-
[show abstract]
[hide abstract]
ABSTRACT: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following at least one negative prostate biopsy (PB).
A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP) or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points.
Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density (OR: 1.47; 95% CI: 1.22-6.64; p: 0.007) and PSA-velocity (OR: 2.87; 95% CI: 1.60-5.12: p < 0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points in detecting PC were 0.15 and 1 ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40 - 35.40), following surgery.
PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity > 1l ng/ml/year and one or more negative saturation biopsies.
Actas urologicas españolas 09/2008; 32(8):779-86. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We are publishing a case of sixteen years old male, with inferior caval agenesis suffering a fall, and having a serious trauma over the left renal unit. We review the recommendations of intervention in front of high grade renal trauma and we too study the existing knowledge on the literature in order to get a posible higher incidence of this kind of trauma in patients with these anomaly.
Actas urologicas españolas 05/2008; 32(4):467-9. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: prostate cancer is the most frequent tumor in males. The use of PSA contributes to diagnose tumors with low stage. Radical Prostatectomy (R.P.) is the gold standard to treat this tumor; however such is not exempt of risks. Different technical modifications like minimal incisions minilaparotomy "minilap" had contributed to improve results. We review our experience with Minilap on patients underwent a RP.
Between April 1997 and September 2005 carry out 110 RP with Minilap technique. All cases were performed with minimal incision 7-8 cm of length. We use and specific retractor developed in our hospital. Median age at time of surgery was 65 (47-79). Clinical stage in 39 (35.4%) were T1c, 64 (58.3%) T2 and 7 (6.3%) T3. Sixty eight percent were Gleason score < or =6, 34(30.9%) 7 and 1 (0.9%) Gleason 8.
In 86 cases (38.5%) pathological stage were pT2, 21 (19%) pT3, 1 (0.9%) pT4 and 2 (1.8%) pT0. Nine patients (8%) had postoperative complications. No re-interventions were necessary and 101 (90%) were discharge without per operatives complications. Mean length of stay was 4 days and 97 (88.8%) of patients were discharge with only five days length of stay. Urinary continence rate with a year like minimal follow up is 92.3% and 40% preserve sexual activity.
Minimal invasive techniques like minilap can be done in regular form with good results and without long learning curve.
Actas urologicas españolas 07/2007; 31(6):593-602. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the current role of PSA as a diagnostic method for prostate cancer, as well as to analyze possible new markers.
We perform a bibliographic review for PSA, and its molecular forms, as a marker to define the presence of prostate cancer. We review the factors related to PSA modifications, predictive models, or the current controversies about the usefulness of its cutpoint to define the risk of prostate cancer or the marker itself. We analyze possible new markers and the most interesting work lines in the development of new markers. We used MEDLINE for the bibliographic search.
Available data confirm that PSA has a high sensitivity; although specificity is low, mainly in the < 10 ng/ml range, it may be increased with the use of various molecular isoforms, ratios or predictive models. Nevertheless, it is true that despite such studies it is difficult to increase specificity, so biopsies are reduced. Currently we have new markers, some of them already marketed, others in development, which seem to improve the specificity of PSA (isoforms, use of molecular biology).
PSA is still the standard marker for the diagnosis of prostate cancer. It is important to improve the specificity; therefore we need new predictive models or new isoforms that help us to do a better selection of candidates for biopsy. There are various promising research lines with new markers, but there is not ideal substitute for PSA yet.
Archivos españoles de urología 12/2006; 59(10):1069-82.
-
[show abstract]
[hide abstract]
ABSTRACT: Locally advanced prostate cancer supposes a high risk condition of post-treatment progression due to the limit situation that represents. Our purpose was to analyze prognoses factors in function of progression probability after using a treatment with external source radiotherapy on patients with this kind of tumors.
We retrospectively reviewed a set of 128 patients submitted to pelvic staging limphadenectomy prior to accomplish an external radiotherapeutic treatment. We employed the Kaplan-Meier curves to study the probability of progression, logarithmic ranks test were used for detection of possible statistically significant differences and proportional risks Cox model was employed to study possible risk factors of progression (employing astro criteria).
5 years freedom probability from progression was of 49,93%; in spite of appreciating important differences in the groups stratified by the predictive variables used (total PSA, gleason of pathological biopsy, clinical stage and % of cores affection on biopsy), none of them reached statistical meaning, being the level of total PSA the closest to it.
The external radiotherapeuthic treatment represents a valid alternative in the treatment of locally advanced prostate cancer, with a tolerable index of secondaries. It must be used combined with hormonotherapy. It seems that the use of higher radiation doses, in a safer way thanks to 3D conformed radiotherapy, allows to improve the results. The most powerful clinical predictor of evolution must be the total PSA.
