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Context: A large proportion of patients with non-muscle-invasive bladder cancer (NMIBC) fall in the gap between bacillus Calmette-Guerin (BCG)-naive and BCG-unresponsive disease. As multiple therapeutic agents move into this gray area, there is a critical need to define the disease state and establish recommendations for optimal trial design. Objective: To develop a consensus on optimal trial design for patients with BCG-exposed NMIBC, defined as high-grade recurrence after BCG treatment that does not meet the criteria for BCG-unresponsive disease. Evidence acquisition: We conducted a literature review using the Cochrane Library, Medline, and Embase and a review of clinical trials in ClinicalTrials.gov as a basis to generate consensus recommendations for clinical trial design in BCG-exposed NMIBC. Evidence synthesis: BCG-exposed NMIBC encompasses BCG resistance (presence of high-grade Ta or carcinoma in situ [CIS] at 3-mo evaluation after induction BCG) and delayed relapse. Randomized controlled trials are required to compare experimental therapies to a control arm receiving additional BCG, although ongoing BCG shortages may impact our ability to follow an optimal trial design. A placebo should be used in combination with BCG if the treatment arm includes BCG plus a study drug. Trials will either need to separate patients with and without CIS into two cohorts, or stratify by the presence of CIS at the time of randomization. If two cohorts are used, the primary endpoint for CIS patients should be complete response within a predetermined time. The primary endpoint in a cohort with Ta/T1 only, or if a single combined cohort is used, should be the duration of event-free survival. Suggested efficacy thresholds and corresponding sample sizes are provided. Conclusions: The International Bladder Cancer Group has developed recommendations regarding definitions, endpoints, and clinical trial design for BCG-exposed NMIBC to encourage uniformity among studies in this disease state. Patient summary: Our consensus provides a precise definition of the disease state for bladder cancer not invading the bladder muscle and exposed to bacillus Calmette-Guerin (BCG) treatment. Clear guidance for conducting optimal clinical trials in this disease setting was established and we believe that this will promote further progress in this field. (C) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Context: Prostate cancer is a public health problem in Spain and in the Western world. Bone involvement, associated to significant morbidity, is practically constant in the advanced stages of the disease. This work aims to review the prognostic factors used in the usual clinical practice that predict the development of bone metastases and to analyze the follow-up and treatment option in these patient profiles. Acquiring of evidence: We performed a review of the literature on the useful factors in the context of therapy with intention to cure. We included the classical clinical values in the diagnosis (PSA, clinical stage, Gleason score on the biopsy) pathological factors (pT stage, margins, bladder invasion, tumor volume, lymph node involvement) and PSA kinetics in their different contexts and the histological and molecular parameters. Synthesis of evidence: The tumor differentiation Gleason score and PSA are the most important predictive factors in the prediction of bone metastases in patients with intention to cure. Kinetic factors such as PSA doubling time (TDPSA) 10 ng/ml in the case of castration-resistant prostate cancer (CPRC), are predictive factors for the development of metastasis. Zoledronic acid and denosumab have demonstrated their effectiveness for the treatment of bone disease in randomized studies. Conclusions: There are predictive factors within the usual clinical practice that make it possible to recognize the "Patient at risk" to develop bone metastatic disease. The currently available treatments, zoledronic acid or denosumab, can help us in the management of the patient at risk of developing metastasis or metastatic patient, increasing the quality of life and decreasing skeletal events. (C) 2013 AEU. Published by Elsevier Espana, S.L. All rights reserved.

Urothelial bladder cancer represents a heterogeneous disease with divergent pathways of tumorigenesis. Tumor invasion and progression are a multifactorial process promoted by microenvironmental changes that include overexpression of matrix metalloproteinases (MMPs). Recent data clearly challenge the classic dogma that MMPs promote metastasis only by modulating the remodeling of extracellular matrix. Indeed, MMPs have also been attributed as an impact on tumor cell behavior in vivo as a consequence of their ability to cleave growth factors, cell surface receptors, cell adhesion molecules, and chemokines/cytokines. Levels of the different MMPs can be measured in several sample types, including tissue, blood (serum and plasma), and urine, and using different methodologies, such as immunohistochemistry, real-time PCR, western and northern blot analyses, enzyme-linked immunosorbent assay, and zymography. Several MMPs have been identified as having potential diagnostic or prognostic utility, whether alone or in combination with cytology. Although MMP inhibitors have shown limited efficacy, advances in the understanding of the complex physiologic and pathologic roles of MMPs might permit the development of new MMP-specific and tumor-specific therapies. In this paper we update the understanding of MMPs based on a systematic PubMed search encompassing papers published up to December 2011.

