Service of Urology

Huércal-Overa, Spain

Service of Urology

Huércal-Overa, Spain
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Imbimbo C.,University of Naples Federico II | Creta M.,University of Naples Federico II | Gacci M.,University of Florence | Simonato A.,University of Genoa | And 8 more authors.
Journal of Sexual Medicine | Year: 2011

Introduction. Preservation of sexual function after surgery represents a major issue for patients undergoing radical prostatectomy (RP). Aim. To investigate determinants of patients' desire to preserve sexual activity before RP and surgeons' final decision to perform a nerve-sparing RP (NSRP). Methods. Overall, 2,408 prostate cancer patients, candidates to RP, from 136 urologic departments across the Italian territory were evaluated in a multicenter prospective observational study. All patients underwent RP, according to single-center indications and procedures. Main Outcome Measures. Age, body mass index, previous benign prostatic hyperplasia history, preoperative tumor characteristics, quality of life through the Short Form Health Survey (SF-12), and the University of California Los Angeles Prostate Cancer Index (UCLA-PCI), erectile function through the International Index of Erectile Function (IIEF-5), desire to preserve sexual activity, NS operative outcomes, and surgical margins status were recorded. Results. Overall, 1,667 were interested to preserve sexual activity. Age, physical component summary of SF12 (PCS-12), sexual function score of UCLA-PCI, and IIEF-5 score were the main determinants of such interest. Only 1,246 patients were suitable for a NSRP according to guidelines. Surgeons performed a non-NSRP (NNSRP) in 1,234 patients, a unilateral NSRP in 318 and a bilateral NSRP in 856. Age, bioptical Gleason score, percentage of positive cores, PCS-12, and patient's desire to preserve sexual activity were the main determinants of final decision for a NSRP. Surgeons performed a NSRP in 424 not suitable and in 121 not interested patients. Positive surgical margins in not suitable patients submitted to NSRP were not higher if compared to that obtained after NNSRP in the same subgroup. Limits include lack of oncological and functional follow-up. Conclusions. Most patients are interested to preserve sexual activity. Discrepancies exist among patients' preferences, guidelines' indications, and surgeon's final decision. © 2011 International Society for Sexual Medicine.

Martin L.B.,Complejo Hospitalario Universitario La Coruna | Pereira P.P.,Complejo Hospitalario Universitario La Coruna | Lista F.S.,Service of Urology | Castanon L.B.,Complejo Hospitalario Universitario La Coruna
Archivos Espanoles de Urologia | Year: 2013

Objective: To report a case of a mesothelioma of the tunica vaginalis and to review the published literature. Methods/Results: A 61-year-old patient complained of one-month increase of right scrotum size with pain. An ultrasound showed a right hydrocele with a mass attached to the tunica vaginalis. He didn't refer any urological history or known exposure to asbestos. Blood levels of tumor markers (alpha-fetoprotein and beta-HCG) were within normal limits. We performed a radical inguinal orchiectomy with an en-bloc resection of the tunica vaginalis. The pathology described a potentially malignant biphasic mesothelioma. The patient has remained asymptomatic with negative extension studies after 10 years of follow up. Conclusions: Paratesticular mesotheliomas are rare tumors (approximately 250 cases reported) with uncertain etiology (only 30-40% are associated with asbestos exposure). The age range is between 50-70 years. Its presentation is usually as a scrotal mass with recurrent reactive hydrocele, which may delay early diagnosis. During surgery, intraoperative biopsy is recommended. It is important to do a differential diagnosis with other benign diseases. Treatment is only curative in early stages with radical orchidectomy and resection in-block of the tunica vaginalis. Despite being multidisciplinary, it is not curative in most cases due to rapid local and distant spread.

Lapi F.,Jewish General Hospital | Lapi F.,McGill University | Lapi F.,University of Florence | Azoulay L.,Jewish General Hospital | And 6 more authors.
JAMA - Journal of the American Medical Association | Year: 2013

