Prospective Study of Homologous Recombination Repair Gene Mutation Prevalence in Patients With Advanced Prostate Cancer From Latin America: Challenges and Future Approaches.

PURPOSE: The prevalence of homologous recombination repair gene mutations (HRRm) in patients with metastatic castration-resistant prostate cancer (mCRPC) in Latin America and the Caribbean (LAC) is unknown. Prevalence of homologous Recombination repair (HRR) gene mutatiOns in patientS with metastatic castration resistant ProstatE Cancer in LaTin America (PROSPECT) aimed to determine this prevalence and to describe the demographic and clinical characteristics of the participants. MATERIALS AND METHODS: This was a prospective, cross-sectional, multicenter study across 11 cancer centers in seven LAC countries. After informed consent, all eligible participants underwent genomic testing by provided blood samples for germline HRR testing; they also provided PC tissue blocks if available for somatic HRR testing. RESULTS: Between April 2021 and April 2022, 387 patients (median age, 70 years [49-89], 94.3% Eastern Cooperative Oncology Group 0-1) with mCRPC were enrolled in the study. Almost 40% of them had a family history of cancer, and the overall time from their initial PC and mCRPC diagnosis was 3 years and 1 year, respectively. The overall prevalence of germline HRRm was 4.2%. The mutations detected included the genes CHEK2 (n = 4, 1%), ATM (n = 3, 0.8%), BRCA2 (n = 3, 0.8%), BRIP1 (n = 2, 0.5%), RAD51B (n = 2, 0.5%), BRCA1 (n = 1, 0.3%), and MRE11 (n = 1, 0.3%). The prevalence of somatic HRRm could not be assessed because of high HRR testing failure rates (79%, 199/251) associated with insufficient DNA, absence of tumor cells, and poor-quality DNA. CONCLUSION: Despite the study's limitations, to our knowledge, PROSPECT was the first attempt to describe the prevalence of HRRm in patients with PC from LAC. Notably, the germline HRRm prevalence in this study was inferior to that observed in North American and European populations. The somatic HRR testing barriers identified are being addressed by several projects to improve access to HRR testing and biomarker-based therapies in LAC.

[Lumboscopy: initial experience with the Berazategui's technique. First 600 cases]. / Lumboscopia: experiencia con la tecnica en Berazategui, primeros 600 casos.

OBJECTIVES: To show the lumboscopy technique developed in our department, our case series and its results. METHODS: From August 15th 1997 to date 606 patients were operated on by means of the lumboscopy technique. 152 nephrectomies, 18 partial nephrectomies, 103 pyeloplasties, 5 adrenalectomies, 89 pyelolithotomies, 153 ureterolithotomies, 44 renal cyst unroofing and other 42 procedures were performed. RESULTS: We perform the retroperitoneal access in the inferior lumbar triangle, with digital blunt dissection only and direct pneumatic dissection with a high flow insufflator, without balloon or balloon trocar dissection. We describe the development of the working space with perirenal fat flaps, as well as the various types of pathology operated and our complications. CONCLUSIONS: The working space in lumboscopy must be created by the surgeon beyond using a balloon or direct digital dissection technique. The technique we describe is easy and reproducible, creating an adequate surgical space and requires the anatomical knowledge to be able to identify landmarks.

Lumboscopia: experiencia con la tecnica en berazategui, primeros 600 casos / Lumboscopy: initial experience with the Berazategui's technique. First 600 cases

Objetivo: Exponer la técnica de lumboscopía desarrollada en nuestro servicio, la casuística, y los resultados obtenidos por este abordaje. Métodos: Desde el 15 de agosto de 1997, a la fecha, fueron operados 606 pacientes por técnica lumboscópica. Se realizaron: 152 nefrectomías, 18 nefrectomías parciales, 103 pieloplastías, 5 adrenaletomías, 89 pielolitotomías, 153 ureterolitotomías, 44 destechamientos de quistes renales y 42 otros procedimientos varios. Resultados: Planteamos el ingreso retroperitoneal en el triángulo lumbar inferior, sólo con disección digital, más disección neumática directa con insuflador de alto flujo, sin utilizar balón o trócar-balón disector. Se describe la creación del espacio de trabajo mediante colgajos de grasa, así como los distintos tipos de patología abordada y sus complicaciones. Conclusiones: El espacio de trabajo en la lumboscopía debe ser creado por el cirujano urológico mas allá de utilizar una técnica con disección por balón o directa en forma digital. La técnica descrita es sencilla y reproducible, creando un espacio quirúrgico adecuado y requiriendo un conocimiento anatómico, para poder identificar las referencias en esta vía (AU)

