Resumen Objetivo: Describir las características de los tumores renales bilaterales, y su impacto en la función renal postquirúrgica en pacientes de una institución de Ciudad de México. Métodos: De marzo 1980 a mayo 2021, 17 pacientes fueron llevados a cirugía por tumores renales bilaterales, 12 fueron sincrónicos y el resto metacrónicos. Se realizó una descripción de las características oncológicas y funcionales. Resultados: La edad media fue de 46.9+13.5 años. Cuatro fueron mujeres y trece hombres. El tamaño del “primer” tumor fue 4.85+/- 2.59 cm y del “segundo” de 5.34+/-3.95 cm. En los tumores sincrónicos se realizaron 9 nefrectomías radicales y 3 parciales para el primer tumor y 2 radicales y 9 parciales para el segundo tumor (1 paciente continúa en vigilancia del segundo tumor). En los metacrónicos se realizaron 5 nefrectomías radicales para el primer tumor, 4 radicales y 1 parcial para el segundo tumor. La concordancia histológica en sincrónicos y metacrónicos fue de 91% y 80%, respectivamente. La TFGe preoperatoria fue 77.53+30.44 (ml/min/1.73 m2) y posoperatoria 46.85+38.34, disminuyendo 35.8% tras segunda cirugía. El seguimiento fue 88.7+/-44.5 meses. Cinco pacientes (29.4%) recurrieron. La supervivencia global y libre de enfermedad fue 67.5 y 43 meses, respectivamente. Conclusiones: La concordancia histológica es equiparable a los reportes de la literatura internacional. El deterioro de la TFGe posoperatoria fue más significativo en los tumores metacrónicos donde hubo mayor porcentaje de nefrectomías radicales. Por lo que resalta la importancia de realizar nefrectomías parciales siempre que sea factible.

Abstract Objective: To describe the characteristics of bilateral renal tumors and its impact on postoperative renal function in patients from an institution in Mexico City. Methods: From March 1980 to May 2021, 17 patients underwent surgery for bilateral renal tumors, 12 were synchronous and the rest metachronous. Oncological and functional characteristics were described. Results: Mean age was 46.9+/-13.5 years. Four were women and thirteen men. The size of the "first" tumor was 4.85+/-2.59 cm and the "second" was 5.34+/-3.95 cm. In synchronous tumors, 9 radical and 3 partial nephrectomies were performed for the first tumor and 2 radical and 9 partial for the second tumor (1 patient is still on surveillance for the second tumor). In metachronous patients, 5 radical nephrectomies were performed for the first tumor, and 4 radical and 1 partial for the second tumor. The histological concordance in synchronous and metachronous was 91% and 80%, respectively. The preoperative eGFR was 77.53+30.44 (ml/min/1.73 m2) and postoperative 46.85+38.34, decreasing 35.8% after the second surgery. Follow-up was 88.7+/-44.5 months. Five patients (29.4%) recurred. Overall and disease-free survival were 67.5 and 43 months, respectively. Conclusions: The histological concordance is in line with previous international reports. Postoperative eGFR decline was more significant in metachronous patients in whom the proportion of radical nephrectomies was higher. Therefore, it highlights the importance of performing partial nephrectomies whenever feasible.

Abstract: Objective: To evaluate the association between life-course leisure-time physical activity (PA) and prostate cancer (PC) among males living in Mexico City. Materials and methods: Information from 394 incident PC cases and 794 population controls matched by age (± 5 years), was analyzed. Using leisure-time PA information at different life stages, life-course PA patterns were constructed. The association between PA and PC was estimated using an unconditional logistic regression model. Results: Three life-course PA patterns were identified: low PA (71.0%), moderate PA (22.0%), and high PA (7.0%); this last pattern was characterized by higher levels and consistent PA practice. Compared with inactive males, those in the high PA pattern (OR: 0.50; 95%CI: 0.26-0.93) had significantly lower PC odds. Conclusion: Intense and regular PA could reduce the possibility of PC. These results are in accordance with PA World Health Organization recommendations.

