Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Background. Metastases from clear cell renal cell carcinoma to the pancreas and to the liver are rare. Their presentation can be asymptomatic, and so detection after nephrectomy is often delayed.                                                                                                                             Clinical case. A 76-year-old woman had a surgical history, 26 years earlier, of right nephrectomy due to renal cell carcinoma.  Years later, she presented with tumors in the pancreas and liver, for which she underwent distal pancreatectomy and treatment with pazopanib, respectively. The pancreatic nodule was positive for cytokeratin 8, 18, and cd10, and liver biopsy reported malignant epithelial neoplasia. Both results were consistent with metastatic clear cell renal cell carcinoma.                                                                           Discussion. The patient is currently asymptomatic and in follow-up and surveillance. Due to the biologic nature of renal cell carcinoma, its metastases must be contemplated, for early stage detection and opportune treatment.

Urothelial muscle-invasive bladder carcinoma has a high probability of producing metastases, and does so most frequently to the lung, bone, and liver.  Urothelial bladder carcinoma metastases to the testes are rare.  The primary tumors that metastasize to the testes are leukemia, prostate cancer, lung cancer, melanoma, and gastrointestinal tumors. We present herein a case of asynchronous metastasis of urothelial carcinoma to the right testis. Testicular metastases should be considered in the differential diagnosis of a gonadal mass, when there is a history of muscle-invasive bladder cancer.    

Aim: To analyze the clinical experience with abiraterone acetate in chemotherapy naïve (CN) patients with metastatic castration resistant prostate cancer (mCRPC), on a real world scenario from a Medical Center at Mexico City. Methods. An observational study of patients from the Urology Department, Centro Médico Nacional “20 de Noviembre”, ISSSTE; with CN-mCRPC was performed. Abiraterone acetate plus prednisone and leuprolide were administered during January 2014 to December 2016. The primary endpoints were time to radiological progression and global survival. Secondary endpoints (time to ECOG decline, time to cytotoxic chemotherapy initiation, time to analgesic use and time to PSA progression) were compared in subgroups divided by Gleason score. Results. Eighteen patients received Abiraterone acetate. Radiographic progression was observed after 7 and 10 months (2 cases, 11.1%); while death (1 case, 5.5%) ocurred after 9 months. Early analgesic use was frequent (>50% at 10 months); while disease progression, reflected by either initiation of chemotherapy, higher ECOG scores or PSA values, ocurred in <50%. In addition, we observed a trend for earlier initiation of chemotherapy, ECOG progression and analgesic use if Gleason score was >7. Thirteen (72.2%) patients showed adverse events like fatigue, back pain, hot flushes and others; none of them were fatal. Conclusion. Abiraterone acetate therapy resulted in similar endpoints of efficacy and safety in the study patients, on a real world scenario; as compared to previous reports from literature. Therefore, abiraterone acetate may be a valuable therapeutic option for similar populations.

Background: Prostate cancer is one of the main oncologic pathologies in males. Close to 1 out of every 7 men are diagnosed with prostate cancer at some point in their lives. Early diagnosis is currently the priority of all screening methods.   Clinical report: A 63-year-old man had a prostate-specific antigen value of 8.2 ng/ml, a non-suspicious digital rectal examination, and a previous prostate biopsy that was negative for malignant pathology. He was referred for a multiparametric magnetic resonance imaging scan of the prostate, which identified a pi-rads 4 pattern. Magnetic resonance imaging/transrectal ultrasound (mri/trus) image-guided fusion biopsy with the Artemis system was performed. Four cores were taken from the suspicious site, resulting in the diagnosis of adenocarcinoma of the prostate, with a Gleason score of 7 (4+3). Conclusion: Through the aid of the Artemis mri/trus image-guided fusion biopsy system in prostate cancer screening, the probability of identifying clinically significant lesions can be increased, the number of cores taken can be reduced, and the probability of identifying prostate cancer in a previously biopsied patient can also be increased, compared with a conventional technique.