Actas urologicas españolas 11/2006; 30(9):856-65. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Renal angiomyolipomas are not very frequent in urologic activities. Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. Tuberous sclerosis shows lesions to different organs, including these both entities.
We retrospectively analyze patients treated in our center. Three most representatives cases are reported. An indexed literature review is done, in order to establish a clinical protocol to manage these kinds of patients. RESULTADOS: Between 1990 and 2004, eight patients have been attended with an angiomyolipoma renal diagnostic. Five women (62%) and three men (38%). Medium age is 52,3y (29-69). In 3 of them (all women), it was also done a diagnostic of pulmonary lymphangioleiomyomatosis.
Bourneville syndrome is not very frequent. Associated angiomyolipomas usually are multiple, bilateral, with tender to grow and require more interventions. Previous diagnostic let us prevent future complications with vigilance, selective arterial embolization and nephron-spare surgery. Tumour size and the presence of symptoms are more decisive to decide best therapy alternative. Young patients with pulmonary lymphangioleiomyomatosis should be advise against pregnancy and the use of preparations containing estrogens.
Actas urologicas españolas 05/2006; 30(4):386-93. · 0.46 Impact Factor
-
A Blanco Díez,
E Fernández Rosado,
G Suárez Pascual,
I Rodríguez Gómez,
M L Ruibal Moldes,
S Novás Castro,
F Gómez Veiga,
L Alvarez Castelo, A Barbagelata López,
J Ponce Díaz-Reixa,
M González Martín
[show abstract]
[hide abstract]
ABSTRACT: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients.
We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent.
we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months.
In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.
Actas urologicas españolas 03/2005; 29(2):190-7. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present two cases in which during retropubic prostatectomy for benign prostatic disease a prostatorectal fistula ocurred. We describe its reparation using a pedicled flap of gracilis muscle. We also present cystographic and opaque enema images which shows the before and after of this surgery. Patients had good outcome without incontinence nor problems related to muscle desinsertion surgery.
Actas urologicas españolas 07/2004; 28(6):466-71. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We present two cases of urethral disruption in women, a very uncommon situation because of the anatomical features. Yet it must be always suspected in all women under a pelvic politraumatism, for eviting important problems. Both cases are traffic politraumatized young girls presenting with pelvic fracture, among others. The surgery performed was combined suprapubic-transvaginal approach, even in one a previous endoscopic realinement was done, who also needed endoscopic complementary treatment: electrofulguration of a fistulous bridge. Outcome of both is fine, achieving good continence. We also make a literature review.
Actas urologicas españolas 05/2004; 28(4):318-23. · 0.46 Impact Factor
-
Actas urologicas españolas 05/2004; 28(4):332. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: High flow arterial priapism is rare and characterized to a prolonged non-painful partial erection. Arteriocavernous fistula, rarely bilateral, is associated with penile or perineal trauma (genitoperineal area). Review of the literature, in only eleven cases this fistula is bilateral. Different treatments with non common norm has been used. We report a case of a 27 years old male who presented high flow priapism secondary to bilateral postraumatic arterio-cavernous fistula. Autologous blood clot was used for fistulas embolization to minimize the risk of impotence in this young patient. No complications was registered. Eight months later the patient had normal erectile function and no fistula was detected on ultrasonography doppler. We consider arteriography with highly selective embolization using re-absorbable agents obtains the best results, the least risks and complications in this process.
Actas urologicas españolas 03/2004; 28(2):152-6. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Emphysematous pyelonephritis is a necrotizing renal parenquima infection, which is diabetes mellitus related in almost all cases. This is life threatening and has a high mortality rates despite aggressive management. The most important thing in management is a high diagnostic suspicious and also a rapid treatment, which means nephrectomy. We expose a case giving especial importance to clinical and image diagnose as treatment and evolution. We also make a literature review trying to understand this entity and find pathways for its therapeutic management.
Actas urologicas españolas 11/2003; 27(9):721-5. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We analyse our experience in performing the wet colostomy, also called urocolostomy and present seven cases treated at our hospital in which this was used. We present: a) three women, one underwent an urocolostomy as a result of a myelomeningocele with urinary and fecal incontinence, another because of a pelvic malignancy, and the third after developing a post radiotherapy cysto-proctitis; b) four men, one underwent this surgical procedure as a result of a traumatic paraplegia with multiple urinary fistulae and neurogenic bladder, the other three were secondary to pelvic malignancies (two bladder and one sigmoid malignacies). The outcome was fine in all cases with no pyelonephritis or metabolic imbalances; in all cases it represented a good option for these patients.
Actas urologicas españolas 10/2003; 27(8):611-7. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically.
The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC).
Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0.002; OR 5.0 (IC 95% 1.75-14.28).
Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes.
Actas urologicas españolas 31(10):1129-33. · 0.46 Impact Factor
