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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: 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.)

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.

Objectives: In situ carcinoma (isT) of the bladder is a poor prognostic tumour with a natural progressive evolution. Treatment with BCG achieves a significant improvement in survival. This paper analyses our experience in the management of isT patients with endovesical BCG., Material and Methods: Between 1983 and 1997 the Urology Unit in the Móstoles Hospital saw 636 patients with transitional carcinoma of the bladder. Of these, 498 (78%) were surface tumours, and 138 (22%) were infiltrant. isT: 80 patients (13%), 14 of which were primary (17%), 37 associated to a surface tumour (46%), and 29 to infiltrant tumours (36%). All surface tumours: isT was present in 51 patients (10%) 44 of which were managed with 2 courses of BCG Connaught (81 mg), for 6 weeks each followed by vesical reassessment. Quarterly follow-up was conducted during a 2-year period. Patients not managed with BCG were treated with radical cystectomy. An analysis was made of patients without complete response to BCG, as well as actuarial analysis of disease-free survival (DFS), survival until progression (SUP) and specific survival (SS). All possible prognostic factors are analyzed: sex, focal isT (a single focus) or diffuse isT (more than one focus). Primary or secondary isT and association to G1, G2 or G3 tumours., Results: In all 44 patients managed with BCG: males 37 (84%), females 7 (16%), primary 14 (32%), focal 22 (50%), diffuse 22 (50%). Six patients died (5 because of the tumour). Mean follow-up of living patients: 3.7 years (0.5-7.5 years). After the 2 BCG courses, 36 (82%) showed complete response. Thirteen patients (30%) had no complete response during follow-up, and 11 (85%) continued to progression. In total 7 patients underwent cystectomy. Of 5 patients directly cystectomized due to persistence of isT or T1G3 tumour at monitoring after BCG, 2 (40%) had infiltrant tumour and one (20%) nodular metastasis. Three patients with persistent isT or T1G3 after BCG were not initially cystectomized: two that were treated with other endovesical therapies because of their age progressed, and the third one underwent a third BCG course and required cystectomy due to tumour persistency. 5-year DFS: 56%, being diffuse isT vs. focal isT (p = 0.0206) was an unfavourable prognostic factor. 5-year SUP: 63%, no significant prognostic factor. 5-year SS: 79%, being a female was an unfavourable prognostic factor (p = 0.0201)., Conclusions: Based on our results and the analysis of the literature we recommend treatment with 2 BCG courses of all isTs of the bladder that present some of the following factors: Diffuse cancer associated to T1G3, involvement of prostatic urethra or overexpression of p53 over 20%. In the rest of vesical tumours, one BCG course followed by a second one if lack of response to the first. After failure of both BCG courses, cystectomy must be performed in both groups.

Bellini's collecting ducts carcinoma represent a subgroup within renal carcinoma with an incidence of 0.4 to 2% of all renal tumours. The collecting ducts share their embryological origin in Wölf's duct with the calices, renal pelvis and ureter. This common embryological origin could justify the association of carcinoma originated in the collecting ducts with transitional urothelial carcinoma. This paper contributes two patients with Bellini's collecting ducts carcinoma associated to "in situ" carcinoma and transitional papillar carcinoma in the adjacent renal pelvis respectively. The authors review the diagnostic, pathoanatomical and therapeutical aspects found in the literature. A high index of suspicion is required to diagnose a case of Bellini's carcinoma in the face of predominantly central-medullar renal solid lesions, with infiltrating growth that causes morphological changes in the excretory system without deforming the external renal outline. The authors highlight the value of immunohistochemical studies to reach a diagnosis, considering the natural history and the sombre prognosis of this uncommon renal neoplasia.

Primary prostatic carcinoma accounts for 2% to 4.5% of all neoplasias to this organ, and it has been observed in 2.8% of all radical cystoprostatectomies performed in the Mayo clinic. It originates in the poorly differentiated reservoir cells of the prostatic periurethral ductus which explains why diagnosis is most often obtained in advanced stages (stromal involvement), thus limiting its management to radical surgery. This paper contributes one case report of a patient diagnosed by transrectal biopsy of a primary prostatic transitional carcinoma presenting with incoercible rectorrahges and urinary obstruction symptoms. Treatment was through pelvic exenteration, and urinary and gut by-pass.

