Acute kidney injury and percutaneous nephrolithotomy: incidence and predictive factors.

INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for patients with large stones. The risk of acute kidney injury (AKI) has not been reported in the Western world. Our objective was to assess the frequency of AKI in patients undergoing PCNL and to identify independent predictors of AKI. METHODS: A retrospective review of PCNL cases performed between January 2014 and June 2019 was reformed. Demographic, laboratory, and intraoperative date were obtained. Perioperative AKI was defined as (1) Increase in serum creatinine by ≥ 0.3 mg/dL (≥ 26.5 micromol/L) within 48 h, or (2) increase in serum creatinine to ≥ 1.5 times baseline. Multivariable logistic regression analysis was performed to determine the factors influencing AKI. A p value of 0.05 was considered significant. RESULTS: A total of 566 patients were included. Mean age was 58 ± 14.4 years. The frequency of AKI was 4.4% (n = 25). The risk factors for AKI after PCNL were having a baseline creatinine > 1.54 mg/dl (p = 0.03, odds ratio [OR] = 2.66, confidence interval [CI] = 1.07-6.6), and a preoperative hemoglobin of less than 10.6 g/dL (p = 0.02, odds ratio [OR] = 2.47, confidence interval [CI] = 1.09-5.5). Patients without AKI had a median hospitalization of 2 days, while those with an AKI were hospitalized for a median of 3 days, and this difference was statistically significant (p < 0.001). CONCLUSIONS: Perioperative AKI occurs in 4.4% of patients undergoing PCNL. Preoperative hemoglobin and serum creatinine can identify those at increased risk, in whom it may be important to avoid nephrotoxic agents.

Ureteral Diameter as Predictor of Ureteral Injury during Ureteral Access Sheath Placement.

PURPOSE: We determined the association between ureteral diameter and ureteral injury during ureteral access sheath placement. MATERIALS AND METHODS: Patients were prospectively enrolled in the study from July 2014 to September 2015. All patients underwent preoperative noncontrast computerized tomography and had a 12Fr to 14Fr ureteral access sheath placement without pre-stenting. A measurement of proximal ureteral diameter was carried out by 2 urologists and 1 radiologist. Ureteral wall injuries were evaluated by 2 endourologists using the 5-grade classification. RESULTS: A total of 68 patients were included and the overall success rate for sheath placement was 94.1% (64). Among this group 46 patients (71.9%) had evidence of any type of injury to the ureter wall and the rate of high grade injuries was 26.1% (12). The ureteral diameter of patients who had a high grade injury was significantly smaller compared to those with low grade injuries (mean±SD 3.29±0.46 mm vs 4.5±0.97 mm, p <0.001). On multivariate analysis narrower proximal ureteral diameter was associated with a higher risk of high grade ureteral injury (OR 2.8, 95% CI 1.9-3.4, p <0.001), regardless of age, gender, body mass index, and middle and distal ureteral diameter. CONCLUSIONS: The proximal ureteral diameter is associated with high grade ureteral injury. A smaller ureteral diameter increases the risk and the severity of ureteral injury. Therefore, preoperative measurement of the ureteral diameter is recommended for ureteral access sheath placement to predict the risk of ureteral injury.

Is it Safe to Continue Aspirin in Patients Undergoing Percutaneous Nephrolithotomy?

