RESUMO
OBJECTIVE: Cryptorchidism is an abnormality of the male genitourinary tract in which one or both testes fail to descend into the scrotum. The American Urological Association (AUA) clinical guidelines for the evaluation and treatment of cryptorchidism were recently published. We reviewed our experience with the evaluation and management of our patients and examined our findings with respect to the AUA and European Association of Urology (EAU) guidelines. METHODS: Data were obtained from pediatric patients who underwent a surgical intervention for an undescended testis from 2007 through 2017 at HIMA Hospital and the University Pediatric Hospital (both in Puerto Rico); all the surgeries were performed by the same surgeon. A total of 754 patients were identified; 142 patients were excluded due to lack of follow-up data (N = 612). The data obtained included age, testes locations, radiologic and surgical findings, and postoperative results. RESULTS: At their initial evaluations, a large proportion of the patients (46.4%) came accompanied with radiographic imaging. These findings were consistent with those of the physical examination in 58.5% of the patients and with the surgical findings in 63.1% (sensitivity 77.9%, specificity 45.8%). Our data showed that the median referral age was 24 months, which suggests that there was a significant delay in diagnosis. At the time of surgery, the average age of the patients who required an orchiectomy was 3.93 years, while those who underwent an orchiopexy had an average age of 3.28 years. CONCLUSION: Our data reveal that, despite its lack of usefulness, radiologic imaging continues to be included in the diagnostic workups of children newly identified with cryptorchidism in Puerto Rico. In addition, and contrary to the guidelines, there tends to be a significant delay in treatment with surgical intervention. It is important to continue to educate our referring physicians on the AUA and EUA guidelines in order to create awareness and encourage the proper diagnostic and treatment approach for cryptorchidism.
Assuntos
Criptorquidismo/cirurgia , Orquiectomia/estatística & dados numéricos , Orquidopexia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Etários , Pré-Escolar , Criptorquidismo/diagnóstico , Diagnóstico Tardio , Seguimentos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Porto Rico , Sensibilidade e EspecificidadeRESUMO
A identificação de dor em bovinos e seu alivio, são essenciais para o bem estar animal, todavia ainda não há um teste ideal para esta avaliação. Alguns pesquisadores têm utilizados cortisol sérico e frequências cardíaca e respiratória para esta avaliação, enquanto outros utilizam escalas baseadas em comportamento ou expressões faciais, não existindo uma escala que leve em consideração a união destes identificadores para bovinos. Além disso, a maioria dos pesquisadores manipulam os animais para identificar a dor, o que poderia mascarar os resultados. Desta maneira o presente trabalho propôs elaborar e validar uma escala análogo visual para identificação de dor em bovinos submetidos à orquiectomia. Para tanto 8 bovinos holandeses de 200 dias de vida e 250 kg de peso vivo foram submetidos a orquiectomia com previa anestesia local e uso de analgésicos. A identificação de dor foi baseada em analises fisiológica (cortisol sérico e frequência respiratória), comportamental, de expressão facial e análogo visual nos momentos -30 (30 minutos antes do procedimento) e 1, 3, 6 12, 24, 72 e 420 horas após o procedimento; e com a exceção do cortisol, todas as analises foram realizadas sem a interferência do avaliador com o animal, por meio de filmagens de vídeos. Notou-se que todas as metodologias propostas foram capazes de identificar dor pós orquiectomia em bovinos, no entanto a graduação de maior dor foi em momentos pós-cirúrgicos distintos conforme o parâmetro avaliado. Assim houve fraca correlação entre os modelos propostos, pois se encontrou limitações para a maioria das metodologias avaliadas, concluindo-se que a associação entre os vários parâmetros de dor, tal qual o utilizado na escala análogo visual, aumenta a acurácia em identificar a dor após orquiectomia em bovinos.(AU)