Objectives: Surface carcinoma of the bladder shows a high incidence of tumour recurrence that require frequent examinations associated to potential morbidity. This paper analyses our series of patients with vesical tumours with no known unfavourable clinical prognostic factors, aiming to detect low risk groups where it may be feasible to change the usual follow-up criteria., Material and Methods: Between 1983 and 1996, 503 patients with vesical cancer, 388 of which 388 were primarily surface tumours, were monitored. The study analyzed 24 patients with surface transitional carcinoma with no unfavourable prognostic factor, i.e. Ta tumours, grade 1, single, under 1 cm, negative urine cytology and multiple negative vesical biopsies. This group was then compared to a control group comprising all other patients with surface tumours in our series (364 patients), and the prognostic factors were assessed based on the disease-free interval, progression-free interval, and overall and tumour-specific survival. Also the recurrence-free interval from the first endoscopic control at 3 months after transurethral resection, were studied according to Parmar's criteria., Results: With a mean follow-up of 53 months, 37% patients in the study group have relapsed versus 41% in the control group (n = 0.9), after 2 years on average. Actuarial curves in the control group reveal statistical significance for higher degree tumours recurrence. No grade progression has occurred in the study group versus 9% in the control group. No patient evolved to T2 versus 5% in the control group; also in this group, 5% patients died because of their tumour versus none in the study group. The 24 patients in the study belong to group 1 in Parmar's low risk, while the remainder of patients in the control group ranked according to these criteria have demonstrated an unfavourable statistical significance (p < 0.01) in patients with early relapse., Conclusions: Good results obtained in the evolution of patients with surface tumours with no unfavourable prognostic factors are due to the strict monitoring they undergo in order to detect early relapses. However, 37% of recurrences in this group does not allow to modify the usual follow-up schedule. In our experience, Parmar's criteria does not contribute any benefit over classical criteria to evaluate prognostic factors in surface vesical cancer.

We are currently witnessing a lively controversy over which should be the optimal treatment for patients with infiltrant urothelial carcinoma with muscle location (stage B Jewett's Grading or T2-T3 on the TNM Rating Scale, UICC 1992). This paper reports a randomized, prospective study in 37 patients with T2-T3a tumours. Arm A (n = 20) received systemic chemotherapy with cisplatin, methotrexate and vinblastine (CMV) after TUR, and was carefully followed aiming for vesical preservation. Arm B (n = 17) was given chemotherapy with CMV after TUR and then underwent cystectomy. Disease-free survival at 5 years for the overall series is 69%, 47% for group A and 88% for group B (log-rank, p = 0.14). No statistically significant differences in survival were detected relative to age (under or over 65 years), growth patterns (papillary or plain), histological grade (G2 or G3), and size (smaller or greater than 5 cm). Survival was different depending on the clinical suspicion of nodular involvement (log-rank, p < 0.001). In summary, although the number of patients in the series does not allow to draw conclusions in terms of statistical significance, there is enough evidence to consider that vesical preservation based on TUR and systemic chemotherapy as definitive treatment is a dangerous option without the good survival rates achieved by T2/T3a patients undergoing cystectomy.

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.

Transitional cell tumours of the bladder in children are exceptionally rare. This paper presents a new case in an 11-year old patient. The benignity of these tumours during the paediatric age can be verified due to the low infiltration incidence; some authors, however, describe cases of relapses which are commented upon. The careful follow-up that has to be done in this type of patients is underlined.

Lately, nuclear morphometry methods are being used to analyze the malignant potential of tumoral cells. This paper presents a retrospective study of a series of 163 patients with the three histological grades (WHO), of superficial papillary transitional cell carcinoma (pTa-pT1) of the bladder with a mean follow-up of 60 months. A morphometric analysis of the initial tumour biopsies was made. Mean nuclear area (NA) and its standard deviation (NASD) were measured in a semi-automatic image analyzer (MOP-videoplan, Kontron). NA and NASD show increasingly higher values with increased grade (p < or = 0.0001). NA and NASD values raise in those progressing to muscle-infiltrant stage; tumours were, then, divided into two morphometric groups: small NA (< 50 microns 2) and large NA (> 50 microns 2); the difference between them being statistically significant. The likelihood of no tumoral progression at 30, 60 and 90 months was, respectively, 96, 94 and 92 percent, form small NAs, and 76, 65 and 64 percent for large NA (p < or = 0.0001).

