[Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.] / Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva.

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz.MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p<0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG.

Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva / Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS

El programa actual de la formación en España. Comisión nacional de especialidad / The current urological training program in Spain. Urology National Specialty Commission

Objetivo: La Ley 44/2003 de Ordenación de profesiones sanitarias creó el Consejo Nacional de Especialidades en Ciencias de la Salud y las Comisiones Nacionales de las Especialidades en Ciencias de la Salud. Métodos: Revisión de las principales normas legales implicadas en la Formación Especializada y papel de la Comisión Nacional de Especialidad. Discusión: La Ley 44/2003 regula la formación de los profesionales sanitarios y establece el procedimiento para la creación por la Comisión Nacional de Especialidad y su posterior aprobación y publicación en el BOE de los programas formativos de las especialidades. El acceso a la formación especializada se realizará con la convocatoria anual y de carácter nacional de examen MIR. El Ministerio de Sanidad fija los criterios de acreditación de los centros y unidades docentes, y la Comisión Nacional de Especialidad, como órgano asesor, emite un informe favorable o desfavorable sobre las nuevas peticiones de acreditación. El RD 183/2008 desarrolla la figura del tutor, la evaluación formativa junto con el Libro del Residente y cómo serán las rotaciones externas. Conclusiones: Para poder entender el sistema de formación en la especialidad de Urología debemos conocer las normas que lo regulan, siendo la más importante la 44/2003. La Comisión Nacional de Especialidad es un órgano consultivo del Ministerio, cuya función principal es la de elaborar el programa formativo de Urología y establecer los criterios de evaluación de los especialistas en formación (AU)

Objectives: 44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences. Methods: Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission.Discussion: 44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident’s Book and how will be like the external rotations. Conclusions: to understand the Urology's specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation (AU)

Situación laboral en España tras finalizar la residencia en Urología. Análisis de una encuesta a nivel nacional / Job status after the resident training period in Spain. Analysis of a national survey

Objetivos: Desde la instauración de las enseñanzas de especialización a través del sistema de residencia, la sanidad española ha pretendido mantener un equilibrio entre las necesidades establecidas y los profesionales formados, con el objetivo de evitar el déficit o exceso de especialistas sanitarios con las consecuencias que de ello pudieran derivar. El objetivo de la presente revisión es conocer la situación laboral de los médicos especialistas en urología al finalizar el periodo formativo MIR. Métodos: Se presentan los resultados de una encuesta destinada a médicos especialistas en urología que finalizaron su contrato de residencia desde el 2012 hasta 2016, valorando situación laboral, datos académicos y laborales durante los primeros meses tras la finalización de la formación especializada. Resultados: Se recogieron un total de 42 respuestas. La totalidad de los encuestados tuvo contrato laboral a los 6 meses tras finalizar el MIR. El 71% contaba con un contrato temporal, la mayoría con una duración menor de un año. Hay más números de contratos en la empresa pública, aunque aumentan progresivamente en la privada. Más de la mitad de los encuestados se encontraban satisfechos con su situación laboral. Conclusiones: La inserción laboral de los urólogos recientemente especializados es alta, llegando al 100% a los 6 meses de finalizar su especialización. No son tan positivas cuestiones relacionadas con la calidad laboral, observando una gran inestabilidad laboral asociada a una alta proporción de contratos temporales menores de 6 meses (AU)

Objectives: Since the establishment of specialization of medicine through the residency system, Spanish health care has sought to maintain a balance between established needs and trained professionals, with the aim of avoiding the deficit or excess of health specialists with its consequences. The objective of the present review is to know the working conditions of urologist specialists at the end of the residency training period. Méthods: The results of a survey for urologist who completed their residency contract from 2012 to 2016 are presented, assessing working status, academic and working data during the first months after the completion of specialized training. Results: A total of 42 surveys were collected. All respondents had a working contract within 6 months of completing their training. 71% had a temporary contract, most with duration of less than one year. There are more contract numbers in the public health system, although they increase progressively in the private sector. More than half of the respondents were satisfied with their work situation. Conclusiones: The work insertion of the recently specialized urologists is high, reaching 100% within 6 months of finishing their specialization. Labor quality issues are not so positive, observing great working instability associated to a high proportion of temporary contracts lower than 6 months (AU)

[The current urological training program in Spain. Urology National Specialty Commission.] / El programa actual de la formación en España. Comisión nacional de especialidad.

