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In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment.Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out.We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts.The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy.

Introduction: In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event. Material and methods: We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction. Results: This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient’s progress was satisfactory. Conclusion: Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.

Background: Ureterointestinal stenosis is a frequent complication after radical cystectomy, occurring in up to 10%–12% of cases. Endoscopic treatment of complete stenosis has been described through double access, with antegrade flexible ureteroscopy and simultaneous retrograde endoscopy through the intestinal diversion. We present a case of endoscopic treatment without use of antegrade ureteroscopy. Case Presentation: A 52-year-old man underwent surgery for peritoneal carcinomatosis secondary to mucinous adenocarcinoma. Ileocecal resection, omentectomy, sigmoidectomy, rectal resection, cystoprostatectomy, and ileal duct were performed. He had a complicated postoperative period because of enterocutaneous fistulas, peritonitis, and secondary intention wall closure, needing multiple surgeries. Four months later, he was diagnosed with left ureteroinestinal stenosis, for which endoscopic management was the chosen treatment. Intraoperative diagnosis was complete stenosis. To locate the stenosis, methylene blue was instilled using a percutaneous ureteral catheter. With a resectoscope inserted through the ileal duct, the stenosis was observed and opened using cold knife and Collins knife. The stenosis was resolved satisfactorily. Conclusion: Endoscopic management of complete ureterointestinal stenosis is a viable treatment option. Although stenosis localization has previously been described with two endoscopes using transillumination, we demonstrate another localization technique using methylene blue.

Resumen Antecedentes y objetivo El objetivo fue determinar la prevalencia de disfuncion erectil en los varones mayores de 40 anos, y su relacion con enfermedades frecuentes en atencion primaria. Pacientes y metodos Se incluyeron 302 varones (40-79 anos). Se determinaron antecedentes medicos, habitos y parametros antropometricos. Se les administro el cuestionario internacional de sintomatologia prostatica (IPSS), el cuestionario de salud sexual del varon (SHIM) y el test de Goldberg para ansiedad y depresion. Se determino la prevalencia de disfuncion erectil y se estudio la relacion de las diferentes variables obtenidas mediante analisis univariante y multivariante. Resultados La prevalencia de disfuncion erectil fue del 36%. Los pacientes de mayor edad, fumadores, con obesidad abdominal, hipertensos, diabeticos, con riesgo de depresion o con sintomas miccionales tenian puntuaciones mas bajas del cuestionario de salud sexual. Segun el analisis multivariante, el riesgo de padecer disfuncion erectil aumentaba con la edad, si se era diabetico o si existia sintomatologia miccional. Conclusion La edad, la diabetes mellitus y la presencia de sintomatologia miccional son factores asociados a la disfuncion erectil en el ambito de la atencion primaria.

Background and objective The objective was to determine the prevalence of erectile dysfunction in men over 40 years of age and their relationship with frequent pathologies in Primary Care. Patients and methods Three hundred two men (40–79 years) were included. Anthropometric medical history, habits and parameters were determined. They were given the international prostate symptomatology questionnaire (IPSS), the male sexual health questionnaire (SHIM) and the Goldberg test for anxiety and depression. The prevalence of erectile dysfunction was determined and the relationship of the different variables obtained by univariate and multivariate analysis was studied. Results The prevalence of erectile dysfunction was 36%. Older patients, smokers, with abdominal obesity, hypertensive, diabetic, at risk of depression or with voiding symptoms had lower scores on the sexual health questionnaire. According to the multivariate analysis, the risk of suffering from erectile dysfunction increased with age, if the person was diabetic, or if there was voiding symptomatology. Conclusion Age, diabetes mellitus and the presence of voiding symptoms are factors associated with erectile dysfunction in the field of Primary Care.

Objective: To determine possible risk factors for accidental nephrostomy tube dislodgement and compare two different tube types in this context in patients with chronic catheters. Materials and Met...