Resumen: Objetivo: Evaluar la asociación entre la actividad física (AF) en la vida y el cáncer de próstata (CP) en hombres. Material y métodos: Se analizó la AF de 394 casos incidentes de CP y 794 controles poblacionales pareados por edad (± 5 años). Se utilizó la información de AF en diferentes etapas para generar los patrones de AF a lo largo de la vida. La asociación entre AF y CP se estimó mediante regresión logística no condicionada. Resultados: Se identificaron tres patrones de AF: baja (71.0%), moderada (22.0%) y alta (7.0%); este último patrón se caracterizó por una AF consistentemente mayor a lo largo de la vida. Comparado con los hombres inactivos, aquéllos en el patrón de alta AF (RM= 0.50; IC95% = 0.26-0.93) presentaron menos posibilidades de tener CP. Conclusión: El papel protector de la AF parece estar en función de la intensidad y regularidad de su práctica y apoyan las recomendaciones de la OMS.

Resumen Objetivo: Describir el uso de clips de polímero (Hem-o-lok®) para el control vascular renal en nefrectomía simple de donador laparoscópica (NSL) Materiales y Métodos: Realizamos un análisis retrospectivo y descriptivo de las nefrectomías de donador mínimamente invasivas (mano-asistidas y laparoscópicas puras) realizadas entre 2008 y 2020. Se incluyeron pacientes sometidos a NSL en las cuales se utilizaron clips de polímero (Hem-o-lok®) para el control vascular del hilio renal. Resultados: Se realizaron 330 NSL, 183 (55%) fueron mano asistidas y el resto laparoscópicas puras. Se obtuvo un tiempo de isquemia caliente promedio de 3.98 minutos, una pérdida de sangre promedio de 100±140 ml. Cuatro pacientes (1.2%) ameritaron conversión a cirugía abierta debido a lesión vascular. Se registraron 31 (9.3%) complicaciones postoperatorias de las cuales 23 (6.9%) fueron complicaciones menores. No se reportaron muertes ni pérdidas del injerto. Limitantes del estudio: Las principales limitantes del estudio son que se trata de un estudio retrospectivo de un solo centro. Originalidad o valor: Se trata un estudio que cuestiona la contraindicación emitida por la FDA para el uso de clips de polímeros para el control vascular en NSL, al mostrar ser una opción segura y efectiva. Conclusiones: El uso de clips de polímero, específicamente Hem-o-lok®, es un método seguro para el control vascular del hilio renal en nefrectomías laparoscópicas de donador.

Abstract Objective: To describe our experience using polymer clips (Hem-o-lok®) for renal vessel control in laparoscopic living donor nephrectomy (LLDN). Materials and methods: We conducted a retrospective and descriptive analysis from our database of all minimally invasive living donor nephrectomies (hand-assisted and pure laparoscopic) performed from 2008 to 2020 in our institution. We included patients who underwent LLDN using polymer clips (Hem-o-lok®) for vascular control of renal arteries and veins, and whose clinical records were complete. Results: 330 LLDN were performed, 183 (55.5%) were hand-assisted nephrectomies and 147 (44.5%) were pure laparoscopic nephrectomies. Mean warm ischemia time (WIT) was 3.98 minutes and median of estimated blood loss (EBL) was 100±140 ml. Four patients (1.2%) required conversion to an open procedure due to vascular injury. 31 complications (9.3%) were registered, of which 23 (6.9%) were non-life-threatening complications. No deaths nor loss of renal grafts were reported. Limitations: the main drawbacks of this study are its retrospective nature, and that it is limited to only one center. Originality and value: It is a study that questions the contraindication issued by the FDA for the use of polymer clips for vascular control in LLDN, demonstrating its use is a safe and effective option. Conclusion: The use of polymer clips, specifically Hem-o-lok®, is a safe method for vascular control of the renal hilum vessels in laparoscopic living donor nephrectomies.

