Indicaciones e histología de 489 orquiectomías analizadas según la edad del paciente / Indications and histology of 489 orchiectomies analyzed by patient age

Objetivo Evaluar indicaciones e histología de nuestra serie de orquiectomías, analizando los resultados dependiendo de la edad del paciente. Métodos Estudio de las orquiectomías realizadas en nuestro centro entre 2005 y 2020 a pacientes mayores de 18 años. Evaluamos: datos demográficos, indicaciones, histología y efectividad del diagnóstico ecográfico según 3 grupos de edad. Resultados Se realizaron 489 orquiectomías, 364 (74%) en los pacientes entre 18-50 años (grupo A), 59 (12%) entre los pacientes de 51-70 años (grupo B) y 66 (13,4%) en mayores de 70 años (grupo C). En el grupo A, 284 (78%) orquiectomías fueron indicadas por sospecha tumoral, 261/284 (91,9%) fueron neoplasias malignas, 253 (89%) germinales. La ecografía testicular tuvo un valor predictivo positivo (VPP) para tumor testicular maligno del 90%. En el grupo B, 34 (57%) orquiectomías fueron indicadas por sospecha tumoral y 25/34 (73,5%) presentaron neoplasias malignas. La ecografía tuvo un VPP para malignidad del 68%. En el grupo C, la orquiepididimitis fue la causa más frecuente de orquiectomía con 30 casos (45,5%). Entre las 20 orquiectomías por sospecha de tumor (30,3%), se encontró malignidad en 6. La ecografía tuvo un VPP para malignidad del 31%. Conclusión En menores de 70 años la indicación principal de orquiectomía fue la sospecha tumoral y en mayores, la orquiepididimitis. Los tumores germinales fueron la histología más frecuente en los menores de 70 años; en los mayores la malignidad fue infrecuente. Con la edad, disminuyó el VPP de la ecografía testicular para neoplasia maligna. En los mayores de 50 años se debería mejorar el proceso diagnóstico antes de indicar orquiectomía por sospecha tumoral (AU)

Objective To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. Methods We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. Results We included 489 orchiectomies, which 364 (74%) belonged to group A (patients between 18-50 years), 59 (12%) to group B (50-70 years) and 66 (14%) to group C (older than 70 years). In group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. Conclusion In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done (AU)

Cistectomía radical asistida por robot vs. cistectomía radical abierta: revisión sistemática de ensayos controlados aleatorizados / Robot-assisted vs. open radical cystectomy: Systematic review and meta-analysis of randomized controlled trials

Introducción En la última década se han puesto en marcha varios ensayos controlados aleatorizados (ECA) con el objetivo de evaluar la seguridad quirúrgica y la eficacia oncológica de la cistectomía radical asistida por robot (CRAR) frente a la cistectomía radical abierta (CRA) en pacientes con cáncer de vejiga. El objetivo del estudio fue realizar una revisión sistemática y un metaanálisis de ECA para comparar los resultados perioperatorios y oncológicos de ambas. Métodos Se realizó una búsqueda bibliográfica hasta julio de 2022 en las bases de datos PubMed/Medline, Embase y Web of Science. Se siguieron las directrices de la declaración PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) para identificar los estudios elegibles. Los criterios de evaluación fueron los resultados intraoperatorios, postoperatorios y oncológicos de la CRAR frente a la CRA. Resultados Un total de 8ECA con 1.024 pacientes cumplieron los criterios de inclusión. La CRAR se asoció con un tiempo quirúrgico mayor (media de 92,34 min, IC 95%: 83,83-100,84; p<0,001) y una tasa de transfusión de sangre menor (odds ratio [OR] 0,43; IC 95%: 0,30-0,61; p<0,001). No se observaron diferencias en cuanto a las complicaciones globales (p=0,28) ni graves (p=0,57) a los 90 días, la duración de la estancia hospitalaria (p=0,18), la recuperación de la función intestinal (p=0,67), la calidad de vida relacionada con la salud (p=0,86), la recurrencia (p=0,77) ni la progresión (p=0,49) de la enfermedad entre los 2abordajes. La principal limitación reside en el bajo número de pacientes incluidos en el 50% de los ECA revisados. Conclusiones Este estudio respalda la no inferioridad de la CRAR respecto a la CRA en términos de seguridad quirúrgica y resultados oncológicos. El beneficio de tasas reducidas de transfusión sanguínea obtenido con la CRAR debe sopesarse con relación a los costes derivados del procedimiento (AU)

