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1.
Actas Urol Esp (Engl Ed) ; 47(6): 360-368, 2023.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36746347

RESUMO

INTRODUCTION: The objective of the study was to establish a possible relationship between mitomycin-C (MMC) and bacillus Calmette-Guérin (BCG) treatments and quality of life impairment. MATERIAL AND METHODS: Quasi-experimental, prospective, and longitudinal study including patients undergoing adjuvant treatment in NMIBC. The Short form-12 (SF-12) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to measure quality of life. Questionnaire scores were compared between cases with MMC and BCG before induction (M1), at 4 weeks (M2) and at 2 months (M3). RESULTS: Of the 90 patients enrolled, 54 were in the BCG group and 36 in the MMC group. It was found that BCG patients had worse perceived physical quality of life compared to MMC patients in M2 (OR:2.59, p=0.046). In addition, significant changes were found in the urinary quality of life of patients on MMC treatment between the different time points (UDI-6 score: 33.33 in M1, 27.78 in M2 and 16.67 in M3, p=0.001). CONCLUSIONS: There are no differences in urinary quality of life between patients treated with MMC and BCG. Patients with MMC show a significant recovery of urinary quality of life from the completion of the induction course, which becomes even more significant after 2 months. In addition, BCG-treated patients have worse physical quality of life after 4 weeks of treatment than those treated with MMC.


Assuntos
Antibióticos Antineoplásicos , Neoplasias da Bexiga Urinária , Humanos , Antibióticos Antineoplásicos/uso terapêutico , Estudos Longitudinais , Qualidade de Vida , Estudos Prospectivos , Vacina BCG/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Mitomicina/uso terapêutico , Adjuvantes Imunológicos/uso terapêutico
2.
Cancer Treat Res Commun ; 27: 100374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33932757

RESUMO

INTRODUCTION: Renal cell carcinoma (RCC) accounts for 2-3% of all tumors being the most frequent solid lesion in the kidney. OBJECTIVE: To determine what genetic alterations and immunohistochemical (IHC) of clear cell renal carcinoma (ccRCC) are associated with prognosis and tumor aggressiveness. PATIENTS AND METHODS: Experimental analytical study with 57 patients who underwent radical and partial nephrectomy between 2005 and 2011, all with diagnosis of ccRCC and minimum post-operative follow-up of 36 months. The pathological study included IHC determination of biomarkers associated (CAIX, CAM 5.2, CD10, c-erbB-2, EGFR, HIF-1a, Ki67, MDM2, PAX-2 y 8, p53, survivin and VEGFR 1 and 2). Genetic analysis was carried out using multiplex ligation-dependent probe amplification (MLPA). Clinical data were collected and summarized using an access-type database, adding genetic analysis and IHC data of each patient's tumor sample. IHC statistical analysis included Chi-square, Kruskal-Wallis and multivariate analysis. The genetic analysis was performed using multivariate logistic regression (normal/deletion-duplication). Significance level p<0.05. RESULTS: Pathologic stage was: pT1 (61.8%), pT2 (32.7%); pT3-T4 (5.4%); 16.3% were pN+ and 19.3% M1. 23.6% recurred being predominantly to distance in 83.3%. 27.3% of patients died (73.3% ccCCR). CAIX (Carbonic anhydrase IX) and tumor size were associated with worse Fuhrman grade (p = 0.035; p = 0.001 respectively). Deletion-duplication of genes increased the likelihood: of death (APC, Bcl-2 and CDKN2A by 11, 7 and 4 respectively and SMAD4 reduced the probability by 88%); tumor recurrence (CDKN2A by fifteen fold and VHL reduced the probability by 87%); pT greater than 2 (CCND2, MDM2 and WT1 multiplied by 6, 7 and 9); risk of N+ (CDK4 and EBF1 by 13); distant metastases (BRCA2 and DLEU1 by 5); Fuhrman grade ≥3 (BRCA1, BRCA2 and p53 by 40, 75 and 34 respectively, while that FHIT reduced by 96%). Deletion-duplication of CDK4 and DCC increased survival by a factor of 13 and 16, while that DLEU1 and RUNX1 decreased survival time by 80%. CONCLUSION: CAIX and tumor size are associated with increased aggressiveness. The mutations to level 5q, 9p, 11p, 12, 13q, 17, 18q and 21q are associated with more aggressive tumors and with worse survival rate.


