[UROTAC-crossed renal ectopia].
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Diagnostic Techniques, Urological↗
Biomedical subjects
F Domínguez Freire
Publications and source records attributed to F Domínguez Freire.
[The usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progresion of the prostate cancer after radical prostatectomy].
OBJECTIVE: To evaluate the usefulness of Ki67 expression in the biopsy specimens, to predict the biochemical progression of the prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the Ki67 expression in the biopsy specimens of 103 patients treated with radical prostatectomy. The mean follow up is 3.4 years (1.3-8.8 years). We correlate the biochemical progression with traditional prognostic factors as the PSA (> 10/< or = 10), Gleason (> or = 7/< 7), pT classification (pT3/pTO-2) and immunohistochemical factor Ki67 (> 3%/< or = 3%). RESULTS: Of all 103 patients, in 71 (69%) biochemical progression was not detected and in 32 (31%) biochemical progression was detected. The mean of preoperative PSA is 10.07 ng/ml in the patients without progression and 20.90 ng/ml in the patients with biochemical progression (p=0.0001). The mean of Gleason score in 6.03 in the patients without progression and 6.75 in the patients with biochemical progression (p=0.0001). The percentage of Ki67 expression is 3.95% in the patients without progression and 5.05% in the patients with biochemical progression (p=0.030). The tumors pT0-2 progressed 12/67 (17.9%) and the tumors pT3 progressed 20/36 (55.6%) (p=0.0001). Multivariant regression analysis indicate that it does not exist a statistically significant relation between Ki67 (> 3%/< or = 3%) expression in the biopsy specimens and the biochemical progression of the prostate cancer after radical prostatectomy (p=0.204). CONCLUSIONS: The immunohistochemical factor Ki67 (> 3%/< or = 3%) in the biopsy specimens, is less effective than the classic factors, PSA (> 10/< or = 10), Gleason (> or = 7/< 7) and pT classification (pT3/pT0-2), to predict the biochemical progression of the prostate cancer after radical prostatectomy.
Aged↗
[Mucinous adenocarcinoma of the urachus].
OBJECTIVE: The Adenocarcinoma of the Urachus is very rare tumor, with an incidence of 1/5,000,000 inhabitants, represents less than 0.001 of all types of bladder cancer. CASE REPORT: A 51 year old man with a chronic history of suprapubic pain and hematuria. Physical examination and excretory urography were normal. The cystoscopy demonstrated a oedematosa area in cupola of bladder wall. The transuretral biopsy was moderately differentiated adenocarcinoma, with positive antibody to CK7 and CK20, the carcinoembryonic antigen was 6.6 ng/ml. Extended partial cystectomy was done, followed for chemotherapy and radiotherapy. CONCLUSIONS: The treatment of adenocarcinoma of the urachus with a combination of extended partial cystectomy, chemotherapy and radiation, is a effective treatment.
Adenocarcinoma, Mucinous↗
[Clinical and biological progression of incidental prostatic cancer ( Stage T 1a)].
OBJECTIVES: To analyze the biological and clinical progression of the prostate cancer stage T1a. MATERIAL AND METHODS: Retrospective study of 44 patients diagnosed of T1a prostate carcinoma between 1985 and 2001. We value biological and clinical progression, time up to the progression, mortality for tumour reason and survival, with the following stratification: patients without initial treatment and patients treated by means of external radiotherapy or radical prostatectomía. RESULTS: Of all 44 patients biological progression was observed in 5 (11.36%) and clinical progression in 4 (9.09%). The mortality to 5 years for tumour reason was of 2 (4.54%). Of all 38 patients without initial treatment biological progression was observed in 5 (13.15%), in an average time of 25.8 months and clinical progression in 4 (10.52%), in an average time of 34.5 months. The mortality to 5 years was of 2 (5.26%). In all 6 patients to whom radical treatment carried out them progression was not observed and they all live. There are no statistically significant differences between both groups of patients (p = NS). CONCLUSIONS: The biological and clinical progression of the T1a prostate cancer is low, 11.36% and 9.09%, respectively. The mortality to 5 years is of 4.54%. Differences of survival do not exist, statistically significant, between treated and not treated.
Adenocarcinoma↗
[Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy].
OBJECTIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.
Adenocarcinoma↗
[Indications for BCG in surface tumors of the bladder].
