[Urinary tract hemangiopericytoma treated with radical surgery and neoadjuvant chemotherapy. Report of two cases.] / Hemangiopericitoma en la via urinaria tratados con cirugía radical y quimioterapia neoadyuvante. A propósito de dos casos.

OBJECTIVE: Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment of choice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery. METHODS: The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy. RESULTS: In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment. CONCLUSIONS: In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas.

OBJETIVO: El hemangiopericitoma es un tumor de origen vascular muy infrecuente en la próstata. Son tumores de características agresivas y actualmente el tratamiento de elección es la cirugía radical. En la literatura existen descritos menos de 50 casos de hemangiopericitomas, y ninguno con tratamiento neoadyuvante. Dicho tratamiento neoadyuvante está descrito en otro tipo de sarcomas con buenas respuestas. Presentamos dos casos de un hemangiopericitoma maligno, uno tratado sólo con cirugía radical y otro con neoadyuvancia quimioterápica previa a la cirugía radical.MATERIAL Y MÉTODOS: El primer caso es un varón de 40 años con síntomas urinarios obstructivos. Se diagnosticó de hemangiopericitoma tras realización de biopsia transrectal. Se decidió neoadyuvancia quimioterápica previa a la cirugía. El segundo paciente es un varón de 74 años con hallazgo accidental de masa renal. Tras nefrectomía radical se diagnosticó de hemangiopericitoma. RESULTADOS: Tras la neoadyuvancia, en el primer paciente, se realizó una cistoprostatectomía radical y una resección de recto con derivación urinaria tipo Bricker y colostomía. El segundo paciente no precisó tratamiento adyuvante tras la cirugía radical. CONCLUSIONES: El hemangiopericitoma es una entidad rara en los tumores urinarios. Actualmente la neoadyuvancia quimioterápica no está establecida como pilar del tratamiento de estos tumores, aunque en otros campos donde los sarcomas son más frecuentes, si que se objetiva mejor respuesta. En nuestro caso obtuvimos una buena respuesta con dicha neoadyuvancia previa a la cirugía, aunque es necesario un mayor seguimiento a una mayor cohorte de pacientes para establecer el uso de la quimioterapia neoadyuvante en los hemangiopericitomas urinarios.

Hemangiopericitoma en la via urinaria tratados con cirugía radical y quimioterapia neoadyuvante. A propósito de dos casos / Urinary tract hemangiopericytoma treated with radical surgery and neoadjuvant chemotherapy. Report of two cases

Objetivo: El hemangiopericitoma es un tumor de origen vascular muy infrecuente en la próstata. Son tumores de características agresivas y actualmente el tratamiento de elección es la cirugía radical. En la literatura existen descritos menos de 50 casos de hemangiopericitomas, y ninguno con tratamiento neoadyuvante. Dicho tratamiento neoadyuvante está descrito en otro tipo de sarcomas con buenas respuestas. Presentamos dos casos de un hemangiopericitoma maligno, uno tratado sólo con cirugía radical y otro con neoadyuvancia quimioterápica previa a la cirugía radical. Material y métodos: El primer caso es un varón de 40 años con síntomas urinarios obstructivos. Se diagnosticó de hemangiopericitoma tras realización de biopsia transrectal. Se decidió neoadyuvancia quimioterápica previa a la cirugía. El segundo paciente es un varón de 74 años con hallazgo accidental de masa renal. Tras nefrectomía radical se diagnosticó de hemangiopericitoma. Resultados: Tras la neoadyuvancia, en el primer paciente, se realizó una cistoprostatectomía radical y una resección de recto con derivación urinaria tipo Bricker y colostomía. El segundo paciente no precisó tratamiento adyuvante tras la cirugía radical. Conclusiones: El hemangiopericitoma es una entidad rara en los tumores urinarios. Actualmente la neoadyuvancia quimioterápica no está establecida como pilar del tratamiento de estos tumores, aunque en otros campos donde los sarcomas son más frecuentes, si que se objetiva mejor respuesta. En nuestro caso obtuvimos una buena respuesta con dicha neoadyuvancia previa a la cirugía, aunque es necesario un mayor seguimiento a una mayor cohorte de pacientes para establecer el uso de la quimioterapia neoadyuvante en los hemangiopericitomas urinarios

Objective: Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment ofchoice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery. Methods: The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy. Results: In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment. Conclusions: In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas

[Report of two cases of malignant mesothelioma of the tunica vaginalis.] / Analisis de dos casos de mesotelioma maligno de la túnica vaginal.

