Oncologic outcomes in 408 consecutive patient cohort treated with da Vinci robot-assisted radical prostatectomy. / Resultados oncológicos de un programa de prostatectomía radical asistida por robot «da Vinci¼ en una cohorte de 408 pacientes consecutivos.

The objective of this study is to evaluate the general characteristics and oncological results in a cohort of 408 cases submitted to da Vinci Standard 4-armed robot-assisted radical prostatectomy (RARP), performed between October 2006 and February 2015 at Clínico San Carlos hospital. Statistical analysis was performed with the SPSS 20.0 program. Qualitative variables are presented with their frequency distribution and quantitative variables with their mean and standard deviation or median and interquartile range. The χ2 test was used to analyze the association of qualitative variables. The disease-free survival outcome variable was evaluated with a Kaplan-Meier curve analysis, and the differences were contrasted with the Breslow test. A Cox regression model was adjusted. Among the results, we highlight the follow-up of 47 months (32-68.75m), recurrence-free survival of 90 months (95% CI, 86-94), median time to recurrence of 23 months (10.5-37 m), recurrence 16'6% (68/408), biochemical recurrence (62/498, 15'2%) and 22% of complications, mostly Clavien I-II. The results are summarized in Tables 1 to 7 and Figure 1. CONCLUSIONS: 1) RARP is a safe technique with an acceptable percentage of complications, mostly minor (Clavien grades iandii), 2) We found a higher probability of remaining recurrence-free in the lower grades of the ISUP classification and a higher probability of recurrence in high-risk cases, and 3) The multivariate model showed that the ISUP grade was significantly related to survival and the ISUP and PSM classification grades were independent prognostic variables.

Robot Assisted Radical Prostatectomy in Kidney Transplant Recipients. Our Clinical Experience and a Systematic Review.

INTRODUCTION: Radical prostatectomy is a more skillful procedure in kidney graft recipients. Robotic surgery can provide a useful minimally invasive tool. OBJECTIVES: The study aims to evaluate the robotic-assisted laparoscopic prostatectomy (RALP) in kidney transplant recipients, describing intra/postoperative complications, renal and oncological outcomes. METHODS: This is a retrospective study conducted in a single institution of 84 RALP. Four of them were kidney transplant recipients. Side of the renal graft, clinical stage, intra/postoperative events, operating time, creatinine levels before/after intervention and oncologic follow-up were recorded. A systematic review of the literature was performed. RESULTS: Aged 61.25 ± 7.76 years, interval between renal transplantation and RALP: 10 ± 3.16 years. Mean prostate specific antigen: 7.1 ± 2.8 ng/ml, 2 patients were cT1c and 2 cT2a. Preoperative biopsies: Gleason score 3 + 3 in 3 patients, 3 + 4 in 1 patient. Charlson comorbidity index mean was 4.82 ± 0.82. No intra/postoperative events were reported. Mean operating time: 196 ± 20.8 min. Positive surgical margins: 2/4 patients. Pathological analysis: Gleason 3 + 4 in 2 patients and Gleason 3 + 3 in the others 2. A patient developed a bladder neck sclerosis. No differences between pre/postoperative creatinine. Three patients are free of biochemical recurrence and 1 patient required adjuvant radiotherapy. CONCLUSION: RALP in renal transplant recipients is a safe and feasible technique for localized prostate cancer. No difference in oncological outcomes and no impairments on renal function were found.

Fractura de pene. Revisión de la literatura y presentación de dos casos / Fracture of the penis. Literature review and contribution of two cases

Presentamos dos casos de una patología poco frecuente como es la rotura de cuerpo cavernoso de pene, sometidos a tratamiento quirúrgico precoz con buenos resultados. Revisamos así mismo, los aspectos etiológicos, clínicos, diagnósticos y el tratamiento más apropiado (AU)

[Neoadjuvant chemotherapy MVAC in the treatment of infiltrating bladder carcinoma]. / Quimioterapia neoadyuvante MVAC en el tratamiento del carcinoma vesical infiltrante.

INTRODUCTION: Aiming to preserve the bladder in patients with infiltrative carcinoma of the bladder and to offer patients improved quality of life with no detriment for survival, a therapeutical protocol was set up. MATERIAL AND METHODS: Between August 1988 and January 1997 63 patients with stage T2 and T3a infiltrative carcinoma of the bladder, with no metastasis or node extension detectable with imaging techniques were treated in our unit. 45 of these patients met all protocol criteria and were given 3 neoadjuvant chemotherapy courses with MVAC (methotrexate, vincristine, adriamycin, cisplatin). INCLUSION CRITERIA: age under 75 years, Karnofsky greater than 50%, leucocytes greater than 2,500 cell/mL and platelet greater than 100,000/mL. Following chemotherapy, re-assessment was performed through lab tests, chest X-rays, abdomino-pelvic CT, bone scanning, cystoscopy, multiple randomized biopsies, tumoral bed scar resection and resection of relapsed urothelioma. Patients with complete remission were given radiotherapy. Those showing stabilisation of progression were proposed to undergo cystectomy. Fisher's test or chi 2 test were used for the comparison of qualitative variables. The survival analysis was performed using the Kaplan-Meier method. The curves comparison was done with Breslow's exact test. A Cox's proportional risk method allowed to calculate the relative risks together with their 95% confidence interval. RESULTS: 53.7% patients included in this protocol showed complete remission, 41.5% stable disease and 4.9% progression. 62.2% of patients were given radiotherapy versus 17.8% who underwent cystectomy. 20% received other therapies after rejecting both cystectomy or radiotherapy. Median follow-up was 43.38 months. Overall median survival was 96 months. The accumulate probability of survival at 4 years was 79%. 50% patients with complete clinical response relapsed during follow-up. Tumoral stage of those who relapsed was lower than the initial one in 63.7% cases, remained the same in 18.2%, and higher in 18.2%. With regards to grading, 66.7% patients had lower grading at relapse if tumour was initially grade 2. For those with initial tumour grade 3, only 20% had a lower grade. CONCLUSION: 64.4% patients retained their bladder. In 26.7% there was demonstrable metastatic disease. No differences were seen in the distribution or survival time based on the different treatment given after chemotherapy (p = 0.22). Patients with complete remission after chemotherapy have greater actuarial survival which is statistically significant (p = 0.04).

