[Prognostic factors of mortality in patients with urothelial bladder tumor treated with radical cistectomy.] / Factores pronósticos de mortalidad en pacientes con tumor urotelial de vejiga tratados con cistectomía radical.

INTRODUCTION: Radical cystectomy (RC) with pelvic lymphadenectomy is the treatment of choice in patients with muscle invasive bladder cancer (MIBC). OBJECTIVE: To identify clinical and pathological variables that influence global mortality (GM) and cancer specific mortality (CSM) in patients with urothelial bladder tumor (UBT) treated with RC. METHODS: Retrospective analysis of 517 patients diagnosed with UBT and treated with RC between 1986 and 2009. Demographic, clinical, surgical and pathological variables, as well as complications and evolution after RC were collected. A comparative analysis was carried out with Chi square and ANOVA test. Survival analysis was performed with the Kaplan-Meier method and the long-rank test. Univariate and multivariate analysis were performed using Cox regression to identify independent predictors of GM and CSM. RESULTS: 91% of the patients were males with a median age of 66 years. The most frequent local pathological stage was pT3 (32.6%), with lymph node involvement in 23.8% of the patients. After a median follow-up of 34 months, 170 patients were alive and 311 had died from any cause (63.5%), being UBT the cause of death in 225 patients (45%). Rates of global survival and cancer specific survival at 5 and 10 years were 45%/34.3% and 52.5%/46.6% respectively. On the multivariate analysis age ( p = 0.004), ASA ( p = 0.000), the existence of hydronephrosis ( p = 0.01), pT ( p = 0.000) and pN ( p = 0.003) were identified as independent predictors of GM, as well as pT ( p = 0.000) and pN ( p = 0.002) for CSM. CONCLUSIONS: Age, anesthetic risk, presence of hydronephrosis, pT and pN stage were identified as independent predictors of GM, as well as pT and pN stage for CSM.

INTRODUCCIÓN: La cistectomía radical (CR) con linfadenectomía pélvica es el tratamiento de elección en los pacientes con tumor vesical músculoinfiltrante (TVMI). OBJETIVO: Identificar variables clínicas y patológicas que influyen en la mortalidad global (MG) y cáncer-específica (MCE) en pacientes con tumor urotelial vesical (TUV) tratados con CR. MATERIAL Y MÉTODOS: Análisis retrospectivo de 517 pacientes diagnosticados de TUV y tratados con CR entre 1986 y 2009. Se recogieron variables demográficas, clínicas, quirúrgicas y patológicas, así como complicaciones acontecidas y evolución tras CR. Análisis comparativo con test de Chi Cuadrado y ANOVA. Cálculo de supervivencia con el método de Kaplan-Meier y test de long-rank. Análisis univariante y multivariante mediante regresión de Cox para identificar variables predictoras independientes de MG y MCE. RESULTADOS: El 91% de los pacientes fueron varones con mediana de edad de 66 años. El estadio patológico local más frecuente fue el pT3 (32,6%), con afectación ganglionar en el 23,8% de los pacientes. Tras mediana de seguimiento de 34 meses, 170 pacientes estaban vivos y 311 habían fallecido por cualquier causa (63,5%), siendo el TUV la causa de muerte en 225 pacientes (45%). Se objetivaron tasas de supervivencia global y cáncer específica a 5 y 10 años del 45/34,3% y del 52,5/46,6% respectivamente. En el análisis multivariante se identificaron la edad ( p = 0,004), el ASA ( p = 0,000), la existencia de hidronefrosis ( p = 0,01), el pT ( p = 0,000) y el pN ( p = 0,003) como variables predictoras independientes de MG, así como el pT ( p = 0,000) y pN ( p = 0,002) para MCE. CONCLUSIONES: La edad, el riesgo anestésico, la presencia de hidronefrosis, el estadio pT y pN se identificaron como variables predictoras independientes de MG, así como el estadio pT y pN para MCE.

