Estimulación transcutánea del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia refractaria, de origen idiopático y neurógenico / Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin

Objetivo: Evaluar la eficacia del tratamiento con la estimulación transcutánea del nervio tibial posterior (T-PTNS) en pacientes con incontinencia urinaria de urgencia, de origen neurógenico o no neurógenico, refractaria a las opciones terapéuticas de primera línea. Material y métodos: Se incluyeron 65 pacientes con incontinencia urinaria de urgencia refractaria a tratamiento médico. Antes de T-PTNS se realizó anamnesis, estudio urodinámico y potenciales evocados somatosensoriales (PESS), estudiando el estado funcional urólogico mediante un diario miccional. El tratamiento consistió en 10 sesiones semanales de T-PTNS de 30 minutos de duración. Resultados: Un 57,7% de los pacientes presentaban PESS tibiales anormales y en un 42% PESS pudendos anormales. Se objetivó una mejoría sintomática estadísticamente significativa en todos los parámetros clínicos tras el tratamiento con T-PTNS, y en el 66% se evidenció una mejora global, independientemente del género, presencia de alteraciones neurológicas de base, hiperactividad detrusoriana en el estudio urodinámico o trastornos en los PESS. No se produjeron efectos adversos durante el tratamiento. Conclusiones: T-PTNS es un tratamiento efectivo y bien tolerado en pacientes con incontinencia de urgencia refractaria a terapias de primera línea, y debería ser ofrecida precozmente en la estrategia de tratamiento. Son necesarios nuevos estudios para identificar los parámetros óptimos de estimulación, los protocolos de tratamiento más efectivos y la eficacia a largo plazo, así como su aplicabilidad a pacientes con un sustrato neurogénico

Objective: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. Material and methods We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30 minutes. Results: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. Conclusions: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrated

Metaloproteinasa 11, potencial marcador y diana molecular en cáncer de próstata avanzado y resistente a la castración. Estudio en cultivo de fibroblastos peritumorales / Metalloproteinase 11, potential marker and molecular target in advanced and castration-resistant prostate cancer. Culture study of peritumoral fibroblasts

Objetivo: Analizar el comportamiento de la metaloprotesa 11 (MMP11) en fibroblastos cultivados procedentes de tumores prostáticos humanos con diferentes características clinicopatológicas. Material y métodos: Para este estudio se analizaron muestras de biopsias de próstata obtenidas por vía transrectal de tumores con diferentes características, tratados o no con privación androgénica (PA). Tras la optimización del método de cultivo, se aislaron y cultivaron los fibroblastos para realizar el estudio (PCR) del ARNm de MMP11. Resultados: Se estudiaron finalmente 37 casos: 5 muestras de hiperplasia benigna de próstata, 14 casos con neoplasias localizadas (7 de alto riesgo según la clasificación de D’Amico), 5 con tumores con metástasis óseas y 13 tratados con PA, de los que 6 cumplían los requisitos para ser definidos como resistentes a la castración. En los tumores sin PA, la expresión de MMP11 fue significativamente mayor (p = 0,001) en los fibroblastos de tumores de grados más altos. Se encontró una correlación significativa (p = 0,001) entre PSA y expresión de MMP11 fibroblástica y un aumento significativo de la expresión de MMP11 en los tumores metastásicos. En los tumores con PA se objetivó una expresión significativamente mayor de MMP11 en pacientes resistentes a la castración que en los sensibles a esta (p = 0,003). Conclusión: En tumores de próstata avanzados o en fases de mayor agresividad tumoral, la producción de MMP11 por los fibroblastos resulta significativamente mayor que en tumores no metastásicos o en fases de sensibilidad a la PA

Objective: To analyze the expression of metalloprotein 11 (MMP11) in cultured fibroblasts obtained from human prostate tumors with different clinical and pathological characteristics. Material and methods: For this study we analyzed samples of transrectal prostate biopsies from tumors with different characteristics, treated with or whithout androgen deprivation (AD). After optimization of the culture method, fibroblasts were isolated and cultured to perform the study (PCR) of MMP11 mRNA. Results: Finally, 37 cases were studied: 5 samples of benign prostatic hyperplasia, 14 cases with localized neoplasms (7 high-risk according to the D’Amico classification), 5 with metastasic tumors (bone metastases), and 13 treated with AD therapy, of which 6 fulfilled the requirements to be defined as resistant to castration. In tumors without AD therapy, MMP11 expression was significantly higher (P= .001) in fibroblasts of higher grade tumors. A significant (P= .001) correlation was found between PSA and expression of MMP11 in fibroblast s and a significant increase of MMP11 expression in metastatic tumors. In tumors with AD therapy, a significantly greater expression of MMP11 was observed in resistant to castration patients than in those sensitive to castration (P= .003). Conclusion: In advanced prostate tumors or in stages of increased tumor aggressiveness, the production of MMP11 by fibroblasts is significantly greater than in non-metastatic tumors or in AD sensitive tumors

Beneficio de la nefrectomía en el tratamiento del carcinoma de células renales metastásico / Benefit of on nephrectomy for treating metastatic renal cell carcinoma

