Overweight and obesity in men with prostate cancer do not constitute risk factors for biochemical recurrence.

AIM: To investigate if overweight and obesity were associated with a higher degree of biochemical recurrence (BCR) after radical prostatectomy, in Mexican men with prostate cancer (PCa). METHODS: We included 180 men with PCa, who underwent radical prostatectomy (RP). Body mass index (BMI) was determined and the degree of PCa aggressiveness was established according to the D'Amico classification. Postoperative follow-up of all patients was performed with PSA quantification every/6 weeks after surgery and then at 3-month intervals for 1 year, followed every/6 months for 5 years. Postoperative BCR was defined as two consecutive increases in PSA levels ≥0.4 ng/mL, after RP. RESULTS: Sixty eight percent of the patients presented overweight or obesity. We found that only intermediate/high risk patients presented an increased risk factor for BCR-free survival (HR = 4.39; 95% CI = 1.74-11.24; p = 0.002). The median follow-up of all men has been 7.9 years and no significant differences in BCR-free survival time has been observed between the BMI groups. CONCLUSIONS: The overweight and obesity do not represent a risk factor to present BCR after RP for PCa. However, an intermediate/high risk, according to the D'Amico's classification, constitutes a risk factor to present BCR after radical prostatectomy, which is not related to the BMI.

Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients.

PURPOSE: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. MATERIALS AND METHODS: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. RESULTS: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45% of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow up. CONCLUSIONS: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

The correlation between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED): results from a survey in males from Mexico City (MexiLUTS).

INTRODUCTION: ED and LUTS affect a high proportion of male population. Although Hispanics are suspected to have a higher risk of experiencing LUTS, detailed information on its frequency and association with ED in this population is scarce. OBJECTIVE: To determine the frequency of LUTS and ED, and its correlation in Mexican males. METHODS: A cross-sectional analytical survey was answered by 1041 men. It included the International Prostate Symptom Score and the quality of life question (IPSS/QoL); International Index of Erectile Function (IIEF-5); the short form of the International Consultation of Incontinence Questionnaire (ICIQ-SF); and demographic data. For the analysis, we divided our population into 2 groups (18-39 and 40 and older), and then an exploratory correlation analysis was performed to search for significant differences among IPSS severity groups, and finally a multivariate regression model was applied. RESULTS: Mean age was 48.6 ± 14.5 years. One hundred twenty-three individuals (11.8 %) were asymptomatic, and 611 (58.7 %) had mild, 226 (21.7 %) had moderate, and 81 (7.8 %) had severe IPSS score. The most common symptoms were nocturia (72.4 %), increased urinary frequency (58.3 %), and slow urinary stream (42.6 %). Two hundred fifty-eight (24.7 %) complained of incontinence. Of 765 individuals, 484(63.2 %) reported some degree of ED. Severe LUTS, DM, and age were independent risk factors for ED severity. CONCLUSION: LUTS and ED may represent one of the largest sources of morbidity in our population, and their association was demonstrated. Awareness on these entities should be raised, and further research is required to determine the higher frequency of LUTS and ED in Hispanics.

Genetic variants in ATP6 and ND3 mitochondrial genes are not associated with aggressive prostate cancer in Mexican-Mestizo men with overweight or obesity.

Mitochondrial defects have been related to obesity and prostate cancer. We investigated if Mexican-Mestizo men presenting this type of cancer, exhibited somatic mutations of ATP6 and/or ND3.Body mass index (BMI) was determined; the degree of prostate cancer aggressiveness was demarcated by the Gleason score. DNA from tumor tissue and from blood leukocytes was amplified by the polymerase chain reaction and ATP6 and ND3 were sequenced. We included 77 men: 20 had normal BMI, 38 were overweight and 19 had obesity; ages ranged from 52 to 83. After sequencing ATP6 and ND3, from DNA obtained from leukocytes and tumor tissue, we did not find any somatic mutations. All changes observed, in both genes, were polymorphisms. In ATP6 we identified, in six patients, two non-synonymous nucleotide changes and in ND3 we observed that twelve patients presented non-synonymous polymorphisms. To our knowledge, this constitutes the first report where the complete sequences of the ATP6 and ND3 have been analyzed in Mexican-Mestizo men with prostate cancer and diverse BMI. Our results differ with those reported in Caucasian populations, possibly due to ethnic differences.

