Search

Resumen Introduccion y objetivo El carcinoma primario de uretra (CPU) es una enfermedad neoplasica poco frecuente que surge en la uretra, sin evidencia de carcinoma previo o sincronico en todo el tracto urinario. Dado que las enfermedades raras suelen diagnosticarse y tratarse de forma incorrecta, el objetivo de este estudio fue analizar la experiencia de un unico centro urologico en el tratamiento del CPU, centrandose en las neoplasias que surgen de la uretra anterior masculina. Materiales y metodos Se revisaron retrospectivamente las historias clinicas de los pacientes con neoplasias a nivel de la uretra peneana y bulbar que se presentaron en nuestro centro terciario de referencia entre enero de 1988 y diciembre de 2018. Se excluyeron los pacientes con carcinoma de la uretra prostatica. El diagnostico se obtuvo con la ayuda de una uretroscopia y biopsia de la lesion. El estadio patologico local se evaluo mediante resonancia magnetica nuclear (RMN) con contraste en pacientes seleccionados. El estadiaje se evaluo mediante examen clinico, ecografia y tomografia computarizada (TC). La cirugia radical (cistectomia radical + penectomia total + linfadenectomia inguinal bilateral) se propuso a los pacientes con tumores ≥ T2 o cN + con un buen estado funcional, tumor proximal y sin comorbilidades graves. En caso de afectacion ganglionar, se ofrecio adicionalmente quimioterapia neoadyuvante. Los pacientes con enfermedad localizada ( Resultados Se estudiaron retrospectivamente un total de 13 pacientes varones con CPU anterior. Se realizo penectomia total en siete casos, mientras que cinco casos recibieron uretrectomia parcial y un caso, penectomia parcial. De los siete pacientes que se sometieron a una penectomia total, cinco recibieron cistectomia radical junto con linfadenectomia inguinal bilateral. Tres pacientes fueron tratados con quimioterapia sistemica neoadyuvante, de los cuales dos eran cT3N + y 1 era cT3N0. El subtipo histologico predominante fue el carcinoma de celulas escamosas (CCE), encontrado en siete pacientes (53,8%), mientras que el carcinoma urotelial (CU) estaba presente en cinco pacientes (38,5%) y un fibrohistiocitoma maligno en un caso. La mayoria de los pacientes fueron diagnosticados en estadios avanzados de la enfermedad, con tumores T2 en el 15,4% y T3 en el 46,2%. La mediana de seguimiento fue de 24 meses (rango 1-294). Despues del tratamiento quirurgico, ocho pacientes (61,5%) presentaron recidiva de la enfermedad en una mediana de 6,3 meses, con una SLR a cinco anos del 58 ± 14%. La tasa de SG a cinco anos fue del 50 ± 14%, mientras que la tasa de SCE a cinco anos fue del 66 ± 13%. Conclusion Dada su poca frecuencia, el carcinoma uretral debe ser tratado en un centro de referencia. Las opciones de tratamiento incluyen enfoque radical o cirugia de preservacion del pene (uretrectomia o penectomia parcial) en casos de enfermedad localizada. Debido a la alta tasa de recurrencia, el seguimiento estricto es imprescindible.

We report the reliability of computerized tomography urography and ureteroscopy in the diagnosis and management of upper tract urothelial carcinoma.From 2015 to November 2018 we prospectively collected and retrospectively analyzed 244 cases of ureteroscopy with available preoperative computerized tomography urography. Computerized tomography urography was categorized as positive, suspicious, unlikely and negative. Correspondence between imaging, ureteroscopy and histology was analyzed. The therapeutic indication, based on 2020 EAU Guidelines and patient clinical data, was recorded before and after ureteroscopy. Cohen's Kappa was used for agreement analysis. Logistic regression was used for prediction of positive ureteroscopy.Ureteroscopy was positive for upper tract urothelial carcinoma in 107/115 (93%), 48/77 (62.3%), 15/27 (55.6%) and 12/25 (48%) cases with positive, suspicious, unlikely and negative computerized tomography urography, respectively. On cytohistology the result was confirmed in 164/182 (90.1%) cases. The positive predictive value of a filling defect, stenosis, thickening and hydronephrosis on computerized tomography urography was 87.7% (121/138 cases), 65.6% (21/32), 69.6% (64/92) and 79.7% (59/74), respectively. On multivariate analysis a filling defect (95% CI 2.76-11.5, OR 5.63, p0.0001) or hydronephrosis (1.04-6.18, OR 2.52, p=0.04) was associated with ureteroscopy outcome. Among cases with positive computerized tomography urography and ureteroscopy, the lesions differed in dimensions (20/107), number (14/107) and site (11/107), for a total of 45/107 (42.1%) cases. The indication of elective treatment changed after ureteroscopy in 37/76 (48.1%) cases (Kappa=0.31), as 17/28 (60.7%), 11/20 (55%) and 11/28 (39.2%) indications were confirmed for endoscopic management, ureterectomy and nephroureterectomy, respectively.The complementary use of computerized tomography urography and ureteroscopy in the diagnostic workup of upper tract urothelial carcinoma should be evaluated.

Resumen Introduccion Comparar los resultados oncologicos, funcionales y postoperatorios de la crioablacion hemiglandular (CH) vs. crioablacion de toda la glandula (CT) como terapia primaria del cancer de prostata localizado. Material y metodo Se incluyeron 66 pacientes consecutivos tratados entre 2010 y 2018 con crioablacion total (CT = 40) o crioablacion hemiglandular (CH = 26) en un centro de referencia terciario. Todos los pacientes tenian cancer de prostata de riesgo bajo-intermedio segun criterios D’Amico. Se propuso crioablacion hemiglandular en caso de cancer de prostata unilateral comprobado por biopsia y RM. La variable principal de evaluacion fue el fracaso de la crioterapia, para el que se consideraron y compararon tres definiciones: 1) fallo bioquimico (> PSA nadir + ≥ 2 ng/mL), 2) rebiopsia positiva de prostata Gleason ≥ 7, y 3) inicio de un tratamiento adicional para el cancer de prostata. Resultados La edad media de los pacientes durante el tratamiento fue 74 [42-81] vs. 76 [71-80] anos en el grupo de CT vs. CH, respectivamente (p = 0,08). Los grupos de riesgo bajo e intermedio (D’Amico) fueron 15% y 85% frente a 23% y 77% (p = 0,75), respectivamente. El tiempo medio de seguimiento fue de 41 [1,5-99,0] vs. 27 [0,9-93] meses (p = 0,03). La supervivencia libre de fracaso de la crioterapia a cuatro anos en CT vs. CH fue de 69% vs. 53% con la definicion 1 (p = 0,24), 82% vs. 80% con la definicion 2 (p = 0,95), y 83% vs. 77% con la definicion 3 (p = 0,73). La continencia urinaria postoperatoria y al ano fue de 60% y 83% en CT frente a 72% y 83% en CH (p = 0,26). La impotencia de novo tras la crioterapia fue del 75% frente al 46% (p = 0,33) en CT y CH, respectivamente. Conclusiones En nuestra cohorte de pacientes altamente seleccionados con CP unilateral de riesgo bajo-intermedio, la crioterapia hemiglandular puede proporcionar resultados oncologicos similares y menos complicaciones tempranas en comparacion con la crioablacion de toda la glandula.

