Radiofrecuencia percutánea guiada por ecografía en el tratamiento de masas renales pequeñas / Ultrasound-guided percutaneous radiofrequency ablation for treating small renal masses

Introducción: El objetivo del presente estudio ha sido analizar y evaluar la experiencia en ablación por radiofrecuencia de masas renales pequeñas mediante abordaje percutáneo guiado por ecografía con contraste en pacientes no aptos para la resección quirúrgica, y/o que no aceptaron vigilancia u observación. Material y método: Desde enero de 2007 hasta agosto de 2015 se han realizado 164 tratamientos en un total de 148 pacientes. Se presentan las características clínico-radiológicas de los pacientes, los resultados oncológicos y funcionales a corto y medio plazo. Resultados: La tasa de éxito técnico global fue del 97,5%, con éxito final en una sesión en el 100% de lesiones ≤ 3 cm y el 92% en lesiones entre 3-5 cm. El diámetro medio de los tumores en los que el tratamiento fue finalmente exitoso fue de 2,7 cm, mientras que el diámetro medio de estos fallos fue de 3,9 cm (p < 0,05). No se observaron diferencias estadísticamente significativas en la creatinina sérica y en el filtrado glomerular estimado. Conclusiones: A pesar de la baja tasa de biopsia renal positiva en la serie, la aplicación de radiofrecuencia percutánea ecoguiada en el tratamiento de lesiones renales pequeñas parece un procedimiento eficaz y seguro, con un mínimo impacto sobre la función renal, un aceptable control oncológico a corto y medio plazo, con una baja tasa de complicaciones

Introduction: The objective of this study was to analyse and assess the experience with radiofrequency ablation of small renal masses using a contrast-enhanced, ultrasound-guided percutaneous approach for patients who are not suitable for surgical resection and/or who refused surveillance or observation. Material and method: From January 2007 to August 2015, 164 treatments were performed on a total of 148 patients. We present the patients’ clinical-radiological characteristics, oncological and functional results in the short and medium term. Results: The overall technical success rate was 97.5%, with a successful outcome in 1 session in 100% of the lesions ≤ 3cm and 92% in lesions measuring 3-5cm. The mean tumour diameter in the patients for whom the treatment was ultimately successful was 2.7 cm, while the mean diameter of these in the unsuccessful operations was 3.9 cm (P < .05). There were no statistically significant differences in the serum creatinine levels and estimated glomerular filtration rates. Conclusions: Despite the low rate of positive renal biopsies in the series, ultrasound-guided percutaneous radiofrequency ablation for treating small renal lesions appears to be an effective and safe procedure with a minimum impact on renal function, an acceptable oncologic control in the short and medium term and a low rate of complications

Ultrasound-guided percutaneous radiofrequency ablation for treating small renal masses. / Radiofrecuencia percutánea guiada por ecografía en el tratamiento de masas renales pequeñas.

INTRODUCTION: The objective of this study was to analyse and assess the experience with radiofrequency ablation of small renal masses using a contrast-enhanced, ultrasound-guided percutaneous approach for patients who are not suitable for surgical resection and/or who refused surveillance or observation. MATERIAL AND METHOD: From January 2007 to August 2015, 164 treatments were performed on a total of 148 patients. We present the patients' clinical-radiological characteristics, oncological and functional results in the short and medium term. RESULTS: The overall technical success rate was 97.5%, with a successful outcome in 1 session in 100% of the lesions≤3cm and 92% in lesions measuring 3-5cm. The mean tumour diameter in the patients for whom the treatment was ultimately successful was 2.7cm, while the mean diameter of these in the unsuccessful operations was 3.9cm (P<.05). There were no statistically significant differences in the serum creatinine levels and estimated glomerular filtration rates. CONCLUSIONS: Despite the low rate of positive renal biopsies in the series, ultrasound-guided percutaneous radiofrequency ablation for treating small renal lesions appears to be an effective and safe procedure with a minimum impact on renal function, an acceptable oncologic control in the short and medium term and a low rate of complications.

