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Introduction: Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the 'As Low As Reasonably Achievable' (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD., Methods: A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines., Results: Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p=0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p=0.9). The overall Clavien-Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n=71) and 8.5% (n=131), and 1.7% (n=23) and 3% (n=47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures., Conclusion: The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones., Basic Procedures: A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded., Main Findings: Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure., Conclusion: Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women. Since 1948, the relationship between urinary pH and antibiotics (ABs) has been established. We aimed to search for the best urinary pH for each family of antibiotics and to assess whether pH changes bacterial susceptibility to them. We included in vitro research and in vivo studies including one or more bacterial species and tested the effect of one or more ABs at different pH values. We also included randomized controlled clinical trials (RCTs) in uncomplicated UTI (EAU guidelines 2019 definition), choosing the ABs based on urinary pH or using an antibiotic plus urinary pH modifiers (L-methionine, vitamin C…) vs. an antibiotic and a placebo. Quadas-2 tool was used as a quality assessment of the studies and PRISMA set of items for systematic reviews. Two authors independently screened and evaluated the papers, while two additional authors individually repeated the search. A fifth researcher acted as an arbiter, and another author collaborated as a hospital pharmaceutical consultant. Alkaline-friendly antibiotics are most fluoroquinolones, aminoglycosides, trimethoprim. Acidic-friendly antibiotics are fosfomycin, tetracycline, nitrofurantoin and some β-lactams. We suggest performing urine cultures with antibiogram tests, in both acidic and alkaline media, to define the bacterial susceptibility profile. There is insufficient in vivo evidence to support whether choosing an antibiotic based on a patient's urinary pH or adding urinary pH modifiers will lead to a higher cure rate., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

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.)

Introduction: Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney., Material and Methods: Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: "pelvic ectopic kidney", "ureterorenoscopy", "extracorporeal lithotripsy", "PCNL", "pyelolithotomy". We incluyed original articles, meta-analysis, review and case reports., Results: 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85%-90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor., Conclusion: Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach., (Copyright © 2021 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

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., (Copyright © 2020 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

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., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Context: 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., Objective: To carry out a pragmatic synthesis of current scientific evidence on liquid biopsy for prostate cancer patients., Evidence Acquisition: 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., Evidence Synthesis: 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., Conclusions: 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., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

