Desarrollo e implementación de una unidad de inmunoterapia en un servicio de urología / Development and implementation of an immunotherapy unit in a urology department

Introducción La inmunoterapia está revolucionando el tratamiento del cáncer, siendo los anticuerpos monoclonales dirigidos contra moléculas reguladoras del punto de control la terapia más ampliamente utilizada en la actualidad. Un total de seis fármacos inhibidores del punto de control inmunitario (CPI) han sido aprobados por la U.S. Food and Drug Administration (FDA) y por la European Medicines Agency (EMA) para su uso en diversos tumores sólidos del aparato genitourinario. Material y métodos Se revisó la literatura y se analizó la metodología y experiencia propia adquirida para instaurar el tratamiento con CPI en un servicio de Urología. Resultados Se describen los requisitos recomendables desde el punto de vista formativo, logístico y procedimental para implementar una unidad de inmunoterapia en un servicio de Urología que permita ofrecer con seguridad el tratamiento experto con CPI a los pacientes con tumores genitourinarios. Conclusiones El cumplimiento del programa propuesto garantiza la administración segura de CPI en un entorno hospitalario (AU)

Introduction Immunotherapy is revolutionizing cancer treatment, with monoclonal antibodies directed against checkpoint regulatory molecules currently being the most widely used therapy. A total of six immune checkpoint inhibitor (CPI) drugs have been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for use in various solid tumors of the genitourinary tract. Material and methods the literature is reviewed and the methodology, as well as our own experience, are analyzed to establish treatment with CPI in a urology department. Results The requirements recommended in terms of training, logistics and procedure are described in order to safely offer expert treatment with CPI to patients with genitourinary tumors. Conclusions Compliance with the proposed program ensures safe administration of immune checkpoint inhibitors in a hospital setting (AU)

Development and implementation of an immunotherapy unit in a urology department.

INTRODUCTION: Immunotherapy is revolutionizing cancer treatment, with monoclonal antibodies directed against checkpoint regulatory molecules currently being the most widely used therapy. A total of six immune checkpoint inhibitor (CPI) drugs have been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for use in various solid tumors of the genitourinary tract. MATERIAL AND METHODS: The literature is reviewed and the methodology, as well as our own experience, are analyzed to establish treatment with CPIs in a urology department. RESULTS: The requirements recommended in terms of training, logistics and procedure are described in order to safely offer expert treatment with CPIs to patients with genitourinary tumors. CONCLUSIONS: Compliance with the proposed program ensures safe administration of immune checkpoint inhibitors in a hospital setting.

[Radiofrequency ablation as an alternative treatment for organ confined renal tumor]. / Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado.

INTRODUCTION: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complications. MATERIAL AND METHODS: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3 cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter. RESULTS: 11 tumors, 9 patients. The mean age was 76 years (63-85 years). The average tumor size was 3.5 cm (2.2-5.8 cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3-52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. CONCLUSIONS: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate.

Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado / Radiofrequency ablation as an alternative treatment for organ confined renal tumor

Introducción: Presentamos nuestra serie inicial de tumores renales tratados mediante radiofrecuencia (RF) continua percutánea y evaluamos la eficacia, la tolerabilidad y las complicaciones de la técnica. Material y métodos: Revisión retrospectiva de los pacientes tratados en nuestro hospital con RF renal ecoguiada. Todos diagnosticados de tumor renal y no candidatos a cirugía por tumor bilateral, comorbilidad importante o rechazo al tratamiento quirúrgico. Utilizamos un generador Amitech® de 220W con una punta de electrodo de 3 cm, agujas de punta recta y en gancho. Los controles fueron realizados mediante una tomografía computarizada toracoabdominopélvica a las 24h, a los 7 días, al mes, a los 3 meses y a los 6 meses, y cada 6 meses después. Resultados: Se hallaron 11 tumores en 9 pacientes. La media de edad fue de 76 años (63–85). La media de tamaño tumoral fue de 3,5cm (2,2–5,8). En 2 tumores se necesitó de quimioembolización previa y en otros dos se necesitó una nueva sesión de RF. Hubo 9 tumores con tratamiento considerado como eficaz. La media de seguimiento fue de 17,5 meses (3–52). Un paciente tuvo persistencia de enfermedad a los 3 meses con necesidad de nefrectomía radical laparoscópica y otros dos tuvieron metástasis pulmonares a los 26,5 meses de media. No hubo complicaciones relevantes clínicamente. Conclusiones: En nuestra experiencia, estimamos que la RF es un tratamiento considerado como una alternativa para los tumores renales de estadio clínico T1 o T2 muy sintomáticos, en pacientes en los que no es posible la cirugía, con unos resultados aceptables a medio plazo, una buena tolerancia, un escaso consumo de recursos hospitalarios y un bajo índice de complicaciones (AU)

Introduction: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complicactions. Material and methods: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter.Results11 tumors, 9 patients. The mean age was 76 years (63–85 years). The average tumor size was 3.5cm (2,2–5,8cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3–52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. Conclusions: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate (AU)

[Malignant fibrous histiocytoma of the bladder. A literature review]. / Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica.

