Supervivencia del cáncer de próstata avanzado en España según escala de Gleason, edad y estadio / Advanced prostate cancer survival in Spain according to the Gleason score, age and stage

Objetivos: El objetivo de este estudio fue estimar la supervivencia global y desagregada en función de la escala de Gleason, de la edad y del tipo de extensión de una cohorte de pacientes con diagnóstico de cáncer de próstata avanzado de acuerdo a la práctica clínica habitual. Material y método: Se utilizó un diseño de estudio observacional y retrospectivo. En cada paciente se registraron variables clínicas como el tipo de extensión (metastásico o localmente avanzado), escala de Gleason, edad, fecha de diagnóstico, fecha del último contacto con el sistema de salud y el estado vital en el último contacto. Se utilizaron técnicas estadísticas de supervivencia de tipo univariante y multivariante. Los métodos de supervivencia paramétrica permitieron calcular la supervivencia media mediante extrapolación. Se analizaron 219 pacientes atendidos en el sistema de salud público entre 2008 y 2011. El análisis mostró diferencias estadísticamente significativas en la supervivencia en función de la escala de Gleason, la edad y el estadio. La supervivencia mayor se dio en el subgrupo menor de 75 años, con extensión local y categoría de bajo riesgo en la escala de Gleason (19,41 años) y la menor en el subgrupo opuesto, que fue de 0,97 años. La supervivencia de los otros subgrupos se movió entre esos valores extremos. Conclusión: La principal aportación de este trabajo consiste en calcular por primera vez la supervivencia media del CPA en España en relación con las variables de nuestra población de estudio. Esta información permite al clínico predecir la esperanza de vida de cada paciente según sus factores pronósticos

Objectives: The aim of this study was to determine the overall and disaggregated survival based on the Gleason score, age and extent of a patient cohort diagnosed with advanced prostate cancer according to standard clinical practice. Material and method: We used an observational and retrospective design for the study. For each patient, we recorded clinical variables such as the extent (metastatic or locally advanced), Gleason score, age, date of diagnosis, date of last contact with the health system and the vital status during the last contact. We used univariate and multivariate statistical techniques of survival. The parametric survival methods enabled us to calculate the mean survival using extrapolation. We analysed 219 patients treated in the public health system between 2008 and 2011. The analysis showed statistically significant differences in survival depending on Gleason score, age and stage. The longest survival was in the subgroup younger than 75 years, with a local extent and a low-risk category on the Gleason scale (19.41 years), and the shortest survival (0.97 years) was in the 75 years or older group. The survival of the other subgroups ranged between these outliers. Conclusion: The main contribution of this study is that it is the first to calculate the mean survival of advanced prostate cancer in Spain in terms of the variables of our study population. This information helps clinicians predict the life expectancy of each patient according to their prognostic factors

Advanced prostate cancer survival in Spain according to the Gleason score, age and stage. / Supervivencia del cáncer de próstata avanzado en España según escala de Gleason, edad y estadio.

OBJECTIVES: The aim of this study was to determine the overall and disaggregated survival based on the Gleason score, age and extent of a patient cohort diagnosed with advanced prostate cancer according to standard clinical practice. MATERIAL AND METHOD: We used an observational and retrospective design for the study. For each patient, we recorded clinical variables such as the extent (metastatic or locally advanced), Gleason score, age, date of diagnosis, date of last contact with the health system and the vital status during the last contact. We used univariate and multivariate statistical techniques of survival. The parametric survival methods enabled us to calculate the mean survival using extrapolation. We analysed 219 patients treated in the public health system between 2008 and 2011. The analysis showed statistically significant differences in survival depending on Gleason score, age and stage. The longest survival was in the subgroup younger than 75 years, with a local extent and a low-risk category on the Gleason scale (19.41 years), and the shortest survival (0.97 years) was in the 75 years or older group. The survival of the other subgroups ranged between these outliers. CONCLUSION: The main contribution of this study is that it is the first to calculate the mean survival of advanced prostate cancer in Spain in terms of the variables of our study population. This information helps clinicians predict the life expectancy of each patient according to their prognostic factors.

