Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen.

OBJECTIVE: To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS: Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS: We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION: The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.

Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria / Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen

Objetivo Reportar nuestra experiencia inicial de prostatectomía radical robótica (PRR) en régimen ambulatorio. Material y métodos Análisis retrospectivo de los pacientes intervenidos de PRR en cirugía mayor ambulatoria (CMA) en nuestro centro entre marzo de 2021 y mayo de 2022. Recopilamos las características basales de los pacientes, los resultados intraoperatorios y los datos del postoperatorio (necesidad de asistencia médica no planificada y complicaciones al mes de la cirugía). Se recogieron las características oncológicas al diagnóstico de la enfermedad (PSA, estadificación, ISUP, RMN) y el resultado anatomopatológico tras la intervención. Resultados Identificamos un total de 35 pacientes, con una edad promedio de 60,8 ±6,88 años y un IMC de 27 ±2,9kg/m2. Todos presentaban un riesgo anestésico bajo y un 25,71% tenían alguna cirugía abdominal previa. El tiempo quirúrgico fue de 151,66 ±42,15 minutos y el sangrado promedio fue de 301,2 ±184,38mililitros. Dos pacientes (5,7%) ingresaron la primera noche de la cirugía y 7 pacientes (20%) consultaron en urgencias en el mes siguiente, de los cuales 3 (8,57%) reingresaron. Registramos una complicación intraoperatoria, 7 complicaciones postoperatorias leves (ClavienI-II) y una complicación grave (ClavienIIIb). La complicación grave transcurrió al octavo día postoperatorio y no tuvo relación con la ambulatorización del procedimiento. Conclusión La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en régimen de CMA como una técnica segura dirigida a pacientes seleccionados (AU)

Objective To report our initial experience with robotic radical prostatectomy (RRP) as an outpatient procedure. Material and methods Retrospective analysis of patients who underwent RRP as major ambulatory surgery (MAS) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. Results We identified a total of 35 patients with an average age of 60,8 ±6,88years and a BMI of 27 ±2,9kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ±42,15minutes and the average blood loss was 301,2 ±184,38milliliters. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, 7 mild postoperative complications (ClavienI-II) and one severe complication (ClavienIIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. Conclusion The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients (AU)

Association between single-nucleotide polymorphisms in DNA double-strand break repair genes and prostate cancer aggressiveness in the Spanish population.

BACKGROUND: Novel predictors of prognosis and treatment response for prostate cancer (PCa) are required to better individualize treatment. Single-nucleotide polymorphisms (SNPs) in four genes directly (XRCC5 (X-ray repair complementing defective repair in Chinese hamster cells 5) and XRCC6 (X-ray repair complementing defective repair in Chinese hamster cells 6)) or indirectly (PARP1 and major vault protein (MVP)) involved in non-homologous end joining were examined in 494 Spanish PCa patients. METHODS: A total of 22 SNPs were genotyped in a Biotrove OpenArray NT Cycler. Clinical tumor stage, diagnostic PSA serum levels and Gleason score at diagnosis were obtained for all participants. Genotypic and allelic frequencies were determined using the web-based environment SNPator. RESULTS: (XRCC6) rs2267437 appeared as a risk factor for developing more aggressive PCa tumors. Those patients carrying the GG genotype were at higher risk of developing bigger tumors (odds ratio (OR)=2.04, 95% confidence interval (CI) 1.26-3.29, P=0.004), present higher diagnostic PSA levels (OR=2.12, 95% CI 1.19-3.78, P=0.011), higher Gleason score (OR=1.65, 95% CI 1.01-2.68, P=0.044) and D'Amico higher risk tumors (OR=2.38, 95% CI 1.24-4.58, P=0.009) than those patients carrying the CC/CG genotypes. Those patients carrying the (MVP) rs3815824 TT genotype were at higher risk of presenting higher diagnostic PSA levels (OR=4.74, 95% CI 1.40-16.07, P=0.013) than those patients carrying the CC genotype. When both SNPs were analyzed in combination, those patients carrying the risk genotypes were at higher risk of developing D'Amico higher risk tumors (OR=3.33, 95% CI 1.56-7.17, P=0.002). CONCLUSIONS: We believe that for the first time, genetic variants at XRCC6 and MVP genes are associated with risk of more aggressive disease, and would be taken into account when assessing the malignancy of PCa.