OBJECTIVE: To evaluate peri-operative outcomes in patients on chronic aspirin therapy undergoing percutaneous nephrolithotomy (PCNL), with and without discontinuation of aspirin. Anti-coagulation and anti-platelet therapy are contraindications for PCNL per American Urological Association guidelines due to bleeding risk. However, there is potentially increased cardiovascular risk with peri-procedural aspirin withdrawal. METHODS: Patients on chronic aspirin undergoing PCNL between January 2014 and May 2019 were retrospectively reviewed and stratified by continued or discontinued aspirin >5 days preoperatively. Hematologic complications, transfusions, and thrombotic complications were assessed with logistic regression model. RESULTS: Three hundred twenty-five patients on chronic aspirin therapy underwent PCNL-85 continued and 240 discontinued aspirin. There were no significant differences in hemoglobin change, estimated blood loss, transfusions, creatinine change, thrombotic complications, 30-days re-admissions, complications, or 30-day emergency department visits. Patients who continued aspirin had longer length of stay (1.6 vs 1.9 days, P = .03). American Society of Anesthesiologists (ASA) score of 3 (OR 3.2, P = .02, 95% confidence intervals (CI) [1.2-8.4]), ASA score of 4 (OR 4.0, P = .02, 95% CI [1.2-13.1]), Black race, and previous smoking (OR 2.1, P = .02, 95% CI [1.1-3.9]) was associated with continued aspirin. Body mass index ≥30 was associated with aspirin discontinuation (OR 0.9, P = .004, 95% CI [0.9-1.0]). Increased postoperative hematologic complications were associated with additional anticoagulation medication (OR 2.9, P = .04, 95% CI [1.0-4.4]). CONCLUSION: Continued aspirin use did not increase in postoperative complications in patients undergoing PCNL. Patients who are on additional anticoagulation medication are at risk of hematologic complications.

Artificial Intelligence in Urology: Application of a Machine Learning Model to Predict the Risk of Urolithiasis in a General Population.

This research presents our application of artificial intelligence (AI) in predicting urolithiasis risk. Previous applications, including AI for stone disease, have focused on stone composition and aiding diagnostic imaging. AI applications centered around patient-specific characteristics, lifestyle considerations, and diet have been limited. Our study comprised a robust sample size of 976 Chilean participants, with meticulously analyzed demographic, lifestyle, and health data through a comprehensive questionnaire. We developed a predictive model using various classifiers, including logistic regression, decision trees, random forests, and extra trees, reaching high accuracy (88%) in identifying individuals at risk of kidney stone formation. Key protective factors highlighted by the algorithm include the pivotal role of hydration, physical activity, and dietary patterns that played a crucial role, emphasizing the protective nature of higher fruit and vegetable intake, balanced dairy consumption, and the nuanced impact of specific protein sources on kidney stone risk. In contrast, identified risk factors encompassed gender disparities with males found to be 2.31 times more likely to develop kidney stones than females. Thirst and self-perceived dark urine color emerged as strong predictors, with a significant increase in the likelihood of stone formation. The development of predictive tools with AI, in urolithiasis management signifies a paradigm shift toward more precise and personalized health care. The algorithm's ability to process extensive datasets, including dietary habits, heralds a new era of data-driven medical practice. This research underscores the transformative impact of AI in medical diagnostics and prevention, paving the way for a future where health care interventions are not only more effective but also tailored to individual patient needs. In this case, AI is an important tool that can help patients stay healthy, prevent diseases, and make informed decisions about their overall well-being.

Ergonomics in the OR: An Electromyographic Evaluation of Common Muscle Groups Used During Simulated Flexible Ureteroscopy - a Pilot Study.

OBJECTIVE: To assess the effects of different surgeon positions and ureteroscope types on muscle activation as measured by surface electromyography (sEMG) during simulated ureteroscopy in an endourology box-trainer model and the kidney phantom. METHODS: For this exploratory study, sEMG was used to quantify muscle activation of 3 endourology fellows during various ureteroscopic tasks. Electrodes were placed on the ureteroscope-holding side of the following muscles: thenar, forearm flexor, forearm extensor, biceps, triceps, deltoid, and trapezius. Subjects wore fitted lead aprons in an operating room and used a cystoscopy table with surgical drapes and an endoscopic video tower. Trials were completed with a disposable and reusable ureteroscope, both in the standing and sitting positions. Each subject performed an identical set of tasks in a phantom silicone kidney and ureteroscopy box trainer to recreate the procedural components of basketing, navigating a renal collecting system, and dusting. Raw EMG data for each task was processed and normalized as a percent of each subject's maximum voluntary contraction to allow comparison. RESULTS: The forearm extensor was the most heavily utilized muscle. The trapezius and deltoid muscles were activated more during sitting whereas the forearm flexors had increased activity during standing. The heavier reusable ureteroscope had increased forearm extensor activation compared to the disposable ureteroscope. CONCLUSION: Preliminary data show measurable differences in muscle activation based on both surgical posture and type of ureteroscope used. This highlights the need for more extensive EMG studies to identify techniques and equipment to optimize ergonomics and potentially minimize injury during flexible ureteroscopy.