Resumen Antecedentes: El papel de la nefrectomía citorreductora como tratamiento del carcinoma de células renales metastásico (CCRm) es controversial debido a su alta complejidad. Objetivo: Identificar factores de riesgo para complicaciones posquirúrgicas en pacientes con CCRm tratados con nefrectomía citorreductora. Método: Estudio retrospectivo, observacional, de 67 pacientes tratados con nefrectomía citorreductora por CCRm. Se registraron las características demográficas, perioperatorias y clinicopatológicas. Las complicaciones posquirúrgicas fueron clasificadas con el sistema Clavien-Dindo (mayores aquellas de grado 3 o superior). Se realizó un análisis de regresión logística binaria para identificar factores de riesgo para complicaciones. Resultados: La edad media fue de 56 años (rango: 37-83), y 58 pacientes (89.7%) presentaron síntomas, predominando la pérdida de peso (50.8%). El diámetro tumoral medio fue de 10.8 cm (rango: 4.6-22.5). Un 65% tuvo complicaciones posquirúrgicas; en el 31.4% fueron mayores. Los factores de riesgo asociados fueron el sangrado transoperatorio ≥ 500 ml (odds ratio [OR]: 44; intervalo de confianza del 95% [IC 95%]: 2.51-789; p = 0.01) y el diámetro tumoral > 10 cm (OR: 17.9; IC 95%: 1.2-273; p = 0.04). Conclusiones: La nefrectomía citorreductora es una opción de tratamiento para pacientes estrictamente seleccionados. Nuestra tasa de complicaciones mayores fue del 31.4%. Los factores de riesgo asociados fueron el sangrado transoperatorio y el diámetro tumoral.

Abstract Background: The role of cytoreductive nephrectomy on the treatment of metastatic renal cell carcinoma (mRCC) is controversial due to its high complexity. Objective: To identify risk factors associated to postoperative complications in patients with mRCC after cytoreductive nephrectomy. Method: We conducted a retrospective, observational study in 67 patients who underwent cytoreductive nephrectomy for the management of mRCC. Demographic, perioperative and clinicopathologic characteristics were registered. Surgical complications were classified using the Clavien-Dindo system; major complications were those of grade 3 or higher. We performed a binary logistic regression analysis to identify risk factors associated with surgical complications. Results: Mean age was 56 years (37-83). Symptoms were present in 58 patients (89.7%). Weight loss was the predominant symptom (50.8%). Mean tumor diameter was 10.8 cm (4.6-22.5 cm). The rate of postoperative complications was 65%; 21 patients (31.4%) had major complications. Risk factors were estimated blood loss > 500 ml (OR 44.5, CI 95% 2.51-789, p = 0.01) and tumor diameter > 10 cm (OR 17.9, CI 95% 1.2-273, p = 0.04). Conclusions: Cytoreductive nephrectomy is a good option in highly selected patients with mRCC. Our major complication rate was 31.4%. Risk factors associated were blood loss and tumor diameter.

Background: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. Objective: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. Methods: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Results: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Conclusions: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

ABSTRACT Purpose: To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period. Material and Methods: A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects. Results: Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services. Conclusions: During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.

Abstract The COVID-19 pandemic has forced the modification of medical attention around the world, to reserve the greatest amount of resources for the treatment of patients with SARS-CoV-2 infection. Urology departments, just like the rest of the surgical services, have had to adapt to this situation, reducing the medical attention given to different illnesses and only selecting and attending to emergency consultations, procedures, and surgeries, or to oncologic maladies that cannot be postponed. The aim of the present review was to make recommendations regarding outpatient consultation management and the correct selection of surgeries and procedures. The postponement of the majority of non-urgent procedures should continue until the COVID-19 pandemic is controlled in Mexico.

