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Resumen Introduccion y objetivo Conocer el manejo de la estenosis uretral (EU) es importante para evaluar la calidad asistencial y planificar acciones formativas. Planteamos investigar practicas diagnosticas y terapeuticas de los urologos en Espana para el manejo de EU anterior del varon adulto. Materiales y metodos Realizamos un cuestionario on line de 23 preguntas entre los miembros de la Asociacion Espanola de Urologia (AEU). Evaluamos datos demograficos y referentes a la evaluacion y tratamiento de EU. Fueron enviadas por correo electronico 1.737 invitaciones, con un 21,7% de respuestas. La recogida prospectiva fue durante 2016. El analisis descriptivo y las comparaciones univariantes se efectuaron empleando el test de Chi cuadrado. Hubo significacion estadistica cuando p ≤ 0,05. Resultados Participaron principalmente urologos de hospitales terciarios y universitarios. El 63,2% tratan ≥ 10 pacientes/ano con EU. La uretrografia retrograda es la prueba diagnostica mas empleada, seguida de la uroflujometria (UF). La uretrotomia interna bajo vision directa (UIVD) es el tratamiento mas comun. El 84,4% limita la UIVD a EU ≤ 1,5 cm. El 62,3% realiza ≤ 5 uretroplastias/ano. El 75,7% hace uretroplastias anastomoticas y el 68,9% emplea injertos. Existe preferencia por injertar dorsalmente. El 23,9% emplea tecnicas non-transecting. La UF es la prueba preferida para el seguimiento. El 88,4% refiere que son necesarias unidades de referencia. En centros terciarios realizan cuestionarios Patient Reported Outcome Measure mas frecuentemente que en secundarios. Urologos con alto volumen de cirugias usan mas comunmente tecnicas non-transecting y eligen la uretroplastia como opcion de primera linea. Conclusiones La EU anterior del varon en Espana es tratada por gran cantidad de urologos, principalmente mediante endoscopia. La uretrografia retrograda se prefiere para el diagnostico y la UF para el seguimiento. Un elevado porcentaje de urologos realiza uretroplastia, mayoritariamente anastomotica, pero con bajo numero de casos.

Introduction and objective Assessment of urethral stricture (US) management seems important to evaluate the quality of attention and plan educational interventions. We aim to investigate the practice patterns on diagnostic and therapeutic approaches to adult male anterior US among urologists in Spain. Materials and methods 23-question on-line survey conducted among all members of AEU (Spanish Urological Association). Demography data and practices on evaluation and treatment of US were included. 1737 invitation letters sent by email, with 21.7% response rate. Data were prospectively collected during 2016. Descriptive analysis and univariate comparisons conducted using X2 test. Statistical significance considered when P ≤ 0.05. Results Responders were mainly from Tertiary and Teaching University Hospitals. 63.2% treated ≥10 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool followed by uroflowmetry (UF), and internal urethrotomy under direct vision (DVIU) the most frequent treatment. 84.4% limited DVIU for US ≤ 1.5 cm. 62.3% performed ≤5 urethroplasties/year. Anastomotic urethroplasties were performed by 75.7% and graft repairs by 68.9%. Dorsal grafting was preferred rather than ventral. Non-transecting techniques were used by 23.9%. UF was the most common follow-up tool. 88.4% felt that referral units were required. Tertiary hospitals used Patient Reported Outcome Measure (PROM) questionnaires more frequently than secondary centres. High-volume urologists were more likely to use non-transecting techniques and to choose urethroplasty as first choice procedure. Conclusions Male anterior US in Spain are treated by many urologists, mainly using endoscopic procedures. RUG is preferred for diagnosis, and UF for follow-up. A high percentage of urologists perform urethroplasties, mainly anastomotic repairs, but in low volume.

Resumen Objetivo Explorar la relacion entre la disfuncion erectil (DE), los niveles de testosterona y el Indice de comorbilidad de Charlson (ICC). Material y metodos Estudio transversal en pacientes derivados a la unidad de andrologia de 7 hospitales espanoles. La DE se diagnostico y clasifico mediante el International Index of Erectile Function . Los niveles de testosterona, la prevalencia de cada comorbilidad y el ICC se compararon entre pacientes con distintos grados de DE. Ademas de la correlacion entre la testosterona total y el ICC, la influencia de cada comorbilidad y de la severidad de la DE en el ICC se evaluaron mediante una regresion lineal multiple. Resultados El estudio incluyo 430 hombres con una media de 61 anos de edad. El ICC medio fue 3,5 y la testosterona total 15,2 nmol/l; 389 (91%) de los sujetos tenian algun grado de DE: 97 (23%) leve, 149 (35%) leve a moderada, 86 (20%) moderada y 57 (13%) severa. La severidad de la DE se asocio a un nivel menor de testosterona (p = 0,002) y a un mayor ICC (p 2 = 0,426). La severidad de la DE mostro una contribucion significativa al modelo (p = 0,011), pero la testosterona total no (p = 0,204). Conclusiones El ICC se asocia significativamente con la severidad de la DE, pero muestra una correlacion debil con los niveles de testosterona.

Resumen Introduccion La enfermedad estenotica de la uretra posterior es una complicacion no menor de los tratamientos aplicados en la hipertrofia benigna de prostata, cancer de prostata (CaP) y tras neovejigas ortotopicas, pudiendo comprometer el resultado funcional miccional. Objetivos Identificar los factores etiologicos de la enfermedad estenotica de causa no traumatica de la uretra posterior, su prevencion y su tratamiento. Adquisicion de la evidencia Se han revisado los articulos indexados en PubMed en idiomas ingles y espanol de las secuelas estenoticas de la uretra posterior tras los tratamientos aplicados en el cancer de prostata, en la cirugia de la hipertrofia benigna de prostata y de las neovejigas ortotopicas. Se han incluido estudios de cohortes, revisiones de articulos y estudios prospectivos y retrospectivos, con el mayor numero de casos. Sintesis de la evidencia La evidencia obtenida en la bibliografia es que la frecuencia de aparicion de dichas estenosis no es despreciable, que su morbilidad puede ser importante y que debe sospecharse tras la perdida de la calidad miccional. Su prevencion empieza con una apropiada tecnica quirurgica y/o radioterapica. Aunque el tratamiento endoscopico es el preferido inicialmente, en ocasiones se requieren uretroplastias complejas abiertas, siendo la incontinencia urinaria la secuela mas importante, pudiendo requerir implantes de esfinteres artificiales. Conclusiones Las estenosis no traumaticas de la uretra posterior son complicaciones que pueden ser importantes, llegando a comprometer el exito del tratamiento inicial de la enfermedad de base y requiriendo en ocasiones de cirugias complejas que pueden llevar a la incontinencia.

