Protocol description and initial experience in kidney graft perfusion using infrared thermography.

PURPOSE: Protocol description for renal perfusion study using thermographic technology and description of the thermographic and clinical behavior of the transplanted kidneys before and after unclamping. METHODS: Infrared thermographic images of renal grafts are obtained before kidney reperfusion, 10 min after and just before closing the surgical wound. Thermographic data is evaluated together with the type of graft and donor, cold ischemia time, hypovascularized areas determined by the surgeon during surgical intervention, alterations in vascular flow in postoperative echo-Doppler, time at the beginning of graft function and serum creatinine monitoring during postoperative follow-up. RESULTS: 17 grafts were studied. The mean temperature of the grafts before reperfusion, 10 min after and at the end of the surgery were 18.7 °C (SD 6.27), 32.36 °C (SD1.47) and 32.07 °C (SD1.78) respectively. 4 grafts presented hypoperfused areas after reperfusion. These areas presented a lower temperature compared to the well perfused parenchyma surface using thermographic images. CONCLUSION: The study of the usefulness and applicability of thermography can allow the development of tools that provide additional objective information on organ perfusion in real time and non-invasive manner. Our protocol and initial results can contribute to provide new evidence. Further analyses should be developed to shed light on the role of this technology.

Biomarkers and intermediate-high risk non-muscle invasive bladder cancer: a multivariate analysis of three different cellular pathways with pronostic implications

Purpose To determine the presence of a group of mutations, and establish the prognostic value for recurrence and progression. Materials and methods Prospective observational study. Intermediate-to-high-risk non-muscle invasive bladder cancer (NMIBC) was evaluated. Data from genetic analyses were included in a database along with clinicopathological variables of interest. Results Seventy-four patients. Twenty-five (33.8%) recurred and 3 (4.1%) progressed. Median time to recurrence: 8 months (5.7–12.7). Median time to progression: 14 months (P75: 12). Mutation distribution: KRAS codon 12: one patient (1.4%), BAT25: five patients (6.8%), BAT-26: four patients (5.4%), and D2S123: 6 patients (8.1%). Arg72Pro polymorphism: 50 patients (67.6%) exhibited homozygous mutations, 23 (31.1%) were heterozygous, and 1 patient (1.4%) did not present the mutation. We found an association between presence of MSI at BAT26 and female sex (p < 0.05) and tumor stage and the TP53 Arg72Pro polymorphism. Recurrence-free survival (RFS) was significantly associated with presence of MSI at D2S123, with a HR of 5.44 for patients presenting the mutation (95% CI 1.83–16.16). On multivariate analysis, we found a statistically significant increase in risk of recurrence among patients with MSI at D2S123 (HR 5.15; p < 0.05) and more than 2 previous transurethral bladder resections (TURBs) (HR 5.07; p < 0.05) adjusted for tumor stage and grade. Harrell’s concordance index revealed an accuracy of 0.74 (p < 0.05). Conclusion An association was found between presence BAT26 MSI and female sex, Arg72Pro polymorphism with tumor stage and D2S123 and more than 2 TUR procedures were associated with RFS adjusted to tumor stage and grade (AU)

Biomarkers and intermediate-high risk non-muscle invasive bladder cancer: a multivariate analysis of three different cellular pathways with pronostic implications.

PURPOSE: To determine the presence of a group of mutations, and establish the prognostic value for recurrence and progression. MATERIALS AND METHODS: Prospective observational study. Intermediate-to-high-risk non-muscle invasive bladder cancer (NMIBC) was evaluated. Data from genetic analyses were included in a database along with clinicopathological variables of interest. RESULTS: Seventy-four patients. Twenty-five (33.8%) recurred and 3 (4.1%) progressed. Median time to recurrence: 8 months (5.7-12.7). Median time to progression: 14 months (P75: 12). Mutation distribution: KRAS codon 12: one patient (1.4%), BAT25: five patients (6.8%), BAT-26: four patients (5.4%), and D2S123: 6 patients (8.1%). Arg72Pro polymorphism: 50 patients (67.6%) exhibited homozygous mutations, 23 (31.1%) were heterozygous, and 1 patient (1.4%) did not present the mutation. We found an association between presence of MSI at BAT26 and female sex (p < 0.05) and tumor stage and the TP53 Arg72Pro polymorphism. Recurrence-free survival (RFS) was significantly associated with presence of MSI at D2S123, with a HR of 5.44 for patients presenting the mutation (95% CI 1.83-16.16). On multivariate analysis, we found a statistically significant increase in risk of recurrence among patients with MSI at D2S123 (HR 5.15; p < 0.05) and more than 2 previous transurethral bladder resections (TURBs) (HR 5.07; p < 0.05) adjusted for tumor stage and grade. Harrell's concordance index revealed an accuracy of 0.74 (p < 0.05). CONCLUSION: An association was found between presence BAT26 MSI and female sex, Arg72Pro polymorphism with tumor stage and D2S123 and more than 2 TUR procedures were associated with RFS adjusted to tumor stage and grade.

