Development and implementation of an immunotherapy unit in a urology department.

INTRODUCTION: Immunotherapy is revolutionizing cancer treatment, with monoclonal antibodies directed against checkpoint regulatory molecules currently being the most widely used therapy. A total of six immune checkpoint inhibitor (CPI) drugs have been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for use in various solid tumors of the genitourinary tract. MATERIAL AND METHODS: The literature is reviewed and the methodology, as well as our own experience, are analyzed to establish treatment with CPIs in a urology department. RESULTS: The requirements recommended in terms of training, logistics and procedure are described in order to safely offer expert treatment with CPIs to patients with genitourinary tumors. CONCLUSIONS: Compliance with the proposed program ensures safe administration of immune checkpoint inhibitors in a hospital setting.

[Radiofrequency ablation as an alternative treatment for organ confined renal tumor]. / Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado.

INTRODUCTION: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complications. MATERIAL AND METHODS: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3 cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter. RESULTS: 11 tumors, 9 patients. The mean age was 76 years (63-85 years). The average tumor size was 3.5 cm (2.2-5.8 cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3-52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. CONCLUSIONS: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate.

[Malignant fibrous histiocytoma of the bladder. A literature review]. / Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica.

OBJECTIVES: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. MATERIALS AND METHODS: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. RESULTS: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. CONCLUSIONS: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy.

[Indications, results and techniques of permanent prostate brachytherapy for localized prostate cancer]. / Braquiterapia de baja tasa en el tratamiento del cáncer de próstata localizado.

INTRODUCTION AND OBJECTIVE: Prostate brachytherapy is a first-line therapeutic approach for localized prostate cancer in selected patients. We present our experience in brachytherapy and a thorough review of the literature. MATERIALS AND METHODS: A review of the literature and evaluation of patient's selection was done. Furthermore the implantation technique, oncological results according to the different risk groups and acute and chronic complications were also analyzed. RESULTS: The biochemical relapse-free 10 year survival rate was 87-96% in low risk tumours and 63-86% in intermediate risk tumours. A total of 3-24% underwent urinary retention that required TURP in 0-8,7%. Other complications were urinary incontinence in 0-6,7%, proctitis in 0-15,5%, erectile dysfunction in 6,3-30%, rectal ulcer/fistula in 0-5,4%. CONCLUSIONS: Prostate brachytherapy is a safe and effective treatment in low and intermediate risk patients with prostate cancer.

[Spontaneous retroperitoneal hemorrhage: our experience at last 10 years]. / Hemorragia retroperitoneal espontánea: nuestra experiencia en los ultimos 10 años.

INTRODUCTION AND OBJECTIVES: Etiology, clinical features, diagnostic methods and treatment of spontaneous retroperitoneal hemorrhage were analyzed. METHODS: We report 27 cases with diagnosis of spontaneous retroperitoneal hemorrhage treated in our hospital between January 1996 and December 2005. The imaging techniques were abdominal ultrasonography, abdominal CT scan and MRI. RESULTS: The most common cause of retroperitoneal hemorrhage was renal angiomyolipoma rupture in 7 patients. Continuous flank or abdominal pain were the primary symptoms. Abdominal ultrasonography showed hematoma in 81.8% patients, but the actual etiologic diagnosis was ascertained in only 40.9% of them. Retroperitoneal hemorrhage was demonstrated by means of abdominal CT scan in all cases and bleeding origin was established in 92.6% of cases. Ten patients underwent urgent surgery while conservative treatment was attempted in the remaining 17. CONCLUSIONS: In our experience, in cases of spontaneous retroperitoneal hemorrhage, CT scan is the best imaging method to establish the diagnosis and the management of such entity although it will need to be individualized for every case because it depends on the hemodinamic situation and etiologic diagnosis.

[Retroperitoneal malignant fibrous histiocytoma with contiguous organs infiltration]. / Histiocitoma fibroso maligno retroperitoneal con infiltración de organos vecinos.

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed.

[Yield diagnosis of the peripheral cores in 10 needle extended prostate biopsy]. / Rentabilidad diagnóstica de los cilindros de los cuernos laterales en las biopsias prostáticas ampliadas a 10 muestras.

