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To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach, for performing lymph node dissection (LND) in penile cancer: the Pelvic and Inguinal Single Access (PISA) technique.10 patients with different penile squamous cell carcinoma stages (cN0 and ≥pT1G3 or cN1/cN2) were operated by means of the PISA technique, between 2015-2018. Intraoperative frozen section analysis was carried out routinely and if ≥2 inguinal nodes (pN2) or extracapsular nodal extension (pN3) are detected, ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions.30-day PCs, estimated blood loss (EBL), transfusion rate, operative time, time to drainage removal, and length of hospital stay (LOS). Medians and ranges of values for selected variables were reported as descriptive statistics.Inguinal LND was bilateral in all cases, and pelvic LND was required in 40%. Total operative time was 120-170 min and median EBL was 66 (30-100) cc. No blood transfusion was required. No intraoperative complications were noted, and postoperative complications rate was 40% (10% major complications-symptomatic inguinal lymphocele). Median LOS was 5.8 (3-10) days. Median time to inguinal drain removal was 4.7 days. Mean number of lymph nodes removed by inguinal LND: 10.25 (8-14). Limited volume retrospective experience from a referral center with short follow-up. Outcomes reported may not be reproducible by surgeons with less experience and skills.PISA is a novel, minimally invasive single-site surgical approach to one stage bilateral inguinal/pelvic LNDs for penile cancer showing a low rate of major complications.

Resumen Introduccion y objetivos Analizar la evolucion de la funcion renal tras nefrectomia parcial (NP) y radical (NR) laparoscopica e identificar factores predictores de deterioro de funcion renal. Material y metodo Estudio retrospectivo de pacientes birrenos con filtrado glomerular (FG) > 60 mL/min/1,73 m2 y tumor renal unico cT1 tratados en nuestro centro entre los anos 2005 y 2018. Resultados 372 pacientes cumplieron los criterios de inclusion para el estudio. 156 (41,9%) fueron tratados mediante NR y 216 (58,1%) mediante NP. Al alta hubo una diferencia de 26,75 mL/min/1,73 m2 de FG entre NR y NP. La edad > 60 anos, las complicaciones postoperatorias (OR 2,97, p = 0,005) y NR (OR 10,03, p = 0,0001) fueron factores predictores de FG 70 anos, diabetes mellitus (DM) (HR 2,12, p = 0,001), hipertension arterial (HTA) (HR 1,73, p = 0,01) y NR (HR 2,88, p = 0,0001) se comportaron como factores predictores independientes de FG 70 anos, DM (HR 1,99 IC 95% 1,04 a 3,83, p = 0,04) y NR (HR 5,88 IC 95% 2,57 a 13,45, p = 0,0001). Conclusiones La NR es un factor de riesgo a corto y largo plazo de ERC, aunque con baja probabilidad de ERC grave o IRT en pacientes con FG > 60 mL/min/1,73 m2 preoperatoria. La edad, DM e HTA contribuyen al empeoramiento de la funcion renal durante el seguimiento.

To analyze the evolution of kidney function after laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) and to identify predictive factors for deterioration in kidney function.Retrospective study of patients with two kidneys, glomerular filtration rate (GFR)60 mL/min/1.73 mA total of 372 patients met the inclusion criteria for the study; 156 (41.9%) were treated by RN and 216 (58.1%) by PN. There was a difference of 26.75 mL/min/1.73 mRN is a short- and long-term risk factor for CKD, although with a low probability of severe CKD or ESRD in patients with preoperative GFR60 mL/min/1.73 m

Resumen Introduccion y objetivos La embolizacion prequirurgica de la arteria renal (EPAR) puede emplearse en grandes masas renales antes de la nefrectomia para simplificar el procedimiento y disminuir el sangrado intraoperatorio. Nuestro objetivo es determinar el papel de la EPAR sobre el sangrado intraoperatorio y las complicaciones postoperatorias en los tumores renales izquierdos con trombo tumoral limitado a la vena renal izquierda (nivel-0). Material y metodos Analisis retrospectivo de 46 pacientes intervenidos de nefrectomia radical izquierda y trombectomia como tratamiento de un carcinoma de celulas renales asociado a trombo tumoral de nivel 0 durante el periodo 1990-2020. La EPAR se limito a aquellos casos en los que el acceso quirurgico a la arteria renal principal se encontraba a priori dificultado en el estudio de imagen prequirurgico (n = 9; 19,6%). El sangrado intraoperatorio se estimo en base a la tasa de transfusion perioperatoria, y las complicaciones postoperatorias se categorizaron segun la clasificacion de Clavien-Dindo. Para el contraste de variables se utilizo el test Chi-cuadrado. Se realizo un analisis multivariable para identificar los predictores de transfusion y complicaciones. Resultados No existieron diferencias significativas en la tasa de complicaciones global (11,1 vs. 32,4%; p = 0,19), complicaciones graves (0 vs. 8,1%; p = 0,51), o tasa de transfusion (11,1 vs. 19%; p = 0,49) entre ambos grupos (EPAR vs. no-EPAR). En el analisis multivariable la EPAR no se comporto como un predictor de complicaciones (OR: 0,11; IC95% 0,01-2,86; p = 0,18) ni de transfusion (OR: 0.46; IC95% 0,02-7,38; p = 0,58). Conclusiones En nuestro estudio sobre carcinomas de celulas renales izquierdos con trombo tumoral de nivel 0 y dificultad de acceso a la arteria renal principal, la EPAR no se asocio a un incremento del sangrado o complicaciones postoperatorias, ni se comporto como un predictor independiente de los mismos. Por tanto, podria emplearse como una maniobra prequirurgica segura para facilitar el manejo vascular en casos seleccionados.

