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Resumen Objetivos Evaluar la eficacia y la eficiencia de la biopsia prostatica sistematica (BPS) y la biopsia de prostata por fusion cognitiva (BPFC) para diagnosticar el cancer de prostata (CaP) y el CaP significativo (CaPs) y analizar si la BPFC podria reemplazar con seguridad a la BPS. Material y metodos Una cohorte de 314 hombres consecutivos que tenian PI-RADS ≥ 2 en una biopsia previa 3T resonancia magnetica multiparametrica se sometieron prospectivamente a BPFC ecografica transrectal (dos nucleos por area sospechosa hasta un maximo de tres areas) y una BPS de 12 nucleos perifericos. Se considero CaPs cuando el grado de la OMS fue superior a 2 (Gleason 4 + 3 o superior). Resultados Se diagnostico CaP en 133 pacientes (42,4%), de los que 83 (62,4%) fueron CaPs. La BPS detecto CaP en 114 hombres (85,7%) y BPFC en 103 (77,4%), p Conclusiones Las BPFC son mas efectivas y tambien mas eficientes que las BPS para detectar CaPs. Sin embargo, las BPFC aun no pueden reemplazar las BPS de manera segura porque no pueden detectar hasta el 15% de los CaPs.

Resumen Introduccion Las biopsias prostaticas (BP) de repeticion, ante la persistencia de la sospecha de cancer de prostata (CP), son frecuentes y su rendimiento bajo. En el contexto de una BP negativa existe un escenario microscopico (EM), que definimos como el conjunto de lesiones no neoplasicas identificable. La existencia de algunas de estas lesiones incrementa el riesgo de deteccion de CP en BP sucesivas, mientras que otras parecen tener un efecto protector. El objetivo de esta revision sistematica es identificar el conjunto de lesiones que puede formar parte del EM de una BP negativa y analizar la evidencia actual de su asociacion con el riesgo de deteccion de CP en BP sucesivas. Adquisicion de la evidencia Dos revisores independientes realizaron una busqueda bibliografica en Medline, Embase y Central Cochrane, con los terminos de busqueda: small acinar proliferation or ASAP or prostatic intraepithelial neoplasia or HGPIN or adjacent small atypical glands or pinatyp or atrophy or proliferative inflammatory atrophy or pia or prostatic inflammation or prostatitis and prostate cancer. Se identificaron 1.015 referencias y siguiendo los principios de la declaracion PRISMA y de seleccion PICO, se identificaron 57 articulos originales validos para esta revision. Sintesis de la evidencia La proliferacion acinar atipica de celula pequena se asocia a una tasa de deteccion de CP en BP sucesivas que oscila entre el 32 y 48%. La neoplasia intraepitelial prostatica de alto grado (HGPIN) se asocia a CP entre el 13 y 42%, siendo su multifocalidad la que define el incremento en el riesgo de deteccion. La atrofia prostatica, la atrofia proliferativa inflamatoria y la infamacion prostatica parecen tener un efecto protector sobre la deteccion de CP en BP sucesivas. Por otra parte, el riesgo de deteccion de CP en varones con HGPIN multifocal se reduce significativamente si coexiste atrofia proliferativa inflamatoria. Conclusiones El EM de una BP negativa puede estar compuesto por las lesiones de proliferacion acinar atipica de celula pequena, HGPIN, atrofia prostatica, atrofia proliferativa inflamatoria e infamacion prostatica ya que todas parecen estar asociadas al riesgo de deteccion de CP en BP sucesivas. Esta revision nos permite generar la hipotesis de que el EM de una BP negativa puede ser de utilidad en la decision indicar BP de repeticion.

Introduction In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyze the current evidence of their association with the risk of detecting PC in subsequent PBs. Evidence acquisition Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. Evidence synthesis Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13–42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. Conclusions The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB.

Context and objective There have been significant advances in the knowledge of renal carcinogenesis in the last years. Nowadays, renal tumours 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 analyze 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 analyzed 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.

Resumen Introduccion y objetivos La incontinencia urinaria es una de las principales complicaciones tras la prostatectomia radical. El objetivo del estudio fue describir las caracteristicas anatomicas, evaluadas preoperatoriamente mediante resonancia magnetica, que permitan predecir la recuperacion precoz de la continencia urinaria tras la prostatectomia radical asistida por robot. Material y metodos Se analizo prospectivamente a 72 pacientes tratados mediante prostatectomia radical asistida por robot. Los resultados funcionales se evaluaron mediante los cuestionarios EPIC (1, 6 y 12 meses) y la fecha de primera continencia autoinformada. La longitud de la uretra membranosa (LUM) y el angulo entre la LUM y el eje prostatico (aLUMP) fueron evaluados preoperatoriamente en imagenes sagitales ponderadas en T2. Resultados La tasa de continencia fue del 67,2, el 92,6 y el 95,2% a 1, 6 y 12 meses, respectivamente. Los pacientes con valores de aLUMP inferiores alcanzaron continencia urinaria temprana: al mes, los continentes habian tenido una aLUMP media de 107,21° (IC del 95% 90,3-124,6), mientras que entre los que presentaban incontinencia era de 118,5° (IC del 95% 117,7-134); p = 0,014. Hemos encontrado diferencias en el aLUMP entre los grupos segun la continencia a los 6 meses: angulo en continentes de 114,24° (IC del 95% 104,6-123,9), mientras que en los incontinentes habia sido 142° (IC del 95% 126,5-157,6), p = 0,015. A los 12 meses, los continentes tenian una LUM preoperatoria significativamente superior a los incontinentes. En el analisis multivariante solamente el aLUMP fue un predictor independiente de continencia urinaria a los 6 meses OR 0,007 (IC del 95% 0,002-0,012), p = 0,012. Conclusiones La evaluacion de parametros anatomicos preoperatorios previos a la cirugia puede ayudar a definir que pacientes recuperaran la continencia urinaria precozmente, auxiliando a la toma de decisiones terapeuticas.