Overall view of Bacille de Calmette-Guerin (BCG) immunotherapy in the prophylaxis and treatment of surface cancer of the bladder. A series of issues, on some of which a consensus has been reached while controversy is still frequent in others are discussed. Intravesical instillation of BCG as the single route has been considered to best mode of administration. With regard to the BCG strain to be used, there is still no consensus after the analysis of the data provided by the studies conducted. Relative to the treatment schedule, it appears clear that maintenance therapy is superior to an exclusively induction regime. No consensus has been reached about optimal dosage or the possibility to reduce toxicity. Although some studies support the belief that intravesical immunotherapy with BCG is superior to chemotherapy, further data is required to confirm such assumption. In conclusion, although treatment with BCG has proven to be effective in patients with surface tumours of the bladder, it should not be considered a panacea to be indiscriminately used in any patient with this malignancy.
BCG Vaccine↗
[Metastatic prostate adenocarcinoma in hernial sac. Contribution of one case].
Presentation of a case of stage D2 prostatic adenocarcinoma, diagnosed through a chance finding of micrometastasis in the pathohistological study of the hernial sac of a patient undergoing inguinal herniorrhaphy. Most usual sites for prostate cancer metastasis are lymph nodes, bones, lungs, liver, and brain. During our revision of unusual anatomical sites for prostatic carcinoma metastasis, we found references of metastasis on the uvea, larynx, orbit and maxillary sinus. The peritoneal cavity was not found to be a common site for metastatic implants. It was also found that such peritoneal spread was usually diagnosed after a postmortem examination.
Adenocarcinoma↗
[A massive hernia of the bladder into the scrotum. A report of a case].
The hernia of the bladder in the scrotum is a highly uncommon observation. From the clinical standpoint the usual manifestation is a two-stroke voiding. The recommended urological examinations to reach a diagnosis are ultrasound, endovenous urography, retrograde urethrocystography and cystoscopy. Management includes the de-obstruction of the lower urinary tract, if present, resection of associated peritoneum, resection or reduction of the vesical hernia and repairment of inguinal path. The case contributed corresponds to a vesical hernia in a 72-year-old patient, with no obstructive cause, that was treated surgically by resection of the herniated bladder, with good morphological and functional results.
Aged↗
[Superficial cancer of the bladder: which controls should follow and for how long the free of tumor patients?].
OBJECTIVES: To answer the following question: what monitoring and for how long should be maintained in patients with Ta-T1 vesical neoplasia and no tumoral relapse? MATERIAL AND METHOD: Analysis of relapse probabilities in 123 patients with Ta-T1G1G2G3 primary tumours who had not relapsed for at least three years of follow up after transurethral resection. All patients were treated between January 1976 and December 1986; they all have follow-up potential of over 10 years. Mean follow-up 8.1 years, minimum 4 years, maximum 18 years. RESULTS: Probabilities of relapse at 3 to 5 years, 6 to 10 years, 11 to 18 years are 18%%, 24% and 13%, respectively. Relapses were superficial in 38 cases (90%), infiltrant in 4 (10%) G1 in 21 (50%), G2 in 12 (29%), G3 in 9 (9%), single in 33 (79%), multiple in 9 (21%), under 2 cm in 35 (83%), over 2 cm in 7 (17%). CONCLUSIONS: Epidemiologically, individuals with a background of surface vesical tumour have a much higher risk of relapse than the Spanish normal population and therefore they should be monitored for life. Relapses are usually superficial, low grade, single and small in size. Cystoscopy is the monitoring technique offering more possibilities for detection.
Adult↗
[Prevention of superficial bladder cancer with mitomycin C or interferon: final results of a prospective study].
OBJECTIVES: Herein we present the final results of a prospective randomized study comparing two prophylactic treatment modalities for superficial bladder tumors: chemotherapy with mitomycin C and immunotherapy with interferon. METHODS: The study comprised 65 patients. Mitomycin C was utilized in 34 and interferon in 31 patients. RESULTS: The mitomycin C-treated patients had 41% recurrence, 1.7 recurrence/100 patients-month, 17 months mean time to recurrence and 8.8% tumor progression. The patients receiving interferon had 45% recurrence, 2.4 recurrence/100 patients-month, 12 months mean time to recurrence and 22.2% tumor progression rate. No significant differences were observed between the two groups of patients. Treatment was well-tolerated by both groups and the cost:efficacy ratio was higher for the interferon-treated patients. CONCLUSIONS: Immunoprophylaxis with interferon is as effective, but costs more than chemoprophylaxis with mitomycin C. Both agents have a moderate effect relative to control of recurrence, time to recurrence and tumor progression.
