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ABSTRACT Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.
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Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.
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Próstata , Neoplasias de la Próstata , Biopsia , Humanos , Biopsia Guiada por Imagen/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Estudios Prospectivos , Próstata/diagnóstico por imagen , Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patologíaRESUMEN
PURPOSE OF REVIEW: The aim of this review is to provide an overview of epidemiology, risk factors, and treatment of urological malignancies in renal transplant recipients (RTR). RECENT FINDINGS: Although optimal immunosuppressive therapy and cancer management in these patients remain controversial, adherence to general guidelines is recommended. Kidney transplantation is recognized as the standard of care for the treatment of end-stage renal disease (ESRD) as it offers prolonged survival and better quality of life. In the last decades, survival of RTRs has increased as a result of improved immunosuppressive therapy; nonetheless, the risk of developing cancer is higher among RTRs compared to the general population. Urological malignancies are the second most common after hematological cancer and often have more aggressive behavior and poor prognosis.
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Fallo Renal Crónico , Trasplante de Riñón , Neoplasias Urológicas , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Calidad de Vida , Receptores de Trasplantes , Neoplasias Urológicas/epidemiología , Neoplasias Urológicas/terapiaRESUMEN
BACKGROUND: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.
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Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)
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Humanos , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/cirugía , América LatinaRESUMEN
ABSTRACT Purpose: To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period. Material and Methods: A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects. Results: Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services. Conclusions: During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.
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Humanos , Neumonía Viral/embriología , Neoplasias Urogenitales/terapia , Infecciones por Coronavirus/epidemiología , Pandemias , Betacoronavirus , Atención al Paciente , SARS-CoV-2 , COVID-19 , Oncología Médica/métodosRESUMEN
PURPOSE: To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period. MATERIAL AND METHODS: A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects. RESULTS: Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services. CONCLUSIONS: During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.
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Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Neoplasias Urogenitales/terapia , Betacoronavirus , COVID-19 , Humanos , Oncología Médica/métodos , Pandemias , Atención al Paciente , SARS-CoV-2RESUMEN
INTRODUCTION: ED and LUTS affect a high proportion of male population. Although Hispanics are suspected to have a higher risk of experiencing LUTS, detailed information on its frequency and association with ED in this population is scarce. OBJECTIVE: To determine the frequency of LUTS and ED, and its correlation in Mexican males. METHODS: A cross-sectional analytical survey was answered by 1041 men. It included the International Prostate Symptom Score and the quality of life question (IPSS/QoL); International Index of Erectile Function (IIEF-5); the short form of the International Consultation of Incontinence Questionnaire (ICIQ-SF); and demographic data. For the analysis, we divided our population into 2 groups (18-39 and 40 and older), and then an exploratory correlation analysis was performed to search for significant differences among IPSS severity groups, and finally a multivariate regression model was applied. RESULTS: Mean age was 48.6 ± 14.5 years. One hundred twenty-three individuals (11.8 %) were asymptomatic, and 611 (58.7 %) had mild, 226 (21.7 %) had moderate, and 81 (7.8 %) had severe IPSS score. The most common symptoms were nocturia (72.4 %), increased urinary frequency (58.3 %), and slow urinary stream (42.6 %). Two hundred fifty-eight (24.7 %) complained of incontinence. Of 765 individuals, 484(63.2 %) reported some degree of ED. Severe LUTS, DM, and age were independent risk factors for ED severity. CONCLUSION: LUTS and ED may represent one of the largest sources of morbidity in our population, and their association was demonstrated. Awareness on these entities should be raised, and further research is required to determine the higher frequency of LUTS and ED in Hispanics.
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Disfunción Eréctil/complicaciones , Disfunción Eréctil/epidemiología , Síntomas del Sistema Urinario Inferior/complicaciones , Síntomas del Sistema Urinario Inferior/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Salud Urbana , Adulto JovenRESUMEN
OBJECTIVE: To assess the prevalence and risk factors of erectile dysfunction (ED) in HIV patients from the HIV clinic of a tertiary referral center in Mexico City. DESIGN: Prevalence was obtained from cross-sectional studies, and the International Index of Erectile Function (IIEF), a standardized method, was used to assess ED. METHODS: A cross-sectional study was performed in the HIV clinic. Participants completed the IIEF to allow ED assessment. Information on demographics, clinical and HIV-related variables was retrieved from their medical records. RESULTS: One hundred and nine patients were included, with a mean age of 39.9 ± 8.8 years. ED was present in 65.1% of the individuals. Patients had been diagnosed with HIV for a mean of 92.7 ± 70.3 months and had undergone a mean 56.4 ± 45.5 months of HAART. The only variable associated with ED in the univariate analysis was dyslipidemia, and this association was also found in the multivariate analysis (P = 0.01). CONCLUSIONS: ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, and Castillejos-Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24-30.
