Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients

ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

Erectile dysfunction therapy in countries where implant is economically not feasible.

Erectile dysfunction (ED), a frequent complaint in the primary care setting, is strongly associated with obesity, cigarette smoking and other common cardiovascular risk factors like hypertension, diabetes mellitus (DM), lipid disorders and the metabolic syndrome. The prevalence of these cardiovascular disorders is rising at staggering rates in most Latin American countries. ED is a symptom that mainly affects economically productive men (40-70 years of age) potentially causing major psychosocial repercussions and reduced quality of life. The management of ED in these developing countries is increasingly challenging due to poor patient education and non-adherence to the medical treatment of theses concomitant comorbidities. The financial implications of commonly prescribed medications and surgical procedures limit their use to a minority of patients. For this reason, the clinician must adopt a holistic approach in the management of this disease focusing on preventive measures based on patient education and non-surgical interventions. This review summarizes common associated risk factors of ED and outlines non-pharmacological interventions for the management of this disease.

Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor.

OBJECTIVE: To assess the prevalence and risk factors of erectile dysfunction (ED) in HIV patients from the HIV clinic of a tertiary referral center in Mexico City. DESIGN: Prevalence was obtained from cross-sectional studies, and the International Index of Erectile Function (IIEF), a standardized method, was used to assess ED. METHODS: A cross-sectional study was performed in the HIV clinic. Participants completed the IIEF to allow ED assessment. Information on demographics, clinical and HIV-related variables was retrieved from their medical records. RESULTS: One hundred and nine patients were included, with a mean age of 39.9 ± 8.8 years. ED was present in 65.1% of the individuals. Patients had been diagnosed with HIV for a mean of 92.7 ± 70.3 months and had undergone a mean 56.4 ± 45.5 months of HAART. The only variable associated with ED in the univariate analysis was dyslipidemia, and this association was also found in the multivariate analysis (P = 0.01). CONCLUSIONS: ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, and Castillejos-Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24-30.

[Comparison between surveillance, adjuvant radiotherapy, or salvage radiotherapy after radical prostatectomy in patients with prostate cancer (PCa) in stage pT3 or higher and/or positive surgical margins]. / Comparación entre vigilancia y radioterapia adyuvante o de salvamento después de una prostatectomía radical para cáncer de próstata (CaP) pT3 o con márgenes positivos.

OBJECTIVE: To assess the mid-term evolution of high-risk prostate cancer (PCa) initially treated with radical prostatectomy (RP) and to compare the role of surveillance and postoperative radiotherapy, either adjuvant (aRT) or salvage (sRT). METHODS: Retrospective study of 390 patients with PCa treated with RP at our institution from February 1988 to December 2012. Those in stage pT3 or higher and/or with positive surgical margins (PSM) were included. They were divided in three groups: group 1, undergoing surveillance after RP; group 2 receiving aRT; and group 3 receiving sRT. Cancer-specific survival (CSS) was estimated using the Kaplan-Meier method. RESULTS: 156 patients were analyzed. Mean age was 63.8 ± 6.9 years (45-79). Mean follow-up was 58 ± 45 months; 71 (45.5%) had PSM, 40 (25.6%) were in stage pT3 or higher, and 45 (28.8%) had both features. Group 1 included 91 patients, group 2, 43 and group 3, 22. Initial prostate-specific antigen (PSA) was 12.8 ng/ml in group 1, 14.9 ng/ml in group 2, and 14.5 ng/ml in group 3 (p = 0.07). First postoperative PSA was 0.27, 0.87, and 0.50 ng/ml in group 1, 2 and 3, respectively (p = 0.007). Seven men died of PCa: three in group 1, three in group 2, and one in group 3 (p = 0.6). The CSS at five and 10 years was 100 and 89% for group 1, 95 and 80% for group 2, and 94 and 94% for group 3 (p = 0.71). CONCLUSION: Our results retrospectively show that surveillance, aRT and sRT are equivalent for the mid-term control of PCa after RP.

[Long-term renal function in patients with renal-cell carcinoma treated surgically: comparison between radical and partial nephrectomy]. / Función renal a largo plazo en pacientes con cáncer de células renales tratados quirúrgicamente: comparación entre nefrectomía radical y parcial.

PURPOSE: To compare the renal function (RF) in patients with renal-cell carcinoma (RCC) treated by radical (RN) or partial nephrectomy (PN) and to assess the impact of the two surgical techniques in the glomerular filtration rate (GFR). MATERIAL AND METHODS: We retrospectively analyzed the database of patients with renal tumors treated surgically. RF was assessed preoperatively and postoperatively and compared between both techniques. GFR was estimated using CKD-EPI formula. Statistical analysis included X2, Student's t and Friedman tests and a method of logistic regression (multivariate analysis). RESULTS: 223 patients with RCC, who underwent surgery between 1981 and 2010, had complete information. The mean follow-up was 67.6 +/- 49.6 months. There were no significant differences in baseline characteristics between the RN (n = 196) and PN (N = 27) groups. After 6 months a GFR < 60 mL/min/1.73 m2 was detected in 63% vs. 29% (p = 0.0007), after 12 months in 64% vs. 33% (p = 0.002) and after 60 months in 53% vs. 40% (p = 0.2) of the patients in RN and PN groups, respectively. The absolute decrease in GFR was 22% after RN and 17% after PN. In the multivariate analysis, preoperative GFR and type of surgery were associated with an impairment of RF after 6 and 12 months. CONCLUSION: RN results in a more important impairment of RF after 6 and 12 months. At 60 months, patients treated with PN maintain a mean GFR > 60 mL/min/1.73 m2.

