Predicting factors for recurrence in low-grade Ta primary bladder tumours.

OBJECTIVES: Ta bladder tumors constitute 53% of primary bladder neoplasms, 70% of them being low-grade (G1). These tumors present a 15- 38% chance of recurrence during the first year. The aim of this paper is to identify the predicting factors of the first recurrence in a series of TaG1 primary bladder tumors. METHODS: We have retrospectively analyzed patients who were diagnosed with TaG1 primary bladder tumor by transurethral resection between 2004 and 2012. We established their tumor grade and pathological stage according to the WHO's classification guides for 1973 and 2004 as well as 2009's TNM. Those patients who were diagnosed before 2009 did not receive any adjuvant treatment. Those who were diagnosed later on received 40 mg of endovesical Mitomycin C during their immediate post operative period as their only treatment. We define recurrence as the presence of tumor after the first cystoscopy and relapse-free survival (RFS) as the period of time (in months) until the first recurrence appeared. Follow up constitutes the period of time (in months) until the last check-up or first recurrence. We also analyzed different variables: age, gender, smoking habits, muscular representation in the sample, size of the tumor (> or < 1 cm), multiple or single tumors and adjuvant treatment. The survival analysis was performed by the Kaplan-Meier method, using the long-rank test to evaluate the differences between groups. RESULTS: 68 patients were included in the study (73.5% men, 75% smokers). The average age was 61.9 years (the median being 58.5). Average follow up was 33.2 months (median 28.4). 35.3% of patients experienced recurrence. Average RFS was 19.2 ± 12.7 months (median 13.5). The majority of tumors were of a single nature (77.9%), with a size of less than 1 cm (55.9%) and with muscle representation (52.9%). 57.4% of patients did not receive adjuvant treatment. Only the absence of adjuvant treatment was associated with recurrence in uni and multivariate analysis (p<0,001), with a relative risk of 17,5 IC95% (7,6-30,2). CONCLUSION: The absence of adjuvant therapy with Mitomycin C is the only factor that, in a statistically significant way, increases the risk of recurrence, regardless of demographic factors and the characteristics of the tumor.

Factores predictores de recidiva en el tumor vesical primario Ta de bajo grado / Predicting factors for recurrence in low-grade Ta primary bladder tumours

OBJETIVO: Los tumores vesicales Ta constituyen el 53% de las neoplasias primarias de la vejiga, siendo el 70% de bajo grado (G1), presentando una probabilidad de recurrencia al primer año del 15-38%. El objetivo de nuestro trabajo es identificar los factores predictivos de primera recidiva de nuestra serie de tumores vesicales primarios TaG1. MÉTODOS: Analizamos retrospectivamente los pacientes diagnosticados mediante RTU de tumor vesical primario TaG1 entre 2004 y 2012. Los pacientes diagnosticados antes de 2009 no recibieron tratamiento adyuvante. Los diagnosticados posteriormente recibieron 40 mg de Mitomicina C endovesical en el postoperatorio inmediato como único tratamiento. Definimos como recidiva la presencia de tumor después de la primera cistoscopia. Definimos como supervivencia libre de recidiva (SLR) el tiempo en meses hasta la primera recidiva y como tiempo de seguimiento el tiempo en meses hasta la última revisión o primera recidiva. Analizamos las variables: edad, sexo, tabaquismo, representación muscular en la muestra, tamaño tumoral (> o < 1 cm), tumor único o múltiple y tratamiento adyuvante. Realizamos un análisis univariado y multivariado mediante chi-cuadrado y regresión logística para identificar las variables relacionadas con la recidiva. Realizamos un análisis de supervivencia mediante el método de Kaplan-Meier, utilizando el test Log-Rank para evaluar las diferencias entre los grupos. RESULTADOS: Incluimos 68 pacientes (73,5% varones, 75% fumadores). La edad media fue 61,9 años (mediana 58,5). El seguimiento medio fue 33,2 meses (mediana 28,4). El 35,3% de los pacientes recidivaron. La SLR media fue 19,2±12,7 meses (mediana 13,5). La densidad de incidencia de recidiva fue 13,5 recidivas /100 casos/año. Mayoritariamente los tumores fueron únicos (77,9%), <1 cm (55,9%) y con representación muscular (52,9%). El 57,4% de los pacientes no recibieron adyuvancia. Solamente la ausencia de tratamiento adyuvante se asoció con la recidiva en los análisis uni y multivariado (p<0,001), con un riesgo relativo de 17,5 IC95% (7,6-30,2). CONCLUSIONES: La ausencia de adyuvancia con Mitomicina C es el único factor que incrementa de forma estadísticamente significativa el riesgo de recidiva, independientemente de los factores demográficos y características tumorales

