Evaluación clínico-radiológica de la técnica de aloinjerto compactado y vástago cementado en cirugías de revisión de cadera / Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery

Objetivo. Evaluar a largo plazo, el resultado clínico-radiológico, la supervivencia y las complicaciones intra y postoperatorias de pacientes intervenidos de cirugía de revisión de cadera mediante esta técnica. Material y métodos. Estudio analítico observacional, prospectivo y no aleatorizado de 26 pacientes intervenidos de cirugía de revisión de cadera en nuestro hospital (1997-1998), a los que se les realizó un seguimiento clínico-radiológico y un análisis de la supervivencia del implante. Resultados. Se observan diferencias estadísticamente significativas en los valores pre y postoperatorios de las escalas de Harris y de Merle D'Aubigne. La supervivencia del implante teniendo en cuenta como punto final la cirugía de revisión fue del 84% a los 13 años. Hubo 9 complicaciones intraoperatorias (6 de ellas fueron fracturas) e influyeron de forma significativa en la estancia hospitalaria. El 70% de los pacientes no tuvo ninguna complicación postoperatoria. Ninguna de las variables analizadas influyó en el hundimiento radiográfico de los implantes. Discusión. Diversas técnicas intentan solventar el déficit de stock óseo en las cirugías de revisión de cadera, pero solo una intenta recuperarlo, el injerto compactado. Conclusiones. La técnica de Ling ofrece una mejoría clínica tanto en la escala de Merle D'Aubigne como en la de Harris, a medio-largo plazo. La presentación de complicaciones intraoperatorias incrementa la estancia hospitalaria y los días necesarios para iniciar la sedestación. La técnica de Ling es una buena opción a tener en cuenta en pacientes jóvenes en los que es previsible que haya una nueva cirugía de revisión en el futuro (AU)

Objective. Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. Material and methods. An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. Results. Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D'Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. Discussion. Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. Conclusions. The Ling's technique shows an improvement over the Merle D'Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future (AU)

[Clinical-radiological evaluation of the impaction allografting and cemented rod technique in revision knee surgery]. / Evaluación clínico-radiológica de la técnica de aloinjerto compactado y vástago cementado en cirugías de revisión de cadera.

OBJECTIVE: Long term clinical and radiological evaluation of results, survival, and peri- operative and post-operative complications of the patients who have been operated on for revision total hip arthroplasty using the impaction allografting and cemented rod technique. MATERIAL AND METHODS: An observational, analytical, prospective and non-random study was conducted on 26 patients who underwent revision total hip arthroplasty in our Hospital (1997-98). They were clinically and radiologically assessed, and a survival analysis of the implant was performed. RESULTS: Statistically significant differences were identified in the pre- and post-operative values, according to Harris and Merle D́Aubigne scores. The femoral components survival was considered as an endpoint of the revision replacement, which was 84% at a mean of 13 years. There were 9 intraoperative complications (6 were fractures) and they significantly affected the length of hospital stay. No post-operative complications were observed in 70% of the patients. None of the analysed variables had any influence on the radiological subsidence of the femoral component. DISCUSSION: Several techniques aim to solve the bone stock deficiency in revision total hip arthroplasty, but only impaction grafting attempts to recover it. CONCLUSIONS: The Ling's technique shows an improvement over the Merle D́Aubigne and Harris scores, in the medium-long term. The intraoperative complications are mainly an increase in the length of hospital stay and the number of days needed to be able to sit down. Ling's technique is a good option to consider in young patients where it is foreseeable that there is a new revision surgery in the future.

[TVT and TOT for surgical correction of female stress urinary incontinence. Comparison between techniques]. / TVT y TOT para la corrección quirúrgica de la incontinencia femenina de stress. Comparacion de ambas técnicas.