Resumen La pandemia por COVID-19 ha obligado a modificar la atención médica alrededor del mundo con la finalidad de reservar la mayor cantidad de recursos para la atención de pacientes infectados por el SARS-CoV-2. Los departamentos de urología al igual que el resto de los servicios quirúrgicos han tenido que adaptarse a esta situación disminuyendo la atención de los distintos padecimientos, seleccionando y atendiendo solamente los motivos de consulta, los procedimientos y las cirugías que sean urgentes o por padecimientos oncológicos inaplazables. El objetivo de la siguiente revisión es hacer algunas recomendaciones para el manejo de la consulta externa y la correcta selección de cirugías y procedimientos. La postergación de la mayor parte de los procedimientos no urgentes deberá continuar hasta que la pandemia por COVID-19 en México esté controlada.

Abstract Objective: To know the impact the COVID-19 pandemic has had on the practice of urology in Mexico. Materials and Methods: A survey was conducted on Mexican urologists, utilizing the SURVIO® mobile application, within the time frame of March 16-22, 2020. It consisted of 8 dichotomous, multiple-choice questions on the practice of urology and how it has been affected by the COVID-19 pandemic. Results: A total of 374 questionnaires were received, in which 66% of the respondents stated that the healthcare institution they worked in had already emitted a management protocol for patients with COVID-19, 80% stated that urology consultations had not been reprogrammed or cancelled at their work centers, and 42% did not know which surgeries would be deferred. In addition, digital applications were included among the tools that would be the most widely used for substituting face-to-face consultation. Limitation: The present work has the limitations inherent in a survey. Originality: The present original work describes how the COVID-19 pandemic has impacted the daily urology practice. Conclusions: The COVID-19 pandemic is a challenge for our entire healthcare system. The practice of urology is facing unprecedented changes right now and will continue to do so in the future.

Resumen Objetivo: Conocer el impacto que ha generado la pandemia por COVID-19 en la práctica urólogica en México. Material y Métodos: Se realizó una encuesta a urólogos mexicanos con la aplicación SURVIO® vía web del 16 al 22 de marzo 2020, la cual consistió en 8 preguntas dicotómicas y de opción múltiple sobre la práctica urológica y su afectación por la pandemia de COVID-19. Resultados: Se recibieron un total de 374 respuestas, 66% respondió que la institución en la que laboran ya había emitido un protocolo de manejo para pacientes con COVID-19, el 80% negó que la consulta de urología hubiese sido reprogramada o cancelada en sus centros de trabajo, el 42% desconocía qué cirugías tendrían que ser diferidas y las herramientas que más ocuparán para sustituir la consulta presencial incluyen aplicaciones digitales. Limitante: Se trata de una encuesta con las limitaciones inherentes. Originalidad: Trabajo original el cual nos presenta un panorama de cómo ha impactado la pandemia por COVID-19 la práctica urológica diaria. Conclusiones: La pandemia de COVID-19 representa un reto para todo nuestro sistema de salud. La práctica urológica enfrentará en este momento y en el futuro cambios sin precedentes.

Abstract: Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico’s prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.

Resumen : El uso del Antígeno Prostático Específico (APE) para tamizaje para cáncer de próstata sigue siendo tema de amplio debate. La implementación de estrategias de tamiz organizado de cáncer de próstata ha sido un reto en parte porque la prueba de APE se presta para detección oportunista. A medida que aumenta el acceso a las pruebas de detección de cáncer en los países de ingresos bajos y medianos (PIBM), existe la necesidad urgente de evaluar cuidadosamente las estrategias actuales y futuras de detección oportuna de cáncer para garantizar su beneficio y controlar sus costos. Utilizamos los esfuerzos de tamizaje de cáncer de próstata de México para ilustrar los retos para PIBM. Ofrecemos cinco consideracio nes dirigidas a tomadores de decisión que permitan contar con estrategias racionales de implementación de tamizaje para cáncer de próstata basado en el uso de APE.

Abstract: Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico’s prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.