The identification of pain in cattle and your relief, are essential for animal welfare, however there is still no ideal test for this evaluation. Some researchers have used serum cortisol, heart and respiratory rates for this assessment, while others use scales based on behavior or facial expressions. However, doesn't exist but a scale that takes into account the union of these identifiers for cattle. Furthermore, most researchers manipulate the animals to identify pain, which could mask the result. In this way, this paper proposed design and validate a visual analog scale for pain identification in cattle undergoing orchiectomy. For this, 8 Holstein calves with 200 days old and 250kg live weight were submitted to orchiectomy with local anesthesia and analgesics. The identification of pain was based on physiological analysis (serum cortisol and respiratory rate), behavioral, and facial expression in the visual-analogue -30 (30 minutes before surgery) and 1, 3, 6, 12, 24, 72 and 420 hours after the procedure; and with the exception of cortisol, all analyzes were performed without the interference of the appraiser with the animal, by videos. It was noted that all the methods proposed were able to identify post orchiectomy pain in cattle, however the degree of pain were higher in different post-surgical times. There was poor correlation between the proposed models, because it was found limitations for most assessed methodologies. We concluded an association between various parameters of pain, as visual analogue scale, can increase the accuracy to identify pain orchiectomy in bulls.(AU)
Assuntos
Animais , Bovinos , Dor/diagnóstico , Bovinos/anatomia & histologia , Orquiectomia/estatística & dados numéricos , Castração/veterináriaRESUMO
OBJECTIVE: To assess regional practices in management of cryptorchidism with regard to timely fixation by the current recommended age of 18 months. STUDY DESIGN: A retrospective study was performed. Charts of all patients who underwent surgical correction for cryptorchidism by a pediatric general surgeon or urologist within a tertiary pediatric hospital in an urban setting were systematically reviewed. RESULTS: We identified 1209 patients with cryptorchidism. The median age of surgical correction was 3.7 years (IQR: 1.4, 7.7); only 27% of patients had surgical correction before 18 months of age. Forty-six percent of our patients were white, 40% were African American, and 8% were Hispanic. African American and Hispanic patients were less likely to undergo timely repair (P?=?.01), as were those with public or no insurance (P?
Assuntos
Criptorquidismo/cirurgia , Tempo para o Tratamento , Pré-Escolar , Criptorquidismo/diagnóstico , Diagnóstico por Imagem/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Masculino , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Orquiectomia/estatística & dados numéricos , Orquidopexia/estatística & dados numéricos , Complicações Pós-Operatórias , Áreas de Pobreza , Grupos Raciais/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Estados Unidos , População UrbanaRESUMO
Este artigo apresenta os resultados de um protocolo de contenção farmacológica para orquiectomia eletiva realizada em campo pela técnica aberta, na Região Noroeste do Estado do Paraná, em 106 cavalos (sendo cinco pôneis) e 29 muares, utilizando abraçadeira de náilon 6.6 (poliamida) para ligaduras vasculares hemostáticas. Os 135 equídeos foram contidos por meio de injeção intravenosa da associação de cloridrato de detomidina, cloridrato de cetamina e diazepam, acondicionados em uma mesma seringa, o que facilita o manejo, especialmente quando se trabalha com animais inquietos ou agressivos. O método empregado teve fácil execução e baixo custo, e os resultados permitem sugerir seu uso em orquiectomias e outras pequenas cirurgias de campo em equídeos domésticos.(AU)
This paper reports the results of an anesthetic protocol used for elective field orchiectomy performed by open technique, in the northwestern region of Paraná State, Brazil, in 106 equids (being five ponies) and 29 mules, using 6.6 nylon (polyamide) cable ties for hemostatic vascular ligature. The 135 equids were chemically restrained by intravenous injection of a combination of detomidine HCl, ketamine HCl and diazepam, mixed in the same syringe, in order to facilitate handling, especially when working with restless or aggressive animals. The method was considered low-cost and easy to perform, and the results allows to suggest its use in orchiectomies and other minor field surgeries in domestic equids.(AU)
Este artículo presenta los resultados de un protocolo de contención farmacológica para castración electiva realizada en campo por técnica abierta, en la Región Noroeste del Estado de Paraná, en 106 caballos (incluyendo cinco ponis) y 29 mulares, utilizando abrazaderas de nylon 6,6 (poliamida) para las ligaduras hemostáticas vasculares. Los 135 équidos fueron anestesiados mediante inyección intravenosa de la asociación de clorhidrato de ketamina, clorhidrato de detomidina y diazepam, mesclados en una misma jeringa, lo que facilita la manipulación, especialmente cuando se trabaja con animales inquietos o agresivos. El método empleado ha sido fácil de realizar y de bajo costo, los resultados sugieren su uso en la castración y otras pequeñas cirugías de campo en équidos domésticos.(AU)
