Javier de la Peña

First experience with the ATOMS® implant, a new treatment option for male urinary incontinence

Introduction Urinary incontinence (UI) is defined as any complaint of involuntary urine leakage. A description is provided of our experience with the ATOMS® (Adjustable Transobturator Male System. Agency for Medical Innovations. A.M.I.) adjustable implant in patients with mild to moderate UI. Material and methods A retrospective study was made of the data referring to 13 patients treated with this adjustable system. Demographic and personal data were collected along with information on the etiology, severity, characteristics, duration of UI, complementary tests, surgery times, complications and results obtained. Results The full continence (no use of pad) recovery rate at the close of the study was 12/13 (92.3%). Three cases required a single filling during the mean 16 months of follow–up (range 4–32; median 14 months). A complication in the form of perineal hematoma was resolved with conservative treatment and a case of urinary retention was resolved by placing a bladder catheter for the duration of one week. Three patients experienced perineal–scrotal dysesthesias that disappeared spontaneously in the first three months. Conclusions The described adjustable continence system has been found to be very effective in males with mild to moderate UI. In our experience, the ATOMS® implant offers excellent results over the middle term with a very low rate of complications that were easily resolved in all cases.

Human recombinant erythropoietin does not promote cancer growth in presence of functional receptors expressed in cancer cells.

Human recombinant erythropoietin (hrEPO) therapy might be associated with tumor progression and death. This effect has been suggested to be secondary to rhEPO binding to its receptor (EPOR) expressed on cancer cells. However, there are several concerns about EPOR functionality when expressed on cancer cells. In this paper we have provided evidence that EPOR expressed in cancer cells could be implicated in proliferation events because a transfection of EPOR siRNA to EPOR-expressing bladder cancer cells resulted in a marked reduction in cell growth. However, these cell lines do not grow in the presence of hrEPO. Furthermore, bladder cancer patients that expressed EPOR in tumor samples had a reduced survival in absence of rhEPO treatment. Therefore, EPOR is implicated in bladder cancer growth but this effect appears to be independent from rhEPO supplementation. Reports which suggest that rhEPO promotes cancer growth due to the expression of EPOR in cancer cells must be observed with caution since in the presence of functional EPOR rhEPO does not promote growth.

Nefroureterectomía laparoscópica: nueva posición para el manejo ureteral

OBJETIVOS El principal reto de la nefroureterectomia laparoscopica es el manejo del ureter distal que ademas tendra una repercusion importante en el resultado oncologico en muchos de los casos. Presentamos nuestra experiencia en este aspecto, teniendo en cuenta que las 5 ultimas nefroureterectomias laparoscopicas las hemos realizado con una posicion de Trendelemburg forzado, lo que ha supuesto un manejo mas comodo y seguro del ureter distal. METODOS Desde agosto hasta diciembre de 2006 se han realizado 5 nefroureterectomias con rodete vesical puramente laparoscopico con el paciente en posicion de Trendelemburg forzado, muy similar a la posicion empleada en las cistectomias o prostatectomias radicales laparoscopicas. RESULTADOS El tiempo quirurgico medio es de 182 minutos (170-210). El sangrado medio intraoperatorio es de 100cc y ninguno de estos pacientes ha precisado transfusion. El tiempo hospitalario medio es de 4 dias. CONCLUSIONES Creemos que esta posicion es una buena alternativa para el manejo del ureter distal en el abordaje laparoscopico. Se trata de una tecnica muy similar a la cirugia abierta, que hoy por hoy continua siendo el gold Standard.

Nefroureterectomía abierta y laparoscópica en tumores uroteliales del tracto urinario superior: experiencia inicial

Resumen Objetivo El desarrollo de la laparoscopia en urologia permite el abordaje de tumores del tracto urinario superior con una seguridad oncologica cada vez mayor, aunque todavia se sigue considerando el abordaje abierto como la tecnica de eleccion. Presentamos nuestra experiencia laparoscopica en los ultimos 4 anos frente a la tecnica abierta. Material y metodos Entre 1995 y 2009 se ha realizado un total de 95 nefroureterectomias por tumor, 70 por via abierta y 25 laparoscopicas. El abordaje por lumbotomia con desinsercion endoscopica del ureter ha sido el mas frecuente en cirugia abierta, y en laparoscopia, se ha realizado en todos los casos un acceso transperitoneal, con rodete vesical en la mayoria de los casos (56%). Resultados En las nefroureterectomias abiertas la media de tiempo quirurgico fue 205 (130-300) min, con una media de sangrado de 525 (100-1.800) ml y transfusion en 17 (24,2%) ocasiones. La media de estancia fue 8,4 (3-30) dias. En las nefroureterectomias laparoscopicas, la media de tiempo quirurgico fue 189 (120-270) min, con una media de sangrado de 130 (100-400) ml y transfusion en 4 (16%) ocasiones. La media de estancia fue 4,5 (2-28) dias. Conclusiones Los pacientes intervenidos por laparoscopia presentaron una menor tasa de transfusion y una estancia hospitalaria mas corta. El control oncologico fue similar con ambas tecnicas, si bien la laparoscopia precisa de un mayor seguimiento y mayor numero de casos.

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors.

Introduction High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors. Material and methods We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL). Results We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3). Conclusions The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.

Open and Laparoscopic Partial Nephrectomy: Experience at La Paz University Hospital

Objective: Partial nephrectomy is a safe procedure in renal tumors less than 4 cm. The laparoscopic technique is one of the most complex surgeries in urology. We present our experience in 12 years with open and laparoscopic technique. Material and Methods: The analyzed period covers from 1995 to 2006, during which 96 parenchymal sparing renal surgical procedures were performed, 75 of them open (1995–2004) and 21 laparoscopic (2004–2006). Absolute contraindications for laparoscopic surgery were solitary kidney, tumor size greater than 4 cm and location of the tumor close to the hilus. Results: There are statistically significant differences in operating time (shorter in laparoscopy), intraoperative bleeding and transfusion (greater in open surgery), and hospital stay (3.3 d in laparoscopic vs. 7.5 d in open). The positive margins are greater (not statistically significant) in laparoscopic procedure because the learning curve. Conclusion: Conservative renal surgery is a common approach for tumors less than 4 cm. The laparoscopic procedure is a difficult surgery and should be performed by surgeons with expertise in laparoscopy. The development of both laparoscopic instruments and new biological sealants allows for an easier implementation of this minimally invasive procedure.