Salvage Radical Prostatectomy in Nonmetastatic Castration-Resistant Prostate Cancer.

OBJECTIVE: To analyze the perioperatory and short-oncological outcomes in 5 cases with CRPC M0 developed after pRT that underwent salvage laparoscopic RP (sLRP) and review the current evidence. MATERIAL AND METHODS: Perioperatory and oncological outcomes were prospectively analyzed. Inclusion criteria were patients that had received pRT and posteriorly presented with CRPC M0 in standard imagines and positron emission tomography MRI coline. Evidence was reviewed in PUBMED database. RESULTS: No surgical complications and blood transfusion were reported. Two patients required an endoscopic urethrotomy due to bladder neck contracture (Clavien IIIb). Final pathological findings were T3 or more, multifocal with 3 positive surgical margins. Four patients reach undetectable PSA after surgery except one that continuous under ADT without disease progression. After 12 months follow-up, 4 patients persist with undetectable PSA and one with stable disease under ADT. Current evidence demonstrated that CRPC M0 treated with open, laparoscopic or robotic RP a biochemical recurrence of 68.7% as a hormone-sensitive PC; however, 17.4% were disease-free after 4 years of follow-up. CONCLUSION: Our serie, 4 cases are disease free after 12 months follow-up. Current evidence is a retrospective and multicenter experience with few cases and intermediate oncological follow-up. More cases with longer follow-up and better evidence are required to opt for this treatment as a first line.

Cistytis Glandularis: An Infrequent and Little-Known Tumor. Two Cases Report and Current Evidence.

OBJECTIVE: To report 2 cases of an extremely rare bladder tumor such as Cystitis Glandularis (CG) that were management by different strategies and review the current evidence. MATERIAL AND METHODS: Both cases of 43 and 48 years reported the same lower urinary tract symptoms that simulated a malignant bladder tumor. Case 1 presented with an extensive tumor affecting the trigone and the left upper urinary tract; the second case presented a less extensive tumor also at the bladder trigone. RESULTS: The first patient required two bladder tumor resection and a laparoscopic uretero-vesical reimplantation with adyuvant steroids. The other patient only required one bladder tumor resection without adyuvant treatment. Finally, after 7 and 6 months, both patients do not present tumor recurrence; respectively. CONCLUSION: Cystitis Glandularis (CG) represent an extremely rare tumor. Usually presentation is in young people with predilection at the bladder trigone. Current evidence ruled out being preneoplastic without standardized treatment. Two cases were analyzed with completely different characteristics, but with satisfactory treatment.

Salvage Radical Prostatectomy in Nonmetastatic Castration-Resistant Prostate Cancer

Objective: To analyze the perioperatory and short-oncological outcomes in 5 cases with CRPC M0 developed after pRT that underwent salvage laparoscopic RP (sLRP) and review the current evidence. Material and Methods: Perioperatory and oncological outcomes were prospectively analyzed. Inclusion criteria were patients that had received pRT and posteriorly presented with CRPC M0 in standard imagines and positron emission tomography MRI coline. Evidence was reviewed in PUBMED database. Results: No surgical complications and blood transfusion were reported. Two patients required an endoscopic urethrotomy due to bladder neck contracture (Clavien IIIb). Final pathological findings were T3 or more, multifocal with 3 positive surgical margins. Four patients reach undetectable PSA after surgery except one that continuous under ADT without disease progression. After 12 months follow-up, 4 patients persist with undetectable PSA and one with stable disease under ADT. Current evidence demonstrated that CRPC M0 treated with open, laparoscopic or robotic RP a biochemical recurrence of 68.7% as a hormone-sensitive PC; however, 17.4% were disease-free after 4 years of follow-up. Conclusion: Our serie, 4 cases are disease free after 12 months follow-up. Current evidence is a retrospective and multicenter experience with few cases and intermediate oncological follow-up. More cases with longer follow-up and better evidence are required to opt for this treatment as a first line (AU)

Cistytis Glandularis: An Infrequent and Little-Known Tumor. Two Cases Report and Current Evidence