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., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: 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., Objectives: 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., Material and Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Various studies tried to validate Club Urológico Español de Tratamiento Oncológico (CUETO) tables, yet, none of this papers focused on the high and very high risk bladder cancers. The aim of the study was to externally validate the CUETO model for predicting disease recurrence and progression in group of T1G3 tumors treated with BCG immunotherapy., Patients or Materials and Methods: Data from 414 patients with primary T1G3 bladder cancer were analysed. To evaluate the model discrimination, Cox proportional hazard regression models were created and concordance indexes were calculated., Results: The median follow-up was 68 months. The recurrence was observed in 212 (51.2%) and 64 patients (15.5%) experienced the recurrence more than once during the study follow-up. Progression of the cancer was observed in 106 patients (25.6%). Radical cystectomy was performed in 115 patients (27.8%) and there were 64 (15.5%) cancer specific deaths. For recurrence and progression probability, the concordance index of the CUETO models was 0.633 and 0.697 respectively. CUETO tables underestimated significantly the risk of recurrence and marginally the risk of progression in the first year of observation. For 5 years of observation, the trend for the recurrence was much less clear. On the contrary, there was slight overestimation in the risk of progression. The study is limited by retrospective nature., Conclusions: It was shown that the CUETO risk tables exhibit a fair discrimination for both disease recurrence and progression in T1G3 patients treated with BCG. CUETO scoring model underestimates the risk of tumor recurrence, but predicts well risk of progression., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Context and Objective: 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)., Evidence Acquisition: 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., Evidence Synthesis: 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., Conclusions: 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., (Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: 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., Material and Methods: 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., Results: 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., Conclusion: 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., (Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Context and Objectives: 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., Evidence Acquisition: 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., Evidence Synthesis: 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., Conclusions: 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., (Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: 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., Objectives: To identify factors related to aetiology, prevention and treatment of non-traumatic posterior urethral stenosis and contractures., Acquisition of Evidence: 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., Synthesis of Evidence: 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., Conclusions: 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., (Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the efficacy of Escherichia Coli extract (OM-89) in the prophylaxis of recurrent uncomplicated urinary tract infection (UTI) through a contemporary systematic review and meta-analysis., Methods: Inclusion criteria were double-blind randomized trials using orally administrated OM-89, 6mg daily, during three months with a minimum of three months of monitoring. Outcomes were the frequency of bacteriuria in 3 and 6 months, dysuria in 6 months and UTI in 6 months., Databases: PubMed, MEDLINE, Cochrane Collaboration and their key references. After analysis by three independent reviewers, 15 double-blind randomized trials were identified, 10 papers excluded due to methods flaws and 5 used for data analysis due to double blinding and reporting drop-outs., Results: Among 5 selected studies the date of publication ranged from 1985 to 2005, totalizing 396 patients in the OM-89 group and 392 in the control group. Overall, there were 61 dropouts in the control group and 76 in the OM-89 group. As a major limitation there was no appropriate description of their methodologies and none of the studies described conflict of interest or commitment to the pharmaceutical industry. All studies were multi-centric, except for two, which showed no clarity on allocation concealment. All studies show benefit in favor of vaccine., Conclusions: Current literature on prospective randomized controlled trials evaluating the use of oral OM-89 vaccine in the recurrent UTI prophylaxis is of low quality, limited to the first six months only and with variable definition of bacteriuria and UTI. Although all studies show benefit in favor of vaccine, no robust trial was identified, resulting in a high heterogeneity in the data analyzed. Also, publication bias could not be excluded and future higher quality studies are warranted adding intermediate (>12 months) and long-term follow-up., (Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: 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., Materials and Methods: 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., Results: 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%), BMI>30 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%., Conclusions: 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., (Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs., Evidence Acquisition: A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms "testis-sparing surgery", "testicular sparing surgery", "partial orchiectomy", "testis tumour", "sex cord tumour", and "testis function". Other significant studies cited in the reference lists of the selected papers were also evaluated., Evidence Synthesis: No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature., Conclusions: TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety., (Copyright © 2013 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Context: In patients with prostate cancer, bone health is compromised by advanced age at diagnosis, androgen suppression treatments and the developmentofbone 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 bone density is reported due to androgen suppression therapy. From then on, loss bone density seems to slow down, persisting at long-term. It is important to know the starting point and the dynamics of loss bone 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 loss bone., Conclusions: The prevention and management of bone involvement in patients with prostate cancer is critical to quality of life in these patients and requires 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., (Copyright © 2014 AEU. Published by Elsevier Espana. All rights reserved.)

Introduction: 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., Evidence Acquisition: 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., Conclusions: 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., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Objective: To present the new findings in oncologic urology with impact on clinical practice which were displayed at 2013 major annual meetings (EAU, ESTRO, AUA, ASCO and ASTRO)., Methods: The abstracts on prostate kidney, bladder and upper tract urothelial cancer with the highest scores by the OncoForum committee, presented in 1013 Congresses are included in this paper., Results: the following messages were considered as important by the OncoUrology Forum committee. In renal tumors T1a, comorbidities should be evaluated by its impact on overall and specific cancer survival, especially in men over 65. In metastatic renal tumors, the benefit of Everolimus vs. Sunitinib has not been demonstrated. Patients with non-muscle invasive bladder cancer of high risk, with three or more risk factors, should be considered for radical cystectomy. The ERSPC study' data demonstrate the benefit of the systematic screening in prostate cancer. In metastatic disease, the results of the Ra-223 and enzalutamide studies show benefit in pain control and overall survival in metastatic disease., Conclusions: Localized renal and non-muscle invasive bladder of high-risk tumors, should be assessed according to comorbidities or oncologic risk factors, to determinate the adequate treatment options. New data from metastatic prostate cancer clinical trials have shown promising results in the control of the disease., (Copyright © 2014 AEU. Published by Elsevier Espana. All rights reserved.)

Context: 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., Evidence Acquisition: 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., Summary of Evidence: Focal therapy standardized criteria must be: low risk tumors, PSA<10-15, 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 PSA>15., Conclusions: 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., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Introduction: 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., Material and Methods: 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., Results: 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., Conclusion: 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., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Context: 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., Evidence Acquisition: 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., Summary of Evidence: Focal therapy standardized criteria must be: low risk tumors, PSA<10-15, 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 PSA>15., Conclusions: 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., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Objectives: Overactive bladder (OAB) is a pathology impairing patients' quality of life and with a high percentage of patients who are refractory to medication. In this paper, technical opinion of an «expert panel» is assessed in order to gain the most reliable professional consensus on scientific evidence available on the criteria of use of Onabotulinumtoxin A (OnabotA) in OAB., Material and Methods: according to DELPHI method, 42 panelists answered a survey of 93 items divided into four strategic areas including clinical criteria and recommendations in order to improve, at different levels, the current approach to patients with OAB. The recent advances in the field, areas of controversy and their real application possibilities in the different areas of our health care system were taken into consideration., Results: Two rounds of the questionnaire were completed by all experts. In the first round, a criteria consensus was reached for 64 of 93 (68.8%) questions analyzed; in the second round the consensus reached was for 83 items evaluated (89.25%). An agreement among panelist was reached for: 1) definition, classification, detection and differential diagnosis; 2) medical treatment; 3) surgical treatment; 4) role of OnabotA in the treatment of OAB., Conclusions: the consensus is broadly in line with the latest scientific evidence on OAB. The panelists believe that it is necessary to propose a change in the current definition of OAB and that it seems necessary to improve the screening tools too. Medical treatment of OAB must be tailored to each patient, staged and progressive. The use of OnabotA (Botox(®)) could imply therapeutic advantages with respect to other treatments, and positions itself as a safe and effective alternative to treat drug refractory OAB., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Introduction: Outcome of urethroplasty techniques in our environment and risk factors for recurrence of stenosis in these patients are studied in this paper., Material and Methods: Retrospective study on men with urethral strictures treated with urethroplasty in the period 2000-2012. Maximum flow (Qmax), post-void residual (PVR) urine and patient perception of voiding were obtained pre- and postoperatively. Complications were recorded according to the Clavien-Dindo scale. Recurrent stricture was defined according to clinical criteria and endoscopic or imaging confirmation (failure of urethroplasty). Univariate analysis (log-rank) and multivariate (Cox regression) were performed to define the variables implied in the recurrence., Results: 82 patients with mean age 55.6 ± 17.4 (19-84 years) underwent surgery for urethroplasty. 28% of patients showed multiple stricture, 73.2% bulbar stricture, 41.54% penile stricture and 14.6% membranous stricture. End-to-end anastomosis was performed in 26 cases (31.7%), flap urethroplasty in 21 (25.6%), urethroplasty with free graft in 31 (37.8%) and two-time urethroplasty in 4 (4.9%). Graft urethroplasty showed a longer operative time (p = 0.02) and shorter hospital stay (P = 0.0035). The results were: mean ΔQmax (mean on baseline) 9.1 ± 7.5 and mean ΔPVR -65.8 ± 136 (both P < 0.0001). Minor early complications occurred in 8 (9.8%) and major in 3 (3.6%). Recurrence occurred at a mean time of 39.8 ± 39.2 months in 18 patients (21.9%). The percentage of recurrence-free patients was: 91.4% (1-year), 82.1% (5-year) and 78.1% (10-year). Univariate analysis assessed technique used (log-rank, P = 0.13), age (P = 0.2), length stricture (P = 0.003), previous Sachse (P = 0.18), associated lichen (P = 0.18), multiplicity (P = 0.36), year of surgery (P = 0.2), Qmax (P = 0.3) and RPM (P = 0.07) preoperative. End to end anastomosis (HR 4.98, P = 0.04) and length > 3 cm (HR 4.6, P = 0.01) were identified by regression analysis as independent variables associated with poor prognosis., Conclusion: Length stricture is both prognostic factor and criterion on choosing the type of urethroplasty, and it makes more complicated to compare the success rates of each surgical procedure. Whatever the stricture size is, the results of anastomotic urethroplasty are worse than those of urethroplasty with buccal mucosal-free grafts., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Objectives: 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., Material and Methods: 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 black & white. Chromolithographs were produced by Mr. Leuba in the printing owned by Lemercier et Cie, Paris., Results: 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., Conclusions: 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., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

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., (Copyright © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.)

Objectives: Shorter length of the right renal vein (RRV) may represent an additional difficulty for transplant. This paper has aimed to present our experience with RRV elongation in the kidney from a cadaveric donor and to compare the results with the rest of kidneys transplanted in the same period of time., Material and Methods: We performed 377 kidneys transplants within the last 11 years. Of these, in 120, the RRV was elongated with the vena cava. The surgical technique is described and the results compared with the remaining transplants of the series. Renal function, graft survival and complications were assessed at 1, 3 and 12 months. Data were obtained retrospectively from the database of the Urology Department and Hospital medical records., Results: In the 377 transplants, there were 4 (1%) venous thrombosis, 2 (1.6%) of which concerned kidneys with elongation of the RRV and 2 (0.7%) in the rest of transplanted kidneys. There was no difference in postoperative bleeding, 11 (9.1%) occurred in kidneys with elongated RRV and 22 (8.5%) in the remaining kidney. In no case was the bleeding related to the elongated segment. Graft survival and renal function were similar for both groups., Conclusions: Elongation of the RRV with the vena cava is a feasible, fast, and effective procedure that does not increase morbidity or affect renal function or graft viability. It facilitates vascular anastomosis and places the kidney in a less forced position, shortens the warm ischemia time and avoids the risk of kinking of the renal artery because it is equal to the length of the vein artery., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