Utilidad del índice RENAL -Radius; Exo/endophitic; Nearnes to sinus; Anterior/posterior; Location relative to polar lines- en el manejo de las masas renales / Utility of the RENAL index -Radius; Exophytic/endophytic; Nearness to sinus; Anterior/posterior; Location relative to polar lines- in the management of renal masses

Contexto: La creciente incidencia de las masas renales y el amplio abanico de tratamientos disponibles hacen necesario el establecimiento de herramientas predictivas que apoyen la toma de decisiones. El índice RENAL -Radius; Exo/endophitic; Nearnes to sinus; Anterior/posterior; Location relative to polar lines- permite estandarizar la anatomía de una masa renal diferenciando 3 grupos de complejidad. Desde su presentación existe una creciente, y a veces contradictoria, literatura que evalúa la utilidad clínica de su aplicación. Objetivo: Analizar la evidencia científica sobre la relación entre el índice RENAL y las principales estrategias para el manejo de una masa renal. Adquisición de la evidencia: Se realizó una búsqueda en la base de datos Medline, encontrando 576 citas bibliográficas sobre el índice RENAL. De acuerdo con la Declaración PRISMA se seleccionaron 100 resúmenes y finalmente se revisaron 96 artículos. Síntesis de la evidencia: El índice RENAL tiene un alto grado de concordancia interobservador y ha sido validado como nomograma predictivo de resultado histológico. En vigilancia activa se ha relacionado con la velocidad de crecimiento tumoral y la probabilidad de nefrectomía. En terapia ablativa se ha asociado con la eficacia terapéutica, complicaciones y recidiva tumoral. En nefrectomía parcial se ha relacionado con la tasa de complicaciones, la conversión a cirugía radical, el tiempo de isquemia, la preservación funcional y la recidiva tumoral, hallazgo también observado en nefrectomía radical. Conclusiones: El índice RENAL es un sistema objetivo, reproducible y útil como herramienta predictiva de parámetros clínicos tan relevantes como la tasa de complicaciones, el tiempo de isquemia, la función renal y los resultados oncológicos en los diversos tratamientos actualmente aceptados para el manejo de una masa renal

Context: The growing incidence of renal masses and the wide range of available treatments require predictive tools that support the decision making process. The RENAL index -Radius; Exophytic/endophytic; Nearness to sinus; Anterior/posterior; Location relative to polar lines- helps standardise the anatomy of a renal mass by differentiating 3 groups of complexity. Since the introduction of the index, there have been a growing number of studies, some of which have been conflicting, that have evaluated the clinical utility of its implementation. Objective: To analyse the scientific evidence on the relationship between the RENAL index and the main strategies for managing renal masses. Acquisition of the evidence: A search was conducted in the Medline database, which found 576 references on the RENAL index. In keeping with the PRISM Declaration, we selected 100 abstracts and ultimately reviewed 96 articles. Synthesis of the evidence: The RENAL index has a high degree of interobserver correlation and has been validated as a predictive nomogram of histological results. In active surveillance, the index has been related to the tumour growth rate and probability of nephrectomy. In ablative therapy, the index has been associated with therapeutic efficacy, complications and tumour recurrence. In partial nephrectomy, the index has been related to the rate of complications, conversion to radical surgery, ischaemia time, function preservation and tumour recurrence, a finding also observed in radical nephrectomy. Conclusions: The RENAL index is an objective, reproducible and useful system as a predictive tool of highly relevant clinical parameters such as the rate of complications, ischaemia time, renal function and oncological results in the various currently accepted treatments for the management of renal masses

Utility of the RENAL index -Radius; Exophytic/endophytic; Nearness to sinus; Anterior/posterior; Location relative to polar lines- in the management of renal masses. / Utilidad del índice RENAL ­Radius; Exo/endophitic; Nearnes to sinus; Anterior/posterior; Location relative to polar lines­ en el manejo de las masas renales.

CONTEXT: The growing incidence of renal masses and the wide range of available treatments require predictive tools that support the decision making process. The RENAL index -Radius; Exophytic/endophytic; Nearness to sinus; Anterior/posterior; Location relative to polar lines- helps standardise the anatomy of a renal mass by differentiating 3 groups of complexity. Since the introduction of the index, there have been a growing number of studies, some of which have been conflicting, that have evaluated the clinical utility of its implementation. OBJECTIVE: To analyse the scientific evidence on the relationship between the RENAL index and the main strategies for managing renal masses. ACQUISITION OF THE EVIDENCE: A search was conducted in the Medline database, which found 576 references on the RENAL index. In keeping with the PRISM Declaration, we selected 100 abstracts and ultimately reviewed 96 articles. SYNTHESIS OF THE EVIDENCE: The RENAL index has a high degree of interobserver correlation and has been validated as a predictive nomogram of histological results. In active surveillance, the index has been related to the tumour growth rate and probability of nephrectomy. In ablative therapy, the index has been associated with therapeutic efficacy, complications and tumour recurrence. In partial nephrectomy, the index has been related to the rate of complications, conversion to radical surgery, ischaemia time, function preservation and tumour recurrence, a finding also observed in radical nephrectomy. CONCLUSIONS: The RENAL index is an objective, reproducible and useful system as a predictive tool of highly relevant clinical parameters such as the rate of complications, ischaemia time, renal function and oncological results in the various currently accepted treatments for the management of renal masses.