[Radical prostatectomy. A review of our series between 1997-2003]. / Prostatectomía radical. Revisión de nuestra serie en el periodo 1997-2003.

OBJECTIVE: To evaluate the complications and results of our series of 398 radical retropubic prostatectomies as an elective treatment for clinically localized prostate cancer. PATIENTS AND METHODS: Between January 1997 and June 2003, a total of 398 radical retropubic prostatectomies have been performed. Mean age was 63.8 years (45.8-78.2), mean PSA at diagnosis 9.32 ng/ml (0.9-129.7). Mean surgical time was 141.6 minutes (70-280), and mean hospitalization was 6.75 days (2-37). RESULTS: Mean follow-up was 65.18 months. We report as peroperatory complications: rectal injury 1.8%, lymphatic leakage 0.3%, urinary fistula 5%. As delay complications: uretrovesical junction stenosis 6%. We observed 49.1% of patients with positive surgical margins. We don't report any peroperatory death. The overall survival rate is 98.5%, the cancer specific survival rate is 99.75%, and the recurrence-free survival rate is 84.97%. CONCLUSIONS: Radical retropubic prostatectomy is an excellent treatment form for patients with clinically localized prostate cancer. A strict selection of patients candidates is important to obtain good results.

Prostatectomía radical. Revisión de nuestra serie en el periodo 1997-2003 / Radical prostactectomy. A review of our serie between 1997-2003

Objetivos: Analizar los resultados y complicaciones de nuestra serie de 398 casos de prostatectomía radical retropúbica como tratamiento electivo del cáncer de próstata órgano confinado. Material y metodos: Entre enero de 1997 y junio de 2003 hemos realizado un total de 398 prostatectomías radicales. La edad media fue de 63,8 años (45,8-78,2), con una media de PSA al diagnóstico de 9,32 ng/ml (0,9-129,7). La media del tiempo quirúrgico es de 141,6 minutos (70-280), y la media de días de ingreso hospitalario de 6,75 días (2-37).Resultados: El seguimiento medio de nuestra serie ha sido de 65,18 meses. Como complicaciones peroperatorias destacamos: lesión rectal 1,8%, linforrea 0,3%, fístula urinaria 5%. Como complicaciones tardías: estenosis anastomosis uretrovesical 6%.Hemos objetivado un porcentaje de márgenes positivos del 49,1%. No hemos tenido ningún exitusperoperatorio. La supervivencia global de la serie es del 98,5%, la supervivencia cáncer específica del 99,75%, y la supervivencia libre de enfermedad del 84,97%.Conclusiones: La prostatectomía radical es una excelente opción de tratamiento en pacientes con cáncer de próstata órgano confinado. Es indispensable para obtener buenos resultados una correcta selección de los pacientes candidatos a tratamiento quirúrgico (AU)

Objetive: To evaluate the complications and results of our series of 398 radical retropubic prostatectomies as an elective treatment for clinically localized prostate cancer. Patients and methods: Between january 1997 and june 2003, a total of 398 radical retropubic prostatectomies have been performed. Mean age was 63.8 years (45.8-78.2), mean PSA at diagnosis 9.32 ng/ml (0.9-129.7). Mean surgical time was 141.6 minutes (70-280), and mean hospitalization was 6.75 days (2-37). Results: Mean follow-up was 65.18 months. We report as peroperatory complications: rectal injury 1.8%, lymphatic leakage 0.3%, urinary fistula 5%. As delay complications: uretrovesical junction stenosis 6%. We observed 49.1% of patients with positive surgical margins. We don´t report any peroperatory death. The overall survival rate is 98.5%, the cancer specific survival rate is 99.75%, and the recurrence-free survival rate is 84.97%. Conclusions: Radical retropubic prostatectomy is an excellent treatment form for patients with clinically localized prostate cancer. A strict selection of patients candidates is important to obtain good results (AU)

[Retrospective study of 130 patients with organconfined prostate cancer treated with brachytherapy]. / Estudio retrospectivo de 130 pacientes con cáncer prostático organoconfinado tratados con braquiterapia prostática.

