Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

Purpose: To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa). Materials and Methods: From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year. Results: Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy , the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13 percent; pT2b: 34 percent; pT2c: 27 percent; pT3a: 13 percent; and pT3b: 13 percent. Bleeding > 600 mL occurred in 14 percent of the cases; urethral stenosis in 50 percent; and urinary incontinence (two or more pads/day) in 72 percent. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months. Conclusions: SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.

The unusual and potentially fatal growing teratoma syndrome

Objective: Growing teratoma syndrome consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells and normalization of the tumor markers. They can metastasize to any site, particularly the retroperitoneum, mediastinum and cervical region. Here we report our experience with this rare syndrome and stress the need for early recognition and treatment to avoid the subsequent morbidity and mortality associated with it. Patients and Methods: We reviewed the hospital records of patients suffering from testicular tumors with retroperitoneal metastasis treated at our hospital between January 2002 and December 2006. We included those who underwent radical orchiectomy, followed by chemotherapy and retroperitoneal lymphadenectomy for persistence of post-treatment large tumor, but whose tumor markers had normalized. Results: In this period, fourteen patients underwent retroperitoneal lymphadenectomy for persistence of tumor masses and normalization of tumor markers. Of these, the result of the anatomo-pathological examination was teratoma in six cases. Two of these patients evolved poorly and died from the disease; one because we were unable to fully remove the lesion, with subsequent renal insufficiency from bilateral ureteral obstruction and colonic obstruction with sepsis and the other due to cachexia because of the impossibility of removing the cervical and thoracic masses. Conclusions: Patients suffering from growing teratoma syndrome need to be recognized and treated surgically as soon as possible to avoid the negative consequences of morbidity and death, as occurred in two of our patients.

Evaluation of urogenital fistulas by magnetic resonance urography / Avaliação das fístulas urogenitais por urorressonância magnética

OBJETIVO: As fístulas vesicovaginais e ureterovaginais são complicações incomuns, secundárias a doenças ou a cirurgias pélvicas. O sucesso terapêutico dessas fístulas depende de adequada avaliação pré-operatória para o diagnóstico e visualização do seu trajeto. Este trabalho tem o objetivo de demonstrar o potencial da urorressonância no diagnóstico das fístulas urogenitais e na visualização dos seus trajetos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os prontuários médicos e as imagens radiológicas e de urorressonância magnética de sete pacientes do sexo feminino com diagnóstico de fístula urogenital. Para a urorressonância foram realizadas seqüências 3D-HASTE com saturação de gordura. RESULTADOS: Seis pacientes apresentavam fístula vesicovaginal e uma paciente tinha diagnóstico de fístula ureterovaginal à direita. Com a utilização da urorressonância magnética, foi possível demonstrar o trajeto da fístula em seis das sete pacientes (85,7 por cento), sem a necessidade de cateterização vesical ou da injeção de contraste. CONCLUSÃO: Este estudo demonstra o potencial e a aplicabilidade da urorressonância na avaliação dessas fístulas.

OBJECTIVE: Vesicovaginal and ureterovaginal fistulas are unusual complications secondary to pelvic surgery or pelvic diseases. The therapeutic success in these cases depends on an appropriate preoperative evaluation for diagnosis and visualization of the fistulous tract. The present study is aimed at demonstrating the potential of magnetic resonance urography for the diagnosis of vesicovaginal and ureterovaginal fistulas as well as for defining the fistulous tracts. MATERIALS AND METHODS: Seven female patients clinically diagnosed with vesicovaginal or ureterovaginal fistulas had their medical records, radiological and magnetic resonance images retrospectively reviewed. Magnetic resonance urography included 3D-HASTE sequences with fat saturation. RESULTS: Six patients presented vesicovaginal fistulas and, in one patient, a right-sided ureterovaginal fistula was diagnosed. Magnetic resonance urography allowed the demonstration of the fistulous tract in six (85.7 percent) of the seven patients evaluated in the present study, without the need of bladder catheterization or contrast injection. CONCLUSION: This study demonstrates both the potential and applicability of magnetic resonance urography in the evaluation of these types of fistulas.