Nowadays, Robotic assistedkidney transplantation (RAKT) is considered a lessinvasive alternative to the Open Kidney Transplantation(OKT) with several advantages such as image magnification,3D vision and articulated instruments and with arelatively short learning curve for an experienced surgeon.RAKT has shown comparable outcomes with theOKT literature data in terms of surgical and functionalresults. RAKT may decrease the complication rate, meanhospital stay, postoperative pain, and also improve aestheticoutcomes. The aim of this study was to perform asystematic review of the literature on this novel approachof KT.A systematic review was performed in accordance with the Preferred ReportingItems for Systematic Reviews and Meta-Analyses (PRISMA)statement. The search was conducted using the databases PubMed/Medline, including as outcomes: (1) indications, (2) step-by-step technique for RAKT, (3) RAKT in special cases (4) surgical and functional outcomes,and (5) future perspectives in RAKT.The indications for RAKT are expanding, sothat including obese recipients, graft with multiple vesselsand graft from deceased donor. To date, the two absolute contraindications to RAKT are patients unfitfor pneumoperitoneum and presenting advanced atheromatic plaques where vessel clamping could result challenging. As far as the outcomes, the surgical and functional results are in line with the OKT experience.Complication rate is low in RAKT, particularly in terms of arterial and venous thrombosis (1%), lymphocele (3%),ureteral stricture (2%), and wound infection (0.3%). Arobotic assisted kidney auto-transplantation (RAKAT) has been recently described, as novel approach in case of complex proximal benign ureteral stenosis. Despite great advances in this field, some limits still need to be approached such as the modality to main tain the graft to a constant low temperature (20 ºC) and to find the proper location of arteriotomy in advanced atheromatic disease without the tactile feedback.The present review has confirmed that RAKT is as safe and feasible as OKT with comparable surgical and functional results. Complication rate is lower in RAKT than OKT and the indications are expanding quickly. Furthermore, new technologies are being introduced in order to improve the surgical performances and to expand more the indications for robotic surgery.However, a prospective randomized study in order to compare RAKT versus OKT is still required.Hoy en día, el trasplante de riñón asistido robótico (TRAR) se considera una alternativa menos invasiva al Trasplante Renal Abierto (TRA) con varias ventajas como la imagen magnificada 3D y los instrumentos articulados. Además, con curva de aprendizaje relativamente corta para cirujanos expertos. El TRAR ha demostrado resultados quirúrgicos y funcionales comparables con los publicados sobre el TRA. El TRAR parece que disminuye la tasa de complicaciones, la estancia hospitalaria, el dolor postoperatorio y todo ello mejorando los resultados estéticos. El objetivo de este estudio es realizar una revisión sistemática de la literatura sobre este abordaje quirúrgico para el trasplante renal.MATERIALES Y MÉTODOS: Se realizó una revisión sistemática de conformidad con la declaración de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se llevó a cabo utilizando las bases de datos PubMed/Medline, incluyendo como resultados: (1) indicaciones, (2) técnica paso a paso para TRAR, (3) TRAR en casos especiales, (4) resultados quirúrgicos y funcionales, y (5) perspectivas futuras en TRAR.Las indicaciones para TRAR se están expandiendo, de modo que incluyen receptores obesos, injerto con múltiples vasos e injerto de donante fallecido. Las dos contraindicaciones absolutas el TRAR son pacientes que no puedan tolerar el pneumoperitoneo y/o que presentan placas ateromatosas lo que podría dificultar el clampaje arterial. En cuanto a los resultados, los resultados quirúrgicos y funcionales están en línea con la experiencia de OKT. La tasa de complicaciones es baja en RAKT, particularmente en lo que se refiere a trombosis arterial y venosa (1%), linfocele (3%), estenosis ureteral (2%), infección de herida quirúrgica (0,3%). Recientemente, se ha descrito el auto-trasplante renal asistido robótico como abordaje novedoso en caso de estenosis ureteral benigna compleja y localización proximal. A pesar de los grandes avances en este campo, todavía hay que abordar algunos límites comola dificultad para mantener el injerto renal a una temperatura baja constante (20ºC) y cómo elegir el sitioa decuado donde realizar la arteriotomía en pacientes con enfermedad ateromatosa avanzada, ante la imposibilidad de palpar la arteria.CONCLUSIÓN: La presente revisión ha confirmado que TRAR es tan seguro y reproducible como el TRA con resultados quirúrgicos y funcionales comparables. La tasa de complicaciones es más baja en el TRAR y las indicaciones se están expandiendo rápidamente. Además, se están introduciendo nuevas tecnologías y nuevos dispositivos con el fin de mejorar el rendimiento quirúrgico y ampliar aun más las indicaciones para la cirugía robótica. Sin embargo, no existe y quizás sea necesario un estudio prospectivo aleatorizado para comparar los 2 abordajes.

INTRODUCTION AND OBJECTIVE:Kidney auto-transplantation is a useful technique to be reserved for cases where kidney function is compromised by a complex anatomical configuration, such as long ureter...

INTRODUCTION AND OBJECTIVE:The diagnosis and risk stratification of upper urinary tract urothelial carcinoma (UTUC) can be challenging. Urinary cytology (UC) has low sensitivity and CT scan is not ...

INTRODUCTION AND OBJECTIVE:Transurethral resection of bladder tumor (TURBT) is considered the gold standard in the diagnosis and risk stratification bladder cancer (BC). En-bloc resection of bladde...

Introduction: Appropriate risk stratification and complete tumor ablation are the key factors to optimize the oncologic outcomes of patients undertaking endoscopic management for upper urinary trac...

Objective To assess the accuracy of ureteroscopic (URS) biopsies in predicting stage and grade at final pathology in upper tract urothelial carcinoma (UTUC). Materials and methods The meta-analysis was performed in accordance with the PRISMA statement. Studies providing data on tumor stage and grade at URS biopsy and surgical specimens were included. The negative predictive value (NPV) implies concordance between the absence of subepithelial connective tissue invasion or the presence of low-grade tumors at URS biopsy and the absence of a muscle-invasive disease in the final pathology. Results A total of 23 studies were included (3547 patients). The stage-to-stage match between URS biopsy/final pathology showed a positive predictive value (PPV) for cT1+/muscle-invasive disease of 94% (95% CI: 84%–100%) and a NPV for cTa-Tis/non-muscle-invasive disease of 60% (95% CI: 52%–68%). The grade-to-grade match between URS biopsy/final pathology was 66% (95% CI: 55%–77%) for low-grade (cLG/pLG) tumors and 97% (95% CI: 94%–98%) for high-grade (cHG/pHG) tumors. The PPV for cHG/muscle-invasive disease was 60% (95% CI: 54%–66%) and the NPV for cLG/non-muscle-invasive disease was 77% (95% CI: 73%–82%). The undergrading and understaging rates were 32% (95%CI: 25%–38%) and 46% (95% CI: 38%–54%), respectively. Conclusions There is a substantial correlation between tumor grade at URS biopsy and the final pathology. The identification of cHG tumors and subepithelial connective tissue invasion (cT1+) in URS biopsy showed a moderate and a strong correlation with invasive UTUC, respectively. Nevertheless, a certain risk of undergrading and understaging should be assumed.

Resumen Contexto La destreza para escribir y la importancia de la calidad de la redaccion estan sujetas a un cierto menosprecio. Igual que hay guias sobre que debe constar en cada parte del articulo cientifico (introduccion, material y metodos, resultados y conclusion), existen tambien «normas» sobre como redactarlo. Resultados novedosos solo pueden ser reflejados adecuadamente en un texto formal y estructuralmente correcto. Objetivo Despertar la conciencia del buen uso del lenguaje en todos los ambitos profesionales, asi como dar algunas recomendaciones practicas para evitar los errores mas frecuentes en nuestro medio. Adquisicion de evidencia Se realizo una busqueda de los terminos «estilo cientifico», «lenguaje cientifico» y «como escribir un articulo» en las bases de datos de los buscadores Medes, Dialnet e Indice Bibliografico Espanol en Ciencias de la Salud (IBECS). Se consultaron tambien libros sobre la tematica. Con ello analizamos las caracteristicas del estilo cientifico y los errores mas comunes que se observan en los textos cientificos. Sintesis de evidencia Las caracteristicas del lenguaje cientifico son: claridad, precision, brevedad, concision, fluidez y sencillez. El estilo cientifico evita, entre otras cosas: frases largas, ausencia de conectores, errores en la sintaxis, la redundancia, barbarismos, extranjerismos, falsos amigos, expresiones coloquiales, cacofonias, jerga, exceso de gerundios, abusar de abreviaturas, usar excesivamente la voz pasiva y errores ortograficos. Conclusiones Las caracteristicas principales del estilo cientifico son la claridad, precision y brevedad. A escribir articulos se aprende con la practica, leyendo y con la ayuda de escritores experimentados.

