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PURPOSE: The Butterfly Prostatic Retraction Device ("Butterfly") is a permanent nitinol implant for benign prostatic hyperplasia. This study examines the chronic response of prostate tissue to the Butterfly in histological specimens from patients in the Butterfly pilot clinical study. METHODS: Retrospective qualitative and semi-quantitative review of histological specimens of seven (7) patients who participated in the Butterfly pilot clinical study. Patients had at least 1-month implantation with the Butterfly prior to implant removal and TURP. Tissue samples were graded by two pathologists. RESULTS: Four out of six patients had IPSS decreased from baseline. All seven patients' samples had signs of chronic inflammation; one demonstrated acute inflammation and one demonstrated fibrosis. In three cases, intraglandular calcification was identified. There was no ischemic necrosis induced by the implant, and no encrustation, urethral edema, or cellular atypia was noted. CONCLUSION: The Butterfly demonstrated an overall favorable safety profile in terms of tissue response. This study demonstrates that there is no significant tissue reaction in the prostatic urethra due to presence of Butterfly device.
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Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Resección Transuretral de la Próstata , Masculino , Humanos , Próstata , Hiperplasia Prostática/cirugía , Hiperplasia Prostática/diagnóstico , Estudios Retrospectivos , Inflamación , Síntomas del Sistema Urinario Inferior/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: The Butterfly Prostatic Retraction device is a novel transurethral implant designed to dilate the prostatic urethra and treat lower urinary tract symptoms. We assessed its safety, efficacy and impact on urinary flow, ejaculation, and quality of life. MATERIALS AND METHODS: We included 64 men, treated for benign prostate hyperplasia for at least 1 year. All patients had Qmax≤ 13 mL/s and IPSS >12. Insertion of the device was performed via cystoscopy. Follow-up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL, and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. RESULTS: Patients age was 50-83 years. 28 patients completed a 1-year follow-up with an intact device. Mean Qmax improved by 2 mL/s (25%), IPSS median drop was 10 points (40%), and QoL score was 1.5 points (38%). Sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the devices with urethral mucosa was observed. In 1 patient, the device was repositioned. In 19 patients, the device was removed. 12 patients returned to alpha-blocker therapy and 7 patients underwent TURP. One patient developed a bulbar urethral stricture. CONCLUSIONS: We demonstrated feasibility and good tolerability of the Butterfly device.
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Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Resección Transuretral de la Próstata , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Hipertrofia/cirugía , Síntomas del Sistema Urinario Inferior/cirugía , Próstata , Hiperplasia Prostática/cirugía , Calidad de Vida , Resultado del TratamientoRESUMEN
Objectives: To characterize the fecal microbiome in newly diagnosed prostate cancer patients. Patients and methods: Forty-nine consecutive patients who were referred for trans rectal prostate biopsy were tested. Patients who received antibiotics 3 months prior to the biopsy, patients with history of pelvic irradiation, prostate or colon cancer, inflammatory bowel disease and urinary tract infection were excluded. A rectal swab was obtained just prior to the biopsy, immediately placed in a sterile tube and kept in -80°C. Sequencing was performed for the 16S rRNA 515F + 806R gene fragment using the QIIME2 software. Analytic tests included Beta diversity (Weighted Unifrac, Unweighted Unifrac, Bray-Curtis), Alpha diversity (Faith, Evenness), Taxa bar plots and PCoA plots. Results: Forty-five samples were suitable for analysis with at least 8000 readings per sample. All patients were Caucasian. Twenty patients had prostate cancer and 25 had benign prostates (BPH). Among prostate cancer patients, Gleason Score was 3 + 3 in 11 patients, 3 + 4 in 5, 4 + 3 in 3, and 4 + 4 in 2. There was no statistical difference in demographic parameters between the groups. We identified over 1000 bacterial species, typical for the colonic microbiome. No significant differences in bacterial populations were found between prostate cancer versus benign prostate patients nor between age groups or between subgroups of Gleason or International Society of Uro-pathology (ISUP) scores. Conclusions: Although the microbiome has previously been shown to have an impact on the human microenvironment and cancer risk, we could not demonstrate a significant difference between the flora diversity of newly diagnosed prostate cancer patients and BPH patients. Further research into distinct bacterial metabolic pathways may reveal unique risk factors for prostate cancer.
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BACKGROUND: Ureteroscopy is becoming the primary treatment for ureteral stones. As a standard of care, ureteroscopy is performed under the supervision of fluoroscopy. Recent advances in endourological technology make the need for fluoroscopy questionable. OBJECTIVES: To summarize our experience with a no-fluoroscopy technique for selected cases of ureteral stones. METHODS: Patients were considered suitable for fluoroless ureteroscopy if they had one or two non-impacted stones, in any location in the ureter, 5-10 mm size, with a normal contralateral renal unit and no urinary tract infection. Procedures were performed using rigid scopes, nitinol baskets/forceps for stone retrieval, and Holmium:YAG laser for lithotripsy. Stents were placed per surgeon's decision. RESULTS: During an 18-month period, 103 patients underwent fluoroless ureteroscopy. In 94 patients stones were removed successfully. In six, the stones were pushed to the kidney and treated successfully on a separate session by shock wave lithotripsy. In three patients no stone was found in the ureter. In five patients, miniature perforations in the ureter were noted and an indwelling double J stent was placed. CONCLUSIONS: Fluoroless ureteroscopy resulted in a high rate of success. We believe that in selected cases it can be used with minimal adverse events.
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Fluoroscopía , Complicaciones Posoperatorias , Cirugía Asistida por Computador , Cálculos Ureterales , Ureteroscopía , Femenino , Fluoroscopía/métodos , Fluoroscopía/estadística & datos numéricos , Humanos , Israel/epidemiología , Litotricia/métodos , Litotricia/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Selección de Paciente , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Salud Radiológica/métodos , Stents/estadística & datos numéricos , Cirugía Asistida por Computador/efectos adversos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Cálculos Ureterales/diagnóstico por imagen , Cálculos Ureterales/epidemiología , Cálculos Ureterales/cirugía , Ureteroscopía/efectos adversos , Ureteroscopía/métodosRESUMEN
BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.
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Cistoscopía/métodos , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Uretra/diagnóstico por imagen , Estrechez Uretral/diagnóstico , Urografía/métodos , Anciano , Estudios de Cohortes , Cistografía/métodos , Estudios de Seguimiento , Humanos , Israel , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Resección Transuretral de la Próstata/efectos adversos , Resultado del Tratamiento , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/cirugíaRESUMEN
AIM: To report on a simple and rapid method of urinary diversion. This method was applied successfully in different clinical scenarios when primary reconstruction of the ureters was not possible. MATERIALS AND METHODS: The disconnected ureter is catheterized by a feeding tube. The tube is secured with sutures and brought out to the lateral abdominal wall as cutaneous tube ureterostomy (CTU). RESULTS: This method was applied in three different clinical scenarios: a 40-year-old man who sustained multiple high-velocity gunshots to the pelvis with combined rectal and bladder trigone injuries and massive bleeding from a comminuted pubic fracture. Damage control included colostomy and bilateral CTUs. A 26-year-old woman had transection of the right lower ureter during abdominal hysterectomy. Diagnosis was delayed for 3 weeks when the patient developed sepsis. The right kidney was diverted with a CTU. A 37-year-old male suffered from bladder perforation and hemorrhagic shock. Emergency cystectomy was done and urinary diversion was accomplished with bilateral CTUs. In all cases, effective drainage of the urinary system was achieved with normalization of kidney function. CONCLUSION: When local or systemic conditions preclude definitive repair and damage control surgery is needed, CTU provides fast and effective urinary diversion.