Introduction Posterior urethral stenoses and contractures are complications after treatment of benign prostatic hyperplasia (BPH), localized prostate cancer (PCa), and orthotopic neobladder formation, compromising prognosis and functional outcomes. Objectives To identify factors related to etiology, 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.

Introduction The posterior urethral lesions are associated with pelvis fractures in 5–10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level. Objectives To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management. Acquisition of evidence Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic. Synthesis of the evidence With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. Conclusions Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions.

Resumen Introduccion Las lesiones de la uretra posterior (UP) se asocian a fractura de pelvis (FP) en un 5-10%. La UP se fija a la pelvis osea mediante los ligamentos pubo-prostaticos y la membrana perineal, esto explica que la disrupcion del anillo pelviano pueda lesionar la uretra a este nivel. Objetivos Identificar los casos sospechosos de traumatismo de UP, como realizar el diagnostico y su manejo inmediato o diferido. Adquisicion de la evidencia Busqueda en PubMed de articulos relacionados con lesiones traumaticas de UP, escritos tanto en ingles como en espanol. Se revisaron las publicaciones relevantes incluyendo revisiones de la literatura y capitulos de libros relacionados con el tema. Sintesis de la evidencia Ante un paciente con FP siempre hay que descartar lesion de UP. El examen diagnostico de eleccion es la uretrografia retrograda, que junto con la gravedad del paciente determinara el manejo en la fase aguda y si el tratamiento se realizara de forma inmediata o diferida. El diagnostico precoz y un manejo agudo correcto disminuyen las complicaciones asociadas, como la estenosis, la incontinencia urinaria y la disfuncion erectil. Conclusiones A pesar de que la asociacion de las lesiones de UP con FP es clasica, su manejo tanto inmediato como diferido sigue siendo controvertido. Gracias al interes en aumento por la enfermedad uretral, cada vez se realizan mas estudios que permiten acercarnos a un mejor manejo de estas lesiones.

Resumen Introduccion El carcinoma microcitico vesical (CMCV) o carcinoma de celulas pequenas es una enfermedad infrecuente, agresiva, de mal pronostico y alto poder metastasico; se presenta en edades y estadios avanzados. Presentamos nuestra casuistica evaluando su comportamiento y los tratamientos aplicados. Material y metodo Revision retrospectiva de pacientes diagnosticados de CMCV en nuestro hospital entre febrero de 1992 y febrero de 2014. Analizamos caracteristicas demograficas, clinicas y propias del tumor, los tratamientos aplicados y la supervivencia. Analisis estadistico descriptivo del seguimiento medio (SM), supervivencia global (SG) y supervivencia cancer especifica (SCE) mediante el programa SPSS version 15.0. Resultados En esos 22 anos se diagnosticaron 20 pacientes con CMCV (solo 2 mujeres), con edad media de 75 anos. El sintoma predominante fue la hematuria macroscopica (75%). Tras la RTU-V inicial y el diagnostico anatomopatologico el 35% (7 pacientes) no recibio tratamiento adicional, el 15% (3 pacientes) recibio quimiorradioterapia (QRT), el 10% (2 pacientes) RTU el 15% (3 pacientes) quimioterapia (QT) el 5% (un paciente) RTU asociada a QRT, el 5% (un paciente) cirugia radical, el 5% (un paciente) cirugia radical asociada a QRT adyuvante, el 5% (un paciente) cirugia paliativa (ligadura de arterias hipogastricas) asociada a QT adyuvante y el 5% (un paciente) radioterapia (RT) hemostatica. Con un SM de 13,8 meses, la SG fue de 14,48 meses (IC 95%: 6,22-22,75) y la SCE 18,04 meses (IC 95%: 6,51-29,57), permaneciendo unicamente 2 pacientes vivos (10%) al final del estudio. Conclusion El CMCV es una neoplasia vesical infrecuente y agresiva que se diagnostica mas frecuentemente en varones de edad y estadios avanzados, de pronostico desfavorable y escasa supervivencia. Debido a su estadio local avanzado al diagnostico la cistectomia es aplicable en muy contados casos, debiendo recurrir a un tratamiento multimodal, aun por definir.

Introduction Microcytic carcinoma of the urinary bladder or bladder small cell carcinoma (SCC) is a rare entity, characterized by an aggressive behavior, with a poor prognosis, elevated metastatic potential, and is commonly found in older patients and in advanced disease stages. Here we present our experiences with the behavior of the disease and the treatments applied. Material and method This was a retrospective study on patients diagnosed with bladder SCC in our hospital between February 1992 and February 2014. We analyzed the demographic and clinical characteristics of the tumor, the applied treatments and survival. We performed a descriptive statistical analysis of the median follow-up time, overall survival (OS) and cancer-specific survival (CSS), using the SPSS statistical package v. 15.0. Results Over 22 years, 20 patients with an average age of 75 years were diagnosed with bladder SCC (2 female). The predominant symptom was macroscopic haematuria (75%). After the first transurethral resection (TUR) of the bladder and the histological diagnosis, 35% (7 patients) did not receive additional treatment, 15% (3 patients) were treated with chemoradiotherapy (CRT), 10% (2 patients) with TUR, 15% (3 patients) with chemotherapy (QT), 5% (1 patient) with TUR associated to CRT, 5% (1 patient) with radical surgery, 5% (1 patient) with radical surgery treatment followed by adjuvant CRT, 5% (1 patient) with palliative surgery (hypogastric arteriae ligation) followed by adjuvant QT and 5% (1 patient) with hemostatic radiotherapy (RT). With a median follow-up time of 13.8 months, the OS was 14.48 months (95% CI: 6.22–22.75) and the CSS 18.04 months (95% CI: 6.51–29.57). Only 10% (2 patients) survived till the end of the study. Conclusion Microcytic carcinoma of the urinary bladder is a rare and aggressive entity commonly diagnosed in males of advanced age and in advanced disease stages. It has a poor prognosis and reduced survival. Due to its aggressiveness previous to the initial diagnosis, a cystectomy is only possible in very few cases; therefore multimodal treatment is necessary. This treatment is yet to be defined.

