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.

Changes in prolactin receptor location in prostate tumors / Cambios en la ubicación del receptor de prolactina en tumores de próstata

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. Objetive: To evaluate the expression of PRL and PRLR in normal and tumor prostate tissues with different Gleason patterns. Methos: 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.(AU)

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 microscopioconfocal. 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 porcentajede 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 laproliferación celular y la supervivencia.(AU)

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

[Management of lithiasis associated with intrarrenal stenosis using the flexible videoureteroroscope.] / Manejo de la litiasis asociada a estenosis intrarrenales mediante el uso del videoureterorrenoscopio flexible.

OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard. METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were less than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%. CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of less perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery.

OBJETIVO: Reportar dos casos de estenosis intrarrenales asociado a litiasis manejados con el videoureterrenoscopio flexible (STORZ) y el láser de Holmium (CALCULASE II) como herramienta tecnológica y moderna.MATERIAL Y MÉTODOS: El caso 1 presentaba un divertículo calicial el cual fue tratado mediante la incisión del ostium diverticular con láser y posterior tratamiento de la litiasis. El segundo caso presentaba una estenosis del ostium caliceal secundario a una cirugía percutánea previa pudiendo acceder al cáliz mediante la dilatación del mismo. RESULTADOS: El tiempo quirúrgico fue de 60 y 82 minutos para el caso 1 y 2, con una estancia hospitalaria de 8 horas y sin complicaciones perioperatorias. La tasa libre de enfermedad fue del 100%. CONCLUSIONES: El videoureterorrenoscopio flexible y laser de Holmium para el manejo de las estenosis intrarrenales es altamente efectivo y seguro con las ventajas de presentar menos complicaciones perioperatorias, menos invasividad y ser ambulatorio comparado con la cirugía percutánea.

Manejo de la litiasis asociada a estenosis intrarrenales mediante el uso del videoureterorrenoscopio flexible / Management of lithiasis associated with intrarrenal stenosis using the flexible videoureteroroscope

OBJETIVO: Reportar dos casos de estenosis intrarrenales asociado a litiasis manejados con el videoureterrenoscopio flexible (STORZ) y el láser de Holmium (CALCULASE II) como herramienta tecnológica y moderna. MATERIAL Y MÉTODOS: El caso 1 presentaba un divertículo calicial el cual fue tratado mediante la incisión del ostium diverticular con láser y posterior tratamiento de la litiasis. El segundo caso presentaba una estenosis del ostium caliceal secundario a una cirugía percutánea previa pudiendo acceder al cáliz mediante la dilatación del mismo. RESULTADOS: El tiempo quirúrgico fue de 60 y 82 minutos para el caso 1 y 2, con una estancia hospitalaria de 8 horas y sin complicaciones perioperatorias. La tasa libre de enfermedad fue del 100%. CONCLUSIONES: El videoureterorrenoscopio flexible y laser de Holmium para el manejo de las estenosis intrarrenales es altamente efectivo y seguro con las ventajas de presentar menos complicaciones perioperatorias, menos invasividad y ser ambulatorio comparado con la cirugía percutánea

OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard. METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to Access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were les than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%. CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of les perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery

Cirugía intrarrenal retrógrada para el tratamiento de litiasis renal. Experiencia de 63 casos en un centro ambulatorio / Retrograde Intrarenal Surgery for the Treatment of Renal Lithiasis. An Experience in 63 Cases in an Ambulatory Center