Introducción. El objetivo de este estudio es evaluar el aislamiento de cepas Escherichia coli (E. coli)resistentes a las betalactamasas (ECRB) en pacientes con infección del tracto urinario.  Material y método. Se realiza un estudio retrospectivo entre enero 2012 y diciembre de 2016. Se incluyeron pacientes con cultivos de orina positivos para E. colien el Departamento de Salud de Castellón, España. Se analizaron las siguientes variables: edad, sexo, procedencia del paciente (medio ambulatorio u hospitalario) y factores de riesgo. Se analizó la prevalencia de ECRB mediante un análisis descriptivo.  Se utilizó el programa SPSS 18.0 para el análisis estadístico, para las variables cuantitativas se utilizó la prueba T-student y para las variables cualitativas la prueba de Chi-cuadrado. Resultados.  Se obtuvieron 11.740 cultivos positivos para E. coli, de estos 446 (3,79%) fueron ECRB. El porcentaje por año de ECRB fue entre un 1,7% y un 6,5% evidenciando una tendencia a el aumento de aislamiento de cepas resistentes en los últimos años. La edad media fue 68,9 años, sin diferencias entre sexos. Un total de 350 cultivos procedían de pacientes ambulatorios (78,7%), correspondiendo el 70,5 % de estos a mujeres. Los factores de riesgo más asociados a ECBR fueron presentar ITU el último año y haber recibido tratamiento antibiótico en los 3 meses previos, de estos un 50% recibió un betalactámico. Conclusiones. El aislamiento de ECRB es similar a otras series observando un aumento en la prevalencia de estas infecciones de difícil tratamiento. La mayoría de pacientes fueron procedentes de medio ambulatorio, tratados previamente con antibióticos y con episodios de ITU recurrentes.

Objective. Enuresis is urinary incontinence in children and it negatively affects their quality of life, causing psychologic and social stress. There is no consensus on the treatment of enuresis using neuromodulation through percutaneous, electrical posterior tibial nerve stimulation (ptns). The present review analyzes the current status of enuresis treatment with neuromodulation through ptns. Materials and Methods. A systematic search in the PubMed, Cochrane, and Scopus databases was carried out for articles on enuresis published within the last ten years, in Spanish and English. Results. Only 5 articles referred to ptns and enuresis, 3 in English and 2 in Spanish. The overall clinical response rate was from 9% to 85%, with almost no adverse effects. Treatment was reported as ineffective in 20% of patients in one of the studies. Conclusions. Neuromodulation through ptns offers good results as treatment for enuresis, but controlled studies are needed to determine its therapeutic relevance, especially regarding the monosymptomatic condition.

Objective: To present our experience in relation to the safety and efficacy of the 180W Greenlight XPS laser for photoselective vaporization of the prostate. Materials and methods: A retrospective, observational, analytic, and descriptive study was conducted within the time frame of July 2014 to November 2017, evaluating technical aspects and preoperative and postoperative variables at 1, 3, and 6 months. Results: Fifty-five patients were included in the study. Their mean age was 69 years. A total of 49.1% presented with comorbidities, 14.5% with heart disease, and 20% with an ASA III. The preoperative parameters were: IPSS 14.5 points (5-35), Qmax 7.19 ml/sec (1.5-12), prostate volume 74 cc (29.2-130), PSA 5.7 ng/ml, and Foley catheter placement (54%). Laser use, time with catheter, previous infections, and previous biopsy were described, as were intraoperative complications (10.8%), postoperative complications (27.3%), Clavien-Dindo (C-D) I (80.2%), C-D II (6.6%), and C-D IIIa (13.2%). Postoperative control at 6 months was: Qmax 17.2 ml/sec (10.2-34.4) (p=0.01) and IPSS 4.2 points (0-19) (p=0.02). Surgical reintervention was performed in 3.6% of the patients, hospital stay was 1.5 days, and the mortality rate was 0%. Conclusions: Photoselective vaporization of the prostate with the GreenLight laser is a safe surgical technique with good results in high-risk surgical patient populations. Complications are similar to those when utilizing the gold standard, but patients taking anticoagulants and antiaggregants can be operated on with the