The objective of thisstudy is to review three cases using urokinase in patientswith urinary catheter obstructed by clots, aswell to carry out a review of the published literature. METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department.In addition, a reference search was performedin Pubmed. RESULTS: The first case was a woman with metastaticbreast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who requirednephrostomy placement due to sepsis. After instillationswith urokinase, the first two cases respondedadequately, while the third was unsuccessful. CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulatedurinary catheters that does not respond toother measures.Reportar tres casos acercadel uso de la urocinasa en pacientes portadores decatéteres urinarios obstruidos por coágulos y realizaruna revisión de la literatura publicada. MATERIAL Y MÉTODOS: Revisión de casos quehan precisado de urocinasa en nuestro servicio de2019 a 2020 en relación a pacientes con catéteresurinarios obstruidos por coágulos. Además, se realizóbúsqueda de referencias en Pubmed. RESULTADOS: El primer caso fue una mujer concarcinoma de mama metástasico que precisó colocaciónde nefrostomías. El segundo fue un paciente pediátricocon traumatismo renal que requirió sondajevesical. El último enfermo fue un varón con obstrucciónbenigna de uréter que precisó de nefrostomía porsepsis. Tras instilaciones con urocinasa, los dos primerospacientes respondieron adecuadamente, mientrasque no hubo éxito en el tercero. CONCLUSIONES: La urocinasa puede ser unaterapia eficaz y bien tolerada en el tratamiento decatéteres urinarios coagulados que no responden aotras medidas.

Resumen Introduccion El objetivo del estudio fue establecer los factores que se relacionan de forma independiente con el desarrollo de resistencia a la castracion (RC) a medio plazo en el cancer de prostata (CP). Material y metodos Ciento cincuenta y cinco pacientes con CP metastasicos al diagnostico del registro nacional de CP con un seguimiento de hasta 39 meses. Las variables estudiadas fueron: edad, PSA, nadir de PSA, Gleason, invasion perineural, estadios T, N y M y tipo de bloqueo (intermitente/continuo). Resultados Media de seguimiento 26,2 ± 13,4 meses. El 47,1% desarrollo RC precoz, con una media hasta el desarrollo de RC 12,2 ± 8,7 meses. Analisis univariante: se relacionaron con la RC la media de PSA (290 ± 905,1 ng/ml en no RC, 519,1 ± 1437,2 ng/ml en RC, p Analisis multivariante: las variables independientes relacionadas con la RC son edad (HR: 0,96; IC 95%: 0,94-0,99, p = 0,01), nadir de PSA (HR: 1,65; IC 95%: 1,43-1,91, p Conclusiones El nadir de PSA y un estadio tumoral T3-T4 al diagnostico se relacionan con un riesgo aumentado de desarrollar RC. Ademas, la edad al diagnostico se muestra como una variable que disminuye el riesgo, de forma que, a mas edad, menos riesgo de desarrollar RC a medio plazo.

Introduction The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term. Material and methods 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent / continuous). Results Mean follow-up 26,2 ± 13,4 months. 47.1% developed early CR, with mean time until onset of 12,2 ± 8,7 months. Univariate analysis: the mean PSA was correlated with CR (290 ± 905,1 ng/mL in non CR, 519,1 ± 1437,2 ng/mL in CR, p Multivariate analysis: the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, p = 0.01), PSA nadir (HR: 1.65. 95% CI: 1,43–1,91, p Conclusions PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term.

INTRODUCTION The study aimed to present the outcomes of an endoureterotomy series using the Lovaco technique for the treatment of ureterointestinal strictures. Factors influencing the success or failure of this technique were also determined. MATERIALS AND METHODS Data were collected from all endoureterotomies for ureterointestinal strictures performed in a single-center between 2017 and 2020. Clinical variables and characteristics of the stricture were recorded in each case, and success was defined as the complete resolution of ureterohydronephrosis. Univariate analysis was used to correlate the variables recorded with procedural success or failure. RESULTS A total of 25 patients were recruited: 16 with strictures on the left side, 5 on the right, and 4 bilateral. With the first endoureterotomy, 52% of the cases (13 patients) were resolved, and in patients undergoing a second intervention 64% success (16 patients) was achieved. Infectious complications occurred in 23.3% of surgeries. Stricture length, poor renal function, and left side involvement were associated with endoureterotomy failure. CONCLUSIONS Endoureterotomy with the Lovaco technique is a useful method in the setting of ureterointestinal strictures, achieving complete resolution of the obstruction in more than 60% of cases. Factors that can negatively affect the success of the procedure include stricture length, poor renal function, and left side involvement.

