Rafael Sánchez-salas - Academia.edu (original) (raw)
Uploads
Papers by Rafael Sánchez-salas
Indian Journal of Urology, 2014
Clinical Genitourinary Cancer, 2021
The Cancer of the Bladder Risk Assessment (COBRA) score is a predictive tool for estimating Cance... more The Cancer of the Bladder Risk Assessment (COBRA) score is a predictive tool for estimating Cancer Specific Survival (CSS) after Radical Cystectomy (RC) for urothelial carcinoma. COBRA score variables are: age at RC, Tumor stage and Lymph Node Density (LND). We sought to externally validate the COBRA score and to improve its performance in estimating CSS adding Lymphovascular Invasion (LVI) as a further variable (Modified COBRA score). Clinicopathological and survival data from 789 patients who underwent RC and Pelvic Lymph Node Dissection (PLND) between January 2007 and December 2020 in two European referral centers (Paris, France and Badalona, Spain) were analyzed. COBRA score was applied to our cohort and CSS Kaplan-Meier curves were performed. Univariable and Multivariable analysis was performed in order to identify risk factors for Cancer Specific Mortality (CSM) and a score was assigned for any statistically significant risk factor; afterward, c-index calculation was performed and CCS curves have been plotted for the model after having integrated LVI variable to the COBRA score. Finally, we compared both COBRA score and Modified COBRA score models with the established AJCC model. A total of 789 patients underwent RC during the observation period. Complete data were available for 731 patients with a median follow-up of 32 months (8-47). CSM was 27.6% (no. 218 patients) at follow-up. When COBRA score was applied to our cohort, c-index was 0.76. Regression COX analysis has shown HR 0.36, CI 95% (0.16-0.83), P = .016 for patients with COBRA score 1; HR 0, CI 95% (0-1.77), P =.94 for score 2; HR 0.51, CI 95% (0.39 -0.67), P =.001 for score 3; HR 1.67, CI 95% (1.23-2.27), P =.001 for score 4; HR 2.45, CI 95% (1.51-3.99), P =.001 for score 5; HR 2.01, CI 95% (1.42-2.85), P =.001 for score 6 and HR 0.66, CI 95% (0.09-4.73), P =.682 for score 7. When the LVI variable was added to the CSS predictive model the discriminatory power increased to a c-index of 0.78. COBRA score adequately identifies those patients with a higher risk of CSM, with a c-index of 0.76. Moreover, LVI variable further improves its predictive accuracy from c-index of 0.76 to c-index of 0.78. LVI variable could be integrated in the COBRA score to optimizing prognosis stratification for patients who undergo RC.
The Journal of Urology, 2021
INTRODUCTION AND OBJECTIVE:To validate a prognostic nomogram (Necchi et al, nomogram-doi:10.1016/... more INTRODUCTION AND OBJECTIVE:To validate a prognostic nomogram (Necchi et al, nomogram-doi:10.1016/j.clgc.2018.09.008) for exclusive locoregional recurrence after radical cystectomy and bilateral pel...
The Canadian journal of urology, 2012
To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and ... more To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and received postoperative medical therapy for erectile dysfunction. We performed a prospective study in men who underwent laparoscopic radical prostatectomy between September 2003 and November 2005 at our center and who received penile rehabilitation after surgery. All patients had antegrade interfascial dissection. They received 10 mg tadalafil on the fifth postoperative day and continued to receive it every other day, regardless of erectile function. Intracavernous injection of alprostadil was initiated at 3 or 6 months depending on response to treatment with tadalafil. Follow up evaluations were done at 3, 6, 12, 18 and 24 months. Oncologic and functional outcomes and compliance were assessed. Patients filled in International Index of Erectile Function-5 (IIEF-5) questionnaires. Of 1078 men who underwent laparoscopic radical prostatectomy during this time, 586 patients met inclusion crit...
World Journal of Urology, 2014
Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Ber... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Berlin Heidelberg. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Archivos Españoles de Urología (Ed. impresa), 2009
Revisar la bibliografía y presenter una visión contemporánea del bloqueo androgénico en el cáncer... more Revisar la bibliografía y presenter una visión contemporánea del bloqueo androgénico en el cáncer de próstata. MÉTODOS: Llevamos a cabo una búsqueda bibliográfica en PubMed sobre bloqueo androgénico intermitente (BAI). Para la elaboración del presente artículo utilizamos los artículos obtenidos y la experiencia del Instituto Mutualista Montsouris. RESULTADOS: El BAI es un abordaje del tratamiento de deprivación androgénica que mantiene un control oncológico eficaz y a la vez evita la morbilidad asociada con el bloqueo androgénico continuo. Los matices de BAI han sido evaluados por la comunidad urológica para verificar sus posibles beneficios. Un abordaje ba sado en la evidencia apoya la idea del BAI como un tratamiento estándar en cáncer de próstata avanzado que necesite bloqueo androgénico. Las variaciones en tre los equipos médicos en los criterios de tratamiento y vigilancia están a la espera de estandarización. CONCLUSIONES: Es necesario revisar el "Gold Stan dard" del bloqueo androgénico en cáncer de próstata avanzado. La evolución innegable del BAI necesita que la comunidad urológica lo abrace.
