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OBJECTIVES: Although prostate cancer isprobably the most frequent cancer in men, little is knownabout its etiology. Clear evidence exists about variationsin the incidence of prostate cancer between populationsliving in different countries. These variations could beexplained by differences in lifestyle and a possible association with a set of substances that are able tointervene in the origin of the disease.METHODS: The reason that lifestyle may be the causeof prostate cancer is related to endocrine disruptors.These are a group of chemical substances that canmimic or alter hormone signaling. These disruptors areable to exert their effect at very low doses and actinsidiously over the years, even being able to pass theireffect on from one generation to the next. Cholesterolis an essential precursor in the synthesis of androgens,estrogens and other substances that are active inprostate cancer. Cholesterol is a central metabolite inlipid metabolism, the inflammatory response and otherelements involved in the formation and progressionof cancer. High cholesterol concentrations can giverise to the accumulation of androgens in tumor cells.Additionally, endocrine disruptors have been identifiedas being responsible for processes related withfertility, genital malformations and various hormonedependentcancers. Disruptors already identified includediethylstilbestrol, dichlorodiphenyltrichloroethane (DDT),polychlorinated biphenyls and dioxins.RESULTS: Though no clear direct association has yet beenfound in humans between most endocrine disruptors andprostate cancer, evidence suggests that an inadequatediet and contact with certain toxic agents predisposes tothe disease. These disruptors are known to be especiallyrelevant at particular times, such as during pregnancy,neonatal stages and puberty.CONCLUSIONS: The problem with these toxic agentsis that their peculiarities and way of acting over timemake their study difficult. Nonetheless, research must beencouraged given their importance.
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INTRODUCTION: In 2006, sunitinibapproval by the FDA was a real revolution for thetreatment of metastatic renal cell carcinoma (mRCC).However, considerable rates of dose reductions andtherapeutic suppressions with the standard regimen(4:2) have forced the search for new schedule proposalsin order to optimize the balance between side effectsand oncologic efficacy. Among these new proposals,the 2:1 scheme is the one that has generated moreexpectations.OBJECTIVE: The objective of this paper is to make areview and critical discussion of current evidence aboutthe new schedules of treatment with sunitinib.METHODS: Unstructured review of the literature on thevarious therapeutic regimens with sunitinib, making acomparison in terms of progression-free survival (PFS),overall survival (OS) and toxicity.RESULTS: We summarize the data from all relevantstudies published to date comparing the standard 4:2schedule versus the new 2:1. Most patients treatedwith 2:1 scheme are grouped in three retrospectiveobservational studies and mostly correspond to patientswho were initially treated with a 4:2 scheme and thenmoved to 2:1. A phase II randomized clinical trialcomparing 4:2 and 2:1 schemes from the beginninghas also been conducted. None of these studies foundsignificant differences between the two regimens interms of PFS or OS. Regarding the toxicity profile, the2:1 scheme has proved to be more advantageous thanthe 4:2.CONCLUSIONS: Despite the still limited amount of data,current evidence supports the use of a 2:1 schedule, asit provides patients substantial advantages because ofits better tolerability profile, without a loss in oncologicalefficacy. Currently, the 2:1 scheme is an appropriatealternative therapeutic strategy, especially in patientswith poor tolerance to the standard 4:2 regimen.
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OBJECTIVE: Hypercalciuria is a commonlithogenic risk factor. The aim of this study was, first,to study the characteristics of urine biochemical factorsof children with hypercalciuria (HC) and compare themwith those of children without hypercalciuria. Second,to analyze the differences between children with HC and lithiasis (HCL) and children with HC and no lithiasis(HCNL).METHODS: The sample was composed by 111cases with HC, divided into 2 groups: HCNL group,consisting of 93 cases with no personal history ofkidney stones, and HCL group, 18 cases with personalhistory of kidney stones. As a cohort control group, 113healthy children were used. Creatinine, urea, sodium,potassium, chlorine, uric acid, calcium, phosphorus,magnesium and osmolality: blood and 24-hour urinefollowing parameters were determined. Oxalate andcitrate were determined in urine.RESULTS: The mean values of natriuresis, uricosuria,phosphaturia, magnesuria, citraturia, calcium oxalateand calcium phosphate saturation were higher in HCNLthan in control group. The HCL group had phosphaturia,calcium oxalate and calcium phosphate saturationsmore elevated compared with the control group. Therewere no significant differences in urinary excretion ofvarious parameters when the groups HCL and HCNLwere compared.CONCLUSIONS: Our results show that childrenwith hypercalciuria without lithiasis associated showan increase in natriuresis, phosphaturia, uricosuria,magnesuria and citraturia. We found no differencesbetween these urinary abnormalities when comparedhypercalciuric children without lithiasis with those withhypercalciuria and urolithiasis
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Differentiating between the cases of megaureter that require surgery and the ones in whom treatment can be delayed is challenging. A large number of surgical techniques for the treatment of POM have been proposed aiming mainly to reduce renal damage by relieving the affected ureter. Resection of the affected ureteral segment followed by vesicoureteral reimplantation either with or without reduction ureteroplasty is the classic treatment, however posing a high rate of complications when performed in patients aged less than one year. Endoscopic techniques have also been described to avoid external diversion. Recently, refluxing ureteral reimplantation has been proposed as a temporary treatment for patients with POM. OBJECTIVE: To describe the ureteral meatotomy technique as an alternative to the refluxing ureteral reimplantation for POM in patients aged less than one year.METHOD: Retrospective study of patients with POM undergoing ureteral meatotomy, aiming to temporarily relieve the ureter. The procedure consists of a 1.5 cm-long cut made with scissors on the upper edge of the ureteral ostium at the 12 o’clock position, until the dilated portion of the ureter was found and abundant urine drainage was observed. The edges of the incision were sutured, joining together the ureteral mucosa and the bladder mucosa.RESULT: From 2011 to 2015, three patients with POM underwent ureteral meatotomy, with four renal units treated altogether. None of the patients presented complications and, as a sign of obstruction relief, all showed reduced dilatation at the ultrasound. No patient had complications.CONCLUSIONS: Ureteral meatotomy is a safe and effective technique in the initial treatment of POM in patients aged less than one year.
