[Interpretation of the metabolic study in renal lithiasis and its treatment]. / Interpretación del estudio metabólico en la litiasis renal y su tratamiento.

Urolithiasis is a common disease, and is an important health problem that is associated with a great economic burden. The nature of stone disease varies according by dietary and lifestyle factors, including, among others, climate variations. The majority of patients will suffer a new lithiasic episode at some point in their life, unless preventive measures, such as changing lifestyles and dietary habits, are put in place to avoid it. The risk factors involved in lithogenesis should be evaluated in order to reduce recurrences. In the majority of these patients, metabolic changes are observed in the urine that predispose lithogenesis. The kind of evaluation depends on stone composition and on the clinical presentation. A diagnosis of systemic and renal diseases of lithogenic nature can be diagnosed with these studies, and they also enable the adoption of precise prophylactic measures that achieve control of recurrence in a great number of patients.

Comparative analysis of the expression of metalloproteases (MMP-2, MMP-9, MMP-11 and MMP-13) and the tissue inhibitor of metalloprotease 3 (TIMP-3) between previous negative biopsies and radical prostatectomies. / Análisis comparativo de la expresión de metaloproteasas (MMP-2, MMP-9, MMP-11 y MMP-13) y del inhibidor tisular de la metaloproteasa 3 (TIMP-3) entre las biopsias previas negativas y las prostatectomías radicales.

Metalloproteases (MMPs) and tissue inhibitor of metalloprotease-3 (TIMP-3) have been associated to the risk of having cancer and tumor aggressiveness. When facing the difficulties of prostate cancer diagnosis, the expression of MMPs and TIMP-3 in negative biopsies could be helpful to evaluate a diagnostic suspicion. Our objective is to carry out a comparative study of the expression of MMPs and TIMP-3 in previous negative biopsies and radical prostatectomies (RP). MATERIAL AND METHODS: Retrospective analysis of a hospital-based cohort including 21 patients with suspicion of prostate carcinoma, whose expressions of MMP-2, 9, 11 and 13 and TIMP-3 were evaluated by immunohistochemistry in the tumor area from previous negative biopsies and RP. RESULTS: Immunohistochemical staining values (Score) for MMPs (-11 and -13) and TIMP-3 showed no significant differences when comparing the areas of negative biopsies where tumors subsequently developed with those of the RP. However, we did observe a significant difference in the increased expression of MMP-2 (P=.002) and MMP-9 (P=.001) in the tumor area of the RP with respect to the corresponding area of the previous negative biopsy. CONCLUSIONS: Our data indicate a higher overall expression of MMP-2 and MMP-9 in the tumor area of the RP compared to the corresponding areas of the negative previous biopsy, which seems to be associated to the process of malignant transformation.

Problemas de la esfera sexual en el paciente renal / Sexual disorders in the renal patient

En la actualidad se considera a la calidad de vida relacionada con la salud como uno de los objetivos terapéuticos primordiales en pacientes que precisan tratamiento sustitutivo para seguir viviendo. La salud sexual es un derecho básico que afecta positivamente a la calidad de vida. Aunque una parte significativa de pacientes crónicos presenta algún tipo de disfunción sexual, esta no se plantea abiertamente en la consulta. Es importante que el médico aborde la dimensión sexual de estos pacientes. Repasamos la fisiopatología de las disfunciones sexuales del paciente renal crónico, tanto en hombres como en mujeres. Explicamos los efectos de la diálisis y el trasplante sobre la función sexual. Y exponemos las principales disfunciones sexuales y su tratamiento

Quality of Life Related to Health is currently considered one of the primary therapeutic objectives in renal failure patients who need substitution treatment as life prolonging therapy. Sexual health is a basic right that positively affects the quality of life. Although a significant percentage of chronic patients have some type of sexual dysfunction, this is not openly discussed, making it important for doctors to address these issues in the clinic. A review is presented on the pathophysiology of sexual dysfunctions in both male and female chronic renal patients. The effects of dialysis and transplantation on sexual function will be addressed, as well as presenting the main sexual dysfunctions and their treatment

[Sexual disorders in the renal patient]. / Problemas de la esfera sexual en el paciente renal.

