Small renal masses in Latin-American population: characteristics and prognostic factors for survival, recurrence and metastasis - a multi-institutional study from LARCG database.

BACKGROUND: To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. METHODS: A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. RESULTS: PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. CONCLUSIONS: PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.

American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.

PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

International multi-institutional experience with the vessel-sparing technique to reconstruct the proximal bulbar urethra: mid-term results.

OBJECTIVE: To present mid-term outcomes from an international, multi-institutional cohort of patients undergoing vessel-sparing excision and primary anastomosis urethroplasty for the reconstruction of the anterior urethra. MATERIALS AND METHODS: From June 2003 to December 2011, 68 patients underwent vessel-sparing anterior urethral reconstruction at five different international institutions using the vessel-sparing technique described by Jordan et al. (J Urol 177(5):1799-1802, 2007). RESULTS: Patients' age range was from 3 to 82 years (mean 51.2). Stricture length ranged from 1 to 3 cm (mean 1.78). After a mean follow-up of 17.6 months, 95.6 % of patients had a widely patent urethral lumen. Three patients failed the procedure, requiring either direct vision internal urethrotomy or urethral dilation, after which all were free of symptoms and did not require further instrumentation. Complications were minimal and as expected following open urethroplasty. CONCLUSION: Preservation of blood supply is a noble pursuit in surgery; however, it can be technically difficult and often requires more time and effort. This vessel-sparing technique for anterior urethral reconstruction is reproducible and appears to be reliable in this international cohort. Larger studies and longer follow-up are needed to support these encouraging results.

Solitary Fibrous Tumor of the pelvis involving the bladder. Case report and literature review.

A case of a patient with diagnosis of Solitary Fibrous Tumor of de urinary bladder is presented. A 69 year old man presented with abdominal pain localized at the hypogastrium. In the computed tomography appears a mass of 100 × 80 mm at the minor pelvis. Mass resection, radical cystoprostatectomy and ileal conduit diversion were done. A Solitary Fibrous Tumor of the urinary bladder was diagnosed. CD 34 (+). Surgical resection with negative margins has curative intention. Is necessary long-term follow up to assure there is not local or distant recurrence.

Características epidemiológicas de la estrechez y estenosis uretral masculina en una institución de alta complejidad en Buenos Aires, Argentina / Epidemiological characteristics of male urethral stricture and stenosis in a highly complex institution in Buenos Aires, Argentina

Objetivo: Determinar la etiología actual y las características clínicas de la estrechez y estenosis de uretra masculina, en una institución de alta complejidad. Método: Estudio observacional, descriptivo de tipo transversal. Se recolectó información de 344 pacientes con estrechez o estenosis de uretra a los cuales se les realizó uretroplastia entre enero de 2011 y marzo de 2019. Para cada paciente se tuvo en cuenta la edad, la etiología, el sitio uretral comprometido, la longitud de la estrechez, procedimientos previos y la cirugía realizada. Resultados: La edad media fue 59,6 años (rango 14-90 años). La etiología más común fue la iatrogénica (68,1%), seguida de la inflamatoria (13,9%), idiopática (12,2%) y traumática (5,5%). De las causas iatrogénicas, el 39,2% fueron secundarias a instrumentación uretral, el 20,6% a cirugía endoscópica de próstata, el 4,3% poscirugía de hipospadias, un 2,3% otras y un 1,7% cirugía de próstata abierta. Al estratificar por edad, la etiología de la estrechez más común fue iatrogénica en los tres grupos etarios: en el grupo de 0-45 años con un 32,6%, en el grupo de 46-59 años con un 63,3% y en el grupo de mayores de 60 años con un 83,4%. Conclusión: La estrechez de uretra es una patología que cada vez se presenta con más frecuencia en la práctica urológica diaria, no es una enfermedad de los ancianos sino que involucra a todas las edades. Actualmente, la principal causa es la etiología iatrogénica, por lo cual estamos obligados a mejorar las estrategias de prevención

Objective: To determine the actual etiology and clinical characteristics of male urethral stricture and stenosis in a highly complexity institution. Method: Observational, descriptive cross-sectional study. Information was collected from 344 patients with urethral stricture or stenosis who underwent urethroplasty between January 2011 and March 2019. Age, etiology, compromised urethral site, length of the stricture, previous procedures and surgery performed were considered for each patient. Results: The median age was 59.6 years (range 14-90 years). The most common etiology was iatrogenic 68.1%, followed by inflammatory 13.9%, idiopathic 12.2% and traumatic 5.5%. Of the iatrogenic causes, 39.2% were secondary to urethral instrumentation, 20.6% endoscopic prostate surgery, 4.3% post-hypospadias surgery, 2.3% other, and 1.7% open prostate surgery. When stratifying by age, the most common etiology of stricture was iatrogenic in all three age groups: in the 0-45 years group (32.6%), in the 46-59 years group (63.3%) and in the group of over 60 years (83.4%). Conclusion: Urethral stricture is a pathology that occurs more and more frequently in daily urological practice, it is not a disease of the elderly but involves all ages. Currently, the main cause is iatrogenic etiology, for which reason we are obliged to improve prevention strategies