INTRODUCTION: The prostate brachytherapy with I 125 seeds has an indication in patients with organconfined prostate cancer. Our objective is to describe the population treated in our institution with permanent I125 seeds implants, the dosimetric characteristics of the technique and the preliminary results of our group-study in terms of evolution and toxicity. MATERIAL AND METHODS: Between May 2000 and March 2003, 130 patients with permanent implants of I125 seeds were treated. Beforehand we did prostate volumetric with transrectum prostate echography in order to assess the configuration of the implant, number of seeds and their place in the prostate with the objective to get a fine coverage of PTV (planet target volume). Stage distribution: 75.72% T1c; 24.28% T2a; Gleason<6, 94%. The PSA pretreatment average was 6.38 ng/ml. The average prostate volume was 30 cc. The 16.67% of the patients included had hormonal treatment previously to get the implants. The average age was 64 years. The characteristic techniques of the implants were: the average width of the needle as 24 (14-35) and the average of the seeds 76 (46-111). Finally the average activity was 0.39 mCi/seed, which means average total implant activity of 80 mCi. RESULTS: We analyzed 130 patients with average follow up 6 months. A 1 to 2 year surveillance was carried out on 98.9% and the global free disease surveillance (biochemic relapse) of 98.9% at the year and of the 87.8% at the end of the 2 years. The relapse in the low risk patients was 98.8% after the first year and 88.7% at the end of 2 year. On the contrary in the middle risk was of 100% and 83% respectively, although the amount of patients in significantly less. As a relevant acute secondary effects we found slight rectitys or GI (RTOG scale) in 1.4 and that needs synthomatic medication or GII (RTOG scale) in 0.8%. We found slide hematuria or GI (RTOG scale) in the 53% and other measures or GII (RTOG scale) in the 2.64% was needed. Finally we had to set a urinary prove for acute retention in 4.3%. CONCLUSION: The prostate brachyterapy is a complex procedure that needs a multidisciplinary team participation in order to be able to carry out. It avoids a long term hospitalization and allows for the patient to have daily activity within a short period of time. Despite the fact of the brief follow-up, the results over biochemical relapse and toxicity were similar to the ones in the literature. Tolerance to the implant was good. It would necessary a longer follow-up in order to be able to come to long term conclusions.

Estudio retrospectivo de 130 pacientes con cáncer prostático organoconfinado tratados con braquiterapia prostática / Retrospective study of 130 patients with organconfined prostate cancer trated with brachitherapy

Introducción: La braquiterapia prostática con semillas de I125 está indicada en pacientes con cáncer de próstata organoconfinado. Nuestro objetivo es describir la población tratada en nuestra institución mediante implante permanente con semillas de I125, las características dosimétricas de la técnica y los resultados preliminares de nuestra serie en cuanto a evolución y toxicidad. Material y métodos: Entre mayo 2000 y marzo de 2003 fueron tratados 130 pacientes con implante permanente transperineal de semillas de I125. Previamente a todos se les realizó volumetría mediante una ecografía prostática transrectal para determinar la configuración del implante, número de semillas y su localización en la próstata con el fin de obtener una adecuada cobertura del PTV (planed target volume o volumen planificado para tratar). Distribución por estadios: 75,72% T1c; 24,28% T2a. Gleason < 6, 94,24%. La mediana del PSA pretratamiento 6,38 ng/ml. El volumen prostático mediano fue de 30 cc. El 16,67% de los pacientes cuando los recibimos llevaban tratamiento hormonal previo al implante. La edad mediana fue de 64 años. En cuanto a las características técnicas de los implantes: la mediana de agujas utilizadas fue de 24 (14-35), y la mediana de semillas: 76 (46-111). Finalmente la mediana de la actividad fue de 0,39mCi/semilla, lo que supuso una actividad total implantada media de 80 mCi. Resultados: Analizamos los 130 pacientes con un seguimiento mínimo de 6 meses. La supervivencia a 1 y 2 años fue del 99,1% y la supervivencia libre de enfermedad global del 98,9% al año y del 87,8% a los dos años La supervivencia libre de enfermedad bioquímica en los pacientes de bajo riesgo eran, al año de 98,8% y a los dos años del 88,7%. Por el contrario en los de riesgo intermedio eran del 100% y del 83,3% respectivamente, aunque el número de pacientes es significativamente menor. Como efectos secundarios agudos relevantes encontramos rectitis leve o GI (escala de la RTOG) en 1,4% y que necesitó medicación sintomática o GII (escala de la RTOG) en 0,8%. Se presentó hematuria leve o GI (escala de la RTOG) el 53%, y que precisaran otras medidas o GII (escala de la RTOG) en el 2,64%. Finalmente hubo que colocar sonda urinaria por retención aguda el 4,3%. Conclusión: La braquiterapia prostática es un procedimiento complejo que exige la participación de un equipo multidisciplinar en su realización. Evita una hospitalización prolongada y permite al paciente recuperar sus actividades cotidianas en un periodo corto de tiempo. Aunque la media de seguimiento es corta, los resultados en cuanto a supervivencia libre de recidiva bioquímica y toxicidad son comparables a los descritos en la literatura. La tolerancia al implante ha sido buena. Es necesario un mayor seguimiento para poder establecer conclusiones a largo plazo

