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INTRODUCTION: Prostate Fusion biopsy (MRI + prostate ultrasound) is described in literature as superior to classic random transrectal biopsy in order to identify suspicious lesion.OBJECTIVES: To evaluate the Prostate Imaging Reporting and Data System (PI-RADS) proposed by the European Society of Urogenital Radiology (ESUR) for detection of prostate cancer by multiparametric MRI in a consecutive cohort of patients with MRI and transrectal ultrasound prostate fusion-guided biopsy.MATERIAL AND METHODS: 87 patients with suspected Prostatic Cancer on prostate MRI underwent fusion transperineal prostate biopsy in our Department. 37 patients had at least one prior negative classic prostatic transrectal biopsy. Clinically significant tumor was described as Gleason 7(3+4) or higher. The Chi-square test was used to analyze the relationship between prostate cancer and the different PIRADS stages, as well as logistic regression and linear trend tests, comparing the proportions using measures of association intensity. We use the HITACHI Real-Time Virtual Sonography (HI-RVS) system, and the STATA/IC v.14.2 software for statistical analysis. RESULTS: 64.37% patients had tested positive for malignancy. Median age 67.89 years old. Median PSA 9.15 ng/ml, and average prostate volume was 54.05 cc. 124 suspicious lesions were described in prostate MRI (25% PIRADS III, 57% PIRADS IV and 17% PIRADS V). 5/31 lesions PIRADS III, 47/71 PIRADS IV and 18/22 PIRADS V were positive for malignancy, with a statistically significant linear relationship between PIRADS and malignancy (p<0.001) - HR 4.10 (CI 95% 1.81 to 9.32) for PIRADS IV and HR 5.07 (CI95% 2.22 to 11.59) for PIRADS V vs. PIRADS III. 3.23% lesions PIRADS III, 32.39% PIRADS IV and 63.64% PIRADS V corresponded to significant tumors. A statistically significant association between PIRADS and significant tumors (p<0.001) - HR 10.04 (CI95% 1.42 to 71.09) for PIRADS IV and HR 19.73 (CI95% 2.80 to 139.18) for PIRADS V vs PIRADS III was observed -.CONCLUSION: Our results show that transperineal targeted prostate biopsy using multiparametric MRI and transrectal ultrasound fusion is a safe procedure with excellent outcomes to obtain an accurate diagnosis of prostate cancer. Fusion biopsy has the potential to improve the diagnosis of malignancy and clinically significant tumors while reducing overdiagnosis.
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OBJECTIVE: The aim of this study was to report clinical features and management of penile cancer (CP) at the National Cancer Institute (INCan) of Mexico City over 20 years. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 405 cases of primary penile cancer (PC) treated at our institution between 1989 until 2015. Diagnosis, treatment and oncological outcomes are reported. RESULTS: Clinicopathologic and demographic information was available for 375 patients (mean age, 56 ys). At diagnosis, 140 (37.3 %) patients were cN0, 71(18.9%) cN1, 164 (43.37%) cN2 and 33 (8%) cN3. 14% had metastatic disease (lung and bone). Initial treatment included partial penectomy (n=123; 33.6%), and total penectomy (n=126;33.6%). 138 (36.2%) patients with high risk disease underwent bilateral inguinal lymph node dissection. 8% (56) had positive lymph nodes. Kaplan-Meier survival analysis showed a 10-year CSS (cancer specific survival) rate of 70%. There was no significant difference in CSS when stratifying per age. Five-year CSS for pT1, pT2, pT3 and T4 was 96%, 88%, 58% y T4 0%, respectively. A difference in CSS was found between pT2 and pT3 (p=0.047).CONCLUSION: The findings of our descriptive analysis provide information on natural history of penile cancer in Mexico. The surgical penile removal of the primary tumour remains standard of care. There was no difference in survival for age group.
