Early Ultrasound after Endoscopic Puncture of Ureterocele: Signs that Show Surgical Treatment Success

Introduction: We show the ability of early ultrasound after surgery to show the success of endoscopic puncture of the ureterocele. Method: Description of the clinical cases, therapeutic management and description of the ultrasound findings. Results: We present two infants aged 1 and 4 months who underwent endoscopic puncture of ectopic ureteroceles during a period of 3 months at our institution. The first case was operated urgently for urinary sepsis, while the second was punctured to preserve renal function. In both cases, ultrasound was performed two hours after surgery, and the ultrasound findings were recorded. In both patients, the ureterocele was considered resolved one year after the puncture. Conclusions: Findings such as puncture notch, flap-like collapse of the walls, decrease in ureterohydronephrosis, or disappearance of debris in the upper tract, are ultrasound signs that are visualized in the immediate postoperative period of endoscopic puncture of the ureterocele. Thus, early ultrasound is useful for early monitoring of endoscopic treatment of ureterocele (AU)

Introducción: Mostramos la capacidad de laecografía precoz tras cirugía para mostrar el éxito de lapunción endoscópica del ureterocele.Método: Descripción de los casos clínicos, manejoterapéutico y descripción de los hallazgos ecográficos.Resultados: Presentamos dos lactantes de 1 y 4 mesesintervenidas de punción endoscópica de ureteroceles ectópicos durante un periodo de 3 meses en nuestra institución. El primer caso se intervino urgente por una sepsis urinaria, mientras que el segundo se puncionó para preservarla función renal. En los dos casos, se realizó ecografía doshoras después de la cirugía, siendo registrados los hallazgos ecográficos. En ambas pacientes se consideró resueltoel ureterocele al año de la punción.Conclusiones: Hallazgos como la muesca de punción, el colapso a modo de colgajo de las paredes, la disminución de la ureterohidronefrosis, o la desaparición deldetritus en vía superior, son signos ecográficos que se visualizan ya en el postoperatorio inmediato de la punciónendoscópica del ureterocele. Así pues, la ecografía precozes útil en la monitorización temprana del tratamiento endoscópico del ureterocele. (AU)

Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España / Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain

Introducción: El objetivo del estudio fue establecer los factores que se relacionan de forma independiente con el desarrollo de resistencia a la castración (RC) a medio plazo en el cáncer de próstata (CP). Material y métodos: Ciento cincuenta y cinco pacientes con CP metastásicos al diagnóstico del registro nacional de CP con un seguimiento de hasta 39 meses. Las variables estudiadas fueron: edad, PSA, nadir de PSA, Gleason, invasión perineural, estadios T, N y M y tipo de bloqueo (intermitente/continuo). Resultados: Media de seguimiento 26,2 ± 13,4 meses. El 47,1% desarrolló RC precoz, con una media hasta el desarrollo de RC 12,2 ± 8,7 meses. Análisis univariante: se relacionaron con la RC la media de PSA (290 ± 905,1ng/ml en no RC, 519,1 ± 1437,2 ng/ml en RC, p < 0,001), media de edad (73,3 ± 8,3 años en no RC, 69,1 ± 9,3 en RC, p = 0,01), media de nadir de PSA (15,5 ± 57,3 ng/ml en no RC, 15,9 ± 23,7 ng/ml en RC, p < 0,001), Gleason (en ≥ 8, HR: 2,11; IC 95%: 1,22-3,65, p = 0,006) y estadio T (en T3-T4, HR: 2,85; IC 95%: 1,57-5,19, p < 0,001). Análisis multivariante: las variables independientes relacionadas con la RC son edad (HR: 0,96; IC 95%: 0,94-0,99, p = 0,01), nadir de PSA (HR: 1,65; IC 95%: 1,43-1,91, p < 0,001) y estadio T3-T4 (HR: 2,11; IC 95%: 1,10-4,04, p = 0,02). Conclusiones: El nadir de PSA y un estadio tumoral T3-T4 al diagnóstico se relacionan con un riesgo aumentado de desarrollar RC. Además, la edad al diagnóstico se muestra como una variable que disminuye el riesgo, de forma que, a más edad, menos riesgo de desarrollar RC a medio plazo