Scrotal neoplasia: would truck drivers be at greater risk?

OBJECTIVE: To analyze how scrotal neoplasias have been managed during the past decade and to question possible factors or professions associated to its presence. MATERIALS AND METHODS: We retrospectively evaluated every case reported from 1995 to 2005 at our hospital. We described the clinical scenario, complementary exams, treatments and outcomes. We also tried to verify if there was any risk, predisposing factors or professions that would explain the cancer origin. RESULTS: Six cases were reviewed. Out of these, three patients were truck drivers. Five of them showed restricted lesions without inguinal lymph nodes enlargement. Histologically, six patients presented squamous carcinoma, with two of them having the verrucous type. The median age of patients was 52 years old (31 to 89). The five patients who are still alive had their lesions completely removed with safety margin and primary closure. CONCLUSIONS: We have noticed that the scrotal carcinoma behavior is similar to that of the penis, where removal of the lesion and study of the regional lymph nodes help to increase the patient survival rate. The outstanding fact was that three out of six patients were truck drivers, raising the hypothesis that such profession, maybe due to the contact or attrition with the diesel exhaust expelled by the engine or to sexual promiscuity, would imply in a larger risk of developing this rare neoplasia.

Desenvolvimento e validaçäo de programa multimídia aplicado ao ensino do câncer da próstata / Development and validation of multimedia program applied to teach prostate cancer

O modelo atual de ensino médico em nível de graduação está em debate, já que os níveis de retenção de conhecimento e o interesse dos alunos parecem estar declinando nos últimos anos. Para entender melhor esse o fenômeno, desenvolvemos um programa multimídia sobre câncer da próstata com a intenção de avaliar o seu papel como um instrumento de ensino da Urologia em nível de graduação. Sessenta estudantes do terceiro ano médico foram divididos em dois grupos: Grupo I, com 31 estudantes, que foram expostos ao programa multimídia sobre câncer da próstata; Grupo II, com 29 alunos, que assistiram a uma aula expositiva sobre o mesmo assunto. No final, o nível de aquisição de conhecimento de ambos os grupos foi avaliado através de uma prova com testes de múltipla escolha. Adicionalmente, os componentes do Grupo I responderam a um questionário sobre suas opiniões no ensino baseado na informática. As notas obtidas pelos membros dos Grupos I e II foram similares (60 por cento versus 62 por cento, p>O,O5). Por outro lado, a maioria dos estudantes (23/31) expostos ao programa multimídia, mencionaram que o professor não pode ser substituído pelo programa e que a interação com o professor ainda é relevante. De acordo com os dados do presente estudo, programas multimídia já podem ser utilizados como instrumento de ensino de graduação em Medicina, desde que adicionalmente seja oferecido um contato com o professor

Prevalência de infartos renais em necropsias de chagásicos crônicos / Prevalence of renal infarction in necropsies of chronic chagasic patients

Renal infarction (RI) is usually secondary to arterial obstruction due to emboli originating from the heart. Chronic chagasic patients may present cardiac alterations originating from intracavitary thrombi, even without congestive heart failure (CHF). In this study RI incidence was comparatively evaluated in chronic chagasic individuals, in different anatomoclinic forms and in non chagasic individuals. There has been a review on necropsy reports of individuals aged 20 or over. In 259 necropsies, 78 (30.1 per cent) were chagasics, and 19 of them (24.4 per cent) developed RI, while 27 (15.0 per cent) of the non chagasic individuals presented RI. The ages of chagasics with RI were similar to those of non chagasic individuals. A significant prevalence of RI and thrombosis among chronic chagasic individuals has been found. A significantly higher prevalence of RI among chronic chagasics having CHF (52.6 per cent) was observed when they were compared to other forms of chronic Chagas disease and when compared to non chagasic individuals. It was concluded that RI was more frequent in chronic chagasic individuals, specially those who developed CHF, which probably played a role in the renal manifestations and systemic hemodynamic changes in those patients.