Introduction Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs. open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs. ORC. Methods A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs. ORC. Results A total of 8RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI: 83.83-100.84, P<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI: 0.30-0.61, P<0.001). No differences emerged in terms of 90-day overall (P=0.28) and major (P=0.57) complications, length of stay (P=0.18), bowel recovery (P=0.67), health-related quality of life (P=0.86), disease recurrence (P=0.77) and progression (P=0.49) between the 2approaches. The main limitation is represented by the low number of patients included in half of RCTs included. Conclusions This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure (AU)

Manejo del carcinoma in situ de tramo urinario superior diagnosticado por biopsia ureteroscópica: ¿es el bacilo de Calmette-Guérin una alternativa a la nefroureterectomía? / Management of primary upper urinary tract carcinoma in situ diagnosed by ureteroscopic biopsy: Is bacillus Calmette-Guerin an alternative to nephroureterectomy?

Introducción La nefroureterectomía radical (NFU) es el tratamiento estándar del carcinoma de tramo urinario superior (TUS). No obstante, desde 1985 se ha introducido el tratamiento conservador en el manejo del carcinoma in situ en TUS (cis-TUS). El objetivo de este estudio fue comparar la evolución oncológica de los pacientes con cis-TUS tratados en nuestro centro con NFU vs. instilaciones de bacilo de Calmette-Guérin (BCG). Métodos Se trata de un estudio retrospectivo de pacientes con diagnóstico de cis-TUS primario entre 1990-2018. Todos los pacientes presentaban diagnóstico histológico de cis-TUS con ausencia de otro carcinoma de TUS concomitante. La confirmación histológica se obtuvo mediante ureteroscopia con múltiples biopsias. Los pacientes fueron tratados mediante NFU, ureterectomía distal o instilaciones de BCG. Los datos clinicopatológicos y la evolución oncológica fue comparada entre los grupos NFU y BCG. Resultados Se incluyeron un total de 28 pacientes, 29 unidades renales (UR). Dieciséis (57,1%) pacientes (17 UR) recibieron BCG. Las instilaciones fueron administradas por nefrostomía en 4 pacientes, catéter en J simple en 5 y doble J en 7. La respuesta completa y la persistencia o recurrencia fueron detectadas en 10 (58,8%) y 7 (41,2) UR tratadas con BCG. Ocho UR (27,6%) fueron tratadas con NFU, con una recurrencia contralateral detectada en 4 casos (50%). Finalmente, 4 UR con cis-TUS (13,8%) fueron tratadas con ureterectomía distal. No se detectaron diferencias en la supervivencia libre de recurrencia (p=0,841) ni en la supervivencia cáncer específica (p=0,77) entre los grupos de NFU y BCG. Conclusiones Aunque la nefroureterectomía radical representa el tratamiento estándar para el CIS de tramo urinario superior, nuestros resultados confirman que las instilaciones con BCG también son efectivas. La confirmación histológica de cis-TUS debería realizarse previamente a la decisión terapéutica (AU)

