[Optimization of follow up in prostate cancer active surveillance]. / Optimizacion del seguimiento de cancer de prostata en vigilancia activa.

OBJECTIVES: Prostate cancer is a highly prevalent disease but with reduced cause-specific mortality. Active surveillance represents an alternative to postpone or avoid the potential sequelae derived from curative treatments in selected patients. The objective of this article is to review the diagnostic and follow-up methods for patients included in active surveillance programs. METHODS: We performed an exhaustive bibliographic review with the terms "Prostate cancer", "Active surveillance", "expectant management", including the greatest series published since 2007. CONCLUSIONS: Awaiting for genetic markers that help us to predict diagnosis and evolution of prostate cancer, PSA kinetics, digital rectal examination and repeated biopsies continue being the inclusion and follow up criteria for patients in active surveillance programs. Emerging complementary tests such as multi parametric MRI, PCA3 and Phi seem to add specificity to the existing clinical criteria. The reduced number of patients included, the limited follow up and the great disparity of inclusion and follow up criteria between different groups make the implementation of consensus guidelines that could help a more widespread application of this alternative difficult.

Optimización del seguimiento de cáncer de próstata en vigilancia activa / Optimization of follow up in prostate cancer active surveillance

OBJETIVO: El cáncer de próstata es una patología con una alta prevalencia pero con una reducida mortalidad causa-específica. La vigilancia activa, representa una alternativa para posponer o evitar las posibles secuelas derivadas de los tratamientos con intención curativa en pacientes seleccionados. Objetivo: Revisar los métodos de diagnóstico y seguimiento de los pacientes incluidos en programas de vigilancia activa. MÉTODO: Se ha realizado una revisión bibliográfica exhaustiva con los términos "prostate cáncer", "active surveillance", "expectant management", incluyendo las publicaciones con mayores series desde 2007. CONCLUSIONES: En espera de marcadores genéticos que nos ayuden a predecir el diagnóstico y la evolución del cáncer de próstata, los criterios para la inclusión y seguimiento de los pacientes en programas de vigilancia activa siguen siendo la cinética de PSA, el tacto rectal y las biopsias de repetición. La aparición de exploraciones complementarias como la resonancia magnética multiparamétrica, el PCA3 y el Phi parecen añadir especificidad a los criterios clínicos existentes. El reducido número de pacientes incluidos, el seguimiento limitado de los mismos y la gran disparidad de criterios de inclusión y seguimiento entre los diferentes grupos, dificultan la creación de unas guías de consenso que puedan facilitar una aplicación más amplia de esta alternativa

OBJECTIVES: Prostate cancer is a highly prevalent disease but with reduced cause-specific mortality. Active surveillance represents an alternative to postpone or avoid the potential sequelae derived from curative treatments in selected patients. The objective of this article is to review the diagnostic and follow-up methods for patients included in active surveillance programs. METHODS: We performed an exhaustive bibliographic review with the terms "Prostate cancer", "Active surveillance", "expectant management", including the greatest series published since 2007. CONCLUSIONS: Awaiting for genetic markers that help us to predict diagnosis and evolution of prostate cancer, PSA kinetics, digital rectal examination and repapeated biopsies continue being the inclusion and follow up criteria for patients in active surveillance programs. Emerging complementary tests such as multi parametric MRI, PCA3 and Phi seem to add specificity to the existing clinical criteria. The reduced number of patients included, the limited follow up and the great disparity of inclusion and follow up criteria between different groups make the implementation of consensus guidelines that could help a more widespread application of this alternative difficult

[Priapism secondary to penis infiltration of bladder cancer]. / Priapismo secundario a infiltración peneana por contigüidad de carcinoma vesical infiltrante.

Metastasic priapism is a rare entity produced by tumor cell implantation or direct infiltration of corpora cavernousum of the penis. In up to 80% of cases the primary tumor has an urological origen like prostate or bladder cancers. Treatment depends on syntomatology and patient's prognosis. Generally, average survival in these patients is poor due to metastasic progression, among 1 to 1 and a half years. We present a case report of secondary priapism for direct bladder carcinoma's invasion of the corpora cavernousum. A total penectomy due to a penile infected necrosis was required.

