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To evaluate the relevance of tumour size in adrenal tumours in the estimation of malignancy risk and in the outcomes of adrenalectomy.We evaluate the histological results and surgical outcomes (intraoperative and postsurgical complications) in a retrospective single-centre cohort of patients without history of active extraadrenal malignancy with adrenal tumours consecutively operated in our centre during January 2010 and December 2020. We compared these results in lesions smaller and larger than 40, 50, and 60 mm.Of 131 patients with adrenal tumours who underwent adrenalectomy, 76 (58.0%) had adrenal masses measuring ≥ 40 mm; 47 were 50 mm and 28 60 mm. The final diagnosis was adrenocortical carcinoma (ACC) in 7 patients, pheochromocytoma in 35, and benign lesions in the remaining. All patients with ACC had adrenal masses 50 mm, with Hounsfield units 40 and low lipidic content in the CT. The risk of ACC and pheochromocytoma increased as tumour size did. The diagnostic accuracy of tumour size was quite good for the prediction of ACC (AUC-ROC 0.883). Nevertheless, when only adrenal tumours with HU 40 were considered, the risk of ACC was 0% independent of tumour size. For pheochromocytomas, the risk was of 8.6% independent of tumour size for lesions with 20HU. The risk of intraoperative and postoperative complications was independent of tumour size.Risk of malignancy and of pheochromocytoma increased as tumour size increased, but, in the presurgical estimation of malignancy risk and of pheochromocytoma, not only tumour size, also lipidic content and other radiological features, should be considered. The risk of complications was independent of tumour size, but hospital stay was longer in patients with complication or open approach.

OBJECTIVE To provide latest findings of Urologic Oncology on prostate, kidney, and bladder cancer, and analyze its impact on clinical practice as well as future schemes in the medium- and long-term. METHODS This document reviews the abstracts on Uro-Oncology presented at the 2020 Congresses (EUA, AUA, ASCO, ESMO and ASTRO), the publications with the highest impact and especially the new lines of development and progress in Uro-Oncology evaluated by the OncoForum committee. RESULTS The use of prostate-specific membrane antigen (PSMA) radioligands in the diagnosis of prostate cancer may have great potential and utility in the coming years due to their improved sensitivity and specificity. The genetic characterization of the tumor is important at both, germline and somatic levels, due to the significant role of BRCA2 mutations regarding risk. The cohort multiple randomised controlled trial is the most suitable study design at the genitourinary cancer level. The application of big data will lead to process improvements, savings in healthcare costs, and an empowerment of real-life studies through ease of data comparison, management, and storage. CONCLUSIONS The use of new diagnostic techniques with PSMA ligands will provide a more comprehensive diagnostic modality, increase the number of studies about tumor genetic profiling, and enhance their quality. The practical application of artificial intelligence will improve the treatment genitourinary cancer.

Background Xanthogranulomatous pyelonephritis (XGP) is an inflammatory condition of the kidney and its treatment most often involves a combination of antibiotics and nephrectomy. This study aimed to define the clinical features and management of XGP, focusing on microbiological aspects and antibiotic therapy. Methods We performed a retrospective study of 27 cases of XGP diagnosed between January 2001 and January 2020 to analyse their clinical and management characteristics. In addition, a literature review was conducted of XGP case series covering the period from 2000–2020. We searched PubMed for case series through April 2020 without language restrictions. Studies reporting case series of XGP (more than ten cases) were included if they were relevant to this study. Results Twenty-seven patients were diagnosed with XGP, and 26 of them were histologically proven to have XGP. A total of 81.5% of the patients were female and the mean age was 59.6 years (SD 19.2). The most frequent symptoms were flank pain (70.4%) and fever (59.3%), while 77.8% of patients had renal stones. Proteus mirabilis was detected in the urine culture in 18.5% of patients, followed by detection of Escherichia coli in 14.8% of patients. The computed tomography (CT) findings included perirenal (29.6%) or pararenal (29.6%) involvement in the majority of patients. Twenty-six patients underwent nephrectomy. Piperacillin/tazobactam and ceftriaxone were the most commonly prescribed antibiotics for treatment. The reported piperacillin/tazobactam and ceftriaxone resistance rates were 14.3% and 16.6%, respectively. Twenty-six case series were included in the literature review, reporting 693 cases in total. Conclusion We found well-established characteristics of XGP patients among series in terms of previous history, clinical, laboratory and imaging findings, and operative and postoperative outcomes. It is important to know the clinical presentation and potential severity of XGP, as well as the most frequently involved microorganisms and their antibiotic resistance profiles, to select the most appropriate antibiotic therapy.

