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The natural history of renal cell carcinoma is heterogeneous. Some scenarios can be found in terms of clinical presentation, clinical evolution or type of recurrence (local/metastatic). The aim of this publication is to analyze the most important prognostic factors published in the literature.A literature review ob published papers was performed using the Pubmed, from first Motzer's classification published in 1999 to 2015, according to PRISMA declaration. Search was done using the following keywords: kidney neoplasm, kidney cancer, renal cell carcinoma, prognostic factors, mortality, survival and disease progression. Papers were classified according to level of evidence, the number of patients included and the type of study performed.The evolution in the knowledge of molecular pathways related to renal oncogenesis and the new targeted therapies has left to remain obsolete the old prognostic models. It's necessary to perform a continuous review to actualize nomograms and to adapt them to the new scenarios.Is necessary to perform a proper external validation of existing prognostic factors using prospective and multicentric studies to add them into the daily urologist clinical practice.

Posterior urethral stenoses and contractures are complications after treatment of benign prostatic hyperplasia (BPH), localised prostate cancer (PCa), and orthotopic neobladder formation, compromising prognosis and functional outcomes.To identify factors related to aetiology, prevention and treatment of non-traumatic posterior urethral stenosis and contractures.Review of the published evidence related to posterior urethral stenosis and contractures after PCa treatment, BPH therapies and orthotopic neobladder formation. PubMed database search with English and Spanish papers considered. Cohort studies, case series, prospective and retrospective studies and review papers were included.Posterior urethral stenoses and contractures are common, leading to significant morbidity. A worsening on voiding quality should rise some concerns. Careful surgical and/or radiotherapic techniques prevent their development. Endoscopic therapies are the initial approach, with complex urethroplasties often required. Subsequent urinary incontinence, the most important sequelae, may need artificial sphincters.Non-traumatic posterior urethral stenoses could be important complications, potentially compromising the outcomes of initial therapy. They could require complex surgeries leading to urinary incontinence.

The European Association of Urology (EAU) Guideline Group for urothelial cell carcinoma of the upper urinary tract (UUT-UCC) has prepared new guidelines to aid clinicians in assessing the current evidence-based management of UUT-UCC and to incorporate present recommendations into daily clinical practice.This paper provides a brief overview of the EAU guidelines on UUT-UCC as an aid to clinicians in their daily practice.The recommendations provided in the current guidelines are based on a thorough review of available UUT-UCC guidelines and papers identified using a systematic search of Medline. Data on urothelial malignancies and UUT-UCCs in the literature were searched using Medline with the following keywords: urinary tract cancer, urothelial carcinomas, upper urinary tract, carcinoma, transitional cell, renal pelvis, ureter, bladder cancer, chemotherapy, nephroureterectomy, adjuvant treatment, neoadjuvant treatment, recurrence, risk factors, and survival. A panel of experts weighted the references.There is a lack of data in the current literature to provide strong recommendations due to the rarity of the disease. A number of recent multicentre studies are now available, whereas earlier publications were based only on limited populations. However, most of these studies have been retrospective analyses. The TNM classification 2009 is recommended. Recommendations are given for diagnosis as well as for radical and conservative treatment; prognostic factors are also discussed. Recommendations are provided for patient follow-up after different therapeutic options.These guidelines contain information for the diagnosis and treatment of individual patients according to a current standardised approach. When determining the optimal treatment regimen, physicians must take into account each individual patient's specific clinical characteristics with regard to renal function including medical comorbidities; tumour location, grade and stage; and molecular marker status.

Context Penile prosthesis surgery is currently the most effective treatment for erectile dysfunction when medical treatment is ineffective or contraindicated. Among the surgical approaches described in the literature, the scrotal, infrapubic and subcoronal are the most common in the daily clinical practice. Objectives The main objectives were to describe the infrapubic surgical technique evaluating its indications and complications, as well as comparing its advantages and disadvantages with the penoscrotal approach. Acquisition and synthesis of the evidence A literature review from 1983 until current date was carried out in Medline (PubMed and Cochrane Library databases) following PRISMA standards. Sixteen studies were included: 4 prospective, 4 retrospective, one systematic review, one randomized trial, one original article, 5 expert opinion/surgical technique descriptive paper. Discussion According to the literature reviewed, although the penoscrotal approach is the most applied, the infrapubic approach showed a shorter operative time and a tendency for an earlier recovery of sexual activity after surgery. Complications are rare, having similar rates to the penoscrotal approach; no cases of glans hypoesthesia have been reported and peri-prosthetic infection rates were less than 3%. Satisfaction rates of infrapubic penile prosthesis were higher than 80%. Conclusions Penile prosthesis implantation requires of a profound knowledge of the different surgical approaches in order to best adapt each technique based on each individualized case. The infrapubic approach, even if it is not the most used, is as feasible and reliable as the penoscrotal approach. The infrapubic approach is effective and safe, with high level of both, patients and partners’ satisfaction.

