Graft Survival in Patients With Polycystic Kidney Disease With Nephrectomy of Native Kidney Pretransplant.

INTRODUCTION: Autosomal-dominant polycystic disease (ADPKD) represents 5%-10% of cases of end-stage renal failure. However, management of these patients in terms of whether or not to perform a transplant and optimal timing remains controversial. The objective of our analysis was to evaluate graft survival in patients with ADPKD in which we conduct pretransplant nephrectomy. METHODS: This retrospective study including renal transplant patients secondary to ADPKD in our hospital between January 2000 and December 2012. Pretransplant native kidney nephrectomy was indicated in cases of need for space or repeated complications (cysts). We compared the initial function and graft survival between groups of transplanted based on whether nephrectomy had been performed or not. RESULTS: Eighty-seven patients underwent a kidney transplant owing to ADPKD; 62% (n = 54) were male, with an average age of 55.22 years. Twenty-seven patients (30%) underwent nephrectomy native kidneys before transplantation. There were no serious postoperative complications. Patients who underwent nephrectomy (group 1) showed values of creatinine of 1.57 and 1.50 mg/dL at 3 and 6 months, respectively. In the no nephrectomy group, these values were 2.03 and 1.83 mg/dL, respectively. Graft survival after the first year was of 98% for group 1 and 95% for group 2. The 5-year implant survival was 95% and 80%, respectively. CONCLUSIONS: Native kidney nephrectomy before transplantation in ADPKD is safe in an experienced center, both in terms of surgery-related morbidity and mortality and graft survival and function.

[Determination of free prostatic specific antigen cut point for the selection of patients in first prostate biopsy]. / Determinación del punto de corte del porcentaje de PSA libre para la selección de pacientes sometidos a primera biopsia de próstata.

OBJECTIVES: Determine the cut point of free PSA rate for optimize the first prostate biopsy indication. MATERIAL AND METHODS: Prospective trial between june 2002-september 2004, We included patients in first prostate biopsy with normal rectal digital examen, total PSA between 3-10 ng/ml and normal transrectal prostate ultrasound. We realize descriptive stadistic analisis of variables age, total PSA, prostate volume and % free PSA and analitic stadistic analisis with ROC curves of variables total PSA and % free PSA for determine as of her predicts the best one rate of prostate cancer. RESULTS: We reclute 727 men with a mean age 62.91 years, total PSA mean 6.12 ng/ml, prostate volume mean 42.78 cc and % free PSA mean 15.22%. We had 106 prostate cancer, the prostate cancer rate in first biopsy was 14.6%; 77 cases had 1 lobe prostate cancer and 29 in 2 lobes. The most frecuent gleason was 6 (46 cases 43.4%) and the second gleason 7 (43 cases 40.6%). In the ROC curves analysis, total PSA had area under the curve 0.476 (p=0.3) and 0.611 (p=0.023) for % free PSA. The optime cut point for % free PSA in our trial was 19% (Sensibility 91.4% and Specificity 20%). The use of this cut point had allowed the saving us 138 biopsies (19.11%) with the lost one of diagnose of 10 cases of cancer of prostate. CONCLUSIONS: The use of the % free PSA is useful and allows in our region the best indication of the patients who are going to first biopsy of prostate, avoiding the accomplishment of unnecessary biopsies.

Determinación del punto de corte del porcentaje de PSA libre para la selección de pacientes sometidos a primera biopsia de próstata / Determination of free prostatic specific antigen cut point for the selection of patients in first prostate biopsy

Objetivo: Determinar el punto de corte de %PSA libre que nos permita optimizar la indicación de primera biopsia de próstata. Material y métodos: Estudio prospectivo entre junio 2002 y septiembre 2004 en el que incluimos pacientes sometidos a primera biopsia de próstata con tacto rectal normal, niveles de PSA total entre 3-10 ng/ml y ecografía transrectal de próstata normal. Realizamos estudio estadístico descriptivo de las variables edad, PSA, volumen prostático y porcentaje de PSA libre. Realizamos análisis estadístico analítico mediante curvas ROC de las variables PSA y % PSAL determinando cual de ellas predice mejor la existencia de cáncer de próstata en la primera biopsia transrectal de próstata. Resultados: Se reclutan un total de 727 hombres con una edad media de 62,91 años, el PSA medio de 6,12 ng/ml, el volumen prostático medio 42,78 cc, el % PSA libre medio de 15,22%. Se diagnosticaron un total de 106 tumores de próstata, obteniendo una tasa de biopsia prostática del 14,6%; 77 con afectación de 1 lóbulo y 29 con afectación de los 2 lóbulos. El gleason más frecuente fue el 6 (46 casos 43,4%) seguido del gleason 7 (43 casos 40,6%). En el análisis mediante curvas ROC el área bajo la curva para el PSA total fue de 0,476 (p=0,3) y para el % PSA libre de 0,611 (p=0,023). El punto de corte óptimo para el % PSA libre en nuestra serie se situó en el 19% con una sensibilidad del 91,5% y una especificidad del 20%. El uso de este parámetro nos hubiese permitido la realización de 138 biopsias menos (19,11%) con la pérdida de diagnóstico de 10 casos de cáncer de próstata. Conclusiones: El uso del %PSA libre es útil y permite en nuestro medio la mejor indicación de los pacientes que van a ser sometidos a primera biopsia de próstata, evitando la realización de biopsias innecesarias

