Impacto de la anemia sobre la supervivencia de los pacientes intervenidos de cistectomía radical por tumor vesical / Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer

OBJETIVO: Evaluar la prevalencia de anemia preoperatoria y su impacto sobre los resultados oncológicos de pacientes intervenidos de cistectomía radical (CR) por tumor vesical. MATERIAL Y MÉTODOS: Estudio retrospectivo de 176 CR realizadas entre mayo de 2008 y julio de 2018 en un mismo centro. La anemia fue definida según los criterios de la OMS (hemoglobina < 130 mg/dl en hombres y < 120 mg/dl en mujeres). Mediante el método de Kaplan-Meier analizamos la supervivencia global, la supervivencia específica de cáncer y la supervivencia libre de recurrencia. Utilizamos la regresión logística multivariante para identificar los factores pronósticos de mortalidad global. RESULTADOS: Del total, 89 (50,6%) pacientes eran anémicos preoperatoriamente y 44 de ellos (49,4%) recibieron quimioterapia neoadyuvante. Los pacientes anémicos tuvieron un ASA mayor (ASA > 2: 54,6 vs. 27,5%, p = 0,003), más ectasia prequirúrgica (41,6 vs. 19,5%; p = 0,002), peor estadio patológico (pT > 2: 49,4 vs. 33,3%; p = 0,03), realizaron más quimioterapia neoadyuvante (49,4 vs. 19,5%; p < 0,001) y requirieron más transfusiones sanguíneas (25,8 vs. 11,5%; p = 0,015). La mediana de seguimiento fue de 27,2 meses (RIC 11,12-72,28). La supervivencia global (105 vs. 34 meses; p = 0,001), la supervivencia específica de cáncer (89 vs. 61 meses; p = 0,004) y la supervivencia libre de recurrencia (85 vs. 57 meses; p = 0,002) fueron peores en las CR anémicas. En el estudio multivariante, la anemia, un estadio pT > 2 y tener afectación ganglionar fueron identificados como factores predictores independientes de mortalidad. CONCLUSIÓN: La anemia previa a CR es común y asocia un peor pronóstico oncológico. Siendo esta una variable modificable, la implementación de programas de Patient Blood Management durante la prehabilitación puede tener un papel importante para mejorar la supervivencia de estos pacientes

OBJECTIVE: To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer. MATERIAL AND METHODS: Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male < 130 mg/dL, female < 120 mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates. RESULTS: Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA > 2: 54.6 vs. 27.5%; P = .003), ectasia rate previous to RC (41.6 vs. 19.5%; P = .002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P < .001), blood transfusion rate (25.8 vs. 11.5%; P = .015) and pathological stage (pT > 2: 49.4 vs. 33.3%; P = .03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P = .001), cancer-specific survival (89 vs. 61 months; P = .004) and recurrence-free survival (85 vs. 57 months; P = .002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT > 2 and N ≥ 1 were independently associated with overall mortality. CONCLUSION: Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients

Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer. / Impacto de la anemia sobre la supervivencia de los pacientes intervenidos de cistectomía radical por tumor vesical.

OBJECTIVE: To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer. MATERIAL AND METHODS: Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male<130mg/dL, female<120mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates. RESULTS: Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA>2: 54.6 vs. 27.5%; P=.003), ectasia rate previous to RC (41.6 vs. 19.5%; P=.002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P<.001), blood transfusion rate (25.8 vs. 11.5%; P=.015) and pathological stage (pT>2: 49.4 vs. 33.3%; P=.03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P=.001), cancer-specific survival (89 vs. 61 months; P=.004) and recurrence-free survival (85 vs. 57 months; P=.002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT>2 and N≥1 were independently associated with overall mortality. CONCLUSION: Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients.

[Transformation of glandular cystitis into bladder transitional carcinoma with adenocarcinoma areas]. / Conversión de cistitis glandular a carcinoma transicional vesical con áreas de adenocarcinoma.