Resumen Introduccion El rinon en herradura es una anomalia congenita poco frecuente en la poblacion general que combina ectopia renal, malrotacion y alteraciones en la vascularizacion. El tumor que mas frecuentemente se desarrolla en estos casos es el carcinoma de celulas renales (50%). Una de sus caracteristicas a destacar es la gran variabilidad en su anatomia, sobre todo a nivel vascular. Material y metodos Presentamos 2 casos de pacientes con diagnostico de tumor renal en rinones en herradura, ambos tratados con nefrectomia parcial laparoscopica, llevados a cabo en nuestro servicio; y realizamos una revision de la literatura actual. Discusion Las indicaciones de tratamiento quirurgico en tumores en esta enfermedad son las mismas que en los rinones anatomicamente normales. Tradicionalmente, el tratamiento ha sido la cirugia abierta, siendo la heminefrectomia la cirugia de eleccion. En la actualidad se tiende a defender la cirugia conservadora de nefronas, y el abordaje laparoscopico ha adquirido mas importancia progresivamente. Conclusion Es fundamental realizar un estudio de imagen minucioso para una correcta planificacion quirurgica.

Introduction The horseshoe kidney is a rare congenital anomaly in the general population that combines renal ectopia, malrotation and abnormal vascular supply. The most frequently developed tumor in this case is renal cell carcinoma (50%). One of its main characteristics is great anatomical variation, especially in terms of vascular structures. Material and methods We present two cases of patients with diagnosis of renal tumor in horseshoe kidneys, both treated with laparoscopic partial nephrectomy in our department. Additionally, we have carried a review of the current literature. Discussion Indications for surgical treatment in this pathology are the same as in kidneys with normal anatomy. Traditionally, treatment has been open surgery, with heminephrectomy as surgery of choice. The current trend is to advocate nephron-sparing surgery, and the laparoscopic approach has been progressively gaining importance. Conclusion A thorough imaging study is essential for proper surgical planning.

Diagnosis and treatment of renal cell carcinoma with venous tumor thrombosis remains a challenge today, requiring multidisciplinary teams, mainly in tumor thrombus levels III-IV. Our objective is to present the various diagnostic techniques used and its controversies. A review of the most relevant related articles between January 2000 and August 2020 has been carried out in PubMed, EMBASE and Scielo. Continuous technological development has allowed progress in its detection, in the approximation of the histological subtype, and in the determination of tumor thrombus level. Regardless of the imaging technique used for its diagnosis (CT, MRI, TEE, ultrasound with contrast), the time elapsed until treatment is vitally important to reduce the risk of complications, some of them fatal, such as pulmonary thromboembolism.

Resumen El diagnostico y tratamiento del carcinoma de celulas renales asociado con trombosis venosa tumoral sigue suponiendo un reto en la actualidad, requiriendo de equipos multidisciplinares, fundamentalmente en niveles del trombo III y IV. Nuestro objetivo es la exposicion de las distintas tecnicas diagnosticas empleadas y de las controversias asociadas. Para ello se ha llevado a cabo una revision de los articulos relacionados mas relevantes entre enero del 2000 y agosto de 2020 en PubMed, EMBASE y Scielo. El continuo desarrollo tecnologico, ha permitido avanzar en su deteccion, en la aproximacion del subtipo histologico y en la determinacion del nivel del trombo tumoral. Independientemente de la tecnica de imagen utilizada para su diagnostico (TC, RMN, ETE, ecografia con contraste), es de vital importancia el tiempo transcurrido hasta su tratamiento con el fin de disminuir el riesgo de complicaciones, algunas de ellas fatales como la tromboembolia pulmonar.

Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation.Review of the available literature on kidney procurement procedure.Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish.Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time.Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques.