Context: Intravesical bacillus Calmette-Guerin (BCG) is a standard conservative treatment for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). Many patients will experience recurrence or progression following BCG and are termed BCG failures. Objective: To summarise the current treatment options available for patients with high-risk NMIBC who experience BCG failure. Evidence acquisition: We searched the Medline, Embase, and Cochrane Trials databases for studies of BCG failure using predetermined relevant Medical Subject Heading terms and free text terms. Evidence synthesis: Radical cystectomy (RC) should be strongly recommended when a patient has been deemed to fail BCG, if the patient is fit and fully informed of the risks, benefits, and quality-of-life issues. RC achieves long-term survival in excess of 90% with ongoing improvements in morbidity. While other salvage intravesical therapies have to be considered oncologically inferior to RC, several options are now available if bladder preservation is the objective. The options can be categorised as immunotherapy, chemotherapy, device-assisted therapy, and sequential combinations of these newer modalities with conventional therapy. Some agents have shown specific promise in BCG-failure patients (eg, gemcitabine, thermochemotherapy, taxane chemotherapy), and some modalities have been shown to be effective only in non-BCG-failure cohorts (eg, electromotive mitomycin). Conclusions: The definition, prediction, and treatment of BCG failure remain unclear secondary to inconsistent studies and the heterogeneous entity of patients with NMIBC. RC should be the default position upon failing BCG, but if bladder preservation is sought, then several promising intravesical salvage options are available. It will be necessary to individually tailor the management of such patients based on tumour risk and medical profiles. Currently data are still inadequate to formulate definitive recommendations, and larger studies of salvage intravesical agents are urgently required. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.

No data (2010) UEM

Se trata de un paciente masculino de 40 años de edad quien, posterior a una RTU de recidiva de tumor no músculo invasivo sin perforación aparente e instilación inmediata de Mitomicina C, consultó al cuarto día postoperatorio a nuestro servicio de urgencias con sintomatología urinaria irritativa baja severa. Se solicitó una ecografía renovesical que evidenció una colección perivesical. El manejo fue conservador con sondaje vesical por 10 días siendo necesaria la punción-drenaje de la colección. We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it.

La esclerosis de la unión cérvico-uretral es una de las complicaciones que pueden aparecer tras una prostatectomía radical, el tratamiento endoscópico suele ser resolutivo en la mayoría de los casos. Presentamos la reparación vía abierta de una esclerosis cérvico-uretral tras prostatectomía radical que no respondió al manejo endoscópico. La técnica quirúrgica constó de un primer tiempo perineal y un segundo tiempo con abordaje hipogástrico. A los 6 meses de esta compleja cirugía se colocó un esfínter artificial al paciente. Tras 3 años de seguimiento el paciente se encuentra asintomático y continente. The sclerosis of the cervico-urethral union is one of the complications that may arise after a radical prostatectomy, in most cases, the endoscopic treatment usually solves it. We introduce repair by open approach of a sclerosis cervico-urethral after radical prostatectomy that did not respond to endoscopic management. The surgical technique had two times, the first perineal and a second time with hypogastric approach. After six months of this complex surgery an artificial sphincter was placed to patient. The patient is asymptomatic and continent after three years of follow up surgery.

El componente quístico del cáncer renal (CR) aparece en el estudio radiológico y queda consolidado con el examen anatomopatológico. El concepto "cáncer renal quístico" o "tumor renal quístico" es de uso habitual y comprende una serie de entidades que van desde los CR con patrón de crecimiento quístico a aquellos que poseen cavidades pseudoquísticas o se hallan imbricados en cualquiera de las enfermedades renales que presentan quistes renales. Diversas publicaciones utilizan de forma indistinta el calificativo "quístico" sin esperar al estudio anatomopatológico, provocando confusión en la terminología. La gran variabilidad en la forma de presentación tanto del CR como de las enfermedades quísticas renales produce distintas formas de presentación radiológica en que se mezclan áreas sólidas y otras de contenido líquido, aunque sólo el examen patológico podrá afirmar que se trata de un CR quístico genuino. Sólo el CR con patrón de crecimiento quístico y el carcinoma multilocular quístico pueden ser llamados con propiedad tumores renales quísticos. Para el resto de entidades, en especial durante el estudio iconográfico, es más adecuado utilizar expresiones no concluyentes como "masa renal de configuración quística" o "tumor renal de aspecto quístico". The renal cancer (RC) cystic component is on the radiological tests and could be consolidate with pathological analysis. The concepts "cystic renal cancer" or "cystic renal tumor" contain a group of entities range from cystic grown pattern RCs to pseudocystic tumors as well as cystic renal diseases coinciding with the RC. The CR and the cystic renal diseases have a great variety to sorts of presentations, giving different ways of radiological images, blending solid and cystic areas. Some papers use indiscriminately expression "cystic" without pathologic proof. Just cystic grown pattern RCs and multilocular cystic carcinoma could be named "cystic renal tumors". For de rest, especially over image study, is more suitable to use expressions as "renal tumor of cystic configuration", while pathologic report are available.

Introducción: Una de las complicaciones de la progresión del cáncer de próstata es la uropatía obstructiva, por infiltración y compresión del tramo ureteral distal, que puede conllevar a una insuficiencia renal aguda, con afectación de la calidad de vida y la supervivencia de estos pacientes. El tratamiento del cáncer de próstata con ureterohidronefrosis secundaria es paliativo y siguiendo las tendencias actuales, se debe considerar la colocación de una nefrostomía. Materiales y Métodos: Se realizó una búsqueda en PUBMED y se revisaron los artículos más representativos. El algoritmo se construyó con base en la práctica clínica diaria basada en la rutina, el protocolo de nuestro centro y con la evidencia científica disponible en la literatura médica. Resultados: Se propone un algoritmo de decisiones para definir la derivación urinaria en pacientes con uropatía obstructiva secundaria a cáncer de próstata. Conclusiones: La indicación de colocar una nefrostomía en pacientes con uropatía obstructiva secundaria a cáncer de próstata debe abordarse individualmente, de acuerdo a las condiciones generales y la calidad de vida del paciente con base en escalas ya definidas en la literatura (ECOG y Karnofsky) y en factores de buen o mal pronóstico, siempre teniendo en cuenta consideraciones éticas y el consentimiento del paciente y de su familia. Background: One of the prostate cancer progression complications is the obstructive uropathy, by infiltration and compression of the distal ureteral section, that can entail to an acute renal insufficiency, with affectation of the quality of life and the survival of these patients. The treatment of prostate cancer with secondary ureterohidronefrosis is palliative and following the present tendencies, the positioning of a nephrostomy is considered. Materials and Methods: A search was made in PUBMED and the most representative articles were reviewed. The algorithm was constructed with the daily routine clinical base, the protocol of our center and with the scientific evidence available in medical literature. Results: An algorithm of decisions sets out to define the urinary derivation in patients with obstructive uropathy secondary to prostate cancer. Conclusions: The indication to place a nephrostomy in patients with obstructive uropathy secondary to prostate cancer must be approached individually, according to the general conditions and the quality of life of the patient with base in scales defined in literature (ECOG and Karnofsky) and in factors of good or bad prognosis, always considering ethical considerations and the consent of the patient and his family.

El uso de diuréticos del asa esta muy extendido en la práctica medica. Con un amplio margen de seguridad, poseen efectos adversos que deben ser tenidos en cuenta para evitarlos o reconocerlos en cuanto aparecen. La ototoxicidad asociada a la furosemida es, en principio, excepcional y remite con la supresión del tratamiento, aunque se ha descrito cofosis permanente por lesión coclear. Loop diuretics are quite often used in medical practice. In spite of a wide security, there are several adverse events that should be known, in order to be early recognised as soon as they appear. Ototoxicity associated to furosemide is infrequent and reversible. However, permanent deafness associated with furosemide administration has been previously reported.

El mielolipoma extra-adrenal es raro, son tumores benignos compuestos de material hematopoyetico y tejido graso. Pero, estos tumores pueden presentarse con hemorragia, aunque suelen ser asintomático. Generalmente se descubren de forma casual con el estudio de otras patologías. Presentamos el caso clínico de un paciente que a raíz de estudio de dolor lumbar se diagnostica de mielolipoma pararrenal. Extra-adrenal myelolipomas are rare bening tumours that are componed of mature fat cells and myeloid elements. These lesions are usually asyntomatic and often found incidentally on radiographic studies. We report a case of extra-adrenal perirenal myelolipoma.

Objetivo: Presentamos los primeros casos de nuestra serie de prostatectomía radical robótica con Da Vinci (PRRdaV), que corresponden a la curva de aprendizaje (CA) del cirujano que se ha iniciado en la técnica. Métodos: Se revisan los 20 primeros pacientes sometidos a PRRdaV y realizados por un cirujano experto, sin entrenamiento laparoscópico previo, pero con amplia experiencia en prostatectomía radical retropúbica y perineal (HV). Se analiza: tiempo operatorio, pérdidas hemáticas, tasa de conversión, complicaciones intra y postoperatorias, estancia hospitalaria y días de sonda vesical. También: las tasas y la localización de los márgenes positivos, así como los resultados funcionales con un seguimiento medio de 10 meses. Resultados: La media de tiempo operatorio fue de 140 minutos (100-211) y la pérdida hemática media de 180 mL (80-360), no requiriendo transfusión sanguínea en ningún caso. No se presentaron complicaciones intraoperatorias, y tampoco ninguna reconversión. Como acontecimientos postoperatorios sólo destaca una retención aguda urinaria tras retirada de sonda vesical. La estancia hospitalaria media fue 3,35 días (3-5). Se obtuvieron 6 casos con márgenes quirúrgicos positivos (30%). La localización más frecuente fue postero-lateral. Dieciocho de los 20 pacientes (90%) son completamente continentes de forma precoz, 2 (10%) requirieron utilizar una compresa de seguridad durante los 6 primeros meses por incontinencia leve de esfuerzo que se resolvió espontáneamente. De los 20 casos, 2 de ellos (10%) presentaban disfunción eréctil preoperatoria; de los 18 restantes, 12 (66.6%) conservaban potencia en el momento de la revisión y 6 (33.4%) presentaron disfunción eréctil postoperatoria. Conclusiones: La prostatectomía radical mediante cirugía robótica se ha demostrado claramente ventajosa (excelente maniobrabilidad para una técnica mínimamente invasiva, postura más cómoda y anatómica, visión tridimensional y corta curva de aprendizaje). Una amplia experiencia quirúrgica previa en cirugía abierta y/o laparoscópica, acortan de forma significativa esta curva de aprendizaje de la PRRdaV. Objective: We present the first cases of our robotic radical prostatectomy with Da Vinci (RRPdaV) that corresponds to the learning curve (LC) of the surgeon that has initiated with this technique. Methods: We reviewed the first 20 patients that underwent RRPdaV, performed by an expert surgeon, without previous laparoscopic training, but with a wide experience in retropubic and perineal prostatectomy (HV). We analyzed: Surgical time, blood loss, conversion rate, intra and postoperative complications, hospital stay and days of bladder catheterization. Also: rates and location of surgical margins, as well as functional outcomes with an average follow up of 10 months. Results: Mean operating time was 140 minutes (100-211) and blood loss 180 mL (80-360), and none required a blood transfusion. There were no intraoperative complications and neither any conversion to open surgery. The only postoperative outstanding fact was mean hospital stay were 3,35 days. (3-5). We had 6 cases of positive surgical margins (30%). The most frequent location was postero-lateral. Eighteen out of 20 patients (90%) were early totally continent, 2 (10%) required the use of one pad during the first six months due slight stress incontinence that stopped spontaneously. From 20 cases, two of them (10%) had preoperative erectile dysfunction; 12 out of the remaining 18 (66.6%) preserved potency at review and 6 (33.4%) had postoperative erectile dysfunction. Conclusions: It has been demonstrated that robotic surgery for radical prostatectomy is clearly an advantage technique (easy maneuver although it is a minimally invasive technique, comfortable and ergonomic position for the surgeon, 3D visualization and short learning curve). The RRPDAv learning curve is significantly shorter if the surgeon has a wide previous surgical experience in open and/or laparoscopic surgery.