Introduction: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. Material and methods: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). Results: Mean follow-up 26,2 ± 13,4 months. 47.1% developed early CR, with mean time until onset of 12,2 ± 8,7 months. Univariate analysis the mean PSA was correlated with CR (290 ± 905,1 ng/mL in non CR, 519,1 ± 1437,2 ng/mL in CR, P < .001), mean age (73,3 ± 8,3 years in non CR, 69,1 ± 9,3 in CR P = .01), mean PSA nadir (15,5 ± 57,3 ng/mL in non CR, 15,9 ± 23,7 ng/mL in CR, p < 0,001), Gleason (in ≥ 8, HR: 2,11. 95% CI: 1.22-3.65, p = 0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P < .001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P = .01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P < .001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P = .02). Conclusions: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term

Factors related to early castration resistance in metastatic prostate cancer. Results from the National Prostate Cancer Registry in Spain. / Factores relacionados con la resistencia a la castración precoz en el cáncer de próstata metastásico. Resultados del Registro nacional de cáncer de próstata en España.

INTRODUCTION: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. MATERIAL AND METHODS: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous). RESULTS: Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02). CONCLUSIONS: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.

Estudio comparativo entre láser tulio (Tm: YAG) 150W y láser verde (LBO:ND-YAG) 120W para el tratamiento de la hiperplasia benigna de próstata: eficacia y seguridad a corto plazo / Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: short-term efficacy and security

Objetivo: Comparar los resultados de eficacia y seguridad del láser tulio 150W frente a láser verde 120W en el tratamiento de la hiperplasia benigna de próstata a corto plazo (12 meses de la cirugía). Material y métodos: Estudio retrospectivo observacional, donde se incluyen varones intervenidos con la técnica de fotovaporización prostática durante un periodo de 4 años en nuestro centro. Se comprobó la homogeneidad de la muestra, y se compararon las complicaciones postoperatorias (retención aguda de orina, reingreso, necesidad de transfusión), los fracasos al año de la cirugía (reintervenciones, flujo máximo < 15ml/seg, ausencia de mejoría en el I-PSS) y disminución de PSA al año de la cirugía. Análisis bivariante mediante Chi-cuadrado y «t» de Student. Resultados: Ciento dieciséis pacientes tratados con tulio y 118 con láser verde. Muestra homogénea para variables preoperatorias (p>0,05). No se objetivaron diferencias en las complicaciones: en retenciones agudas de orina, 4,3% con tulio y 6,8% con láser verde (p = 0,41); en reingresos 2,6% con tulio y 1,7% con láser verde (p = 0,68); en necesidad de transfusión 2,6% con tulio y 0% con láser verde (p = 0,12). Tampoco se observaron diferencias en el porcentaje de pacientes reintervenidos (1,7% en el grupo de tulio, 5,1% en el de láser verde, p = 0,28), ni en el de individuos con Qmáx menor de 15 ml/seg (6,9% con tulio, 6,77% con láser verde, p = 0,75), ni en el de ausencia de mejoría del I-PSS (5,2% con tulio, 3,4% con láser verde, p = 0,65). Tampoco hubo diferencia en los niveles de PSA en ng/ml al año de la cirugía: con tulio 2,78 ± 2,09 y con láser verde 1,83±1,48 (p = 0,75). Conclusiones: La fotovaporización prostática con láser tulio 150W es comparable a la realizada con láser verde de 120 W para el tratamiento de los síntomas obstructivos del tracto urinario inferior por HBP, siendo ambas técnicas eficaces y seguras a los 12 meses de la intervención. Futuros estudios prospectivos aleatorizados son necesarios para confirmar esta conclusión sobre ambas técnicas

Objective: To compare the results of efficacy and safety of Thulium laser 150 W against Greenlight laser 120 W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). Material and methods: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow < 15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. Results: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P > .05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P = .41); in readmissions, 2.6% with thulium and 1.7% with green laser (P = .68); in need for transfusion, 2.6% with thulium and 0% with green laser (P = .12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P = .28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P = .75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P = .65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78 ± 2.09 and with green laser 1.83 ± 1.48 (P = .75). Conclusions: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques

Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: Short-term efficacy and security. / Estudio comparativo entre láser tulio (Tm: YAG) 150W y láser verde (LBO:ND-YAG) 120W para el tratamiento de la hiperplasia benigna de próstata: eficacia y seguridad a corto plazo.

