[Radiofrequency ablation of renal cell carcinoma]. / Ablación del cáncer renal por radiofrecuencia.

INTRODUCTION: The standard treatment of small renal masses is partial nephrectomy, which has showed similar oncologic results when compared with radical nephrectomy. Recently, ablative techniques, including radiofrequency and cryotherapy ablation, has been developed, with the purpose of minimizing adverse effects of standard surgical excision. In this article we review the technique of radiofrequency ablation. MATERIAL AND METHODS: For this review we conducted a search in the Medline database using the terms "renal radiofrequency ablation". RESULTS: The different currently marketed systems for the delivery of radiofrequency energy are examined. The different techniques of delivery (open, laparoscopic and percutaneous) are described; we observe a trend towards the use of the percutaneous method. Among the published clinical studies there are series of patients with midterm follow-up (3 years) that show oncologic outcomes similar to traditional resection techniques, with fewer complications. CONCLUSIONS: Renal tumor radiofrequency ablation has proved an effective therapy with minimal complications. However, it should be used only in selected patients until longer follow-up studies are available.

[Radiofrequency ablation of renal cell carcinoma]. / Ablación del cáncer renal por radiofrecuencia.

INTRODUCTION: Standard treatment for small renal masses is partial nephrectomy, which has shown oncological results similar to radical nephrectomy. Ablation procedures such as radiofrequency and cryotherapy have recently been developed in order to minimize the side effects of conventional surgical excision. This article reviews radiofrequency ablation. MATERIALS AND METHODS: For this review, a search was made in the Medline database using the term "renal radiofrequency ablation". RESULTS: The different currently marketed systems for delivery of radiofrequency energy are examined. The different delivery approaches (open, laparoscopic, and percutaneous) are described. A trend towards use of the percutaneous approach was seen. Published clinical studies already include patient series with mid-term follow-ups (3 years) showing oncological outcomes similar to conventional resection procedures with fewer complications. CONCLUSIONS: Renal tumor radiofrequency ablation has proved to be an effective treatment with minimal complications. However, it should only be used in selected patients until longer follow-up studies are available.

[Consensus on castration-resistant prostate cancer management in Spain.] / Consenso sobre el manejo del cáncer de próstata resistente a la castración avanzado en España.

OBJECTIVES: To move towards a more standardized approach in clinical practice to manage patients with castration-resistant prostate cancer (CRPC) in Spain. METHODS: A panel of 18 Spanish experts in Urology with expertise managing CRPC followed a modified Delphi process with two rounds and a final face-to-face consensus meeting. The panel considered a total of 106 clinical questions divided into the following 6 sections: definition of CRPC, diagnosis of metastases by imaging techniques, symptoms of CRPC, progression of CRPC, M0 and M1 management and therapeutic sequencing. RESULTS: A bone scan (BS) is recommended at diagnosis, at the onset of bone pain, and depending on PSA levels, but it is not sensitive enough to confirm or exclude bone metastases if there is bone pain. Whole-body MRI and axial MRI are more sensitive than BS and plain X-rays, but more expensive, so they have to be used in certain situations. There is CRPC progression when there is radiologic, clinical or confirmed PSA progression. Flare phenomenon appears in treatment with taxanes and abiraterone. It was agreed that in M0 CRPC patients no drug treatment is currently recommended, although in M1 CRPC patients the first-line therapy would be mainly enzalutamide/abiraterone and/or docetaxel, depending on the symptom burden. CONCLUSION: After the consensus, we provide a series of recommendations for Spanish physicians treating CRPC to address the disease characteristics,how to tailor patient management decisions, the use of imaging techniques, and how to handle disease progression appropriately to improve patients' quality of life.

[Manoeuvres to perform a completely laparoscopic nephroureterectomy]. / Maniobras para realizar la nefroureterectomia totalmente por via laparoscopica.