Resumen Objetivos El carcinoma urotelial vesical variedad en nidos es extremadamente infrecuente, y tiene un comportamiento mas agresivo que el resto de tumores de vejiga. El objetivo principal de este estudio es analizar si su comportamiento en nuestro medio es tan agresivo como lo descrito en la literatura. Material y metodo Revision de 12 casos diagnosticados de carcinoma urotelial vesical variedad en nidos y analisis de las caracteristicas tumorales, opciones de tratamiento, analisis de recurrencia y supervivencia de la enfermedad entre enero de 1997 y diciembre del 2010 en nuestra institucion. Resultados El 50% de los casos tuvo un estadio tumoral ≥ T2, siendo el grado de diferenciacion G2 (50%) o G3 (50%). Tras el resultado anatomopatologico de la primera reseccion transuretral (RTU) vesical en 5 pacientes se practico cistoprostatectomia radical, 3 una segunda RTU y 4 pacientes solo con tratamiento quimioterapico (QT) posterior y/o radioterapia (RT). De los 12 casos 5 (41,7%) fallecieron por causa tumoral y 3 (25%) por otras causas (sepsis urinaria, insuficiencia respiratoria, insuficiencia renal). Con una mediana de seguimiento de 40 meses la supervivencia global fue del 50% y la supervivencia cancer especifica del 65,6%. Conclusiones El carcinoma urotelial vesical variedad en nidos es un tumor que se presenta en estadios avanzados, con altas tasas de recurrencias y mortalidad a pesar del uso de diferentes herramientas de tratamiento. No existe hasta la fecha una guia de practica clinica para esta variedad de tumor urotelial.

Objectives The nested variant of bladder transitional cell carcinoma is extremely rare and has a different biological behavior to other bladder tumors. The aim of this study is to analyse if their behavior is as aggressive as has been described in the literature. Material and method Review of 12 diagnosed cases with nested variant of bladder transitional cell carcinoma and analysis of demographic characteristics, clinical presentation, tumor characteristics, treatment options, analysis of recurrence and cancer-specific survival between January 1997 and December 2010 in our hospital. Results 50% of the cases had a pathologic stage ≥T2, with grade of differentiation G2 (50%) or G3 (50%). After the pathological result of the TUR (transurethral resection) Bladder, 5 cases underwent radical cystoprostatectomy, 3 a second TUR bladder and 4 cases with treatment chemotherapy and/or radiotherapy (RT). Five out of 12 cases (41.7%) died due to bladder cancer and 3 died (25%) of other causes (urinary sepsis, respiratory failure, renal failure). With a median follow up of 40 months, the overall survival was 50% and cancer-specific survival of 65.6%. Conclusions The nested variant of bladder transitional cell carcinoma is a disease with an advanced-stage presentation, with high recurrence and mortality rates despite the use of different treatments. So far there is not a clinical practice guideline for this variety of urothelial tumor.

Resumen Objetivos Analizar si el numero real de instilaciones de BCG aplicadas en los tumores vesicales no musculo-infiltrantes tiene alguna influencia en su pronostico, asi como otras variables clinicas y del tumor: edad, sexo, diferentes protocolos, dosis de BCG, primario o recurrente, G3 o Cis. Pacientes y metodos De 1.491 pacientes incluidos en la base de datos del grupo CUETO se analizaron 324 tumores de alto grado (15 TaG3, 184 T1G3, 125 Cis). Tras la induccion de 6 instilaciones de BCG post-RTU fueron programados para recibir una instilacion cada 2 semanas (3-6 veces), total 9-12 instilaciones. Un tercio de dosis (27 mg) en 112 casos y dosis total (81 mg) en 212 casos. Seguimiento medio: 59,6 meses. Analisis estadistico: Kaplan-Meier, regresion de Cox uni y multivariado. Resultados Con el analisis de Kaplan-Meier y regresion de Cox multivariado se obtuvo mayor riesgo de recidiva (p = 0,032) y progresion (p = 0,013), y peor supervivencia cancer-especifica (p = 0,005) si Conclusiones Con los resultados obtenidos parece que el numero de instilaciones aplicadas tiene alguna influencia sobre el pronostico, quedando por determinar cual es el minimo de instilaciones a partir del cual el paciente se puede beneficiar y su tiempo de aplicacion. Dosis de 27 mg y el ser mujer son factores predictivos para mayor recidiva.