Resumen Objetivo Analizar la supervivencia de los pacientes con cancer de prostata (CP) con factores pronosticos desfavorables (FPD) tratados con PR y radioterapia de rescate (RTR) tras recidiva bioquimica (RB) y persistencia bioquimica (PB). Material y metodo Analisis retrospectivo de 446 pacientes con al menos uno de los siguientes FPD: score de Gleason ≥ 8, estadio patologico ≥ pT3 y/o margenes quirurgicos positivos (MQ + ). El criterio de RB fue la elevacion del PSA por encima de 0,4 ng/ml. Evaluacion de supervivencia mediante Kaplan-Meier y log-rank. Para identificar factores de riesgo con posible influencia en la respuesta a RTR y la supervivencia causa-especifica (SCE) se uso analisis uni y multivariable (regresion de Cox). Resultados Mediana de seguimiento: 72 (rango 37-122) meses, mediana de tiempo hasta RB: 42 (rango 20-112) meses. El 36,3% presentaron RB. Presentaron respuesta bioquimica a la RTR 121 (74,7%) pacientes. La supervivencia libre de recaida (SLR) despues de la RTR a los 3, 5, 8 y 10 anos fue del 95,7, del 92,3, del 87,9 y del 85%, la SG a los 5, 10 y 15 anos fue del 95,6, del 86,5 y del 73,5%. La SCE a los 5, 10 y 15 anos fue del 99,1, del 98,1 y del 96,6%, respectivamente. Solo el tiempo hasta la RB Conclusiones La PR solo consigue control de la enfermedad a los 10 anos en aproximadamente la mitad de los casos. El tratamiento multimodal secuencial (PR + RTR cuando precise) aumenta este control bioquimico hasta > 87%, lograndose una larga SCE. Los pacientes con un tiempo hasta recidiva > 24 meses respondieron mejor al tratamiento de rescate.

Objective Survival analysis of patients with prostate cancer (PCa) with adverse prognostic factors (APF) treated with radical prostatectomy (RP) and salvage radiotherapy (SRT) after biochemical recurrence (BR) or biochemical persistence (BP). Materials and methods Retrospective analysis of 446 patients with at least one of the following APF: Gleason score ≥8, pathologic stage ≥pT3 and/or positive surgical margins. BR criteria used was PSA level over 0.4 ng/ml. A survival analysis using Kaplan–Meier was performed to compare the different variable categories with log-rank test. In order to identify risk factors for SRT response and cancer specific survival (CSS) we performed univariate and multivariate analyses using Cox regression. Results Mean follow up: 72 (IQR 27–122) months, mean time to BR: 42 (IQR 20–112) months, mean PSA level at BR: 0.56 (IQR 0.42–0.96). BR was present in 36.3% of the patients. Biochemical response to SRT was observed in 121 (75.7%) patients. Recurrence-free survival (RFS) rates after SRT at 3, 5, 8 and 10 years were 95.7%, 92.3%, 87.9%, and 85%; overall survival (OS) rates after 5, 10 and 15 years was 95.6%, 86.5% and 73.5%, respectively. CSS rates at 5, 10 and 15 years were 99.1%, 98.1% and 96.6%. Only time to BR Conclusions In these patients, RP only controls the disease in approximately half of the cases. Multimodal sequential treatment (RP + SRT when needed) increases this control, achieving high CSS rates and biochemical control in over 87% of the patients. Patients with time to recurrence >24 months responded better to rescue treatment.

Introduction Recurrence trends after renal cell cancer (RCC) nephrectomy are not clearly defined. Objective To evaluate recurrence trends according to recurrence risk groups (RRG). Methods Retrospective analysis of 696 patients with RCC treated with nephrectomy between 1990−2010. Three RRG were defined according to the presence of anatomopathological variables (pTpN stage, nuclear grade, tumor necrosis (TN), sarcomatoid differentiation (SD), positive resection margin (RM)): - Low RG (LRG):pT1pNx-0 G1–4, pT2pNx-0 G1–2; no TN, SD and/or RM(+) - Intermediate RG (IRG):pT2pNx-0 G3–4;pT3–4pNx-0 G1–2; LRG with TN. - High RG (HRG):pT3–4pNx-0 G3–4;pT1–4pN+;IRG with TN and/or SD; LRG with SD and/or RM (+). The Kaplan-Meier method has been used to evaluate recurrence-free survival as a function of RRG. The log-rank test was used to evaluate differences between survival curves. Results The median follow-up was 105 (IQR 63–148) months. Of the total series, 177 (25.4%) patients presented recurrence: distant 15.9%, local 4.9% and 4.6% distant and local. The recurrence rate varied according to the RRG with values of 72.9% for HRG, 16.9% for IRG and 10.2% for LRG (P = .0001). Most cases in LRG presented single organ recurrence (72.2%) (P = .006). The LRG experienced recurrence as single metastasis in 50% of cases, compared to 30% and 18.6% in IRG and HRG, respectively (P = .009). The most common sites of recurrence were lung and abdomen. Lung recurrence predominated in the HRG (72.9%) (P = .0001) and abdominal, in the LRG (83.3%) with a tendency to significance (P = .15). Conclusions Recurrence rates (especially bone and lung) increase with higher RG. Single organ recurrences and single metastases are more frequent in LRG.