OBJECTIVE: Paratesticular mesothelioma isan infrequent tumor and only 250 cases have been published.It originates in the scrotal tunica vaginalis. It represents0.3-1.4% of mesotheliomas and it predominates inpatients with history of asbestos exposure and old age. Itsdiagnosis is usually casual. Our objective is to present thecases that occurred in our service with malignant paratesticularmesothelioma and to carry out a review of the currentliterature on this pathology. METHODS: We report two cases diagnosed with malignantparatesticular mesothelioma that happened in the lasttwo years. RESULT: The first case was a 73-year-old male with asymptomatichydrocele. The second was a 57-year-oldmale who had testicular pain and hydrocele. Both werediagnosed of mesothelioma after hydrocelectomy. The firsttreatment was radical orchiectomy in both cases. The firstpatient did not need more treatments. The second patientpresented pulmonary nodules, lymphadenopathy and localrelapse, which was treated with chemotherapy and localresection. CONCLUSION: Paratesticular mesothelioma is an infrequenttumor. Scrotal mass associated with hydrocele is thetypical form of presentation. Surgical treatment consists ofradical orchiectomy. They have poor prognosis because inmost cases there is rapid local and dissemination.

OBJETIVO: El mesotelioma paratesticular es  un tumor infrecuente, con menos de 250 casos publicados, originado en la túnica vaginal escrotal. Representa el 0,3-1,4% de los mesoteliomas. Predomina en pacientes añosos, con la exposición al asbesto y su diagnóstico sueleser casual. Nuestro objetivo es presentar dos casos ocurridos en nuestro servicio con mesotelioma paratesticular maligno y realizar una revisión de la literatura actual sobre dicha patologia.MÉTODO: Aportamos dos casos diagnosticados de mesotelioma paratesticular maligno acontecidos en nuestro servicio durante los últimos dos años. RESULTADO: El primer caso es un varón de 73 años que debutó con hidrocele sin dolor. El segundó es un varón de 57 años que inició su clínica con un cuadro de dolor testicular e hidrocele. En ambos se diagnostica de mesotelioma maligno de la túnica vaginal tras hidrocelectomía. Se realiza como tratamiento inicial una orquiectomía radical en ambos pacientes. El primer paciente no precisó ningún tratamiento adicional. El segundo paciente presentó nódulos pulmonares y adenopatías junto con recidiva local, que se trató con quimioterapia y resección local.CONCLUSIÓN: El mesotelioma paratesticular es un tumor infrecuente, sin una clínica especifica. Su forma típica de presentación es una masa escrotal indolora asociada a hidrocele.El tratamiento quirúrgico consiste en orquiectomía radical. En la mayoría de los casos existe una rápida diseminación local y a distancia que otorgan a estos tumores un mal pronóstico.

Analisis de dos casos de mesotelioma maligno de la túnica vaginal / No disponible

Objetivo: El mesotelioma paratesticular es un tumor infrecuente, con menos de 250 casos publicados, originado en la túnica vaginal escrotal. Representa el 0,3-1,4% de los mesoteliomas. Predomina en pacientes añosos, con la exposición al asbesto y su diagnóstico suele ser casual. Nuestro objetivo es presentar dos casos ocurridos en nuestro servicio con mesotelioma paratesticular maligno y realizar una revisión de la literatura actual sobre dicha patologia. Método: Aportamos dos casos diagnosticados de mesotelioma paratesticular maligno acontecidos en nuestro servicio durante los últimos dos años. Resultado: El primer caso es un varón de 73 años que debutó con hidrocele sin dolor. El segundó es un varón de 57 años que inició su clínica con un cuadro de dolor testicular e hidrocele. En ambos se diagnostica de mesotelioma maligno de la túnica vaginal tras hidrocelectomía. Se realiza como tratamiento inicial una orquiectomía radical en ambos pacientes. El primer paciente no precisó ningún tratamiento adicional. El segundo paciente presentó nódulos pulmonares y adenopatías junto con recidiva local, que se trató con quimioterapia y resección local. Conclusión: El mesotelioma paratesticular es un tumor infrecuente, sin una clínica especifica. Su forma típica de presentación es una masa escrotal indolora asociada a hidrocele. El tratamiento quirúrgico consiste en orquiectomía radical. En la mayoría de los casos existe una rápida diseminación local y a distancia que otorgan a estos tumores un mal pronóstico