OBJECTIVES: 44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences. METHODS: Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission. DISCUSSION: 44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident's Book and how will be like the external rotations. CONCLUSIONS: to understand the Urology's specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation.

[Job status after the resident training period in Spain. Analysis of a national survey.] / Situación laboral en España tras finalizar la residencia en Urología. Análisis de una encuesta a nivel nacional.

OBJECTIVES: Since the establishment of specialization of medicine through the residency system, Spanish health care has sought to maintain a balance between established needs and trained professionals, with the aim of avoiding the deficit or excess of health specialists with its consequences. The objective of the present review is to know the working conditions of urologist specialists at the end of the residency training period. METHODS: The results of a survey for urologist who completed their residency contract from 2012 to 2016 are presented, assessing working status, academic and working data during the first months after the completion of specialized training. RESULTS: A total of 42 surveys were collected. All respondents had a working contract within 6 months of completing their training. 71% had a temporary contract, most with duration of less than one year. There are more contract numbers in the public health system, although they increase progressively in the private sector. More than half of the respondents were satisfied with their work situation. CONCLUSIONS: The work insertion of the recently specialized urologists is high, reaching 100% within 6 months of finishing their specialization. Labor quality issues are not so positive, observing great working instability associated to a high proportion of temporary contracts lower than 6 months.

Factores pronósticos en cáncer renal con trombo en vena. Análisis de supervivencia / Prognostic factors in renal cancer with venous thrombus survival analysis

OBJETIVO: Analizar el tratamiento quirúrgico en el cáncer renal con trombo venoso a distintos niveles, así como las complicaciones perioperatorias y los diversos factores pronósticos relacionados a supervivencia global, cáncer específica y libre de enfermedad. MÉTODOS: Estudio descriptivo retrospectivo de 42 casos de cáncer renal con trombo venoso entre 2005 y 2015. El nivel alcanzado por el trombo se estableció según la clasificación de la Clínica Mayo. Las complicaciones postoperatorias se estadificaron según la clasificación de Clavien-Dindo. RESULTADOS: Predominio masculino con media de edad de 65,7 años. El 16,6% correspondieron a tumores con trombo de nivel II. En el 58,9% se realizó un abordaje subcostal. En 2 pacientes se estableció hipotermia con parada cardíaca y circulación extracorpórea. En 3 pacientes se realizó resección de lesiones metastásicas durante la nefrectomía radical. La necesidad de reintervención fue del 2,3% mientras que, la mortalidad perioperatoria fue del 4,7%. El 30% debutaron con metástasis al diagnóstico. Veinte pacientes progresaron a 15,5 meses (3-55). La supervivencia global fue de 60 meses. La mortalidad cáncer específica fue del 75%. La supervivencia libre de enfermedad fue del 30% a 55 meses. CONCLUSIONES: El tratamiento quirúrgico del cáncer renal con trombo venoso precisa un manejo multidisciplinar. La técnica quirúrgica seleccionada varía en función del nivel del trombo tumoral. El estadiaje tumoral es el factor pronóstico de mayor importancia. El nivel del trombo influye en el pronóstico, teniendo una supervivencia mayor aquellos pacientes con trombo confinado en vena renal (pT3a) frente a los tumores con trombo en aurícula (pT3c)

OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification. RESULTS: Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months.CONCLUSIONS: Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c)

[Prognostic factors in renal cancer with venous thrombus survival analysis.] / Factores pronósticos en cáncer renal con trombo en vena. Análisis de supervivencia.

OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification. RESULTS: Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months. CONCLUSIONS: Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c).

[Usefulness of urodynamics in the treatment of mixed urinary incontinence in women with suburethral slings]. / Utilidad de la urodinámica en el tratamiento de la incontinencia urinaria femenina mixta con slings suburetrales.