Resumen Contexto y objetivo En los ultimos anos se han producido avances significativos en el conocimiento de la carcinogenesis renal. Hoy en dia los tumores renales se clasifican en funcion de su perfil genetico, y ademas se han desarrollado tratamientos especificos basados en la identificacion de dianas terapeuticas. Sin embargo, todavia no se han identificado marcadores pronosticos. El objetivo de esta revision es analizar la literatura que ha evaluado la expresion de la proteina STAT3 como marcador molecular en el carcinoma renal de celula clara (ccRCC). Adquisicion de evidencia En enero de 2018 se realizo una busqueda sistematica de la literatura en Pubmed, Cochrane Library y Sciencedirect de las publicaciones realizadas desde 1990. Los terminos de busqueda fueron renal cell carcinoma and STAT3 or STAT-3 and prognostic factor. Se siguieron los principios de la declaracion PRISMA y la estrategia de seleccion PICO, seleccionandose los articulos originales con series de pacientes diagnosticados de ccRCC localizado o metastasico, donde se analiza la actividad de STAT3 como marcador pronostico. Se identificaron 132 publicaciones de las que finalmente se han revisado 10 por cumplir los criterios de inclusion. Sintesis de evidencia La activacion (fosforilacion) de STAT3 (pSTAT3) en el residuo Ser727 es importante en el desarrollo y progresion de ccRCC. La expresion de pSTAT3 parece ser un marcador pronostico y predictor de resistencia a algunos tratamientos en pacientes con enfermedad diseminada. Existe poca evidencia de su utilidad como un marcador pronostico en pacientes con enfermedad localizada. Conclusiones La expresion de pSTAT3(Ser727) en el nucleo de las celulas del ccRCC puede ser un marcador pronostico y de respuesta al tratamiento en pacientes con ccRCC. La evidencia cientifica actual es limitada y son necesarios mas estudios que demuestren su utilidad.

INTRODUCTION AND OBJECTIVE:Posterior rhabdosphincter reconstruction (PRRS) following radical prostatectomy was designed to improve early urinary continence. We executed a randomized clinical trial ...

Resumen Introduccion El objetivo del presente estudio ha sido analizar y evaluar la experiencia en ablacion por radiofrecuencia de masas renales pequenas mediante abordaje percutaneo guiado por ecografia con contraste en pacientes no aptos para la reseccion quirurgica, y/o que no aceptaron vigilancia u observacion. Material y metodo Desde enero de 2007 hasta agosto de 2015 se han realizado 164 tratamientos en un total de 148 pacientes. Se presentan las caracteristicas clinico-radiologicas de los pacientes, los resultados oncologicos y funcionales a corto y medio plazo. Resultados La tasa de exito tecnico global fue del 97,5%, con exito final en una sesion en el 100% de lesiones ≤ 3 cm y el 92% en lesiones entre 3-5 cm. El diametro medio de los tumores en los que el tratamiento fue finalmente exitoso fue de 2,7 cm, mientras que el diametro medio de estos fallos fue de 3,9 cm (p Conclusiones A pesar de la baja tasa de biopsia renal positiva en la serie, la aplicacion de radiofrecuencia percutanea ecoguiada en el tratamiento de lesiones renales pequenas parece un procedimiento eficaz y seguro, con un minimo impacto sobre la funcion renal, un aceptable control oncologico a corto y medio plazo, con una baja tasa de complicaciones.

Introduction The objective of this study was to analyze and assess the experience with radiofrequency ablation of small renal masses using a contrast-enhanced, ultrasound-guided percutaneous approach for patients who are not suitable for surgical resection and/or who refused surveillance or observation. Material and method From January 2007 to August 2015, 164 treatments were performed on a total of 148 patients. We present the patients’ clinical-radiological characteristics, oncological and functional results in the short and medium term. Results The overall technical success rate was 97.5%, with a successful outcome in 1 session in 100% of the lesions ≤3 cm and 92% in lesions measuring 3–5 cm. The mean tumor diameter in the patients for whom the treatment was ultimately successful was 2.7 cm, while the mean diameter of these in the unsuccessful operations was 3.9 cm (p Conclusions Despite the low rate of positive renal biopsies in the series, ultrasound-guided percutaneous radiofrequency ablation for treating small renal lesions appears to be an effective and safe procedure with a minimum impact on renal function, an acceptable oncologic control in the short and medium term and a low rate of complications.

Resumen Contexto y objetivo La evolucion natural del carcinoma renal es heterogenea, encontrando diversos escenarios en cuanto a la presentacion clinica, evolucion y tipo de recidiva (local/metastasica). El objetivo de esta publicacion es revisar la literatura existente con relacion a los principales factores pronosticos del carcinoma renal. Adquisicion de evidencia Se realiza una revision sistematica mediante Pubmed de los articulos publicados, de acuerdo con los principios de la declaracion PRISMA, desde 1999 (primera publicacion de la clasificacion de Motzer) hasta 2015. Los terminos utilizados en la busqueda han sido «kidney neoplasms», «kidney cancer», «renal cell carcinoma», «prognostic factors», «mortality», «survival» y «disease progression». Sintesis de evidencia El mejor conocimiento de las vias moleculares implicadas en la oncogenesis renal junto con la aparicion de tratamientos dirigidos con nuevas moleculas estan provocando que los antiguos modelos pronosticos queden obsoletos, requiriendo de una revision continua para la actualizacion de los nomogramas disponibles adaptados a los nuevos escenarios. Conclusiones Es importante una correcta validacion externa de los factores pronosticos existentes mediante estudios prospectivos y multicentricos, para poder asi incorporarlos a la practica clinica habitual del urologo.

Purpose: It remains unclear whether patients with prostate cancer suspicion and negative magnetic resonance imaging (M.R.I.) can safely obviate biopsy. The purpose of this study was to assess the clinical negative predictive value (N.P.V.) of M.R.I. in excluding prostate cancer. The secondary end-point was to compare N.P.V. to detect significant prostate cancer of M.R.I.The secondary end-point was to compare N.P.V. to detect significant prostate cancer in M.R.I. classified as P.I.-R.A.D.S.1 and as P.I.-R.A.D.S.2 Methods: From December 2012 to January 2017, 1128 M.R.I.s were performed consecutively due to prostate cancer clinical suspicion. The absence of suspicious and presence of low-risk areas were considered as negative M.R.I., P.I.-R.A.D.S.1 and 2. Biopsy results were compared according to P.I.-R.A.D.S. classification. The clinically significant disease was defined as International Society of Urological Pathology group higher than 1. Results: Two hundred and twenty-two (20%) M.R.I.s didn’t highlight targetable imaging suspicious areas, which were recorded as negative tests: 130 (59%) P.I.-R.A.D.S.1 and 92 (41%) P.I.-R.A.D.S.2. Detection of clinically significant prostate cancer in at least one biopsy core was higher in the P.I.-R.A.D.S.2 group, 9% (8/92) vs 3% (4/130), p = 0.047. The N.P.V. in biopsy-naïve men and P.I.-R.A.D.S.1 was 95% for significant disease, while in patients subjected to repeated biopsies and P.I.-R.A.D.S.1, the N.P.V. found was 99%. Those rates differ from the P.I.-R.A.D.S.2 group: N.P.V. in biopsy-naïve patients was 84%, and 95% in repeated biopsy. Conclusions: P.I.-R.A.D.S.2 shouldn’t be considered as a negative M.R.I. A biopsy cannot be routinely omitted in biopsy-naïve men with clinical suspicion of cancer and a low-suspicious area in M.R.I., giving the possibility of missing clinically significant tumors.