Objectives Despite the growing trend in the development of orthotopic neobladders, the procedure cannot be performed in many cases, thereby retaining the validity of other techniques. We propose a comparative analysis between patients with radical cystectomy for bladder neoplasm and reconstruction using the ileal conduit (IC) or ureterosigmoidostomy (USG). Patients and method Observational retrospective study on 255 patients with radical cystectomy between 1985 and 2009, selecting group assignments by the use of IC and USG. Analysis of the demographic and preoperative characteristics, perioperative complications, pathology and medium to long-term complications. Comparison of groups using T -Student, U -Mann–Whitney and chi square tests, with p Results There were 41 cases of IC and 55 cases of USG, with a mean patient age of approximately 61 years. USGs were performed on a greater number of females than ICs. There were no differences in the need for transfusion, with similar results as other series. There was a greater trend toward the appearance of intestinal fistulae and greater morbidity and mortality in the postoperative period in USG, although it was not significant. There was a greater long-term presence of eventrations in IC, and of pyelonephritis and the need for taking alkalinizing agents in USG. The appearance of peristomal hernias in IC was less than in previous series. With a mean follow-up greater than 50 months, the overall survival was 40% at 5 years, with no differences according to urinary diversion. Conclusions IC and USG are two applicable urinary diversions in the event that orthotopic neobladder surgery cannot be performed. They have a similar long-term complication and survival profile in our series, although with a higher morbidity in postoperative complications for USG.

Objectives Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. Material and Methods A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. Results Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. Conclusions The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.

Resumen Objetivos Validacion del cuestionario PROSQOLI adaptado al castellano, persiguiendo la obtencion de un instrumento para evaluar, en la practica clinica habitual, la calidad de vida en pacientes con cancer de prostata localmente avanzado o diseminado en nuestro pais. Material y metodos Se diseno un estudio transversal prospectivo en 750 pacientes (150 centros) con cancer de prostata diseminado o localmente avanzado (criterio TNM) que acudian a revision programada. Se recogieron datos socio-demograficos y clinicos de los participantes. Estos cumplimentaron los cuestionarios PROSQOLI y EQ-5D. El analisis incluyo 561 casos que cumplieron criterios de seleccion. Se estudiaron las caracteristicas psicometricas (factibilidad, validez y fiabilidad) del cuestionario PROSQOLI adaptado. Resultados La edad media fue de 73,63 (7,59) anos. El 72,01% de los participantes sufria enfermedad localmente avanzada; en el 28,16% el tratamiento primario fue radioterapia y en el 12,30% prostatectomia. El 83,48% recibia tratamiento hormonal. La media para cada escala del cuestionario PROSQOLI vario entre 68,86 y 74,51. El porcentaje de no respuesta fue inferior al 3% para cada escala. El porcentaje de sujetos con puntuacion minima en alguna escala fue despreciable, y el de puntuacion maxima no sobrepaso el 5%. El tiempo medio de cumplimentacion fue 109,42 (101,00) segundos. El coeficiente α-Cronbach fue 0,937 y la correlacion item-total superior a 0,7 para todos los items. Las correlaciones con el cuestionario EQ-5D fueron moderadas. Las puntuaciones en el cuestionario se asociaron con todos los parametros estudiados relacionados con la enfermedad. Conclusiones el cuestionario adaptado presento adecuadas propiedades psicometricas para su uso tanto en investigacion como en la practica clinica.

Resumen Objetivos Explorar la opinion de los urologos espanoles respecto a los principales puntos en el diagnostico, prevencion, calidad de vida y tratamiento del cancer de prostata. Material y metodos Se administro un cuestionario anonimo a 290 especialistas que representan el colectivo profesional urologico involucrado en el manejo del cancer de prostata en Espana. En su definicion se tuvo en cuenta el grado de experiencia profesional, el ambito de trabajo, la relacion contractual con el paciente y el caracter academico del centro. El analisis estadistico se baso en el estudio de frecuencias relativas para variables cualitativas. La interpretacion de resultados se llevo a cabo en 2009-2010 y el informe de emision final de los mismos en 2011. Resultados La tasa de respuesta recogida y correctamente transcrita de los formularios fue del 96,9% (n = 281), lo que supone un 10-15% del colectivo nacional. La mediana de edad fue 47,7 (29-69) anos y el 92% fueron hombres. La mediana de experiencia profesional fue 19,1 (1-43) anos. Se analizan las respuestas recogidas relativas a 153 cuestiones que tratan: a) como se lleva a cabo el diagnostico de la enfermedad en el entorno de los encuestados; b) las opiniones vertidas acerca de la prevencion de la enfermedad; c) el tratamiento de la enfermedad localizada; d) el tratamiento de la enfermedad avanzada; y e) la definicion de campos de interes para el profesional. Conclusion Esta encuesta demuestra una importante variabilidad en algunos puntos de la practica clinica con respecto a las recomendaciones de expertos. Pone tambien en evidencia las principales preocupaciones del profesional, define oportunidades de mejora formativa y detecta necesidades en el colectivo urologico nacional.

Xanthogranulomatous orchiepididymitis (XGO) is a rare inflammatory and destructive disease of the testis that may simulate testicular malignancy. To the authors' knowledge only 19 cases of XGO have been previously reported. Herein is reported the case of a 52-year-old man with XGO who presented with a left testicular mass and pyogenic discharge from the scrotum. Ultrasound examination indicated heterogeneous testicular areas suggestive of neoplasia. Testicular tumor markers were normal. Orchidectomy was performed and histopathology showed XGO and a concurrent, occult typical seminoma. As far as the authors know the coincidence of these two lesions has not been documented previously. XGO may mimic testicular malignancy and may coexist with it. Pathologists should be aware of this concurrence of lesions to avoid potential misdiagnosis. Wide sampling of the orchidectomy specimens with XGO is mandatory to exclude an occult seminoma.

