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Background: Ureteral strictures are a recurrent chronic condition that leads to severe side effects and poor quality of life. Management of ureteral stricture is a great challenge for urologists and no specific guidelines exist. Retrograde Allium® ureteral stent (AUS) is a newly developed ureteral stent to treat either bulbar urethral or ureteral stenosis. Case Presentation: We describe a case of a 74-year-old Caucasian adult male presenting with a severe ureteral stricture secondary to an ureteroscopy for stone disease. Treatment with retrograde AUS placement produced a complete loss of renal function after 36 months, probably because of the development of a long achalasic stretch of the ureter. Conclusions: AUS is a new and promising device for the treatment of ureteral stenosis. However, a lack of standardization of the technique recommends a close instrumental follow-up after the procedure to decide the optimal time for stent removal.

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OBJECTIVES: To describe our 10-year experience with the use of oral ethinylestradiol in the treatment of metastatic castration-resistant prostate cancer. METHODS: From February 2000 to April 2010, 116 patients with a metastatic castration-resistant prostate cancer were prospectively submitted to oral ethinylestradiol monotherapy. Inclusion criteria were: diagnosis of castration-resistant prostate cancer after failure of at least two lines of androgen deprivation therapy and radiological evidence of metastases. Exclusion criteria were: symptomatic cases with a European Cooperative Oncology Group score >2 and severe or uncontrolled cardiovascular diseases. At inclusion in the study, all patients discontinued the previous androgen deprivation therapy and started oral ethinylestradiol at the daily dose of 1 mg. Aspirin (100 mg/daily) was concomitantly given. RESULTS: The median ethinylestradiol therapy duration was 15.9 months (range 8-36 months), whereas the median follow up of patients was 28 months (range 13-36 months). During ethinylestradiol therapy, a confirmed prostate-specific antigen response was found in 79 patients (70.5%). The median time to prostate-specific antigen progression was 15.10 months (95% confidence interval 13.24-18.76 months). A toxicity requiring treatment cessation was observed in 26 patients (23.2%) at a median time of 16 months (mainly thromboembolism). CONCLUSIONS: Our 10-year experience shows that ethinylestradiol provides a prostate-specific antigen response in a high percentage of patients with metastatic castration-resistant prostate cancer. Cardiovascular toxicity can be managed through accurate patient selection, close follow up and a concomitant anticoagulation therapy.

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OBJECTIVE: Our target in this study is to evaluate the efficacy of ultrasound (US)-guided anesthesia in comparison it to the digital-guided one, considering pain and discomfort reduction, during prostate biopsy. MATERIALS AND METHODS: We analyzed 150 patients that underwent prostate biopsy between March 2011 and January 2012; conditions to enter the sample were: elevated PSA levels and/or psa ratio free/total less than 15% and/or detection of alteration via ultrasound examination and/or a positive outcome of a digital rectal examination. Patients were randomized into two groups. In 75 patients (group A) was performed local US-guided anesthesia with a dose of 10 ml of mepivacaine 1%, in the other 75 patients (group B) a local digital-guided anesthesia was performed, again with an equal dose of 10 ml of mepivacaine 1%. After the biopsy patients were kept under observation for two hours, after that they were asked to provide description of the pain experienced during biopsy, using a 10-point visual analog scale (visual analogue scale; 0 for no pain, 10 for excruciating pain). RESULTS: In group A, 49 patients scored a VAS value of zero, 23 a value of 1 and 2 a value of 3. On the other side, in group B, 9 patients scored a VAS value of 1, 36 a value of 2, 28 a value of 3 and 2 a value of 4. In comparison patients in group A scored VAS values statistically lower than patients in group B (t student test, p < 0.01). CONCLUSIONS: The ultrasound-guided prostatic anesthesia is preferable to the digital-guided, because it considerably reduce the pain related to this procedure.