El tratamiento del cáncer de próstata localmente avanzado continúa siendo controvertido. Las opciones terapéuticas comprenden desde la prostatectomía radical (PR), a la radioterapia (RT) y la hormonoterapia (HT). Se ha efectuado una revisión en la base de datos Medline de los trabajos publicados en los últimos 15 años, con las palabras clave en inglés: "cáncer de próstata", "localmente avanzado", "alto riesgo" y "tratamiento". Cincuenta y uno de 329 artículos fueron seleccionados y revisados. El criterio de selección incluía un mínimo nivel de evidencia científica IIa, destacando alguna referencia puntual con evidencia IV. Como demuestran múltiples estudios aleatorios, estos pacientes se pueden beneficiar de una terapia combinada con RT y HT. La PR en enfermedad localmente avanzada ha demostrado su utilidad en algunos casos seleccionados. Los resultados a largo plazo de algunas series son equiparables a los obtenidos con RT y HT. Además, la posibilidad de sobreestadiaje clínico también es un argumento a favor de la PR. Se realiza una revisión actualizada de todas las posibles opciones disponibles en el tratamiento de estos tumores. Treatment of locally advanced prostate cancer remains controversial. Treatment options include radical prostatectomy (PR), radiotherapy (RT) and hormonotherapy (HT). A Medline database search with key words "prostate cancer", "locally advanced", "high risk" and "treatment" in articles published during the last 15 years was done. Fifty one out of 329 papers were selected and reviewed. Selection criteria were a minimum of scientific evidence level of IIa, except for some specific level IV reference. Numerous randomized studies show that patients may benefit of a combined therapy with RT and HT. RP has shown its usefulness in selected cases of locally advanced prostate cancer. Results of long follow-up series are similar to those obtained with RT and HT. Furthermore, the possibility of clinical over staging is an argument in favour of RP. We perform an updated revision of every possible choice available in the treatment of these tumours.

La cirugía robótica es ya una realidad. Revisar la historia de la robótica antigua (ver parte I) y moderna es importante para conocer cómo funcionan los nuevos robots. La fabricación de máquinas que imitan al ser humano se ha mantenido desde hace más de 4000 años. En la robótica clásica destacaron inventores como Arquitas de Tarento (hacia 400 a.C.), Heron de Alejandría, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen (ver parte I). En 1942 Asimov publica las tres leyes de la robótica. Con el desarrollo de la mecánica, la electrónica y la informática en el siglo XX se han desarrollado robots capaces de realizar de forma autónoma tareas de gran complejidad. En 1985 el robot PUMA 560 fue utilizado para introducir una aguja en el cerebro. A partir de ahí se desarrollan robots cirujanos como World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. En el año 2000 la FDA aprueba el da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA) un sofisticado robot asistente del cirujano. Procedimientos urológicos como la prostatectomía, cistectomía o la nefrectomía son realizadas con el robot da Vinci, situando a la urología como una de las especialidades más idóneas para la cirugía robótica. Robotic surgery is a reality. In order to to understand how new robots work is interesting to know the history of ancient (see part i) and modern robotics. The desire to design automatic machines imitating humans continued for more than 4000 years. Archytas of Tarentum (at around 400 a.C.), Heron of Alexandria, Hsieh-Fec, Al-Jazari, Bacon, Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors. At 1942 Asimov published the three robotics laws. Mechanics, electronics and informatics advances at XXth century developed robots to be able to do very complex self governing works. At 1985 the robot PUMA 560 was employed to introduce a needle inside the brain. Later on, they were designed surgical robots like World First, Robodoc, Gaspar o Acrobot, Zeus, AESOP, Probot o PAKI-RCP. At 2000 the FDA approved the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons. Currently urological procedures like prostatectomy, cystectomy and nephrectomy are performed with the da Vinci, so urology has become a very suitable speciality to robotic surgery.