Introducción: La tasa de infección del sitio quirúrgico es un buen indicador de la calidad asistencial en los servicios quirúrgicos. La profilaxis antibiótica representa una medida de eficacia probada en la prevención de la infección del sitio quirúrgico y su cumplimiento constituye un objetivo en los contratos de gestión de los servicios de salud. La eficacia de esta medida preventiva requiere la existencia de protocolos de actuación actualizados y la evaluación de los mismos. Objetivo: Evaluar el cumplimiento de ese protocolo antibiótico en nuestro Servicio analizando las causas de profilaxis inadecuada de forma global y por procedimientos. Material y métodos: El servicio de Medicina Preventiva, como observador externo, por medio de un estudio retrospectivo analizó 695 intervenciones quirúrgicas (en pacientes ingresados y ambulantes) realizadas por el servicio de Urología durante los años 2003 al 2006 para su evaluación anual del cumplimiento del protocolo de profilaxis antibiótica. Se considera profilaxis inadecuada la administrada no estando indicada, la no administrada estando indicada y la administrada con pauta incorrecta. Resultados: El cumplimiento del protocolo es adecuado en el 83,16% de las intervenciones. La causa de inadecuación más frecuente fue la pauta incorrecta en el 15,3 %. Dentro de esta pauta incorrecta la causa principal fue el momento de administración tardío del antibiótico profiláctico y en menor medida una duración incorrecta de la pauta antibiótica. Conclusiones: El porcentaje de cumplimento del protocolo antibiótico en nuestro servicio de Urología es alto. La evaluación detectó dos problemas de diferente índole y solución: El adecuar el momento de administración del antibiótico es un problema funcional, estructural y organizativo a resolver junto al servicio de Anestesiología; El número de dosis de antibiótico en cirugía abierta de próstata requiere el conocimiento y cumplimiento estricto de la pauta por parte de los cirujanos. La efectividad de la profilaxis antibiótica requiere la existencia de protocolos adecuados y actualizados para la unificación de criterios entre los profesionales, para detectar nuevos problemas, así como para buscar soluciones para un correcto cumplimiento del mismo.

Resumen Trasplante cardio-renal. Evolucion del injerto renal Introduccion La mejora en las tecnicas de conservacion de organos, quirurgicas y en el tratamiento inmunosupresor ha permitido que los pacientes necesitados de un segundo organo sean incluidos en lista de espera para trasplante bien sincronico o asincronico Objetivos Revision de los resultados obtenidos en el trasplante renal (TxR) en pacientes con trasplante cardiaco (TxC) bien de forma sincronica o asincronica Material y metodos Estudio retrospectivo de los pacientes con TxC y TxR realizados en nuestro Hospital. Se revisaron las caracteristicas de los pacientes, causa del fallo cardiaco y renal, evolucion del injerto renal y paciente asi como las complicaciones del TxR Resultados Entre 1985 y 2006 realizamos 411 TxC, en 7 de estos pacientes (1,7%) realizamos 9 TxR, 2 sincronicos y 7 asincronicos. Los 7 pacientes eran varones con una edad media al TxC de 51,3±12,2 anos (24-60); la causa del TxC fue miocardiopatia dilatada en 4 (57,2%), cardiopatia reumatica en 1 (14,3%) y cardiopatia isquemica en 2 (28,5%). La edad al TxR fue 57,5±11,2 anos (32-68); la causa de insuficiencia renal fue nefrotoxicidad por ciclosporina en 3 (33,3%), nefroangioesclerosis en 1 (11,1%), nefropatia intersticial cronica en 2 (22,2%), glomerulonefritis membranoproliferativa en 1 (11,1%) y nefropatia cronica del injerto en 2 (22,2%). Hubo 2 Tx sincronicos en los cuales la isquemia fria renal fue de 4 horas, en 1 (50%) hubo diuresis inmediata; no hubo ninguna complicacion relacionada con el injerto renal. En los 7 asincronicos el tiempo entre el TxC y TxR fue de 105,9±51.8 meses (23 y 201meses); la isquemia fria renal fue 20,3±1,5 horas (18-22); hubo diuresis inmediata en 5 de ellos (71,5%). En 2 de ellos no hubo complicaciones, hubo 2 casos de rechazo agudo, 1 hematoma perirrenal, 1 infarto polar, 1 linfocele, 1 infeccion de herida, 1 infeccion de orina y 2 infecciones respiratorias. El seguimiento medio es de 52,2±33,9 meses (12-93); todos los pacientes viven con injerto funcionante con cifras de creatinina de 1,8±0,43 mg/100 (1,4-2,4). Los 2 injertos que se perdieron fue por nefropatia cronica del injerto a los 138 y 270 dias. La pauta de inmunosupresion fue variable, siendo la asociacion de micofenolato y tacrolimus con o sin esteroides la mas repetida Conclusiones El fracaso renal cronico asociado a cardiopatias que precisen o hayan precisado TxC no excluye el trasplante de ambos organos

Objective: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guerin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. Material and methods: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n = 108), re-TURBT (n = 153), induction with 27 mg of BCG (Connaught strain) (n = 87), induction with 81 mg of BCG (n = 489) or induction with 81 mg of BCG + maintenance (n = 202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. Results: The mean follow-up was 62 +/- 39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81 mg of BCG than in the other treatment groups (P

Resumen La ectopia renal cruzada es una anomalia renal congenita poco frecuente y en la mayoria de los casos se presenta con fusion de ambos rinones. Estos pacientes suelen permanecer asintomaticos hasta la 4a-5a decada y desarrollar entonces problemas de infecciones urinarias, litiasis, masa abdominal o dolor que simula un problema gastrointestinal. Presentamos el caso de un tumor de celulas renales aparecido en un paciente con ectopia renal cruzada con fusion, descubierto en un TAC realizado por sospecha de patologia gastrointestinal.

Resumen Tumores de urotelio superior Objetivos:Evaluar los metodos diagnosticos empleados, el tratamiento y el seguimiento de los pacientes afectos de tumor de urotelio superior. Pacientes y metodo Desde 1978 hasta diciembre de 2002 han sido operados 105 pacientes afectos de tumor de urotelio superior, siendo validos para el analisis 94. La edad media ha sido de 65 anos, siendo el 85% varones. La hematuria fue el sintoma mas frecuente de presentacion. Resultados Se realizo UIV en el 93% de los pacientes, la ecografia en el 77% y el TAC en el 67%. Predomino el tumor pielico (71%) y el tratamiento mayoritario fue la nefroureterectomia total con reseccion del collarete vesical perimeatal (76,4%). El tumor vesical previo o simultaneo se constato en 22 casos (23,3%) y posterior en 28 casos (30%). Con un seguimiento medio de 76 meses, la supervivencia es del 53%. Conclusiones El tumor de urotelio superior debe considerarse como una enfermedad panurotelial debido a la alta frecuencia de tumor vesical previo, simultaneo o posterior, lo cual empeora aun mas el pronostico de esta enfermedad.

