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PURPOSE: We estimate the annual incidence of bladder cancer in Spain and describe the clinical profile of patients with bladder cancer enrolled in a population based study. MATERIALS AND METHODS: Using the structure of the Spanish National Health System as a basis, in 2011 the AEU (Spanish Association of Urology) conducted this study with a representative sample from 26 public hospitals and a reference population of 10,146,534 inhabitants, comprising 21.5% of the Spanish population. RESULTS: A total of 4,285 episodes of bladder cancer were diagnosed, of which 2,476 (57.8%) were new cases and 1,809 (42.2%) were cases of recurrence, representing an estimated 11,539 new diagnoses annually in Spain. The incidence of bladder cancer in Spain, age adjusted to the standard European population, was 20.08 cases per 100,000 inhabitants (95% CI 13.9, 26.3). Of patients diagnosed with a first episode of bladder cancer 84.3% were male, generally older than 59 years (81.7%) with a mean ± SD age of 70.5 ± 11.4 years. Of these patients 87.5% presented with some type of clinical symptom, with macroscopic hematuria (90.8%) being the most commonly detected. The majority of primary tumors were nonmuscle invasive (76.7%) but included a high proportion of high grade tumors (43.7%). According to the ISUP (International Society of Urologic Pathology)/WHO (2004) classification 51.1% was papillary high grade carcinoma. Carcinoma in situ was found in 2.2% of primary and 5.8% of recurrent cases. CONCLUSIONS: The incidence of bladder cancer in Spain, age adjusted to the standard European population, confirms that Spain has one of the highest incidences in Europe. Most primary nonmuscle invasive bladder cancer corresponded to high risk patients but with a low detected incidence of carcinoma in situ.
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Neoplasias da Bexiga Urinária/epidemiologia , Administração Intravesical , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/administração & dosagem , Comorbidade , Feminino , Hematúria/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Invasividade Neoplásica , Estadiamento de Neoplasias , Vigilância da População , Fumar/epidemiologia , Espanha/epidemiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Adulto JovemRESUMO
INTRODUCTION AND OBJECTIVE: The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival. PATIENTS AND METHOD: Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p). RESULTS: Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp=0.018), preservation of puboprostatic ligaments (adjp=0.02), preservation of endopelvic fascia (adjp=0.001) and performing periurethral suspension (adjp<0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp=0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance. CONCLUSIONS: The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival.
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Procedimentos Cirúrgicos Robóticos , Incontinência Urinária , Masculino , Humanos , Próstata , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Incontinência Urinária/etiologia , Prognóstico , Estudos Prospectivos , Prostatectomia/métodosRESUMO
To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.
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Neoplasias da Próstata , Urologia , Masculino , Humanos , Antagonistas de Androgênios , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , HormôniosRESUMO
INTRODUCTION AND OBJECTIVE: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL. MATERIAL AND METHODS: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations. RESULTS: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed. CONCLUSIONS: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations.
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Neoplasias de Próstata Resistentes à Castração , Antagonistas de Androgênios , Humanos , Masculino , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Qualidade de Vida , Resultado do TratamentoRESUMO
INTRODUCTION AND OBJECTIVES: Nivolumab is an immunotherapy agent that has been an approved treatment for previously treated patients with advanced renal cell carcinoma (RCC). Experience in real-life settings, especially regarding immune- related adverse events, is scarce. We present our experience with reference to the safety of nivolumab in patients with metastatic RCC (mRCC) treated in 9 hospitals in Spain. MATERIAL AND METHODS: Retrospective, multicentre study of patients with mRCC treated with nivolumab between 2016 and 2018. Data on baseline socio-demographic and clinical characteristics and drug-related adverse events were collected. RESULTS: The mean age of the 26 patients included was 63.7±11.5 years; 96% were ECOG 0-1 and 78% had favourable or intermediate MSKCC risk scores; 73% had the clear cell histological subtype and 30% metastatic disease. Median follow-up was 9 months (range 1-14). All patients experienced an adverse event at different grades, with fatigue, fever and anaemia being the most common (27%). Grade 3 adverse events occurred in 23% of patients. Adverse reactions led to treatment suspension in 3 patients (11%). CONCLUSION: In the real-life clinical setting, nivolumab shows favourable outcomes, similar to those reported by other studies.
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Antineoplásicos Imunológicos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Nivolumabe/uso terapêutico , Adulto , Idoso , Antineoplásicos Imunológicos/efeitos adversos , Carcinoma de Células Renais/secundário , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Nivolumabe/efeitos adversos , Estudos Retrospectivos , EspanhaRESUMO
Great social-health care changes in the short term have been predicted that will seriously affect the departmental structure and care hierarchy of future hospital, universitary, public or private. The Spanish Association of Urology (AEU) wondered whether in these circumstances, in which the welfare and economic management of the hospital so-called "industrial" will dominate over other traditional aspects of the scientific hierarchy, social welfare and teaching of head Urology of service, will change his image, goals, functions, and ultimately its authority. Likewise which must be the attributes of this new generation of department heads. To this end the AEU call a roundtable requesting opinions and comments which are reflected in the enclosed text.