OBJECTIVE: The association of cystitis glandularis with primary bladder tumors is well known. A case of cystitis glandularis progressing to transitional cell carcinoma is described and the literature briefly reviewed. METHODS/RESULTS: We report on a case of diffuse cystitis glandularis in whom progression to transitional cell carcinoma with areas of adenocarcinoma had been discovered. Treatment was by radical cystectomy with urinary diversion. CONCLUSION: Extensive and diffuse cystitis glandularis can be a potentially malignant lesion. Patients with diffuse cystitis glandularis should have a regular cystoscopic follow-up for early detection of progression to a bladder tumor.

[Ureteral stenosis secondary to Churg-Strauss allergic granulomatous vasculitis]. / Estenosis ureteral producida por vasculitis alérgica granulomatosa de churg-strauss.

OBJECTIVE: Ureteral stenosis secondary to vasculitis is a rare disease. The etiology and treatment of this unusual cause of ureteral obstruction are discussed. METHODS/RESULTS: We report a case of ureteral obstruction secondary to Churg-Strauss vasculitis in a 45-year-old man. The patient was treated with prednisone and cyclophosphamide. Subsequently ureteral resection and reanastomosis were performed. CONCLUSIONS: Vasculitis of the ureter should be considered in patients with connective tissue disorders who present with ureteral dilatation. In some cases ureteral stenosis may require surgery in combination with steroid and/or immunosuppressive therapy.

[Intrascrotal aggressive angiomyxoma]. / Angiomixoma agresivo intraescrotal.

OBJECTIVE: To describe a case of aggressive scrotal angiomyxoma in a 55-year old man. METHODS: Ultrasound examination revealed a tumor on the scrotum. Surgical resection and histopathological study of the tumor was performed. The literature is briefly reviewed. RESULTS: Pathological analysis disclosed spindle-shaped neoplastic cells widely separated by a myxoid stroma rich in collagen fibers and prominent irregular-shaped blood vessels. Immunohistochemically, the stromal cells stained consistently for vimentin but not for desmin or S-100 protein. The patient had no symptom or signs of systemic disease and remains symptom-free 15 months later. CONCLUSIONS: Aggressive angiomyxoma is a rare condition that can be successfully treated surgically and has a great tendency to local recurrence.

[Submucous urethral angioma]. / Angioma uretral submucoso.

OBJECTIVES: Urethral hemangioma is a rare benign vascular tumor. The clinical features of this tumor type and the therapeutic options are discussed. METHODS/RESULTS: We report on a 55-year-old male with urethral hemangioma who consulted for urethral hemorrhage. CONCLUSIONS: To our knowledge, approximately 40 cases of this rare tumor type have been reported in the literature. Urethroscopy is the best diagnostic procedure. Treatment depends on tumor site, size and number. Transurethral resection of the tumor, urethrectomy, arterial embolization, radiotherapy or ablation with Nd:YAG laser can be utilized.

[Ureteral stenosis secondary to methacrylate used in total hip arthroplasty]. / Estenosis ureteral secundaria a metacrilato utilizado en una artoplastia total de cadera.

OBJECTIVES: The urological complications in orthopedic surgery, the mechanisms of injury and its treatment are discussed. METHODS/RESULTS: Herein we describe a case of ureterohydronephrosis arising from extrinsic ureteral compression by cement utilized in total hip arthroplasty in a patient with a solitary kidney. CONCLUSIONS: The risk of acetabular perforation and subsequent migration of the cement into the pelvic cavity must be taken into account in patients undergoing hip replacement surgery. Conservative endourological management should first be attempted in the event of ureteral involvement, although resolution is by surgical repair in most cases.

[Urethral hemangioma. Description of a case and review of the literature]. / Hemangioma uretral. Descripción de un caso y revisión de la literatura.