Objective: To report 2 cases of an extremely rare bladder tumor such as Cystitis Glandularis (CG) that were management by different strategies and review the current evidence. Material and Methods: Both cases of 43 and 48 years reported the same lower urinary tract symptoms that simulated a malignant bladder tumor. Case 1 presented with an extensive tumor affecting the trigone and the left upper urinary tract; the second case presented a less extensive tumor also at the bladder trigone. Results: The first patient required two bladder tumor resection and a laparoscopic uretero-vesical reimplantation with adyuvant steroids. The other patient only required one bladder tumor resection without adyuvant treatment. Finally, after 7 and 6 months, both patients do not present tumor recurrence; respectively. Conclusion: Cystitis Glandularis (CG) represent an extremely rare tumor. Usually presentation is in young people with predilection at the bladder trigone. Current evidence ruled out being preneoplastic without standardized treatment. Two cases were analyzed with completely different characteristics, but with satisfactory treatment (AU)

Changes in prolactin receptor location in prostate tumors. / Cambios en la localización del receptor prolactina en tumores prostáticos.

INTRODUCTION: Prolactin (PRL) binds its receptor (PRLR) and stimulates cell proliferation, differentiation and survival in prostate cancer (PCa) cell lines via STAT5a, MAPK and AKT. OBJECTIVE: To evaluate the expression of PRL and PRLR in normal and tumor prostate tissues with different Gleason patterns. METHODS: Samples of normal, benign prostatic hyperplasia and PCa with different Gleason patterns were selected from radical prostatectomy. The intensity, location and percentage of stained cells for PRL and PRLR were evaluated by Immunohistochemistry. Co-localization was observed by confocal microscopy. RESULTS: PRL was expressed diffusely and with a mild intensity in the cytoplasm of normal and tumor prostate luminal cells. Its expression only augmented in the Gleason 3 pattern (p< 0.0001). The immunostaining intensity and the percentage of positive cells for PRLR did not vary between normal and tumor tissues. However, the location of the PRLR was modified by the tumorigenic process.In non-tumor tissues, PRLR expression was mostly in plasma membrane in the apical zone of epithelial cells. In tumor tissues, it was expressed in intracellular vesicles.The co-localization of PRL and PRLR was demonstrated in normal and tumor tissues suggesting that PRL could be acting in an autocrine and paracrine manner. CONCLUSION: PRL and its receptor were present in the cytoplasm of the epithelial cells of the normal and tumor prostate gland. In tumor tissues, the change in the location and appearance of cryptic PRLRs that store PRL may keep active the different signaling pathways related to cell proliferation and survival.

INTRODUCCIÓN: La prolactina (PRL) se une a su receptor (PRLR) y estimula la proliferación celular, la diferenciación y la supervivencia de la líneas celulares de cáncer de próstata vía STAT5a, MAPK y AKT.OBJETIVO: Evaluar la expresión de la PRL y PRLR en tejido normal y tejido de cáncer de próstata con varios patrones de Gleason.MÉTODOS: Se seleccionaron muestras de tejido benigno, hiperplasia y cáncer de próstata con diferentes patrones de Gleason de prostatectomías radicales. La intensidad, localización y porcentaje de células teñidas por PRL y PRLR fueron evaluadas por immunohistoquimica. La co-localización se observó con microscopio confocal.RESULTADOS: PRL se presentó de forma difusa y con intensidad media en el citoplasma de células luminales normales y de tumor prostático. La expresión solamente aumentó en patrón Gleason 3 (p<0,0001). La intensidad de la tinción immunohistoquímica y el porcentaje de células positivas para PRLR no varió entre células normales y tejidos tumorales. Pero, la localización del PRLR fue modificada por el proceso generador del tumor. En tejidos no-tumorales, la expresión de PRLR fue sobre todo en la membrana plasmática en la zona apical de las células epiteliales. En tejidos tumorales, se presentó en las vesículas intracelulares. La co-localizacion de la PRL y PRLR se demostró en tejido normal y tumoral sugeriendo que la PRL funciona con un efecto autocrino y paracrino.CONCLUSIÓN: La PRL y su receptor estuvieron presentes en el citoplasma de células epiteliales de tejido normal y glándula prostática tumoral. En tejidos tumorales, el cambio de localización y la apariencia cripticas del PRLR que guarda la PRL debe mantener activos los diferentes caminos de señalización relacionados con la proliferación celular y la supervivencia.

Retrograde intrarenal surgery as a tool for lithiasis management in renal anomalies. Four cases description. / Cirugía retrógrada intrarrenal como herramienta para el manejo de la litiasis en anomalías renales: aportación con cuatro casos.