Factores pronósticos de mortalidad en pacientes con tumor urotelial de vejiga tratados con cistectomía radical / Prognostic factors of mortality in patients with urothelial bladder tumor treated with radical cistectomy

Introducción: La cistectomía radical (CR) con linfadenectomía pélvica es el tratamiento de elección en los pacientes con tumor vesical músculoinfiltrante (TVMI). Objetivo: Identificar variables clínicas y patológicas que influyen en la mortalidad global (MG) y cáncer-específica (MCE) en pacientes con tumor urotelial vesical (TUV) tratados con CR. Material y métodos: Análisis retrospectivo de 517 pacientes diagnosticados de TUV y tratados con CR entre 1986 y 2009. Se recogieron variables demográficas, clínicas, quirúrgicas y patológicas, así como complicaciones acontecidas y evolución tras CR. Análisis comparativo con test de Chi Cuadrado y ANOVA. Cálculo de supervivencia con el método de Kaplan-Meier y test de long-rank. Análisis univariante y multivariante mediante regresión de Cox para identificar variables predictoras independientes de MG y MCE. Resultados: El 91% de los pacientes fueron varones con mediana de edad de 66 años. El estadio patológico local más frecuente fue el pT3 (32,6%), con afectación ganglionar en el 23,8% de los pacientes. Tras mediana de seguimiento de 34 meses, 170 pacientes estaban vivos y 311 habían fallecido por cualquier causa (63,5%), siendo el TUV la causa de muerte en 225 pacientes (45%). Se objetivaron tasas de supervivencia global y cáncer específica a 5 y 10 años del 45/34,3% y del 52,5/46,6% respectivamente. En el análisis multivariante se identificaron la edad ( p = 0,004), el ASA ( p = 0,000), la existencia de hidronefrosis ( p = 0,01), el pT ( p = 0,000) y el pN ( p = 0,003) como variables predictoras independientes de MG, así como el pT ( p = 0,000) y pN ( p = 0,002) para MCE. Conclusiones: La edad, el riesgo anestésico, la presencia de hidronefrosis, el estadio pT y pN se identificaron como variables predictoras independientes de MG, así como el estadio pT y pN para MCE

Introduction: Radical cystectomy (RC) with pelvic lymphadenectomy is the treatment of choice in patients with muscle invasive bladder cancer (MIBC). Objective: To identify clinical and pathological variables that influence global mortality (GM) and cancer specific mortality (CSM) in patients with urothelial bladder tumor (UBT) treated with RC. Methods: Retrospective analysis of 517 patients diagnosed with UBT and treated with RC between 1986 and 2009. Demographic, clinical, surgical and pathological variables, as well as complications and evolution after RC were collected. A comparative analysis was carried out with Chi square and ANOVA test. Survival analysis was performed with the Kaplan-Meier method and the long-rank test. Univariate and multivariate analysis were performed using Cox regression to identify independent predictors of GM and CSM. Results: 91% of the patients were males with a median age of 66 years. The most frequent local pathological stage was pT3 (32.6%), with lymph node involvement in 23.8% of the patients. After a median follow-up of 34 months, 170 patients were alive and 311 had died from any cause (63.5%), being UBT the cause of death in 225 patients (45%). Rates of global survival and cancer specific survival at 5 and 10 years were 45%/34.3% and 52.5%/46.6% respectively. On the multivariate analysis age (p=0.004), ASA (p=0.000), the existence of hydronephrosis (p=0.01), pT (p=0.000) and pN (p=0.003) were identified as independent predictors of GM, as well as pT (p=0.000) and pN (p=0.002) for CSM. Conclusions: Age, anesthetic risk, presence of hydronephrosis, pT and pN stage were identified as independent predictors of GM, as well as pT and pN stage for CSM

[Prognostic factors predicting failure of the trial without catheter after tamsulosin in patients with acute urinary retention.] / Factores pronósticos predictores de fracaso en la prueba miccional con Tamsulosina en pacientes con retención aguda de orina.