Resultados oncológicos de un programa de prostatectomía radical asistida por robot «da Vinci» en una cohorte de 408 pacientes consecutivos / Oncologic outcomes in 408 consecutive patient cohort treated with da Vinci robot-assisted radical prostatectomy

El objetivo de este estudio es evaluar las características generales y los resultados oncológicos en una cohorte de 408 casos de prostatectomía radical asistida por robot da Vinci Standard de 4 brazos, realizadas entre octubre del 2006 y febrero del 2015. El análisis estadístico se realizó con el programa SPSS 20.0. Las variables cualitativas se presentan con su distribución de frecuencias y las cuantitativas con su media y desviación estándar o mediana y rango intercuartil. La asociación entre variables cualitativas se analizó con el test de la χ2. La variable de resultado de la supervivencia libre de enfermedad se evaluó con un análisis de curvas de Kaplan-Meier y se contrastaron las diferencias con el test de Breslow. Se ajustó un modelo de regresión de Cox. Entre los resultados destacamos un seguimiento 47 meses (32-68,75 meses), supervivencia libre de recurrencia 90 meses (IC del 95%, 86-94), mediana de tiempo a recurrencia de 23 meses (10,5-37 meses), recurrencia del 16,6% (68/408), recidiva bioquímica (62/498, 15,2%) y un 22% de complicaciones, la mayoría Clavien I-II. Los resultados se resumen en las tablas 1 a 7 y en la figura 1. CONCLUSIONES: 1) la prostatectomía radical robótica es una técnica segura con un porcentaje asumible de complicaciones, en su mayoría menores (grados I y II de Clavien); 2) encontramos mayor probabilidad de permanecer libre de recidiva en los grados más bajos de la clasificación de ISUP y mayor probabilidad de recidiva en casos de alto riesgo, y 3) en el modelo multivariante comprobamos que el grado ISUP se relacionó de forma significativa con la supervivencia y fueron variables pronosticas independientes los grados de la clasificación ISUP y los márgenes quirúrgicos positivos

The objective of this study is to evaluate the general characteristics and oncological results in a cohort of 408 cases submitted to da Vinci Standard 4-armed robot-assisted radical prostatectomy (RARP), performed between October 2006 and February 2015 at Clínico San Carlos hospital. Statistical analysis was performed with the SPSS 20.0 program. Qualitative variables are presented with their frequency distribution and quantitative variables with their mean and standard deviation or median and interquartile range. The χ2 test was used to analyze the association of qualitative variables. The disease-free survival outcome variable was evaluated with a Kaplan-Meier curve analysis, and the differences were contrasted with the Breslow test. A Cox regression model was adjusted. Among the results, we highlight the follow-up of 47 months (32-68.75 m), recurrence-free survival of 90 months (95% CI, 86-94), median time to recurrence of 23 months (10.5-37 m), recurrence 16'6% (68/408), biochemical recurrence (62/498, 15'2 %) and 22% of complications, mostly Clavien I-II. The results are summarized in Tables 1 to 7 and Figure 1

Oncologic outcomes in 408 consecutive patient cohort treated with da Vinci robot-assisted radical prostatectomy. / Resultados oncológicos de un programa de prostatectomía radical asistida por robot «da Vinci¼ en una cohorte de 408 pacientes consecutivos.