Estudio multicéntrico de costes de 2 técnicas quirúrgicas: láser GreenLight XPS 180 W vs resección transuretral de la próstata / Multicenter Study on Costs Associated With Two Surgical Procedures: GreenLight XPS 180 W Versus the Gold Standard Transurethral Resection of the Prostate

Objetivo: Analizar los costes asociados al tratamiento quirúrgico de la sintomatología del tracto urinario inferior secundaria a hiperplasia benigna de próstata mediante el láser GreenLigh XPS 180 W respecto a la técnica quirúrgica endoscópica de referencia, resección transuretral de la próstata. Métodos: Se realizó un estudio retrospectivo y multicéntrico de costes desde la perspectiva del Sistema Nacional de Salud y en un horizonte temporal de 3 meses, desagregándolos en fases temporales: prequirúrgica, quirúrgica y posquirúrgica. Los datos fueron extraídos de las historias de los pacientes intervenidos secuencialmente, con IPSS = 15, Qmax = 15 ml/seg y volumen prostático de 40-80 ml, incorporando solo costes sanitarios directos (euros de 2013) asociados a la intervención y al manejo de complicaciones. Resultados: Entre julio y octubre de 2012 se intervinieron de forma secuencial 39 pacientes con láser GL XPS y 40 con RTUP. El resultado clínico fue equivalente (94,9 y 92,5%, respectivamente) no mostrando diferencias estadísticamente significativas (p = 0,67). El coste medio total por paciente se redujo en 121 Euros en el grupo láser GL XPS respecto de RTUP; en la fase quirúrgica el coste fue superior con láser GL XPS (diferencia: 1.209 Euros; p < 0,001) mientras que fue inferior en la fase posquirúrgica (diferencia: -1.351 Euros, p < 0,001). Conclusiones: La intervención de los pacientes con STUI secundario a HBP mediante la nueva tecnología láser GL XPS se asocia a una reducción de costes respecto de la RTUP, debida a una menor duración de la estancia hospitalaria, la cual compensa el coste imputado a dicha tecnología

Objective: To analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate. Methods: A multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS = 15, Qmax = 15 mL/seg and a prostate volume of 40–80 mL, adding only direct healthcare costs (Euros, 2013) associated with the procedure and management of complications. Results: A total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (p = 0.67). The average direct cost per patient was reduced by 114Euros in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: 1209Euros; p < 0.001) but was lower in the post-surgical phase (difference: Euros − 1351; p < 0.001). Conclusions: The GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate.

OBJECTIVE: To analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate. METHODS: A multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15 mL/seg and a prostate volume of 40-80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. RESULTS: A total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P=.67). The average direct cost per patient was reduced by €114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: €1,209; P<.001) but was lower in the post-surgical phase (difference: €-1,351; P<.001). CONCLUSIONS: The GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Tratamiento del cáncer de próstata y cáncer renal con fármacos orales (abiraterona y antiangiogénicos): posicionamiento de la Asociación Española de Urología / Treatment of prostate and renal cancer with oral drugs (abiratarone and antiangiogenic agents): Positioning statement from the Spanish Association of Urology

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[Pseudosarcomatous tumor of the bladder]. / Tumor seudosarcomatoso de vejiga.

Pseudosarcomatous tumour of the bladder is a benign neoforming process of uncommon occurrence, consisting in a fibroblastic proliferation originated in the vesical wall and the perivesical fat, with unknown etiology, that given its cellular pleomorphism and the infiltrative nature of the injury can be incorrectly diagnosed as a sarcoma. This paper presents one case of pseudosarcomatous tumour of the bladder in a 9 year-old child, with no history of local traumatism or previous surgery, consisting in a tumoration affecting the vesical wall associated with a significant perivesical fibrosis with extension towards the area of the iliac veasels. Microscopically, the injury shows proliferation of spindle cells, arranged in a myxoid stroma with a prominent vascular net. No cytologic atypia is demonstrated or increase in the number of mitosis. The immunohistochemical study shows features of myofibroblasts in the proliferant cell. A review of the literature is made on 40 cases of inflammatory pseudosarcoma, evaluating the clinical characteristics, morphologic findings and treatment involved, as well as the postoperative evolution of the patient.