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OBJECTIVE: To determine if the presence of moderate to severe lower urinary tract symptoms in medical resident are associated with workplace bullying.MATERIAL AND METHODS: Cross-sectional study con-ducted in medical residents. Moderate to severe lower urinary tract symptoms were defined as greater than 8 points on the International Prostate Symptom Score. Resi-dents were classified as bullied if their total score on the Negative Acts Questoinnarie-Revised, was above 41 points. Perceived bullying was considered as present when any positive answer was documented in a specif-ic question to measure this variable. Bivariate analysis to determine statistical differences between presence of lower urinary tract symptoms and exposure to both types of bullying was performed using c2. The magnitude and directions of all associations were determined by cal-culating the Odds Ratio with 95% level of confidence.RESULTS: 209 residents were included, 63% men; 68% reported at least one lower urinary tract symptom, of which, 56% were mild, 10% moderate and 2% severe. The prevalence of bullying was 42% while perceived bullying was present in 39%. Residents with ≥8 points on the International Prostate Symptom Score had higher risk of being exposed to bullying (OR: 2.8, 95% CI: 1.1-6.7, p=0.01) and/or perceived bullying (OR: 3.1 95% CI: 1.3-7.5, p=0.00). Female gender had greater risk than man for presenting lower urinary tract symptoms at basal state (OR: 2.8, 95% CI: 1.1-6.6, p=0.01).CONCLUSIONS: Medical residents with moderate or severe urinary tract symptoms may be related to bully-ing. Being a woman is associated with an increased risk of developing LUTS.
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OBJECTIVE: To evaluate the impact of a new renal lithiasis classification on the stone free rate. The new system would allow standarization of comparison between different series of percutaneous nephrolithotomy. MATERIAL AND METHODS: Patients undergoing NPCL between November 2011 and November 2016 were retrospectively analyzed. The stones were classified as simple (pelvic and/or calyceal stones that required a single access and/or use of a rigid nephroscope), complex (required the use of more than one percutaneous access and/or flexible instruments and/or combined access) and extremely complex (complete staghorn stones or anatomical alterations), according to the Ibarluzea-Llanes classification. Other variables analyzed were age, sex, diabetes, hypertension or taking anticoagulants, stones composition, placement of postoperative nephrostomy and surgical time. We performed a univariate and multivariate analysis using the chi-square or Fisher test and logistic regression.RESULTS: Sixty-nine procedures were included in 57 patients with a mean age of 51 years (13-84) and a mean follow-up time of 30 months. The stone free rate was 86%, 75% and 55% for a simple, complex or extremely complex stone, both at three months and a year. Only the stone type was associated with a worse stone free rate (p 0.03) with RR of 2.5 for a 95% CI.CONCLUSIONS: The Ibarluzea-Llanes clasification could be used as a new system for standarization of PCNL outcomes reporting.
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OBJECTIVE: To compare peri-operative and mid-term oncological outcomes between Open rad-ical cystectomy (ORC) and Laparoscopic radical cystec-tomy (LRC). METHODS: A retrospective cohort was assembled, in which 182 patients had been subjected consecutively to Radical Cystectomy (RC) for treatment of muscle-inva-sive bladder cancer (MIBC) between 2000 and 2010 in a single center. Two cohorts were included: ORC (n=83) and LRC (n=99). All the RCs were performed by the same surgeon. Perioperatory complications were registered according to Clavien-Dindo classification. We evaluated recurrence-free survival, cancer-specific survival and association between the surgical technique performed and disease recurrence, with co-variable ad-justment. RESULTS: Clinical and pathologic characteristics were similar for both groups. Significant differences were ob-served between the two groups, regarding blood loss, operative time and hospitalization days (p<0.04). The ORC group displayed 27 (32.5%) Clavien I-II cases, vs. 11 (11.1%) in the LRC group. Four Clavien≥III (4.8%) complications were reported in the ORC, vs. 7 (7%) in the LRC group (NS). Mean follow-up time for patients without recurrence was 23 months (12-48). A total of 60 patients (72.3%) showed recurrence in the ORC group, compared to 59 (59.6%) in the LRC group. Cumula-tive cancer-specific mortality index, stratified by surgical technique, was similar between both groups (p.-0.9)CONCLUSIONS: Based on our experience, LRC showed advantages in intraoperative bleeding and length of hospital stay with no difference in major com-plications between both groups. Mid-term oncological control, regarding local recurrence and cancer-specific survival, showed no significant difference between LRC and ORC in the management of MIBC.