Resumen Objetivos Determinar la influencia de la prostatectomia radical (PR) y de la radioterapia externa (RT) sobre el eje hipotalamo-hipofisario de 120 pacientes con cancer de prostata clinicamente localizado tratados con PR o RT exclusiva. Material y metodos Estudiamos 120 pacientes con cancer de prostata localizado. Noventa y dos pacientes recibieron PR y 28 RT exclusiva. Medimos los niveles sericos de hormona luteinizante, hormona foliculo estimulante (FSH), testosterona total (T), testosterona libre y estradiol basalmente y a los 3 y 12 meses tras completar el tratamiento. Resultados Los pacientes sometidos a PR eran mas jovenes y presentaban mayor volumen prostatico (64,3 vs. 71,1 anos, p Conclusiones El tratamiento del cancer de prostata influye en el eje hipotalamo-hipofisario. La influencia parece mas importante en los pacientes tratados con RT. Necesitamos mas estudios que eluciden el papel que la prostata puede jugar como organo endocrino.

Resumen Introduccion Las nuevas generaciones de marcadores tumorales para diagnosticar precozmente el cancer de prostata (CaP) deberian ser capaces de discriminar entre pacientes portadores de tumores agresivos y aquellos sin cancer, o con tumores de baja agresividad. El objetivo de este estudio ha sido validar en una institucion academica el indice de salud prostatica (PHI) como marcador de tumores agresivos de prostata. Metodos Se determino PHI en 357 varones sometidos a biopsia prostatica entre junio de 2013 y julio de 2014. Posteriormente, un subgrupo de 183 hombres menores de 75 anos, con PSA entre 3,0 y 10,0 ng/ml y programados para su primera biopsia fue seleccionado para este estudio. En todos ellos se llevo a cabo una biopsia prostatica transrectal, guiada por ultrasonidos y bajo anestesia local, que obtuvo 12 cilindros de la zona periferica. En todos los casos se determino antes del procedimiento: PSA total (tPSA), PSA libre (fPSA), [-2] proPSA (p2PSA) y volumen prostatico. Se calculo el porcentaje de fPSA (%fPSA), densidad de PSA (PSAd) y PHI. Se consideraron tumores agresivos aquellos que tuvieron algun patron 4 en la biopsia. Se comparo PHI con %fPSA y PSAd a traves del analisis de curvas ROC. Se establecieron dinteles para detectar el 90% y el 95% de todos los tumores y el 95% y el 100% de los tumores agresivos, y se calcularon las tasas de biopsias evitadas con cada uno de ellos. Resultados La tasa global de deteccion de CaP fue del 37,2% y la de tumores agresivos del 24,6%. El area bajo la curva (AUC) de PHI para detectar cualquier tipo de tumor fue superior a la de %fPSA y PSAd (0,749 vs 0,606 y 0,668 respectivamente). De forma similar, cuando se consideraron solo los tumores agresivos las AUC fueron respectivamente 0,786 vs 0,677 y 0,708. La tasa de biopsias evitadas para detectar el 95% de los tumores agresivos fue del 20,2% para PHI, 14,8% para %fPSA y 23,5% para PSAd. Para detectar el 100% de tumores agresivos la tasa de biopsias evitadas cayo al 5,9% para PHI, 9,3% para %fPSA y 7,9% para PSAd. Conclusiones PHI parece un buen marcador para diagnosticar el CaP. Sin embargo, cuando el objetivo es detectar al menos el 95% de los tumores agresivos no parece ser mas eficaz que el %fPSA y la PSAd.

Introduction and aims Urinary incontinence is a common complication after radical prostatectomy. The aim of our study was to describe the preoperative anatomical features using magnetic resonance imaging in order to predict early continence recovery after robotic radical prostatectomy. Material and methods 72 patients who underwent robotic radical prostatectomy were prospectively analysed. EPIC questionnaire (1, 6 and 12 mo) and first self-reported continence were used to assess functional outcomes. Membranous urethral length (MUL) and MUL-prostate axis angle (aMULP) were assessed preoperatively on T2 weighted sagittal images. Results Continence rate was 67.2%, 92.6% and 95.2% at 1, 6 and 12 months, respectively. Early continence was achieved in patients with the lower aMULP. At 1 month, average aMULP in continent patients was 107.21° (CI 95% 90.3–124.6) vs. 118.5° (CI 95% 117.7–134) in incontinent ones (p = 0.014). At 6 month differences in aMULP among groups were found: 114.24° (CI 95% 104.6–123.9) in continents vs. 142° (CI 95% 126.5–157.6) in incontinents (p = 0.015). At 12 month, continent group showed a significantly higher preoperative aMULP. aMULP was revealed as the only independent predictor of urinary continence at 6 mo in multivariate analysis, OR 0.007 (CI 95% 0.002–0.012), p = 0.012. Conclusions Preoperative anatomical parameters assessment prior surgery can help to identified those patients will achieve early continence recovery and it supports therapeutic decisions making.

Background Proliferative inflammatory atrophy (PIA) has been involved in prostatic carcinogenesis. However, little is known about the clinical significance of a PIA finding in prostatic biopsies (PBs). The aim of this study is to determine the incidence of prostate inflammatory atrophy (PIA) in prostate biopsies (PBs), its association to high-grade prostatic intraepithelial neoplasia (HGPIN), prostate cancer (PCa), and tumor aggressiveness. Methods Prospective and observational study of PIA lesion in 528 extended PBs and 200 radical prostatectomy specimens (RPS). Outcome measurements: PIA, HGPIN, PCa incidence, Gleason score, clinical and pathologic tumor stage and insignificant tumor rate. Univariate and multivariate analysis. Results Overall incidence of PIA and HGPIN was 30.3% and 54%. In RPS, the incidence was 30.5% and 72%, respectively. No significant association was found between PIA and HGPIN. Overall PCa detection rate in PBs was 38.1%. PCa was found in 27.5% PBs with PIA and 42.7% of those without PIA, P