[Transitional carcinomas of the urinary tract: synchronous and metachronous lesions]. / Carcinomas transicionales del tracto urinario: lesiones sincrónicas y metacrónicas.

OBJECTIVE: The urothelium is a pseudostratified cylindrical epithelium that lines the calices, renal pelvis, urethers, bladder, part of the urethra and part of the prostate ducts. Transitional cell carcinoma (TCC) is a malignant neoplasia that can appear in any site where urothelium is present, being the bladder the most frequently affected organ. We performed an analysis of our experience and conducted a literature-based metanalysis to evaluate the coexistence of tumoral lesions at different locations in the urinary tract. MATERIAL AND METHODS: Between 1983 and 1993, 397 patients with TCC lesions involving the upper urinary tract (UUT), bladder, urethra or prostate, were diagnosed and treated. Coexistence, either synchronic or metachronic, of several lesions in different sites of the urinary tract was considered as a multiple tumor. RESULTS: Overall, 440 tumors were diagnosed in 397 patients. A single lesion appeared in 360 patients, while 37 presented multiple locations with a total of 79 tumors. The lesions were located at the following levels: 17 renal, 21 uretheral, 372 vesical, 13 in the urethra and 17 in the prostate ducts. According to the location, the frequency of single lesions was: UUT 58%, bladder 91%, urethra 8% and prostate ducts 35%. Synchronic UUT and intravesical tract tumors develops in 1% and 4% of patients with bladder TCC, respectively. Two percent of vesical tumors showed metachronic relationship with UUT tumors and the same rate was seen for intravesical lesions. CONCLUSIONS: Urothelial UUT tumors have a typical nosologic entity with specific features. Their coexistence with vesical tumors is frequent. When tumors of the bladder occur after a UUT tumor the interval of highest incidence between diagnoses is 2-3 years, and there are no histological risk factors among them for prognosis. Transitional cell prostatic urethral tumors are most often secondary to histologically similar, poor prognosis, bladder tumors, and usually synchronic.

[Descriptive epidemiology of bladder cancer in the health area 8 in Madrid. Retrospective study on 315 patients]. / Epidemiología descriptiva del cáncer vesical en el area sanitaria 8 de Madrid. Estudio retrospectivo sobre 315 pacientes.

The Madrid Health Care District No. 8 includes 19 town councils located in the South and West of the Autonomous Community. The actual population is 381,052 inhabitants with a floating population of 50,000 people. Currently, Mostoles Hospital is the Referral Health Centre of this district. Between 1983 and 1992, 315 patients received treatment for vesical cancer. Of them, 77% were primarily superficial and 23% infiltrant. 98% were transitional carcinomas. Patient's mean age was 65.9 years, with 83.5% men and 15.5% women. Incidence obtained was 14 x 10(5) inhabitants (23.5 men and 4.6 women). Smoking was the only risk factor statistically significant. Prevalence was 39.3 x 10(5). Actual mortality rate obtained for vesical cancer was 1.3 x 10(5). Comparison of our overall data with national and international statistics show extended consistence except for the mortality rate which was lower than the data consulted.

[Flow index: a substitute for uroflow nomograms?]. / Indice de flujo: sustituye a los nomogramas de uroflujo?

One hundred and twenty-nine flowmetries from an equal number of male patients with urinary obstructive symptoms have been analyzed, and the data provided by Siroky's nomogram compared to the flow ratios. Flow ratio was considered compatible with obstruction if below 0.80, which in turn correlated to -2 DE in Siroky's nomogram. Agreement between both parameters was noted in 95% cases (p < 0.05). The use of a flow ratio as a substitute for Siroky's nomogram to evaluate urinary obstructive disease would be justified by the easiness of interpretation, since it avoids translation of maximum flow and mean flow data to a plot. Flowmetry should only be considered determinant with clearly obstructive values.

[Extracorporeal lithotripsy for urolithiasis: retrospective study of 227 patients]. / Litotricia extracorpórea por urolitiasis: estudio retrospectivo de 227 pacientes.

