Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study.

BACKGROUND: Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). METHODS: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4 mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (ß-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. RESULTS: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with ß-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. CONCLUSION: In patients with PCa and bone metastases treated with ZA, ß-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important.

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study.

BACKGROUND: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). METHODS: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxy-terminal telopeptide of type I collagen (ß-CTX) were analysed. RESULTS: Patients with RCC who died or progressed had higher baseline ß-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline ß-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that ß-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. CONCLUSION: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOL.

The value of endorectal MRI in the early diagnosis of prostate cancer.

OBJECTIVE: Assess the value of endorectal MR imaging (EMRI) in the early diagnosis of prostate cancer (PCa) and compare this test to prostate specific antigen (PSA) and digital rectal examination (DRE) in the prediction of negative biopsies. MATERIAL AND METHODS: 92 patients with elevated PSA (>4 ng/ml) and/or abnormal DRE were studied. All patients underwent an EMRI previous to transrectal ultrasound guided needle sextant biopsies (3 cores in each peripheral zone), and were followed up. We performed a total of 184 biopsies: 92 patients underwent 1 biopsy; out of them, 61 patients underwent 2 biopsies, 27 patients 3 biopsies, 3 patients 4 biopsies and 1 patient 5 biopsies. 67 patients had a final negative biopsy and 25 had a final positive biopsy. Mean PSA was 10.44 ng/ml, and the mean % fPSA/tPSA was 0.20. Uni- and multivariate analysis and ROC curves were used to compare the accuracy of the different tests. The probability of positive biopsy with each technique was also assessed. RESULTS: EMRI had a high negative predictive value (91.07%) and the highest accuracy (77%) of all tests, higher than PSA (62%). Mean PSA was not statistically different in patients with negative biopsies (9.44 ng/ml) and positive biopsies (11.8 ng/ml) (p=0.064). The association of EMRI-DRE-PSA had the highest accuracy (83%) significantly higher than DRE-PSA (70%). The probability of positive biopsy in patients with negative DRE and EMRI, and PSA values between 5 and 15 ng/ml was 5-10% at first and second biopsies, but decreased progressively on subsequent biopsies (<8% at third biopsy, <5% at fourth biopsy and <3% at fifth biopsy). CONCLUSION: In patients with elevated PSA and/or abnormal DRE with two previous negative biopsies, an EMRI is a useful test to rule out PCa, when negative, and avoid subsequent biopsies, as they have a low chance of positive biopsy.

[Supraselective embolization of renal pseudoaneurysm caused by an abdominal stab wound]. / Embolización supraselectiva de pseudoaneurisma renal por herida incisa abdominal.

OBJECTIVE: To report the results of conservative management of post-traumatic (abdominal stab wound) pseudoaneurysm with arteriovenous fistula in segmental artery of left kidney and secondary persistent hematuria in an HIV positive patient. METHODS/RESULTS: A supraselective left renal arteriography revealed a pseudoaneurysm. We performed embolization of the aneurysmal artery with coils and fibrin particles. Resolution of the hematuria was immediately achieved with no side effects or significant complications. CONCLUSIONS: In our view, supraselective embolization is the first option in the treatment of post-traumatic renal artery aneurysms due to its low morbidity and limited aggressiveness.

[Dermatomyositis and small cell tumor of the kidney]. / Dermatomiositis y tumor renal de células pequeñas.

Dermatomyositis is an inflammation of the striated muscle with an important leukocyte infiltrate which is accompanied by a characteristic cutaneous exanthema. In the international classification we find DM associated with neoplasm in 10% of cases. It is accepted that neoplasms are related to DM if it does not exceed it in two years (prior o after the onset of the disease. The most commonly associated are lung, ovary and breast cancers. In the pas ten years only two cases of DM associated to renal cancer (both in renal cell cancers) have been published. In this article we present a case history of a woman with a DM associated to a renal oat-cell carcinoma. Also, we will review the literature on this theme and will evaluate the predictive parameters of the presence of malignancies in this pathology.

[Barcelona pouch. An external continent urinary diversion]. / Barcelona Pouch. Una derivación urinaria externa continente.

