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1.
Actas Urol Esp ; 34(3): 223-31, 2010 Mar.
Article in Spanish | MEDLINE | ID: mdl-20416238

ABSTRACT

INTRODUCTION: Laparoscopic surgery has been increasingly used in urology in recent years. Laparoscopy has been performed at our center since 2001. Changes over time in the indication of open versus laparoscopic/robotic surgery, hospital stay, and learning curve are reviewed. MATERIALS AND METHODS: A retrospective review of our database from 1997 to the end of 2007. A total of 3622 procedures were performed during this time (endoscopic procedures were excluded): 67.75% open, 26.17% laparoscopic, 2.29% perineal, and 3.78% robotic surgeries. Of these, 83.79% were performed in males and 16.20% in females. Mean patient age was 58.8 years. Data from the study period, including mean hospital stay and changes over time in operating time as a function of the learning curve, were analyzed and compared to data for the last 12 months of the study period. RESULTS: The percentages of all surgical procedures performed using a laparoscopic approach in the 1997-2006 versus the last 12 study months were as follows: nephrectomy, 31.8% versus 74.7%; living donor nephrectomy, 93% versus 100%; nephroureterectomy, 28.1% vs. 93.4%; partial nephrectomy, 31.3% vs 87%; and radical prostatectomy, 17.6% versus 73.5% including laparoscopic and robotic approaches. Shorter mean hospital stays and operating times were also seen. CONCLUSIONS: Use of the laparoscopic approach has greatly increased in the 10-year period studied. In renal surgery, few indications remain for open surgery. In prostate surgery, introduction of robotic surgery in 2005 and learning of laparoscopy by several of our urologists have dramatically changed the therapeutic approach. Gradual incorporation of laparoscopic surgery has led to a decreased hospital stay and to a shortening of the learning curve.


Subject(s)
Laparoscopy , Nephrectomy/methods , Prostatectomy/methods , Robotics , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/trends
2.
Actas Urol Esp ; 31(7): 743-5, 2007.
Article in Spanish | MEDLINE | ID: mdl-17902467

ABSTRACT

INTRODUCTION AND OBJECTIVES: to evaluate the frequency of reoperation caused by massive hematuria in the postoperation of open prostatectomy in benign prostatic hyperplasia (BHP) at our hospital. At the same time, we also want to evaluate the effectiveness and possible secondary effects of using transurethral approach to solve this surgical complications. MATERIAL AND METHODS: we analyzed retrospectively 540 open surgeries in benign prostatic hyperplasia, carried out from 1998 to 2005. We evaluated effectiveness, average surgery time and complications in case of endoscopic review. RESULTS: a reoperation was necessary in 2.5% of all 540 cases. In all the cases reoperated, hemorrhage was controlled using transurethral approach. Average surgery time was 37 minutes and secondary effects observed were not important. CONCLUSIONS: transurethral approach is a simple and effective technique in the treatment of massive hematuria after open prostatectomy in BPH. Surgery time spent is acceptable, and early and delayed complications observed have been few and cannot, in our opinion, be imputed only to this tech-


Subject(s)
Hematuria/etiology , Hematuria/surgery , Prostatectomy/adverse effects , Prostatic Hyperplasia/surgery , Humans , Male , Retrospective Studies , Urethra , Urologic Surgical Procedures, Male/methods
3.
Actas urol. esp ; 31(7): 743-745, jul.-ago. 2007.
Article in Es | IBECS | ID: ibc-055808

ABSTRACT

Introducción y objetivos: Evaluar la frecuencia de reintervención por hematuria postadenomectomía en nuestro centro al igual que la efectividad y los posibles efectos secundarios del abordaje transuretral como tratamiento resolutivo en el postoperatorio inmediato. Material y métodos: Se analizaron retrospectivamente 540 adenomectomías retropúbicas realizadas en el periodo 1998-2005. Se evaluó la efectividad, el tiempo quirúrgico medio de reintervención y las complicaciones en los casos en que se realizó la revisión endoscópica. Resultados: En un 2,5% del total de adenomectomías retropúbicas fue necesaria por hematuria la revisión endoscópica. En todos estos casos se logró por esta vía el control hemostático. El tiempo quirúrgico medio fue de 37 minutos y los efectos secundarios observados insignificantes. Conclusiones: La vía transuretral es una técnica simple y eficaz en el tratamiento de la hematuria masiva postadenomectomía retropúbica. El tiempo quirúrgico empleado es aceptable y las complicaciones observadas a largo plazo son mínimas y no pueden atribuirse únicamente a dicha técnica