The objective of this study is to evaluate the general characteristics and oncological results in a cohort of 408 cases submitted to da Vinci Standard 4-armed robot-assisted radical prostatectomy (RARP), performed between October 2006 and February 2015 at Clínico San Carlos hospital. Statistical analysis was performed with the SPSS 20.0 program. Qualitative variables are presented with their frequency distribution and quantitative variables with their mean and standard deviation or median and interquartile range. The χ2 test was used to analyze the association of qualitative variables. The disease-free survival outcome variable was evaluated with a Kaplan-Meier curve analysis, and the differences were contrasted with the Breslow test. A Cox regression model was adjusted. Among the results, we highlight the follow-up of 47 months (32-68.75m), recurrence-free survival of 90 months (95% CI, 86-94), median time to recurrence of 23 months (10.5-37 m), recurrence 16'6% (68/408), biochemical recurrence (62/498, 15'2%) and 22% of complications, mostly Clavien I-II. The results are summarized in Tables 1 to 7 and Figure 1. CONCLUSIONS: 1) RARP is a safe technique with an acceptable percentage of complications, mostly minor (Clavien grades iandii), 2) We found a higher probability of remaining recurrence-free in the lower grades of the ISUP classification and a higher probability of recurrence in high-risk cases, and 3) The multivariate model showed that the ISUP grade was significantly related to survival and the ISUP and PSM classification grades were independent prognostic variables.

Robot Assisted Radical Prostatectomy in Kidney Transplant Recipients. Our Clinical Experience and a Systematic Review.

INTRODUCTION: Radical prostatectomy is a more skillful procedure in kidney graft recipients. Robotic surgery can provide a useful minimally invasive tool. OBJECTIVES: The study aims to evaluate the robotic-assisted laparoscopic prostatectomy (RALP) in kidney transplant recipients, describing intra/postoperative complications, renal and oncological outcomes. METHODS: This is a retrospective study conducted in a single institution of 84 RALP. Four of them were kidney transplant recipients. Side of the renal graft, clinical stage, intra/postoperative events, operating time, creatinine levels before/after intervention and oncologic follow-up were recorded. A systematic review of the literature was performed. RESULTS: Aged 61.25 ± 7.76 years, interval between renal transplantation and RALP: 10 ± 3.16 years. Mean prostate specific antigen: 7.1 ± 2.8 ng/ml, 2 patients were cT1c and 2 cT2a. Preoperative biopsies: Gleason score 3 + 3 in 3 patients, 3 + 4 in 1 patient. Charlson comorbidity index mean was 4.82 ± 0.82. No intra/postoperative events were reported. Mean operating time: 196 ± 20.8 min. Positive surgical margins: 2/4 patients. Pathological analysis: Gleason 3 + 4 in 2 patients and Gleason 3 + 3 in the others 2. A patient developed a bladder neck sclerosis. No differences between pre/postoperative creatinine. Three patients are free of biochemical recurrence and 1 patient required adjuvant radiotherapy. CONCLUSION: RALP in renal transplant recipients is a safe and feasible technique for localized prostate cancer. No difference in oncological outcomes and no impairments on renal function were found.

[Prognostic factors of spontaneous expulsion in ureteral lithiasis]. / Factores predictivos para la expulsión de la litiasis ureteral.

UNLABELLED: Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. OBJECTIVES: To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. MATERIAL AND METHODS: A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. RESULTS: 34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR=1.823, p=0.013), size (>5 mm, OR=3.37, p>0.02), and medication (combination of alpha blockers and NSAIDs, OR=8.70, >0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0.006) and medication (p>0.001) as independent predictive factors.The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8.21 (95%CI 3.37-20.01) the possibilities of spontaneous expulsion. CONCLUSIONS: Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.

Factores predictivos para la expulsión de la litiasis ureteral / Prognostic factors of spontaneous expulsion in ureteral lithiasis