Objectives: To assess whether the use of endoscopic exploration (EE) as a routine diagnostic tool in patients with clinical suspicion of upper tract urothelial carcinoma (UTUC) following radical cystectomy (RC) significantly impacts management decision-making and to describe the oncological outcomes of patients with UTUC after RC. Materials and methods: We performed a retrospective review of medical records of patients with suspicion of UTUC after RC between 2000 and 2019. Patient demographics, clinicopathological features, treatments, and outcomes were analyzed. Results: We identified 60 patients with suspicion of UTUC. After diagnostic work-up, 16 were submitted to radical nephroureterectomy (RNU) and 44 underwent diagnostic EE. After EE, a further 18/44 (40.9%) were submitted to RNU, while no evidence of tumor was found in 12 (27.3%) and the remaining 12 (27.3%) underwent endoscopic treatment (ET). Thus, in 24/44 (54.5%) patients the primary treatment strategy, i.e., RNU, was altered. Twenty-nine (85.3%) of the 34 patients who underwent RNU had high-grade tumors and 16 (47%) had the muscle-invasive disease. In the ET group, 6 (50%) had high-grade tumors and 10 (83.4%) had tumors less than 2 cm. The 5-year estimated recurrence-free survival and cancer-specific survival were, respectively, 58.4% and 45.6% in the RNU group and 25% and 80.8% in the ET group. Conclusion: EE significantly impacts clinical decision-making in patients with suspicion of UTUC after RC, resulting in a change in treatment strategy in approximately half of the patients. UTUC following RC has a poor prognosis and although RNU is the gold standard, ET could be considered in a selected group of patients. (C) 2021 Elsevier Inc. All rights reserved.

Resumen Objetivos Revisar nuestra experiencia en cistectomia radical robotica, valorando las complicaciones, resultados oncologicos y funcionales. Material y metodos Desde el 2007 al 2014 realizamos 67 cistectomias radicales roboticas asociadas a linfadenectomia en 61 casos. En 37 pacientes por tumor musculo-invasivo y en 30 por no musculo-invasivo de alto riesgo. La derivacion urinaria se realizo de forma extracorporea, siendo con neovejiga tipo Studer en 47 casos. Resultados La perdida hematica media fue 300 ml. Ningun caso requirio conversion a cirugia abierta. La mediana de ganglios extraidos fue 16 (rango: 3-33). La anatomia patologica revelo 16 pT0, 15 (pTis,-pT1-pTa) y 44 tumores musculo-invasivos, 8 pN+ y uno con margenes positivos. La estancia media hospitalaria fue 9 dias. Con una mediana de seguimiento de 16 meses, 9 (13%) reingresaron tras el alta, la mayoria por infecciones asociadas a cateteres y sonda vesical. Cuarenta pacientes (59,7%) presentaron complicaciones (la mayoria Clavien 1-2). En 4 casos (6%) hubo recurrencia durante el seguimiento y fallecieron por enfermedad oncologica 4 (5,9%). Diecinueve (28,3%) pacientes tuvieron complicaciones despues de 30 dias, siendo en su mayoria infecciones urinarias. De 47 pacientes con neovejiga presentan una correcta continencia diurna 45 (95%) y nocturna del 89%. De los pacientes con funcion sexual previa normal o disminuida un 90% y 64% respectivamente conservan funcion sexual con o sin uso de tratamiento farmacologico. Conclusiones La cistectomia radical mas linfadenectomia robotica, con reconstruccion extracorporea de la derivacion urinaria, ofrece buenos resultados oncologicos y funcionales sin aumentar el numero de complicaciones.

INTRODUCTION: Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in urology, that is not devoid of postoperative complications. Minimally invasive surgery, and especially robot-assisted RC (RARC) has emerged as an alternative to open RC (ORC) in an attempt to minimize surgical morbidity and facilitate the surgical approach. The aim of this paper was to present the current knowledge on the oncological efficacy and complication outcomes of RARC. EVIDENCE ACQUISITION: A non-systematic review on all relevant studies with the keywords "Radical cystectomy," "Open," "Robot-assisted," "Complications," "Recurrence," "Survival," "Neobladder," "Potency," "Continence" and "Intracorporeal" was performed using PubMed, MEDLINE, Embase, American Urological Association (AUA), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU) Guidelines. EVIDENCE SYNTHESIS: RARC shows similar lymph node yields and positive surgical margin rates as well as perioperative complication outcomes compared with ORC. RARC exhibits significantly less blood loss and less intra- and postoperative blood transfusion. Moreover, survival and recurrence rates are not related to the surgical approach. Finally, RARC seems to be more expensive and has a longer operating time compared to the open technique. CONCLUSIONS: As current evidence shows, RARC seems as a technically feasible and safe procedure, providing equivalent perioperative and oncological results compared to ORC. More prospective, randomized-controlled trials are necessary to draw definitive conclusions on all comparative aspects. ispartof: MINERVA UROLOGICA E NEFROLOGICA vol:71 issue:4 pages:301-308 ispartof: location:Italy status: published

Radical cystectomy (RC) is one of the most complex and morbid surgical procedures in Urology. Several retrospective and prospective studies have demonstrated that robotic-assisted RC (RARC) represents a minimally invasive alternative to open surgery, showing non-inferiority in mid-term oncological outcomes. Moreover, important advantages related with perioperative complications have also been published. The aim of this article is to describe RARC surgical steps and to review the most relevant ndings in the eld of RARC, focusing on its strengths and weaknesses when compared with open RC.We performed a detailed step-by-step description of the RARC surgical technique, paying particular attention to its specific surgical details and adding our tips and tricks for an out standing performance. We also conducted a review of the most relevant articles in literature in terms of oncological, pathological and perioperative results. All these findings have been compared with the classical open radical cystectomy (ORC) technique.None of the studies published have demonstrated RARC to have worse oncological outcomes (PSM,RFS, CSS, OS) compared to ORC. RARC shows a decrease in blood loss and transfusion rates. No differences have been observed in complications rate, length of hospital stay, quality of life, and time to bowel movement between both approaches. The two disadvantages of RARC compared to ORC are a longer operative time and increased cost. Operating time can be reduced with surgeons gaining experience and technique standardization. The cost disparities and operative time between ORC and RARC at high-volume academic centers are less pronounced than in the general medical community.RARC is a technically feasible and safe approach, with oncological, pathological and perioperative results, at least, equivalent to ORC.ARTICULO SOLO EN INGLES.OBJETIVO: La cistectomía radical (CR) esuno de los procedimientos quirúrgicos más complejosy con mayor morbilidad. Varios estudios retrospectivosy prospectivos han demostrado que la CR asistida porrobot (CRAR) representa una alternativa mínimamente invasivaa la cirugía abierta, mostrando no inferioridad enlos resultados oncológicos a medio plazo. Además, sehan publicado importantes ventajas en relación con lascomplicaciones peroperatorias. El objetivo de este artículoes describir los pasos quirúrgicos de la CRAR y revisarlos hallazgos más relevantes en el campo de la CRAR,focalizando en sus fortalezas y debilidades cuando secomparan con la CR abierta. MÉTODOS: Realizamos una descripción paso a paso,detallada, de la técnica quirúrgica de CRAR, poniendoparticular atención a sus detalles quirúrgicos específicos yañadiendo nuestros trucos y consejos para una ejecución excelente. También realizamos una revisión de los artículos más relevantes de la literatura en términos de resultadosoncológicos, patológicos y peroperatorios. Todosestos hallazgos se han comparado con los de la técnicaclásica de cistectomía radical abierta (CRA). RESULTADOS: Ninguno de los estudios publicados hademostrado que la CRAR tenga peores resultados oncológicos(márgenes quirúrgicos positivos, supervivencia librede recurrencia, cáncer específica y global) en comparación con la CRA. La CRAR muestra un descenso del sangradoy las tasas de transfusión. No se han observadodiferencias entre ambos abordajes en las tasas de complicaciones,estancias hospitalarias, calidad de vida y eltiempo hasta la deposición. Dos desventajas de la CRARen comparación con la CRA son el tiempo operatoriomás largo y el aumento del coste. El tiempo operatorio puede reducirse con el aumento de la experiencia de loscirujanos y la estandarización de la técnica. Las disparidadesen los costes y la duración de la cirugía son menospronunciadas en centros académicos de gran volumen que en los de la comunidad médica general. CONCLUSIONES: La CRAR es un abordaje técnicamentefactible y seguro, con resultados oncológicos, patológicosy peroperatorios, al menos, equivalentes a los dela CRA.