OBJECTIVE: The management of stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy. MATERIAL AND METHODS: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystickidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age andgender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification. RESULTS: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hour safter surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II). CONCLUSION: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decision making.

OBJETIVO: El manejo de la litiasis en anomalías renales es un desafío para el urólogo debido a su infrecuencia; motivo por el cual, el objetivo es presentar nuestra experiencia en Cirugía Retrógrada Intrarrenal (RIRS) en 4 casos con el uso del videoureterorrenoscopio flexible.MATERIAL Y MÉTODOS: Analizamos retrospectivamente la base de datos de las primeras 100 RIRS por litiasis desde la incorporación del videoureterorrenoscopio flexible (FLEX-X 8.4 Fr-STORZ®). Un total de 4 (4%) pacientes presentaban una anomalía renal asociada;un riñón en herradura, un riñón poliquístico, una ectopía renal cruzada fusionada y un divertículo calicial. Las variables analizadas fueron; demográficas (edad y género); tamaño de la litiasis, tratamientos previos, presentación clínica, tasa libre de litiasis y tasa de complicaciones perioperatorias según la clasificación Dindo-Clavien. RESULTADOS: Entre febrero 2017- marzo del 2018, 4 (4%) pacientes presentaban litiasis asociada a alguna malformación renal. Todos los procedimientos fueron ambulatorios y las litiasis accesibles a la deflexión del endoscopio a pesar de la malformación. La edad promedio fue de 56 años (43 a 65 años) siendo 3 hombres y 1 mujeres. El tamaño medio de la litiasis fue de 16,25 milímetros (6 a 23 mm). Todos los pacientes habían sido tratados previamente con Litotricia Extracopórea por Ondas de Choque (LEOC) y, el paciente con ectopía renal cruzada, mediante un abordaje percutáneo sin éxito. El tiempo promedio de cirugía fue de 57 minutos (43 a 79 minutos) siendo la tasa libre de litiasis del 100%. Como complicaciones, un paciente presentó dolor lumbar a las 48 horas de la cirugía que no cedió con analgésicos vía oral requiriendo tratamiento endovenoso aunque sin hospitalización (Clavien II).CONCLUSIÓN: La cirugía retrógrada intrarrenal es factible, segura y efectiva para el manejo de la litiasis en anomalías renales. No obstante, se necesitan mayor número de casos y estudios comparativos con la litotricia percutánea y extracorpórea como para optarlo como tratamiento de primera línea y no como alternativa a los anteriores.

Cirugía retrógrada intrarrenal como herramienta para el manejo de la litiasis en anomalías renales: aportación con cuatro casos / Retrograde intrarenal surgery as a tool for lithiasis management in renal anomalies. Four cases description

OBJETIVO: El manejo de la litiasis en anomalías renales es un desafío para el urólogo debido a su infrecuencia; motivo por el cual, el objetivo es presentar nuestra experiencia en Cirugía Retrógrada Intrarrenal (RIRS) en 4 casos con el uso del videoureterorrenoscopio flexible. MATERIAL Y MÉTODOS: Analizamos retrospectivamente la base de datos de las primeras 100 RIRS por litiasis desde la incorporación del videoureterorrenoscopio flexible (FLEX-X 8.4 Fr-STORZ®). Un total de 4 (4%) pacientes presentaban una anomalía renal asociada;un riñón en herradura, un riñón poliquístico, una ectopía renal cruzada fusionada y un divertículo calicial. Las variables analizadas fueron; demográficas (edad y género); tamaño de la litiasis, tratamientos previos, presentación clínica, tasa libre de litiasis y tasa de complicaciones perioperatorias según la clasificación Dindo-Clavien. RESULTADOS: Entre febrero 2017- marzo del 2018, 4 (4%) pacientes presentaban litiasis asociada a alguna malformación renal. Todos los procedimientos fueron ambulatorios y las litiasis accesibles a la deflexión del endoscopio a pesar de la malformación. La edad promedio fue de 56 años (43 a 65 años) siendo 3 hombres y 1 mujeres. El tamaño medio de la litiasis fue de 16,25 milímetros (6 a 23 mm). Todos los pacientes habían sido tratados previamente con Litotricia Extracopórea por Ondas de Choque (LEOC) y, el paciente con ectopía renal cruzada, mediante un abordaje percutáneo sin éxito. El tiempo promedio de cirugía fue de 57 minutos (43 a 79 minutos) siendo la tasa libre de litiasis del 100%. Como complicaciones, un paciente presentó dolor lumbar a las 48 horas de la cirugía que no cedió con analgésicos vía oral requiriendo tratamiento endovenoso aunque sin hospitalización (Clavien II). CONCLUSIÓN: La cirugía retrógrada intrarrenal es factible, segura y efectiva para el manejo de la litiasis en anomalías renales. No obstante, se necesitan mayor número de casos y estudios comparativos con la litotricia percutánea y extracorpórea como para optarlo como tratamiento de primera línea y no como alternativa a los anteriores

