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Dimitropoulos K, Tzortzis V. Could there be a relationship between type of anesthesia and oncological parameters after transurethral resection of bladder cancer? Transl Androl Urol 2018; 7:287-288. [PMID: 29733085 PMCID: PMC5911533 DOI: 10.21037/tau.2018.03.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Karatzas A, Papadopoulos V, Katsiouli V, Pisters L, Papandreou C, Tzortzis V. Primitive neuroectodermal tumor transformation of testicular teratoma. Urol Ann 2018; 10:413-415. [PMID: 30386097 PMCID: PMC6194792 DOI: 10.4103/ua.ua_182_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Malignant transformation of teratoma develops in a small subset of testis cancer patients. Primitive neuroectodermal tumor represents a highly malignant component of testicular germ cell tumors. It is a rare clinical entity which is characterized by a high risk of disease progression and death. Surgical resection plus chemotherapy appears to be the therapy of choice.
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Karatzas A, Paridis D, Kozyrakis D, Tzortzis V, Samarinas M, Dailiana Z, Karachalios T. Fanconi syndrome in the adulthood. The role of early diagnosis and treatment. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2017; 17:303-306. [PMID: 29199190 PMCID: PMC5749037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zachos I, Dimitropoulos K, Karatzas A, Samarinas M, Petsiti A, Tassoudis V, Tzortzis V. Ultrasound-guided radiofrequency ablation for cT1a renal masses in poor surgical candidates: mid-term, single-center outcomes. Ther Adv Med Oncol 2016; 8:331-8. [PMID: 27583025 DOI: 10.1177/1758834016654694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Surgical management of small renal masses can be challenging in frail patients and thus modalities such as radiofrequency ablation (RFA) have emerged as valid alternative options. The aim of the current study was to present mid-term oncological and functional results on a series of patients with cT1a renal cell carcinomas (RCCs) who were unfit for surgery and underwent RFA using ultrasound guidance under local anesthesia. METHODS Data from patients fulfilling the study selection criteria were retrospectively collected. RENAL nephrometry score was used for tumor description. Parametric tests were used for data analysis and survival curves were estimated using the Kaplan-Meier method. RESULTS Overall, 32 patients (mean±standard deviation age, 72.4 ± 7.6 years) with biopsy-proven RCCs (tumor size, 23.75 ± 10.44 mm and RENAL score, 5.28 ± 1.33) underwent 32 RFA sessions. Twenty-seven patients (84.4%) had low complexity masses and five patients had masses of intermediate complexity (15.6%) according to RENAL score categorization. Over a follow-up period of 22.1 ± 13.7 months, one case of primary treatment failure was recognized (primary technical success 97.0%), and overall, three patients were diagnosed with residual disease (primary technique effectiveness 90.6%). No major complications occurred during the postprocedure 90-day follow up, while no difference was found in serum creatinine and estimated glomerular filtration rate pre and post procedure. Patients with intermediate-complexity renal lesions had shorter time to recurrence in comparison to low-complexity masses (p = 0.002). All patients were alive at the time of study data analysis without diagnosed metastases. CONCLUSIONS Percutaneous RFA of small RCCs using ultrasound-based guidance under local anesthesia can be an effective alternative method for managing patients who are unfit for surgery.
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Dimitropoulos K, Skriapas K, Karvounis G, Tzortzis V. Intrauterine device migration to the urinary bladder causing sexual dysfunction: a case report. Hippokratia 2016; 20:70-72. [PMID: 27895447 PMCID: PMC5074402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intravesical migration represents an uncommon complication of intrauterine device (IUD) insertion. We present the case of an IUD that migrated to the urinary bladder, causing significant sexual complaints. CASE REPORT A 38-year-old woman presented with complaints of gradually evolving dyspareunia and recurrent urinary tract infections during the past 12 months. She reported an IUD insertion 18 months before. Further detailed evaluation revealed disorders in all sexual domains. Imaging and cystoscopy detected the presence of IUD in the urinary bladder. Under anesthesia, the IUD was removed out of the bladder without any complications. In her follow-up evaluation after six months, her sexual function was significantly improved and she had no urinary symptoms. CONCLUSION Sexual difficulties in a woman with an IUD should raise the suspicion of device dislodgement or dislocation. Hippokratia 2016, 20(1): 70-72.
