Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor.

Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate. Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA). Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months. Results: PSAD showed a significant association with PSM (p < 0.0001), PSA persistence (p < 0.0001), and Gleason ⩾ 7 (p < 0.0001), without being statistically significant in predicting BCR (p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649). Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.

Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor Prostate-specific antigen density (PSAD) has an established role in the diagnostic process of prostate cancer (PCa). However, controversy remains on the assessment of its value as a pretreatment prognostic factor. The aim of our study was to evaluate the predictive ability of PSAD for oncological outcomes in PCa patients treated with robot-assisted radical prostatectomy (RARP) and to compare with the value of preoperative PSA (pPSA). The present analysis showed a significant association of PSAD with positive surgical margins (PSM), Gleason Score >=7 and prostate-specific antigen (PSA) persistence after RARP. Moreover, PSAD demonstrated to perform comparably to pPSA in predicting the outcomes of clinically significant PCa (csPCa) and post-RARP PSA persistence. Therefore, PSAD is considered a preoperative predictive factor potentially useful in conjunction with other previously established prognostic criteria and clinical features.

Bladder carcinoma data with clinical risk factors and molecular markers: a cluster analysis.

Bladder cancer occurs in the epithelial lining of the urinary bladder and is amongst the most common types of cancer in humans, killing thousands of people a year. This paper is based on the hypothesis that the use of clinical and histopathological data together with information about the concentration of various molecular markers in patients is useful for the prediction of outcomes and the design of treatments of nonmuscle invasive bladder carcinoma (NMIBC). A population of 45 patients with a new diagnosis of NMIBC was selected. Patients with benign prostatic hyperplasia (BPH), muscle invasive bladder carcinoma (MIBC), carcinoma in situ (CIS), and NMIBC recurrent tumors were not included due to their different clinical behavior. Clinical history was obtained by means of anamnesis and physical examination, and preoperative imaging and urine cytology were carried out for all patients. Then, patients underwent conventional transurethral resection (TURBT) and some proteomic analyses quantified the biomarkers (p53, neu, and EGFR). A postoperative follow-up was performed to detect relapse and progression. Clusterings were performed to find groups with clinical, molecular markers, histopathological prognostic factors, and statistics about recurrence, progression, and overall survival of patients with NMIBC. Four groups were found according to tumor sizes, risk of relapse or progression, and biological behavior. Outlier patients were also detected and categorized according to their clinical characters and biological behavior.

Análisis de decisión en la evaluación económica del tratamiento de la uropatía obstructiva crónica / Decision analysis for economic evaluation of the management of chronic obstructive uropathy

OBJETIVO: Demostrar cuál es la mejor decisión para tratar una uropatía obstructiva de larga evolución: la derivación urinaria convencional mediante un catéter ureteral doble J o la prótesis metálica termoexpandible Memokath 051, en base a la supervivencia estimada del enfermo, la cantidad de recambios de catéter que va a necesitar y el coste que cada acto terapeútico va a conllevar.MÉTODO: Se recogieron los datos de costes de la inserción de un catéter ureteral doble J teniendo en cuenta visitas preoperatorias y postoperatorias, acto quirúrgico con costes estructurales, médicos, de material fungible y de la prótesis. A continuación se hizo una simulación de los costes de inserción de una prótesis Memokath 051, en base a los datos del cateterismo ureteral. Se realizó un árbol de decisión y un análisis económico de Coste Efectividad (ACE) para medir la efectividad de las dos intervenciones sanitarias. A través de él se identificaron, cuantificaron y valoraron los costes de las dos alternativas de intervención sanitaria disponibles para alcanzar la resolución de la obstrucción ureteral.RESULTADOS: Los datos de costes de cada procedimiento son: catéter doble J en régimen de cirugía Mayor Ambulatoria (CMA) 1.275,44 €, prótesis metálica termoexpandible en CMA 4865,16 €, doble J con ingreso de 1 día 1424,52 € y prótesis con ingreso de un día 5014,24 €.La diferencia de costes entre el catéter ureteral y la prótesis metálica termoexpandible es de 3589,72 € por cada tratamiento en CMA a favor del catéter ureteral.CONCLUSIÓN: A pesar de su alto coste inicial la prótesis metálica termoexpandible ofrece ventajas económicas añadidas al catéter ureteral convencional doble J en el tratamiento de la obstrucción ureteral maligna. A partir del tercer cambio de catéter ureteral doble J, y si la supervivencia del paciente es lo suficientemente prolongada, la opción más coste efectiva es la prótesis metálica en régimen de CMA(AU)