OBJECTIVES: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. MATERIALS AND METHODS: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. RESULTS: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. CONCLUSIONS: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy.

Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica / Malignant fibrous histiocytoma of the bladder. A literature review

Objetivos: El histiocitoma fibroso maligno (HFM) es un tumor poco frecuente del tracto urinario. Pretendemos actualizar los criterios diagnósticos, las características anatomopatológicas e inmunohistoquímicas, la clasificación histológica, los factores pronóstico y las alternativas terapéuticas. Material y métodos: Revisión bibliográfica y estudio descriptivo de los casos de HFM de vejiga publicados en la literatura médica internacional. Resultados: Existen 29 casos publicados de HFM de vejiga y las variantes morfológicas más frecuentes son la estoriforme-fascicular (41%) y la inflamatoria (36%). Las variantes no mixoides comportan peor pronóstico. El 72% fue T3 en el momento del diagnóstico. La tasa de recurrencia local y a distancia del HFM de vejiga fue del 50 y del 25%, respectivamente, tras tratamiento exclusivamente quirúrgico. Conclusiones: El HFM de vejiga es un tumor con alta tasa de recurrencia local y a distancia, así como baja supervivencia, requiriendo un tratamiento precoz y agresivo. La cistectomía radical con linfadenectomía y radioterapia adyuvante, con eventual quimioterapia, se considera el tratamiento de elección (AU)

Objectives: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. Materials and methods: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. Results: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. Conclusions: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy (AU)

Sintomatología obstructiva en mujer joven por hidrosalpinx izquierdo / Obstructive symptopms in young woman by left hydrosalpins

Se describe el caso de una mujer de 43 años con sintomatología de llenado y vaciado tras realización de histerectomía con estudio urodinámico compatible con obstrucción infravesical. Se diagnosticó un hidrosalpinx izquierdo que fue tratado quirúrgicamente tras el cual la paciente quedo asintomática (AU)

We describe the case of a 43 years old woman with obstructive and irritative symptoms after having an hysterectomy. Bladder outlet obstruction was observed in an urodinamyc study. She was later diagnosed with left hidrosalpinx. Salpingectomy was performed, as a result all symptoms have disappear (AU)

[Indications, results and techniques of permanent prostate brachytherapy for localized prostate cancer]. / Braquiterapia de baja tasa en el tratamiento del cáncer de próstata localizado.

INTRODUCTION AND OBJECTIVE: Prostate brachytherapy is a first-line therapeutic approach for localized prostate cancer in selected patients. We present our experience in brachytherapy and a thorough review of the literature. MATERIALS AND METHODS: A review of the literature and evaluation of patient's selection was done. Furthermore the implantation technique, oncological results according to the different risk groups and acute and chronic complications were also analyzed. RESULTS: The biochemical relapse-free 10 year survival rate was 87-96% in low risk tumours and 63-86% in intermediate risk tumours. A total of 3-24% underwent urinary retention that required TURP in 0-8,7%. Other complications were urinary incontinence in 0-6,7%, proctitis in 0-15,5%, erectile dysfunction in 6,3-30%, rectal ulcer/fistula in 0-5,4%. CONCLUSIONS: Prostate brachytherapy is a safe and effective treatment in low and intermediate risk patients with prostate cancer.

[Spontaneous retroperitoneal hemorrhage: our experience at last 10 years]. / Hemorragia retroperitoneal espontánea: nuestra experiencia en los ultimos 10 años.

INTRODUCTION AND OBJECTIVES: Etiology, clinical features, diagnostic methods and treatment of spontaneous retroperitoneal hemorrhage were analyzed. METHODS: We report 27 cases with diagnosis of spontaneous retroperitoneal hemorrhage treated in our hospital between January 1996 and December 2005. The imaging techniques were abdominal ultrasonography, abdominal CT scan and MRI. RESULTS: The most common cause of retroperitoneal hemorrhage was renal angiomyolipoma rupture in 7 patients. Continuous flank or abdominal pain were the primary symptoms. Abdominal ultrasonography showed hematoma in 81.8% patients, but the actual etiologic diagnosis was ascertained in only 40.9% of them. Retroperitoneal hemorrhage was demonstrated by means of abdominal CT scan in all cases and bleeding origin was established in 92.6% of cases. Ten patients underwent urgent surgery while conservative treatment was attempted in the remaining 17. CONCLUSIONS: In our experience, in cases of spontaneous retroperitoneal hemorrhage, CT scan is the best imaging method to establish the diagnosis and the management of such entity although it will need to be individualized for every case because it depends on the hemodinamic situation and etiologic diagnosis.

[Retroperitoneal malignant fibrous histiocytoma with contiguous organs infiltration]. / Histiocitoma fibroso maligno retroperitoneal con infiltración de organos vecinos.

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed.

Braquiterapia de baja tasa en el tratamiento del cáncer de próstata localizado / Indications, results and techniques of permanent prostate brachitherapy for localized prostate cancer

Introducción y Objetivo: La braquiterapia prostática se ha consolidado en los últimos años como tratamiento de primera línea en pacientes seleccionados con cáncer de próstata localizado. Pretendemos realizar una actualización del tema. Material y Métodos: Revisión bibliográfica de las principales series publicadas analizando, indicaciones (selección de pacientes), las diferentes técnicas de implantación, los resultados oncológicos en función de grupos de riesgo y las complicaciones agudas y crónicas. Resultados: La supervivencia libre de recaída bioquímica fue del 87-96% a 10 años en tumores de bajo riesgo y del 63-86% a 10 años en tumores de riesgo intermedio. Las principales complicaciones fueron la retención urinaria en el 3-24%, necesitando RTU de próstata en 0-8,7%, la incontinencia urinaria en el 0-6,7%, proctitis en 0- 15,5%, disfunción eréctil en 6,3-30%, úlceras/fístulas rectales en 0-5,4%. Conclusiones: La braquiterapia prostática constituye una alternativa terapéutica en el cáncer de próstata localizado de bajo riesgo y en pacientes seleccionados de riesgo intermedio, con escasas complicaciones y una aceptable tasa de control bioquímico

Introduction and Objective: Prostate brachytherapy is a first-line therapeutic approach for localized prostate cancer in selected patients. We present our experience in brachytherapy and a thorough review of the literature. Materials and Methods: A review of the literature and evaluation of patient’s selection was done. Furthermore the implantation technique, oncological results according to the different risk groups and acute and chronic complications were also analyzed. Results: The biochemical relapse-free 10 year survival rate was 87-96% in low risk tumours and 63-86% in intermediate risk tumours. A total of 3-24% underwent urinary retention that required TURP in 0-8,7%. Other complications were urinary incontinence in 0-6,7%, proctitis in 0-15,5%, erectile dysfunction in 6,3-30%, rectal ulcer/fistula in 0-5,4%. Conclusions: Prostate brachytherapy is a safe and effective treatment in low and intermediate risk patients with prostate cancer

Hemorragia retroperitoneal espontánea: nuestra experiencia en los últimos 10 años / Spontaneous retroperitoneal hemorrhage: our experience at last 10 years

Introducción y Objetivos: El análisis de la etiología, manifestaciones clínicas, métodos diagnósticos y tratamiento empleado en la hemorragia retroperitoneal espontánea (HRE), en nuestra serie de pacientes. Métodos: Presentamos 27 casos de HRE diagnosticados en nuestro hospital entre Enero de 1996 y Diciembre de 2005. Las técnicas de imagen empleadas fueron ecografía abdominal, TC abdomino-pélvica y resonancia magnética. Resultados: La causa más frecuente de sangrado fue la rotura de un angiomiolipoma renal en 7 pacientes. Entre las manifestaciones clínicas, el dolor lumbar o abdominal fue el síntoma predominante. La ecografía abdominal detectó el hematoma en el 81,8% de pacientes, aportando un diagnóstico etiológico en tan sólo el 40,9% de los casos. La TC abdomino-pélvica reveló la hemorragia retroperitoneal en todos casos, y además diagnosticó en el 92,6%, el origen del sangrado. El tratamiento fue cirugía de urgencia en 10 pacientes, mientras que en los 17 restantes se optó, inicialmente, por medidas terapéuticas conservadoras. Conclusiones: En nuestra experiencia, en los casos de HRE, la TC abdomino-pélvica es la prueba diagnóstica de elección y el manejo terapéutico de esta patología deberá individualizarse en función de la situación hemodinámica del paciente y la etiología del síndrome

Introduction and Objectives: Etiology, clinical features, diagnostic methods and treatment of spontaneous retroperitoneal hemorrhage were analyzed. Methods: We report 27 cases with diagnosis of spontaneous retroperitoneal hemorrhage treated in our hospital between January 1996 and December 2005. The imaging techniques were abdominal ultrasonography, abdominal CT scan and MRI. Results: The most common cause of retroperitoneal hemorrhage was renal angiomyolipoma rupture in 7 patients. Continuous flank or abdominal pain were the primary symptoms. Abdominal ultrasonography showed hematoma in 81.8% patients, but the actual etiologic diagnosis was ascertained in only 40.9% of them. Retroperitoneal hemorrhage was demonstrated by means of abdominal CT scan in all cases and bleeding origin was established in 92.6% of cases. Ten patients underwent urgent surgery while conservative treatment was attempted in the remaining 17. Conclusions: In our experience, in cases of spontaneous retroperitoneal hemorrhage, CT scan is the best imaging method to establish the diagnosis and the management of such entity although it will need to be individualized for every case because it depends on the hemodinamic situation and etiologic diagnosis

Histiocitoma fibroso maligno retroperitoneal con infiltración de órganos vecinos / Retroperitoneal malignant fibrous histiocytoma with contiguous organs infiltration

Los tumores retroperitoneales primarios son neoformaciones extremadamente raras, de naturaleza maligna en la mayoría de los casos. Presentamos el caso de un varón de 48 años con una gran masa retroperitoneal detectada durante el estudio de un síndrome constitucional. La masa fue tratada quirúrgicamente y el diagnóstico anatomopatológico fue de histiocitoma fibroso maligno. Realizamos una revisión de la literatura y analizamos su presentación clínica, hallazgos histológicos, pruebas diagnósticas de imagen y manejo terapéutico

Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed

[Yield diagnosis of the peripheral cores in 10 needle extended prostate biopsy]. / Rentabilidad diagnóstica de los cilindros de los cuernos laterales en las biopsias prostáticas ampliadas a 10 muestras.

OBJECTIVE: To value if the increase in the number of cylinders in the prostate's biopsy raise the diagnostic performance of this test. MATERIAL AND METHOD: In March 2005 we initiate this prospective study with patients who are subject to a first prostate Biopsy by a PSA between 4 and 10 ng/ml and negative rectal touch. Transrectal, echodirected prostatic biopsies with ten punctures are carried out according to the following programme as follows: 6 Biopsies according to classic sextant technique, to what we add 4 cylinders from the most lateral zones of the prostate (lateral horns). The variables are analyzed: Age, Total PSA, Free PSA/Total PSA, prostatic volume and PSA density. RESULTS: We value 90 patients consecutively. Prostatic adenocarcinoma was diagnosed to 37 of the 90 patients, which means that the diagnostic rate of the extended Biopsy reached a 41%. Nevertheless, the rate for the classic sextant Biopsy was 32.3%. These differences are statistically significant (Mcnemar test 0.008); besides, this supposes a 27% increase in the diagnostic rentability. The "extra" cylinders in the lateral horns detected 8 tumours which were not detected in the cylinders of the the sextant, and 5 of them presented a Gleason higher or equal to 6. CONCLUSIONS: In our centre we think that the Biopsy extended to 10 cylinders is an adequate strategy for potential prostatic adenocarcinoma patients who are going to be subject to their first Biopsy. Realizing the clinic relevance of the tumours diagnosed thanks to "extra" cylinders, we do not think that this modality implies an over-diagnosis and consequently an overtreatment of the prostate cancer.

Rentabilidad diagnóstica de los cilindros de los cuernos laterales en las biopsias prostáticas ampliadas a 10 muestras / Yield diagnosis of the peripheral cores in 10 needle extended prostate biopsy