[Comparison between surveillance, adjuvant radiotherapy, or salvage radiotherapy after radical prostatectomy in patients with prostate cancer (PCa) in stage pT3 or higher and/or positive surgical margins]. / Comparación entre vigilancia y radioterapia adyuvante o de salvamento después de una prostatectomía radical para cáncer de próstata (CaP) pT3 o con márgenes positivos.

OBJECTIVE: To assess the mid-term evolution of high-risk prostate cancer (PCa) initially treated with radical prostatectomy (RP) and to compare the role of surveillance and postoperative radiotherapy, either adjuvant (aRT) or salvage (sRT). METHODS: Retrospective study of 390 patients with PCa treated with RP at our institution from February 1988 to December 2012. Those in stage pT3 or higher and/or with positive surgical margins (PSM) were included. They were divided in three groups: group 1, undergoing surveillance after RP; group 2 receiving aRT; and group 3 receiving sRT. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. RESULTS: 156 patients were analyzed. Mean age was 63.8 ± 6.9 years (45-79). Mean follow-up was 58 ± 45 months; 71 (45.5%) had PSM, 40 (25.6%) were in stage pT3 or higher, and 45 (28.8%) had both features. Group 1 included 91 patients, group 2, 43 and group 3, 22. Initial prostate-specific antigen (PSA) was 12.8 ng/ml in group 1, 14.9 ng/ml in group 2, and 14.5 ng/ml in group 3 (p = 0.07). First postoperative PSA was 0.27, 0.87, and 0.50 ng/ml in group 1, 2 and 3, respectively (p = 0.007). Seven men died of PCa: three in group 1, three in group 2, and one in group 3 (p = 0.6). The CSS at five and 10 years was 100 and 89% for group 1, 95 and 80% for group 2, and 94 and 94% for group 3 (p = 0.71). CONCLUSION: Our results retrospectively show that surveillance, aRT and sRT are equivalent for the mid-term control of PCa after RP.

Extended sampling at first biopsy improves cancer detection rate: results of a prospective, randomized trial comparing 12 versus 18-core prostate biopsy.

PURPOSE: We determined whether increasing the number of cores at first prostate biopsy would improve the cancer detection rate without increasing the detection of clinically insignificant tumors. MATERIALS AND METHODS: From January 2009 to January 2010 patients scheduled for prostate biopsy were randomized to 12 or 18-core sampling. Study inclusion criteria were 1) age 45 to 75 years, 2) abnormal digital rectal examination and/or prostate specific antigen 4 to 20 ng/ml, and 3) no previous biopsy. The primary end point was the cancer detection rate. Secondary end points were clinically insignificant cancer detection and morbidity. RESULTS: A total of 150 patients were enrolled in the study. Preoperative variables were similar in the 2 groups of 75 patients each. Cancer was detected in 23 patients (30.7%) in group 1 and in 36 (48%) in group 2 (p = 0.02). More cases of insignificant cancer were detected in group 2 (p not significant). In men with prostate volume 65 cc or less the detection rate was 30.9% in group 1 and 52.8% in group 2 (p = 0.02). In men with prostate specific antigen 10 ng/ml or less the detection rate was 19.6% in group 1 and 38.4% in group 2 (p = 0.03). Two group 2 patients (5.5%) were diagnosed based on additional samples but the diagnosis corresponded to insignificant cancer. There was no statistically significant difference in morbidity. CONCLUSIONS: The 18-core protocol improves prostate cancer detection without increasing morbidity. Results suggest that the 12-core biopsy protocol is adequate for prostate cancer detection at first biopsy.

Time to recurrence after nephrectomy as a predictor of cancer-specific survival in localized clear-cell renal cell carcinoma.

OBJECTIVE: To evaluate the prognostic impact of early recurrence (within 12 months) after surgery on cancer-specific survival (CSS) of patients with localized clear-cell renal cell carcinoma (ccRCC). METHODS: Patients with surgically treated localized ccRCC were studied. Using the Kaplan-Meier method, we calculated CSS; by univariate and multivariate models we analyzed the association of early recurrence with cancer-related mortality. RESULTS: We identified 259 patients with pT1-4/NX/0M0 ccRCC treated between February 1981 and September 2009; of 66 (25.5%) with disease recurrence, 29 (43.9%) had early relapse. Overall, 43 patients (16.6%) died from ccRCC. The 5- and 10-year CSS for those without, late and early recurrence was 98.5 and 96.5%, 53 and 39.8%, and 23 and 23%, respectively (p < 0.0001). In the multivariate Cox model, pT stage (p = 0.01) and early recurrence (p < 0.0001) independently predicted CSS. CONCLUSIONS: Recurrent disease after localized ccRCC confers a poor prognosis, especially if detected within 12 months after surgery. Thus, this criterion should be included as an independent risk factor for cancer-related mortality.