El tratamiento médico, la litotricia y la ureteroscopia son opciones terapéuticas para el tratamiento de la litiasis ureteral. La ureteroscopia y la litotricia son altamente resolutivas, si bien no están exentas de riesgos quirúrgicos y anestésicos. El tratamiento médico expulsivo es menos efectivo pero carece de esos riesgos. La selección de enfermos para el tratamiento médico debe ser cuidadosa, atendiendo a factores como el tamaño, la composición y la localización de la litiasis. Objetivos: Analizar retrospectivamente el papel de las características litiásicas y de la medicación (alfabloqueantes, antiinflamatorios no esteroideos [AINE] o la combinación de ambos) como factores predictivos de la expulsión de cálculos ureterales. Material y métodos: Para el estudio se encontraron disponibles 278 litiasis ureterales correspondientes a 260 enfermos. La variable principal del estudio fue el «resultado clínico» (expulsión o persistencia de la litiasis). Se analizaron la influencia de la localización, el tamaño, la composición y la medicación administrada (alfabloqueantes, AINE o la combinación de ambos) con el test de la chi cuadrado. A continuación, se llevó a cabo un análisis multivariante con un modelo de regresión logística para estudiar la influencia de cada una de las variables en presencia del resto de las covariables. Resultados: Se produjo la expulsión del 34,2% de las litiasis. La localización (uréter pelviano, odds ratio [OR]= 1,823; p=0,02), el tamaño (<5mm, OR=3,37; p<0,001) y la medicación administrada (combinación de alfabloqueantes y AINE, OR=8,70; p<0,001) resultaron factores predictivos para la expulsión. El análisis multivariante confirmó al tamaño (p=0,006) y a la medicación (p<0,001) como factores predictivos independientes. El tratamiento con una combinación de AINE y alfabloqueantes multiplica por 8,21 (intervalo de confianza del 95%: 3,37–20,01) las posibilidades de expulsión en comparación con la mera actitud expectante. Conclusiones: El tamaño del cálculo y la medicación son factores predictivos independientes para la expulsión de la litiasis ureteral (AU)

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment. Objectives: To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone. Material and methods: A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance. Results: 34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR= 1,823, p=0,013), size (<5mm, OR=3,37, p<0,02), and medication (combination of alpha blockers and NSAIDs, OR= 8,70, p<0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0,006) and medication (p<0,001) as independent predictive factors. The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8,21 (95% CI 3.37–20,01) the possibilities of spontaneous expulsion. Conclusions: Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones (AU)

Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología / Adequacy of referral from primary care to a department of urology

Objetivo: Valorar indirectamente el grado de adhesión de los médicos de Atención Primaria (AP) a un protocolo de derivación consensuado con Atención Especializada (AE) sobre diez motivos de consulta urológica. Material y métodos: Se analizaron todas las derivaciones al servicio de urología llevadas a cabo durante un período de 19 meses por 135 médicos adscritos a 10 centros de AP (CAP). El urólogo juzgó como 'confome' o 'no conforme al protocolo' la derivación. Se compararon los porcentajes de adecuación de las derivaciones desde cada CAP. Se exploraron las diferencias en la adecuación de las derivaciones procedentes de cada CAP en función del problema de salud. La relación entre el número de derivaciones y el número de canalizaciones adecuadas se exploró mediante un modelo de regresión lineal. Resultados: El análisis tuvo lugar sobre 2841 derivaciones. El 57,2% de esas derivaciones se ajustó al protocolo. No se detectaron diferencias significativas en los porcentajes de derivaciones ‘conforme al protocolo’ en relación a los CAP. Se detectaron diferencias significativas entre CAP en las derivaciones por cólico nefrítico e incontinencia urinaria. Se detectó una relación entre el número de pacientes remitidos y el número de remisiones 'no conforme al protocolo' (r2=0,86). Conclusiones: La adecuación al protocolo fue escasa. Algunos problemas de salud deberían de ser revisados a nivel local; la mayoría de los motivos de derivación (de modo particular la microhematuria) deberían de revisarse en todos los CAP

Objetive: To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics. Materials & methods: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between 'absolute number of referrals' and 'adequate referrals' was tested using a linear regression model. Results: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between 'absolute number of referrals' and 'adequate referrals' was evident (r2=0.86). Conclusions: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center

[Adequacy of referral from primary care to a Department of Urology]. / Adecuación de las derivaciones desde Atención Primaria a un Servicio de Urología.