Adult↗
[Unilateral agenesis of the vas deferens, a clinical sign useful for the diagnosis of genitourinary malformations].
Unilateral absence of the vas deferens is a rare anomaly in healthy men. Its infrequently clinical sign has been associated with ipsilateral genitourinary anomalies in the 80% of cases. We report a clinical case of a asymptomatic youngman with unilateral absence of the left was deferens presented in the time of elective vasectomy and associated with ipsilateral genitourinary anomalies. We review the literature about it. In conclusion, the palpation of the vas deferens should always be part of routine urological examination.
Abnormalities, Multiple↗
[Cystitis folicular. A case report and review of the literature].
OBJECT: We report a patient with cystitis follicularis and review the literature about it. CLINICAL CASE: A man 78 years old with prostate cancer, who need a permanent bladder catheter. We make a desobstructive TUR, prostate resection and many nodular lesions in the lateral walls and bladder down. The diagnostic was cystitis follicularis. CONCLUSIONS: The cystitis follycularis is a cystitis inespecific and chronic kind with a important inflammation made of lymphocytes and plasmatic cells. Its makes lymphocytes foliculos in the bladder subepithelial wall. The indefination its alive about cystitis follicularis etiopageny, treatment and prognostic. The histopathology study is neccessary.
Aged↗
[Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy].
OBJECTIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12%) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy <0.20 ng/ml. b) The time to biochemical recurrence >6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of follow-up of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.
Follow-Up Studies↗
[Prognostic implications of positive margins in radical prostatectomy specimens].
UNLABELLED: To evaluate the histopathologic implication of positive margins of prostatectomy specimens in the biochemical recurrence. MATERIAL AND METHODS: The study group consisted of 290 patients with clinically localized prostate cancer who were treated by radical retropubic prostatectomy. Patients with neoadjuvant hormonal therapy and positive lymph nodes were excluded. The mean age at the time of surgery was 63 years (range 47-73); 166 (57.2%) patients were T1c and 124 (42.8%) T2; the average time of folow-up was of 4 years (range 1-12). Positive surgical margins were defined as the presence of cancer cells at the surface inked of prostatectomy specimens. They were classified as: Margin for capsular incision (without extraprostatic extension evidence)/ margin for extraprostatic extension, margin with smooth rounded surface/margin with irregular surface, margin < or = 4 mm/margin > 4 mm, unifocal margin/multifocal margin. We define biochemical recurrence if the PSA exceeds 0.20 ng/ml in two consecutive determinations. RESULTS: The overall rate of positive margins was 65/290 (22.4%). The 5-year survival free of biochemical recurrence was as follows: Negative margins 71% vs positive margins 44% (p < 0.001); positive margins for capsular incision 84% vs positive margins for extraprostatic extension 33% (p < 0.01); positive margins with smooth rounded surface 58% vs positive margins with irregular surface 26% (p < 0.01); positive margins < or = 4 mm 57% vs positive margins > 4 mm 32% (p < 0.05); unifocal margins 53% vs multifocal margins 0% (p < 0.01). The multivariate analysis revealed that preoperative PSA, Gleason score and pathological classification were the best predictors of biochemical recurrence. CONCLUSIONS: Two groups are established of positive margin. The first group with high probability of biochemical recurrence: margin for extraprostatic. The second group with less probability of biochemical recurrence: margin for capsular incision, margin with smooth rounded surface, margin < or = 4 mm and unifocal margin.
Aged↗
[Extragonadal germ cell tumor with "burned-out" phenomenon in the testis].
The "burned-out" phenomenon in germ-cell neoplasias is defined by the presence of an extragonadal germ-cell tumour with no tumour at the testis level where a series of distinctive histological lesions can be detected indicative of the earlier presence of an already disappeared testicle tumoration. Extragonadal germ-cell tumours with "burned-out" phenomenon show better evolution than their primary counterparts and are treated similarly to primary tumours of the testis. Currently, in the presence of retroperitoneal tumoration, a scrotal ultrasound study with high frequency transducers can lead to a suspected picture of tumoral involution. This paper contributes one retroperitoneal seminoma with "burned-out" phenomenon in the homolateral testis in a 35-year old patient. Available clinical and radiological criteria were enough to reach a suspected diagnosis. Homolateral orchiectomy and biopsy of retroperitoneal tumoration were performed, rounding treatment up with polychemotherapy. Evolution was good with immediate complete response.
Adult↗