Assuntos
Anidrase Carbônica IX/metabolismo , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/metabolismo , Neoplasias Renais/genética , Neoplasias Renais/metabolismo , Recidiva Local de Neoplasia/genética , Carga Tumoral/genética , Idoso , Carcinoma de Células Renais/secundário , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica/genética , Estadiamento de Neoplasias , Nefrectomia , Prognóstico , Taxa de Sobrevida , Transcriptoma
3.
Actas Urol Esp (Engl Ed) ; 43(10): 562-567, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31301868

RESUMO

INTRODUCTION: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND METHODS: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTS: Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONS: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.


Assuntos
Neoplasias de Próstata Resistentes à Castração/etiologia , Fatores Etários , Idoso , Análise de Variância , Antineoplásicos Hormonais/uso terapêutico , Seguimentos , Humanos , Masculino , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Neoplasias de Próstata Resistentes à Castração/sangue , Neoplasias de Próstata Resistentes à Castração/patologia , Sistema de Registros , Espanha , Fatores de Tempo
4.
Actas Urol Esp (Engl Ed) ; 42(8): 524-530, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29631914

RESUMO

INTRODUCTION: To study the relationship between quantitative mRNA determination (hTERT) in patients with bladder tumor, history of bladder tumor, and in subjects without a history of this neoplasia. MATERIAL AND METHODS: A prospective randomized controlled study with 91 subjects included. The value of mRNA-hTERTN was determined in 63 patients with a history or suspicion of bladder tumor and in 28 controls. Urine samples were sent for evaluation of the mRNA level (hTERT), the cytological study and the NMP22 result. RESULTS: Differences were observed in mean hTERTN levels in each of the groups: tumor presence 21.33+/- 40.66, tumor history 2.16+/- 2.67, controls 0.9+/- 1, 75 (p<0.001). In patients with tumor, there was no difference in mean hTERTN levels between the different grades and stages, although there was a tendency: low grade tumor 9.04+/- 16.95, high grade 28.95+/- 48.36 (p=.069), stage Ta 10.33+/- 19.39, T1 17.88+/- 27.14, T2 54.8+/- 74.05 (p=.056). In addition, the sensitivity of hTERTN was superior to that of other test (76%), although specificity and positive and negative predictive values were better for cytology (94%, 88.4% and 72.3% respectively) and NMP22 (88%, 80.6% and 73.3% respectively). CONCLUSIONS: hTERTN mRNA levels in urine were higher in patients with bladder tumors compared to patients with a history of bladder tumor and with negative cystoscopy, as well as in the control group. This determination showed a higher diagnostic yield compared with the detection of NMP22 and urinary cytology.


Assuntos
Biomarcadores Tumorais/urina , Proteínas Nucleares/urina , RNA Mensageiro/urina , Telomerase/genética , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/urina , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos
5.
Semergen ; 43(3): 189-195, 2017 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-27344583

RESUMO

INTRODUCTION: In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not. PATIENTS AND METHODS: A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test. RESULTS: A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer. CONCLUSIONS: In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker.


Assuntos
Médicos de Atenção Primária/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos
6.
Aging Male ; 19(4): 254-258, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27876434

RESUMO

Erectile dysfunction and low sexual desire are multifactorial diseases. The decrease in testosterone levels is one of the causes, but the effect of estradiol is not well known. Moreover, study has shown that the testosterone/estradiol ratio has more influence over sexuality than does estradiol alone. The aim of the study was to determine whether the balance between testosterone and estradiol has any relation to some aspects of sexual function. It was an ambispective study of 230 patients with urological problems unrelated to sexuality. They underwent a detailed history and hormone study including total, free, bioavailable testosterone and estradiol. They completed the Sexual Health Inventory for Men and questions 11 and 12 of the IIEF15 were used to assess impairment in sexual desire. The T/E ratio was calculated, and the relationship between the different parameters and erectile function and sexual desire were studied by univariate and multivariate analysis. The mean age was 66.32 ± 8.17 years. The percentage of patients with erectile dysfunction was 60.9% (7% severe, 14.3% moderate, 12.6% mild to moderate and 27% mild) and decreased sexual desire was 46.5%. Age, free and biodisponible testosteron were the only variables with a positive linear association with erectile dysfunction and decreased sexual desire. Age was the only independent variable for both, erectile dysfunction and sexual desire, in the multiple linear regression. There was no association between a testosterone/estradiol imbalance and an alteration in erectile function and sexual desire. Consequently, in the clinical study of these patients, it is not necessary to request estradiol in the laboratory analyses.


