[Anemia and neoadjuvant hormone therapy in radical surgery of localized cancer of the prostate]. / Anemia y hormonoterapia neoadyuvante en la cirugía radical del cáncer de próstata localizado.

RATIONALE: Erythropoiesis is stimulated by androgens either through a direct action on bone marrow cells or through increased erythropoietin production. Androgen deprivation is a known cause for anaemia. The aim of this study was to evaluate the effect of neoadjuvant hormone therapy prior to radical surgery on haemoglobin (Hb) and haematocrit (Ht) levels in localised prostate cancer. MATERIAL AND METHOD: 47 patients with clinical localised prostate cancer were given LH-RH analogs plus flutamide for complete androgenic blockade (CAB) for at least 3 months prior to radical prostatectomy. A blood profile was obtained prior to start CAB and 3 months after therapy, and peri-operative transfusional requirements were evaluated. To assess any significant changes. Student's t test was used in the statistical analysis of paired data. RESULTS: In our study all patients (100%) showed decreased Hb and Ht levels after 3 months on CAB. Mean decline for Hb was 1.9 g/dL (range 1.6-2.2) p:0.0001, and for Ht 5.8% (range 4.8-6.8) p:0.0001. Hb was lower than 12 g/dL in 10.6% patients after hormone therapy and anaemia results were normocytic-normochromic. 60% patients needed peri-operative blood transfusion, 2 units of packed cells on average. CONCLUSIONS: Neoadjuvant CAB prior to radical prostatectomy results in a significant decline of Hb and Ht levels after 3 months treatment. Such decline may contribute to increase peri-operative transfusional requirements in a group of patients undergoing aggressive surgery which in itself involves a significant blood loss.

Anemia y hormonoterapia neoadyuvante en la cirugía radical del cáncer de próstata localizado / Anaemia and neoadjuvant hormone therapy in radical surgery of localised prostate cancer

FUNDAMENTO: Los andrógenos estimulan la eritropoyesis por acción directa sobre las células de la médula ósea y por aumento en la producción de eritropoyetina. La deprivación androgénica es una causa conocida de anemia. El objetivo de este trabajo fue estudiar el efecto sobre la hemoglobina (Hb) y el hematocrito (Hto) de la hormonoterapia neoadyuvante previa a la cirugía radical en el cáncer de próstata localizado. MATERIAL Y MÉTODO: 47 pacientes con cáncer de próstata clínicamente localizado, recibieron bloqueo androgénico completo (BAC) con análogos LH-RH más flutamida, durante un mínimo de 3 meses antes de la prostatectomía radical. Se realizó un estudio hematológico básico antes de iniciar el BAC y 3 meses después de la hormonoterapia y se valoraron los requerimientos transfusionales perioperatorios. El análisis estadístico se realizó mediante el test de la t de Student para datos pareados para valorar cambios significativos. RESULTADOS: Todos los pacientes (100 por ciento) de nuestro estudio presentaron un descenso en los niveles de Hb y de Hto después de 3 meses de BAC. El descenso medio de Hb fue 1,9 g/dl (rango de 1,6-2,2) p:0,0001 y del Hto de 5,8 (rango de 4,8-6,8) p:0,0001. La Hb fue inferior a 12 g/dL en el 10,6 de los pacientes después de la hormonoterapia y la anemia fue normocítica-normocrómica. El 60 por ciento de los pacientes requirieron una transfusión perioperatoria, con un promedio de 2 concentrados de hematíes transfundidos. CONCLUSIÓN: El BAC neoadyuvante previo a la prostatectomía radical origina un descenso significativo en los niveles de Hb y de Hto después de 3 meses de tratamiento. Este descenso puede contribuir a aumentar los requerimientos transfusionales perioperatorios, en un grupo de pacientes sometidos a una intervención agresiva que de por sí conlleva pérdidas sanguíneas importantes (AU)

[Uretero-colonic fistula in non-functioning ureter]. / Fístula uretero-colónica en uréter desfuncionalizado.

OBJECTIVE: To present a case of ureterocolonic fistula secondary to acute sigmoid diverticulitis in a nonfunctioning ureter due to a previous nephrectomy. METHODS/RESULTS: A 68-year-old patient that had undergone nephrectomy due to xanthogranulomatous pyelonephritis two years earlier, consulted for long-standing non-specific abdominal pain. Radiological evaluation showed a pneumogram pattern in the ureteral stump associated to a pelvic mass. The patient underwent surgery for a suspected uretero-intestinal fistula. The intraoperative findings and anatomopathological study demonstrated a uretero-sigmoid fistula due to diverticular disease of colon. CONCLUSIONS: Uretero-intestinal fistulas present unimportant clinical features. Radiological assessment and a clinical suspicion are important to diagnosis.

[Incidental diagnosis of bladder carcinoma]. / Diagnóstico incidental del carcinoma vesical.