Objetivos: El objetivo del estudio fue evaluar nuestra experiencia inicial en cirugía intrarrenal retrógrada para el tratamiento de litiasis renales y determinar si es una cirugía eficaz y segura para realizarse en un centro ambulatorio. Materiales y métodos: Se evaluó a todos los pacientes sometidos a ureterorrenoscopia flexible con láser Holmium en la Clínica Andina de Urología luego de un año de procedimientos. Se determinaron datos demográficos, características de las litiasis operadas, porcentaje libre de litiasis y complicaciones según escala modificada de Clavien. Resultados: Un total de 63 pacientes fueron intervenidos desde marzo de 2017 a marzo de 2018. El tamaño medio de las litiasis urinarias fue de 11,6 mm. En un 93,6% de los pacientes la cirugía se pudo completar sin inconvenientes con un tiempo medio de 44 minutos. El porcentaje global libre de litiasis fue del 76,19%. Un 17,4% tuvo complicaciones generales, sin embargo, solo 2 pacientes requirieron reinternación. Conclusiones: La ureterorrenoscopia flexible es una cirugía mínimamente invasiva, eficaz y segura, con un bajo índice de complicaciones (AU)

Objectives: The aim of this study was to evaluate our initial experience in retrograde intrarenal surgery for the treatment of renal lithiasis and determinate if the surgery is effective and safe to be practice in an ambulatory center. Materials and methods: We recorded all patients who underwent flexible ureterorenoscopy and laser Holmium at Clínica Andina de Urología after one year of surgeries. Demographic information, stones characteristics, stone free rate and complication using Clavien system were gathered. Results: A total of 63 patients underwent flexible ureterorenoscopy from March 2017 to March 2018. Mean stone diameter was 11.6 mm. Surgery was complete in 93.6% of patients with a mean operative time of 44 minutes. Stone free rate was 76.19%. The overall complication rate was 17.4%, nevertheless, only 2 patients were readmitted. Conclusions: IFlexible ureterorenoscopy is a minimally invasive procedure, effective and safe, with a low rate of complications. (AU)

Relación entre estradiol plasmático, glucemia en ayunas y triglicéridos en varones con síndrome metabólico / Relationship between plasma oestradiol, fasting glucose, and triglycerides in males with metabolic syndrome

Introducción: En varones, el estradiol circula en pequeñas concentraciones (8-40 pg/ml), sin estar del todo claras aún sus funciones. En este contexto, es necesario aclarar los efectos de esta hormona en el sexo masculino. Además de estudiarse el posible papel en la reproducción masculina, en los últimos años se ha tratado de encontrar la relación entre sus niveles y los componentes del síndrome metabólico. Sin embargo, la bibliografía existente no aclara si ejerce un papel protector o perjudicial con respecto a dicha patología. Objetivos: Analizar las relaciones existentes entre el estradiol y los componentes del síndrome metabólico en una muestra de varones excedidos de peso con síndrome metabólico de la provincia de Mendoza. Metodología: Se estudió a 40 varones con sobrepeso u obesidad y síndrome metabólico residentes en la ciudad de Mendoza, con edades entre 53 y 74 años, los cuales fueron evaluados a partir de una consulta médica de rutina. Se determinaron estradiol, testosterona, glucemia en ayunas, insulina en ayunas, índice HOMA, perfil lipídico y ácido úrico. Se evaluó el estado nutricional mediante antropometría: peso, talla, circunferencias, pliegues cutáneos y medidas derivadas. El análisis estadístico se realizó mediante correlación de Pearson o Spearman según la normalidad de las variables y la prueba de la t de Student para muestras independientes. Se utilizó un nivel mínimo de significación de p < 0,05. Resultados: Los niveles de estradiol se correlacionaron negativamente con los valores de triglicéridos (r = -0,401; p = 0,013) y con la glucemia en ayunas (r= -0,333; p= 0,041). Por otra parte, los individuos normotrigliceridémicos (valor de triglicéridos < 150 mg/dl) mostraron valores mayores de estradiol que los hipertrigliceridémicos (p = 0,02). Conclusiones: Los niveles de estradiol muestran relación inversa con triglicéridos y glucemia en ayunas en varones con síndrome metabólico.