OBJECTIVES: Retrospective analysis of a series of patients with stress urinary incontinence that underwent surgery in our department, by means of the TVT and TOT techniques. We evaluate post operative continence, considering "cured" the patient with complete continence and "failure" any type of involuntary stress urine leak, independently of its severity registering the time of its appearance. For this purpose we used the Kaplan-Meier analysis comparing both techniques with the Breslow test. Additionally, postoperative complications were evaluated. RESULTS: 128 patients who underwent surgery by TVT (69 patients, 53.9%) and TOT (59 patients, 46.1%). Mean age was 54.4 years for TVT (95% CI 52.0-56.8) and 59 years for TOT (95% CI 55.9-62.1). Mean follow-up time was 18.7 months for TVT (95% CI 15.6-21.9) and 7.4 months for TOT (95% CI 5.8-8.9). Overall continence rate was 86.7%, 88.4% for TVT and 84.7% for TOT The probability of being continent six months after surgery was 89.1% for TVT and 78.2% for TOT (no significant differences, p = 0.31), with almost all failures within the first six months after surgery. TVT was more frecuently associated with urgency symptoms (33.3%, p = 0.001) and urge incontinence (18.8%,p = 0.16), urinary retention (11.6%, p = 0.38), and prevesical hematoma requiring mesh retrieval. Greater post operative pain was observed with TOT (20.3%, p = 0.005). CONCLUSIONS: Our results evidence a similar efficacy with both techniques, with the failures appearing over the first months after surgery. Complications of the voiding urgency type are significantly more frequent with TVT.

TVT y TOT para la corrección quirúrgica de la incontinencia femenina de stress. Comparación de ambas técnicas / TVT and TOT for surgical correction of female stress urinary incontinence. Comparison between technique

Objetivo: Evaluar los resultados en nuestras manos con las técnicas TVT y TOT. Métodos: Análisis retrospectivo de pacientes con incontinencia urinaria de esfuerzo operadas en nuestro servicio, mediante las técnicas de TVT y TOT. Evaluamos la continencia postoperatoria, considerando a las pacientes curadas si presentaban continencia total y como fracaso a cualquier tipo de pérdida involuntaria con el esfuerzo, independientemente de su severidad, registrándose el momento de su aparición. Para ello se empleó un análisis Kaplan-Meier comparando ambas técnicas mediante test de Breslow. Además se evaluaron las complicaciones postoperatorias. Resultados: El análisis se realizó con 128 pacientes intervenidas mediante TVT (69 pacientes, 53,9%) y TOT (59 pacientes, 46,1%). La media de edad para el TVT fue de 54,4 años (IC 95% 52,0-56,8), y de 59 años para el TOT (IC 95% 55,9-62,1). El tiempo medio de seguimiento fue 18,7 meses (IC 95% 15,6-21,9) para el TVT y 7,4 meses (IC 95% 5,8-8,9) para TOT. La tasa global de continencia fue de 86,7%, siendo de 88,4% para TVT y 84,7% para TOT. La probabilidad de permanecer continente a partir de los 6 meses de la cirugía fue de 89,1% para el TVT y de 78,2% para el TOT (diferencia no significativa, p=0,31), con la práctica totalidad de los fracasos antes de los 6 meses postcirugía. Con el TVT se produjo mayor sintomatología de urgencia (33,3%, p= 0,001) e incontinencia de urgencia (18,8%, p= 0,16), retención de orina (11,6%, p=0,38), y dos pacientes con hematoma prevesical que requirieron la retirada de la malla. Se observó mayor dolor postoperatorio con el TOT (20,3%, p=0,005). Conclusiones: Nuestros resultados evidencian una eficacia similar con ambas técnicas, presentándose los fracasos durante los primeros meses tras el procedimiento. Las complicaciones tipo urgencia miccional son significativamente mayores con el TVT (AU)

Objectives: Retrospective analysis of a series of patients with stress urinary incontinence that underwent surgery in our department, by means of the TVT and TOT techniques. We evaluate post operative continence, considering «cured» the patient with complete continence and «failure» any type of involuntary stress rine leak, independently of its severity, registering the time of its appearance. For this purpose we used the Kaplan-Meier analysis comparing both techniques with the Breslow test. Additionally, postoperative complications were evaluated. Results: 128 patients who underwent surgery by TVT (69 patients, 53.9%) and TOT (59 patients, 46.1%). Mean age was 54.4 years for TVT (95% Cl 52.0-56.8) and 59 years for TOT (95% CI 55.9-62.1). Mean follow-up time was 18.7 months for TVT (95% CI 15.621.9) and 7.4 months for TOT (95% CI 5.8-8.9). Overall continence rate was 86.7%, 88.4% for TVT and 84.7% for TOT. The probability of being continent six months after surgery was 89.1% for TVT and 78.2% for TOT (no significant differences, p = 0.31), with almost all failures within the first six months after surgery. TVT was more frecuently associated with urgency symptoms (33.3%,p = 0.001) and urge incontinence (18.8%,p = 0.16), urinary retention (11.6%,p = 0.38), and prevesical hematoma requiring mesh retrieval. Greater post operative pain was observed with TOT (20.3%, p= 0.005). Conclusions: Our results evidence a similar efficacy with both techniques, with the failures appearing over the first months after surgery. Complications of the voiding urgency type are significantly more frequent with TVT (AU)

[Clinical significance of prostatic intraepithelial neoplasm and atypical small acinar proliferation: relationship with prostate cancer]. / Significado clínico de la neoplasia intraepitelial prostática y de la proliferación acinar focal atípica: relación con el cáncer de próstata.

