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OBJECTIVES: To analyze the indicationcriteria used for conducting seminal vesicles biopsiesas well as the diagnostic capacity of other variablesinvolved.METHODS: We present the results of an observationaland retrospective study (May 2006 - December 2012)using a sample of 140 patients to whom seminal vesiclesbiopsies was performed in a first set of prostate biopsy.They were patients eligible for curative treatment andpresented any of the following criteria: PSA ≥15 ng/ml,suspicion of neoplastic seminal vesicle invasion ontransrectal US, and/or suspicious node in the prostatebase on DRE or transrectal US.RESULTS: Seminal vesicle invasion due to prostatecancer was detected in 22.2%. Patients with 3criteria had T3b in 66.7% of cases. The criterion mostassociated with T3b was the presence of a suspiciousnode in the prostate base, with an association of 29.3%of cases. Variables analyzed that had shown a greaterassociation with stage T3b were PSA density, thepresence of suspicious DRE, the Gleason sum.CONCLUSIONS: Our seminal vesicle biopsy protocolhas detected 22.2% of seminal vesicle invasion. Thedetection of a suspicious node at the prostate base hasshown the greatest association with T3b
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OBJECTIVE: The limitations of total serum PSA values remains problematic; nomograms may improve the prediction of a positive prostate biopsy (PB). We compare in a prospective study of Chilean men with suspicion of prostate cancer due to an elevated total serum PSA and/or abnormal digital rectal examination, the use of two on-line nomograms with the detection of primary malignant circulating prostate cells (CPCs) to predict a positive PB for high risk prostate cancer.METHODS: Consecutive men with suspicion of prostate cancer underwent 12 core TRUS prostate biopsy. Age, total serum PSA and percent free PSA, family history, ethnic origin and prostate ultrasound results were registered. Risk assessment was performed using the online nomograms. The European Randomized Study of Screening for Prostate Cancer derived Prostate Risk Indicator (SWOP-PRI) and the North American Prostate Cancer Prevention Trail derived Prostate Risk Indicator (PCPT-CRC) were used to calculate risk of prostate cancer. Immediately before PB an 8 ml blood sample was taken to detect CPCs. Mononuclear cells were obtained by differential gel centrifugation and identified using double immunomarcation with anti-PSA and antiP504S. Biopsies were classified as cancer/no-cancer, CPC detection test as negative/positive and the total number of cells/8ml registered. Areas under the curve (AUC) for total serum PSA, free percent, PSA, SWOP-PRI, PCPT-CRC and CPCs were calculated and compared. Diagnostic yields were calculated, including the number of possible biopsies that could be avoided and the number of clinically significant cancers that would be missed.RESULTS: 1,223 men aged > 55 years were analyzed, 467 (38.2%) had a biopsy positive for cancer of which 114/467 (24.45) complied with the criteria for active observation; 177/467 (36.8%) were Gleason 7 or higher. Discriminative power of detecting prostate cancer, showed areas under the curve of total PSA 0.559, SWOP nomogram 0.687, PCPTRC nomogram 0.716, free percent PSA 0.765 and CPC detection 0.844. CPC detection was superior to the other models (p>0.0001). Using the recommended cutoff values, free percent PSA avoided 81% of biopsies missing 58% of significant cancers; for the other models the values were SWOP 75% and 56%; PCPTRC 61% and 62%, CPC detection 57% and 4% respectively.CONCLUSIONS: CPC detection was superior to the other models in predicting the presence of clinically significant prostate cancer at initial biopsy; potentially reduces the number of unnecessary biopsy while missing few significant cancers. Being a positive/negative test it avoids defining a cutoff value which may differ between populations. Multicenter studies to validate this method are warrented.
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OBJECTIVE: Testicular cancer (TC) is themost common cancer in men between 15 and 44 years.It has been reported that the incidence of TC is rising.The aim of this article is to determine the epidemiologyof TC in Colombia.METHODS: A literature review on four databases wasperformed PubMed, Embase, Lilacs and Scielo. Studiesof incidence, prevalence, mortality and survival of TCwere taken from different countries. Studies includedwere published in the last 10 years.RESULTS: 2308 references were reviewed by title andabstract. In search of local references in non-indexed journals 5 references were extracted. In total 139references for review in full text were selected. Theglobal incidence and prevalence of cancer varies. In theNorthern Europe region, the highest incidence is evident,mainly in Denmark, Croatia and Norway. Followedby Western Europe and South America with Chile. InColombia the general age incidence is 2,2/100.000,finding a zero incidence in departments such as Chocóand Guajira.CONCLUSIONS: A rise in the incidence of TC has beenseen globally, this trend mainly in developing countries.In Colombia most studies are crossectional studies. Byseeing the epidemiological data from some departmentsand the lack of specialists in those regions, it can bededuced the existence of an underreport of the diseasethat reveals the need to improve both surveillancesystems and information registration, such as policies toachieve early diagnosis of TC.