OBJECTIVES: To test which is the best treatment for chronic obstructive uropathy: urinary diversion using a conventional double-J ureteral stent or the metal thermo-expandable Memokath 051 prosthesis.METHODS: We collected cost data of the insertion of a double-J stent taking into account preoperative and postoperative visits and surgery. Structural, medical, consumables and the prosthesis costs were considered. The estimated survival of the patient, number of spare stents and cost of each therapeutic measure were computed. Then, a simulation of the cost of inserting a Memokath 051 prosthesis was conducted, based on data of ureteral catheterization.We performed a decision tree and Cost Effectiveness economic analysis to measure the effectiveness of both health interventions.RESULTS: Cost data of each procedure were: 1275.44 € for the double J catheter in a program of day case surgery (DCS), 4865.16 € for the metal thermo-expandable prosthesis as DCS, and 1424.52 € for the double J stent with 1 day admission and 5014.24 € for the prosthesis with 1 day admission.The cost difference between ureteral stent and metal thermo-expandable prosthesis is 3589.72 € per treatment for the ureteral stent as DCS.CONCLUSIONS: Despite its high initial cost, the metal thermo-expandable prosthesis potentially offers economic advantages over the conventional double-J ureteral stent in the treatment of long evolution ureteral obstruction. After the third change of double-J stent, and if the patient survival is long enough, the metal prosthesis as DCS should be the most cost effective option(AU)

Renocolic fistula as a complication of radiofrequency in the treatment of renal cell carcinoma.

METHOD: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula. RESULTS: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil. CONCLUSIONS: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken.

Fístula renocólica como complicación de radiofrecuencia para tratamiento de carcinoma renal de células claras / Renocólic fistula as a complication of ratiofrequency in the treatment of renal cell carcinoma

OBJETIVO: Describir un caso clínico de fístula reno cólica como complicación de ablación por radiofrecuencia de carcinoma de células renales. Se revisa la literatura y se exponen las diferentes actitudes diagnósticas y terapéuticas. MÉTODO: Tras la sospecha postoperatoria se realizó pielografía retrograda, cuyas imágenes se muestran, que demuestra la fístula. RESULTADO: El tratamiento definitivo ha sido la nefrectomía tras intento fallido de sellar la fístula con sutura y tachosil. CONCLUSIÓNES: Si bien la ablación por radiofrecuencia puede ser una técnica válida para el tratamiento del tumores renales de pequeño tamaño en pacientes con elevada morbilidad, no está exenta de complicaciones importantes como la descrita en este caso, a pesar de las precauciones tomadas(AU)

OBJECTIVES: To describe a clinical case of renocolic fistula as a complication of radiofrequency ablation of renal cell carcinoma. We reviewed the literature and presented different diagnostic and therapeutic approaches. METHOD: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula. RESULTS: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil. CONCLUSIONS: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken(AU)

Una intervención para mejorar la adecuación de las canalizaciones desde atención primaria a un servicio de urología / An intervention to improve the adequacy of referrals from primary care to a department of urology