OBJECTIVES: To describe a new technique for external continent urinary diversion based on the Vesica Ileale Padovana technique (VIP) with a continent hydraulic valve, which obviates the need for external permanent collecting urinary systems. METHODS: An ileal neobladder was created following the VIP technique to which we added a modified Benchekroun continent hydraulic valve utilizing mechanical sutures. RESULTS: A continent heterotopic neobladder was achieved. The technique was easy to perform and permitted preservation of the upper urinary tract due to the pouch's low internal pressures. CONCLUSIONS: In our view, this technique is a valid alternative in patients unamenable to orthotopic diversion and are able to perform self-catheterization.

[Simplified vasovasostomy]. / Vaso-vasostomía simplificada.

OBJECTIVES: A simplified technique to repair seminal duct obstruction is described. METHODS: Optical magnification, a channeled instrument as a suture guide that we have developed and fibrin glue are utilized. RESULTS: This technique is safe, reduces operating time and achieves similar results as with a surgical microscope. CONCLUSIONS: This technique facilitates repair of small caliber structures, reduces the operating time and does not require large microscopic systems.

[New compound needle for percutaneous renal puncture]. / Nueva aguja compuesta para la punción renal percutánea.

OBJECTIVE: We have developed a needle for direct percutaneous access in order to introduce the flexible wire with a single puncture, without creating two parallel tracks, thereby affording a lower morbidity than the conventional technique. METHOD: The needle consists of an internal and an external device, with different lengths and diameters, that let us first create the access to the urinary tract with the inner device and then dilate with the outer device in order to introduce the metallic wire with a single puncture, sliding the outer over the inner device. RESULTS: We can achieve the same number of percutaneous accesses with less morbidity since less punctures are required to create the track. CONCLUSION: This is a useful needle for any type percutaneous access.

[Cyst of the seminal vesicle associated with renal dysgenesis and ipsilateral ectopic ureter. Apropos of 3 clinical cases]. / Kyste de la vésicule séminale associée à une dysgénésie rénale et à un uretère ectopique ipsilatéral. Présentation de 3 cas cliniques.

We discuss the cystic pathology of seminal vesicles, and its relation with ureteral ectopy, as well as the therapeutic options for both entities. We present our experience in the resolution of three typical cases.

[The therapeutic management of the rupture of a kidney graft]. / Actitud terapéutica ante la rotura del injerto renal.

From a consecutive series of 106 renal transplants, we present our experience on spontaneous renal allograft rupture. This complication appeared in 6 patients, which accounts for 5.6% of the overall group: four patients (66.6%) had acute rejection, two (33.3%) developed thrombosis of the renal vein (one of which coincided with rejection), and rupture was attributed to trauma in one patient (16.6%). Rupture was diagnosed within the first two weeks after transplant in five patients and on day 27 in one patient. The therapeutic approach was determined according to the cause of the rupture. In our view, nephrectomy is warranted in those cases with venous thrombosis and in acute rejection correction of hypovolemia and adequate immunosuppression are essential. Drainage of perirenal hematoma is the first step when conservative surgical treatment is required. We use three-dimensional renal corsetage with polyglycolic acid mesh (PAM) for hemostasis and to prevent expansion and fragmentation of the parenchyma. PAM is easy to handle and covers the kidney completely and uniformly. Two nephrectomies were carried out and in both cases thrombosis of the renal vein was diagnosed. PAM was placed in two cases: one with rejection and the other with trauma. The remaining two patients were managed conservatively due to the good response of rejection to immunosuppressor therapy and the patients response to medical treatment. There were no deaths and complications were observed in only one patient (16.6%). All patients with preserved transplant (66.6%) had a good course and renal function was preserved.

Histological and urographic findings in the autotransplanted ureter without kidney in dogs: preliminary report.

We took 7 dogs to undergo thorough autotransplant of the ureter as an autologous nonvascularized free graft, after having obtained good results with rats. The steps followed in these 7 dogs were the removal of a 10- to 12-cm segment of the ureter and the replantation of the same segment to the same animal. We must point out that both anastomoses were performed with interrupted sutures. Although some complications such as stenosis occurred, urographic studies showed that some animals kept their renal function for over 8 months after autotransplantation. Using contrast, we were able to observe the ureter. Similarly, we observed peristaltic waves on the ureters which were always dilated. Histologic studies showed preservation of the ureteral layers with hyperplasia of the ureteral mucosa, greater or lesser degree of submucosal fibrosis, and a variable degree of hyperplasia or muscular atrophy. Extensive areas of bone metaplasia were observed in some animals.