INTRODUCTION: Prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) in the setting of prostatic needle biopsies are considered premalignant although questions still remain. OBJECTIVES: In this paper, we have studied the clinical relevance of these histologic findings. MATERIAL AND METHODS: We collected 138 subjects (108 PIN, 30 ASAP); in 67% we performed a second biopsy and the rate of cancer in this late biopsy were 19% and 27% respectively. We cannot identify any clinical factor to predict the finding of cancer in the re-biopsy (PSA, age, digital rectal examination, prostatic volume). RESULTS: In the follow-up, we observed higher rates of cancer for the ASAP; the finding of ASAP was the single clinical or histopathological factor that was an independent predictor of cancer. CONCLUSIONS: We observed that the finding of ASAP was an indication for re-biopsy because of the higher rates of cancer; on the contrary, the paper of PIN in the prostatic needle biopsy still requires further investigation.

[Trends in the incidence of testicular germ cell cancer in a 300.000 inhabitants Spanish population (1991-2005)]. / Tendencia en la incidencia del cáncer testicular de células germinales en un área sanitaria española de 300.000 habitantes (1991-2005).

OBJECTIVE: To describe the features and the time trends of the testicular cancer in a spanish population. MATERIALS AND METHODS: Data on incident cases of testicular germ cell cancer diagnosed in our population were extracted from the Cancer Registry of our Department. We calculed annual incidence rates of testicular cancer, the Spanish population-adjusted annual percent change (APC), age of diagnosis and the different histologic types frequencies. RESULTS: The overall incidence rate rose from 0.84 per 100,000 males to 1.91 per 100,000 males from 1991 till 2005, with a peak of 6.77 per 100,000 males in 2003. The Spanish population-adjusted APC was 2.39%. By histologic subgroup, for seminomas: the incidence rate varied from 0.84 per 100,000 males to 0.64 per 100,000 (1991-2005), with a peak of 5.41 per 100,000 in 2003 and the Spanish population-adjusted APC was 6.06. For nonseminomas, the incidence rate varied from 1.66 per 100,000 to 1.28 per 100,000 (1992-2005), with a peak of 3.65 per 100.000 in 2001 and the Spanish population-adjusted APC was 12.74. Mean ages were 31.23 years (median 30, SD 8.56) for seminomas, and 23.68 years (median 25, SD 6.85) for nonseminomas, with statistic significance (p < 0.0001). DISCUSSION: The increasing testicular cancer incidence observed for this population follows the time trends showed in other European countries.

Significado clínico de la neoplasia intraepitelial prostática y de la proliferación acinar focal atípica: relación con el cáncer de próstata / Clinical significance of prostatic intraepithelial neoplasm and atypical small acinar proliferation: relationship with prostate cancer

Introducción: El papel de la neoplasia intraepitelial prostática (PIN) y de la proliferación acinar focal atípica (ASAP) en el marco de una biopsia transrrectal todavía no se encuentra por completo definido; aunque ambas lesiones han sido consideradas clásicamente premalignas, hoy en día la necesidad de la rebiopsia sistemática sigue siendo controvertido. Objetivos: En este trabajo hemos estudiado el papel de estas lesiones y su relación con el cáncer de próstata. Material y métodos: Se incluyeron 138 sujetos (108 PIN, 30 ASAP) a los que se le practicó rebiopsia al 67%; la tasa de cáncer en la rebiopsia inmediata fue del 19 y 27% respectivamente sin identificar ningún factor clínico para predecir cáncer en la rebiopsia (PSA, edad, tacto rectal, volumen prostático).Resultados: Durante el seguimiento, la mayor tasa de cáncer se observó en el ASAP, seguido del PIN y finalmente de las lesiones benignas; el único predictor clínico-patológico independiente de cáncer en este caso fue la existencia de ASAP en la primera biopsia transrrectal. Conclusiones: La necesidad de rebiopsiar sistemáticamente a los sujetos con PIN en la biopsia de próstata ha sido puesta en duda en la literatura reciente, mientras que la necesidad de rebiopsiar los ASAP sigue estando claramente indicado (AU)