Introduction and objectives: to evaluate the frequency of reoperation caused by massive hematuria in the postoperation of open prostatectomy in benign prostatic hyperplasia (BHP) at our hospital. At the same time, we also want to evaluate the effectiveness and possible secondary effects of using transurethral approach to solve this surgical complications. Material and methods: we analyzed retrospectively 540 open surgeries in benign prostatic hyperplasia, carried out from 1998 to 2005. We evaluate the effectiveness, average surgery time and complications in case of endoscopic review. Results: a reoperation was necessary in 2.5% of all 540 cases. In all the cases reoperated, hemorrhage was controlled using transurethral approach. Average surgery time was 37 minutes and secondary effects observed were not important. Conclusions: transurethral approach is a simple effective technique in the treatment of massive hematuria after open prostatectomy in BPH. Surgery time spent is aceptable, and early and delayed complications observed have been few and cannot, in our opinion, be imputed only to this technique


Subject(s)
Male , Humans , Postoperative Complications/surgery , Prostatectomy/adverse effects , Hematuria/etiology , Hematuria/surgery , Treatment Outcome , Prostatectomy/methods , Retrospective Studies , Time Factors
4.
Actas Urol Esp ; 31(3): 185-96, 2007 Mar.
Article in Spanish | MEDLINE | ID: mdl-17658147

ABSTRACT

Robotic surgery is a reality. In order to to understand how new robots work is interesting to know the history of ancient (see part i) and modern robotics. The desire to design automatic machines imitating humans continued for more than 4000 years. Archytas of Tarentum (at around 400 a.C.), Heron of Alexandria, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XXth century developed robots to be able to do very complex self governing works. At 1985 the robot PUMA 560 was employed to introduce a needle inside the brain. Later on, they were designed surgical robots like World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons. Currently urological procedures like prostatectomy, cystectomy and nephrectomy are performed with the da Vinci, so urology has become a very suitable speciality to robotic surgery.


Subject(s)
Robotics/history , Equipment Design , History, 20th Century , History, 21st Century , Urologic Surgical Procedures/history , Urologic Surgical Procedures/instrumentation
5.
Actas Urol Esp ; 31(2): 69-76, 2007 Feb.
Article in Spanish | MEDLINE | ID: mdl-17645084

ABSTRACT

Robotic surgery is the newst technologic option in urology. To understand how new robots work is interesting to know their history. The desire to design machines imitating humans continued for more than 4000 years. There are references to King-su Tse (clasic China) making up automaton at 500 a. C. Archytas of Tarentum (at around 400 a.C.) is considered the father of mechanical engineering, and one of the occidental robotics classic referents. Heron of Alexandria, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors in the middle age, renaissance and classicism. At the XIXth century, automaton production underwent a peak and all engineering branches suffered a great development. At 1942 Asimov published the three robotics laws, based on mechanics, electronics and informatics advances. At XXth century robots able to do very complex self governing works were developed, like da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons.


Subject(s)
Robotics/history , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, Ancient , History, Medieval
6.
Actas urol. esp ; 31(3): 185-196, mar. 2007. ilus, tab
Article in Es | IBECS | ID: ibc-054072

ABSTRACT

La cirugía robótica es ya una realidad. Revisar la historia de la robótica antigua (ver parte I) y moderna es importante para conocer cómo funcionan los nuevos robots. La fabricación de máquinas que imitan al ser humano se ha mantenido desde hace más de 4000 años. En la robótica clásica destacaron inventores como Arquitas de Tarento (hacia 400 a.C.), Heron de Alejandría, Hsieh-Fec, Al- Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen (ver parte I). En 1942 Asimov publica las tres leyes de la robótica. Con el desarrollo de la mecánica, la electrónica y la informática en el siglo XX se han desarrollado robots capaces de realizar de forma autónoma tareas de gran complejidad. En 1985 el robot PUMA 560 fue utilizado para introducir una aguja en el cerebro. A partir de ahí se desarrollan robots cirujanos como World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. En el año 2000 la FDA aprueba el da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA) un sofisticado robot asistente del cirujano. Procedimientos urológicos como la prostatectomía, cistectomía o la nefrectomía son realizadas con el robot da Vinci, situando a la urología como una de las especialidades más idóneas para la cirugía robótica