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Tzortzis V, Dimitropoulos K, Karatzas A, Zachos I, Stamoulis K, Melekos M, Gravas S. Feasibility and safety of radical cystectomy under combined spinal and epidural anesthesia in octogenarian patients with ASA score ≥3: A case series. Can Urol Assoc J 2015; 9:E500-4. [PMID: 26279724 DOI: 10.5489/cuaj.2063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION This study evaluated the feasibility and safety of open radical cystectomy (RC) under combined regional anesthesia (CRA) in high-risk octogenarian patients. METHODS We retrospectively evaluated the medical records of high-risk, octogenarian bladder cancer patients submitted to open RC with CRA. Demographic and clinical data, intraoperative parameters and perioperative and postoperative complications were recorded using the Clavien-Dindo classification. RESULTS In total, 14 male and 4 female patients, with a median age of 82.5 years were enrolled. Ureterocutaneostomy was performed in 15 patients and Bricker ileal conduit in the remaining 3. Operative time ranged from 97 to 184 minutes. Five patients were transfused and no major intraoperative complications occurred. Postoperative complications 30 days later included ileus (Grade II) in 3 patients, surgical trauma infection in 1 patient (Grade II), respiratory infection in 2 patients (Grade III), and hydronephrosis with concurrent urinary tract infection in 3 patients (Grade III). No deaths occurred. CONCLUSIONS Our study showed that octogenarian, high-risk bladder cancer patients with indications for RC can safely undergo the surgical procedure under CRA, without apparent increase in major complications.
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Dimitropoulos K, Karatzas A, Papandreou C, Daliani D, Zachos I, Pisters LL, Tzortzis V. Sexual dysfunction in testicular cancer patients subjected to post-chemotherapy retroperitoneal lymph node dissection: a focus beyond ejaculation disorders. Andrologia 2015; 48:425-30. [DOI: 10.1111/and.12462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 01/01/2023] Open
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Dimitropoulos K, Bargiota A, Mouzas O, Melekos M, Koukoulis G, Tzortzis V. Dissatisfaction with male sexual performance and female sexual dysfunction in women with type 1 diabetes. Int J Impot Res 2014; 27:25-8. [DOI: 10.1038/ijir.2014.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/17/2013] [Accepted: 06/06/2014] [Indexed: 11/09/2022]
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Tzortzis V, Dimitropoulos K, Gravas S, Karatzas A, Zachos I, Gkialas I, Papadopoulos G, Melekos M. The impact of stapling devices use on patients with increased body mass index treated with radical cystectomy. THE CANADIAN JOURNAL OF UROLOGY 2014; 21:7114-7119. [PMID: 24529011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The aim of this retrospective study was to evaluate the impact of stapling devices use on overweight and obese bladder cancer patients treated with radical cystectomy (RC). MATERIALS AND METHODS Fifty-two overweight and 24 obese patients underwent open RC for muscle invasive bladder cancer. Bladder removal was performed using standard suture technique (SST) or multifire autosuture articulated vascular Endo-GIA (eG). Twenty-three overweight and 11 obese patients formed the SST arms and the remaining 29 overweight and 13 obese patients formed the eG arms. Intra and postoperative parameters and early postoperative complications (30 days) using the Clavien-Dindo classification were recorded. RESULTS SST and eG arms of overweight and obese patients were comparable in intra and postoperative parameters. Both overweight and obese eG arms had significantly lower estimated blood loss, lower number of transfused packed red blood cells units (PRBC) and lower cystectomy intraoperative time compared with the SST ones (p < 0.05). In obese patients, staplers use led to significantly lower total length of stay compared with SST (p = 0.041). Complications rate was significantly higher in the obese group compared with the overweight group (58.33% versus 30.77%, p = 0.042). No difference in complications was found between the SST and eG arms of the overweight and obese patients. No deaths occurred. CONCLUSIONS Staplers use in RC in overweight/obese patients is accompanied by significantly shorter intraoperative time, lower blood loss and lower number of transfused PRBC units, compared with SST. In obese patients, eG use led to shorter length of stay.