Resumen : El uso del Antígeno Prostático Específico (APE) para tamizaje para cáncer de próstata sigue siendo tema de amplio debate. La implementación de estrategias de tamiz organizado de cáncer de próstata ha sido un reto en parte porque la prueba de APE se presta para detección oportunista. A medida que aumenta el acceso a las pruebas de detección de cáncer en los países de ingresos bajos y medianos (PIBM), existe la necesidad urgente de evaluar cuidadosamente las estrategias actuales y futuras de detección oportuna de cáncer para garantizar su beneficio y controlar sus costos. Utilizamos los esfuerzos de tamizaje de cáncer de próstata de México para ilustrar los retos para PIBM. Ofrecemos cinco consideracio nes dirigidas a tomadores de decisión que permitan contar con estrategias racionales de implementación de tamizaje para cáncer de próstata basado en el uso de APE.

Abstract Background: Current evidence shows that cytoreductive nephrectomy (CN) could offer a survival benefit for patients with metastatic renal cell carcinoma (RCC). Nevertheless, due to a higher risk of perioperative complications this therapeutic strategy should be evaluated thoroughly. To identify perioperative mortality and morbidity predictors associated to CN, we analyzed metastatic RCC patients treated with surgery in our Institution. Patients and methods: We evaluated those patients with metastatic RCC treated with CN between 1980-2016 at our Institution. Univariate and binomial logistic regression analysis was used to assess predictors of adverse outcomes within a 30-day postoperative period. We defined a p value < 0.05 as statistically significant. Results: 46 patients with clinical stage IV RCC were included in this analysis; 32.6% had perioperative morbidity. Clavien-Dindo grade ≥ III complications occurred in 17.4%. Perioperative mortality was 15.2%. In multivariate analysis, age ≥ 65 years was an independent predictor of perioperative morbidity (p = 0.001). No factors were associated with perioperative mortality. Conclusions: Patients ≥ 65 years old with metastatic RCC, nephrectomy has a higher risk of complications and perioperative mortality. Therefore, the benefit of surgical therapy in this population should be evaluated thoroughly.

Resumen Introducción: La nefrectomía citorreductiva (NC) podría mejorar la supervivencia de pacientes con carcinoma de células renales (CCR) metastásico. No obstante, debe ponderarse el riesgo de complicaciones perioperatorias importantes que obliguen a replantear la estrategia terapéutica. Con el objetivo de identificar factores predictores de morbilidad y mortalidad perioperatoria en NC, analizamos a pacientes con CCR metastásico tratados quirúrgicamente en nuestra institución. Material y métodos: Se realizó un estudio retrospectivo de pacientes con CCR metastásico sometidos a NC entre 1980-2016. Mediante un análisis univariante y multivariante de regresión logística binomial evaluamos predictores de efectos adversos en los primeros 30 días a la cirugía. Consideramos estadísticamente significativa una p < 0.05. Resultados: Incluimos 46 pacientes con CCR estadio clínico IV. El 32.6% presentó alguna complicación, un 17.4% fueron grado ≥ 3 de Clavien-Dindo. La mortalidad perioperatoria fue del 15.2%. En el análisis multivariante, la edad ≥ 65 años demostró ser el único factor de riesgo para complicaciones perioperatorias (p = 0.001). Ningún factor se asoció de manera independiente a mortalidad. Conclusiones: En pacientes ≥ 65 años de edad con CCR metastásico, la nefrectomía implica mayor riesgo de complicaciones y mortalidad perioperatoria, por lo que en esta población debe evaluarse cuidadosamente el beneficio del tratamiento quirúrgico.

ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

Abstract OBJECTIVE: To determine the prevalence of overactive bladder and the degree of impact it has on the quality of life of patients recruited from five hospital centers in Mexico City. MATERIALS AND METHODS: A descriptive, observational, cross-sectional study was conducted through the prospective collection of patient data from the General Medicine, Family Medicine, or Internal Medicine outpatient consultation at five hospital centers in Mexico City, within the time frame of January and December 2017. Participants were asked to fill out the validated Spanish version of the ICIQ-OAB questionnaire at that same consultation, one time only. The patients were divided into ten-year age groups starting at 18 years of age. The data were analyzed through descriptive statistics. RESULTS: There were questionnaires from 352 participants at the time of the intermediate analysis. A total of 72% (n = 253) reported urgency as the key symptom of overactive bladder (78 vs 66% in women and men, respectively, p<0.05). Moderate-severe symptoms were reported in 16% of the patients above the age of 57 years. Severe symptoms were more frequent in women (68%). A total of 31% of the patients described a moderate-severe impact on quality of life. The main concomitant symptom was nicturia (81%) but urge incontinence was the most bothersome symptom for patients (32%). CONCLUSION: The prevalence of urgency (the cardinal symptom of overactive bladder) was high in a population in Mexico City.