Robotic surgery is a reality. In order to to understand how new robots work is interesting to know the history of ancient (see part i) and modern robotics. The desire to design automatic machines imitating humans continued for more than 4000 years. Archytas of Tarentum (at around 400 a.C.), Heron of Alexandria, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XXth century developed robots to be able to do very complex self governing works. At 1985 the robot PUMA 560 was employed to introduce a needle inside the brain. Later on, they were designed surgical robots like World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons. Currently urological procedures like prostatectomy, cystectomy and nephrectomy are performed with the da Vinci, so urology has become a very suitable speciality to robotic surgery


Subject(s)
Humans , Robotics/history , Urologic Surgical Procedures/history , History of Medicine
7.
Actas urol. esp ; 31(2): 69-76, feb. 2007. ilus
Article in Es | IBECS | ID: ibc-053775

ABSTRACT

La cirugía robótica es la última novedad tecnológica en urología. Para conocer como funcionan los nuevos robots es interesante conocer su historia. La fabricación de máquinas que imitan al ser humano se ha mantenido desde hace más de 4000 años. Existen referencias a King-su Tse, China clásica, que inventa un autómata en el 500 a. C. Arquitas de Tarento (hacia 400 a.C.) es considerado el padre de la ingeniería mecánica, y uno de los maestros clásicos de la robótica occidental. Figuras como Heron de Alejandría, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen construyeron robots en la edad media, el renacimiento y el clasicismo. En el siglo XIX existe un auge de los autómatas y se producen importantes avances en todas las ramas de la ingeniería. En 1942 Asimov publica las tres leyes de la robótica coincidiendo con el inicio de la robótica moderna, basada en los avances en mecánica, electrónica e informática. El desarrollo de robots en el terreno industrial, bélico y aeroespacial durante el siglo XX permite la aparición de robots de gran precisión, útiles en cirugía, como el robot quirúrgico da Vinci (Intuitive Surgical Inc, Sunnyvale, CA, USA)


Robotic surgery is the newst technologic option in urology. To understand how new robots work is interesting to know their history. The desire to design machines imitating humans continued for more than 4000 years. There are references to King-su Tse (clasic China) making up automaton at 500 a. C. Archytas of Tarentum (at around 400 a.C.) is considered the father of mechanical engineering, and one of the occidental robotics classic referents. Heron of Alexandria, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors in the middle age, renaissance and classicism. At the XIXth century, automaton production underwent a peak and all engineering branches suffered a great development. At 1942 Asimov published the three robotics laws, based on mechanics, electronics and informatics advances. At XXth century robots able to do very complex self governing works were developed, like da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons


Subject(s)
Robotics/history , History of Medicine , Surgical Equipment/history , Technological Development/trends , Prostheses and Implants/history , Medical Informatics Applications , Mechanics , Electronics/history
8.
Actas Urol Esp ; 30(5): 492-500, 2006 May.
Article in Spanish | MEDLINE | ID: mdl-16884100

ABSTRACT

Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, where upon a conservative attitude was adopted.


Subject(s)
Kidney Neoplasms/surgery , Laparoscopy/methods , Nephrectomy/methods , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Peritoneum
9.
Actas urol. esp ; 30(5): 492-500, mayo 2006. ilus, tab
Article in Es | IBECS | ID: ibc-046165

ABSTRACT

La cirugía laparoscópica constituye una técnica quirúrgica que el urólogo debe incorporar a su armamentario quirúrgico. Su realización intenta simular los pasos quirúrgicos de la cirugía abierta, así como sus indicaciones. La nefrectomía parcial laparoscópica es una técnica compleja que implica para su desarrollo una experiencia amplia en el manejo de las técnicas endoscópicas. Presentamos nuestra experiencia de 35 nefrectomías parciales laparoscópicas transperitoneales con una media de seguimiento de 25 meses. El tiempo medio de cirugía fue de 200 minutos, el sangrado de 190 cc, y la estancia media de cinco días. Se han objetivado dos sangrados postoperatorios, ninguna conversión y en dos casos se informó de márgenes positivos, optándose por una actitud conservadora


Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, whereupon a conservative attitude was adopted


Subject(s)
Humans , Nephrectomy/methods , Laparoscopy/methods , Kidney Neoplasms/surgery , Laparoscopes
11.
Eur Urol ; 41(1): 30-3, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11999462