OBJECTIVES: This study briefly reviews the histological types, clinical features, diagnostic and therapeutic aspects of urethral hemangioma, an uncommon benign vascular tumor. METHODS/RESULTS: A case of urethral hemangioma in a male patient with a long history of hematuria is described. CONCLUSIONS: Urethroscystoscopy is the most useful diagnostic technique in urethral hemangioma. Treatment is by transurethral resection, radical surgery, radiotherapy or selective arterial embolization depending on tumor location, number, size and patient condition. This tumor type frequently recurs.

[Anuria secondary to perianeurysmal fibrosis]. / Anuria secundaria a fibrosis perianeurismática.

Presentation of one case of obstructive anuria secondary to perianeurysmal retroperitoneal fibrosis (PRF). Diagnosis was confirmed by abdominal ultrasound and CAT. The condition's initial treatment consisted in bilateral percutaneous nephrostomy. Following clinical stabilization of the patient, surgical resection of aorta aneurysm and ureterolysis with bilateral intraperitonealization was performed. A revision of the specific literature revealed 17 cases similar to ours. Clinical, diagnostic, and pathophysiologic aspects as well as recommended therapeutical procedures are analyzed.

[Carcinoma of Bellini's collecting ducts]. / Carcinoma de los conductos colectores de Bellini.

Description of one case of carcinoma of Bellini's ducts, a very uncommon renal neoplasia. The existing literature is reviewed, commenting on its clinical manifestations, etiology, diagnostic methodology and therapeutical manoeuvres.

[Intravesical foreign body. Post-traumatic migration of autologous bone fragment]. / Cuerpo extraño endovesical. Migración postraumática de fragmento óseo autólogo.

We report on a 24-year-old female patient with posttraumatic migration of a bony fragment from the site of the fracture to the bladder. The foreign body was removed from the bladder by endoscopy. The etiopathogenic mechanism, clinical signs, diagnostic method and therapeutic management are discussed.

[Adenocarcinoma in addition to bladder exstrophy. Apropos a case and a review of the literature]. / Adenocarcinoma sobre extrofia vesical. A propósito de un caso y revisión de la literatura.

Herein we describe a case of adenocarcinoma complicating exstrophy of the bladder in a 59-year-old patient. The morphologic, histochemical and immunohistochemical analyses revealed a colonic glandular adenocarcinoma. The two hypotheses relative to its pathogenesis are briefly discussed. To date, 106 cases have been reported in the literature.

[Bladder inverted papilloma. Can it be considered as a neoplasm with low degree of malignancy?]. / Papiloma invertido vesical. Se puede considerar una neoplasia de bajo grado de malignidad?

We report a case of inverted papilloma of the bladder. The clinical features, diagnosis and treatment of this tumor type are discussed. We underscore the histology and histogenesis of the two types: trabecular inverted papilloma and glandular inverted papilloma. A review of the literature has shown that inverted papillomas do not show clinical or histological features of malignancy most of the time. The cases with synchronous or metachronous association with transitional cell carcinoma, recurrence or histologic signs of malignant transformation of a lesion may be considered to have a neoplasm of low grade malignancy and these patients must be followed closely.

[Diclofenac sodium therapy in irritating micturition syndrome following TUR for benign prostatic hyperplasia]. / Tratamiento con diclofenaco sódico del síndrome miccional irritativo tras resección transuretral por hiperplasia prostática benigna.

The irritative micturition syndrome is commonly observed following endoscopic surgery for benign prostatic hyperplasia. This condition almost consistently presents following removal of the bladder catheter and may last from 15 to 45 days. The present study was undertaken to determine the efficacy of treatment with diclofenac sodium. Fifty patients submitted to endoscopic resection for benign prostatic hyperplasia received the agent IM a few hours prior to catheter removal and posteriorly via the rectal route for a total treatment period of 13 days. Good results were achieved in 95.5% of the cases. Mild side effects were observed in 14% of the patients.