Proceedings from the SIU B2B Uro-Oncology: GU Cancers Triad Virtual Meeting May 21–22, 2021, 2021
![Research paper thumbnail of [Perirenal myxoliposarcoma. Case report with laparoscopic approach]](https://attachments.academia-assets.com/83313519/thumbnails/1.jpg)
](Archivos espanoles de urologia, 2007
OBJECTIVE To report our experience in the management of one case of perirenal myxoliposarcoma. ME... more OBJECTIVE To report our experience in the management of one case of perirenal myxoliposarcoma. METHODS We report the case of an 86-year-old male consulting for occasional dizziness. Examination revealed a left flank abdominal mass. CT scan reported the presence of a 12 cm multiloculated cystic mass at the lower pole of the right kidney Hand-assisted right laparoscopic nephrectomy was carried out. RESULTS The operation was uneventful and the pathologic study reported a kidney with preserved architecture and a tumor showing characteristics of grade 1-2 myxoliposarcoma with undifferentiation to grade 3 myxofibrosarcoma in intimate contact with the lower pole. CONCLUSIONS We believe that laparoscopic surgery permits the surgical solution of this type of lesion without compromising the oncological principles, and offers the well-known advantages of a minimally invasive approach.
The Journal of Urology, 2009
European Urology Supplements, 2011
Actas urologicas españolas
The treatment of transitional cell bladder cancer with muscular invasion remains difficult, due t... more The treatment of transitional cell bladder cancer with muscular invasion remains difficult, due to the numerous patterns of biological behaviour of the disease. There is controversy regarding the application of systemic therapy in invasive bladder carcinoma and the ideal time for the indication of perioperative chemotherapy. This is an overview of systemic therapy in invasive bladder cancer. Using MEDLINE, we reviewed relevant English and Spanish literature published during the last five years, with "chemotherapy in bladder cancer" as keywords. We selected randomised trials, meta-analyses and clinical trials. We obtained 241 articles, 31 of which referred to neoadjuvant and adjuvant chemotherapy in invasive bladder cancer. We classified the articles into three different groups: neoadjuvant, adjuvant and neoadjuvant plus chemotherapy. This information is shown in the tables within the text. A multidisciplinary approach to the treatment of invasive bladder cancer is essential to guarantee adequate oncological control. Detailed evaluation and proper selection of each patient is fundamental in determining the best moment to start chemotherapy.
Archivos españoles de urología
Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy ... more Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy with diagnosis of right crossed fused renal ectopia, history of recurrent urinary tract infection and previous failure of surgical treatment. Three year old boy with diagnosis of right crossed fused renal ectopia of the inferior moiety underwent a laparoscopic heminephrectomy of the inferior renal unit, due to severe hydronephrosis and recurrent urinary tract infections. A laparoscopic right heminephrectomy of the inferior renal moiety was performed uneventfully. Operation room time was 200 minutes and there were no perioperative complications. Patient was discharged 18 hours after the procedure. After 5 years of follow up patient remains asymptomatic with good renal function. The laparoscopic approach is an acceptable option to treat this anomaly, with all the advantages of minimally invasive surgery.
European Urology Supplements, 2011
Archivos españoles de urología
Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and managem... more Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and management is controversial due to the bleeding risk. We report a bladder cavernous hemangioma resolved using bipolar transurethral resection. We review the case of a female patient who presented with asymptomatic hematuria. On cystoscopy we discovered a reddish sessile lesion compatible with bladder hemangioma. We describe the diagnostic work up, surgical management and review other therapeutic alternatives for these lesions. Fifty five year old healthy female patient consulting for total painless hematuria. Cystoscopic evaluation revealed a 1 cm diameter sessile reddish elevated lesion near the bladder neck. We performed a transurethral endoscopic resection using the Gyrus Bipolar resectoscope®. Pathologic report concluded cavernous angioma. Bladder hemangiomas are benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent ...
