Effect of Hypertension on Outcomes of High-Risk Patients After BCG-Treated Bladder Cancer

Immunotherapy with Bacillus Calmette Guerin (BCG) is the most efficacious treatment for high-risk bladder cancer (BC) (Ta/T1 or carcinoma in situ) to reduce the risk of recurrence. Our aim was to evaluate whether hypertension and diabetes influence the outcome of patients with noninvasive BC treated with BCG instillations. In order to collect homogeneous data, we considered as "hypertensive" only those patients who had previous diagnosed hypertension and a history of taking medical therapy with antihypertensive drugs (AHT), and as "diabetic" only those prescribed oral antidiabetics or insulin (ADT). We analyzed 343 high-risk BC patients undergoing BCG 1995 2010) with a median follow-up of 116 months (range 48-238). The distribution of various kinds of AHT and antidiabetic drugs was homogeneous, with no significant differences (p > 0.05). In both univariate and multivariate analyses, the only statistically significant parameter propostic for recurrence after BCG treatment was AHT. Recurrence-liee survival curves showed a significant correlation with AHT (p = 0.0168, hazards ratio [HR] 1.45, 95% confidence interval [CI] 1.0692-1.9619); there was no correlation ( p = 0.9040) with ADT (HR 0.9750, 95% CI 0.6457-1.4721). After stratification of AHT and A.DT according to drug(s) prescribed, there were no significant differences in the BC recurrence rate (p > 0.05). In this study with a very long-term follow-up, hypertension alone (evaluated by AHT) revealed the increased risk of BC recurrence after BCG treatment. Several hypotheses have been formulated to support these findings, but further prospective studies are needed to both evaluate the real influence of hypertension and identify a possible prognostic factor to be used in selecting poor-prognosis BC patients as early candidates for surgical treatment

Anesthesiologic effects of transperitoneal versus extraperitoneal approach during robot-assisted radical prostatectomy: results of a prospective randomized study

To compare the effects of CO(2) insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses

Peripheral primitive neuroectodermal tumor of seminal vesicles: is there a role for relatively aggressive treatment modalities?

A 50 year old white man received an incidental ultrasound diagnosis of hypoechoic mass interesting the right seminal vesicle. A CT scan showed the presence of a 7.8 cm roundish cyst, originating from the right seminal vesicle. He had been followed by the removal of the right seminal vesicle and both the cystic lesion. The histological findings of the specimen documented the presence of small round cells compatible with Ewing's sarcoma/PPNET. The patient received also adjuvant chemotherapy and radiation treatment. After 10 years, the follow-up is still negative

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Objective: We performed an update of previous reviews of the literature to provide an overview on incidence, predictive factors, management and prognosis of positive surgical margins (PSMs) after partial nephrectomy (PN) including recent surgical series and studies comparing different approaches and techniques. Material and methods: A literature search was performed from January 2013 to January 2018 using the Medline database. The search strategy included a free-text protocol using the term "nephron-sparing surgery" OR "partial nephrectomy" AND "positive surgical margins" across the title and abstract fields of the records. From each selected study, we extracted the following data: number of analyzed patients, study design, approach and surgical technique used, PSMs rate, pathological features, type of PSMs treatment, mean (median) follow-up duration and final patient status. Meta-analysis was conducted using Review Manager software v. 5.2 (Cochrane Collaboration, Oxford, UK). Results: We selected a total of 36 (48%) studies. All studies were retrospective and the best statistical method used for comparison was the matched-pair analysis (level 4). Overall, 45,786 patients treated with PN were included in the selected studies. PSMs were reported in a total of 3,093 (6.7%) patients. The mean estimated PSMs rate was 7%, 5% and 4.3% in patients who underwent robot-assisted PN (RAPN), laparoscopic PN (LPN) and open PN (OPN), respectively. Comparative studies showed a significant advantage in favor of OPN compared with minimally invasive approach, while RAPN showed more favourable PSMs risk compared with LPN (odds ratio 3.02, 95% confidence intervals 2.05–4.45). No differences were detected stratifying data according to other surgical or tumor-related factors. Tumor size, nuclear grading and pT3a stage represent the most important predictors of PSMs. In 6,809 patients, follow-up data were available. Only 101 (1.4%) local recurrences and 88 (1.3%) distant recurrences were observed both in PSMs and negative surgical margins subgroups. PSMs were associated with a significant increased risk of local recurrence with a significant impact on local recurrence-free survival and metastasis-free survival. However, a significant impact on cancer-specific and overall survival could not be demonstrated. Conclusions: Studies published in the last 5 years confirmed that PSMs after PN are a rare condition. Although PSMs increase the risk of local and distant recurrence, their influence on cancer-specific and overall survival seems to be limited. Close surveillance should be strongly recommended as initial treatment of patients with PSMs after PN