OBJECTIVE: [corrected] To indirectly address the adequacy of referrals from general practitioners (GP) to specialized care taking into account a previously agreed protocol on ten urological topics. MATERIALS & METHODS: The study analyzed all referrals to the Urology department originated in 10 primary care centres (135 GPs involved) throughout a 19-month period. Adequacy of 2841 referrals was checked. The urologist judged the referral as compliant (adequate) or not compliant (inadequate) with the terms of the protocol. Compliance per primary care centres was compared. Also referral adequacy corrected per centre and clinical topic was compared. The relationship between "absolute number of referrals" and "adequate referrals" was tested using a linear regression model. RESULTS: 57.2% of the referrals were inadequate. Overall, no significant differences were detected between primary care centres. Nevertheless significant differences between centres were evident in terms of referrals due to renal colic and female urinary incontinence. 70% (94/135) of the GPs complied with the protocol in, at least, 50% of the cases. A strong association between "absolute number of referrals" and "adequate referrals" was evident (r2=0.86). CONCLUSIONS: Overall compliance with the protocol was modest. While no significant differences between centres were detected in terms of adequacy of referrals certain conditions have to be locally revisited; most of the topics (particularly microhematuria) have to be revisited in every center.

[Surgical treatment of stress urinary incontinence in our setting: analysis of results]. / Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en nuestro medio: análisis de resultados.

INTRODUCTION AND OBJECTIVE: Surgical repair is the most effective option for the treatment of stress urinary incontinence (SUI) between the different therapeutical options available at present. The main objective of our study is to compare the outcome of the different techniques employed in the treatment of SUI in our setting. METHOD: We have performed a retrospective analysis of the patients who underwent surgical intervention for SUI between 1991 to 1999 (213 surgical interventions in 194 patients) clustering the surgical procedures into three groups: abdominal, abdomino-vaginal, and sling procedures. The results of the treatment were defined as follows: total continence, significant improvement and insufficient improvement. Comparison of continence rates was performed with chi 2 test and Fisher's exact test. Association between qualitative variables was also evaluated by means of chi 2 test. Multivariate analysis of predictive factors was performed with a Cox model. The outcome was also evaluated by Kaplan-Meier's curves, and comparisons made with log-rank test. Statistical significance level was established for p < 0.05. RESULTS: Global cure rate at 24 months was 54.5% (116 patients). Significant improvement was observed in 33 patients (15.5%), and insufficient improvement was seen in 64 patients (30%). The most frequent postoperative complications were suprapubic pain (33%), acute urinary retention (26%), significant postvoiding residual urine (24%) and wound seroma or infection (20%). None of the analyzed factors (age, weight, number of births, preoperative pads, postoperative acute urinary retention, and need for postoperative bladder clean intermittent catheterization were independent predictive factors for postoperative continence. The actuarial analysis with Kaplan-Meier curves shows no statistical differences between the studied techniques (log rank p = 0.41). Sling techniques presented with a superior rate of most postoperative complications. CONCLUSIONS: The cure rate of our serie was 54.5% at 24 months, with a 70% of clinically satisfactory responses. With regard to continence status, it seems that there is not a better surgical technique in our hands, presenting sling techniques with a higher rate of postoperative complications. We could not find no pre o postoperative independent factors as predictors of postoperative continence.

Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en nuestro medio: análisis de resultados / Outcome analysis for surgical treatment of stress urinary incontinence in our setting

INTRODUCCIÓN: La corrección quirúrgica es actualmente el método más efectivo de tratamiento para la incontinencia urinaria de esfuerzo (IUE) de entre las diferentes opciones terapéuticas de las que se dispone en la actualidad. El objetivo de este trabajo consiste en comparar la eficacia de los distintos grupos de técnicas empleadas para el tratamiento de la IUE en nuestras pacientes. MATERIAL Y MÉTODO: Hemos llevado a cabo un análisis retrospectivo de las pacientes intervenidas en nuestro Servicio por IUE durante el periodo comprendido entre abril de 1991 y julio de 1999 (213 intervenciones en 194 pacientes), agrupando los procedimientos en 3 grupos: técnicas abdominales, técnicas abdomino-vaginales, y técnicas de cabestrillo. La tasa de éxito de la intervención fue valorada mediante tres categorías: continencia total, mejoría clínicamente significativa, y ausencia de mejoría. La comparación bivariante de proporciones se realizó mediante la prueba exacta de Fisher y el test de Chi-cuadrado. La asociación de variables cualitativas se evaluó mediante el test de Chi-cuadrado: se utilizó un modelo de Cox para el análisis multivariante de los factores predictores de continencia, y curvas de Kaplan-Meier para la evaluación de la supervivencia de la continencia post-operatoria. Para todos ellos se tomó como nivel de significación estadística una p<0,05. RESULTADOS: La tasa de continencia total de nuestra serie fue del 54,5 por ciento (116 pacientes continentes) a los 2 años. En el grupo de mejoría clínica significativa fueron incluidas 33 pacientes (15,5 por ciento) y en el grupo de pacientes sin mejoría 64 pacientes (30 por ciento) (Figs. 3 y 4). Las complicaciones más frecuentes fueron la presencia de dolor suprapúbico (33 por ciento), la infección de la herida (20 por ciento), la retención de orina post-operatoria (26 por ciento), y la presencia de residuo post-miccional significativo (24 por ciento). Ninguno de los múltiples factores analizados, se mostraron como factores predictivos independientes para la continencia post-operatoria. En el análisis actuarial, tras la comparación de las curvas de Kaplan-Meier correspondientes a cada técnica, objetivamos que no existen diferencias entre las distintas técnicas (logrank; p=0,41) presentando la técnica de sling un mayor número de complicaciones. CONCLUSIONES: La tasa de continencia total post-quirúrgica de nuestra serie es de un 54,5 por ciento a los dos años, encontrando un total de 70 por ciento de respuestas clínicamente satisfactorias. No parece existir una técnica claramente superior a las demás en cuanto a eficacia para nuestras pacientes, presentando la técnica de sling un porcentaje superior de complicaciones. No hemos encontrado factores pre o post-operatorios que influyan de modo independiente en la predicción de la continencia post-quirúrgica (AU)