Introduction: Oestradiol circulates in low concentrations (8-40 pg/ml) in males, with its functions still not being entirely clear. In this context, there is a need to determine the effects it has on males. Apart from studying the potential role oestradiol has on male reproduction in recent years, efforts have been made to determine the relationship between oestradiol levels and metabolic syndrome components. Nevertheless, the existing bibliography does not clarify whether oestradiol plays a protective or detrimental role in this condition. Objectives: The present work aimed to analyse the relationship between serum oestradiol levels and metabolic syndrome components in overweight men from Mendoza. Methodology: The sample consisted of 40 overweight or obese males, aged 53-74, with metabolic syndrome, and living in the city of Mendoza. Based on a health routine check-up, they were evaluated by determining the levels of oestradiol, testosterone, fasting blood glucose, insulin, HOMA index, lipid profile, and uric acid. Nutritional status was assessed using anthropometric measurements: weight, height, circumferences, and skinfold thickness. Statistical analysis was carried out using Pearson or Spearman correlation according to the normality of variables and the Student t test for independent samples. A minimum level of significance of P<.05 was used. Results: Oestradiol levels negatively correlated with triglyceride values (r = -0.401; P=.013) and fasting blood glucose (r= -0.333; P=.041). Furthermore, those with normal triglycerides (triglyceride values <150 mg/dl) showed higher oestradiol levels compared to those with high triglycerides (P=.02). Conclusions: Oestradiol levels show an inverse relationship as regards triglycerides and fasting blood glucose in men with metabolic syndrome.

[Testosterone replacement therapy and prostate cancer: the downfall of a paradigm?]. / Terapia de reemplazo con testosterona y cáncer de próstata: ¿la caída de un paradigma?

For six decades, it has been a part of the conventional medical wisdom that higher levels of testosterone increase the risk of prostate cancer. This belief is mostly derived from the well-documented regression of prostate cancer after surgical or pharmacological castration. However, there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer. Moreover, men with hypogonadism have substantial rates of prostate cancer in prostatic biopsies, suggesting that low testosterone has no protective effect against the development of prostate cancer. Moreover, prostate cancer rate is higher in elderly patients when hormonal levels are low. These results argue against an increased risk of prostate cancer with testosterone replacement therapy.

Por casi seis décadas ha sido parte de la cultura médica en general, que los niveles altos de testosterona incrementan el riesgo de padecer o agravar un cáncer de próstata. Esta creencia se ha derivado fundamentalmente de la bien documentada regresión del cáncer de próstata luego de la castración médica o quirúrgica. Sin embargo, no existe evidencia científica que apoye la idea de que niveles altos de testosterona están asociados con un incremento del riesgo de cáncer de próstata. Más aún, los hombres con hipogonadismo tienen una tasa substancialmente alta de cáncer de próstata detectado por biopsia, lo que sugiere que los niveles bajos de testosterona no tienen un efecto protector en el desarrollo de cáncer de próstata y, además, la tasa de cáncer de próstata es más alta en los pacientes de edades avanzadas cuando sus niveles hormonales son más bajos. Estos argumentos tienden a demostrar que no existiría un incremento del riesgo de padecer un cáncer de próstata asociado a la terapia de reemplazo con testosterona.

Relación entre el índice de masa corporal y antígeno prostático específico en varones libres de enfermedad prostática / Relationship between body mass index and prostate-specific antigen in men without prostatic diseases / Relação entre índice de massa corporal e antígeno prostático específico em homens livres de doença prostática

