Impacto de la anemia sobre la supervivencia de los pacientes intervenidos de cistectomía radical por tumor vesical / Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer

OBJETIVO: Evaluar la prevalencia de anemia preoperatoria y su impacto sobre los resultados oncológicos de pacientes intervenidos de cistectomía radical (CR) por tumor vesical. MATERIAL Y MÉTODOS: Estudio retrospectivo de 176 CR realizadas entre mayo de 2008 y julio de 2018 en un mismo centro. La anemia fue definida según los criterios de la OMS (hemoglobina < 130 mg/dl en hombres y < 120 mg/dl en mujeres). Mediante el método de Kaplan-Meier analizamos la supervivencia global, la supervivencia específica de cáncer y la supervivencia libre de recurrencia. Utilizamos la regresión logística multivariante para identificar los factores pronósticos de mortalidad global. RESULTADOS: Del total, 89 (50,6%) pacientes eran anémicos preoperatoriamente y 44 de ellos (49,4%) recibieron quimioterapia neoadyuvante. Los pacientes anémicos tuvieron un ASA mayor (ASA > 2: 54,6 vs. 27,5%, p = 0,003), más ectasia prequirúrgica (41,6 vs. 19,5%; p = 0,002), peor estadio patológico (pT > 2: 49,4 vs. 33,3%; p = 0,03), realizaron más quimioterapia neoadyuvante (49,4 vs. 19,5%; p < 0,001) y requirieron más transfusiones sanguíneas (25,8 vs. 11,5%; p = 0,015). La mediana de seguimiento fue de 27,2 meses (RIC 11,12-72,28). La supervivencia global (105 vs. 34 meses; p = 0,001), la supervivencia específica de cáncer (89 vs. 61 meses; p = 0,004) y la supervivencia libre de recurrencia (85 vs. 57 meses; p = 0,002) fueron peores en las CR anémicas. En el estudio multivariante, la anemia, un estadio pT > 2 y tener afectación ganglionar fueron identificados como factores predictores independientes de mortalidad. CONCLUSIÓN: La anemia previa a CR es común y asocia un peor pronóstico oncológico. Siendo esta una variable modificable, la implementación de programas de Patient Blood Management durante la prehabilitación puede tener un papel importante para mejorar la supervivencia de estos pacientes

OBJECTIVE: To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer. MATERIAL AND METHODS: Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male < 130 mg/dL, female < 120 mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates. RESULTS: Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA > 2: 54.6 vs. 27.5%; P = .003), ectasia rate previous to RC (41.6 vs. 19.5%; P = .002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P < .001), blood transfusion rate (25.8 vs. 11.5%; P = .015) and pathological stage (pT > 2: 49.4 vs. 33.3%; P = .03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P = .001), cancer-specific survival (89 vs. 61 months; P = .004) and recurrence-free survival (85 vs. 57 months; P = .002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT > 2 and N ≥ 1 were independently associated with overall mortality. CONCLUSION: Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients

Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer. / Impacto de la anemia sobre la supervivencia de los pacientes intervenidos de cistectomía radical por tumor vesical.

OBJECTIVE: To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer. MATERIAL AND METHODS: Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male<130mg/dL, female<120mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates. RESULTS: Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA>2: 54.6 vs. 27.5%; P=.003), ectasia rate previous to RC (41.6 vs. 19.5%; P=.002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P<.001), blood transfusion rate (25.8 vs. 11.5%; P=.015) and pathological stage (pT>2: 49.4 vs. 33.3%; P=.03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P=.001), cancer-specific survival (89 vs. 61 months; P=.004) and recurrence-free survival (85 vs. 57 months; P=.002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT>2 and N≥1 were independently associated with overall mortality. CONCLUSION: Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients.

[Extraperitoneal laparoscopic radical prostatectomy. First 50 cases in a middle sized hospital. Evaluation of the learning curve]. / Prostatectomia radical laparoscópica extraperitoneal. Primeros 50 casos en un centro comarcal. Análisis de la curva de aprendizaje.