IMPORTANCE: The use of androgen deprivation therapy (ADT) in the treatment of advanced prostate cancer has been shown to delay the clinical progression of the disease. However, the testosterone suppression associated with this therapymay lead to a hypogonadal condition that can have detrimental effects on renal function, thus raising the hypothesis that ADT-induced hypogonadism could potentially lead to acute kidney injury (AKI). OBJECTIVE: To determine whether the use of ADT is associated with an increased risk of AKI in patients newly diagnosed with prostate cancer. DESIGN AND SETTING: A nested case-control analysis using medical information extracted from the UK Clinical Practice Research Datalink linked to the Hospital Episodes Statistics database. PARTICIPANTS: Men newly diagnosed with nonmetastatic prostate cancer between January 1, 1997, and December 31, 2008, were selected and followed up until December 31, 2009. Cases were patients with incident AKI during follow-up who were randomly matched with up to 20 controls on age, calendar year of prostate cancer diagnosis, and duration of follow-up. MAIN OUTCOMES AND MEASURES: Conditional logistic regressionwas used to estimate odds ratios (ORs) with 95%CIs of AKI associated with the use of ADT. ADT was categorized into 1 of 6 mutually exclusive groups: gonadotropin-releasing hormone agonists, oral antiandrogens, combined androgen blockade, bilateral orchiectomy, estrogens, and combination of the above. RESULTS: A total of 10 250 patients met the study inclusion criteria. During a mean follow-up of 4.1 (SD, 2.9) years, 232 incident cases of AKI were identified (rate, 5.5/1000 person-years). Overall, current use of any ADT was associated with an increased risk of AKI when compared with never use (OR, 2.48 [95%CI, 1.61-3.82]), generating a rate difference of 4.43/1000 persons per year (95%CI, 1.54-7.33). This association was mainly driven by a combined androgen blockade consisting of gonadotropin-releasing hormone agonists with oral antiandrogens (OR, 4.50 [95%CI, 2.61-7.78]), estrogens (OR, 4.00 [95%CI, 1.06-15.03]), other combination therapies (OR, 4.04 [95%CI, 1.88-8.69]), and gonadotropin-releasing hormone agonists (OR, 1.93 [95%CI, 1.20-3.10]). CONCLUSIONS AND RELEVANCE: In a cohort of patients with newly diagnosed nonmetastatic prostate cancer, the use of ADT was significantly associated with an increased risk of AKI. These findings require replication in other well-designed studies as well as further investigation of their clinical importance.

Decrausaz L.,Service of Urology | Revaz V.,Service of Urology | Bobst M.,Service of Urology | Corthesy B.,University of Lausanne | And 2 more authors.
International Journal of Cancer | Year: 2010

Cervical cancer, the second leading cause of cancer mortality in women worldwide, results from infection with a subset of human papillomaviruses (HPV), HPV-16 being the most prevalent type. The available prophylactic vaccines are an effective strategy to prevent this cancer in the long term. However, they only target 70-80% of all cervical cancers and cannot control existing HPV infections and associated lesions. Therapeutic vaccines are thus necessary for women who cannot benefit from prophylactic vaccination. Induction of protective immune responses in the genital mucosa (GM) may be crucial for efficacy of HPV therapeutic vaccines. We report here that mice that received a single subcutaneous (s.c.) vaccination of an adjuvanted long synthetic HPV16 E7 1-98 polypeptide showed induction of 100% tumor protection against s.c. TC-1 tumors and that tumor regression was mainly provided by CD8 T cells. In vivo cytotoxic assay revealed high E7-specific cytolytic T lymphocytes activity in spleen and in genital draining lymph nodes (LN), and E7-specific CD8 T cells could be detected in GM by tetramer staining. More importantly, high-avidity E7-specific INF-γ secreting CD8 T cells were induced not only in blood, spleen and LN but also in GM of vaccinated mice, thus providing evidence that a parenteral vaccination may be sufficient to provide regression of genital tumors. In addition, there was no correlation between the responses measured in blood with those measured in GM, highlighting the necessity and relevance to determine the immune responses in the mucosa where HPV-tumors reside. © 2009 UICC.

Arrabal-Polo M.A.,Service of Urology | Cano-Garcia M.D.C.,Service of Urology | Parra M.,Service Administration Surgical Waiting list | Gomez P.,Unit of Information Systems and Communication | And 3 more authors.
Archivos Espanoles de Urologia | Year: 2015