Approximately 80% of prostate cancer patients achieve symptomatic and objective responses following androgen suppression, and serum prostate specific antigen (PSA) levels decrease in almost all patients. Surgical or medical castration results in a median progression-free survival of 12-33 months and a median overall survival of 23-37 months in patients with stage M1 disease. However, for reasons that remain unknown, the cell death process induced by androgen ablation, by whatever means, fails to eliminate the entire malignant cell population [1]. Another limitation of conventional androgen ablation is that it increases the rate of progression of prostate cancer to an androgen-independent state [1], and, after a variable period of time averaging 24 months, the tumor inevitably recurs with increasing serum PSA levels and is characterized by androgen-independent growth. Over the past 20 years, most efforts have focused on maximizing the degree of androgen suppression therapy by combining agents that inhibit or block both testicular and adrenal androgens. However, maximal androgen ablation increases treatment-related side effects and expenses, while prolonging disease-free interval by 3-6 months in most patients [2].

Background: Bacillus Calmette-Guerin (BCG) maintenance therapy for 3 yr following BCG induction can reduce the progression of urothelial bladder carcinoma versus BCG induction alone, but is associated with high toxicity. Objective: To investigate whether a modified 3-yr BCG maintenance regimen following induction therapy is more effective than standard BCG induction therapy alone and exhibits a low toxicity profile. Design, setting, and participants: Patients from the outpatient clinics of the participating centres with high-risk non-muscle-invasive bladder carcinoma (NMIBC) were randomised between October 1999 and April 2007. Intervention: Participants received BCG induction once-weekly for 6 wk (no maintenance arm) or BCG induction followed by one BCG instillation every 3 mo for 3 yr (maintenance arm). Outcome measurements and statistical analysis: Primary endpoints were disease-free interval (DFI) and time to progression (TTP). Secondary endpoints included survival duration and toxicity. Differences between treatment arms were tested using Student's t test and chi(2) and log-rank tests. Results and limitations: A total of 397 patients were randomised, 195 to the nomaintenance and 202 to the maintenance arm. A median time to recurrence was not reached in either treatment arm. DFI was similar between the arms (hazard ration [HR] 0.83; 95% CI 0.61-1.13; p = 0.2) with disease relapse at 5 yr of 33.5% and 38.5%, respectively. TTP was also similar between the treatment arms (HR 0.79; 95% CI 0.50-1.26; p = 0.3), with a progression rate at 5 yr of 16% and 19.5%, respectively. There were no significant differences between the treatment groups for overall survival and cancer-specific survival at 5 yr. Twenty and five patients in the maintenance and nomaintenance arms, respectively, stopped treatment because of toxicity. The most common local side effects were frequency (65% of patients), dysuria (63%), and haematuria (43%); the most frequent systemic side effects were general malaise (7.2%) and fever (34%). Conclusions: In NMIBC patients treated with maintenance therapy comprising a single BCG instillation every 3mo for 3 yr following standard induction BCG, we did not observe a decrease in recurrence and progression rates versus induction therapy alone. Patient summary: Patients who undergo surgery to remove bladder cancer are usually treated with bacillus Calmette-Guerin (BCG) for 6 wk if there is a high risk of disease recurrence. Extending BCG therapy by 3 yr can further minimise disease recurrence and progression, but is associated with more side effects. We report that a modified 3-yr BCG treatment regimen showed low toxicity, but seemed to be no more effective than 6-wk treatment. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Intravesical bacillus Calmette-Guérin (BCG) is an effective therapy in non-muscle-invasive bladder cancer (NMIBC), but it has limitations in terms of recurrence and toxicity.To determine whether the sequential combination of mitomycin C (MMC) and BCG is superior to BCG alone in increasing a disease-free interval (DFI).We conducted a prospective randomized trial including 407 patients with intermediate- to high-risk NMIBC and allocated 211 to the MMC and BCG arm and 196 to the BCG-alone arm.The trial was designed to provide concurrently a power of 80% for the detection of a relative risk reduction of 35% (hazard ratio [HR]: 0.65) of disease relapse with a type I error of 0.05. Times to events were estimated using cumulative incidence functions and compared using the Cox regression model. We used the Kaplan-Meier technique to estimate survival curves.In the intention-to-treat analysis at 5 yr, DFI was significantly improved by the sequential scheme (HR: 0.57; 95% confidence interval [CI], 0.39-0.83; p=0.003), reducing the disease relapse rate from 33.9% to 20.6%. Higher toxicity was observed with the combination, even reducing the MMC dose, especially in G3 local toxicity compared with BCG with a difference of 17.4% (95% CI, 7.6-27.2; p0.001). In recurrent T1 tumors, the potential benefit of the sequential scheme was more evident than in the remaining subgroup (18.8% vs 12.8%), with a number needed to treat of five versus eight to avoid an event and with similar toxicity.Although the sequential scheme is more effective than BCG alone in reducing disease relapse, due to higher toxicity it could be offered only to patients with a high likelihood of recurrence, such as those with recurrent T1 tumors.We analyzed the outcomes of a randomized trial demonstrating that in intermediate- to high-risk non-muscle-invasive bladder cancer, mitomycin C and bacillus Calmette-Guérin (BCG) reduced disease relapse compared with BCG alone but was more toxic. Consequently, it could be offered only to patients with recurrent T1 tumors.CUETO 93009.