OBJECTIVE: The management of Stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy. MATERIAL AND METHODS: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017 and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystic kidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age and gender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification. RESULTS: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average Stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hours after surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II). CONCLUSION: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decisión making

Signet ring cell carcinoma of the prostate. Report of 5 cases and literature review. / Carcinoma de próstata en celulas en anillo de sello. Serie de 5 casos y revisión de la literatura.

OBJECTIVE: Signet ring cell carcinoma (SRCC) of the prostate is very a rare tumor. It is comprised of cells that are similar to signet ring cell tumors of the gastrointestinal tract. Diagnosis requires histopathology and also elimination of the adenocarcinomas of other organs. To our knowledge 157 cases have been reported in the literature. MATERIAL AND METHODS: We retrospectively searched in tumor registries from Hospital Aleman de Buenos Aires to identify all prostate cancer since 1990. We analyzed the following variables: age at diagnosis, median prostate-specific antigen (PSA) level, stage, global survival, among others. A review of the literature was done and compared with this series of cases. RESULTS: We identified 5 cases. In our series we found: Mean age 77.8 years (SD 3.2), Median PSA level 18 ng/ml (Range 10.6-331 ng/ml), 3/5 (60%) localized disease and 2/5 (40%) with distant disease at diagnosis. Median survival of 23 months. Comparing with other series we found patients of older age and lower median survival. CONCLUSION: Primary Signet ring cell carcinoma of the prostate is a rare and aggressive histological variant of adenocarcinomas of the prostate. Treatment is the same as classical adenocarcinoma with an emphasis on aggressive multimodal treatment.

OBJETIVO: El carcinoma de células en anillo de sello (CPAS) de la próstata es un tumor muy raro y agresivo. Está compuesto por células que son similares a los tumores de células del anillo de sello del tracto gastrointestinal. El diagnóstico requiere histopatología y también la eliminación de los adenocarcinomas de otros órganos. Hasta donde sabemos se han publicado 157 casos en la literatura.MATERIAL Y MÉTODOS: Realizamos una búsqueda retrospectiva en los registros de tumores del Hospital Alemán de Buenos Aires para identificar todos los tumores de próstata desde 1990. Analizamos las siguientes variables: edad de presentación, mediana de antígeno prostático específico (PSA), estadio oncológico al diagnóstico y supervivencia global entre otras. También se revisó los tratamientos instaurados y se comparó esta serie de casos con la literatura existente. RESULTADOS: Identificamos 5 casos con CPAS. En nuestra serie encontramos: edad promedio de 77,8 años (DE 3,2), mediana de PSA 18 ng/ml (rango 10,6-331 ng/ml), 3/5 (60%) enfermedad localizada y 2/5 (40%) con enfermedad a distancia en el momento del diagnóstico. Mediana de supervivencia de 23 meses. Comparando con otras series encontramos pacientes de mayor edad y menor mediana de supervivencia. CONCLUSIONES: El carcinoma primario de células en anillos de la próstata es una variante histológica rara y agresiva de los adenocarcinomas de próstata. El tratamiento del adenocarcinoma primario de células en anillos de sellos de la próstata es el mismo que el adenocarcinoma clásico con énfasis en el tratamiento multimodal agresivo.