Muscle-invading urothelial carcinoma of the bladder, stage B of the Jewett-Marshall Scale (T2-T3a/pN0), treated effectively with radical cystectomy, is known to be a highly curable disease. But certain difficulties arise when it comes to apply the traditional morphological factor to the prognosis of this population, partly due to their relative small numbers and the lack of prospective studies on the subject. Apart from the presence or absence of lymph invasion, it is unclear whether the prognostic factors of poor evolution in tumours are also valid in more invasive lesions. This paper presents the cytogenetic study conducted in 7 patients with Stage B urothelial carcinoma in cystectomy portions. All of them showed favourable evolution except for one case with associated profusion of marker chromosomes and tetraploidy. As it has already been shown in Stage T1 vesical carcinoma, this association almost certainly carries a major predictive value of poor prognosis in the muscle-invading localized disease.

The SCC antigen expresses in the squamous epithelium during the process of a neoplastic transformation. This paper's objective is to evaluate the biological behaviour of SCC antigen in surface, deep, localized and spread malignant vesical carcinoma. To this end, 100 patients divided in two groups were studied. The first group consisted in 30 healthy subjects strictly selected and the second group comprised 70 patients diagnosed with transitional cell vesical carcinoma. SCC Antigen measurement was made by Radioimmunoassay (RIA, Abbott). Our results suggest that this tumoral antigen has no use as a prognostic factor in patients diagnosed with transitional cells vesical carcinoma, since serum concentrations suffer no change in relation to size, extent and degree of tumoral differentiation.

Cyclophosphamide has been used since 1958 in the treatment of various malignant tumours and certain systemic diseases, toxicity to the urothelium, frequently causing haemorrhagic cystitis and less often urothelial carcinomas, being one of its most notorious side effects--some 60 urothelial carcinoma cases have been published following therapy with cyclophosphamide since 1971. The present paper is a contribution of two new cases and its raises the need of paying special attention to urinary manifestations as well as narrowing the cooperation between the physicians which prescribe cyclophosphamide and the urologist, in order to make an appropriate follow-up and management of the patient.

The dermatomyositis is a connective tissue disease characterized by changes affecting both the skin and the muscle, appearing most frequently around the fifth and sixth decades and which association to a vesical tumour is very rare. This paper contributes one case of paraneoplastic dermatomyositis associated to infiltrant vesical tumour, presenting erythematous damage in face, nape of the neck and upper thorax, as well as periorbital heliotrope erythema and fingernails base and sides telangiectasia, all of which are typical signs of dermatomyositis.

The evolution of 168 patients, 136 of which underwent bilateral lymphadenectomy is analyzed in this paper. In 126 cases it was possible to obtain all the data in order to define N within the T.N.M. rating. With regard to the remaining patients 10, of which we lack the anatomopathological report, and 32 which did not undergo lymphadenectomy, are included under item Nx. During follow-up, metastasis was diagnosed in 60% node-positive patients. We believe it to have been already present at the time of undergoing surgery. Survival was significantly higher in the group without node dissemination than in both negative-nodes and Nx groups. When assessing the nodular dissemination group, patients treated with 2000 rad prior to cystectomy showed higher survival rates: 36% vs 22% and 11% for groups treated with 4500 rad and no radiotherapy. respectively. Metastatic percentage, however, was lower for the group managed with surgery alone (50%) than those treated with pre-operative radiotherapy (73% and 67% with 2000 and 4500 rad, respectively), on the other side, it would seem a contradiction that a 2000 rad dosage should be more effective than a 4500 rad dosage for this group of patients, since theoretically, the latter is closer to the ideal dosage to eradicate the nodular disease. Since 3 of 5 patients have micrometastasis, which we are yet unprepared to detect, all positive-node patients should receive chemotherapy immediately after recovery from surgery.

The paper presents our experience with in situ carcinoma associated to bladder surface tumour. The relationship between in situ carcinoma associated to surface tumour and new occurrences, as well as increase of tumoral stage, versus those tumours not associated to in situ carcinoma is assessed through a comparative study. It is concluded that bladder surface tumours with associated in situ carcinoma begin to recur from the first months at higher rate than other surface tumours. Bladder surface tumours with associated in situ carcinoma, however, do not increase tumoral stage at a different rate than other surface tumours, at least not for a period of 18 months.