Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study.

Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9-4.1) and 3.6% (95% CI: 1.9-6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.

Time of administration of a single dose of oral levofloxacin and its effect in infectious complications from transrectal prostate biopsy.

OBJECTIVE: To evaluate the efficacy of two prophylactic schemes for prostate biopsy using a single dose of oral levofloxacin given either before, or immediately after transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: A total of 300 men formed two groups of 150 patients each: the first group received one dose of 500 mg of levofloxacin 30 min to an hour before, and the second group the same antibiotic immediately after prostate biopsy. No pre-biopsy enema was used. Side effects after prostate biopsy were recorded, and the two groups were compared. RESULTS: Only one patient from the first group developed a urinary tract infection after biopsy. A mean number of more than 10 cores per patient were taken. Haematuria was the most common complaint, followed by haemospermia. Haematuria and rectal bleeding were more common in patients where more than 8 cores were taken from the prostate (P = 0.005 and P = 0.017, respectively). Prostate cancer was detected in 34.3% of patients in total. CONCLUSION: The use of a single dose of 500 mg levofloxacin given immediately after prostate biopsy proved to be quite effective for the prevention of infectious complications, even in the setting of an extensive biopsy protocol.

Characteristics of patients with stage T1b incidental prostate cancer.

OBJECTIVE: To study the characteristics of patients with incidental prostate cancer. MATERIAL AND METHODS: The proportion of incidentally diagnosed prostate cancer was investigated in patients who underwent transurethral resection of the prostate (TURP) at our clinic over a 5-year period. "True" incidental prostate cancer was defined as cases where the preoperative digital rectal examination (DRE) and the prostate-specific antigen (PSA) value were normal. Patients with known malignancy of the prostate were excluded, together with those with PSA >4 ng/ml and/or a positive DRE. The characteristics of these patients were compared to those of benign prostatic hyperplasia patients and the group as a whole. RESULTS: Of the 786 patients operated on between 1999 and 2003, 34 (4.3%) had a positive pathology report for "true" incidental prostate cancer. An increased frequency of poorly differentiated tumors (32.3%) was noted. Of the 34 patients, 17 were stage T1a and 17 T1b; 11 patients had a Gleason sum of 7-10, all of them in the T1b group. In the T1b group the mean age was 74 years, the mean PSA level 2.9 ng/ml and the mean weight of tissue resected 11.1 g. Corresponding values in the T1a patients were 70.1 years, 3.32 ng/ml and 18.2 g. CONCLUSIONS: Compared to previous studies, we noticed a low incidence of "true" incidental prostatic carcinoma but a high ratio of poorly differentiated tumors (all stage T1b). Compared to the group as a whole, patients with incidental prostate cancer were older and had smaller prostate and transition zone volumes. Further research is needed to identify parameters that may aid in the earlier identification of incidental prostate cancer, as patients may benefit from curative treatment.

Complications of laparoscopic urological surgery.

OBJECTIVES: To describe the complications of laparoscopic surgery in general but also specifically in the field of Urology and then analyze the preventive measures that must be taken in order to minimize these complications. METHODS: At first we outline the absolute and the relative contraindications of laparoscopic surgery in general. Then we describe the various intra and postoperative complications seen in laparoscopic surgery and finally we discuss the complications reported specifically in Urological laparoscopic procedures. RESULTS AND CONCLUSIONS: The applications of laparoscopic surgery in Urology grows every day. The main complications are vascular injuries and visceral lesions but the complications rate diminishes as surgeons improve in their learning curve. Laparoscopy for Urology is here to stay.

Complicaciones de la cirugía laparoscópica urológica / Complications of laparoscopic urological surgery

Objetivos: Describir las complicaciones de la cirugía laparoscópica en general y también específicamente en el campo de la urología y analizar las medidas preventivas que deben tomarse para disminuirlas al mínimo. Métodos: Primero delineamos las contraindicaciones absolutas y relativas de la cirugía laparoscópica en general. Después describimos diferentes complicaciones intra y postoperatorias vistas en cirugía laparoscópica y finalmente discutimos las complicaciones específicamente comunicadas en procedimientos laparoscópicos urológicos. Resultados y Conclusiones: La aplicación de la cirugía laparoscópica en urología crece cada día. Las principales complicaciones son las lesiones vasculares y viscerales, pero la incidencia de complicaciones disminuye a medida que el cirujano mejora en su curva de aprendizaje. La laparoscopia en urología está aquí para quedarse (AU)