According to the declaration of the Budapest Open Access Initiative (OAI) is defined as a editorial model in which access to scientific journal literature and his use are free. Free flow of information allowed by Internet has been the basis of this initiative. The Bethesda and the Berlin declarations, supported by some international agencies, proposes to require researchers to deposit copies of all articles published in a self-archive or an Open Access repository, and encourage researchers to publish their research papers in journals Open Access. This paper reviews the keys of the OAI, with their strengths and controversial aspects; and it discusses the position of databases, search engines and repositories of biomedical information, as well as the attitude of the scientists, publishers and journals. So far the journal Actas Urológicas Españolas (Act Urol Esp) offer their contents on Open Access as On Line in Spanish and English.

Prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) in the setting of prostatic needle biopsies are considered premalignant although questions still remain.In this paper, we have studied the clinical relevance of these histologic findings.We collected 138 subjects (108 PIN, 30 ASAP); in 67% we performed a second biopsy and the rate of cancer in this late biopsy were 19% and 27% respectively. We cannot identify any clinical factor to predict the finding of cancer in the re-biopsy (PSA, age, digital rectal examination, prostatic volume).In the follow-up, we observed higher rates of cancer for the ASAP; the finding of ASAP was the single clinical or histopathological factor that was an independent predictor of cancer.We observed that the finding of ASAP was an indication for re-biopsy because of the higher rates of cancer; on the contrary, the paper of PIN in the prostatic needle biopsy still requires further investigation.

San Antonio, Somacarrera (1977) and Rousaud-Inmark (1984) studies established the first data of incidence and prevalence about urolithiasis in Spain. Other regional or national epidemiologic details were given for several authors from 1977 to 2002.Sixteen papers with original data about incidence or prevalence have been selected, 5 of them are about incidence, 8 about prevalence and 3 include both. Ten papers are based on poblational research (San Antonio, Martin, Pedrajas, Rousaud-Inmark, Torres, Ripa, Romero, Grases, Alapont, Aíbar), 5 on subjective estimations (Solé-Balcells, Cifuentes, Puigvert, Serrallach, Conte) and one include both (Somacarrera). Seven papers are nationwide and 9 are about local areas. A map with different location studies is presented and a data register show incidence and prevalence medians.The Spanish median urolithiasis incidence is 0.73%, corresponding to 325,079 new cases per year; and the prevalence is 5.06%, corresponding to 2,233,214 cases.Methodologically the best epidemiologic studies about lithiasis are based on general population survey. The commonest slant is extract data from retrospective clinical registers. Most studies have significant methodological difficulties, but they reflected interest about epidemiology of stone disease in Spain. There is a concordance between Spanish results and international published data.

[corrected] To assess the usefulness of pelvic lymphadenectomy in bladder cancer.With the followings key words: "bladder cancer, lymphadenectomy, lymph node metastasis" we search in Medline/PubMed database for papers published during the last ten years. Thirty three papers fulfilling the search criteria were selected.It does not exist any randomized prospective study comparing different pelvic lymphadenectomy techniques. Nodal metastasis in bladder cancer after radical cystectomy and pelvic lymphadenectomy ranged between 18% and 28%. Standard lymphadenectomy could improve tumor staging and probably survival in selected patients. It is advisable to remove, as a quality parameter, at least 10 to 14 nodes in a pelvic lymphadenectomy. Lymph node density seems to predict survival better than TNM staging system. It is advisable to perform separate lymph node dissection rather than en-bloc.