Review the latest evidence on urologic oncology on kidney, bladder and prostate tumors.Abstracts on kidney, bladder and prostate cancer presented at the 2019 congresses (EAU, AUA, ASCO and ESMO) and the publications with the greatest impact in this period, with the highest evaluation by the OncoForum committee, are reviewed.In patients with metastatic kidney cancer, regimens including immunotherapy (nivolumab + ipilimumab, pembrolizumab) have been shown to be superior to sunitinib in terms of survival. In patients with non-muscle invasive bladder cancer, pembrolizumab has been shown to be an effective alternative in those refractory to bacillus Calmette-Guérin, while in patients with metastatic urothelial cancer, third-line enfortumab vedotin achieved a significant response rate (44%). In patients with localized prostate cancer (PCa), ultrafractionated external radiotherapy did not show any greater acute toxicity than fractionated or hypofractionated radiotherapy. The benefit of enzalutamide and apalutamide associated with castration has been confirmed in M1 PCa patients, regardless of disease volume. In patients with castration-resistant M0 PCa, treatment with enzalutamide, apalutamide or darolutamide has been associated with a delay in the occurrence of metastasis and prolonged survival. Cabazitaxel has demonstrated a survival benefit in patients with metastatic CRPC, while olaparib showed anti-tumor activity after chemotherapy in those tumors with mutations in DNA repair genes.These data show the implementation of immunotherapy as a novel alternative against renal and bladder cancer. The arrival of new agents for advanced urothelial carcinoma should be highlighted, and the efficacy of enzalutamide and apalutamide in de novo metastatic prostate cancer is established. In metastatic CRPC, cabazitaxel and olaparib (targeting mutations) are promising therapeutic options.

Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for apical pelvic organ prolapse (POP). Artificial urinary sphincter (AUS) has a high success rate in treating recurrent stress urinary incontinence (SUI).To describe the first simultaneous LSC and AUS implantation through a vesicovaginal approach to the bladder neck.Operation is performed through a transperitoneal approach. The rectovaginal space is created and the posterior mesh is fixed. The vesicovaginal and both laterovesical spaces are dissected. The vesicovaginal space is connected to both lateral spaces. This is main step of the procedure because it let us place the cuff around the bladder neck in a non-blind fashion. The anterior mesh is fixed to the vagina. The anterior side of the bladder neck is dissected and the cuff implanted. Both meshes are fixed to the promontory. Pressure-regulating balloon is inserted, the pump is placed in the labia majora and the components are connected. Peritoneum is closed.Surgical time was 180 minutes, bladder catheter was removed at 5th postoperative day, hospital stay was 5 days. The AUS was activated 6 weeks after surgery. No perioperative complications occurred. After 12 months the patient is pad-free and prolapse was objectively and subjectively cured.Vesicovaginal dissection is a shared step in this technique of LSC and AUS implantation. This approach could minimize the risk of bladder neck injury. We propose this technique in selected cases of prolapse and recurrent SUI.

Penile prosthesis implantation is a good option for the treatment of refractory erectile dysfunction. However, the patient's expectations, among other factors, condition his satisfaction after surgery. This review article aims to present the scientific evidence available concerning patient satisfaction with penile prosthesis surgery.

To evaluate the incidence, clinical presentation and factors associated with the development of urinary sepsis after performing ureterorenoscopy.Retrospective study of patients undergoing ureterorenoscopy for the treatment of lithiasis between July 2015 and October 2017. Patients who developed urinary sepsis during the 30 days following the intervention were identified. Personal, clinical, surgical and microbiological backgrounds were collected. Statistical analysis was performed with the Chi squared test (or Fisher's exact test), Student's t (or U Mann-Whitney) or logistic regression as appropriate.246 ureterorenoscopies were performed, 184 (74.8%) on ureteral stones and 62 (25.2%) on kidney stones, with a mean age of 52 (44.5-59.5) years. After procedure, 18 (7.3%) patients developed urinary sepsis, 10 of them (55.5%) occurred in the first 24h. The urine culture showed enterobacteria (61.1%) and enterococci (38.9%). The antibiogram showed greater sensitivity to nitrofurantoins (100%) and quinolones (72%). The statistical analysis showed that female sex, the clinical debut of urolithiasis as urinary sepsis, having received antibiotic or having required urinary diversion by a double J during debut, positive presurgical uroculture and the persistence of residual lithiasis after surgery were significantly associated (P.05) with the development of urinary sepsis after ureterorenoscopy.Urinary sepsis is a complication that appears after performing ureterorenoscopy, especially in female patients with a history of urinary sepsis, antibiotic therapy, double J, previous positive urine culture or residual lithiasis after the procedure.

