Search

Bladder cancer is a frequent, chemosensitive disease and has shown good outcomes on several chemotherapy regimens over last 60 years. However, very little improvement has been shown in terms of overall survival and side-effects decrease.A review on manuscripts published in English and Spanish from 1949 including the terms chemotherapy and bladder cancer has been performed.Locally advanced or metastatic bladder cancer chemotherapy was initially introduced for metastasis management. The utilization of cisplatin base regimens has shown superiority over single therapy. The most commonly used regimens are cisplatine-metotrexate-vinblastine, metotrexate-vinblatine-adriamicine-cisplatin y gemcitabine-cisplatin. Neoadjuvant chemotherapy has shown to provide a minimal overall survival advantage, based on level 1 evidence. Neoadjuvant chemotherapy utilizes the same cisplatin-based regimens. Neoadjuvant chemotherapy is underutilized due to the inability to identify non-responders. Adjuvant chemotherapy is more controversial due to the lack of strong evidence. It is used when neoadjuvant chemotherapy has been utilized and the cystectomy pathology report is locally advanced. The best outcomes are for low-volume node positive patients.In bladder preservation protocols (aiming to decreased morbidity associated with cystectomy and chemotherapy), several regimens have been utilized in combination with radiation therapy. No standardized treatmentis available as no comparisons with cystectomy have been done.Chemotherapy has been utilized for several decades in muscle invasive bladder cancer without any major survival improvements or decreaseon side-effects. That is the rational why the treatment regimen are widely different amongst groups without a standard treatment.A pesar de que el tumor vesical es un proceso oncológico frecuente, ser quimiosensible y haber comunicado resultados con distintos quimioterápicos desde hace más de 60 años, pocos han sido los avances logrados en supervivencia global y disminución de efectos secundarios.ADQUISICIÓN DE LA EVIDENCIA: Se realiza una revisión de los artículos publicados en lengua españolae inglesa desde enero de 1949 con las palabras quimioterapia, cáncer y vejiga en cualquier campo de la publicación.La quimioterapia en el cáncer localmente avanzado o metastásico fue la primera empleada para intentar hacer regresar las metásta-sis. El empleo de combinaciones basadas en cisplatino ha demostrado superioridad sobre la monoterapia. Los regímenes más utilizados son cisplatino-metotrexate-vinblastina, metotrexate-vinblastina-adriamicina-cisplatino y gemcitabina-cisplatino. Como quimioterapia neoadyuvante, su utilización, aunque la mejoría en supervivencia es modesta, está basada en niveles de altos evidencia. Los regímenes son los mismos que para el avanzado y la imposibilidad de diferenciar los respondedores de los resistentes a la quimioterapia ha hecho que esté infrautilizada. La aplicación de quimioterapia adyuvante tiene más controversia porque los niveles de evidencia no son tan robustos. Se emplea cuando no se ha tratado con quimioterapianeoadyuvante y en la pieza de cistectomía el estadío es avanzado y tiene mejores resultados cuando es N+ con poca carga tumoral. En la preservación de órgano, para intentar disminuir la morbimortalidad del tratamiento de neoadyuvancia más cistectomía considerado el tratamiento con mayor evidencia, se han empleado diversas drogas combinadas en general con radioterapia sin conseguir un estándar de tratamiento al no haber comparaciones con la cistectomía.CONCLUSIÓN: La quimioterapia utilizada desde hace varias décadas en los tumores músculo-infiltrantes de vejiga no ha conseguido grandes mejoras en supervivencia ni disminución de los efectos secundarios. Por este motivo los esquemas de tratamiento varían de unos grupos a otros sin que haya un estándar de tratamiento.