Quality of Life Related to Health is currently considered one of the primary therapeutic objectives in renal failure patients who need substitution treatment as life prolonging therapy. Sexual health is a basic right that positively affects the quality of life. Although a significant percentage of chronic patients have some type of sexual dysfunction, this is not openly discussed, making it important for doctors to address these issues in the clinic. A review is presented on the pathophysiology of sexual dysfunctions in both male and female chronic renal patients. The effects of dialysis and transplantation on sexual function will be addressed, as well as presenting the main sexual dysfunctions and their treatment.

Resultados de la adrenalectomía en la metástasis del cáncer de pulmón / Results of adrenalectomy in lung cancer metastases

Introducción: El objetivo de este estudio es describir la experiencia en nuestro centro sobre pacientes con carcinoma de pulmón y metástasis adrenal tratados de manera secuencial, resección pulmonar y adrenalectomía, en los últimos 15 años. Pacientes y método: Analizamos una serie retrospectiva de 19 pacientes a los que se les realizó adrenalectomía por metástasis de carcinoma de pulmón. Todos los pacientes fueron operados en un mismo centro, entre octubre de 2000 y octubre de 2015. Se llevó a cabo un análisis descriptivo y de supervivencia global y libre de enfermedad. Resultados: Se incluyeron 13 varones y 6 mujeres. El tumor primario de pulmón más frecuente fue el adenocarcinoma, siendo el 87,5% G3. En 7 pacientes la metástasis adrenal se detectó de forma sincrónica, y en 12 metacrónica. El tamaño mediano de la metástasis fue de 63mm. El 21% de los casos presentaron recidiva local y el 79% metástasis a distancia. La mediana para la SLE fue de 21.5 meses, mientras la estimación de la SLE a 5 años fue del 58,33%. La mediana para la supervivencia global fue de 37,3 meses, mientras la estimación de la supervivencia a los 5 años fue del 42,86%. Ninguno de los factores pronósticos evaluados tuvieron significación estadística. Conclusiones: La adrenalectomía en casos de metástasis aislada de carcinoma de pulmón puede ofrecer una mayor supervivencia global. La edad y el grado de diferenciación del primario pulmonar son los factores que más influirían en una peor supervivencia

Background: The aim of this study was to report our centre's experience over the past 15 years with patients with lung carcinoma and adrenal metastases treated sequentially with lung resection and adrenalectomy. Patients and methods: We analysed a retrospective series of 19 patients who underwent adrenalectomy for lung carcinoma metastasis. All patients were operated on at the same centre, between October 2000 and October 2015. We performed a descriptive analysis and an overall survival and disease-free survival analysis. Results: The study included 13 men and 6 women. The most common primary lung tumour was adenocarcinoma, 87.5% of which were G3. In 7 patients, the adrenal metastasis was detected synchronously, and in 12 patients it was detected metachronously. The median size of the metastasis was 63mm. Twenty-one percent of the cases presented local recurrence, and 79% presented distant metastasis. The median DFS was 21.5 months, while the DFS at 5 years was calculated at 58.33%. The median overall survival was 37.3 months, while survival at 5 years was calculated at 42.86%. None of the prognostic factors evaluated were statistically significant. Conclusions: Adrenalectomy in cases of isolated lung carcinoma metastasis can offer increased overall survival. Age and the degree of differentiation of the primary lung carcinoma are the factors that most influence poorer survival

Qué debe saber el médico de primaria sobre los nuevos marcadores en el cáncer de próstata / What primary care physicians should know about new markers in prostate cancer

La utilización del antígeno prostático específico como herramienta diagnóstica en el cribado del cáncer de próstata se ve reflejada en un incremento en la incidencia, un incremento en el diagnóstico de cánceres más precoces y un aumento en los tratamientos con intención curativa, aun a costa de un sobretratamiento. Sabemos, por datos recogidos en la literatura, que no todo paciente con antígeno prostático específico elevado necesita biopsia, y que no todo paciente con diagnóstico de cáncer de próstata necesita tratamiento. Con los nuevos marcadores prostáticos emergentes vamos a tratar de mejorar la especificidad del antígeno prostático específico en la zona gris (4-10 ng/ml) evitando biopsias innecesarias, de mejorar la sensibilidad en la detección de cáncer de próstata significante con antígeno prostático específico bajo y a intentar reducir el riesgo de sobretratamiento. Por otro lado, los biomarcadores pronósticos con test genómicos nos van a ayudar a elegir la mejor opción terapéutica para el paciente