Introduction: Prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) in the setting of prostatic needle biopsies are considered premalignant although questions still remain. Objetives: In this paper, we have studied the clinical relevance of these histologic findings. Material and methods: We collected 138 subjects (108 PIN, 30 ASAP); in 67% we performed a second biopsy and the rate of cancer in this late biopsy were 19% and 27% respectively. We cannot identify any clinical factor to predict the finding of cancer in the re-biopsy (PSA, age, digital rectal examination, prostatic volume).Results: In the follow-up, we observed higher rates of cancer for the ASAP; the finding of ASAP was the single clinical or histopathological factor that was an independent predictor of cancer. Conclusions: We observed that the finding of ASAP was an indication for re-biopsy because of the higher rates of cancer; on the contrary, the paper of PIN in the prostatic needle biopsy still requires further investigation (AU)

Tendencia en la incidencia del cáncer testicular de células germinales en un área sanitaria española de 300.000 habitantes (1991-2005) / Trends in the incidence of testicular germ cell cancer in a 300.000 inhabitants spanish population (1991-2005)

Objetivo: Describir las características y tendencia temporal de los cánceres testiculares en un área sanitaria española. Material y métodos: Se realizó una búsqueda de todos los pacientes residentes en nuestra área sanitaria diagnosticados de cáncer testicular por primera vez. Se calcularon los datos de incidencia, cambio porcentual anual (APC) según tasa de incidencia ajustada a la población española, edad al diagnóstico y las frecuencias de los diferentes tipos histológicos tumorales. Resultados: La incidencia del cáncer testicular pasó de 0,84/100.000 varones en 1991 a 1,91/100.000 varones en2005, con un pico de 6,77/100.000 varones en 2003. El cambio porcentual anual (APC) ajustado a la población españolase calculó en 2,39%. Por subtipos histológicos, para los seminomas: la tasa de incidencia pasó de 0,84 a0,64/100.000 (1991-2005), con un pico de 5,41/100,000 en 2003 y un APC ajustado a la población española de 6,06. Para los no seminomas, la tasa de incidencia varió de 1,66 a 1,28/100.000 (1992-2005), con un pico de 3,65/100.000en 2001 y un APC ajustado a la población española de 12,74. La edad al diagnóstico fue, para los seminomas: media31,23, DE 8,56, mediana 30; y para los tumores no seminomatosos: media 23,68, DE 6,85, mediana 25. La comparación de las medias de ambas edades resultó estadísticamente significativa (p‹ 0,0001).Discusión: Existe un aumento de la incidencia del cáncer testicular de células germinales en nuestro medio, tal y como se ha demostrado en otros países (AU)

Objective: To describe the features and the time trends of the testicular cancer in a spanish population. Materials and methods: Data on incident cases of testicular germ cell cancer diagnosed in our population were extracted from the Cancer Registry of our Department. We calculed annual incidence rates of testicular cancer, the Spanish population-adjusted annual percent change (APC), age of diagnosis and the different histologic types frequencies. Results: The overall incidence rate rose from 0.84 per 100,000 males to 1.91 per 100,000 males from 1991 till 2005, with a peak of 6.77 per 100,000 males in 2003. The Spanish population-adjusted APC was 2.39%. By histologic subgroup, for seminomas: the incidence rate varied from 0.84 per 100,000 males to 0.64 per 100,000 (1991-2005), with apeak of 5.41 per 100,000 in 2003 and the Spanish population-adjusted APC was 6.06. For non seminomas, the incidence rate varied from 1.66 per 100,000 to 1.28 per 100,000 (1992-2005), with a peak of 3.65 per 100.000 in 2001 and theSpanish population-adjusted APC was 12.74. Mean ages were 31.23 years (median 30, SD 8.56) for seminomas, and23.68 years (median 25, SD 6.85) for non seminomas, with statistic significance (p‹ 0.0001). Discussion: The increasing testicular cancer incidence observed for this population follows the time trends showed in other European countries (AU)

[Natural history of metastasic prostate cancer treated with androgen deprivation therapy and secondary hormonal therapy efficiency]. / Historia natural del cáncer de próstata metastásico sometido a bloqueo hormonal y eficacia del tratamiento hormonal de segunda línea.