Background: A ureteroileal anastomosis stricture (UAS) is one of the most frequent complications after radical cystectomy. Open surgical repair is the treatment of choice but is associated with morbidity. Objective: To describe the efficacy and safety of laparoscopic management for benign secondary UAS. Design, setting, and participants: A review was performed of the 11 initial procedures performed at our academic center from December 2010 to December 2014, with mean follow-up of 38 mo (range 12-169). Patients included had benign ureteroileal strictures longer than 1 cm. Surgical procedure: A pure laparoscopic approach was systematically used, involving a two-step procedure for left and a one-step procedure for right ureteral stenosis. Measurements: Perioperative data were collected and complications were assessed using the Clavien-Dindo grading system. Outcomes and follow-up data were analyzed. Results and limitations: A descriptive statistical analysis was performed for 11 surgeries in ten patients. The median stricture length was 2.4 cm. No conversion to open surgery was required. The mean blood loss was 180 ml and the mean hospital stay was 10 d. Early complications included limited lymphorrhea (n = 1), limited anastomotic leakage (n = 2), and accidental descent of a ureteral catheter (n = 1) that was replaced with radiologic intervention. The mean follow-up was 38 mo (range 12-169). No late complications were reported. After 1 yr of follow-up, six patients had good glomerular filtration rates, all patients were asymptomatic, and no stenotic relapses were detected. Conclusions: This laparoscopic technique for the management of benign secondary UAS is feasible, with good results and without long-term complications. This minimally invasive approach reduces the morbidity associated with open surgery while retaining good success rates. Patient summary: We describe a novel laparoscopic approach for patients with a ureteroileal anastomosis stricture after radical cystectomy to avoid the complications associated with open surgery. The surgery was found to be viable and safe with good long-term results. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Introduction Radical cystectomy with extended lymphadenectomy is the surgical treatment of choice for muscle-invasive bladder cancer. The technical and technological improvements and the positive results from robot-assisted kidney and prostate surgery have led to the progressive development of robot-assisted radical cystectomy (RARC). We provide a global structured overview and an update on the complications of RARC, recorded according to the Clavien-Dindo classification system. Acquisition of evidence We conducted a search on PubMed of all publications on RARC to date (2014). Of the 259 publications found, we excluded review articles and cost analyses, publications with less than 30 cases, updates of previous studies and those whose main objective was the study of other issues related to RARC other than complications, leaving a total of 38 articles for the final analysis. Summary of the evidence The most common complications associated with RARC are gastrointestinal, infectious and genitourinary system, mainly Clavien 1–2, followed by Clavien 3–4. RARC had lower overall complication rates than open radical cystectomy and laparoscopic radical cystectomy and had a lower incidence of severe complications, less intraoperative bleeding and better postoperative recovery. Conclusions Although further scientific evidence is needed, RARC is an increasingly widespread technique that appears to reduce complications as well as the need for transfusion, and it improves recovery times.

Resumen Introduccion La cistectomia radical (CR) con linfadenectomia ampliada es el tratamiento quirurgico de eleccion para el cancer de vejiga musculo invasivo. Las mejoras tecnicas y tecnologicas, asi como los buenos resultados de la cirugia robotica renal y prostatica han propiciado el progresivo desarrollo de la CR robotica (CRR). Proporcionamos una vision global estructurada y una puesta al dia de las complicaciones de la CCR, recogidas segun la clasificacion de Clavien-Dindo. Adquisicion de evidencia Realizamos la busqueda en PubMed de todas las publicaciones sobre CRR hasta la actualidad (2014). De las 259 publicaciones encontradas se excluyeron los articulos de revision y de analisis de costes, publicaciones con menos de 30 casos, las actualizaciones de estudios previos y aquellas cuyo objetivo principal era el estudio de otros temas relacionados con la CRR distintos de las complicaciones, quedando para el analisis final un total 38 articulos. Sintesis de evidencia Las complicaciones mas frecuentemente asociadas a la CRR son las gastrointestinales, infecciosas y genitourinarias, principalmente Clavien 1-2, seguidas de las Clavien 3-4, con tasas globales menores que en la cistectomia radical abierta (CRA) y laparoscopica (CRL), y con menor incidencia de complicaciones graves, menor sangrado intraoperatorio y mejor recuperacion postoperatoria. Conclusiones Aunque se requiere mayor evidencia cientifica, la CCR es una tecnica cada vez mas extendida que parece reducir las complicaciones, la necesidad de transfusion y mejora el tiempo de recuperacion.

To evaluate on a lesion-by-lesion basis Narrow-Band Imaging flexible videoscopy (NBI-FV) in the detection of cancer compared to White-Light Imaging flexible videoscopy (WLI-FV). WLI-FV and NBI-FV were sequentially performed in patients scheduled for TURBT for primary bladder cancer. Suspicious findings were individually harvested and characterized under WLI-FV (suspicious/non-suspicious) and NBI-FV (5-point Likert scale) and pathology. The primary objective was to determine if NBI-FV informed at least 20% more cancer lesions than WLI-FV (Relative true-positive rate > 1.19). A minimum of 120 specimens was to be analyzed to reach 90% power. Of 147 specimens taken in 68 patients, 101 were found suspicious under WLI-FV and 64 (64/101, 63.4%) confirmed as cancer. Of the 46 lesions undetected by WLI-VF, 16 were found positive for cancer (16/46, 34.8%). For NBI-FV, a significant increase in positive samples was observed with increments in Likert scale (p

Metastatic prostate cancer is a very heterogeneous disease with several treatment options. In some cases of oligometastatic disease, local treatment of the primary tumor complemented by metastasis directed therapy seems to improve oncological results. The objectives of this study are to define and understand oligometastatic prostate cancer, to show the usefulness and rationale of cytoreductive surgery in this scenario and to review all published studies about radical prostatectomy in patients with initially metastatic prostate cancer.We performed a Pubmed bibliographic search using the keywords: prostate cancer, metastatic, oligometastatic, local treatment, radical prostatectomy, and cytoreductive surgery. We included all published works on radical prostatectomy in initially metastatic patient. Furthermore, we reviewed published articles about cytoreductive surgery and biology of the oligometastatic disease in journals of different medical specialties.Oligometastatic prostate cancer is recognized as an intermediate clinical stage between local and disseminated disease that seems to benefit from local treatment of the primary tumor plus metastasis directed treatment. In this scenario, different retrospective studies have demonstrated that radical prostatectomy diminishes local complication rate and improves oncological results without increasing morbidity. Currently, there is no consensus definition about the number, location, and imaging techniques to employ to consider a patient oligometastatic. Thus, it is difficult to compare the results of the different studies and identification of a subgroup of patients that could benefit from this local treatment.In absence of prospective randomized data, radical prostatectomy seems to be useful for local treatment of the primary tumor in a selected group of patients with oligometastatic prostate cancer.