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Diretores Médicos , Administração Hospitalar , EspanhaRESUMO
CONTEXT: Radium-223 is an â¡ -particle transmitter with specific action on bone metastases. The Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) study showed that radium-223 extended overall survival and delayed the onset of bone events in patients with symptomatic castration-resistant prostate cancer with bone metastases (mCRPC) and without visceral metastases, with a good safety profile. OBJECTIVE: To review the new scientific evidence on radium-223 based on prespecified and post-hoc analyses of the ALSYMPCA study and on early-access programs after the publication of the ALSYMPCA study, thereby providing new data on the management of patients with mCRPC. ACQUISITION OF EVIDENCE: We searched for evidence on PubMed and in the abstracts of international urology and oncology congresses, as well as ongoing clinical trials (ClinicalTrials.gov). SYNTHESIS OF THE EVIDENCE: The results of the reviewed studies offer promising results that will broaden the therapeutic benefits of radium-223 to patients with mild symptoms and those with no symptoms. The results also provide preliminary evidence on the benefit of radium-223 treatment after the failure of docetaxel, enzalutamide or abiraterone or the combination of radium-223 with these agents or other therapeutic agents such as bone-targeted agents and immunotherapy. CONCLUSION: Radium-223 can be a treatment option for patients with mild symptoms and can provide a therapeutic benefit after failure of currently available treatments or in combination with these treatments. This evidence should be corroborated in clinical trials before being added to clinical practice.
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Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias de Próstata Resistentes à Castração/patologia , Rádio (Elemento)/uso terapêutico , Humanos , MasculinoRESUMO
BACKGROUND: The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. METHODS: We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. RESULTS: There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DISCUSSION: Following the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. CONCLUSIONS: After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.
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BACKGROUND: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. MATERIAL AND METHODS: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. RESULTS: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) <48h, >48h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade1. There were no statistically significant differences between the strains. CONCLUSIONS: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed.
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Adjuvantes Imunológicos/uso terapêutico , Vacina BCG/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adjuvantes Imunológicos/efeitos adversos , Idoso , Vacina BCG/efeitos adversos , Humanos , Mycobacterium tuberculosis/classificação , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION AND OBJECTIVES: Patients after radical prostatectomy describe sexual dysfunctions such as orgasm-associated incontinence also termed climacturia. Our aim is to analyse incidence and data in relation with this symptom. METHODS: 119 phone surveys carried out to patients after radical prostatectomy to Know about climacturia incidence. We are trying to show the relationship between this symptom and the degree and type of incontinence, affectation at bladder neck and apex, and the age. RESULTS: The climacturia incidence came to 20%. The average age of the patients with this symptom was 59 years, the same as for those without it. The patients with both, incontinence and climacturia perform stress incontinence basically but urgency-incontinence to a greater extent (20%) that those with no climacturia (5%). Most patients with climacturia suffer a light leakage (87%) and a 62% always associated to orgasm. Negative effect of the symptom in the patient's and partner's sexual life appeared only in 2 cases (13%). CONCLUSIONS: We suggest the same term in Spanish than in English. Age and affectation of the bladder neck and apex do not have an effect on climacturia. Stress incontinence is more often related to patients with climacturia and the degree of incontinence is higher than in those without it.
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Orgasmo , Prostatectomia/efeitos adversos , Disfunções Sexuais Fisiológicas/etiologia , Incontinência Urinária/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/epidemiologia , Incontinência Urinária/epidemiologiaRESUMO
Clinico-pathological study of six patients with cerebral metastasis from vesical carcinoma with no prior administration of systemic chemotherapy. In two cases the symptoms of intracranial mass were the initial reason for infiltrant vesical carcinoma examination. Despite the rarity of such occurrence, the possibility of vesical tumours showing in such a way must be taken into account. The singularity of cerebral metastatic seeding throughout the natural history of a vesical neoplasia is analyzed. Also, a review is made of the factors hypothetically responsible for the increase of cerebral metastasis establishment following current chemotherapy.
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Neoplasias Encefálicas/secundário , Neoplasias da Bexiga Urinária/patologia , Idoso , Neoplasias Encefálicas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Neoplasias da Bexiga Urinária/tratamento farmacológicoRESUMO
We intend to approach the genitourinary and nephrological pathologies presented in our environment by patients with HIV infection. To this end we have carried out a retrospective study on a series of patients selected on the basis of follow-up possibility. A continuous history, recording a detailed clinical examination including repeated sampling and serological testing, would allow us to stress the relevance of hidden urological pathologies which these patients rarely complain about. Further studies with larger series are required to be able to establish a relationship between nephro-urological symptoms and the disease evolution parameters.