OBJECTIVE: The urodynamic results in suburethral slings (SS), are contradictory. We evaluate a series on patients with stress urinary incontinence (associated or not with bladder hyperactivity) that underwent suburethral slings (SS) operations. METHODS: 42 women (age 62±12 years) with urinary incontinence underwent suburethral slings (86% TOT, 12% TVT, 2% others), 36% of them with simultaneous pelvic organ prolapse correction. Medical history and a pre and postsurgery urodynamic studies (according to ICS instructions, except when specified) were performed. RESULTS: After surgery, the improvement of urinary incontinence was lower in patients with previous detrusor hyperactivity (DH) than without DH (60% vs 81 %), and the bladder capacity (BC) was lower (123±36 ml) in patients with previous mixed urinary incontinence (MUI) versus no MUI (241±83 ml) (p=0.004). The decrease of BC was higher with previous MUI (184±92 ml vs 123±36 ml) versus no MUI (240±91 ml vs 237±78 ml), and the DH was more frequent in previous MUI and DH. There was a significant decrease of maximum flow rate (Qmax) (p=0.000) (although without clinical manifestation), and post void residual urine (p=0.007). We demonstrated a significant increase (p=0.001) of mean urethral resistance (URA): 12±9 cm H2O versus 15±12 cm H2O (without reaching obstruction range), and an improvement of detrusor contractility (W80-20): (3±4 W/m2; vs 6±17 W/m2;). CONCLUSION: We demonstrated worst results in MUI in patients with urinary incontinence undergoing SS. The urodynamic study gives a better prognosis reliability in the treatment of female urinary incontinence with SS.

Utilidad de la urodinámica en el tratamiento de la incontinencia urinaria femenina mixta con slings suburetrales / Usefulness of urodynamics in the treatment of mixed urinary incontinence in women with suburethral slings

OBJETIVO: Los resultados urodinámicos en casos de slings suburetrales (SUS) son contradictorios. Valoramos una serie de pacientes con incontinencia urinaria de esfuerzo IUE, asociada o no a hiperactividad vesical (HV) sometidas a SUS. MÉTODOS: 42 mujeres incontinentes (edad 62±12 años) tratadas con SUS (86% TOT, 12% TVT, 2% otros), 36% con corrección simultánea de prolapso pélvico. Se realizó historia clínica y estudio urodinámico (EUD) (pre/postcirugía), según normas ICS, excepto cuando se especifica. RESULTADOS: Postcirugía la mejoría de la IU fue menor en casos con hiperactividad del detrusor (HD) previa que sin HD (60% vs 81%), y la capacidad vesical (CV) fue menor (123±36 ml) en los casos de incontinencia urinaria mixta (IUM) previa vs sin IUM (241±83 ml) (p = 0,004). El descenso de la CV fue mayor con IUM previa (184±92 ml vs 123±36 ml) vs sin IUM previa (240 ±91 ml vs 237±78 ml), siendo la HD más frecuente en los casos de IUM y HD previa. Hubo disminución del flujo miccional máximo (p = 0,000) (aunque sin repercusión clínica) y del residuo postmiccional (p = 0,007) (ambas significativas) postcirugía. Se demostró incremento significativo (p = 0,001) de la resistencia uretral (URA: 'Urethral Resistance Average') (12±9 cm H2O vs 15±12 cm H2O), sin llegar a rangos de obstrucción y mejoría de la contractilidad del detrusor (W80-W20) (3±4 Watios/m2 vs 6±17 Watios/m2). CONCLUSIÓN: Se demostraron en nuestra serie peores resultados en los casos de IUM, sometidos a cirugía antincontinencia con SUS. El EUD completo ofrece una mayor fiabilidad pronóstica en el tratamiento de la IU en la mujer con SUS