Objetivo: Este estudio analiza el efecto de dos intervenciones puestas en funcionamiento para mejorar la adhesión a los términos de un protocolo de derivación desde atención primaria a un servicio de urología. Material y método: El programa incluyó la activación de recursos de comunicación y la celebración de reuniones conjuntas. Los términos “adecuado” e “inadecuado” se utilizaron para diferenciar las derivaciones que se ajustaron al protocolo de las que no. Para este estudio se analizó la adecuación al protocolo antes de la activación del programa (T0) y transcurridos 6 meses desde la primera (T1) y la segunda (T2) reunión. Para analizar tendencias en la adecuación se llevó a cabo un análisis lineal de tendencias. Resultados: Se analizó la adecuación de 6.088 derivaciones. En T0, se consideró adecuado el 58% de las derivaciones. La adecuación mejoró en T1 (el 70,6 frente al 58% en T0; c2 < 0,001). En T2, el 75,4% de las derivaciones se ajustó al protocolo. En general (T0 frente a T2), se confirmó una mejoría del 17,4% en la adecuación de las derivaciones (c2 < 0,001).Además, se confirmó una tendencia temporal hacia derivaciones más adecuadas (z = 9,62; p < 0,001). Dado lo anecdótico de la utilización de los sistemas de comunicación, no fue posible un análisis matemático de su efecto en la adecuación. Conclusiones: Las actividades educativas son útiles para mejorar la adecuación de las derivaciones. Son posibles tasas estables. La activación de sistemas de comunicación puede resultar superflua si la accesibilidad está garantizada (AU)

Introduction: This study analyses the effect of two interventions implemented in order to improve adherence to the terms of a protocol for referring patients from primary care to a urology department. Material and method: A telephone counselling line for professionals was implemented, and joint training sessions were held (twice, at six-month intervals). The terms “appropriate” and “inappropriate” were used to identify referrals complying with the locally developed protocol and those that did not, respectively. Referral appropriateness at baseline (T0) was compared with that six months after the first (T1) and second (T2) meeting. Linear trend analysis was used to test for trends in adequacy across the study. Results: Appropriateness of 6,088 consecutive referrals was analysed. At T0, 58% of the referrals (2810/4841) were judged to be “appropriate”. Adequacy improved significantly at T1 (70.6% vs. 58% at T0; c2 < 0.001). At T2, 75.4% of the referrals met the terms of the protocol; the difference between results at T1 and T2 was not statistically significant (c2 = 0.06). Overall (T0 vs. T2), a 17.4% improvement was confirmed (c2 < 0.001). A trend toward more appropriate referrals was detected over time (Mantel-Haenszel test for linear trend, z = 9.62; p < 0.001). As the use of communication resources was anecdotal, mathematical analysis of its effect on adequacy could not be performed. Conclusions: Training activities are worthwhile for improving referral adequacy. Stableates over time are possible. Using communication resources may be unnecessary if accessibility is guaranteed (AU)

An intervention to improve the adequacy of referrals from primary care to a department of urology.

INTRODUCTION: This study analyses the effect of two interventions implemented in order to improve adherence to the terms of a protocol for referring patients from primary care to a urology department. MATERIAL AND METHOD: A telephone counselling line for professionals was implemented, and joint training sessions were held (twice, at six-month intervals). The terms "appropriate" and "inappropriate" were used to identify referrals complying with the locally developed protocol and those that did not, respectively. Referral appropriateness at baseline (T0) was compared with that six months after the first (T1) and second (T2) meeting. Linear trend analysis was used to test for trends in adequacy across the study. RESULTS: Appropriateness of 6,088 consecutive referrals was analysed. At T0, 58% of the referrals (2810/4841) were judged to be "appropriate". Adequacy improved significantly at T1 (70.6% vs. 58% at T0; chi2 < 0.001). At T2, 75.4% of the referrals met the terms of the protocol; the difference between results at T1 and T2 was not statistically significant (chi2 = 0.06). Overall (T0 vs. T2), a 17.4% improvement was confirmed (chi2 < 0.001). A trend toward more appropriate referrals was detected over time (Mantel-Haenszel test for linear trend, z = 9.62; p < 0.001). As the use of communication resources was anecdotal, mathematical analysis of its effect on adequacy could not be performed. CONCLUSIONS: Training activities are worthwhile for improving referral adequacy. Stable rates over time are possible. Using communication resources may be unnecessary if accessibility is guaranteed.