OBJECTIVES: Ta bladder tumors constitute 53% of primary bladder neoplasms, 70% of them being low-grade (G1). These tumors present a 15-38% chance of recurrence during the first year. The aim of this paper is to identify the predicting factors of the first recurrence in a series of TaG1 primary bladder tumors. METHODS: We have retrospectively analyzed patients who were diagnosed with TaG1 primary bladder tumor by transurethral resection between 2004 and 2012. We established their tumor grade and pathological stage according to the WHO’s classification guides for 1973 and 2004 as well as 2009’s TNM. Those patients who were diagnosed before 2009 did not receive any adjuvant treatment. Those who were diagnosed later on received 40 mg of endovesical Mitomycin C during their immediate post operative period as their only treatment. We define recurrence as the presence of tumor after the first cystoscopy and relapse-free survival (RFS) as the period of time (in months) until the first recurrence appeared. Follow up constitutes the period of time (in months) until the last check-up or first recurrence. We also analyzed different variables: age, gender, smoking habits, muscular representation in the sample, size of the tumor (> or < 1 cm), multiple or single tumors and adjuvant treatment. The survival analysis was performed by the Kaplan-Meier method, using the long-rank test to evaluate the differences between groups. RESULTS: 68 patients were included in the study (73.5 % men, 75% smokers). The average age was 61.9 years (the median being 58.5). Average follow up was 33.2 months (median 28.4). 35.3% of patients experienced recurrence. Average RFS was 19.2 ± 12.7 months (median 13.5). The majority of tumors were of a single nature (77.9%), with a size of less than 1 cm (55.9%) and with muscle representation (52.9%). 57.4% of patients did not receive adjuvant treatment. Only the absence of adjuvant treatment was associated with recurrence in uni and multivariate analysis (p<0,001), with a relative risk of 17,5 IC95% (7,6-30,2). CONCLUSION: The absence of adjuvant therapy with Mitomycin C is the only factor that, in a statistically significant way, increases the risk of recurrence, regardless of demographic factors and the characteristics of the tumor

Predictors of success and hospitalization in semi-rigid ureteroscopy for lithiasis as an outpatient procedure.

OBJECTIVES: To analyze the outcomes, predictors of success and predictors of need for hospital admission in our series of patients who underwent ureteroscopy (URS) as a major outpatient surgery (MOS) procedure. METHODS: We carried out a retrospective analysis of 402 patients who had undergone semi-rigid URS for ureteral calculi as a MOS procedure in our center between 2004 and 2012. Patients with previous DJ catheter were excluded. We classified the calculi according to their location (lumbar, pelvic, iliac), size (< or> 1cm) and number (single or multiple). Follow-up was done by plain X-ray of the abdomen and ultrasound one month after surgery. The procedure was considered successful when patients were free from the treated calculi or had ureteral fragments < 3 mm one month after surgery. Univariate and multivariate analyses were carried out to identify the factors involved in success and hospitalization not being required. RESULTS: A total of 269 patients were included. The majority of the stones were single (92.2%), <1 cm in size (76.6%), pelvic (62.1%), and left-sided (57.2%). 89.6% of the procedures were performed as MOS and 82.2% were considered to be successful. In the multivariate analysis, left-sided (p<0.001) and pelvic location of the calculi (p=0,01) were found to be independent predictors for the success of the procedure In terms of hospital admission, the only independent predictor was the presence of intraoperative complications ( p=0.006). CONCLUSIONS: Left-sided and pelvic locations were the independent predictors for the success of the URS. A lack of intraoperative complications was the independent predictor for not requiring hospitalisation.