Impact of metabolic syndrome on biochemical recurrence of prostate cancer after radical prostatectomy.

INTRODUCTION: Metabolic syndrome (MS) is linked to hormone-dependent cancers. Its prognostic implication in prostate cancer (PCa) is unclear. We analyzed the impact of MS in the survival of men with PCa treated surgically. PATIENTS AND METHODS: We studied patients with PCa, treated surgically between 1990 and 2007, and compared the survival of men with MS (group 1) and without MS (group 2). A subgroup analysis of those in stage pT2 was also performed. We calculated biochemical progression-free survival (bPFS) and cancer-specific survival, and the relation of clinical and pathological variables with these end-points. RESULTS: 65 men had MS. The 5- and 10-year bPFS in group 1 was 36 and 32% vs. 72 and 68% in group 2 (p < 0.0001). In multivariate analysis, prostate-specific antigen (p = 0.001) and MS (p < 0.0001) predicted biochemical progression/recurrence (BP/R). There was no difference in cancer-specific survival between groups (p = 0.40). Of 146 men in stage pT2, 38 had MS; group 1 men had worse 5- and 10-year bPFS (55 and 48%) than group 2 (80 and 73%; p = 0.001). In multivariate analysis, MS was the strongest predictor of BP/R (p = 0.0007). CONCLUSIONS: MS is related to adverse characteristics in PCa and confers poor bPFS after radical prostatectomy. MS is independently associated to the risk of BP/R.

[Prognostic factors in renal-cell carcinoma treated surgically: analysis of a cohort of 345 cases]. / Factores pronósticos en carcinoma de células renales tratado quirúrgicamente: análisis de una cohorte de 345 casos.

OBJECTIVE: To assess the prognostic role of clinical and pathological variables in patients with renal-cell carcinoma (RCC) treated surgically. MATERIAL AND METHODS: We retrospectively analyzed our database of 394 consecutive patients with renal tumors. We excluded those with hereditary conditions, benign tumors or histological diagnosis other than RCC. The variables evaluated were weight loss, performance status, thrombocytosis, tumor diameter, nuclear grade, lymph node invasion and metastases. The main endpoint was cancer-specific survival (CSS). We performed univariate and multivariate analysis to determine prognostic factors. RESULTS: We identified 345 patients with RCC treated surgically between 1980 and 2009. After a median follow-up of 32 months, 23% died from cancer; they had larger tumors (p<0.0001), higher nuclear grade (p<0.0001) and lymphovascular invasion (p<0.0001). The 5- and 10-year CSS was 97.6 and 97.6% for stage I, 75.3 and 63.8% for stage II; 62.3 and 55.5% for stage III; 16.5 and 11.0% for stage IV (p<0.0001). All variables were associated with CSS on univariate analysis. On multivariate analysis tumor size, thrombocytosis, nuclear grade, lymph node invasion and metastases were independently associated with cancer-related mortality. CONCLUSION: Our findings confirm the potential role of tumor size, nuclear grade, lymph node invasion and metastases. Thrombocytosis also has a prognostic role in patients with renal-cell carcinoma.

Impact of lymph node invasion and sarcomatoid differentiation on the survival of patients with locally advanced renal cell carcinoma.