Magnetic-Assisted Robotic and Laparoscopic Renal Surgery: Initial Clinical Experience with the Levita Magnetic Surgical System.

Introduction: The Levita™ Magnetic Surgical System (LMSS) is a new device that can provide retraction using magnets and can reduce the number of ports used during laparoscopic and robotic procedure. It is U.S. Food and Drug Administration (FDA) approved for laparoscopic cholecystectomy, bariatric operation, and robotic radical prostatectomy. Our objective was to evaluate the safety and feasibility of the magnetic surgical system during renal procedure. Methods: We performed a prospective, single-center, single-arm, open-label study to assess the safety and performance of the LMSS. The system includes a deployable, single-use magnetic grasper and a reusable external magnet. Selected patients undergoing either laparoscopic or robotic renal procedure from April 2019 to August 2019 were included. Robotic procedures were performed with the da Vinci Xi or single-port (SP) surgical platforms. Preoperative demographic, intraoperative data, and postoperative data were collected and analyzed. Results: Ten procedures were performed using the LMSS. Cases included Xi robotic partial nephrectomy (n = 3), Xi robotic radical nephrectomy (n = 2), SP robotic partial nephrectomy (n = 2), SP robotic pyeloplasty (n = 1), laparoscopic donor nephrectomy (n = 1), and laparoscopic radical nephrectomy (n = 1). No cases required conversion to an open procedure. Issues included one small liver capsular tear from the device jaws necessitating fulguration and occasional robotic "recoverable fault" errors when the external magnet was placed too close to the robotic arms. All patients were discharged home on postoperative day 1 or 2, and there were no readmissions within 30 days. Conclusions: This is the first report on the use of the LMSS for renal procedure. Its use for laparoscopic and robotic renal procedure appears safe and feasible. The grasper is especially useful for exposing the renal hilum during dissection and the ureteropelvic junction during SP robotic procedures, mimicking multiport techniques. Further study is required to optimize use of the LMSS and evaluate its cost effectiveness.

[Renal and perinephric abscesses: a series of 44 cases]. / Abscesos renales y peri-renales: análisis de 44 casos.

Renal abscesses are infrequent event and may occasionally be fatal. In order to characterize its main clinical features, its diagnosis and evolution, a retrospective-descriptive study was done with cases identified between 1996 and 2006 in a teaching hospital. Forty-four cases were collected (mean age 49.9 years). Diabetes mellitus was present in 38.6%, urinary calculi in 36.4%, and previous urinary tract infection in 11.4% of the studied population. Enterobacteriaceae were the most frequent isolated microorganisms (44.4%), and 33.3% had a poli-microbial culture in abscess samples. S. aureus was rarely identified. Main therapeutic approaches were minimally invasive procedures (pigtails, percutaneous drainage or nephrostomy) in 50% followed by surgical interventions (nephrectomy or surgical debridement) in approximately 30%. Only 20.5% of patients were treated exclusively by antibiotics. Minimally invasive procedures were applied progressively after 2001 (p < 0.005). In this series case-fatality rate was 4.5%; 13.6% (n = 6) developed septic shock. Nephrectomy was performed in 9 cases (20.5%). Patients selected for nephrostomy had a lower risk for ICU admission (Odds Ratio 0.083 IC95 0.008-0.911). Renal abscesses are cause of morbidity but had a low case-fatality ratio; the therapeutic approach has changed in recent years favoring at present minimally invasive procedures.

Indocyanine Green (ICG) in Urologic Surgery.

Indocyanine green (ICG) is a dye used for fluorescent-guided surgery. This review article addresses the recent surge in reported uses of ICG in various surgical fields and provides a comprehensive and up to date review of the uses of ICG in urologic surgery.

Exosomes from bulk and stem cells from human prostate cancer have a differential microRNA content that contributes cooperatively over local and pre-metastatic niche.

