Acetato de abiraterona prequimioterapia. Propuesta de un algoritmo de tratamiento en el carcinoma de próstata resistente a castración / Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer

Contexto: El tratamiento del cáncer de próstata sigue siendo un reto para el urólogo. El control médico en el cáncer de próstata metastásico o localmente avanzado se realiza habitualmente con análogos LHRH y antiandrógenos. Cuando se produce la progresión bioquímica y clínica de la enfermedad diferentes tratamientos han sido propuestos y otros nuevos han cambiado la perspectiva y esperanza de vida de los pacientes. Objetivo: El objetivo de esta revisión es establecer el papel actual del acetato de abiraterona en el tratamiento del cáncer de próstata resistente a la castración y facilitar la toma de decisión del urólogo mediante un algoritmo de tratamiento. Adquisición de la evidencia: Se realiza una búsqueda de la evidencia actual del tratamiento con abiraterona en pacientes con cáncer de próstata metastásico resistente a castración en PubMed, analizando principalmente aquellos estudios diseñados como ensayos clínicos. Además se realiza una revisión y actualización del papel del tratamiento hormonal y de los receptores androgénicos en el cáncer de próstata. Síntesis de la evidencia: Existen en la actualidad fundamentalmente 2 ensayos clínicos que demuestran la eficacia de abiraterona en el cáncer de próstata metastásico con respecto a placebo. En el estudio COU AA-302 se observa un beneficio evidente con abiraterona previo a quimioterapia en pacientes con cáncer de próstata resistente a castración, lo que permite establecer un algoritmo de tratamiento inicial que facilita la toma de decisión por parte del urólogo. Conclusión: Abiraterona es una opción de tratamiento prequimioterapia en pacientes seleccionados con cáncer de próstata metastásico resistente a la castración, aunque debe mejorarse la oferta económica y diseñar más ensayos clínicos multicéntricos para optimizar la relación coste/beneficio

Context: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogs and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients’ perspective and life expectancy. Objective: This review has aimed to establish the current role of abiraterone acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. Acquisition of the evidence: A search of current evidence on Abiraterone treatment in patients with castration-resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. Evidence synthesis: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. Conclusion: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration-resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio

Valoración urodinámica de la función vesical y esfinteriana antes y después de la prostatectomía radical asistida por robot / Urodynamic Assessment of Bladder and Urethral Sphincter Function Before and After Robot-assisted Radical Prostatectomy

Introducción: Está demostrada la existencia de una afectación vesical tras la prostatectomía abierta en relación con la disminución de la capacidad vesical y la acomodación, la hiperactividad o la hipoactividad y la disfunción de vaciado. Comparando el estudio urodinámico preoperatorio con el realizado a los 3 meses tras la prostatectomía, nos proponemos investigar el impacto de la cirugía robótica sobre la función vesical y la esfinteriana. Material y métodos: Hemos evaluado de forma prospectiva a 32 pacientes que de manera consecutiva han sido intervenidos de prostatectomía robótica. A todos estos pacientes se les ha realizado un estudio urodinámico un mes antes de la intervención y otro a los 3 meses tras la prostatectomía radical. Resultados: Hemos detectado una hiperactividad del detrusor en un 25% tras la prostatectomía robótica con una disminución de la acomodación vesical de 30,2 a 21,8 ml/cmH2O. En el perfil uretral hemos encontrado una disminución de la longitud funcional uretral de 67 a 44 mm y de la presión uretral máxima de 48,5 a 29,3 cmH2O. La hipoactividad se ha demostrado en el 21,8% de los pacientes y la obstrucción ha disminuido del 28,1 al 12,5% tras la prostatectomía robótica. Conclusiones: La disminución de la acomodación vesical, la hiperactividad o hipoactividad detrusoriana y la mejoría de la obstrucción en el estudio de presión-flujo se asocian a la afectación esfinteriana formando parte de un síndrome complejo de disfunción del tracto urinario inferior que aparece tras la prostatectomía robótica