[Outpatient female stress urinary incontinence surgery: budget impact study]. / Cirugia de la incontinencia urinaria femenina en regimen de cirugia mayor ambulatoria: estudio de impacto presupuestario.

OBJECTIVES: The surgical procedures for the insertion of tension free vaginal tapes in the treatment of female stress urinary incontinence (SUI) are simple and can be done as outpatient operations. The aim of this study was to perform a budget study comparing TVT in an outpatient basis with transobturator tape (TOT) with hospital admission. METHODS: Retrospective analysis of the medical records of 23 patients undergoing surgery for SUI between October 2004 and October 2005. 13 patients were treated by TVT in an outpatient basis (group 1, Department of Urology), 10 patients were treated by TOT with hospital admission (Group 2, Department of Gynaecology). Cost analysis was carried out by the construction of a Marcov model, incorporating the time sequence of the treatment, including adverse events and results. Variables considered for the analysis: number of visits, preoperative tests, operative time, tape cost, hospital stay, unpredicted visits in the first postoperative month at the outpatient clinics or emergency room, and hospital readmissions. Statistical analysis was performed with the G-Stat software. Student's t test was used to compare quantitative variables. RESULTS: 11/13 patients (84.6%) in group 1 completed the day-surgery protocol. Mean surgical time was 61.7 min. (SD 16.2; 35-100) and 61.6 min. (SD 8.3; 50-73) for groups I and 2 respectively. Two cases in group 1 had perioperative complications (15.4%); no patient in group 2 had perioperative complications. Mean hospital stay was 1.3 days for group 1 (SD 0.85; 1-4) and 2.9 days for group 2 (SD 0.31; 2-3). Three patients in group 1 (23%) and 2 in group 2 (20%) presented postoperative complications. Mean cost per process was 4740 EUR for group 1 and 7099 EUR for group 2. CONCLUSIONS: SUI correction by tension free tapes as day surgery is a valid option which saves a substantial amount of resources.

Cirugia de la incontinencia urinaria femenina en regimen de cirugia mayor ambulatoria: estudio de impacto presupuestario / Outpatient female stress urinary incontinence surgery: budget impact study

Objetivo: Las técnicas de inserción de mallas periuretrales libres de tensión para el tratamiento de la incontinencia urinaria de esfuerzo (IUE) son sencillas y permiten la realización del procedimiento en régimen cirugía mayor ambulatoria (CMA). El objetivo del trabajo es realizar un estudio de impacto presupuestario comparando la TVT en régimen de CMA con la TVT-O en régimen de cirugía con ingreso. Métodos: Análisis retrospectivo de 23 pacientes intervenidas por IUE entre octubre del 2004 y octubre del 2005. Trece (13) pacientes fueron tratadas en el servicio de urología (TVT - CMA) (Grupo 1) y 10 en el servicio de ginecología (TVT-O con ingreso)(Grupo 2). Se llevó a cabo un análisis de costes mediante la construcción de un modelo de Marcov, que incorpora la secuencia temporal y lógica del tratamiento, incluyendo los acontecimientos adversos y los resultados. Las variables consideradas para el cálculo de coste global incluyeron el numero de visitas y pruebas complementarias preoperatorios; los tiempos de quirófano, el coste del implante, las estancias, y las visitas imprevistas en consultas, urgencias y/o reingresos durante el primer mes posterior a la cirugía. El análisis estadístico se realizó con el programa G-Stat. Las comparaciones entre variables cuantitativas se realizaron mediante la prueba de la t de student. Resultados: Once de las 13 pacientes (84.6%) del grupo 1 completaron satisfactoriamente el protocolo de CMA. El tiempo medio de quirófano fue de 61.7 minutos (DE 16.2; Rango 35-100) y 61.6 minutos (DE 8.3; Rango 50-73) (p = 0.97) para los grupos 1 y 2, respectivamente. En el grupo 1 aparecieron complicaciones perioperatorias en 2 casos (15,4%); ninguna paciente del grupo 2 presentó complicaciones. La estancia media en el grupo 1 fue de 1.3 días (DE 0.85; rango 1-4) y en el grupo 2 2.9 días (DE 0.31; rango 2-3) . 3 pacientes presentaron complicaciones postoperatorias en el grupo 1 (23%) y 2 en grupo 2 (20%). El coste medio por proceso fue de 4740 euros para el grupo 1 y 7099 en el grupo 2. Conclusiones: La corrección de la IUE mediante mallas libres de tensión en régimen de CMA es una opción viable que supone un ahorro substancial de recursos (AU)