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BACKGROUND: Muscle-invasive bladder cancer is most commonly treated by radical cystectomy. Patients who are too sick to go through this surgery or who are unwilling to accept the mutilation associated with it are referred to chemoradiation. We compared the results of these 2 modalities using age-matched populations. PARTICIPANTS AND METHODS: Between 1998 and 2008, 33 patients were treated with chemoradiation for biopsy-proven T2-4aN0M0 urothelial bladder cancer. For every patient treated with chemoradiation, an age-matched patient who underwent radical cystectomy on the same year was selected for comparison. Mean radiotherapy dose was 62 Gy (standard deviation = 8.4) and median follow-up of both groups was approximately 36 months. RESULTS: The groups were similar in age, proportion of men, and length of follow-up. However, the Charlson comorbidity index was significantly lower for operated patients (3.45 vs. 4.36, P = 0.01). Furthermore, 2 patients (6%) in the chemoradiation group had salvage cystectomy (one for disease recurrence and another for bladder shrinkage). The 2- and 5-year overall survival rates after surgery were 74.4% and 54.8%, respectively, and after chemoradiation were 70.2% and 56.6% (P = 0.8), respectively. The 2- and 5-year disease-free survival rates after surgery were 67.8% and 63.2%, respectively, and after chemoradiation were 63% and 54.3% (P = 0.89), respectively. Side effects were mild in both groups, with grade 3+toxicity seen in only 2 operated and 4 irradiated patients. CONCLUSIONS: Despite having a significantly higher comorbidity index, patients treated with chemoradiation had similar overall and disease-free survival rates with low toxicity. Treatment with chemoradiation should be considered in patients with T2-4aN0M0 bladder cancer.
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Neoplasias de la Vejiga Urinaria/terapia , Anciano , Estudios de Casos y Controles , Quimioradioterapia , Cistectomía , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Invasividad Neoplásica , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
OBJECTIVE: To analyze the epidemiological and clinical characteristics and therapeutic outcomes of patients with cystine stones and to compare them with the characteristics of patients with calcium oxalate stones. PATIENTS AND METHODS: We identified 30 patients with cystine stones who were consulted in our department from January 1972 until December 2013. These patients were matched and paired, based on age and gender, to 30 calcium oxalate stone formers who were diagnosed and treated in our department from January 2011 until December 2013. RESULTS: Cystine stones were significantly large in size (p<0.001) and most of them were found in the kidney (p=0.002). Patients with cystinuria had their first stone episode at an early age (p<0.001) compared with patients with calcium oxalate stones. No significant differences were observed regarding the frequency and the severity of symptoms. Both groups had similar visits per year in outpatient clinics, emergency room admissions, and episodes of febrile urinary tract infections. Cystine stone formers had undergone significantly higher number of procedures for stone removal (p<0.001). No statistical differences were found in the compliance rates between the groups. Patients with cystine stones had significantly higher serum creatinine levels (p=0.005). CONCLUSIONS: Cystine stones present in an earlier age and have the likelihood to be large in size. Patients with cystine stones undergo a greater number of procedures, and they have a greater risk to develop chronic renal impairment.
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Cistina , Cistinuria/epidemiología , Cálculos Renales/química , Adulto , Edad de Inicio , Oxalato de Calcio , Estudios de Casos y Controles , Cistinuria/terapia , Femenino , Humanos , Cálculos Renales/epidemiología , Cálculos Renales/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cálculos Urinarios/química , Cálculos Urinarios/epidemiología , Cálculos Urinarios/terapia , Infecciones Urinarias/etiologíaRESUMEN
BACKGROUND: Partial cystectomy provides oncological results comparable with those of radical cystectomy in selected patients with invasive bladder cancer without the morbidity associated with radical cystectomy and urinary diversion. We describe a novel technique of partial cystectomy that allows accurate identification of tumor margins while minimizing damage to the rest of the bladder. METHODS: During the study period, 30 patients underwent partial cystectomy for invasive high-grade cancer. In 19 patients, the traditional method of tumor identification was used, ie, identifying the tumor by palpation and cystotomy. In eleven patients, after mobilization of the bladder, flexible cystoscopy was done and the light of the cystoscope was pointed toward one edge of the planned resected ellipse around the tumor, thus avoiding cystotomy. RESULTS: Patients who underwent partial cystectomy using the novel method were similar in all characteristics to patients operated on using the traditional technique except for tumor diameter which was significantly larger in patients operated on using the novel method (4.3±1.5 cm versus 3.11±1.18 cm, P=0.032). Complications were rare in both types of surgery. The 5-year local recurrence-free survival was marginally superior using the novel method (0.8 versus 0.426, P=0.088). Overall, disease-specific and disease-free survival rates were similar. CONCLUSION: The use of a flexible cystoscope during partial cystectomy is a simple, low-cost maneuver that assists in planning the bladder incision and minimizes injury to the remaining bladder by avoiding the midline cystotomy. Initial oncological results show a trend toward a lower rate of local recurrence compared with the standard method.