OBJECTIVE: to analyze metastatic prostate cancer progression in patients treated with hormonal blockade as well as second line hormonal treatments outcomes. PATIENTS AND METHODS: 199 metastatic patients were selected from a 455 hormonal treated patients pool. Time to biochemical progression was studied with Kaplan Meier analysis and patients were stratified according to pathological differentiation. Second line treatment lasting and efficacy were also assessed. RESULTS: 74 patients out of 192 metastatic patients (56.1%) progressed in terms of PSA. Median time to biochemical progression was 1.7 years (1.2-2.3, CI 95%). We did not find stadistical differences on pathological differentiation (p = 0.238). Second line treatment's efficacy, applied to 41 patients was 34.1%, without any stadistical differences among these treatments. Response treatment median time was 6.8 months without stadistical differences among different treatments (p = 0.220). CONCLUSIONS: hormonal blockade efficacy in metastatic prostate cancer has a limited value in time in our experience. One third of these patients have a limited response to a second line treatment although this response is even shorter in duration.

Historia natural del cáncer de próstata metastásico sometido a bloqueo hormonal y eficacia del tratamiento hormonal de segunda línea / Natural history of metastasic prostate cancer treated with androgen deprivation therapy and secondary hormonal therapy efficiency

Objetivos: analizar la evolución de los pacientes con cáncer de próstata metastásico sometidos a bloqueo androgénico hasta la progresión de la enfermedad, así como la eficacia de los tratamientos hormonales de segunda línea aplicados. Material y métodos: de 455 pacientes sometidos a bloqueo androgénico se seleccionaron 192 en estadio metastático. En éstos se analizó el tiempo desde el inicio del tratamiento hasta la progresión de PSA, estratificándose a los pacientes en función del grado de diferenciación histológica, mediante un análisis Kaplan-Meier. Asimismo se analizó la respuesta a manipulaciones hormonales de segunda línea aplicadas en términos de eficacia y duración de la misma. Resultados: de 192 pacientes con estadio clínico metastático al inicio del bloqueo, 74 (56,1%) presentaron progresión de PSA. La mediana de tiempo hasta la aparición de dicha progresión fue de 1,7 años (1,2-2,3; IC95), no hallándose diferencias al estratificar a los pacientes en función del grado de diferenciación al diagnóstico (p=0,238). La eficacia global del tratamiento hormonal de segunda línea, aplicado a 41 pacientes, fue de 34,1%, sin hallarse diferencias entre las tres modalidades. La mediana de tiempo de duración de dicha respuesta fue de 6,8 meses, no objetivándose diferencias estadísticamente significativas entre modalidades (p=0,220). Conclusiones: en nuestra experiencia, la eficacia del bloqueo hormonal en pacientes con cáncer prostático metastásico tiene una duración limitada. Aproximadamente un tercio de estos pacientes responde a manipulación hormonal de segunda línea, aunque la duración de dicha respuesta es aún más limitada

Objective: to analyze metastatic prostate cancer progression in patients treated with hormonal blockade as well as second line hormonal treatments outcomes. Patients and Methods: 199 metastatic patients were selected from a 455 hormonal treated patients pool. Time to biochemical progression was studied with Kaplan Meier analysis and patients were stratified according to pathological differentiation. Second line treatment lasting and efficacy were also assessed. Results:74 patients out of 192 metastatic patients (56.1%) progressed in terms of PSA. Median time to biochemical progression was 1.7 years (1.2-2.3, CI 95%). We did not find stadistical differences on pathological differentiation (p=0.238). Second line treatment’s efficacy, applied to 41 patients was 34.1%, without any stadistical differences among these treatments. Response treatment median time was 6.8 months without stadistical differences among different treatments (p=0.220). Conclusions: hormonal blockade efficacy in metastatic prostate cancer has a limited value in time in our experience. One third of these patients have a limited response to a second line treatment although this response is even shorter in duration

[Smoking habit and superficial bladder tumours' natural history]. / Efecto del tabaco sobre la evolución de los tumores de vejiga.

