Objective: The objective of the study was to determine the recurrence rate of localized prostate cancer after radical prostatectomy according to the D'Amico classification. Methods: This was a observational and 5-year comparative retrospective cohort study. Data were obtained from clinical records of patients with localized prostate cancer who underwent radical prostatectomy and the recurrence rate of the disease was evaluated. It was analyzed with descriptive and comparative statistical tests, p<0.05 was considered significant. Results: One hundred and eight patients were analyzed, and the average age was 65.3 years. About D'Amico's risk classification, 33.33% low risk, 55.56% intermediate risk, and 11.11% high risk. The prostatespecific antigen (PSA) recurrence rate was 14.81%. Low-risk patients had recurrence of 13.89%, intermediate risk 18.33%, and high risk had no recurrence. Regarding surgical pieces, 25.93% presented adverse characteristics. The post-operative Gleason scale shows an increase of 44.44% in low risk, 26.67% in intermediate risk, and 41.67% in high risk. Conclusions: Radical prostatectomy offers adequate control of localized prostate cancer. The PSA recurrence rate was lower than other international reports. Likewise, the biochemical recurrence of low, intermediate, and high risk was similar to the global trend.
Objetivo: Reportar caso de nefrectomía parcial bilateral con adecuada evolución, exponiendo abordaje médico y quirúrgico. Presentación de caso clínico: Paciente masculino de 70 años, quien es evaluado y se evidencia presencia de masas sólidas renales bilaterales, no se evidencia invasión vascular, ni adenopatías. Dichas lesiones se encuentran limitadas al parénquima renal, por lo que paciente pasa sala de operaciones para realización de nefrectomía parcial bilateral. Pieza quirúrgica en cortes histológicos corresponde a neoplasia con patrón alveolar compuesta por nidos celulares (Carcinoma de células renales, variedad de células claras). Paciente con adecuada evolución post operatoria con buen pronóstico. Discusión: El carcinoma de células renales corresponde un 85-90% de los tumores renales sólidos, estos se presentan en forma bilateral en un 1-4% de los pacientes. El tumor bilateral puede ser sincrónico o asincrónico, los sincrónicos se presentan de forma simultánea o hasta un año luego de diagnosticada la primera lesión y considerando a los que aparecen más tarde como metacrónicos o asincrónicos. El abordaje de dichas lesiones es complejo, la evidencia científica es escasa respecto al abordaje idóneo en tumores renales bilaterales debido a los pocos casos reportados a nivel mundial. Conclusión: La nefrectomía parcial bilateral es un procedimiento quirúrgico con pronostico favorable para los pacientes, conservando la función renal con el fin de proteger la calidad de vida. (1-3)
Introduction. Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment for urolithiasis. Tamsulosin is capable of causing dilation and facilitating the migration of stones. The aim of this study is to evaluate the efficacy of adjuvant treatment with tamsulosin for improving the stone-free rate after a single session of ESWL in the treatment of kidney stones. Methods. This is a randomized, nonplacebo-controlled study with a sample of 60 adults with a single radiopaque kidney stone of 5–20 mm in diameter. After the ESWL session, the patients were divided into two groups. The control group received standard treatment for analgesia consisting of oral diclofenac (75 mg/12 h) as needed. The tamsulosin group received standard treatment for analgesia plus oral tamsulosin (0.4 mg/day) for eight weeks. In both groups, stone-free status was determined using a CT scan eight weeks after ESWL. The protocol of this study was registered with ClinicalTrials.gov, identifier: NCT04819828. Results. Only 57 patients completed the study (28 tamsulosin and 29 control). Overall, the average stone diameter was 11.42 ± 4.52 mm. The stone-free rate was 50.88% (29 of 57) overall, 53.57% (15 of 28) for the tamsulosin group, and 48.27% (14 of 29) for the control group ( p = 0.680). The estimated relative risk in favor of the tamsulosin group to achieve a stone-free status was 1.11 (95% CI 0.67–1.9). The estimated number needed to treat to achieve a single patient with renal stone-free status after eight weeks of ESWL adjuvant treatment with tamsulosin was 19. Conclusion. Our findings suggest that tamsulosin as adjuvant treatment after a single ESWL session is well tolerated and safe, but it does not increase the stone-free rate in patients with a single radiopaque renal stone of 5–20 mm in diameter. Our results may support the use of tamsulosin with ESWL in the case of patients with a single radiopaque renal stone of 11–20 mm in diameter based on an apparent higher stone-free rate and a low rate of complications.
Introducción: Los tumores de tipo fibrotecoma son extremadamente raros, representan el 4 % de las neoplasias gonadales, derivan la túnica albugínea o del estroma gonadal y se asemeja al estroma ovárico, se consideran benignos. El tratamiento será la resección y será curativo si es una enfermedad localizada únicamente en gónadas. Objetivo: Presentar el caso clínico de un paciente masculino de 15 años con un tumor del estroma del cordón sexual de tipo fibrotecoma, características clínicas, exámenes de laboratorio,estudios de imágen y el manejo brindado. Métodos: Se evalúa paciente en consulta externa con evidencia de tumor testicular,se realizan estudios complementarios y se lleva a sala de operaciones realizando orquiectomía radical, la pieza es analizada histológicamente reportando fibrotecoma con cordón espermático libre de tumor. Paciente evoluciona adecuadamente, se da egreso y continua con seguimiento por el departamento de urología. Conclusiones: En pacientes masculinos, la neoplasia de tipo fibrotecoma es considerado poco frecuente y benigna, puede presentarse como tumoración de lento crecimiento o pubertad sexual precoz y si se diagnostica en etapa temprana, la resección será el tratamiento de elección y curativa. Se han reportado pocos casos a nivel mundial, por lo que el seguimiento del paciente se considera estricto.
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