The pandemic caused by the new SARS / Cov-2 Coronavirus represents an unprecedented scenario in modern medicine that affects many aspects of daily healthcare. Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) has a high prevalence and is related to high consumption of health resources. For this reason, we performed a revision of the management of LUTS and HBP during and after COVID-19 pandemic.A group of experts in benign prostatic hyperplasia from different regions of Spain were selected to design a strategy to reorganize the management of benign prostatic hyperplasia and lower urinary tract symptoms during the pandemic. A comprehensive review of the literature was undertaken and a set of recommendations are generated.Recommendations for the management of LUTS-BPH during and after the SARS/CoV2 coronavirus pandemic outbreak consist of promoting telemedicine and developing joint protocols with Primary Care Attention .Clear diagnostic and treatment criteria and referral criteria must be established. Referral of patients for risk complications such as kidney failure, recurrent hematuria and obstructive uropathy are a priority. Surgeries due to BPH are generally potentially delayed until phases I and II of the pandemic, in which the percentage of hospitalized patients with COVID-19 does not exceed 25%, and it is necessary to determine COVID19 negativity. The surgical technique that associates the least complications and the shortest stay should be selected.The diagnosis and prescription of treatment for BPH during the COVID-19 pandemic should be based on telemedicine and joint protocols for primary care attention and urology. Elective surgical treatment can be delayed until we are in phases I or II, individualizing the surgical and anaesthetic technique of choice to minimize risks.La pandemia causada por el nuevo Coronavirus SARS/Cov-2 supone un escenario sin precedentes en la medicina moderna que afecta de manera indirecta en numerosos aspectos de nuestra actividad diaria como sanitarios. La hiperplasia benigna de próstata (HBP) es una patología con una elevada prevalencia y consumo de recursos sanitarios. Por ello, es necesaria una revisión en el manejo de la misma con el fin de adecuarlo a las necesidades impuestas por los acontecimientos recientes.MATERIAL Y MÉTODOS: Un grupo de expertos en hiperplasia benigna de próstata de distintas comunidades autónomas de España fueron contactados para diseñar una estrategia para reorganizar el manejo de la hiperplasia benigna de próstata y los síntomas del tracto urinario inferior durante la pandemia. Se realiza una revisión narrativa de la literatura publicada y se generan una serie de recomendaciones de manejo.Entre las recomendaciones para el manejo de HBP en tiempos de pandemia por coronavirus SARS/CoV2 se incluyen la promoción de teleconsulta y la realización de protocolos conjuntos con Atención Primaria estableciendo criterios de diagnóstico, tratamiento y derivación claros y homogéneos. Deben priorizarse las derivaciones pacientes complicaciones de riesgo tales como insuficiencia renal, hematuria recidivante y uropatía obstructiva. Desde el punto de vista quirúrgico, se trata generalmente de cirugías potencialmente demorables hasta fases I y II de la pandemia, donde el porcentaje de pacientes hospitalizados con Covid-19 no supera el 25%, siendo preciso determinar negatividad de COVID19. Debe seleccionarse la técnica quirúrgica que asocie una menor tasa de complicaciones así como una estancia más baja.El diagnóstico y el inicio del tratamiento médico de la HBP durante la pandemia debe basarse en la instauración de la telemedicina y protocolos conjuntos con atención primaria y urología. El tratamiento quirúrgico electivo se puede demorar hasta encontrarnos en fases I o II, individualizando la técnica quirúrgica y anestésica de elección para minimizar riesgos.

To analyze the available evidence on Radium 223 therapy, an alfa particle emitter with specific action on bone metastases, studied on patients with castration resistant prostate cancer.We review the pivotal study ALSYMPCA, that served to get the drug approval for this phase of the disease, and the new data obtained from its use. We also performed a search of ongoing studies with Radium 223 alone or in combination with other molecules.According to the ALSYMPCA study, Radium 223 significantly prolongs the overall survival of patients with castration resistant prostate cancer and bone metastases; approximately 3.6 months in comparison with patients who received placebo, which turns into a median life expectancy of 14.9 months, and a 36-month survival of 46%, associated with a 30% reduction in death risk. Overall survival results were consistent both in patients who receive Docetaxel previously and those who did not.for secondary variables support the positive effect of Radium 223 therapy on symptomatic skeletal events (for example, the use of external beam radiotherapy to alleviate pain) and bone markers, confirming its efficacy in bone metastases.Radium 223 is the first treatment directed to bone that has demonstrated significant improvement on overall survival. It also prolonged the time to the first skeletal event and the median time to PSA increase significantly. All this in addition to its manageable adverse effects, lower than those appeared in the placebo arm of the pivotal study ALSYMPCA.