Sedentarismo y sobrepeso como factores de riesgo en la detección del cáncer de próstata y su agresividad / Sedentarism and overweight as risk factors for the detection of prostate cancer and its aggressivenes

Objetivo: Analizar la influencia del sedentarismo (SE) y sobrepeso (SP) en el riesgo de detección de cáncer de próstata (CP) y su agresividad. Material y método: Se realizó biopsia prostática (BP) a 2.408 varones consecutivos, no tratados con 5 ARI, a causa de elevación sérica del PSA por encima de 4,0 ng/ml (91%) o tacto rectal sospechoso (9%). En la BP, transrectal y ecodirigida, se obtuvieron 10 cilindros, y entre 2 y 8 adicionales en función de la edad y del volumen prostático. La actividad física se evaluó mediante una encuesta (SE vs no SE) y se calculó el índice de masa corporal (normal vs SP: > 25 kg/cm2). La agresividad tumoral se evaluó según la suma de Gleason (alto grado [AG]: Gleason > 7) y el riesgo de D'Amico (alto riesgo [AR]: T > 3a o PSA > 20 o suma de Gleason > 7). Resultados: Se halló una asociación significativa entre SE (52,5%) y SP (72,9%), p > 0,001. La tasa global de detección de CP fue 35,2%. En varones con SE fue 36,7% y en no SE 33,6%, p = 0,048. La tasa global de tumores de AG fue 28,3%, 29,2% en varones con SE y 27,1% en no SE, p = 0,261. La tasa global de tumores de AR fue 35%, 39,7% en varones con SE y 29,4% en no SE, p < 0,001. Se detectó CP en un 38,1% de hombres con IMC normal y 34,3% en hombres con SP, p = 0,065. La tasa de tumores de AG fue 18,1 y 31,4% respectivamente, p < 0,001, y la tasa de tumores de AR fue 22,6 y 39,2% respectivamente, p < 0,001. La regresión logística binaria mostró que el SE fue un predictor independiente de CP, RR 0,791 (95% IC: 0,625-0,989), p = 0,030. SE y SP fueron predictores independientes de AG: RR 0,517 (95% IC: 0,356-0,752), p = 0,001, y RR 1,635 (95% IC 1,070-2,497), p = 0,023. SE y SP también fueron predictores independientes de AR: RR 0,519 (95% IC: 0,349-0,771), p = 0,001, y RR 1,998 (95% IC: 1,281-3,115), p = 0,002. Conclusiones: En varones que cumplen criterios de biopsia prostática se encontró una asociación entre sedentarismo y sobrepeso. El sedentarismo se asoció a mayor riesgo de detección de CP, mientras sedentarismo y sobrepeso incrementaron el riesgo de detección de tumores más agresivos

Objective: To analyze the influence of sedentary (SE) and overweight (OW) in the risk of prostate cancer detection (CP) and aggressiveness. Material and method: We performed prostate biopsy (PB) to 2,408 consecutive male, 5 ARIs untreated, because of elevated serum PSA above 4.0 ng/mL (91%) or suspicious digital rectal examination (9%). In all ultrasound guided PB, 10 cores were obtained plus 2 to 8 additionals, according to age and prostate volume. Physical activity was assessed using a survey (SE vs non-SE) and calculated body mass index (normal vs OW > 25 kg/cm2). The tumor aggressiveness was evaluated according to the Gleason score (high grade «HG»: Gleason> 7) and D’Amico risk (high risk «HR»: T > 3a or PSA > 20 or Gleason score > 7). Results: We found a significant association between SE (52.5%) and OW (72.9%), P < 0.001. The overall PC detection rate was 35.2%. In men with SE it was 36.7% and non-SE 33.6%, P = 0.048. The overall rate of AG tumors was 28.3%, 29.2% in men with SE and 27.1 in non-SE, P = 0.261. The overall rate of AR tumors was 35%, 39.7% in men with SE and 29.4% non-SE, P < 0.001. CP was detected in 38.1% of men with normal BMI and 34.3% in men with OW, P = 0.065. HG tumor rates were 18.1% and 31.4% respectively, P < 0.001 and AR tumor rates were 22.6% and 39.2% respectively, P < 0.001. Binary logistic regression showed that SE was an independent predictor of CP, OR .791 (95% CI: .625-0.989), P = 0.030. SE and OW were independent predictors of HG: OR .517 (95% CI: .356-0.752), P = 0.001, and OR 1.635 (95% CI: 1070-2497), p = 0.023. SE and OW were also independent predictors of HR: OR 0.519 (95% CI 0.349-.771), P = 0.001, and OR 1.998 (95% CI 1.281-3.115), P = 0.002. Conclusions: In men who met criteria for prostate biopsy an association between sedentary and overweight exist. A sedentary lifestyle is associated with increased risk of PC detection while sedentary and overweight were associated with more aggressive tumors