To put forth new findings of urologic oncology with impact on clinical practice presented during 2017 in the main annual meetings.This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee.Among patients at high risk of recurrent renal cell carcinoma after nephrectomy, adjuvant sunitinib compared to placebo showed a benefit in patients at higher risk of recurrence. In cisplatin-ineligible advanced urothelial cancer, pembrolizumab elicits clinically meaningful, durable responses. Among patients with localized prostate cancer, treatment for disease progression was less frequent (absolute difference, 26.2 percentage pontis) and adverse events was more frequent with surgery than with observation. Among patients with locally advanced or merastatic prostate cancer, androgen-deprivation therapy plus abiraterone and prednisolone resulted in fewer deaths and fewer treatment-failure events (P.001). Among patients with metastatic castration-resistant prostate cancer previously treated with abiraterone acetate, enzalutamide median radiographic progression free survival was 8,1 months and enzalutamide median overall survival was not reached.Among patients at high risk of recurrent renal cell carcinoma after nephrectomy, adjuvant sunitinib showed a benefit across subgroups including patients at higher risk of recurrence. Among patients with localized prostate cancer, surgery was not associated with significantly lower all-cause or porstate-cancer mortality than observation. Among patients with locally advanced or merastatic prostate cancer, androgen-deprivation therapy plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than androgen-deprivation therapy alone. In patients with metastatic castration-resistant prostate cancer previously treated with abiraterone enzalutamide remained active.

The artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck.We present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12mm infraumbilical trocar. The connections were externalised through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection.Surgery time: 140 and 135minutes, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72h. At 3 and 9 months the patients were fully continent.We present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.

Background Delayed graft function (DGF) negatively impacts graft survival. Expanded criteria donors (ECD) show a higher rate of DGF. Hypothermic machine perfusion (HMP) has shown a DGF decrease and an increase of survival at 1 year. Several authors found that renal resistance (RR) at the end of machine perfusion was an independent risk factor for the development of DGF and poorer graft survival. The objective of this study was to analyze HMP results in the context of an ECD program and assess the impact of donor parameters and resistance index (RI) during perfusion in graft survival after kidney transplantation. Methods Donor age, terminal creatinine, machine perfusion time, percentage of glomerulosclerosis, and RI at the end of the perfusion were considered as risk predictors. Univariate and multivariate Cox regression analysis was constructed to find independent risk factors of DGF. Finally, diagnostic validity for RR was determined by sensitivity, specificity, and positive and negative predictive values. Results Twenty-three percent of patients developed DGF. We found no difference in the ability of flow or RI to predict the development of DGF. The predictive accuracy of RI for DGF by receiver operator characteristic curve was poor, with a c-statistic of 0.66 (95% CI, 0.50–0.81; P = .046). Our analysis did not identify risk factors that predicted graft survival at 1 year. Patient and graft survival were 98.8% and 89.7%, respectively. Conclusions HMP has reduced the rate of DGF in our cohort of recipients of ECD grafts compared with historical data (23.3% vs 38.0%). Analysis did not identify risk pretransplant factors for graft survival at 1 year.

To put forth new findings of urologic oncology with impact on clinical practice presented during 2016 in the main annual meetings.This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee.In High-Risk Renal-Cell carcinoma after nephrectomy, disease-free survival was significantly greater for sunitinib than placebo group, with adverse events more frequents. In locally advanced and metastatic urotherial carcinoma patients, aletozumab achieved overall response rate in all subgroups of patients, included poor prognostic. In localized prostate cancer, the difference of prostate-cancer-specific mortality among active monitoring, radical prostatectomy and external-beam radiotherapy was not significant (P=0,48). In TERRAIN study, with castration-resistant prostate cancer patients, adverse events was reported in 31% and 23% of patients treated with enzalutamide and bicalutamide, respectively. Moreover, enzalutamide significantly improved median progression-free survival (15.7 months) compared bicalutamide (5.8 months) (P.0001). In SRTIVE study, Enzalutamide reduced the risk of progression or death by 76% compared with bicalutamide (P.001).In high-risk renal-cell carcinoma after nephrectomy, sunitinb has been considered as treatment choice. In localized prostate cancer, prostate-cancer-specific mortality was low irrespective of the treatment assigned (active monitoring, radical prostatectomy and external-beam radiotherapy). In metastatic castration-resistant prostate cancer new results of treatment with enzalutamide and abiraterone has been published, wich have been shown beneficial effects in metastatic and no metastatic patients.

