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1.
Arch Esp Urol ; 73(4): 257-267, 2020 May.
Article in Spanish | MEDLINE | ID: mdl-32379060

ABSTRACT

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.


INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz.MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p<0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG.


Subject(s)
Sepsis , Shock, Septic , Urinary Tract Infections , Biomarkers , Humans , Prognosis , Prospective Studies , ROC Curve
2.
Arch. esp. urol. (Ed. impr.) ; 73(4): 257-267, mayo 2020. tab, graf
Article in Spanish | IBECS | ID: ibc-192985

ABSTRACT

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz. MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p < 0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG


INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC: 0.919). SS risk factors (p < 0.05) were the history of cancer, immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows an early identification of patients with OU subsidiary of been complicated with SS


Subject(s)
Humans , Sepsis/complications , Ureteral Obstruction , Biomarkers , Early Diagnosis , Prospective Studies , Blood Gas Analysis , Risk Factors , Logistic Models , Urinary Diversion , Immunosuppression Therapy
3.
Arch Esp Urol ; 66(8): 815-7, 2013 Oct.
Article in English, Spanish | MEDLINE | ID: mdl-24136485

ABSTRACT

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis.


Subject(s)
Carcinoma, Transitional Cell/secondary , Penile Neoplasms/secondary , Skin Neoplasms/secondary , Urinary Bladder Neoplasms/pathology , Aged , Humans , Male
4.
Arch. esp. urol. (Ed. impr.) ; 66(8): 815-817, oct. 2013. ilus
Article in Spanish | IBECS | ID: ibc-129203

ABSTRACT

OBJETIVO: Presentamos un caso de una metástasis cutánea originada desde un tumor vesical. MÉTODOS: Varón de 68 años diagnosticado de un carcinoma urotelial de alto grado de la ISUP con afectación de toda la pared vesical incluida la grasa perivesical y macrometástasis en la cadena ilio-obturatriz izquierda (T3N2MO) que presenta una induración en la cara dorsal del glande, no dolorosa y con áreas ulceradas no exudativas, de varios meses de evolución. Dado el resultado negativo de la serología, se biopsió la lesión para su estudio anatomopatológico. RESULTADOS: El estudio histopatológico de la lesión correspondía a una metástasis cutánea de carcinoma urotelial de alto grado. CONCLUSIÓN: Existen aproximadamente 370 casos de metástasis peneana descritos y en el 30-35% de los casos el tumor primario se localiza en la vejiga. La presentación de estas lesiones es muy heterogénea precisando para el diagnóstico definitivo el estudio anatomopatológico de la lesión (AU)


OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis (AU)


Subject(s)
Humans , Male , Aged , Neoplasm Metastasis/pathology , Penile Neoplasms/secondary , Urinary Bladder Neoplasms/pathology , Skin Neoplasms/pathology
5.
Arch Esp Urol ; 65(4): 467-75, 2012 May.
Article in English, Spanish | MEDLINE | ID: mdl-22619138

ABSTRACT

OBJECTIVES: Testicular cancer represents about 1% of malignant tumors in men. Of these tumors 95% are germ cell tumors (GCTs), which have a maximum incidence between the second and third decades of life. Our objective was to carry out a retrospective analysis of testicular tumor cases that had been diagnosed in our Health Area between the years 2000 and 2010. METHODS: We performed a retrospective descriptive study between the years 2000 and 2010 analyzing 43 patients treated for testicular cancer, including in the analysis tumor incidence, the patient's age, clinic attended, patient's time until appointment, presence of tumor markers, patient's time before treatment, use of testicular prostheses, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. RESULTS: We found an incidence of 4-5 cases/100,000 population/year in our Health Area. Two-thirds of the cases were detected in Stage I, and 100% of these cases showed complete remission. Among those with higher stage tumors, two out of three patients were cured after chemotherapy. For the remaining one-third, rescue treatments managed to achieve a remission rate of 66%. Mortality was low and was linked to lymphoma or metastatic dissemination. CONCLUSION: The trend towards early diagnosis with detection during the initial cancer stages, together with current chemotherapy protocols, enables a high cure rate for testicular cancer. Mortality in our series was associated with primary or secondary lymphomas.