The different prostate cancer (PCa) cell populations (bulk and cancer stem cells, CSCs) release exosomes that contain miRNAs that could modify the local or premetastatic niche. The analysis of the differential expression of miRNAs in exosomes allows evaluating the differential biological effect of both populations on the niche, and the identification of potential biomarkers and therapeutic targets. Five PCa primary cell cultures were established to originate bulk and CSCs cultures. From them, exosomes were purified by precipitation for miRNAs extraction to perform a comparative profile of miRNAs by next generation sequencing in an Illumina platform. 1839 miRNAs were identified in the exosomes. Of these 990 were known miRNAs, from which only 19 were significantly differentially expressed: 6 were overexpressed in CSCs and 13 in bulk cells exosomes. miR-100-5p and miR-21-5p were the most abundant miRNAs. Bioinformatics analysis indicated that differentially expressed miRNAs are highly related with PCa carcinogenesis, fibroblast proliferation, differentiation and migration, and angiogenesis. Besides, miRNAs from bulk cells affects osteoblast differentiation. Later, their effect was evaluated in normal prostate fibroblasts (WPMY-1) where transfection with miR-100-5p, miR-21-5p and miR-139-5p increased the expression of metalloproteinases (MMPs) -2, -9 and -13 and RANKL and fibroblast migration. The higher effect was achieved with miR21 transfection. As conclusion, miRNAs have a differential pattern between PCa bulk and CSCs exosomes that act collaboratively in PCa progression and metastasis. The most abundant miRNAs in PCa exosomes are interesting potential biomarkers and therapeutic targets.

Increased SNAIL expression and low syndecan levels are associated with high Gleason grade in prostate cancer.

Prostate cancer (PC) is a leading male oncologic malignancy wideworld. During malignant transformation, normal epithelial cells undergo genetic and morphological changes known as epithelial-mesenchymal transition (EMT). Several regulatory genes and specific marker proteins are involved in PC EMT. Recently, syndecans have been associated with malignancy grade and Gleason score in PC. Considering that SNAIL is mainly a gene repressor increased in PC and that syndecan promoters have putative binding sites for this repressor, we propose that SNAIL might regulate syndecan expression during PC EMT. The aim of this study was to analyze immunochemically the expression of SNAIL, syndecans 1 and 2 and other EMT markers in a tissue microarray (TMA) of PC samples and PC cell lines. The TMAs included PC samples of different Gleason grade and benign prostatic hyperplasia (BPH) samples, as non­malignant controls. PC3 and LNCaP cell lines were used as models of PC representing different tumorigenic capacities. Semi-quantitative immunohistochemistry was performed on TMAs and fluorescence immunocytochemistry and western blot analysis were conducted on cell cultures. Results show that SNAIL exhibits increased expression in high Gleason specimens compared to low histological grade and BPH samples. Accordingly, PC3 cells show higher SNAIL expression levels compared to LNCaP cells. Conversely, syndecan 1, similarly to E-cadherin (a known marker of EMT), shows a decreased expression in high Gleason grades samples and PC3 cells. Interestingly, syndecan 2 shows no changes associated to histological grade. It is concluded that increased SNAIL levels in advanced PC are associated with low expression of syndecan 1. The mechanism by which SNAIL regulates the expression of syndecan 1 remains to be investigated.

Impact of CYP1A1, GSTM1, and GSTT1 polymorphisms in overall and specific prostate cancer survival.

