INTRODUCTION:Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? METHODS:We conducted a systematic review according to PRISMA guidelines and described our case series. RESULTS:Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively. CONCLUSION:Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

El priapismo isquémico es una urgencia médica que, de no ser tratada, puede conducir a una disfunción eréctil permanente. Aunque la asociación entre cocaína y priapismo está establecida, todavía se desconocen los datos relativos a las características de los pacientes, el tratamiento y los resultados. El objetivo de este trabajo es responder a la siguiente pregunta de investigación: ¿Cuáles son las características, las estrategias de tratamiento y el pronóstico de la función eréctil de los pacientes que consumen cocaína y presentan priapismo? Realizamos una revisión sistemática según las directrices PRISMA y describimos nuestra serie de casos. Se seleccionaron 8 estudios para la síntesis cualitativa, en los que se presenta información sobre 10 pacientes. En nuestra serie de casos exponemos la información de 4 pacientes. Según la revisión sistemática, el tiempo medio de evolución fue de 42,6 h, y el número medio de procedimientos necesarios para resolver el priapismo fue de 2,4; en nuestra serie de casos, estos valores fueron de 42,75 h y 2, respectivamente. El priapismo asociado al consumo de cocaína podría conllevar un diagnóstico tardío, necesitar más procedimientos para su tratamiento y tener un peor pronóstico. Se necesitan estudios más amplios y prospectivos. Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? We conducted a systematic review according to PRISMA guidelines and described our case series. Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 hours, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 hours and 2, respectively. Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

Objectives: To present a National Registry of patients with prostate cancer as monitored through active surveillance, with the intention of testing the hypothesis that cancer-specific mortality in very low-risk and low-risk patients is less than 5% at 15 years.Material and methods: A multicentre observational study (AEU-PIEM/2014/0001) sponsored by the Spanish Association of Urology was conducted using their platform for multicentre studies. The clinical-pathological inclusion criteria were as follows: cT1a-cT3a, PSA <= 20 ng/ml, initial minimum biopsy of 10 cores, number of affected cores <= 3, 1st Gleason score of 3 and 2nd Gleason score <= 4 and a known prostate volume (in cc). A unified follow-up was not established for all recruiting centres; however, a survey was conducted that reflects the follow-up characteristics based on a number of tangible parameters that allow for their comparison. With the same philosophy of flexibility, the use of certain biomarkers and multiparametric MRI was not considered necessary for inclusion.Results: We describe the Registry's characteristics and possibilities, as well as the preliminary results from the 324 patients included in its first 5 months of operation in the 15 recruiting centres. We also report the clinical-pathological variables, biomarkers, radiodiagnosis technique and quality-of-life questionnaires considered for the database, as well as the possibilities for indefinite follow-up, remaining open to any active treatment recognized in clinical guidelines.Conclusions: The AEU-PIEM/2014/0001 represents an extremely useful tool for all Spanish urologists for multicentre clinical research. The registry will undoubtedly enable the dissemination of active surveillance of our patients in a more coordinated manner, thus maintaining the advantages of optimised opportunistic screening for prostate cancer without resulting in overtreatment. (C) 2015 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