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Karatzas A, Tzortzis V, Giannatou E, Gravas S, Zachos I, Oeconomou A, Melekos M, Tsezou A. Lack of association between the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene polymorphism and the risk of benign prostatic hyperplasia in Caucasian men. Mol Biol Rep 2013; 40:6665-9. [PMID: 24057187 DOI: 10.1007/s11033-013-2781-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
Glucuronidation, mediated by the UDP-glucuronosyltransferase 1A1 (UGT1A1) enzyme, is an important metabolic process during which steroids are converted to more easily excreted compounds in steroid target tissues, such as the prostate. The aim of our study was to investigate the possible correlation between UGT1A1 promoter gene polymorphism and benign prostatic hyperplasia. 421 blood samples were obtained from 138 consecutive patients diagnosed with benign prostatic hypeplasia (BPH group) and 283 healthy volunteers (control group). A(TA)6TAA promoter polymorphism of UGT1A1 gene was studied using the Fragment Analysis Software of an automated DNA sequencer and three genotypes (homozygous 7/7, heterozygous 6/7 and normal homozygous 6/6) were identified. No significant differences were observed between the BPH group and controls regarding the genotyping distribution of the three UGT1A1 promoter genotypes (P = 0.39). Also, no association was found between overall disease risk and the presence of the polymorphic homozygous genotype (TA(7)/TA)7) vs. TA(6)/TA(7) + TA(6)/TA(6)) (P = 0.31). Our data suggest that the TA repeat polymorphism of UGT1A1 is not associated with increased BPH risk susceptibility in Caucasian men.
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Rountas C, Sioka E, Karagounis A, Golphinopoulos S, Kourti P, Stefanidis I, Zacharoulis D, Tzortzis V. Spontaneous perirenal hemorrhage in end-stage renal disease treated with selective embolization. Ren Fail 2013; 34:1037-9. [PMID: 22880810 DOI: 10.3109/0886022x.2012.706887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spontaneous nontraumatic rupture of the kidney (Wunderlich syndrome) is an extremely uncommon condition on hemodialysis. We report a case of 44-year-old hemodialysis patient presented with hemorrhagic shock and a right quadrant abdominal pain to the emergency department. There was no history of trauma. A kidney rupture was revealed by abdominal computed tomography, and active bleeding was successfully managed with arterial embolization. This case illustrates the safe and successful application of interventional radiology in the management of nontraumatic renal hemorrhage in the specific group of hemodialyzed patients even in the emergency setting.