Wunderlich's syndrome: Three cases of acute spontaneous renal bleeding, conservately treated

Wunderlich's syndrome is a clinical condition defined as a spontaneous renal bleeding of non traumatic origin, contained within the Gerota's fascia. Wunderlich's syndrome is rare. Spontaneous bleeding of kidney tumors, either benign or malignant, represents the more common causes. Classically it presents with acute flank pain, tender palpable mass and clinical hemodynamic deterioration. These symptoms are defined as the Lenk's classic triad. We present three cases of spontaneous renal bleeding

Planeamiento estratégico de la extracción de cobre con enfoque de economía circular

En el presente documento se elaboró el Plan Estratégico en el sector cobre con enfoque en Economía Circular en el Perú. El plan estratégico es resultado de un exhaustivo análisis de los factores externos e internos del sector minero del cobre, que nos permitió identificar cuáles eran las principales oportunidades, amenazas, fortalezas, y debilidades de la industria. Asimismo, a partir de la elaboración de diferentes matrices, se pudieron establecer las estrategias principales para cumplir con los objetivos a largo plazo y sus correspondientes objetivos a corto plazo, con la finalidad de poder alcanzar la visión trazada. El sector del cobre es una industria atractiva y competitiva, cuyo crecimiento ha sido sostenido y por encima al crecimiento económico del país, con oportunidades hacia el año 2017 sobre la base de una importante cartera de proyectos cupríferos, bajo costo de energía, elevadas reservas de cobre y buen posicionamiento del país como tercer mayor productor mundial. Las estrategias propuestas en el plan estratégico se centran en la implementación de procesos de biolixiviación, desarrollar la industrialización de cobre, invertir en fitoremediación, creación de centros de investigación y desarrollo de bacterias lixiviantes, invertir en proyectos de educación, incrementar la inversión en comunidades; con la visión de que al año 2025, el proceso de extracción de cobre en el Perú será reconocido como un referente mundial por su alta productividad y bajos costos, resultados de la aplicación del enfoque de economía circular, satisfaciendo las necesidades de los clientes, colaboradores, comunidades y accionistas, buscando capturar mayor inversión y rentabilidad, orientado al bienestar social y medioambiental.The Strategic Plan of this document is developed in the Peruvian copper sector, with focus on Circular Economy. The strategic plan is the result of a thorough analysis of external and internal factors of the copper mining industry, which allows identifying which are the main opportunities, threats, strengths, and weaknesses of the industry. Also, from the development of different matrices, the result is the main strategies to meet long-term goals and their short-term goals, in order to be able to reach the vision outlined. The copper industry is an attractive and competitive industry, whose growth has been sustained and above the economic growth of the country, with opportunities by the year 2017 based on a large portfolio of copper projects, low cost energy, high reserves copper and good positioning of the country as the third largest producer. The strategies proposed in the strategic plan focus on the implementation of bioleaching processes, invest in phytoremediation, create a State body biomining processes, investing in education and improvement projects infrastructure while maintaining special focus in communities, with the view that the extraction of copper in Peru, with a circular economy model in 2025, is recognized as a world leader for its efficient execution that generate sustainability in the extraction of this metal, meeting the current and potential needs, the environment, customers, employees, society and shareholders sector.Tesi

Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic?

Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse

Urology practice during the COVID-19 vaccination campaign

The current scenario of the COVID-19 pandemic is significantly different from that of the first, emergency phase. Several countries in the world are experiencing a second, or even a third, wave of contagion, while awaiting the effects of mass vaccination campaigns. The aim of this report was to provide an update of previously released recommendations on prioritization and restructuring of urological activities