The use of prostate-specific antigen as a diagnostic tool in the screening of prostate cancer is reflected in an increase in the incidence, an increase in diagnosis at initial stages, and an increase in radical therapies, even at the expense of over-treatment in some cases. It is known from the data collected in the literature that not every patient with high prostate-specific antigen needs a biopsy, and that not every patient diagnosed with prostate cancer needs treatment. With the new emerging prostate markers, we will try to improve the specificity of prostate-specific antigen in the grey area (4-10 ng/ml) should be improved. This should avoid unnecessary biopsies. The sensitivity in the detection of significant prostate cancer with low prostate-specific antigen should also be improved in an attempt to reduce the risk of over-treatment. On the other hand, prognostic biomarkers with genomic tests will help to choose the best therapeutic option for the patient

[What primary care physicians should know about new markers in prostate cancer]. / Qué debe saber el médico de primaria sobre los nuevos marcadores en el cáncer de próstata.

The use of prostate-specific antigen as a diagnostic tool in the screening of prostate cancer is reflected in an increase in the incidence, an increase in diagnosis at initial stages, and an increase in radical therapies, even at the expense of over-treatment in some cases. It is known from the data collected in the literature that not every patient with high prostate-specific antigen needs a biopsy, and that not every patient diagnosed with prostate cancer needs treatment. With the new emerging prostate markers, we will try to improve the specificity of prostate-specific antigen in the grey area (4-10 ng/ml) should be improved. This should avoid unnecessary biopsies. The sensitivity in the detection of significant prostate cancer with low prostate-specific antigen should also be improved in an attempt to reduce the risk of over-treatment. On the other hand, prognostic biomarkers with genomic tests will help to choose the best therapeutic option for the patient.

Results of adrenalectomy in lung cancer metastases. / Resultados de la adrenalectomía en la metástasis del cáncer de pulmón.

BACKGROUND: The aim of this study was to report our centre's experience over the past 15 years with patients with lung carcinoma and adrenal metastases treated sequentially with lung resection and adrenalectomy. PATIENTS AND METHODS: We analysed a retrospective series of 19 patients who underwent adrenalectomy for lung carcinoma metastasis. All patients were operated on at the same centre, between October 2000 and October 2015. We performed a descriptive analysis and an overall survival and disease-free survival analysis. RESULTS: The study included 13 men and 6 women. The most common primary lung tumour was adenocarcinoma, 87.5% of which were G3. In 7 patients, the adrenal metastasis was detected synchronously, and in 12 patients it was detected metachronously. The median size of the metastasis was 63mm. Twenty-one percent of the cases presented local recurrence, and 79% presented distant metastasis. The median DFS was 21.5 months, while the DFS at 5 years was calculated at 58.33%. The median overall survival was 37.3 months, while survival at 5 years was calculated at 42.86%. None of the prognostic factors evaluated were statistically significant. CONCLUSIONS: Adrenalectomy in cases of isolated lung carcinoma metastasis can offer increased overall survival. Age and the degree of differentiation of the primary lung carcinoma are the factors that most influence poorer survival.

Actualización en incontinencia urinaria femenina / Female urinary incontinence: an update

La incontinencia urinaria es un síntoma muy prevalente en la población adulta femenina. Genera importantes connotaciones psicosociales y económicas, repercutiendo en la calidad de vida de las pacientes que la padecen. Es un problema infradiagnosticado, ya que las pacientes no siempre consultan por ello, por lo que es importante tenerlo presente y hacer un cribado oportunista desde atención primaria. Es difícil conocer el gasto sanitario que genera, parece que puede llegar a ser hasta el 2% del presupuesto sanitario. Todo esto hace que sea de gran importancia saber diagnosticar esta enfermedad, conocer los diferentes tipos de incontinencia que existen, sus posibles causas y los tratamientos disponibles. Para ello se presenta esta revisión, con el fin de conocer las herramientas diagnósticas y terapéuticas de las que se dispone, ver cuál es el papel de atención primaria en esta enfermedad y cuándo se debe derivar al nivel asistencial correspondiente (AU)

The urinary incontinence is a highly prevalent symptom in the adult female population. It has important psychosocial and economic connotations, and affects the quality of life of these patients. As it is an under-diagnosed problem due to patients not always consulting for it, it is very important to keep this in mind and to provide an opportunistic screening from Primary Health Care. It is difficult to determine the costs of this, but it is estimated to be the 2% of the health budget. Because of all of this, it is very important to know how to make a correct diagnose of this condition, to determine the different types of incontinence, possible causes, and treatments available. The purpose of this review is to show the different diagnostic and therapeutic tools available, to show the Primary Health Care role in this condition, and when to refer to specialist care (AU)