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INTRODUCTION: Bones represent the most common metastatic sites in prostate cancer (PCa) patients, and in addition with androgen deprivation therapy, they represent the causative reasons of bone mineral density loss and the onset of skeletal-related events. AREAS COVERED: An extensive search of PubMed/Medline was performed to identify randomized, Phase II/III controlled trials reporting results regarding the prevention of skeletal morbidity in patients with PCa. EXPERT OPINION: Preventing bone health is an imperative issue for preserving quality of life and elongate survival and, thus, a concerted effort should be made to monitor skeletal changes and to apply treatment for preventing bone loss. Although several agents have received approval for routine use, it is of paramount importance to identify the appropriate patients who would mostly be benefited by the use of these agents with attention to documenting the toxicity and economic implications. Additionally, it remains to be justified the frequency of administration in order to balance the efficacy and the potential complications.
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Enfermedades Óseas Metabólicas/prevención & control , Neoplasias Óseas/prevención & control , Neoplasias de la Próstata/tratamiento farmacológico , Antagonistas de Andrógenos/efectos adversos , Antineoplásicos/efectos adversos , Densidad Ósea/efectos de los fármacos , Conservadores de la Densidad Ósea/uso terapéutico , Enfermedades Óseas Metabólicas/inducido químicamente , Neoplasias Óseas/secundario , Ensayos Clínicos como Asunto , Antagonistas de los Receptores de la Endotelina A/uso terapéutico , Humanos , Masculino , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/fisiopatología , Inhibidores de Proteínas Quinasas/uso terapéutico , Calidad de Vida , Radioisótopos/uso terapéutico , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéuticoRESUMEN
OBJECTIVE: To create a model for prediction of stone radiopacity based on computed tomography (CT) parameters. METHODS: We reviewed the medical records of 513 patients referred to our department for consultation for urolithiasis between March 2011 and December 2012. CT scan and kidney-ureter-bladder (KUB) film were reviewed to identify the value of scout film in revealing radiopaque stones and to identify parameters predicting radiopacity in scout-negative stones. RESULTS: Of 375 patients who met inclusion criteria and were finally analyzed, all 206 visible stones in scout film were KUB radiopaque. Analyzing scout-negative stones, we found that 92 stones (54.4%) were radiopaque in KUB. Multivariate analysis showed that stone size >9.7 mm, non-midureteral stone location, anterior abdominal wall fat thickness ≤23.9 mm, and Hounsfield units >772 are all independent predictors of stone radiopacity in stones that were not visible in scout film, and the aforementioned parameters were used for the creation of a Web-based calculator. CONCLUSION: Scout film can identify radiopaque stones in KUB with high specificity, and thus, KUB can be used for following-up stones which are visible in CT scout film. For stones that are not visible in scout film, the probability of a stone to be radiopaque in KUB can be calculated trough our predictive model.
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Riñón/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Urolitiasis/diagnóstico por imagen , Adulto , Femenino , Humanos , Cálculos Renales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Resultado del Tratamiento , Cálculos Ureterales/diagnóstico por imagen , Cálculos de la Vejiga Urinaria/diagnóstico por imagen , Película para Rayos XRESUMEN
We describe an unusual presentation of metastatic lung adenocarcinoma as malignant retroperitoneal fibrosis (MRPF). The diagnostic challenge, due to the small solitary lung mass and absence of a discrete retroperitoneal mass, was overcome by diagnostic laparoscopy. Molecular analysis of tissue acquired was positive for ALK gene rearrangement. Treatment of the patient with crizotinib reversed MRPF. He was weaned off the nephrostomy tubes and is with stable renal function 11 months after diagnosis.
