[Diagnostic and therapeutic management in a series of 1156 patients with the diagnosis of prostate cancer in Castilla y Leon during 2014.] / Manejo diagnóstico y actitud terapeútica de 1156 pacientes diagnosticados de cáncer de próstata en la comunidad de Castilla y León durante el año 2014.

OBJECTIVES: To evaluate the current clinical practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014. METHODS: A retrospective multicenter study was designed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened. Descriptive statistics on variables related to characteristics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided. RESULTS: A total of 1156 new cases of PC were analyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤ 6, 7 and  ≥ 8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/ watchful waiting, 423 (36.6%) radical prostatectomy (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively. CONCLUSIONS: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making.

OBJETIVO: Conocer la práctica clínica real en pacientes con Cáncer de Próstata (CP) en las Áreas Sanitarias de Castilla y León (CyL) en el año 2014. MATERIAL Y MÉTODOS: Se diseña un estudio multicéntrico con carácter retrospectivo para disponer de datos sobre el diagnóstico y tratamiento del CP en CyL: se logra una cobertura del 87,8% de los pacientes comunitarios. Se aporta estadística descriptiva sobre las variables referentes a características del paciente, del tumor y de la modalidad de tratamiento de primera línea a la que fue sometido. RESULTADOS: Se analizan 1.156 nuevos casos de CP con una edad media de 68,2 años y una mediana de PSA de 8,4 ng/ml. La puntuación de Gleason (PG) muestra 538 (46,2%), 418 (35,9%) y 200 (17,1%) pacientes para PG ≤  6, 7 y  ≥ 8 respectivamente. El 91,0% de los pacientes (1.053 pacientes) son diagnosticados en estadio localizado. 56 pacientes (4,8%) son tratados con estrategias diferidas (EDs), vigilancia activa/ observación, 423 (36,6%) con prostatectomia radical (PR), 348 (30,1%) con radioterapia, 98 (8,4%) con braquiterapia (BT) y 170 (14,7%) con hormonoterapia (HT). CONCLUSIONES: Las EDs aún supusieron un porcentaje pequeño de los tratamientos. PR y RT/BT fueron de elección en pacientes con estadios localizados de la enfermedad y menores de 70 años. Estadios más avanzados y pacientes mayores fueron tratados con HT principalmente. La edad se postula como el principal factor implicado en la toma de decisiones terapéuticas.

Manejo diagnóstico y actitud terapeútica de 1156 pacientes diagnosticados de cáncer de próstata en la comunidad de Castilla y León durante el año 2014 / Diagnostic and therapeutic management in a series of 1156 patients with the diagnosis of prostate cancer in Castilla y Leon during 2014

Objetivo: Conocer la práctica clínica real en pacientes con Cáncer de Próstata (CP) en las Áreas Sanitarias de Castilla y León (CyL) en el año 2014. Material y métodos: Se diseña un estudio multicéntrico con carácter retrospectivo para disponer de datos sobre el diagnóstico y tratamiento del CP en CyL: se logra una cobertura del 87,8% de los pacientes comunitarios. Se aporta estadística descriptiva sobre las variables referentes a características del paciente, del tumor y de la modalidad de tratamiento de primera línea a la que fue sometido. Resultados: Se analizan 1.156 nuevos casos de CP con una edad media de 68,2 años y una mediana de PSA de 8,4 ng/ml. La puntuación de Gleason (PG) muestra 538 (46,2%), 418 (35,9%) y 200 (17,1%) pacientes para PG ≤ 6, 7 y ≥ 8 respectivamente. El 91,0% de los pacientes (1.053 pacientes) son diagnosticados en estadio localizado. 56 pacientes (4,8%) son tratados con estrategias diferidas (EDs), vigilancia activa/ observación, 423 (36,6%) con prostatectomia radical (PR), 348 (30,1%) con radioterapia, 98 (8,4%) con braquiterapia (BT) y 170 (14,7%) con hormonoterapia (HT). Conclusiones: Las EDs aún supusieron un porcentaje pequeño de los tratamientos. PR y RT/BT fueron de elección en pacientes con estadios localizados de la enfermedad y menores de 70 años. Estadios más avanzados y pacientes mayores fueron tratados con HT principalmente. La edad se postula como el principal factor implicado en la toma de decisiones terapéuticas

Objectives: To evaluate the current clinical practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014. Methods: A retrospective multicenter study was designed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened. Descriptive statistics on variables related to characteristics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided. Results: A total of 1156 new cases of PC were analyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤6, 7 and ≥8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/ watchful waiting, 423 (36.6%) radical prostatectomy (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively. Conclusions: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making

Early experience in reconstruction of long ureteral strictures with allogenic amniotic membrane.