OBJECTIVE: Prognostic biomarkers that distinguish between patients with good or poor outcome can be used to guide decisions of whom to treat and how aggressively. In this sense, several groups have proposed genetic polymorphisms as potential susceptibility and prognostic biomarkers; however, their validity has not been proven. Thus, the main goal of the present work was to investigate the potential role of single and combined CYP1A1, GSTM1, and GSTT1 genotypes as modifiers of cancer survival in Chilean patients with prostate cancer. METHODS AND MATERIALS: A total of 260 histologically confirmed patients were recruited from a voluntary screening, and genomic DNA was obtained from their blood samples for genotyping analyses to detect the CYP1A1*2A polymorphism and GSTM1 and GSTT1 deletions. The progression of illness and mortality were estimated with a median follow-up of 8.82 years. Adjusted estimated genotype risks were evaluated by hazard ratio and 95% CI using the Cox proportional model. In addition, the Kaplan-Meier survival method and log-rank test were used to evaluate patient survival with regard to genotype. RESULTS: The 9-year overall and specific survival rates were 67.6% and 36.6% in the GSTT1null group, 67.6% and 58.7% in the GSTM1non-null group, 69.0% and 51.6% in the *1A/*2A group, 63.9% and 61.5% in the *2A/*2A group vs. 76.2% and 62.3% in the GSTT1non-null group, 82.3% and 50% in the GSTM1null group, and 83.7% and 56.3% in the *1A/*1A group, respectively. The hazard ratios and the Kaplan-Meier curve results demonstrate that the GSTM1non-null, GSTT1null, and CYP1A1*2A genotypes are significantly associated with mortality. Our study has two main limitations: a relatively small sample size and a low global mortality percentage (25.4%); thus, we need to continue the follow-up to confirm these findings. CONCLUSIONS: Our results suggest that the GSTM1non-null, GSTT1null, and CYP1A1*2A genotypes may be good prognosis markers, particularly in patients with high-risk tumors.

PCA3 sensitivity and specificity for prostate cancer detection in patients with abnormal PSA and/or suspicious digital rectal examination. First Latin American experience.

INTRODUCTION: Prostate Cancer Gene 3 (PCA3) is a recently described and highly specific urinary marker for prostate cancer (CaP). Its introduction in clinical practice to supplement low specificity of prostate specific antigen (PSA) can improve CaP diagnosis and follow-up. However, before its introduction, it is necessary to validate the method of PCA3 detection in distinct geographic populations. OBJECTIVES: Our aim was to describe for the first time in Latin America, the application of the PROGENSA PCA3 assay for PCA3 detection in urine in Chilean men and its utility for CaP diagnosis in men with an indication of prostate biopsy. MATERIALS AND METHODS: Sixty-four Chilean patients (mean age, 64 years) with indication of prostate biopsy because of elevated PSA and/or suspicious digital rectal examination (DRE) were prospectively recruited. PCA3 scores were assessed from urine samples obtained after DRE, before biopsy, and compared with PSA levels and biopsy outcome. RESULTS: The median PSA value and mean PCA3 score were 5.8 ng/ml and 31.7, respectively. Using a cutoff PCA3 score of 35, the sensitivity and specificity for detecting CaP were 52% and 87%, respectively. The receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0.77 for PCA3 and 0.57 for PSA, for the same group of patients. In patients with previous negative biopsy, PCA3 specificity increased by 2.2%. CONCLUSIONS: This is the first report in Latin America on the use of PCA3 in diagnosing CaP. Our results are comparable to those reported in other populations in the literature, demonstrating the reproducibility of the test. PCA3 score was highly specific and we specially recommend its use in patients with persistent elevated PSA and prior negative biopsies.

Laparoscopic partial nephrectomy: A series of one hundred cases performed by the same surgeon.

INTRODUCTION: Laparoscopic partial nephrectomy (LPN) has become the first-line surgical technique for the management of renal tumors smaller than 4 cm. Its main advantages are an excellent oncologic control together with the preservation of nephron units. Moreover, it implies a shorter length of hospital stay, less postoperative pain, and shorter recovering times for patients. CONTEXT: We included 100 patients who consecutively underwent LPN between years 2000 and 2010 in our institution. AIMS: The aim was to present our experience and to compare it with the results reported in the literature by other centers. SETTINGS AND DESIGN: This was a prospective study. SUBJECTS AND METHODS: One hundred consecutive patients (67 men and 33 women) who underwent LPN within years 2000 and 2010 were included in the study. In all cases, surgery was performed by the same surgeon (JMC). Data were collected retrospectively, including clinical and histopathologic information, as well as surgical and functional results. STATISTICAL ANALYSIS USED: Statistical analysis was performed using the chi-square test and SPSS v17 software. A P-value < 0.05 was considered significant in all the analyses. RESULTS: The indication for LPN was a renal tumor or a complex renal cyst in the 96% of the cases. A retroperitoneal or transperitoneal approach was performed in the 62% and 38% of the cases, respectively. The average size of the tumor was 3.3 cm (range 1-8). The mean surgical time was 103.5 min (range 40-204). The mean estimated blood loss was 193.7 cc. The average hospital length of stay was 50.2 h. Six (6%) patients had complications related to the surgery. The majority (n = 2) was due to intraoperative bleeding. With an average follow-up time of 42.1 months, there is no tumor recurrence reported up to now. CONCLUSIONS: Our results are similar to those reported in the international literature. LPN is a challenging surgical technique that in hands of a trained and experienced surgeon has excellent and reproducible results for the management of small renal masses and cysts.