Objectives: The surgical procedures for the insertion of tension free vaginal tapes in the treatment of female stress urinary incontinence (SUI) are simple and can be done as outpatient operations. The aim of this study was to perform a budget study comparing TVT in an outpatient basis with transobturator tape (TOT) with hospital admission. Methods: Retrospective analysis of the medical records of 23 patients undergoing surgery for SUI between October 2004 and October 2005. 13 patients were treated by TVT in an outpatient basis (group 1, Department of Urology), 10 patients were treated by TOT with hospital admission (Group 2, Department of Gynaecology). Cost analysis was carried out by the construction of a Marcov model, incorporating the time sequence of the treatment, including adverse events and results. Variables considered for the analysis: number of visits, preoperative tests, operative time, tape cost, hospital stay, unpredicted visits in the first postoperative month at the outpatient clinics or emergency room, and hospital readmissions. Statistical analysis was performed with the G-Stat software. Student’s t test was used to compare quantitative variables. Results: 11/13 patients (84.6%) in group 1 completed the day-surgery protocol. Mean surgical time was 61.7 min. (SD 16.2; 35-100) and 61.6 min. (SD 8.3; 50-73) for groups 1 and 2 respectively. Two cases in group 1 had perioperative complications (15.4%); no patient in group 2 had perioperative complications. Mean hospital stay was 1.3 days for group 1 (SD 0.85; 1-4) and 2.9 days for group 2 (SD 0.31; 2-3). Three patients in group 1 (23%) and 2 in group 2 (20%) presented postoperative complications. Mean cost per process was 4740 EUR for group 1 and 7099 EUR for group 2. Conclusions: SUI correction by tension free tapes as day surgery is a valid option which saves a substantial amount of resources (AU)

[Abdominal compartment syndrome in an urological patient]. / Sindrome compartimental abdominal en un paciente urológico.

OBJECTIVES: Abdominal compartment syndrome is an infrequent clinical entity, the course of which has a rapid progression with multiorgan compromise leading to a fatal outcome if appropriate and urgent action is not undertaken. METHODS AND RESULTS: We report the clinical case of a patient who developed the clinical picture after renal trauma. Diagnosis was obtained by CT scan and arteriography, afterwards the patient required ICU admission with intra-abdominal pressure monitoring, and several decompression laparotomies before definitive closure with a reabsorbable mesh. CONCLUSIONS: Urologists should know the existence of this syndrome its appropriate treatment, because we manage patients who are candidates to suffer it. Due to the high mortality rate associated, it is essential to know how to recognize it in order to act fast.

[Comparative analysis of complications between different surgical techniques in the treatment of urinary stress incontinence at our centre]. / Análisis comparativo de complicaciones entre las diferentes técnicas empleadas para el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en nuestro medio.

