RESUMO
This report is of a 68-year-old male patient with a three-year history of severe, progressive, low urinary tract symptoms (LUTS) with a score of 20 points on the International Symptom Scale. The patient received alpha-1-blocker therapy without adequate response. Transurethral resection of the prostate was performed, and the anatomopathological report indicated the presence of a haematolymphoid small-cell neoplasia and glandulostromal prostatic hyperplasia. Posterior immunohistochemistry evaluation reported an extra-nodal marginal zone-B lymphoma non-Hodgkin lymphoma. The patient was followed up for five years by the urology and oncology departments. In the fourth year of follow-up, the patient had B symptoms (fever, night sweats and weight loss). At the same time, laboratory tests showed haemolytic anaemia; then a new bone marrow biopsy was carried out. The histopathological specimen showed six lymphoid aggregates, constituted by a B-cell population with intra-trabecular predominance and reactivity for CD20 and BCL-2. New thoracic and abdominal computed tomographies were performed without any findings suggestive of extra-prostatic spreading. Subsequently, a chemotherapy regimen was started on the patient with the following therapeutic scheme: Rituximab 375 mg/m2 IV per day, cyclophosphamide 750 mg/m2 IV per day, Vincristine 1.4 mg/m2 IV dose per day and Prednisone 40 mg/m2 on days 1-5 (R-CVP scheme) for 21 days, until he completed six cycles. No signs, symptoms or progression have been recorded.
RESUMO
PURPOSE: To report one of the largest series of clinical and renal function outcomes of treated iatrogenic vascular lesions (IVL) after partial nephrectomy (PN). Angioembolization (AE) is the treatment of choice for patients with these lesions, but the additional renal injury conferred by this treatment has not been well described. PATIENTS AND METHODS: Patients who underwent open, laparoscopic, or robot-assisted PN from 2002 to 2012 were identified and those with AE were selected. Patients' charts were reviewed, and renal function was analyzed using estimated glomerular filtration rate (eGFR) and progression of chronic kidney disease (CKD) classification before and after PN and AE. RESULTS: There were 849 patients who underwent PN and an IVL developed in 28 (3.3%). Twenty (71%) presented with gross hematuria at a mean of 10.2 ± 7.7 days after PN and 8 (28%) needed transfusion. All patients had identifiable IVL at the time of selective AE, and technical success was achieved in 24/28 (86%), although 4 needed subsequent additional AE. The paired decrease in eGFR after PN was significant (P<0.01), while the paired change in eGFR after AE was not with either short-term (2.8 days) or intermediate-term (362 days) follow-up (P=0.50). Four patients experienced transient worsening in CKD classification after AE, although three experienced CKD stage improvement. CONCLUSION: Selective AE for IVL after PN is safe, efficacious, and does not lead to a significant impairment of renal function. It remains the preferred approach for the evaluation and management of post-PN hemorrhage.
