Prevalence of Anxiety and Depression in Prostate Cancer Patients and Their Spouses: An Unaddressed Reality.

OBJECTIVES: To estimate the prevalence of unsuspected anxiety or depression in prostate cancer patients and their spouses, as well as factors involved in its onset. Materials and Methods. A prospective study of 184 patients and 137 spouses evaluated in our hospital during 2019 using the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire depression module (PHQ-9). This study provides an internal validity assessment of the scales and their correlation (alpha and rho coefficients; index r). The contributions of age, education level, months after diagnosis, pain, prostate-specific antigen (PSA) level, stage of the disease and treatment performed to the positivity of the questionnaires were studied using the Wilcoxon-Mann-Whitney and chi-square tests. RESULTS: The prevalence of anxiety was 10.9% (MAX-PC) and 28.3% (MAX-PC-PSA). The HADS-A questionnaire indicated pathology in 14.1% of the patients and 16.05% of the spouses. Depression was detected in 7% (HADS-D) and 9.2% (PHQ-9) of patients as well as in 8.8% (HADS-D) and 16.05% (PHQ-9) of their spouses. The greatest concordance between men and women was with the PHQ-9 (Spearman's rho: 0.78; p = 0.01). Education level is significantly related to the presence of anxiety and depression, regardless of the questionnaire applied. The probability of detecting pathology in the MAX-PC varied from 6% in patients with elementary education to 23.5% in university students (p = 0.04). The greatest differences were detected when applying the PHQ-9 to patients (4% pathological, elementary education vs. 35.3% pathological, university education). Our study confirms the lack of a relationship between rates of anxiety and depression and factors such as PSA level, age of the patient and number of comorbidities. CONCLUSION: There is a high prevalence of unsuspected anxiety and depression in patients with prostate cancer and their wives. Education level correlates with such prevalence.

Leiomyosarcoma of the Penis, an Exceptional Entity.

In tumors of the penis, mesenchymal tumors are extremely rare and within them, sarcomas are exceptional. We report a patient with a sarcomatous lesion treated with conservative surgery with good surgical outcome and the review of the literature, to present the latest advances in the treatment of this unusual entity.

[Referral criteria for benign prostatic hyperplasia in primary care]. / Criterios de derivación en hiperplasia benigna de próstata para atención primaria.

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with alpha-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with alpha-blockers or 5alpha-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with alpha-blockers, or the sixth month with 5alpha-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10 ng/ml or PSA>4 ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication.

[New etiopathogenic findings in renal cell carcinoma: carcinogenesis and tumor development pathways]. / Novedades etiopatogénicas en el carcinoma de células renales: carcinogénesis y vías de desarrollo tumoral.

Renal cancer is the third leading urological tumor after prostate and bladder cancers. Annual incidence of renal cancer in all stages has markedly increased in recent years. This represents a true increase in the number of actual cases that is not fully accounted for by widespread use of diagnostic imaging tests. This article is intended to provide an update on the carcinogenesis and tumor development pathways involved in the genesis of this tumor. Renal cell carcinoma (RCC) arises in renal epithelium and accounts for more than 90% of all malignant kidney tumors. Approximately 2% of RCCs are associated to hereditary syndromes, specific oncogenes, or changes in tumor suppressor genes. Changes in the VHL gene exist in all hereditary cases. This gene (located in the short arm of chromosome 3:3p25-26) is also involved in more than 60% of sporadic cases. This paper systematically addresses the latest findings on implications of the VHL gene in angiogenesis and its potential relationship to new molecules involved in management of RCC.

Complicaciones en cirugía laparoscópica renal en la edad pediátrica: análisis de nuestra experiencia y revisión de la literatura / Complications in laparoscopy renal surgery in pediatric age: Analysis of our experience and literature review

