Concomitant intraductal carcinoma of the prostate and response to hormonal therapy in metastatic prostate carcinoma.

INTRODUCTION AND OBJECTIVE: Most prostate cancers are classified as acinar adenocarcinoma. Intraductal carcinoma of the prostate (IDC-P) is a distinct histologic entity that is believed to represent retrograde spread of invasive acinar adenocarcinoma into prostatic ducts and acini. We have analyzed the impact of IDC-P in hormonal naïve and castration resistant metastatic prostate cancer patients. PATIENTS AND METHODS: We retrospectively evaluated 118 metastatic castration resistant prostate cancer (mCRPC) patients who were initially diagnosed with distant metastases from May 2010 to September 2018. Group 1 patients included 81 metastatic PCa patients with acinar adenocarcinoma and Group 2 included 37 metastatic PCa patients with IDC-P. RESULTS: Mean age at presentation was 76 years (IQR 73.4-78.7) in group 1 and 74 years (68.5-80.6) in group 2. Mean PSA at diagnosis was 619 ng/mL (IQR 85-1113) and 868 ng/mL (IQR 186-1922), respectively. Time to castration resistance was 24.7 months (IQR 16.7-32.7) in group 1 and 10.2 months (IQR 4.2-16.2) in group 2 (P = .007). Time to progression in CPRC patients was: 10.6 months (IQR 5.6-15.6) and at 6.2 months (3.2-9.2), respectively (P = .05). Overall survival was 57.9 months in group 1(CI 95% 56.4-59.5) and 38 months (CI 95% 19.9-48.06) in group 2 (P = .001). In the multivariate analysis, adenocarcinoma subtype was statistically significant P .014, CI 95% (HR 0.058, 0.006-0.56) CONCLUSIONS: IDC-P seems to be a subtype of prostate cancer that is associated with a shorter response to hormonal treatment when compared to acinar adenocarcinoma in metastatic patients. New drugs in CRPC scenario as abiraterone and enzalutamide also obtained less response in IDC-P patients. Once IDC-P is identified, clinicians could extrapolate the relative poor response to hormonal therapy. Consequently, follow-up of these patients in this scenario should be more strict.

[Presentation of a new case of primary clear cell adenocarcinoma of the urethra and its surgical management]. / Presentación de un nuevo caso de adenocarcinoma de células claras uretral y su manejo quirúrgico.

OBJECTIVE: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. MATERIAL AND METHODS: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. CONCLUSIONS: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.

[Laparoscopic radical prostatectomy: learning curve with a mentor training program]. / Prostatectomía radical laparoscópica: la curva de aprendizaje con tutor.

INTRODUCTION: We describe and evaluate the results of our mentor training program for laparoscopic radical Prostatectomy (LRP). MATERIAL AND METHODS: From March 2004 through December 2005, we have performed 105 (LRP). Three groups have been analysed: Group 1: The mentor as the first surgeon with the trainee acting as the assistant. Group 2: The trainee as the first surgeon with the mentor acting as the assistant. Group 3: The trainee as the first surgeon with another trainee/resident as the assistant. We have evaluated operative, postoperative data and surgical/oncological control. RESULTS: There was no statistical difference in mean operative time in Groups 2 and 3 (200'-198'), but there was a difference from Group 1 (148,4') (p<0,05) we have observed a progressive operative time decrease only in Group 1. Blood loss, surgical-oncological control, pathological stage and hospital stay have been similar in the three groups. CONCLUSIONS: Skills for LRP can be effectively and safely taught by the presence of an experienced mentor. Waiting for long term results according to potency and continence, it was not associated to higher patient risk, neither to a worse surgical/oncologic outcome. We consider that this program is reproducible and allows a shorter learning curve.

[Comparison between open and laparoscopic approach in radical prostatectomy]. / Prostatectomia radical laparoscópica versus abierta.

INTRODUCTION: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). MATERIAL AND METHODS: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). RESULTS: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed. CONCLUSION: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

[Bipolar versus monopolar transurethral resection of the prostate: peroperative analysis of the results]. / Resección transuretral de próstata bipolar vs monopolar: análisis peroperatorio de los resultados.