OBJECTIVE: To analyze prognostic variables that impact on the trial without catheter after tamsulosin in patients with acute urine retention. METHODS: Retrospective analysis of a prospective database of a cohort of successive patients with acute urinary retention due to benign prostatic hyperplasia attended at the urology emergency room during one year time period. We analyzed the clinical and radiological characteristics and the international prostatic symptom score questionnaire of a total 65 male patients. RESULTS: The trial without catheter after tamsulosin showed positive results in 25 patients (38%) and failed in the remaining 40 (62%). In multivariate analysis, none of the analyzed variables resulted in an independent predictive factor for spontaneous micturition after the trial without catheter. However, the severe IPSS (p=0.085) presented an important statistical tendency for predicting failure of spontaneous micturition, as well as we found that the 84% of diabetic patients presented failure to the trial with catheter. CONCLUSIONS: The only variable that impact negatively on the trial without catheter was the severe IPSS with an approximation to statistical significance. The presence of diabetes as a related factor is a hypothesis that should be investigated with a higher number of cases.

Factores pronósticos predictores de fracaso en la prueba miccional con Tamsulosina en pacientes con retención aguda de orina / Prognostic factors predicting failure of the trial without catheter after tamsulosin in patients with acute urinary retention

OBJETIVO: Analizar las variables relacionadas con el fracaso en la prueba miccional con Tamsulosina en pacientes con retención aguda de orina. MÉTODOS: Análisis retrospectivo de una base de datos de cumplimentación prospectiva de pacientes consecutivos durante un año que acudieron al servicio de urgencias de urología por retención aguda de orina secundaria a hiperplasia prostática benigna. Se analizaron las características clínicas, radiológicas y cuestionario international prostatic symptom score (IPSS) antes de la retención aguda de orina (RAO) de un total de 65 pacientes. RESULTADOS: La prueba miccional con Tamsulosina fue positiva en 25 pacientes (38%) y fallida en 40 (62%). Se realizó análisis multivariante en el cual ninguna de las variables analizadas se comportó como un factor pronóstico independiente para predecir la micción espontánea tras la prueba miccional. Sin embargo, el IPSS severo (p = 0,085) presentó una tendencia estadística importante a la significación para predecir negativamente la micción espontánea, también encontrando que el 84% de los pacientes diabéticos presentaron fracaso en la prueba miccional. CONCLUSIÓN: La única variable que impacta negativamente en la prueba miccional con aproximación a la significancia estadística fue el IPSS. La presencia de diabetes como factor relacionado con el desenlace en la prueba miccional es una hipótesis que requiere una investigación con un mayor número de casos

OBJECTIVE: To analyze prognostic variables that impact on the trial without catheter after tamsulosin in patients with acute urine retention. METHODS: Retrospective analysis of a prospective database of a cohort of successive patients with acute urinary retention due to benign prostatic hyperplasia attended at the urology emergency room during one year time period. We analyzed the clinical and radiological characteristics and the international prostatic symptom score questionnaire of a total 65 male patients. RESULTS: The trial without catheter after tamsulosin showed positive results in 25 patients (38%) and failed in the remaining 40 (62%). In multivariate analysis, none of the analyzed variables resulted in an independent predictive factor for spontaneous micturition after the trial without catheter. However, the severe IPSS (p = 0.085) presented an important statistical tendency for predicting failure of spontaneous micturition, as well as we found that the 84% of diabetic patients presented failure to the trial with catheter.Coclusions: The only variable that impact negatively on the trial without catheter was the severe IPSS with an approximation to statistical significance. The presence of diabetes as a related factor is a hypothesis that should be investigated with a higher number of cases

Seguridad oncológica de la cistectomía radical laparoscópica asistida por robot / Robotic assisted radical cystectomy: oncological safety