INTRODUCTION: The application of current prognosticators in locally advanced nonmetastatic renal cell carcinoma (RCC) is controversial. We analyzed the impact of clinical and pathological variables on the survival of this subset of patients. PATIENTS AND METHODS: We studied patients with RCC in stages III and IV without metastases, treated surgically between 1980 and 2009. We calculated disease-free (DFS) and cancer-specific survival (CSS), and the relation of clinical and pathological variables with these end-points. RESULTS: We identified 126 patients with locally advanced RCC; 8.7% had sarcomatoid differentiation. Tumor stage was pT3a in 48% and pT3b in 42%; 11.9% had lymph node invasion (N+). Patients with N- and N+ had a 10-year DFS of 49.0 and 23.4%, respectively (p = 0.0001). In multivariate analysis N+ (p = 0.0002) was the strongest predictor of DFS. The 10-year CSS of patients without sarcomatoid differentiation was 53.1% while those with sarcomatoid differentiation did not reach the median time to death (p < 0.0001). In multivariate analysis, sarcomatoid differentiation (p = 0.01) was the strongest predictor of CSS. CONCLUSIONS: Locally advanced RCC portends poor prognosis. Preoperatively, weight loss and Eastern Cooperative Oncology Group performance status are predictors of recurrence and mortality, respectively. However, the most powerful predictors of DFS and CSS in our cohort were lymph node status and sarcomatoid differentiation.

Comparison of the self-reported training level between Mexican and Western Europe residents in urology: results of an international survey.

OBJECTIVE: To find out how Mexican residents in urology perceive their own level of training in comparison with how residents in Europe perceive theirs. METHODS: A questionnaire of self-assessment was distributed to 104 European and 24 Mexican urologists-in-training. We assessed the perception of residents about their level of training and factors associated with self-perceived performance. RESULTS: Mean age of 128 residents was 32.69 +/- 3.33 years. Mexican residents spent significantly more time in urological departments than European residents. The weekly amount of hours spent at work was higher in Europe; while the number of residents per hospital was higher in Mexico. Mexican residents reported more reliable support from a supervising senior. European residents perceived they had a superior level regarding transplantation in female urology and urinary lithiasis, whereas Mexican residents felt more confident regarding urological infections and paediatric urology. Factors associated with better self-perceived performance were the number of months in urology, the number of non-urologic rotations and a supervising senior. CONCLUSION: Mexican residents in urology perceive that their own level of training is similar to that of European residents. The number of months of training in urology, the number of non-urologic rotations and a supporting senior are associated with a better self-perceived performance.

The role of radical prostatectomy in the management of patients with high-grade prostate cancer and/or locally advanced disease.

OBJECTIVE: To analyze the outcome of patients with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP) in whom high-grade (HGPCa) and/or locally advanced disease (LAPCa) was found at RP specimen and to evaluate the prognostic value of well-known factors in this subset of patients. MATERIAL AND METHODS: Biochemical progression-free (bPFS) was determined with the Kaplan-Meier method. The effect of PSA, biopsy Gleason, clinical stage and number of adverse pathological factors was assessed with univariate and multivariate analyses. RESULTS: After RP, 87 men had HGPCa (20.7%) or LAPCa (56.3%), with 20 (23%) having both criteria. Mean PSA was 15.5 +/- 14.0 ng/mL and mean follow-up 50.5 +/- 42.6 months. The 5-year bPFS for men with PSA < 10 ng/mL and > or = 10 ng/mL was 54.7% and 35.7%, respectively (p = 0.03). Regarding biopsy Gleason, the 5-year bPFS was 49% and 26% for patients with a score < or = 7 and > 7, respectively (p = 0.002). In the multivariate model, the biopsy Gleason score remained independently associated with biochemical progression. CONCLUSIONS: HGPCa and/or LAPCa confer poor prognosis; however, RP appears to offer acceptable control, particularly when initial PSA is < 10 ng/mL and biopsy Gleason is 7 or less.

[Survival after radical prostatectomy in patients with prostate cancer and seminal vesicle invasion]. / Supervivencia después de prostatectomía radical en pacientes con cáncer de próstata e invasión a vesículas seminales.

OBJECTIVE: To assess the outcome of patients with clinically localized prostate cancer (PCa) and seminal vesicle invasion (SVI) in the radical prostatectomy (RP) specimen. MATERIAL AND METHODS: 212 patients with clinically localized PCa underwent RP at our institution from 1988 to 2007. SVI (stage pT3bNOMO of the TNM 2002 system) was demonstrated in 40 (18.9%). RESULTS: Patients with SVI and PSA <10 ng/mL had better prognosis than those with a PSA > or =10 ng/mL, with a 5-year biochemical progression-free survival (bPFS) of 68.2% and 19.9%, respectively (p=0.008). In univariate analysis, an initial prostate specific antigen (PSA) > or =10 ng/mL (p=0.01) and preoperative high risk group (p=0.05) were related to the likelihood of biochemical failure. In multivariate analysis, only PSA remained independently associated to the risk of biochemical recurrence. CONCLUSIONS: In the present study, the frequency of SVI was 18.9%. SVI confers a poor prognosis. Preoperative PSA > or =10 ng/mL was associated to the risk of biochemical recurrence.

