[Neoadjuvant chemotherapy MVAC in the treatment of infiltrating bladder carcinoma]. / Quimioterapia neoadyuvante MVAC en el tratamiento del carcinoma vesical infiltrante.

INTRODUCTION: Aiming to preserve the bladder in patients with infiltrative carcinoma of the bladder and to offer patients improved quality of life with no detriment for survival, a therapeutical protocol was set up. MATERIAL AND METHODS: Between August 1988 and January 1997 63 patients with stage T2 and T3a infiltrative carcinoma of the bladder, with no metastasis or node extension detectable with imaging techniques were treated in our unit. 45 of these patients met all protocol criteria and were given 3 neoadjuvant chemotherapy courses with MVAC (methotrexate, vincristine, adriamycin, cisplatin). INCLUSION CRITERIA: age under 75 years, Karnofsky greater than 50%, leucocytes greater than 2,500 cell/mL and platelet greater than 100,000/mL. Following chemotherapy, re-assessment was performed through lab tests, chest X-rays, abdomino-pelvic CT, bone scanning, cystoscopy, multiple randomized biopsies, tumoral bed scar resection and resection of relapsed urothelioma. Patients with complete remission were given radiotherapy. Those showing stabilisation of progression were proposed to undergo cystectomy. Fisher's test or chi 2 test were used for the comparison of qualitative variables. The survival analysis was performed using the Kaplan-Meier method. The curves comparison was done with Breslow's exact test. A Cox's proportional risk method allowed to calculate the relative risks together with their 95% confidence interval. RESULTS: 53.7% patients included in this protocol showed complete remission, 41.5% stable disease and 4.9% progression. 62.2% of patients were given radiotherapy versus 17.8% who underwent cystectomy. 20% received other therapies after rejecting both cystectomy or radiotherapy. Median follow-up was 43.38 months. Overall median survival was 96 months. The accumulate probability of survival at 4 years was 79%. 50% patients with complete clinical response relapsed during follow-up. Tumoral stage of those who relapsed was lower than the initial one in 63.7% cases, remained the same in 18.2%, and higher in 18.2%. With regards to grading, 66.7% patients had lower grading at relapse if tumour was initially grade 2. For those with initial tumour grade 3, only 20% had a lower grade. CONCLUSION: 64.4% patients retained their bladder. In 26.7% there was demonstrable metastatic disease. No differences were seen in the distribution or survival time based on the different treatment given after chemotherapy (p = 0.22). Patients with complete remission after chemotherapy have greater actuarial survival which is statistically significant (p = 0.04).

[Vesico-acetabular fistula following prosthesis migration]. / Fístula vésico-acetabular tras migración protésica.

A rare case is described of vesico-acetabular fistula following acetabulum displacement of a hip replacement towards the inner bladder, fourteen years after the original insertion of the prosthesis. In all the reviewed literature of we have not found a single described case of vesico-acetabular fistula associated with displacement towards the bladder interior of a hip prosthesis, which leads us to consider this complication an exceptional one.

[Quantitative determination of epidermal growth factor urothelial receptor (EGFR) in superficial and invasive bladder carcinoma]. / Dosificación cuantitativa del receptor urotelial del factor de crecimiento epidérmico (EGFR) en carcinomas vesicales superficiales e invasivos.

The epidermic growth factor (EGF) is a polypeptide which stimulates tissue proliferation. The mechanism of action takes place through an specific membrane receptor, known as the EGFR. Recent scientific contributions have allowed to know its implication in various tumoral processes (breast, ovary, bladder, etc), so that its expression may be used as a major prognostic factor. The objective of this work is to quantify and analyze the epidermic growth factor receptor (EGFR) in surface and invasive vesical carcinoma. To this end, 43 tissular samples divided in two groups were studied. The groups were: 1) Group 1 or control group, comprising 14 samples of "control" vesico-urothelial tissue, and 2) Group 2, assembling 29 patients with vesical carcinoma (17 surface and 12 infiltrant). All tissue samples underwent a process of homogenization and subsequent determination of membrane EGFR by means of radioimmunoassay (EGFR-Receptor Assay, Vienna Lab, Labordiagnostika GmbH). Our results demonstrate the expression of EGFR in both control and tumoral vesico-urothelial tissue in 100% of cases, with detection of significantly higher concentrations (p) in samples from vesical carcinoma than in those from control specimens (15.24 vs. 5.02 fmol/mg protein) and higher levels in infiltrant rather than in surface vesical carcinomas (18.92 vs. 11.4 fmol/mg protein).

[Diversions of the upper urinary tract] in oncologic patients]. / Derivaciones del tracto urinario superior en pacientes oncológicos.