Objetivo: Valorar si el aumento del número de cilindros en la biopsia de próstata incrementa el rendimiento diagnóstico de esta prueba. Material y método: En marzo del 2005 iniciamos este estudio prospectivo pacientes que son sometidos a una primera biopsia de próstata por un PSA entre 4 y 10 ng/ml y tacto rectal negativo. Se les lleva a cabo una biopsia prostática transrectal ecodirigida con 10 punciones según el siguiente esquema: 6 biopsias según la técnica sextante clásica, a los que añadimos 4 cilindros de las zonas más laterales de la próstata (cuernos laterales). Se analizan las variables: Edad, PSA total, PSA libre/PSA total, volumen prostático y PSA densidad. Resultados: Valoramos 90 pacientes consecutivos. Se diagnosticó adenocarcinoma prostático a 37 de los 90 pacientes, es decir, la tasa diagnóstica de la biopsia ampliada alcanzó el 41%. Sin embargo, la de la sextante clásica fue del 32,2%. Estas diferencias fueron estadísticamente significativas (test de Mcnemar 0,008); además esto supone un aumento en la rentabilidad diagnóstica del 27%. Los cilindros 'extra' en los cuernos laterales detectaron 8 tumores que no eran objetivados en los cilindros de la sextante, y 5 de ellos presentaban un Gleason mayor o igual a 6. Conclusiones: En nuestro centro, pensamos que la biopsia ampliada a 10 cilindros es una estrategia adecuada para los pacientes con sospecha de adenocarcinoma prostático que van a ser sometidos a su primera biopsia. Teniendo en cuenta la relevancia clínica de tumores dianosticados gracias a los cilindros 'extra'. No creemos que esta modalidad implique un sobrediagnóstico y consecuente sobretratamiento del cáncer de próstata

Objective: To value if the increase in the number of cylinders in the prostate´s biopsy raise the diagnostic performance of this test. Material and Method: In March 2005 we initiate this prospective study with patients who are subject to a first prostate Biopsy by a PSA between 4 and 10 ng/ml and negative rectal touch. Transrectal, echodirected prostatic biopsies with ten punctures are carried out according to the following programme as follows: 6 Biopsies according to classic sextant technique, to what we add 4 cylinders from the most lateral zones of the prostate (lateral horns). The variables are analyzed: Age, Total PSA, Free PSA/Total PSA, prostatic volume and PSA density. Results: We value 90 patients consecutively. Prostatic adenocarcinoma was diagnosed to 37 of the 90 patients, which means that the diagnostic rate of the extended Biopsy reached a 41 %. Nevertheless, the rate for the classic sextant Biopsy was 32.3 %. These differences are statistically significant (Mcnemar test 0,008); besides, this supposes a 27% increase in the diagnostic rentability. The 'extra' cylinders in the lateral horns detected 8 tumours which were not detected in the cylinders of the the sextant, and 5 of them presented a Gleason higher or equal to 6. Conclusions: In our centre we think that the Biopsy extended to 10 cylinders is an adequate strategy for potential prostatic adenocarcinoma patients who are going to be subject to their first Biopsy. Realizing the clinic relevance of the tumours diagnosed thanks to 'extra' cylinders, we do not think that this modality implies an overdiagnosis and consequently an overtreatment of the prostate cancer

[Comparative study between tobramicin and tobramicin plus ciprofloxacin in transrectal prostate biopsy prophylaxis]. / Estudio comparativo entre tobramicina y tobramicina más ciprofloxacino como profilaxis para la biopsia transrectal de próstata.

INTRODUCTION AND OBJECTIVES: To compare the efficacy of tobramicin and tobramicin + ciprofloxacin for prevention of transrectal prostatic biopsy infectious complications. We revised our complications, microorganism most common in the infectious complications, and their sensibility. MATERIAL AND METHODS: Prospective and randomized study in 153 patients with 157 prostatic biopsies. The 71 patients in group A were treated with intramuscular tobramicin 100 mg, one dose 30 minutes before biopsy and another one 8 hours afterwards. The 85 patients in group B were treated with the same tobramicin doses and oral ciprofloxacin 500 mg, one dose 30 minutes before biopsy and afterwards they continue with the ciprofloxacin every 12 hours during 3 days. RESULTS: we did 71 biopsies in group A and 86 in group B. 50 (31,8%) patients had hematuria, 20 (12,7%) fever, 15 (9,5%) hemospermia, 7 (4,4%) perineal pain, one (1,2%) orchiepididymitis and another one (1,2%) urinary retention. The patients who had fever were 15 of the group A and 5 of the group B (p=0,004). A total of 15 (21,1%) patients with fever of the group A needed to be treated in the hospital and 3 patients (3,5%) of the group B (p=0,0006). E. coli growthed in 67% of the blood cultures and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins were the antibiotics more eficacious. CONCLUSIONS: Prophylaxis scheme with tobramicin plus ciprofloxacin was more efficacy that tobramicina alone in transrectal prostatic biopsy. Hematuria was the most common complication. E. coli was the microorganism most frequent in infectious complications after prostatic biopsy and amoxicillin-clavulanic, tobramicin and third generation of cephalosporins the most effective antibiotics in our hospital.