Objetivo: Exposición de un caso de rotura recurrente de neovejiga tratada de forma conservadora. Revisión de los artículos publicados desde 1985 sobre tratamiento conservador en estos casos. Resultados: Desde 1985 se han publicado 19 artículos sobre rotura espontánea de neovejigas, de los cuales, 4 hablan de la posibilidad de tratamiento conservador con éxito, siempre que los paciente sean bien seleccionados. Conclusiones: En pacientes con neovejiga es fundamental sospechar una perforación espontánea ante dolor abdominal, y, si es posible, confirmarlo mediante cistografía o TC. En muchas ocasiones, será necesaria una laparotomía exploradora, bien por la falta de diagnóstico, bien porque el estado del paciente no permite otra actitud, pero en casos seleccionados y con un diagnóstico preciso, el tratamiento conservador puede ser resolutivo. Purpose: To present a case of recurrent neobladder rupture treated in a conservative fashion. To review the articles on conservative management of cases like this one published from 1985. Results: Nineteen articles have been published since 1985 on spontaneous neobladder rupture, 4 of which describe the possibility of a successful conservative management, provided that the patients are carefully selected. Conclusions: Faced to abdominal pain in patients with neobladder, it is essential to suspect spontaneous perforation and, if possible, to confirm such suspicions by means of cystography or CT. An exploratory laparotomy may be necessary in many instances, sometimes due to lack of a diagnosis and sometimes because the patient’s status rules out any other procedure, but in selected and precisely diagnosed cases a conservative management can be resolvent.

La cirugía robótica es la última novedad tecnológica en urología. Para conocer como funcionan los nuevos robots es interesante conocer su historia. La fabricación de máquinas que imitan al ser humano se ha mantenido desde hace más de 4.000 años. Existen referencias a King-su Tse, China clásica, que inventa un autómata en el 500 a. C. Arquitas de Tarento (hacia 400 a.C.) es considerado el padre de la ingeniería mecánica, y uno de los maestros clásicos de la robótica occidental. Figuras como Heron de Alejandría, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen construyeron robots en la edad media, el renacimiento y el clasicismo. En el siglo XIX existe un auge de los autómatas y se producen importantes avances en todas las ramas de la ingeniería. En 1942 Asimov publica las tres leyes de la robótica coincidiendo con el inicio de la robótica moderna, basada en los avances en mecánica, electrónica e informática. El desarrollo de robots en el terreno industrial, bélico y aeroespacial durante el siglo XX permite la aparición de robots de gran precisión, útiles en cirugía, como el robot quirúrgico da Vinci (Intuitive Surgical Inc, Sunnyvale, CA, USA). Robotic surgery is the newst technologic option in urology. To understand how new robots work is interesting to know their history. The desire to design machines imitating humans continued for more than 4000 years. There are references to King-su Tse (clasic China) making up automaton at 500 a. C. Archytas of Tarentum (at around 400 a.C.) is considered the father of mechanical engineering, and one of the occidental robotics classic referents. Heron of Alexandria, Hsieh-Fec, Al-Jazari, Roger Bacon, Juanelo Turriano, Leonardo da Vinci, Vaucanson o von Kempelen were robot inventors in the middle age, renaissance and classicism. At the XIXth century, automaton production underwent a peak and all engineering branches suffered a great development. At 1942 Asimov published the three robotics laws, based on mechanics, electronics and informatics advances. At XXth century robots able to do very complex self governing works were developed, like da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, CA, USA), a very sophisticated robot to assist surgeons.