Introducción: El desarrollo de la cirugía mínimamente invasiva en la edad pediátrica ha sido más lento que en la edad adulta ya que sus ventajas no son tan claras. El aprendizaje y las complicaciones presentadas durante este periodo, así como el tipo de material utilizado han sido los factores que han contribuido a este hecho. Objetivo: Mostrar nuestra experiencia y las complicaciones presentadas en la cirugía laparoscópica de exéresis renal, añadiendo una revisión bibliográfica de las publicadas en esta edad hasta la fecha. Material y Métodos: Estudio retrospectivo de nuestros casos clínicos en que practicamos cirugía renal laparoscópica extirpativa. Encontramos 56casos desde Enero de 2003, en que se implantó, hasta Septiembre del 2008. Hubo 36 niños (64%) y 20 niñas (36%). La edad media de intervención fue de 3,6 años. Analizamos el diagnóstico principal, la situación que condujo a la intervención así como el tipo de cirugía efectuada, vía de abordaje, tiempo utilizado, tiempo de ingreso, complicaciones y tratamiento aplicado. Los resultados se analizaron mediante el programa estadístico SPSS® (SPSSCorp, Chicago, Illinois). La revisión bibliográfica se efectuó en las bases de datos MEDLINE, EMBASE y COCHRANE. Los trabajos seleccionados fueron revisados por dos investigadores. Series que contuvieran adultos fueron excluidas. Resultados: Se han efectuado 42 nefrectomías (75%), 13 heminefrectomías (23%) y 1 quistectomía (2%). En 5 casos (9%) utilizamos la retroperitoneoscopia y en 51 (91%) la vía transperitoneal. El tiempo medio quirúrgico fue de 118+/-0,75 min, para las nefrectomías, de 192+/-1,07 min., para lasnefrectomías parciales, 111+/-0,64 min para las nefroureterectomías y de 240 minutos para la quistectomía. La estancia media ha sido de 3,18 (2-6) días para las nefrectomías, 5,91 (3-11) días para las nefrectomías parciales, 3 días (2-4) para las nefroureterectomías y 6 días para la quistectomía. Hemos tenido 8 complicaciones (14%): 2 reconversiones por sangrado y dificultad técnica y 6 postoperatorias (3 fueron menores, fiebre durante el postoperatorio y 3 mayores (2 Urinomas y un pseudoaneurisma, requiriendo 2 intervenciones y una colocación de catéter doble J). La evolución ha sido buena en todos los casos. En la revisión bibliográfica se seleccionaron 47 artículos con un nivel de evidencia IIIB (Oxford Centre for Evidence-based Medicine). El número de nefrectomías encontrado ha sido de 347 pacientes. Las causa más frecuente de reconversión fueron los problemas vasculares y las complicaciones variaron de ninguna hasta el 37%.Conclusiones: La cirugía laparoscópica ha demostrado ser una técnica segura y fiable en el tratamiento de la patología renal benigna de la edad pediátrica con buenos resultados. Actualmente sus indicaciones se están ampliando a procesos de reconstrucción, donde muestran unos resultados prometedores, y a procesos oncológicos seleccionados (AU)

Introduction: The development of the minimally invasive surgery in pediatric age has been slower than in the adult age since their advantages are not so clear. The learning curve and the complications presented during this period, as well as the type of material used has been the factors that have contributed to this fact. Objective: We collected our experience and the complications presented in renal laparoscopic exegesis surgery, adding a review of the published literature to date. Materials and Methods: Retrospective study of our clinical cases in that we practiced laparoscopic renal exegesis surgery. We collected 56 cases from January 2003, when it was implanted, to September 2008. We had 36 boys (64%) and 20 girls (36%). The mean age was 3.6 years. We analyzed principal diagnosis, the situation that conducted to the surgery and the type of surgery performed, time of surgery, hospital stay and complications with their solution. The results were analyzed by the statistical program SPSS® (SPSS Corp, Chicago, Illinois). The literature review was practiced in MEDLINE, EMBASE and COCHRANE database. The selected works were reviewed by two investigators. Series containing adults were excluded. Results: We perfomed 42 nephrectomies (75%), 13 heminephrectomies (23%) and 1 quistectomy (2%). 5 cases (9%) were done by retroperitoneoscopy and 51 cases (91%) transperitoneally. The mean operative time was 118+/-0,75 min, for nephrectomies; 192+/-1,07 min, for partial nephrectomies,111+/-0,64 for nephroureterectomies and 240 min for quistectomía. The mean hospital stay was 3.18 min (2-6) days for nephrectomies; 5.91 (3-11)days for partial nephrectomies, 3 days (2-4) for nephroureterectomies and 6 days for the quistectomy. We had 8 complications (14%): 2 conversions for bledding and technical difficulty and 6 postoperative complications (3 were minor complications, postoperative fever and 3 mayor (2 Urinomas and one pseudoaneurism, requiring 2 interventions and one catheter double J placement). The evolution has been satisfactory in all cases. In the bibliographic review 47 articles with a level of evidence IIIB were selected (Oxford Centers for Evidence-based Medicine). The main reasons to conversion to open surgery were vascular problems and the complication rate change from anyone to 37%.Conclusions: Laparoscopic surgery has proved to be a secure and feasible technique in the treatment of benign renal pathology in pediatric age with satisfactory results. Actually the indications are expanding to reconstructive procedures, with promising results, and selected oncologic procedures (AU)

Novedades etiopatogénicas en el carcinoma de células renales: carcinogénesis y vías de desarrollo tumoral / New etiopathogenic findings in renal cell carcinoma: carcinogenesis and tumor development pathwais