Human papilloma virus (HPV) infection is the most common sexually transmitted infection worldwide. There is a high detection rate in sexually active young people but the risk, in males, persists over years. Currently, the American Center for Disease Control and Prevention does not recommend the evaluation of men for HPV and, the extant bibliography, backs up this stance for several reasons. Objective of the paper was to evaluate the usefulness of HPV detection methods for men; A comprehensive and exhaustive review of the literature was performed. Many are methods for HPV detection used in cervical cancer screening as well as in the study and management of patients with cytological alterations of the lower genital tract. Need for HPV detection methods in men are numerous: screening for both partner/gender; anogenital warts; recurrent respiratory papillomatosis; HPV-related cancer in men; fertility. No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix. Many are methods for HPV detection that have shown their usefulness in some of the pathologies associated with male HPV but, despite this, none of them has been approved for man.

To review the incidence, clinical features and management guidelines for patients with isolated prostatic intraepithelial neoplasia (PIN) diagnosed through prostate transrectal biopsy.Search in Medline database for papers published between 1990 and 2000 based on the following key words: "prostatic intraepithelial neoplasia and needle biopsy". Nineteen papers fulfilling the search criteria were selected.The incidence of PIN in patients seen as part of an early diagnosis program is much lower than in patients attending standard Urology practices. PSA level and ultrasound changes are poor predictors of PIN presence in the biopsy. Prostate cancer incidence in successive biopsies ranges between 13.3% and 100%. None of the clinical variables used to diagnose prostate cancer (DRE, PSA and transrectal ultrasound) can predict accurately the existence of cancer associated to PIN, and only prostatic intraepithelial neoplasia grading is considered a good cancer predictor. There is no consensus with regard to diagnostic and therapeutic management in these patients.

Although the background and major details concerning the events that in 1911 culminated with the creation of the Spanish Association of Urology are well known as they have been published earlier in several papers, until now and as far as we know, no paper had presented the dates and particulars of the preparatory and constituent meetings of the Society, the first Regulations, and the semblance and biographies of the project's main inspirators and initiators. This article, prepared with abundant material from newspapers and literature of the period, extricated from the resources of the National Library and the archives of the Royal Academy of Medicine in Madrid, uncovers some unpublished data on the foundation and its advocates, and rediscovers other that although published in journals at the beginning of the century, remained forgotten or were unknown for most urologists. In this way, we complete the history of a part of our past, perhaps the most interesting one, and that of its main players.

Brief report on the case report of a young female diagnosed and treated (TUR) of a low grade transitional vesical tumour. The reason behind this paper is the early presentation of this tumoral species. Although this neoplasia used to be practically anecdotal, this is no longer the case. This fact prompted our concern and urged us to continue to investigate the reasons for vesical tumours having an increasingly higher incidence in our environment. In order to manage these neoplasias will shall merge data from ultrasonography with that obtained from urinary cytology. Cystoscopies shall be avoided as far as possible. References used to prepare this paper come from a brief review of the relevant Spanish urological literature. We believe this to be sufficient to prepare a "Clinical report" type original.

The endoscopically-guided lateral discharge laser (VLAP) has been considered an alternative in the management of benign prostate hyperplasia (BPH). The purpose of this paper is to describe the technique, results obtained in 20 treated patients, and pathoanatomical findings in those later treated with prostate transurethral resection. Four patients were carriers of an indwelling catheter, while IPSS/QL mean values in the other 16 patients were 23/4. Mean maximum flow was 7.01 mL/s. Assessment after one and two years shows a fall of mean IPSS/QL to 5/1 and mean maximum flow to 15.2 mL/s and 21 mL/s, respectively, but the difference is not significant. This paper also describes the morbidity affecting 65% patients, which is comparable to the retreatment rate (15%) obtained in other series published. The results are similar to those described in the literature although, in our view, the high rate of complications undermines this choice as an alternative in BPH management.

To study the number of authors of papers published in Actas Urologicas Españolas, and to assess the consequences on multiple authorship of the restriction to 6 of the number of authors for paper, established in the instructions for authors since January 1995.The authors and papers appearing on sections "Originals". "Reviews" and "Case reports" from 1992 to 1995, were counted.Five hundred and forty eight papers were reviewed. The mean (+/- standard deviation) number of authors (6.1 +/- 2; 95% IC = 5.9-6.3) didn't show a statistically significant change between the 4 studied years (ANOVA, F = 1.42; p = 0.23). Fifty percent of the Originals and Reviews and 36% of Case reports had more than 6 authors and these proportions didn't change significantly between years (chi 2 = 3.48; p = 0.32), even considering that more than one third of papers published in 1995 were accepted that year.A great number of authors should modify their habits of co-authorship on papers submitted to Actas Urologicas Españolas, in order to fulfill the new instructions for authors.