Aspectos actuales sobre el cribado en el cáncer de próstata / Current aspects of prostate cancer screening

Los programas de cribado de cáncer de próstata basados en la determinación sérica del antígeno específico de próstata han llevado a un sobrediagnóstico y, como consecuencia, a un sobretratamiento. Un porcentaje de varones diagnosticados de cáncer de próstata tienen un tumor que no progresará o lo hará lentamente (sobrediagnóstico o pseudoenfermedad). Esta tasa de sobrediagnóstico oscila entre el 17-50%. El cribado poblacional se define como la exploración sistemática de hombres asintomáticos. La detección precoz o cribado oportunista conlleva la búsqueda de casos individuales, siendo iniciada por el médico o el propio paciente. Ante un paciente que acuda a consulta solicitando un antígeno específico de próstata se le deben explicar una serie de cuestiones relativas al sobrediagnóstico, el sobretratamiento y los posibles daños derivados de la biopsia. Con los datos de los estudios aleatorizados sobre el antígeno específico de próstata y el cribado de cáncer de próstata, ninguna sociedad urológica recomienda realizar cribado poblacional (AU)

Screening programs for prostate cancer based on the determination of serum prostate specific antigen has led to overdiagnosis, and consequently overtreatment. A percentage of men diagnosed with prostate cancer have a tumour that will not progress, or do so slowly (overdiagnosis or pseudo-disease). This overdiagnosis rate ranges from 17-50%. Mass screening is defined as the systematic examination of asymptomatic men. Early detection or opportunistic screening involves the pursuit of individual cases being initiated by the doctor or the patient. In the case of a patient who requests a prostate specific antigen from their general practitioner, a number of issues on overdiagnosis, over-treatment and possible damage from the biopsy, should be explained to him. With data from randomised studies on prostate specific antigen and prostate cancer screening, population screening is not recommended by any urological society (AU)

[Female urinary incontinence: An update]. / Actualización en incontinencia urinaria femenina.

The urinary incontinence is a highly prevalent symptom in the adult female population. It has important psychosocial and economic connotations, and affects the quality of life of these patients. As it is an under-diagnosed problem due to patients not always consulting for it, it is very important to keep this in mind and to provide an opportunistic screening from Primary Health Care. It is difficult to determine the costs of this, but it is estimated to be the 2% of the health budget. Because of all of this, it is very important to know how to make a correct diagnose of this condition, to determine the different types of incontinence, possible causes, and treatments available. The purpose of this review is to show the different diagnostic and therapeutic tools available, to show the Primary Health Care role in this condition, and when to refer to specialist care.

[Current aspects of prostate cancer screening]. / Aspectos actuales sobre el cribado en el cáncer de próstata.

Screening programs for prostate cancer based on the determination of serum prostate specific antigen has led to overdiagnosis, and consequently overtreatment. A percentage of men diagnosed with prostate cancer have a tumour that will not progress, or do so slowly (overdiagnosis or pseudo-disease). This overdiagnosis rate ranges from 17-50%. Mass screening is defined as the systematic examination of asymptomatic men. Early detection or opportunistic screening involves the pursuit of individual cases being initiated by the doctor or the patient. In the case of a patient who requests a prostate specific antigen from their general practitioner, a number of issues on overdiagnosis, over-treatment and possible damage from the biopsy, should be explained to him. With data from randomised studies on prostate specific antigen and prostate cancer screening, population screening is not recommended by any urological society.

[Therapeutic effect of mitomycin C in the immediate postoperative period in patients with intermediate-risk non-muscle-invasive bladder tumors]. / Efecto terapéutico de mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de riesgo intermedio.

INTRODUCTION: Approximately 70-85% of transitional bladder cell carcinomas are non-muscle-invasive. After an initial surgery, around 60-90% will have a recurrence, being the highest risk period the first two years. Urothelium instability could be the main reason for recurrence in mid grade tumours, reason why a single dose of a chemotherapy after transurethral resection of the bladder (TURB) might be insufficient. That is why a deferred therapy in occasions associated with maintenance is recommended. PATIENTS AND METHODS: A prospective, controlled and randomized study was performed. We included non-muscle-invasive mid risk bladder tumours. All patients had initially a TURB performed and were randomized to receive a single dose of mitomycin C (MMC), in the immediate postoperative period. RESULTS: A total of 105 patients were included. Mean follow-up was 22, 70 +/- 8, 15 months. MMC was administered to 53 patients. Of these 66, 0% had no recurrence and 34.0% had a non-muscle-invasive recurrence. Of the 52 patients in the non MMC group, 53.8% had no recurrence and 44.2% had a non-muscle-invasive recurrence and only 1 patient had a muscle-invasive progression. We did not find significantly differences in time to recurrence in mid risk tumours when using immediate postoperative single dose of MMC or deferred therapy. There was only one case of myelosuppression. DISCUSSION: In mid risk non-muscle-invasive tumors, some studies suggest that early intravesical instillation of chemotherapy reduces the risk of recurrence after TURB. We could not show significantly differences when comparing postoperatorive MMC versus traditional deferred instillations.

Características clínico-patológicas del carcinoma de células renales detectado incidentalmente mediante estudios radiológicos / Clinicopathologic features of renal cell carcinoma incidentally detected through radiological studies

Objetivos: Evaluar el motivo de diagnóstico del carcinoma renal y su variación a lo largo de los años en los Servicios de Radiodiagnóstico 1 y Urología 1 del Hospital Universitario Central de Asturias (HUCA), comparando los periodos 1970-1995 y 1996-2005 y determinar si el hallazgo incidental puede explicar de forma independiente el pronóstico de estos tumores o es dependiente de sus características clínico-patológicas. Material y métodos: Se llevó a cabo una revisión exhaustiva de las historias clínicas, de manera retrospectiva, de 373 carcinomas de células renales sometidos a resección quirúrgica entre los años 1970 y 2005, recogiéndose unos datos según un protocolo establecido. Resultados: De los 373 tumores de nuestra serie, 146 (39,1%) fueron diagnosticados según nuestros criterios de forma incidental, mientras que 227 (60,9%) lo fueron por presentar clínica sospechosa de presencia de un tumor. Cuando realizamos el recuento distribuyendo estos pacientes en dos grupos, por un lado los diagnosticados entre los años 1970-1995, y por otro lado los diagnosticados entre 1996-2005, observamos un incremento significativo en el número de tumores diagnosticados de forma incidental en el segundo periodo. Encontramos como factores independientes en la supervivencia cáncer específica la presencia de metástasis, la invasión microvascular de la pieza quirúrgica y el tratamiento de la recidiva (quirúrgico vs otros), mientras que los factores independientes de la recidiva resultaron ser el grado nuclear, la presencia de adenopatías y el estadio T3, por tanto la presencia de clínica no fue un factor independiente de recidivani de supervivencia cáncer específico. Conclusiones: Clásicamente el carcinoma de células renales se diagnosticaba cuando presentaba síntomas locales (la hematuria y el dolor lumbar, eran los más frecuentes), síntomas derivados de las metástasis o por la expresión de un síndrome paraneoplásico. Desde la generalización de la ecografía y la tomografía computerizada (TC) en el estudio de la patología abdominal ha aumentado de forma espectacular el descubrimiento de adenocarcinomas renales asintomáticos. Cabe destacar, en nuestro estudio, que a pesar de que los pacientes diagnosticados con tumores incidentales presentaron un mayor tiempo libre de enfermedad y de supervivencia sin embargo, la presencia de clínica no fue un factor independiente ni de recidiva ni de supervivencia cáncer específico (AU)

Objectives: To evaluate the reason for diagnosis of renal cell carcinoma and its variation over the years in Radiology 1 and Urology 1departments of the Asturias Central Universitary Hospital (HUCA) comparing periods 1970-1995 and 1996-2005 and determine whether incidental findings may explain in an independent the prognosis of these tumors or it is dependent on its clinic pathologic characteristics. Material and methods: We conducted retrospectively, an exhaustive review of medical records of 373 renal cell carcinoma patients that underwent surgical resection during the period 1970-2005, collecting data according to a set protocol. Results: Of the 373 tumors in our series, 146 (39,1%) were diagnosed according to our criteria incidentally, while 227 (60,9%) were diagnosed due to clinical suspicion of a tumor presence. We observed a significant increase in the number of tumors incidentally diagnosed in the second period, when we performed the counting distributing these patients into two groups, firstly those diagnosed between the years 1970-1995 and, secondly, those diagnosed between 1996-2005. We found metastasis, microvascular invasion of surgical piece and treatment of the recurrence as independent factors for specific cancer survival, while nuclear grade, the presence of lymphadenopathies and T3 stage were found as independent factors for recurrence. Conclusions: Classically renal cell carcinoma was diagnosed when local symptoms were present (hematuria and back pain, were the most common), symptoms associated with metastasis, or the expression of a paraneoplastic syndrome. The discovery of asymptomatic renal cell carcinomas has dramatically increased, since the widespread use of ultrasound and computed tomography (CT) in the study of abdominal pathology. It is worth mentioning that, in our study, although patients diagnosed with incidental tumors had a longer time free to recurrence and survival, however, the presence of clinic was not an independent risk factor for recurrence or cancer-specific survival (AU)