Indian Journal of Urology, 2014
Clinical Genitourinary Cancer, 2021
The Cancer of the Bladder Risk Assessment (COBRA) score is a predictive tool for estimating Cance... more The Cancer of the Bladder Risk Assessment (COBRA) score is a predictive tool for estimating Cancer Specific Survival (CSS) after Radical Cystectomy (RC) for urothelial carcinoma. COBRA score variables are: age at RC, Tumor stage and Lymph Node Density (LND). We sought to externally validate the COBRA score and to improve its performance in estimating CSS adding Lymphovascular Invasion (LVI) as a further variable (Modified COBRA score). Clinicopathological and survival data from 789 patients who underwent RC and Pelvic Lymph Node Dissection (PLND) between January 2007 and December 2020 in two European referral centers (Paris, France and Badalona, Spain) were analyzed. COBRA score was applied to our cohort and CSS Kaplan-Meier curves were performed. Univariable and Multivariable analysis was performed in order to identify risk factors for Cancer Specific Mortality (CSM) and a score was assigned for any statistically significant risk factor; afterward, c-index calculation was performed and CCS curves have been plotted for the model after having integrated LVI variable to the COBRA score. Finally, we compared both COBRA score and Modified COBRA score models with the established AJCC model. A total of 789 patients underwent RC during the observation period. Complete data were available for 731 patients with a median follow-up of 32 months (8-47). CSM was 27.6% (no. 218 patients) at follow-up. When COBRA score was applied to our cohort, c-index was 0.76. Regression COX analysis has shown HR 0.36, CI 95% (0.16-0.83), P = .016 for patients with COBRA score 1; HR 0, CI 95% (0-1.77), P =.94 for score 2; HR 0.51, CI 95% (0.39 -0.67), P =.001 for score 3; HR 1.67, CI 95% (1.23-2.27), P =.001 for score 4; HR 2.45, CI 95% (1.51-3.99), P =.001 for score 5; HR 2.01, CI 95% (1.42-2.85), P =.001 for score 6 and HR 0.66, CI 95% (0.09-4.73), P =.682 for score 7. When the LVI variable was added to the CSS predictive model the discriminatory power increased to a c-index of 0.78. COBRA score adequately identifies those patients with a higher risk of CSM, with a c-index of 0.76. Moreover, LVI variable further improves its predictive accuracy from c-index of 0.76 to c-index of 0.78. LVI variable could be integrated in the COBRA score to optimizing prognosis stratification for patients who undergo RC.
The Journal of Urology, 2021
INTRODUCTION AND OBJECTIVE:To validate a prognostic nomogram (Necchi et al, nomogram-doi:10.1016/... more INTRODUCTION AND OBJECTIVE:To validate a prognostic nomogram (Necchi et al, nomogram-doi:10.1016/j.clgc.2018.09.008) for exclusive locoregional recurrence after radical cystectomy and bilateral pel...
The Canadian journal of urology, 2012
To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and ... more To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and received postoperative medical therapy for erectile dysfunction. We performed a prospective study in men who underwent laparoscopic radical prostatectomy between September 2003 and November 2005 at our center and who received penile rehabilitation after surgery. All patients had antegrade interfascial dissection. They received 10 mg tadalafil on the fifth postoperative day and continued to receive it every other day, regardless of erectile function. Intracavernous injection of alprostadil was initiated at 3 or 6 months depending on response to treatment with tadalafil. Follow up evaluations were done at 3, 6, 12, 18 and 24 months. Oncologic and functional outcomes and compliance were assessed. Patients filled in International Index of Erectile Function-5 (IIEF-5) questionnaires. Of 1078 men who underwent laparoscopic radical prostatectomy during this time, 586 patients met inclusion crit...
World Journal of Urology, 2014
Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Ber... more Your article is protected by copyright and all rights are held exclusively by Springer-Verlag Berlin Heidelberg. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Archivos Españoles de Urología (Ed. impresa), 2009
Revisar la bibliografía y presenter una visión contemporánea del bloqueo androgénico en el cáncer... more Revisar la bibliografía y presenter una visión contemporánea del bloqueo androgénico en el cáncer de próstata. MÉTODOS: Llevamos a cabo una búsqueda bibliográfica en PubMed sobre bloqueo androgénico intermitente (BAI). Para la elaboración del presente artículo utilizamos los artículos obtenidos y la experiencia del Instituto Mutualista Montsouris. RESULTADOS: El BAI es un abordaje del tratamiento de deprivación androgénica que mantiene un control oncológico eficaz y a la vez evita la morbilidad asociada con el bloqueo androgénico continuo. Los matices de BAI han sido evaluados por la comunidad urológica para verificar sus posibles beneficios. Un abordaje ba sado en la evidencia apoya la idea del BAI como un tratamiento estándar en cáncer de próstata avanzado que necesite bloqueo androgénico. Las variaciones en tre los equipos médicos en los criterios de tratamiento y vigilancia están a la espera de estandarización. CONCLUSIONES: Es necesario revisar el "Gold Stan dard" del bloqueo androgénico en cáncer de próstata avanzado. La evolución innegable del BAI necesita que la comunidad urológica lo abrace.