OBJECTIVE: To value if the increase in the number of cylinders in the prostate's biopsy raise the diagnostic performance of this test. MATERIAL AND METHOD: In March 2005 we initiate this prospective study with patients who are subject to a first prostate Biopsy by a PSA between 4 and 10 ng/ml and negative rectal touch. Transrectal, echodirected prostatic biopsies with ten punctures are carried out according to the following programme as follows: 6 Biopsies according to classic sextant technique, to what we add 4 cylinders from the most lateral zones of the prostate (lateral horns). The variables are analyzed: Age, Total PSA, Free PSA/Total PSA, prostatic volume and PSA density. RESULTS: We value 90 patients consecutively. Prostatic adenocarcinoma was diagnosed to 37 of the 90 patients, which means that the diagnostic rate of the extended Biopsy reached a 41%. Nevertheless, the rate for the classic sextant Biopsy was 32.3%. These differences are statistically significant (Mcnemar test 0.008); besides, this supposes a 27% increase in the diagnostic rentability. The "extra" cylinders in the lateral horns detected 8 tumours which were not detected in the cylinders of the the sextant, and 5 of them presented a Gleason higher or equal to 6. CONCLUSIONS: In our centre we think that the Biopsy extended to 10 cylinders is an adequate strategy for potential prostatic adenocarcinoma patients who are going to be subject to their first Biopsy. Realizing the clinic relevance of the tumours diagnosed thanks to "extra" cylinders, we do not think that this modality implies an over-diagnosis and consequently an overtreatment of the prostate cancer.

[Comparative study between tobramicin and tobramicin plus ciprofloxacin in transrectal prostate biopsy prophylaxis]. / Estudio comparativo entre tobramicina y tobramicina más ciprofloxacino como profilaxis para la biopsia transrectal de próstata.

INTRODUCTION AND OBJECTIVES: To compare the efficacy of tobramicin and tobramicin + ciprofloxacin for prevention of transrectal prostatic biopsy infectious complications. We revised our complications, microorganism most common in the infectious complications, and their sensibility. MATERIAL AND METHODS: Prospective and randomized study in 153 patients with 157 prostatic biopsies. The 71 patients in group A were treated with intramuscular tobramicin 100 mg, one dose 30 minutes before biopsy and another one 8 hours afterwards. The 85 patients in group B were treated with the same tobramicin doses and oral ciprofloxacin 500 mg, one dose 30 minutes before biopsy and afterwards they continue with the ciprofloxacin every 12 hours during 3 days. RESULTS: we did 71 biopsies in group A and 86 in group B. 50 (31,8%) patients had hematuria, 20 (12,7%) fever, 15 (9,5%) hemospermia, 7 (4,4%) perineal pain, one (1,2%) orchiepididymitis and another one (1,2%) urinary retention. The patients who had fever were 15 of the group A and 5 of the group B (p=0,004). A total of 15 (21,1%) patients with fever of the group A needed to be treated in the hospital and 3 patients (3,5%) of the group B (p=0,0006). E. coli growthed in 67% of the blood cultures and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins were the antibiotics more eficacious. CONCLUSIONS: Prophylaxis scheme with tobramicin plus ciprofloxacin was more efficacy that tobramicina alone in transrectal prostatic biopsy. Hematuria was the most common complication. E. coli was the microorganism most frequent in infectious complications after prostatic biopsy and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins the most effective antibiotics in our hospital.

[Conservative surgery of bilateral renal angiomyolipoma during pregnancy]. / Cirugía conservadora del angiomiolipoma renal bilateral durante el embarazo.

The existence of bilateral renal angiomyolipoma (AML) is fairly infrequent, especially when not associated with such syndromes as tuberous sclerosis or linfangioleimiomatosis. Here we present the case of a 40-year-old woman who was accidentally diagnosed at week 33rd of gestation by an ultrasound, of bilateral renal AML and that could be treated with kidney sparing conservative treatment. We have also done a review of the literature focusing on its management and its relationship with pregnancy.