Resumen Introduccion No estan claramente definidos los patrones de recurrencia tras nefrectomia por cancer renal. Objetivo Evaluar patrones de recidiva en funcion del grupo de riesgo de recurrencia (GRR). Material y metodo Analisis retrospectivo de 696 pacientes con carcinoma de celulas renales tratados con nefrectomia entre 1990-2010. Se definieron tres GRR segun la presencia de variables anatomopatologicas (estadio pTpN, grado nuclear, necrosis tumoral [NT], diferenciacion sarcomatoide [DS], margen de reseccion positivo [MR]): -GR bajo (GRB): pT1pNx-0 G1-4, pT2pNx-0 G1-2; no NT, DS y/o MR (+). -GR intermedio (GRI): pT2pNx-0 G3-4;pT3-4pNx-0 G1-2; GRB con NT. -GR alto (GRA): pT3-4pNx-0 G3-4; pT1-4pN + ; GRI con NT y/o DS; GRB con DS y/o MR (+). Para el contraste de variables cualitativas se utilizo el test de la Chi cuadrado. El metodo de Kaplan-Meier se ha utilizado para evaluar la supervivencia libre de recidiva en funcion de los GRR. Para evaluar diferencias entre las curvas de supervivencia se ha utilizado el test de log-rank. Resultados La mediana de seguimiento fue de 105 (IQR 63-148) meses. Del total de la serie recidivaron 177 (25,4%) pacientes: 15,9% a distancia, 4,9% local y 4,6% a distancia y local. La tasa de recurrencia vario segun el grupo de riesgo con tasas del 72,9% en GRA, 16,9% en GRI y 10,2% en GRB (p = 0,0001). La recurrencia en organo unico fue mayoritaria en el GRB (72,2%) (p = 0,006). El GRB presento recidiva en forma de metastasis unica en el 50% de los casos, frente al 30% y 18,6% en GRI y GRA, respectivamente (p = 0,009). Las localizaciones de recurrencia mas habituales fueron pulmon y abdomen. La localizacion pulmonar predomino en el GRA (72,9%) (p = 0,0001) y la abdominal en el GRB (83,3%) con una tendencia a la significacion (p = 0,15). Conclusiones A medida que aumenta el grupo de riesgo aumentan las recurrencias, sobre todo oseas y pulmonares. En el GRB son mas frecuentes las metastasis unicas y en organo unico.

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases.

Objective Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. Material and methods Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986–2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan–Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer–Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). Results BC was the cause of death in 225 patients (45%); 1, 3 and 5-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65–77%, p = .000) for the 1st year, 73.9% (CI95% 69.2–78.6%, p = .000) for the third and 73.2% (CI% 68.5–77.9%, p = .000) for the 5th year. Conclusions The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8%, 73.9% and 73.2%, respectively.

Resumen Objetivo Elaborar un modelo predictivo de mortalidad cancer especifica (MCE) a 1, 3, y 5 anos basandonos en variables clinicas precirugia y patologicas poscirugia en pacientes con tumor urotelial vesical tratados con cistectomia radical. Material y metodos Analisis retrospectivo de 517 pacientes diagnosticados de tumor urotelial vesical y tratados con cistectomia radical (1986 y 2009). Se recogieron variables demograficas, clinicas, quirurgicas y patologicas, asi como complicaciones acontecidas y evolucion tras cistectomia radical. Analisis comparativo con test de Chi cuadrado y ANOVA. Calculo de supervivencia con metodo de Kaplan-Meier y test de log-rank. Analisis univariante y multivariante mediante regresion logistica para identificar las variables predictoras independientes de MCE. Se calculo la probabilidad individual de MCE a 1, 3 y 5 anos segun la ecuacion general (funcion logistica). La calibracion se obtuvo mediante metodo de. Hosmer-Lemeshow y la discriminacion con elaboracion de una curva ROC (area bajo la misma). Resultados El tumor urotelial vesical fue la causa de muerte en 225 pacientes (45%). Se obtuvo una MCE el 1.°, 3.° y 5.° anos del 17%, 39,2% y 46,3% respectivamente. El estadio pT y pN se identificaron como variables pronosticas independientes de MCE al 1.°, 3.° y 5.° anos. Se construyeron 3 modelos predictivos. La capacidad predictiva fue del 70,8% (IC95% 65-77%, p = 0,000) para el 1.° ano, del 73,9% (IC95% 69,2-78,6%, p = 0,000) para el 3.° ano y del 73,2% (IC95% 68,5-77,9%, p = 0,000) para el 5.° ano. Conclusiones El modelo predictivo permite estimar el riesgo de MCE a los 1, 3 y 5 anos con fiabilidad del 70,8, 73,9 y 73,2% respectivamente.