Introduction: The prostate brachitherapy with I 125 seeds has an indication in patients with organconfined prostate cancer. Our objective is to describe the population trated in our institution with permanent I125 seeds implants, the dosimetric characteristics of the technique and the preliminary results of our group-study in terms of evolution and toxicity. Material and methods: Between May 2000 and March 2003, a 130 patients with permanent implants of I125 seeds were trated. Beforehand we did prostate volumetric with transrectum prostate ecography in order to asses the configuration of the implant, number of seeds and their place in the prostate with the objective to get a fine coverage of PTV (planet target volume). Stage distribution: 75.72% T1c; 24.28% T2a. Gleason<6, 94%. The PSA pretreatment average was 6.38 ng/ml. The average prostate volume was 30 cc. The 16.67% of the patients included had hormonal treatment previously to get the implants. The average age was 64 years. The characteristic techniques of the implants were: the average width of the needle as 24 (14-35) and the average of the seeds 76 (46-111). Finally the average activity was 0.39 mCi/seed, wic means average total implant activity of 80 mCi. Results: We analized 130 patients with average follow up 6 months. A 1 to 2 year surveillance was carried out on 98.9% and the global free disease surveillance (biochemic relapse) of 98.9% at the year and of the 87.8% at the end of the 2 years. The relapse in the low risk patients was, 98.8% after the first year and 88.7% at the end of 2 year. On the contrary in the middle risk was of 100% and 83% respectively, although the amount of patients in significantly less. As a relevant acute secondary effects we found slight rectitys or GI (RTOG scale) in 1.4 and that needs synthomatic medication or GII (RTOG scale) in 0.8%. We found slide hematuria or GI (RTOG scale) in the 53% and other measures or GII (RTOG scale) in the 2.64% was needed. Finally we had to set a urinary prove for acute retention in 4.3%. Conclusion: The prostate brachiterapy is a complex procedure that needs a multidisciplinary team participation in order to be able to carry out. It aboids a long term hospitalitzation and allows for the patient to have daily activity within a short period of time. Despite the fact of the brief follow-up, the results over biochemical relaps and toxicity were similars to the ones in the literature. Tolerance to the implant was good. It would necessary a longer follow-up in order to be able to come to long term conclusions

[Prostatic brachytherapy indications and technique]. / Indicaciones y técnica de la braquiterapia prostática.

Prostate cancer is an important health problem, mainly in elderly men. It is the second cause of death among men in USA ant the third at the "Registro del Cáncer de Tarragona", behind both the lung and colorectal cancer. About the 58% of the newly diagnosed cancers are localized, therefore, they have to be treated with curative intention. Radical prostatectomy is considered the gold standard treatment for organ confined prostate cancer in our country. On basis to the experience of American groups and the improvement of both, image techniques and dosimetric calculation, brachytherapy has been brought in as a new option in the treatment of localized prostate cancer. We started our program of brachytherapy for prostate cancer on May 2000. We have performed 51 procedures by now. Our protocol and the technique to perform a prostatic brachytherapy are described following.