[Therapeutic effect of mitomycin C in the immediate postoperatory in patients with low-risk non-muscle-invasive bladder tumours]. / Efecto terapéutico de mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de bajo riesgo.

INTRODUCTION: Bladder cancer is a disease with a high prevalence due to its recurrence rate. Transurethral resection of the bladder (TURB) is the treatment in initial stages. Nevertheless, a high percentage of non-muscle-invasive tumors treated will have a recurrence 1-2 years afterwards. Adjuvant quemotherapy or immunotherapy after TURB has been administered in order to decrease the rate of recurrence and to prevent progression. PATIENTS AND METHODS: A prospectived, controlled and randomized study was performed. We included 100 patients with non-muscle-invasive and bladder tumors the low grade. All patients had initially a TURB performed and were randomized to either receive or not a single dose mitomycin C (MMC) in the immediate postoperatory. RESULTS: All low grade tumors was less than 3 cm. Mean follow-up was 26.43 +/- 7.65 months. MMC was administered in 49 patients, of these, 67.3% had no recurrence and 32.7% had a non-muscle-invasive recurrence. Of the 51 patients in the non mitomycin, 51% had no recurrence while 47% had a non-muscle-invasive recurrence, and 2% had a muscle-invasive progression. We found significantly differences in time to recurrence among the two groups. SUMMARY: We found a greater time to recurrence in the group of single dose adjuvant MMC being this difference statistically significantly when comparing with the other group.

Efecto terapéutico de Mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de riesgo intermedio / Therapeutic effect of mitomycin C in the immediate postoperative period in patients with intermediate-risk non-muscle-invasive bladder tumors

Introducción: Aproximadamente del 70-85% de los carcinomas de células transicionales de vejiga no invaden la muscular propia. La recidiva después de la cirugía se cifra en un 60-90% de pacientes, siendo el periodo de alto riesgo los dos primeros años. La causa fundamental de recidiva en tumores de riesgo intermedio podría ser la inestabilidad del urotelio, por lo que la instilación única de un quimioterápico después de la RTU podría considerarse insuficiente, recomendándose un tratamiento diferido asociado con mantenimiento en algunos casos. Pacientes y Métodos: Estudio prospectivo, controlado y randomizado. Sólo se incluyeron pacientes con tumores vesicales no músculo-invasores de grado intermedio. Todos los pacientes fueron sometidos inicialmente a RTU y posteriormente randomizados para recibir Mitomicina C (MMC) postoperatoria en dosis única. Resultados: Se incluyeron 105 pacientes. La media de seguimiento fue de 22,70±8,15 meses. Se administró MMC en 53pacientes, de los cuales el 66% no recidivó y el 34% lo hicieron como tumor vesical no invasor. De los 52 pacientes que no recibieron MMC, el 53,8% no recidivaron, el 44,2% recidivaron como tumor no invasor y sólo un caso recurrió como tumor invasor.En cuanto al tiempo libre de enfermedad, no se encontraron diferencias significativas en los que se empleó MMC postoperatoriao tratamiento diferido. Sólo existió un caso de mielosupresión. Discusión: En tumores no músculo invasores de medio riesgo, diversos estudios sugieren que una instilación intravesical inmediata de un quimioterápico disminuye el riesgo de recidiva después de la RTU. No hemos logrado demostrar diferencias significativas al comparar la MMC postoperatoria frente a las instilaciones diferidas tradicionales (AU)