Introducción: Estudios recientes indican que los varones obesos tienen menor concentración plasmática de antígeno prostático específico (PSA) que los que tienen peso normal, posiblemente debido a un mayor volumen plasmático (hemodilución) y/o a una menor actividad androgénica, dificultando la detección precoz del câncer de próstata. No está establecido claramente si esta relación se acompaña de menores cantidades absolutas dePSA. El objetivo del presente trabajo fue determinar la asociación entre el índice de masa corporal (IMC), la concentración de PSA y sus cantidades absolutas circulantes (“PSA masa”). Material y Métodos: Se determinó PSA total en 570 varones de 45 a 80 años, con PSA considerado no sospecho-so de patologías prostáticas (<4ng/mL). Se evaluaron el peso, la talla y el IMC, se estimó el volumen plasmático (VP) y el PSA masa fue calculado a partir de la concentración plasmática de PSA y el VP. El análisis estadístico se realizó mediante coeficiente de correlación de Pearson o Spearman según la normalidad de las variables (p<0,05). Resultados: El IMC se asoció significativamente con un mayor VP (r = 0,512; p<0,0001). Dado que las concentraciones de PSA se asociaron positivamente con la edad (r = 0,248; p<0,0001), se analizaro...

Recent studies indicate that obese men have lower plasma prostate-specific antigen (PSA) concentrations than normal weight men, which may probably be explained by higher plasma volume (hemodilution) and/or a lower androgenic activity. This may interfere with the ability to detect early-stage prostate cancer. It is not clear whether this relationship is accompanied by lower absolute amounts of PSA. The aim of this study was to determine the association between the body mass index (BMI), the PSA concentrations and the totalamount of PSA in circulation (“PSA mass”). Material and methods: The total amount of PSA was determined in 570 men aged 45-80 years, whose PSA values were not indicators of prostate disease (<4ng/mL). Weight, height and BMI were measured, plasma volume(PV) was estimated, and PSA mass was calculated taking into account plasma PSA concentrations and PV. The statistical analysis was performed using Pearson orSpearman/'s correlation coefficient according to the normality of the variables (P<0.05). Results: The BMI was significantly associated with a higher PV (r = 0.512; P<0.0001). Due to the positive correlation between PSA concentrations and age (r = 0.248;P<0.0001), partial correlations adjusted for...

Estudos recentes indicam que os homens obesos têm menor concentração plasmática de antígeno prostático específico (PSA) que os que têm peso normal, possivelmente devido a um maior volume plasmático (hemodiluição) e/ou a uma menor atividade androgênica,dificultando a detecção precoce do câncer de próstata. Não está estabelecido claramente se esta relação está acompanhada de menores quantidades absolutas de PSA. O objetivo do presente trabalho foi determinar a associação entre o índice de massa corporal (IMC), a concentração de PSA e suas quantidades absolutas circulantes (/"PSA masa/"). Material e Métodos: Determinou-se PSA total em 570 homens de 45 a 80 anos, com PSA considerado não suspeitoso de patalogias prostáticas (<4ng/mL). Foram avaliados o peso, a altura e o IMC, estimou-se o volume plasmático (VP) e o PSA massa foi calculado a partir da concentração plasmática de PSA e o VP. A análise estatística foi realizada mediante coeficiente de correlação de Pearson ou Spearman segundo a normalidade das variáveis(p<0,05). Resultados: O IMC se associou significativamente com um maior VP (r = 0,512; p<0,0001). Dado que as concentrações de PSA se associaram positivamente com a idade (r = 0,248; p<0,0001), analisaram-se as correlações parciais corrigidas para esta variável. Assim, o IMC se associou com uma menor concentração de PSA (r = -0,298;p<0,0001) e menor PSA massa...

El consumo elevado de licopeno sumado a una ingestión reducida de carnes rojas aumenta el poder antioxidante total

