ABSTRACT
The objective of this study was to evaluate and compare efficacy and safety of two different Disposable circumcision suture devices (DCSDs). A prospective comparative non-randomized multicenter study was performed between November 2019 and February 2023. Patients underwent circumcision using a DCSD (CircCurerTM or the ZSR® device) according to the surgeon preference and device availability. A total of 378 patients were circumcised; 184 using CircCurerTM and 194 patients using ZSR®. No differences in baseline characteristics were observed. CircCurer and ZSR Groups showed similar rates of operative time (7.7 ±2.1 vs 7.3 ±2.0 min), surgical site infection (1.1% Vs 1.5%), edema (13% Vs 8.2%), hematomas (2.7% Vs 1.1%), and postoperative pain (2.5 Vs 2.0 points). ZSR Group had a significantly higher rate of clip fallout (62.9% Vs 38%, p < 0.001). At 2 months, patients of both groups reported a median satisfaction of 9 (8-9) points. Main limitation consist in non-randomized study. DCSDs seem to be effective and safe, with short operative times, uncommon and mild complications, and high patient satisfaction. ZSR® device has a higher rate of spontaneous staple dropout.
ABSTRACT
PURPOSE: The COVID-19 pandemic which has affected Spain since the beginning of 2020 compels us to determine recomendations for the practice of Andrology in present times. MATERIALS AND METHODS: A web search is carried out in English and Spanish and a joint proposal is defined by experts in Andrology from different regions of Spain. RESULTS: Most diagnostic and therapeutic procedures in Andrology can be safey postponed during the COVID-19 pandemic. Online consultations and outpatient surgeries must be encouraged. Andrologic emergencies and penile cancer management should be considered high priority, and should be diagnosed and treated promptly even in the most severe phases of the pandemic.
INTRODUCCIÓN: La pandemia COVID-19 que ha afectado a España desde comienzos de 2020 obliga a definir unas recomendaciones para la práctica de la Andrología en la actualidad.MATERIAL Y MÉTODOS: Se realiza una búsqueda web en inglés y español y se define una propuesta conjunta por parte de expertos en Andrología de distintas regiones de España.RESULTADOS: La mayor parte de los procedimientos diagnósticos y terapéuticos en Andrología pueden ser demorados con seguridad durante la pandemia COVID-19. Se debe fomentar la consulta telemática y la cirugía ambulatoria. Las urgencias andrológicas y el manejo del cáncer de pene deben considerarse una prioridad alta, diagnosticándose y tratándose con brevedadi ncluso en las fases más severas de la pandemia.
Subject(s)
Coronavirus Infections , Pandemics , Penile Neoplasms , Pneumonia, Viral , Andrology , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Humans , Male , Penile Neoplasms/diagnosis , Penile Neoplasms/therapy , Pneumonia, Viral/epidemiology , SARS-CoV-2 , SpainABSTRACT
CONTEXT: Kidney transplantation is the best treatment for patients with end-stage renal disease. Incidence of small renal masses (SRMs), which most frequently are renal cell carcinomas (RCCs), is highest in patients aged >60 yr. The increasing age of donors can lead to the diagnosis of a higher number of SRMs when assessing the patient for transplantation, and so can theoretically decrease the number of kidneys suitable for transplantation. Aiming to increase the pool of kidneys suitable for transplantation, a number of studies have reported their experience using kidneys with SRMs for transplantation. OBJECTIVE: To systematically review all available evidence on the effectiveness and harm of using kidneys with SRMs as a source of transplantation. EVIDENCE ACQUISITION: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting outcomes of adult renal transplantation using kidneys with SRMs. EVIDENCE SYNTHESIS: Nineteen studies enrolling 109 patients were included and synthesized narratively. The mean recipient age was 44.2 yr, and kidneys used were retrieved from living donors in 86% (94/109) of cases. Tumor excision was performed ex vivo in all cases except for two. The vast majority of excised tumors were RCCs (88/109 patients), and clear-cell subtype was most common. The mean tumor size was 2cm (range 0.5-6.0cm) and tumor grade was G1-G2 in 93% (75/81) of patients. With a mean follow-up of 39.9 mo, overall survival rates at 1, 3, and 5 yr were 97.7%, 95.4%, and 92%, respectively, and the mean graft survival rates 99.2%, 95%, and 95.6%, respectively. Only one local relapse occurred 9 yr after transplantation, which was managed conservatively. Functional outcomes, although infrequently reported, appear to be similar to those of conventional transplants, with 1.6% of these patients needing reoperation. CONCLUSIONS: The current literature, although with low-level evidence, suggests that kidneys with excised SRMs are an acceptable source of transplantation without compromising oncological outcomes and with similar functional outcomes to other donor kidneys. PATIENT SUMMARY: Renal transplantation using a kidney with a small renal mass does not appear to increase the risk of cancer recurrence and can be a good option for selected patients after appropriate counseling and allocation.
Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Kidney Transplantation , Living Donors , Tissue Donors , Carcinoma, Renal Cell/pathology , Humans , Kidney/pathology , Kidney Neoplasms/pathology , Kidney Transplantation/adverse effects , Kidney Transplantation/methodsABSTRACT
CONTEXT: Cancer development after kidney transplant (KT) has become a major problem, and currently, it is one of the primary causes of death in this population. Urological cancers after KT such as prostate cancer (PCa) have also increased, partly due to the increasing age of recipients and prolonged survival. PCa is the second most commonly diagnosed cancer in men, accounting for 15% of all cancers. Managing localised PCa after KT remains challenging because of treating an immunosuppressed patient with a kidney graft in the pelvic cavity. Several papers reporting PCa treatment after KT have been published. Merging all the available data and summarising most important evidence could be useful for scientific community involved in this issue. OBJECTIVE: To systematically review all the available evidence in literature regarding the management of localised PCa after KT. EVIDENCE ACQUISITION: Computerised bibliographic search of Medline, Embase, and Cochrane databases was performed for all studies reporting outcomes of localised PCa diagnosed in KT patients undergoing curative treatments, including surgery, external beam radiotherapy (EBR) and brachytherapy. EVIDENCE SYNTHESIS: In total, 41 studies included 319 patients with localised PCa after KT. Their mean age was 61.8 (range, 47-79) yr and mean time from KT to PCa was 122 (range, 2-336) mo. Mean prostate-specific antigen was 8.5 (range, 0.3-82), most frequent biopsy Gleason score was 3+3 (50.5%), 62.1% were cT1-cT2, and 56.1% belonged to low-intermediate D'Amico-risk groups. Surgery was performed in 82.1%. After mean follow-up of 33 (range, 1-240) mo, cancer-specific survival at 5 yr was 97.5%, 87.5%, and 94.4% after surgery, EBR, and brachytherapy, respectively. CONCLUSIONS: Radical prostatectomy is the preferred treatment of localised PCa after KT. Overall oncological outcomes do not seem to be worse than general population when performed in referral centres. Other curative treatments such as EBR or brachytherapy were less frequently used; however, brachytherapy showed promising results in a small number of patients. Further better-quality studies should help to clarify the optimal method of managing localised PCa after KT. PATIENT SUMMARY: Localised PCa after KT seems to have similar oncological outcomes after curative treatments than in general population, with surgery being the most common option for treatment.
Subject(s)
Kidney Transplantation/adverse effects , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/surgery , Aged , Brachytherapy/methods , Brachytherapy/statistics & numerical data , Humans , Immunosuppression Therapy/adverse effects , Kidney Transplantation/mortality , Male , Middle Aged , Neoplasm Grading , Prostate-Specific Antigen/blood , Prostatectomy/methods , Prostatic Neoplasms/diagnosis , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVES: To analyze therapeutic management and survival of renal adenocarcinoma with tumor venous extension treated by surgery in our experience. METHODS: We retrospectively evaluate a series of 29 cases of renal adenocarcinoma with venous thrombus who underwent radical nephrectomy and thrombectomy from January 1986 to November 2003. Mean age was 63.4 11.9 (29-79) years. 23 patients were males (79%) and 6 (21%) females. 17 (59%) patients had the tumor in the right kidney and 12 (42%) in the left kidney. Tumor thrombus level was: Level I (renal vein-inferior vena cava) 13 (45%), Level II (infrahepatic vena cava) 9 (31%), Level III (retrohepatic vena cava/suprahepatic) 3 (10%), and Level IV (auricula) 4 (14%). 92% of the cases presented perirenal fat involvement. Survival analysis was performed including 24 cases of the 29. We analyzed overall and cancer-specific survival, as well as possible influence of tumor thrombus level, fat involvement, and tumor grade as prognostic factors. RESULTS: Mean tumor size was 8.15 +/- 2.25 cm (5-13). Surgical approach was purely abdominal in 23 cases (79%) and thoraco-phreno-laparotomy in 6 (21%). Hepatic mobilization maneuvers and hepatic pedicle clamping were performed in 5 (17%) patients. Venous clamping was: renal-cava 13 cases (44%), triple clamping I1 (37%) (9 infrahepatic and 2 suprahepatic), and supradiaphragmatic-auricula 5 (17%). Conventional extracorporeal circulation (CEC) with moderate hypothermia (26-28 degrees C) was employed in 4 cases and CEC with heart arrest (4 min) in one. Mean follow-up was 52 months. At the time of review 9 patients were alive, 11 had died from tumor and 4 had died from other causes. Mean overall survival was 71 +/- 12 months and cancer specific survival 86 +/- 14 months. Neither renal fat involvement (p=0.6) nor tumor thrombus level (p = 0.9) were prognostic factors for survival in the univariant analysis, but tumor grade was (p = 0.03). CONCLUSIONS: Patients with venous tumor extension without lymph node involvement or metastasis should be treated by radical surgery with complete excision of the tumor thrombus. Tumor grade was a prognostic factor for survival, but venous involvement level and presence of perirenal fat involvement were not.