OBJECTIVE: To analyse the differences in the postoperative period between bipolar and monopolar resection of the prostate in the endoscopic surgery of the benign prostatic hyperplasia. METHODS: 45 patients were prospectively randomized. Twenty-one underwent monopolar resection (Storz Ch 26, 30 degrees) and 24 underwent bipolar resection (Olympus ch 26, 30 degrees). RESULTS: Mean age in the bipolar group was 69,5 years versus 67,3 in the monopolar group; mean flow before surgery (7,7 ml/s vs 7,2 ml/s); ecographic prostate volume (39,5 cc vs 42,7 cc); resection volume 13 g vs 12,6 g and mean resection time was 39,7 vs 42,5 min. Cut capacity was considered notable-excellent in 90% of the patients in the bipolar group vs 50% in the monopolar group (p=0,01); adherence of fragments were considered abundant or very abundant in 0% vs 60% (p=0,01); coagulation capacity was excellent-notable in 25% vs 75% (p=0,03). There were no significant differences on the days of catheterization (2,92 vs 3,1), continuous irrigation (1,79 vs 2,05), hospitalization (3,63 vs 3,67), hematocrite descent (3,48 vs 3,32) and plasmatic sodium (0,52 vs 1,16), neither on episodes of acute urine retention (only one patient in the monopolar group). CONCLUSIONS: In our experience, TURP with SurgMaster resector in prostate smaller than 70 g offers better peroperative qualities for the surgeon (better cut capacity, less adherence of fragments) than the monopolar resection, with similar postoperative outcomes.

[Current status of radical laparoscopic prostatectomy]. / Estado actual de la prostatectomía radical laparoscópica.

Laparoscopic surgery can be said to have come of age when it was first indicated for cancer conditions. Advances in this field are largely due to the French school, which has made it a standard practise in prostate cancer. It complies with the principles required for cancer as well as conventional surgery, but it remains to be verified whether its long-term results, both from tumoral and functional perspectives, are not only similar to those of classical surgery, but even better. In fact, increasing numbers of clinical groups are incorporating this technique in their daily work.

[Dermatomyositis and small cell tumor of the kidney]. / Dermatomiositis y tumor renal de células pequeñas.

Dermatomyositis is an inflammation of the striated muscle with an important leukocyte infiltrate which is accompanied by a characteristic cutaneous exanthema. In the international classification we find DM associated with neoplasm in 10% of cases. It is accepted that neoplasms are related to DM if it does not exceed it in two years (prior o after the onset of the disease. The most commonly associated are lung, ovary and breast cancers. In the pas ten years only two cases of DM associated to renal cancer (both in renal cell cancers) have been published. In this article we present a case history of a woman with a DM associated to a renal oat-cell carcinoma. Also, we will review the literature on this theme and will evaluate the predictive parameters of the presence of malignancies in this pathology.

[Barcelona pouch. An external continent urinary diversion]. / Barcelona Pouch. Una derivación urinaria externa continente.

OBJECTIVES: To describe a new technique for external continent urinary diversion based on the Vesica Ileale Padovana technique (VIP) with a continent hydraulic valve, which obviates the need for external permanent collecting urinary systems. METHODS: An ileal neobladder was created following the VIP technique to which we added a modified Benchekroun continent hydraulic valve utilizing mechanical sutures. RESULTS: A continent heterotopic neobladder was achieved. The technique was easy to perform and permitted preservation of the upper urinary tract due to the pouch's low internal pressures. CONCLUSIONS: In our view, this technique is a valid alternative in patients unamenable to orthotopic diversion and are able to perform self-catheterization.

[Simplified vasovasostomy]. / Vaso-vasostomía simplificada.

OBJECTIVES: A simplified technique to repair seminal duct obstruction is described. METHODS: Optical magnification, a channeled instrument as a suture guide that we have developed and fibrin glue are utilized. RESULTS: This technique is safe, reduces operating time and achieves similar results as with a surgical microscope. CONCLUSIONS: This technique facilitates repair of small caliber structures, reduces the operating time and does not require large microscopic systems.

[New compound needle for percutaneous renal puncture]. / Nueva aguja compuesta para la punción renal percutánea.

OBJECTIVE: We have developed a needle for direct percutaneous access in order to introduce the flexible wire with a single puncture, without creating two parallel tracks, thereby affording a lower morbidity than the conventional technique. METHOD: The needle consists of an internal and an external device, with different lengths and diameters, that let us first create the access to the urinary tract with the inner device and then dilate with the outer device in order to introduce the metallic wire with a single puncture, sliding the outer over the inner device. RESULTS: We can achieve the same number of percutaneous accesses with less morbidity since less punctures are required to create the track. CONCLUSION: This is a useful needle for any type percutaneous access.

[Cyst of the seminal vesicle associated with renal dysgenesis and ipsilateral ectopic ureter. Apropos of 3 clinical cases]. / Kyste de la vésicule séminale associée à une dysgénésie rénale et à un uretère ectopique ipsilatéral. Présentation de 3 cas cliniques.

We discuss the cystic pathology of seminal vesicles, and its relation with ureteral ectopy, as well as the therapeutic options for both entities. We present our experience in the resolution of three typical cases.