[Survival after radical prostatectomy in patients with prostate cancer and seminal vesicle invasion]. / Supervivencia después de prostatectomía radical en pacientes con cáncer de próstata e invasión a vesículas seminales.

OBJECTIVE: To assess the outcome of patients with clinically localized prostate cancer (PCa) and seminal vesicle invasion (SVI) in the radical prostatectomy (RP) specimen. MATERIAL AND METHODS: 212 patients with clinically localized PCa underwent RP at our institution from 1988 to 2007. SVI (stage pT3bNOMO of the TNM 2002 system) was demonstrated in 40 (18.9%). RESULTS: Patients with SVI and PSA <10 ng/mL had better prognosis than those with a PSA > or =10 ng/mL, with a 5-year biochemical progression-free survival (bPFS) of 68.2% and 19.9%, respectively (p=0.008). In univariate analysis, an initial prostate specific antigen (PSA) > or =10 ng/mL (p=0.01) and preoperative high risk group (p=0.05) were related to the likelihood of biochemical failure. In multivariate analysis, only PSA remained independently associated to the risk of biochemical recurrence. CONCLUSIONS: In the present study, the frequency of SVI was 18.9%. SVI confers a poor prognosis. Preoperative PSA > or =10 ng/mL was associated to the risk of biochemical recurrence.

[Efficacy and safety of vardenafil in patients with erectile dysfunction. Results of the Mexican Multicentric Study]. / Eficacia y seguridad del vardenafil en pacientes con disfunción eréctil. Resultados del estudio multicéntrico mexicano.

UNLABELLED: The objective of the present study was to determine the efficacy and safety of a fixed dose of vardenafil in the treatment of patients with erectile dysfunction (ED). MATERIAL AND METHODS: This was an open label, prospective and multicentric trial. After a 4-week wash out period, all patients received 20 mg of vardenafil given on demand for 12 weeks. Primary efficacy variables were the erectile function domain of the International Index of Erectile Function (IIEF), answers to questions 2 and 3 of the Sexual Encounter Profile (SEP) and the Global Assessment Question (GAQ). All adverse events were recorded and reported. RESULTS: 229 patients were screened. 177 received at least one dose of vardenafil and were included in the safety analysis. Mean age was 54.4 years old. Etiology of ED was organic or mixed in 77% of the patients. Erectile function domain of the IIEF changed from a basal mean score of 14.8 to 25.5 at the end of the study. 80.5% of the patients reported erections of rigidity and duration enough for satisfactory sexual intercourse and 93.3% improved their erections at the end of the study. Adverse events were mild to moderate and the most common were headache, dyspepsia, rhinitis and facial flushing. The drop out rate due to adverse events was 1.7%. CONCLUSIONS: This multicenter study confirms the high efficacy of this new phosphodiesterase type 5 inhibitor, vardenafil. There was a low rate of discontinuations due to adverse events and a favorable safety profile. The results of this study are similar to the results of other studies conducted in other parts of the world.

Fisiología de la erección y tratamiento de la disfunción eréctil / Physiology of penile erection and treatment of erectile dysfunction

La disfunción eréctil es un padecimiento con alta prevalencia asociada a enfermedades crónicas primordialmente del sistema cardiovascular. El mejor conocimiento de la fisiología ha permitido desarrollar nuevos fármacos que permiten ofrecer opciones terapéuticas apropiadas para cada tipo de paciente. Se vislumbra un panorama de creciente investigación básica y clínica que seguramente redundarán en mejores tratamientos para esta enfermedad. Esta revisión pretende hacer un resumen de los conceptos fisiológicos modernos y aplicarlos a un mejor entendimiento de los medicamentos disponibles actualmente.

Linfoma testicular en dos pacientes con SIDA y dos sin SIDA / Testicular lymphoma in two patients with AIDS and two without AIDS

Objetivo. Describir las características clínicas morfológicas, inmunofenotípicas y seguimiento de los linfoma no Hodgkin del testículo atendidos en un hospital de tercer nivel. Métodos. De 1987 a 1997 se resivieron los casos de linfoma testicular del archivo de patología quirúrgica. Se analizaron los datos clínicos, estudios de laboratorio, gabinete, evolución, tratamiento y se extrajeron cortes en blanco para estudios de inmunohistoquímica (CD45, CD20, CD43, proteína latente de membrana y anticuerpo UCHL-1). Se hizo un análisis comparativo y ciego de las características morfológicas predictoras de mayor agresividad y se utilizó la prueba exacta de Fisher para la identificación de significancia estadística. Resultados. Hubo 53 pacientes con tumores testiculares y cuatro correspondieron a linfomas (7.5 por ciento), con edad promedio de 47 años (intervalo de 33.73). Dos de los cuatro tenían SIDA. El análisis comparativo evidenció mayor invasión local a bordes de resección y sistémica en los casos asociados a SIDA. El estudio inmunohistoquímico demostró que la población neoplásica estaba constituida por células B negativas para proteína latente de membrana del virus de Epstein-barr. En la última consulta los pacientes sin SIDA no presentaban actividad de linfoma. Los sujetos con SIDA murieron uno y tres meses después de hacerse el diagnóstico de linfoma testicular. Conclusión. Los cuatro casos de linfoma testicular fueron de células grandes de estirpe B, sin expresión inmunohistoquímica para proteína latente de membrana de virus de Epstein-Barr. El curso clínico fue más agresivo en los dos casos asociados a SIDA