OBJECTIVE: The urodynamic results in suburethral slings (SS), are contradictory. We evaluate a series on patients with stress urinary incontinence (associated or not with bladder hyperactivity) that underwent suburethral slings (SS) operations. METHODS: 42 women (age 62±12 years) with urinary incontinence underwent suburethral slings (86% TOT, 12% TVT, 2% others), 36% of them with simultaneous pelvic organ prolapse correction. Medical history and a pre and postsurgery urodynamic studies (according to ICS instructions, except when specified) were performed. RESULTS: After surgery, the improvement of urinary incontinence was lower in patients with previous detrusor hyperactivity (DH) than without DH (60% vs 81 %), and the bladder capacity (BC) was lower (123±36 ml) in patients with previous mixed urinary incontinence (MUI) versus no MUI (241±83 ml) (p = 0.004). The decrease of BC was higher with previous MUI (184±92 ml vs 123±36 ml) versus no MUI (240±91 ml vs 237±78 ml), and the DH was more frequent in previous MUI and DH. There was a significant decrease of maximum flow rate (Qmax) (p = 0.000) (although without clinical manifestation), and post void residual urine (p = 0.007). We demonstrated a significant increase (p = 0.001) of mean urethral resistance (URA): 12±9 cmH2O versus 15±12 cmH2O (without reaching obstruction range), and an improvement of detrusor contractility (W80-20): (3±4 W/m2 vs 6±17 W/m2))

[Small cell carcinoma of the bladder: Our experience]. / CARCINOMA DE CÉLULAS PEQUEÑAS DE VEJIGA.

OBJECTIVES: Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series. METHODS: Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013. RESULTS: Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response. CONCLUSIONS: Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests.

Carcinoma de células pequeñas de vejiga / Small cell carcinoma of the bladder: Our experience

OBJETIVO: El carcinoma vesical de células pequeñas presenta una baja incidencia y escasa supervivencia, por lo que no existen esquemas terapéuticos basados en estudios randomizados. Nos planteamos como objetivo revisar nuestra casuística. MÉTODOS: Estudio observacional retrospectivo de 10 pacientes diagnosticados de carcinoma de células pequeñas entre 2006 y 2013. RESULTADOS: La edad media fue de 65,7 años y sólo se presentó en una mujer de los 10 pacientes. Se relacionó en su totalidad con antecedentes de tabaquismo, siendo la forma de presentación la hematuria. 4 casos presentaban carcinoma urotelial de alto grado junto con el componente microcítico. Se realizó cistectomía radical en el 40% de los pacientes, recibiendo además tratamiento con quimioterapia, radioterapia o ambos. La mediana del tiempo de supervivencia fue de 330 días (IC 95%: 40,757 - 619,243). Sólo en un caso obtuvimos respuesta completa. CONCLUSIONES: El carcinoma de células pequeñas de vejiga es un tumor con baja incidencia pero de peor pronóstico que los tumores uroteliales. Aunque se necesiten más estudios randomizados para definir el mejor tratamiento, y nuestra casuística sea limitada, se ha publicado que los mejores resultados en cuanto a supervivencia en los estadios localizados se consiguen con quimioterapia neoayuvante seguida de cirugía radical

OBJECTIVES: Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series. METHODS: Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013. RESULTS: Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response. CONCLUSIONS: Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests

Indicaciones y complicaciones de la embolización renal: análisis retrospectivo / Indications and complications of renal embolization: a retrospective analysis

La embolización renal es un procedimiento intervencionista, cuyas aplicaciones terapéuticas han variado a lo largo del tiempo. Realizamos una revisión retrospectiva de 48 embolizaciones, analizando las causas y complicaciones asociadas a esta técnica. Nuestra indicación principal fue la embolización prequirúrgica de tumores renales de gran tamaño, aunque la indicación de mayor relevancia clínica actual es el tratamiento conservador de fístulas arterio-venosas iatrogénicas, angiomiolipomas o traumatismos renales con sangrado activo. La complicación menor más frecuente es el síndrome post-embolización (52.8 por ciento), situación que remite fácilmente con tratamiento médico. Como complicaciones mayores destacan la sepsis y la migración de material embolígeno, ambos muy poco frecuentes en nuestra serie...

Renal embolization is an interventional procedure, whose therapeutic applications have varied over time. We conducted a retrospective review of 48 embolizations, analyzing the causes and complications associated with this technique. Our main indication was the preoperative embolization of large renal tumors, although the most relevant indication today is the conservative treatment of iatrogenic arteriovenous fistula, angiomyolipomas or renal trauma with active bleeding. The most common minor complication is post-embolization syndrome (52.8 percent), a situation that is easily managed with medical treatment. Major complications include sepsis and migration of embolic material and both are very rare in our series...