Resumen Introduccion Las guias recomiendan cirugia parcial en tumores renales T1. Diferentes aspectos han evolucionado en estos ultimos anos: forma y duracion del clampaje, enucleacion, abordaje por retroperitoneoscopia y la utilizacion de puertos de 3 mm. Presentamos nuestra serie inicial de tumorectomia renal laparoscopica por retroperitoneoscopia (TRLR) analizando nuestra curva de aprendizaje y el uso de instrumental de 3 mm. Material y metodos De enero 2011 a enero 2015, realizamos TRLR a 50 pacientes con tumores renales T1 de cara posterior o convexidad renal. Tras 10 casos, la tecnica paso a ser off-clamp y posteriormente en 11 casos se realizo con 3 mm. Resultados El tamano tumoral fue de 34,36 mm (14-62) con un PADUA de 8,42 (5-12), tiempo operatorio de 163,1 minutos (75-300) y tiempo de isquemia caliente de 4,21 minutos (0-28). No se clampo la arteria renal principal en 41 (82%) pacientes y ningun vaso (isquemia 0) en 39 (78%). Siete casos presentaron margenes positivos (6 focales). Se realizaron 11 TRLR con material de 3 mm con un tiempo quirurgico, sangrado intraoperatorio y estancia hospitalaria menores. Conclusiones La retroperitoneoscopia sumada a enucleacion permiten la extirpacion sin clampaje de tumores posteriores del rinon con una curva de aprendizaje relativamente corta. El material de 3 mm permite realizar la tecnica aunque en nuestra experiencia ha resultado en una mayor tasa de margenes quirurgicos positivos.

Objectives Rescue lymphadenectomy for testicular cancer is a complex surgery, with a high number of complications. The laparoscopic approach appears to offer faster recovery and improved quality of life compared with open surgery. The aim of our study is to report on our experience and to define whether there is a limit (oncological, anatomical or technical) for laparoscopic management. Materials and methods A retrospective study was conducted that included 15 patients who underwent laparoscopic retroperitoneal lymphadenectomy after chemotherapy. In addition to epidemiological and oncologic variables, we analyzed the mean surgical time, intraoperative and postoperative complications, the mean hospital stay and the mean follow-up time. Results The mean surgical time was 294 min (range, 180–240). There were 4 large-vessel vascular lesions, and all of which were large-volume retroperitoneal masses, with diameters >7 cm. The rate of postoperative complications was 33%; there was only 1 case of Clavien > III . The mean hospital stay was 5.38 days (range, 2–9), and the mean patient follow-up was 28.9 months (range, 1–79). There was no recurrence in any of the cases. Conclusions The laparoscopic approach is an oncologically safe option for the rescue treatment of testicular cancer. The complex location of these masses entails the onset of severe intraoperative complications. We have observed a clear relationship between vascular complications and large masses (>7 cm). We therefore believe that it would be appropriate to establish a limit on the size for laparoscopic treatment.

Context Writing skills and the importance of drafting quality are often disregarded. Just as there are guidelines on what each part of a scientific article should comprise (introduction, material and methods, results and conclusion), there are ‘norms’ as to how to draft the article. Novel results can only be appropriately reflected in a formal and structurally correct text. Objective To raise awareness on the correct use of language in all professional areas, and to provide some practical recommendations to avoid the most common errors in our environment. Evidence acquisition We performed a search of the terms ‘scientific style’, ‘scientific language’ and ‘how to write an article’ in the databases of the search engines Medes, Dialnet and Indice Bibliografico Espanol en Ciencias de la Salud (IBECS). We also consulted books on the subject. We then analyzed the characteristics of scientific style and the most common errors observed in scientific texts. Evidence synthesis The characteristics of scientific language are: clarity, precision, brevity, conciseness, fluidity and simplicity. Scientific style avoids: long sentences, a lack of connectors, syntax errors, redundancies, barbarisms, foreignisms, false friends, colloquial expressions, cacophonies, slang, too many gerunds, too many abbreviations, too much use of the passive voice and spelling mistakes, etc. Conclusions The principal characteristics of scientific style are clarity, precision and brevity. When we write articles, we learn through practice, reading and the help of experienced writers.

Context The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. Evidence acquisition Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumor selection, characteristics and indications cited in MEDLINE search were reviewed. Summary of evidence Focal therapy standardized criteria must be: low risk tumors, PSA 15. Conclusions Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.

Resumen Contexto Los tratamientos radicales o de seguimiento activo son alternativas en el manejo del cancer de prostata localizado, ambos no exentos de riesgos y efectos secundarios. El objetivo de este trabajo es analizar las diferentes posibilidades de la terapia focal en sus diferentes opciones para tratar el cancer de prostata localizado. Adquisicion de evidencia Realizamos una revision en Medline de las diferentes posibilidades de tratamiento focal desde el punto de vista tecnico, desarrolladas en la actualidad con atencion a los estudios prospectivos aleatorizados, asi como las formas de seguimiento y evolucion de resultados. Sintesis de evidencia Diferentes tecnicas en este momento estan disponibles para realizar terapia focal, basicamente aquellas minimamente invasivas —terapia vascular fotodinamica (TVF), crioterapia, braquiterapia, ultrasonido focalizado de alta intensidad (HIFU), laser intersticial— que permiten acceso directo y dirigido a la glandula. Los resultados preliminares de los estudios actuales demuestran una buena aceptabilidad de las tecnicas con escasos efectos secundarios y buenos resultados oncologicos. La biopsia junto con la resonancia magnetica nuclear (RMN) son las guias de seguimiento en estos pacientes, siendo el papel del antigeno prostatico especifico (PSA) menos definido. Conclusiones La terapia focal es en la actualidad una alternativa con tecnicas disponibles para una buena ejecucion. Los datos actuales apuntan a una escasa morbilidad y buenos resultados oncologicos que hacen de la terapia focal una posible alternativa de tratamiento en los tumores localizados, a la espera de los resultados de mas estudios aleatorizados.

Resumen Objetivo Analizar los perfiles de expresion genica del cancer de prostata (CaP) e identificar los genes diferencialmente expresados. Determinar si la expresion diferencial en tejido se mantiene en muestras de orina-posmasaje prostatico (PMP). Material y metodos Un total de 46 muestras de tejido prostatico (36 de pacientes con CaP y 10 controles) y 158 orinas-PMP (113 de pacientes con CaP y 45 controles) se recogieron entre diciembre de 2003 y mayo de 2007. Se utilizaron microarrays de ADN para identificar los genes diferencialmente expresados entre las muestras de tejido tumorales y las controles. Diez genes fueron seleccionados para la validacion tecnica de los microarrays en las mismas muestras tisulares mediante PCR cuantitativa (RT-qPCR). Se seleccionaron 42 genes para ser validados en muestras de orina-PMP mediante RT-qPCR. Resultados El grafico de escalado multidimensional mostro una clara separacion entre las muestras de tejido tumorales y las controles. Se han identificado 1.047 genes diferencialmente expresados (FDR ≤ 0,1) entre los 2 grupos. La correlacion entre los datos de microarrays y RT-qPCR fue alta (r = 0,928, p Conclusion Existe un perfil de expresion genica diferencial en el CaP. Aunque la extrapolacion de la expresion genica obtenida en tejido prostatico a orina-PMP se debe realizar con precaucion, el analisis del tejido prostatico permite la identificacion de nuevos biomarcadores para diagnostico no invasivo del CaP.

Androgen deprivation therapy is the standard of care for the initial treatment of metastatic prostate cancer. However, the majority of these patients live long enough to experience disease progression despite castration. This scenario is defined as castration-resistant prostate cancer (CRPC) and has a poor outcome and limited options for treatment. First-line treatment after hormonal therapy failure include secondary hormonal manipulation and docetaxel. Advances in the understanding of the molecular mechanisms underlying CRPC have translated into a recent increase in the number of effective systemic agents, and some of them have been already approved as first and second-line treatment. Despite these advances, the median survival in the first-line setting of metastatic CRPC is approximately 20 months and in the postdocetaxel setting is approximately 15 months. Promising and necessary new therapies in Phase III trials include hormonal agents, new cytotoxics agents, as well as other immunotherapeutics and antiprostate-specific membrane antigen therapies.