OBJECTIVE: To compare the results of efficacy and safety of Thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). MATERIAL AND METHODS: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. RESULTS: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P>.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P=.41); in readmissions, 2.6% with thulium and 1.7% with green laser (P=.68); in need for transfusion, 2.6% with thulium and 0% with green laser (P=.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P=.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P=.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P=.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (P=.75). CONCLUSIONS: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.

Uso de contenedores individuales para las muestras obtenidas en biopsia prostática: ¿ganamos en rendimiento diagnóstico? / Use of individual containers for prostate biopsy samples: Do we gain diagnostic performance?

Objetivo: Los cilindros de próstata obtenidos en la biopsia transrectal suelen enviarse en viales separados para su procesamiento anatomopatológico. Aunque es una práctica frecuente, existen trabajos controvertidos sobre su utilidad. Se quiso comparar el porcentaje de diagnóstico de cáncer de próstata al procesar las muestras en 2 contenedores o en contenedores individuales, para comprobar si existen diferencias. Como objetivo secundario se han comprobado los porcentajes de diagnóstico de varios subtipos de tumores en cada uno de los 2 grupos. Material y métodos: Estudio retrospectivo observacional sobre 2.601 casos de biopsias prostáticas. Se extrajeron 10 cilindros en cada biopsia. Dividimos la muestra en 2 grupos: envío de biopsia al servicio de anatomía patológica en 2 recipientes (lóbulo izquierdo y derecho) o en 10 (uno por cada cilindro), según diferente criterio utilizado en nuestro centro en varias épocas. Posteriormente se clasificaron los casos según ausencia de neoplasia, tumor insignificante (afectación de un solo cilindro, < 5%, Gleason < 7), Gleason 6, Gleason ≥ 7. Análisis estadístico bivariante mediante Chi-cuadrado. Resultados: Se incluyeron 1.777 sujetos en el grupo de 2 contenedores y 824 en el de 10. Se diagnosticaron un 32,4% de cánceres en el grupo de 2 recipientes y un 40% en el de 10, existiendo una diferencia estadísticamente significativa (p < 0,001). Los carcinomas insignificantes se diagnosticaban con más frecuencia en el grupo de 2 botes, el 6,4% frente al 4,3% en el de 10 (p = 0,03). Los Gleason 6 se diagnosticaban más en el grupo de 10 contenedores en comparación con el de 2 (11,9% frente al 8,1% [p = 0,002]). Lo mismo sucedía con los Gleason ≥ 7, el 23,8% en el grupo de 10 viales frente al 17,9% en el de 2 (p < 0,001). Conclusiones: Se diagnostican más cánceres de próstata al enviar los cilindros biopsiados en botes individuales. Además, llevando a cabo esta maniobra, hemos observado en nuestra serie una disminución de los diagnósticos de carcinoma insignificante en detrimento de un mayor diagnóstico de carcinomas no insignificantes

Objective: Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumour subtypes in each of the 2 groups. Material and methods: A retrospective observational study was conducted of 2,601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our centre in the past. We then classified the cases according to the absence of neoplasia, insignificant tumour (involvement of just 1 cylinder, < 5%, Gleason score < 7), Gleason 6 or Gleason ≥ 7. A bivariate statistical analysis was performed using the chi-squared test. Results: A total of 1,777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P < .001). The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P = .03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P = .002). The same occurred with the Gleason score ≥ 7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P < .001). Conclusions: We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas

Use of individual containers for prostate biopsy samples: Do we gain diagnostic performance? / Uso de contenedores individuales para las muestras obtenidas en biopsia prostática: ¿ganamos en rendimiento diagnóstico?

OBJECTIVE: Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumour subtypes in each of the 2 groups. MATERIAL AND METHODS: A retrospective observational study was conducted of 2,601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our centre in the past. We then classified the cases according to the absence of neoplasia, insignificant tumour (involvement of just 1 cylinder, <5%, Gleason score<7), Gleason 6 or Gleason≥7. A bivariate statistical analysis was performed using the chi-squared test. RESULTS: A total of 1,777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P<.001). The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P=.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P=.002). The same occurred with the Gleason score≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P<.001). CONCLUSIONS: We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas.