Radium 223 combined with new hormone therapies for the treatment of castrate-resistant metastatic prostate cancer: scientific evidence and sharing of our experience.

Presentation of the interesting case of a patient suffering from castrate-resistant prostate cancer (CRPC) with bone metastasis, who received concomitant treatment with abiraterone acetate (AA) and radium-223. The patient experienced significant clinical improvement in his quality of life and pain relief after beginning the aforementioned treatment, without being affected by adverse toxicities. Currently, the correct selection of patients to receive radium-223 treatment is still a clinical challenge in the case of CRPC with metastasis. In this article, we discuss the future prospects of this treatment, reviewing current evidence about concomitant therapies with radium-223 and its present state, based upon the recent recommendations from the Pharmacovigilance Risk Assessment Committee (PRAC), and the data presented in the ERA-223 study. Based on our clinical experience, we provide practical orientation for the integration of this radiopharmaceutical in the therapeutic plan for this group of patients. We conclude, despite some of the positive results and our excellent experience, that it would be wise to wait for the results of the clinical trials that are studying the safety and benefits of the combined use of radium-223 with new hormone therapies. Bearing in mind that to date, the only published large-scale randomised trial that investigated the combination of AR-axis-targeted therapy with Ra-223 is negative, the harms of the combination outweighed any benefits in ERA-223. Nonetheless, in order to recommend whether or not this treatment should be used, it is essential to define the patient profile that could benefit from this therapeutic option.

[Post-hysterectomy uretero-vaginal fistula: Laparoscopic management with ureteroneocystostomy and psoas hitch.] / Fístula ureterovaginal post-histerectomía: manejo laparoscópico mediante ureteroneocistostomía y técnica de vejiga psóica.

OBJECTIVE: This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. METHOD: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch. RESULTS: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. CONCLUSION: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity.

OBJETIVO: Presentamos nuestra experiencia inicial mediante ureteroneocistostomía laparoscópica en dos pacientes con lesión del uréter distal tras cirugía ginecológica (histerectomía). A su vez, se lleva a cabo una revisión de la literatura acerca de la incidencia, prevención y manejo de las lesiones urinarias secundarias a cirugía laparoscópica ginecológica.MÉTODO: Presentamos dos pacientes con fístula ureterovaginal tras lesión ureteral distal post-histerectomía, que son sometidos a ureteroneocistostomía por vía laparoscópica aplicando la técnica de vejiga psóica. RESULTADOS: Ambos procedimientos se realizaron con éxito sin necesidad de reconversión a cirugía abierta. No se objetivaron complicaciones intra ni postoperatorias. Nuestro enfoque mínimamente invasivo ofrece excelentes resultados, similares a los obtenidos en la reparación quirúrgica por vía abierta. CONCLUSIÓN: El tratamiento de la fístula ureterovaginal secundaria a lesión ureteral distal post-histerectomía, mediante ureteroneocistostomía laparoscópica aplicando técnica de vejiga psóica, es una técnica factible y segura, con buenos resultados y bajas tasas de morbilidad asociada.

Fístula ureterovaginal post-histerectomía: manejo laparoscópico mediante ureteroneocistostomía y técnica de vejiga psóica / Post-hysterectomy uretero-vaginal fistula: Laparoscopic management with ureteroneocystostomy and psoas hitch

Objetivo: Presentamos nuestra experiencia inicial mediante ureteroneocistostomía laparoscópica en dos pacientes con lesión del uréter distal tras cirugía ginecológica (histerectomía). A su vez, se lleva a cabo una revisión de la literatura acerca de la incidencia, prevención y manejo de las lesiones urinarias secundarias a cirugía laparoscópica ginecológica. Método: Presentamos dos pacientes con fístula ureterovaginal tras lesión ureteral distal post-histerectomía, que son sometidos a ureteroneocistostomía por vía laparoscópica aplicando la técnica de vejiga psóica. Resultados: Ambos procedimientos se realizaron con éxito sin necesidad de reconversión a cirugía abierta. No se objetivaron complicaciones intra ni postoperatorias. Nuestro enfoque mínimamente invasivo ofrece excelentes resultados, similares a los obtenidos en la reparación quirúrgica por vía abierta. Conclusión: El tratamiento de la fístula ureterovaginal secundaria a lesión ureteral distal post-histerectomía, mediante ureteroneocistostomía laparoscópica aplicando técnica de vejiga psóica, es una técnica factible y segura, con buenos resultados y bajas tasas de morbilidad asociada

Objective: This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. Method: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch.Results: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. Conclusion: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity

Predictive Factors of Renal Function in Partial Laparoscopic Nephrectomy in Patients with a Kidney Tumor.

BACKGROUND: Laparoscopic partial nephrectomy has proven to be an ideal option for tumors in initial stages, preserving part of the renal parenchyma and reducing the possible risk of glomerular filtration decrease. OBJECTIVES: The main objective of this study is to determine the factors that can influence, to a greater extent, renal function deterioration after surgery. METHODS: This is an observational, descriptive and longitudinal study. The renal funct ion was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and patients were divided into 2 groups depending on whether or not their renal function had been affected after surgery. We studied the correlation between the decrease of renal function and other variables. RESULTS: The sample comprised 48 patients. In 30 of these cases, renal function had deteriorated after surgery. We observed a statistically significant relationship between the weight of the patient (p = 0.0230), size of the tumor (p = 0.0035), ischemic time (p = 0.0287), duration of the surgery (p = 0.0297), the RENAL score (p = 0.0230) and renal function deterioration. CONCLUSIONS: Partial laparoscopic nephrectomy is associated with a deterioration in renal function, where there is a decrease in glomerular filtration after surgery. The deterioration will depend on the weight of the patient, size of the tumour, ischemic time and duration of the surgery. The RENAL score can be used to predict said deterioration.