Recurrence and progression of T1 grade 3 (T1G3) urothelial bladder carcinomas (UBCs) treated with bacille Calmette-Gu,rin (BCG) are common events, but the long-term follow-up of the disease remains controversial. To evaluate the long-term outcomes of BCG intravesical therapy in relation to disease recurrence and progression in primary T1G3 UBCs and upper tract disease. A single-institution, retrospective, population-based analysis of 316 patients with primary T1G3 UBC treated with transurethral resection (TUR) and BCG induction intravesical instillations was performed. Response was determined and monitored by routine periodic urine cytology, cystoscopy, and upper tract imaging. The median follow-up was 70 months (maximum 210 months). Among all of the tumours, 49.4 % did not relapse, 48.7 % recurred in the bladder during the first 5 years of surveillance, and only 6 patients (1.9 %) recurred after being free of disease during the first 5 years of follow-up. Nineteen percentage of the UBCs progressed to stage T2, and only 2 patients (1.2 %) progressed after the first 5 years of surveillance. An upper urinary tract recurrence was detected in 9.2 % of the patients; 65.5 % were diagnosed within the upper urinary tract during the first 5 years of follow-up. Following a 5-year tumour-free period, there is minimal risk of recurrence and progression in T1G3 UBCs treated with TUR and BCG induction intravesical instillations. This finding supports a less intensive and potentially less invasive surveillance scheme of bladder follow-up and upper urinary tract imaging in patients without any recurrence.

Objectives: To review our experience in robot-assisted radical cystectomy, assessing the complications and oncological and functional results. Materials and methods: From 2007 to 2014, we performed 67 robot-assisted radical cystectomies combined with lymphadenectomy in 61 cases. The operations were performed on 37 patients due to muscle-invasive tumours and on 30 due to high-risk nonmuscle-invasive tumours. Urinary diversion was conducted extracorporeally, using a Studer neobladder in 47 cases. Results: The mean blood loss was 300 nnL. No case required conversion to open surgery. The median number of lymph nodes extracted was 16 (range 3-33). Pathology revealed 16 pT0, 15 pTis,-pT1-pTa and 44 muscle-invasive tumours, 8 pN+ and 1 with positive margins. The mean hospital stay was 9 days. With a median follow-up of 16 months, 9 (13%) patients were readmitted after the discharge, most for infections associated with the vesical catheter and other catheters. Forty patients (59.7%) presented complications (most were Clavien grade 1-2). There was recurrence during the follow-up in 4 cases (6%), and 4 (5.9%) patients died from cancer. Nineteen (28.3%) patients had complications after 30 days, most of which were urinary tract infections. Of the 47 patients with a neobladder, 45 (96%) had proper daytime continence and 42 (89%) had proper nighttime continence. Ninety percent and 64% of the patients with previously normal, sexual function and reduced sexual function, respectively, were able to preserve sexual function with or without drug treatment. Conclusions: Robot-assisted radical cystectomy plus lymphadenectomy, with extracorporeal reconstruction of the urinary diversion, offers good oncological and functional results without increasing the number of complications. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Resumen Objetivo Evaluar la tasa de persitencia, infraestadificacion y complicaciones perioperatorias en pacientes con tumor no musculo-invasivo de alto grado que han sido sometidos a re-reseccion transuretral (re-RTU). Material y metodos Revision retrospectiva de 47 pacientes con estadio clinico de tumor vesical de alto grado no musculo-invasivo sometidos a re-RTU entre enero de 2007 y diciembre de 2009 en nuestro centro. Evaluamos la tasa de tumor residual (persistencia) y de infraestadificacion, asi como las complicaciones quirurgicas y el coste de la re-RTU. Resultados En 22 casos se indico la re-RTU por ausencia de muscular propia en el especimen (cTx). Observamos tumor residual en 8/47 pacientes (17%) e infraestadificacion en 2 casos (4,2%), en los 2 unicos pacientes infraestadificados no se habia observado muscular propia en el especimen de la RTU inicial. Los 20 cTx restantes (90%), fueron cT0 en la re-RTU. No observamos ningun caso de cT1 en los que en la re-RTU apareciera infraestadiaje (≥ cT2). Seis pacientes (12,6%) presentaron complicaciones secundarias a la re-RTU (una estenosis uretral, 2 reintervenciones por sangrado, una infeccion urinaria febril y 2 perforaciones vesicales). Conclusiones En nuestro estudio la ausencia de muscular en el especimen de la RTU es el unico factor de riesgo de infraestadificacion. Es por ello que en estos casos consideramos que la re-RTU es obligatoria. Por el contrario, en los casos donde la RTU ha sido completa y la muscular se encuentra libre de tumor (cTa-T1) creemos que la re-RTU sistematica es innecesaria, solo indicada en casos concretos y mas no estando exenta de complicaciones.

To investigate the existence of predictive factors for concomitant, primary UUT-UCC and BC. Upper urinary tract urothelial cell carcinoma (UUT-UCC) is a pan-urothelial disease of the transitional epithelial cells. Although several studies have shown the association of bladder recurrence following UUT-UCC, little is known on the incidence of concomitant UUT-UCC and bladder cancer (BC) without previous BC. A retrospective review of 673 patients diagnosed and treated for UUT-UCC was performed. Patients with history of BC were excluded. We investigated age, sex, location of the upper tract tumor (calyx, renal pelvis, upper ureter, mid-ureter, lower ureter), multifocality, clinical symptoms, tumor grade and pathological stage. Contingency tables and chi-square test were used for categorical variables and analysis of variance (ANOVA) for quantitative variables. 450 patients eligible for inclusion were identified. Of these, 76 (17 %) presented concomitant primary UUT-UCC and BC. Location of primary UUT-UCC was in calyx and/or renal pelvis in 25 patients (34 %), upper ureter 8 (11 %) and lower ureter 37 (49 %). In 6 patients (8 %), data were missing. Concomitant BC was found in 10, 18, and 33 % of patients with primary caliceal/renal pelvis, upper ureter and lower ureter UUT-UCC, respectively. On multivariate analysis, location of UUT-UCC was the only predictive factor for concomitant bladder tumor (OR: 1.7; 95 % CI, 1.007-2.906 p = 0.047). Our findings suggest that the possibility of concomitant BC in primary diagnosed patient with UUT-UCC is as high as 33 % and mainly depends on upper tract tumor location.

Study Type – Aetiology (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? For patients with high grade (HG) non-muscle invasive urothelial cell cancer (UCC) of the bladder, transurethral resection of bladder tumor (TURBT) in conjunction with induction and maintenance intravesical therapy is a commonly used treatment modality. Early cystectomy, although offering the best opportunity for cure, would in turn constitute overtreatment in some cases. Conservative management strategies, as opposed to radical surgery, are a viable treatment option within a well selected subset of patients with HG T1 UCC. OBJECTIVE • To determine whether a survival difference exists between patients with high grade (HG) cT1 urothelial cell carcinoma (UCC) receiving immediate radical cystectomy (IRC) as opposed to those choosing bladder-sparing therapy. PATIENTS AND METHODS • Between January 1990 and August 2010, 349 patients were retrospectively identified with a diagnosis of HG cT1 UCC of the bladder. Patients were divided into two groups: those who underwent IRC and those treated with conservative management (CM), consisting of transurethral resection of the bladder tumour (TURBT) and intravesical therapy. IRC was defined as surgery within 90 days of HG cT1 diagnosis with no intervening transurethral resection (TUR) or intravesical therapy (IVT). Trends in patient selection and cancer-specific survival (CSS) were analyzed over consecutive decades. • The primary outcome was to compare CSS among patients during consecutive decades whereby management paradigms shifted from IRC to CM. The secondary outcome was to examine whether patient selection changed over time for each respective intervention. RESULTS • One hundred and thirteen patients underwent IRC and 236 had CM. From 1990 to 1999, only 90 patients were diagnosed with HG cT1 disease, and a majority of patients (n= 54) underwent IRC. From 2000 to 2010, only 23% (59/259) of the patients with HG cT1 underwent IRC. Despite 42.3% more patients successfully maintaining their bladder in the long-term, no difference in 5 year bladder CSS was noted between decades (77% vs 80% consecutively, P= 0.566). A subset analysis of risk factors for bladder cancer progression/recurrence demonstrated more patients with lymphovascular invasion (LVI) on TUR underwent IRC in the current era (13/59 (22.0%) vs 13/200 (6.5%), P < 0.001). These findings remain to be validated in prospective work at other institutions. CONCLUSION • Conservative management strategies are a viable treatment option within a well selected subset of patients with HG cT1 UCC.

