ABSTRACT
Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy is the current standard of care for muscle-invasive bladder cancer (MIBC). However, less than half of patients are candidates for this treatment, and 50% will develop metastatic disease. Adjuvant chemotherapy could be offered if neoadjuvant treatment has not been administered for suitable patients. It is important to reduce the risk of systemic recurrence and improve the prognosis of localized MIBC. Systemic therapy for metastatic urothelial carcinoma has evolved in recent years. Immune checkpoint inhibitors and targeted agents, such as antibody-drug conjugates or FGFR inhibitors, are new therapeutic alternatives and have shown their benefit in advanced disease. Currently, several clinical trials are investigating the role of these drugs, as monotherapy and in combination with chemotherapy, in the neoadjuvant and adjuvant settings with promising outcomes. In addition, the development of predictive biomarkers could predict responses to neoadjuvant therapies.
ABSTRACT
Metastatic urothelial carcinoma (mUC) is an incurable and aggressive disease. In the past decades there have been few effective treatment options that have impacted the prognosis of mUC patients. However, in the last few years, several drugs have emerged as new treatment choices that are changing the therapeutic landscape of mUC. Immune checkpoint inhibitors (ICIs) and targeted agents are useful treatment strategies that have been incorporated into our clinical practice. Nevertheless, cisplatin-based chemotherapy is still the standard of care in the first-line of metastatic disease. The results of the JAVELIN Bladder 100 phase 3 trial were presented at ASCO 2020, this trial evaluated the role of avelumab, an ICI, as maintenance therapy in patients who had not progressed after first-line platinum-based chemotherapy. The trial met its primary endpoint demonstrating an overall survival benefit with avelumab maintenance. In addition, new drugs and combinations are being evaluated to improve the outcomes of second and subsequent lines. Fibroblast growth factor receptor (FGFR) inhibitors and immunotherapy combinations were some of the strategies presented at ASCO 2020 that have shown promising results. Finally, the development of predictive biomarkers that help us in the decision-making process will be one of the most important challenges in the next years.
ABSTRACT
OBJECTIVE: To report a new case of bladder hernia. We reviewed the clinical features, diagnosis and treatment of this disease. METHODS: Case report of a patient diagnosed with bladder hernia. RESULTS: We expose the clinical picture and the most common form of diagnosis and the more effective treatment. CONCLUSIONS: Bladder hernia is rare disorder that is diagnosed clinically and whose treatment is surgical, with very good results.
Subject(s)
Hernia/therapy , Urinary Bladder Diseases/therapy , Hernia/diagnosis , Herniorrhaphy , Humans , Male , Middle Aged , Surgical Mesh , Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/surgery , Urologic Surgical ProceduresABSTRACT
OBJETIVO: Aportar un nuevo caso de hernia vesical. Revisamos los aspectos clínicos, diagnósticos y terapéuticos de este tipo de patología.MÉTODOS: Caso clínico de un paciente diagnosticado de hernia vesical.RESULTADO: Exponer la clínica más frecuente así como la forma de diagnóstico y tratamiento más efectiva.CONCLUSIONES: La hernia vesical es una patología poco frecuente que se diagnostica de forma clínica y cuyo tratamiento de elección es quirúrgico, con muy buenos resultados(AU)
OBJECTIVE: To report a new case of bladder hernia. We reviewed the clinical features, diagnosis and treatment of this disease.METHODS: Case report of a patient diagnosed with bladder hernia.RESULTS: We expose the clinical picture and the most common form of diagnosis and the more effective treatment.CONCLUSIONS: Bladder hernia is rare disorder that is diagnosed clinically and whose treatment is surgical, with very good results(AU)
Subject(s)
Humans , Cystocele/diagnosis , Diagnostic Imaging/methods , Cystocele/surgeryABSTRACT
La relación entre los síntomas del tracto urinario inferior (STUI) y la disfunción eréctil (DE) es el resultado de su mayor asociación en edades avanzadas. Sin embargo, varias investigaciones demuestran que los síntomas urinarios se relacionan en forma independiente con disfunción sexual y menor satisfacción. Asimismo, la gravedad de los STUI se correlaciona con la magnitud de la disfunción sexual en todos los grupos etarios, lo cual sugiere una posible relación causal.Una serie de hipótesis se han formulado para explicar la existencia de una fisiopatología común entre STUI y DE. En la actualidad, esta relación entre STUI y DE está apoyada por cuatro teorías, no mutuamente excluyentes, que incluyen (a) la hiperactividad autonómica y la hipótesis de síndrome metabólico, (b) los cambios en la sintetasa de óxido nítrico / óxido nítrico (NOS / NO) de la vía guanina monofosfatasa en la próstata y el pene, (c) la activación de Rho-kinasa y la vía de la endotelina, y (d) las consecuencias fisiopatológicas de la aterosclerosis pélvica.Dada la contribución del funcionamiento sexual en el mantenimiento de la calidad de vida, en la elección del tratamiento para el paciente con hiperplasia prostática benigna deben tomarse en cuenta los posibles efectos negativos sobre la función sexual.El enfoque terapéutico combinado de estas dos entidades (DE y STUI) provoca un beneficio sobre el paciente tanto en la sintomatología urinaria como en la esfera sexual, aunque se precisan estudios controlados con placebo para confirmar estos datos y dilucidar el papel de la terapia de combinación para el tratamiento de estas dos condiciones(AU)
The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is the result of their greater association in advanced age. Nevertheless, several investigations show that urinary tract symptoms have an independent relationship with sexual dysfunction and lower satisfaction. Likewise, the severity of LUTS correlates with the magnitude of sexual dysfunction in all age groups, which suggests a possible causal relationship.A series of hypothesis have been posed to explain the existence of a common physiopathology for LUTS and ED. Currently, this relationship between LUTS and ED is supported on four theories, which are not mutually excluding, (a) autonomic hyperactivity and metabolic syndrome hypothesis, (b) changes in nitric oxide/nitric oxide (NOS/NO) synthetase in the guanine monophosphatase pathway in penis and prostate, (c) the activation of Rho kinase and the endothelin pathway, and (d) the physiopathological consequences of pelvic arteriosclerosis.Given the contribution of sexual function to keep the quality of life, possible negative effects on sexual function should be taken into consideration when choosing treatment for benign prostatic hyperplasia.The combined therapeutic approach of these two entities (ED and LUTS) brings a benefit to the patient both in urinary symptoms and sexual sphere, although placebo controlled studies are required to confirm these data and to ascertain the role of combination therapy in the treatment of both conditions(AU)
