Biomedical subjects

Humberto Villavicencio Mavrich

Publications and source records attributed to Humberto Villavicencio Mavrich.

11 recordsLinked to original sources

PubMed2006

Intravesical instillations with bacillus calmette-guérin for the treatment of carcinoma in situ involving prostatic ducts.

OBJECTIVES: Bacillus Calmette-Guérin (BCG) has proven its efficacy in the treatment of carcinoma in situ (CIS) of the prostatic urethra. We performed a retrospective study to evaluate the use of intravesical instillations of BCG in patients with carcinoma in situ involving prostatic ducts after complete transurethral resection (TUR). MATERIAL AND METHODS: Eligibility for the study was CIS of the prostatic urethra involving prostatic ducts. Previous instillation with BCG was an exclusion criterion. Patients were treated with intravesical BCG Connaught (81 mg) administered once a week, over a 6-wk period. TUR loop biopsies of the prostate were performed only when a macroscopic tumor was present. RESULTS: In this retrospective study of 11 patients, 8 (73%) presented with macroscopic tumor in the prostatic urethra. Ten patients (91%) had a simultaneous superficial bladder carcinoma. Eight patients (73%) had tumoral involvement of the bladder neck region. After a median follow-up of 27 mo (n=10 patients), the response in the prostatic urethra was 82%, and the response in the bladder due to superficial tumor recurrence was 64%. Two patients with residual ductal disease in the prostatic urethra were subsequently treated with cystoprostatectomy and are currently free of disease. In one of those patients, the cystoprostatectomy specimen did show prostatic stromal invasion. Another patient developed distant metastatic disease and died a few months after diagnosis. Thus, progression was encountered in two patients (18%). Currently, 90% of patients are alive without evidence of disease and 72.7% have benefitted from this bladder preservation strategy. CONCLUSION: Intravesical BCG is a feasible treatment option for patients with CIS involving prostatic ducts. In this retrospective study, bladder preservation was successful in 8 of 11 patients (70%) and there was only one oncologic death. Obviously, these patients need a careful follow-up with cystoscopy and cytology to detect either recurrence or progression and in those with persistent disease after the initial BCG induction therapy, prompt cystectomy is indicated.

Adjuvants, Immunologic↗

PubMed2006

[Determination of P53 in infiltrative primary bladder tumors as a prognostic factor for understaging].

OBJECTIVES: To determine if p53 expression in patients with infiltrative bladder cancer is a prognostic factor on clinical staging and cancer specific survival. METHODS: Immunohistochemical analysis of p53 in 34 patients (33 males and 1 female) undergoing radical cystectomy for infiltrative bladder cancer, with a mean follow-up of 16 months. RESULTS: p53 overexpression was detected in 18 patients (64%). In the p53 positive group two patients were stage T1G3, 18 patients T2, 1 patient T3, and 2 patients T4. In the negative group a better correspondence between TUR and cystectomy stage was found, with stage worsening only in 3 patients. On follow-up, p53 positive patients showed worse outcomes due to their worse stages, although no statistical differences were found (p = 0.24). In the group of patients following a bladder sparing protocol (n = 6), p53 negative patients had complete remission of the disease. CONCLUSIONS: We see significant differences on understaging/more aggressive local outcome in p53 positive patients, with no greater mortality in this group. P53 expression does not contraindicate the inclusion of a patient in a bladder sparing protocol, although larger studies would be necessary to confirm these results.

Aged↗

PubMed2006

[Radical prostatectomy in patients with history of transurethral resection of the prostate].

OBJECTIVES: To perform a retrospective evaluation of surgical complications and morbidity in patients undergoing radical retropubic prostatectomy (RRP) as elective treatment for organ-confined prostate cancer in our center with previous transurethral resection of the prostate (TURP). METHODS: Between 1980-2004 we performed 59 radical prostatectomies in patients with previous TURP. We analyze the morbidity and mortality of the RRP, its functional outcomes, and the accordance between clinical and pathological stage. RESULTS: Mean time between TURP and RRP was 16 months. Mean patient age at the time of diagnosis was 63 years. Clinical stage: 16 T1a, 18T1b, 20T1c, 3T2a, 2T2b. Average surgical time was 180 minutes. Intraoperative events: technical difficulties in the dissection of the gland 57%, bladder neck preservation 27%, neuro vascular bundles preservation 3.39%, ureter ligation 1.69%, rectal laceration 1.69, urethrorrhagia 1.69%, urinary leak 5%, and blood transfusions 11.8%. Postoperative complications: urinary tract infection 10.17%, wound infection 10.17%, pelvic hematoma 5.08%, deep vein thrombosis 1.69%, and one sudden death of unknown cause one month after surgery. Pathologic report: 49pT2b, 8 pT3 and 2pT4. Late complications: erectile dysfunction 85.7%, vesicourethral anastomosis stenosis 10.3%, and complete urinary incontinence 3%. CONCLUSIONS: Radical retropubic prostatectomy in patients with previous TURP is technically more difficult and has comparable outcomes to RRP patients without previous TURP.