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Síndrome da Imunodeficiência Adquirida/epidemiologia , HIV , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Urinárias/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Comorbidade , Feminino , Hematúria/epidemiologia , Humanos , Incidência , Masculino , Proteinúria/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
The paper describes an unusual angiographic pattern within the context of stenosis of the pyeloureteral union and giant hydronephrosis of the adult, with a presumed congenital origin. From the embryonic point of view we discuss the remote possibility of this being a real "agenesis" of the renal artery with no agenesis of the kidney, irrigated by multiple segmental arteries following the characteristic metamerism of the mesonephros. On the other hand, it seems more consistent to explain such vascular pattern as an image of severe atrophy, in correlation with the hydronephrosis advanced stage, and not as a primary congenital defect. However, the interaction of both factors (congenital-malformative and acquired-involutive) could be more overlapped than what initially appears to be.
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Hidronefrose/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Adulto , Atrofia , Humanos , Hidronefrose/embriologia , Masculino , Mesonefro/irrigação sanguínea , Radiografia , Artéria Renal/anormalidades , Artéria Renal/embriologia , Artéria Renal/patologiaRESUMO
Confusion surrounding diagnosis of central prostate cysts is explained for the rarity of the condition. Deferento-vesiculography is diagnostic and must be performed independently (right-left) for a better anatomical evaluation of the area. The endoscopic images do not allow differential diagnosis from other prostate cysts. Recovery of bearer's fertile ability following endoscopic resection does not result, in our experience, as effective as it could be expected from resolving the obstructive cause.
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Cistos/diagnóstico , Ductos Ejaculatórios , Adulto , Cistos/terapia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
RATIONALE: To study sociodemographic characteristics and current diagnostic and therapeutic behaviour with Benign Prostate Hyperplasia (BPH) patients in Spain at the end of the 20th century. METHODS: Sociodemographic, clinical, therapeutic and quality of life (QoL) data from study ESECI-98, conducted in Spain (1998-1999) in patients with BPH. RESULTS: Nine hundred and forty nine patients were evaluable, with a mean (+/- SD) age of 65.6 (+/- 7.8) years, with concomitant diseases (40%), pain/discomfort (34%) and anxiety/depression (23%); QoL score (mean +/- SD) was 72.1 +/- 16.1 on a total possible score of 100. BPH diagnosis was based on symptoms (93%), digital rectal examination (93%) and abdomino-pelvic ultrasonography (76%). PSA was mentioned for the diagnosis of BPH in 54% of the patients and 77% were receiving pharmacological treatment (61% alpha-blockers) during less than 6 months (38%) or more than a year (35%). CONCLUSIONS: In this study the diagnosis of BPH was mainly based on symptoms, digital rectal examination and abdomino-pelvic ultrasonography. It is worth mentioning that PSA for the diagnosis of BPH, was used in a half of the total number of patients. Pharmacological therapy was used in 3 out of every 4 patients. Compared to a previous national study, there is a change on diagnosis and therapy of BPH.
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Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/epidemiologia , Idoso , Humanos , Masculino , Fatores Socioeconômicos , EspanhaRESUMO
Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p > 0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p < 0.05).
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Cefotaxima/economia , Cefotaxima/uso terapêutico , Ceftriaxona/economia , Ceftriaxona/uso terapêutico , Cefalosporinas/economia , Cefalosporinas/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células de Transição/tratamento farmacológico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma de Células de Transição/epidemiologia , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Terapia Combinada , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Epirubicina/administração & dosagem , Epirubicina/efeitos adversos , Humanos , Mitomicina/administração & dosagem , Mitomicina/efeitos adversos , Invasividade Neoplásica , Recidiva Local de Neoplasia/prevenção & controle , Guias de Prática Clínica como Assunto , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
OBJECTIVE: Radical cystectomy with urinary diversion is a procedure in which a reduction of morbidity, quick postoperative rehabilitation, limited length of stay and cost containment are difficult to achieve. Postoperative ileus has been identified as the most common cause of delayed recovery and prolonged length of stay. With our review, we try to establish the main causes. MATERIAL AND METHODS: A total of 154 patients underwent radical cystectomy from 1990 to 2008. We examined demographic and perioperative variables of the patients who did and did not develop ileus. RESULTS: No significant association was found between ileus and all the factors we studied. CONCLUSIONS: Postoperative ileus stands out as one of the most frequent complications that causes increased length of stay. More detailed studies are required to determine perioperative regimens to reduce this complication.