Estudio comparativo entre láser tulio (Tm: YAG) 150W y láser verde (LBO:ND-YAG) 120W para el tratamiento de la hiperplasia benigna de próstata: eficacia y seguridad a corto plazo / Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: short-term efficacy and security

Objetivo: Comparar los resultados de eficacia y seguridad del láser tulio 150W frente a láser verde 120W en el tratamiento de la hiperplasia benigna de próstata a corto plazo (12 meses de la cirugía). Material y métodos: Estudio retrospectivo observacional, donde se incluyen varones intervenidos con la técnica de fotovaporización prostática durante un periodo de 4 años en nuestro centro. Se comprobó la homogeneidad de la muestra, y se compararon las complicaciones postoperatorias (retención aguda de orina, reingreso, necesidad de transfusión), los fracasos al año de la cirugía (reintervenciones, flujo máximo < 15ml/seg, ausencia de mejoría en el I-PSS) y disminución de PSA al año de la cirugía. Análisis bivariante mediante Chi-cuadrado y «t» de Student. Resultados: Ciento dieciséis pacientes tratados con tulio y 118 con láser verde. Muestra homogénea para variables preoperatorias (p>0,05). No se objetivaron diferencias en las complicaciones: en retenciones agudas de orina, 4,3% con tulio y 6,8% con láser verde (p = 0,41); en reingresos 2,6% con tulio y 1,7% con láser verde (p = 0,68); en necesidad de transfusión 2,6% con tulio y 0% con láser verde (p = 0,12). Tampoco se observaron diferencias en el porcentaje de pacientes reintervenidos (1,7% en el grupo de tulio, 5,1% en el de láser verde, p = 0,28), ni en el de individuos con Qmáx menor de 15 ml/seg (6,9% con tulio, 6,77% con láser verde, p = 0,75), ni en el de ausencia de mejoría del I-PSS (5,2% con tulio, 3,4% con láser verde, p = 0,65). Tampoco hubo diferencia en los niveles de PSA en ng/ml al año de la cirugía: con tulio 2,78 ± 2,09 y con láser verde 1,83±1,48 (p = 0,75). Conclusiones: La fotovaporización prostática con láser tulio 150W es comparable a la realizada con láser verde de 120 W para el tratamiento de los síntomas obstructivos del tracto urinario inferior por HBP, siendo ambas técnicas eficaces y seguras a los 12 meses de la intervención. Futuros estudios prospectivos aleatorizados son necesarios para confirmar esta conclusión sobre ambas técnicas

Objective: To compare the results of efficacy and safety of Thulium laser 150 W against Greenlight laser 120 W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). Material and methods: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow < 15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. Results: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P > .05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P = .41); in readmissions, 2.6% with thulium and 1.7% with green laser (P = .68); in need for transfusion, 2.6% with thulium and 0% with green laser (P = .12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P = .28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P = .75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P = .65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78 ± 2.09 and with green laser 1.83 ± 1.48 (P = .75). Conclusions: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques

Comparative study between thulium laser (Tm: YAG) 150W and greenlight laser (LBO:ND-YAG) 120W for the treatment of benign prostatic hyperpplasia: Short-term efficacy and security. / Estudio comparativo entre láser tulio (Tm: YAG) 150W y láser verde (LBO:ND-YAG) 120W para el tratamiento de la hiperplasia benigna de próstata: eficacia y seguridad a corto plazo.

OBJECTIVE: To compare the results of efficacy and safety of Thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). MATERIAL AND METHODS: This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/sec, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. RESULTS: 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (P>.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (P=.41); in readmissions, 2.6% with thulium and 1.7% with green laser (P=.68); in need for transfusion, 2.6% with thulium and 0% with green laser (P=.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, P=.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, P=.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, P=.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (P=.75). CONCLUSIONS: Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.

Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study.

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

[Radiofrequency ablation as an alternative treatment for organ confined renal tumor]. / Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado.

INTRODUCTION: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complications. MATERIAL AND METHODS: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3 cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter. RESULTS: 11 tumors, 9 patients. The mean age was 76 years (63-85 years). The average tumor size was 3.5 cm (2.2-5.8 cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3-52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. CONCLUSIONS: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate.