Quimioterapia neoadyuvante MVAC en el tratamiento del carcinoma vesical infiltrante / Neoadjuvant chemotherapy with MVAC in the treatment of infiltrative carcinoma of the bladder

INTRODUCCIÓN: Se inició este protocolo de tratamiento con intención de conservar la vejiga en los pacientes con carcinoma vesical infiltrante y, con ello, dar al paciente una mejor calidad de vida sin detrimento de su supervivencia. MATERIAL Y MÉTODO: Desde Agosto de 1988 hasta Enero de 1997 hemos tratado a 63 pacientes portadores de carcinoma vesical infiltrante en estadio clínico T 2 y T 3a sin metástasis ni diseminación ganglionar objetivables por técnicas de imagen. De estos 45 cumplieron estrictamente el protocolo y recibieron 3 ciclos de quimioterapia neoadyuvante MVAC (metotrexate, vincristina, adriamicina y cisplatino). Los criterios de inclusión fueron : edad menor de 75 años, Karnofsky mayor del 50 por ciento, recuento leucocitario mayor de 2.500 células/ml y plaquetas superiores a 100.000/ml. Se realizó reevaluación tras la quimioterapia mediante estudios analíticos, radiografía de tórax, CT abdominopélvico, gammagrafía ósea, cistoscopia, biopsias múltiples randomizadas, resección de la cicatriz del lecho tumoral o resección de urotelioma recidivado. Los pacientes con remisión completa recibieron radioterapia. A los que presentaron estabilización o progresión se les propuso cistectomía. La comparación entre variables cualitativas se ha realizado con el test de la ??2 o test de Fisher. Se realizó un análisis de supervivencia con el método de Kaplan-Meier. La comparación de curvas se realizó con el test exacto de Breslow. Un modelo de riesgos proporcionales de Cox permitió el cálculo de los riesgos relativos junto a su intervalo de confianza al 95 por ciento. RESULTADOS: De los pacientes incluidos en este protocolo mostraron remisión completa el 53.7 por ciento, estabilización el 41.5 por ciento y progresión el 4.9 por ciento. El 62.2 por ciento de los sujetos recibieron radioterapia, frente al 17.8 por ciento a los que se realizó cistectomía. El 20 por ciento recibió otros tratamientos por negarse a cistectomía o radioterapia. La mediana de seguimiento fue de 43,38 meses. La supervivencia global mediana fue de 96 meses. La probabilidad acumulada de supervivencia a los 4 años fue del 79 por ciento. De los pacientes que tuvieron respuesta clínica completa recidivaron durante el seguimiento el 50 por ciento. De éstos el 63.7 por ciento lo hicieron en un estadio menor que el tumor inicial, un 18.2 por ciento repitieron estadio y un 18.2 por ciento presentaron un estadio superior. En cuanto al grado el 66.7 por ciento de los pacientes presentaron un grado menor en la recidiva si el tumor inicialmente era de grado 2. Aquellos que inicialmente presentaron un grado 3 solo disminuyeron el mismo en un 20 por ciento de los casos. CONCLUSIONES : El 64.4 por ciento de los pacientes conservaron su vejiga. La enfermedad metastásica demostrable apareció en el 26.7 por ciento. No se observaron diferencias en la distribución en el tiempo de la supervivencia según los diferentes tratamientos administrados tras la quimioterapia (p=0.22).Los pacientes que presentan remisión completa tras quimioterapia tienen una mayor supervivencia actuarial que es estadísticamente significativa (p=0.04) (AU)

[Fracture of the penis. Review of the literature and presentation of 2 cases]. / Fractura de pene. Revisión de la literatura y presentación de dos casos.

We report two cases of a very uncommon pathology as is the rupture of the corpus cavernosum of the penis, undergoing early surgical management with good results. We also review the diagnostic, clinical and etiological aspects, and the most appropriate treatment.

[Renal transplant in patient older than 65 years of age]. / Trasplante renal en pacientes mayores de 65 años.

OBJECTIVE: To analyze the outcome of renal transplantation in patients more than 65 years old. METHODS: From 1991 to 1997, 83 renal transplants were performed in patients aged over 60 years at our institution; 20 of these patients were more than 65 years old. The control group comprised graft recipients under than age from the 477 cases that had undergone transplantation during the period 1980-1996. Graft donor selection was done according to standard practice. The immunosuppression protocol changed over time; 5 patients received triple therapy and another 15 patients received quadruple sequential immunosuppression therapy. RESULTS: The mean age of the recipients was 66.8 years (range 65-72); 9 patients required dialysis after renal transplantation. Patients aged over 65 years had a 94% survival at 6 months, 88% at 12 months, and 88% at 48 months, whereas the survival rates for the control group were 96%, 95% and 87% for the respective time periods. Graft survival was 95% at one month, 90% at 3 months and 74% at 48 months versus 93%, 87% and 78% for the control group. CONCLUSION: Patients more than 65 years old with chronic renal failure and who are on dialysis can benefit from renal transplantation.