OBJETIVO: Describir los parámetros de calidad establecidos en base a los aspectos quirúrgicos y patológicos del tratamiento del cáncer urotelial de vejiga en el trabajo publicado por el Bladder Cáncer Collaborative Group (BCCG) y compararlos con las publicaciones del International Robotic Cystectomy Consortium (IRCC). MÉTODOS: Búsqueda en la base de datos MEDLINE de los artículos publicados BCCG y el IRCC y descripción de los mismos. RESULTADO: Márgenes: El trabajo del IRCC presentó globalmente un 6,8% de márgenes positivos, resultado próximo al 6,5% del BCCG. Los márgenes resultaron similares en pacientes con enfermedad organoconfinada (≤pT2 ) y, en aquellos con enfermedad extravesical (pT3-pT4), el trabajo del IRCC presentó un 4,6% más de márgenes positivos con respecto a la cirugía abierta. En aquellos que presentaron afectación ganglionar, los márgenes negativos fueron un 6% mejor para la cirugía convencional (BCCG: 14% frente a IRCC: 20%). El impacto de la curva de aprendizaje en los márgenes quirúrgicos en cirugía robótica no resultó significativo. Linfadenectomía: En el trabajo del BCCG al 11% de los pacientes no le realizaron linfadenectomía, a un 9% le hicieron una LL, a un 67% LE y a un 13% LA. El promedio de ganglios recogido fue de 12,5 ganglios, con una mediana de 11. En el IRCC al 82,9% de los pacientes le realizaron linfadenectomía (definida como aquella con mas de 10 ganglios resecados), de los cuales al 43% le extrajeron más de 20 ganglios. La mediana de toda la serie fue de 17 ganglios (rango: 0-68). CONCLUSIONES: La CRLAR es una técnica con resultados similares a la cirugía convencional en cuanto a los márgenes quirúrgicos y permite realizar una linfadenectomía pélvica adecuada. Los resultados a largo plazo están pendiente de un seguimiento mas prolongado de los casos intervenidos hasta la fecha(AU)

OBJECTIVES: To describe the quality parameters established based on surgical and pathological aspects of bladder carcinoma treatment in the study published by the Bladder Cancer Collaborative Group (BCCG) and compare them against the publications of the International Robotic Cystectomy Consortium (IRCC) Ligament. METHODS: A MEDLINE database search for articles published by BCCG and IRCC and description of them. RESULTS: Margins: IRCC work globally presented 6.8% of positive margins, a result close to the 6.5% of BCCG. The margins were similar in patients with organ-confined disease (. pT2) and those with extravesical disease (pT3-pT4), IRCC work showed a 4.6% positive margin compared to open surgery. In those who had lymph node involvement, negative margins were 6% higher for conventional surgery (BCCG: 14% vs. IRCC: 20%). The impact of learning curve in surgical margins in robotic surgery was not significant.Lymphadenectomy: In BCCGfs work, 11% of patients did not have a lymphadenectomy performed, 9% underwent an LL, 67% SL and 13% EL. The mean number of lymph nodes collected was 12.5, with a median of 11. In the IRCC, 82.9% of patients underwent lymphadenectomy (defined as with more than 10 lymph nodes removed), of which 43% had more than 20 nodes removed. The median of the entire series was 17 nodes (range 0-68). CONCLUSIONS: The robotic assisted laparoscopic radical cystectomy (RALRC) is a technique with similar results to conventional surgery in terms of surgical margins and enables the performance of an adequate pelvic lymphadenectomy. Long term results are pending of a longer follow-up of patients operated to date(AU)

Robotic assisted radical cystectomy: oncological safety.

OBJECTIVES: To describe the quality parameters established based on surgical and pathological aspects of bladder carcinoma treatment in the study published by the Bladder Cancer Collaborative Group (BCCG) and compare them against the publications of the International Robotic Cystectomy Consortium (IRCC). METHODS: A MEDLINE database search for articles published by BCCG and IRCC and description of them. RESULTS: Margins: IRCC work globally presented 6.8% of positive margins, a result close to the 6.5% of BCCG. The margins were similar in patients with organ-confined disease (≤ pT2) and those with extravesical disease (pT3-pT4), IRCC work showed a 4.6% positive margin compared to open surgery. In those who had lymph node involvement, negative margins were 6% higher for conventional surgery(BCCG: 14% vs. IRCC: 20%). The impact of learning curve in surgical margins in robotic surgery was not significant. Lymphadenectomy: In BCCG's work, 11% of patients did not have a lymphadenectomy performed, 9% underwent an LL, 67% SL and 13% EL. The mean number of lymph nodes collected was 12.5, with a median of 11. In the IRCC, 82.9% of patients underwent lymphadenectomy (defined as with more than 10 lymph nodes removed), of which 43% had more than 20 nodes removed. The median of the entire series was 17 nodes (range 0-68). CONCLUSIONS: The robotic assisted laparoscopic radical cystectomy (RALRC) is a technique with similar results to conventional surgery in terms of surgical margins and enables the performance of an adequate pelvic lymphadenectomy. Long term results are pending of a longer follow-up of patients operated to date.