[Endoscopic management of paranasal sinus mucoceles: experience with 46 patients]. / Manejo endoscópico de mucoceles de senos paranasales: experiencia en 46 pacientes.

OBJECTIVE: The purpose of this study was to determine changes in the surgical treatment of patients with the diagnosis of paranasal mucoceles managed in a Latin American hospital. We hypothesised that endonasal endoscopic surgeries had emerged as the main treatment option for this disease in the last five years. METHODS: A retrospective chart review of all patients who were diagnosed with paranasal sinus mucoceles and treated at the Otorhinolaryngology Head and Neck Department of our hospital from 2002 to 2010 was performed. Patient demographic data, mucoceles location, symptoms, surgical approach and complications were recorded. RESULTS: A total of 46 patients were included (27 males; 19 females). This series include 29 patients (63%) with frontal or frontoethmoidal mucoceles, 14 (30.4%) with maxillary and 3 (6.5%) with sphenoid mucoceles. Ninety-five percent of the patients were treated with intranasal endoscopic surgery. Complications occurred only in 7 cases (15.2%). CONCLUSIONS: This study confirms that over the last 9 years significant changes have occurred in the surgical treatment of paranasal mucocele in our hospital, as endoscopic surgeries increased from 34% to over 90% as the first option of treatment for mucoceles.

Altered expression patterns of syndecan-1 and -2 predict biochemical recurrence in prostate cancer.

The clinical features of prostate cancer do not provide an accurate determination of patients undergoing biochemical relapse and are therefore not suitable as indicators of prognosis for recurrence. New molecular markers are needed for proper pre-treatment risk stratification of patients. Our aim was to assess the value of altered expression of syndecan-1 and -2 as a marker for predicting biochemical relapse in patients with clinically localized prostate cancer treated by radical prostatectomy. The expression of syndecan-1 and -2 was examined by immunohistochemical staining in a series of 60 paraffin-embedded tissue samples from patients with localized prostate cancer. Ten specimens from patients with benign prostatic hyperplasia were used as non-malignant controls. Semiquantitative analysis was performed to evaluate the staining patterns. To investigate the prognostic value, Kaplan-Meier survival curves were performed and compared by a log-rank test. In benign samples, syndecan-1 was expressed in basal and secretory epithelial cells with basolateral membrane localisation, whereas syndecan-2 was expressed preferentially in basal cells. In prostate cancer samples, the expression patterns of both syndecans shifted to granular-cytoplasmic localisation. Survival analysis showed a significant difference (P < 0.05) between normal and altered expression of syndecan-1 and -2 in free prostate-specific antigen recurrence survival curves. These data suggest that the expression of syndecan-1 and -2 can be used as a prognostic marker for patients with clinically localized prostate cancer, improving the prostate-specific antigen recurrence risk stratification.

