[Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.]

INTRODUCTION

Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%.

OBJECTIVE

Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS.

MATERIAL AND METHODS

Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out.

RESULTS

64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805.

CONCLUSIONS

There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

[The current urological training program in Spain. Urology National Specialty Commission.]

OBJECTIVES

44/2003 Law involved the creation of the National Council of Specialties in Health Sciences and the National Commissions of the Specialties in Health Sciences.

METHODS

Analysis of the main laws implicated in Specialized Training and the role of the National Specialty Commission.

DISCUSSION

44/2003 Law regulates the training of health professionals and establishes the procedure for the training programs creation by the National Specialty Commission and its later approval and publication in the BOE. Access to specialized training will be carried out with the annual and national MIR exam. The Health Ministry establishes the criteria for educational centers accreditation, and the National Specialty Commission issues a favorable or unfavorable report as advisor about new accreditation requests. 183/2008 RD develops the tutor figure, the formative evaluation through the Resident's Book and how will be like the external rotations.

CONCLUSIONS

to understand the Urology's specialty training system we must know the laws that regulate it, being the most important the 44/2003 Law. The National Specialty Commission is an advisory party of the Ministry, whose main function is to elaborate the Urology training program and to establish the evaluation criteria of the specialists in formation.

[Prognostic factors in renal cancer with venous thrombus survival analysis.]

OBJECTIVES

To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival.

MATERIAL AND METHODS

Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification.

RESULTS

Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months.

CONCLUSIONS

Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c).

[Small cell carcinoma of the bladder: Our experience]

OBJECTIVES

Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series.

METHODS

Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013.

RESULTS

Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response.

CONCLUSIONS

Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests.