Revista mexicana de urologia最新文献

Introduction and aims

The study of the anti-apoptotic protein, Bcl2, in localized prostate cancer has not been carried out in advanced stages of the disease. Therefore the aim of our study was to evaluate Bcl2 expression in advanced prostate cancer and identify its association with age, body weight, height, body mass index, prostate-specific antigen, testosterone, Gleason score, bone metastasis, disease duration, and time until the appearance of hormone resistance.

Material and method

A comparative study was conducted on 19 patients with castration-resistant prostate cancer (CRPC) and 19 patients with hormone-sensitive prostate cancer (HSPC). Bcl2 was identified in a blinded manner through immunohistochemistry in prostate biopsies.

Results

Prostate-specific antigen was higher in patients with CRPC and disease duration was 39.71 months for CRPC and 23.89 months for HSPC. Resistance appeared at 30.05 months. There were no significant differences in relation to the other variables. Bcl2 was identified in 63.16% of the patients with CRPC and in 84.21% of those with HSPC, odds ratio 0.32, 95% CI: 0.07-1.45. There was mild staining intensity in 47.37% of the CRPC cases and moderate staining in 15.79%. Staining was mild in 57.89% of the HSPC patients and moderate in 26.32%. The differences were not significant. Correlation analysis showed a negative correlation trend between Bcl2 and body weight and a positive trend between Bcl2 and disease duration, with no statistical significance.

Conclusion

Bcl2 was identified in advanced prostate cancer and showed a trend toward greater expression in hormone-sensitive cancer. There was no correlation between Bcl2 and the clinical variables analyzed. However, there was a negative correlation between Bcl2 stain intensity and body weight and a positive trend between Bcl2 and disease duration.

Introduction

Laparoscopy is currently one of the options for the surgical treatment of kidney tumors and upper urinary tract tumors with oncologic results that are similar to those of open surgery.

Aim

To describe the experience in the laparoscopic treatment of kidney and upper urinary tract tumors at our hospital.

Materials and methods

A retrospective and descriptive study was conducted, analyzing the database of patients with kidney or upper urinary tract tumors treated through the laparoscopic procedures of nephrectomy (radical or partial) or nephroureterectomy within the time frame of August 2006 and June 2015. Radiologic and histopathologic variables were analyzed, along with the frequency of complications (Clavien-Dindo classification).

Results

Ninety-six patients were identified that underwent the laparoscopic approach. Fifty-eight radical nephrectomies, 24 partial nephrectomies, and 14 nephroureterectomies were performed. The conversion rate was 16.6% and the mean hospital stay was 5 days. Grade IIIa and IVa complications presented in 9.3% of the cases. The mean follow-up period was 31.2 months and only one patient has died, due to leukemia.

Conclusions

We consider the laparoscopic approach to be a good treatment option for kidney tumors and upper urinary tract tumors.

Percutaneous nephrolithotomy is an endourologic technique commonly used in the management of nephrolithiasis. However, this procedure is not complication-free. Splenic injury is exceptionally rare with a reported rate of 1% from the total case load. We present herein two cases of splenic puncture during percutaneous nephrolithotomy that illustrate two different outcomes. In the first case, the patient remained asymptomatic and was discharged on her third post-operative day after removing the nephrostomy, without any sign of hemodynamic compromise. In the second case, the patient presented with hemodynamic instability and an abdominal computed tomography scan was done that showed free fluid in the peritoneal cavity. Emergency laparotomy was performed and revealed a deep peripheral laceration (20 mm × 5 mm in length) that required splenectomy. After a thorough review of the existing literature, we could find only 11 other instances of injury to the spleen in which treatment outcomes were reported. Patient hemodynamic status was the main factor in deciding on the type of treatment.

Background

Metastatic prostate cancer is a frequent disease in Mexico. There are factors that can be associated with an adequate response to androgen deprivation therapy. Other therapeutic regimens have been proposed to improve results.

Aim

To identify factors influencing the response to androgen deprivation therapy in patients with prostate cancer and bone metastases.

Materials and methods

The study covered a 7-year period and included patients that presented with metastatic prostate cancer. Patient factors were evaluated during androgen deprivation therapy and follow-up. The association between factors and response was assessed through bivariate and multivariate analyses.

Results

Eighty-nine patients were included in the study. The factors associated with the development of castration resistance were: age, Gleason score, prostate-specific antigen reduction > 95%, less than 9 months to reach the nadir, and androgen deprivation therapy duration. Having received palliative radiotherapy and periods of intermittence were the factors that were contrastingly associated with cancer-specific mortality. Other factors related to prostate-specific antigen kinetics were not statistically significant in the multivariate analysis.

Conclusions

The described factors were associated with the response to androgen deprivation therapy in patients with metastatic prostate cancer.