Los sistemas antioxidantes del cuerpo humano son capaces de remover a los radicales libres, protegiendo así al organismo del daño que estos pueden ocasionar, y pueden ser valorados en conjunto mediante la determinación del poder antioxidante total (TAS, por sus siglas en inglés). Este biomarcador es modulado por la alimentación mediante la incorporación de sustancias con propiedades antioxidantes o prooxidantes. El objetivo del presente trabajo fue estimar la ingestión de nutrientes antioxidantes y grupos específicos de alimentos y correlacionarla con el TAS. Fueron seleccionados al azar 45 sujetos de sexo masculino, entre 50 y 75 años, de una consulta médica de rutina. El trabajo consistió en una evaluación de TAS mediante técnica ABTS más una entrevista nutricional donde se evaluó la composición corporal mediante antropometría y la ingestión habitual de nutrientes y grupos específicos de alimentos mediante un recordatorio de 24 h y un cuestionario de frecuencia de consumo de alimentos validado para tal fin. El análisis estadístico se realizó mediante Coeficiente de Correlación de Pearson o Spearman según la normalidad de la muestra (p<0,05). El TAS se correlacionó positivamente con el consumo de licopeno (r=0,295; p=0,049) y negativamente con la ingestión de carnes rojas (r= -0,403; p=0,007). Los demás nutrientes o alimentos no se correlacionaron con el TAS. Por lo tanto, una ingestión elevada de licopeno y un consumo reducido de carnes rojas ayudarían a mejorar el sistema antioxidante del organismo.

High intake of lycopene together with low intake of red meat increases the total antioxidant status. The body's antioxidant systems are able to remove free radicals, thus protecting the body from the damage they may cause. They can be estimated, as a whole, through the determination of total antioxidant status (TAS). This biomarker can be modulated by dietary factors through the incorporation of substances with antioxidant or prooxidant properties. The aim of this study was to estimate the intake of antioxidant nutrients and specific food groups, and its correlation with TAS. Fortyfive male volunteers between 50 and 75 years were randomly selected from a medical consultation. The study included a TAS determination by ABTS and a nutritional interview where corporal composition was studied through anthropometry and the habitual consumption of nutrients was estimated by means of 24 hour diary and food consumption frequency questionnaire. Statistical analysis was performed by using Pearson or Spearman correlation coefficient (p <0.05). TAS was positively correlated with lycopene consumption (r=0,295; p=0,049), and negatively with red meat intake (r= -0,403; p= 0,007), while intake of other studied antioxidant nutrients did not correlate significantly with TAS. In conclusion, high intake of lycopene and reduced red meat consumption increase TAS.

[High intake of lycopene together with low intake of red meat increases the total antioxidant status]. / El consumo elevado de licopeno sumado a una ingestión reducida de carnes rojas aumenta el poder antioxidante total.

The body's antioxidant systems are able to remove free radicals, thus protecting the body from the damage they may cause. They can be estimated, as a whole, through the determination of total antioxidant status (TAS). This biomarker can be modulated by dietary factors through the incorporation of substances with antioxidant or prooxidant properties. The aim of this study was to estimate the intake of antioxidant nutrients and specific food groups, and its correlation with TAS. Forty-five male volunteers between 50 and 75 years were randomly selected from a medical consultation. The study included a TAS determination by ABTS and a nutritional interview where corporal composition was studied through anthropometry and the habitual consumption of nutrients was estimated by means of 24 hour diary and food consumption frequency questionnaire. Statistical analysis was performed by using Pearson or Spearman correlation coefficient (p < 0.05). TAS was positively correlated with lycopene consumption (r = 0.295; p = 0.049), and negatively with red meat intake (r = -0.403; p = 0.007), while intake of other studied antioxidant nutrients did not correlate significantly with TAS. In conclusion, high intake of lycopene and reduced red meat consumption increase TAS.

Obesity modifies prostatic specific antigen in men over 45 years.

