Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy. / Estudio retrospectivo de diferentes opciones de tratamiento conservador con Bacilo de Calmette-Guèrin en el carcinoma urotelial vesical T1G3: terapia de mantenimiento.

OBJECTIVE: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. MATERIAL AND METHODS: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. RESULTS: The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003). CONCLUSIONS: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance.

Electronic device for endosurgical skills training (EDEST): study of reliability.

PURPOSE: Minimally Invasive Surgery procedures are commonly used in many surgical practices, but surgeons need specific training models and devices due to its difficulty and complexity. In this paper, an innovative electronic device for endosurgical skills training (EDEST) is presented. A study on reliability for this device was performed. METHOD: Different electronic components were used to compose this new training device. The EDEST was focused on two basic laparoscopic tasks: triangulation and coordination manoeuvres. A configuration and statistical software was developed to complement the functionality of the device. A calibration method was used to assure the proper work of the device. A total of 35 subjects (8 experts and 27 novices) were used to check the reliability of the system using the MTBF analysis. RESULTS: Configuration values for triangulation and coordination exercises were calculated as 0.5 s limit threshold and 800-11,000 lux range of light intensity, respectively. Zero errors in 1,050 executions (0%) for triangulation and 21 errors in 5,670 executions (0.37%) for coordination were obtained. A MTBF of 2.97 h was obtained. CONCLUSIONS: The results show that the reliability of the EDEST device is acceptable when used under previously defined light conditions. These results along with previous work could demonstrate that the EDEST device can help surgeons during first training stages.

[Rectal injury during radical surgery of bladder and/or prostate]. / La lesión del recto en el transcurso de la cirugía radical de la vejiga y/o próstata.

Contribution of 42 patients, aged 57 to 69 (mean age 58) with infiltrant vesical neoplasia who underwent radical cystoprostatectomy according to the technique described by P.C. Walsh (38/42) or radical cystectomy with hysterectomy (4/42). Neoplasia stages were as follows: 7 T2G-III; 13 T3aGII: 15 T3aG-III and 7 T3bG-III. Ten (10) patients, aged between 48 and 70 (mean age 57), with prostate neoplasia who were performed radical prostatectomy using the technique described by the above author, were also ascribed to the last group. Prostate neoplasias were at the following stages: 4 T2c; 5 T3a and 1T3b. T3 stages had been given hormonal therapy prior to the procedure. No patient received radiotherapy. Rectal injury occurred in 2 of the 52 (2/52) patients described. One was a female patient who was being performed cystectomy and hysterectomy plus double adnexectomy. Urinary by-pass in this case was C.F.C. detubulized ureterosigmoidostomy. The second case was a male patient undergoing radical prostatectomy. In both cases pre- and post-operative discharge colostomy was performed. Suture of rectal injury was also done in the patient where colostomy was performed during the procedure. The authors emphasise that no rectal injury that may take place during radical prostatectomy or cystoprostatectomy should be disregarded. They raise and answer questions of great practical interest such as: Is simple suture of the rectum enough? Should the omentum be used in rectal repair? Is it indispensable to perform discharge colostomy? and, is prognosis more serious when the gut is not prepared?

[Small cell (oat cell) carcinoma of the prostate. Presentation of a case and review of the literature]. / Carcinoma de células pequeñas ("oat-cell") de próstata. Presentación de un caso y revisión de la literatura.

Prostate small cell carcinoma (SCC) is a rare and fatal condition over which countless enigmas hover both with regard to its origin and biological behaviour as well as to its management, the topic of this paper. We contribute the case of a 69-year old male diagnosed through transrectal biopsy and presenting lung, nodes and bone metastasis who underwent palliative UTR but died within four days of the intervention as a consequence of the metastatic condition. Microscopic and immunohistochemical findings characteristic of this type of tumour are described, emphasising the relevance of diagnosing this entity based on its poor prognosis and different therapeutic approach from that used for typical prostate adenocarcinoma.

[Benign fibrous histiocytoma of the female urethra]. / Histiocitoma fibroso benigno de uretra femenina.

Presentation of one case of benign fibrous histiocytoma of the female urethra in a 49-year old woman. Investigation of the various clinical and diagnostic aspects. Vaginal tumorectomy was curative, and no recurrence was observed 14 months after the control.