[Epidemiologic analysis of clear cell and chromophilic carcinoma of the kidney]. / Análisis epidemiológico del carcinoma renal de células claras y cromofílico.

OBJECTIVE: Finding differences in the characteristics of the two most frequent variants of renal cancers: the clear-cell renal carcinoma, and the chromophilic one. MATERIAL AND METHODS: Retrospective analysis of epidemiological characteristics of patients diagnosed of renal carcinoma in our hospital between 1991 and 2001. Statistical differences were searched between patients' characteristics (age, sex, smoking habitus) and tumors' characteristics (size, focality, stage, side and grade). RESULTS: Sixty six renal tumors were diagnosed, of which 41 (62.1%) were clear-cell tumors and 9 (13%) were chromophilic. We only found statistical differences between both subpopulations' tumor size (p < 0.05), being greater for clear-cell tumors (7 +/- 3.92 cm) than for chromophilic ones (4.89 +/- 1.96 cm). We could also appreciate a bias towards a less advanced stage of the chromophilic type, although not statistically significant. CONCLUSIONS: Clear-cell renal carcinoma and chromophilic renal carcinoma are the two more frequent variants of renal tumors. The chromophilic type is smaller and is usually found in a less advanced stage, although this bias could not be demonstrated in our series.

Análisis epidemiológico del carcinoma renal de células claras y cromofílico / Epidemiologic analysis of the clear-cell and chromophilic renal carcinoma

OBJETIVO: Encontrar diferencias en las características epidemiológicas de las dos variedades más frecuentes de cánceres renales: el carcinoma renal de células claras y el cromofílico (papilar). MATERIAL Y MÉTODOS: Análisis retrospectivo de las características epidemiológicas de los pacientes diagnosticados de carcinoma renal en nuestro hospital entre los años 1991 y 2001. Se buscaron diferencias estadísticamente significativas entre las características de los pacientes (edad, sexo y hábito tabáquico) y de los tumores (tamaño, focalidad, estadio, lateralidad y grado). RESULTADOS: Se diagnosticaron 66 tumores renales, de los cuales 41 (62,1 por ciento) eran de células claras y 9 (13 por ciento) cromofílicos. Únicamente se encontraron diferencias estadísticamente significativas entre ambas subpoblaciones en lo referente al tamaño (p<0,05), siendo mayor en el caso de los de células claras (7 ñ 3,92 cm) frente a los cromofílicos (4,89 ñ 1,96 cm). También se apreció una sensible tendencia de los tumores cromofílicos a encontrarse en estadios más precoces en el momento del diagnóstico. CONCLUSIONES: Los carcinomas renales de células claras y los cromofílicos son las dos variedades más frecuentes de tumores renales. Los cromofílicos son de menor tamaño y suelen encontrarse en un estadio menos avanzado, aunque esta tendencia no se ha podido demostrar en nuestra serie (AU)

[Epidermal growth factor receptor (EGFR) in the prognosis of bladder carcinoma. Experience of 5 years]. / Receptor del factor de crecimiento epidérmico (EGFR) en el pronóstico del carcinoma vesical. Experiencia a 5 años.