Nefrolitectomía endoscópica transpiélica durante pieloplastía laparoscópica asistida por robot: Combinación de técnicas endourológicas para la resolución de un caso de estenosis pieloureteral asociado a nefrolitiasis / Endoscopic nephrolithotomy transpielic during a robot assisted laparoscopic pyeloplasty: Combination of endourological techniques for solving a case of pelvi-ureter stenosis associated with nephrolithiasis

La estenosis pieloureteral (EPU) puede predisponer al desarrollo de nefrolitiasis debido a estasis urinaria. Inicialmente la endopielotomía percutánea fue la alternativa mínimamente invasiva de elección frente a la cirugía abierta para la resolución de los casos de EPU con nefrolitiasis concomitante. Sin embargo, el bajo éxito de la endopielotomía percutánea ha favorecido el uso de la laparoscopía convencional o asistida por robot para el tratamiento de las EPU. Se han reportado casos de pieloplastías laparoscópicas en los cuales se ha introducido un nefroscopio flexible a través de un trócar para resolver la nefrolitiasis por vía transpiélica. Acá reportamos nuestra experiencia en un caso.(AU)

The pelvi-ureter stenosis may predispose to the development of nephrolithiasis due to urinary stasis. Initially, a percutaneous endopyelotomy was minimally invasive alternative of choice versus open surgery for resolving cases of EPU with concomitant nephrolithiasis. However, the low success of percutaneous endopyelotomy has favored the use of conventional laparoscopy or robot-assisted treatment of the pelvi-ureter stenosis. There have been reports of laparoscopic pyeloplasty in which a flexible nephroscope is inserted through a trocar to solve nephrolithiasis by a transpielic via. Here we report our experience in one case.(AU)

Modulación del metabolismo de esfingolípidos en cáncer de vejiga como una potencial estrategia para optimizar resultados de terapias intravesicales para tumores de vejiga no musculoinvasores / Modulation of sphingolipid metabolism in bladder cancer as a potential strategy to optimize outcomes of intravesical therapies for non-muscle invasive bladder cancers

El cáncer de vejiga representa un problema de salud pública importante a nivel mundial. En Chile su relevancia es aún mayor en la región de Antofagasta. Este cáncer se caracteriza por una alta tasa de recurrencia, por lo que los pacientes requieren un seguimiento estricto que afecta su calidad de vida e implica elevados costos para los sistemas de salud. Esto explica la necesidad de optimizar los tratamientos actuales (quimioterapia e inmunoterapia con BCG intravesical) para reducir las tasas de recurrencia y progresión. Los esfingolípidos son lípidos bioactivos que a nivel celular cumplen funciones relacionadas con la regulación del crecimiento, proliferación, migración, invasión, resistencia a drogas y apoptosis. La evidencia disponible a la fecha sobre el rol de los esfingolípidos en cáncer de vejiga es escasa, pero sugiere que en este cáncer existe un metabolismo esfingolipídico desplazado hacia la reducción de los niveles intracelulares de ceramida y esfingosina (esfingolípidos pro-apoptóticos) y aumento de esfingosina 1-fosfato (esfingolípido anti-apoptótico). La manipulación del metabolismo esfingolipídico para invertir esta relación se propone en esta revisión como una estrategia que podría ayudar a optimizar el efecto de las terapias disponibles actualmente para reducir las recurrencias y progresiones de los tumores de vejiga no músculo-invasores...

Bladder cancer is an important health problem worldwide. In Chile it has particular relevance in the region of Antofagasta. This cancer is characterized by a high recurrence rate, for which patients need a strict follow up that impairs their quality of life and determines increased costs for health care systems. These facts explain the necessity of optimizing the actual treatments (chemotherapy and BCG immunotherapy) for reducing the rates of recurrence and progression. Sphingolipids are bioactive lipids that at a cellular level have roles related to the regulation of growth, proliferation, migration, invasiveness, drug resistance and apoptosis. To date, the available evidence about the role of sphingolipids in bladder cancer is scarce, but suggests that in this cancer there is a sphingolipid metabolism shifted towards a reduction of the intracellular levels of ceramide and sphingosine (pro-apoptotic sphingolipids) and an increase of sphingosine 1-phosphate (anti-apoptotic sphingolipid). In this review we propose that the manipulation of the sphingolipid metabolism to invert this balance can contribute to optimize the effect of the actual therapies to reduce the rates of recurrence and progression of non-muscle invasive bladder cancers...