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Bargiota A, Dimitropoulos K, Mouzas O, Melekos M, Tzortzis V, Koukoulis G. The Impact of Parental Bonding on Sexual Distress in Women with Type 1 Diabetes Mellitus. J Sex Med 2013; 10:378-85. [DOI: 10.1111/j.1743-6109.2012.02969.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gravas S, Efstathiou K, Zachos I, Melekos MD, Tzortzis V. Is there a learning curve for photodynamic diagnosis of bladder cancer with hexaminolevulinate hydrochloride? THE CANADIAN JOURNAL OF UROLOGY 2012; 19:6269-6273. [PMID: 22704312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION To assess the learning curve for fluorescence cystoscopy using hexaminolevulinate hydrochloride (HAL) in patients with bladder cancer. MATERIAL AND METHODS Fifty patients underwent bladder instillation with HAL. Two senior residents inspected separately the bladder using white light cystoscopy, followed by fluorescence cystoscopy and mapped the lesions. An experienced with photodynamic diagnosis (PDD) urologist also performed both cystoscopies, mapped, resected or cold biopsied suspect lesions under the supervision of another experienced urologist. To evaluate the learning curve, patients were divided into five subgroups, including group 1 (patients 1-10), group 2 (11-20), group 3 (21-30), group 4 (31-40) and group 5 (41-50). The kappa statistics was calculated to assess interobserver agreement between the physicians and the false positive rates of urologists and residents were also compared. RESULTS Histologically verified tumors were diagnosed in 103 of 142 lesions identified by PDD. The interobserver agreement between urologists and residents was moderate, moderate, good, excellent, and excellent for group 1, 2, 3, 4, and 5, respectively. Both residents had increased false positive rates compared to urologists in all subgroups of patients but this difference did not reach statistical significance. In addition, false positive rate of residents was declining as the number of procedures was increasing. CONCLUSIONS Our data suggest that 20 cases of HAL PDD are required to achieve a good interobserver agreement between inexperienced and experienced operator, and excellent agreement is achieved after 30 cases. The false positive rate of inexperienced operators was comparable to the experts and showed a gradual decrease.
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Dimitropoulos K, Bargiota A, Mouzas O, Melekos M, Tzortzis V, Koukoulis G. Sexual Functioning and Distress among Premenopausal Women with Uncomplicated Type 1 Diabetes. J Sex Med 2012; 9:1374-81. [DOI: 10.1111/j.1743-6109.2012.02664.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Panteliou SD, Tzortzis V, Anagnostopoulos GT, Sunaric M, Sarris J, Hatzimouratidis K, Hatzichristou D. Development of a New Optical Device and Its Feasibility in Prostate Cancer Detection. Urol Int 2012; 89:290-5. [DOI: 10.1159/000339966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/07/2012] [Indexed: 11/19/2022]
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Gravas S, Tzortzis V, de la Riva SIM, Laguna P, de la Rosette J. Focal therapy for prostate cancer: patient selection and evaluation. Expert Rev Anticancer Ther 2011; 12:77-86. [PMID: 22149434 DOI: 10.1586/era.11.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent stage migration toward low-risk prostate cancer, overtreatment of biologically insignificant tumors with radical prostatectomy at the additional expense of a non-negligible morbidity and undertreatment of patients improperly selected for active surveillance are the main reasons that have fueled the concept of focal therapy. Optimal selection of patients is the key for the successful implementation of focal therapy. Selection criteria for focal therapy vary widely and depend on clinical, histological and imaging characteristics of the patients that are highlighted in this article. In addition, the rationales, merits and limitations of the available methods for the assessment of potential candidates, the evaluation of treatment efficacy and follow-up of these patients are discussed.
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Karatzas A, Zachos I, Tzortzis V, Melekos M. Use of haemostatic glue for fistula prevention after iatrogenic combined rupture of anterior vaginal wall, bladder and urethra, during vaginal delivery. J OBSTET GYNAECOL 2011; 31:670-1. [PMID: 21973153 DOI: 10.3109/01443615.2011.601360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zachos I, Tzortzis V, Konstantinopoulos PA, Karatzas A, Gravas S, Melekos M, Papavassiliou AG. Molecular pathogenesis of non muscle-invasive bladder cancer: implications for novel targeted therapies. Curr Mol Med 2011; 11:623-32. [PMID: 21902654 DOI: 10.2174/156652411797536697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/03/2011] [Accepted: 07/09/2011] [Indexed: 11/22/2022]
Abstract
Approximately 70% to 80% of patients with urothelial carcinomas of the bladder are initially diagnosed with non-muscle invasive disease. Superficial, non-muscle invasive bladder cancers (NMIBCs) are managed with cystoscopic transurethral resection of all visible lesions followed by intravesical chemotherapy and/or immunotherapy. Despite this treatment, up to 70% of these tumors will recur within five years and 15% will ultimately progress to muscle-invasive disease, suggesting that novel therapeutic strategies are necessary. Recent studies have greatly advanced our understanding of urothelial carcinogenesis and have highlighted the distinct molecular pathogenesis of NMIBCs versus muscle-invasive bladder tumors. It is now clear that diverse genetic and epigenetic events are driving the oncogenesis of NMIBCs, thereby attesting to their potential as therapeutic targets for these tumors. This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease.