The treatment of the ectopic ureter in the pediatric patient must be individualized in each caseMETHOD: Description of clinical cases, therapeutic management and evolution of patients.We present four pediatric patients with ectopic ureters who underwent surgery. We describe a case of laparoscopic nephroureterectomy, one of laparoscopic uretero-ureterostomy, one of bilateral ureteral reimplantation and another of unilateral reimplantation. The discussion about the diagnosis and different surgical treatments of each case is deepened.We present four cases of pediatric patients with ectopic ureters, treated by different surgeries. We present how was the preoperative diagnosis and the importance of individualizing the surgical treatment in eachc ase. Aspects recently described in the context of ureteralectopy, such as diagnostic evaluation by MRI or the role of minimally invasive techniques in treatment, should be taken into account in its management.El tratamiento del uréter ectópico en el paciente pediátrico debe individualizarse en cada caso.MÉTODO: Descripción de los casos clínicos, manejo terapéutico y evolución de los pacientes.Presentamos cuatro pacientes pediátricos con uréteres ectópicos sometidos a cirugía. Se describe un caso de nefroureterectomía laparoscópica, uno de uretero-ureterostomía laparoscópica, uno de reimplante ureteral bilateral y otro de reimplante unilateral. Se profundiza en la discusión sobre el diagnóstico y diferentes tratamientos quirúrgicos de cada caso.Presentamos cuatro casos de pacientes pediátricos con uréteres ectópicos, tratados mediante diferentes cirugías. Exponemos cómo fue el diagnóstico preoperatorio y la importancia de individualizar el tratamiento quirúrgico en cada caso. Aspectos descritos recientemente en el contexto de la ectopia ureteral, como la evaluación diagnóstica mediante RMN o el papel de las técnicas mínimamente invasivas en el tratamiento, deben tenerse en cuenta en su manejo.

To describe the case of a patient with subcutaneous inguinal recurrence of penile cancer without lymph node involvement.Description of a clinical case and review of the literature on the subject.We present the case of a 72-year-old man with penile cancer and extranodal inguinal extension that affected subcutaneous cell tissue, with a history of negative sentinel lymph node and subsequently without invasion of the regional lymph nodes in lymphadenectomy after chemotherapy. The patient presented disease progression despite multimodal treatment.Extranodal inguinal involvement in penile cancer may occur despite a history of negative sentinel lymph node. The evolution of the patient we presented was disastrous despite the multimodal treatment carried out.Describir el caso de un paciente con recurrencia inguinal subcutánea de cáncer de pene sin afectación ganglionar. MÉTODOS: Descripción de un caso clínico y revisión de la literatura sobre el tema. RESULTADOS: Presentamos el caso de un hombre de 72 años con cáncer de pene y extensión inguinal extranodal que afectó al tejido celular subcutáneo, con antecedente de ganglio centinelal negativo y posteriormente sin invasión de los ganglios linfáticos regionales en linfadenectomía tras quimioterapia. El paciente presentó progresión de enfermedad a pesar de un tratamiento multimodal. CONCLUSIÓN: La afectación extraganglionar inguinal en cáncer de pene puede producirse a pesar de un antecedente de ganglio centinela negativo para neoplasia. La evolución del paciente que presentamos fue nefasta a pesar del tratamiento multimodal llevado a cabo.

Introduction To study the relationship between quantitative mRNA determination (hTERT) in patients with bladder tumor, history of bladder tumor, and in subjects without a history of this neoplasia. Material and methods A prospective randomized controlled study with 91 subjects included. The value of mRNA-hTERTN was determined in 63 patients with a history or suspicion of bladder tumor and in 28 controls. Urine samples were sent for evaluation of the mRNA level (hTERT), the cytological study and the NMP22 result. Results Differences were observed in mean hTERTN levels in each of the groups: tumor presence 21.33 ± 40.66, tumor history 2.16 ± 2.67, controls 0.9 ± 1.75 (p Conclusions hTERTN mRNA levels in urine were higher in patients with bladder tumors compared to patients with a history of bladder tumor and with negative cystoscopy, as well as in the control group. This determination showed a higher diagnostic yield compared with the detection of NMP22 and urinary cytology.