Bladder cancer is a common disease that is often detected late and has a high rate of recurrence and progression. The current standard of care for the primary detection and follow-up of NMIBC consists of urethro-cystoscopy associated with cytology. However, several clinical risk factors have been claimed to predict recurrence and progression, these factors have a predictive value on a population basis, but no parameter has been found that reliably predicts how an individual patient’s tumor will behave. In the last years many markers have been described in order to decrease the number of cystoscopies and try to provide individualized risk-stratified decision-making. We have focused our review in tumor markers for primary diagnosis, surveillance of non-muscle-invasive bladder cancer, and predicting progression to muscle-invasive disease. After our review, we can conclude that to the date no non-invasive biomarker has proven to be sensitive and specific enough to replace cystoscopy, neither in the diagnosis nor in the follow-up. On the other hand, promising results have been reported of potential biomarkers for predicting recurrence, early progression and poor response to BCG, new studies should be promoted to validate these results and make possible to incorporate markers as a new tool in clinical guidelines.

Some patients with the indication of radical prostatectomy (RP) have often undergone previous surgical treatment for bladder outlet obstruction (BOO). These previous treatments make oncological surgery more challenging because of the difficulty in the identification of bladder neck and ureteral orifices. We present a new technique that entails previous endoscopic marking of bladder neck in order to make radical prostatectomy easier.Twelve men with previous prostatic surgery for BOO underwent a laparoscopic/robotic radical prostatectomy between August 2008 and October 2012. The same technique was performed in all cases, a first circular endoscopic incision (EI) to mark the bladder neck and a second laparoscopic/robotic approach to complete the RP. We analyzed oncological and functional outcomes, as well as complications.Median operative time (EI + RP) was 175 minutes (140-205), being surgical time for endoscopic approach 20 minutes (17-31). No ureteral lesions were described and no ureteral stents were required. Positive margin rate was 8.3%. Only 1 of 5 complications observed needed surgery to be solved. Continence rate was 66.7% at one year of surgery.Our results show that a previous endoscopic bladder neck incision in patients with previous surgery for BOO makes easier the identification and dissection of the bladder neck itself during radical prostatectomy decreasing the risk of ureteral lesions as well as improving functional outcomes.

INTRODUCTION AND OBJECTIVES: It is unusual to diagnose a urothelial cell carcinoma in the intramural ureter based on the visualization of papillae in the ureteral meatus or as an incidental finding during the transurethral resection of a bladder tumour (TURBT) adjacent to the ureteral meatus. We analyse the incidence of stenosis and upper urinary tract tumours (UTUC) after TURBT/excision of the intramural portion of the distal ureter and/or bladder cancer. METHODS: 112 patients, with a mean age of 69.3 13 years and a mean follow-up of 56 4 months, underwent TUR of the intramuralureter and were diagnosed with non-muscle-invasive bladder cancer (NMIBC) at that location: 58% of cases were concomitant with primary tumours. The TUR specimen of the ureteral meatus was always sent separately for histological analysis. In patients with apparent tumour remaining in the distal ureter, ureterorenoscopy was performed at 3e4 months. A double J catheter was left in patients undergoing extensive resection of the trigone area (32.1%). 22.3% and 75.9% of patients received mitomycin and BCG respectively. RESULTS: Pathological examination revealed Ta in 64%, T1 in 22.3% and CIS in 17%.17 patients (15.2%) developed UTUC, which was located in the distal ureter in 65.4%, and 13 (11.6%) a distal ureteral stenosis. The presence of a ureteral catheter did not influence the outcome (23% vs 33%, p1⁄40.45). In univariate analysis, statistically significant differences were observed between primary and recurrent tumours with respect to the incidence of symptoms (60% vs 26%, p 3 cm were associated with a higher likelihood of development of distal ureteral stenosis and CIS of the intramural portion increased the risk of UTUC. Closer follow-up of should be undertaken since these factors are associated with a higher incidence of upper urinary tract problems.

This systematic review in this month’s issue of European Urology offers a very good overview of the diagnosis and management of carcinoma in situ (CIS) of the lower urinary tract [1]. Since CIS of the bladder was identified as a flat, highgrade lesion confined to the mucosa, we have learned much about its natural history, diagnosis, and management; however, some aspects of understanding and treatment still need to be improved to detect and obtain better results for our patients. CIS of the bladder is commonly associated with highgrade bladder disease, both non–muscle invasive and muscle invasive, but it can also be associated with lowgrade disease [2]. In non–muscle-invasive disease, approximately 45–71% of patients are disease free after intravesical bacillus Calmette-Guerin (BCG) treatment, and the rate of progression to muscle-invasive disease is 14–22% [3]. There are important discrepancies in data on the incidence of CIS in primary non–muscle-invasive bladder cancer (NMIBC). According to the European Organisation for Research and Treatment of Cancer (EORTC), the incidence is 1500 patients with primary NMIBC, all of whom underwent multiple bladder biopsies, the incidence of CIS was 19% [2]. The same group observed a 15% incidence of CIS for the period from 2000 to 2008 (unpubl. data). There are no published data on the variation in incidence among areas or onwhich factors may influence the differences, but it remains the case that whenever multiple biopsies of the bladder are routinely done, the incidence is higher and may influence clinical decision making. According to the international guidelines, mapping or random bladder biopsies are not routinely recommended in patients with TaT1 tumors because of the low likelihood of detecting CIS unless there is positive cytology or suspicious areas in the bladder [4]. The discrepancies regarding the incidence may arise from various sources, including whether preoperative urinary cytology is routinely performed, the nature of the population studied, the presence of local risk factors, whether multiple biopsies of the bladder are routinely performed to search for CIS, whether adjuvant tools are used in the diagnosis (photodynamic diagnosis) [4], and differences in pathologist or uropathologist interpretation. Thorstenson et al [5] presented their results in a series of 538 patients, 61% of whom underwent multiple bladder biopsies. Among the latter patients, 14% were diagnosed as having concomitant CIS. Ultimately, better results were obtained in this subgroup of patients because most of them received BCG or upfront cystectomy. It may be concluded that this subgroup had better cancer-specific survival because of the knowledge that CIS was present. Good communication between urologists and pathologists is important to evaluate results regarding the detection of CIS in their own series; it has been demonstrated in bladder cancer that the staging results may vary when evaluation is performed by referral to uropathologists [6]. Urologists should always request urinary cytology before transurethral resection (TUR) of a primary tumor; if cytology is positive, theymust proceed tomultiple biopsies, including of the prostatic urethra [4]. This should also be done when suspicious areas are seen during TUR of bladder tumor. The classification of CIS, which is useful to determine some distinct groups, is not really relevant to clinical decision making, even though various studies have shown concurrent CIS to have a worse prognosis than primary CIS. In a series of 90 patients with CIS, Meijer et al [3] reported a EU RO P E AN URO L OG Y 6 7 ( 2 0 1 5 ) 8 8 9 – 8 9 0