METHODS: From November 1992 to November 1993, a prospective study was conducted on 20 controls and 61 patients with bladder carcinoma. EGFR expression was determined by radioimmunoassay and the correlation of the results of histological analysis and the clinical course was analyzed. The follow-up period was from November 1992 to July 1998. The association between qualitative variables and the x2 or Fisher exact test was compared using the hypothesis of the proportional ordinal trend for the ordinal variables, and the quantitative variables were analyzed using Student's t test and/or variance analysis (ANOVA). Survival was analyzed by the Kaplan-Meier method and comparison was performed using the Breslow exact test. The Cox proportional hazards regression model was utilized. The SPSS software for Windows 7.0 was used for the analysis. RESULTS: The EGFR values were higher for patients with bladder carcinoma than in controls (14.48 vs 2.54 fmol/mg of protein). EGFR values were higher in patients with superficial bladder tumor than in those with infiltrating tumors (27.03 fmol/mg vs. 10.05 fmol/mg of protein; p = 0.000). Poorly differentiated tumors showed higher values of EGFR (6.73, 14.48 and 17.07 fmol/mg of protein for grades I, II and III, respectively; p < 0.05). The EGFR values were higher in patients that died from cancer during follow-up (64.8) than in those who died from other causes (47.5) and those who are alive and on follow-up (42). An increase in EGFR values did not carry a risk of death from cancer (p = 0.1269; ns). Analysis of the grade of tumor differentiation showed that for the more aggressive tumor grade, a positive EGFR was a sign of reduced survival. Survival in patients with superficial and infiltrating tumor did not appear to change significantly according to the EGFR value. EGFR determination was not useful in predicting recurrence and increased EGFR values did not correlate with a higher risk of recurrence. CONCLUSIONS: 1) The normal pattern of EGFR could not be established. 2) EGFR was not useful in identifying subgroups at risk of death. 3) Knowledge about these proteins synthesized by oncogenes offers new possibilities in the treatment of cancer.

[P185 (Neu) oncoprotein in the prognosis of bladder carcinoma. Experience of 5 years]. / Oncoproteína P185 (Neu) en el pronóstico del carcinoma vesical. Experiencia a 5 años.

OBJECTIVE: To determine the utility of p185 oncogene in the biological characterization of transitional cell carcinoma and in the prediction of recurrence, and to analyze survival at 5 years mean follow-up. METHODS: A prospective clinical cohort study was conducted on 81 patients. Tissue specimens were obtained between November 1992 and November 1993. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). p185 expression was determined by enzyme immunoanalysis (EIA). A statistical analysis of the results was performed. RESULTS: p185 oncoprotein levels were higher in patients with recurrence (1098.97 HNU/mg protein vs. 924.54 HNU/mg). Although higher levels of p185 were found in the patients that had died vs those who are alive, the differences were not statistically significant for overall survival or stratification by tumor grade or infiltration (p = 0.556; ns). CONCLUSIONS: Determination of p185 oncoprotein was found to be useful in the prediction of tumor recurrence at 5 years mean follow-up.

Receptor del factor de crecimiento epidérmico (EGFR) en el pronóstico del carcinoma vesical. Experiencia a 5 años / Epidermal growth factor receptor (EGFR) in the prognosis of bladder cancer: 5-years experience