PPARGC1A and ADIPOQ polymorphisms are associated with aggressive prostate cancer in Mexican-Mestizo men with overweight or obesity.

BACKGROUND: Obesity constitutes a risk factor for the development of aggressive forms of prostate cancer. It has been proposed, that prostate cancer has a genetic predisposition and that PPARGC1A and ADIPOQ polymorphisms play a role in the development of this condition. OBJECTIVE: To analyse the association of two PPARGC1A and ADIPOQ polymorphisms as well as their haplotypes, with the development of aggressive prostate cancer in Mexican-Mestizo men with overweight or obesity. SUBJECTS AND METHODS: Two hundred fifty seven men with prostate cancer of Mexican-Mestizo origin were included. Body mass index (BMI) was determined and the degree of prostate cancer aggressiveness by the D'Amico classification. DNA was obtained. Rs7665116 and rs2970870 of PPARGC1A, and rs266729 and rs1501299 of ADIPOQ were studied by real-time PCR allelic discrimination. Pairwise linkage disequilibrium, between single nucleotide polymorphisms was calculated and haplotype analysis was performed. RESULTS: A higher-risk (D'Amico classification) was observed in 21.8% of patients. An association of cancer aggressiveness with rs2970870 of PPARGC1A, and rs501299 of ADIPOQ, as well as with one haplotype of ADIPOQ was documented. CONCLUSIONS: This is the first study regarding the relationship of PPARGC1A and ADIPOQ polymorphisms, and the aggressiveness of prostate cancer in men with overweight or obesity.

Association of a TFAM haplotype with aggressive prostate cancer in overweight or obese Mexican Mestizo men.

BACKGROUND: Mitochondrial dysfunction has been associated with the development of cancer and obesity, being prostate cancer more aggressive in obese men. It has been suggested that the mitochondrial transcription factor A (TFAM) plays a central role in these events. OBJECTIVE: The aim of this study was to analyze the possible association of 3 TFAM polymorphisms, as well as their haplotypes, with the development of aggressive prostate cancer in overweight or obese Mexican Mestizo men. SUBJECTS AND METHODS: A total of 257 unrelated men with histologically confirmed prostate cancer, of Mexican Mestizo ethnic origin, were included. Body mass index was determined and the degree of prostate cancer aggressiveness was demarcated by the D'Amico classification. DNA was obtained from blood leukocytes. The rs1937, rs1049432, and rs11006132, as well as their haplotypes, were studied by real-time polymerase chain reaction allelic discrimination. Deviations from Hardy-Weinberg equilibrium were tested. Pairwise linkage disequilibrium between single nucleotide polymorphisms was calculated; haplotype analysis was performed. RESULTS: A higher risk (D'Amico classification) was documented in 56 patients (21.8%). We did not find a significant association among those polymorphisms analyzed; however, one haplotype was significantly associated with cancer aggressiveness. CONCLUSIONS: To our knowledge, this constitutes the first study regarding the relationship of 3 TFAM polymorphisms, as well as their haplotypes, and the aggressiveness of prostate cancer in overweight or obese men; the most frequent haplotype was associated with cancer aggressiveness.

[Neuroendocrine differentiation and markers of cell proliferation in a group of patients with prostate adenocarcinoma and normal or high serum prostate-specific antigen levels]. / Diferenciación neuroendocrina y marcadores de proliferación celular en adenocarcinoma de próstata en un grupo de casos con antígeno prostático específico normal vs elevado.