Assuntos
Animais , Cavalos/cirurgia , Orquiectomia/estatística & dados numéricos , Orquiectomia/veterinária , Anestesia , Ketamina , Receptores de GABA-ARESUMO
The present study aimed to compare different sterilization scenarios allowing the adoption of the most adequate strategy to control owned dog and cat population sizes as the official veterinary public policy for animal control in an urban area of Campinas municipality, Brazil. To achieve this goal, the vital parameters of the owned pet population were measured in a neighborhood of Campinas called Jardim Vila Olimpia through questionnaires used in two census studies performed in February 2012 and June 2013. Different hypothetical sterilization scenarios were compared with the scenario of a single sterilization campaign performed in the study area between the census studies. Using a deterministic mathematical model, population dynamics were simulated for these different scenarios. We have observed that for both owned dogs and cats, the impact on the population size achieved by a single sterilization campaign would be diluted over the years, equating to the impact achieved by the usual sterilization rate practiced before the sterilization campaign yearly. Moreover, using local and global sensitivity analyses, we assessed the relative influence on animal population evolution of each vital parameter used in the mathematical models. The more influential parameters for both species were the carrying capacity of the environment and sterilization rates of males and females (for both species). We observed that even with sterilizing 100% of the intact animals annually, it would not be possible to obtain proportions greater than 86% and 88% of sterilized dogs and cats, respectively, after 20 years due to the high introduction of new intact animals. There is no public dog and cat sterilization service in place in the city, and sporadic and local sterilization campaigns are performed with a prior communication to the owners to bring their animals to be sterilized in a selected veterinary facility. If a sterilization campaign was performed annually in the study area, it would have the most favorable cost effectiveness ratio after 20 years compared to the scenarios of 50% and 100% sterilization of intact animals annually. These results allowed the veterinary public policy stakeholders to make decisions based on scientific evidence to implement adequate control of dog and cat populations in urban areas, aiming to reduce zoonosis transmission to humans and other problems associated with uncontrolled animal populations.
Assuntos
Orquiectomia/veterinária , Ovariectomia/veterinária , Política Pública , Animais , Brasil , Gatos , Cidades , Cães , Feminino , Masculino , Modelos Teóricos , Orquiectomia/legislação & jurisprudência , Orquiectomia/estatística & dados numéricos , Ovariectomia/legislação & jurisprudência , Ovariectomia/estatística & dados numéricos , Propriedade , Densidade Demográfica , Dinâmica PopulacionalRESUMO
OBJECTIVES: Ultrasound (US) is often used for the work-up of testicular pathology. The findings may implicate on its management. However, there is only scant data on the correlation between US findings and testicular tumor type and size. Herein, we report on a multicenter study, analyzing these correlations. METHODS: The study included patients who underwent orchiectomy between 2000 and 2010. Their charts were reviewed for US echogeneity, lesion size, pathological dimensions, histology, and the presence of calcifications, fibrosis, necrosis and/or intraepithelial neoplasia. The incidence of these parameters in benign versus malignant lesions and seminomatous germ cell tumors (SGCT) versus nonseminomatous germ cell tumors (NSGCT) was statistically compared. RESULTS: Eighty five patients fulfilled the inclusion criteria, 71 malignant (43 SGCT, 28 NSGCT) and 14 benign. Sonographic lesions were at least 20% smaller than the pathologically determined dimensions in 21 (25%) patients. The ability of US in estimating the size of malignant tumors was 71%, compared to 100% of benign tumors (p=0.03), with no significant difference between SGCT and NSGCT. Necrosis was more frequent in malignant tumors (p=0.03); hypoechogeneity and fibrosis were more frequent in SGCT than in NSGCT (p=0.002 and 0.04 respectively). CONCLUSIONS: Testis US of malignant lesions underestimates the size in 25% of the cases, a fact that may impact on the decision of testicular sparing surgery. The ultrasonic lesions were eventually proven to be benign in 16% of the cases. Therefore it is advised to apply frozen sections in borderline cases. Hypoechogeneity is more frequent in SGCT than NSGCT.