Introducción y objetivos: Identificar los factores pronósticos independientes del cáncer de próstata y construir una tabla predictiva de la probabilidad de cáncer de próstata no localizado que permitirá ajustar la indicación de prostatectomía radical a aquellos pacientes con mas probabilidad de que ésta fuera curativa. Métodos: Se analizaron retrospectivamente 1.293 pacientes con cáncer de próstata clínicamente localizado, sin antecedentes de tratamiento hormonal ni de radioterapia prostática, a los que se practicó una prostatectomía radical en el periodo 1990-2003. Para analizar los factores pronósticos se realizó una regresión logística estudiando los posibles factores de confusión e interacción e introduciendo las variables independientes de forma "forward" con los siguientes criterios: BCON(0,0001) LCON(0,00001) ITER(50) POUT (0,1). Las variables pronosticas se categorizaron y a partir de éstas se construyó la tabla predictiva de probabilidad de cáncer de próstata no localizado. Resultados: Se identificaron como factores pronósticos independientes el estadio clínico, el antígeno prostático específico y el "grado" de Gleason, observando que a medida que éstos aumentan también lo hacía la probabilidad de cáncer de próstata no localizado. La regresión logística permitió la construcción de una tabla predictiva de la probabilidad de cáncer de próstata no localizado, en la que tomando como punto de corte una probabilidad del 50% se obtiene una sensibilidad del 26,13% y una especificidad del 94,65%. El estudio anatomopatológico de la próstata y la linfadenectomía demostró que globalmente el 70% de los tumores estaban localizados. Conclusiones: El uso de tablas predictivas de la probabilidad de cáncer de próstata no localizado permite mejorar la exactitud pronostica de los llamados "grupos de riesgo" permitiendo una indicación terapéutica más acorde con la realidad de la enfermedad. Introduction and objectives: To identify the independent prognostic factors of prostate cancer and to develop a table for predicting the probabilities of not-localised prostate cancer occurrence, thus permitting to restrict the radical prostatectomy indication to those patients who have greater probabilities of being cured by the procedure. Methods: 1293 patients with clinically localised prostate cancer, with histories of neither hormone therapy nor prostate radiation therapy, in whom radical prostatectomy was performed during the period 1990-2003, were retrospectively evaluated. In order to analyse the prognostic factors, logistic regression was carried out by studying all the potential confusion and interaction factors, and by introducing the independent variables in a forward fashion with the following criteria: BCON(0.0001) LCON(0.00001) ITER(50) POUT(0.1). The prognostic variables were categorised, and the prediction table of the not-localised prostate cancer probability was developed from them. Results: Clinical stage, prostatic specific antigen and Gleason's "grade" were identified as prognostic factors, taking into account that the higher they are, the higher the probability of not-localised prostate cancer occurrence. Logistic regression enabled us to develop a table to predict the probability of not-localised prostate cancer in which, taking a 50% probability as the cutoff point, a 26.13% sensitivity and a 94.65% specificity are obtained. The pathological examination of the prostate and the lymphadenectomy showed that, globally, 70% of the tumours were localised. Conclusions: Application of tables to predicting the probability of having not-localised prostate cancer offers the possibility of improving the prognostic accuracy of the so-called "risk groups", and enables to issue a therapeutic indication better adjusted to the actual status of the disease.

La cirugía laparoscópica constituye una técnica quirúrgica que el urólogo debe incorporar a su armamentario quirúrgico. Su realización intenta simular los pasos quirúrgicos de la cirugía abierta, así como sus indicaciones. La nefrectomía parcial laparoscópica es una técnica compleja que implica para su desarrollo una experiencia amplia en el manejo de las técnicas endoscópicas. Presentamos nuestra experiencia de 35 nefrectomías parciales laparoscópicas transperitoneales con una media de seguimiento de 25 meses. El tiempo medio de cirugía fue de 200 minutos, el sangrado de 190 cc, y la estancia media de cinco días. Se han objetivado dos sangrados postoperatorios, ninguna conversión y en dos casos se informó de márgenes positivos, optándose por una actitud conservadora. Laparoscopic surgery is a surgical technique the urologist should add to his surgical armamentarium. Its performance tries to mimic the surgical phases of open surgery, and also its indications. Laparoscopic partial nephrectomy is a sophisticated technique that requires wide experience in the performance of endoscopic strategies. We are submitting our experience with 35 laparoscopic partial transperitoneal nephrectomies with a mean follow-up of 25 months. The mean surgical time was 200 minutes, the mean bleeding 190 cc, and the mean hospitalisation five days. Two postoperative bleedings were identified, there were no conversions, and positive margins were notified in two cases, whereupon a conservative attitude was adopted.

