RESUMO
OBJECTIVE: To evaluate erectile disfunction (ED) after radical prostatectomy in a non selected group of patients and their response to sildenafil. METHODS: We included our patients who were operated on between 1998 and 2001. The patients filled in a modification of IIEF (mIIEF) before the RP operation. We tried sildenafil with doses of 100 mg in 3 different periods: 3-6, 12 and 18-24 months after the RP operation. In the event of a complete response they filled in the mIIEF again. RESULTS: The mean age of the patients was 62.8 years old and the mean observation period was 31.7 months. Only 111 (62%) of the total number of patients operated on wanted treatment and only 90 took sildenafil in the proposed protocol; 27 (30%), 18 (20%) and 45 (50%) patients had a complete response, a partial response or no response to the sildenafil respectively. The mIIEF showed 6.5+/-5.7 points less than the mIIEF pre-treatment. In the univariate analysis, the preservation of bundles, the presence of a previous partial response and the presence of the previous tumescence were significantly related to the complete response; however, only tumescence kept its value in the multivariate study. CONCLUSIONS: Urologists must involve themselves in the early rehabilitation of the erectile function even in those patients where preservation of the NVB was not possible. One must always try to preserve, uni or bilaterally, whenever the patient desires preservation of EF. The response to sildenafil is better after the first year and in patients who have previous tumescence.
Assuntos
Disfunção Erétil/tratamento farmacológico , Inibidores de Fosfodiesterase/uso terapêutico , Piperazinas/uso terapêutico , Prostatectomia/efeitos adversos , Idoso , Algoritmos , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Purinas , Citrato de Sildenafila , SulfonasRESUMO
OBJECTIVES: To select a group of useful serum markers in renal cell carcinoma (RCC) with investigational purpose in future. MATERIAL AND METHODS: Periodic determination in serum of 21 RCC patients of the following markers: EGR, RPC, hemogram and leucocyte differential count (LDC), standard biochemist parameters, beta-2 microglobuline, CEA, CA 12.5, CA 50, CA 15.3, ferritin, interleukin-6, serum interleukin-2 receptor, TNF-alpha and TPSA. RESULTS: Different elements within the LDC had relations with the presence of symptoms/signs, tumour size, pathological stage and disease progression. There was a significant increase of beta-2 microglobuline and sIL-2 receptor when disease progressed, as well as a similar statistical trend with RPC and alkaline phosphatases. Beta-2 microglobuline and sIL-2 receptor also decreased after treatment of the disease progression. CONCLUSIONS: We will keep analysing hemogram, LDC and standard byochemics, RPC, ferritin, beta-2 microglobuline and sIL-2 receptor only with investigational purposes, obviating the determination of the rest of the tested markers.
Assuntos
Biomarcadores Tumorais/sangue , Carcinoma de Células Renais/sangue , Neoplasias Renais/sangue , Progressão da Doença , HumanosRESUMO
OBJECTIVE: To analyze the results and indications of the three surgical techniques commonly utilized alone or as part of other treatments for infiltrating bladder tumors. METHODS: Our series of patients with infiltrating bladder tumors are analyzed and the literature reviewed. RESULTS: Transurethral resection (TUR) is essential for tumor staging and is controversial as a therapeutic approach. However, using stringent selection criteria and careful follow-up, retrospective studies have reported survival rates of 82-83%, which are similar to those of radical cystectomy in similar cases, but with bladder preservation rates of 67%-75%. However, only 19-21% of patients can benefit from this surgical technique and the selection criteria are relatively subjective. Partial cystectomy achieves a considerable survival rate of 40-80%, but very stringent selection criteria must be met, which are partly similar to those of the previously mentioned technique, therefore it is not an alternative to TUR since it is a more aggressive surgical procedure. It could be an alternative to radical cystectomy in the more advanced stages of the disease, but although it may be technically biologically feasible, there is a high risk of local and cicatricial recurrence and difficulty in the early detection of recurrence caused by the anatomical disturbance in the bladder wall. For all the foregoing, partial cystectomy is utilized only for very specific cases of urachal carcinoma, as a palliative approach instead of cystectomy, or for areas that are not accessible to TUR. However, although it has specific indications, it has been demonstrated to be effective in the evaluation of the response to chemotherapy and systematically utilized in bladder preservation programs. CONCLUSIONS: Radical cystectomy continues to be the standard treatment for infiltrating bladder tumors with overall 5-year survival rates in recent series ranging from 56%-72%, and is related with the pathological stage and particularly nodal involvement. The morbidity has dropped and the operative mortality rate is about 2%. Quality of life has also improved with the new techniques of urinary diversion, especially orthotopic diversion.