Assuntos
Orquiectomia/estatística & dados numéricos , Seminoma/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Testículo/diagnóstico por imagem , Carga Tumoral , Fibrose , Secções Congeladas , Humanos , Tumor de Células de Leydig/diagnóstico por imagem , Tumor de Células de Leydig/patologia , Masculino , Necrose , Tamanho do Órgão , Valor Preditivo dos Testes , Estudos Retrospectivos , Seminoma/patologia , Neoplasias Testiculares/patologia , Testículo/patologia , UltrassonografiaRESUMO
ABSTRACTObjectives:Ultrasound (US) is often used for the work-up of testicular pathology. The findings may implicate on its management. However, there is only scant data on the correlation between US findings and testicular tumor type and size. Herein, we report on a multicenter study, analyzing these correlations.Methods:The study included patients who underwent orchiectomy between 2000 and 2010. Their charts were reviewed for US echogeneity, lesion size, pathological dimensions, histology, and the presence of calcifications, fibrosis, necrosis and/or intraepithelial neoplasia. The incidence of these parameters in benign versus malignant lesions and seminomatous germ cell tumors (SGCT) versus nonseminomatous germ cell tumors (NSGCT) was statistically compared.Results:Eighty five patients fulfilled the inclusion criteria, 71 malignant (43 SGCT, 28 NSGCT) and 14 benign. Sonographic lesions were at least 20% smaller than the pathologically determined dimensions in 21 (25%) patients. The ability of US in estimating the size of malignant tumors was 71%, compared to 100% of benign tumors (p=0.03), with no significant difference between SGCT and NSGCT. Necrosis was more frequent in malignant tumors (p=0.03); hypoechogeneity and fibrosis were more frequent in SGCT than in NSGCT (p=0.002 and 0.04 respectively).Conclusions:Testis US of malignant lesions underestimates the size in 25% of the cases, a fact that may impact on the decision of testicular sparing surgery. The ultrasonic lesions were eventually proven to be benign in 16% of the cases. Therefore it is advised to apply frozen sections in borderline cases. Hypoechogeneity is more frequent in SGCT than NSGCT.
Assuntos
Humanos , Masculino , Orquiectomia/estatística & dados numéricos , Seminoma , Carga Tumoral , Neoplasias Testiculares , Testículo , Fibrose , Secções Congeladas , Tumor de Células de Leydig/patologia , Tumor de Células de Leydig , Necrose , Tamanho do Órgão , Valor Preditivo dos Testes , Estudos Retrospectivos , Seminoma/patologia , Neoplasias Testiculares/patologia , Testículo/patologiaRESUMO
Prostate cancer (PC) is the most common cancer in men. Many patients have prolonged survival and die of other diseases, so treatment decisions are often influenced by age and coexisting comorbidities. The main procedure to diagnose PC is an ultrasound-guided core needle biopsy, which is indicated when a digital rectal examination (DRE) finds nodularity or when PSA is >10 ng/ml, but is also recommended with PSA between 4.0 and 10 ng/ml. Depending on age, PSA, Gleason score and characteristics of the tumour, treatment options for localised PC are active surveillance, radical prostatectomy and radiation therapy. Androgen deprivation treatment (ADT) should be added to radiotherapy for men with intermediate- or high-risk PC. ADT is the current standard first-line treatment for metastatic PC. Castration-resistant PC is a heterogeneous entity. Several treatments such as sipuleucel-T, docetaxel-based chemotherapy, radium 223, cabazitaxel or abiraterone plus prednisone, zoledronic and denosumab, are useful for this situation.