Herein it is described the survival rate, the quality of life and the complications of the upper urinary tract diversion in 22 pluri-treated tumoral patients (both male and female, average 65.2 years old). Cancer etiology has been: colon-rectum neoplasia (36.3%), bladder carcinoma (36.3%), prostate carcinoma (9.9%), ovary cancer (4.5%), abdominal wall desmoid tumor (4.5%), pheochromocytoma (4.5%) and gastric carcinoma (4.5%). Urinary diversions type has been: percutaneous nephrostomy (40.9%), ureteral stent (31.8%), both (13.6%) and cutaneous ureterostomy (13.6%). Urinary diversions were performed unilateral in 90.9%. The average survival has been 4.8 months. The quality of life was poor in 68.1%. The following complications were observed: urinary infection (45.4%), hematuria (36.3%), diversion catheter lose (34.8%) and obstruction (27.2%). Urinary diversion in pluri-treated cancer patients must be carefully indicated to prevent negative aspects upon psychophysic and social activity of the patients.

[Results of electric stimulation in the treatment of post-prostatectomy urinary incontinence]. / Resultados de la electroestimulación en el tratamiento de la incontinencia urinaria post-prostatectomía.

Clinical and urodynamic studies were conducted in 19 patients undergoing intrarectal electrostimulation due to post-prostatectomy urinary incontinence. It was corroborated that patients referring incontinence with isolated coughing presented better clinical outcome (80% positive results) than those who also referred urgency-incontinence (44%). Patients with stress incontinence showed positive clinical results post-stimulation in 78% cases. Patients with vesical instability, in 40% cases and patients with mixed incontinence, in 60%. In contrast, elimination of vesical instability was urodynamically proven in 60% cases, but in only 22% with stress incontinence. In mixed incontinence (instability + stress) the instability persisted only in 20% while stress incontinence persisted in 80% cases. The above data would advocate electric stimulation as a therapeutical alternative in post-prostatectomy urinary incontinence.

[Clinical results of the treatment of urinary incontinence with peripheral electric stimulation]. / Resultados clínicos del tratamiento de la incontinencia urinaria con estimulación eléctrica periférica.

A series of 126 patients, 98 women (78%) and 29 male (22%), average 50.2 years old, with different types of urinary incontinence (incontinence at cough, urge-incontinence, post-prostatectomy incontinence and nocturnal enuresis), has been treated with periferic electrostimulation to evaluate the clinical value of this type of treatment. Extrahospitalary management with electrostimulation by vaginal in 39 cases (30.9%) or rectal in 87 cases (69.1%) electrodes was performed. Frequencies has been different in urge-incontinence (10 Hz) and urinary incontinence at coughing (50 Hz). Average treatment duration was 3.3 months. Incontinence intensity decreased significantly with electrostimulation treatment (51-62%). Non statistical differences between other parameters (age, sex, clinical features, clinical incompetence type, cistocele grade) was observed. Positive results in larger period treatment (over 3 months) was obtained (p < 0.005). Best results were obtained with 10 Hz and 50 Hz frequencies (p < 0.05). Therapeutic results, good tolerance (89%), easy application for the patient and absence of secondary effects could made electrostimulation as an alternative therapy in all type of urinary incontinence.

[Role of growth factors in the etiopathogenesis of benign prostatic hyperplasia]. / Implicaciones de los factores de crecimiento en la etiopatogenia de la hiperplasia prostática benigna.

A comment is made on the role growth factors play on the regulation of prostate growth. These factors require the mediation of an specific membrane receptor to which they have to bind in order to exercise their action correctly. The objective of the present job is to carry out a comprehensive review of each and every growth factor involved in prostate growth: family of the epidermal growth factor, family of the beta-transforming growth factor, and family of the fibroblast growth factor. As a final conclusion, it should be mentioned that the two prostate growth-regulating factors more extensively studied and with greater etiopathogenic relevance in benign prostate hyperplasia, are the epidermal growth factor and, more particularly, the fibroblast growth factor.

[Endoscopic myocapsulotomy. Evaluation of the short-term clinical and urodynamic results]. / Miocapsulotomía endoscopia (MC). Evaluación de los resultados clínicos y urodinámicos a corto plazo.

Clinical and urodynamic evaluation of a series of 35 patients aged between 49 and 85 years. Clinical symptoms presented post-miocapsulotomy reduction both in obstructive and irritative signs and symptoms in 97.2% and 91.6% cases, respectively. Likewise, a decrease in peak flow and peak flow percentile was shown in 80.5% and 80% of cases, respectively. Vesical instability was seen in 90.9% and 55.5% of cases in pre- and post-operative studies respectively. An statistically significant post-operative drop (p < 0.05) in the detrusor's peak pressure during miction, (76.6 vs. 56 cm H2O), was confirmed. From our results it may be concluded that MC is a useful surgical technique in the treatment of prostatic obstruction, with the advantage versus other techniques that very frequently it preserves the proximal urinary continence mechanism and the sexual sphincter.

[Urologic neoplasms in patients with renal transplantation. Experience and review of the literature]. / Neoplasias urológicas en pacientes con trasplante renal. Experiencia y revisión de la literatura.

The presence of neoplasms in patients with renal transplant in a higher frequency than in general people is known since a long time. The most frequent tumours were the skin tumours, followed by other tumours common in immunosuppressed patients. The ain of this work has been study the frequency, type, diagnosis, treatment and evolution of the urinary system tumours in patients with renal transplant and an exhaustive review of literature. We have found 11 tumours of the urinary system over 57 tumours in 41 patients, with a frequency 26.8%. 6 were kidney tumours, 3 of prostate and 3 of the bladder. We have analyzed the incidence, diagnosis, treatment and evolution of tumour and its effects on the graft. We believe that the posttransplant follow-up of the patient, overcoat in males, who have tumours in more frequency, is important for the early diagnosis.