In the recent years, more than 60% of available deceased donors are either older than 50 yr or have significant vascular comorbidities. This makes the acceptance and rejection criteria of renal allografts very rigorous, especially in cases of younger recipients, and at the same time encourages live donations. In our country, there is a lack of homogeneity in the percentages of use of expanded criteria donor (ECD) allografts between the different autonomous communities. Furthermore, the criteria vary greatly, and in some cases, great importance is given to the biopsy while in others very little. In this study, we present a unified and homogenous criteria agreed upon by consensus of a 10-member Panel representing major scientific societies related to renal transplantation in Spain. The criteria are to be used in accepting and/or rejecting kidneys from the so-called ECDs. The goal was to standardize the use of these organs, to optimize the results, and most importantly to provide for the maximum well being of our patients. Finally, we believe that after taking into account the Panel's thorough review of specific scientific literature, this document will be adaptable to other national renal transplant programmes.

Objective To assess the long-term results and complications of pelvic organ prolapse treatment with transvaginal mesh. Study design Prospective observational study of 75 women who underwent surgery between 2005 and 2008 by the same surgeon. 44 patients (58,7%) underwent concomitant treatment of stress urinary incontinence. Anatomical criterion for failure was prolapse grade >I in any compartment. Analysis of functional features consisted of an assessment of urinary, sexual, and defecation symptoms, and pelvic pain. Subjective global evaluation of the treatment was carried out through the Visual Analogue Scale (VAS). Analysis of the early and late complications and their medical or surgical management was performed. Evaluation of risk factors for failure of treatment and extrusion was carried out through logistic regression. Results The median follow-up was 5,3 years. The anatomical results showed correction in 91,3% of the patients. Median subjective VAS evaluation: 9/10. Urinary symptoms improved after the surgery. Constipation and dyspareunia rates worsened. Pelvic pain improved. There were two early complications: one rectal perforation, repaired intraoperatively and one pulmonary embolism, managed medically. Late complications: 9 extrusions (3 managed with topical oestrogen, 3 with expectant management, and 3 reoperated, one twice), one cervix elongation and one forgotten gauze (both reoperated), 4 de novo pain managed successfully conservatively. 58,8% of the complications occurred after one year. Risk factors analyzed showed no statistical significance. Conclusions Vaginal mesh provides favorable anatomical, functional and subjective outcomes in long-term follow-up. The number of complications is relatively low, but many complications occurred a long-time after surgery.

Analysis of the results of patients who had been operated of renal cell carcinoma with vascular invasion in our institution, evaluation of prognostic factors and complications.Retrospective observational study of 37 patients diagnosed of renal cell carcinoma with vascular invasion operated between May 1999 and July 2013. We used the method of Kaplan-Meier survival analysis and the Mantel-Haenszel's test (log rank) and the Cox's proportional hazards analysis test to analyse the risk factors of mortality.The median age was 60 years. Mean follow-up period was 42.1 months. The median overall survival and disease-free survival were 53.8and 36.3 months, respectively. There was statistical association between overall survival and ASA (p=0.047), tumor stage (p=0.003), lymph node involvement (p=0.024), presence of metastases (p=0.013), level of tumor thrombus (p=0, 05) and histological type (p=0.001). 14 patients had grade IIIb complications or higher according to the Clavien Dindo classification, the most frequent was bleeding.Renal cell carcinoma with vascular invasion is a disease with high rate of mortality. Surgery is a therapeutic option that can be curative. The number of complications is important. Survival is conditioned by the ASA, tumor stage, the level of tumor thrombus, lymph node involvement, metastasis and histological type.

To review the latest evidence on the oncologic urology of prostate, renal and bladder tumours, analysing their impact on daily clinical practice and future medium to long-term regimens.We review the abstracts on prostate, renal and bladder cancer presented at the 2015 congresses (EAU, AUA, ASCO, ESMO y ASTRO) that received the best evaluations by the OncoForum committee.Cabozantinib could represent a new second-line (or subsequent) treatment option for patients with advanced renal cancer. In muscle-invasive bladder cancer, the genetic expression profile could predict the clinical benefit of neoadjuvant therapy in treating urothelial tumours. In metastatic castration-resistant prostate cancer, results were presented from various studies that evaluated the addition of chemotherapy to standard treatment with androgen deprivation, showing a reduction in the progression risk and higher PSA response rates.New options for the second-line treatment of renal cancer were presented. In metastatic castration-resistant prostate cancer, various studies have been published on treatment with enzalutamide, which has been shown to delay the symptomatic disease and benefit overall survival.