Introduction: Affectation of the bladder after open prostatectomy is demonstrated. Decrease in bladder capacity and bladder compliance, detrusor hyper-or hypo-activity and voiding dysfunction are observed. We propose to investigate the effects of robotic surgery on bladder and sphincter function through the comparative study of preoperative and postoperative urodynamic values 3 months after prostatectomy. Material and methods: Prospective study of 32 consecutive patients undergoing robotic prostatectomy. They all underwent urodynamic study one month before the intervention and 3 months after the radical prostatectomy. Results: Twenty-five percent of patients undergoing robotic prostatectomy showed detrusor hyperactivity accompanied by a decrease in bladder compliance of 30.2 to 21.8 ml/cmH2O. Urethral profile showed diminished functional length of 67 to 44 mm and decreased maximum urethral pressure of 48.5 to 29.3 cmH2O. After robotic prostatectomy 21.8% of patients had detrusor hypoactivity, obstruction decreased between 28.1 and 12.5%. Conclusions: Decreased bladder compliance, detrusor hypo- or hyperactivity and obstruction improvement observed in the study of the flow pressure have been associated with sphincter involvement. It is part of the complex of lower urinary tract dysfunction that occurs after robotic prostatectomy

Urodynamic assessment of bladder and urethral sphincter function before and after robot-assisted radical prostatectomy.

INTRODUCTION: Affectation of the bladder after open prostatectomy is demonstrated. Decrease in bladder capacity and bladder compliance, detrusor hyper-or hypo-activity and voiding dysfunction are observed. We propose to investigate the effects of robotic surgery on bladder and sphincter function through the comparative study of preoperative and postoperative urodynamic values 3 months after prostatectomy. MATERIAL AND METHODS: Prospective study of 32 consecutive patients undergoing robotic prostatectomy. They all underwent urodynamic study one month before the intervention and 3 months after the radical prostatectomy. RESULTS: Twenty five percent of patients undergoing robotic prostatectomy showed detrusor hyperactivity accompanied by a decrease in bladder compliance of 30.2 to 21.8 ml/cmH2O. Urethral profile showed diminished functional length of 67 to 44 mm and decreased maximum urethral pressure of 48.5 to 29.3 cmH2O. After robotic prostatectomy 21.8% of patients had detrusor hypoactivity, obstruction decreased between 28.1% to 12.5%. CONCLUSIONS: Decreased bladder compliance, detrusor hypo- or hyperactivity and obstruction improvement observed in the study of the flow pressure have been associated with sphincter involvement. It is part of the complex of lower urinary tract dysfunction that occurs after robotic prostatectomy.

Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer.

CONTEXT: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogues and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients' perspective and life expectancy. OBJECTIVE: This review has aimed to establish the current role of Abiraterone Acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. ACQUISITION OF THE EVIDENCE: A search of current evidence on Abiraterone treatment in patients with castration- resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. EVIDENCE SYNTHESIS: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. CONCLUSION: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio.

Enucleación prostática con láser holmium / Prostatic enucleation with holmium laser

Objetivo: La hipertrofia prostática afecta a partir de los 40 años a un porcentaje creciente de varones, aumentando este con la edad, actualmente contamos con una nueva arma terapéutica, el láser Holmium. Método: Recogemos de manera retrospectiva los datos obtenidos de forma retrospectiva de los 300 enfermos intervenidos mediante HoLEP prostático en nuestro centro. Resultados: Obtenemos: una estancia media hospitalaria de 1,8 días (Rango 1-15 días, mediana 1,8), un tiempo medio de cateterismo de 30,6h (Rango 12-312, Mediana 30,3), el tiempo quirúrgico total desde que el enfermo entra hasta que sale del quirófano es de 75 min. (Rango 38-150, Mediana 71), El flujo máximo es de 24,7 ml/seg a 6 meses y de 23,9 ml/seg a 12 meses. El rendimiento quirúrgico, los gramos resecados por minuto es de 0,48 en el grupo completo. Observamos una variación en los datos que afecta a los 20 primeros casos, con un empeoramiento de los resultados en este grupo Conclusiones: en nuestra opinión la enucleación con láser de Holmium es un método adecuado que garantiza unos resultados óptimos, perfectamente comparables a los obtenidos mediante técnicas quirúrgicas endoscópica clásicas y cirugía abierta, con un número de complicaciones bajo y que beneficia al enfermo al disminuir la necesidad de trasfusiones, el tiempo de sondaje vesical y de estancia hospitalaria, en contrapartida, presenta una curva de aprendizaje en torno a 20 procedimientos, en la que se pueden presentar complicaciones que desanimen al cirujano y que paralicen el proyecto de implantación de la técnica en un centro, al tener procedimientos fáciles y asequibles a su alcance ya establecidos (AU)