Proceedings from the SIU B2B Uro-Oncology: GU Cancers Triad Virtual Meeting May 21–22, 2021, 2021
Archivos espanoles de urologia, 2007
OBJECTIVE To report our experience in the management of one case of perirenal myxoliposarcoma. ME... more OBJECTIVE To report our experience in the management of one case of perirenal myxoliposarcoma. METHODS We report the case of an 86-year-old male consulting for occasional dizziness. Examination revealed a left flank abdominal mass. CT scan reported the presence of a 12 cm multiloculated cystic mass at the lower pole of the right kidney Hand-assisted right laparoscopic nephrectomy was carried out. RESULTS The operation was uneventful and the pathologic study reported a kidney with preserved architecture and a tumor showing characteristics of grade 1-2 myxoliposarcoma with undifferentiation to grade 3 myxofibrosarcoma in intimate contact with the lower pole. CONCLUSIONS We believe that laparoscopic surgery permits the surgical solution of this type of lesion without compromising the oncological principles, and offers the well-known advantages of a minimally invasive approach.
The Journal of Urology, 2009
European Urology Supplements, 2011
Actas urologicas españolas
The treatment of transitional cell bladder cancer with muscular invasion remains difficult, due t... more The treatment of transitional cell bladder cancer with muscular invasion remains difficult, due to the numerous patterns of biological behaviour of the disease. There is controversy regarding the application of systemic therapy in invasive bladder carcinoma and the ideal time for the indication of perioperative chemotherapy. This is an overview of systemic therapy in invasive bladder cancer. Using MEDLINE, we reviewed relevant English and Spanish literature published during the last five years, with "chemotherapy in bladder cancer" as keywords. We selected randomised trials, meta-analyses and clinical trials. We obtained 241 articles, 31 of which referred to neoadjuvant and adjuvant chemotherapy in invasive bladder cancer. We classified the articles into three different groups: neoadjuvant, adjuvant and neoadjuvant plus chemotherapy. This information is shown in the tables within the text. A multidisciplinary approach to the treatment of invasive bladder cancer is essential to guarantee adequate oncological control. Detailed evaluation and proper selection of each patient is fundamental in determining the best moment to start chemotherapy.
Archivos españoles de urología
Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy ... more Crossed fused renal ectopia is a rare congenital anomaly. We report the case of a 3 year old boy with diagnosis of right crossed fused renal ectopia, history of recurrent urinary tract infection and previous failure of surgical treatment. Three year old boy with diagnosis of right crossed fused renal ectopia of the inferior moiety underwent a laparoscopic heminephrectomy of the inferior renal unit, due to severe hydronephrosis and recurrent urinary tract infections. A laparoscopic right heminephrectomy of the inferior renal moiety was performed uneventfully. Operation room time was 200 minutes and there were no perioperative complications. Patient was discharged 18 hours after the procedure. After 5 years of follow up patient remains asymptomatic with good renal function. The laparoscopic approach is an acceptable option to treat this anomaly, with all the advantages of minimally invasive surgery.
European Urology Supplements, 2011
Archivos españoles de urología
Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and managem... more Bladder hemangioma is a benign rare lesion. There are no pathognomonic clinical signs and management is controversial due to the bleeding risk. We report a bladder cavernous hemangioma resolved using bipolar transurethral resection. We review the case of a female patient who presented with asymptomatic hematuria. On cystoscopy we discovered a reddish sessile lesion compatible with bladder hemangioma. We describe the diagnostic work up, surgical management and review other therapeutic alternatives for these lesions. Fifty five year old healthy female patient consulting for total painless hematuria. Cystoscopic evaluation revealed a 1 cm diameter sessile reddish elevated lesion near the bladder neck. We performed a transurethral endoscopic resection using the Gyrus Bipolar resectoscope®. Pathologic report concluded cavernous angioma. Bladder hemangiomas are benign and rare lesions. Clinical presentation has no pathognomonic signs although gross painless hematuria is the most frequent ...