Resumen Introduccion El objetivo fue estudiar la relacion entre la determinacion cuantitativa de ARNm (hTERT) en pacientes con tumor vesical, antecedentes de tumor vesical y en sujetos sin antecedentes de esta neoplasia. Material y metodos Se trata de un estudio prospectivo, aleatorizado y controlado con 91 sujetos incluidos. El valor de ARNm-hTERTN se determino en 63 pacientes con antecedentes o sospecha de tumor vesical y en 28 controles. Se enviaron muestras de orina para evaluar el nivel de ARNm (hTERT), el estudio citologico y el resultado de NMP22. Resultados Se observaron diferencias en los niveles medios de hTERTN en cada uno de los grupos: presencia de tumor 21,33 + /- 40,66, antecedente del tumor 2,16 + /- 2,67, controles 0,9 + /- 1, 75 (p Conclusiones Los niveles de mRNA de hTERTN en la orina fueron mas altos en pacientes con tumores vesicales en comparacion con pacientes con antecedentes de tumor de vejiga y con cistoscopia negativa, asi como en el grupo de control. Esta determinacion mostro un mayor rendimiento diagnostico en comparacion con la deteccion de NMP22 y citologia urinaria.

Resumen Introduccion El objetivo ha sido mostrar la satisfaccion y adherencia al tratamiento en disfuncion erectil (DE) a medio y largo plazo. Material y metodos Estudio descriptivo y comparativo llevado a cabo en 2 centros mediante entrevistas telefonicas a pacientes que realizaron una primera visita entre 2012 y 2014 por DE. Se realizo una anamnesis completa sobre el uso y abandono del tratamiento. En caso de uso actual se cumplimentaron los cuestionarios EDITS y GAQ, y en caso de uso pasado solo el GAQ. Para el analisis estadistico se utilizaron el test exacto de Fisher para las comparaciones de porcentajes y el test de Kruskal-Wallis para comparar medias. Resultados Doscientos cincuenta pacientes incluidos, habiendo recetado a un 20,8% alprostadilo intrauretral (AL-IU), a un 17,2% alprostadilo intracavenoso (AL-IC), a un 92,8% un primer IPD5, y a un 24,8% al menos un segundo IPD5. El abandono del tratamiento fue del 62,07% en el primer IPD5 utilizado, del 41,94% en el ultimo IPD5 probado, del 69,23% en el AL-IU y del 65,11% en el AL-IC (p = 0,007). La principal razon de abandono en los IPD5 fue la falta de respuesta (32,76% de individuos que los toman). En el caso del AL-IU y AL-IC, ademas de esta destacan las reacciones adversas (28,85% y 11,63% respectivamente). La media de utilizacion hasta el abandono fue de 4,3 meses en IPD5, 2,2 meses en AL-IU y 5,5 meses en AL-IC (p = 0,064). Las puntaciones del GAQ y EDITS mas favorables se observaron en los IPD5 (EDITS de 74). Sildenafilo y tadalafilo tienen los tiempos mas largos de uso (media mayor de 5 meses). Conclusiones El porcentaje de abandono en el tratamiento de la DE es alto, con tiempos cortos de uso de pocos meses, siendo las principales causas de abandono la falta de respuesta y las reacciones adversas. Los farmacos que aportan mayor satisfaccion son los IPD5, sin existir diferencias significativas en el tiempo medio de uso entre los diferentes tipos y en aspectos como la media de uso hasta el abandono o los porcentajes de abandono.