We describe two new cases of pelvic hydatid cysts, one with a clinical profile of local compression and the other one asymptomatic. The first case is a 75 year-old man who reported difficulty in defecating and urinating. An ultrasound revealed a large pelvic cystic mass displacing the bladder and rectosigmoid region. Computed tomography showed images compatible with hydatid disease and a hydatid liver cyst. The patient underwent a surgical procedure, with the pelvic cyst being partially excised. The other case of pelvic hydatid disease was asymptomatic, and was discovered by chance while examining a 75 year-old man for a prostatic adenoma. Because he was asymptomatic, we opted for observation. The pathology confirmed the diagnosis in the first case and radiological findings confirmed the second. Both patients are now asymptomatic. Hydatid disease must be considered in the differential diagnosis of any cystic masses in the pelvic organs, especially in countries where the disease is endemic. Although there are no serological tests which are 100% specific, there are some radiological procedures which can help to confirm the disease. Surgery is the treatment of choice.

Journal Article; PURPOSE To evaluate change in quality of life (QoL) and symptoms in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) in conditions of current clinical practice. METHODS Prospective, longitudinal, multicenter open-label study was carried out in urology outpatient clinics. Patients were ≥40 years of age with an International Prostate Symptom Score (IPSS) score ≥8. QoL and symptoms were measured at baseline and 6 months using the Benign Prostatic Hyperplasia Impact Index (BII) and the IPSS. RESULTS 1713 patients were included for analysis. Mean (SD) IPSS and BII scores at baseline were 16.8 (5.4) and 6.8 (2.6), respectively. 8.9 % (n = 153) of study participants did not receive treatment (watchful waiting, WW), 70.3 % (n = 1204) were prescribed monotherapy (alpha-adrenergic blockers [AB]; phytotherapy [PT, of which 95.2 % was the hexanic extract of Serenoa repens, HESr]; or 5-alpha-reductase inhibitors [5ARI]), and 20.8 % (n = 356) received combined treatment (AB + 5ARI; AB + HESr; others). At 6 months, improvements in QoL were similar across the different medical treatment (MT) groups, both for monotherapy (AB: mean improvement [SD] of 2.4 points [2.4]; PT: 1.9 [2.4]; 5ARI: 2.5 [2.3]) and combined therapy (AB + 5ARI: 3.1 [2.9]; AB + PT: 3.1 [2.5]). There were no clinically significant differences between MT groups and all showed significant improvement over WW (p

Background: The number of robotic-assisted procedures offered in Spain is rapidly increasing despite a lack of consensus criteria for training and credentialling. Objective: This national multicentre study was designed to analyze the different areas of the robotic urological surgery learning curve. Material and Methods: A questionnaire was sent to all 13 urology units in Spain with an active robotics programme requesting information on training and problems encountered. Results: In most centres (n = 11, 84.6%), training programmes were animal-based; cadavers were used at only 2 (15.4%). Proctoring in initial procedures was practiced by 12 groups (92.3%). When initiating the robotics programme, the console was shared at 8 units (61.5%). Prior experience in open and/or laparoscopic surgery was reported by 10 of the groups (76.9%), and experience in open surgery only by 2 (15.4%) or robotic surgery alone by 1 (7.7%). The procedure with which the robotics programme was started in all 13 participating units was radical prostatectomy. The number of cases needed to complete the learning curve for this procedure was 20–25 cases according to 8 (61.5%) surgery teams. Conclusions: Up until March 26, 2010, 1,692 operations, mostly radical prostatectomies, were conducted using the da Vinci robot in our country.

We describe two new cases of pelvic hydatid cysts, one with a clinical profile of local compression and the other one asymptomatic. The first case is a 75 year-old man who reported difficulty in defecating and urinating. An ultrasound revealed a large pelvic cystic mass displacing the bladder and rectosigmoid region. Computed tomography showed images compatible with hydatid disease and a hydatid liver cyst. The patient underwent a surgical procedure, with the pelvic cyst being partially excised. The other case of pelvic hydatid disease was asymptomatic, and was discovered by chance while examining a 75 year-old man for a prostatic adenoma. Because he was asymptomatic, we opted for observation. The pathology confirmed the diagnosis in the first case and radiological findings confirmed the second. Both patients are now asymptomatic. Hydatid disease must be considered in the differential diagnosis of any cystic masses in the pelvic organs, especially in countries where the disease is endemic. Although there are no serological tests which are 100% specific, there are some radiological procedures which can help to confirm the disease. Surgery is the treatment of choice.

