RESUMEN
INTRODUCTION: Upper urinary tract urothelial carcinoma (UTUC) is a rare disease. Thus, little evidence-based data are available to guide clinical decision-making. The aim of the study was to provide an overview of the currently available prognostic factors for UTUC. MATERIAL AND METHODS: A systematic literature search was conducted using the PubMed databases to identify original articles regarding prognostic factors in patients with UTUC. RESULTS: We divided the prognostic factors for UTUC in four different categories: clinical factors, preoperative characteristics, intraoperative/surgical factors and postoperative/pathologic factors. Prognostic factors described in order of importance are: tumor stage and grade, lymph node involvement, a concomitant cis, age at the diagnostic, lymphovascular invasion, tumor architecture and necrosis, tumor location and multifocality, gender. The impact of obesity, smoking and other comorbidities (ECOG, ASA) on outcomes has been recently reported but needs to be validated. The endoscopic approach of distal ureter management during radical nephroureterectomy has been shown to be at higher risk of bladder recurrence. CONCLUSION: The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.
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Carcinoma de Células Transicionales/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Ureterales/diagnóstico , Distribución por Edad , Índice de Masa Corporal , Carcinoma de Células Transicionales/mortalidad , Carcinoma de Células Transicionales/terapia , Medicina Basada en la Evidencia , Humanos , Clasificación del Tumor , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Obesidad/complicaciones , Pronóstico , Factores de Riesgo , Distribución por Sexo , Fumar/efectos adversos , Neoplasias Ureterales/mortalidad , Neoplasias Ureterales/terapiaRESUMEN
INTRODUCTION: Urinary symptoms occur in 50 to 80% of patients with Multiple Sclerosis (MS). This study was conducted to determine prevalence of renal failure during MS follow-up and to investigate the correlation of these complications with disease characteristics and urodynamic findings. METHODS: One hundred and twenty-one consecutive patients have been followed for (MS) (61 men and 60 women) between 1995 and 2009 in our institution. The demographic findings of patients were documented. The history was obtained and a detailed neurological and urological physical examination was performed for all patients. Urological symptoms (urgency, frequency, urge incontinence, dysuria), urinary scores (UPS and International Consultation on Incontinence Questionnaire [ICIQ]) and renal failure were recorded. All patients underwent ultrasound imaging of the bladder during their follow-up and on the last evaluation. Expanded Disability Status Scale (EDSS) was evaluated during neurologic follow-up. For each patient mean onset age of disease, mean onset age of micturation disorders, mean illness duration and mean urological follow-up duration were recorded. Urodynamic investigation was performed for all patients. Urodynamic assessment was carried out according to the International Continence Society (ICS) standards (detrusor overactivity, detrusor/sphincteric dyssynergia and low bladder compliance). RESULTS: Mean illness duration was 13.8 years (1-50). According to the history and clinical findings, 21 patients had primary-progressive (PPMS), 59 relapsing-remitting (RRMS) and 41 secondary-progressive multiple sclerosis (SPMS). Four patients have shown renal failure during their follow-up (3.3% - three men and one woman). Renal failure was associated with disease characteristic (SPMS - EDSS score >6.5), mean illness duration (30 years [12-48]) and low bladder compliance (17 [7-23]) (P=0.03; P=0.02; P=0.049). CONCLUSION: Relationship between renal failure, disease characteristics and urodynamic findings was suggested in our study. More accurate follow-up might be used for SPMS (EDSS >6.5), longer mean illness duration (>30 years), and low bladder compliance (<30).
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Esclerosis Múltiple/complicaciones , Insuficiencia Renal/complicaciones , Edad de Inicio , Anciano , Estudios de Cohortes , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple Crónica Progresiva/complicaciones , Prevalencia , Pronóstico , Estudios Prospectivos , Calidad de Vida , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/epidemiología , Insuficiencia Renal/etiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Incontinencia Urinaria de Urgencia/etiología , UrodinámicaRESUMEN
We report the case of a single patient suffering of a primary signet-ring cell carcinoma of the urinary bladder. This histological subtype of primary bladder cancer is very rare. We thus want to emphasize on its pathological specificity in order to improve the postoperative strategic treatment, knowing it is a rare but very aggressive kind of tumor.
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Carcinoma de Células en Anillo de Sello/patología , Neoplasias de la Vejiga Urinaria/patología , Anciano , Humanos , MasculinoRESUMEN
OBJECTIVES: Through a retrospective cohort, to analyse causative factors of acute renal infarction and specific therapeutic. Recall the need to carry a computerised tomoraphy (CT) in any flank pain suggestive of renal colic can hide a renal infarct. METHOD: Over a period of 24 months (2008-2009), we have compiled six patients admitted for acute lumbar pain reported in renal colic and showing a renal infarction. We report the risk factors for cardiovascular disease, the clinical presentation, and the interest of heparin therapy started early in the recovery of renal function. We emphasise the need for abdominal-pelvic CT in emergency before a renal colic pain associated with injection of contrast medium if no stone obstacle is identified. RESULTS: Five patients had risk factors for cardiovascular disease including one personal history of deep vein thrombosis and pulmonary embolism and two, a family history of myocardial infarction. Five patients were treated early with LMWH, and for one the herapin was started at 72 hours of onset of symptoms. In all cases, no effect on renal function was noted. CONCLUSION: Renal infarction is a rare but probably underestimated, occurring on land known cardiovascular often. The abdominopelvic CT without injection is increasingly practiced in front of abdominal pain syndromes, it seems imperative to complete the review by the injection of contrast material if stone obstruction is unconfirmed. Early management by herapin appears to improve the complete recovery of renal function.
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Infarto/complicaciones , Infarto/diagnóstico por imagen , Isquemia/complicaciones , Isquemia/diagnóstico por imagen , Riñón/irrigación sanguínea , Cólico Renal/diagnóstico por imagen , Cólico Renal/etiología , Tomografía Computarizada Espiral , Adulto , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: Prospective evaluation of bladder tumor targeting by Hexvix(®) fluorescence. PATIENT AND METHODS: From September 2008 to September 2009, 28 patients have been evaluated using Hexvix(®) technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected and patients have been classified using EORTC score. RESULTS: From the 28 patients, 14 have been identified with bladder cancer (31 tumors) and 90 samples have shown positive fluorescence in blue light. Compared to white light, four additional tumors have been diagnosed by Hexvix(®) for three patients (p=NS): two cis, one LMP, one pTa low grade. The false positive rate for Hexvix(®) was 65.5 versus 58.5% for white light. EORTC score for bladder cancer was associated with better bladder cancer targeting by Hexvix(®) (p<0.05). CONCLUSION: In our experience, Hexvix(®) targeting was associated with better diagnosis for bladder cancer. Thirteen percent of new positive samples have been found for 10.7% of patients. In our study false positive rate is a critical point (65.5%). EORTC score for recurrence and progression might allow to select patients to be targeted by Hexvix(®).