La vigilancia activa en pacientes con cáncer de próstata localizado. Análisis de adherencia y salida del protocolo / Active surveillance in patients with localized prostate cancer. Analysis of adherence and exit from the protocol

Objetive: VA is currently considered the treatment of choice for patients with low and very low risk prostate cancer. We analyzed the evolution of this treatment strategy in our series and adherence to the protocol. Material and methods: Ambispective study of patients in VA in our center between 2014- 2019. 237 meet inclusion criteria, of which 142 (60%) have a minimum of 12 months of follow- up. Mean age: 68.5 (46-78), median PSA 6.37 ng / ml (1-33). 229 (96.6%) are ISUP 1 and 8 (3.4%) ISUP 2. Objectives are pro- posed to assess our adherence to the protocol. Descriptive statistics are used to communicate the results. Results: According to the classification by risk groups of the NCCN, 145 (61.2%), 49 (20.7%) and 42 (17.7%) were very low risk, low risk and favorable intermedi- ate risk patients, respectively. The median of follow-up is 14 months (0-66). Of the patients with a minimum follow-up of 12 months, 107 (75.4%) were re-biopsied. 80 (33.8%) leave the protocol in these 5 years, 31.3% (25) by their own decision, 55% (44) due to medical criteria, and 11.3% (9) go to WW. After 5 years of follow-up, 99.2% of patients are still alive, 0.8% died of specific non-cancer causes. Of the objectives to assess adherence, 8 are achieved, 1 partially and 1 is not evaluable. Conclusions: VA in our center is already the treatment of choice for very low-risk patients, with a constant increase from year to year. Adherence to the protocol has been favorable during the period of time studied.(AU)

Tratamiento quirúrgico de adenomas adrenales / Surgical treatment of adrenal adenoma

Presentamos nuestra casuística de 60 adrenalectomías por adenoma, desde febrero de 1993 hasta enero de 2010, determinando los aspectos clínicos y patológicos más importantes desde el punto de vista quirúrgico, comparando la técnica laparoscópica respecto a la cirugía abierta. Material y métodos: Estudio retrospectivo observacional valorando características clínicas y hormonales, destacando las variables relacionadas con la cirugía (tamaño y localización del tumor, tipo y duración de la cirugía, tipo de incisión), incidencias intra operatorias, pérdidas hemáticas, datos anatomo patológicos (peso, tamaño y confirmación microscópica), complicaciones pos operatorias. Resultados: De los 60 pacientes, 24 eran hombres y 36 mujeres, con una edad media de 52,5 años (79,3 - 8,1). Todos ellos fueron diagnosticados anatomo patológicamente de adenoma adrenal siendo 50 adenomas funcionantes frente a 10 no funcionantes. De los adenomas funcionantes se establecieron los siguientes diagnósticos: 34 de síndrome de Con (56,6 por ciento), 15 casos de síndrome de Cushing (25 por ciento) y 1 síndrome adrenogenital (1,6 por ciento). La localización predominante fue la izquierda con 38 casos (63,3 por ciento) frente a la derecha con 22 casos (36,6 por ciento).En 39 pacientes se realizó adrenalectomía laparoscópica transperitoneal, mientras que en los 21 pacientes restantes se realizó cirugía abierta. La duración quirúrgica media fue de 147 minutos (230-50). El tamaño medio de la pieza quirúrgica fue de 3,27 cm (8-0,7). La estancia media hospitalaria fue de 6,4 días (20-2). Entre las complicaciones destacaron dos neumotórax, una angina de pecho, una neumonía nosocomial y dos pacientes que precisaron reintervención a las 24 horas de la cirugía por hemorragia y shock hipovolémico. Conclusiones: Debe considerarse la adrenalectomía laparoscópica unilateral como el tratamiento de elección del adenoma adrenal...

We present our series of sixty adrenalectomy for adrenal adenoma, from February 1993until January 2010, determining the most important clinical and pathological aspects from a surgical point of view. We compare the laparoscopic approach with open surgery. Material and methods: Retrospective observational study evaluating clinical and hormonal characteristics. We highlight the surgery-related variables (tumor size and location, type and duration of surgery, type of incision), intraoperative events, blood loss, histological findings (weight, size and microscopic confirmation) and postoperative complications. Results: Total number of 60 patients, 24 were men and 36 women with a mean age of 52.5 years (79.3to 8.1). All of them were histologically diagnosed of adrenal adenoma. 50 were functioning adenomas (10 non-functioning) with the final following diagnoses: 34 Conn’s syndrome (56,6 percent), 15 Cushing’s syndrome (25percent) and 1 adrenogenital syndrome (1,6 percent). The primary side was left with 38 cases(63,3 percent) compared to the right side with 22 cases (36,6 percent).Thirty-nine patients (65 percent) underwent transperitoneal laparoscopic adrenalectomy, while the remaining 21 patients had open surgery. The average operating time was 147 minutes (230-50). The mean sizeof the specimen was 3.27 cm (8-0.7). The average hospital stay was 6.4 days (20 - 2). The most important complications were: two pneumothorax, one angina pectoris, a nosocomial pneumonia and two patients who were reoperated 24 hours after surgery due to hemorrhage and hypovolemic shock. Conclusion: Unilateral laparoscopic adrenalectomy should be considered as the treatment of choice for adrenal adenoma, as it is a safe surgical technique with a low complication rate. It allows a shorter hospital stay and a more rapid incorporation into everyday life...

[Quality of life in patients with urinary incontinence]. / Calidad de vida en las pacientes con incontinencia urinaria.

OBJECTIVE: To assess the quality of life of female patients with urinary stress incontinence (USI) who were attended at the urology department of the University Hospital at Albacete. METHOD: Between November 2001 and December 2005, 126 patients with USI were surveyed in our hospital using the King's Health Questionnaire (KHQ), which is a specific instrument to measure the quality of life among female patients with urinary incontinence (UI). RESULTS: The mean age of patients was 57.09 años (SD: 9.57) and the mean BMI was 28.14 Kg/m2 (SD: 4.66). The mean evolution of UI was 114.48 months, with a median of 96 months. During the last week of the study period, a total of 73 women (57.94%) had more than 10 urine leaks a day. As regards the number of sanitary towels used a day, 82.5% (104 cases) stated they used less than 6. The urodynamic diagnosis was described as normal in 8 cases (6.3%), 16 cases (12.7%) were diagnosed as mixed urinary incontinence and, finally, 102 cases (81%) suffered genuine USI. The best scores were presented in the Personal Relationships scale with a mean score of 26.8, whereas the worse scores were noted in that of Impact of Urinary Incontinence, whose mean score was 82.96. Generally, the lowest scores (better quality of life) were obtained in the youngest age groups. Scores in the scales of General Health, Impact on daily activities, Impact on physical activity, Impact on social activity and Emotions, were significantly higher in patients who had undergone a histerectomy. Patients whose evolution of urinary incontinence was longer presented lower scores in the Personal Relationships scale (r=0.179; p=0.045). CONCLUSIONS: The quality of life of female patients with U.I. is affected, which limits both their physical activity and image. Their quality of life worsens with age, a greater extent of incontinence, greater urinary symptomatology and when episodes of urinary infection are associated.