Context: The incidence of postoperative complications is still the most frequently used surrogate marker of quality in surgery, but no standard guidelines or criteria exist for reporting surgical complications in the area of urology., Objective: To review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system when used for the reporting of complications related to urologic surgical procedures, to identify shortcomings in reporting complications, and to propose recommendations for the development and implementation of future reporting systems that are focused on patient-centred outcomes., Evidence Acquisition: Standardised systems for reporting and classification of surgical complications were identified through a systematic review of the literature. To establish a possible change in attitude towards reporting of complications related to urologic procedures, we performed a systematic literature search of all papers reporting complications after urologic surgery published in European Urology, Journal of Urology, Urology, BJU International, and World Journal of Urology in 1999-2000 and 2009-2010. Data identification for the systematic assessment of the Clavien-Dindo system currently used for the reporting of complications related to urologic surgical interventions involved a Medline/Embase search and the search engines of individual urologic journals and publishers using Clavien, urology, and complications as keywords. All selected papers were full-text retrieved and assessed; analysis was done based on structured forms., Evidence Synthesis: The systematic review of the literature for standardised systems used for reporting and classification of surgical complications revealed five such systems. As far as the attitude of urologists towards reporting of complications, a shift could be seen in the number of studies using most of the Martin criteria, as well as in the number of studies using either standardised criteria or the Clavien-Dindo system. The latter system was not properly used in 72 papers (35.3%)., Conclusions: Uniformed reporting of complications after urologic procedures will aid all those involved in patient care and scientific publishing (authors, reviewers, and editors). It will also contribute to the improvement of the scientific quality of papers published in the field of urologic surgery. When reporting the outcomes of urologic procedures, the committee proposes a series of quality criteria., (Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.)

Objective: Bladder outlet obstruction with obstructive and irritative urinary symptoms may be a complication of surgery for female urinary incontinence. In presence of persistent symptoms, the therapy is surgical and usually consists in an accurate urethrolysis. The way of approach is generally transvaginal. In this paper we propose and describe our experience with a transvestibular approach., Material and Methods: 18 women who had undergone anti-incontinence surgery (TVT 12 pts, TOT 3 pts, Burch retropubic colposuspension 3 pts) with obstruction and/or irritative symptoms underwent to a transvestibular urethrolysys. Five patients had urinary retention and the rest of patients had post voiding residual urine>100 ml. Using a scalpel blade a circum-meatal incision was performed and the urethra was progressively freed, dissecting just below the os pubis upwards and on the vaginal wall downwards, untethering it under direct vision in order to abtain a complete circular freeing of the urethra. In the end, the urethral meatus is repositioned with circular stiches., Results: The operation lasts between 20 and 40 minutes. An urethral catheter was left in place for 24-48 hours and no complications were observed. The post-voiding residual urine decreased in all of the cases and the irritative symptoms were reduced., Conclusions: The transvestibular approach for urethrolysis is safe and effective regardless of the previous anti-incontinence surgery carried out. This procedure has the advantage of working in a relatively unscarred tissue, allows for a complete untethering of the urethra even in the retropubic space and leaves the vaginal wall intact., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Context: 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., Objective: This paper provides a brief overview of the EAU guidelines on UUT-UCC as an aid to clinicians in their daily practice., Evidence Acquisition: 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., Evidence Synthesis: 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., Conclusions: 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., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Context: The first European Association of Urology (EAU) guidelines on incontinence were published in 2001. These guidelines were periodically updated in past years., Objective: The aim of this paper is to present a summary of the 2009 update of the EAU guidelines on urinary incontinence (UI)., Evidence Acquisition: The EAU working panel was part of the 4th International Consultation on Incontinence (ICI) and, with permission of the ICI, extracted the relevant data. The methodology of the 4th ICI was a comprehensive literature review by international experts and consensus formation. In addition, level of evidence was rated according to a modified Oxford system and grades of recommendation were given accordingly., Evidence Summary: A full version of the EAU guidelines on urinary incontinence is available as a printed document (extended and short form) and as a CD-ROM from the EAU office or online from the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/). The extent and invasiveness of assessment of UI depends on severity and/or complexity of symptoms and clinical signs and is different for men, women, frail older persons, children, and patients with neuropathy. At the level of initial management, basic diagnostic tests are applied to exclude an underlying disease or condition such as urinary tract infection. Treatment is mostly conservative (lifestyle interventions, physiotherapy, physical therapy, pharmacotherapy) and is of an empirical nature. At the level of specialised management (when primary therapy failed, diagnosis is unclear, or symptoms and/or signs are complex/severe),more elaborate assessment is generally required, including imaging, endoscopy, and urodynamics. Treatment options include invasive interventions and surgery., Conclusions: Treatment options for UI are rapidly expanding. These EAU guidelines provide ratings of the evidence (guided by evidence-based medicine) and graded recommendations for the appropriate assessment and according treatment options and put them into clinical perspective., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Since 2007, various urological procedures have been performed with laparoendoscopic single-site surgery (LESS surgery), including nephrectomy, pyeloplasty, simple prostatectomy and, with the refinement of laparoscopic instrumentation, radical prostatectomy. This paper reports our initial experience in radical prostatectomy using the SILS Port from Covidiem and two lateral 5-mm trocars for triangulation. The SILS Port allows for accurate, simple insertion through a Hadson incision. The flexible port accommodates three 5-mm cannulas or two 5-mm cannulas and a 12-mm port for easier instrument exchange through a single incision. This approach decreases morbidity from bleeding, hernia and/or internal organ damage and improves cosmetic. One-port single-incision laparoscopy is part of the natural development of minimally invasive surgery. Future research is required to assess the intraoperative and postoperative benefits of LESS surgery as compared to standard laparoscopy.