OBJECTIVE: To analyze the prognostic factors of incidentally diagnosed bladder carcinomas with special reference to the complementary diagnostic tests. METHODS: 308 cases of carcinoma of the bladder were reviewed. These were divided into two groups: those that had been diagnosed on the basis of the clinical features and those that had been incidentally detected. The prognostic factors of size, grade, histological type, and pathological stage were analyzed. RESULTS: Local tumor stage was the only statistically significant prognostic factor. 14.7% of the superficial and 3.6% of the infiltrating carcinomas had been incidentally diagnosed. Ultrasound was the most frequently utilized diagnostic method (87.2%). CONCLUSIONS: In our series, the incidentally diagnosed carcinoma of the bladder has a higher probability of being a superficial lesion than those that are symptomatic and therefore the prognosis is better. Since ultrasound was the most frequently utilized diagnostic method, it might be advisable to assess the bladder in patients undergoing abdominal ultrasound evaluation.

[The preoperative diagnosis of complex renal cystic masses]. / Diagnóstico preoperatorio de las masas quísticas renales complejas.

OBJECTIVE: To analyze the preoperative diagnostic methodology in a series of patients with complicated cystic renal masses in relation to the definitive anatomopathological findings. METHOD: 20 cases of asymptomatic complicated cystic renal masses in 19 patients submitted to surgical exploration are described. All cases were evaluated by US and CT. Fine needle punction-aspiration biopsy (FNPA) was done in 17 of the 20 masses and pre and postoperative anatomopathological analyses were performed. RESULTS: Following the Bosniak classification for complicated cystic masses, the US study showed two cases were type I, 5 type II, 10 type III, and 3 type IV, while the CT findings showed no type I, 8 type II, 9 type III and 3 type IV. The definitive anatomopathologic diagnosis was that of renal cell carcinoma in 11 cases. All but one (type II) of these 11 cases were Bosniak III or IV. Nine had a preoperative FNPA which showed malignant cells in two cases, while the remaining 7 were negative. The preoperative biopsy was negative in one of the 11 cases with renal cell carcinoma. The remaining 9 cases of complicated renal mass were simple cysts complicated by hemorrhage or infection. CONCLUSIONS: In our series, the use of the Bosniak classification system preoperatively highly correlated with the presumed benign or malignant nature of the lesion. FNPA biopsy, however, was not found to be very useful in the preoperative diagnosis of complicated cystic renal masses; it showed a sensitivity of 22% and a negative predictive value of 46.7%. Although the foregoing data have no statistical significance, a negative FNPA biopsy of a complicated cystic renal mass that raises reasonable doubts does not change the indication for a surgical exploration.

[Early diagnosis by opportunistic screening in cancer of the prostate. Results of a 1-year protocol. Comparison with historical data]. / Diagnóstico precoz por cribado oportunístico en cáncer de próstata. Resultados de un año de protocolo. Comparación con datos históricos.

RATIONALE: The high prevalence of Prostate Cancer (PC) and long survival of patients with advanced disease, added to the high cost of palliative treatment (hormone therapy), versus the existence of curative therapies at earlier stages, fully justify the campaigns for early diagnosis. The objective of the study was to increase the number of cases diagnosed at local stages, using an opportunistic screening methodology. METHODS: All male patients between 50-70 years of age, seen over one year in Urology and primary care in CAP-Barceloneta because of urinary symptomatology, were included in a screening program. This cohort were performed total PSA determination and digital rectal examination. When digital rectal examination was suspicious and/or PSA values higher than 4 ng/ml, they underwent echo-guided prostate biopsy. RESULTS: A total of 595 male were seen; 43.9% met the inclusion criteria; 39.4% were rated as suspicious, neoplasia being confirmed in 51% of these. Prevalence of PC in this cohort was 20.1%, half of them in local stage. CONCLUSIONS: Populational screening in PC has proven to be ineffective from a health care standpoint, as opposed to opportunistic screening. Overdiagnosis was not significant, although there were more cases diagnosed in organ-confined stages, this is, eligible for curative therapy; thus, hormone therapy and the resulting morbidity were significantly decreased; quality of life of patients under curative treatment was improved; there was a large reduction of health care costs and, although it will have to be further confirmed in large multicentre series, we believe survival was improved.

[Epidemiologic data of uro-oncologic pathology in a urology service of a university general hospital. Comments regarding cancer of the prostate]. / Análisis de datos epidemiológicos de patología uro-oncológica en un servicio de urología de un Hospital General Universitario. Comentarios respecto al cáncer de próstata.

Data from 92, 93 and 94 tumoral records is analyzed based on the first visit system, staging at time of diagnosis, intervals between visits and management. After finding data unsatisfactory, a program for health care improvement is developed in order to secure diagnosis at earlier stages which may allow for curative radical treatment. The program was implemented in 1995. Results are communicated, and compared with those from previous years; the effectiveness of the program is verified.