Resumen Introduccion El papel de la quimioterapia adyuvante (QTAdy) en el tumor vesical musculo-invasivo sigue siendo controvertido actualmente. Objetivo Evaluar el efecto de la QTAdy en la supervivencia cancer especifica del tumor vesical musculo-invasivo tras cistectomia radical (CR). Material y metodos Analisis retrospectivo de 292 pacientes diagnosticados de tumor vesical urotelial tratados con CR entre 1986-2009 con estadio pT3-4pN0/+cM0, divididas en dos cohortes:185(63,4%) pacientes tratados con QTAdy y otra con 107(36,6%) sin QTAdy. Mediana de seguimiento de 40,5 meses (IQR 55-80,5). Analisis comparativo con test Chi cuadrado y t Student/ANOVA. Calculo de supervivencia con el metodo de Kaplan-Meier y test de long-rank. Analisis multivariante (regresion de Cox) para identificar variables predictoras independientes de mortalidad cancer especifica (MCE). Resultados El 42,8% de la serie presento afectacion ganglionar tras CR. Al finalizar el seguimiento, 22,9% estaban libres de tumor vesical y 54,8% habian fallecido por esa causa. La mediana de supervivencia cancer especifica fue de 30 meses. No se observaron diferencias significativas en supervivencia cancer especifica en funcion del tratamiento con QTAdy en pacientes pT3pN0 (p = 0,25) ni pT4pN0 (p = 0,29), pero si en pT3-4pN+ (p = 0,001). En el analisis multivariante se identificaron el estadio patologico (p = 0,0001) y el tratamiento con QTAdy (p = 0,007) como factores pronosticos independientes de MCE. La QTAdy redujo el riesgo de MCE (HR:0,59, IC95% 0,40-0,87, p = 0,007). Conclusiones El estadio pT y pN se identificaron como variables predictoras independientes de MCE tras CR. La administracion de QTAdy en nuestra serie se comporto como factor protector reduciendo el riesgo de MCE, aunque en el analisis por estadios, unicamente los pacientes pN+ se vieron beneficiados.

Introduction Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor (MIBC) remains controversial. Objective To evaluate the effect of ADJ on cancer specific survival (CSS) of MIBC after radical cystectomy (RC). Material and methods Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor (BT) pT3-4pN0/+ cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55–80.5). Comparative analysis was performed with Chi-square test and Student’s t test/ANOVA. Survival analysis was carried out with the Kaplan–Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). Results 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median CSS was 30 months. No significant differences were observed in CSS regarding the treatment with ADJ in pT3pN0 (p = .25) or pT4pN0 (p = .29) patients, but it was significant in pT3-4pN+ (p = .001). Multivariate analysis showed pathological stage (p = .0001) and treatment with ADJ (p = .007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95%CI 0.40–0.87, p = .007). Conclusions pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN + patients were benefited in the stage analysis.

Resumen Introduccion No existe consenso sobre el seguimiento tras nefrectomia por cancer renal(CCR), siendo necesario establecer grupos de riesgo de recurrencia(GRR). Objetivo Clasificar en GRR los CCR. Material y metodo Analisis retrospectivo de 696 pacientes con cancer renal intervenidos entre 1990-2010; 568 (81,6%) pacientes con nefrectomia radical y 128 (18,4%) con nefrectomia parcial. Se clasificaron las variables patologicas como variables de 1.er nivel: estadio pTpN y grado de Fuhrman y variables patologicas de 2.° nivel (VP2N): diferenciacion sarcomatoide (DS), necrosis tumoral (NT), infiltracion microvascular y margenes de reseccion(MR). Realizamos un analisis multivariante (regresion de Cox) para identificar las variables de 1.er nivel relacionadas con la recurrencia. Clasificamos a los pacientes en 3 GRR segun las variables de primer nivel: bajo (GRB) 50%. Tras ello realizamos un analisis univariante y multivariante con las VP2N para cada GRR. Con estos datos se reclasificaron los pacientes en GRR+. Para la comparacion de los GRR con los GRR+ se utilizaron curvas ROC. Resultados La mediana de seguimiento fue de 105 (IQR 63-148) meses. Recidivaron 177 (25,4%) pacientes: 111 (62,7%) con recidiva a distancia, 34 (19,2%) recidiva local y 32 (18%) a distancia y local. Se comportaron como factores predictores independientes de recurrencia el grado de Fuhrman (HR = 2,75; p = 0,0001) y el estadio pTpN (HR = 2,19; p = 0,0001). Se agruparon los pacientes en GRR (ABC = 0,76; p = 0,0001): - GRB (pT1pNx-0 G1-4; pT2pNx-0 G1-2): 456 (65,5%) pacientes. - GRI (pT2pNx-0 G3-4; pT3-4pNx-0 G1-2): 110 (15,8%) pacientes. - GRA (pT3-4pNx-0 G3-4; pT1-4pN+): 130 (18,6%) pacientes. Tras el analisis multivariable con las VP2N, los GRR se reclasificaron (GRR+) (ABC = 0,84; p = 0,0001): -GRB+: GRB sin NT,DS y/o MR(+). -GRI+: GRI; GRB con NT. -GRA+: GRA; GRB con DS y/o MR(+); GRI con NT y/o DS. Conclusiones La adicion de las variables patologicas de segundo nivel a la clasificacion, segun las variables de primer nivel, mejora la capacidad de discriminacion de la clasificacion en GRR.