Subject(s)
Neoplasms, Germ Cell and Embryonal , Testicular Neoplasms , Adult , Biomarkers, Tumor/blood , Humans , Incidence , Male , Middle Aged , Neoplasms, Germ Cell and Embryonal/epidemiology , Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Germ Cell and Embryonal/therapy , Retrospective Studies , Spain/epidemiology , Testicular Neoplasms/epidemiology , Testicular Neoplasms/pathology , Testicular Neoplasms/therapy , Tumor Burden , Young Adult
6.
Arch. esp. urol. (Ed. impr.) ; 65(4): 467-475, mayo 2012. tab, graf
Article in Spanish | IBECS | ID: ibc-99381

ABSTRACT

OBJETIVO: El cáncer de testículo representa alrededor del 1% de los tumores malignos en el varón. El 95% corresponde a tumores germinales (TTG) cuya máxima incidencia tiene lugar entre la 2ª y 3ª década de la vida. Nuestro objetivo es realizar un análisis retrospectivo de los tumores testiculares diagnosticados en nuestra Área de Salud entre los años 2000 y 2010. MÉTODOS: Estudio descriptivo retrospectivo de los pacientes con cáncer testicular entre los años 2000 y 2010, analizándose un total de 43 pacientes, con evaluación de la incidencia, edad, presentación clínica, tiempo hasta la consulta, marcadores tumorales, tiempo hasta el tratamiento, solicitud de prótesis testicular, tipo histológico y características anatomopatológicas propias, tratamiento oncológico, progresión tumoral y mortalidad. RESULTADOS: En nuestro área de salud encontramos una incidencia de 4-5 casos-/100000habitantes/año. Las dos terceras partes de los casos se detectaron en Estadio I, consiguiendo remisión completa en el 100%. En Estadios superiores hay curación en 2 de cada 3 pacientes tras la quimioterapia y en el tercio restante, los tratamientos de rescate consiguen la remisión en el 66%. La mortalidad es baja y asociada a afectación por Linfoma o a diseminación metastásica. CONCLUSIÓN: La tendencia al diagnóstico precoz con detección en estadios iniciales, asociado a los actuales protocolos de quimioterapia, permiten altos índices de curación en el cáncer testicular. La mortalidad en nuestra serie se asocia mayoritariamente a afectación por Linfoma primario o secundario(AU)


OBJECTIVES: Testicular cancer represents about 1% of malignant tumors in men. Of these tumors 95% are germ cell tumors (GCTs), which have a maximum incidence between the second and third decades of life. Our objective was to carry out a retrospective analysis of testicular tumor cases that had been diagnosed in our Health Area between the years 2000 and 2010. METHODS: We performed a retrospective descriptive study between the years 2000 and 2010 analyzing 43 patients treated for testicular cancer, including in the analysis tumor incidence, the patient’s age, clinic attended, patient’s time until appointment, presence of tumor markers, patient’s time before treatment, use of testicular prostheses, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. RESULTS: We found an incidence of 4-5 cases/100,000 population/year in our Health Area. Two-thirds of the cases were detected in Stage I, and 100% of these cases showed complete remission. Among those with higher stage tumors, two out of three patients were cured after chemotherapy. For the remaining one-third, rescue treatments managed to achieve a remission rate of 66%. Mortality was low and was linked to lymphoma or metastatic dissemination. CONCLUSION: The trend towards early diagnosis with detection during the initial cancer stages, together with current chemotherapy protocols, enables a high cure rate for testicular cancer. Mortality in our series was associated with primary or secondary lymphomas(AU)


Subject(s)
Humans , Male , Testicular Neoplasms/epidemiology , Neoplasms, Germ Cell and Embryonal/epidemiology , Retrospective Studies , Age Distribution , Early Detection of Cancer
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