ABSTRACT

OBJECTIVE: Nephroureterectomy is the treatment of choice for tumors of the upper urinary tract (UUTT). In 1952, a modified version of this technique was described, involving endoscopic detachment of the ureter followed by nephroureterectomy with a single lumbar incision. We reviewed a retrospective survey to assess whether UUTT patients treated with nephroureterectomy with no prior history of bladder tumor had different rates of incidence or different sites of bladder recurrence according to the specific technique employed. METHODS: Patients were divided into group A, 87 patients who underwent a double incision nephroureterectomy and group B with 58 patients with prior detachment of the ureter. In both groups, incidence was calculated for two variables (bladder tumor recurrences and homolaterality of such recurrences) and chi-square tested. RESULTS: Bladder tumor was diagnosed at follow-up in 39% of patients in group A and 34.5% in group B, with no statistically significant difference (N.S.). Bladder tumor recurrences were homolateral to UUTT in 50% of group A cases and 55% of group B cases (N.S.). CONCLUSIONS: Although this is a retrospective survey of two asynchronous groups, given the similar nature of the UUTT cases in both groups and the fact that no statistically significant differences have been found, it is reasonable to conclude that nephroureterectomy with prior endoscopic detachment of the ureter is a safe and radical procedure.


Subject(s)
Kidney Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Ureter/surgery , Ureteral Neoplasms/surgery , Urinary Bladder Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Chi-Square Distribution , Cohort Studies , Confidence Intervals , Endoscopy/methods , Female , Follow-Up Studies , Humans , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Nephrectomy/methods , Probability , Prognosis , Retrospective Studies , Risk Assessment , Surgical Procedures, Operative/methods , Survival Analysis , Treatment Outcome , Ureteral Neoplasms/mortality , Ureteral Neoplasms/pathology , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/pathology
12.
Eur Urol ; 40(3): 318-23, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11684849

ABSTRACT

PURPOSE: We assessed the incidence of upper urinary tract tumors (UUTTs) after cystectomy for invasive or superficial transitional cell carcinoma (TCC) of the bladder. The risk factors, patients' characteristics and evolution of those who developed UUTTs are analyzed. MATERIALS AND METHODS: From August 1980 to February 1994, 568 radical cystectomies were performed for TCC of the bladder: in 469 instances (82.5%) due to invasive tumor (T2-T4), and in 99 cases (17.5%) for superficial tumor (Ta, T1, Tis). All patients were followed for at least 5 years or until death. A retrospective study of patients who developed UUTTs has been performed. A revision of bladder tumor and UUTT characteristics, and the intervals between both is also evaluated. RESULTS: 26 patients (4.5%) developed UUTTs: 11 of the 99 patients cystectomized for superficial TCCs (11.1%); 6 of the 392 patients with primary invasive TCC (1.5%), and 9 of the 77 (11.6%) patients with invasive tumors and a prior history of superficial TCC. The interval to the development of UUTT was higher after cystectomy for superficial tumor. TCCs of the bladder that subsequently developed UUTTs were high grade in 84%, multifocal in 80%, or had carcinoma in situ in 65%, tumor in the prostatic urethra in 52%, and involvement of the distal ureter in 57%. Twenty-two UUTTs (84%) were located in the calyces or the renal pelvis, 3 were bilateral (11.5%), 14 multiple (58%) and 4 superficial (16%). With a median follow-up time of 18 (range 3-103) months, 14 patients (53.8%) died of tumor, 2 were alive with disease, 2 were lost for follow-up, and 8 (30%) were alive and free of disease. CONCLUSIONS: We found that patients cystectomized for superficial or invasive TCC with a prior history of superficial TCC have a higher incidence of UUTTs. These cases require follow-up with annual urography or loopography.