Resumen Objetivo Comparar los resultados de eficacia y seguridad del laser tulio 150 W frente a laser verde 120 W en el tratamiento de la hiperplasia benigna de prostata a corto plazo (12 meses de la cirugia). Material y metodos Estudio retrospectivo observacional, donde se incluyen varones intervenidos con la tecnica de fotovaporizacion prostatica durante un periodo de 4 anos en nuestro centro. Se comprobo la homogeneidad de la muestra, y se compararon las complicaciones postoperatorias (retencion aguda de orina, reingreso, necesidad de transfusion), los fracasos al ano de la cirugia (reintervenciones, flujo maximo Resultados Ciento dieciseis pacientes tratados con tulio y 118 con laser verde. Muestra homogenea para variables preoperatorias (p > 0,05). No se objetivaron diferencias en las complicaciones: en retenciones agudas de orina, 4,3% con tulio y 6,8% con laser verde (p = 0,41); en reingresos 2,6% con tulio y 1,7% con laser verde (p = 0,68); en necesidad de transfusion 2,6% con tulio y 0% con laser verde (p = 0,12). Tampoco se observaron diferencias en el porcentaje de pacientes reintervenidos (1,7% en el grupo de tulio, 5,1% en el de laser verde, p = 0,28), ni en el de individuos con Qmax menor de 15 ml/seg (6,9% con tulio, 6,77% con laser verde, p = 0,75), ni en el de ausencia de mejoria del I-PSS (5,2% con tulio, 3,4% con laser verde, p = 0,65). Tampoco hubo diferencia en los niveles de PSA en ng/ml al ano de la cirugia: con tulio 2,78 ± 2,09 y con laser verde 1,83 ± 1,48 (p = 0,75). Conclusiones La fotovaporizacion prostatica con laser tulio 150 W es comparable a la realizada con laser verde de 120 W para el tratamiento de los sintomas obstructivos del tracto urinario inferior por HBP, siendo ambas tecnicas eficaces y seguras a los 12 meses de la intervencion. Futuros estudios prospectivos aleatorizados son necesarios para confirmar esta conclusion sobre ambas tecnicas.

Objective To compare the results of efficacy and safety of thulium laser 150 W against Greenlight laser 120 W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). Material and methods This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow Results 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (p > 0.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (p = 0.41); in readmissions, 2.6% with thulium and 1.7% with green laser (p = 0.68); in need for transfusion, 2.6% with thulium and 0% with green laser (p = 0.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, p = 0.28); or in individuals with Qmax less than 15 ml/sec (6.9% with thulium, 6.77% with green laser, p = 0.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, p = 0.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78 ± 2.09 and with green laser 1.83 ± 1.48 (p = 0.75). Conclusions Prostate vaporization with thulium laser 150 W is comparable to that made with green laser 120 W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.

Renal papillary necrosis is described as an ischemic or chemical lesion at the end of the Malpighi pyramid, which causes the necrosis, with detachment and expulsion of the papilla in the urine. It ...

The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood.A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis.A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group (We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.

Ureteral realignment using a ureteral stent can be an alternative treatment in cases of complete ureteral transection and may avoid the need for reconstructive surgery. The combined access can help the passage of the guidewire through the injured area and the threading of the urinary system of the patient. We present a case of a 38-year-old man with multiples abdominal surgeries, who underwent a complete ureteral section treated with ureteral realignment with combined access. The subsequent evolution was favourable, with resolution of the ureteral injury at the acute time, and without the presence of long-term obstruction. Although we must accept that the standard treatment of the complete ureteral transection is reconstruction and anastomosis, in cases such as the one prsented, with multiple abdominal surgeries and whenever it is technically feasible, ureteral realignment may be a treatment option.

Objective Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumor subtypes in each of the 2 groups. Material and methods A retrospective observational study was conducted of 2601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our center in the past. We then classified the cases according to the absence of neoplasia, insignificant tumor (involvement of just 1 cylinder, Results A total of 1777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P = 0.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P = 0.002). The same occurred with the Gleason score ≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P Conclusions We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas.