OBJECTIVES: Surgical repair is the most effective treatment for stress urinary incontinence (SUI) currently. Nevertheless, this method is not without complications. The objective of this work is to compare the incidence of complications between different groups of surgical techniques employed for the treatment of SUI in our patients. METHODS: We performed a retrospective analysis of patients diagnosed of SUI who underwent surgery at our department between January 1991 and December 1999, grouping patients in three categories depending on the procedure: abdominal technique, abdomino-vaginal techniques, and sling procedures. Complications were grouped into two categories: major and minor complications. Chi-square and Fisher's test were used for the association analysis of complications' frequencies. All confidence intervals and level of statistical significance were calculated for a p value < 0.05. RESULTS: 5.16% of the patients undergoing surgery for SUI suffered major complications. Globally, the most frequent complications were suprapubic pain (33%), wound seroma and/or infection (20%), postoperative acute urinary retention (AUR) (26%), and presence of significant post void residual (24%), being the sling procedure with a greater number of postoperative complications, as much in postoperative pain, as in AUR, as in presence of post void residual (p < 0.05). CONCLUSIONS: Sling procedures present a significantly higher percentage of complications when compared with abdominal and combined techniques.

Análisis comparativo de complicaciones entre las diferentes técnicas empleadas para el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en nuestro medio / Comparative analysis of complications between different surgical techniques in the treatment of urinary stress incontinence at our centre

OBJETIVO: La corrección quirúrgica es actualmente el método más efectivo de tratamiento de la incontinencia urinaria de esfuerzo (IUE) de las que se dispone en la actualidad. No obstante, este método no se encuentra exento de complicaciones. El objetivo de este trabajo consiste en comparar la frecuencia de complicaciones entre los distintos grupos de técnicas empleadas para el tratamiento de la IUE en nuestras pacientes. MÉTODO: Hemos llevado a cabo un análisis retrospectivo de las pacientes intervenidas en nuestro Servicio por IUE durante el periodo comprendido entre Enero de 1991 y Diciembre de 1999, agrupando a las pacientes en 3 grupos según la intervención realizada: técnicas abdominales, técnicas abdómino-vaginales, y técnicas de cabestrillo. Las complicaciones fueron agrupadas en dos grupos: complicaciones mayores y complicaciones menores. Para el análisis de la asociación de la frecuencia de estas complicaciones con el tipo de técnica empleado se utilizó el test de Chi-cuadrado y la prueba exacta de Fisher. Todos los intervalos de confianza y el nivel de significación estadística se calcularon para una p < 0,05. RESULTADOS Se produjeron complicaciones mayores en un 5,16 por ciento de las pacientes intervenidas de IUE. Globalmente, las complicaciones más frecuentes fueron la presencia de dolor suprapúbico (33 por ciento), la presencia de seroma y/o infección de la herida (20 por ciento), la retención de orina postoperatoria (26 por ciento), y la presencia de residuo postmiccional significativo (24 por ciento), presentando la técnica de sling un mayor número de complicaciones postquirúrgicas, tanto en la presencia de dolor importante postoperatorio, como en la aparición de RAO, como en la presencia de residuo postmiccional (p < 0,05). CONCLUSIONES: La técnica de sling presenta un porcentaje significativamente superior de complicaciones frente a las técnicas abdominales y combinadas (AU)

[Collecting duct carcinoma. Personal experience and review of the literature]. / Carcinoma de los conductos colectores. Experiencia personal y revisión de la literatura.

OBJECTIVE: To present our experience with renal collecting duct carcinoma and review the literature. METHODS: We reviewed our experience with collecting duct carcinoma of the kidney. We found 6 cases out of 176 nephrectomies (3.4%), which accounts for one of the largest series reported in the literature. The radiological, histological and immunohistochemical findings are analyzed. RESULTS: The histological and immunohistochemical findings showed a specificity for high molecular weight cytokeratins and Ulex europeaeus but the imaging findings were not distinct from those of other renal tumors. According to the anatomopathological findings, we have classified the patients into three groups with three distinct courses. All patients underwent radical nephrectomy and one patient received adjuvant therapy. CONCLUSIONS: We have identified a subgroup of low grade collecting duct carcinoma of the kidney with a particularly favorable behavior in two patients of our series. At 56 and 41 months' follow-up, both patients remain disease-free. As reported in the literature, patients with high grade and stage collecting duct carcinoma of the kidney have a poor outcome. They develop severe complications and die less than one year after the diagnosis, despite adjuvant immunotherapy.