Resumen Objetivo Evaluar las complicaciones quirurgicas de la prostatectomia radical (PR) en nuestro medio Pacientes y metodo Desde agosto de 1991 a diciembre de 1999, hemos realizado 138 PR en pacientes con adenocarcinoma de prostata (CaP) clinicamente localizado. Analizamos solo los 133 casos de los que conocemos la evolucion. La tecnica utilizada ha sido la ascendente descrita por Walsh por via retropubica. La edad media era de 64,8 y la media del PSA era de 17,6 ng/ml Resultados Con un seguimiento medio de 43 meses diferenciamos las complicaciones precoces de las tardias. Entre las primeras tenemos la fistula urinaria (9%), la linforrea (5,22%) y la lesion rectal (2,2%). De las tardias la mas preocupante es la incontinencia de orina (27%) de la que el 4,5% es grave. La mas frecuente es la disfuncion erectil (98%) y la estenosis de la anastomosis (12%) es la menos preocupante. Solo tres pacientes han fallecido debido a la neoplasia. Comparamos nuestros resultados con las series mas amplias nacionales y extranjeras Conclusiones La cirugia radical de prostata en nuestro medio tiene una morbilidad similar a otras series. La incontinencia urinaria y la disfuncion erectil son las secuelas mas preocupantes que los pacientes deben conocer para decidir otras opciones terapeuticas

The Leydig cell tumor is the most frequent of non-germ cell tumors of the testis. Clinical findings depend on the age of presentation. We present two cases of Leydig Cell tumors of the testis, diagnosed in a 8 years old child with isosexual precocity, and a 42 years old adult with Gynaecomastia. After reviewing the existing literature on this uncommon pathology we consider that the iconography presented is very interesting for furthering the knowledge on this subject.

Resumene El carcinoma de prostata puede manifestarse clinicamente o bien diagnosticarse por los sintomas que origina su extension locoregional o a distancia. El sistema linfatico es la primera estacion metastasica del cancer de prostata, afectandose en un elevado porcentaje de casos, incluso pudiendo simular en ocasiones procesos linfoproliferativos, siendo muy raro llegar al diagnostico por una macroafectacion linfatica como primer sintoma. En estos casos al diagnostico de confirmacion se puede llegar por medio del estudio histologico y fundamentalmente inmunohistoquimico mediante la determinacion del antigeno prostatico especifico de una adenopatia. El tratamiento, en estos tumores diseminados, sera paliativo mediante hormonoterapia. El pronostico es, en general, bastante malo con supervivencias muy bajas a los 5 anos.

Resumen Objetivos Evaluar la utilidad del test NMP-22 en el diagnostico del cancer vesical; calcular el punto ideal de corte; comparar los resultados con la citologia urinaria y cistoscopia. Material y metodo 166 pacientes con sospecha clinica o en seguimiento por cancer vesical. Se excluyen pacientes con otras enfermedades urologicas, radioterapia en los ultimos tres meses, quimioterapia sistemica en el ultimo mes, trauma reciente de vejiga y portadores de sonda vesical. Se recoge una muestra de orina recien emitida y se separa en dos alicuotas, una para citologia u otra para NMP-22; posteriormente se hace cistoscopia y RTU si se sospecha tumor vesical. Mediante curva ROC calculamos el valor ideal de corte para NMP-22. Para cada prueba calculamos sensibilidad, especificidad, valor predictivo positivo y negativo. Se comparan los resultados de las diferentes pruebas con el test de McNemar. Todos los resultados se dan con un intervalo de confianza del 95%. Resultados El punto ideal de corte fue 6 u/ml; con el se obtiene una sensibilidad del 82,72% frente al 67,90% de la citologia (p = 0,0118). la especificidad fue del 80% y 94,12% respectivamente (p = 0,0018). por grados la sensibilidad fue 72,22% en g1, 70,97% en g2 y 100% en g3 para el nmp-22 frente a 44,44%, 58,06% y 90,62% de la citologia. por estadios fue 68,42% ta, 83,83% t1 y 100% t2 o superior con nmp-22 frente a 36,84%, 75% y 85,71% de la citologia. la cistoscopia detecto el 100% de los tumores, su especificidad fue 89,41%. Conclusiones El NMP-22 es un test util en el diagnostico del cancer vesical; mas sensible y menos especifico que la citologia, a la que pensamos que puede reemplazar en el protocolo de diagnostico y seguimiento del cancer vesical. El punto ideal de corte se situa en 6 U/ml.

Resumen El carcinoma de conductos colectores de Bellini constituye una rara y agresiva variedad histologica de adenocarcinoma renal, cuyo origen parece asentar en el epitelio del tubulo colector, con unas caracteristicas histologicas, citogeneticas e inmunohistoquimicas bien establecidas que nos permiten independizar este tipo tumoral del resto de adenocarcinomas renales. En la literatura nacional existen unos 7 casos publicados; presentamos un nuevo caso, con la particularidad de mostrar una inusual forma de presentacion, debutando clinicamente sin sintomatologia urologica especifica y radiologicamente en forma de masa retroperitoneal que justifica las manifestaciones clinicas del paciente. Abstract Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patien’s clinical manifestations.

Objectives: To analyze if the true number of BCG instillations applied in non-muscle invasive bladder tumors has any influence on their prognosis as well as other tumor and clinical characteristics: age, sex, different protocols, BCG dose, whether primary or recurrent, solitary or multiple, tumor size G3 or Cis. Patients and methods: A total of 324 high grade NMIBC (15 TaG3, 184 T1 G3, 125 Cis) out of 1491 cases included in the CUETO database were analyzed. Following 6 post transurethral resection (RTU) BCG instillations, the patients were scheduled to receive one instillation every two weeks (3-6 times), for a total of 9-12 instillations. One third of the dose (27 mg) (112 cases) or total dose of 81 mg (212 cases). Mean follow-up was 59.6 months. Statistical Analysis: Kaplan-Meier, Cox-regression (uni-multivariate). Results: A higher level of recurrence (p = 0.032) and progression (P=.013) risk as well as worse Ca-specific survival (P=.005) were obtained if there were fewer than 12 instillations with the Kaplan-Meier and Cox-regression multivariate analysis. A 27 mg (P=.008) dosage and being a female (P