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BACKGROUND: The management of patients with high-grade non muscle invasive bladder cancer (NMIBC) brings diagnostic and therapeutic challenges. In the current study, we sought to study the natural history of progression to "secondary" muscle-invasive bladder cancer (MIBC)-cancer that developed during follow up of patients presenting with non-muscle invasive bladder cancer (NMIBC). METHODS: Between 1998 and 2008, 760 patients were treated for bladder cancer. Primary MIBC (>=T2) tumors (present upon presentation) were diagnosed in 114 patients. All patients with high-grade NMIBC were treated with intravesical BCG. Mean follow-up was 44 months. RESULTS: Forty patients (6.1%) developed secondary MIBC after a mean period of 21 months from initial diagnosis of bladder cancer. The 2- and 5-year disease-specific survival rates were better for patients with secondary MIBC (90% and 56% compared to 69% and 42% for patients with primary disease, p=0.03). The Kaplan-Meier curves of the two groups were parallel but displaced by approximately 2 years. CONCLUSION: In the current series, MIBC progression occurred among initially presenting patients with NMIBC in 6.1%. In most patients, the initial diagnosis of NMIBC is correct and muscle invasion occurs after a mean period of about 2 years. This supports a non-radical approach in patients with high-grade T1, Ta or Tis. Meticulous follow-up with liberal biopsy of any suspicious lesion may provide early diagnosis of invasive disease.
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Neoplasias de los Músculos/mortalidad , Neoplasias de los Músculos/patología , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Primarias Secundarias/patología , Neoplasias de la Vejiga Urinaria/mortalidad , Neoplasias de la Vejiga Urinaria/patología , Anciano , Comorbilidad , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Israel/epidemiología , Masculino , Invasividad Neoplásica , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
The objective of the study is to assess the etiology and prognosis of gross hematuria (GH) in patients with carcinoma of the prostate (CAP). From 1991 to 2011, 81 men (mean age 74.3 years, SD 6.5) with CAP were hospitalized with GH. Primary treatment of CAP was radical surgery in 13 patients (group 1) and nonsurgical therapy in 68 (group 2), mostly radiotherapy (35 cases) and hormonal treatment (25 cases). The common etiologies of GH in group 1 were bladder cancer (38.5%) and urinary infection (23%). In contrast, CAP itself caused GH in 60% of the patients in group 2. Thirty-nine patients (48%) required transurethral surgery to manage GH which was effective in all cases; nevertheless, the prognosis of group 2 patients was dismal with median overall survival of 13 months after sustaining hematuria, compared to 50 months in group 1 (P = 0.0015). We conclude that the etiology of GH in patients with CAP varies according to primary treatment. After radical prostatectomy, it is habitually caused by bladder cancer or infection. When the primary treatment is not surgical, GH is most commonly due to CAP itself. Although surgical intervention is effective in alleviating hematuria of these patients, their prognosis is dismal.
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OBJECTIVE: To evaluate the importance of stone composition and crystallite size in the formation of ultimate stone burden. Crystallite is the smallest building block, which is unique in size and architecture for each type of stone component. Currently, the knowledge about the clinical importance of crystallite size is very limited. METHODS: The results of quantitative X-ray diffraction phase analysis performed on 286 kidney stones extracted during endourological surgery or expelled spontaneously were retrospectively analyzed. Stone composition and crystallite size were determined and were compared to the burden occupying the pelvicalyceal system. RESULTS: A total of 286 renal stones were analyzed. Stones were low burden and high burden in 242 and 44 of cases, respectively. We observed statistically significant association of phosphates and urates with high-burden stones in contrast to oxalates, which formed mainly low-burden stones. Crystallite sizes were available for 179 stones. Large-sized crystallites of calcium oxalate monohydrate and hydroxyl apatite formed low-burden stones, whereas small-sized crystallites formed staghorn stones. Struvite and urates had a uniform average size of crystallites. CONCLUSION: Oxalate stones have statistically significant association with smaller stones, whereas high-burden calculi are significantly associated with urates and phosphates, especially the struvite type. The smaller the crystallite size is to start with, the larger will be the ultimate stone burden. This rule is followed by calcium oxalate monohydrate and Apatite minerals.
