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The extensive use of prostate-specific antigen (PSA) testing and improved imaging technologies have resulted in an increased diagnosis of prostate cancer. Early diagnosis is often accompanied by an increased number of localized (i.e. unifocal or unilateral), small-volume and low-grade prostate cancers. Focal therapy is an emerging treatment option in prostate cancer, targeting individual cancer areas while sparing important functional and anatomical urological structures. Irreversible electroporation is an innovative treatment modality in focal therapy based on the process of cell membrane electroporation limiting damage to adjacent tissue and vital structures. The first phase I-II trials in humans have shown the safety of IRE for focal ablative therapy of prostate cancer and showed encouraging results considering functional preservation. Histological analysis after IRE showed fibrosis without glandular ducts and necrotic tissue with sharp demarcation between unaffected prostatic glandular tissue and the ablation zone. Short-term oncological results are promising; however more data on long-term oncological outcomes are necessary. New studies with IRE and other focal treatment modalities are initiated to explore opportunities for focal therapy in prostate cancer and to optimize current treatment protocols.

Bladder cancer is one of the most frequents pathologies in urology. The introduction of the laser among the technical tools supposed a great advance, but the initial results with the first model failed with the expectations. Nevertheless, nowadays we have at our disposal a great variety of laser for urological use, with different functions and applications. We perform a review and try to assess the actual indications for its employment in the treatment of bladder cancer, as well as future applications.

Objectives: To determine the clinical utility of free/total PSA ratio and PSA density in the early diagnosis of prostate cancer (patients with serum PSA between 4 and 10 ng/ml) and to determine the differences, if any, in the free/total PSA ratio in patients with cancer and those with benign prostatic hyperplasia (BPH)., Methods: A prospective and descriptive study was conducted on 61 patients with low grade obstructive symptoms and total serum PSA between 4 and 10 ng/ml (group 1), and 42 patients who underwent prostate surgery and had an anatomopathologically confirmed diagnosis of BPH (group 2). Free and total PSA were determined, as well as prostate volume by transrectal US, in all cases. Prostate biopsy was performed in all patients with a total PSA value between 4-10 ng/ml. The sensitivity, specificity, positive and negative prognostic values of free/total PSA ratio and PSA density were analyzed., Results: The mean age of the patients in group 1 was 67.7 years and 68.3 years in group 2. The mean prostate volume by US was 55.2 and 47.1, respectively (n.s.). The mean total PSA was 6.39 ng/ml for group 1 and 5.73 ng/ml for group 2 (n.s.). No significant difference was found between the mean free PSA values of both groups. However, the free/total PSA ratio and PSA density were significantly different (p < 0.000). In group 1 (total PSA 4-10 ng/ml), prostate biopsy was positive in 32.8% of the patients. In this group of patients, there were no significant differences in the parameters analyzed. Application of different cutoffs for both tests showed a higher clinical utility for the 0.24-0.30 range., Conclusions: At similar mean prostate volume and mean total PSA, significant differences were found in the free/total PSA ratio and PSA density of patients submitted to surgery for BPH and those with a total PSA value of 4-10 ng/ml. However, these results were not observed when patients with PSA of 4-10 ng/ml were analyzed for presence or absence of evidence of malignancy in the prostate biopsy.

Objectives: To determine the need for nephrectomy prior to renal transplantation in patients with adult polycystic renal disease., Methods: We reviewed the records of 54 (31 females, 23 males) of 62 patients with polycystic renal disease that had been treated at our center from 1951 to 1994. Eight of the earlier cases, whose complete clinical data were unavailable, were excluded from the study. The patients were classified into three groups: nephrectomized transplanted, nephrectomized non-transplanted and non-nephrectomized transplanted patients., Results: No patient had required nephrectomy due to a tumor. No surgical difficulty during transplantation had been reported in the non-nephrectomized patients. Nephrectomy had been performed in most of the cases for hematuria or preparatory to renal transplantation. The infections complications (11.76%) were resolved with antibiotic therapy., Conclusions: In the absence of renal tumor and given the low prevalence of complicated cysts, in our view it is unnecessary to perform nephrectomy routinely prior to renal transplantation in patients with adult polycystic renal disease. Nephrectomy should be reserved for cases with severe cystic complications, such as severe intracystic hemorrhage, hematuria causing anemia, pyonephrosis, or patients with grossly enlarged kidneys in whom we suspect that technical difficulties might arise at the time of transplantation.

With the advent of laparoscopic lymphadenectomy, attention has been focussed again to the perineal approach for cancer of the prostate. The high rate of postoperative impotence and the abdominal incision required had made radical perineal prostatectomy unpopular. From August 1990 to July 1991, 76 patients with localized prostate cancer were surgically treated at the University of St. Louis. These patients were divided into three groups; group A comprised 26 patients who were submitted to laparoscopic lymphadenectomy and radical perineal prostatectomy, group B comprised patients treated by laparoscopic lymphadenectomy and radical retropubic prostatectomy, and group C or controls underwent open lymphadenectomy and radical retropubic prostatectomy. Fifty-three patients were sexually potent preoperatively but only 20 (7 from group A, 5 from group B and 8 from group C) were considered for preservation of the neurovascular bands. All the patients were followed for a minimum of one year. Comparison of these three groups revealed significant differences for perioperative bleeding and postoperative hospital stay in favor of Group A. The overall stress incontinence rate was 5.3% and the complications ranged from 4.1% for group C and 29.1% for group B. The postoperative sexual potency ranged from 57% for group A to 75% for group C, the differences not being statistically significant. Radical perineal prostatectomy is as valid as radical retropubic prostatectomy for localized prostatic cancer and has the advantages of less bleeding and a faster recovery, particularly if combined with laparoscopic lymphadenectomy.