Assuntos
Disfunção Erétil/diagnóstico , Estradiol/sangue , Libido , Testosterona/sangue , Fatores Etários , Idoso , Disfunção Erétil/sangue , Humanos , Libido/fisiologia , Masculino , Inquéritos e Questionários
7.
Actas Urol Esp ; 40(8): 485-91, 2016 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27260350

RESUMO

OBJECTIVE: The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer. MATERIAL AND METHODS: An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression. RESULTS: The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p<.05) in age (63.50±6.5 vs. 69.0±6.7), PSA (8.76±16.97 vs. 13.21±15.88), biopsied cores, percentage of positives cores (30.0±22 vs. 38.7±29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre. CONCLUSION: According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer.


Assuntos
Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Idoso , Braquiterapia , Demografia , Humanos , Masculino , Prostatectomia , Neoplasias da Próstata/patologia , Sistema de Registros , Espanha
8.
Actas Urol Esp ; 40(4): 224-8, 2016 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26620124

RESUMO

OBJECTIVE: Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumour subtypes in each of the 2 groups. MATERIAL AND METHODS: A retrospective observational study was conducted of 2,601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our centre in the past. We then classified the cases according to the absence of neoplasia, insignificant tumour (involvement of just 1 cylinder, <5%, Gleason score<7), Gleason 6 or Gleason≥7. A bivariate statistical analysis was performed using the chi-squared test. RESULTS: A total of 1,777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P<.001). The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P=.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P=.002). The same occurred with the Gleason score≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P<.001). CONCLUSIONS: We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas.


Assuntos
Próstata/patologia , Neoplasias da Próstata/patologia , Manejo de Espécimes/instrumentação , Idoso , Biópsia , Humanos , Masculino , Estudos Retrospectivos
9.
Actas Urol Esp ; 39(4): 203-9, 2015 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25466644

RESUMO

OBJECTIVES: The involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. MATERIAL AND METHODS: observational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10 ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. RESULTS: Forty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P < .01) and PSA density (P < .01), as well as a lower mean prostate volume (P < .01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P < .01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P < .01), 4.65 times higher for PSA levels >19.60 ng/dL (P < .01) and 2.95 times higher if there is a suspicious rectal examination (P = .014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P < .01). The ROC curves showed maximum sensitivity and specificity at 19.6 ng/mL for PSA and 0.39 for PSA density. CONCLUSIONS: In this series, greater involvement of seminal vesicles was associated with a PSA level ≥20 ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.


Assuntos
Adenocarcinoma/patologia , Biópsia por Agulha , Neoplasias da Próstata/patologia , Glândulas Seminais/patologia , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico por imagem , Idoso , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Tamanho do Órgão , Palpação , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Curva ROC , Estudos Retrospectivos , Glândulas Seminais/diagnóstico por imagem , Ultrassonografia
10.
Actas Urol Esp ; 37(1): 27-32, 2013 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-22482934

RESUMO

OBJECTIVE: The aim of this study was to identify the rate of clinical significant disease (Gleason score>6 or tumor volume>0.5 cc in the RP specimen) among patients who had an insignificant prostate cancer on biopsy, evaluating the presence of prognostic factors. PATIENTS AND METHODS: Patients who fulfilled the following criteria were included: PSA ≤ 10ng/ml, T1c disease, biopsy Gleason Score ≤ 6 affecting <5% of only 1 core and who had undergone a radical prostatectomy. The following variables were studied: Age, PSA, dPSA, free/total PSA ratio and prostatic volume assessed by transrectal ultrasound. RESULTS: In a series of 2424 biopsies, 77 patients completely fulfilled the inclusion criteria, with 66.23% (n=51) of clinical significant disease in the prostatectomy specimen. No differences were observed between these patients and those with insignificant disease in age, PSA, free/total PSA ratio. However, prostatic volume was significantly greater and PSA density significantly lower in those patients with an insignificant disease. Statistical analysis using a logistical regression showed that dPSA was the only prognostic factor (OR: 25067.10, CI 95%: 26.79-2.34×10(7), P=.004). CONCLUSIONS: These findings suggest that a high rate of patients who have a suspected insignificant prostate cancer on biopsy have a clinical significant disease, being dPSA the only independent prognostic factor.


Assuntos
Adenocarcinoma/patologia , Prostatectomia , Neoplasias da Próstata/patologia , Adenocarcinoma/cirurgia , Idoso , Biópsia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Carga Tumoral
11.
Actas Urol Esp ; 37(1): 33-9, 2013 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-22819348

RESUMO

INTRODUCTION: Erectile dysfunction (ED) is a multifactorial process which requires an integral approach. It is also a sentinel symptom of endothelial dysfunction that opens a door to the overall health of a man. OBJECTIVES: To analyze the prevalence of cardiovascular risk factors and other disorders in patients with ED. The relationship between the severity of ED and the total serum testosterone level and the therapeutic approach of doctors were also analyzed. MATERIAL AND METHODS: An observational, multicenter, national study in patients > 18 years who came to uroandrology or primary care consultations. Sociodemographic, anthropometric, lifestyle habits and medical history data of patients and the physician's therapeutic approach, were all collected. ED was diagnosed and total testosterone was assessed when necessary. RESULTS: 1340 patients aged from 22-81 years took part in the study. Age was the most prevalent factor to develop the condition. Abdominal obesity, diabetes, and smoking had a high prevalence. Half of the patients presented psychological and/or sexual problems. 33% and 13.5% of patients had suboptimal levels of total testosterone (cut-off point of 12 nmol/l and 8 nmol/l, respectively), with a direct relationship with disease severity. CONCLUSION: Our study supports the need to examine cardiovascular risk factors in patients with ED and to identify patients who might benefit from testosterone replacement therapy. Psychological disorders should receive specialized care.


Assuntos
Doenças Cardiovasculares/epidemiologia , Disfunção Erétil/epidemiologia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/sangue , Comorbidade , Estudos Transversais , Disfunção Erétil/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Testosterona/sangue , Adulto Jovem
12.
Actas Urol Esp ; 35(8): 448-53, 2011 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-21550143

RESUMO

INTRODUCTION: Pelvic organ prolapse (POP) surgery has variable results of recurrence and complications. We have aimed to analyze our outcomes in order to know the factors associated with anatomical and functional failure in POP surgery. MATERIAL AND METHODS: A retrospective study of 69 patients who underwent POP surgery at our hospital was performed. Registered variables were: Age, BMI, number of deliveries, previous pelvic surgery, menopause, quality of life, urinary incontinence, associated frequency-urgency symptoms, high POP stage, vaginal compartments repaired, type of mesh, urethro-suspension and vaginal hysterectomy during POP surgery and its complications. Patients were evaluated at 1, 6 and 12 months post-surgery. The technique was considered as failed when relapse or mesh erosion occurred and when the patient is not satisfied or there was relapse. The sample is described, analyzing the relationship of the variables studied by univariate analysis (Chi square and Mann-Whitney U test) and a study was made of which variables may have predictive value in the failure of the repair (multiple logistic regression). RESULTS: Surgery failed in 17 patients during the follow-up at one year. BMI (29.6±2.03 vs 27.1±3.32), delivery number (3.4±0.71 vs. 2.8±1.88), menopause, frequency- urgency symptoms and number of vaginal compartments repaired were associated with treatment failure although only BMI, delivery number and frequency-urgency symptoms were defined as independent predictive variables when the logistic regression was carried out. CONCLUSIONS: Overweightness-obesity, previous delivery number and frequency-urgency symptoms before surgery are factors associated to anatomical and functional failure after POP repair.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
13.
Actas Urol Esp ; 32(7): 696-704, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-18788485