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Cálculos Renales/diagnóstico por imagen , Difracción de Rayos X/métodos , Apatitas/análisis , Oxalato de Calcio/análisis , Cristalografía por Rayos X , Humanos , Cálculos Renales/química , Fosfatos/análisis , Radiografía , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: Most urothelial carcinomas are exophytic, but some tumors exhibit subepithelial components, either in the form of endophytic growth pattern (EGP) or as von Brunn's nests involvement (VBNI). The purpose of this study was to investigate the frequency, inter-relations and clinical significance of these forms of subepithelial neoplasia in urothelial carcinoma. PATIENTS AND METHODS: Between June 1995 and December 2007, 760 patients (mean age of 67.5 years) underwent transurethral resection of bladder tumors in our institution, including 478, 157, and 112 patients with stage Ta, T1, and ≥T2 disease, respectively. Isolated or concomitant Tis were present in 137 (18%) patients. Median postoperative follow-up period was 53 months. RESULTS: EGP was found in 86 cases (11.3%) and VBNI in 30 (3.9%) patients. Both forms of subepithelial growth were significantly more common in higher stage and grade tumors and were associated with each other. Multivariate analysis showed that EGP is an independent prognostic factor of stage progression (HR 4.6, P < 0.0001) and disease specific mortality (HR 2.6, P = 0.001) but not of tumor recurrence (HR 1.2, P = 0.51). VBNI was found an independent prognostic factor of tumor progression (HR 5.1, P < 0.0001), but neither of tumor recurrence nor disease specific mortality. CONCLUSIONS: Subepithelial growth is not an uncommon in bladder cancer. It is more frequent in high-grade and high-stage tumors. The findings of this study suggest that subepithelial growth carries a higher risk for stage progression (EGP and VBNI) and mortality (EGP), but not tumor recurrence.
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Carcinoma de Células Transicionales/patología , Neoplasias de la Vejiga Urinaria/patología , Adulto , Anciano , Carcinoma de Células Transicionales/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Pronóstico , Neoplasias de la Vejiga Urinaria/mortalidadRESUMEN
BACKGROUND AND PURPOSE: Biofilms on the surfaces of urinary catheters are among the pivotal factors for recurrent and persistent infections in urology. Many techniques have been investigated and applied for eradication of these biofilms--but with no full success. The aim of this study was to examine the effect of sustained release medicated varnish, releasing chlorhexidine, on the formation of biofilm on the urinary catheter surface in an in-vitro model. MATERIALS AND METHODS: A batch model was used to test the antibacterial/antibiofilm effect of the sustained release varnish: Catheter pieces coated with sustained release varnishes were placed in bacterial growth medium that was infected with Pseudomonas aeruginosa for 96 hours. Various concentrations of chlorhexidine impregnated in the varnish were tested. After the incubation period, the catheter pieces were assessed for biofilm formation by measuring the optical density, colony-forming units, and using confocal laser scanning microscopy, and electron scanning microscopy. RESULTS: Biofilm growth measurement (colony-forming units [CFU]) on the catheter surface coated with the various concentrations of chlorhexidine in sustained released varnish revealed a 94% reduction with 1% chlorhexidine (P<0.0001) and 43% reduction with 0.1% chlorhexidine (P=0.08) coated varnish in comparison with a positive control or the placebo varnish in preventing biofilm growth of P. aeruginosa. These biologic assays were confirmed using confocal and electron microscopy. CONCLUSIONS: Of the various tested concentrations of sustained release varnishes, the 1% chlorhexidine concentration has demonstrated the superior antibiofilm effect on urinary catheters with P. aeruginosa. Although similar varnishes are used in dentistry, it needs extended research in animals before applying this technology in human trials.