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OBJECTIVES: To analyze whether the addition of a cyclooxygenase (COX)-2 inhibitor after transurethral resection of the prostate (TURP) offers an advantage compared with TURP alone in reducing postoperative urethral strictures. At urethroscopy, stenosis of the urethra with a circumference of less than 19 mm was defined as stricture. METHODS: This was a prospective, unblinded, randomized, single-center study. Between December 2001 and December 2003, 96 consecutive men with benign prostatic hyperplasia underwent TURP. After TURP, patients were randomly assigned to receive or not receive a COX-2 inhibitor (rofecoxib 25 mg/day). In the group given the COX-2 inhibitor, the therapy was started at catheter removal and continued for 20 days. Follow-up was performed on an outpatient basis after 1 month. A diagnosis of postoperative urethral stricture was assessed during a follow-up of 12 months. RESULTS: At the 1-month visit, the mean and median improvement in the peak urinary flow rate from preoperative values was +6.25 +/- 3.76 mL/s (median 7.30) in the no COX-2 inhibitor group and +9.42 +/- 3.06 mL/s (median 8.75) in the COX-2 inhibitor group. The improvement was significantly (P < 0.0001) greater for the group treated with the COX-2 inhibitor. At 1 year of follow-up, a urethral stricture had been diagnosed in 8.3% of all cases; in particular, in 17% and 0% of cases in the no COX inhibitor group and COX-2 inhibitor group, respectively. Post-TURP COX-2 inhibitor therapy was significantly (P = 0.0039) and inversely (r = -0.2876) associated with urethral stricture development. CONCLUSIONS: We suggest that limited postoperative treatment with a COX-2 inhibitor can effectively prevent post-TURP urethral stricture development by specifically interfering with the inflammatory processes that can precede scar formation.

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In this article, we will try to address the following aspects: which factors are responsible of the introduction of new candidates for hormone therapy in prostate cancer, who are actually candidates for hormone therapy, classifying them on the basis of the stage of the disease, and which treatment modalities can be proposed for each candidate. Since the introduction of hormone therapy for the treatment of prostate cancer, there has been a debate about the optimal timing of hormone therapy. A modification in the timing of hormone therapy produced new candidates for hormone manipulation. In particular, the use of hormone treatment for younger patients, longer periods and early prostate cancer, absolutely requires a whole re-evaluation of which therapy is indicated and it may produce new problems such as higher risk of over-treatment, need of a better evaluation of quality of life in younger patients and the research for better tolerated therapies. Therapies that resist for longer periods without the production of a hormone-refractory disease are also required.

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PURPOSE: To evaluate whether the pretreatment determination of serum chromogranin A (CgA) can provide information beyond that obtained with serum prostate specific antigen (PSA) and Gleason score at biopsy as a predictive factor of clinical understaging (T2-pT3) of prostate adenocarcinoma. MATERIALS: In this prospective study, we analyzed 83 consecutive patients with clinical T2N0M0 prostate adenocarcinoma submitted to radical prostatectomy (RRP). On the same day of RRP, before surgery, a blood sample for the determination of serum total PSA and CgA levels (RIA) was obtained. RESULTS: After RRP, 27 of the 83 cases (32.5%) showed extracapsular disease extension (pT3) at the final pathological examination and were considered clinically understaged. A significant association between serum CgA and pathological stage (r = 0.3830; P = 0.0004) was found. At the multivariate analysis, serum CgA and PSA, but not biopsy Gleason score, were found to be significant pretreatment independent predictors of pT3 at RRP (P = 0.00004 and P = 0.0018, respectively). The relative risk of clinical understaging significantly varied according to serum CgA levels. Using a CgA cut-off value of 60 ng/ml, PPV and NPV for clinical understaging were 0.5161 and 0.7885, respectively (P = 0.0072). CONCLUSIONS: Serum CgA could be incorporated into risk assessment models of newly diagnosed prostate cancer.

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In this article, we will try to address the following aspects: which factors are responsible of the introduction of new candidates for hormone therapy in prostate cancer, who are actually candidates for hormone therapy, classifying them on the basis of the stage of the disease, and which treatment modalities can be proposed for each candidate. Since the introduction of hormone therapy for the treatment of prostate cancer, there has been a debate about the optimal timing of hormone therapy. A modification in the timing of hormone therapy produced new candidates for hormone manipulation. In particular, the use of hormone treatment for younger patients, longer periods and early prostate cancer, absolutely requires a whole re-evaluation of which therapy is indicated and it may produce new problems such as higher risk of over-treatment, need of a better evaluation of quality of life in younger patients and the research for better tolerated therapies. Therapies that resist for longer periods without the production of a hormone-refractory disease are also required.

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