El cáncer renal representa el tercer tumor urológico más frecuente después del cáncer de próstata y vejiga. La incidencia anual se ha incrementado en los últimos años de forma notoria, en todos los estadios, lo cual implica un verdadero aumento del número de casos reales, no justificado plenamente por el uso masivo de pruebas de imagen diagnósticas. Este trabajo pretende ser una actualización de la carcinogénesis y vías de desarrollo tumoral implicadas en la génesis de esta neoplasia. El carcinoma de células renales (CCR) se origina del epitelio renal y representa más del 90% de todas las neoplasias malignas de este órgano. Aproximadamente el 2% de los CCR se asocian con síndromes hereditarios, oncogenes específicos o alteraciones de genes supresores tumorales. Todos los casos hereditarios presentan alteraciones del gen VHL. Este gen (que se localiza en el brazo corto del cromosoma 3:3p25-26), está también implicado en más del 60% de los casos esporádicos. En este trabajo desarrollamos de forma sistemática los últimos avances sobre las implicaciones del gen VHL en la angiogénesis y su posible relación con las nuevas moléculas implicadas en el tratamiento del CCR (AU)

Renal cancer is the third leading urological tumor after prostate and bladder cancers. Annual incidence of renal cancer in all stages has markedly increased in recent years. This represents a true increase in the number of actual cases that is not fully accounted for by widespread use of diagnostic imaging tests. This article is intended to provide an update on the carcinogenesis and tumor development pathways involved in the genesis of this tumor. Renal cell carcinoma (RCC) arises in renal epithelium and accounts for more than 90% of all malignant kidney tumors. Approximately 2% of RCCs are associated to hereditary syndromes, specific oncogenes, or changes in tumor suppressor genes. Changes in the VHL gene exist in all hereditary cases. This gene (located in the shortarm of chromosome 3:3p25-26) is also involved in more than 60% of sporadic cases. This paper systematically addresses the latest findings on implications of the VHL gene in angiogenesis and its potential relationship to new molecules involved in management of RCC (AU)

[Bladder leiomyoma: diagnosis by imaging]. / Leiomioma vesical: diagnóstico por imagen.

OBJECTIVE: To report a case of leiomyoma of the bladder in a patient with unspecific urinary symptoms and discuss the utility of the diagnostic imaging techniques. METHODS/RESULTS: A 56-year-old woman who consulted for unspecific urinary symptoms is described. Patient evaluation with ultrasound, CT and MRI showed a mass in the posterior aspect of the urinary bladder. CONCLUSIONS: Leiomyoma of the bladder is an uncommon benign tumor that is asymptomatic in most of the cases and is frequently discovered incidentally during assessment for other conditions. The case described herein presented with unspecific urinary symptoms. Patient evaluation with different diagnostic imaging techniques was required for correct diagnosis and treatment.

Leiomioma vesical: diagnóstico por imagen / Leiomyoma of the bladder: Dyagnosis by imaging techniques

OBJETIVOS: Presentación de un caso de leiomioma vesical con sintomatología urinaria inespecífica, una patología muy poco frecuente y en la mayoría de los casos asintomática, con un estudio diagnostico por imagen que nos orienta hacia la patología del caso.MÉTODOS: Paciente de 56 años de edad que consulta por síntomas urinarios inespecíficos, que tras su estudio se diagnostica de masa en cara posterior de vejiga mediante ecografía, T.A.C. y R.M.N.CONCLUSIONES: El leiomioma vesical es un tumor benigno de baja incidencia que en la mayoría de los casos se diagnostica de forma incidental en el transcurso del estudio de otra especialidad u otra patología. El caso que nosotros presentamos debutó con clínica urinaria inespecífica y fue necesaria la realización de diversas técnicas de diagnostico por imagen hasta llegar a un correcto enfoque terapéutico del caso (AU)

Litiasis vesical yatrogénica en la técnica de Burch. Una complicación infrecuente / Iatrogenic bladder lithiasis following colposuspension: An uncommon complication

OBJETIVOS: Utilidad de las técnicas endoscópicas para resolver litiasis yatrogénicas tras intervención de incontinencia urinaria de esfuerzo (IUE) en la mujer. Presentamos el caso de una mujer intervenida mediante técnica de Burch de incontinencia urinaria de esfuerzo, que acude dos años después por presentar clínica irritativa. MÉTODO: Sección endoscópica, bajo anestesia local de litiasis adherida a hilo. RESULTADO: Extracción De la litiasis sin afectar la continencia. CONCLUSIONES: Las técnicas endoscópicas permiten resolver las litiasis yatrogénicas por perforación vesical con hilo de sutura en la mujer sin afectar la continencia (AU)