Factores predictores de éxito y necesidad de ingreso en la ureteroscopia semirigida en régimen ambulante / Predictors of success and hospitalization in semi-rigid ureteroscopy for lithiasis as an outpatient procedure

OBJETIVO: La ureteroscopia constituye una opción con elevadas tasas de éxito en el tratamiento de los cálculos ureterales, siendo superiores a la litotricia en la mayoría de los casos. El objetivo de nuestro trabajo es analizar las variables clínicas y demográficas, resultados y complicaciones, de nuestra serie de pacientes sometidos a ureteroscopia en régimen de cirugía mayor ambulatoria (CMA) y analizar los factores predictores de éxito del tratamiento y necesidad de ingreso hospitalario. MÉTODOS: Analizamos de forma retrospectiva 402 pacientes sometidos a ureteroscopia semirrígida (URS) por litiasis ureteral en régimen de CMA en nuestro centro entre 2004 y 2012. Excluimos los pacientes con catéter doble jota (CDJ) previo. Clasificamos las litiasis según su localización (lumbar, iliaca, pélvica) tamaño (< o > 1cm) y número (única o múltiple). El tratamiento se realizó mediante extracción con pinzas, LASER Holmium, o fragmentación mecánica. La revisión se realizó mediante radiografía simple de abdomen y ecografía al mes de la intervención. Consideramos éxito del procedimiento los pacientes libres del cálculo tratado o con restos litiásicos ureterales <3 mm al mes de la intervención. Realizamos un análisis univariante y multivariante mediante chi cuadrado y regresión logística para identificar los factores implicados en el éxito y la no necesidad de hospitalización. RESULTADOS: Incluimos 269 pacientes, 59% varones. La mayoría de la litiasis fueron únicas (92,2%), menores de un centímetro (76,6%), de localización pélvica (62,1%) e izquierdas (57,2%). Realizamos dilatación neumática del orificio ureteral en 67,3% de los casos, tratamos la mayoría de las litiasis con LASER (48%) y dejamos CDJ postoperatorio en el 92,2% de los casos. En el 83,3% de los procedimientos no existieron complicaciones intraoperatorias, realizándose el 89,6% en CMA, considerándolo éxito en el 82,2%. En el análisis multivariante, la lateralidad izquierda (p<0,001) y la localización pélvica de la litiasis (p=0,01) resultaron factores predictivos independientes de éxito del procedimiento. Para la necesidad de ingreso hospitalario solo la ausencia de complicaciones intraoperatorias resulto factor predictivo independiente (p=0,006). CONCLUSIONES: La lateralidad izquierda y la localización pélvica constituyen los factores predictores independientes de éxito de la URS. La ausencia de complicaciones intraoperatorias constituye el factor predictor independiente de no precisar hospitalización (AU)

OBJECTIVES: To analyze the outcomes, predictors of success and predictors of need for hospital admission in our series of patients who underwent ureteroscopy (URS) as a major outpatient surgery (MOS) procedure. METHODS: We carried out a retrospective analysis of 402 patients who had undergone semi-rigid URS for ureteral calculi as a MOS procedure in our center between 2004 and 2012. Patients with previous DJ catheter were excluded. We classified the calculi according to their location (lumbar, pelvic, iliac), size (< or > 1cm) and number (single or multiple). Follow-up was done by plain X-ray of the abdomen and ultrasound one month after surgery. The procedure was considered successful when patients were free from the treated calculi or had ureteral fragments <3 mm one month after surgery. Univariate and multivariate analyses were carried out to identify the factors involved in success and hospitalization not being required. RESULTS: A total of 269 patients were included. The majority of the stones were single (92.2%), <1 cm in size (76.6%), pelvic (62.1%), and left-sided (57.2%). 89.6% of the procedures were performed as MOS and 82.2% were considered to be successful. In the multivariate analysis, left-sided (p<0.001) and pelvic location of the calculi (p=0,01) were found to be independent predictors for the success of the procedure In terms of hospital admission, the only independent predictor was the presence of intraoperative complications (p=0.006). CONCLUSIONS: Left-sided and pelvic locations were the independent predictors for the success of the URS. A lack of intraoperative complications was the independent predictor for not requiring hospitalisation (AU)