Carcinoma de próstata en celulas en anillo de sello. Serie de 5 casos y revisión de la literatura / Signet ring cell carcinoma of the prostate. Report of 5 cases and literature review

OBJETIVO: El carcinoma de células en anillo de sello (CPAS) de la próstata es un tumor muy raro y agresivo. Está compuesto por células que son similares a los tumores de células del anillo de sello del tracto gastrointestinal. El diagnóstico requiere histopatología y también la eliminación de los adenocarcinomas de otros órganos. Hasta donde sabemos se han publicado 157 casos en la literatura. MATERIAL Y MÉTODOS: Realizamos una búsqueda retrospectiva en los registros de tumores del Hospital Alemán de Buenos Aires para identificar todos los tumores de próstata desde 1990. Analizamos las siguientes variables: edad de presentación, mediana de antígeno prostático específico (PSA), estadio oncológico al diagnóstico y supervivencia global entre otras. También se revisó los tratamientos instaurados y se comparó esta serie de casos con la literatura existente. RESULTADOS: Identificamos 5 casos con CPAS. En nuestra serie encontramos: edad promedio de 77,8 años (DE 3,2), mediana de PSA 18 ng/ml (rango 10,6-331 ng/ml), 3/5 (60%) enfermedad localizada y 2/5 (40%) con enfermedad a distancia en el momento del diagnóstico. Mediana de supervivencia de 23 meses. Comparando con otras series encontramos pacientes de mayor edad y menor mediana de supervivencia. CONCLUSIONES: El carcinoma primario de células en anillos de la próstata es una variante histológica rara y agresiva de los adenocarcinomas de próstata. El tratamiento del adenocarcinoma primario de células en anillos de sellos de la próstata es el mismo que el adenocarcinoma clásico con énfasis en el tratamiento multimodal agresivo

OBJECTIVE: Signet ring cell carcinoma (SRCC) of the prostate is very a rare tumor. It is comprised of cells that are similar to signet ring cell tumors of the gastrointestinal tract. Diagnosis requires histopathology and also elimination of the adenocarcinomas of other organs. To our knowledge 157 cases have been reported in the literature. MATERIAL AND METHODS: We retrospectively searched in tumor registries from Hospital Aleman de Buenos Aires to identify all prostate cancer since 1990. We analyzed the following variables: age at diagnosis, median prostate-specific antigen (PSA) level, stage, global survival, among others. A review of the literature was done and compared with this series of cases. RESULTS: We identified 5 cases. In our series we found: Mean age 77.8 years (SD 3.2), Median PSA level 18 ng/ml (Range 10.6-331 ng/ml), 3/5 (60%) localized disease and 2/5 (40%) with distant disease at diagnosis. Median survival of 23 months. Comparing with other series we found patients of older age and lower median survival. CONCLUSION: Primary Signet ring cell carcinoma of the prostate is a rare and aggressive histological variant of adenocarcinomas of the prostate. Treatment is the same as classical adenocarcinoma with an emphasis on aggressive multimodal treatment

Synthetic Renal Capsule Tailoring: A Novel Renorrhaphy Technique After Subcapsular Dissection of Renal Tumors with Severe Adherent Perirenal Fat During Laparoscopic Partial Nephrectomy.

BACKGROUND: Multiple factors can account for surgical complexity during laparoscopic partial nephrectomy (LPN); severe adhesion of perirenal fat (PRF) is a crucial one. Consequent renal decapsulation can deem renorrhaphy a very challenging task. We propose a novel technique (synthetic renal capsule tailoring [SYRCT]) to facilitate renorrhaphy in decapsulated kidneys and suggest early decapsulation as a safe option in cases with severe PRF. MATERIALS AND METHODS: We retrospectively analyzed perioperative results of this novel technique performed in cases with severe PRF. All cases were classified as high grade in the Mayo Adhesive Probability (MAP) score. RESULTS: A total of six cases were performed with the SYRCT technique. All patients were male with a mean age of 70 years (62-76 years) and mean body mass index of 30 kg/m2 (23.66-33.86). Of the six cases, five were T1a and 1 T1b. Mean tumor size was 2.83 cm (range 1.2-6 cm). Mean operative time was 121 minutes (range 74-150 minutes); mean warm ischemia time was 17.2 minutes (range 13-25 minutes). Mean operative bleeding was 128 mL (range 50-250 mL). Mean hospital stay was 2.3 days. There were no surgical complications greater or equal to Clavien II. CONCLUSION: Performing complete renal decapsulation with subcapsular dissection and SYRCT in cases with high MAP score and severe PRF is safe and reproducible. Using this novel technique, we were able to obtain perioperative results comparable to the ones we found in LPN with normal PRF.