Introduction

Pyeloplasty has been described by different authors and taken into minimally invasive surgery through laparoscopy, becoming the criterion standard of the procedure. Today its laparoscopic results are similar to those with the open technique, but the former requires much more experience and skill. When performed through robotic-assisted surgery, this minimally invasive procedure has the potential to more easily manipulate intracorporeal suturing and combine trans-trocar cystoscopy for litholapaxy.

Materials and methods

A 32-year-old man presented with colicky, left lumbar pain of moderate intensity with associated urinary symptoms and positive costovertebral angle percussion. An abdominopelvic tomography scan revealed ureteropelvic junction stricture and a pelvic stone measuring 1.3 cm.

Discussion

Robotic-assisted pyeloplasty was first described in 2002 by Gettman and its success rates are similar to those of other techniques.

Conclusions

Robotic-assisted pyeloplasty is a good alternative technique for defect suturing and repair. It can also be a hybrid surgery through its combination with trans-trocar endoscopy to simultaneously perform litholapaxy of the renal pelvis or renal cavities.

Introduction

The incidence of primary tumors of the ureter is <1% and fibroepithelial polyps make up 20% of them. These polyps are related to chronic inflammation, chronic damage, or chronic stimulation. They are asymptomatic and can cause obstructive uropathy or hematuria.

Aim

To present a case of fibroepithelial polyp managed laparoscopically at the Hospital General de México «Dr. Eduardo Liceaga».

Materials and methods

A 46-year-old woman had oppressive pain of moderate intensity in the right renal fossa irradiating to the iliac fossa of 4-year progression. She presented with dysuria and intermittent total hematuria with no clots. A tomography scan revealed mild right pelvic ectasia and a filling defect at the lower third of the ureter. Endoscopic revision found a ureteral lesion with a pedunculated base 8 cm from the right ureteral meatus. The pathology report stated fibroepithelial polyp. The polyp was laparoscopically resected, end-to-end anastomosis was performed, and a double-J ureteral stent was placed.

Results

The case of a patient that underwent laparoscopic treatment of a fibroepithelial polyp is presented.

Discussion

Few cases of fibroepithelial polyp have been treated laparoscopically. In 2011 Jin Xun-Bo et al. reported on a case of laparoscopic resolution of a ureteral fibroepithelial polyp and in 2009 M.A. Childs conducted a review of their clinical database at the Mayo Clinic within the time frame of 1945-2008 in which 27 cases of ureteral fibroepithelial polyp were identified.

Conclusion

Laparoscopy offers a satisfactory approach for resection of ureteral fibroepithelial polyps.

Background

In this work the changes in and evolution of radiotherapy for the treatment of prostate cancer in the last decades are described. This includes the application of advanced technology that incorporates imaging and computer systems into the new linear accelerators designed to apply high doses of radiation to the prostate, significantly diminishing the toxicity to the surrounding tissues.

Aims

Results found in the international literature are analyzed that consider increasing the radiation doses with the 3D-CRT and IMRT techniques, and in this manner improve biochemical failure-free survival and overall survival, especially in intermediate and high-risk patients with clinically localized prostate cancer, as well as adding radiotherapy and neoadjuvant, concomitant, and adjuvant hormone therapy.

Materials and methods

Presented herein is the personal experience that included 38 patients with clinically localized prostate cancer treated in private practice with external beam radiotherapy and hormone therapy as primary treatment, as well as the experience including 46 patients with pT3 disease after radical prostatectomy that received adjuvant treatments of radiotherapy and hormone therapy.

Results

Even though this clinical study includes a small number of patients, to the best of our knowledge it is the first and only report in the national literature on the use and benefits of the combined treatment of external beam radiotherapy and hormone therapy as primary treatment of clinically localized prostate cancer and as combined adjuvant treatment in patients with pT3 disease after radical prostatectomy.

Background

Tuberculosis is one of the diseases in which poverty, overcrowding, and malnutrition result in a poor immunologic state. Genitourinary tuberculosis is the most common extra-pulmonary site of tuberculosis, but involvement of the prostate gland is observed in only 2.6% of the cases.

Aim

To present a case of tuberculosis of the prostate and its medical and surgical management.

Case presentation A 63-year-old man had a history of intense smoking and occasional drinking and he sought medical attention for acute urinary retention. He had a prostate-specific antigen level of 1.36 ng/ml. Examination identified a 3 × 3 cm, hard, irregular prostate that was not painful upon palpation. Malignancy was suspected and the patient underwent a prostate biopsy that reported chronic granulomatous prostatitis. Studies for pulmonary or genitourinary disease were negative. Immunofluorescence corroborated the diagnosis of tuberculosis of the prostate. Anti-tuberculosis treatment was begun and continued for 6 months, after which transurethral resection of the prostate was performed.

Discussion

Primary tuberculosis of the prostate resembles different pathologies, such as prostate cancer and acute or chronic prostatitis, and therefore ultrasound-guided transrectal biopsy is indicated. The definitive diagnosis is made through histopathologic confirmation of the bacillus to differentiate it from nonspecific granulomatous prostatitis. Endourologic surgery is not contraindicated for this pathology.