Fitting a penial prosthesis has become an effective procedure to treat sexual impotence. However, its main complication, infection, remains a relatively frequent problem which forces the implant removal with the resulting treatment failure. This paper summarizes our early experience in 4 patients with infected penial prosthesis, who were treated by correcting the patient's general status, adequate antibiotic treatment, and deep and regular curing of the infected area. In these 4 patients, we managed to preserve the implant, achieving an adequate functional and cosmetic result. The paper discusses the pathophysiological mechanisms which would explain these improvements and points to the eventual indications and contraindications of the treatment. Finally, a recommendation is made to use this treatment with caution since our experience was still preliminary.

The renal adenocarcinoma is not a frequent tumour within the scope of multiple neoplasias, at least in the clinical series. Conversely, it appears at a higher relative rate in the post-mortem series. This paper submits a review of renal adenocarcinoma associated in life to other malignant neoplasias, enumerating their major clinical and epidemiological data. Also, it reviews the literature with regard to frequency and etiology, applying the data to our series. The paper concludes that hypernephroma is not a tumour frequently associated with others in life, given its tendency to be secondary to other primary ones, therefore its development depending on survival to the initial tumour. It also emphasizes the need for adequate anamnesis aimed to detect multi-cancer syndromes and the etiology of multiple neoplasias. Further studies are needed to understand the scope of multiple neoplasias and their relative risk.

One of the major challenges of using prostate transrectal ultrasound scanning as a procedure to diagnose through images is the theoretical possibility of reaching an early diagnosis of prostate cancer. This paper compiles the author's experience in this field. Based on 142 established diagnosis of prostate cancer since 1984, the conclusion being reached is that prostate cancer has no pathognomonic signs, and therefore it is impossible to make an early diagnosis just by using the images obtained with transrectal ultrasound scanning. This procedure could be used, however, to select patients with scan abnormalities (Alarm signs) who should have a biopsy performed. The support of ultrasound-led transperineal biopsy of the prostate is currently indispensable to achieve an early diagnosis. This paper suggests that a biopsy should be done at the appearance of just one alarm sign, although this may involve a large number of cancer negative biopsies. The almost null incidence of complications from transperineal biopsies enhances this reasoning.

Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging as the most sensitive and specific imaging tool for detection, lesion characterization and staging of PCa. Therefore, we carried out an updated review of magnetic resonance imaging in the diagnostic PCa reviewing the latest papers published in PubMed.

Human papilloma virus (HPV) infection is the most common sexually transmitted infection worldwide. There is a high detection rate in sexually active young people but the risk, in males, persists over years. Currently, the American Center for Disease Control and Prevention does not recommend the evaluation of men for HPV and, the extant bibliography, backs up this stance for several reasons. Objective of the paper was to evaluate the usefulness of HPV detection methods for men; A comprehensive and exhaustive review of the literature was performed. Many are methods for HPV detection used in cervical cancer screening as well as in the study and management of patients with cytological alterations of the lower genital tract. Need for HPV detection methods in men are numerous: screening for both partner/gender; anogenital warts; recurrent respiratory papillomatosis; HPV-related cancer in men; fertility. No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix. Many are methods for HPV detection that have shown their usefulness in some of the pathologies associated with male HPV but, despite this, none of them has been approved for man.

Renal arteriovenous fistulae (AVF) conform a pathology the urologist is not used to see. The basic purpose of this paper is to collect and update the current knowledge of this renal-vascular disorder, quite frequently forgotten when establishing the likely causes of haematuria. The paper describes the etiology of renal AVF and their generation mechanisms, as well as clinical presentations they can have. A most appropriate diagnostic method is still selective renal arteriography, which usually evidences the anomaly through indirect arteriographic signs. However, when the lesion is small it can be difficult to detect it. Finally, a discussion of therapeutical possibilities, both conservative and radical, and a case recently treated in out unit are presented.