To review the latest evidence on the oncologic urology of prostate, renal and bladder tumors, analyzing their impact on daily clinical practice and the future medium to long-term regimens.We review the abstracts on prostate, renal and bladder cancer presented at the 2014 congresses (European Association of Urology, American Urological Association, American Society of Clinical Oncology and American Society for Radiation Oncology) that received the best evaluations by the OncoForum committee.The committee considered the following messages important: cytoreductive nephrectomy followed by treatment with a tyrosine-kinase inhibitor can significantly increase the overall survival of patients with metastatic renal cancer; for advanced bladder cancer, early adjuvant chemotherapy after cystectomy is preferable because it significantly increases progression-free survival; and several studies have shown that multiparametric magnetic resonance imaging and fusion imaging improve the diagnosis of prostate cancer and provide greater possibilities for placing patients in the appropriate risk group in order to offer them the best treatment possible. The results of the PREVAIL study have demonstrated the efficacy of enzalutamide on the overall survival of men with castration-resistant prostate cancer and metastases, with no prior chemotherapy. The study also demonstrated the drug's favorable safety profile.Progress is continuing in renal and bladder cancer, improving the approach and clinical results with current therapeutic options. There is constant progress in castration-resistant prostate cancer; in 2014, prechemotherapy treatments were consolidated.

To present the new findings in oncologic urology with impact on clinical practice which were displayed at 2013 major annual meetings (EAU, ESTRO, AUA, ASCO and ASTRO).The abstracts on prostate kidney, bladder and upper tract urothelial cancer with the highest scores by the OncoForum committee, presented in 1013 Congresses are included in this paper.the following messages were considered as important by the OncoUrology Forum committee. In renal tumors T1a, comorbidities should be evaluated by its impact on overall and specific cancer survival, especially in men over 65. In metastatic renal tumors, the benefit of Everolimus vs. Sunitinib has not been demonstrated. Patients with non-muscle invasive bladder cancer of high risk, with three or more risk factors, should be considered for radical cystectomy. The ERSPC study' data demonstrate the benefit of the systematic screening in prostate cancer. In metastatic disease, the results of the Ra-223 and enzalutamide studies show benefit in pain control and overall survival in metastatic disease.Localized renal and non-muscle invasive bladder of high-risk tumors, should be assessed according to comorbidities or oncologic risk factors, to determinate the adequate treatment options. New data from metastatic prostate cancer clinical trials have shown promising results in the control of the disease.

To put forth new findings in urologic oncology with impact in the clinical practice, presented in the principal annual meetings (EAU, ESTRO, AUA, ASCO and ASTRO).The reporters of the OncoUrology Forum select and classify the summaries on genitourinary cancer based on the impact on present or future practice. This document includes the summaries having the highest scores.The OncoUrology Forum committee considered the following messages important. The PIVOT study shows that radical prostatectomy reduces the specific mortality of prostate cancer (PCa) compared to follow-up in observation, in localized high risk PCa or PSA10 ng/mL. Dissection of the pelvic lymph nodes should be done in all the patients with bladder cancer treated by radical cystectomy, regardless of the tumor stage, in accordance with baseline analysis of the Surveillance, Epidemiology and End Results (SEER) data. An analysis of the SEER of patients with renal cancer concluded that the radical nephrectomy is associated to worse cardiovascular and overall survival compared to those treated with partial nephrectomy in localized renal cell carcinoma of ≤2 cm. In patients with nonseminomatous germ cells cancer, retroperitoneal lymph node dissection should not be omitted when the residual tumor size is ≤1 cm because of the considerably high risk of teratoma and viable cancer.Although these studies do not offer a final response for all the oncourological subjects, these results will have an impact on the daily clinical practice.

To highlight the most important issues of the 2010 annual meetings of the European Association of Urology, EAU), the American Urological Association, AUA, the American Society of Clinical Oncology, ASCO, and the American Society for Therapeutic Radiology and Oncology, ASTRO.A group of experts in oncological urology selected the most important summaries of the four congresses. Subsequently, the revisors assessed the findings in relation to their present and future impact on clinical practice. This document includes the summaries with the highest points.The following messages were considered important. In pT3 prostate cancer, postoperative radiotherapy (RT) improves local control and biochemical progression-free survival, with no significant impact on distant metastasis and overall survival. In patients with bladder cancer without muscle invasion and with the risk of intermediate recurrence, maintenance chemotherapy does not increase recurrence-free survival after transurethral resection. There is no evidence of a synergist effect of the combination of Temsirolimus/ Bevacizumab in patients with metastatic kidney cell carcinoma without prior treatment. In the SWENOTECA V protocol for the treatment of seminomatous germ-cell testicular cancer, the adjuvant RT was interrupted because the concern regarding the induction of secondary cancers was greater than the reduction of relapses.In 2010, new data was produced on the diagnosis and treatment in oncological urology, thanks to the interesting work of different trials.