[Response to adjuvant chemotherapy after radical cystectomy in patients with infiltrative bladder: Analysis of 397 cases]. / Respuesta a la quimioterapia adyuvante post-cistectomía en pacientes con tumor de vejiga infiltrante:análisis de 397 casos.

OBJECTIVES: To define the usefulness of adjuvant chemo-therapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease. METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given. RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy significantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) patients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-specific survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality. CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to improve cancer-specific survival, adjuvant chemotherapy may be considered as a "protective factor" (RR=0.651, p=0.08).

[Mondor's syndrome. Case review and bibliographic review]. / Síndrome de Mondor. Revisión de la literatura. A propósito de un caso.

OBJECTIVE: We review the presentation, diagnosis and treatment of Mondor's disease of the penis, with the contribution of a new clinical case. METHODS: A 43-year-old male reported to the emergency room with preputial inflammation and edema associated to swelling of the dorsal region of the penis for the previous three weeks. RESULTS: Doppler ultrasound revealed thrombosis of the superficial dorsal vein of the penis, associated to candidiasic balanitis. Treatment was provided in the form of nonsteroidal antiinflammatory drugs and antibiotic and antifungal agents. The symptoms disappeared after 7 days of treatment, followed by the development of punctate phimosis that required circumcision. CONCLUSIONS: Mondor's syndrome is an infrequent condition usually caused by trauma, though it is important to consider the possibility of associated coagulation problems, infections and neoplastic processes. Doppler ultrasound is the technique of choice for confirming the diagnosis and resolution of the condition. Treatment is based on nonsteroidal antiinflammatory medication, antibiotherapy and sexual abstinence. The use of anticoagulation is controversial, but may prove useful in patients with coagulation disorders.

Síndrome de Mondor. Revisión de la literatura. A propósito de un caso / Mondor´s sindrome. Case review and bibliographic review

OBJETIVO: Revisar la forma de presentación, diagnóstico y tratamiento de la enfermedad de Mondor del pene mediante la presentación de un nuevo caso.MÉTODOS: Varón de 43 años que acude a urgencias por inflamación y edema prepucial asociado a tumefacción del dorso peneano de 3 semanas de evolución.RESULTADOS: Se realizó ecografía doppler peneana con el diagnóstico de trombosis del la vena dorsal superficial del pene, asociada a balanitis candidiásica. Se instauró tratamiento con antiinflamatorios no esteroideos, antibiótico y antifúngico. La sintomatología desapareció tras 7 días de tratamiento, con desarrollo posterior de fimosis puntiforme que requirió circuncisión. CONCLUSIONES: La enfermedad de Mondor es una patología infrecuente cuya etiología suele ser traumática, aunque es importante tener en cuenta su posible asociación a trastornos de la coagulación, infecciones y neoplasias.La técnica de elección para la confirmación del diagnostico y la resolución del cuadro es la ecografía doppler.El tratamiento se fundamenta en AINES, antibioterapia y reposo de la actividad sexual. La utilización de anticoagulantes es un aspecto controvertido, aunque de utilidad en los pacientes que presentan trastornos de la coagulación(AU)

OBJECTIVE: We review the presen-tation, diagnosis and treatment of Mondor’s disease of the penis, with the contribution of a new clinical case.METHODS: A 43-year-old male reported to the emergency room with preputial inflammation and edema associated to swelling of the dorsal region of the penis for the previous three weeks.RESULTS: Doppler ultrasound revealed thrombosis of the su-perficial dorsal vein of the penis, associated to candidiasic balanitis. Treatment was provided in the form of nonsteroidal antiinflammatory drugs and antibiotic and antifungal agents. The symptoms disappeared after 7 days of treatment, follo-wed by the development of punctate phimosis that required circumcision.CONCLUSIONS: Mondor’s syndrome is an infrequent con-dition usually caused by trauma, though it is important to consider the possibility of associated coagulation problems, infections and neoplastic processes.Doppler ultrasound is the technique of choice for confirming the diagnosis and resolution of the condition.Treatment is based on nonsteroidal antiinflammatory medica-tion, antibiotherapy and sexual abstinence. The use of anti-coagulation is controversial, but may prove useful in patients with coagulation disorders(AU)