Introduction Radical nephroureterectomy (RNU) still represents the gold standard treatment for upper tract urothelial carcinoma (UTUC); however, since the 1980s attempts have been made to treat upper urinary tract CIS (UT-CIS) conservatively. The aim of this study was to compare the outcome of patients with primary UT-CIS treated in our center by means of RNU vs. bacillus Calmette-Guérin (BCG) instillations. Methods This retrospective study included patients with diagnosis of primary UT-CIS between 1990 and 2018. All patients had histological confirmation of UT-CIS in the absence of other concomitant UTUC. Histological confirmation was obtained by ureteroscopy with multiple biopsies. Patients were treated with RNU, distal ureterectomy, or BCG instillations. Clinicopathological features and outcomes were compared between the RNU and BCG groups. Results A total of 28 patients and 29 renal units (RUs) were included. Sixteen (57.1%) patients (17 RUs) received BCG. BCG was administered via a nephrostomy tube in 4 patients, a single-J ureteral stent in 5, and a Double-J stent in 7. Complete response and persistence or recurrence were detected in ten (58.8%) and seven (41.2%) RUs treated with BCG, respectively. Eight (27.6%) RUs underwent RNU, with contralateral recurrence detected in four (50%), and 4 (13.8%) RUs underwent distal ureterectomy. No differences were found in recurrence-free survival (p=0.841) and cancer-specific survival (p=0.77) between the RNU and BCG groups. Conclusions Although RNU remains the gold standard treatment for UT-CIS, our results confirm that BCG instillations are also effective. Histological confirmation of UT-CIS is mandatory before any treatment (AU)

Robot-assisted vs. open radical cystectomy: systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs ORC. METHODS: A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs ORC. RESULTS: A total of eight RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI 83.83-100.84, p<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI 0.30-0.61, p<0.001). No differences emerged in terms of 90-day overall (p=0.28) and major (p=0.57) complications, length of stay (p=0.18), bowel recovery (p=0.67), health-related quality of life (p=0.86), disease recurrence (p=0.77) and progression (p=0.49) between the two approaches. The main limitation is represented by the low number of patients included in half of RCTs included. CONCLUSIONS: This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure.

Management of primary upper urinary tract carcinoma in situ diagnosed by ureteroscopic biopsy: Is bacillus Calmette-Guerin an alternative to nephroureterectomy?

BACKGROUND: Radical nephroureterectomy (RNU) represents the gold standard treatment for upper tract urothelial carcinoma (UTUC); however, attempts have been made to treat upper urinary tract CIS (UT-CIS) conservatively. The aim of this study was to compare the outcome of patients with primary UT-CIS treated in our center by means of RNU vs. bacillus Calmette-Guérin (BCG) instillations. METHODS: This retrospective study included patients with diagnosis of primary UT-CIS between 1990 and 2018. All patients had histological confirmation of UT-CIS in the absence of other concomitant UTUC. Histological confirmation was obtained by ureteroscopy with multiple biopsies. Patients were treated with BCG instillations, RNU or distal ureterectomy. Clinicopathological features and outcomes were compared between RNU and BCG groups. RESULTS: A total of 28 patients and 29 renal units (RUs) were included. Sixteen (57.1%) patients (17 RUs) received BCG. BCG was administered via nephrostomy tube in 4 patients, with a single-J ureteral stent in 5, and using a Double-J stent in 7. Complete response and persistence or recurrence were detected in ten (58.8%) and seven (41.2%) RUs treated with BCG, respectively. Eight (27.6%) RUs underwent RNU, and 4 (13.8%) Rus distal ureterectomy. No differences were found in recurrence-free survival (p=0.841) and cancer-specific survival (p=0.77) between the RNU and BCG groups. CONCLUSIONS: Although RNU remains the gold standard treatment for UT-CIS, our results confirm that BCG instillations are also effective. Histological confirmation of UT-CIS is mandatory before any treatment.

Indications and histology of 489 orchiectomies analyzed by patient age.

OBJECTIVE: To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. METHODS: We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. RESULTS: We included 489 orchiectomies, which 364 (74%) belonged to Group A (patients between 18-50 years), 59 (12%) to Group B (50-70 years) and 66 (14%) to Group C (older than 70 years). In Group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In Group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In Group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. CONCLUSION: In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done.