Ablación con radiofrecuencia como alternativa de tratamiento para el tumor renal localizado / Radiofrequency ablation as an alternative treatment for organ confined renal tumor

Introducción: Presentamos nuestra serie inicial de tumores renales tratados mediante radiofrecuencia (RF) continua percutánea y evaluamos la eficacia, la tolerabilidad y las complicaciones de la técnica. Material y métodos: Revisión retrospectiva de los pacientes tratados en nuestro hospital con RF renal ecoguiada. Todos diagnosticados de tumor renal y no candidatos a cirugía por tumor bilateral, comorbilidad importante o rechazo al tratamiento quirúrgico. Utilizamos un generador Amitech® de 220W con una punta de electrodo de 3 cm, agujas de punta recta y en gancho. Los controles fueron realizados mediante una tomografía computarizada toracoabdominopélvica a las 24h, a los 7 días, al mes, a los 3 meses y a los 6 meses, y cada 6 meses después. Resultados: Se hallaron 11 tumores en 9 pacientes. La media de edad fue de 76 años (63–85). La media de tamaño tumoral fue de 3,5cm (2,2–5,8). En 2 tumores se necesitó de quimioembolización previa y en otros dos se necesitó una nueva sesión de RF. Hubo 9 tumores con tratamiento considerado como eficaz. La media de seguimiento fue de 17,5 meses (3–52). Un paciente tuvo persistencia de enfermedad a los 3 meses con necesidad de nefrectomía radical laparoscópica y otros dos tuvieron metástasis pulmonares a los 26,5 meses de media. No hubo complicaciones relevantes clínicamente. Conclusiones: En nuestra experiencia, estimamos que la RF es un tratamiento considerado como una alternativa para los tumores renales de estadio clínico T1 o T2 muy sintomáticos, en pacientes en los que no es posible la cirugía, con unos resultados aceptables a medio plazo, una buena tolerancia, un escaso consumo de recursos hospitalarios y un bajo índice de complicaciones (AU)

Introduction: We report our early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC) and evaluate the efficacy, tolerability and complicactions. Material and methods: Retrospective review of patients treated in our hospital with kidney ecoguide RF. All of them diagnosed with renal tumor and not candidates for surgery because of bilateral tumor, significant comorbidity or refusal to surgical treatment. We use an Amitech® 220 Watts generator with an electrode tip 3cm. Straight knitting needles and hooks. Controls were performed with axial tomography at 24h, 7 days, 1, 3 and 6 months and every 6 months thereafter.Results11 tumors, 9 patients. The mean age was 76 years (63–85 years). The average tumor size was 3.5cm (2,2–5,8cm). In 2 tumors was needed prior chemoembolization. In other two new RF session was needed. 9 tumors with treatment considered effective. Mean follow-up was 17.5 months (3–52 months). One patient had local recurrence at 14 months and needed a laparoscopic radical nephrectomy and two patients developed lung metastases 41.5 months after RF. There were no clinically relevant complications. Conclusions: In our experience, we believe that RF is considered an alternative treatment for renal tumors with clinical stage T1 or T2 very symptomatic in patients in whom surgery is not possible, with acceptable results in the medium term, a good tolerance, reduced consumption of hospital resources and low complication rate (AU)

[Malignant fibrous histiocytoma of the bladder. A literature review]. / Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica.

OBJECTIVES: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. MATERIALS AND METHODS: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. RESULTS: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. CONCLUSIONS: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy.

Histiocitoma fibroso maligno de vejiga. Revisión bibliográfica / Malignant fibrous histiocytoma of the bladder. A literature review

Objetivos: El histiocitoma fibroso maligno (HFM) es un tumor poco frecuente del tracto urinario. Pretendemos actualizar los criterios diagnósticos, las características anatomopatológicas e inmunohistoquímicas, la clasificación histológica, los factores pronóstico y las alternativas terapéuticas. Material y métodos: Revisión bibliográfica y estudio descriptivo de los casos de HFM de vejiga publicados en la literatura médica internacional. Resultados: Existen 29 casos publicados de HFM de vejiga y las variantes morfológicas más frecuentes son la estoriforme-fascicular (41%) y la inflamatoria (36%). Las variantes no mixoides comportan peor pronóstico. El 72% fue T3 en el momento del diagnóstico. La tasa de recurrencia local y a distancia del HFM de vejiga fue del 50 y del 25%, respectivamente, tras tratamiento exclusivamente quirúrgico. Conclusiones: El HFM de vejiga es un tumor con alta tasa de recurrencia local y a distancia, así como baja supervivencia, requiriendo un tratamiento precoz y agresivo. La cistectomía radical con linfadenectomía y radioterapia adyuvante, con eventual quimioterapia, se considera el tratamiento de elección (AU)

Objectives: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments. Materials and methods: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done. Results: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only. Conclusions: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy (AU)