate cancer, neither they are linked to the risk of suffering prostate cancer.
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OBJECTIVES: Helical CT without contrast iscurrently being evaluated for the diagnosis of renoureteralcolic. Ureteral obstruction and other pathologies withsimilar symptoms can be rapidly identified. This studyintends to evaluate the validity of CTh for these patientsand to compare it with the ultrasound technique in orderto consider the CTh as an efficient diagnostic alternativefor these pathologies.METHODS: A diagnostic evaluation study was carriedout between January 2004 and December 2006 in patients with persistent renoureteral colic after standardcare. They were blindly evaluated by ultrasound andCTh, maintaining the follow up until the “gold standard”confirmation. Qualitative variables were described byfrequency and 95%CI and quantitative variables byposition and dispersion measures. The χ 2 test was usedto compare qualitative variables. Validity indicators and95% CI were calculated and compared with McNemartest.RESULTS: 124 patients were studied. Lithiasis and theother diagnosis had frequencies of 59.7% and 40.3%respectively. The percentage of lithiasis obtained byultrasound (92) was 22.8% and by CTh (124) was59.7%.Validity indicators for CTh were superior to 95%, with100% sensitivity and positive predictive value. Ultrasoundspecificity and positive predictive value were 100%, butsensitivity was only 29.6% (p>0.05).CONCLUSION: CTh can be considered a goodalternative diagnostic technique in the renoureteral colicmanagement
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OBJECTIVES: To report a new case of late renal cell carcinoma recurrence.METHODS: Renal cell carcinoma represents approximately 3% of all adult malignancies. The most frequent metastatic sites are lung (76%), regional lymph nodes (66%), bone (42%), and liver (41%), and it is the third most common infraclavicular neoplasm to metastasize to head and neck. RESULTS: 73 year-old man with a 1 week history of recurrent epistaxis. He underwent left nephrectomy 17 years before due to a renal mass of 8.5 cm in the upper pole of the left kidney. The histological diagnosis of the referred mass was clear cell carcinoma. No metastatic lesion was found at that time (Stage I, pT2N0M0). CT scan showed a mass in the right nasal cavity, invading the right ethmoidal sinus and the right orbit. Examination under general anaesthesia and biopsy was performed revealing metastasis of a renal cell carcinoma.CONCLUSIONS: The natural history of renal cell carcinoma is highly variable, metastases may present decades after the removal of the primary disease, however, only 1% of patients with renal cell carcinoma have metastases confined only to the head and neck, and solitary cervical metastatic mass is rare. Moreover, renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck
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OBJECTIVES: To present a revision on the signet-ring cell bladder adenocarcinomas found in our department.METHODS/RESULTS: We reviewed all the transurethral resections of the bladder (TURB) performed between 1990 and 2009 finding 9 cases of primary signet ring cell adenocarcinomas ( 4 pure and 5 mixed). Eight were male and one female, with ages between 39 and 82 years. Definitive treatment was radical cystectomy with Bricker´s urinary diversion in four patients, cysctectomy with Mainz´s II diversion in one patient and palliative management with TURB in three cases and percutaneous nephrostomy in the remaining case. We used adyuvant chemotherapy in three cases. Only two patients were alive at the time of the study. Mean survival was 327 days for pure tumors and 586 for the mixed ones.CONCLUSIONS: Signet-ring cell primary adenocarcinoma of the bladder is an uncommon type of tumor, with worse prognosis than transitional cell cancer. It is important to discard other possible metastatic origins (like stomach, prostate, lung, or ovary) because the management will be different. Radical cystectomy is the treatment of choice, with adyuvant chemotherapy if possible. Five year survival is less than 11%.
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OBJECTIVE: To report an infrequent case of Stauffer’s Syndrome with jaundice as a paraneoplastic syndrome of a metastatic renal cancer.METHODS: We describe the set up of cholestatic jaundice without neoplastic liver infiltration in a patient with a metastatic renal cell carcinoma, which turned back with surgery and systemic treatment.RESULTS: Proper treatment of baseline disease enables turn back paraneoplastic signs and symptoms of Stauffer’s Syndrome.CONCLUSIONS: Reversible cholestatic jaundice without evidence of hepatic disease is an infrequent form of the Stauffer’s syndrome. This paraneoplastic syndrome is associated particularly with renal carcinoma but was described in lymphoproliferative diseases, prostate cancer and broncogenic tumors.This paraneoplastic entity is characterized by elevated alkaline phosphatase, erythrocyte sedimentation rate and gamma-glutamyl transferase without liver neoplastic infiltration
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Case Report
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