Introduction There is no consensus on the follow-up protocol after nephrectomy for renal cell carcinoma (RCC), and the identification of recurrence risk groups (RRG) is required. Objective Establish recurrence risk groups (RRG). Material and methods A retrospective analysis of 696 patients with renal cancer submitted to surgery between 1990 and 2010; 568 (81.6%) patients treated with radical nephrectomy and 128 (18.4%) treated with partial nephrectomy. Pathological variables were classified as: 1st-level variables (1LPV): pTpN stage and Fuhrman grade (FG); and 2nd level pathological variables (2LPV): sarcomatoid differentiation (SD), tumor necrosis (TN), microvascular invasion (MVI) and positive surgical margins (PSM). Univariate and multivariate analysis have been performed using Cox regression to determine 1LPV related to recurrence. Based on 1LPV, we classified patients into three RRG: Low (LRG) 50%. We performed univariate and multivariate analysis with the 2LPVs for each RRG. With these data, patients were reclassified as RRG +. ROC curves were used for comparison of RRG and RRG+. Results The median follow-up was 105 months (range 63–148). There were 177 (25.4%) patients with recurrence: 111 (15.9%) distant, 34 (4.9%) local and 32 (4.6%) distant and local. In the multivariable analysis, Fuhrman grade HR = 2,75; p = 0,0001 and pTpN stage HR = 2,19;p = 0,0001 behaved as independent predictive variables of recurrence. Patients were grouped as RRG AUC = 0,76; p = 0,0001: - LRG (pT1pNx-0 G1-4; pT2pNx-0 G 1-2 ): 456 (65.5%) patients. - IRG (pT2pNx-0 G 3-4 ; pT 3-4 pNx-0 G 1-2 ): 110 (15.8%) patients. - HRG (pT 3-4 pNx-0 G 3-4 ; pT1-4pN+): 130 (18.6%) patients. After multivariate analysis with 2LPV, RRG were reclassified RRG+ AUC = 0,84, p = 0,0001: -LRG+ (LRG without TN, SD and/or PSM(+)) -IRG+ (IRG; LRG with TN) -HRG+ (HRG; LRG with SD and/or PSM(+); IRG with TN and/or SD) Conclusion The inclusion of 2LPV to the classification according to VP1N improves the discriminating capacity of RRG classification.

Peritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors.We present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma.Between 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition.Peritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles.

Complications arising from ureterovesical anastomosis in kidney transplantation have an important influence on the success of the procedure. The most serious and frequent complications are fistula and stenosis of the ureterovesical junction. The placement of double J stents in anastomosis is currently recommended to reduce these complications.The aim of the study is to evaluate whether the placement of a DJ stent affects complications of anastomosis.Retrospective analysis of 697 patients treated with cadaveric donor renal transplant in our center from 1999 to 2018 was performed. Results were compared according to double J stent placement and the surgical technique employed for anastomosis.Transplantation was performed without DJ placement in 51.7% of the patients, compared to 48.3% who were treated with DJ stent placement. The most commonly used technique was Lich-Gregoir. Ureterovesical fistula occurred in 5% of cases, and ureterovesical stenosis in 4.2%. DJ stent behaved as a protective factor for ureterovesical fistula but did not significantly influence the development of stenosis. The Taguchi technique greatly increased the risk of developing both ureterovesical fistula and stenosis. The incidence of stenosis and fistula was significantly higher when the Taguchi technique was combined with no DJ stent placement.DJ stent placement acts as a protective factor for ureterovesical stenosis complications. The results of our study seem to agree with current literature.

Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC).Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN.372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR)60 mL/min/1.73 mLaparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR60 mL/min/1.73 m

Resumen Introduccion El objetivo es comparar el rendimiento de la secuencia resonancia magnetica (RM) y biopsia transrectal «cognitiva» (BTRCog) frente a la biopsia transrectal clasica (BTRCl) en pacientes con al menos una biopsia de prostata (BP) negativa. Material y metodo Analisis retrospectivo de 205 pacientes con al menos una BP negativa. A 144 (70,2%) pacientes se les realizo antes de la biopsia una RM y a 61 (29,8%) no. Los nodulos se clasificaron segun la clasificacion PI-RADS v2 agrupando pZa, pZpl y pZpm como zona periferica (ZP), Tza, Tzp y CZ como zona transicional (ZT) y areas AS como zona anterior (ZA). A los pacientes con RM se les realizo BTRCog. A los pacientes sin RM se les realizo una BTRCl de la ZP y de la ZT. Comparacion de variables cualitativas con test de la chi2 y de cuantitativas con t de Student. Analisis multivariante (regresion logistica) para identificar variables predictoras. Resultados La mediana de edad fue 68 (IQR 62-72%) anos, de PSA 8,3 (IQR 6,2-11,7) ng/ml y del numero de biopsias previas fue 1 (IQR 1-2). En 169 (82,4%) el tacto rectal (TR) fue normal, mientras que en 36 (17,6%) sospechoso (cT2a-b en 34 y cT2c en 2). La mediana del volumen prostatico (VP) fue de 48 (IQR 38-65) cc. Existio diferencia en el PSAD (p = 0,03) entre ambos grupos. En la ETR se identifico nodulo hipoecoico en 8 (13,1%) pacientes con BTRCl y en 62(43,1%) (p = 0,0001) con BTRCog. La mediana de cilindros extraidos en BTRCl fue 10 (IQR 10-10) y en el grupo BTRCog fue 11 (IQR 9-13) (p = 0,75). Se diagnostico cancer en 74 (36,1%) pacientes. En BTRCl 10 (16,4%) y en BTRCog 64 (44,4%) (p = 0,0001). Los tumores diagnosticados fueron clasificados: ISUP-1: 34 (45,9%), ISUP-2: 21 (28,4%), ISUP-3: 9 (12,2%), ISUP-4: 7 (9,5%), ISUP-5: 3 (4,1%). No existieron diferencias (p = 0,89). La mediana de cilindros afectados en BTRCl fue 1 (IQR 1-5) frente a 2 (IQR 1-4) en el grupo BTRCog (p = 0,93). Variables predictoras independientes de cancer: edad (OR = 12,05, p = 0,049). TR sospechoso (OR = 2,64, p = 0,04), nodulo hipoecoico en ecografia (OR = 2,20, p = 0,03) y la secuencia RM + BTRCog (OR = 3,49, p = 0,003). Conclusiones La secuencia RMNmp + BTRCog en pacientes con al menos una BP previa negativa multiplica casi por 3,5 (OR = 3,49) la probabilidad de diagnosticar un cancer frente a la BTRCl.