RESUMO

INTRODUCTION: Radical cystectomy in elderly is a controversial issue that increases importance overtime because average life span is growing. OBJECTIVE: The purpose of our work was to analize the differences about perioperative and later outcomes between ages of patients with muscle-invasive bladder neoplasm treated with radical cystectomy. MATERIAL AND METHODS: We retrospectively reviewed the records of patients who underwent radical cystectomy for muscle-invasive bladder cancer. Two age groups were compared: < 70-years-old at time of cystectomy (n = 55) and > or = 70 years (n = 57). RESULTS: There was no difference between both age groups about: time of surgery, intraoperative complications (< 70 = 21,8%, > or = 70 = 31,6%), postoperative mortality (< 70 = 3,6%, > or = 70 = 8,8%), minor (< 70 = 18,2%, > or = 70 = 26,3%) and major medical postoperative complications (< 70 = 7,3%, > or = 70 = 8,8%), late outcomes as cancer-specific morby-mortality and actuarial overall survival stratified by patient age. The rate of major postoperative complications (< 70 = 23,6%, > or = 70 = 43,9%) as well as the mean length of hospital stay (< 70 = 10,2, > or = 70 = 15,2 days) differed significantly between the two age groups. Age and cardiovascular risk factors were independient predictive factors of mayor postoperative complications. CONCLUSIONS: Radical cystectomy could be performed in carefully selected elderly patients.


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cistectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/patologia
14.
Actas Urol Esp ; 28(4): 298-307, 2004 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-15248401

RESUMO

PURPOSE: To assess the prognostic value of DNA ploidy and nuclear morphometry in metastatic prostate cancer after androgenic deprivation treatment. METHODS: Fifty four patients with prostate cancer and bone metastases who had undergone androgenic suppression treatment were retrospectively studied. The deoxyribonucleic acid (DNA) content was analysed by flow cytometry. Nuclear morphometry characterized 14 nuclear descriptors. The study also included age, Gleason score, T classification, haematocrite, serum albumin, serum alkaline phosphatase, serum prostatic acid phosphatase and the amount of metastatic foci detected during radioisotope bone scan. Univariate survival analyses were performed and Cox's proportional hazards model was used to identify significant prognostic factors. To assess how the experimental factors improve the capacity of the classical factors for predicting the patients who reach median survival, logistic regression multivariate analysis was performed for the classical prognostic factors only and after added experimental variables (DNA content and Nuclear Area). RESULTS: The univariate survival analyses assigned a prognostic value to T category, level of albumin, alkaline phosphatase, Gleason score, bone scan, DNA ploidy and mean nuclear area. In the case of the Cox regression model only Gleason score, bone scan, mean nuclear area and DNA ploidy provided independent prognostic information. In logistic regression for classic prognostic factors only Gleason score is significant (sensibility 89.3%, specificity 64%). However, when the experimental factors are added, in addition to Gleason score, radioisotope bone scan and DNA ploidy are of prognostic value (sensibility 90% and specificity 72%). CONCLUSIONS: The study of DNA content and nuclear morphometry in the primitive tumor provides independent prognostic information in survival analysis for patients with metastatic prostate cancer. However, there is limited improvement with respect to the classical factors in predicting survival. This questions its utility in the daily clinical usage.


Assuntos
Adenocarcinoma/genética , Adenocarcinoma/secundário , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Adenocarcinoma/mortalidade , Idoso , Núcleo Celular/patologia , Humanos , Masculino , Análise Multivariada , Ploidias , Prognóstico , Neoplasias da Próstata/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida
15.
Actas Urol Esp ; 27(6): 442-9, 2003 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-12918151

RESUMO

INTRODUCTION: With serum prostate specific antigen (PSA) levels of 4.1 to 10 ng/ml a significant number of patients are unnecessary subjected to biopsy. We try to determine if the calculation of prostate specific antigen density (PSAD) and prostate specific antigen density of the transition zone (PSADTZ) improve the capacity to discriminate between non-malignant disease and prostate cancer. METHODS: A prospective study including 314 males with PSA levels between 4.1 and 10 ng/ml is reported. Transrectal ultrasonography and prostatic biopsy were performed in all of them and total prostate and transition-zone volumes were calculated. PSA density and PSA density of the transition zone were calculated for each patient. Receiver operating characteristics (ROC) curves for PSA, PSAD and PSADTZ were constructed for all the patients and for those patients with digital rectal examination unsuspicous of malignancy, determining the sensitivity and specificity for several cutoff values. RESULTS: The area under the curve for both, PSAD and PSADTZ, were greater than for PSA (p < 0.05), without any significant differences between PSADTZ and PSAD. The cutoff value of greatest diagnostic efficiency for PSAD was 0.17 ng/ml/cc (71.4% sensitivity and 55.7% specificity), while it was 0.41 ng/ml/cc for DPSATZ (70% sensitivity and 61.5% specificity). For those cases of normal digital rectal examination, no differences were observed between PSA and PSAD but they were between PSA and PSADTZ. In any event, the area under ROC curves was always less than 0.7, and, in order to avoid a large number of biopsies (high specificity), a large number of cancers are left without diagnosis (low sensitivity). CONCLUSIONS: We conclude that PSAD and PSADTZ are not excessively useful for adequately discriminating between patients with prostate cancer and those with non-malignant disease, particularly when digital rectal examination is normal.