OBJECTIVES: To disclose the features of bladder cancer in current smokers at diagnosis and to study the differences in recurrence and progression between smokers and non-smokers. PATIENTS & METHODS: 786 consecutive patients with bladder cancer from 1991 to 2004 were studied in a retrospective manner and characteristics of smokers tumours were compared to non smokers. RESULTS: 377 (48%) patients were smokers at diagnosis. There were no differences in terms of age and T stage between smokers and non smokers (t student and Chi square). We found statistical differences in tumours grade, size and multiplicity ( Chi square, p=0.046, p=0.001 and p=0.12 respectly). No differences were found between smokers and non smokers according to recurrence. (Log Rank, Breslow y Tarone-Ware N.S.). We did find differences according to progression (Log Rank p=0.03, Breslow p=0.05 y Tarone-Ware p=0.03) although it did not support multivariate study. CONCLUSIONS: Currents smokers present bigger and higher grade tumors and, more frequently in a multiple fashion at diagnosis than non-smokers.

Efecto del tabaco sobre la evolución de los tumores de vejiga / Smoking habit and superficial bladder tumours´natural history

Objetivos: Evaluar las características de las neoplasias vesicales en pacientes fumadores en el momento del diagnóstico y estudiar las diferencias en recurrencia y progresión de los pacientes fumadores y los no fumadores. Pacientes y Métodos: Se revisaron 786 historias clínicas de pacientes con tumores vesicales de nuestra base de datos de una forma retrospectiva desde 1991 al 2004 y se analizaron las características tumorales así como el evento recurrencia y progresión de los pacientes fumadores frente a los no fumadores. Resultados: 377 (48%) pacientes eran fumadores al momento del diagnóstico. No encontramos diferencias significativas en cuanto a edad ni a categoría T tumoral entre ambos grupos (t student y Chi cuadrado). Sin embargo, si encontramos diferencias estadísticamente significativas en cuanto a grado tumoral, tamaño tumoral ( mayor o menor de 2 cm.) y multiplicidad (Chi cuadrado, p=0,046, p=0,001 y p=0,012 respectivamente). No encontramos diferencias significativas para la recidiva.(Log Rank, Breslow y Tarone-Ware N.S.). En cuanto a progresión si se aprecia una diferencia estadísticamente significativa entre fumadores y no fumadores en el estudio univariante (Log Rank p=0,03, Breslow p=0,05 y Tarone-Ware p=0,03) aunque no soporta el estudio multivariante. Conclusiones: No puede reconocerse el hábito tabáquico como un factor independiente de recurrencia o progresión en los tumores superficiales. Sin embargo, los fumadores debutan más frecuentemente con tumores de alto grado, de una manera múltiple y de un tamaño igual o superior a 2 cm. de una manera significativa frente a los no fumadores

Objectives: To disclose the features of bladder cancer in current smokers at diagnosis and to study the differences in recurrence and progression between smokers and non-smokers. Patients & Methods: 786 consecutive patients with bladder cancer from 1991 to 2004 were studied in a retrospective manner and characteristics of smokers tumours were compared to non smokers. Results: 377 (48%) patients were smokers at diagnosis. There were no differences in terms of age and T stage between smokers and non smokers (t student and Chi square). We found statistical differences in tumours grade, size and multiplicity ( Chi square, p=0.046, p=0.001 and p=0.12 respectly). No differences were found between smokers and non smokers according to recurrence. (Log Rank, Breslow y Tarone-Ware N.S.). We did find differences according to progression (Log Rank p=0.03, Breslow p=0.05 y Tarone-Ware p=0.03) although it did not support multivariate study. Conclusions: Currents smokers present bigger and higher grade tumors and, more frequently in a multiple fashion at diagnosis than non-smokers

[The meaning of PSA progression after radical prostatectomy. Preliminary results]. / Significado de la progresión de PSA tras prostatectomía radical. Resultados preliminares.