espanolIntroduccion y objetivo Una de las caracteristicas inherentes a los tumores renales es la capacidad de extenderse al interior del sistema venoso como trombos tumorales. El objetivo de este estudio es evaluar en los pacientes con cancer renal en un estadio pT3apN0cM0 si la existencia de afectacion tumoral venosa influye en la recidiva tumoral. Materiales y metodos Analisis retrospectivo de pacientes con cancer renal en estadio pT3apN0cM0 tratados con nefrectomia radical entre 1990-2015. Analisis univariante y multivariante mediante regresion de Cox para identificar variables predictoras y variables predictoras independientes relacionadas con la recidiva. Resultados Se analizaron los resultados de 153 pacientes. La mediana de seguimiento fue de 82 (IQR 36-117) meses. La supervivencia libre de recidiva a los 5 anos fue del 58,9% con una mediana de 97 (IC95% 49,9-144,1) meses. Recidivaron 77 (50,3%) pacientes. En 70 (90,9%) casos las metastasis fueron a distancia, en 17 (14,2%) de estos pacientes se objetivo recurrencia local en el lecho de nefrectomia sincronica. En el analisis multivariable se identificaron como variables predictoras independientes de recidiva tumoral la necrosis tumoral (p=0,0001) y la invasion microvascular (p=0,001). Conclusiones La existencia de extension tumoral venosa no se ha relacionado, en nuestra serie y tras la realizacion del analisis multivariable, con la recidiva. La necrosis tumoral y la infiltracion microvascular si se comportaron como factores predictores independientes de recidiva tumoral. EnglishIntroduction and objective One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence. Materials and methods A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990-2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence. Results The results of 153 patients were studied. The median follow-up was 82 (IQR 36-117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9-144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p=.0001), and microvascular invasion (p=.001) were identified as independent predictors of tumour recurrence in the multivariable analysis. Conclusions In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Introduction and objective One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence. Materials and methods A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990 and 2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence. Results The results of 153 patients were studied. The median follow-up was 82 (IQR 36–117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9–144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p = 0.0001), and microvascular invasion (p = 0.001) were identified as independent predictors of tumour recurrence in the multivariable analysis. Conclusions In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Resumen Introduccion Evaluacion de la efectividad de la biopsia cognitiva (BC) en los pacientes con sospecha clinica de cancer de prostata (caP) y al menos una biopsia negativa (BTR). Material y metodo Analisis retrospectivo de 144 pacientes con al menos una BTR y una resonancia magnetica nuclear (RMN) previa. Los nodulos de la RMN se clasificaron segun la clasificacion PI-RADS v2 agrupando pZa, pZpl y pZpm como zona periferica (ZP), Tza, Tzp y CZ como zona transicional (ZT) y areas AS como zona anterior (ZA). Se indico biopsia en nodulos ≥ PI-RADS 3. Se llevo a cabo analisis uni y multivariante (regresion logistica) tratando de identificar variables relacionadas con tumor en biopsia de PI-RADS 3. Resultados La mediana de edad fue de 67 (IQR: 62-72) anos, la de PSA 8,2 (IQR: 6,2-12) ng/ml. Se identifico nodulo en la RMN en la ZP en 97 (67,4%) casos, en la ZT en 29 (20,1%) casos y en ZA en 41 (28,5%) casos. Se diagnostico caP en la biopsia en 64 (44%) pacientes. En PI-RADS 3 se obtuvo un 17,5% (7/40) de cancer, PI-RADS 4 un 47,3% (35/73) y en los PI-RADS 5 un 73,3% (22/29) (p = 0,0001). Analisis multivariable con variables que pudieran influir en el resultado de la biopsia en pacientes con PI-RADS 3: ninguno (edad, PSA, numero de biopsias previas, tacto rectal, PSAD, volumen prostatico ni numero de cilindros extraidos) se comporto como factor predictor independiente de tumor. Conclusiones El rendimiento diagnostico de la BC en pacientes con al menos una biopsia previa negativa fue del 44% incrementandose segun el grado de PI-RADS, siendo en PI-RADS 3 bajo. No se identifico ninguna variable clinica predictora de caP en pacientes con PI-RADS 3.

