Jesús María Fernández Gómez

Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management

Benign prostatic hyperplasia (BPH) is a complex disease that is progressive in many men. BPH is commonly associated with bothersome lower urinary tract symptoms; progressive disease can also result in complications such as acute urinary retention (AUR) and BPH‐related surgery. It is therefore important to identify men at increased risk of BPH progression to optimise therapy. Several factors are associated with progression, including age and prostate volume (PV). Serum prostate‐specific antigen level is closely correlated with PV, making it useful for determining the risk of BPH progression. Medical therapy is the most frequently used treatment for BPH. 5‐alpha‐reductase inhibitors impact the underlying disease and decrease PV; this results in improved symptoms, urinary flow and quality of life, and a reduced risk of AUR and BPH‐related surgery. Alpha‐blockers achieve rapid symptom relief but do not reduce the overall risk of AUR or BPH‐related surgery, presumably because they have no effect on PV. Combination therapy provides greater and more durable benefits than either monotherapy and is a recommended option in treatment guidelines. The Combination of Avodart® and Tamsulosin (CombAT) study is currently evaluating the combination of dutasteride with tamsulosin over 4 years in a population of men at increased risk of BPH progression. A preplanned 2‐year analysis has shown sustained symptom improvement with combination therapy, significantly greater than with either monotherapy. CombAT is also the first study to show benefit in improving BPH symptoms for combination therapy over the alpha‐blocker, tamsulosin, from 9 months of treatment.

Pancreatic and psoas abscesses as a late complication of intravesical administration of bacillus Calmette-Guerin for bladder cancer: a case report and review of the literature

IntroductionBacillus Calmette-Guerin (BCG) is a live attenuated strain of Mycobacterium bovis that has been used to treat urothelial carcinoma since 1976, and has been reported to eradicate disease in more than 70% of patients with in situ and stage I disease. To the best of our knowledge, we report the first case of disseminated bacillus Calmette-Guerin infection causing multiple abscesses affecting the pancreatic head and right psoas muscle, diagnosed 5 years after intravesical treatment with bacillus Calmette-Guerin therapy for bladder cancer.Case presentationAn 83-year-old Caucasian man was hospitalized with a 2-month history of back pain, anorexia, generalized weakness and a 47-pound weight loss. He had previously undergone two transurethral resections for high-grade transitional cell carcinoma of the bladder and had received 12 intravesical bacillus Calmette-Guerin instillations without any complications. He complained of abdominal pain in his right flank. A computed tomography scan of the abdomen showed multiple abscesses affecting the pancreatic head and right psoas muscle. Growth of Mycobacterium bovis was determined in cultures of the purulent material obtained by surgical drainage of the abscesses.ConclusionsThis case illustrates the fact that although intravesical administration of bacillus Calmette-Guerin is generally considered to be safe, it is not exempt from complications and these could appear immediately after treatment or as a delayed complication many years later.

TOLERANCIA Y COMPLICACIONES DE LAS BIOPSIAS PROSTATICAS ECODIRIGIDAS MEDIANTE EL USO DE UN GEL INTRARECTAL CON LIDOCAINA.

Resumen es: Objetivo: El objetivo de nuestro estudio, fue valorar la tolerancia por parte del paciente a una biopsia de prostata transrectal ecodirigida usando como ...

Tumor fibroso solitario pararrenal

Resumen es: Objetivo: Anadir a la literatura un caso clinico poco frecuente de tumor fibroso solitario pararrenal, analizando las caracteristicas anatomo-patologicas...