After reviewing all of our hospital admittances, this paper presents two cases of nephrobronchial fistula (NBF) occurring in two patients, one with renal abscess-like granulomatous pathology and one with xantogranulomatous pyelonephritis (XGP). After commenting on these cases and including iconography, among which a fistulography, very rare in this type of cases, should be emphasized, the coincidence of the three microorganisms (and the presence of Morganella morganii) in lung cultures, and kidney in one case, is recorded. The paper remarks on the hidden clinical development, modes of presentations and the time of diagnosis which was pre-operative. Also clinical, diagnostic and behaviour of the NBFs and etiological diseases is reviewed.

Despite being a validated source of biomarkers, liquid biopsy has not yet succeeded in becoming part of the standard clinical practice in prostate cancer patients. Few biomarkers undergo adequate validation, prospective and independent, of their predictive and/or prognostic value, which results in a lack of the different available tests in the clinical practice.To carry out a pragmatic synthesis of current scientific evidence on liquid biopsy for prostate cancer patients.Non-systematic literature review, narrowing the search to papers on liquid biopsy from blood samples in prostate cancer patients. We mainly selected works evaluating clinical endpoints in prostate cancer.The most clinically advanced forms of liquid biopsy are circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Both CTCs and ctDNA have demonstrated their prognostic value in metastatic disease. ARV7 determination is the first predictive biomarker of the disease. Its implementation into routine clinical practice requires methodological standardization and adequate clinical validation of the different available ways to detect it. The detection of CTCs in the early stages of the disease still depends on the optimization of the diagnostic methods and on the development of the biological characterization of these cells. The biological information provided by CTCs and ctDNA is different; therefore, the study of its adequate combination is the object of cutting-edge research.The absence of protocols and methodological standards is the limiting factor when aiming to reach conclusions that could have a potential impact on clinical practice. Therefore, the real short-term challenge for liquid biopsy is the establishment of consensus and common criteria.

With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice.To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy.A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based.Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases.According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.

There have been significant advances in the knowledge of renal carcinogenesis n the last years. Nowadays, renal tumors are classified according to their genetic profile and specific treatments based on the identification of therapeutic targets have also been developed. However, no prognostic markers have yet been identified. The aim of this review is to analyse literature that has evaluated the expression of the STAT3 protein as a molecular marker in clear cell renal carcinoma (ccRCC).In January 2018 a systematic review was conducted in Pubmed, Cochrane library and Sciencedirect databases, from papers published from 1990. Search terms were"renal cell carcinoma"and"STAT3"or"STAT-3"and"prognostic factor. Following the principles of the PRISMA declaration and the PICO selection strategy, original articles with series of patients diagnosed with localized or metastatic ccRCC, and where the activity of STAT3 is analysed as a prognostic marker, were selected. A total of 132 publications were identified, of which 10 were finally revised, for they met the inclusion criteria.STAT3 activation (phosphorylation) through Ser727 is important during ccRCC development and progression. PSTAT3 expression seems to be a prognostic marker and an antiangiogenic-resistance marker in metastatic patients. There is little evidence as prognostic marker in patients with localized disease.STAT3 (Ser 727) expression in the nucleus of the ccRCC cells can be a prognostic marker and an antiangiogenic-resistance marker. Current scientific evidence is limited and more studies are needed to demonstrate its usefulness.

ureteral stump syndrome is defined as a recurrent urinary infection, low abdominal pain and haematuria in patients with a history of nephrectomy. Its incidence is low and the symptoms are non-specific. The aim of our paper was to present our results with endoscopic treatment of symptomatic ureteral remnants.We performed a retrospective study of patients with ureteral remnant syndrome after nephrectomy treated in our centre between 2004 and 2015. We present a series of 10 patients. The patients were treated endoscopically with electrofulguration of the ureter and edges of the affected meatus, with subsequent injection of filler material into the suburetheral submucosa to aid in the coaptation of the ureteral remnant walls.The mean age at treatment was 2 years. The right ureteral remnant was treated in 6 patients and the left in 4. Seven meatuses were ectopic and 3 orthotopic. Follow-up was 8 years. After endoscopic treatment only 2patients relapsed.Endourological treatment of ureteral stump syndrome is a simple, safe, rapid and effective option that can be performed as an outpatient, for orthotopic and ectopic stumps. It does not compromise subsequent open resection of the ureteral remnant if required, and therefore we believe that it should be considered a valid alternative for the initial treatment of this disorder.