OBJECTIVES: We describe a series of surgical manoeuvres to perform a completely laparoscopic nephroureterectomy. METHODS/RESULTS: We set the patient in the lateral position. The trocars are placed in a rhombus shape, with an accessory trocar for liver retraction on the right side. Once the parietal peritoneum is open the ureter and gonadal vein are localized. We clip and section the gonadal vein. The renal pedicle is localized and dissected. We divide separately the renal artery and vein. We complete the dissection of the kidney. We start the caudal dissection of the ureter from the iliac vessels level down to the pelvis. We clip the ureter. Due to the trocar deployment we reach a point in which ureteral dissection becomes difficult. Then we perform 3 manoeuvres: 1) We change the camera from the lower trocar to the right side one. 2) We move the monitor to the feet of the patient. 3) The surgeon moves to the other side of the patient to work with the superior and inferior trocars. We introduce a retractor through the remaining trocar. With these changes the ureter is in line with the camera and we may have a good access to the pelvis, making the distal dissection of the ureter easier. The dissection ends when the classic image of tent of the vesicoureteral junction is seen. The bladder patch is resected and the bladder is sutured closed with a continuous suture. The specimen is bagged and extracted opening the orifice of the iliac fossa trocar. CONCLUSIONS: With this technique, a completely laparoscopic nephroureterectomy may be performed following the oncological principles of open surgery.

Consenso sobre el manejo del cáncer de próstata resistente a la castración avanzado en España / Consensus on castration-resistant prostate cancer management in Spain

OBJETIVOS: Establecer recomendaciones sobre la práctica clínica habitual del manejo del cáncer de próstata resistente a la castración (CPRC) en España. MÉTODOS: Un panel de 18 expertos en Urología con experiencia en el manejo del CPRC participaron en un proceso Delphi modificado a dos rondas con una reunión final presencial. El panel consideró un total de 106 cuestiones clínicas divididas en las siguientes secciones: definición del CPRC, diagnóstico de metástasis por técnicas de imagen, síntomatología, progresión, manejo de M0 y M1 y secuenciación terapéutica. RESULTADOS: Se recomienda realizar una gammagrafía ósea (GO) en el diagnóstico, al comienzo del dolor óseo y dependiendo de los niveles de PSA. La resonancia magnética de cuerpo entero y la axial son más sensibles que la GO y la radiografía, pero más caras, por lo que se reservan para ciertas situaciones. Existe progresión del CPRC cuando se confirma la progresión radiológica, clínica o por PSA. El fenómeno "flare" aparece en el tratamiento con taxanos y abiraterona. En pacientes M0 no se recomienda tratamiento farmacológico actualmente, y el tratamiento en primera línea para los pacientes M1 incluiría principalmente enzalutamida/ abiraterona y/o docetaxel, según los síntomas. CONCLUSIÓN: Se proponen recomendaciones para personalizar la toma de decisiones ante cada paciente, el uso de técnicas de imagen y cómo abordar la progresión de la enfermedad para mejorar la calidad de vida de los pacientes

OBJECTIVES: To move towards a more standardized approach in clinical practice to manage patients with castration-resistant prostate cancer (CRPC) in Spain. METHODS: A panel of 18 Spanish experts in Urology with expertise managing CRPC followed a modified Delphi process with two rounds and a final face-to-face consensus meeting. The panel considered a total of 106 clinical questions divided into the following 6 sections: definition of CRPC, diagnosis of metastases by imaging techniques, symptoms of CRPC, progression of CRPC, M0 and M1 management and therapeutic sequencing. RESULTS: A bone scan (BS) is recommended at diagnosis, at the onset of bone pain, and depending on PSA levels, but it is not sensitive enough to confirm or exclude bone metastases if there is bone pain. Whole-body MRI and axial MRI are more sensitive than BS and plain X-rays, but more expensive, so they have to be used in certain situations. There is CRPC progression when there is radiologic, clinical or confirmed PSA progression. Flare phenomenon appears in treatment with taxanes and abiraterone. It was agreed that in M0 CRPC patients no drug treatment is currently recommended, although in M1 CRPC patients the first-line therapy would be mainly enzalutamide/abiraterone and/or docetaxel, depending on the symptom burden. CONCLUSION: After the consensus, we provide a series of recommendations for Spanish physicians treating CRPC to address the disease characteristics how to tailor patient management decisions, the use of imaging techniques, and how to handle disease progression appropriately to improve patients' quality of life

Ablación del cáncer renal por radiofrecuencia / Radiofrequency ablation of Renal Cell Carcinoma