To evaluate the effects of holmium laser enucleation of the prostate (HoLEP) on sexual function.A retrospective analysis of 202 sexually active patients who underwent HoLEP was performed. Patients were assessed at baseline and 3 and 12 months post-HoLEP. Evaluations included uroflowmetry and symptom questionnaires (five-item version of the International Index of Erectile Function [IIEF-5], ICIQ-male sexual matters associated with LUTS [ICIQ-MLUTSsex], American Urological Association symptom score [AUA-SS], and single-question quality of life [QoL] score). Nonparametric, Fisher's exact, and chi-squared tests were used to assess changes from baseline and to identify risk factors, if any, associated with deterioration of sexual function after surgery.No significant differences were found between the preoperative and postoperative scores on the questionnaires that evaluated erection quality. However, 6.9% and 12.4% of the patients reported an increase or a reduction, respectively, of greater than five points in total IIEF-5 score. The reduction in IIEF-5 score was statistically significant only in the subgroup of patients without preoperative erectile dysfunction (ED). No preoperative characteristics and no parameters related to the surgery or postoperative outcome were significantly associated with the impairment of erection quality after surgery. In fact, neither capsular perforation nor the total laser energy used during the procedure affected erections. Loss of antegrade ejaculation was found in 70.3% of patients, while 21% reported a reduction in semen quantity. However, concern regarding ED or ejaculatory dysfunctions decreased with surgery.Although erectile function was not altered in the vast majority of patients after HoLEP, patients without preoperative ED displayed a relatively small, but still significant, negative effect on erections. The overwhelming majority of patients suffered from retrograde ejaculation after surgery.

To evaluate the efficacy and efficiency of systematic prostatic biopsy (SPB) and cognitive fusion PB (CFPB) to diagnose prostate cancer (PCa) and significant PCa (SPCa), and to analyse if CFPB could safely replace SPB.A cohort of 314 consecutive men having PI-RADS ≥2 in a pre-biopsy 3T mp-MRI were prospectively subjected to trans-rectal ultrasound CFPB (two cores per suspicious area until a maximum of three areas) and a 12 peripheral core SPB. SPCa was considered when the WHO grade was higher than 2 (Gleason 4+3 or higher).PCa was diagnosed in 133 patients (42.4%), being 83 (62.4%) SPCa. SPB detected PCa in 114 men (85.7%) while CFPB in 103 (77.4%), P.001. SPB detected SPCa in 64 men (77.1%) while CFPB in 71 (85.5%), P.001. In 52 of the 81 men (64.2%) SPCa was detected in SPB and CFPB. In 19 men SPCa was only detected in CFPB (23.5%) while in 10, it was only detected in SPB (12.3%). 33.1 cores were needed to diagnose one PCa in SPB while 8.5 in CFPB, P.001. 58.9 cores were needed to diagnose one SPCa in SPB, while 12.4 in CFPB, P.001.CFPB are more effective and also more efficient than SPBs in detecting SPCa. However, CFPBs still can't safely replace SPBs because they are not able to detect up to 15% of SPCa.

Serum testosterone measurement is recommended to assess the efficacy of androgen deprivation therapy (ADT) and to diagnose castration resistance in patients with prostate cancer (PCa). Currently, the accepted castrate level of serum testosterone is 50 ng/dL. Liquid chromatography and tandem mass spectrometry (LC MSMS) is the appropriate method to measure testosterone, especially at low levels. However, worldwide, chemiluminescent assays (CLIAs) are used in clinical laboratories, despite their lack of accuracy and reproducibility, because they are automatable, fast, sensitive, and inexpensive.We compared serum testosterone levels measured using LC MSMS and CLIAs in 126 patients with PCa undergoing luteinizing hormone-releasing hormone (LHRH) agonist therapy.The median serum testosterone level was 14.0 ng/dL (range, 2.0-67.0 ng/dL) with LC MSMS and 31.9 ng/dL (range, 10.0-91.6 ng/dL) with CLIA (P .001). The serum testosterone levels, measured using LC MSMS, were 20 ng/dL in 83 patients (65.9%), 20 to 50 ng/dL in 40 (31.7%), and50 ng/dL in 3 patients (2.4%). These ranges were found in 34 (27%), 72 (57.1%), and 20 (15.9%) patients when testosterone was measured using CLIA (P .001). The castrate level of serum testosterone using LC MSMS and CLIA was 39.8 ng/dL (95% confidence interval [CI], 37.1-43.4 ng/dL) and 66.5 ng/dL (95% CI, 62.3-71.2 ng/dL), respectively.We found that CLIA overestimated the testosterone levels in PCa patients undergoing LHRH agonist therapy. Thus, the castration level was incorrectly considered inadequate with CLIA in almost 15% of patients. The true castration level of serum testosterone using an appropriate method is 50 ng/dL.

Objective To analyze and evaluate our experience in surgical treatment with the open approach of the complex ureteral stenosis after adult kidney transplantation in a tertiary level hospital in the last seven years. We have reviewed the different surgical options used. Patients and methods A total of 589 consecutive adult renal transplants were performed from January 2005 to December 2012. Of these, 1.1% showed some degree of symptomatic obstructive uropathy which after initial urinary diversion required open surgical approach using the ipsilateral or contralateral native urinary tract. Characteristics of the patient, clinical examinations performed and surgical technique performed as well as their results are presented. Results During the period under review, in 5 men and 2 women who had ureteral stenoses after renal transplant, 7 reparative surgeries were performed by open ureteropyelostomy, using ipsilateral native ureter in 6 cases and contralateral ureter in the remaining case. In one case, uretero-calicial anastomosis was performed due to severe pyelic shrinkage. There were no significant complications. Native kidney nephrectomy was not required for further complications. All the patients operated on had optimum plasma creatinine levels with resolution of previous dilatation. Conclusions The initial percutaneous nephrostomy followed by open surgical repair using native ureter represents a definitive, valid and optimal alternative in terms of safety and preservation of renal function.

Resumen Objetivo Analizar y evaluar nuestra experiencia en el tratamiento quirurgico mediante abordaje abierto de las estenosis ureterales complejas postrasplante renal de adulto en un centro de tercer nivel en los ultimos 7 anos. Se revisan las diferentes alternativas quirurgicas utilizadas. Pacientes y metodos Desde enero de 2005 hasta diciembre de 2012 se han realizado un total de 589 trasplantes renales de adulto consecutivos. Un 1,1% del total presentaron algun grado de uropatia obstructiva sintomatica que, tras derivacion urinaria inicial, requirieron de abordaje quirurgico abierto utilizando la via urinaria nativa ipsilateral o contralateral. Se presentan las caracteristicas de los pacientes, clinica, exploraciones realizadas asi como tecnica quirurgica llevada a cabo y sus resultados. Resultados Durante el periodo evaluado se llevaron a cabo un total de 7 cirugias reparativas en 5 varones y 2 mujeres que presentaban estenosis ureterales postrasplante renal mediante ureteropielostomia abierta utilizando ureter nativo ipsilateral en 6 casos y contralateral en el restante. En un caso de realizo anastomosis ureterocalicilar por retraccion pielica extrema. No ha habido complicaciones relevantes ni se ha requerido de nefrectomia de rinon nativo por complicacion posterior. La totalidad de los pacientes intervenidos presentaron cifras de creatinina plasmatica optimas con resolucion de la dilatacion previa. Conclusiones La nefrostomia percutanea inicial seguida de la correccion quirurgica abierta mediante la utilizacion de ureter nativo representa una alternativa definitiva, valida y optima en terminos de seguridad y preservacion de la funcion renal.