Objetives: Determine the cut point of free PSA rate for optimize the first prostate biopsy indication. Material and methods: Prospective trial between june 2002-september 2004, We included patients in first prostate biopsy with normal rectal digital examen, total PSA between 3-10 ng/ml and normal transrectal prostate ultrasound. We realize descriptive stadistic analisis of variables age, total PSA, prostate volume and % free PSA and analitic stadistic analisis with ROC curves of variables total PSA and % free PSA for determine as of her predicts the best one rate of prostate cancer. Results: We reclute 727 men with a mean age 62.91 years, total PSA mean 6.12 ng/ml, prostate volume mean 42.78 cc and % free PSA mean 15.22%. We had 106 prostate cancer, the prostate cancer rate in first biopsy was 14.6%; 77 cases had 1 lobe prostate cancer and 29 in 2 lobes. The most frecuent gleason was 6 (46 cases 43.4%) and the second gleason 7 (43 cases 40.6%). In the ROC curves analysis, total PSA had area under the curve 0.476 (p=0.3) and 0.611 (p=0.023) for % free PSA. The optime cut point for % free PSA in our trial was 19% (Sensibility 91.4% and Specificity 20%).The use of this cut point had allowed the saving us 138 biopsies (19.11%) with the lost one of diagnose of 10 cases of cancer of prostate. Conclusions: The use of the % free PSA is useful and allows in our region the best indication of the patients who are going to first biopsy of prostate, avoiding the accomplishment of unnecessary biopsies

[Review of cut-off points between stages T1 and T2 in the 1997 TNM classification of renal carcinoma]. / Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997.

OBJECTIVE: We retrospectively review the patients treated at our institution for renal cell carcinoma (RCC). We compare the patients classified in TNM state T1N0M0 in the 1997 revision with the 1992 one in order to determine survival differences. We divide patients in three size related groups and compare its survival rates. MATERIAL AND METHODS: We review 168 surgically treated patients. 72 of them were classified into T1N0M0 stage. We compare cancer-free survival in patients included in 1997 and 1992 T1 stage. We divide patients in three groups: 1-3 cm, 3-5 cm, 5-7 cm and compare respective cancer-free survival. RESULTS: There is a survival difference between T1(1997)-T2(1992) (p = 0.478). There is an inferior survival in size group 5-7 cm compared with 1-3 cm and 3-5 cm ones (p = 0.02/0.0465). CONCLUSIONS: In our patients, 1997 revision of T1 size supposes a descent of cancer-free survival compared with 1992 one. We consider a better stage limit under 5 cm, instead of actual 7 cm.

Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997 / Cut-off point revision between 1997 TNM classification stages T1 and T2 o renal carcinoma

OBJETIVO: Realizamos un estudio retrospectivo de los pacientes tratados en nuestra institución por carcinoma de células renales (CCR). Comparamos los pacientes clasificados en el estadio T1N0M0 según la revisión TNM de 1997 con la clasificación según la revisión de 1992 para establecer diferencias de supervivencia. Comparamos diferentes cortes por tamaño tumoral y valoramos su implicación en la supervivencia. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 168 pacientes intervenidos por CCR, de ellos 72 clasificados en estadio T1N0M0. Comparamos supervivencia según las dos últimas revisiones TNM y en tres grupos de tamaño: 1-3 cm, 3-5 cm y 5-7 cm. RESULTADOS: Hallamos menor supervivencia en los pacientes T11997 (p=0,0478) y en grupo de tamaño 5-7 cm, con respecto al 1-3 cm (p=0,02) y al de 3-5 cm (p=0,0465).CONCLUSIONES: En nuestra serie, la revisión de 1997 en el estadio T1 supone un descenso de supervivencia. El límite en 7 cm es excesivo, lo consideramos más apropiado por debajo de 5 cm (AU)