OBJECTIVES: To determine whether lower serum prostate-specific antigen (PSA) concentration in obese men is caused by plasma hemodilution and/or decreased serum testosterone levels. METHODS: A sample of 413 men, from 45 to 75 years old, were randomly selected for the study among those who participated in prostate cancer screening at 2 urban urology practices in Argentina and Puerto Rico. Weight, height, serum testosterone and total PSA concentration were determined. Body mass index (BMI), body surface, plasma volume, and PSA mass were calculated. Prostate volume was estimated by transrectal ultrasound using the prolate ellipsoid formula. RESULTS: Mean age was 59 years old (range, 45 to 75) and mean BMI was 28.8 kg/m2 (range, 24 to 46). Mean serum PSA concentration was 1.43 ng/ml in normal weight patients (n=68), 1.4 ng/ml in overweight patients (n=222), 1.05 ng/ml in obese patients (n=114), and 0.85 ng/ml in morbidly obese patients (n=9). BMI was directly correlated with plasma volume (r= 0.687; p= 0.001) and inversely correlated with serum PSA concentration (r= -0.235; P= 0.001). PSA mass tended to be lower in obese and morbidly obese patients (P= 0.0063)compared to normal weight and overweight subjects. Serum testosterone concentration (P= 0.91) and prostate volume (P= 0.068) were similar among all BMI groups. CONCLUSIONS: Obese men had lower serum PSA concentrations than normal weight men mainly due to plasma hemodilution. PSA mass tended to be lower in obese patients, but it is unlikely a consequence of lower serum testosterone concentrations.

La obesidad modifica el antígeno prostático específico en hombres mayores de 45 años de edad / Obesity modifies prostatic specific antigen in men over 45 year

OBJETIVO: Determinar si las menores concentraciones séricas de antígeno prostático específico (PSA) encontradas en los sujetos obesos son consecuencia de bajos niveles de testosterona circulante y/o del mayor volumen plasmático (-VP- hemodilución).MÉTODOS: Fueron seleccionados 413 individuos de sexo masculino entre 45 y 75 años. El trabajo consistió en una evaluación de la composición corporal mediante antropometría (medición de peso y talla y cálculo del índice de masa corporal –IMC-, superficie corporal- SC- y VP), estimación de peso prostático por ecografía transrectal (ETR) y un análisis de laboratorio incluyendo dosaje de la PSA total y, en un subgrupo de pacientes (n= 108), determinación de la concentración sérica de testosterona. Se calculó la masa de PSA circulante (PSA masa). El análisis estadístico se realizó mediante Anova I y el coeficiente de correlación de Pearson (p<0.05).RESULTADOS: La edad promedio fue de 59,08 años y la media de IMC de 28,80 kg/m2. Los sujetos con IMC entre 20-24,9 kg/m2 (n= 68) presentaron una media de PSA de 1,43 ng/ml; en los voluntarios con sobrepeso (n=222), IMC entre 25-29,9 kg/m2, la media encontrada de fue de 1,40 ng/ml; en los obesos tipo I (n=114), IMC entre 30-39,9 kg/m2, se halló una PSA media de 1,05 ng/ml y finalmente en los obesos tipo II (n= 9), IMC > 40 kg/m2 , el PSA tuvo un valor medio de 0,85 ng/ml. Un mayor IMC se asoció significativamente con un mayor VP (r= 0,687; p =0,001) y con una menor concentración sérica de PSA (r= -0,235; p= 0,001). Por su parte, el PSA masa fue menor en los pacientes obesos tipo I y II que en los voluntarios con sobrepeso y normopeso aunque estadísticamente no significativo ( p<0.063). El peso prostático y los niveles de testosterona fueron similares en todos los voluntarios independientemente del estado nutricional que presentaran(AU)

CONCLUSIÓN: La principal causa de menor concentración de PSA en sujetos obesos sería la hemodilución por mayor volumen plasmático; sin embargo, también hay una discreta reducción en la secreción de proteína PSA en estos sujetos aunque no estaría relacionada bajos niveles de testosterona(AU)