Objectives Cardiovascular mortality is the leading cause of death in patients with prostate cancer (PC), metabolic syndrome (MS) being related to it. The main objective of this study was to determine the prevalence of MS in patients with CP undergoing androgen suppression (AS). Materials and methods We performed a retrospective study of cases and controls that included 159 patients. The study group was made up of 53 patients with PC undergoing SA for a period exceeding 12 months. The control group had 53 patients with PC at the time of diagnosis and 53 patients with negative prostate biopsy. All the patients were evaluated for presence of MS according to NCEP-ATPIII criteria. Results Prevalence of MS in patients without PC was 32.1% and in those with non-treated PC 35.8%, P = .324. In patients with PC undergoing AS, prevalence of MS was 50.9%, P

Resumen Objetivos La mortalidad cardiovascular es la primera causa de muerte en pacientes con cancer de prostata (CP) y el sindrome metabolico (SM) esta relacionado con ella. El objetivo principal de este estudio fue conocer la prevalencia del SM en pacientes con CP sometidos a supresion androgenica (SA). Material y metodos Se realizo un estudio retrospectivo de casos y controles que incluyo 159 pacientes. Cincuenta y tres pacientes con CP sometidos a SA durante un periodo superior a 12 meses formaron el grupo de casos; 53 pacientes con CP en el momento de su diagnostico y 53 pacientes con biopsia prostatica negativa formaron el grupo control. En todos los pacientes se evaluo la existencia de SM segun los criterios del NCEP-ATPIII. Resultados La prevalencia de SM en pacientes sin CP fue del 32,1% y en pacientes con CP no tratados fue del 35,8%; p = 0,324. En pacientes con CP sometidos a SA la prevalencia de SM fue del 50,9%; p 102 cm) y la hiperglucemia (> 110 mg/dl) fueron los 2 componentes del SM que se incrementaron significativamente. La SA y su duracion fueron factores predictores independientes del desarrollo de SM. Conclusiones La SA continuada incrementa la prevalencia de SM y especialmente el perimetro abdominal y la hiperglucemia. Su desarrollo aumenta con la duracion de la SA.

Resumen Introduccion La neoplasia intraepitelial prostatica de alto grado (HGPIN) es considerada una entidad precursora del cancer de prostata (CP). La prediccion de su coexistencia con CP ha variado a lo largo del tiempo y hoy en dia estan poco definidas las recomendaciones para el urologo en su practica clinica. Puesto que la HGPIN es un hallazgo frecuente en la biopsia prostatica y actualmente no existe una actitud clinica consensuada, es recomendable un esfuerzo en la comprension de su significado clinico. Objetivo Sintetizar las principales caracteristicas de la HGPIN y evaluar su relacion con el CP. Justificar las variaciones de su incidencia y analizar el significado clinico actual de su deteccion en la biopsia prostatica. Material y metodos Revision de la literatura basada en la busqueda y analisis de las publicaciones halladas en PubMed con las palabras «prostate» e «intraepithelial neoplasms». Resultados La tasa de deteccion de HGPIN se ha incrementado en la medida en que se ha aumentado el numero de punciones realizadas en la biopsia prostatica. Con los esquemas de biopsia actuales (10-12 punciones), la tasa de deteccion de CP en biopsias de repeticion es similar en pacientes con y sin HGPIN aislada. Sin embargo, la multifocalidad de la HGPIN predice un mayor riesgo de deteccion de CP en la biopsia de repeticion. Conclusion La deteccion de HGPIN es frecuente con los esquemas actuales de biopsia. Su relacion genetica con el CP es clara y su multifocalidad es el factor predictor de CP mas importante.

Objetivo Analizar la influencia del sedentarismo (SE) y sobrepeso (SP) en el riesgo de deteccion de cancer de prostata (CP) y su agresividad. Material y metodo Se realizo biopsia prostatica (BP) a 2.408 varones consecutivos, no tratados con 5 ARI, a causa de elevacion serica del PSA por encima de 4,0 ng/ml (91%) o tacto rectal sospechoso (9%). En la BP, transrectal y ecodirigida, se obtuvieron 10 cilindros, y entre 2 y 8 adicionales en funcion de la edad y del volumen prostatico. La actividad fisica se evaluo mediante una encuesta (SE vs no SE) y se calculo el indice de masa corporal (normal vs SP: > 25 kg/cm2). La agresividad tumoral se evaluo segun la suma de Gleason (alto grado [AG]: Gleason > 7) y el riesgo de D?Amico (alto riesgo [AR]: T > 3a o PSA > 20 o suma de Gleason > 7). Resultados Se hallo una asociacion significativa entre SE (52,5%) y SP (72,9%), p > 0,001. La tasa global de deteccion de CP fue 35,2%. En varones con SE fue 36,7% y en no SE 33,6%, p = 0,048. La tasa global de tumores de AG fue 28,3%, 29,2% en varones con SE y 27,1% en no SE, p = 0,261. La tasa global de tumores de AR fue 35%, 39,7% en varones con SE y 29,4% en no SE, p < 0,001. Se detecto CP en un 38,1% de hombres con IMC normal y 34,3% en hombres con SP, p = 0,065. La tasa de tumores de AG fue 18,1 y 31,4% respectivamente, p < 0,001, y la tasa de tumores de AR fue 22,6 y 39,2% respectivamente, p < 0,001. La regresion logistica binaria mostro que el SE fue un predictor independiente de CP, RR 0,791 (95% IC: 0,625-0,989), p = 0,030. SE y SP fueron predictores independientes de AG: RR 0,517 (95% IC: 0,356-0,752), p = 0,001, y RR 1,635 (95% IC 1,070-2,497), p = 0,023. SE y SP tambien fueron predictores independientes de AR: RR 0,519 (95% IC: 0,349-0,771), p = 0,001, y RR 1,998 (95% IC: 1,281-3,115), p = 0,002. Conclusiones En varones que cumplen criterios de biopsia prostatica se encontro una asociacion entre sedentarismo y sobrepeso. El sedentarismo se asocio a mayor riesgo de deteccion de CP, mientras sedentarismo y sobrepeso incrementaron el riesgo de deteccion de tumores mas agresivos.

