Association of ABC and RENAL Scoring Systems With Morbidity in Partial Nephrectomy.

BACKGROUND/AIM: Different nephrometry scoring systems (NSSs) are used to evaluate the surgical complexity and outcomes of partial nephrectomy (PN) in patients with small renal tumors. This study aimed to assess the validity of nephrometry scoring systems towards aiding the preoperative planning of laparoscopic partial nephrectomy (PN). PATIENTS AND METHODS: Data of 77 patients who underwent partial nephrectomy at the Puerto Real University Hospital between January 2011 and December 2017 were retrospectively analyzed. Statistical analyses were carried out to determine whether there was an association between the complexity of the surgical procedure and the assigned nephrometry scores. RESULTS: Operative complications (bleeding volume, conversion to open surgery, perioperative bleeding, and postoperative fistula) were significantly associated with independent variables (age, sex, body mass index, radiological tumor size, and operative ischemia time) and with the classification of patients using arterial-based complexity (ABC) and radius endophytic/exophytic nearness anterior-posterior location (RENAL) scores. There was also a strong correlation between the RENAL and ABC scores [Cramer's V coefficient (0.682) and Fisher's test (p<0.0001)]. CONCLUSION: The RENAL and ABC scores are associated with the risk of the complexity of partial nephrectomy for T1 renal tumors, even for ≥T1b tumors and/or with complex anatomical features.

Treatment of Metastatic Castration-resistant Prostate Cancer Patients With Abiraterone Acetate and Prednisone and Corresponding Survival Prognostic Factors.

BACKGROUND/AIM: The aim of the study was to evaluate the combined treatment with abiraterone acetate and prednisone (AA+P) in patients with castration-resistant prostate cancer (mCPRC), and to identify the survival prognostic factors. PATIENTS AND METHODS: Patients diagnosed with mCPRC not previously treated with chemotherapy and administered with AA+P were classified into two groups: those with lower and higher survival rates (at 30 months vs. 60 months). RESULTS: A total of 53 patients were studied at the time of mCRPC diagnosis. Patients with the highest survival rate had suffered prostate cancer for >45 months. At the time of initial prostate cancer diagnosis, they belonged to the risk groups 1-4, had pain intensity measured according to the brief pain inventory (BPI) scale of 0-2, were treated with AA+P>16 months, and had the following tumour marker serum levels: LDH baseline ≤163 U/l, alkaline phosphatase at 6 months ≤56 U/l and PSA at 6 months ≤0.95 ng/ml. CONCLUSION: Good response to treatment with AA+P for patients with mCRPC was demonstrated. Factors that contributed to the higher prognostic accuracy were time suffering from prostate cancer, the intensity of the pain measured by the BPI scale, the duration of AA+P treatment, and tumour marker levels.

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

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

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

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

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

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

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

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

Serum biomarkers of inflammation for diagnosis of prostate cancer in patients with nonspecific elevations of serum prostate specific antigen levels.

BACKGROUND: Lactate dehydrogenase (LDH) and C-reactive protein (CRP) are biomarkers of inflammation commonly used in medicine. The aim was to evaluate the utility of serum LDH and CRP levels for diagnosis of prostate cancer (PC) in men with nonspecific elevations of serum total prostate specific antigen (PSA) levels. METHODS: The following serum biomarkers were measured in patients with PSA between 4 and 10 ng/mL: LDH, CRP and free-PSA. The free-to-total serum PSA ratio (%fPSA) was (free-PSA/PSA) ×100. Patients were classified into two groups according to diagnosis of prostate biopsy: PC and NOT PC patients. Logistic regression was used for develop a probabilistic model to predict PC patients. Diagnostic accuracy was determined using receiver operating characteristic (ROC) curves, calculating the area under the ROC curve (AUC). RESULTS: We studied 232 patients with ages between 43 and 98 years old (median =72), 200 NOT PC and 32 PC patients. CRP was not statistically significantl to differentiate between PC and NOT PC patients. Probabilistic model (%) was 100× (1+ e-Z)-1; (Z =0.0070× LDH -0.1589× %fPSA -1.4898). The AUCs were 0.657 (P=0.0048), 0.802 (P<0.0001), and 0.844 (P<0.0001) for serum LDH levels, %fPSA values and probabilistic model, respectively. CONCLUSIONS: CRP was not useful to differentiate benign from malignant prostate disease, in contrast LDH could be used for diagnosis of PC. A probabilistic model using LDH and %fPSA can improve the diagnostic accuracy in patients with PSA between 4 and 10 ng/mL.