ObjetivoComparar diferentes opciones de tratamiento conservador del tumor vesical no músculo-invasivo (TVNMI) T1 de grado alto. El bacilo de Calmette-Guérin (BCG) es el tratamiento intravesical preferido para los tumores T1 de grado alto; sin embargo, algunos expertos aún cuestionan la necesidad de la BCG de mantenimiento.Materiales y métodosSe analizaron retrospectivamente los datos de 1.039 pacientes con TVNMI T1G3 primario y recurrente. Todos los pacientes fueron tratados mediante una resección transuretral del tumor vesical (RTUTV) completa, con músculo en la muestra y múltiples biopsias de la vejiga. Los pacientes fueron tratados con solo una RTUTV inicial (n=108), re-RTUTV (n=153), inducción con 27mg de BCG (cepa Connaught) (n=87), inducción con 81mg de BCG (n=489) o inducción con 81mg de BCG+mantenimiento (n=202). El tiempo hasta la primera recidiva, progresión (a T2 o mayor, o a enfermedad metastásica) y mortalidad específica de la enfermedad se evaluaron mediante la función de supervivencia de Kaplan-Meier y se compararon utilizando la prueba de logaritmo del rango (log-rank) y el modelo multivariado de regresión de Cox de riesgos proporcionales.ResultadosEl seguimiento medio fue de 62±39 meses. El riesgo de recurrencia fue significativamente menor en los pacientes tratados con terapia de mantenimiento con 81mg de BCG que en los otros grupos de tratamiento (p<0,001). El riesgo de progresión del tumor también fue significativamente más bajo en los pacientes tratados con mantenimiento con BCG que en los pacientes tratados solo con una RTUTV, re-RTUTV y con terapia de inducción con 27mg de BCG (p=0,0003). La mortalidad específica de la enfermedad fue significativamente más baja con el mantenimiento con BCG (9,4%) que con solo una RTUTV (27,8%; p=0,003).ConclusionesEn el caso del TVNMI T1G3, la dosis completa de BCG con mantenimiento va asociada a mejores resultados de recurrencia que otras modalidades de tratamiento conservador. Los resultados de progresión y de supervivencia específica de la enfermedad también fueron mejores con la BCG de inducción, con o sin mantenimiento.

Objective: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guerin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG.Material and methods: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n = 108), re-TURBT (n = 153), induction with 27 mg of BCG (Connaught strain) (n = 87), induction with 81 mg of BCG (n = 489) or induction with 81 mg of BCG + maintenance (n = 202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks.Results: The mean follow-up was 62 +/- 39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81 mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27 mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003).Conclusions: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Recurrence is the main concern in the conservative treatment of urothelial cell carcinoma in the upper urinary tract tumor (UUTT); there are short series and scarce information about this approach. We review and evalutae in an Spanish multicenter study prognostic factors of recurrence, progression and cancer-specific mortality in patients treated with endourology for UUTT.

Management of T1G3 non-muscle invasive bladder cancer (NMIBC) has evolved during the last 20 years but recurrence and progression remain the main concerns in these patients. The introduction of intravesical Bacillus Calmette-Guerin (BCG) with maintenance has changed the perspective in conservative approach. There are several clinical prognostic factors that influence recurrence and progression: gender, age, association to CIS, tumour size, multifocality and primary or recurrent tumour. To evaluate, in a large retrospective series of patients, the differences in recurrence, progression to invasive disease and cancer specific survival according to the characteristics of the tumours related to the treatment received.

Primary urothelial cell carcinoma in the upper urinary tact (UUT-UCC) are often invasive tumors. They are mainly diagnosed in the workup because of hematuria and/or lumbar pain. There are no clear data of the difference in clinical symptoms, diagnosis and treatment according to the history of previous bladder cancer (BC) in UUT-UCC. We present an evaluation of the differences in patients with UUT-UCC according to the past history of BC on different aspects in the diagnosis and management of these patients.

Assessed the performance of instillations of bacillus Calmette-Guerin (BCG) and mitomycin C (MMC) in urothelial tumors of upper urinary tract treated with endourology approach and preservation of renal functional unit.