Assuntos
Carcinoma/terapia , Guias de Prática Clínica como Assunto , Neoplasias da Próstata/terapia , Algoritmos , Carcinoma/diagnóstico , Carcinoma/patologia , Humanos , Masculino , Oncologia/legislação & jurisprudência , Metástase Neoplásica , Estadiamento de Neoplasias/métodos , Orquiectomia/estatística & dados numéricos , Prostatectomia/estatística & dados numéricos , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Espanha , Falha de TratamentoRESUMO
Several studies have demonstrated that gonadal hormones show significant effects on the brain and signaling pathways of effector organs/cells that respond to neurotransmitters. Since little information is available concerning the impact of male and female gonadal hormones on the renal and peripheral sympathetic system, the objective of this study was to further assess whether and how the renal content and plasma concentration of catecholamines are influenced by gender and the estrous cycle in rats. To achieve this, males Wistar rats were divided into 4 groups: (i) sham (i.e., control), (ii) gonadectomized, (iii) gonadectomized and nandrolone decanoate replacement at physiological levels or (iv) gonadectomized and nandrolone decanoate replacement at high levels. Female Wistar rats were divided into 6 groups: (i) ovariectomized (OVX), (ii) estrogen replacement at physiological levels and (iii) estrogen replacement at at high levels, (iv) progesterone replacement at physiological levels and (v) progesterone replacement at at high levels, and (vi) sham. The sham group was subdivided into four subgroups: (i) proestrus, (ii) estrus, (iii) metaestrus, and (iv) diestrus. Ten days after surgery, the animals were sacrificed and their plasma and renal catecholamine levels measured for intergroup comparisons. Gonadectomy led to an increase in the plasma catecholamine concentration in females, as well as in the renal catecholamine content of both male and female rats. Gonadectomized males also showed a lower level of plasma catecholamine than the controls. The urinary flow, and the fractional excretion of sodium and chloride were significantly increased in gonadectomized males and in the OVX group when compared with their respective sham groups.
Assuntos
Catecolaminas/sangue , Catecolaminas/metabolismo , Ciclo Estral/sangue , Ciclo Estral/metabolismo , Rim/metabolismo , Animais , Cloretos/urina , Relação Dose-Resposta a Droga , Estradiol/administração & dosagem , Estradiol/farmacologia , Feminino , Hormônios Gonadais/administração & dosagem , Hormônios Gonadais/farmacologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Masculino , Nandrolona/administração & dosagem , Nandrolona/análogos & derivados , Nandrolona/farmacologia , Decanoato de Nandrolona , Orquiectomia/métodos , Orquiectomia/estatística & dados numéricos , Ovariectomia/métodos , Ovariectomia/estatística & dados numéricos , Progesterona/administração & dosagem , Progesterona/farmacologia , Ratos , Ratos Wistar , Caracteres Sexuais , Sódio/urina , Micção/efeitos dos fármacos , Micção/fisiologiaRESUMO
OBJECTIVE: To compare the proportion of patients choosing surgical versus medical castration to treat prostate cancer, before and after the National Health Fund (NHF) of Jamaica began to subsidize hormone therapy. METHODS: A retrospective review was performed at the University Hospital of the West Indies (UHWI), Jamaica. The pathology database at UHWI was searched to identify patients who had prostate biopsies between January 2000 and December 2007. These were combined with records of biopsies at external institutions. Medical records of all patients with positive prostate biopsies were reviewed to determine if they had received androgen deprivation therapy (ADT). Patients were classified as having had surgical castration (bilateral orchiectomy) or medical castration. Chi-square statistics were used to determine the difference in proportions between those choosing medical versus surgical castration before and after March 2005, when the NHF began offering subsidies for ADT drugs. RESULTS: Of the 1,529 prostate biopsies performed during the study period, 680 (44.0%) cases of prostate cancer were diagnosed. Of these, 458 patients underwent ADT and had complete records available for analysis. The mean patient age was 72 years. During the entire study period, surgical castration was performed in 265 patients (58.0%) and medical castration in 193 (42.0%). A greater proportion of orchiectomies were performed before March 2005, rather than after (P < 0.001). Estrogens were the most common method of medical castration used before the NHF subsidy became available (62.0%); while luteinizing hormone-releasing hormone analogues (38.0%) and antiandrogens (36.5%) were most often chosen afterwards. CONCLUSIONS: Surgical castration was more common than medical castration before March 2005. After the NHF began to subsidize the cost of drugs for hormone therapy, medical castration was chosen more often. Increased access to drugs for hormone therapy has changed treatment patterns in Jamaica.