Involvement of the prostatic urethra by bladder cancer directly impacts prognosis, risk of urethral recurrence, and timing of radical cystectomy (RC); it also affects the type of urinary diversion chosen. Both cold cup biopsies and transurethral (TUR) loop biopsies have been used to evaluate the status of the prostatic urethra. We report our 20 year experience with preoperative and intro-operative prostatic urethral biopsies in order to determine relative efficacy and associated treatment implications.The Columbia University urologic oncology database was reviewed and yielded 234 men who underwent preoperative endoscopic biopsies of the prostatic urethra before RC between 1990 and 2010. Two techniques were described: 1) cold cup biopsy, and 2) TUR loop biopsy. We evaluated the sensitivity, specificity, and predictive values for these respective techniques relative to the final pathological status of the prostatic urethra (PU) in the RC specimen.Of the 234 urethral biopsies 115 (49.1%) were cold cup and 96 (41.1%) were TUR loop biopsies. In the remaining 9.8% of patients, the technique could not be determined. Eighty-one preoperative biopsies (34.6%) revealed involvement of the urethra. No differences were observed in predictive values, sensitivity, and specificity between the two preoperative techniques. The negative predictive value (NPV) was higher than positive predictive value (PPV) for both preoperative approaches. Thirty-eight patients (16.2%) had a urethral frozen section analysis done intra-operatively. Only 1 patient (3%) had an abnormality on frozen section, being the negative predictive value (NPV) higher than the positive predictive value (PPV) for the test's ability to predict the status of the final urethral margin. Urethrectomy was performed at cystectomy in 52 patients with a positive biopsy; 15 (28.8%) of these patients ultimately had a negative PU on final pathology. Only 2/182 (1%) of the patients with an intact urethra presented with a urethral recurrence with a median follow up of 30.5 months.Preoperative prostatic urethral biopsy does not adequately predict final prostatic urethral status at radical cystectomy. No differences in predictive capacity could be detected with either cold cup biopsy or TUR biopsy. Intra-operative biopsy of the prostatic urethra is predictive of a negative urethral margin. Simultaneous radical urethrectomy should not be performed based up on preoperative prostatic urethral biopsy results alone.

Objective: To analyze gene expression profiles of prostate cancer (PCa) with the aim of determining the relevant differentially expressed genes and subsequently ascertain whether this differential expression is maintained in post-prostatic massage (PPM) urine samples. Material and methods: Forty-six tissue specimens (36 from PCa patients and 10 controls) and 158 urine PPM-urines (113 from PCa patients and 45 controls) were collected between December 2003 and May 2007. DNA microarrays were used to identify genes differentially expressed between tumour and control samples. Ten genes were technically validated in the same tissue samples by quantitative RT-PCR (RT-qPCR). Forty two selected differentially expressed genes were validated in an independent set of PPM-urines by qRT-PCR. Results: Multidimensional scaling plot according to the expression of all the microarray genes showed a clear distinction between control and tumour samples. A total of 1047 differentially expressed genes (FDR

and 2009 archived at our institution. A total of 330 patients with initially diagnosed NMIBC were identified. The use of antihypertensive drugs at TUR-BT was reviewed focusing on the use of RAS inhibitors and other agents (calcium-channel blockers, ƒA-blockers, and diuretics). We retrospectively investigated the clinical outcomes following TUR-BT in patients who did or did not administer RAS inhibitors. The median follow-up period was 4.1 years. RESULTS: A total of 128 patients (38.8%) experienced subsequent tumor recurrence during follow-up. One hundred sixteen patients (35.2%) received medications for hypertension at TUR-BT. Fifty-one patients (15.5%) had received ACEI or ARB administration. Multivariate analysis demonstrated that tumor multiplicity, the absence of BCG instillation, and no ACEI or ARB administration (P 0.010 HR 2.26) were independent risk factors for subsequent tumor recurrence. The 5-year recurrence-free survival rate was 78.4% in patients administered ACEIs or ARBs, and 53.3% in their counterparts (p 0.011). CONCLUSIONS: The absence of RAS inhibitor administration was an independent risk factor for subsequent tumor recurrence in patients with initially diagnosed NMIBC. Our data supports further investigation of the RAS inhibitors as a potential therapy to decrease tumor recurrence in NMIBC.

Radical cystectomy with lymphadenectomy and urinary diversion is the gold standard treatment for bladder cancer in organ-confined muscle-invasive disease and selected patients who have high-grade non-muscle-invasive disease or are non-responders to BCG. The main and most morbid complications of this challenging surgery are related to the use of bowel for urinary tract reconstruction. For this reason, many past projects were devoted to finding an alternative to the use of bowel. The aim of this review is to provide a summary of the evolution of alloplastic bladder substitution. A comprehensive review of the literature was performed using the Medline National Library of Medicine database and Google Scholar. Keywords used were cystectomy and intestine/bowel, replacement, bladder substitution, organ replacement, artificial bladder, alloplastic material, biomaterial, and tissue engineering. Various prostheses have been proposed for replacement of the urinary bladder, silicone being the most frequently used material. The first published model of an alloplastic bladder was described by Bogash et al. in late 1959, while the last, in 1996, was suggested by Rohrmann. Interprofessional collaboration, recent advances in technology, and tissue engineering may help in developing suitable bladder prostheses. Urologists as well as engineers and the industry need to give this matter serious attention.

Objectives: Evaluate the rate of residual tumor, understaging and perioperative complications in patients with high grade non-muscle-invasive bladder cancer who underwent second transurethral resection (re-TUR). Material and methods: A retrospective review of 47 patients with high grade non-muscle-invasive bladder cancer who underwent second TUR from January 2007 to December 2009 at our institution. We evaluated the rate of residual tumor and understaging detected by re-TUR, complications, and the cost of the surgery. Results: Twenty-two patients underwent second TUR because of the absence of muscle in the initial resection specimen (cTx). We observed residual disease in 8/47 patients (17%) and understaging in 2 cases (4.2%), the only 2 patients understaged muscularis propria was not present in the sample of initial TUR. The other 20 cTx (90%) were cT0 in the re-TUR. We did not identify any case of cT1 understaged in the re-TUR (>= cT2). Six patients (12.6%) reported complications related with the second TUR (one urethral stricture, two patients required reintervention because of bleeding, one febrile urinary infection and two bladder perforations). Conclusions: Our findings show that the absence of muscle in the initial resection specimen is the only risk factor for understaging. Therefore, we consider re-TUR is mandatory in these cases. On the other hand, when complete TUR has been performed and the muscularis propria is present and tumor free (cTa-T1), we consider systematic re-TUR is not necessary and only indicated in selected patients, even more if we consider that re-TUR is not exempt from complications. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.

To determine which patients may benefit from prostate-sparing surgery and which factors are predictive of invasive prostatic involvement.A total of 717 men underwent radical cystoprostatectomy (RC) for bladder transitional cell carcinoma (TCC) between 1978 and 2002. Analysis of prostatic urethral involvement by transitional cell carcinoma (pTCC) and of invasive prostatic involvement by TCC was performed according to recurrence, presence of carcinoma in situ (CIS) and multifocality, previous intravesical chemotherapy, grade, stage and location of bladder tumor, presence of CIS in precystectomy transurethral resection (TUR) and indication for RC.pTCC was present in specimens from 140 patients (19.5%), of whom 83 (59.3%) showed invasive prostatic involvement. Tumor location at the trigone or bladder neck (p = 0.011, OR 2.29, 95% CI 1.21-4.33) and a history of CIS (p = 0.003, OR 2.03, 95% CI 1.27-3.22) were independent predictors of pTCC. Presence of a solitary T2-T3 bladder tumor was a predictive factor for invasive prostatic involvement (p = 0.001, OR 3.73, 95% CI 1.70-8.16). Neither solitary tumors nor T2-T3 bladder tumors showed significant differences in 5 year specific survival (p = 0.277 and p = 0.618 respectively) when comparing patients according to the presence of superficial or invasive prostatic involvement. Bladder tumor stage in precystectomy TUR was a predictor of disease-specific survival (p = 0.018, OR 1.62, 95% CI 1.08-2.44).Patients with a history of CIS and bladder tumor location at the trigone or bladder neck are not candidates for prostate-sparing surgery. The only variables that can predict invasive prostatic involvement are the presence of a solitary T2-T3 bladder tumor at the trigone or bladder neck.