Assuntos
Adenocarcinoma/diagnóstico , Biomarcadores Tumorais/análise , Antígeno Prostático Específico/análise , Neoplasias da Próstata/diagnóstico , Adenocarcinoma/sangue , Adenocarcinoma/química , Adenocarcinoma/patologia , Idoso , Biópsia por Agulha , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Palpação , Estudos Prospectivos , Próstata/química , Próstata/diagnóstico por imagem , Próstata/ultraestrutura , Doenças Prostáticas/diagnóstico , Doenças Prostáticas/metabolismo , Neoplasias da Próstata/sangue , Neoplasias da Próstata/química , Neoplasias da Próstata/patologia , Curva ROC , Sensibilidade e Especificidade , Ultrassonografia
16.
Hum Reprod ; 18(6): 1281-5, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12773459

RESUMO

BACKGROUND: Patients persistently azoospermic after chemotherapy have been considered traditionally as sterile unless sperm was frozen before therapy. Recent advances during the last decade combining testicular sperm extraction (TESE) and ICSI in patients with non-obstructive azoospermia allow these males to father their own genetic offspring. METHODS: A retrospective study was conducted of 12 patients with non-obstructive azoospermia after chemotherapy undergoing TESE between 1995 and 2002. Cancer type and anti-neoplastic treatments were recorded, together with maximum testicular volume, serum FSH levels and testicular histopathology. When TESE was successful, spermatozoa were cryopreserved for performing ICSI later. RESULTS: In five patients (41.6%) motile spermatozoa for cryopreservation and ICSI were retrieved. Four of them had received chemotherapy for testicular cancer, and one had been treated by chemotherapy/radiotherapy for Hodgkin's disease. Clinical and histological parameters were unable to predict with certainty TESE outcome in an individual patient. Eight ICSI cycles were performed on five couples and one pregnancy was obtained which resulted in the delivery of a healthy girl. CONCLUSION: Some patients with permanent azoospermia after chemotherapy can be successfully treated by TESE-ICSI. This procedure, however, may have potential genetic risks. Therefore, freezing semen before starting gonadotoxic therapy is the strategy of choice, and patients should be counselled accordingly.


Assuntos
Antineoplásicos/efeitos adversos , Oligospermia/induzido quimicamente , Injeções de Esperma Intracitoplásmicas , Testículo/citologia , Coleta de Tecidos e Órgãos , Adulto , Criopreservação , Transferência Embrionária , Feminino , Humanos , Masculino , Neoplasias/tratamento farmacológico , Oligospermia/terapia , Gravidez , Estudos Retrospectivos , Preservação do Sêmen , Motilidade dos Espermatozoides , Resultado do Tratamento
17.
Actas Urol Esp ; 25(7): 493-8, 2001.
Artigo em Espanhol | MEDLINE | ID: mdl-11534402

RESUMO

UNLABELLED: The present study analyzes the prognostic influence of tumor percentage in cylinders of prostatic biopsy in this patient group. MATERIAL AND METHODS: Retrospective study of 68 patients with a diagnosis of adenocarcinoma, clinical stage T1-T2 who had undergone a radical prostatectomy from May 1997 to october 2000. Following preoperative parameters were analyzed: age, PSA, clinical staging, Gleason and six cylinders of ultrasonography-leaded transrectal prostatic biopsy, studying the amount of positive biopsies, the tumor percentage of the total amount of biopsies and the maximum percentage of tumor in one cylinder. Univariate (square-Chi, Student t) and multivariate (multiple logistic regression) analysis are performed in order to study the relationship of these parameters with the presence or not of an organ-located disease. RESULTS: An organ-located disease was shown at 44 patients through the piece of radical prostatectomy. The univariate analysis gave all studied parameters, except age, a prognostic value of the existence or not of an organ-located disease. In the multivariate analysis only the total percentage of biopsy tumors (p = 0.0002) and PSA (p = 0.005) behaved as independent prognostic factors. CONCLUSION: Tumor percentage in prostatic biopsy seems to be a factor with a high predictive value of an organ-located disease, possibly because it is an index of tumoral volume.