MÉTODO: Durante el periodo comprendido entre Noviembre de 1992 y Noviembre de 1993 realizamos un estudio prospectivo, seleccionando un total de 20 controles y 61 carcinomas vesicales. Se determinó la expresión del receptor del factor de crecimiento epidérmico (EGFR) por RIA y se trataron de correlacionar con los resultados del los análisis histológicos y de la evolución clínica. El periodo de seguimiento comprende Noviembre de 1992 y Julio de 1998. Se evaluó la asociación entre variables cualitativas con el test de 2 o la prueba exacta de Fisher, se contrastó la hipótesis de tendencia ordinal de proporciones en el caso de variables ordinales, y se analizó el comportamiento de las variables cuantitativas mediante el test de la t de Student y/o el análisis de la varianza (ANOVA) Se estimaron las funciones de supervivencia por el método de Kaplan-Meier, y se realizó la comparación de las funciones de supervivencia mediante el test exacto de Breslow. Se ajustó un modelo de regresión de riesgos proporcionales de Cox. El paquete informático utilizado para el análisis fue SPSS para Windows versión 7.0.RESULTADOS: Los valores de EGFR fueron superiores en pacientes con carcinoma vesical que en controles (14,48 vs 2,54 fmol/mg de proteína). Se detectaron niveles de EGFR superiores en tumores superficiales en comparación con los tumores infiltrantes (27,03 fmol/mg de proteína vs 10,05 fmol/mg) (P=0,000). Los tumores peor diferenciados expresaron mayores concentraciones de EGFR (6,73, 14,48, y 17,07 fmol/mg de proteína para los grados I, II, y III respectivamente) (p<0,05). Los valores de EGFR fueron mayores en pacientes que fallecieron por cáncer en el seguimiento (64,8) en comparación con los que fallecieron por otra causa (47,5) y con los que permanecen vivos y en seguimiento (42). El incremento en los valores de EGFR no supuso riesgo de muerte por cáncer (P=0,1269, NS). El análisis del grado de diferenciación tumoral demostró que, para los grados más agresivos, la positividad a EGFR supuso una disminución de la supervivencia. La supervivencia tanto en tumores superficiales como infiltrantes, no pareció variar de modo significativo según el nivel de EGFR. La determinación de EGFR no fue de utilidad en la predicción de recidiva, y, unos valores incrementados de EGFR no supusieron mayor riesgo de recidiva. CONCLUSIONES: 1) No pudo establecerse un patron Trabajo subvencionado por la Fundación para la Investigación en Urología (AUE) de normalidad para EGFR. 2) EGFR no resultó de utilidad en la obtención de subgrupos de riesgo de muerte.3) El conocimiento de estas proteínas sintetizadas por oncogenes está abriendo nuevos caminos en la lucha contra el cáncer (AU)

Fístula vésico-acetabular tras migración protésica / Vesico-acetabular fistula following prosthesis displacement

Se describe el caso excepcional de una fístula vésico-acetabular tras la migración del acetábulo de una prótesis de cadera hasta el interior vesical, catorce años después del implante de dicha prótesis y que cursó con osteomielitis, linfedema, infección urinaria recurrente, hematuria y fiebre. A propósito de nuestra paciente se realiza una revisión de los casos recogidos en la literatura (AU)

[Usefulness of PSA-complex in the diagnosis of prostatic carcinoma]. / Utilidad del PSA-complex en el diagnóstico del carcinoma de próstata.

OBJECTIVE: Since its discovery as a marker for prostate cancer, there have been many attempts to enhance the diagnostic efficacy of the prostate specific antigen (PSA). Among these are the studies that analyze the behavior of different forms of serum PSA bound to different antiproteases, such as alpha-1-antichymotrypsin, which forms the complexed PSA (PSA-c). This study analyzed the utility of PSA-c to enhance specificity without altering sensitivity in comparison to total PSA (PSA-t). METHODS: From September 1998 to March 1999, blood samples were obtained from 96 patients that had undergone a prostate biopsy due to a suspicion of prostate cancer. PSA-c, PSA-t (Technicon Immunol system, Bayer) and PSA-c/PSA-t ratio were analyzed in these patients. RESULTS: ROC curves were plotted and the optimal cutoffs were found for which the specificity was higher for PSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI 95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%, 27-51]) while maintaining a similar sensitivity index (90%). PSA-c showed similar results for other values of sensitivity. CONCLUSIONS: PSA-c was found to improve specificity in comparison to PSA-t and PSA-c/PSA-t ratio. PSA-c determination could avoid unnecessary biopsies without altering sensitivity; i.e., the same number of prostate cancers will be detected.

[Vesico-acetabular fistula following prosthesis migration]. / Fístula vésico-acetabular tras migración protésica.

A rare case is described of vesico-acetabular fistula following acetabulum displacement of a hip replacement towards the inner bladder, fourteen years after the original insertion of the prosthesis. In all the reviewed literature of we have not found a single described case of vesico-acetabular fistula associated with displacement towards the bladder interior of a hip prosthesis, which leads us to consider this complication an exceptional one.