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INTRODUCTION: The standard of care in muscle invasive bladder cancer is radical cystectomy; however; transurethral resection (TUR) followed by ex-ternal radiotherapy and systemic chemotherapy demon-strates comparable results with radical cystectomy in terms of local control and survival rates. OBJECTIVES: To evaluate our results of multimodality bladder preservation therapy (BPT) in patients who had muscle-invasive bladder cancer and were reluctant to radical cystectomy. METHODS: The retrospective analysis of twenty-three patients with stage T2 transitional cell bladder cancer that were consecutively treated with BPT was performed. Treatment strategy included radical TUR followed by 3 cycles of cisplatin, gemcitabine combination, and ra-diotherapy of 64 Gy as adjuvant treatment. The Ka-plan-Meier survival estimates and log rank were calcu-lated. RESULTS: Median follow-up time was 58 (15-158) months. Disease-free survival (DFS) and five year over-all survival (OS) rates for 23 patients were 55.9% and 63.9%, respectively. Cancer-specific OS was 67%. There were no grade 3 or higher complications. CONCLUSIONS: Our small patient group suggests that BPT can be safely applied in selected cases with blad-der cancer or in patients that refused radical cystectomy.
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OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures.METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospec-tive study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative dai-ly uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the pa-tients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, re-spectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silo-dosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.
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OBJECTIVES: The double-J (DJ) stents are commonly used to relieve the ureteral obstruction. Besides several known benefits, some of the patients encounter stent-related morbidities with considerable ef-fects on the quality of life, general health situation, sex-ual matters, and daily work performance. In this study, we evaluated the effectiveness of tamsulosin/solifenacin combination and mirabegron in reducing DJ stent-related symptoms.MATERIALS AND METHODS: A total of 120 patients with 28cm 4.7fr DJ catheter inserted due to ureteral ob-struction were included in this study. Patients were randomly divided into three groups of 40 each; group one received only oral hydration for six weeks; group two received 0.4 mg tamsulosin/10 mg solifenacin, and group three received 50 mg mirabegron. Preoperative and after 6 weeks, the VAPS, OAB-q index, and IPSSs forms were filled.RESULTS: The mean age of the patients was 41.60 ± 12.34 years. There was no significant difference be-tween the groups in terms of preoperative and postoper-ative VAPS values (p>0.05). There was a significant dif-ference in postop IPSSs values (p:0.001). It was higher in the hydration group than tamsulosin/solifenacin and mirabegron groups. Postoperative IPSS value of the hy-dration group was 21.78 ± 2.54 while the tamsulosin/solifenacin and mirabegron groups were 15.6 ± 4.37 and 13.65 ± 4.97, respectively. The use of mirabegron and tamsulosin/solifenacin combination alleviates the LUTSs related with DJ stent. There was also a significant difference between groups in terms of postoperative OAB-q values (p:0.001). Postoperative OAB-q values in the tamsulosin/solifenacin group were significantly higher than the mirabegron group. Postoperative OAB-q value of the hydration group was 29.95 ± 5.21, while the tamsulosin/solifenacin and mirabegron groups were 23.68 ± 4.07 and 18.15 ± 4.1, respectively. Our re-sults also showed that, as a beta-3 adrenergic receptor agonist, mirabegron can improve the OAB-q scores.CONCLUSION: Tamsulosin and solifenacin combina-tion is a significantly good treatment option for reduc-ing LUTS associated with DJ stents. Mirabegron single therapy showed good results in treating LUTS and better results in treating OAB symptoms related with DJ stents than other therapies.