Introduction High grade prostatic intraepithelial neoplasia (HGPIN) is regarded as a precursor of prostate cancer (PC). However, its relationship to cancer has changed throughout the literature, being currently poorly defined and remains controversial for urologists in their clinical practice. Because of his frequency and the impact on patient outcomes that the lack of consensus clinical attitude could carry out, it seems advisable to review the understanding of this disease. Objective The aim of this literature review is to summarize the main features of this entity (histopathology, molecular, epidemiological) and evaluate their relationship with prostate adenocarcinoma, explaining the variation of incidence seen in the literature and the clinical significance of their finding. Material and Methods Review of the literature, based on the research and analysis of publications found in Pubmed with the words “prostate” and “intraepithelial neoplasms”. Results The HGPIN detection rate has increased to the extent that it has increased the number of punctures in prostate biopsies. With the current biopsy schemes (10–12 punctures), the detection rate of PC in repeat biopsies is similar in patients with and without isolated HGPIN. However, HGPIN multifocality predicts increased risk of PC detection in repeat biopsy. Conclusion HGPIN detection is common with current biopsy schemes. Its genetic relationship with PC is clear and its multifocality is the most important predictor factor of PC.

Resumen Introduccion La atrofia proliferativa inflamatoria (PIA) es una lesion frecuentemente observada en biopsias prostaticas, y algunos autores han postulado su implicacion en la carcinogenesis prostatica. Sin embargo, en la actualidad no se conocen bien los mecanismos que permitirian su transformacion neoplasica ni el significado clinico de su hallazgo en una biopsia prostatica. Objetivo Analizar las caracteristicas de la lesion de PIA, su posible papel en la carcinogenesis prostatica y su relacion con la agresividad tumoral. Material y metodo Se realiza una revision sistematica de la literatura en PubMed con los terminos proliferative inflammatory atrophy o PIA y prostate. Se resumen los hallazgos mas relevantes de acuerdo a los objetivos del estudio. Resultados La PIA parece estar implicada en la carcinogenesis prostatica. Esta hipotesis se sustenta en su asociacion frecuente con lesiones de cancer (CaP) y en algunas alteraciones geneticas que le son comunes a la neoplasia intraepitelial de alto grado (HGPIN) y al CaP, fundamentalmente deficit en la expresion de GSTP1 y sobreexpresion de AGR2. Actualmente no existen estudios epidemiologicos que evaluen la incidencia de PIA ni su asociacion con HGPIN y CaP. Un solo estudio, realizado por nuestro grupo, ha determinado la incidencia global de PIA en el 30% de las biopsias prostaticas, una menor asociacion a CaP que la lesion de HGPIN y una asociacion entre PIA y tumores de menor grado e insignificantes. Conclusiones La PIA comparte alteraciones geneticas con el HGPIN y el CaP. Actualmente no existe evidencia epidemiologica para considerar que la PIA se asocia a mayor incidencia de CaP y los datos geneticos y epidemiologicos disponibles sugieren asociacion con tumores poco agresivos.

The aim of this study was to evaluate hormonal recovery after cessation of androgen deprivation therapy (ADT) in a group of elderly prostate cancer patients.Forty patients with locally advanced or metastatic prostate cancer, with a mean age of 71.5 years [95% confidence interval (CI) 69.1-73.9], were treated with ADT for a mean duration of 74.6 months (95% CI 59.7-89.5 months). Mean follow-up time after ADT cessation was 36.5 months (95% CI 30.6-42.3 months). Serum testosterone and luteinizing hormone (LH) were determined at 6 month intervals after ADT cessation.After 18 months of follow-up, all patients had recovered normal LH levels, while 38% of patients still presented castration levels of testosterone ( 50 ng/dl). A multivariate analysis was performed to find factors related to testosterone recovery (testosterone50 ng/dl). Neither age at start of ADT nor clinical stage reached statistical significance. Only time under ADT was correlated with testosterone recovery (p = .031). Kaplan-Meier curves were obtained. Mean time for testosterone recovery was 14.5 months (95% CI 6.5-22.6 months) in patients treated with ADT for less than 60 months compared to 29.3 months (95% CI 19.6-39.1 months) in patients treated with ADT for more than 60 months (log-rank p = .029).Age did not correlate with testosterone recovery in a group of elderly prostate cancer patients in whom ADT was stopped. Testosterone recovery after ADT cessation was significantly correlated with time under ADT treatment. Significant implications related to economic aspects of the dosage schedule may be considered.

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

To determine the influence of radical prostatectomy (RP) and external beam radiation therapy (EBRT) on the hypothalamic pituitary axis of 120 men with clinically localized prostate cancer treated with RP or EBRT exclusively.120 patients with localized prostate cancer were enrolled. Ninety two patients underwent RP and 28 patients EBRT exclusively. We measured serum levels of luteinizing hormone, follicle stimulating hormone (FSH), total testosterone (T), free testosterone, and estradiol at baseline and at 3 and 12 months after treatment completion.Patients undergoing RP were younger and presented a higher prostate volume (64.3 vs. 71.1 years, p0.0001 and 55.1 vs. 36.5 g, p0.0001; respectively). No differences regarding serum hormonal levels were found at baseline. Luteinizing hormone and FSH levels were significantly higher in those patients treated with EBRT at three months (luteinizing hormone 8,54 vs. 4,76 U/l, FSH 22,96 vs. 8,18 U/l, p0,0001) while T and free testosterone levels were significantly lower (T 360,3 vs. 414,83ng/dl, p 0,039; free testosterone 5,94 vs. 7,5pg/ml, p 0,018). At 12 months FSH levels remained significantly higher in patients treated with EBRT compared to patients treated with RP (21,01 vs. 8,51 U/l, p0,001) while T levels remained significantly lower (339,89 vs. 402,39ng/dl, p 0,03).Prostate cancer treatment influences the hypothalamic pituitary axis. This influence seems to be more important when patients with prostate cancer are treated with EBRT rather than RP. More studies are needed to elucidate the role that prostate may play as an endocrine organ.

What's known on the subject? and What does the study add? Metabolic syndrome can identify patients at high risk of cardiovascular disease. The prevalence of metabolic syndrome is increasing worldwide and is associated with increased age, obesity and hypogonadism. The association between metabolic syndrome and prostate cancer development has not been studied comprehensively, and published studies report divergent results. This study indicates that tumours detected in men with metabolic syndrome are more aggressive than those detected in men without this condition. Objective To further examine the association between metabolic syndrome (MS), prostate cancer (PC) detection risk and tumour aggressiveness. Patients and Methods From 2006 to 2010, 2408 men not receiving 5α-reductase inhibitors were scheduled for prostatic biopsy due to PSA above 4 ng/mL and/or abnormal digital rectal examination. MS was evaluated according to the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III definition. Tumour aggressiveness was evaluated through biopsy Gleason score, clinical stage and risk of biochemical recurrence after primary treatment. Results The rates of PC detection were 34.5% and 36.4% respectively in men with and without MS, P = 0.185. High grade PC rates (Gleason score 8–10) were 35.9% and 23.9% respectively, P < 0.001. The advanced disease rates (cT3–4 N0–1 M0–1) were 17% and 12.7% respectively, P = 0.841. The high risk PC rates (cT2c–4 or Gleason score 8–10 or PSA > 20) were 38.5% and 33.0% respectively, P = 0.581. Multivariate analysis confirmed that MS was not associated with the risk of PC detection but it was associated with an increased risk of high grade tumours (odds ratio 1.75, 95% CI 1.26–2.41), P < 0.001. Conclusion MS seems not be associated with an increased risk of PC detection but it is associated with an increased risk of more aggressive tumours.