[Leiomyosarcoma within a bladder diverticulum]. / Leiomiosarcoma en el seno de un divertículo vesical.

Sarcomas are a rare entity among malignant tumours of the bladder. This paper presents the case of a male patient with leiomyosarcoma within a vesical diverticulum. The approach undertaken was diverticulectomy and, since the tumour was limited to the diverticulum and no metastatic disease was present, no other adjuvant therapy was considered.

[Advances regarding tumor markers in bladder cancer]. / Avances en marcadores tumorales en cáncer vesical.

INTRODUCTION: Currently, there is not known tumoral marker for vesical carcinoma that would allow to distinguish when a surface tumour may become invasive. OBJECTIVE: To analyze the functionality of a series of biological substances (CEA, CA 50, CA 19.9 and TPS) in vesical carcinoma. MATERIAL AND METHODS: Between September 1992 and June 1994, a total of 385 biological specimens divided into two groups were analyzed. The first group comprised 271 serum samples from 81 control subjects and 190 patients with vesical carcinoma. The second group included 114 urothelial tissue samples (56 controls and 58 vesical carcinoma). Serum and tissue levels of CA, CA 50, CA 19.1 and TPS were determined in both groups by fluoroimmunoassay, RIA and IRMA, respectively. An statistical evaluation was done using Student's 't' and/or Mann-Whitney tests depending on whether data distribution adjusted to normal or not. RESULTS: Patients with vesical carcinoma, ana within this group those with infiltrant tumours, showed higher CEA serum levels. Also CEA tissue levels found in neoplastic vesical urothelium were higher than those in the control group (p < 0.05). Tissue levels were higher in infiltrant tumours. Higher TPS serum and tissue levels were found in the vesical tumours group. Same as with CEA, CA 50 also exhibited higher serum levels in the group with vesical Ca than in the controls (p < 0.01). Likewise, CA 50 tissue values were higher in the group with vesical Ca, more specifically in the infiltrant tumours group (p < 0.001). Statistically significant differences become apparent when the above values were compared to tissue samples from the control group (p < 0.001). On the other hand, serum CA 19.9 levels were lower in the vesical carcinoma group although tissue levels were higher in the vesical Ca group (p < 0.001). CONCLUSIONS: Transitional cell vesical carcinoma is a tumour that produces and secretes CEA, CA 50, CA 19.1 and TPS. CEA and CA 50 levels could be used as prognostic factors.

[Comparative population-based survey as evaluation method of prostate disease changes]. / Estudio poblacional comparativo mediante encuesta como método de evaluación de las modificaciones sobre la patología prostática.

A survey-based comparative study was conducted to evaluate the changes on the prostate pathology in two male populations separated by a time interval of two years (1st and 3rd Week of Prostate Health). A total of 2056 respondents in the 1st Week, and 2126 in the 3rd Week were evaluated. The questionnaire included questions relative to prostate awareness, impact of urinary complaints on daily like activities, Spanish validated IPSS and selective questions for prostate patients. The comparison between both surveys disclosed visits to the urologist at earlier age and longer-standing symptoms. The most prevalent symptoms continue to be decreased calibre of the urinary stream, pollakiuria and urgency. IPSS/L and IPSS/age ratios remained unchanged. There was increased number of visits by mildly symptomatic patients (IPSS < 8), increased periodical revisions, and in the number of patients seen and treated by the urologist. A significant approximation to the diagnostic testing criteria established by the WHO for BPH was demonstrated. The number of patients who received treatment raised and there was also a significant improvement in the outcome. Comparative populational studies could allow to assess changes in the awareness status of the prostate, changes in symptomatic levels and quality of life of the population requesting health care, as well as changes in the diagnostic and therapeutical schemes in patients suspected of having BPH.

[Determination of serum SCC antigen in transitional cell carcinoma of the bladder]. / Dosificación sérica de antígeno SCC en el carcinoma vesical de células transicionales.

The SCC antigen expresses in the squamous epithelium during the process of a neoplastic transformation. This paper's objective is to evaluate the biological behaviour of SCC antigen in surface, deep, localized and spread malignant vesical carcinoma. To this end, 100 patients divided in two groups were studied. The first group consisted in 30 healthy subjects strictly selected and the second group comprised 70 patients diagnosed with transitional cell vesical carcinoma. SCC Antigen measurement was made by Radioimmunoassay (RIA, Abbott). Our results suggest that this tumoral antigen has no use as a prognostic factor in patients diagnosed with transitional cells vesical carcinoma, since serum concentrations suffer no change in relation to size, extent and degree of tumoral differentiation.

[Cost-effectiveness comparative study of ceftriaxone verus cefotaxime in the treatment of complicated urinary infections]. / Estudio comparativo coste eficacia ceftriaxona versus cefotaxima en el tratamiento de las infecciones urinarias complicadas.

Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p > 0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p < 0.05).