We review the association between surgically resolvable aortic disease and horseshoe kidney with a discussion of diagnostic problems and therapeutic options. Male patient 81 years of age with horseshoe kidney and an abdominal aortic aneurysm that was discovered by chance in an abdominal ultrasound during a check-up for his prostate condition. A retroperitoneal approach was used in order to resect the aneurysm and perform an aorto-aortic bypass with no complications occurring. Two years after the diagnosis, the patient is still asymptomatic from a vascular point of view. The co-presence of horseshoe kidney and aortic disease needing surgical correction is infrequent, but it significantly increases the technical complexity of aortic reconstruction. A literature review is included.

Se analiza la relación entre enfermedad aórtica quirúrgica y riñón en herradura, y se comentan los problemas diagnósticos y las diferentes posibilidades terapéuticas. Paciente de 81 años con riñones en herradura que, durante el seguimiento de su enfermedad prostática, se descubre de forma casual por ecografía un aneurisma de aorta abdominal. Se realizó mediante abordaje retroperitoneal una resección del aneurisma y bypass aortoaórtico, sin complicaciones. A los 2 años del diagnóstico, el paciente continúa asintomático en cuanto a la alteración vascular. La coexistencia de riñón en herradura y afección aórtica que precise corrección quirúrgica ocurre con poca frecuencia, pero incrementa de forma significativa la complejidad técnica de la reconstrucción aórtica. Se realiza una revisión de la literatura.

To report a successfully treated case of inflammatory aortic aneurysm.A 57-year-old patient reported low back pain and urinary infections. An abdominal CT scan revealed a large inflammatory aneurysm in the abdominal aorta. An aortic bypass was performed with no complications.Patient course since surgery has been uneventful, and currently has no symptoms.Contribution of the radiographic team, mainly with the CT scan, is of great value both for differential diagnosis and adequate management and follow-up. Surgery is indicated to prevent aneurysm rupture, but an increased postoperative morbidity and mortality should be assumed.

The aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved.We reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with a minimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression.12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died.A stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance.

Resumen Objetivo Presentamos un caso de aneurisma aortico inflamatorio resuelto con exito. Material y metodos Paciente de 57 anos que consulta por dolor lumbar e infecciones urinarias. Se realiza una angio-TC y se descubre un aneurisma de aorta abdominal inflamatorio de gran tamano. Se interviene quirurgicamente, realizando un bypass aortoaortico, sin complicaciones intraoperatorias. Resultados El paciente evoluciona favorablemente desde la cirugia; en la actualidad, se encuentra asintomatico. Conclusiones La participacion del equipo de radiologia, fundamentalmente con el angio-TC, es de gran valor, tanto para el establecimiento de un diagnostico diferencial, como para un tratamiento y seguimiento correctos. La cirugia esta indicada para prevenir la rotura de estos aneurismas, asumiendo un incremento en la morbimortalidad postoperatoria.

Resumen Cada dia son diagnosticados con mas frecuencia de manera incidental Carcinomas Renales (CR), debido al aumento del uso de las tecnicas de Radiodiagnostico para el estudio de otras patologias. Su incidencia en los paises desarrollados es superior al 40%, siendo malignos el 80% de los tumores solidos de rinon menores de 4cm. El tratamiento estandar de este tipo de tumores es la nefrectomia parcial con un indice de recidivas del 1-2%. El mayor incremento en el diagnostico de esta patologia se ha producido en pacientes entre los 70 y 90 anos, grupo de edad que se acompana de gran numero de comorbilidades. En las dos ultimas decadas y acompanando al desarrollo de las tecnicas radiologicas, se han establecido entre nosotros dos tecnicas, ablativas, que a traves del frio, la Crioterapia (CA), y a traves del calor, la Radiofrecuencia (RFA), consiguen la necrosis del tumor. Los resultados oncologicos a corto y medio plazo alcanzan un 95% de remisiones en tumores menores de 4 cm. y al ser tecnicas que se pueden realizar por via percutanea, tanto las complicaciones como las estancias hospitalarias han disminuido. Ya en 1995 Bosniak basandose en la experiencia de la observacion del crecimiento y conducta de los CR pequenos durante mas de 8 anos propugna la postura de “Esperar y Ver” o “Vigilancia Activa”(VA). Presentamos la CA, nuestra serie de RAF y revisamos la literatura de la VA. Conclusiones En pacientes con edad avanzada, enfermedades concomitantes que desaconsejen la cirugia, monorrenos, con tumores renales multiples o pacientes que rechacen la cirugia, las tecnicas ablativas pueden ser utilizadas de manera segura y eficaz en manos expertas, alcanzando a medio plazo resultados oncologicos similares a la nefrectomia parcial, del mismo modo que en pacientes correctamente informados la vigilancia activa se ha demostrado como segura a medio plazo. Para mejorar las indicaciones, seran necesarias nuevas tecnicas diagnosticas, que nos ayuden a diferenciar los tumores potencialmente mas agresivos de los que no se van a desarrollar y series mayores y con mas anos de evolucion para confirmar los resultados actuales.