Indicaciones y técnica de la braquiterapia prostática / Indications and procedure of prostatic brachitherapia

El cáncer de próstata es un problema de salud importante que afecta principalmente á los varones de edad avanzada. Es la segunda causa de muerte entre los varones en EE.UU. y la tercera en frecuencia entre los varones en el Registro del Cáncer de Tarragona, después del cáncer de pulmón y del cáncer colorectal. Se estima que un 58 por ciento de los cánceres de próstata diagnosticados serán órganoconfinados y, por tanto, tributarios de un tratamiento con intención curativa. En nuestro medio la prostatectomía radical es considerado el tratamiento de elección para el cáncer de próstata órganoconfinado. En base a la amplia experiencia en el tratamiento del cáncer de próstata órganoconfinado mediante braquiterapia de algunos grupos en EE.UU., junto con la mejora a nivel de técnicas de imagen y cálculo dosimétrico, está terapéutica ha empezado a introducirse en nuestro medio como una nueva opción para el tratamiento del cáncer de próstata. Nuestro grupo inició su experiencia con la braquiterapia prostática en mayo de 2000, habiéndose realizado hasta la actualidad 51 procedimientos. A continuación exponemos nuestro protocolo de inclusión y técnica para la realización de braquiterapia en el cáncer de próstata órgano confinado (AU)

[Pelvic lipomatosis: clinical review and report of 4 new cases]. / Lipomatosis pélvica: revisión clínica y aportación de cuatro nuevos casos.

First described by the end of the fifties, pelvic lipomatosis is an uncommon disease that develops as a result of an excessive proliferation of benign fat tissue within the perivesical and perirectal spaces. The compressive effect on the urinary, and to a lesser degree, the digestive and vascular structures result in the well-known symptoms. Diagnosis is reached through X-ray studies, primarily computerised tomography. Contribution of four new cases in young males diagnosed through imaging studies as well as biopsies in three of them. Evolution has been varying, with medical control of symptoms in two cases and renal function impairment due to upper obstructive uropathy in the other two.

Lipomatosis pélvica: revisión clínica y aportación de cuatro nuevos casos / Pelvic lipomatosis: clinical review and contribution of four new cases

Descrita a finales de la década de los cincuenta, la lipomatosis pélvica es una infrecuente entidad patológica caracterizada por la proliferación excesiva de tejido adiposo benigno en los espacios perivesical y perirrectal. Los efectos compresivos sobre las estructuras urinarias, y en menor medida, digestivas y vasculares originan la sintomatología. Los estudios radiológicos y, especialmente la tomografía axial computerizada, nos permiten el diagnóstico. Presentamos cuatro nuevos casos en varones jóvenes diagnosticados mediante estudio imagen, así como biopsias en tres de ellos. La evolución ha sido desigual, con control sintomático bajo tratamiento médico en dos casos y deterioro de la función renal por uropatía obstructiva alta en los otros dos (AU)

[Preservation by pulsatile perfusion machine: the initial experience]. / Preservación mediante maquina de perfusión pulsátil: experiencia inicial.

The increasing numbers of patients in a waiting list for a renal transplantation together with the epidemiological changes in donor's characteristics have given rise to a growing interest in preservation with pulsatile perfusion machines. The availability of objective predictive parameters of renal functioning after transplantation as well as of improving preservation to reduce the incidence of acute tubular necrosis (ATN) are the major features of this preservation technique. This paper presents our experience in preservation with pulsatile perfusion machines which have allowed us to have objective parameters to assess an organ's future functioning and to improve, as far as possible, the quality of treated kidneys preservation.

[Electrovaporization in the treatment of benign prostatic hypertrophy. Our experience]. / Electrovaporización en el tratamiento de la HBP. Nuestra experiencia.

OBJECTIVE: To report our experience in the treatment of BPH with transurethral electrovaporization of the prostate (TUEVP) with the Roller device (Storz). METHODS: 105 patients with clinical BPH of 30 to 60 gm were treated by TUEVP. This technique allowed removal of the bladder catheter 14-16 hours after the procedure, with a mean length of hospital stay ranging from 19-36 hours. The postoperative clinical situation is similar to that of TUR, with a maximum flow of 17-41 ml/sec. CONCLUSION: In our experience, transurethral electrovaporization of the prostate is a simple, efficient, safe and economic technique with a very low morbidity.