Presentation of a retrospective study in 227 lithiasic patients with indication for extracorporeal lithotrity (ESWL) as first line of therapy or as adjuvant treatment, referred to three lithotripter units over the last five years. There was a high percentage of personal history of lithiasis (55.5%), colic pain being the most frequent symptom (78%). Lithiasis largely affected one single renal unit, most often the left one (54.7%) and was solitary in 54.6% of cases. Calyceal and pyelic sites were the most common ones, the size of the stones ranging between 10-19 mm in 44.5% of cases. Overall results reflect a 78.5% success rate, with statistically significant lower occurrence of residual fragments in the right renal unit. There was greater success rates in ureteral calculi followed by calyceal ones and also in the smaller ones compared to those greater than 20 mm. Double-J ureteral catheterism was performed in 27% patients, with evidence of statistical significance between them and those uninstrumented in relation to occurrence of lithiasic trail. An 11% rate of significant complications requiring endourological handling due to obstruction in 7.5%, and open surgery in 3.5% due to complication or lack of resolution was detected.

[Scrotal suspension with hypogastric suture. Hemostatic technique in intrascrotal surgery]. / Suspensión del escroto con sutura a hipogastrio. Técnica hemostática en la cirugía intraescrotal.

Appearance of haemorrhages and bruises after surgery of scrotal bags contents is one of the most frequent complications in Urology. Presentation of results obtained in a prospective study carried out on 86 patients who had underwent surgery due to intrascrotal disease. In all of them and regardless of the approach used (inguinal or scrotal), suspension of bags to hypogastrium using suture traction was performed by Oesterling technique in combination to Joseph and O'Boyle's technique. Drainage was not used in any case. The article explains the characteristics of undergoing pathologies' surgical indications, describing both the technique used and the results obtained. It concludes by stating this is a useful method to prevent routine complications in scrotal surgery.

[Flurbiprofen: therapeutic alternative in nephritic colic]. / Flurbiprofen: alternativa terapéutica en el dolor del cólico nefrítico.

A double blind randomized study was conducted in 52 patients with renoureteric colic to compare the therapeutic efficacy of two analgesics given in a single intramuscular dose. Following the administration of 2 gm dipirone plus 20 mg hyoscine N-butylbromide (n = 26) or 150 mg flurbiprofen (n-26), the patients were assessed for pain intensity, relief and pain status for a period of one hour. Both treatments afforded a similar analgesic effect, with pain remitting in 76.9% of the cases. No significant differences were observed for the latency periods or degree of pain at 5, 10, 30 and 60 minutes following treatment. Additional analgesic therapy was required in 34.6% of the patients who received dipirone and 26.9% of the flurbiprofen group, the difference not being statistically significant. Overall both drugs were well tolerated and only local adverse effects were observed, pain being the most frequent.

[Renal fungal infection: presentation forms and therapeutic advances]. / Infeccion fúngica renal: formas de presentación y avances terapéuticos.

Fluconazole is a broad spectrum anti-fungal agent which combines good tolerance, efficacy and low toxicity, and offers useful advantages in the treatment of certain forms of mycosis. Three cases of renal fungal disease treated with surgery (nephrectomy in two cases and pyelolitectomy plus partial nephrectomy in the third one) and fluconazole or amphotericin B are presented. In all three cases there was at least one predisposing factor (diabetes, urolithiasis, urinary catheter, previous therapy with antibiotics, or AIDS), and the causing pathogens were Candida and Mucor. Administration of fluconazole 100 mg b.i.d. for 4 weeks in the two candida infected patients accomplished a complete cure of the disease. Incidence, etiopathology, presentation forms and diagnostic techniques of urinary mycosis are analyzed together with the current therapeutical options, making special reference to fluconazole.

[Diagnosis and treatment with ureterorenoscopy of ureteral obstruction caused by papillary necrosis]. / Diagnóstico y tratamiento mediante ureterorrenoscopia de la obstrucción ureteral por papila necrosada.

Increasing use of endourological procedures to establish a diagnosis of pyeloureteral lesions detected as a repletion deficiency during urographic study, which when they are obstructive, affect the upper urinary tract. The present report describes the use of ureterorenoscopy as a diagnostic and therapeutic procedure for the ureteral obstruction occurring in a patient with papillary necrosis secondary to analgesics abuse. The papilla was indwelt in the right distal ureter causing obstruction and symptoms of renal colic and septicemia.

