Acta Urológica Portuguesa最新文献

Spigelian hernia (SH) is an uncommon clinical entity, being particularly rare in children. While it may be associated with acquired factors, most pediatric cases appear to be due to congenital changes. SH is often associated with other congenital defects, the most frequent association being with ipsilateral cryptorchidism. The testis is often seen in the hernia sac, with no identifiable gubernaculum or inguinal canal in some cases. Given the risk of incarceration and strangulation of the contents of HS, its early diagnosis and timely treatment are essential. Treatment consists of hernia repair and extradartos orchidopexy, which should be conducted through a subcutaneous tunnel if the inguinal canal is not observed. The frequency of the association of HS and ipsilateral cryptorchidism suggests that the presence of the testis should always be confirmed at diagnosis. This association should also be taken into consideration in cases of cryptorchidism with non‐palpable testis in its normal route. In this article we present the case of an infant with a spigelian hernia associated with cryptorchidism, who underwent hernia correction and extra‐dartos orchidopexy.

Background

The impact of using ASA (acetylsalicylic acid), metformin and statins on the prostate cancer may be significant, but is not clear and findings from previous studies are inconsistent. This study aims to evaluate the relationship between the use of ASA, metformin and statins and the pathological characteristics and risk of biochemical recurrence (BCR) of prostate cancer.

Methods

A total of 311 patients submitted to radical prostatectomy (RP) at Hospital de Braga between January 2010 and June 2014 were analyzed. Data were obtained from clinical records and the crude and adjusted association between the use of a specific drug and prostate specific antigen (PSA), pathological stage, Gleason score, positive surgical margin and risk of biochemical recurrence were calculated.

Findings

Overall, 26 (8.4%) of the patients used ASA, 35 (11.3%) metformin and 112 (36%) statins. The ASA users had a lower PSA compared with the non users (5.9 vs. 8.9 ng/m; p = 0.008). Its use was an independent predictor of positive surgical margin (OR = 3.77; IC 95%: 1.45‐9.78). The use of metformin was associated with advanced pathological stages, more precisely pT3b (20% vs. 7.7%; p = 0.048). No other differences were detected between ASA, metformin and statins users.

Conclusions

The use of ASA, metformin and statins has no beneficial effect on prostatic cancer patients. On the opposite, an association between the use of metformin and advanced pathological stages was observed. These results should be validated in other larger samples and longer follow‐up. The association between the use of ASA and lower PSA was already detected in other studies, whose mechanism should be clarified in future

Introduction

Renal cell tumors comprise both benign – oncocytoma – and malignant – clear cell renal cell carcinoma, papillary renal cell carcinoma, and chromophobe renal cell carcinoma – entities. Since the differential diagnosis among renal cell tumors is sometimes difficult on clinical, imaging and pathological grounds, and prognosis is quite dissimilar, epigenetic-based diagnostic biomarkers, specially promoter methylation, might be useful for accurate diagnosis and therapeutic planning.

Materials and methods

EpiTect Methyl II PCR Array was used to screen methylation status of 22 genes, involved in epithelial to mesenchymal transition. Quantitative real-time methylation specific polymerase chain reaction was performed for candidate gene validation, and methylation levels of renal cell tumors subtypes and normal kidney were determined and compared.

Results

MST1R promoter methylation level was significantly higher in clear cell renal cell carcinoma (median: 5367) compared to other renal cell tumors (median: papillary renal cell carcinoma – 1084, chromophobe renal cell carcinoma – 1023, oncocytoma – 1337) and normal kidney (median: 1125), allowing for accurate discrimination from other renal cell tumors with high sensitivity (>96.7%) and specificity (86.7%).

Conclusion

Quantitative MST1R promoter methylation may be useful as biomarker for accurate diagnosis of clear cell renal cell carcinoma in problematic cases.

Introduction

Over the past three decades, nephrectomy for the treatment of patients with metastatic renal cell carcinoma (mRCC) has undergone several modifications, resulting from the implementation of systemic therapies, such as those using cytokines (IL‐2 and IFN‐α), and more recently molecular targeted therapies, such as inhibitors of angiogenesis and mTor. Using a case report as a starting point, we conducted a literature review to determine whether there is still a place for cytorreductive nephrectomy in an “era” that sees the increasing use of systemic therapies.

Clinical case

We present a 53‐year‐old patient who was diagnosed with metastatic RCC and underwent laparoscopic cytorreductive nephrectomy after completion of neo‐adjuvant therapy with Sunitinib.