Resumen Objetivo Los cilindros de prostata obtenidos en la biopsia transrectal suelen enviarse en viales separados para su procesamiento anatomopatologico. Aunque es una practica frecuente, existen trabajos controvertidos sobre su utilidad. Se quiso comparar el porcentaje de diagnostico de cancer de prostata al procesar las muestras en 2 contenedores o en contenedores individuales, para comprobar si existen diferencias. Como objetivo secundario se han comprobado los porcentajes de diagnostico de varios subtipos de tumores en cada uno de los 2 grupos. Material y metodos Estudio retrospectivo observacional sobre 2.601 casos de biopsias prostaticas. Se extrajeron 10 cilindros en cada biopsia. Dividimos la muestra en 2 grupos: envio de biopsia al servicio de anatomia patologica en 2 recipientes (lobulo izquierdo y derecho) o en 10 (uno por cada cilindro), segun diferente criterio utilizado en nuestro centro en varias epocas. Posteriormente se clasificaron los casos segun ausencia de neoplasia, tumor insignificante (afectacion de un solo cilindro, Resultados Se incluyeron 1.777 sujetos en el grupo de 2 contenedores y 824 en el de 10. Se diagnosticaron un 32,4% de canceres en el grupo de 2 recipientes y un 40% en el de 10, existiendo una diferencia estadisticamente significativa (p Los carcinomas insignificantes se diagnosticaban con mas frecuencia en el grupo de 2 botes, el 6,4% frente al 4,3% en el de 10 (p = 0,03). Los Gleason 6 se diagnosticaban mas en el grupo de 10 contenedores en comparacion con el de 2 (11,9% frente al 8,1% [p = 0,002]). Lo mismo sucedia con los Gleason ≥ 7, el 23,8% en el grupo de 10 viales frente al 17,9% en el de 2 (p Conclusiones Se diagnostican mas canceres de prostata al enviar los cilindros biopsiados en botes individuales. Ademas, llevando a cabo esta maniobra, hemos observado en nuestra serie una disminucion de los diagnosticos de carcinoma insignificante en detrimento de un mayor diagnostico de carcinomas no insignificantes.

Introduction: We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery.Methods: We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered.Results: A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5ºC (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p

Objective To describe holmium laser endoureterotomy with the Lovaco technique for the treatment of ureterointestinal stenosis. This common problem after cystectomy represents a surgical challenge, with endourological techniques being useful in this context. We present a technique that has been described before, but which we consider useful and decisive. The key points and difficult aspects of the technique are shown, along with our experience with it. Methods We collected data on cases of ureterointestinal stenosis treated using holmium laser endoureterotomy with the Lovaco technique, in a prospective manner, between January 2017 and January 2018. Intraoperative data, postoperative complications, and success rate were recorded. Cases, where there was an improvement of renal function, and the cause that led to surgery was resolved, were considered to be successful. Results Nine endoureterotomies were performed in 7 male patients (2 bilateral), all of them had an ileal conduit. The average age was 68 years, and the average surgery time was 75 minutes. There were no intraoperative complications in any surgery. One patient was readmitted to the hospital 48 hours after discharge, due to febrile urinary tract infection. Of the 7 patients, 1 died shortly after surgery due to a tumor, and another has a short follow-up time. Of the remaining 5 patients, we have considered surgery to have an 80% success rate. The minimum follow-up was 4 months, the maximum was 13 months. Conclusion We consider endoureterotomy with the Lovaco technique a useful and decisive surgery for the treatment of ureterointestinal stenosis, being a reproducible technique. In comparison to other similar techniques, it has advantages such as being safer and not requiring the use of flexible material. The use of holmium laser allows a precise incision and good visibility. Larger series and a longer follow-up are needed to obtain weighty conclusions.

Objectives The involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. Material and methods Observational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10 ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. Results Forty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P 19.60 ng/dL (P Conclusions In this series, greater involvement of seminal vesicles was associated with a PSA level ≥ 20 ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.

Resumen Objetivos La afectacion de las vesiculas seminales en el cancer de prostata puede afectar al pronostico y condicionar el tratamiento. El objetivo es conocer si podemos predecir su infiltracion en el momento de realizar la biopsia prostatica para saber cuando hay que indicar la biopsia de las mismas. Material y metodos Estudio retrospectivo observacional sobre 466 pacientes a los que se les realizo biopsia de vesiculas seminales. La indicacion de esta biopsia fue: PSA mayor de 10 ng/ml o angulo prostatoseminal no conservado. En el analisis se incluyeron las siguientes variables: PSA, densidad de PSA, volumen prostatico, numero de cilindros biopsiados, tacto rectal sospechoso y conservacion del angulo prostatoseminal, estudiandose su relacion con la afectacion de las vesiculas seminales. Resultados Cuarenta y un sujetos (8,8%) con vesiculas seminales infiltradas y 425 (91,2%) libres de afectacion. En el analisis univariado los casos con infiltracion tenian una media superior en PSA (p 19,60 ng/dl (p Conclusiones En esta serie se asocian con mayor afectacion de vesiculas seminales un PSA mayor o igual a 20 ng/ml, un tacto rectal sospechoso, o la ausencia de conservacion del angulo prostatoseminal.