You have accessJournal of UrologyProstate Cancer: Localized III1 Apr 2010591 LOW DOSE BRACHYTHERAPY WITH I125 IN PATIENTS WITH LOCAL PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY F.G. Gómez Veiga, A. Marino, I. Gómez, L.A. Castelo, J. Gonzalez Dacal, S. Breijo, D. Lopez, J. Ponce, A. Candal, and V. Chantada F.G. Gómez VeigaF.G. Gómez Veiga , A. MarinoA. Marino , I. GómezI. Gómez , L.A. CasteloL.A. Castelo , J. Gonzalez DacalJ. Gonzalez Dacal , S. BreijoS. Breijo , D. LopezD. Lopez , J. PonceJ. Ponce , A. CandalA. Candal , and V. ChantadaV. Chantada View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.863AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment for patients with biochemical progression after radical prostatectomy (RP) and suspicion of local recurrence usually consists of external beam radiotherapy. This a valid option, but not exempt from complications, and is demanding in terms of dose adjustment and definition of target volumes. Low dose- brachytherapy (LDB) is an alternative option for patients with localized prostate cancer. The aim of this prospective study was to analyze the capacity of LDB to treat patients with local progression after RP in terms of toxicity and oncologic control METHODS 42 patients were treated for local prostate cancer relapse from April 2004 to July 2009. Median age was 69.2 years(54-76). The pathologic staging after at RP was 1(2.4%) pT0, 5(11.9%) pT2a, 7(16.7%), pT2b, 14(33.3%)pT2c, 11(26.2%) pT3a and 4(9.5%) pT3b. Local progression in all cases was confirmed by positive biopsy. The Gleason score (GS) on control biopsy ranged from 6-9, 20(47.1%) GS 6, 18(42.9%) GS 7 and 4 (9.5%) GS ≥8. Only patients with more than 6 months follow-up were included n=35. The median follow-up was 29.5 months (6-60.5), and median time to biochemical progression 26 months. Median PSA before LDB was 1.9 ng/mL(range 0.24-6.8). Real-time implant was realized using Variseed 7.2 program and Rapid Strand ®seeds were used. Treatment dose planning was for 144 Gy to cover the anastomotic area. Median volume prescription was 10cc (3.1-23), seeds activity 0.48mci, seeds per session 44.4, and median prostate and urethra d90 174Gy and 121G respectively. All patients were assessed for acute and late gastrointestinal (GI) and genitourinary (GU) toxicity as defined by RTOG. Biochemical failure was defined using the Phoenix definition. All cases were hormone naive prior to LDB. RESULTS Median hospital stay was 21h. There were no major perioperative complications. All patients were discharged without urethral catheter. Acute GI and GU complications grade 1 and 2 were 2(5.7%), 1(2.9%) and 14(40%) and 3(8.6%) respectively.Mild previous incontinence improved in 3 patients (8.6%). Late GI and GU complications grade 1 or 2 were 3 (8.8%), 1 (2.9%), and 3 (8.6%) and 1 (2.9%) respectively. With a median follow up of 29.5 months, biochemical relapsed-free survival was 88.6%, 4 patients had biochemical failure and one patient died, related to prostate cancer the cancer- free survival was 97%. CONCLUSIONS Although longer follow up is needed, these promising results, with minimal morbidity and excellent biochemical response, lead us to believe that LDB is a valid salvage option or patients with local relapse after RP A Coruna, Spain© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e232 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information F.G. Gómez Veiga More articles by this author A. Marino More articles by this author I. Gómez More articles by this author L.A. Castelo More articles by this author J. Gonzalez Dacal More articles by this author S. Breijo More articles by this author D. Lopez More articles by this author J. Ponce More articles by this author A. Candal More articles by this author V. Chantada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Progress in immunosuppressive therapy and surgical practice experience in combined transplants has made possible that cardio-renal transplants (CRT) a successful option for treating patients that suffer from terminal heart disease and chronic renal failure. The aim of this study is to review the results of CRT in our center.

Carboxamides bearing sulphonamide functionality have been shown to exhibit significant lethal effect on Plasmodium falciparum , the causative agent of human malaria. Here we report the synthesis of thirty-two new drug-like sulphonamide pyrolidine carboxamide derivatives and their antiplasmodial and antioxidant capabilities. In addition, molecular docking was used to check their binding affinities for homology modelled P . falciparum N-myristoyltransferase, a confirmed drug target in the pathogen. Results revealed that sixteen new derivatives killed the parasite at single-digit micromolar concentration (IC 50 = 2.40–8.30 μM) and compounds 10b , 10c , 10d , 10j and 10o scavenged DPPH radicals at IC 50 s (6.48, 8.49, 3.02, 6.44 and 4.32 μg/mL respectively) comparable with 1.06 μg/mL for ascorbic acid. Compound 10o emerged as the most active of the derivatives to bind to the PfNMT with theoretical inhibition constant ( K i = 0.09 μM) comparable to the reference ligand pyrazole-sulphonamide ( K i = 0.01 μM). This study identifies compound 10o , and this series in general, as potential antimalarial candidate with antioxidant activity which requires further attention to optimise activity.