Subject(s)
Carcinoma, Transitional Cell/epidemiology , Cystectomy , Kidney Neoplasms/epidemiology , Neoplasms, Second Primary/epidemiology , Ureteral Neoplasms/epidemiology , Urethral Neoplasms/epidemiology , Urinary Bladder Neoplasms/surgery , Aged , Female , Humans , Male , Middle Aged
13.
Arch Esp Urol ; 54(3): 205-9, 2001 Apr.
Article in Spanish | MEDLINE | ID: mdl-11432034

ABSTRACT

OBJECTIVE: To analyze the presenting features, diagnosis and management of uncommon cystic lesions located at the midline of the prostate. METHODS: From 1990 to 1999, 8 patients with medial prostatic cyst were treated in our hospital. Vesicorenal ultrasound evaluation was the first procedure that was performed and was diagnostic in most of the cases. Only those patients that underwent surgery required admission to hospital. RESULTS: The most common presenting features were irritative and obstructive voiding syndromes. Treatment achieved cure or clinical improvement. CONCLUSIONS: Vesicorenal ultrasound assessment is the first procedure that should be considered in the diagnosis of this disease. Before ascribing the symptoms to a prostate cyst, other urological conditions with more prognostic relevance should be excluded. Treatment should be instituted only in the symptomatic patients and should be individualized according to the characteristics of each case.


Subject(s)
Cysts/therapy , Prostatic Diseases/therapy , Adult , Aged , Follow-Up Studies , Humans , Male , Middle Aged
14.
Arch Esp Urol ; 54(3): 211-7, 2001 Apr.
Article in Spanish | MEDLINE | ID: mdl-11432035

ABSTRACT

OBJECTIVE: To evaluate the cystoscopic findings during initial follow-up, the anatomopathological correlation of tumor endoscopic features and the results of standard control multiple biopsy performed 6 months after TUR in patients with G3T1 transitional carcinoma treated with BCG. METHODS: 114 patients with G3T1 bladder tumor (52% associated with Cis) were treated with 81 mg Connaught BCG intravesical instillations weekly for 6 consecutive weeks. Follow-up was performed with cystoscopy and cytology at 3 months, and cystoscopy and standard multiple biopsy at 6 months. The endoscopic findings were described as normal bladder, macroscopically tumorous lesion or erythematous lesion. RESULTS: During the first 6 months of follow-up superficial recurrence was found in 16% and 5% showed progression to muscle invasion. Tumor recurrence or progression was found in 61% and 39% at 3 and 6 months, respectively. Most of the macroscopically tumorous lesions resulted in a tumor at 3 and 6 months in 56% and 64%, respectively, and the remaining lesions were mainly inflammatory granulomas produced by BCG therapy. Twenty biopsies of erythematous areas detected only one case of Cis (5%) and 98 standard multiple biopsies of endoscopically normal mucosa detected 10 cases of Cis (overall, 3 at 3 months and 7 at 6 months); all cases were preceded by initial Cis except in one case. CONCLUSIONS: Cystoscopy performed at 3 months is very useful since it detected 61% of the superficial recurrences and 66% of the cases with progression to muscle invasion during the first 6 months. Routine biopsy of erythematous areas detected during cystoscopy is of little value since a large number of these biopsies are unnecessary in view of its diagnostic yield (5%). Since 90% of the Cis detected during the first 6 months of follow-up were patients with Cis in the initial tumor, it would be appropriate to perform standard multiple biopsy for control only in this subgroup of patients if the sensitivity of cytology is low in high grade tumors or Cis.


Subject(s)
Adjuvants, Immunologic/therapeutic use , BCG Vaccine/therapeutic use , Carcinoma, Transitional Cell/drug therapy , Carcinoma, Transitional Cell/pathology , Cystoscopy , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/surgery , Follow-Up Studies , Humans , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging , Time Factors , Urinary Bladder Neoplasms/surgery
15.
J Urol ; 165(5): 1488-91, 2001 May.
Article in English | MEDLINE | ID: mdl-11342902

ABSTRACT

PURPOSE: Intravesical instillations of bacillus Calmette-Guerin have demonstrated satisfactory results in the treatment of vesical carcinoma in situ and high grade superficial bladder tumors. We designed a protocol to evaluate the decrease in tumor recurrence with maintenance therapy. MATERIALS AND METHODS: Between June 1989 and May 1995 an initial course of 6 intravesical instillations of Connaught strain bacillus Calmette-Guerin was administered in patients with carcinoma in situ and/or high grade superficial bladder tumors. Six months later 131 disease-free patients were randomly assigned to a control group or a maintenance therapy group that received 6 instillations every 6 months (6 x 6) for a 2-year period. RESULTS: Of the 126 evaluable patients at a mean followup of 79 months there were no significant differences in recurrence nor progression. A total of 16 patients (26.2%) in the control and 10 (15.1%) in the maintenance group had superficial relapse at a mean of 24 and 20 months, respectively (p = 0.07). Eight patients underwent radical cystectomy due to bladder contraction in 1, high grade superficial recurrence in 4 and disease progression in 3. Of the 65 patients on maintenance therapy 22 (33.85%) completed the planned 2-year treatment. CONCLUSIONS: Six-month maintenance therapy in patients treated initially for carcinoma in situ and/or high grade superficial bladder tumors who are disease-free at 6 months did not significantly decrease recurrence or progression.