Thulium laser vaporization of the prostate (TL-PVP) has been performed for almost 10 years. However, there are very few studies focused on high power (150 W) applications. Published sources have short follow-up periods, few cases and small prostatic volumes. In this study, we present an analysis of the safety and efficacy of this technique in the mediumterm (42 months follow-up) perspective.Data from 235 patients that underwent TL-PVP from March 2011 to November 2013 has been collected, including prostatic size, intraoperative variables, IPSS, Qmax, and PSA, among others.Mean age was 69±9 years. Mean prostatic size was 62±28 ml. The average IPSS score and Qmax were 18±16 and 7.6 ± 3.5 ml/s, respectively. Mean hospital stay was 24±17 h. Mean time with urethral catheter was 38 h. Only 26.1% of the patients had perioperative complications but none of the cases was higher than a Clavien III. From this population, no more than 1.7% required readmission. Mean postoperative Qmax after 3 and 24 months was 19±6 ml/s and 17±8 ml/s. IPSS was 5±5 points. A successful outcome was achieved in 81.3% of the patients. Obstructive symptoms persisted in 15.7% of the population and 3% resulted in filling-phase dysfunction. Reoperation rate was 5%. The only statistically significant difference (p=0.008) between successful and unsuccessful outcomes occurred in prostatic size, where mean values calculated were 59.73 ml and 71.82 ml, respectively.In this study, high power TL-PVP is a safe and effective alternative with subjective and objective functional results that are comparable to the "gold standard" technique. It also offers a shorter hospital stay and a lower complication rate.

To analyze the predictive factors for retreatment in RIRS to achieve complete lithiasis resolution.Retrospective comparative study analyzing 298 cases of RIRS performed in our center over a 3 year period. The cohort was divided in two groups: Resolution in one operation or more than one, evaluating homogeneicity for age and gender. We compared the folowing variables: Hounsfield units, body mass index (BMI), number of stones, size, (on the case of multiple stones, larger stone size), side, location in the kidney and stone biochemistry. Bivariant statistical analysis by Student's t and Chi square tests, and multivariate analysis by binary logistic regression. ROC curves were made to set cutting points for relationship between quantitative variables.The groups were homogeneous for both age and gender (p0.05). 260 (87.25%) patients required one treatment only and 38 (12.75%) more than one. Among the study variables, the only one that showed differences between the groups wa stone size, being the mean size 18 mm in the single treatment group and 26 mm in the more than one treatment group (Difference between mean values -8.27, 95%CI: -5,91 - -10.63, p0,001).RIRS with holmium laser is still an effective technique for the treatment of renal lithiasis. The largest stone size is related with the need of retreatments, so it must be taken into consideration specially over 2 cm. In our series, for every extra millimeter in size the probability of retreatment increased 1.14 times, demonstrating the importance of size in this context.

To investigate if certain common age-related comorbidities are related with a positive aging males' symptoms (AMS) test outcome.This was a multicentric, transversal, observational study carried out in a male population with erectile dysfunction. Comorbidities and testosterone levels were registered. The relationship between comorbidities, testosterone levels, and the AMS test outcomes was studied using the global score and the sub-scale score components.The study included 1112 patients. In the multivariate analysis the global score strongly correlated with TT 12 nmol/L (odds ratio [OR] = 3.17; p 0.05), psychiatric disorders (OR = 2.73), dyslipidemia (OR = 2.07) and diabetes mellitus (OR = 1.64); the somatic sub-component was related to obesity (OR = 8.62), dyslipidemia (OR = 2.2) and TT 12 nmol/L (OR = 2.09); the psychogenic sub-component correlated with psychiatric disorders (OR = 3.73), stress (OR = 2.42), dyslipidemia (OR = 1.78) and TT 12 nmol/L (OR = 1.77); and the sexual sub-component was associated with high blood pressure (OR = 2.94).Although the AMS test is related to low levels of testosterone, it is also of some limited use for diagnosing hypogonadism because it has low specificity and is influenced by pathologies that are frequent during ageing.

