Epidemiology, Diagnosis and Management of Penile Cancer: Results from the Spanish National Registry of Penile Cancer.

INTRODUCTION: Penile cancer (PC) is a rare malignancy with an overall incidence in Europe of 1/100,000 males/year. In Europe, few studies report the epidemiology, risk factors, clinical presentation, and treatment of PC. The aim of this study is to present an updated outlook on the aforementioned factors of PC in Spain. MATERIALS AND METHODS: A multicentric, retrospective, observational epidemiological study was designed, and patients with a new diagnosis of PC in 2015 were included. Patients were anonymously identified from the Register of Specialized Care Activity of the Ministry of Health of Spain. All Spanish hospitals recruiting patients in 2015 were invited to participate in the present study. We have followed a descriptive narration of the observed data. Continuous and categorical data were reported by median (p25th-p75th range) and absolute and relative frequencies, respectively. The incidence map shows differences between Spanish regions. RESULTS: The incidence of PC in Spain in 2015 was 2.55/100,000 males per year. A total of 586 patients were identified, and 228 patients from 61 hospitals were included in the analysis. A total of 54/61 (88.5%) centers reported ≤ 5 new cases. The patients accessed the urologist for visually-assessed penile lesions (60.5%), mainly localized in the glans (63.6%). Local hygiene, smoking habits, sexual habits, HPV exposure, and history of penile lesions were reported in 48.2%, 59.6%, 25%, 13.2%, and 69.7%. HPV-positive lesions were 18.1% (28.6% HPV-16). The majority of PC was squamous carcinoma (95.2%). PC was ≥cT2 in 45.2% (103/228) cases. At final pathology, PC was ≥pT2 in 51% of patients and ≥pN1 in 17% of cases. The most common local treatment was partial penectomy (46.9% cases). A total of 47/55 (85.5%) inguinal lymphadenectomies were open. Patients with ≥pN1 disease were treated with chemotherapy in 12/39 (40.8%) of cases. CONCLUSIONS: PC incidence is relatively high in Spain compared to other European countries. The risk factors for PC are usually misreported. The diagnosis and management of PC are suboptimal, encouraging the identification of referral centers for PC management.

[Diagnosis and treatment of complications related with lymph-node dissection surgery: Lymphorrea, lymphocele and lymphedema.] / Diagnóstico y tratamiento de las complicaciones y secuelas relacionadas con la linfadenectomía: linforrea, linfocele y linfedema.

OBJECTIVES: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage: lymphorrea, lymphocele and lymphedema. METHODS: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. RESULTS: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. CONCLUSIONS: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures. Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price, availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications.

OBJETIVOS: Describir los diferentes métodos de prevención y resolución de complicaciones y secuelas derivadas de actos quirúrgicos relacionados con el drenaje linfático ­ linforrea, linfocele y linfedema.MÉTODOS: Revisión de la literatura y comunicación de la experiencia personal de alternativas diagnósticas y terapéuticas con asistencia guiada de imagen. RESULTADOS: Describimos la linfografía mediante cateterización linfática e intranodal con aceite etiodizado (lipiodol) con fines diagnósticos y terapéuticos; la linfografía gammagráfica mediante el uso de isótopos radioactivos con fines diagnósticos; y el uso de colorantes -azul de isosulfan, azul patente, azul de metileno y verde de indocianina- con finalidad diagnóstica y terapeútica. CONCLUSIONES: La linfografía con lipiodol ofrece imágenes bien definidas y es útil en maniobras de radiología intervencionista. Presenta el inconveniente de precisar cateterismo linfático y la imposibilidad de su uso dinámico intraoperatorio. Las técnicas isotópicas son utilizadas con finalidad diagnóstica y en técnicas de biopsia de ganglio centinela. El uso de colorantes ofrece la ventaja de no precisar cateterismo linfático ni de tecnología compleja, precio, disponibilidad, facilidad de uso y de tratarse de una técnica dinámica que permite la identificación intraoperatoria para la resolución de las complicaciones mencionadas.

Diagnóstico y tratamiento de las complicaciones y secuelas relacionadas con la linfadenectomía: linforrea, linfocele y linfedema / Diagnosis and treatment of complications related with lymph-node dissection surgery: Lymphorrea, lymphocele and lymphedema

Objetivos: Describir los diferentes métodos de prevención y resolución de complicaciones y secuelas derivadas de actos quirúrgicos relacionados con el drenaje linfático - linforrea, linfocele y linfedema. Métodos: Revisión de la literatura y comunicación de la experiencia personal de alternativas diagnósticas y terapéuticas con asistencia guiada de imagen. Resultados: Describimos la linfografía mediante cateterización linfática e intranodal con aceite etiodizado (lipiodol) con fines diagnósticos y terapéuticos; la linfografía gammagráfica mediante el uso de isótopos radioactivos con fines diagnósticos; y el uso de colorantes -azul de isosulfan, azul patente, azul de metileno y verde de indocianina- con finalidad diagnóstica y terapeútica. Conclusiones: La linfografía con lipiodol ofrece imágenes bien definidas y es útil en maniobras de radiología intervencionista. Presenta el inconveniente de precisar cateterismo linfático y la imposibilidad de su uso dinámico intraoperatorio. Las técnicas isotópicas son utilizadas con finalidad diagnóstica y en técnicas de biopsia de ganglio centinela. El uso de colorantes ofrece la ventaja de no precisar cateterismo linfático ni de tecnología compleja, precio, disponibilidad, facilidad de uso y de tratarse de una técnica dinámica que permite la identificación intraoperatoria para la resolución de las complicaciones mencionadas

Objectives: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage:lymphorrea, lymphocele and lymphedema. Methods: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. Results: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. Conclusions: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures.Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price,availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications

High-intensity focused ultrasound in small renal masses.

High-intensity focused ultrasound (HIFU) competes with radiofrequency and cryotherapy for the treatment of small renal masses as a third option among ablative approaches. As an emerging technique, its possible percutaneous or laparoscopic application, low discomfort to the patient and the absence of complications make this technology attractive for the management of small renal masses. This manuscript will focus on the principles, basic research and clinical applications of HIFU in small renal masses, reviewing the present literature. Therapeutic results are controversial and from an clinical view, HIFU must be considered a technique under investigation at present time. Further research is needed to settle its real indications in the management of small renal masses; maybe technical improvements will certainly facilitate its use in the management of small renal masses in the near future.