Resumen Introduccion y objetivos El objetivo de este estudio fue evaluar la evolucion de los pacientes que presentaban un T0 en la pieza de cistectomia para conocer posibles factores que nos ayuden a decidir cuando hacer preservacion vesical. Material y metodos Revisamos 153 cistectomias radicales realizadas por tumor vesical y sin tratamiento neoadyuvante en nuestro centro entre 1995 y 2005, con un seguimiento minimo de 3 anos. Seleccionamos los pacientes con pT0N0. Se tuvieron en cuenta la edad al diagnostico, el sexo, el estadio y el grado patologico de la reseccion transuretral (RTU), numero de resecciones, caracteristicas del tumor (multifocalidad, papilar o solido), tiempo libre de progresion, supervivencia libre de enfermedad y causa de muerte. Realizamos un analisis univariado de los diversos factores estudiados con la progresion de la enfermedad. Resultados Un 12,8% de las piezas de cistectomias fueron T0N0. La progresion ocurrio en un 35% en un plazo de entre 6 meses y 4 anos despues de la cistectomia. La supervivencia cancer especifica fue del 75%; 5 pacientes murieron en una media de 18 meses. La causa de la muerte fue en todos ellos progresion tumoral con metastasis a distancia. Los estudios estadisticos en un analisis univariado solo relacionaban con progresion, el numero de RTU previas, probablemente debido al tamano muestral, aunque la multifocalidad y el grado y el estadio tumoral resultaban destacables. Un 15% de los pacientes con pT0 tenian un fenotipo papilar, y de ellos un 33% murieron. Con fenotipo no papilar murieron un 23,5%. Conclusiones Un pT0N0 en la pieza de cistectomia no define esta cirugia como curativa y nos exige un seguimiento del paciente similar al resto. Es de destacar que no hubo recurrencia local en nuestros casos, sino metastasis a distancia, lo que nos hace pensar que estos pacientes podian haberse beneficiado de un tratamiento con quimioterapia sistemica sin requerir cirugia radical. En nuestra serie, el numero de recidivas previas fue el unico factor pronostico con significacion estadistica.

A case of ductal carcinoma of the prostatic utricle is described, previously known as endometrial carcinoma, and literature is reviewed.75-years-old patient who consults for lower urinary tract obstructive symptoms, with a PSA of 8.1 ng/ml., without more symptoms. Digital rectal examination and ultrasound showed a small and stony prostate. Deobstructive transurethral resection of the prostate was performed and the biopsy revealed ductal carcinoma of the utricle.Nine years after diagnosis signs of dissemination are not present.As incidental finding in the biopsy, ductal carcinoma of the utricle is a rare tumor, the incidence of which among all prostatic carcinomas has been cited as 0.2-0.8%. We report a review about this topic for improving its knowledge. Symptoms, pathological findings and treatment of this carcinoma have been reviewed.

Objetivo: Se presenta un caso de adenocarcinoma ductal prostático, anteriormente conocido como carcinoma endometrioide y se revisa la literatura. Métodos: Paciente de 75 años que acude a la consulta por sintomatología de obstrucción urinaria, PSA de 8,1 ng/ml., sin otra clínica acompañante. El tacto rectal y la ecografía abdominopélvica evidencian una próstata pequeña y pétrea. Se realiza resección transuretral desobstructiva y la anatomía patológica revela carcinoma ductal del utrículo prostático. Resultados: A los 9 años del diagnóstico no presenta signos de diseminación. Conclusiones: De hallazgo casual en el estudio anatomo-patológico, el adenocarcinoma ductal del utrículo prostático es una rara neoformación, cuya incidencia entre todos los carcinomas prostáticos ha sido citada entre 0,2 - 0,8%, si bien resulta interesante hacer una revisión sobre el tema para fomentar su estudio. Se revisan la clínica, diagnóstico y tratamiento de dicho carcinoma.