Context The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology. Objective We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination. Evidence acquisition Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. Evidence summary The full version of the guidelines is available online ( http://www.uroweb.org/guidelines/online-guidelines/ ). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice. Conclusions These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion.

Most of urothelial carcinomas (UC) have a pattern of histological growth of papillary or solid type; nevertheless, in some cases there are histological types that significantly differ from these habitual patterns In this paper we have selected those UC variants that by its diagnosis difficulty and therapeutical or prognosis implications have to be perfectly identified and known by pathologists and urologist. The variants that we have considered of greater clinical and pathological interest have been: tubular and/or nested UC, microcystic UC, micropapillary UC, lymphoepithelioma like UC, plasmacytoid UC and sarcomatoid UC. A revision of the literature has been made of each one of these patterns evaluating the criteria diagnoses, clinical behavior and the present therapeutic options. In addition, we suggest that these UC variants must be explicitly reflected in the pathology report, due to its clinical implications.

Clavien-Dindo classification system has been proposed to grade perioperative complications in percutaneous nephrolithotomy. The complications of this technique that have taken place in the last 2 years are reported in this paper according Clavien-Dindo classification.Between 2011 and 2012 a total of 255 percutaneous nephrolithotomy were performed at our center for stones more than 2 cm in size. In order to determine the incidence of complications classified in the modified Clavien-Dindo system, statistical analysis of the data obtained was carried out.During the period analyzed, 255 percutaneous nephrolithotomy were performed in 249 patients, 41% of the right side, 57% of the left side and 2% bilateral and simultaneous. 137 and 112 patients were males and females, respectively. The most prevalent comorbidities were: hypertension (AHT) in 101 patients (40.6%), BMI30 in 81 patients (32%), diabetes mellitus in 46 patients (18.5%) and coagulation abnormalities in 24 patients (9.6%). A total of 70 cases (27.4%) were distributed according to Clavien-Dindo classification: grade i, 8.4%, grade ii 8.4%, grade iiia 4.4%, grade iiib 6% grade iva .8%, grade ivb: 0% and grade v 0%.A graded classification scheme for reporting the complications of percutaneous nephrolithotomy is useful for monitoring and reporting outcomes. We propose a standardized use of this classification in order to make the results comparable among different centers performing the technique.

Context In patients with prostate cancer, bone health is compromised by advanced age at diagnosis, androgen suppression treatments and the development of bone metastases. In this paper the medical literature is reviewed in order to update the state of the art on their incidence, prevention and management. Evidence acquisition A literature review about bone involvement in patients with prostate cancer in different clinical settings is performed. Synthesis of the evidence Decreased bone mineral density is higher in patients diagnosed of prostate cancer before starting treatment than in healthy men with the same age. During the first year of treatment, a severe loss of bone density is reported due to androgen suppression therapy. From then on, loss of bone density seems to slow down, persisting at long-term. It is important to know the starting point and the dynamics of bone loss in order to prevent its progression. The skeletal events have an important impact on quality of life in patients with prostate cancer. Both denosumab and zoledronic acid have proven effective in reducing bone loss. Conclusions The prevention and management of bone involvement in patients with prostate cancer are critical to quality of life in these patients and require an individualized approach. Before starting a prolonged androgen deprivation, baseline risk of fracture should be evaluated in order to adopt the proper protective measures. In patients with metastases, early treatments reducing the risk of bone events should be taken into account.

The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection.Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumour selection, characteristics and indications cited in MEDLINE search were reviewed.Focal therapy standardized criteria must be: low risk tumors, PSA10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3+4 or PSA15.Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.

prostate cancer is the most frequent solid malignant tumor in Western Countries. Positron emission tomography/x-ray computed tomography imaging with radiolabeled choline analogues is a useful tool for restaging prostate cancer in patients with rising prostate-specific antigen after radical treatment (in whom conventional imaging techniques have important limitations) as well as in the initial assessment of a selected group of prostate cancer patients. For this reason a literature review is necessary in order to evaluate the usefulness of this imaging test for the diagnosis and treatment of prostate cancer.a MEDLINE (PubMed way) literature search was performed using the search parameters: «Prostate cancer» and «Choline-PET/CT». Other search terms were «Biochemical failure» and/or «Staging» and/or «PSA kinetics». English and Spanish papers were selected; original articles, reviews, systematic reviews and clinical guidelines were included.according to available data, radiolabeled choline analogues plays an important role in the management of prostate cancer, especially in biochemical relapse because technique accuracy is properly correlated with prostate-specific antigen values and kinetics. Although is an emerging diagnostic technique useful in treatment planning of prostate cancer, final recommendations have not been submitted.