From November 1984 to April 1989,122 patients with clinical T2-4a Nx-2 MO transitional cell carcinoma of the bladder were entered in a prospective randomized trial to compare survival between a control group of 60 patients treated only with radical cystectomy (arm A) and a group of 62 patients treated with 3 cycles of 100 mg./rn.' neoadjuvant cisplatin before radical cystectomy (arm B). Secondary objectives of the trial were comparison of the disease-free interval and time to death, significance of response of the primary tumor to cisplatin, pattern of relapse and toxicity. As of April 1993 after a median followup of 78.2 months (range 48 to 101) no difference in survival between the control patients and those who received neoadjuvant cisplatin has been observed. The overall direct survival is 37.3% for arm A and 35.5% for arm B. The survival rate of the 109 patients who complied with the protocol is 38.2% for 55 patients of the control group and 40.7% for 54 patients of the cisplatin group. Survival rates of patients theoretically rendered free of disease by radical cystectomy (complete response pTO-4a, pNO-2, MO) is 43.7% for 40 control patients and 47.8% for 41 cisplatin treated patients. The time to relapse in complete response patients was significantly longer (p = 0.0298) for those who received cisplatin (arm A 13.1 months versus arm B 30.3 months). The time to death (cause specific) did not differ significantly between both groups overall (p = 0.1349) but it was significantly different between controls and responders (p = 0.0501). Preoperative cisplatin downstaged the primary tumor in 19 patients (33.9%), of whom 11 (19.6%) had no tumor in the cystectomy specimen (pTO) and 8 (14.3%) had superficial tumor (pl'is pTa pT1). In 6 patients (9.7%) disease progressed during chemotherapy. The survival of the responders was significantly better than that of nonresponders (p = 0.0142), with specific death rate of 26.3% and 62.5%, respectively, and a median time to death of 43 months for responders and 30.5 months for nonresponders. Patients without nodal involvement (pNO) or with only 1 micrometastasis (pN1) fared significantly better (p = 0.0001) than those with major node invasion (pN2-4), irrespective of the treatment received. The survival rate is 48.6% for patients with pNO disease, 37.5% for pN1 and 5% for pN2-4. Toxicity of cisplatin was minimal and there were no differences in perioperative morbidity between the arms. In conclusion, 3 cycles of neoadjuvant cisplatin did not improve the overall survival of patients undergoing cystectomy for muscle infiltrating transitional cell bladder cancer, although they did prolong significantly the disease-free interval (p = 0.0298). Moreover a subgroup of patients whose primary tumor was downstaged by cisplatin showed a significant survival advantage over nonresponders (p = 0.0142). More than 50% of patients with invasive but nonmetastatic urothelial carcinoma of the bladder do not survive for 5 years after radical cystectomy and die of distant metastases despite good local control of the disease.' Combination therapy with preoperative radiation has not added any benefit to overall patient survival.2 Since most of the failures Seem to be caused by subclinical unrecognized disseminated disease at the time of local treatment, some clinicians have argued that systemic chemotherapy might be required to eradicate micrometastases and thereby improve survival."

From November 1984 to April 1989, 122 patients with clinical T2-4a Nx-2 M0 transitional cell carcinoma of the bladder were entered in a prospective randomized trial to compare survival between a control group of 60 patients treated only with radical cystectomy (arm A) and a group of 62 patients treated with 3 cycles of 100 mg./m2. neoadjuvant cisplatin before radical cystectomy (arm B). Secondary objectives of the trial were comparison of the disease-free interval and time to death, significance of response of the primary tumor to cisplatin, pattern of relapse and toxicity. As of April 1993 after a median followup of 78.2 months (range 48 to 101) no difference in survival between the control patients and those who received neoadjuvant cisplatin has been observed. The overall direct survival is 37.3% for arm A and 35.5% for arm B. The survival rate of the 109 patients who complied with the protocol is 38.2% for 55 patients of the control group and 40.7% for 54 patients of the cisplatin group. Survi...

Background We present a case of giant cavernous hemangioma in renal graft tumor; we have not found any cases described in literature. Clinical Case Patient transplanted from a deceased donor, 8 years previous to her admission due to deterioration in renal function, observing a 12-cm renal mass in the front face of the renal graft, which displaces it, provoking obstructive uropathy. On ultrasonography and computed tomography, it is seen as a complicated, cystic lesion. Tumorectomy with a good functional recovery of the graft was carried out. A histopathologic study showed a mass with extensive adherences to the perirenal adipose tissue and a cross section showed a spongy appearance with blood clots in the centre, microscopically formed by vascular channels, lined by a layer of endothelial cells, and filled with blood. Conclusions Giant cavernous hemangioma in renal graft tumor has not been previously described. Given its benign condition, nephron-sparing surgery should be carried out if possible.

Objectives: Study the opinion of the Spanish urologists regarding the main points in the diagnosis, prevention, quality of life and treatment of prostate cancer. Material and methods: An anonymous questionnaire was administered to 290 specialists who represented the urological professional group involved in the management of prostate cancer in Spain. The following were considered in their definition: grade of professional experience, work setting, contractual relation with patient and academic character of the center. The statistical analysis was based on the study of relative frequencies for qualitative variables. The results were interpreted in 2009-10 and the final report of them was done in 2011. Results: Response rate collected and correctly transcribed from the forms was 96.9% (n = 281). This accounts for 10-15% of the national group. Median age was 47.7 (29-69) years and 92% were men. Mean years of professional experience were 19.1 (1-43). Responses collected regarding 153 questions were analyzed. These dealt with: a) How the diagnosis of the disease was carried out in the setting of the surveyed; b) The opinions given on the disease prevention; c) Treatment of the localized treatment; d) Treatment of the advanced disease; and e) The definition of the fields of interest for the professional. Conclusion: This survey showed important variability in some points of clinical practice in regards to the recommendations of the experts. It also shows the principal concerns of the professional, defines opportunities for training improvements and detects needs in the national urological group. (C) 2012 AEU. Published by Elsevier Espana, S.L. All rights reserved.

We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.