Objective: Paratesticular mesothelioma is an infrequent tumor and only 250 cases have been published. It originates in the scrotal tunica vaginalis. It represents 0.3-1.4% of mesotheliomas and it predominates in patients with history of asbestos exposure and old age. Its diagnosis is usually casual. Our objective is to present the cases that occurred in our service with malignant paratesticular mesothelioma and to carry out a review of the current literature on this pathology. Methods: We report two cases diagnosed with malignant paratesticular mesothelioma that happened in the last two years. Result: The first case was a 73-year-old male with asymptomatic hydrocele. The second was a 57-year-old male who had testicular pain and hydrocele. Both were diagnosed of mesothelioma after hydrocelectomy. The first treatment was radical orchiectomy in both cases. The first patient did not need more treatments. The second patient presented pulmonary nodules, lymphadenopathy and local relapse, which was treated with chemotherapy and local resection. Conclusion: Paratesticular mesothelioma is an infrequent tumor. Scrotal mass associated with hydrocele is the typical form of presentation. Surgical treatment consists of radical orchiectomy. They have poor prognosis because in most cases there is rapid local and dissemination

[Mid-term safety and efficacy of high power thulium laser vaporization.] / Vaporización con láser tulio de alta potencia:eficacia y seguridad a medio plazo.

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the mediumterm (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%. The only statistically significant difference (p=0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate.

Vaporización con láser tulio de alta potencia: eficacia y seguridad a medio plazo / Mid-term safety and efficacy of high power thulium laser vaporization

OBJETIVO: La vaporización prostática con láser Tulio (VP-LT) se realiza desde hace 12 años aproximadamente, durante este tiempo los diferentes sistemas láser han ido evolucionado, particularmente los reportes de su uso en alta potencia (150-180W) son aún escasos. En este trabajo presentamos nuestra experiencia en cuanto a su eficacia y seguridad a medio plazo (seguimiento 42 meses). MÉTODOS: Desde Marzo de 2011 a Noviembre de 2013 se recogieron datos de 235 pacientes intervenidos con VP-LT. Las variables incluyen, tamaño prostático, características intraoperatorias, IPSS, Qmax, PSA entre otros. RESULTADOS: La edad media fue 69±9 años. La media del tamaño prostático fue 62±28 ml. Las medias de IPSS y Qmax preoperatorios fueron 18±6 puntos y 7,6±3,5 ml/seg respectivamente. La media del tiempo quirúrgico fue 45,31±16 min. La estancia hospitalaria media fue 24±17 horas y el tiempo medio de sondaje fue 38 horas. Sólo 26,1% sufrieron complicaciones perioperatorias, ninguna mayor de grado III de Clavien. Únicamente 1,7% requirieron reingreso. En el postoperatorio la media del Qmax a los 3 y 24 meses fue 19±6 ml/seg, y 17±8 ml/seg. El IPSS 5±5 puntos. El resultado se considero éxito en 81,3%. Un 15,7% persistió con síntomas obstructivos y 3% con patología funcional de llenado. La tasa de reintervención fue 5%. La única diferencia significativa (p = 0,008) entre resultado exitoso vs. no exitoso fue el tamaño prostático, 60 ml vs. 72 ml respectivamente. La tasa de reintervenciones aumenta significativamente a partir de un tamaño prostático de 70 ml (p = 0,001). CONCLUSIONES: La VP-LT de alta potencia es una alternativa segura, eficaz y eficiente con resultados funcionales subjetivos y objetivos comparables a la técnica "gold standard", ofrece un tiempo de estancia hospitalaria más corto y una menor tasa de complicaciones. Sin embargo su efectividad a mediano plazo disminuye en próstatas mayores de 70 ml aumentando las probabilidades de reintervención