OBJECTIVE: To present our experience with the application of human amniotic membrane for the reconstruction of extensive ureteral wall defects. METHODS: Between 2003 and 2006, 11 patients underwent reconstructive surgery of the ureter. A human amniotic membrane allograft was used to supplement ureteral wall defects. Indications for the procedure included ureteral strictures of a 5.5 cm average (range, 3-8 cm) localized in different parts of the ureter: upper (5), middle (5) and lower (3). The etiology of ureteral loss was: postinflammatory after a complicated stone disease (5), iatrogenic (4) and idiopathic (2). Diagnosis of ureteral stricture was based on antegrade pyelography and excretory urography. Two patients had synchronous treatment for upper and middle ureteral stenosis. Treatment efficacy was assessed by excretory urography and ultrasound. RESULTS: The mean hospitalization time was 11.9 days, mean operation time 128 min and with an average follow up of 25.2 months. Complications included: stricture recurrence (1) and symptomatic urinary tract infections (2). Excretory urography showed lack of obstruction and normal width of ureters. In one patient, residual hydronephrosis was present on ultrasound. CONCLUSIONS: The described method seems to be a promising tool in the reconstruction of extensive ureteral strictures.

Reconstructive surgery of the extensive ureter strictures using human dura mater allografts.

OBJECTIVE: To present and evaluate our experiences with use of human dura mater allografts in reconstructive surgery of long ureter strictures; first human derived, collagen based, oligocellular biomaterial utilized in genitor-urinary reconstructive surgery. To describe on the basis of our experiences with dura mater preferable from a technical and biological standpoint features of biomaterial as a matrix for the ureter regeneration in this condition. We also assessed a technical aspects, suitability and efficacy of the new operative method. PATIENTS AND METHODS: Between 1980 and 1992, in our search for ideal biomaterial useful for reconstructive surgery of extensive ureter obstruction we used to apply human dura mater allografts. A total of 6 females and 2 males were treated with reconstructive surgery with human dura mater allografts utilized for supplementation of the ureter wall defect. Diagnosis was based on ultrasonography, excretory urography and retrograde ureteropyelography. Imaging studies revealed obstructed ureter segment of at least 4 cm length. RESULTS: In all cases procedure was completed without any complications. Hospitalization after the surgery lasted approximately 8-10 days. Early and late follow-up excretory urography demonstrated lack of obstruction in the operated ureter segment. Long term follow-up of 12 months to 18 years (meanly 8,75 years) showed no signs of renal function deterioration, without urine obstruction on the operated side in all patient. Fluoroscopy scans showed signs of peristaltic wave in the operated ureter segment. CONCLUSIONS: Both a supplementary biomaterial used and a new operative method proved to be a promising option in reconstruction of long ureter strictures. Unfortunately a threat of prion related diseases, which resulted in exclusion dura mater grafts and all biomaterial originated from nervous system from transplantology, forced us to search for new suitable material.

Reconstruction of long ureteral obstructions using xenogenic acellular collagen membranes.

OBJECTIVE: Extensive stricture of ureter still poses a difficult challenge for urologic surgons, especially when its middle part is affected. We present a reconstructive method of long ureteral strictures with use of xenogenic collagen membranes as a scaffolding to promote new tissue growth in the area of extensive ureter defect. PATIENTS AND METHODS: Between 1980 and 2002 we applied and evaluated results of the new procedure in a total of 7 females and 3 males suffering from a various degree of hydronephrosis caused by extensive ureter stricture. RESULTS: Early and long-term follow-up excretory urography demonstrated lack of obstruction in the operated ureter segment in all cases. CONCLUSIONS: Easy surgical procedure, no complications after surgery excellent short and long-term results prove the efficacy and usefulness of the presented therapeutic option.

Reconstructive surgery of male urethra using human amnion membranes (grafts)--first announcement.

OBJECTIVE: Assessment of technical aspects of the surgical procedure and usefulness, suitability and efficacy of human amnion grafts as a biomaterial in reconstructive surgery of strictured male urethra. PATIENTS AND METHODS: Human amnion membranes were used in 2 men suffering from long, recurring strictures of urethra. Narrowed part of urethra was careful prepared and cleaned of adjacent tissue. Then a longitudinal incision was performed through the whole length of strictured segment and then it was covered with human amnion membrane. RESULTS: Hospitalization time 4 to 5 days. The Foley catheter was removed 2 weeks after surgery 3 months after surgery controlled urethrographies and urethroscopies show wide urethra lumen, wider than in adjacent parts. In urethroscopy operated place covered with epithelium, smooth, without scare. CONCLUSIONS: Human amnion grafts and described technique seem to be a promising method of managing long, recurring male urethra strictures but need long-term follow-up and analysis of more cases.

[Uretero-uterine fistula as complication of the cesarean section]. / Przetoka moczowodowo-maciczna jako powiklanie ciecia cesarskiego.

CASE PRESENTATION: 26 y.o woman 3 weeks after cesarean section complained of urine leakage from vagina. Urography revealed uretero-uterine fistula. Surgery was performed--3 dexon sutures attaching strictured ureter to the uterine were localized and then cut off. Distally obliterated ureter was separated out of adjacent tissues. The strictured part of ureter was then incised on the length of ca 8 cm, pig tail catheter was induced and human dura mater allograft was put on and sewed in into the strictured segment. In the long term follow-up the woman gave birth to two more children in the vaginal delivery without any complications. Urographies revealed no fistula, no stricture recurrency and normal urine passage.