Assuntos
Neoplasias da Bexiga Urinária/cirurgia , Cistectomia , Humanos , Qualidade de Vida , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
OBJECTIVES: To analyze the need for histological study in suprarenal incidentalomas in the specific status of the oncological patient. MATERIAL AND METHODS: 21 patients with tumoral suprarenal masses, 12 diagnosed in the initial study and 9 during the follow-up RESULTS: 16 masses were benign in nature and 5 were metastatic. Neither the location nor the staging of the initial tumour, the time of diagnosis, or the hormonal study were of any use to separate the primitive tumour from the metastasis. All metastasis were equal to or greater than 5 cm in size. Radiological study only confirmed the nature of the tumour in a few cases. Percutaneous biopsy was resolutive in 4/8 cases (50%). Suprarenalectomy was performed in 15 occasions, associated in 10 to surgical treatment of the primary therapy with not added morbidity. CONCLUSION: When incidentaloma is detected in tumoral patients at the time of diagnosis, it requires an histological study which in 1 out of 3 cases will modify the therapeutic attitude in the presence of metastasis. If the incidentaloma is detected during follow-up, it may be monitored in terms of evolution as we would only be delaying a palliative treatment.
Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias/patologia , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Two additional cases of this rare bladder tumor are described. The immunohistochemical analyses confirmed the histological diagnosis of this aggressive tumor type. The choice of treatment for the tumor and its metastasis is influenced by its rarity.
Assuntos
Neoplasias da Bexiga Urinária/patologia , Idoso , Carcinossarcoma/patologia , Humanos , MasculinoRESUMO
The results of a double blind prospective study comparing the chemoprophylactic effects of adriamycin and mitomycin C and two modes of instillation (early: 6 hours following transurethral resection; late: 7-14 days later) for superficial carcinoma of the bladder are presented herein. Since the minimum follow up is over 5 years, the effects on tumor progression and mortality achieved by each of the 4 arms of the protocol were also evaluated. Concerning tumor recurrence, early instillation of mitomycin and overall early instillation therapy achieved significantly better results (p < 0.01). No differences, however, were observed relative to tumor progression or mortality.
Assuntos
Carcinoma de Células de Transição/tratamento farmacológico , Doxorrubicina/uso terapêutico , Mitomicinas/uso terapêutico , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Carcinoma de Células de Transição/cirurgia , Terapia Combinada , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
A prospective randomized study was conducted to determine the ablation capacity of mitoxantrone in Ta-T1 superficial bladder tumors versus mitomycin C, a drug whose intravesical ablation properties are well-known. Fifty-seven patients comprised the study. The tumor was not completely resected when the patient underwent TUR. This residual tumor was used as control. The patients were treated with either 20 mg Mitoxantrone or 40 mg mitomycin C weekly for 8 weeks and two other instillations every 15 days in 50 ml saline solution. Response to therapy was evaluated between the 4th and 8th week and classified as complete response (CR), defined as no gross and microscopic evidence of residual tumor, or no response (NR) or therapeutic failure. CR was observed in 77.7% of the patients treated with mitomycin C and in 50% in those that had been treated with Mitoxantrone. Treatment was discontinued because of side effects in 15% of the patients treated with mitomycin C and in 63.4% of those who received Mitoxantrone. We can conclude from the results of the present study that Mitoxantrone is a useful agent for ablation therapy of superficial bladder tumors, although the high incidence of severe side effects warrants its limited use and at high dilutions.
Assuntos
Mitomicinas/uso terapêutico , Mitoxantrona/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Estudos Prospectivos , Indução de Remissão , Neoplasias da Bexiga Urinária/patologiaRESUMO
A retrospective study was conducted in patients with bladder tumors equal to or higher than stage T1 to determine the influence on survival of tumor cell invasion of the microscopic lymphatic vessels of the bladder wall. Sixty-two patients were studied (34 recurrent and 28 primary tumors). Evidence of microscopic lymphatic invasion was disclosed following TUR (48 cases) and cystectomy (14 cases). Overall and with a mean follow up of 27 months, 25% of the patients are alive and tumor free, 51.6% had died from the tumor (90% less than 3 years following diagnosis). Forty-five percent had lymph node metastasis and 56.6% node and organ metastases. For a time interval of over 6 months between the diagnosis of L + and definitive treatment, there was an 80% mortality versus 43% when treatment was concurrent with diagnosis. Finally, survival was much better in patients submitted to radical surgery. We can conclude from the present study that evidence of tumor invasion of the lymphatic vessels must be routinely sought by the pathologist in order to identify those patients with a high probability of tumor dissemination.
Assuntos
Neoplasias da Bexiga Urinária/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Humanos , Metástase Linfática , Sistema Linfático/patologia , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/terapiaRESUMO
Locoregional treatment of penile carcinoma continues to be a controversy between those who advocate early treatment of lymph nodes and those who advocate delaying treatment. The present study reviews 81 cases of penile carcinoma and describes our approach to treatment of the lymph nodes. A study undertaken to compare the different treatment modalities revealed that at 71 months mean follow-up 64% of the patients submitted to inguinal lymphadenectomy were alive and disease free versus 33% of those submitted to radiotherapy. Statistical analyses comparing the survival rates revealed that the likelihood of survival at 5 years was 100% for those patients submitted to prophylactic lymphadenectomy versus 51% for those submitted to therapeutic lymphadenectomy. We can conclude that since nodal metastasis represents a worse prognosis in these patients, it is advisable to perform prophylactic or therapeutic lymphadenectomy early and, furthermore, regional treatment by radiotherapy appears to be of little use.