Priapismo secundario a infiltración peneana por contigüidad decarcinoma vesical infiltrante / Priapism secondary to penis infiltration of bladder cancer

El priapismo de origen metastático es una entidad muy poco frecuente, que se produce por implantación de células tumorales o bien por invasión directa por contigüidad principalmente de los cuerpos cavernosos. Hasta en un 80% de los casos el origen de los tumores primarios es genitourinario, principalmente por tumores prostáticos y vesicales. El tratamiento dependerá de la sintomatología que produzca y del pronóstico del paciente. Pero generalmente, la supervivencia al año es muy pobre debido a que presentan una neoplasia en fase metastásica. Presentamos un caso de priapismo secundario a invasión por contigüidad de los cuerpos cavernosos de un carcinoma vesical, al que fue necesario realizarle una penectomía total por necrosis purulenta del glande asociada (AU)

Metastasic priapism is a rare entity produced by tumor cell implantation or direct infiltration of corpora cavernousum of the penis. In up to 80% of cases the primary tumor has an urological origen like prostate or bladder cancers. Treatment depends on syntomatology and patient’s prognosis. Generally, average survival in these patients is poor due to metastasic progression, among 1 to 1 and a half years. We present a case report of secondary priapism for direct bladder carcinoma’s invasion of the corpora cavernousum. A total penectomy due to a penile infected necrosis was required (AU)

[Laparoscopic radical cystectomy in clinically localized (T2) bladder tumors]. / Cistectomía radical laparoscópica en los tumores vesicales clínicamente localizados (T2).

OBJECTIVES: Laparoscopic radical cystectomy has been developed after the expansion of laparoscopic radical prostatectomy. This technique makes possible a minimally invasive approach to muscle-invasive bladder cancer with less blood loss and faster postoperative recovery. METHODS: From September 2004 to January 2007, 54 laparoscopic radical cystectomies were performed, 48 of them in stage T2, from which 43 (90%) were male and 5 (10%) female patients. Mean age was 64 years (27-881. Lymphadenectomy was carried out by laparoscopic approach in all cases, with a mean of 13 nodes obtained (4-24). Urinary diversion was done through the incision needed to extract the specimen in all cases but one that was completed completely intracorporeally; constructing a Bricker-type ureteroileostomy in 30 (62%) cases, orthotopic neobladder (Vesica Ileale Padovana) in 17 cases (35%), and cutaneous ureterostomy in 1 case (2%). RESULTS: Mean surgical time for the whole procedure was 287 minutes (180-480), 270 minutes for Bricker-type derivation cases and 316 minutes for neobladder cases. Blood transfusion rate was 25%. Mean ileal paralysis was 5 days (2-10) with a mean hospital stay of 13 days (6-34) for Bricker cases and 16 days (8-30) for neobladder cases. Oncological control, after a mean follow-up of 10,8 months (0,4-30), showed a cancer-specific survival of 90% with a mean survival time of 28 months (95% CI 26-30). Global mean survival was 79% with a mean survival of 26 months (95% CI 23-29). CONCLUSIONS: Laparoscopic radical cystectomy is a feasible technique that offers some advantages. It allows excision with less blood loss and an easier postoperative period. Randomized studies should demonstrate these advantages to confirm this approach as the technique of choice. Urinary diversion performed through the laparotomy incision, necessary to extract the specimen, optimizes derivation results and whole surgical time without reducing the beneficial effects of the laparoscopic exeresis.

[Urological outcome of patients with sacral agenesis: 20 years follow-up]. / Evolución urológica de pacientes con agenesia de sacro: 20 años de seguimiento.

OBJECTIVES: Complete or partial sacral agenesis is a rare malformation consisting in the absence of one or more sacral vertebrae. It is part of a caudal regression syndrome and it may be associated with other congenital anomalies (Currarino Syndrome). It does not have an established etiology but is associated with insulin-dependent diabetes mellitus in the mother (1%). The objective of this is study was to retrospectively analyze the urological outcome of patients with sacral agenesis in our case series. METHODS: Retrospective analysis of 14 patients between 1975 and 2005. We evaluated reason for consultation, urological status, continence outcome, urological complications, hospital admissions and number of office visits. RESULTS: No patient had history of diabetic mother The number of male/female patients were similar. Mean age at first visit was 13.2 years and main reason for consultation was urinary incontinence. 60% of the patients presented associated myelomeningocele. 70% had a normal upper urinary tract at the beginning of follow-up; 10 patients presented some degree of incontinence (70%). Mean follow-up was 19.7 years (7-30): 50% of the patients keep a normal upper urinary tract. All of them have presented symptomatic urinary tract infection. The main urological reason for hospital admission was programmed surgery (7). The mean number of visits per year was 1.9. CONCLUSIONS: Sacral agenesis is a rare congenital malformation requiring an early diagnosis to avoid mid-term urological complications. These patients need life-long urological follow-up. The mean reason for consultation is urinary incontinence secondary to neurogenic bladder which may be satisfactorily treated in most cases.