OBJECTIVE: Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the medium-term (42 months follow-up) perspective. METHODS: Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others. RESULTS: Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%.The only statistically significant difference (p = 0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively. CONCLUSIONS: In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate

Estudio comparativo de eficacia y seguridad de la nefrolitotomía percutánea (NLPC) y la cirugía retrógrada intrarrenal (CRIR) para litiasis renales de 2-3, 5 cm / Comparative study for the efficacy and safety of percutaneous nefhrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of 2-3,5 cm kidney stones

OBJETIVO: Comparar la eficacia y seguridad de Nefrolitotomía Percutánea (NLPC) y de Cirugía Retrógrada Intrarrenal (CRIR) para el tratamiento de litiasis renales entre 2 y 3,5 cm. MÉTODOS: Revisión de 142 casos con litiasis renal entre 2 y 3,5 cm tratados en nuestro centro entre diciembre 2009 y diciembre 2011; 106 casos de CRIR y 36 casos de NLPC. Se evalúan y comparan edad, sexo, composición, localización, unidades Hunsfield (UHC) y tamaño litiásico, tiempo quirúrgico, complicaciones, días de ingreso y éxito de la técnica en el primer procedimiento y tras un segundo procedimiento. Análisis estadístico con T Student, U Mann-Whitney y Chi2 - V Cramer (p = 0,05). RESULTADOS: No hay diferencias en la edad, distribución de sexos, UHC, tamaño litiasico entre ambos brazos. El tiempo quirúrgico fue menor en el grupo NLPC (mediana 85 minutos vs 112 minutos; p:0,04) La estancia hospitalaria fue significativamente más corta en la CRIR (mediana=16 horas vs 93 horas; p = 0,001). En cuanto a la tasa de complicaciones globales, 94,8% de procedimientos libres de complicaciones para CRIR frente a un 80% de la NLPC (p 0,08). La NLPC obtuvo mejor porcentaje de éxito (80,6% frente al 73,6% de CRIR) aunque estas diferencias no son estadísticamente significativas (p = 0,40). Si comparamos el éxito con segundas maniobras, la NLPC presenta un porcentaje del 94,3% de los casos frente al 93,5% (p = 0,88). CONCLUSIONES: La CRIR se presenta como una opción segura, eficaz y con corta estancia hospitalaria. Puede ser considerada como alternativa a la NLPC en el tratamiento de litiasis renales de hasta 3,5 cm. Sin embargo hacen falta más publicaciones con estudios aleatorizados que confirmen esta hipótesis

OBJECTIVES: Retrograde intrarenal surgery (RIRS) has become an important alternative for the treatment of kidney stones due to its increased safety and efficiency. The purpose of this study is to compare efficacy and safety features of RIRS against percutaneous nephrolithotomy (PCNL) for the treatment of 2 - 3.5 cm kidney stones. METHODS: 142 cases (106 RIRS and 36 PCNL) encompassing 2 - 3.5 cm kidney stones that have been treated in our center between December 2009 and December 2011 have been considered. Demographic variables, stone characteristics, surgical stay and surgical time have been evaluated. Additionally, the complication rate and success rate after one and two procedures (retreatment) have also been assessed. Student`s T, Mann-Whitney U y Chi2 - V Cramer (p = 0.05) tests were used for statistical analysis. RESULTS: There are not statistically significant differences in demographic or stone variables. The calculated mean surgical time was lower for PCNL (85 min) than for RIRS (112 min). Mean hospital stay was statistically significantly shorter in RIRS (16 h vs. 98 h in RIRS, p = 0.001). PCNL exhibited a higher global complication rate of 19.4% vs. 6.6% for RIRS (p = 0.001). PCNL also showed a higher successful rate (80.6% vs. 73.6% for RIRS), although this difference was not statistically significant (p = 0.40). When comparing the success rate after a second procedure, PCNL results in 94.3% vs. 93.5% for RIRS (p = 0.88). CONCLUSION: RIRS was found to be a safe and efficient procedure with a short hospital stay. Overall, RIRS can be considered as an alternative to PCNL for the treatment of renal stones smaller than 3.5 cm

Influencia de la curva de aprendizaje en el diagnóstico del cáncer de próstata mediante biopsia ecodirigida / Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy

OBJETIVO: Analizar si existe una curva de aprendizaje hasta lograr realizar biopsias prostáticas ecodirigidas de alta calidad que permitan efectuar el diagnóstico de cáncer de próstata con eficacia, teniendo en cuenta el resultado anatomopatológico de las muestras. MÉTODOS: Se revisaron retrospectivamente los datos de las 790 biopsias de próstata ecodirigidas realizadas en nuestro servicio entre mayo de 2009 y diciembre 2012 por cuatro cirujanos de modo consecutivo. Se revisaron los siguientes datos: cirujano que la realizaba, fecha de realización, edad del paciente, PSA, tacto rectal, ecografía, volumen prostático, número de cilindros recogidos y resultado anatomopatológico de la biopsia. Los cirujanos eran médicos internos residentes de urología en su primer año en nuestro servicio. Para el análisis estadístico se agruparon las biopsias en bloques de 25 y 75 casos realizados por cirujano, ordenados cronológicamente. Para valorar la influencia de la curva de aprendizaje en el diagnóstico se realizó un análisis univariante y multivariante entre las distintas variables y el resultado anatomopatológico. RESULTADOS: La mediana de edad fue 67 años (42-90). Fueron positivas para cáncer de próstata 300 biopsias (38%). En el análisis univariante respecto a la tasa de detección de cáncer, las variables cirujano, PSA, tacto rectal, resultado ecográfico, volumen prostático, número de cilindros y grupos de 75 mostraron diferencias estadísticamente significativas, esta última mostró un porcentaje de 32% en las primeras 75 biopsias realizadas por los cirujanos y 43,2% en el último grupo. No las mostraron las variables edad (p = 0,11) y grupos de 25 pacientes (p = 0,07). En el análisis multivariante, sin embargo, únicamente fueron estadísticamente significativas las variables PSA, tacto rectal, volumen prostático y grupos de 75 pacientes, esta última con una OR de 1,35 (IC95% 1,09 - 1,66). CONCLUSIONES: Los resultados obtenidos en nuestro estudio muestran que sí influye el número de procedimientos realizados, es decir la experiencia del cirujano, para alcanzar una rentabilidad diagnóstica óptima en las biopsias de próstata ecodirigidas

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p = 0.11) and groups of 25 patients (p = 0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies

[Influence of learning curve in the diagnosis of prostate cancer by ultrasound guided biopsy]. / INFLUENCIA DE LA CURVA DE APRENDIZAJE EN EL DIAGNÓSTICO DEL CÁNCER DE PRÓSTATA MEDIANTE BIOPSIA ECODIRIGIDA.

OBJECTIVE: To analyze if there is a learning curve to get to perform high quality ultrasound guided prostate biopsies that enable to effectively perform the diagnosis of prostate cancer, taking the pathological result of the samples into consideration. METHODS: We retrospectively reviewed data from 790 ultrasound-guided biopsies performed consecutively in our center between May 2009 and December 2012 by four surgeons. We reviewed the following data: Surgeon, date of intervention, patient age, PSA, rectal digital examination (DRE), ultrasound, prostate volume, number of cores obtained, pathology result of the biopsy. The surgeons were residents in Urology in their first year in the department. For statistical analysis the biopsies were grouped in blocks of 25 and 75 cases performed by a surgeon, in a chronological order. To evaluate the influence of the learning curve on diagnosis we performed univariate and multivariate analysis between the different variables and pathological report. RESULTS: Median age was 67 years (42-90). 300 biopsies (38%) were positive for prostate cancer. On univariate analysis, regarding cancer detection rate, the variables surgeon, PSA, DRE, ultrasound result, prostate volume, number of cores and groups of 75 showed statistically significant differences, this latter showing 32% in the first 75 biopsies and 43.2% in the last group. The variables age (p=0.11) and groups of 25 patients (p=0.07) did not show differences. Nevertheless, on multivariate analysis only PSA, DRE, prostate volume and groups of 75 patients were statistically significant, this latter with an OR of 1.35 (95%CI 1.09-1.66). CONCLUSIONS: The results obtained in our study show that the number of procedures performed, namely surgeon experience, does have an influence to achieve an optimal diagnostic yield in ultrasound guided prostatic biopsies.