Background: Midurethral slings are one of the first-line surgical treatments for stress urinary incontinence. The aim of the present study was to evaluate the intraoperative and postoperative complications of retropubic and transobturator midurethral slings and the associated risk factors. Material and methods: A retrospective case series was conducted on 105 women within the time frame of 2016 to 2018. The women were divided into 2 groups: those that underwent retropubic sling placement (n=28) and those that underwent transobturator sling placement (n=77). Demographic variables, risk factors, intraoperative complications, and postoperative complications were analyzed. Descriptive statistics and correlations between variables were performed utilizing the SPSS version 17.0 program and statistical significance was set at a p ≤ 0.05. Results: Mean patient age was 56.7 ± 8.8 years. A total of 31.4% (n=33) of the patients presented with stress incontinence, 65.7% (n=69) with mixed incontinence, and 2.9% (n=3) with occult stress incontinence. The overall complication rate was 29.5% (n=31). The most common intraoperative complication was bladder perforation in 3.8% of the retropubic group patients and was associated with obesity (odds ratio:12.9). The postoperative complications were related to the transobturator sling (p=0.049) and included urinary tract infection (11.4%), inguinal pain (7.6%), and others (6.9%). The risk for postoperative urinary infection was associated with stress incontinence (p=0.03) and the absence of treatment for mixed urinary incontinence (p=0.04), increasing the postoperative urge urinary incontinence rate. Conclusions: The intraoperative complication rates with the transobturator approach were low, compared with the retropubic approach. The most common complication in our case series was urinary tract infection, showing the need for randomized prospective studies to be conducted.

Sr. Editor:   La cistitis enfisematosa es una forma rara de complicación de infección del tracto urinario inferior, caracterizada por gas dentro de la vejiga o en la pared de esta. El principal factor de riesgo es la diabetes mellitus, la cual está presente en más de la mitad de los afectados. Aunque el mecanismo exacto no es claro, se sabe que los patógenos asociados son E. Coli, Klebsiella y Proteus. (1) Hace poco se publicó un caso clínico en la Revista acerca de la Cistitis enfisematosa, donde el gas en la pared vesical se menciona como “un halo hipodenso perivesical en la radiografía convencional de abdomen”, lo cual es incorrecto ya que la terminología indica que a medida que se interponen las diferentes estructuras, los rayos X logran impactar en menor medida en la placa, formando así una imagen “radiopaca”. De manera contraria, si la estructura interpuesta deja pasar una mayor cantidad de rayos X, se formará una imagen “radiolucida”. (2) Aunque parece poco importante, es necesario utilizar la nomenclatura correcta en la radiografía convencional, recordando además que su principal ventaja es el fácil acceso como inicio de abordaje diagnóstico y su utilidad para identificar tumoraciones, calcificaciones y cuerpos extraños. A este paciente después de la radiografía de abdomen se le realiza la tomografía computada, sin embargo, la secuencia de estudios radiológicos más habitual indica que antes de ella es recomendable la realización del ultrasonido debido a su inocuidad, en el cual se podría encontrar: Aumento del tamaño del órgano, presencia de septos o detritus en su interior y fenómeno de reverberancia acústica(3) (a veces mal llamada sombra acústica). Siendo la tomografía computada un excelente método para la exacta localización anatómica, valoración de la extensión y descartar otras causas de aire no enfisematosas como en el caso clínico presentado.(3) Muchas veces se suelen confundir la cistitis enfisematosa y el gas intraluminal, para ello debemos recordar que en la cistitis enfisematosa el gas dentro de la pared se encuentra distribuido de forma difusa dentro de la pared vesical, a diferencia del gas intraluminal que sólo se encuentra dentro del lumen de la vejiga y ubicado en zonas no declive; lo cual resulta importante ya que el tratamiento varía bastante de un diagnóstico al otro. (4,5)

Objective: To minimize the morbidity in robotic-assisted laparoscopic nephrectomy by extracting the surgical specimen through a natural orifice, and to standardize said surgical technique with transvaginal extraction, identifying the critical steps and possible complications. Materials and methods: A woman in the fourth decade of life was multiparous, with a history of recurrent urinary infections secondary to right renal hypoplasia. Right kidney nonfunction was documented through scintigraphy. A traditional surgical technique was proposed. The robotic-assisted laparoscopic transperitoneal approach was performed, with the use of 2 robotic trocars, one abdominal accessory trocar, and one transvaginal accessory trocar. Results: Two robotic trocars, one accessory trocar at the pouch of Douglas, and one abdominal accessory trocar were utilized. Surgery duration was 45 minutes after robot-patient docking, with blood loss of 30 ml. Hospital stay was 2 days and analgesic use was 5 days. The patient presented with the complication of a urinary tract infection in the late postoperative period that merited antibiotic therapy. There were no other complications. Conclusion: The robotic-assisted laparoscopic approach, utilizing a natural orifice for surgical specimen extraction, reduces costs, as well as intraoperative and postoperative morbidity, surgery duration, intraoperative blood loss, hospital stay, and analgesic use.