Multiple primary tumors and second primary neoplasms have been increasing in incidence in recent decades and are reviewed in this paper. The reasons attributed to this significant increase are fundamentalment the best diagnosis of multiple concurrent cases and increased overall survival of patients diagnosed with cancer, allowing surface new primary tumors in other organs during or after standard monitoring. At the same time are invoked as possible causes of the widespread use of radio and chemotherapy for the first tumor. The genitourinary system is frequently involved in cases of multiple neoplasms; urological organs are one of the few settlement sites of primary tumors in almost a quarter of cases. This suggests a susceptibility/genitourinary system increased target for neoplastic disease. For this same reason, the urologist has a fundamental role in managing these patients and especially to follow up. We believe that the concept of clinical monitoring of this subset of patients should be revised, and should entail a screening of the most common second primary neoplasms since the risk of developing a subsequent independent cancer after presenting a urothelial tumor is considerably increased.

Introduction: Nocturnal enuresis is a disorder with a maintained historical interest. Not only the multifactorial etiopathology, also its prevalence., Objective: We consider reviewing the literature for knowing the problematic in the calculation of the prevalence of this disease., Material and Method: We searched in Pubmed database with Mesh terms: "Enuresis", "Nocturnal Enuresis", we added in the search box terms bedwetting and epidemiology or prevalence. We included manuscripts in English and Spanish with more than 1000 patients as sample, we also included review papers. We analyzed the methodology and the prevalence, when it was possible, we stratified results in age, sex and the frequency of wet nights., Results: The analyzed study's methodology is heterogeneous. Therefore comparisons are difficult. Due to the difficulty within the interpretation of the overall frequency, the results are not interesting unless methodology, age range of the sample and diagnosis criteria are previously detailed., Conclusions: An own epidemiology study is necessary in order to solve our problematic.

Objectives: Malignant fibrous histiocytoma (MFH) is an uncommon urinary tract tumor. This paper is intended to provide an update on its diagnostic criteria, pathological and immunohistochemical characteristics, histological classification, prognostic factors, and alternative treatments., Materials and Methods: All published articles on MFH of the urinary bladder have been reviewed and a descriptive study has been done., Results: Twenty-nine cases of MFH of the bladder have been reported. The most common morphological variants are storiform-fascicular (41%) and inflammatory (36%) MFH. Non-myxoid variants have a poorer prognosis. Stage T3 MFH was found in 72% of cases at the time of diagnosis. MFH local recurrence and distant metastasis rates were 50% and 25% respectively after surgical treatment only., Conclusions: MFH of the bladder is a tumor with high local and distant recurrence rates and a low survival rate, and therefore requires early and aggressive treatment. Radical cystectomy with lymphadenectomy and adjuvant radiotherapy is considered to be the treatment of choice, eventually associated to chemotherapy.