Adenocarcinoma de células renales: factores pronósticos y estadificación

OBJETIVOS Valorar el significado pronostico de la clasificacion tumoral TNM de 2002 para el carcinoma de celulas renales (CCR), asi como otros factores implicados en la supervivencia. METODOS Estudio retrospectivo de historias clinicas de 316 carcinomas renales intervenidos entre los anos 1970 y 2003. Se analizaron 25 variables implicadas en el pronostico de pacientes con CCR. RESULTADOS En un 90,5% de pacientes el tipo histologico fue de celulas renales. La mayoria de los tumores fueron T1b o T2, con un grado nuclear de Fuhrman I o II. La media del tamano tumoral fue de 7,17 +/- 3,4 cm. En la mayoria de casos existio tumor unico. En un 8,2% hubo afectacion ganglionar en el momento del diagnostico y en un 8,6% existian metastasis a distancia. La clinica mas frecuente fue hematuria y/o dolor. El seguimiento medio fue de 57,8 meses. Recidivaron un 24,1% de los cuales mas del 50% ocurrio en el primer ano. Los tumores avanzados (T3, T4) tendieron a presentar un grado nuclear III-IV, mayor tamano, necrosis, afectacion vascular, afectacion ganglionar y metastasis a distancia. Al finalizar el seguimiento la mayor parte de pacientes estaba vivo libre de tumor. Los factores que influyeron de forma independiente en la mortalidad cancer especifica fueron los meses libres de enfermedad, la presencia de adenopatias metastasicas, el tratamiento de la primera recidiva y la presencia de anemia. CONCLUSIONES La modificacion de la actual clasificacion de los tumores renales pT3 y pT4, ayudaria a la mejor toma de decisiones en cuanto a la actitud terapeutica de tumores con afectacion vascular, de grasa perirrenal y de glandulas adrenales. La anemia y el tratamiento de la primera recidiva son factores importantes implicados en la supervivencia cancer especifica.

Anemia como factor pronóstico independiente en pacientes con carcinoma renal

BACKGROUND AND OBJECTIVE The aim of this study was to analyze the significance of anemia as well as other prognostic factors influencing survival in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS A retrospective review of data of 316 patients who underwent surgery between 1970 and 2003 was performed. Most important known prognostic factors of RCC were investigated. RESULTS Most of patients had T1b-T2, low nuclear grade and single tumours. In 8.2% and 9% of cases, lymph node and metastatic dissemination were detected at the time of diagnosis, respectively. At the beginning, most frequent symptoms were hematuria and pain, with anemia (Hb >10g/dl) in 69 patients. After a median follow-up of 50 months, 24.1% of patients had a recurrence. From these, more than 50% developed recurrence within one year after nephrectomy. Advanced tumours (T3-4) consisted of high nuclear grade (III-IV) tumours, larger size tumours, with necrosis and vascular infiltration in surgical specimen, as well as lymph node and metastatic dissemination. In multivariate analysis, anemia, time to recurrence, type of treatment for recurrence as well as lymph node dissemination were independent factors of cancer specific survival. CONCLUSION Anemia seems to be a marker of recurrence and progression in patients with renal cell carcinoma undergoing nephrectomy. From our point of view, anemia could be considered a significantly high mortality rate for renal cancer in these patients.

A new form of presentation of renal actinomycosis: renal tumor with retroperitoneal bleeding

Resumen en: Objective: The aim of this case report is to add to the literature a new case of renal actinomycosis, but with a form of presentation that has never been...

Relación entre síntomas del tracto urinario inferior y calidad de vida

Resumen es: OBJETIVOS: Evaluar el impacto de los sintomas del tracto urinario inferior (STUI) referidos en el cuestionario IPSS sobre la calidad de vida y determinar...

METASTASIS SUBCUTÁNEA DE CÁNCER DE PRÓSTATA

OBJETIVOS La tendencia a la diseminacion del cancer de prostata es sobre todo a los ganglios linfaticos regionales y hueso, y en una menor proporcion a pulmon, higado y cerebro. El hallazgo de metastasis en otras localizaciones es un hecho excepcional. El objetivo de este trabajo es revisar la frecuencia y caracteristicas clinicas de las metastasis de adenocarcinoma de prostata en el tejido celular subcutaneo. METODOS Presentamos el caso de un varon de 71 anos que se diagnostico de un adenocarcinoma de prostata. Se realiza prostatectomia radical y colocacion de esfinter artificial por incontinencia urinaria de esfuerzo. RESULTADOS Durante el seguimiento evoluciona con progresion bioquimica, recidiva local y metastasis oseas, es diagnosticado de metastasis en tejido subcutaneo perirreservorio de esfinter artificial. CONCLUSIONES El cancer de prostata es una enfermedad muy prevalerte en nuestro medio, en la cual el hallazgo clinico de metastasis en organos distintos al hueso o ganglios linfaticos regionales, se sigue de un corto periodo de supervivencia. El diagnostico de metastasis en el tejido subcutaneo es un hecho que tal vez estar infradiagnosticado debido su curso clinico indolente y que podria ademas no elevar las cifras de PSA, en cualquier caso es un dato de mal pronostico.

Terapia endovesical: influencia sobre la progresión en el cáncer vesical superficial

Resumen es: Objetivo: Revisar la influencia de distintos tratamientos endovesicales sobre la progresion del cancer vesical superficial. Metodos: Se revisaron retrosp...