Introduction: Approximately 70-85% of transitional bladder cell carcinomas are non-muscle-invasive. After an initial surgery, around 60-90% will have a recurrence, being the highest risk period the first two years. Urothelium instability could be the main reason for recurrence in mid grade tumours, reason why a single dose of a chemotherapy after transurethral resection of the bladder (TURB) might be insufficient. That is why a deferred therapy in occasions associated with maintenance is recommended. Patients and methods: A prospective, controlled and randomized study was performed. We included non-muscle-invasive midrisk bladder tumours. All patients had initially a TURB performed and were randomized to receive a single dose of mitomycin C (MMC), in the immediate postoperative period. Results: A total of 105 patients were included. Mean follow-up was 22, 70±8, 15 months. MMC was administered to 53patients. Of these 66, 0% had no recurrence and 34,0% had a non-muscle-invasive recurrence. Of the 52 patients in the non MMC group, 53,8% had no recurrence and 44,2% had a non-muscle-invasive recurrence and only 1 patient had a muscle invasive progression. We did not find significantly differences in time to recurrence in mid risk tumours when using immediate postoperative single dose of MMC or deferred therapy. There was only one case of myelosuppression. Discussion: In mid risk non-muscle-invasive tumors, some studies suggest that early intravesical instillation of chemotherapy reduces the risk of recurrence after TURB. We could not show significantly differences when comparing postoperatorive MMC versus traditional deferred instillations (AU)

Efecto terapéutico de Mitomicina C en el postoperatorio inmediato de pacientes con tumores vesicales no músculo invasores de bajo riesgo / Therapeutic effect of mitomycin C in the immediate postoperatory in patients with low-risk non-muscle-invasive bladder tumours

Introducción: El cáncer vesical es una de las enfermedades con más alta prevalencia entre los distintos tipos de neoplasia debido a su tendencia a la recidiva. El tratamiento en las etapas iniciales es la resección transuretral (RTU). Sin embargo, después de la RTU de un tumor vesical no músculo invasor, un porcentaje alto recidivarán en 1-2 años. Por esta razón, se ha propuesto la administración de quimioterapia o inmunoterapia adyuvante después de la RTU en un intento de disminuir la recidiva y prevenir la progresión. Pacientes y métodos: Estudio prospectivo, controlado y randomizado. Se incluyeron 100 pacientes con tumores vesicales no músculo-invasores de bajo riesgo. Todos los pacientes sometidos inicialmente a RTU y posteriormente randomizados para recibir Mitomicina C (MMC) postoperatoria en dosis única. Resultados: Todos los tumores eran menores de 3 cm. La media de seguimiento fue de 26,43 ± 7,65 meses. Se administró MMC en 49 pacientes, de los cuales el 67,3% no recidivó y el 32,7% lo hicieron como tumor vesical no invasor. Delos 51 pacientes que no recibieron MMC, el 51% no recidivaron, el 47% recidivaron como tumor no invasor y el 2% como tumor invasor. Se encontraron diferencias significativas en cuanto al tiempo libre de enfermedad según se empleara MMC postoperatoria o nada. Conclusiones: Cuando evaluamos a los pacientes con carcinoma vesical no músculo invasor de bajo riesgo, pertenecientes a un solo centro sanitario y con dosis alta de MMC en dosis única tras la RTU, evidenciamos un mayor tiempo libre de enfermedad estadísticamente significativa frente a los casos en los que no se utilizó ningún tratamiento (AU)

Introductión: Bladder cancer is a disease with a high prevalence due to its recurrence rate. Transurethral resection of the bladder (TURB) is the treatment in initial stages. Nevertheless, a high percentage of non-muscle-invasive tumors treated will have a recurrence 1-2 years afterwards. Adjuvant quemotherapy or immunotherapy after TURB has been administered in order to decrease the rate of recurrence and to prevent progression. Patients and methods: A prospectived, controlled and randomized study was performed. We included 100 patients with non-muscle-invasive and bladder tumors the low grade. All patients had initially a TURB performed and were randomized to either receive or not a single dose mitomycin C (MMC) in the immediate postoperatory. Results: All low grade tumors was less than 3 cm. Mean follow-up was 26,43±7,65 months. MMC was administered in 49 patients, of these, 67,3% had no recurrence and 32,7% had a non-muscle-invasive recurrence. Of the 51 patients in the non mitomycin, 51% had no recurrence while 47% had a non-muscle-invasive recurrence, and 2% had a muscle invasive progression. We found significantly differences in time to recurrence among the two groups. Summary: We found a greater time to recurrence in the group of single dose adjuvant MMC being this difference statistically significantly when comparing with the other group (AU)