[Renal cholesteatoma: keratin accumulation tumor]. / Colesteatoma renal: tumor por acúmulo de queratina.

Presentation of 6 cases of renal cholesteatoma in 4 male and 2 female patients ranging between 30 and 67 years of age. The most consistent clinical data was a history of relapsing nephritic colic of long-evolution. The average time to diagnose was 19 years. In 50% cases an association to malignant neoplastic pathology was found. The clinical diagnosis was based on the urography and the histopathological examination of the material passed with the urine. Renal exeresis was performed in 5 cases. One was treated in a conservative fashion. Also the etiology causes, diagnostic procedure and other therapeutic possibilities were reviewed.

[Orchiectomy and buserelin in combination with flutamide: comparative results in metastatic prostatic carcinoma]. / Orquiectomía y buserelin asociados a flutamida: resultados comparativos en el carcinoma prostático metastásico.

In a prospective, non-randomized study in 44 patients with metastatic prostate carcinoma (D2), without previous hormone therapy, two alternative therapeutic courses to achieve complete androgenic blockade were compared. A first group (n = 29) was assigned to received Flutamide plus Buserelin, whereas the second group (n = 15) underwent orchidectomy, also in association to Flutamide. Both regimes were sustained without interruption, except when progression was evident, and both achieved castration levels of testosterone plasma titres. Mean follow-up duration was 13 months and 7 days, ranging between 2 and 36 months. There were no significant differences between both groups with regard to therapy objective responses and survival. Whereas the responses (CR + PR + E) were 93% in the LHRH analogues group and 86% in the orchidectomy group, overall survival was 66% and 67%, respectively. There were no secondary complications related to the surgical procedure nor adverse effects to drug therapy which required its cessation.

[Alkaline encrusted cystitis: factors affecting prognosis]. / Cistitis incrustada alcalina: factores condicionantes del pronóstico.

Alkaline encrusted cystitis is characterized by the formation of calcareous plaques in the bladder mucosa and submucosa in the presence of several factors: infection by urolithic organisms, earlier pathology of the vesical wall and precipitation of calcium phosphate salts. Treatment includes: urine acidification, correction of the urinary infection and use of acetohydroxamic acid. This paper presents three patients where the response to medical treatment was conditioned by the evolution of the existing vesical impairment. The conclusions state that in the alkaline encrusted cystitis, the concurrent pathology is a major predictor of the disease's future evolution.

[Conservative treatment of bladder and prostatic rhabdomyosarcoma in childhood: possibilities for non-radical surgery]. / Tratamiento conservador del rabdomiosarcoma vesical y prostático en pediatría: posibilidades de la cirugía no radical.

Treatment of rhabdomyosarcoma (RMS) of the bladder and prostate has always been difficult. Despite the significant advancements that have permitted cure, there is no agreement in the choice and order of the different therapeutic options. We reviewed the available literature evaluating the role of non-radical surgery and attempts at bladder preservation especially in children. Partial resection with sufficient margin of safety is only possible in 20% of the primary bladder tumors and the 3-year survival rate is 80%, similar to the overall survival rate for tumors localized to this site. The excellent results achieved in the case described herein underscores the possibilities of a conservative treatment modality in well-selected cases. The patient, who was submitted to partial cystectomy and received VAC polychemotherapy for a period of one year, is alive, tumor free and has preserved bladder function 50 months post-operatively.

[Epithelial tumors of the upper urinary tract]. / Tumores epiteliales del tracto urinario superior.

The paper refers to thirteen patients with epithelial tumours of the upper urinary tract, diagnosed and treated at our unit during the last five years and emphasizes the need of early diagnosis, custumorized therapy and close follow-up. Evolution is clearly more favourable in well differentiated and low stage tumours, regardless the type of surgery performed, versus the poor results obtained in infiltrative and undifferentiated cases for which there is no effective treatment available. Results are analyzed based on a brief literature review and considering the short number of cases contributed.