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

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

Hirsutismo y amenorrea en carcinoma adrenocortical oncocítico hormonalmente activo. Aportación de un caso y revisión de la literatura / Functioning adrenocortical oncocytic carcinoma presenting with hirsutism and amenorrhea. A rare case report and literature review

Los carcinomas de la corteza suprarrenal son tumores poco frecuentes y agresivos, con mal pronóstico. Las neoplasias oncocíticas son una variante excepcional de carcinomas de la corteza suprarrenal y raramente se encuentran en la glándula suprarrenal. Por lo general, son benignas y no funcionantes. Presentamos el caso de un carcinoma adrenocortical oncocítico, secretor de testosterona, en una mujer de 37 años de edad que presenta acné, hirsutismo y ciclos menstruales irregulares. Las investigaciones clínicas revelaron una testosterona y DHEA-S elevadas, así como una masa de 11×8cm dependiente de la glándula suprarrenal izquierda. Se decide adrenalectomía izquierda. La histología mostró la presencia de una tumoración compuesta de células oncocíticas con citoplasma granular y eosinófilo, características compatibles con un carcinoma oncocítico. Durante el seguimiento se lleva a cabo una nueva TAC, a los 2 meses de la intervención, que revela la presencia de metástasis pulmonares. En estos casos la cirugía está asociada con un aumento de la supervivencia, incluso en la enfermedad metastásica. Por ello, debe ser considerada, en pacientes adecuadamente seleccionados, como parte de un tratamiento multimodal. La quimioterapia citotóxica y el uso de mitotane se han utilizado con un grado de beneficio variable, con escasas respuestas a largo plazo. Posteriormente, llevamos a cabo una revisión de la literatura, con la intención de resaltar y resumir los aspectos más significativos de su epidemiología, clínica, diagnóstico, pronóstico y tratamiento (AU)

Adrenocortical carcinoma is a rare and aggressive cancer and its prognosis is frequently unsatisfactory. Oncocytic neoplasms are an exceptional variant of adrenocortical carcinoma and most rarely found in the adrenal gland. They are usually benign and non-functioning. We present a case of a testosterone-secreting oncocytic adrenocortical carcinoma in a 37-year-old female who presented with acne, hirsutism and irregular menses. Clinical investigations revealed an elevated testosterone and DHEA-S and a 11×8cm left adrenal mass. The tumour was successfully excised. Histopathological result of adrenal mass showed the tumour to be comprised of oncocytic cells with granular, eosinophilic cytoplasm, features consistent with an oncocytic carcinoma. However, follow-up computed tomography at 2 months after the left adrenalectomy revealed lung metastasis. Surgery is associated with improved survival, even in metastatic disease. Therefore, surgery should be considered for select patients as part of multimodality treatment. Cytotoxic chemotherapy and mitotane have been utilized with a variable degree of benefit and few long-term responses. Then we deal with a literature review to highlight and summarize most significant aspects of epidemiology, clinical, diagnosis, prognosis and therapy (AU)

Aneyaculación como síntoma inicial atípico en un paciente con fibrosis retroperitoneal idiopática / Anejaculation as an atypical initial symptom in a patient with retroperitoneal idiopathic fibrosis

La fibrosis retroperitoneal es una enfermedad rara de causa desconocida. Fue descrita por primera vez en la literatura inglesa en 1948 por Ormond. Se caracteriza por una inflamación crónica e inespecífica del retroperitoneo, la cual puede atrapar y obstruir las estructuras que allí se encuentran, particularmente a los uréteres. En algunas ocasiones se han documentado trastornos de la eyaculación, siendo este un síntoma poco frecuente. La histología parece necesaria para un diagnóstico de certeza, no siendo imprescindible por el alto rendimiento de las pruebas diagnósticas. Su importancia radica en su diagnóstico precoz e inicio de tratamiento para impedir una evolución tórpida y sus complicaciones asociadas. Presentamos el caso de un paciente varón de 46 años con el diagnóstico de fibrosis retroperitoneal idiopática, que comienza con aneyaculación e hidronefrosis bilateral como síntomas principales (AU)

Retroperitoneal fibrosis is an uncommon disease of unclear cause. It was described for the first time in English literature by Ormond in 1948. It is characterised by chronic non-specific inflammation of the retroperitoneum that can entrap and obstruct retroperitoneal structures, notably the ureters. In some rare instances, it has been coupled with ejaculatory disorders. Histology would appear to be required for accurate diagnosis, but it does not affect the efficiency of diagnostic tests and procedures. Its importance lies in early diagnosis and early treatment to prevent a negative prognosis and further complications. We present the case of a 46-year-old male patient with a diagnosis of idiopathic retroperitoneal fibrosis, whose first symptoms were anejaculation and bilateral hydronephrosis (AU)

[Prolonged hypogonadism after cessation of androgen deprivation therapy for prostate cancer]. / Hipogonadismo prolongado tras la suspensión de tratamiento hormonal en pacientes con cáncer de próstata.