The manuscript of the Doctoral Thesis of Joaquín Albarrán in the Faculty of Medicine in Paris "Étudesur le Rein des Urinaires" has been donated to Asociación Española de Urología. Direct comparison of the original and printed material gives information of the production process of this master work.Direct comparison between the original hand-written work, a single hard bound volume covered with loin cloth and water paper composed of 145 numbered pages plus 206 newly numbered pages of clinico-pathological (37 subjects) and experimental (19 assays in 20 rabbits) data, and the printed work edited by Georges Steinheil in 1889. Prints included 4 plates with 14 figures, 9 temperature charts and 5 tables describing urine examinations. Figures were trichromic and charts and tables blackwhite. Chromolithographs were produced by Mr. Leuba in the printing owned by Lemercier et Cie, Paris.The original work was completed in 1887 without any correction or deletion. Differences are noticeable between the text in the master and printed works: rearrangement of data and inclusion of a new clinical observation, 5 new experiments, summary and dedications. Changes in iconography are noticeable. The masterwork included 24 plates (numbered from 1 to 22, 13bis, 16bis) with 46 figures (44 colored) integrated within the text and 26 double-page temperature registries that accompany clinical observations. Anatomical, histological and microbiological illustrations, including culture media, microbiological stains and histobacteriological preparations were depicted as watercolors (44%), watercolors mixed with pencil or ink (52%) or pencil drawings (4%). Four (9%) were signed by the author, 5 (11%) had numerical annotations and only 14 (30%) were definitely printed with loss of the black component and redrawn of 4/14 (29%) images. The largest images were not printed.Joaquín Albarrán described and beautifully illustrated himself the role "pyogenic bacillus" (E. coli) played in renal infection, bacteriemia, renal failure sepsis and patient death. The evolution of pyelonephritis to perinephritis and perinephric abscess was masterly interpreted, with new description of ascending infection and lymphatic peritubular dissemination of bacteria. The differences detected between written and printed work are numerous and can be explained by the corrections of Prof. Guyon before definite presentation and the technical process to perform the lithographs.

Radical pelvic surgery requires continent or incontinent urinary diversion. There are many techniques, but the orthotopic neobladder is the most used. A continent catheterizable urinary reservoir is sometimes a good alternative when this derivation is not possible or not indicated. This paper has aimed to present our experience with the Indiana pouch continent urinary reservoir.The series is made up of 85 patients, 66 women and 19 men, with a mean age of 56 years (31-77 years). Variables analyzed were operating time, estimated blood loss, transfusion rate, hospital stay and peri-operatory complications.The main indication in 49 cases was resolution of complications related to the treatment of cervical cancer. Average operation time was 110.5 minutes (range 80-130 minutes). Mean blood loss was 450 cc (100-1000 cc). Immediate postoperative complications, all of which were treated medically, occurred in 16 patients (18.85%). One patient suffered anastomotic leakage. Hospital stay was 19 days (range 5-60 days) and there was no mortality in the series. Late complications occurred in 26 patients (32%), these being ureteral anastomotic stenosis in 11 cases, cutaneous stoma stenosis in 9 cases and reservoir stones in 6 cases.The Indiana continent catheterizable urinary reservoir is a valid option for the treatment of both urological and gynecological malignancies as well as for the management of pelvic morbidity related to the treatment of pelvic cancers.

The kidney as an apo-exocrine organ has two important functions: the control of homeostasis and arterial blood pressure. Any pathological disorders witch alters the renal blood flow results in two consequences: renovascular hypertension and renal insufficiency. Renal revascularization looks for with priority the improvement of renal function; the good response and control of hypertension shall come after. The goals of this paper is to actualize the sophisticated diagnostic methods (Angiography, Eco-Doppler, AngioCT, AngioMR, Angioscopy; and the use of contrast potential-mediums), functionallity tests (RN and MR with Captopril) and management (Percutaneous transluminal angioplasty, simple or covered Stents, Embolizations, Occlusive balloons, Fibrinolysis and Trombus Aspiration; direct Arterial Surgery and renal Autotrasplantation) of different renovascular diseases. (Blunt renal injuries, Stenosis, Aneurysms. A-V fistuls, Acute Occlusions or arterial and venous, Thrombosis. Nutckraker Syndrome). The possibility of the

In this paper, we present a case of huge renal hydatic cyst. We review the literature with regard the clinical presentation, diagnosis methods and surgical technique of treatment.

