Positive surgical margins are predictors of local recurrence in conservative kidney surgery for pT1 tumors

ABSTRACT Objectives: The clinical significance of positive surgical margin (PSM) after a Nephron Sparing Surgery (NSS) is controversial. The aim of this study is to evaluate the association between PSM and the risk of disease recurrence in patients with pT1 kidney tumors who underwent NSS. Materials and Methods: Retrospective cohort study. A total of 314 patients submitted to a NSS due to stage pT1 renal tumor between January 2010 and June 2015 were included. Recurrence-free survival was estimated. The Cox model was used to adjust the tumor size, histological grade, pathological stage, age, surgical margins and type of approach. Results: Overall PSM was 6.3% (n=22). Recurrence was evidenced in 9.1% (n=2) of patients with PSM and 3.5% (n=10) for the group of negative surgical margin (NSM). The estimated local recurrence-free survival rate at 3 years was 96.4% (95% CI 91.9 to 100) for the NSM group and 87.8% (95% CI 71.9 to 100) for PSM group (p=0.02) with no difference in metastasis-free survival. The PSM and pathological high grade (Fuhrman grade III or IV) were independent predictors of local recurrence in the multivariate analysis (HR 12.9, 95%CI 1.8-94, p=0.011 / HR 38.3, 95%CI 3.1-467, p=0.004 respectively). Fuhrman grade proved to be predictor of distant recurrence (HR 8.1, 95%CI 1.6-39.7, p=0.011). Conclusions: The PSM in pT1 renal tumors showed to have higher risk of local recurrence and thus, worse oncological prognosis.

Ondas de choque de baja intensidad como alternativa terapéutica de la disfunción eréctil: experiencia inicial en el Hospital Italiano de Buenos Aires y revisión de la bibliografía / Low Intensity Shock Waves as a Therapeutic Alternative for Erectile Dysfunction: Initial Experience at the Hospital Italiano de Buenos Aires and Review of The Literature

Objetivos: los inhibidores de fosfodiesterasa revolucionaron el tratamiento de la disfunción eréctil. Las ondas de choque de baja intensidad emergen como una alternativa terapéutica no invasiva. Materiales y métodos: estudio de cohorte prospectiva y observacional, en el que se evaluó la respuesta de 17 pacientes sexualmente activos al tratamiento con ondas de choque de baja intensidad a los 3 y 6 meses, mediante el Indice Internacional de Función Eréctil (IIEF-6), las preguntas 2 y 3 del Sexual Encounter Profile (SEP-2 y SEP-3), y el Erection Hardness Score (EHS) para evaluar la rigidez peneana, así como una evaluación de satisfacción global con el tratamiento (GAQ) y de recomendación del mismo. Resultados: 6 pacientes presentaban disfunción eréctil leve y 11 disfunción eréctil moderada-severa. Ambos grupos mostraron diferencias estadísticamente significativas en el IIEF-6, SEP-2, SEP-3 y EHS, a los 3 y 6 meses. Sin embargo, no todos los pacientes se mostraron satisfechos o recomendarían el tratamiento, sobre todo en aquellos con disfunción eréctil moderada-severa previo al tratamiento. Conclusión: las ondas de choque de baja intensidad son un tratamiento emergente para la disfunción eréctil, aunque aun sin evidencia clara de su eficacia e indicaciones. Los dispares resultados de los grupos se han debido probablemente a la heterogeneidad de las condiciones basales de los pacientes.(AU)

Objectives: Iphosphodiesterase inhibitors revolutionized the treatment of erectile dysfunction. Low intensity shockwave therapy emerge as a non-invasive therapeutic alternative. Materials and methods: this was a prospective and observational study, in which 17 sexually active patients were evaluated 3 and 6 months after treatment with low intensity shockwave therapy, using the International Index of Erectile Function (IIEF-6), questions 2 and 3 of the Sexual Encounter Profile (SEP-2 and SEP-3), and the Erection Hardness Score (EHS) to assess penile rigidity, as well as a global satisfaction evaluation with the treatment (GAQ) and if they would recommend it to others. Results: 6 patients showed mild erectile dysfunction and 11 moderatesevere erectile dysfunction. Both groups showed statistically significant differences in IIEF-6, SEP-2, SEP-3 and EHS, after 3 and 6 months. However, not all of them were satisfied with the treatment or would recommend it to others, especially those with moderate-severe basal erectile dysfunction. Conclusion: low intensity shockwave therapy is an emergent treatment for erectile dysfunction, although there is no sufficient evidence of its efficacy and indications. The differences between groups were due probably to the heterogeneity of the basal conditions of the patients.(AU)

Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience

ABSTRACT Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney. Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis). Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively. Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.