Dhat syndrome (DS) consists of vague somatic symptoms and at times sexual dysfunction which the patient falsely attributes to involuntary emissions of semen outside of sexual relations. Describe and analyse the occurrences of DS in patients attending the clinic and clarify the existence of this condition within the Spanish Urological service. Patients reporting semen loss in urine or involuntarily outside of sexual relations were studied during a period from May 2006 to December 2007. Variables of age, nationality, marital status, family situation, medical history, reasons for the consultation, physical condition and additional tests were studied. All treatments and its effectiveness were also recorded. DS affected predominantly southern Asian continent citizens (n = 32). The average age was 35.44. Seventeen patients reported semen loss during urination; 20 at the end of urination; 11 spontaneously; 5 while sleeping; 4 during defecation; 1 while showering; 1 while eating meat; and 3 produced by noticing stained clothing. In 28 cases, the supposed loss of semen was linked to sex-related symptoms. All examinations and tests ruled out the existence of actual loss of semen. In urology consultations, we have been witnessing the unusual appearance of DS, a condition known by psychologists and psychiatrists and practically unheard of by urologists. A previously unknown condition in Spain, immigration from Asia, is causing the appearance of this syndrome. Its rapid identification will prevent patients from paying costly and unnecessary tests and provide alternative therapies, within a multidisciplinary approach involving psychologists and psychiatrists.

Resumen Objetivo Analizar los cambios observados en el perfil lipidico y el riesgo aterogenico en pacientes con cancer de prostata sometidos a supresion androgenica. Material y metodos Los niveles sericos de lipoproteinas (colesterol total, colesterol HDL, colesterol LDL y trigliceridos) fueron determinados en 636 pacientes entre 2001 y 2008. De estos,120 fueron tratados con bloqueo androgenico maximo y 177 fueron tratados unicamente con analogo de LHRH. El grupo control estaba formado por 339 pacientes sometidos a biopsia prostatica (212 con cancer de prostata y 127 sin cancer de prostata). El riesgo aterogenico fue calculado segun la formula de Castelli (colesterol total/HDL). Resultados El riesgo aterogenico medio en el grupo control fue de 4,2 y de 4 en el grupo sometido a supresion androgenica (p > 0,05). El riesgo aterogenico medio en los pacientes sometidos a monoterapia con analogos de LHRH fue de 4,1, mientras que en los pacientes en tratamiento con bloqueo androgenico maximo fue de 3,9 (p = 0,02). No se observaron diferencias significativas del valor del riesgo aterogenico en funcion de la duracion del tratamiento. El analisis multivariante confirmo que la modalidad de tratamiento fue la unica variable significativa respecto al riesgo aterogenico. Conclusiones Este estudio demuestra que la supresion androgenica no incrementa el riesgo aterogenico en pacientes con cancer de prostata. Este riesgo tampoco se incrementa a lo largo del tratamiento. La asociacion de la bicalutamida al analogo de LHRH parece ejercer un efecto protector sobre el riesgo aterogenico.

Objective This study has aimed to analyze the changes observed in the lipid profile and atherogenic risk in prostate cancer patients subjected to androgen deprivation. Material and methods Between 2001 and 2008, serum lipoproteins (total cholesterol, HDL, LDL and triglycerides) were determined in 636 patients. Of these, 129 were treated with maximum androgen blockade and 177 patients were only treated with LHRH analogue. The control group was formed by 339 subjected to prostate biopsy (212 with prostate cancer and 127 without prostate cancer). The atherogenic risk was calculated using the Castelli formula (total cholesterol/HDL). Results Mean atherogenic risk was 4.2 in the control group and 4 in the group of patients subjected to androgenic deprivation, p > 0.05. The mean atherogenic risk in those subjected to monotherapy with LHRH analogues was 4.1 while it was 3.9 in patients subjected to maximal androgen blockade, p = 0.02. We did not find significant differences for atherogenic risk according to length of treatment, p > 0.05. The multivariate analysis confirmed that the treatment modality was the only significant variable influencing atherogenic risk. Conclusions This study demonstrates that continuous androgen deprivation does not increase atherogenic risk in patients with prostate cancer. This risk did not increase during the treatment either. The association of bicalutamide to the LHRH analogue seems to have a protective effect on atherogenic risk.

BACKGROUND: Non–muscle-invasive urothelial cell carcinoma (NMIUCC) has a high tendency to recur and affected patients must be monitored regularly using invasive cystoscopies. The aim of the current study was to compare a multicolor fluorescence in situ hybridization (FISH) assay (UroVysion) with routine follow-up (cystoscopy and cytology) in the monitoring of patients with a previous history of NMIUCC. METHODS: An unselected cohort of patients under surveillance for a previous history of NMIUCC was prospectively studied. A total of 248 examinations in 223 patients were analyzed. Each exploration was comprised of cytological and FISH microscopic examination of voided urine samples and cystoscopy. The sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for tumor recurrence of all 3 techniques were determined. RESULTS: The sensitivities of FISH and cystoscopy were not found to be significantly different (92.9% and 82.1%, respectively). The specificities of FISH and cystoscopy were 92.7% and 89.7%, respectively. The PPV and NPV of FISH were 53.5% and 97.2%, respectively, whereas those of cystoscopy were 63.4% and 98.9%, respectively. No significant differences were found between these 2 tests. In contrast, the sensitivity and specificity of cytology were 14.3% and 99.5%, respectively. CONCLUSIONS: Given the lack of statistically significant differences with regard to FISH and cystoscopy results, the authors propose that FISH could be a useful monitoring tool in the surveillance of patients with a previous history of NMIUCC. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society.

Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE To estimate the relative risk of developing a second primary neoplasm, in particular lung cancer, after having non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS Patients were included in the study if they had developed NMIBC between 1995 and 2003. All clinical data were extracted from the medical records of our institution’s database. The interval between neoplasms, smoking habits, histological subtypes and survival were also analysed. Patient follow-up was ≥5 years. RESULTS We found 231 patients with NMIBC, 39 of which had a second primary neoplasm: 10 lung cancer, one pancreas, one gastric, one pharynx, one liver, one parathyroid, one oesophageal, five basal cell carcinoma, three larynx, two colon, three rectal and 10 prostate. In patients with lung cancer, NMIBC was the first primary tumour. Overall, the median (range) interval between occurrence of NMIBC and lung cancer was 54.2 (8–168) months. For the relationship between the observed and expected cases of lung cancer, after normalizing our frequencies to the sex ratio and age of our group of patients, the risk of lung cancer was 10.27-fold higher in patients with NMIBC as compared with the general population of Catalonia (95% confidence interval 4.92–18.88). CONCLUSION We consider that an annual examination for the detection and prevention of lung cancer must be included in clinical guides for patients with NMIBC. This proposal is reinforced by the finding that death in our group of patients with both tumours was always derived from lung cancer and not from bladder cancer.

Resumen Objetivo El objetivo del presente estudio es describir los tipos de pacientes y patologias por los que son remitidos a la consulta de urologia desde las areas de atencion primaria. El area seleccionada para este trabajo es el barrio del Raval Sur, situado en una zona de la ciudad de Barcelona donde se concentra una gran cantidad de inmigrantes. Ello nos permitira conocer las necesidades sanitarias de este grupo de poblacion emergente que empieza a cobrar una gran importancia en numerosas ciudades espanolas, por lo menos en lo referente a la especialidad de urologia. Pacientes y metodos Se estudio, de forma prospectiva, a todos los pacientes que fueron visitados en la consulta de urologia del centro de especialidades del Raval Sur de Barcelona durante el ano 2007. La poblacion elegida fue toda la que acudio por primera vez a la consulta de urologia en dicho periodo. Resultados Se estudio a 247 pacientes, de los cuales 124 eran espanoles, 75 indostanies, 27 americanos, 11 africanos y 10 del resto de paises. La edad media ± desviacion estandar fue superior en los pacientes espanoles, con 57,86 ± 17,85 anos, frente a los 37,54 ± 11,07 anos en el resto de nacionalidades; en ambos grupos predomino el sexo masculino. Se observaron diferencias entre los distintos grupos de pacientes en la sintomatologia prostatica, que fue del 32,4% en los espanoles, el 7,95% de los indostanies, el 17,2% de los americanos y el 9,1% de los africanos. Igualmente, se observaron diferencias significativas en el aumento del antigeno prostatico especifico (PSA), con un 15,2% de los espanoles, y ningun caso del resto de grupos. La patologia funcional de la esfera sexual solo fue motivo de consulta en el grupo de los pacientes indostanies, con un 56,8%. La fimosis-vasectomia fue el motivo de consulta en el 9,8% de los espanoles, el 2,7% de los indostanies y el 25% de los americanos, y no fue requerida por ningun paciente de origen africano. En el caso del dolor lumbar, tambien se observaron diferencias, con un 0,7% de los espanoles, un 1,35% de los indostanies y un 18,2% de los africanos, y no fue la razon de la consulta en ningun paciente americano. La hematuria macroscopica se presento en el 5,1% de los espanoles, el 3,4% de los americanos, el 18,2% de los africanos y en ningun indostani. Conclusiones El motivo de consulta mas frecuente en el grupo de pacientes espanoles fue la sintomatologia debida a la hipertrofia prostatica; en el grupo de pacientes americanos, la demanda de intervencion por fimosis o la esterilizacion quirurgica, y los pacientes indostanies consultan preferentemente por patologia multiple de la esfera sexual, que alcanza el 56,8% en los pacientes de este grupo. No hay grandes diferencias en cuanto al numero de exploraciones complementarias o al numero de visitas que se necesitaron para el diagnostico entre las distintas nacionalidades. Uno de los problemas que mas se observa es la falta de asistencia a las citas en algunos pacientes, que es el doble en el grupo de pacientes extranjeros frente a los espanoles y superior en el grupo de los africanos e indostanies.

OBJECTIVE To evaluate changes in bone mass and fracture risk in patients with prostate cancer on androgen-deprivation therapy (ADT) and with a basal T-score of >−2.0, who were treated with an oral bisphosphonate, as such patients treated with ADT are at increased risk of bone loss and bone fracture. PATIENTS AND METHODS We selected 61 patients with prostate cancer treated with ADT; 31 were treated with oral alendronate 70 mg once-weekly and a control group of 30 were not. At baseline and 12 months we measured bone mineral density (BMD) of the lumbar spine, femoral neck and total hip by dual-energy X-ray absorptiometry. All patients had severe osteopenia or osteoporosis at baseline. The risk of femoral neck fracture was calculated at baseline and 12 months (Z-score 2.7). RESULTS Patients treated with alendronate had a significant increase in BMD at the lumbar spine and femoral neck after 1 year of follow-up, with mean (sd) values of 1.06 (0.26) vs 1.01 (0.21) g/cm2 at baseline (P

OBJECTIVES To analyze the self-learning curve of a single surgeon with holmium laser enucleation of the prostate and to evaluate the safety, effectiveness, and outcome of the procedure after 2 years of experience. METHODS The data from the first 125 patients who underwent holmium laser enucleation of the prostate were retrospectively analyzed. The patients were assessed preoperatively and at 1, 3, 12, and 24 months postoperatively. The patient evaluations included serum prostate-specific antigen measurement, peak urinary flow rate determination, postvoid residual volume measurement, and symptom scores. To assess the effect of the learning curve on the perioperative data and complications, the patients were divided into subgroups of 25 consecutive patients. RESULTS The mean patient age was 71.4 years. The average prostate volume was 75.8 mL, and the mean weight of the enucleated tissue was 46.7 g. The average operative time was 109.8 minutes. The operative times and enucleation and morcellation efficiency rates improved significantly during the learning process. The mean hemoglobin loss was 1.7 g/dL. The median catheter time and hospital stay was 44 and 30 hours, respectively. Compared with baseline, at 1 year postoperatively, the median postvoid residual urine volume had declined by 99 mL, the mean peak urinary flow rate had increased by 19 mL/s, and the mean American Urological Association symptom score had decreased by 16.5 points. All changes observed were significant and regardless of the prostate size. Persistent stress urinary incontinence (4.8%) occurred with the first enucleations of large-size prostates. Other complications included bladder neck contracture (4%) in small-size prostates and bulbar urethra stricture (1.6%). CONCLUSIONS Holmium laser enucleation of the prostate is a safe, reproducible and effective surgical modality. Case selection is necessary to avoid the morbidity associated with the first stages of the self-taught learning curve, mainly urinary incontinence.