Search

Introduction: Radiotherapeutic treatment of prostate cancer has been validated in terms of efficacy, but its relationship with the occurrence of second pelvic primary malignancy and the relevance of radio-induced toxicity is still under debate. This study analyses the occurrence of second pelvic primary malignancy as well as morbidity secondary to radiotherapy treatment in patients treated for prostate cancer., Material and Methods: Retrospective consecutive descriptive study of 317 patients who received radiotherapy treatment for prostate cancer between 2007 and 2017. Predictor variables, side effects and the appearance of second pelvic primary malignancy during a maximum follow-up of 10 years were collected. We analyse whether there is a significant relationship in the appearance of second pelvic primary malignancy and describe the clinical toxicity presented by the patients., Results: The median age was 62.27 years and the most commonly employed treatment modality was brachytherapy with IMRT (60%). 17 patients (5.4%) developed a second pelvic primary malignancy, with a median time to onset of 58 and 25 months for bladder and colon tumours, respectively. Local recurrence and mortality rates are 8% and 7%, respectively. Statistically significant association is demonstrated for the occurrence of second pelvic primary malignancy and for chronic radioinduced toxicity according to type of radiotherapy χ 2 (4) = 16.34; p = 0.003 and χ 2 (1) = 6.47; p = 0.011 respectively., Conclusions: In our series, the occurrence of a second pelvic primary malignancy is statistically associated with the modality of radiotherapy administered and occurrence of chronic adverse effects.

Urolithiasis is a multifactorial and recurrent disease whose incidence is increasing, especially in women but also in the paediatric population. Differences can be found between different regions and between different ethnicities, often due to dietary and environmental factors, without forgetting the genetic influence on different types of stones. There are disease sthat require a high index of suspicion in order to reach a diagnosis, such as renal tubular acidosis (RTA), not only for the benefit of the patient but also for their family members in the case a genetic mutation. Calcium-based stones continue to be the most frequent, but with a progressive increase in uric stones...

Introduction: Renoureteral colic (CRU) is the most common urological emergency, with a wide spectrum of severity that generates high morbidity and high health costs. However, there is no homogeneous scheme of pharmacological treatment in its acutephase., Aims: The main objective of our work is to evaluate the effectiveness and safety profile of the different drugs used in the treatment of CCR and to propose a practical treatment scheme. The secondary objectives are to evaluate the role of fluid therapy in CRU and the treatment of CRU in pregnant women. MATERIAL AND METHODS: We have carried out a literature search on PubMed using the MeSH terms "renalcolic", "treatment", "anti-inflammatory drugs", "antiemeticdrugs", "fluid therapy" and "pregnant". The most relevant clinical trials, meta-analyses and systematic reviews published from 1 January 2005 to 15 September 2020 in Spanish, English and French were reviewed., Results: In the different studies reviewed, non-steroidalanti-inflammatory drugs (NSAIDs) show better pain control, with lower rescue doses and fewer side effects than treatment with opioids. However, fluid therapy has failed to demonstrate an impact on the treatment of CRU., Conclusions: The initial treatment for CRU is NSAIDs, reserving opioids for successive treatment lines. The control of vegetative cortex can be accomplished with Ondansetron as first choice.

Introduction: Medical Expulsive Treatment (MET) for ureteral stones has been questioned for the last few years., Objectives: The main goal of our study is to define the indications of MET, the different drugs that are used and their effectiveness and to propose a follow-up strategy. Secondary objectives include the effectiveness of MET in some special subgroups such as pregnant women and children and to assess aspects of MET cost-effectiveness compared with other options for ureteral lithiasis treatment (ureterorenoscopy or extracorporeal shock wave lithotripsy)., Material and Methods: We have reviewed the most relevant clinical trials and meta-analysis evaluating the impact of the different drugs available for MET. For the research we used some keywords like "medical expulsive treatment/therapy", "ureteral lithiasis", "urolithiasis", "effectiveness", "alpha-blockers" and "calcium-antagonists". MEDLINE database was used for there search (using the portal web Pubmed)., Results: Highest quality studies currently availables how significant methodological limitations leading to heterogeneous and restricted evidence, which is only applicable to patients and lithiasis with specific conditions. Nevertheless, in general terms, it seems that MET can play a certain role in the expulsion of lithiasis ≥ 5mm y ≤ 10 mm located in the distal ureter, although it has not been possible to demonstrate that any of the drugs used may have special superiority in terms of effectiveness. In pregnancy and children, the recommendations of MET are also irregular. Finally, MET seemsto be an alternative cost-effective compared to active options of treatment., Conclusions: Higher quality clinical trials are needed to reliably advice MET. With the current evidence, it appears that MET can improve the expulsion of distal ureteral lithiasis ≥ 5 mm and ≤ 10 mm, even though we have not found differences between the drugs that are available for MET.

Objectives: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC undergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC)., Material and Methods: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test., Results: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria.In this group 21.7% achieved undetectable PSA (group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p=0.000, OR 2.78), Gleason score group 4-5 (p=0.000, OR 2.33), and not to reach undetectable PSA after ADT (p <0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT., Conclusions: We present a sample of patients with advanced PC in treatment with ADT that shows heterogeneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA<0.1 ng/ml after ADT is presented as an indicator of progression to the CRPC stage.

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis' patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way.

Micro-ureteroscopy is a novel technique derived from the need to reduce the morbidity associated with conventional ureteroscopy. Reducing morbidity, we will be able to improve quality of life of patients, for example, by shortening the times to elimination of the stones. In this article the authors intend to expose the different applications of micro ureteroscopy as well as the incipient scientific evidence on the topic.

Objectives: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices., Methods: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively., Results: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases., Conclusions: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures.

Objectives: To report a case of perivesical hematoma without previous trauma in a patient under anticoagulant treatment., Methods: A 70-year-old female admitted with a transitory ischemic cerebrovascular accident was given sodium heparin. Four days later she presented with abdominal distention and hypogastric discomfort. Abdominal ultrasound showed a big perivesical hematoma., Results: CT scan confirmed the presence of a big hematoma. The hematoma was drained five days later after an optimal coagulation profile. Patient was discharged with normal ultrasound after an uneventful postoperative course., Conclusions: Spontaneous bleeding in patients with coagulation abnormalities is a well-known event, although there are few bibliographic references about primary perivesical blood collections. We opted for deferred drainage of the hematoma to avoid perivesical fibrosis.