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Nomikos M, Kardakos I, Kalikaki A, Karyotis I, Serafetinides E, Tzortzis V, Stefanidis I, Delakas D, Melekos M. MP-10.16 Cystatin-C, Interleukin-18 and N-GAL Levels as Biomarkers of Inflammatory Response After Extracorporeal Shock Wave Lithotripsy. Urology 2011. [DOI: 10.1016/j.urology.2011.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Zachos I, Konstantinopoulos PA, Tzortzis V, Gravas S, Karatzas A, Karamouzis MV, Melekos M, Papavassiliou AG. Systemic therapy of metastatic bladder cancer in the molecular era: current status and future promise. Expert Opin Investig Drugs 2010; 19:875-87. [PMID: 20528482 DOI: 10.1517/13543784.2010.496450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Platinum-based chemotherapy is considered the standard-of-care first-line therapy for metastatic bladder cancer. Despite the initial high response rate, the vast majority of patients eventually progress and succumb to their disease, urging the need for development of novel therapies. AREAS COVERED IN THIS REVIEW This article discusses the main signaling pathways implicated in the pathogenesis of bladder carcinomas, reviews recently completed and ongoing clinical trials, and anticipates the future direction of molecularly targeted agents. WHAT THE READER WILL GAIN This manuscript presents the current status of conventional chemotherapy in advanced bladder cancer, and provides a comprehensive review of molecular targeted agents currently in clinical development for this disease. TAKE HOME MESSAGE Improved understanding of the biology of urothelial carcinogenesis has paved the way for the development of novel molecularly targeted therapies, several of which are currently tested in clinical trials. In this regard, VEGF and EGFR pathways are emerging as important therapeutic targets for metastatic bladder cancer, either alone or in combination with conventional chemotherapeutics. Other therapies, including aurora kinase inhibitors, endothelin receptor antagonists, RAS/MAPK pathway inhibitors and novel immunologic strategies, may also prove helpful in the treatment of this disease.
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Karatzas A, Giannatou E, Tzortzis V, Gravas S, Aravantinos E, Moutzouris G, Melekos M, Tsezou A. Genetic polymorphisms in the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene and prostate cancer risk in Caucasian men. Cancer Epidemiol 2010; 34:345-9. [DOI: 10.1016/j.canep.2010.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 02/14/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
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Rioja J, Tzortzis V, Mamoulakis C, Laguna MP. [Cryotherapy for renal tumors: current status and contemporary developments]. Actas Urol Esp 2010; 34:309-317. [PMID: 20470692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The proportion of renal tumors found incidentally dramatically increased in the past decade. More than half of them were diagnosed in patients over 70 years of age, a population with high associated comorbidity. Nephron-sparing minimally invasive surgical procedures are aimed at treating patients with small renal tumors and multiple comorbidities. Cryotherapy stands out among all other ablative procedures because of its better mid-term oncological outcome. A non-systematic review of the literature on cryotherapy as a treatment for renal tumors was made, analyzing its indications, actual and future application techniques, results, and complications.
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Rioja J, Tzortzis V, Mamoulakis C, Laguna M. Crioterapia de tumores renales: estado actual y desarrollos contemporáneos. Actas Urol Esp 2010. [DOI: 10.4321/s0210-48062010000400002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rioja J, Tzortzis V, Mamoulakis C, Laguna M. Crioterapia de tumores renales: estado actual y desarrollos contemporáneos. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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