Sedentarism and overweight as risk factors for the detection of prostate cancer and its aggressivenes.

OBJECTIVE: To analyze the influence of sedentary (SE) and overweight (OW) in the risk of prostate cancer detection (CP) and aggressiveness. MATERIAL AND METHOD: We performed prostate biopsy (PB) to 2,408 consecutive male, 5 ARIs untreated, because of elevated serum PSA above 4.0 ng/mL (91%) or suspicious digital rectal examination (9%). In all ultrasound guided PB, 10 cores were obtained plus 2 to 8 additionals, according to age and prostate volume. Physical activity was assessed using a survey (SE vs non-SE) and calculated body mass index (normal vs OW > 25 kg/cm(2)). The tumor aggressiveness was evaluated according to the Gleason score (high grade «HG¼: Gleason > 7) and D'Amico risk (high risk «HR¼: T > 3a or PSA > 20 or Gleason score > 7). RESULTS: We found a significant association between SE (52.5%) and OW (72.9%), P < .001. The overall PC detection rate was 35.2%. In men with SE it was 36.7% and non-SE 33.6%, P = .048. The overall rate of AG tumors was 28.3%, 29.2% in men with SE and 27.1 in non-SE, P = .261. The overall rate of AR tumors was 35%, 39.7% in men with SE and 29.4% non-SE, P < .001. CP was detected in 38.1% of men with normal BMI and 34.3% in men with OW, P = .065. HG tumor rates were 18.1% and 31.4% respectively, P < .001 and AR tumor rates were 22.6% and 39.2% respectively, P < .001. Binary logistic regression showed that SE was an independent predictor of CP, OR .791 (95% CI: .625-.989), P = .030. SE and OW were independent predictors of HG: OR .517 (95% CI: .356-.752), P = .001, and OR 1.635 (95% CI: 1070-2497), p = 0.023. SE and OW were also independent predictors of HR: OR .519 (95% CI .349-.771), P = .001, and OR 1.998 (95% CI 1.281-3.115), P = .002. CONCLUSIONS: In men who met criteria for prostate biopsy an association between sedentary and overweight exist. A sedentary lifestyle is associated with increased risk of PC detection while sedentary and overweight were associated with more aggressive tumors.

Pheochromocytoma of the urinary bladder: report of 2 cases and review of literature.

Pheochromocytoma of the urinary bladder is a rare neoplasm of the chromaffin tissue of the sympathetic nervous system within the layers of the bladder wall. Approximately 220 cases have been reported in literature. It accounts for less than 0.06% of all urinary bladder tumors and less than 1% of all pheochromocytomas. Females are affected more frequently and it is more common between the second to fourth decades of life. The diagnosis is strongly based on the clinical symptoms related to catecholamine hypersecretion. In some cases however, the tumor is hormonally inactive and may go undetected for years. The cytologic features of benign and malignant tumors overlap and thus there are no reliable features of malignancy. Nevertheless the prognosis seems to be better for patients with superficial tumors comparing to patients with invasive tumors, found in 5-10% of cases. In the majority of cases the treatment of choice is surgical resection. For metastatic tumors, chemotherapy and radiotherapy seem to be effective. The authors present two new cases of pheochromocytoma of the urinary bladder. The presenting symptom was painless hematuria. Both patients had well-controlled blood pressure and none of the characteristic symptoms of pheochromocytoma. The authors discuss the difficulties in diagnosis and treatment and briefly review literature.