To review the incidence of PIN and Atypical Small Acinar Proliferation (ASAP) on first biopsy, the risk to find cancer on following biopsies and what is the importance given to this findings, analizing how frequently and how long after the initial finding this patients are rebiopsied.We selected 6000 patients who underwent TRUS biopsy between 1994 and 2002. Patients with prior cancer diagnosis were not included. 861 of them underwent more than one biopsy, adding up to a total of 7127 biopsies. A descriptive study has been done including percentages and percentiles for qualitative variables, mean and median for continuous variables.Incidence of cancer on the first biopsy was 39,1%. PIN and ASAP are stable or slightly increase from 2 and 2,1% respectively on the first biopsy to more than 6% on the fourth and fifth ones. Mean time between biopsies when ASAP or PIN are the initial findings is 180 +/- 221,6 and 264 +/- 213,8 days respectively. Just 42 and 40% of patients with prior PIN or ASAP diagnose are rebiopsied. On subsequent biopsies 45 and 40% of cancers were respectively found.Presence of PIN or ASAP implies a higher cancer risk on subsequent biopsies; in spite of that, less than half of them are biopsied again. Performing two more biopsies or an amplified biopsy can find most of the tumors associated.

Acquired cystic renal disease (A.C.R.D.) is a risk factor for the development of renal carcinoma in the patient's own kidney after renal transplant (R.T.), development of a primitive tumor in the renal graft is infrequent, but the presence of metastasis of an epithelial tumor is very rare. This is the second case reported in the literature of metastasis of an epithelial tumor in the renal graft and the first case described of renal cell carcinoma metastasis (R.C.C.) in the renal graft. This paper describes the case of a patient with a normally functioning renal transplant and A.C.R.D. who develops RCC in his own kidney, with metastasis in the renal graft.

Percutaneous nephrostomy has been one of most used palliative method of urinary diversion to treat cronic renal failure in neoplasic patients. Psychological and social factors meke this measure to be rejected by some patients even sin situations where this is the only action that would make their survival longer. The utilization of ureteral stents provides benefits to a certain percentage of patients, not being possible its usage in all the occassions. Urinary subcutaneous diversion can be a simple and well tolerated alternative for the patient. The following clinic case describes and approach implementing a subcutaneous stent in a 60-y-old male with a severe ureteric obstruction after failed management by endoscopy or open surgery.

Primary testicular lymphoma is an uncommon testicular tumour that accounts for no more than 9% of all testicular tumours in those series with higher incidence; testicular lymphoma as haematopoietic tumours are also rare accounting for just 1% of all lymphomas; but due to their highly malignant histopathology they may become highly aggressive tumours. Patient age at presentation is over 60 years old which makes it the most frequent tumour for this age group. There is no standard protocol to treat this malignancy due to lack of extensive series. We contribute one case and make a literature review discussing the current therapeutic trends for this disease.

The goal of this research is to make a comparative analysis of acute tubular necrosis (NTA) incidence in function of preservation solution used: Wisconsin vs Celsior.From January 1994 to December 2002, 229 kidney transplantation procedures were executed; 190 of them were perfused with Wisconsin (82.9%) and 39 with Celsior (17.1%). After checking the statistical homogeneity of both groups, we analysis comparatively the incidence of NTA and the evolution of serum creatinine in function of preservation solution utilized.There was not statistical significant difference in NTA incidence between Celsior (23%) and Wisconsin group (36%). We assessed that each group were comparable with regard to NTA incidence of subgroups with cold ischemia times longer 12 hours. Creatinine serum in Celsior group tended to be lower than Wisconsin group at 1, 3, 6 and 12 months posttransplantation (statistically significant difference, p0.05)Kidney preservation in Celsior solution provides similar results to the ones obtained in Wisconsin solution in relation with NTA incidence and kidney function with the added advantage of a lower cost.

We report a new case of sarcomatoid renal cell carcinoma, in a male of 67 years old, with locoregional recidive four months after first surgery, with two episodes of retroperitoneal hemorrhage after second surgery. The objective of this work is to contribute a new case and of doing one revision.

Testicular torsion in adult, is an uncommonly etiology, but we should make differencial diagnosis in every person over thirty years old, with acute scrotum. The wrong diagnosis raises the incidence orchiectomy in adults for vascular etiology. We report a male of 74 years old with acute scrotum and review of the literature.

To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent.From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one.The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13.6%-59.6%). The complications were minimum and the hospital stay was short.In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity.

Malacoplakia is an unusual chronical granulomatous disorder. In the urinary tract is more frequent in female, in 75 percent of cases involve the bladder. Pelvis extension of this disease is infrequent, and even less frequent is the involvement of pelvic and retroperitoneal lymph nodes. We present the second case in the literature of bladder malacoplakia with extravesical and pelvic node involvement.