OBJECTIVES: To determine whether lower serum prostate-specific antigen (PSA) concentration in obese men is caused by plasma hemodilution and/or decreased serum testosterone levels.METHODS: A sample of 413 men, from 45 to 75 years old, were randomly selected for the study among those who participated in prostate cancer screening at 2 urban urology practices in Argentina and Puerto Rico. Weight, height, serum testosterone and total PSA concentration were determined. Body mass index (BMI), body surface, plasma volume, and PSA mass were calculated. Prostate volume was estimated by transrectal ultrasound using the prolate ellipsoid formula.RESULTS: Mean age was 59 years old (range, 45 to 75) and mean BMI was 28.8 kg/m2 (range, 24 to 46). Mean serum PSA concentration was 1.43 ng/ml in normal weight patients (n=68), 1.4 ng/ml in overweight patients (n=222), 1.05 ng/ml in obese patients (n=114), and 0.85 ng/ml in morbidly obese patients (n=9). BMI was directly correlated with plasma volume (r= 0.687; p= 0.001) and inversely correlated with serum PSA concentration (r= -0.235; P= 0.001). PSA mass tended to be lower in obese and morbidly obese patients (P= 0.0063) compared to normal weight and overweight subjects. Serum testosterone concentration (P= 0.91) and prostate volume (P= 0.068) were similar among all BMI groups.CONCLUSIONS: Obese men had lower serum PSA concentrations than normal weight men mainly due to plasma hemodilution. PSA mass tended to be lower in obese patients, but it is unlikely a consequence of lower serum testosterone concentrations(AU)

[Influence of leptin and adiponectin on prostate cancer]. / Influencia de la leptina y adiponectina en el cáncer de próstata.

BACKGROUND: Many studies have investigated the association between obesity, adipose tissue-derived factors (leptin and adiponectin) and prostate cancer (CaP) but the results are still inconsistent. METHODS: The aim of this study was to carry out a comprehensive review of the existing evidence about the role of leptin and adiponectin in prostate carcinogenesis and to provide an overview of it. RESULTS: Recent evidence suggests that leptin may play a rol in prostate cancer progression, while adiponectin may act as an "antiprostatic cancer" adipokine. CONCLUSIONS: Obesity may promote the progression of established prostate cancer and and adipokines may provide a molecular mechanism whereby obesity exerts its effects on prostate tumour biology.

Influencia de la Leptina y adiponectina en el cáncer de próstata / Influence of leptin and adiponectin on prostate cancer

OBJETIVO: Numerosos estudios han investigado la asociación entre la obesidad, las sustancias secretadas por el tejido adiposo (leptina y adiponectina) y el cáncer de próstata (CaP), aunque los resultados no han sido concluyentes. El objetivo del presente trabajo es realizar una revisión bibliográfica sobre el rol de la leptina y la adiponectina en el desarrollo del CaP.MÉTODOS: Se realizó una búsqueda bibliográfica y lectura compresiva de artículos relacionados con “leptina”, “adiponectina”, “obesidad” y “cáncer de próstata” en Pubmed y revistas científicas; y se efectuó una breve descripción sobre el tema.RESULTADOS: Estudios recientes indican que el tejido adiposo y las diferentes sustancias que éste secreta, denominadas adipoquinas, podrían promover o prevenir el desarrollo del CaP. La leptina tendría un efecto promotor del tumor; mientras que la adiponectina tendría un efecto protector.CONCLUSIÓN: La obesidad podría influenciar la carcinogénesis prostática mediante un mecanismo molecular en el que participarían las adipoquinas(AU)

OBJECTIVES: Many studies have investi-gated the association between obesity, adipose tissue-derived factors (leptin and adiponectin) and prostate cancer (CaP) but the results are still inconsistent.METHODS: The aim of this study was to carry out a comprehensive review of the existing evidence about the role of leptin and adiponectin in prostate carcinoge-nesis and to provide an overview of it.RESULTS: Recent evidence suggests that leptin may play a rol in prostate cancer progression, while adiponectin may act as an “anti- prostatic cancer” adipokine.CONCLUSIONS: Obesity may promote the progression of established prostate cancer and and adipokines may provide a molecular mechanism whereby obesity exerts its effects on prostate tumour biology(AU)