OBJECTIVE: Study the morphologic characteristics of neuroendocrine cells in prostate cancer with normal versus elevated prostate specific antigen (PSA). MATERIALS AND METHODS: 372 cases of prostate cancer were identified during a 13 year period, of which 19 displayed normal PSA (group I). Sixteen controls with elevated PSA and similar histopathological characteristics (group II) were included. We studied the degree of tumor necrosis, vascular and perineural invasion. Synaptophysin (SP), neuron specific enolase (NSE), PSA, Ki-67 and p53 inmunoreactivity were also analyzed. RESULTS: Group I positive findings were 61% PSA, 28.6% SP. 7.1% NSE, 50%p53, and 78.6% Ki-67. Group II positive findings were 93% PSA, 13.3% SP, 26.6% NSE 46.6% p53, and 66.7% Ki-67. When we used a <80% cut off point for PSA immunoreactivity in tumor cells, 69.2% of group I and 21.4% of group II were found. CONCLUSIONS: The sole histopathological finding that showed statistical significance was the tissular expression of the specific prostatic antigen in 80% of neoplasic cells in group I. The increase of neuroendocrine cells was associated with a smaller number of tissular antigen producing cells, a finding that could be more apparent if we were to study a larger sample size.

[Surgical treatment of ureteropelvic junction obstruction]. / Estenosis ureteropiélica, tratamiento quirúrgico.

INTRODUCTION: Currently there are many therapeutic options for ureteropelvic junction obstruction (UPJO). Open pyeloplasty is the gold standard with a success rate of approximately 90%. We describe our experience in the treatment of UPJO. MATERIAL AND METHODS: We conducted a retrospective and descriptive study among our patients with UPJO surgically treated at the Department of Urology of our institution from 1970 to 2002. RESULTS: 126 UPJO were diagnosed in 114 patients. The most common symptoms at diagnosis were: pain in 105 patients (92.1), urinary tract infection (UTI) in 37 (32.4%) and hematuria in 24 (21%). The most common associated diseases were urolithiasis in 34 cases, crossing vessels in 10 and horseshoe kidney in 5. 123 procedures were undertaken: 92 (74.8%) dismembered pyeloplasties, 13 (10.7%) Foley Y-V pyeloplasties, in 8 (6.5%) release of crossing vessel, 5 (4%) endopyelotomies, 2 (1.6%) pyeloplasties Scardino-Prince, 2 patients with renal allograft in whom an anastomosis of renal pelvis to native ureter was performed and 1 (0.8%) ureter-ileal anastomosis in a patient with retroperitoneal fibrosis. The mean follow-up time was of 33.2 months. In 114 (92.7%) patients the procedure was successful. The overall complication rate was of 17.9% of which 2.4% were stricture recurrence associated with crossing vessels. CONCLUSION: Open dismembered pyeloplasty is the most common treatment procedure for UPJO at our institution. We report successful results, low morbidity, preservation of renal function and improving symptoms.

[Efficacy and safety of vardenafil in patients with erectile dysfunction. Results of the Mexican Multicentric Study]. / Eficacia y seguridad del vardenafil en pacientes con disfunción eréctil. Resultados del estudio multicéntrico mexicano.

UNLABELLED: The objective of the present study was to determine the efficacy and safety of a fixed dose of vardenafil in the treatment of patients with erectile dysfunction (ED). MATERIAL AND METHODS: This was an open label, prospective and multicentric trial. After a 4-week wash out period, all patients received 20 mg of vardenafil given on demand for 12 weeks. Primary efficacy variables were the erectile function domain of the International Index of Erectile Function (IIEF), answers to questions 2 and 3 of the Sexual Encounter Profile (SEP) and the Global Assessment Question (GAQ). All adverse events were recorded and reported. RESULTS: 229 patients were screened. 177 received at least one dose of vardenafil and were included in the safety analysis. Mean age was 54.4 years old. Etiology of ED was organic or mixed in 77% of the patients. Erectile function domain of the IIEF changed from a basal mean score of 14.8 to 25.5 at the end of the study. 80.5% of the patients reported erections of rigidity and duration enough for satisfactory sexual intercourse and 93.3% improved their erections at the end of the study. Adverse events were mild to moderate and the most common were headache, dyspepsia, rhinitis and facial flushing. The drop out rate due to adverse events was 1.7%. CONCLUSIONS: This multicenter study confirms the high efficacy of this new phosphodiesterase type 5 inhibitor, vardenafil. There was a low rate of discontinuations due to adverse events and a favorable safety profile. The results of this study are similar to the results of other studies conducted in other parts of the world.

Emphysematous pyelonephritis: multicenter clinical and therapeutic experience in Mexico.

OBJECTIVE: To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS: We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS: A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION: EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.