OBJECTIVES: To study the levels of LH, testosterone and PSA after suspending prolonged treatment with LH-RH analogs. MATERIALS AND METHOD: Hormonal evolution was studied in 29 patients from whom treatment had been withdrawn. The patients had previously been receiving treatment with LH-RH analog for more than one year, and with LH< 2 mUI/mL and testosterone < 2.8 ng/mL. LH, testosterone and PSA were determined monthly, together with clinical assessment. The treatment was re-initiated and the period of monitoring ended before the presence of clinical progression and/or PSA > or = 10 ng/mL. The cohort was described and survival was calculated using Kaplan-Meier and Cox regression. RESULTS: The mean period of time without treatment for the series was 35 months (CI 95%, 15.7-54.2 months). Prolonged hypogonadism (> 24 months) was presented by 17% of the patients. The recovery of the LH-T-PSA axis, when it occurred, followed the expected sequence. The variables that influenced the period of recovery of the PSA were the PSA pretreatment and the association of an antiandrogen. CONCLUSIONS: After withdrawing the prolonged treatment with LH-RH analogs, most of the patients recovered the levels of LH-T-PSA, although a subgroup remained hypogonadic for more than 24 months.

[Urethoplasty in balanitis xerotica obliterans. Technical variation]. / Uretroplastia en balanitis xerótica obliterante. Modificación técnica.

OBJECTIVE: We propose a modification to urethroplasty for stricture due to lichen sclerosus (balanitis xerotica obliterans). METHODS: We combine two-stage bucal mucosa graft and onlay ventral island flap. RESULTADOS/CONCLUSIONES: This technique offers enlargement of the graft with the island flap and removal of the pathological skin.

Hipogonadismo prolongado tras la suspensión de tratamiento hormonal en pacientes con cáncer de próstata / Prolonged hypogonadism after cessation of androgen deprivation therapy for prostate cancer

Objetivos: Estudiar los niveles de LH, testosterona y PSA tras suspender el tratamiento prolongado con análogos LH-RH. Material y Método: Se estudió la evolución hormonal de 29 pacientes a los que se les retiró el tratamiento. Los pacientes previamente habían seguido tratamiento con análogo LH-RH por más de un año y con LH<2 mUI/mL y testosterona <2,8ng/mL. Se determinó mensualmente la LH, testosterona y PSA junto con valoración clínica. Se reinicia el tratamiento y el tiempo de seguimiento finaliza ante la presencia de progresión clínica y/o PSA ≥ 10 ng/mL. Se realizó descripción de la cohorte, el cálculo de supervivencia mediante Kaplan-Meier y regresión de Cox. Resultados: El tiempo medio sin tratamiento de la serie fue de 35 meses (IC 95% 15,7-54,2 meses). El 17% de los pacientes presentaron hipogonadismo prolongado (>24 meses). La recuperación del eje LH-T-PSA, cuando se produjo, siguió la secuencia esperada. Las variables que influyeron en el tiempo de recuperación del PSA fueron el PSA pretratamiento y la asociación de antiandrógeno. Conclusiones: Tras retirar el tratamiento prolongado con análogos LH-RH la mayoría de los pacientes recuperan los niveles de LH-T-PSA si bien un subgrupo se mantienen hipogonádicos más de 24 meses (AU)

Objectives: To study the levels of LH, testosterone and PSA after suspending prolonged treatment with LH-RH analogs. Materials and Method: Hormonal evolution was studied in 29 patients from whom treatment had been withdrawn. The patients had previously been receiving treatment with LH-RH analog for more than one year, and with LH< 2 mUI/mL and testosterone <2.8 ng/mL. LH, testosterone and PSA were determined monthly, together with clinical assessment. The treatment was re-initiated and the period of monitoring ended before the presence of clinical progression and/or PSA ≥ 10ng/mL. The cohort was described and survival was calculated using Kaplan-Meier and Cox regression. Results: The mean period of time without treatment for the series was 35 months (CI 95%, 15.7-54.2 months). Prolonged hypogonadism (> 24 months) was presented by 17% of the patients. The recovery of the LH-T-PSA axis, when it occurred, followed the expected sequence. The variables that influenced the period of recovery of the PSA were the PSA pretreatment and the association of an antiandrogen. Conclusions: After withdrawing the prolonged treatment with LH-RH analogs, most of the patients recovered the levels of LH-T-PSA, although a subgroup remained hypogonadic for more than 24 months (AU)

Uretroplastia en balanitis xerótica obliterante. Modificación técnica / Urethroplasty in Balanitis Xerotica obliterans. Technical variation

OBJETIVO: Proponemos una modificación a la uretroplastia en la estenosis que se asocia al liquen escleroatrófico (balanitis xerótica obliterante).MÉTODO: Combinamos dos técnicas (injerto de mucosa bucal en parche y colgajo ventral de piel proximal) en dos tiempos.RESULTADOS/CONCLUSIONES: A la técnica de Barbagli se une la ventaja de ampliar el parche con el colgajo ventral y el hecho de utilizar piel ventral proximal nos aleja de la zona afectada por la balanitis xerótica(AU)

OBJECTIVE: We propose a modification to urethroplasty for stricture due to lichen sclerosus (balanitis xe-rotica obliterans).METHODS: We combine two-stage bucal mucosa graft and onlay ventral island flap.RESULTADOS/CONCLUSIONES: This technique offers enlargement of the graft with the island flap and removal of the pa-thological skin(AU)