Resumen OBJETIVO: Determinar la prevalencia de vejiga hiperactiva y su repercusión (grado de afección) en la calidad de vida de pacientes captados en cinco centros hospitalarios de la Ciudad de México. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal y observacional, efectuado mediante la recolección prospectiva de expedientes provenientes de la consulta externa de Medicina General, Medicina Familiar o Medicina Interna de cinco centros hospitalarios de la Ciudad de México, entre enero y diciembre de 2017. Se solicitó a los participantes responder el cuestionario ICIQ-OAB (versión validada en español), en una sola ocasión y durante la misma visita. Los pacientes se dividieron por grupos etarios decenales a partir de 18 años. Para el análisis de los datos se utilizó estadística descriptiva. RESULTADOS: Al momento del análisis intermedio, se contó con las encuestas de 352 participantes. El 72% (n = 253) reportó urgencia urinaria, como síntoma cardinal de vejiga hiperactiva (78 vs 66% en mujeres y hombres, respectivamente, p<0.05). Los síntomas moderados-severos se reportaron en 16% de los pacientes mayores de 57 años de edad. Los síntomas severos fueron más frecuentes en mujeres (68%). El 31% de los casos refirió afección moderada-severa en la calidad de vida. El principal síntoma concomitante fue nicturia (81%); sin embargo, la incontinencia urinaria de urgencia provocó mayor molestia en los pacientes (32%). CONCLUSIÓN: La urgencia urinaria (síntoma cardinal de vejiga hiperactiva) es una alteración con elevada prevalencia en la población de la Ciudad de México.

Abstract OBJECTIVE: To compare the medium-term results between open pyeloplasty and laparoscopic pyeloplasty in patients with primary or secondary ureteropelvic junction obstruction. MATERIALS AND METHODS: A descriptive, observational, longitudinal, retrospective study was conducted on adult patients that underwent open pyeloplasty or laparoscopic pyeloplasty due to ureteropelvic junction obstruction, within the time frame of January 2007 and March 2017. The variables of surgical success (complete symptom cessation and kidney function improvement) and postoperative complications determined through the Clavien-Dindo classification were analyzed. The qualitative variables were compared using the ꭓ2 test and the independent variables with abnormal distribution were compared using the Mann-Whitney U test. Statistical significance was set at a p <0.05. RESULTS: Forty patients were registered. Their mean age was 39 years and they had a mean follow-up of 38 months (1-180). The patients that underwent the laparoscopic approach had a shorter hospital stay (3.6 ± 1.4 days vs 6.9 ± 2.1 days; p = 0.001). The laparoscopic pyeloplasty success rate was 92% in patients with no prior treatment and 100% in previously treated patients. Low-grade complications (Clavien-Dindo I and II) presented in 40% of the open surgery patients and in 44% of the patients in the laparoscopic group. CONCLUSIONS: Laparoscopic pyeloplasty and open pyeloplasty had similar success rates and outcomes and can be considered safe therapeutic options for the treatment of ureteropelvic junction obstruction.