OBJECTIVE: Report our experience in the first 50 cases of laparoscopic radical prostatectomy performed in our Hospital. We describe the surgical technique and the modifications that we have applied. Time consumptions and technical difficulties are reviewed. METHODS: From January 2005 to September 2006 we indicated 52 extraperitoneal laparoscopic radical prostatectomies. Two of them were done with the advice of a master and won't be included in our series. We followed the Brussels technique with some modifications. RESULTS: We completed integrally by laparoscopy the 78% of the cases (39/50). The 11 converted cases were done within the 25 first ones. Mean operating time for the pure laparoscopic cases was 280 minutes. We divide surgery in six steps with the following mean times in minutes: Trocars placement (30), seminal vessels dissection (95), Santorini (25), specimen in endobag (55), anasthomosis (55) and final (15). After case 25, the results improve. The most challenging step was seminal vessels dissection. Transfusion rate has been 7%. The mean hospitalization time has been 4 days with a 30% of patients discharged 48 hours after surgery. Positive surgical margins were observed in 12%. Two of our patients presented major complications (4%). CONCLUSIONS: Extraperitoneal laparoscopic radical prostatectomy is feasible in an institution like ours if it has the aim of invest a big effort, especially regarding operating time. The most demanding steps are the dissection of the vesicoprostatic plane and the anasthomosis. There is a clear progression after case 25.

Prostatectomía radical laparoscópica extraperitoneal. Primeros 50 casos en un centro comarcal. Análisis de la curva de aprendizaje / Extraperitoneal laparoscopic radical prostatectomy. First 50 cases in a middle size hospital. Evaluation of the learning curve

Introducción y objetivos: Presentar nuestra experiencia en los cincuenta primeros casos de prostatectomía radical laparoscópica. Se describe la técnica quirúrgica y las modificaciones que hemos ido aplicando, se revisan - tanto globalmente como comparando la primera y la segunda mitad de la serie - los costes de tiempo, las dificultades técnicas y pasos limitantes así como las complicaciones. Métodos: Entre enero 2005 y septiembre 2006 hemos indicado 52 prostatectomías radicales laparoscópicas por vía extraperitoneal en nuestro centro. Dos de ellas se realizaron con ayuda de un maestro por lo que no entrarán en nuestro análisis. La técnica empleada es la de Bruselas con modificaciones. Resultados: Hemos completado por vía laparoscópica el 78% de los casos (39/50). Las 11 reconversiones se produjeron en los primeros 25 casos. El tiempo quirúrgico medio para los casos laparoscópicos puros ha sido 280 minutos. Hemos dividido la cirugía en seis pasos con los siguientes tiempos promedio expresados en minutos: Colocación de los puertos (30), disección de vesículas seminales (95), Santorini (25), colocación de pieza en bolsa (55), anastomosis (55) y finalización de la cirugía (15). Los tiempos se reducen y la técnica se afianza a partir del caso 25. El principal paso limitante ha sido la disección de las vesículas seminales. Se ha requerido transfusión de sangre en un 7% de los casos laparoscópicos. La mediana de estancias ha sido 4 días con un 30% de casos dados de alta a las 48 horas de la cirugía. Se han presentado márgenes positivos en el 12% de casos. Ha habido complicaciones mayores en un 4% de casos (2/50). Conclusiones: La prostatectomía radical laparoscópica extraperitoneal es factible en un centro de nuestras características dispuesto a invertir un considerable esfuerzo especialmente en lo que respecta al número de horas de quirófano. Los principales pasos limitantes son la disección del plano vésicoprostático y la anastomosis vésico-uretral. Hay una clara progresión a partir del caso 25

Objective: Report our experience in the first 50 cases of laparoscopic radical prostatectomy performed in our Hospital. We describe the surgical technique and the modifications that we have applied. Time consumptions and technical difficulties are reviewed. Methods: From January 2005 to September 2006 we indicated 52 extraperitoneal laparoscopic radical prostatectomies.Two of them were done with the advice of a master and won’t be included in our series. We followed the Brussels technique with some modifications. Results: We completed integrally by laparoscopy the 78% of the cases (39/50). The 11 converted cases were done within the 25 first ones. Mean operating time for the pure laparoscopic cases was 280 minutes. We divide surgery in sixsteps with the following mean times in minutes: Trocars placement (30), seminal vessels dissection (95), Santorini (25), specimen in endobag (55), anasthomosis (55) and final (15). After case 25, the results improve. The most challenging stepwas seminal vessels dissection. Transfusion rate has been 7%. The mean hospitalization time has been 4 days with a30% of patients discharged 48 hours after surgery. Positive surgical margins were observed in 12%. Two of our patients presented major complications (4%). Conclusions: Extraperitoneal laparoscopic radical prostatectomy is feasible in an institution like ours if it has the aim of invest a big effort, especially regarding operating time. The most demanding steps are the dissection of the vesicoprostatic plane and the anasthomosis. There is a clear progression after case 25

[Transformation of glandular cystitis into bladder transitional carcinoma with adenocarcinoma areas]. / Conversión de cistitis glandular a carcinoma transicional vesical con áreas de adenocarcinoma.

OBJECTIVE: The association of cystitis glandularis with primary bladder tumors is well known. A case of cystitis glandularis progressing to transitional cell carcinoma is described and the literature briefly reviewed. METHODS/RESULTS: We report on a case of diffuse cystitis glandularis in whom progression to transitional cell carcinoma with areas of adenocarcinoma had been discovered. Treatment was by radical cystectomy with urinary diversion. CONCLUSION: Extensive and diffuse cystitis glandularis can be a potentially malignant lesion. Patients with diffuse cystitis glandularis should have a regular cystoscopic follow-up for early detection of progression to a bladder tumor.

[Intrascrotal aggressive angiomyxoma]. / Angiomixoma agresivo intraescrotal.

OBJECTIVE: To describe a case of aggressive scrotal angiomyxoma in a 55-year old man. METHODS: Ultrasound examination revealed a tumor on the scrotum. Surgical resection and histopathological study of the tumor was performed. The literature is briefly reviewed. RESULTS: Pathological analysis disclosed spindle-shaped neoplastic cells widely separated by a myxoid stroma rich in collagen fibers and prominent irregular-shaped blood vessels. Immunohistochemically, the stromal cells stained consistently for vimentin but not for desmin or S-100 protein. The patient had no symptom or signs of systemic disease and remains symptom-free 15 months later. CONCLUSIONS: Aggressive angiomyxoma is a rare condition that can be successfully treated surgically and has a great tendency to local recurrence.

[Submucous urethral angioma]. / Angioma uretral submucoso.

OBJECTIVES: Urethral hemangioma is a rare benign vascular tumor. The clinical features of this tumor type and the therapeutic options are discussed. METHODS/RESULTS: We report on a 55-year-old male with urethral hemangioma who consulted for urethral hemorrhage. CONCLUSIONS: To our knowledge, approximately 40 cases of this rare tumor type have been reported in the literature. Urethroscopy is the best diagnostic procedure. Treatment depends on tumor site, size and number. Transurethral resection of the tumor, urethrectomy, arterial embolization, radiotherapy or ablation with Nd:YAG laser can be utilized.

[Bladder compression caused by hip prosthesis displacement]. / Compresión vesical por desplazamiento de prótesis de cadera.

Case report of one patient with extrinsic vesical compression secondary to a displaced hip prosthesis. Interesting case due to increasing hip prosthesis surgery over the last few years involving, although not frequently, ureteral and vesical injuries of varying consideration which require early diagnosis and management.

[Carcinoma of Bellini's collecting ducts]. / Carcinoma de los conductos colectores de Bellini.

Description of one case of carcinoma of Bellini's ducts, a very uncommon renal neoplasia. The existing literature is reviewed, commenting on its clinical manifestations, etiology, diagnostic methodology and therapeutical manoeuvres.

[Vesico-umbilical fistula. Occurrence in an adult]. / Fístula vesico-umbilical. Presentación en el adulto.

Vesicoumbilical fistula in the adult male basically results from repermeability of the urachus obliterated by an uncompensated vesicoprostatic obstruction. The passage of urine through the umbilicus is practically pathognomonic and the definitive diagnosis is made by IVP and cystourethrography. It is a relatively benign pathology with a good prognosis following surgical treatment. Herein we report a case of vesicoumbilical fistula in an adult male with a previous history of prostatic syndrome and chronic urinary retention, resulting in repermeability of the urachus.

[Bladder endometriosis simulating a bladder tumor]. / Endometriosis vesical simulando un tumor vesical.

Endometriosis is relatively frequent in females of menstrual age and consists in the appearance of active endometrial tissue at sites other than the uterine cavity (genital system or adjacent organs). Endometrial tissue has been described to colonize the urinary system, particularly the urinary bladder. The most common clinical features of vesical endometriosis are urgency and frequency, hypogastric pain and hematuria. We report on a case of vesical endometriosis whose presenting features were urgency and urinary incontinence. The urological work up disclosed a solid vesical mass. Cystoscopy was highly suggestive of endometrial submucosa formation which was confirmed by TUR.

[Percutaneous nephrolithotomy after extracorporeal lithotripsy for the treatment of complex renal lithiasis. Technical details and results]. / Nefrolitotomía percutánea tras litotricia extracorpórea en el tratamiento de la litiasis renal compleja. Detalles de técnica y resultados.

The new therapeutic approach combining percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) has become widely used instead of conventional surgery. The use of this combined treatment modality has been extended to complex renal calculi. In our view, the need to achieve complete removal of struvite stone fragments to cure infection and prevent subsequent stone formation has led to a change in our therapeutic approach. The present study describes several maneuvers to facilitate PNL and compares two treatment modalities: PNL to reduce stone volume + ESWL (an approach utilized by many) and ESWL + PNL for remaining stone fragments (our therapeutic approach). Our approach (ESWL followed by PNL) has enhanced our results in the treatment of complex renal calculi: 68.4% of the renal units were completely stone-free at the time of discharge from the hospital. Good results were achieved in 89.5%, if we include the renal units with stone fragments that could be spontaneously passed.

[Closed renal trauma: 287 cases. Evaluation of treatment and long-term follow-up]. / Traumatismos renales cerrados: 287 casos. Valoración del tratamiento y seguimiento a largo plazo.

We evaluated 287 cases of blunt renal trauma that had been treated at the Urology Department of the Valle de Hebrón Hospital from 1974 to 1987. Data gleaned from patient work up, diagnosis and treatment during the acute phase are presented, highlighting the early and long-term results. Patient follow-up ranging from 1 to 10 years and data from statistical analyses show that conservative treatment achieved better early and late results than surgical treatment of the compromised renal unit. Hypertension was an uncommon secuela in our series (1% incidence). Evaluation with radioisotopes has proved to be the most reliable diagnostic method in the long-term assessment of secuelae in the renal unit.

[Diclofenac sodium therapy in irritating micturition syndrome following TUR for benign prostatic hyperplasia]. / Tratamiento con diclofenaco sódico del síndrome miccional irritativo tras resección transuretral por hiperplasia prostática benigna.

The irritative micturition syndrome is commonly observed following endoscopic surgery for benign prostatic hyperplasia. This condition almost consistently presents following removal of the bladder catheter and may last from 15 to 45 days. The present study was undertaken to determine the efficacy of treatment with diclofenac sodium. Fifty patients submitted to endoscopic resection for benign prostatic hyperplasia received the agent IM a few hours prior to catheter removal and posteriorly via the rectal route for a total treatment period of 13 days. Good results were achieved in 95.5% of the cases. Mild side effects were observed in 14% of the patients.

[Trigono-cervico-prostatomy. Technic, clinical and urodynamic results]. / Trigonocervicoprostatotomía (TCP). Técnica, resultados clínicos y urodinámicos.

Trigono-cervico-prostatotomy (TCP) incision was performed endoscopically in 102 patients, 99 for benign hypertrophy of the prostate (BHP) less than 35 g., and 3 for bladder neck obstruction. Good results were achieved in 81.4%, symptom relief was achieved in 12.7%, and 5.8% required reoperation. The incidence of retrograde ejaculation was only 20.6%. Patient follow-up was one year. Our findings show the usefulness of ultrasound, urethroscopy and urodynamics in determining the size of the adenoma and in assessing the results achieved by the surgical technique.

[Post-traumatic renal hypertension]. / HTA renal postraumática.

Post-traumatic renal hypertension is an uncommon sequela of renal trauma that may appear late making long follow-up advisable. The pathophysiology of this condition, the diagnostic methods, its different modes of presentation including transient and reversible or irreversible permanent hypertension are discussed. The usefulness of renal function tests in its diagnosis and the criteria for reversibility with surgical treatment are analyzed. Three cases of hypertension that presented late (2, 12, and 20 years after renal trauma) are described and the literature reviewed.

Renopleural fistula after percutaneous nephrolithotomy.

We present here a 42-year-old female who developed a renopleural fistula after a percutaneous nephrolithotomy through the 11th intercostal space of a calculus of the upper calyces of the right kidney. The fistula was resolved with a chest tube and a double-J ureteral catheter.