To review the indications and complications of the use of endourological catheters in the treatment of urinary lithiasis and choice of catheter based on its physical and hydrodynamic characteristics and biocompatibility.Data from our experimental and clinical studies, as well as those published in the literature are summarized.Polyurethane, C-flex and Percuflex catheters have the highest retaining capacity, while the silicone, Urosoft and Wiruthan catheters have the lowest. The tensile strength of polyurethane and copolymers is superior to that of silicone. The friction coefficient, which varies within the same material, influences the facility of catheter insertion. The number and size of the side vents are essential to catheter hydrodynamic behavior. Silicone is the most biocompatible material, followed by Urosoft. The polyurethanes and C-flex catheters cause important urothelial hyperplasia and edema of the lamina propia.The choice of endourological catheter should be individualized and based on the clinical indication. For prevention of obstruction from steinstrasse post-lithotripsy, a catheter with a high extraluminal flow and high retaining capacity is indicated to facilitate passage of stone fragments and to avoid catheter migration.

To analyze the impact of the use of the routine double-J stent in the incidence of urological complications, like fistula, stenosis, ureteral obstruction and urinary tract infection.A retrospective study was conducted on two groups of patients: 28 without double-J stent and 28 with it. We reviewed urological complications: stenosis, fistula and obstruction. We paid special attention to urinary tract infection and other inherents complications to the use of double-J stents.A patient from the double-J stended group (3.6%) developed a urinary fistula and there were no obstructions. 13 patients (46.6%) had a positive urinary culture in the first month post RT. Two urinary fistulas and 4 obstructions were developed in the non-stended group. Six major complications of the urinary tract. 14 patients (50%) had a positive urinary culture in the first month post RT.The use of double-J stent across uterovesical anastomosis decreases the post-RT ureteral complications. Stent placement does not increase the risk of urinary tract infection in the early post-RT.

Contribution of a case report of diffuse bladder haemangioma developed since childhood, focusing on the diagnosis and management of these tumours and on the pathoanatomical analysis of the lesion. Literature review.

To report a case of cystitis glandularis, a proliferative disorder of the bladder mucosa whose incidence is estimated to be approximately 1%.A case of diffuse cystitis glandularis in a male patient is presented. Intravesical steroid therapy achieved symptomatic resolution, although the proliferative mucosal lesions persist.There is currently no non ablative treatment that has been demonstrated to be effective in diffuse cystitis glandularis.

To review the history of the development of the double-J ureteral catheter, a device that is necessary in current urological practice.A review of the literature shows that although there are references on the use of the ureteral catheter before 1967, the history of its development began in that year, when Zimskind and co-workers designed and used the first self-retaining catheter that was inserted cystoscopically. However, it was not until 1978 when the double-J shape was adopted following the design of Finney.A review of the history of bioimplants development in the field of Urology shows that catheter design and its biomaterials have developed in parallel, in an attempt to create a device that functions well and one that is also well-tolerated by the body in order to reduce the catheter-related complications.

To evaluate the efficacy of Nitinol (Memotherm) self-expandible metal stents in the treatment of malignant and non-malignant ureteral obstruction in patients who are not eligible for surgery.A total of 14 ureteral strictures (5 malignant, 9 non-malignant) in 13 patients were treated by the implantation of a Nitinol endoprosthesis. Eight were implanted by the antegrade and 6 by the retrograde route. A mean of 1.3 stents were implanted per patient.85% of the stents were patent at a mean follow-up of 10.2 months (range 2-28). Four prostheses developed transient obstruction that was resolved by insertion of a double-J catheter for periods that ranged from 2 to 6 months. One stent required a permanent double-J catheter and another stent showed functional obstruction, although it was morphologically patent.The Nitinol self-expandible metal stent is effective in the treatment of malignant and non-malignant ureteral obstructions in patients who are not eligible for surgery due to the tumor stage or high surgical risk.

Urinary infection (UTI) is the most frequent infection after renal transplantation (RT). The literature shows and incidence between 10-98%. The risk of associated bacteraemia is close to 12%. Gram- bacteria are the most frequent causal agents (70%), although gram+, mainly enterococcus and staphylococcus, candida and some other exotic germs such as Corynebacterium are also potential etiological agents. Certain factors present in the receptor during pre-RT, RT itself and post-RT condition the development and evolution of UTIs. Clinical signs and symptoms are multiple ranging from asymptomatic bacteriuria to graft's abscess or septic shock. Incidence in females (54%) is higher than in males (29%). Immunosuppressive regimes based on Cyclosporin (35%) show lower incidence of UTI than those based in Azathioprine (50%). Antibiotic prophylaxis with Co-trimoxazol reduces incidence of UTIs at post-RT and delays the time of appearance of the first UTI episode.