Introduction Evaluation of the effectiveness of cognitive biopsy (CB) in patients with clinical suspicion of prostate cancer (PC), and at least one negative biopsy (TRB). Material and method Retrospective study of 144 patients with at least one previous TRB and magnetic resonance imaging (MRI). The MRI nodules were classified based on PI-RADS v2 grouping pZa, pZpl and pZpm as the peripheral zone (PZ), Tza, Tzp and CZ as the transitional zone (TZ), and the AS zones as the anterior zone (AZ). A biopsy was indicated for nodules ≥PI-RADS 3. Uni and multivariate analysis was undertaken (logistic regression) to identify variables relating to a PI-RADS 3 tumour on biopsy. Results The median age was 67 (IQR: 62–72) years, the median PSA was 8.2 (IQR: 6.2–12) ng/ml. A nodule was identified on MRI in the PZ in 97 (67.4%) cases, in the TZ in 29 (20.1%), and in the AZ in 41 (28.5%). PC was diagnosed on biopsy in 64 (44%) patients. The cancer rate in the PI-RADS 3 lesions was 17.5% (7/40), in the PI-RADS 4 47.3% (35/73), and in the PI-RADS 5 lesions it was 73.3% (22/29) (p = 0.0001). Multivariable analysis with variables that could influence the biopsy result in patients with PI-RADS 3: none (age, PSA, number of previous biopsies, rectal examination, PSAD, prostate volume or number of extracted cylinders) behaved as an independent tumour predictor. Conclusions The diagnostic performance of CB in patients with at least one previous negative biopsy was 44%, increasing according to the PI-RADS grade, and low in PI-RADS 3. No clinical variable predictive of cancer was found in patients with PI-RADS 3.

"Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM"., The effect of sex on systemic therapy for psoriasis has not been well studied. The aim of this study was to analyse a large multicentre Spanish cohort of 2,881 patients with psoriasis (58.3% males), followed from January 2008 to November 2018, to determine whether sex influences prescription, effectiveness of therapy, and the risk of adverse events. The results show that women are more likely than men to be pre-scribed biologics. There were no differences between men and women in effectiveness of therapy, measur-ed in terms of drug survival. Women were more likely to develop adverse events, but the difference in risk was small and does not justify different management. Study limitations include residual confounding and the use of drug survival as a proxy for effectiveness., The BIOBADADERM project is promoted by the Fundación Piel Sana Academia Española de Dermatología y Venereología, which receives financial support from the Spanish Medicines and Health Products Agency (Agencia Española de Medicamentos y Productos Sanitarios) and from pharmaceutical companies (Abbott/Abbvie, Pfizer, MSD, Novartis, Lilly, Janssen and Almirall).

Introduction and objectives Preoperative renal artery embolization (PRAE) for large renal masses may be performed prior to nephrectomy in order to simplify the procedure and reduce intraoperative bleeding. The objective of this work is to determine the role of PRAE on intraoperative bleeding and postoperative complications in left renal tumors with tumor thrombus limited to the left renal vein (level 0). Material and methods Retrospective analysis to evaluate 46 patients who underwent left radical nephrectomy and thrombectomy for the treatment of renal cell carcinoma with level 0 tumor thrombus during the period 1990–2020. PRAE was limited to those cases in which surgical access to the main renal artery was presumed a priori difficult in the preoperative imaging study (n = 9; 19.6%). Intraoperative bleeding was estimated based on the perioperative transfusion rate, and postoperative complications were categorized according to the Clavien–Dindo classification. The Chi-squared test was used for comparisons. A multivariate analysis was performed to identify predictors of transfusion and complications. Results There were no significant differences in the overall complication rate (11.1% vs. 32.4%, p = 0.19), major complication rate (0% vs. 8.1%, p = 0.51), or transfusion rate (11.1% vs. 19%, p = 0.49) between both groups (PRAE vs. non-PRAE). In the multivariate analysis, PRAE did not behave as a predictor of complications (OR: 0.11, 95%CI 0.01–2.86; p = 0.18) nor transfusion (OR: 0.46, 95%CI 0.02–7.38; p = 0.58). Conclusions In our study on left RCC with level 0 tumor thrombus and difficult access to the main renal artery, PRAE was not associated with increased bleeding or postoperative complications, and it did not behave as an independent predictor of these variables. Therefore, it could be used as a preoperative maneuver to facilitate vascular management in selected cases.