OBJECTIVES: To report our findings regarding to the natural history of prostate cancer (PCa) that shows recurrence after radical prostatectomy (RP), in terms of time to development of metastatic disease and death from PCa. To identify independent predictors of PSA recurrence. MATERIAL AND METHODS: Retrospective analysis of 227 patients with clinically localized PCa who underwent RP. The event PSA recurrence was defined as the presence of a postoperative PSA level of 0,2 ng/ml or higher at least 3 months after surgery. Hence, cases with shorter follow-up time were excluded from analysis. No adjuvant therapy (radiotherapy or hormonal therapy) was performed in the included population. Recurrence free survival was calculated during the follow-up period (Kaplan-Meier analysis). Uni and multivariate study was performed in order to assess the ability of factors as preoperative PSA level, Gleason score in surgical specimen, capsular penetration, positive surgical margins (excluding urethral), extracapsular extension, positive pelvic lymph nodes, and seminal vesicle invasion, to predict PSA recurrence. Finally, we selected the group of patients with PSA recurrence and calculated the probability of being free from distant metastatic disease during the follow-up period. Also, function of disease-specific survival was calculated. RESULTS: A total of 208 records were finally included in the study. Median age was 61 years. A total of 47 (22.6%) presented with extracapsular extension. Median follow-up time was 35.8 months, and 49 (23.6%) developed PSA recurrence. Recurrence free survival was 79.9% and 67.4% at 2 and 5 years, respectively. Only three factors were identified with the aid of multivariate analysis as independent predictors of recurrence: preoperative PSA >= 10 ng/ml (hazard ratio--HR--3.03), Gleason score in surgical specimen 8 or higher (HR 3.42), and the finding of capsular penetration (HR 2.17). When only patients with PSA recurrence were considered, 16.3% developed distant metastasis. Probabilities of being free from distant disease after PSA recurrence were 97.7% and 86.9% at 2 and 5 years respectively (actuarial median time 110.8 months). Only 2 patients died from PCa, therefore disease-specific mortality analysis was not performed. CONCLUSIONS: Although an important proportion of patients present with PSA recurrence after RP in our setting, the prognosis in term of development of metastatic disease is acceptable in the short-medium term. Anyway, further analysis will be needed to ascertain the evolution of these patients in the long term.

Significado de la progresión de PSA tras prostatectomía radical. Resultados preliminares / The meaning of PSA progression after radical prostatectomy. Preliminary results

Objetivos: Ofrecer nuestra experiencia respecto de la historia natural del cáncer de próstata (CaP) que sufre progresión tras la prostatectomía radical (PR), en términos de tiempo hasta la aparición de metástasis o hasta la muerte por esta enfermedad. Identificar los factores clínico-patológicos que pueden condicionar dicha evolución. Material y métodos: Análisis retrospectivo de 227 pacientes con CaP clínicamente localizado sometidos a PR. Se definió el evento progresión bioquímica (PBQ) como el presentar un PSA postoperatorio de 0,2 ng/ml al menos tres meses tras la cirugía, excluyendo del análisis los casos con tiempo de seguimiento inferior al mencionado. No se administró tratamiento precoz (radioterapia externa o bloqueo hormonal) en los pacientes incluidos. Se calculó la supervivencia libre de PBQ a lo largo del tiempo (análisis Kaplan-Meier). Se estudió (análisis uni y multivariante) la capacidad de factores como PSA preoperatorio, score de Gleason en la pieza, presencia de penetración capsular, margen quirúrgico afectado (excluyendo uretral), extensión extracapsular, presencia de ganglios positivos, y afectación de vesículas seminales, para predecir la recurrencia. Por último, para el grupo de pacientes que presentaron PBQ, calculamos la probabilidad de permanecer libre de metástasis a distancia a lo largo del seguimiento, así como la función de supervivencia cáncer-específica. Resultados: Un total de 208 registros fueron finalmente incluidos en el estudio. La mediana de edad fue de 61 años. Un total de 47 (22,6%) presentó estadio patológico extracapsular. La mediana de seguimiento fue de 35,8 meses. Un total de 49 (23,6%) presentaron PBQ. La probabilidad de permanecer libre de PBQ fue de 79,9% y 67,4% a los 2 y 5 años, respectivamente.Tan sólo tres factores fueron identificados por el modelo multivariante como predictores independientes de recurrencia: un PSA preoperatorio>= 10 ng/ml (hazard ratio –HR- 3,03), score de Gleason en la pieza quirúrgica entre 8 y 10 (HR 3,42), y el hallazgo de penetración capsular (HR2,17). De los pacientes que presentaron PBQ, 16,3% desarrolló metástasis a distancia. Las probabilidades de permanecer libre de metástasis tras la PBQ fueron calculadas en 97,7% y 86,9% a los 2 y a los 5 años respectivamente (mediana actuarial de 110,8 meses). Sólo 2 individuos fallecieron por CaP por lo que no se llevó a cabo análisis de mortalidad cáncer-específica. Conclusiones: A pesar de la notable proporción de pacientes con progresión de PSA tras la prostatectomía radical en nuestro entorno, su pronóstico a corto y medio plazo, en términos de desarrollo de metástasis, es aceptable. En cualquier caso, un nuevo análisis será necesario para verificarla evolución a largo plazo de estos pacientes

