Fabiano Palmieri

Vigilancia activa de masas renales pequeñas diagnosticadas en pacientes de edad avanzada o con comorbilidad: en busca de la mejor estrategia de tratamiento

INTRODUCTION Aim of this study is to provide our results after long-term active surveillance (AS) protocol for small renal masses (SRMs), and to report the outcomes of patients who remained in AS compared to those who underwent delayed surgical intervention. PATIENTS AND METHODS We retrospectively reviewed our database of 58 patients diagnosed with 60 contrast enhancing SRMs suspicious for renal cell carcinoma (RCC). All patients had clinical and radiological follow-up every 6 months. We evaluated the differences between patients who remained on AS and those who underwent surgical delayed intervention. RESULTS The mean age was 75 years, the mean follow-up was 88.5 months. The median initial tumor size at presentation was 2.6cm, and the median estimated tumor volume was 8.7cm(3). The median linear growth rate of the cohort was 0.7cm/year, and the median volumetric growth rate was 8.8 cm(3)/year. Death for metastatic disease occurred in 2 patients (3.4%). No correlation was found between initial tumor size and size growth rate. The mean linear and volumetric growth rates of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.9 vs. 0.4cm/year and 16.1 vs. 4.6 cm(3)/year, respectively; P<.001). CONCLUSIONS Most of SRMs demonstrate to have an indolent course and low metastatic potential. Malignant disease could have faster linear and volumetric growth rates, thus suggesting the need for a delayed surgical intervention. In properly selected patients with low life-expectancy, AS could be a reasonable option in the management of SRMs.

Association between selenium and lycopene supplementation and incidence of prostate cancer: Results from the post-hoc analysis of the procomb trial

BACKGROUND Many potential chemopreventive agents have been used in PCa prevention, including selenium (Se) and lycopene (Ly). However, their role has been matter of debate over the years, due to potential of promotion of PCa. PURPOSE In this study we aimed at evaluating the incidence risk of prostate cancer (PCa) in a cohort of patients treated with Se and Ly. METHODS The Procomb trial design has been previously published (ISRCTN78639965). From April 2012 to April 2014 209 patients were followed and underwent prostate biopsy when PSA ≥4 ng/ml and/or suspicion of PCa. The all cohort was composed by patients treated with Se and Ly (Group A = 134 patients) and control (Group B = 75 patients). RESULTS During the follow-up time of 2 years, a total of 24 patients (11.5%) underwent prostate biopsy, of which 9 (4.3%) where diagnosed with PCa and 15 (7.2%) where diagnosed with benign prostatic hyperplasia. We did not observe statistical differences in terms of mean changes of PSA between the two groups (p-value for trend = 0.33). The relative risk (RR) for PCa was 1.07 and 0.89 in group A and B, respectively (p = 0.95). At the multivariate Cox regression analysis supplementation with Se and Ly was not associated with greater risk of PCa (hazard ratio: 1.38; p = 0.67). CONCLUSION In this analysis we did not show evidences supporting a detrimental role of Selenium and Lycopene supplementation in increasing PCa after 2 years of therapy, nor supporting a protective role.

Fournier's gangrene: Clinical case and review of the literature

Fourniers gangrene is a life-threatening acute necrotizing fasciitis of perianal,genitourinary and perineal areas. Nowadays, is well known that Fournier gangrene is almost never an idiopathic disease. In this article we report a case of a 70-year-old patient that initially was not treated properly. The gold standard therapy of the Fourniers gangrene remains today a complete, early and extended surgical debridement.

MP02-01 PROSTATE PHOTOVAPORIZATION VS. TRANSURETHRAL RESECTION OF THE PROSTATE: A MATCHED PAIRED ANALYSIS COMPARING THE BPH6 OUTCOME.

INTRODUCTION AND OBJECTIVES: Urolithiasis is a global health problem with a lifetime risk of up to 15 % in white men and 6 % in womenand a recurrence rate of about 50% in these patients. Over the last three decades (and since the introduction of shockwave lithotripsy [SWL]) there was a change in stone composition observable with an increasing prevalence of calcium phosphate stones. Calcium phosphate crystallization is driven by urinary calcium phosphate supersaturation which rises with elevated urine pH. A recent animal study revealed an increase in urine pH of SWL treated porcine kidneys. We therefore evaluated the effect of SWL on urine pH in the Swiss Kidney Stone Cohort (SKSC), a nationwide, multicenter, prospective register of kidney stone patients. METHODS: Of the first 350 patients enrolled in the SKSC register, 170 patients were eligible; 180 patients had to be excluded because of a short follow-up of <6 months, uric acid stone composition and/or incomplete data on previous stone treatment. The patients were grouped into 3 different groups according to their previous treatment: group A: SWL (n1⁄449), group B: endourological treatment (n1⁄467), group C: spontaneous stone passage (control group; n1⁄454). The paired t-test and one-way ANOVA was used to compare the change of urine pH over time within and between the 3 different groups. RESULTS: 44/170 (26%) patients were female. Median patient age was 47 years (range: 20-86). Stone composition was available in 57% of patients and did not significantly differ between the three groups (p1⁄40.8). The median urine pH at first visit ( 4 weeks post stone passage or intervention) was slightly higher in group A after SWL as compared to the other two groups: pH 5.7 (IQR: 5.1-6.0) in group A; pH 5.5 (IQR: 5.0 -5.9) in group B; pH 5.5 (IQR: 5.1-6.0) in group C; p1⁄40.4. There was a significant rise in urine pH at follow-up visit (3-6 months after initial visit) in group A after SWL treatment whereas no significant change was seen in the non-SWL groups B and C (median pH difference in groups A, B and C: +0.25, -0.19 and -0.005, respectively; p<0.001). CONCLUSIONS: There was an increase in urine pH in patients who had undergone SWLwhile this was not seen in urinary stone patients who were treated endourologically or conservatively. This suggests that SWL may cause tubule cell injury that leads to functional disturbances such as changes of urine pH. Whether this has an impact on the rate of recurrences or future stone composition (increase in calcium phosphate content) will be explored in the further follow-up of these patients.