Objectives: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser. Methods: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate (HoLEP) in our center. Results: The results are: mean hospital stay 1,8 days (range 1-15 days, median 1,8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group. Conclusions: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures (AU)

[Prostatic enucleation with holmium laser]. / Enucleación prostática con láser holmium.

OBJECTIVES: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser. METHODS: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate (HoLEP) in our center. RESULTS: The results are: mean hospital stay 1.8 days (range 1-15 days, median 1.8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group. CONCLUSIONS: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures.

[Localized fibrous tumor of the pleura: radiological findings]. / Tumor fibroso localizado de la pleura: hallazgos radiológicos.

Localized fibrous tumors of the pleura are rare tumors that represent less than 5% of the pleural tumors, although they have also been described in extrathoracic locations such as the abdomen, head and neck or central nervous system. A total of 80% begin in the visceral pleura and are not related with environmental risk factors. They generally occur in patients over 50 with a mild predominance in the woman. Up to 50% of the patients are asymptomatic, so that it appears as an incidental finding on the chest X-ray. These are slow growing tumors. They are seen on the X-ray as well-defined rounded lesions dependent on the pleura and 50% are pediculated. It is important to know its radiological characteristics for its diagnosis of suspicion and correct treatment since surgical resection is generally curative. Local recurrence after the surgery is very common if it is not completely excised.

Tumor fibroso localizado de la pleura: hallazgos radiológicos / Localized fibrous tumor of the pleura: radiological findings

Los tumores fibrosos localizados de la pleura son tumores raros que representan menos del 5% de los tumores pleurales, aunque también han sido descritos en localizaciones extratorácicas como el abdomen, cabeza y cuello o sistema nervioso central.El 80% se originan en la pleura visceral y no están relacionados con factores de riesgo ambientales. Generalmente ocurren en pacientes mayores de 50 años con un leve predominio en el sexo femenino.Hasta el 50% de los pacientes son asintomáticos, por lo que aparece como un hallazgo incidental en la radiografía de tórax. Estos tumores son de lento crecimiento y se presentan radiológicamente como lesiones redondeadas bien delimitadas dependientes de la pleura y en el 50% pediculados. Es importante conocer sus características radiológicas para su diagnóstico de sospecha y su correcto tratamiento, ya que la extirpación quirúrgica suele ser curativa.Es más habitual la recurrencia local tras la cirugía si no se extirpa por completo

Localized fibrous tumors of the pleura are rare tumors that represent less than 5% of the pleural tumors, although they have also been described in extrathoracic locations such as the abdomen, head and neck or central nervous system.A total of 80% begin in the visceral pleura and are not related with environmental risk factors. They generally occur in patients over 50 with a mild predominance in the woman.Up to 50% of the patients are asymptomatic, so that it appears as an incidental finding on the chest X-ray. These are slow growing tumors.They are seen on the X-ray as well-defined rounded lesions dependent on the pleura and 50% are pediculated. It is important to know its radiological characteristics for its diagnosis of suspicion and correct treatment since surgical resection is generally curative.Local recurrence after the surgery is very common if it is not completely excised

[Malignant mesothelioma of the tunica vaginalis of the testis]. / Mesotelioma maligno de la túnica vaginal del testículo.

We report a case of malign mesothelioma of the tunica vaginalis of testis in a 84 years-old male. Clinical presentation was hydrocele. Special attention is given to differential diagnosis and therapeuticals possibilities.