Objectives: To show the lumboscopy technique developed in our department, our case series and its results. Methods: From August 15th 1997 to date 606 patients were operated on by means of the lumboscopy technique. 152 nephrectomies, 18 partial nephrectomies, 103 pyeloplasties, 5 adrenalectomies, 89 pyelolithotomies, 153 ureterolithotomies, 44 renal cyst unroofing and other 42 procedures were performed. Results: We perform the retroperitoneal access in the inferior lumbar triangle, with digital blunt dissection only and direct pneumatic dissection with a high flow insufflator, without balloon or balloon trocar dissection. We describe the development of the working space with perirenal fat flaps, as well as the various types of pathology operated and our complications. Conclusions: The working space in lumboscopy must be created by the surgeon beyond using a balloon or direct digital dissection technique. The technique we describe is easy and reproducible, creating an adequate surgical space and requires the anatomical knowledge to be able to identify landmarks (AU)

[Chronic pelvic pain as a complication of cystourethropexy with tension free vaginal tape. Case report]. / Dolor pélvico crónico como complicación de la cistouretropexia con malla libre de tensión. Presentación de un caso.

OBJECTIVE: To report an interesting case of a rare complication of cystourethropexy, as well as its precise diagnosis and results after treatment. METHODS: We reviewed the medical records of the patients as well as their operative report and she underwent outpatient follow-up for the following six months. We descriptively report the findings. RESULTS: It is the case of a female patient presenting a foreign body rejection of a suburethral tension free vaginal tape (TVT). She complained of severe pain in the immediate postoperative period, which led to retrieval of the tape in spite of a good continence result. CONCLUSIONS: Foreign body rejection is a rare complication of vaginal tapes; it is rarely taken into account but it should be present in any exclusion diagnosis because the possibility of tape retrieval is not always associated with recurrence of the incontinence.

Dolor pélvico crónico como complicación de la cistouretropexia con malla libre de tensión. Presentación de un caso / Chronic pelvic pain as a complication of cystourethropexy with tension free vaginal tape. Case report

OBJETIVO: presentar en la comunidad urológica un caso de interés de una complicación poco común de un procedimiento ya muy extendido como es la cistouretropexia, así como su diagnóstico preciso y resultados al tratamiento. MÉTODO: Se revisó la historia clínica de la paciente así como el protocolo quirúrgico y se le dio seguimiento en la consulta externa por los 6 meses siguientes. Se presentan los hallazgos de manera descriptiva. RESULTADOS: Se trata de una paciente que presenta un rechazo a tejido foráneo por una malla libre de tensión suburetral, quien cursa con dolor intenso en el postoperatorio mediato que lleva al retiro de la misma pese a que el resultado de continencia se había logrado. CONCLUSIONES: El recazo a tejido foráneo es una complicación rara de las malas vaginales por lo cual es poco tomada en cuenta, hay que tener presente que es un diagnóstico de exclusión y que la posibilidad de retiro de la misma no en todos los casos conlleva reaparición de la incontinencia

OBJECTIVE: To report an interesting case of a rare complication of cystourethropexy, as well as its precise diagnosis and results after treatment. METHODS: We reviewed the medical records of the patients as well as their operative report and she underwent outpatient follow-up for the following six months. We descriptively report the findings. RESULTS: It is the case of a female patient presenting a foreign body rejection of a suburethral tension free vaginal tape (TVT). She complained of severe pain in the immediate postoperative period, which led to retrieval of the tape in spite of a good continence result. CONCLUSIONS: Foreign body rejection is a rare complication of vaginal tapes; it is rarely taken into account but it should be present in any exclusion diagnosis because the possibility of tape retrieval is not always associated with recurrence of the incontinence