Adenocarcinoma↗

PubMed2005

[Renal cell carcinoma associated with contralateral metacronous renal oncocytoma].

OBJECTIVES: To report one case of renal cell carcinoma and contralateral metacronous oncocytoma, and to perform a bibliographic review on the topic. METHODS: 52-year-old male patient with history of right radical nephrectomy for renal cell carcinoma. On his ten-year follow-up multiple lesions appeared in the left kidney. Partial nephrectomy was performed. Pathological study showed three oncocytomas. CONCLUSIONS: The presence of metacronous lesions in the contralateral kidney of a patient with history of renal cell carcinoma is rare. The presence of the same histological type of tumor should always be suspected and the management should follow this suspicion. Contralateral metacronous oncocytoma is a rare pathology which has not been reported in the literature so far.

Adenoma, Oxyphilic↗

PubMed2004

[Penile hematoma secondary to rupture of the superficial dorsal vein of the penis].

OBJECTIVES: To report a very unfrequent case of penile hematoma secondary to rupture of the superficial dorsal vein of the penis during intercourse. METHODS: 35-year-old patient presenting at the emergency department with a half moon shape hematoma in the dorsal part of the penis, not much painful, developed when initiating intercourse that we believe was a rupture of the superficial dorsal vein of the penis. RESULTS: In spite of the few cases of rupture of the superficial dorsal vein of the penis described, and after differential diagnosis with other causes of acute penis, conservative attitude with anti-inflammatory drugs and compressive bandage was undertaken. CONCLUSIONS: The rupture of the superficial dorsal vein of the penis is an unfrequent pathology which should be taken into differential diagnosis in a patient consulting with acute penile edema, the attitude is conservative with complete recovery without sequel.

Adult↗

PubMed2003

Quality of life in prostate cancer patients and controls: psychometric validation of the FACTP-4 in Spanish, and relation to urinary symptoms.

OBJECTIVES: To assess the feasibility and a validity of the Spanish version of the FACT-P and its relation to urinary symptoms. METHODS: The Spanish version of the FACT-P was self-administered to 60 Prostate Cancer patients (pts) waiting to undergo radical treatment and 20 age-matched controls (con) with a negative biopsy. Clinical stage for patients was T1c in 34 and T2 in 26. FACT-P was analysed for internal consistency (Chronbach's a) and relation to symptom scales (IPSS, IPSS bother score and incontinence questionnaire (ICI-SF)). RESULTS: Feasibility (evaluable questionnaires) was 80.9 for con and 95% for pts. Internal consistency was high for all sub-scales (alpha > 0.7). Emotional well-being subscale and IPSS were significantly higher in pts. (worse emotional wellbeing and more lower urinary tract symptoms). There were no statistically significant differences between pts and con. in any of the other FACT-P sub-scores nor in symptom scores. Correlations were found between some FACT-P sub-scores and bother score. CONCLUSIONS: The Spanish version of the FACTP is feasible and psychometrically valid. Pts undergoing treatment for localized disease have similar QoL that a control group, but higher scores for emotional distress and IPSS.

Adenocarcinoma↗

PubMed2003

[Prostatic abscess: report of a case].

OBJECTIVES: To report one case of prostatic abscess which required emergency surgical treatment because of its aggressive evolution. METHODS: We describe the case of a 61-year-old male patient who was diagnosed of prostatic abscess in the emergency room, and initially underwent conservative treatment with antibiotics and urinary diversion. Due to clinical impairment to septicemia and upper urinary tract involvement we decided to perform a surgical perineal drainage. RESULTS: The septic clinical picture resolved immediately, but he presented a prostatic-perineal fistula in the intermediate postoperative period which resolved with prolonged urinary diversion by cystotomy catheter. HIV serologies were performed considering the aggressiveness of picture; they were positive. CONCLUSIONS: We emphasize this case because of the great aggressiveness that presented, possibly due to factors such as diabetes and immunosuppression (HIV). Provided the great variety of presentations of this disease, a high degree of suspicion must be exercised for its diagnosis, and once the diagnosis is got immediate treatment is recommended. We review etiopathogenic factors, clinical findings, diagnosis and therapeutic options.

