American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.

PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

Comparison of the self-reported training level between Mexican and Western Europe residents in urology: results of an international survey.

OBJECTIVE: To find out how Mexican residents in urology perceive their own level of training in comparison with how residents in Europe perceive theirs. METHODS: A questionnaire of self-assessment was distributed to 104 European and 24 Mexican urologists-in-training. We assessed the perception of residents about their level of training and factors associated with self-perceived performance. RESULTS: Mean age of 128 residents was 32.69 +/- 3.33 years. Mexican residents spent significantly more time in urological departments than European residents. The weekly amount of hours spent at work was higher in Europe; while the number of residents per hospital was higher in Mexico. Mexican residents reported more reliable support from a supervising senior. European residents perceived they had a superior level regarding transplantation in female urology and urinary lithiasis, whereas Mexican residents felt more confident regarding urological infections and paediatric urology. Factors associated with better self-perceived performance were the number of months in urology, the number of non-urologic rotations and a supervising senior. CONCLUSION: Mexican residents in urology perceive that their own level of training is similar to that of European residents. The number of months of training in urology, the number of non-urologic rotations and a supporting senior are associated with a better self-perceived performance.

Molecular biology in prostate cancer.

Genes involved in cancer generation are usually tumor suppressors and oncogenes. Progressive genetic alterations in these genes are involved in the mechanisms of tumorigenesis. In prostate cancer, additionally several chromosomal loci that should harbor mutated genes have been proposed. Some genes have been found altered in prostate cancer, such as PTEN, TP53, AR, RNASEL (HPC1), ELAC2 (HPC2), CDKN2A and MSR1 and those can be natural targets for new strategies of treatment. Besides, gene therapy has been suggested to be suitable for prostate cancer treatment. This approach includes ex vivo corrective therapy, suicide, and antisense therapy.

Dos casos de trasplante heterólogo con sangre periférica / Heterologous peripheral blood stem cell transplantation in two patients

Se presentan los dos primeros casos en México de pacientes con neoplasias hematológicas malignas en quienes se practicó trasplante heterólogo de células hematopoyéticas totipotenciales obtenidas de la sangre periférica, después de movilizarlas con filgrastim. En un caso, el trasplante se hizo de un gemelo idéntico y en otro de un hermano HLA idéntico. Los enfermos tuvieron recuperación hematopoyéctica rápida y satisfactoria y la hipoplasia post-trasplante duró menos de 15 días. En el trasplante alogénico la enfermedad de injerto contra huésped fue controlada de manera satisfactoria con inmunosupresores. El costo aproximado de cada uno de estos procedimientos fue de 20 000 dólares americanos. Se discuten algunas ventajas del trasplante de células de sangre periférica sobre el de células de médula ósea, enfatizando la disminución de los costos