Case Report
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INTRODUCTION: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital. CASE DESCRIPTION: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients` clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient). RESULTS: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications. CONCLUSION: Laparoscopic removal of urachal remnants is a safe and reproducible technique.
Case Report
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OBJECTIVE: We report two cases of patients diagnosed with lymphoepithelioma-like carcinomas of the urinary tract. We review the literature of this rare entity. The objective is to clarify the clinical and therapeutic characteristics. METHODS: We present a retrospective review of medical records of two patients diagnosed with lymphoepithelioma- like carcinomas, one in the renal pelvis and the other in the bladder. We review the epidemiology, diagnosis and therapeutic alternatives. RESULTS: Case 1: A 74-year-old women with past medical history of left radical nephrectomy and retroperitoneal lymphadenectomy six years before for renal pelvis carcinoma type pure lymphoepithelioma-like, stage pT4R0pN1cM0. She received adjuvant chemotherapy with Cisplatin and Gemcitabine. Five years later, she presented tumor recurrence in the left ureteral meatus, this lesion was resected. The pathology reported a high-grade urothelial carcinoma with marked lymphoid component, stage pT1. At follow-up, one year after the last recurrence, the patient was asymptomatic. In tomography control, no local or distant recurrences were objectified. Case 2: A 82-year-old men with diagnosis of muscle- invasive bladder cancer. The tumor caused right obstructive uropathy without extracapsular, regional or remote extension. We performed a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversión type cutaneous transureterostomy. The pathology reported a urothelial bladder carcinoma type mixed lymphoepithelioma-like, stage pT4aR1pN2cM0. At six months follow-up, the patient had liver and spleen lesions and retroperitoneal adenopathic nodes, all suggestive of metastases. He is currently receiving symptomatic treatment of their disease. CONCLUSIONS: We emphasize the clinical importance involved in the diagnosis of this entity. The diagnosis influence the aggressiveness of treatment and disease-specific survival. Therefore, concomitant transitional cell carcinoma defines the prognosis. The role of immunohistochemical staining is fundamental, allowing us to confirm the presence of the epithelial component.
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OBJECTIVES: To evaluate the results of synchronous dual implantation of penile (PP) and artificial urinary sphincter prosthesis (AUSP) in patients with severe erectile dysfunction (ED) and urinary incontinence (UI) after radical prostatectomy (RP).METHODS: Between January 2006 and March 2015, patients who underwent synchronous dual implantation of PP for severe post-RP ED and AUSP for moderate to severe post-RP UI in our clinic were screened retrospectively. The erectile function and the continence status were evaluated by the questionnaires of IIEF-5 and ICIQ-SF. Results for the preoperative period and for the 1st postoperative year were revealed from patient charts. Long term results were evaluated by telephone interviews. Comorbidities, infection rates and complications were noted.RESULTS: A total of 14 patients underwent synchronous dual implantation; out of which, 11 had a long enough follow up period for a sufficient long term evaluation. 3/11 had MPP and 8/11 had two-piece IPP implantation together with an AUSP. All of the implantations were carried out through an upper transverse scrotal incision. Mean follow up time was 61.3 ± 20 months. In 1 patient who had received adjuvant radiotherapy, both of the devices were removed due to infection and cuff erosion. Mean daily usage of pads diminished from 4 to 1 while ICIQ-SF score decreased from 19 to 2 and IIEF-5 score increased from 3 to 23. CONCLUSION: Synchronous implantation of PP and AUSP is a safe and effective treatment option for patients with severe ED and moderate to severe UI after RP.
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OBJECTIVE: Testicular cancer (TC) is the most 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 epidemiology of TC in Colombia. METHODS: A literature review on four databases was performed PubMed, Embase, Lilacs and Scielo. Studies of incidence, prevalence, mortality and survival of TC were taken from different countries. Studies included were published in the last 10 years.RESULTS: 2308 references were reviewed by title and abstract. In search of local references in non-indexed journals 5 references were extracted. In total 139 references for review in full text were selected. The global incidence and prevalence of cancer varies. In the Northern Europe region, the highest incidence is evident, mainly in Denmark, Croatia and Norway. Followed by Western Europe and South America with Chile. In Colombia the general age incidence is 2,2/100.000, finding a zero incidence in departments such as Chocó and Guajira. CONCLUSIONS: A rise in the incidence of TC has been seen globally, this trend mainly in developing countries. In Colombia most studies are crossectional studies. By seeing the epidemiological data from some departments and the lack of specialists in those regions, it can be deduced the existence of an underreport of the disease that reveals the need to improve both surveillance systems and information registration, such as policies to achieve early diagnosis of TC.