Assuntos
Carcinoma/cirurgia , Excisão de Linfonodo , Neoplasias Penianas/cirurgia , Idoso , Carcinoma/mortalidade , Carcinoma/patologia , Carcinoma/radioterapia , Terapia Combinada , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Neoplasias Penianas/mortalidade , Neoplasias Penianas/radioterapia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
UNLABELLED: The following parameters were analyzed in 55 patients with N + M0 bladder carcinoma: 1. Extent of lymph node involvement: A significant difference was observed for those with N1 whose 5 year survival rate is 46%, whereas those with N3, N4 did not survive at two years. 2. TREATMENT: 29 patients underwent cystectomy and 26 did not. Of these 26 patients, 14 received polychemotherapy and 11 received only symptomatic treatment. Survivorship was significantly better for those who underwent cystectomy than those who received polychemotherapy, and it was better for this latter patient group than for those who received symptomatic treatment. 3. Finally, we studied the possible effect of changing the chemotherapeutic regimen on patient survival. Although patients treated with CMV or M-VAC have only a short follow-up, patient survival appears to be enhanced.
Assuntos
Carcinoma de Células de Transição/cirurgia , Cistectomia , Excisão de Linfonodo , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/terapia , Cisplatino/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Cistectomia/métodos , Doxorrubicina/administração & dosagem , Estudos de Avaliação como Assunto , Feminino , Fluoruracila/administração & dosagem , Humanos , Metástase Linfática , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Espanha/epidemiologia , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Vimblastina/administração & dosagemRESUMO
This paper presents a retrospective study of the incidence and evolution of Penis Verruciform Carcinoma, covering a series of 101 cases of primitive penis carcinomas. Incidence reaches 7.9% of all cases. Analysis of tumour evolution is made and compared with Epidermoid Carcinoma. The findings are that there is neither loco-regional nor distant gangliar dissemination and that no patient dies due to this tumour as apposed to 38% deaths in epidermoid cases. Similarly, the survival likelihood at 5 years is 100% for verruciform carcinomas against 54% for epidermoid ones. All the above confirms the benignancy of Penis Verruciform Carcinoma, which makes it recommendable for conservative therapy, whenever volume and location would allow it. Thus, performance of lymphadenectomies is not generally justified since there is no tumoral dissemination, and adoption of an expectant attitude in presence of inguinal ganglia should be advisable.
Assuntos
Carcinoma Papilar/mortalidade , Neoplasias Penianas/mortalidade , Adulto , Idoso , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
The present study was undertaken to determine the reliability of CAT scanning in the preoperative evaluation to detect or discard pelvic lymph node involvement in patients with infiltrating bladder tumor. We compared the radiologic findings with the results of histopathologic examination of the lymph nodes following lymphadenectomy or biopsy of nodes with gross evidence of tumor spread. A comparative study performed in 84 patients revealed a sensitivity rate of 36.3%, a specificity of 87.2%, and an accuracy rate of 66.2% for CAT scanning and, although radiologic evaluation afforded good results, pelvic lymphadenectomy continues to be the method of choice for correct staging of infiltrating bladder tumors.
Assuntos
Linfonodos/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Pelve , Sensibilidade e EspecificidadeRESUMO
The present retrospective study was undertaken to determine the true incidence of vesicoureteric reflux after transurethral resection (TUR) of superficial bladder tumors. The possible role of tumor size, number, site, etc., relative to the appearance of reflux were analyzed, and the principal pathogenic factors involved in iatrogenic vesicoureteric reflux were determined. The incidence of reflux was studied using pre and postoperative ureterocystograms. The study revealed the presence of vesicoureteric reflux long after TUR in 20.6% of the patients.
Assuntos
Complicações Pós-Operatórias/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Refluxo Vesicoureteral/etiologia , Adulto , Idoso , Estudos de Coortes , Cistoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Neoplasias da Bexiga Urinária/patologia , Refluxo Vesicoureteral/epidemiologiaRESUMO
A review of 921 bladder tumors revealed epidermoid carcinoma accounted for 29 (3.1% of total). The present study was undertaken to determine the most important features of transitional cell carcinoma; e.e. its being highly prevalent in women, the high incidence of infiltrating tumors at the time of diagnosis, and its apparently scant potential to spread. Similarly, we studied the scant response achieved by radiotherapy and emphasize that the best results are achieved by radical surgery combined with preoperative radiotherapy.