Objectives: To report our findings regarding to the natural history of prostate cancer (PCa) that shows recurrence after radical prostatectomy (RP), in terms of time to development of metastatic disease and death from PCa. To identify independent predictors of PSA recurrence. Material and methods: Retrospective analysis of 227 patients with clinically localized PCa who underwent RP. The event PSA recurrence was defined as the presence of a postoperative PSA level of 0,2 ng/ml or higher at least 3 months after surgery. Hence, cases with shorter follow-uptime were excluded from analysis. No adjuvant therapy (radiotherapy or hormonal therapy) was performed in the included population. Recurrence free survival was calculated during the follow-up period (Kaplan-Meier analysis). Uni and multivariate study was performed inorder to assess the ability of factors as preoperative PSA level, Gleason score in surgical specimen, capsular penetration, positive surgical margins(excluding urethral), extracapsular extension, positive pelvic lymph nodes, and seminal vesicle invasion, to predict PSA recurrence.Finally, we selected the group of patients with PSA recurrence and calculated the probability of being free from distant metastatic disease during the follow-up period. Also, function of disease-specific survival was calculated. Results: A total of 208 records were finally included in the study. Median age was 61 years. A total of 47 (22.6%) presented with extracapsular extension. Median follow-up time was 35.8 months, and 49 (23.6%) developed PSA recurrence. Recurrence free survival was 79.9% and 67.4% at 2 and 5 years, respectively. Only three factors were identified with the aid of multivariate analysis as independent predictors of recurrence: preoperative PSA >= 10 ng/ml (hazard ratio –HR- 3.03), Gleason score in surgical specimen 8 or higher (HR 3.42), and the finding of capsular penetration (HR 2.17). When only patients with PSA recurrence were considered, 16.3% developed distant metastasis. Probabilities of being free from distant disease after PSA recurrence were 97.7% and 86.9% at 2 and 5 years respectively (actuarial median time 110.8 months). Only 2 patients died from PCa, therefore disease-specific mortality analysis was not performed. Conclusions: Although an important proportion of patients present with PSA recurrence after RP in our setting, the prognosis in term of development of metastatic disease is acceptable in the short-medium term. Anyway, further analysis will be needed to ascertain the evolution of these patients in the long term

[Left inferior vena cava with renal cell carcinoma]. / Vena cava renal izquierda en un paciente con carcinoma de células renales.

We presented a case of inferior vena cava on the left side diagnosed by abdominal CT scan during the study of a renal cell carcinoma in the right side. This anomaly is very rare but it may suppose a more difficult approach to the nephrectomy.

[Acute urinary retention and hematuria secondary to metastatic renal clear-cell carcinoma to the penis]. / Retención urinaria aguda y hematuria secundarias a metástasis peneanas por carcinoma renal de células claras.

Renal cell carcinoma have a great capacity of dissemination and have a great variety of clinical presentation. We exposed a clinical note of a patient diagnosed of renal cell carcinoma who developed hematuria and acute urinary retention due to a penis metastasis. Next we review the literature about this topic.

Vena cava renal izquierda en un paciente con carcinoma de células renales / Left inferior vena cava with renal cell carcinoma

Presentamos un caso de vena cava renal izquierda diagnosticado mediante CT abdominal durante el estudio de extensión de un paciente por carcinoma de células renales. Esta anomalía es muy rara pero su conocimiento antes de la cirugía es importante para evitar complicaciones durante el procedimiento quirúrgico (AU)

We presented a case of inferior vena cava on the left side diagnosed by abdominal CT scan during the study of a renal cell carcinoma in the right side. This anomaly is very rare but it may suppose a more difficult approach to the nephrectomy (AU)

Retención urinaria aguda y hematuria secundarias a metástasis peneanas por carcinoma renal de células claras / Acute urinary retention and hematuria secondary to metastatic renal clear-cell carcinoma to the penis

El carcinoma renal de células claras es una neoplasia con gran capacidad de diseminación y que se presenta de formas muy variadas. Presentamos un caso clínico de un sujeto que desarrolla hematuria y retención aguda de orina secundarias ambas a metástasis en pene de un carcinoma renal de células claras. A continuación se lleva a cabo una pequeña revisión de la literatura existente sobre metástasis en esta localización (AU)

Renal cell carcinoma have a great capacity of dissemination and have a great variety of clinical presentation. We exposed a clinical note of a patient diagnosed of renal cell carcinoma who developed hematuria and acute urinary retention due to a penis metastasis. Next we review the literature about this topic (AU)