OBJECTIVES: To improve the rates of surgical activity and average waiting times for surgery, and to optimize the number of surgical indications in the Urology Department of a Regional Hospital. METHODS: A study and analysis of the surgical activity and different indexes in 2014 was performed comparing the first half of the year and the second half after implementation of improvement measures. Study variables: operating room occupancy rate, average hospital stay, cancellations, surgical complexity, average number of surgeries per operative room, average global waiting time and waiting time by 120 and 180 days guarantee decrees following the Junta de Andalucía standards. RESULTS: In comparison with the first half of 2014, in the second half the operating room occupancy rate increased from 79% to 85%, the average stay decreased from 6 to 3 days, and a decrease in cancellations from 9% to 6% was observed. Moreover, a decrease in the mean waiting times was observed for surgeries subject to both the 120 days and 180 days guarantee decree and a decrease in the number of surgical indications in urology through the implementation of protocols based on clinical practice guidelines. CONCLUSIONS: Despite the limitations of the study, and being a small Department in a district hospital, we observed that optimization of resources, implementation of protocols, and clinical pathways can improve and optimize different indicators of surgical activity.

Touijer K.,Service of Urology | Fuenzalida R.P.,Service of Urology | Rabbani F.,Service of Urology | Paparel P.,Service of Urology | And 5 more authors.
BJU International | Year: 2011

OBJECTIVE To assess, in a risk/benefit analysis, the additional risk for complications and benefits of extending the indications and anatomical limits of pelvic lymph node dissection (PLND). PATIENTS AND METHODS In total, 971 consecutive patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy from 2003-2007. Before 1 February 2005, patients with a nomogram probability of lymph node invasion (LNI) <2% did not undergo PLND (No PLND group), whereas those with a LNI ≥2% had a PLND limited to the external iliac nodal group (limited PLND group). After 1 February 2005, all patients underwent a standard PLND including the external iliac, hypogastric and obturator fossa nodal groups (standard PLND group). The risk parameters were PLND-related complications and operating time. Complications were graded using a modified Clavien classification. The benefit was the detection of nodal metastases. RESULTS In the subgroup of patients with a LNI ≥2%, standard PLND was a superior operation than the limited PLND in detecting nodal metastases (14.3% vs 4.5%, respectively; P = 0.003). The risk/benefit of standard vs limited PLND would be one additional grade 3 complication per 20 additional patients with nodal metastases. In the subgroup of patients with LNI <2%, three patients (1.0%) had positive nodes after a standard PLND. The risk/benefit of standard PLND vs no PLND would be one additional grade 3 complication per three or four additional patients with nodal metastasis. The no PLND group was associated with the lowest risk of grade 1, 2 and 3 complications compared to either the limited or standard PLND groups (P < 0.001). CONCLUSIONS In patients with LNI ≥2%, standard PLND detects more nodal metastasis. PLND is associated with higher but non-prohibitive complications rate. The present study found no evidence that the incidence of complications would be reduced by a limited PLND. © 2010 BJU INTERNATIONAL.

Perez C.S.,Service of Urology | Martinez S.V.,Service of Urology | Zorzo O.H.,Service of Urology | Parada A.M.,Service of Urology
Archivos Espanoles de Urologia | Year: 2016

OBJECTIVE: We report two cases of patients with a previous diagnosis of hematologic tumor who present with testicular recurrence, and we carry out a review of the literature regarding the infrequency of this pathology. METHODS: We present a retrospective review of the medical records of two patients diagnosed with hematologic malignancies (acute myelogenous leukemia and multiple myeloma) with occurrence of relapse in the testicle. We reviewed the management and outcome after treatment with bilateral orchiectomy. RESULTS: Case 1: The patient was diagnosed with acute myeloid leukemia and treated with an allogeneic transplant. Two years later, the patient reported an increase in testicular size. The complementary studies lead us to suspect a testicular recurrence that was confirmed after orchiectomy. Currently, the patient awaits the start of a chemotherapy treatment prior to a new allogeneic transplant. Case 2: Patient with the diagnosis of multiple myeloma who started a polychemotherapy treatment without response and underwent allogeneic transplant. After five months with complete remission, there were signs of systemic recurrence, and a study for a new transplant was carried out. During the study, potential testicular recurrence was observed. After a batch of complementary tests, bilateral orchiectomy was performed and the diagnosis was confirmed. Currently, the patient is undergoing an allogeneic transplant protocol after radiotherapy and chemotherapy treatment. CONCLUSIONS: Currently the mortality rate in cases of relapse of hematologic malignancy in the testicle has declined despite the sharp rise in its incidence. This is because of, as in our case, early diagnosis and the combined use of chemotherapy, radiotherapy and surgery. This has been achieved through an interdisciplinary collaboration of urologists, hematologists, oncologists and radiotherapists.

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