Utilidad del tacto rectal en pacientes con cáncer de próstata y antígeno prostático menor a 4 ng/ml / Usefulness of DRE in patients with prostate cancer and PSA less than 4ng / ml

Actualmente la necesidad de incorporar el tacto rectal en protocolos de tamizaje ha sido tema de debate. Existe una gran proporción de cáncer de próstata (CaP) que son diagnosticados solo con tacto rectal (TR) sospechoso, aportando además importante información pronostica. En nuestro trabajo, evaluaremos la utilidad que tiene el tacto rectal sospechoso en aquellos pacientes con cáncer de próstata y APE < 4 ng/ml. MATERIALES Y MÉTODOS: Se realiza un estudio transversal y se registran pacientes de un hospital público que fueron controlados entre los años 2010 y 2012 con sospecha de CaP. Resultados: De un total de 268 pacientes que fueron sometidos a biopsia prostática por sospecha de CaP se obtuvo lo siguiente: 8 pacientes con APE < 2.5 ng/ml. cuya media de edad fue 70 años (61-82;7.4), destacó que el 87.5 por ciento tenía TR alterado y un 25 por ciento se confirmó cáncer, otorgando al TR una sensibilidad de 100 por ciento y valor predictivo positivo (VPP) 28.5 por ciento. 17 pacientes con APE 2.5-4.0 ng/ml. cuya media de edad fue 64.7 años (55-74;6.9), en donde un 29.4 por ciento tenía TR alterado y en un 35.3por ciento se confirmó cáncer, la sensibilidad del TR resultó 33por ciento y el VPP de 40 por ciento. 243 pacientes con APE 4.1-10 ng/ml. cuya media de edad fue 66.7 años (44-84;7.1), tenían TR alterado en 17.3porciento y confirmación de cáncer en un 27.3 por ciento, la sensibilidad del TR fue un 28.3 por ciento y el VPP 38 por ciento. CONCLUSIONES: La probabilidad de tener cáncer prostático con tacto rectal alterado es mayor a medida que aumenta el APE, destacando un VPP de 28.5 por ciento y VPN de un 100 por ciento en pacientes con APE < 2.5por ciento. En los pacientes con APE de 2.5-4.0 ng/ ml., el tacto rectal obtiene un VPP 40 por ciento y VPN 66.6 por ciento. Estos valores sugieren que aún es importante realizar el TR de manera rutinaria, ya que aproximadamente un tercio tendrá o desarrollara un cáncer de próstata.

Currently the need to include a rectal examination in screening protocols has been the subject of debate. There is a large proportion of prostate cancer (CaP) who are diagnosed only with suspicious digital rectal examination (DRE), also providing important prognostic information. In our work, we will evaluate the usefulness suspicious digital rectal examination in patients with prostate cancer and PSA <4 ng / ml. MATERIALS AND METHODS: A cross-sectional study was conducted and a public hospital patients who were followed between 2010 and 2012 with suspected PCa are recorded. RESULTS: From the 268 patients who underwent prostate biopsy for suspected CaP the following was obtained: From 8 patients with PSA <2.5 ng / ml. whose average age was 70 years (61-82; 7.4), it was noted that 87.5 percent had altered DRE and in 25 percent cancer is confirmed, giving DRE a 100 percent sensitivity and a positive predictive value of (PPV) 28.5 percent. 17 patients with APE 2.5-4.0 ng / ml. whose mean age was 64.7 years (55-74; 6.9), where 29.4 percent had altered DRE and in 35.3 percent cancer is confirmed, the sensitivity of DRE was 33 percent and a PPV of 40 percent. 243 patients with APE 4.1-10 ng/ml. whose mean age was 66.7 years (44-84; 7.1) DRE was altered in 17.3 percent and confirmation of cancer was 27.3 percent, sensitivity was 28.3 percent and PPV 38 percent. CONCLUSIONS: The chance of having prostate cancer with altered DRE is greater with increasing PSA, highlighting a PPV of 28.5 percent and NPV of 100 percent in patients with PSA <2.5 percent. In patients with PSA of 2.5-4.0 ng / ml., DRE get a PPV 40 percent and NPV 66.6 percent. These values suggest that it is still important to the TR routinely, because approximately one third have or develop prostate cancer.