Subject(s)
Adenocarcinoma/pathology , Adenocarcinoma/surgery , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Neoplastic Cells, Circulating , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Survival RateABSTRACT
OBJETIVO: Analizar nuestra experienciaen el manejo terapéutico y la supervivencia de lospacientes con adenocarcinoma renal con extensiónvenosa tumoral tratados con cirugía.MÉTODOS: Evaluamos retrospectivamente una serie de29 casos de adenocarcinoma renal con trombo venosoque fueron tratados mediante nefrectomía radical ytrombectomía desde Enero de 1986 a Noviembre de2003. La media de edad de nuestra serie fue de 63,411.9 (29-79) años, 23 casos fueron varones (79%) y6 (21%) mujeres. El tumor se localizó en el riñón derechoen 17 (59%) pacientes y en 12 (42%) en el izquierdo.El nivel de trombo tumoral fue: Nivel I (Vena renalcava)13 (45%), Nivel II (Cava Infrahepática)9(31%),Nivel III (Cava Retrohepática/Suprahepática) 3 (10%),Nivel IV (Aurícula) 4 (14%) El 92% de los casos presentabaafectación de la grasa perirrenal. El cálculo dela supervivencia se realizó sobre 24 casos del total de29. Analizamos la supervivencia global y cáncer-específicaasí como la posible influencia del nivel de trombo tumoral, la afectación de grasa y el grado tumoralcomo posibles factores pronósticos.RESULTADOS: El tamaño medio tumoral fue de 8.15 ±2.25 (5-13) cm. La vía de abordaje utilizada fue abdominalpura en 23 casos (79%) y toraco-abdominal en6 (21%). Realizamos maniobras de movilización hepáticay clampaje del pedículo hepático en 5(17%)pacientes. La forma de clampaje venoso realizado fue:Reno-cavo 13(44%), Triple clamplaje 11(37%) (9 infrahepáticoy 2 suprahepático), y Supradiafragmático-Aurícula 5(17%). En 4 casos se utilizó circulación extracorpóreaconvencional (CEC) con hipotermia moderada(26-28º C) y en un caso se uso CEC con ParadaCardiaca (4 min). El seguimiento medio de la serie fuede 52 meses. En el momento de la revisión: 9 pacientesestaban vivos, 11 muertos por tumor y 4 muertospor otras causas. La media de supervivencia global fuede 71±12 meses y cáncer-específica de 86±14meses. En el análisis univariante ni la invasión de lagrasa renal (p=0,6), ni el nivel del trombo venoso(p=0,9) fueron factores pronósticos de supervivencia, sien cambio el grado tumoral (p=0,03).CONCLUSIONES: Los pacientes con extensión tumoralvenosa sin afectación ganglionar o metastásica debende ser tratados con cirugía radical y extracción completadel trombo tumoral. El grado tumoral fue un factorpronóstico en la supervivencia, no así el nivel de afectaciónvenosa y la existencia de invasión de la grasaperirrenal
OBJECTIVES: To analyze therapeutic management and survival of renal adenocarcinoma with tumor venous extension treated by surgery in our experience. METHODS: We retrospectively evaluate a series of 29 cases of renal adenocarcinoma with venous thrombus who underwent radical nephrectomy and thrombectomy from January 1986 to November 2003. Mean age was 63.4 11.9 (29-79) years. 23 patients were males (79%) and 6 (21%) females. 17 (59%) patients had the tumor in the right kidney and 12 (42%) in the left kidney. Tumor thrombus level was: Level I (renal vein-inferior vena cava) 13 (45%), Level II (infrahepatic vena cava) 9 (31%), Level III (retrohepatic vena cava/suprahepatic) 3 (10%), and Level IV (auricula) 4 (14%). 92% of the cases presented perirenal fat involvement. Survival analysis was performed including 24 cases of the 29. We analyzed overall and cancer-specific survival, as well as possible influence of tumor thrombus level, fat involvement, and tumor grade as prognostic factors. RESULTS: Mean tumor size was 8.15 ± 2.25 cm (5- 13). Surgical approach was purely abdominal in 23 cases (79%) and thoraco-phreno-laparotomy in 6 (21%). Hepatic mobilization maneuvers and hepatic pedicle clamping were performed in 5 (17%) patients. Venous clamping was: renal-cava 13 cases (44%), triple clamping 11 (37%) (9 infrahepatic and 2 suprahepatic), and supradiaphragmatic-auricula 5 (17%). Conventional extracorporeal circulation (CEC) with moderate hypothermia (26-28º C) was employed in 4 cases and CEC with heart arrest (4 min) in one. Mean follow-up was 52 months. At the time of review 9 patients were alive,11 had died from tumor and 4 had died from other causes. Mean overall survival was 71 ± 12 months and cancer specific survival 86 ± 14 months. Neither renal fat involvement (p=0,6) nor tumor thrombus level (p = 0.9) were prognostic factors for survival in the univariant analysis, but tumor grade was (p = 0.03). CONCLUSIONS: Patients with venous tumor extension without lymph node involvement or metastasis should be treated by radical surgery with complete excision of the tumor thrombus. Tumor grade was a prognostic factor for survival, but venous involvement level and presence of perirenal fat involvement were not