Review
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OBJECTIVES: Retroperitoneal fibrosis (RPF) is an uncommon disease due an inflammatory condition and deposit of fibrotic tissue that involves the retroperito-neal area over the lower four lumbar vertebrae. Very few epidemiologic studies exist that accurately characterize the incidence and prevalence of the disease. MATERIALS AND METHODS: A review of the English language literature was performed using the MEDLINE combining the keywords: “retroperitoneal fibrosis”, “Or-mond´ disease”, “IG4 related disease”. Additionally, hand search of bibliographies of included studies and previous reviews was also performed to include addi-tional information. RESULTS: RPF develops insidiously, because the initial symptoms are non-specific. Pain is the most common pre-senting symptom. Various radiological diagnostic meth-ods are used in the diagnosis of retroperitoneal fibrosis. Contrast-enhanced computerized tomography (CT) is a useful method for diagnosing retroperitoneal patholo-gies. Magnetic resonance imaging (MRI) is an important radiological method especially in the diagnosis of fibrot-ic tissue and in the examination of the retroperitoneal organ relation with fibrous tissue. Nuclear imaging is also a method used in renal function evaluation and pa-tient follow-up. Various medical and surgical treatments would be used in the treatment of retroperitoneal fibrosis. In general, immunosuppressive agents such as cortico-steroids, tamoxifen, azothiopurine, cyclophosphamide, cyclosporine, progesterone, mycophenolate mofetil are used in medical treatment. Surgical treatment methods are recommended in cases where medical treatment is not efficient. CONCLUSION: Unfortunately, despite a recent surge in the number of publications on this topic, a few progress has been made in our understanding of the classifica-tion, pathophysiology, and, most importantly, the most appropriate treatment for this disease.
Case Report
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INTRODUCTION: Bevacizumab is a mono-clonal antibody used as a targeted therapy in blocking vas-cular endothelial growth factor in different types of onco-logical and non-oncological diseases. It has demonstrated survival benefits in the treatment of many types of malignant tumors, including lung cancer. As all drugs have adverse effects, one of the most uncommon being gastrointestinal perforation and few cases of ureteral stenosis. However, they do not mention or describe the perforation of segments of the urinary tract.OBJECTIVE: To describe renal pelvic perforation as an ad-verse effect to the use of Bevacizumab.CASE DESCRIPTION: 67-year-old male patient with met-astatic lung cancer being treated with Bevacizumab who has perforation of the renal pelvis is presented. A pyelo-gram was performed showing contrast extravasation at the left renal pelvis and a double J catheter was placed, with a satisfactory clinical course, and tomographic control at 1 month without evidence of extravasation of contrast, with-drawing double catheter J.CONCLUSION: Renal pelvic perforation secondary to Bevacizumab is infrequent, but it must be taken into account in patients treated with this drug.
Case Report
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INTRODUCTION: There is still limited knowl-edge about surveillance and optimal management for pa-tients with recurrent chromophobe renal cell carcinoma.OBJECTIVE: Describe our experience in the diagnosis and management in recurrent chromophobe renal cell carcino-ma.MATERIAL AND METHOD: Review of medical records of patients with chromophobe renal cell carcinoma, selecting those cases that developed recurrence. RESULTS: Of the 23 patients, 4 developed recurrence and were the subjects of our analysis. The mean age was 61.5 years. Surgical treatment of primary renal tumor consisted of three radical nephrectomies and one partial nephrecto-my. The mean time from nephrectomy to disease recurrence was 6.7 years. One patient had recurrence in the retro-vesical area, another in bone, and the two others in the retroperitoneum. The treatment for retrovesical recurrence was an incomplete metastasectomy followed by temsiroli-mus and subsequent removal of the residual mass, staying stable. The other three cases were unresectable surgically and received sunitinib. One patient now has a stable dis-ease and the two others died.CONCLUSIONS: Chromophobe renal cell carcinoma showed a greater tendency to metastasize, so requires a surveillance protocol based on the risk of recurrence.