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INTRODUCTION: Orgasmic dysfunction (OD) is defined as the inability to achieve an orgasm, markedly diminished intensity of orgasmic sensations, or marked delay of orgasm during any kind of sexual stimulation. OD definition and method of diagnosis vary widely across studies. AIM: The aim of this study was to identify the prevalence and risk factors that predispose Mexican women to OD. METHODS: A representative sample of women from Mexico City was surveyed using an online website. Women between 18 to 40 years old were selected, and the orgasm domain from the Female Sexual Function Index was used to identify OD. A cutoff point was calculated using a construct with a histogram and calculated median. A univariate and multivariate analysis was conducted to examine the relationship between potential risk factors and sexual function. MAIN OUTCOME MEASURES: OD prevalence; significant risk factors on multivariate analysis. RESULTS: OD prevalence was 18.3%. Univariate analysis showed younger age (P = 0.01), lower degree of education (P = 0.02), single marital status (P = 0.038), and dissatisfaction with the thickness and/or size of partner's penis (P = 0.01) as significant variables related to OD. In multivariate analysis, younger age (P = 0.01) and dissatisfaction with the thickness/size of partner's penis (hazard ratio 3.04, P = 0.01) remained significant. CONCLUSION: OD is a prevalent alteration in young women. Marital status, education, and dissatisfaction with thickness/size of partner's penis are definitely related variables.
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Orgasmo/fisiología , Disfunciones Sexuales Psicológicas/etiología , Adulto , Análisis de Varianza , Estudios Transversales , Emociones , Femenino , Humanos , Estado Civil , México/epidemiología , Satisfacción del Paciente , Prevalencia , Factores de Riesgo , Conducta Sexual/fisiología , Adulto JovenRESUMEN
OBJECTIVE: To analyze the outcomes of emphysematous pyelonephritis (EPN), the impact of different treatment modalities, and to determine risk factors associated with mortality. METHODS: We retrospectively reviewed cases of EPN from 3 tertiary care institutions in Mexico. The diagnosis was confirmed with computed tomographic scan. Treatment was classified as follows: medical management (MM), minimally invasive, and surgical. Demographic, clinical, biochemical, and radiological characteristics were assessed and compared between survivors and nonsurvivors. Comparison was assessed using 1-way analysis of variance and chi-square. Univariate and multivariate logistic regression analyses were performed to determine prognostic factors. Main end point was mortality. RESULTS: A total of 62 patients were included (49 women and 13 men), with a mean age of 53.9 years. The most common comorbidities were diabetes (69.3%) and hypertension (40.3%). Escherichia coli was the most common isolated microorganism (62.7%). MM was provided to 24.2%, minimally invasive treatment to 51.6%, open drainage to 19.3%, and emergency nephrectomy to 4.8%. Overall mortality was 14.5% and was similar among different treatment modalities (P=.06). Survivors were younger (P=.004), had lower creatinine (P=.002), and better estimated glomerular filtration rate (P=.007). In univariate analysis, age (P=.009), creatinine (P=.009), and need for nephrectomy (P=.03) were associated with mortality. In multivariate logistic regression analysis, creatinine (odds ratio 1.56, 95% confidence interval 1.03-2.35, P=.03) and nephrectomy (odds ratio 9.7, 95% confidence interval 1.007-93.51, P=.049) remained significant predictors of mortality. CONCLUSION: EPN needs an aggressive MM and stepwise approach; nephrectomy should be the last resort of treatment. Creatinine level and need for nephrectomy are the strongest predictors of mortality according our analysis.
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Enfisema/microbiología , Enfisema/terapia , Pielonefritis/patología , Pielonefritis/terapia , Adulto , Factores de Edad , Anciano , Análisis de Varianza , Antibacterianos , Manejo de Caso , Estudios de Cohortes , Drenaje/métodos , Enfisema/mortalidad , Femenino , Humanos , Pruebas de Función Renal , Modelos Logísticos , Masculino , México , Persona de Mediana Edad , Análisis Multivariante , Nefrectomía/métodos , Pielonefritis/complicaciones , Pielonefritis/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Tasa de Supervivencia , Centros de Atención Terciaria , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
OBJECTIVE: To analyze the outcome of patients with clinically localized prostate cancer (PCa) treated with radical prostatectomy (RP) in whom high-grade (HGPCa) and/or locally advanced disease (LAPCa) was found at RP specimen and to evaluate the prognostic value of well-known factors in this subset of patients. MATERIAL AND METHODS: Biochemical progression-free (bPFS) was determined with the Kaplan-Meier method. The effect of PSA, biopsy Gleason, clinical stage and number of adverse pathological factors was assessed with univariate and multivariate analyses. RESULTS: After RP, 87 men had HGPCa (20.7%) or LAPCa (56.3%), with 20 (23%) having both criteria. Mean PSA was 15.5 +/- 14.0 ng/mL and mean follow-up 50.5 +/- 42.6 months. The 5-year bPFS for men with PSA < 10 ng/mL and > or = 10 ng/mL was 54.7% and 35.7%, respectively (p = 0.03). Regarding biopsy Gleason, the 5-year bPFS was 49% and 26% for patients with a score < or = 7 and > 7, respectively (p = 0.002). In the multivariate model, the biopsy Gleason score remained independently associated with biochemical progression. CONCLUSIONS: HGPCa and/or LAPCa confer poor prognosis; however, RP appears to offer acceptable control, particularly when initial PSA is < 10 ng/mL and biopsy Gleason is 7 or less.