This paper reports a case of bladder bilharziasis with histopathological exam and different patterns of urodynamic evaluation. The need for urodynamics is emphasized in order to avoid diagnostic and therapeutic mistakes.

Abdomino-pelvic actinomycosis is a condition caused by Actinomyces israelii, a Gram-positive opportunistic bacteria that triggers and develops the infection only in previously injured tissues, and then slowly progresses and spreads until it extrinsically affects the urinary tract. Use of an intrauterine device is a known risk factor to suffer from this disease. Relative risk in IUD users is two- to fourfold higher compared to IUD non-users. Risk increased with prolonged IUD use. Treatment is by removal of the causative agent, surgical resection of necrotic tissues and administration of intravenous Penicillin G, 4 million units every 4 hours for 30 days, followed by Amoxicillin 500 mg every 8 hours for 12 months. This paper contributes two cases of abdomino-pelvic actinomycosis with urinary tract involvement in IUD users. Standard treatment was employed with good evolution.

The current management of localized prostate cancer is a therapeutic challenge with different options including active radicals or active follow-up. The aim of this paper is to analyze the feasibility and validity of the «Focal» active treatment versus the concept of active follow-up or Radical Treatment.We reviewed the literature on the various diagnostic methods, advantages, and difficulties of active follow-up and Radical Treatment, versus focal therapy with the possibilities of defining characteristics of aggressiveness and patient selection.The mesh biopsy techniques along with multiparametric magnetic resonance imaging and association of factors such as tumor size, length of affected cylinder and Gleason are parameters that allow us to define location and definition of clinically significant tumors and subsidiary of focal therapies.The definition, location and aggressiveness of prostate cancer in low-intermediate risk tumors can be defined avoiding radical therapies with their side effects or the risks of underestimating tumors as in active follow-up without the minimum side effects.

With the development and improvement of imaging techniques, we are witnessing a greater number of disease diagnoses considered uncommon only a few years ago. When the diagnosis of a tumoral disease occurs "incidentally" while performing an imaging examination for other reasons, we name the condition "INCIDENTALOMA". A clear example of these in suprarenal conditions is the myelolipoma. Myelolipoma is a benign and non-functioning tumour originating in the suprarenal cortex and histologically consisting of mature fat and haemopoietic tissue. Given its benign and usually inactive nature, the current approach is a conservative attitude. Surgical exeresis is only accepted when large tumoral masses are present or in complicated cases. This paper presents a new case of a 10 cm suprarenal myelolipoma incidentally diagnosed during routine ultrasound examination in a 47-year old male patient. Subsequent exeresis of the suprarenal mass and pathohistological study confirmed the diagnosis.

The "burned-out" phenomenon in germ-cell neoplasias is defined by the presence of an extragonadal germ-cell tumour with no tumour at the testis level where a series of distinctive histological lesions can be detected indicative of the earlier presence of an already disappeared testicle tumoration. Extragonadal germ-cell tumours with "burned-out" phenomenon show better evolution than their primary counterparts and are treated similarly to primary tumours of the testis. Currently, in the presence of retroperitoneal tumoration, a scrotal ultrasound study with high frequency transducers can lead to a suspected picture of tumoral involution. This paper contributes one retroperitoneal seminoma with "burned-out" phenomenon in the homolateral testis in a 35-year old patient. Available clinical and radiological criteria were enough to reach a suspected diagnosis. Homolateral orchiectomy and biopsy of retroperitoneal tumoration were performed, rounding treatment up with polychemotherapy. Evolution was good with immediate complete response.

Dielt’s syndrome is generally known as nephritic colic due to the dilation of the urinary tract that results from a renal ptosis. In spite of renal ptosis being a commonly seen occurrence, sometimes it can be the cause of a serious painful clinical manifestation. This paper presents one case successfully treated through laparoscopic nephropexy. It also includes a discussion on the various diagnostic and therapeutical techniques.