Assuntos
Neoplasias da Próstata/patologia , Idoso , Biópsia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
18.
Actas Urol Esp ; 25(4): 283-90, 2001 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-11455830

RESUMO

OBJECTIVE: To asses the prognostic value of deoxyribonucleic acid (DNA) ploidy in a group of patients with prostate cancer treated with adrogenic blockade. MATERIALS AND METHODS: A retrospective study on 136 patients with prostatic cancer having undergone androgenic blockade was carried out. The prognostic influence of age, T and M categories, Gleason score and flow cytometry-determined DNA ploidy from survival analyses. Univariate survival analysis was carried out following Kaplan-Meier's method, while for multivariate survival analysis Cox's proportional hazard model was used. RESULTS: The univariante analysis showed that T and M categories, Gleason score and DNA ploidy have prognostic value. The Cox's regression analysis identified DNA ploidy, metastasis and Gleason score as independent variables having prognostic potential. CONCLUSIONS: DNA ploidy has independent prognostic value in prostate cancer treated with androgenic blockade and improves the predictive potential of classical prognostic factors.


Assuntos
Adenocarcinoma/genética , DNA de Neoplasias/análise , Ploidias , Neoplasias da Próstata/genética , Adenocarcinoma/química , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias da Próstata/química , Estudos Retrospectivos
19.
Actas Urol Esp ; 21(7): 662-7, 1997.
Artigo em Espanhol | MEDLINE | ID: mdl-9412208

RESUMO

At present there are several minimally invasive options for the treatment of symptomatic simple renal cysts. One of them, the percutaneous puncture with injection of sclerosant substances, has offered good results. Our study has been conducted in 15 patients with symptomatic simple renal cyst treated by evacuant percutaneous puncture and povidone-iodine injection as sclerosant agent, and makes a short- and long-term evaluation of the results obtained using this procedure. Complete cyst recession with no ultrasound relapse during follow-up was seen in 13 cases (86.5%). Only two patients showed a persistent residual cyst that caused no symptomatology. The easiness of performance, absence of complications and good results obtained make this technique a valid option for the treatment of symptomatic renal cysts.


Assuntos
Doenças Renais Císticas/tratamento farmacológico , Povidona-Iodo/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Injeções , Pessoa de Meia-Idade , Fatores de Tempo
20.
Eur Urol ; 32(3): 375-9, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9358230

RESUMO

OBJECTIVES: We report 11 cases of focal xanthogranulomatous pyelonephritis (FXGP), a disease that is very uncommon. The aim of the present work is to assess the effectivity of conservative treatment. MATERIAL AND METHODS: Eleven of the 82 cases of XGP (12.5%) diagnosed between 1970 and 1995 presented the focal form (FXGF). Clinical features, laboratory findings, radiological imaging studies, surgical treatment and follow-up were evaluated. RESULTS: FXGP occurred in middle-aged women (female/male ratio 4.5:1) who had a history of calculosis, urinary infections produced by Escherichia coli and Proteus mirabilis, or urinary tract abnormalities. FXGP was unilateral in all cases. The most frequent symptom was flank pain. Some hematological and biochemical parameters were altered. Intravenous urography and sonography revealed calculosis, hydronephrosis or renal mass, but these findings are nonspecific. Only abdominal CT scan can establish the correct diagnosis. Five of these patients (45.5%) underwent partial nephrectomy at our hospital. During the follow-up, patients showed no relapse in the ipsilateral or contralateral kidney. Serum parameters were in normal range. CONCLUSION: When FXGP is diagnosed, local excision is recommended in all cases, since relapse in the affected kidney is unusual.


Assuntos
Pielonefrite Xantogranulomatosa/cirurgia , Adulto , Infecções por Escherichia coli/complicações , Feminino , Humanos , Hidronefrose/complicações , Masculino , Pessoa de Meia-Idade , Nefrectomia , Infecções por Proteus/complicações , Pielonefrite Xantogranulomatosa/complicações , Pielonefrite Xantogranulomatosa/diagnóstico , Pielonefrite Xantogranulomatosa/patologia , Tomografia Computadorizada por Raios X , Cálculos Urinários/complicações , Infecções Urinárias/complicações
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