Abscess↗

PubMed2002

[Efficacy of finasteride in the treatment of hematuria associated with benign prostatic hypertrophy].

OBJECTIVE: To evaluate the efficacy of finasteride in the treatment of prostatic origin haematuria. METHODS: This is a prospective observational study in 29 patients with hematuria from a demonstrated prostatic-origin which were treated with finasteride 5 mg/day. 58.6% had undergone previous prostatic surgery. Both previous-to-treatment hematuria and response to treatment were evaluated under the Puchner & Miller's criteria. RESULTS: Response rate was 86.2% without additional haematuria episodes. The remaining patients had mild haematuria episodes during follow-up. No patient needed surgery. CONCLUSIONS: Finasteride is effective in the treatment of prostatic-origin haematuria.

5-alpha Reductase Inhibitors↗

PubMedDate not supplied

[Radical cystectomy for superficial tumors in the BCG era].

OBJECTIVE: To analyze the indications and outcome of cystectomy for superficial bladder cancer since the introduction of BCG therapy. METHODS: From June 1990 to December 1996, 384 patients underwent cystectomy for transitional cell bladder tumor. A retrospective study was carried out on 43 cases (11.1%) that underwent cystectomy for Tis, Ta, T1 tumors. The characteristics of patients with superficial bladder cancer, correlation between the clinical stage (determined after TUR) and pathological findings (cystectomy specimen) and outcome were analyzed. RESULTS: 36 patients were male and 7 were female; mean age 63 years (range 39-79). Mean follow-up was 48 months (8-120). Twenty-nine patients received BCG therapy prior to surgery. No response to BCG was the main indication for cystectomy. By clinical stage, 79% were high grade, 65% T1 and 65% CIS. A correlation between the clinical stage and the pathological findings was found in 32.5%, overstaging in 28% and understaging in 39.5%. The increase in stage after analysis of the surgical specimen in 13 patients (30%) was due to progression of the superficial bladder tumor to infiltrating or metastatic tumor. Urinary tract tumor was found during follow-up in 8 patients (18.6%). Eleven patients died of bladder cancer, 3 of other causes and 29 (67%) are free of disease. Seven of the 13 patients (53%) that were clinically understaged and had infiltrating tumor or metastasis died. CONCLUSIONS: No response to BCG therapy was the main indication for cystectomy. Before starting conservative treatment for high risk superficial bladder cancer, the possibility of endoscopic understaging should be taken into account. Patients undergoing cystectomy for superficial bladder cancer have a high risk of developing urinary tract tumor.

Adult↗

PubMedDate not supplied

[Laparoscopic adrenalectomy].

OBJECTIVES: To review indications, techniques and results of laparoscopic adrenalectomy. METHODS: We retrospectively review our experience with 8 cases of transperitoneal laparoscopic adrenalectomy (2 pheochromocytomas, 4 aldosteromas, 1 myelolipoma and 1 non functioning adenoma). RESULTS: Mean operative time was about 3 hours, with an mean estimated blood loss of 200 cc. Mean Hospital stay was 2.5 days, complication rate was 10%, being conversion to open surgery between 5 and 10%. CONCLUSIONS: Laparoscopic adrenalectomy is the operation of choice for functioning adrenal tumours and for incidentally diagnosed tumours < or = 6 cm that have increased in size in successive radiographic examinations.

Adenoma↗

PubMedDate not supplied

[Changes in prostate specific antigen levels during intravesical instillations with Calmette-Guerin bacillus: relationship with transurethral resection of the prostate].

OBJECTIVES: To evaluate variations on the serum PSA levels during and after administration of intravesical BCG and its relationship with previous transurethral resection of the prostate (TURP). METHODS: PSA serum concentration variations were studied after each instillation, at 1 month and at 3 months in 24 patients with superficial bladder cancer and/or CIS under weekly BCG instillations treatment. Three patients had undergone TURP. RESULTS: A raise in PSA was observed in 87.5% of the cases during BCG instillations, although the increase was only significative in patients who had undergone TURP. PSA values descended at one and three months. CONCLUSIONS: Endovesical BCG administration produces an increase on serum PSA levels. This variation is higher in patients with history of TURP.

Adjuvants, Immunologic↗