Resumen OBJETIVO: Comparar los resultados a mediano plazo entre la pieloplastia abierta versus laparoscópica en pacientes con obstrucción de la unión ureteropiélica primaria o secundaria. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo, observacional y longitudinal, efectuado en pacientes adultos tratados con pieloplastia abierta o laparoscópica por obstrucción de la unión ureteropiélica, entre enero de 2007 y marzo de 2017. Se analizaron las variables de éxito quirúrgico (cese completo de los síntomas y mejoría de la función renal) y complicaciones posoperatorias con la clasificación de Clavien-Dindo. Se utilizó la prueba de ꭓ2 para comparar las variables cualitativas y la U de Mann-Whitney para las variables independientes con distribución anormal. Se consideró estadísticamente significativo el valor de p <0.05. RESULTADOS: Se registraron 40 pacientes con edad promedio de 39 años y seguimiento de 38 meses (1-180). Los pacientes con pieloplastia laparoscópica tuvieron menor estancia hospitalaria (3.6 ± 1.4 vs 6.9 ± 2.1 días; p = 0.001). La tasa de éxito de pieloplastias laparoscópicas fue de 92% en pacientes sin tratamiento previo y de 100% en tratados previamente. Solo se reportaron complicaciones de bajo grado (Clavien-Dindo I y II) en 40% de los casos con pieloplastia abierta y en 44% con laparoscopia. CONCLUSIONES: La pieloplastia abierta y laparoscópica muestran tasas de éxito y resultados similares; por tanto, pueden considerarse técnicas seguras para el tratamiento de la obstrucción ureteropiélica.

Abstract Clinical case: A 77-year-old woman had clinical symptom onset with pain in the left flank of 20-day progression and bone pain. An ultrasound study identified a mass that was dependent on the upper pole of the left kidney. A non-contrast-enhanced tomography scan, complemented with a magnetic resonance study, revealed a solid lesion with central necrosis that extended into the renal sinus (T2a; GII). Treatment was laparoscopic left radical nephrectomy. The diagnosis was Bellini duct carcinoma. A new 16-mm left lateroaortic lymph node was found at the follow-up at 5 months. The lesion was excised, and retroperitoneal lymph node dissection was carried out, producing 20 lymph nodes with lymphoid hyperplasia that were negative for malignancy. Thirty-nine months after the nephrectomy, a computed tomography scan identified a retroperitoneal paraaortic tumor and an intercaval-aortic retroperitoneal tumor, consistent with disease recurrence. Metastasectomy was performed and the histopathologic report described a solid, irregular, greyish-white tumor that had extensive areas with blood in the left lower portion and a moderate amount of necrotic foci. At present, after 42 months of follow-up, the patient is under surveillance and has no signs of recurrence. Conclusions: Collecting duct carcinoma is a rare neoplasia. The case reported herein has the longest survival period and recurrence time for symptomatic T2M0 disease: 39 months.

Resumen Caso clínico: Paciente femenina de 77 años de edad, que inició su cuadro clínico con dolor en el flanco izquierdo, de 20 días de evolución, además de dolor óseo. El ultrasonido reportó una masa dependiente del polo superior del riñón izquierdo. La tomografía simple, complementada con resonancia magnética, evidenció una lesión de 5.7 x 7.3 cm, de consistencia sólida, con necrosis central y extensión hacia el seno renal (T2a; GII). El tratamiento consistió en nefrectomía radical laparoscópica izquierda. Se estableció el diagnóstico de carcinoma de conductos colectores de Bellini. El seguimiento a 5 meses mostró un nuevo ganglio latero-aórtico izquierdo de 16 mm. Se realizó escisión de la lesión y linfadenectomía retroperitoneal, que reportó 20 ganglios con hiperplasia linfoide negativa a malignidad. Treinta y nueve meses después de la nefrectomía, la tomografía computada evidenció dos tumores retroperitoneales: uno paraaórtico y otro intercavoaórtico, compatibles con recurrencia de la enfermedad. Se llevó a cabo metastasectomía, que histopatológicamente reportó un tumor sólido, irregular, de color blanco-grisáceo, con áreas extensas de hemorragia en su porción inferior izquierda y focos discretos de necrosis. Hoy día, después de 42 meses de seguimiento, la paciente se mantiene en vigilancia y sin datos de recurrencia. Conclusiones: El carcinoma de conductos colectores es una neoplasia excepcional. El caso aquí reportado corresponde al de mayor supervivencia y tiempo de recurrencia descrito en un caso de T2M0 sintomático: 39 meses.