Evolución urológica de pacientes con agenesia de sacro: 20 años de seguimiento / Urological outcome of patients with sacral agenesis: 20 years follow-up

OBJETIVO: La agenesia sacra total ó parcial es una malformación infrecuente que consiste en la ausencia de una ó más vértebras sacras. Forma parte del síndrome de regresión caudal y se puede asociar a otras anomalías congénitas (síndrome de Currarino). No tiene una etiología establecida pero se asocia a madres diabéticas insulinodependientes (1%). El objetivo de este estudio ha sido analizar retrospectivamente la evolución urológica de los pacientes con agenesia sacra de nuestra serie. MÉTODOS: Análisis retrospectivo de 14 pacientes entre 1975 y 2005. Se valoró el motivo de consulta, situación urológica y neurológica de entrada, tiempo de seguimiento, evolución de la continencia, complicaciones urológicas, ingresos hospitalarios y número de visitas ambulatorias. RESULTADOS: Ningún paciente tenía antecedentes de madre diabética. La distribución por sexos fue similar. Todos los casos fueron de agenesia total. La edad media en la primera visita fue de 13,2 años y el principal motivo de consulta fue la incontinencia urinaria. El 60% de pacientes presentaban mielomeningocele asociado. El 70% tenían el tracto urinario superior normal al inicio del seguimiento; 10 pacientes presentaban algún grado de incontinencia (70%). El tiempo medio de seguimiento ha sido de 19,7 años (7-30): el 50% de los pacientes mantienen el tracto urinario superior normal. El 65% de los pacientes se mantienen continentes. Todos han presentado infección urinaria sintomática. El motivo urológico principal de ingreso hospitalario ha sido la cirugía programada (7). El número medio de visitas anuales por paciente ha sido de 1,9. CONCLUSIONES: La agenesia de sacro es una malformación congénita infrecuente que requiere un diagnóstico precoz para evitar complicaciones urológicas a medio plazo. Estos pacientes son subsidiarios de un control urológico de por vida. El principal motivo de consulta es la incontinencia urinaria por vejiga neurógena que puede ser tratada satisfactoriamente en la mayoría de los casos

OBJECTIVES: Complete or partial sacral agenesis is a rare malformation consisting in the absence of one or more sacral vertebrae. It is part of a caudal regression syndrome and it may be associated with other congenital anomalies (Currarino Syndrome). It does not have an established etiology but is associated with insulin-dependent diabetes mellitus in the mother (1%). The objective of this is study was to retrospectively analyze the urological outcome of patients with sacral agenesis in our case series. METHODS: Retrospective analysis of 14 patients between 1975 and 2005. We evaluated reason for consultation, urological status, continence outcome, urological complications, hospital admissions and number of office visits. RESULTS: No patient had history of diabetic mother. The number of male/female patients were similar. Mean age at first visit was 13.2 years and main reason for consultation was urinary incontinence. 60% of the patients presented associated myelomeningocele. 70% had a normal upper urinary tract at the beginning of follow-up; 10 patients presented some degree of incontinence (70%). Mean follow-up was 19.7 years (7-30): 50% of the patients keep a normal upper urinary tract. All of them have presented symptomatic urinary tract infection. The main urological reason for hospital admission was programmed surgery (7). The mean number of visits per year was 1.9. CONCLUSIONS: Sacral agenesis is a rare congenital malformation requiring an early diagnosis to avoid mid-term urological complications. These patients need life-long urological follow-up. The mean reason for consultation is urinary incontinence secondary to neurogenic bladder which may be satisfactorily treated in most cases