En la década de los 90 fue difícil obtener conclusiones de las publicaciones sobre CPHR, existía una falta de homogeneidad en cuestiones tan importantes como la propia definición de CPHR, la selección de pacientes o la valoración de las respuestas a los tratamientos. En la actualidad ya existen criterios consensuados al respecto que se exponen en el trabajo. A finales de 2004 se publicaron 2 trabajos que demostraron que la quimioterapia basada en docetaxel mejoraba la supervivencia en el CPHR con metástasis. Hasta entonces los distintos tratamientos utilizados únicamente conseguían paliación de síntomas. Pero probablemente no todos los pacientes con CPHR sean candidatos a quimioterapia con docetaxel de entrada. El debate actual se centra en determinar a qué pacientes y en qué instante debe iniciarse la quimioterapia para excluir a los que corran el riesgo de sufrir sus efectos adversos sin ventajas clínicas. Pacientes con CPHR sin metástasis pueden ser candidatos a recibir maniobras hormonales secundarias antes de iniciar quimioterapia En esta revisión analizamos qué cambios se han producido en las estrategias terapéuticas en CPHR, desde la demostración de la utilidad de la quimioterapia, mostrando también cual es en la práctica diaria nuestra actitud en el tratamiento de estos pacientes. Back in the 90’s it was difficult to have access to the conclusions of publications on HRPC. Homogeneity was very scarce regarding issues as significant as the definition of HRPC itself, patient selection, or evaluation of the responses to therapy. Consensus has currently been reached on such matters, and it is described in this text. Two works were published in late 2004 showing that docetaxel-based chemotherapy improved metastatic HRPC survival. Until then, the different treatments used could only provide symptomatic relief. But probably not all of the HRPC patients are eligible for primary docetaxel chemotherapy. The current debate focuses on determinating to which patients should chemotherapy be administered and at which time should it start, in order to exclude those patients at risk of experiencing its adverse effects without benefitting from its clinical advantages. Non-metastatic HRPC patients may be candidates to receiving secondary hormone manoeuvres before starting with chemotherapy. We will analyse in this review the changes occurred in the therapeutic strategies ever since chemotherapy showed its value, and we shall also disclose our attitude regarding treatment of these patients in daily practice.

El tumor urotelial del tracto urinario superior constituye un tipo de tumor de baja prevalencia, frecuentemente asociado a tumor vesical. El uso de la vía endoscópica con acceso anterógrado representa un método de tratamiento seguro, eficaz y mínimamente invasivo. La asociación con inmunoterapia parece efectiva para disminuir la recurrencia. Presentamos un caso de tumor de tramo urinario superior múltiple tratado mediante exéresis percutánea e inmunoterapia terapéutica. Upper tract transitional cell carcinoma is a low prevalent tumour and frequently associated to bladder carcinoma. The antegrade endoscopic access represents a safe, efficient and minimally invasive access. The association to immunotherapy seems effective in decreasing recurrence. We present one patient with multiple upper tract carcinoma treated with percutaneous surgery and BCG.

Renal cell carcinoma (RCC) is a common neoplasm of the urinary tract, that is nowadays often diagnosed incidentally. The risk of developing neoplasms in immunosuppressed patients is well documented. The increasing rate of heart transplantation, and the complementary studies required in the follow up of those patients probably will increase the detection rate of RCC in this population. Due the lack of published reports about the management and evolution of RCC in these patients, we performed a radical nephrectomy, on a immunosuppressed patient without evidence of recurrence 24 moths after surgery.

There is only rare and scanty literature explaining the different surgical techniques and results for rectourethral fistulas. Here we present a review of 18 patients with rectourethral fistula. In half of the cases Bevan-Mason repair was undertaken with success.

We present 9 cases (0.57%) of vesicoprostatic perforation during transurethral resection of 1,562 consecutive operations done during the last 3 years in our urology department. We review the symptomatology, medical and surgical treatment from the point of view of the physiopathology of the intra-abdominal extravasated fluid. A new technique for the evacuation of the extravasate is presented ( multiperforated intraperitoneal catheter) because of its speed and ease of performance.

In 1967, Bolande coined the term, congenital mesoblastic nephroma, in relation to a rare benign kidney tumor which is mainly found in infancy and that can be misdiagnosed clinically as a Wilm's tumor. It has been called renal fetal hamartoma, leiomyomatous hamartoma and renal leiomyoma. Four cases have been described in adults previously and here we report a new case.