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Androgen deprivation therapy (ADT) is the mainstay treatment for metastatic hormone-sensitive prostate cancer (mHSPC). The addition of docetaxel or new hormone therapies (abiraterone, apalutamide, or enzalutamide) improves overall survival and is currently the standard of care. However, the decision on the specific regimen to accompany ADT should be discussed with the patient, considering factors such as possible associated toxicities, duration of treatment, comorbidities, patient preferences, as there is no sufficient evidence to recommend one regimen over the other in most cases. This paper summarizes the evidence on the management of mHSPC and provides consensus recommendations on the optimal treatment in combination with ADT in mHSPC patients, with special attention to the patient's clinical profile., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose of Review: Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation., Recent Findings: Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.

In this study we have characterised the learning curve for percutaneous nephrolithotomy procedures over 301 cases for six years. Different surrogate parameters of clinical expertise have been used, such as dose area product, total procedure time, fluoroscopy time and personal equivalent doses. In addition, two different endourologists have been monitored; one of whom had specific Radiation Protection training (ICRP 85). Eye lens dose was estimated from thermoluminescent dosimeters. Significant differences were observed between both endourologists, especially in the fluoroscopy time. Finally, both entrance skin dose and effective doses of patients have been determined.

Background and Purpose: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex kidney stones, having increased its safety and effectiveness over the last years. Nonetheless, there is little known about its impact on quality of life (QoL). This study aimed at evaluating the effects of PCNL on patients' QoL in the short and long term., Patients and Methods: We prospectively studied 40 consecutive cases who underwent PCNL. QoL was measured using the short form-36 (SF-36) questionnaire, 2 weeks before surgery and then in the third postoperative month and a year after. Changes in QoL were assessed under statistical and clinical relevance criteria., Results: PCNL has rendered 70% of the cases completely stone free with a 35% complication rate (33% Clavien I+II). The baseline scores of all SF-36 domains were worse than the referral population. Three months after PCNL, bodily pain was the only dimension whose change was relevant for patients (effect size [ES]=0.71, minimal clinically important difference [MCID]=0.56). A year after, this favorable effect of PCNL on body pain is still present, being also beneficial on both role physical (ES=0.58, MCID=0.52) and the physical component summary (ES=0.56, MCID=0.43). Social function was also close to reaching clinical relevance a year after the procedure (ES=0.66, MCID=0.72)., Conclusion: Kidney stone disease considerably affects the patients' QoL. PCNL not only has good outcomes rendering the kidney stone free without major complications but produces an immediate body pain relief. This is perceived as relevant by the patients even a year after the procedure, when some other physical aspects of QoL also get better, helping patients to restore their social activities.

Objective: To report 5 cases of adenomatoid tumor of the epididymis that have been diagnosed in the last 11 years at our hospital. We performed a bibliographic review with discussion of diagnosis, differential diagnosis and treatment of this rare type of lesion., Method: We have performed a retrospective analysis of epididymal adenomatoid tumors diagnosed during the last 11 years in our hospital, from January 2001 to June 2012., Results: The average age of the series was 44 years. The predominant reason for consultation was long duration painless scrotal mass, with palpable nodule, usually dependent of the epididymis. 60% of the patients have been studied with abdominal ultrasound, which showed a nodular paratesticular lesion, with an echogenicity compatible with solid tissue. Tumor markers associated with testicular tumors (alpha-fetoprotein (AFP)), beta-human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH) were analyzed in 60% of the cases, being normal in all patients. 3 lumpectomies, 1 epididymectomy and 1 radical orchiectomy have been performed., Conclusions: The discovery of a solid epididymal mass is uncommon in clinical practice. Physical examination and imaging tests should confirm the paratesticular origin of the lesion, being then trans-scrotal epididymectomy the treatment of choice. If diagnosis is uncertain, inguinal approach and intraoperative biopsy are mandatory.

Introduction: The aim of this study is to identify surgical, patient- and stone-related factors predictive of clinical success and complications after percutaneous nephrolithotomy (PCNL)., Materials and Methods: We prospectively studied 100 consecutive PCNL procedures. Univariate and multiple regression models were used in order to identify which variables could act as independent predictors of PCNL outcomes. Success was defined as complete absence of fragments in a non-contrast CT. The Clavien-modified grading system was used to classify the complications., Results: Univariate analysis showed that patients rendered stone-free had a significantly lower stone burden, shorter operating times, single stones and non-struvite composed calculi. Patient age, nephrostomy tract dilation with high pressure balloon and a stone composition different to struvite behaved as significant protective factors for complications. Logistic regression models revealed that the main independent prognostic factor for success was stone surface (OR = 0.997 per mm2, p = 0.000), followed by multiple stones (OR = 0.203, p = 0.050). On the other hand, struvite composition (OR = 5.911, p = 0.028) was an independent predictor for the development of complications, whilst age (OR = 0.936, p = 0.012) and high pressure balloon dilation (OR = 0.041, p = 0.007) were rendered independent protective variables., Conclusions: Stone burden and multiple calculi in the kidney affect the immediate stone-free rate, whilst Amplatz dilation, struvite stones and young patients lead to a higher incidence of postoperative complications. This information can be very useful for patient counseling, regarding percutaneous kidney stone management.

Objective: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy., Methods: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported., Results: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required., Conclusions: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures.

Objective: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis., Patient: We report the case of a 74-year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal., Results: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele)., Conclusions: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei.

Objective: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature., Methods: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment., Results: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day., Conclusions: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5-8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients.

Objective: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis., Methods: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature., Results: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases., Conclusions: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness.

Objective: To analyze the incidence of surgical complications its diagnosis and treatment after renal transplantation., Methods: A retrospective study measuring the incidence of surgical complications and reviewing its diagnosis and treatment in 185 renal single transplants., Results: 185 transplants, 27% had surgical complications. Only one patient lost the graft due to surgical complications and there was no associated mortality. Cold ischemia time 20 hours. Double J stenting in 19%, under surgeon's opinion. Vascular complications 3.2% (all of them renal artery stenosis). Urological complications 6.4%. Perinephric haematoma 7%. Lymphocele 4.9%. Peritoneum related complications 4%. Other 4%. The diagnosis was clinical and radiological in most of cases. 14% needed any kind of intervention., Conclusions: Our results are similar to those reported in other recent series. Only one surgical team involved and the same technique for vascular and vesico-ureteric anastomosis probably makes lower our complications rate. Early postoperative abdominal ultrasonography contributes to the diagnosis of surgical complications. The initial treatment approach is the endoscopic-conservative one, with exceptions.