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.

Renal cancer has been increasingly diagnosed in recent decades. In addition, morphological diversity of renal neoplasms has led to consider that the concept of renal cell (RC) carcinoma encompasses a wide variety of conditions. The recently published EROCARE-4 study showed a 5-year overall survival rate of 59.2%. In this and any other neoplastic disease, determination of adequate prognostic factors would help decide the most appropriate therapeutic strategy in each case, guide future treatments, and develop specific follow-up schemes for our patients. The different prognostic factors for RC may currently be classified into four groups: anatomical, clinical, histological and molecular. This paper analyzes these prognostic factors and reviews the nomograms most commonly used.

Renal cancer is the third leading urological tumor after prostate and bladder cancers. Annual incidence of renal cancer in all stages has markedly increased in recent years. This represents a true increase in the number of actual cases that is not fully accounted for by widespread use of diagnostic imaging tests. This article is intended to provide an update on the carcinogenesis and tumor development pathways involved in the genesis of this tumor. Renal cell carcinoma (RCC) arises in renal epithelium and accounts for more than 90% of all malignant kidney tumors. Approximately 2% of RCCs are associated to hereditary syndromes, specific oncogenes, or changes in tumor suppressor genes. Changes in the VHL gene exist in all hereditary cases. This gene (located in the short arm of chromosome 3:3p25-26) is also involved in more than 60% of sporadic cases. This paper systematically addresses the latest findings on implications of the VHL gene in angiogenesis and its potential relationship to new molecules involved in management of RCC.

Introduction and Objective: In most cases the learning curve of laparoscopic radical prostatectomy is not completed during the residency. This is why International Fellowship programs are becoming more popular. The aim of this paper is to evaluate the efficiency of the fellowship program of the German group., Material and Methods: We describe the evolution of our last fellow in the modular training program developed by the Leipzig group. We also evaluate the efficiency of this program by analyzing the results of 30 procedures performed by the fellow as first surgeon. In addition we have reviewed the literature and compared those outcomes with previous series of the clinic and other training programs., Results: The training programme was completed in four months. After this time, the fellow performed 30 procedures without any assistance from a tutor. 46.67% of these procedures were nerve sparing. The time average was 2 hours and 27 minutes. The programme includes lymphadenectomy in 20 patients. Two patients had positive margins, all anastomosis were tight except for one. Urethral catheter was removed on the fifth day and there were no other intraopertive or early postoperative complications. Results may be compared to previous results of other residents of the department and also of other groups where a long-term tutor program was performed., Conclusion: The learning process of laparoscopic radical prostatectomy should follow a long-term tutorized model. Until the definitive expansion/development of this technique, the Leipzig Fellowship program is a complete and effective formation schedule.

Introduction: Radical prostatectomy technique has improved in the last years based on accumulated surgical experience and new anatomical findings. We think it is time to update anatomical concepts to standardized the criteria formentioning structures related with radical prostatectomy, Material and Method: With the followings key words: "cavernosal nerves, prostatectomy, anatomy, neurovascular bundle" we search in Medline/PubMed database selecting papers fulfilling the search criteria., Conclusions: The prostate does not have a true capsule but rather an incomplete fibromuscular band as an intrinsic part of the gland. Periprostatic fascia seems to be a different structure from this fibromuscular band. Histologically Denonvilliers's fascia is formed by two thin layers that cannot be separated during surgery. The longitudinal smooth muscle fibres located beneath the posterior bladder neck corresponds to the posterior longitudinal fascia of the detrusor muscle. Cavernosal nerves are located between the two layers of the endopelvic fascia, the inner layer could be named periprostatic fascia and the outer, levator ani fascia. Cavernosal nerves merged from the pelvic plexus running within a neurovascular bundle around the prostate that could be found as a singular bundle or spread all around the anterolateral surface of this gland. There are overlapping terms to designate the pelvic fascia, therefore it could be useful for Urologists to standardized them.

Reports on postoperative complications of anti-incontinence surgery followed the widespread use of synthetic slings. In this paper we describe the more frequent complications, such as obstruction, pelvic hematoma, bladder and urethral injuries, to facilitate the management of these complications.

Introduction: Prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) in the setting of prostatic needle biopsies are considered premalignant although questions still remain., Objectives: In this paper, we have studied the clinical relevance of these histologic findings., Material and Methods: 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)., Results: 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., Conclusions: 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.

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.