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OBJECTIVE: To analyze retrospectively the safety and effectiveness of percutaneous microwave ablation of solid renal tumors, and also review different approach techniques.METHODS: It is a retrospective study approved by the ethics committee of both hospitals. 14 tumors with a mean size of 37 mm (12-50 mm) were treated in a single session, under general anesthesia and with CT guidance, in 14 patients (9 men) with a mean age of 66 years, using the ablation system AMICA by different approaches (trans pulmonary, trans peritoneal and retroperitoneal). A biopsy was performed with a core needle to 13 of them prior to ablation in the same session. CT abdominal follow-up was performed (with and without i.v. contrast) at 1, 3, 6, 12, 18 and 24 months after ablation. Changes in serum creatinine levels pre- and post-ablation were also analyzed.RESULTS: The average follow-up time was 16.5 months (3-28 months) and we obtained complete response in 100% of the treated tumors. Only two minor complications were observed: one self-limited perirenal hemorrhage and one asymptomatic hydronephrosis, in the two patients to whom we did a transpulmonary approach, without pneumothorax in any of them.CONCLUSION: Percutaneous ablation of renal tumors seems to be a safe and effective technique, either via transpulmonary, transperitoneal or retroperitoneal approach, depending on tumor location.KEY POINTS: • Microwave ablation produces coagulation necrosis.• The sink effect is smaller in microwave ablation.• Microwave ablation seems to be safe and effective.• The type of approach is not correlated with major complications (Clavien> o =II).
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OBJECTIVES: To analyze the predictivefactors for retreatment in RIRS to achieve complete lithiasisresolution.METHODS: Retrospective comparative study analyzing298 cases of RIRS performed in our center over a 3year period. The cohort was divided in two groups: Resolutionin one operation or more than one, evaluatinghomogeneicity for age and gender. We compared thefolowing variables: Hounsfield units, body mass index(BMI), number of stones, size, (on the case of multiplestones, larger stone size), side, location in the kidneyand stone biochemistry. Bivariant statistical analysisby Student`s t and Chi square tests, and multivariateanalysis by binary logistic regression. ROC curves weremade to set cutting points for relationship between quantitativevariables.RESULTS: The groups were homogeneous for both ageand gender (p>0.05). 260 (87.25%) patients requiredone treatment only and 38 (12.75%) more than one.Among the study variables, the only one that showeddifferences between the groups wa stone size, beingthe mean size 18 mm in the single treatment group and26 mm in the more than one treatment group (Differencebetween mean values -8.27, 95%CI: -5,91 -- -10.63,p<0,001).CONCLUSIONS: RIRS with holmium laser is still aneffective technique for the treatment of renal lithiasis.The largest stone size is related with the need of retreatments,so it must be taken into consideration speciallyover 2 cm. In our series, for every extra millimeter insize the probability of retreatment increased 1.14 times,demonstrating the importance of size in this context.
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OBJECTIVES: Mini-PCNL is a potentiallyless invasive technique than standard percutaneousnephrolithotomy (PCNL). We present our experienceand results comparing both approaches in large burdencomplex renal calculi.METHODS: Prospective non randomized studycomparing PCNL (24/26F nephroscope; Group A)and Mini-PCNL (15/18F; Group B) perioperative andpostoperative results, in 40 (20 each group) consecutivepatients between 2013 and 2014. We analyzedemographic data, hemoglobin drop, urine culture,stone characteristics, operative time, puncture, numberand size of the tract, disintegration energy sources,nephrostomy placement, hospital stay, stone free rateand Clavien-Dindo complications.RESULTS: Evolution has shown growth for Mini-PNL,with the last 17 consecutive cases performed by thisapproach. No preoperative differences in laterality, age,gender or ASA were found; but there were differencesin BMI (median Group A: 26.35 kg/m 2 ; MedianGroup B: 33.05 kg/m 2 , p = 0.008). Median calculisurface area (SA = length x width x π x 0.25) washigher for mini-PNL (6.69 cm 2 vs 14.14; p = 0.003).The operative time was longer for mini-PNL (120 vs162.5 min, p = 0.03). Only one case (5%) requiredtransfusion in NLP 24/26F. Mini-PCNL was associatedwith tubeless technique (55%) (p = 0.022), whichexplains lower 24 h postoperative pain, after surgery,measured by VAS (p = 0.0004). The hospital stay wasequivalent (median: 2 days; p = 0.8). Both techniquesshowed efficacy (SFR at 3 months 80%). There were nostatistically significant differences between the numberand severity of complications between groups (GroupA: 15%, 66.7% Clavien II, Group B: 15%; 66.7%Clavien II, p = 1).CONCLUSIONS: Mini-NLP can manage kidney stonesand even large staghorn calculi without nephrostomy ina high percentage of patients. The technical evolutiontowards a small caliber approach maintains theeffectiveness of the procedure without impacting itssafety, with benefits perceived by patients such as lesspostoperative pain
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OBJECTIVE: We aimed to compare the success and complications of ultra-mini percutaneous nephrolithotomy and micro-percutaneous nephrolithotomy techniques.METHODS: We retrospectively analyzed data from 74 patients. Moderate-size stones were included in the study.RESULTS: Forty-two patients were included in MPNL, and 32 patients were included in UPNL groups. Among our patient cohort, 42 (56.7%) were males, and 32 (43.3%) were females. The mean age of the patients was 40±13.2 years in the MPNL group, and the mean age of the patients was 42±14.1 years in the UPNL group. The mean stone size was 17±3.2 mm in the MPNL group and 16.4±3.7 mm in the UPNL group. The stonefree rates were 88.1% (37/42) and 90.6% (29/32) in the MPNL and UPNL groups, respectively; there was no statically significant difference between the groups. The mean hospital stay was 1.4±0.23 days in the MPNL group and 1.1±0.12 day in the UPNL group.CONCLUSIONS: Two techniques have similar success and complication rates, and both may be preferred particularly in moderate-size stones. Our experience supports that our UPNL technique is safe and effective using with a standard ureteroscope.