Introducción: El tratamiento sistémico del carcinoma de células renales metastásico (CCRm) ha cambiado con la aparición de nuevas terapias, planteándose la utilidad de la nefrectomía (NFT) en estos pacientes. Objetivo: Analizar si la NFT asociada a tratamiento sistémico prolonga el tiempo libre de progresión (TLP) y la supervivencia global (SG). Material y métodos: Estudio descriptivo restrospectivo de 45 pacientes con CCRm entre 2006-2014. Se descartaron casos avanzados con tratamiento paliativo o con metástasis únicas tratados exclusivamente con cirugía. Resultados: Finalmente 34 pacientes fueron tratados con tratamiento sistémico. En 26 se empleó además cirugía. El 70% presentaban riesgo intermedio en la clasificación de Motzer y un índice de Karnofsky > 80%. El TLP fue de 7 m, encontrándose diferencias significativas entre los grupos con y sin NFT (10 vs. 4 m). Hubo menor TLP en pacientes con Motzer alto (p < 0,0001). La SG fue de 11,5 m. Se encontró mayor SG en pacientes con índice de Karnofsky > 80 (13 vs. 5 m; p = 0,005), Motzer medio/bajo (14 vs. 3 m; p=0,0001), NFT (14 vs. 6m; p = 0,001) y tratamiento inhibidor mTOR en segunda línea (9 vs. 5 m; p = 0,003). En el análisis multivariable solo la NFT (p = 0,006; HR 4,5) y un Motzer medio/bajo demostraron una mayor supervivencia (p = 0,020; HR 8,9). Conclusiones: El TLP y la SG aumentaron significativamente en pacientes con NFT asociada, en CCRm de riesgo intermedio/bajo (Motzer). La SG además aumentó en pacientes tratados con mTOR de segunda línea y en pacientes con índice de Karnofsky > 80% en el análisis univariable, no pudiendo demostrarlo en el estudio multivariable

Introduction: Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients. Objective: To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS). Material and methods: A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006-2014. Advanced cases with only palliative care were excluded, also patients with solitary metastasis who were managed with surgical resection. Results: Finally 34 patients were treated with systemic treatment. Twenty-six also with surgery associated. Seventy percent were intermediate/low risk at the Motzer classification and > 80% Karnofsky performance status. PFS was 7 m. NEP improves PFS (10 vs. 4 m). High risk Motzer decreased PFS (P < .001). The OS was 11.5m. Patients with Karnofsky performance status > 80, intermediate or low risk Motzer treated with NEP and mTOR as second line treatment, increased the OS (14 vs. 3 m, P = .0001; 14 vs. 6 m, P = .001; and 9 vs. 5m, P = .003, respectively). In the multivariate analysis only NEP (P = 0,006; HR 4.5) and intermediate/low risk at the Motzer classification(P = .020; HR 8.9) demonstrated significant improvement in OS. Conclusions: Patients treated with NEP associated to systemic treatment and with an intermediate/low risk in the Motzer classification had a better PFS and OS. The OS also improves in patients treated with mTOR in second line, and Karnofsky performance status > 80%in the univariate study, but not in the multivariable one

Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin. / Estimulación transcutánea del nervio tibial posterior en el tratamiento de la incontinencia urinaria de urgencia refractaria, de origen idiopático y neurógenico.

OBJECTIVE: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS: We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.

Metalloproteinase 11, potential marker and molecular target in advanced and castration-resistant prostate cancer. Culture study of peritumoral fibroblasts. / Metaloproteinasa 11, potencial marcador y diana molecular en cáncer de próstata avanzado y resistente a la castración. Estudio en cultivo de fibroblastos peritumorales.

OBJECTIVE: To analyze the expression of metalloprotein 11 (MMP11) in cultured fibroblasts obtained from human prostate tumors with different clinical and pathological characteristics. MATERIAL AND METHODS: For this study we analyzed samples of transrectal prostate biopsies from tumors with different characteristics, treated with or whithout androgen deprivation (AD). After optimization of the culture method, fibroblasts were isolated and cultured to perform the study (PCR) of MMP11 mRNA. RESULTS: Finally, 37 cases were studied: 5 samples of benign prostatic hyperplasia, 14 cases with localized neoplasms (7 high-risk according to the D'Amico classification), 5 with metastasic tumors (bone metastases), and 13 treated with AD therapy, of which 6 fulfilled the requirements to be defined as resistant to castration. In tumors without AD therapy, MMP11 expression was significantly higher (P=.001) in fibroblasts of higher grade tumors. A significant (P=.001) correlation was found between PSA and expression of MMP11 in fibroblast s and a significant increase of MMP11 expression in metastatic tumors. In tumors with AD therapy, a significantly greater expression of MMP11 was observed in resistant to castration patients than in those sensitive to castration (P=.003). CONCLUSION: In advanced prostate tumors or in stages of increased tumor aggressiveness, the production of MMP11 by fibroblasts is significantly greater than in non-metastatic tumors or in AD sensitive tumors.

Benefit of on nephrectomy for treating metastatic renal cell carcinoma. / Beneficio de la nefrectomía en el tratamiento del carcinoma de células renales metastásico.

INTRODUCTION: Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients. OBJECTIVE: To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS). MATERIAL AND METHODS: A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006-2014. Advanced cases with only palliative care were excluded, also patients with solitary metastasis who were managed with surgical resection. RESULTS: Finally 34 patients were treated with systemic treatment. Twenty-six also with surgery associated. Seventy percent were intermediate/low risk at the Motzer classification and>80% Karnofsky performance status. PFS was 7m. NEP improves PFS (10 vs. 4m). High risk Motzer decreased PFS (P<.001). The OS was 11.5m. Patients with Karnofsky performance status>80, intermediate or low risk Motzer treated with NEP and mTOR as second line treatment, increased the OS (14 vs. 3m, P=.0001; 14 vs. 6m, P=.001; and 9 vs. 5m, P=.003, respectively). In the multivariate analysis only NEP (P=0,006; HR 4.5) and intermediate/low risk at the Motzer classification(P=.020; HR 8.9) demonstrated significant improvement in OS. CONCLUSIONS: Patients treated with NEP associated to systemic treatment and with an intermediate/low risk in the Motzer classification had a better PFS and OS. The OS also improves in patients treated with mTOR in second line, and Karnofsky performance status>80%in the univariate study, but not in the multivariable one.