Introducción: El tratamiento estándar de las masas renales de pequeño tamaño es la nefrectomía parcial, que ha demostrado unos resultados oncológicos semejantes a la nefrectomía radical. Recientemente se han desarrollado técnicas de ablación como la radiofrecuencia y la crioterapia, con el fin de minimizar los efectos secundarios de la resección quirúrgica convencional. En este artículo, revisamos la técnica de ablación mediante radiofrecuencia. Material y métodos: Para esta revisión se ha utilizado la base de datos Medline introduciendo los términos “renal radiofrequencyablation”. Resultados: Se analizan los diferentes sistemas que existen en el mercado para la aplicación de radiofrecuencia. Se describen las técnicas de aplicación (abierta, laparoscópica y percutánea), observando una tendencia clara a la aplicación de forma percutánea. En los estudios clínicos publicados existen ya series de pacientes con seguimientos a medio plazo (3 años) en los que se demuestra unos resultados oncológicos semejantes a los de las técnicas de resección clásicas y con un índice de complicaciones menor. Conclusiones: La ablación de tumores renales con radiofrecuencia ha demostrado ser un tratamiento eficaz y con mínimas complicaciones. Sin embargo, hasta que no existan seguimientos a largo plazo, se debe utilizar únicamente en pacientes seleccionados (AU)

Introduction: Standard treatment for small renal masses is partial nephrectomy, which has shown oncological results similar to radical nephrectomy. Ablation procedures such as radiofrequency and cryotherapy have recently been developed in order to minimize the side effects of conventional surgical excision. This article reviews radiofrequency ablation. Materials and methods: For this review, a search was made in the Medline database using the term “renal radiofrequency ablation”. Results: The different currently marketed systems for delivery of radiofrequency energy are examined. The different delivery approaches (open, laparoscopic, and percutaneous) are described. A trend towards use of the percutaneous approach was seen. Published clinical studies already include patient series with mid-term follow-ups (3 years) showing oncological outcomes similar to conventional resection procedures with fewer complications. Conclusions: Renal tumor radiofrequency ablation has proved to be an effective treatment with minimal complications. However, it should only be used in selected patients until longer follow-up studies are available (AU)

Ablación del cáncer renal por radiofrecuencia / Radiofrequency ablation of renal cell carcinoma

Introducción: El tratamiento estándar de las masas renales de pequeño tamaño es la nefrectomía parcial, que ha demostrado unos resultados oncológicos semejantes a la nefrectomía radical. Recientemente se han desarrollado técnicas de ablación como la radiofrecuencia y la crioterapia, con el fin de minimizar los efectos secundarios de la resección quirúrgica convencional. En este artículo, revisamos la técnica de ablación mediante radiofrecuencia. Material y Métodos: Para esta revisión se ha utilizado la base de datos Medline introduciendo los términos “renal radiofrequency ablation”. Resultados: Se analizan los diferentes sistemas que existen en el mercado para la aplicación de radiofrecuencia. Se describen las técnicas de aplicación (abierta, laparoscópica y percutánea), observando una tendencia clara a la aplicación de forma percutánea. En los estudios clínicos publicados existen ya series de pacientes con seguimientos a medio plazo (3 años) en los que se demuestra unos resultados oncológicos semejantes a los de las técnicas de resección clásicas y con un índice de complicaciones menor. Conclusiones: La ablación de tumores renales con radiofrecuencia ha demostrado ser un tratamiento eficaz y con mínimas complicaciones. Sin embargo, hasta que no existan seguimientos a largo plazo, se debe utilizar únicamente en pacientes seleccionados (AU)

Introduction: The standard treatment of small renal masses is partial nephrectomy, which has showed similar oncologic results when compared with radical nephrectomy. Recently, ablative techniques, including radiofrequency and cryotherapy ablation, has been developed, with the purpose of minimizing adverse effects of standard surgical excision. In this article we review the technique of radiofrequency ablation. Material and methods: For this review we conducted a search in the Medline database using the terms “renal radiofrequency ablation”. Results: The different currently marketed systems for the delivery of radiofrequency energy are examined. The different techniques of delivery (open, laparoscopic and percutaneous) are described; we observe a trend towards the use of the percutaneous method. Among the published clinical studies there are series of patients with midterm follow-up (3 years) that show oncologic outcomes similar to traditional resection techniques, with fewer complications. Conclusions: Renal tumor radiofrequency ablation has proved an effective therapy with minimal complications. However, it should be used only in selected patients until longer follow-up studies are available (AU)