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OBJECTIVE: Some patients with the indication of radical prostatectomy (RP) have often undergone previous surgical treatment for bladder outlet obstruction (BOO). These previous treatments make oncological surgery more challenging because of the difficulty in the identification of bladder neck and ureteral orifices. We present a new technique that entails previous endoscoArch pic marking of bladder neck in order to make radical prostatectomy easier.METHODS: Twelve men with previous prostatic surgery for BOO underwent a laparoscopic/robotic radical prostatectomy between August 2008 and October 2012. The same technique was performed in all cases, a first circular endoscopic incision (EI) to mark the bladder neck and a second laparoscopic/robotic approach to complete the RP. We analyzed oncological and functional outcomes, as well as complications.RESULTS: Median operative time (EI + RP) was 175 minutes (140-205), being surgical time for endoscopic approach 20 minutes (17-31). No ureteral lesions were described and no ureteral stents were required. Positive margin rate was 8.3%. Only 1 of 5 complications observed needed surgery to be solved. Continence rate was 66.7% at one year of surgery.CONCLUSIONS: Our results show that a previous endoscopic bladder neck incision in patients with previous surgery for BOO makes easier the identification and dissection of the bladder neck itself during radical prostatectomy decreasing the risk of ureteral lesions as well as improving functional outcomes.
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OBJECTIVE: To investigate the manner to increase specificity in the decision-making process for the performance of prostate biopsy.METHODS: We include in this study men with PSA between 4 and 10 ng/ml and free/total PSA < 20%, candidates for prostate biopsy. Patients receiving 5 alpha reductase inhibitors or with previous biopsies were excluded. Analyzed variables: total PSA, total testosterone, free and bioavailable testosterone, FSH, LH, SHBG, 17 hydroxyprogesterone, Androstenedione, prostatic volume measured by transrectal ultrasound, total testosterone/PSA, testosterone/free PSA, bio available testosterone/PSA and PSA density, total testosterone/prostate volume, free testosterone/prostate volume and bioavailable testosterone/prostate volume. RESULTS: A total 109 patients have been included, divided into 2 groups according to the results of the biopsy. Significant differences were observed in prostatic volume (Group 1: 36.6cc and Group 2: 52.8 cc; p=0.04), PSA density (Group 1: 0.24 Group 2: 0.17; p=0.002), total testosterone/prostate volume (Group 1: 0.15 and Group 2: 0.10; p=0.02) free testosterone/prostate volume (Group 1: 0.002 Group 2: 0.001; p=0.01) and bioavailable testosterone/prostate volume (Group 1: 0.06 Group 2: 0.04; p=0.007). CONCLUSION: The decision for a prostate biopsy on patients with a PSA between 4-10 ng/ml with free/total ratio <20% continues to be an issue, however, we can optimize decision using other parameters such as prostate volume, PSA density and bioavailable testosterone/prostate volume.
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OBJECTIVES: Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series.METHODS: Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013.RESULTS: Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response.CONCLUSIONS: Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests.
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OBJECTIVE: To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy.METHODS: We performed a retrospective comparative study on a cohort of 99 men undergoing EBRT a mean of 4.7 years before for clinically localized prostate, rectum or colon neoplasia, and another cohort formed by 97 men over 50 years who did not undergo radiotherapy.RESULTS: Cystometric bladder capacity and bladder capacity at first voiding desire were significantly lower in the radiotherapy group. Univariate analysis showed that the radiotherapy group evinced a risk to present a diminished compliance of 3.5 times more and 9.3 times more to find stress urinary incontinence, but we did not found increased risk for detrusor overactivity. In multivariate analysis the history of radical surgery acted as a confounding factor in the risk of stress urinary incontinence, but not to suffer diminished bladder compliance.CONCLUSIONS: The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance.
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OBJECTIVES: To assess the risk of bias of clinical trials published in iberoamerican indexed journals from January 1, 2008 to December 31, 2012.METHODS: We performed a descriptive study based on the clinical trials published from January 1st 2008 to December 31st 2012 in the iberoamerican urological journals. We assessed the risk of bias by the Cochrane tool. We used descriptive statistics in Stata 13 and Revman 5.2 to create the risk of bias graphs within and across studies ESULTS: We identified 41 clinical trials: 21 trials in the International Brazilian Journal of Urology, seven trials in Actas Urológicas Españolas, six trials in Archivos Españoles de Urología, two trials in the Boletin Mexicano de Urología, four trials in Revista Mexicana de Urología and one trial in Revista Urología Colombiana. Most of these trials had unclear risk for the generation of the randomization (selection bias), the allocation concealment (selection bias) and the blinding (performance and detection). There was low risk of bias for incomplete results data (Attrition bias) and selective notification (notification bias). High risk of bias was found in other possible sources of bias, mainly because of low sample size. CONCLUSIONS: Based on the Cochrane risk of bias tool assessment, most of the published trials do not accomplish an adequate description of the methods. We should also be aware that most of the trials lack an adequate sample size calculation that limits the power of these trials. We recommend better description of the methods for randomization, and increasing the sample size to improve the quality of the trials published in urologic iberoamerican journals.
Case Report
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OBJECTIVE: To report two cases of emphysematous cystitis, a rare, potentially serious disease.METHODS: Analysis of two different cases treated in our center and review of the existing literature.RESULTS: One patient underwent emergency surgery (radical cystectomy) due to the advanced stage of the disease. The second patient, whose was in an initial stage, benefited from a new treatment, consisting of hyperbaric oxygen and wide spectrum antibiotics.CONCLUSIONS: Early diagnosis is the cornerstone of the conservative management of the disease. Hyperbaric oxygen therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease.
Case Report
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OBJECTIVE: To present the therapeutic management of severe complications related to postoperative mitomycin extravasation.METHODS: Description of clinical cases, medical and surgical management and pathologic results of surgical specimens.RESULTS: We report two cases of patients with extravesical mitomycin leakage after postoperative instillation. No bladder perforation was evident during tumor surgery. In both cases radical cystectomy was required.CONCLUSIONS: Postoperative mitomycin instillation may have undesirable consequences. The possible problems derived from its administration must be known, and each case must be individualized before administering this chemotherapy