Flexible cystoscopy is a common practice in urology. We wanted to determine whether a retention time of 5 minutes between the administration of a local anesthetic lubricant and flexible cystoscope insertion decreased the degree of discomfort or pain in the patient.Males who underwent flexible cystoscopy during 5 months were randomized in a prospective study. They were divided into two groups. In the first one, the Cathejell lubricant with lidocaine 12.5 g was administered and cystoscopy was performed immediately. In the second one, the same lubricant was maintained in the urethra for 5 minutes before the performance of cystoscopy. After scanning, all the patients were requested to indicate the degree of perceived pain on a visual pain scale from 0 to 10, with 0 being no discomfort and 10 being the maximum degree of pain bearable. As a secondary objective, the relationship of pain to age and to the type of cystoscopist (urologist/resident doctor) was studied. For statistical analysis, a Student's t-test for independent samples and correlation analysis were used.A total of 242 patients were studied, 110 in the immediate group and 132 in the 5-minute delay group, with samples being homogeneous for the age and type of cystoscopist. The mean in the pain scale in the immediate group was 2.41, and in the 5-minute delay group was 2.04, with no significant differences between them (p=0.175). There was no relationship with age (r=-0.061, p=0.348) or with the type of cystoscopist (2.06 of average pain in the associate group, 2.35 in the resident, p=0.28).There is no benefit in waiting a short time after the administration of intraurethral lubrication with a local anesthetic in flexible cystoscopy in men. There is also no relationship between the patient age or the type of cystoscopist (urologist/resident doctor) and perceived pain.

To expose the features related to the diagnosis, therapy and follow-up of paratesticular sarcomas, through the presentation of three cases with different histologies.Description of the clinical cases, surgical management, and pathological results of the surgical specimens.We present three cases of paratesticular sarcomas, one case being a rhabdomyosarcoma and two liposarcomas. Two patients underwent a single successful surgery, while the third one required a second intervention after recurrence. Today all three patients are free of disease.Malignant paratesticular sarcomas are infrequent neoplasias in urology. It is essential that the urologist is aware of this possibility when faced with a paratesticular tumor, since radicalness of surgery will be the most decisive factor in the success of the treatment. Adjuvant therapies must be individualized in each case, and the follow-up after surgery should be close, given the poor evolution of these tumors in many cases.

PSA is a frequently used marker in the daily clinical practice for the diagnosis and management of prostate cancer. We analysed the use of PSA in our health department in patients with and without prostate cancer diagnosis.The registry of all PSA petitions in our health department during 2011 and 2012 was used. Demographic data were used to establish each year's population and the data corresponding to the prevalence of prostate cancer patients, performing a descriptive study. Thus, the use of PSA in patients with or without prostate cancer was studied.25.700 PSA petitions are issued annually in our department over a total of 67.000 males older than 45. This entails a cost of 332.815 Euros annually. Within the group of patients with no prostate cancer diagnosis, it was noticed that the percentage of individuals with at least one annual PSA petition per decade of age is of 23% in males in their fifties, 40% in their sixties, 46% in their seventies, and 36% in their eighties or successive decades. Furthermore, in these cancer-free patients, around 3.800 annual petitions fall on individuals over 75 and with PSA under 4 ng/ml, from which 20% are repeated petitions over the same individual in the same year. Over 1100 males under 45 have an annual PSA. Regarding the average PSA value for decade of age in cancer-free patients, it is of 0.89 +/- 0.4 ng/ml in the forties decade, 1.26 +/- 1.07 ng/ml in the fifties, 1.67 +/- 1.38 ng/ml in the sixties, 1.96 +/- 1.78 ng/ml in the seventies, and 2.24 +/- 2.16 ng/ml in the eighties. We ascertained, also, that for every 144 PSA petitions one prostate cancer case is diagnosed. Regarding the use of this marker in cancer patients, 1.800 petitions are destined to patients follow up annually, and over 200 fall on the newly diagnosed cases.Even though annually less than 50% of males get PSA petitions in any decade of age, its use is sometimes incorrect, including repeated petitions in a short period of time or in individuals of extreme age.

To present the therapeutic management of severe complications related to postoperative mitomycin extravasation.Description of clinical cases, medical and surgical management and pathologic results of surgical specimens.We report two cases of patients with extravesical mitomycin leakage after postoperative instillation. No bladder perforation was evident during tumor surgery. In both cases radical cystectomy was required.Postoperative mitomycin instillation may have undesirable consequences. The possible problems derived from its administration must be known, and each case must be individualized before administering this chemotherapy.