Utilidad del PSA-Complex en el diagnóstico del carcinoma de próstata / Utility of complexed PSA in the diagnosis of carcinoma of the prostate

OBJETIVOS: Desde el hallazgo del antígeno prostático específico (PSA), como marcador del cáncer de próstata, han sido muchos los intentos de mejorar su eficacia diagnóstica. Uno de ellos ha sido el estudio del comportamiento de las diferentes formas plasmáticas de PSA en su unión a distintas antiproteasas, entre las que destaca la 1-antiquimiotripsina, con la que forma el PSA complex (PSA-c). El objetivo es estudiar la validez del PSA-c para aumentar la especificidad sin variar la sensibilidad, frente al uso del PSA total (PSA-t).MÉTODOS: Entre septiembre de 1998 y marzo de 1999 se tomaron muestras de sangre a 96 pacientes que fueron sometidos a biopsia prostática por sospecha de cáncer de próstata. En estos pacientes se determinó el PSA-c, PSAt (ambos realizados por el Sistema Technicon Immuno 1 de Bayer) y se calculó el PSA-c/PSA-t. RESULTADOS: Se calcularon las curvas ROC y se hallaron los puntos de corte óptimos, para los cuales, ante un valor de sensibilidad semejante (90 por ciento), la especifici dad resultó mayor en el PSA-c (44,6 por ciento [IC 95 por ciento, 32-57]) frente al PSA-t (35,4 por ciento [IC 95 por ciento, 25-49]), y la ratio PSAc/PSA-t (38,5 por ciento[IC 95 por ciento, 27-51]). Para otros valores de sensibilidad el comportamiento del PSA-c fue análogo. CONCLUSIÓN: el PSA-c mejora la especificidad frente al PSA-t y el PSA-c/PSA-t, por lo cual sería posible con su uso una reducción de biopsias innecesarias sin dejar de detectar el mismo número de cánceres de próstata (igual sensibilidad) (AU)

Oncoproteína P185 (Neu) en el pronóstico del carcinoma vesical. Experiencia a 5 años / P185 (neu) oncoprotein in the prognosis of bladder carcinoma: 5-years' experience

OBJETIVOS: El objetivo de este trabajo es conseguir establecer la utilidad de la determinación de la oncoproteína p185 en la caracterización biológica del carcinoma de células transicionales y evaluar su influencia en la predicción de recidiva y el análisis de la supervivencia tras un periodo medio de 5 años de seguimiento. MÉTODO: Hemos realizado un estudio de cohortes prospectivo que analiza un grupo de 81 pacientes cuyas muestras fueron recogidas entre Noviembre de 1992 y Noviembre de 1993 y que fueron divididos en 2 grupos: el primero formado por 20 muestras de tejido vesical no tumoral y el segundo integrado por 61 pacientes diagnos ticados de carcinoma vesical. Determinamos la expresión de la oncoproteina p185 mediante enzimoinmunoanálisis (EIA), realizando posteriormente un análisis estadístico detallado de los resultados. RESULTADOS: Los niveles detectados de oncoproteína p185 fueron mayores en pacientes con recidiva (1098,97 HNU/mg de proteína vs 924,54 HNU/mg). Pese a que los niveles de p185 fueron mayores en los pacientes fallecidos que en los pacientes vivos, no encontramos diferencias significativas en cuanto a la supervivencia global o estadificada por grado o infiltración (P=0,556, NS).CONCLUSIONES: La determinación de oncoproteína p185 demostró ser de utilidad para la predicción de recidiva tumoral en un seguimiento medio de 5 años (AU)