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos Hormonais/economia , Financiamento Governamental , Política de Saúde/economia , Seguro de Serviços Farmacêuticos/economia , Programas Nacionais de Saúde , Honorários por Prescrição de Medicamentos , Neoplasias da Próstata/tratamento farmacológico , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenocarcinoma/cirurgia , Idoso , Antagonistas de Androgênios/administração & dosagem , Antagonistas de Androgênios/economia , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Biópsia , Estrogênios/administração & dosagem , Estrogênios/economia , Estrogênios/uso terapêutico , Hormônio Liberador de Gonadotropina/agonistas , Acessibilidade aos Serviços de Saúde , Humanos , Jamaica/epidemiologia , Masculino , Orquiectomia/economia , Orquiectomia/psicologia , Orquiectomia/estatística & dados numéricos , Preferência do Paciente , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia , Estudos RetrospectivosRESUMO
O câncer de próstada (CAP) é a neoplasia mais freqüente no homem. Os autores descrevem a técnica operativa da orquiectomia bilateral subepidimária e analisam os parâmetros clínicos e os valores de PSA pré e pós-operatórios em portadores de CAP. Trinta e sete pacientes com CAP avançado foram submetidos à orquiectomia bileteral subepidimária sob anestesia funicular com lidocaìna. A idade média dos doentes foi de 71 anos. Setenta por cento deles apresentaram escore de Gleason igual ou superior a sete. A média dos níveis de PSA decresceu de 161,36np/ml para 12ng/ml no 30º PO; 95 por cento dos pacientes eram T3/T4; a média do PSA foi inferior naqueles com cintilografia óssea negativa e naqueles que receberam hormonioterapia prévia; nenhum paciente referiu dor intensa; ocorreu um caso de hematoma, um de deiscência d FO e fois óbitos durante o estudo. Os autores concluem que a orquiectomia bilateral sob anestesia local é factível...
Assuntos
Adulto , Pessoa de Meia-Idade , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/fisiopatologia , Neoplasias da Próstata/terapia , Orquiectomia/estatística & dados numéricos , Orquiectomia/métodos , Orquiectomia , Antígeno Prostático EspecíficoRESUMO
La diferenciación sexual masculino normal depende por lo menos de dos factores, testosterona y factor inhibidor mülleriano. La ausencia de este último produce una forma rara de pseudohermafroditismo masculino, el síndrome de persistencia del conducto de Müller, o hernia uterina inguinal. Se presenta el caso de un individuo fenotípicamente masculino, sometido a exploración quirúrgica por criptoquirdia bilateral, encontrando útero, trompas de falopio y ambos testículos. Se realizó extirpación de los remanentes müllerianos, orquidectomía derecha y orquidopexia izquierda. Se realiza una revisión de la literatura acerca de la etiología, presentación clínica, diagnóstico y tratamiento de este padecimiento
Assuntos
Adulto , Humanos , Masculino , Criptorquidismo/genética , Criptorquidismo/cirurgia , Técnicas de Diagnóstico por Cirurgia/estatística & dados numéricos , Transtornos do Desenvolvimento Sexual/diagnóstico , Transtornos do Desenvolvimento Sexual/cirurgia , Ductos Paramesonéfricos/anormalidades , Orquiectomia/estatística & dados numéricosAssuntos
Humanos , Masculino , Adulto , Disgerminoma/diagnóstico , Disgerminoma/fisiopatologia , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/parasitologia , Abscesso Hepático Amebiano/fisiopatologia , Metástase Neoplásica/diagnóstico , Metástase Neoplásica/patologia , Tomografia Computadorizada por Raios X , Estadiamento de Neoplasias , Orquiectomia/estatística & dados numéricosRESUMO
Se presenta un informe preliminar de los resultados obtenidos en el manejo del cáncer prostático, entre junio de 1983 y junio 1987, utilizando un protocolo basado fundamentalmente en una etapificación clínico-patológica y con un esquema de tratamiento que incluye en estados avanzados el uso simultáneo de orquidectomía y quimioterapia. La casuística corresponde a 59 pacientes: 85,1 por ciento en estadio D debido básicamente al sistema de etapificación. Las fosfatasas ácidas sólo mostraron elevación en presencia de enfermedad metastásica. En pacientes sin evidencias cintigráficas de metástasis se efectuó una linfadenectomía ilíaca de clasificación. La sobrevida actuarial, con 3 años de seguimiento, es de 100 por ciento para etapas A, B, C y D-1. En etapas D-2 es de 66,5 por ciento cuando sólo la cintigrafía ósea es (+) y del 41,1 por ciento cuando la radiografía es (+)