Subject(s)
BCG Vaccine/therapeutic use , Carcinoma in Situ/therapy , Carcinoma, Transitional Cell/therapy , Immunotherapy , Urinary Bladder Neoplasms/therapy , Adult , Aged , Cystectomy , Disease Progression , Disease-Free Survival , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local
16.
J Urol ; 165(3): 882-3, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11176492

ABSTRACT

PURPOSE: Prostato-perineal fistula is a rare abnormality. We present a simple endoscopic technique to manage this complicated problem. MATERIALS AND METHODS: We report on a 34-year-old man with a prostato-perineal fistula after multiple surgeries for imperforate anus. The patient underwent an endoscopic injection of polytetrafluoroethylene and autologous fat in the fistulous tract. RESULTS: Two endoscopic procedures with the injection of polytetrafluoroethylene and autologous fatty tissue around the prostatic urethral orifice were necessary to occlude the fistula. CONCLUSIONS: The endoscopic injection of polytetrafluoroethylene and autologous fat was an easy, well tolerated and long lasting solution in this patient.


Subject(s)
Adipose Tissue/transplantation , Fistula/therapy , Perineum , Polytetrafluoroethylene , Prostatic Diseases/therapy , Adult , Humans , Injections , Male
17.
Int Urol Nephrol ; 33(3): 469-72, 2001.
Article in English | MEDLINE | ID: mdl-12230274

ABSTRACT

OBJECTIVE: The aim of this study is to find out whether the pseudotumoral lesions (inflammation/granuloma) seen at the follow-up cystoscopy performed three to six months after transurethral resection of primary stage T1 grade 3 bladder tumor and instillations of BCG therapy might have some prognostic value as far as recurrence and/or long term progression are concerned. MATERIAL AND METHODS: From the first group of one hundred and thirteen patients with primary stage of T1 grade 3 bladder tumor treated with 81 mg of BCG Connaught (weekly/during six weeks), those with recurrent tumor at the 3rd and 6th month were excluded, so we evaluated 99 patients. We identified 13 patients with cystoscopically pseudotumoral lesions. RESULTS: of the 13 cystoscopically pseudotumoral lesions, we observed recurrence in two cases (15%), while among the rest of the 86 patients, we observed 22 recurrences (26%) (p = 0.9; not significant). Concerning progression, eight cases were reported out of 86 patients (9%) within the cistocopically normal group. No cases of progression were reported among the 13 patients with cystoscopically pseudotumoral lesions. This difference was not statistically significant (p = 0.5). CONCLUSIONS: The patients with cystoscopically pseudotumoral lesions (inflammation/granuloma) are a reduced group (13%) with less tendency to recurrence and without progression, even though this relationship is not significant.


Subject(s)
Adjuvants, Immunologic/therapeutic use , BCG Vaccine/therapeutic use , Cystoscopy , Granuloma, Plasma Cell/pathology , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/pathology , Disease Progression , Humans , Neoplasm Recurrence, Local , Neoplasm Staging , Prognosis , Urinary Bladder Neoplasms/surgery
18.
Int Urol Nephrol ; 33(3): 485-9, 2001.
Article in English | MEDLINE | ID: mdl-12230277

ABSTRACT

OBJECTIVE: Intravesical instillation of bacillus Calmette-Guerin (BCG) is an established treatment of carcinoma in situ and recurrent superficial bladder tumours. The inflammatory reaction due to BCG provokes cystitis of short duration as a frequent side effect. When the symptomatology is severe and long-lasting, different systemic treatments have been administered with varying degrees of efficacy. MATERIAL AND METHODS: We have studied the treatment of severe BCG cystitis with a anaesthetic anti-inflammatory solution administered by intravesical instillations to 16 patients. RESULTS: Good results were obtained in 94% of the cases, with immediate clinical improvement in terms of pain and urinary symptoms, and with no side effects. CONCLUSIONS: This treatment is inexpensive and easy to administer. We consider that it offers a useful option to solve an infrequent but very annoying problem for the patients.