Discussion

Although cytorreductive nephrectomy is associated with an increase in the overall survival of patients with metastatic RCC when it is accompanied by immunotherapy (INF‐α and IL‐2), the morbidity and mortality inherent to surgery and the positive results obtained by monotherapy regimens, including inhibitors of angiogenesis, such as Sunitinib, has launched a debate on the true benefit of nephrectomy. With this in mind, we analised studies to evaluate whether there is a benefit in administering Sunitinib before and/or after surgery, or just as part of a monotherapy regimen. We found that neo‐adjuvant Sunitinib therapy not only reduced the size of the primary renal tumor, with an increase in the overall survival of the patients, but also allowed the early detection of patients who were refractory to systemic therapy and not likely to benefit from surgery.

Conclusion

Preliminary studies indicate that treatment of patients with metastatic RCC will probably depend on an approach that includes both cytorreductive nephrectomy and systemic therapies

Introduction

Urethral diverticula affect from 0.6 to 4.7% of women, are a frequent cause of persistent urinary symptoms and can present with complications such as lithiasis and malignization. Today, underdiagnosis and diagnostic and therapeutic delay of female urethral diverticula are still common. The aim of this article is to analyse the state of art regarding ethiology, diagnosis and therapeutics of this disease.

Materials and methods

Bibliographic revision of articles published until January/2014 after search of the database Medline for the keywords: “female urethral diverticula”, “female urethral diverticulum”, “urethral diverticula”, “urethral diverticulum” and “female urethra”; and of bibliographic references of the articles obtained.

Results

Most female urethral diverticula are secondary to infection of the periurethral and urethral glands. Despite the classically described triad of dysuria, dyspareunia and post‐void dribbling, the clinical manifestations are diverse and unspecific. Over a third are palpable on gynaecologic examination. Imaging exams, namely magnetic resonance and ultrasound, have high diagnostic capability and contribute to surgical planning. Depending on location, conformation and associated symptoms, urethral diverticula can be managed conservatively or, more frequently, surgically.

Discussion

Clinical evaluation is still essential for the diagnosis of female urethral diverticula. Currently, magnetic resonance is considered to be the best modality to diagnose the diverticula and to exclude pre‐ and post‐operative complications. Less invasive techniques have been described but transvaginal urethral diverticulectomy yields the highest symptomatic cure rates.

Conclusion

Awareness of the medical community is the most powerful weapon to reduce the underdiagnosis and diagnostic delay associated with female urethral diverticula.

Bladder cancer is one of the most common malignancies of the urinary tract. It is associated with significant morbidity and long‐term follow‐up using invasive procedures, like cystoscopy.

The initial diagnosis and staging are dependent on the histopathologic analysis of resected or biopsed samples. However, it is associated with significant under‐staging, often requiring multiple re‐staging procedures.

With the recent advances in Magnetic Resonance Imaging techniques, namely Diffusion Weighted images, it has become possible to improve the detection rate of suspicious lesions and their extension to the deep layers of the bladder wall, therefore improving staging. It is also possible to detect recurrent tumours during follow‐up and even to predict the progression rate.

With this work, the authors intend to review the current literature regarding the role of Magnetic Resonance imaging in the detection, staging and follow‐up of bladder cancer patients.

Objectives

To quantify the effect of statins’ use on Prostate Specific Antigen (PSA) levels in patients referred to prostate biopsy and to determinate if the exposure to statins must be considered to improve the prostate cancer diagnostic accuracy of PSA.

Methods

We selected 551 subjects with PSA <10.0 ng/mL, referred to ultrasound guided trans-rectal prostate biopsy and classified as cancer or non-cancer patients after biopsy. Information regarding statins’ use was obtained from clinical records. We used path analysis to quantify the direct (reflects the influence on PSA biology and metabolism) indirect (reflects the influence on PSA through the effect on the risk of prostate cancer) and total effects (net result of direct and indirect effects) of statins’ use on PSA. We used Receiver Operating Characteristic curves to assess the global predictive accuracy of models including PSA, age, body mass index, 5-α-reductase inhibitors, aspirin and statins’ use for distinguishing between prostate cancer and benign conditions.

Results

We observed a negative total effect of statins on PSA levels (users vs. non-users: −0.633 ng/mL; 95% CI: −1.087; −0.179), which corresponds to approximately 8.9% lower levels among statins’ users, mostly due to the direct effect (−0.588 ng/mL; 95% CI: −1.034, −0.141) rather than that by the indirect effect (−0.045 ng/mL; 95% CI: −0.152, 0.061). There were no statistically significant differences between the area under the curve corresponding to the models with or without statins (P = 0.274).

Conclusion

In patients referred to prostate biopsy, statins’ use contributed to lower Prostate Specific Antigen levels, but the clinical impact in these patients is low.