Subject(s)
Adjuvants, Immunologic/administration & dosage , BCG Vaccine/administration & dosage , Carcinoma in Situ/drug therapy , Carcinoma, Transitional Cell/drug therapy , Urinary Bladder Neoplasms/drug therapy , Adjuvants, Immunologic/therapeutic use , Administration, Intravesical , Aged , BCG Vaccine/therapeutic use , Carcinoma in Situ/pathology , Carcinoma in Situ/surgery , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Combined Modality Therapy , Humans , Male , Middle Aged , Treatment Outcome , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery
19.
Actas Urol Esp ; 24(7): 522-9, 2000.
Article in Spanish | MEDLINE | ID: mdl-11011441

ABSTRACT

OBJECTIVES: Evaluation of a homogeneous series of Superficial Primary TCC of the Bladder. Utility of randomized biopsies (BMN). Study of risk factors and risk groups as a basis for determining treatment and followup patterns. MATERIALS AND METHODS: Survey of 1,529 PSBT cases that underwent TURB and BMN, with a mean followup of 4.2 years. Strict statistical treatment: multivariate analysis using Cox logistic regression according to Kaplan-Meier curves. RESULTS: Tumor features of note: single tumor (65%), smaller than 1.5 cm (45%), high grade (G3: 26%), and high stage (T1: 64%). BMN showed associated CIS in 284 cases (19%). Main risk factors for recurrence were multiplicity, size > 3 cm and association with CIS. The main risk factor for progression was grade 3 (OR 19.9). Grade 3 and association with CIS were found to increase mortality risk. On the basis of this data, we grouped tumors according to low-, middle-, and high-risk, and established our proposed treatment and followup for each group. CONCLUSIONS: This multivariate analysis of a homogeneous cohort of 1,529 primary superficial bladder tumor cases allowed vs to determine risk groups for treatment and followup.


Subject(s)
Urinary Bladder Neoplasms/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Longitudinal Studies , Male , Middle Aged , Neoplasm Staging , Retrospective Studies , Risk Factors
20.
J Urol ; 164(4): 1183-7, 2000 Oct.
Article in English | MEDLINE | ID: mdl-10992362

ABSTRACT

PURPOSE: We evaluated the prognostic factors of primary superficial bladder cancer that may predict a metachronous upper urinary tract tumor. We also determined whether the incidence of upper urinary tract disease varies according to risk group based on primary superficial bladder tumor classification. MATERIALS AND METHODS: We studied disease evolution in a cohort of 1,529 patients with a primary superficial bladder tumor. To determine the prognostic factors of upper urinary tract cancer we performed multivariate analysis using Cox regression. Independent variables were grade, T stage, multiplicity, tumor size, carcinoma in situ association, previous or synchronous upper urinary tract tumor and intravesical instillation. We also performed the chi-square test and Kaplan-Meier survival analysis to assess the variable incidence of upper urinary tract tumors according to primary superficial bladder tumor risk group classification. RESULTS: The incidence of upper urinary tract cancer was 2.6%. The only factor prognostic for an upper urinary tract tumor was multiplicity (relative risk 2.7, 95% confidence interval [CI] 1.06 to 6.84). All patients with an upper urinary tract tumor had a previously recurrent primary superficial bladder tumor. In the low, intermediate and high risk groups the incidence of upper urinary tract cancer was 0.6% (relative risk 1), 1.8% (relative risk 3.1, 95% CI 0.4 to 23.9) and 4.1% (relative risk 8.3, 95% CI 1.1 to 61.6), respectively (chi-square and log rank tests p = 0.007 and p <0.05, respectively). CONCLUSIONS: A higher risk of upper urinary tract cancer must be expected in cases of multiple primary superficial bladder tumors. This finding supports the multicentricity theory of transitional cell carcinoma. Primary superficial bladder tumor classification by risk group is also useful for predicting the various risks of metachronous upper urinary tract cancer.


Subject(s)
Carcinoma, Transitional Cell/pathology , Neoplasms, Second Primary/pathology , Urinary Bladder Neoplasms/pathology , Urologic Neoplasms/pathology , Carcinoma, Transitional Cell/surgery , Humans , Neoplasm Staging , Prognosis , Proportional Hazards Models , Risk Factors , Time Factors , Urinary Bladder Neoplasms/surgery
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