Few cases of verrucous carcinoma of the penis with foci of invasive squamous cell carcinoma have been reported and denominated "hybrid tumors". The accuracy of this term is discussed in this paper.A huge penile mass in a patient that had undergone three previous operations for lesions diagnosed as verrucous carcinoma is reported. Partial penectomy was performed. Histological examination showed a very well-differentiated squamous cell carcinoma. PCR (polymerase chain reaction) did not detect any type of human papillomavirus (HPV) in the tumor.Verrucous carcinoma is a strictly-defined lesion with a different biological behaviour from that of squamous carcinoma. Preoperative deep biopsy may miss the squamous cell carcinoma. Definitive diagnosis can only be achieved by histological examination of the surgical specimen. In future, DNA studies could possibly support preoperative diagnosis of this lesion.

There is very little literature on hernial complications of the abdominal wall in association to renal transplantation. The present report aims to evaluate their incidence and type, as well as the intervention carried out and its results.A retrospective analysis of a series of 650 renal transplantations has been carried out between 1978-1996 in our centre. A braided polypropylene mesh (Prolene) was used to repair abdominal wall defects and/or diagnosed hernias in 8 (1.2%) cases: 5 eventrations, 1 inguinal hernia and one combination of both: the last case required extensive debridement of the abdominal wall due to necrotizing fascitis. Mean time to eventration was 47.3 months (range 1-106).In all cases, the mesh was placed in the pre-peritoneal space. Two patients developed complications (one haematoma and one wound infection), though graft removal was not necessary in any case. Follow-up was 33.1 months (range 6-78) with no findings of hernial relapse. One patient started successful chronic ambulatory peritoneal dialysis (CAPD) 30 days after the intervention.The polypropylene mesh is a sound alternative in the treatment of hernial complications associated to renal transplantation, with acceptable morbidity, and efficacy rates that in our series reached 100%.

To analyze the clinical complications of double-J ureteral catheters.The most relevant studies published in the literature since the self-retaining indwelling catheter was first described in 1967 are reviewed.The experience and results reported in the most relevant studies are presented.The double-J ureteral stent has become an integral part of the urological armamentarium. It allows good urinary drainage from the kidney to the bladder and is generally safe and well-tolerated. However, different complications may occur with short- or long-term use of indwelling stents. These complications vary from minor side effects such as hematuria, dysuria, frequency, flank and suprapubic pain, to major complications such as vesico-ureteric reflux, stent migration, encrustation, urinary infection, stent fracture, necrosis and ureteral fistula. Most of these complications require removal of the catheter.

To analyze the clinical indications of double-J ureteral catheters.The most relevant studies published in the literature since the self-retained indwelling catheter was first described in 1967 are reviewed.The experience and results reported in the most relevant studies are presented.The double J ureteral catheter is essential in urological practice. Although its clinical indications are well-established, its use depends on the urologist's experience in most of the cases.

The UroLume stent has been utilized in the management of symptomatic benign prostatic hyperplasia (BPH), particularly in patients at high surgical risk. Our results are analyzed and the literature reviewed.From June, 1994 to November, 1996, 19 patients at high surgical risk (ASA III/IV) with symptomatic BPH were treated at our center; 17 (89.4%) had an indwelling catheter. The UroLume stent was inserted under local anesthesia and intravenous sedation.Stent placement as monotherapy was found to be clinically effective in 15 patients (78.9%) with a mean follow-up of 8.2 +/- 5.7 months (range 1-18). The mean symptom score (Madsen-Iversen) was 6.1 +/- 1.2. Patients with no further manipulations had a mean maximum flow rate of 8.8 +/- 3.8 ml/s. Two patients (10.5%) required stent removal due to retrograde displacement in one case and perineal discomfort and irritative voiding symptoms in the other. In two other patients (10.5%), remnant tissue had to be resected in order to void spontaneously. Seventeen patients (89.4%) were satisfied with the results. No case of urosepsis or incrustations were documented. A microbiological analysis disclosed urinary tract infection in one patient.The UroLume stent is clinically effective in the treatment of symptomatic BPH in patients unfit for prostatic surgery. It carries a low incidence of major complications and procedure-related morbidity.

Stones with different compositions respond differently to shock wave lithofragmentation. Likewise, the various lithotrity systems used may have different effects on the stones. To determine the relationships between stone composition and their fragmentation patterns, we conducted an in vitro study using endoscopy, magnifying glass, light microscope and scanning electron microscope on fragments obtained after lithotrity of 60 pure stone with different compositions: calcium oxalate monohydrate and dihydrate (OXMH and OXDH), phosphocarbonate (PC), ammonium magnesium phosphate (AMF) and uric acid (UA). Fragmentation was carried out with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulse laser). No morphologic differences in the fractures induced by the various lithofragmenting sources were demonstrated. OXMH and UA stones basically break up by intercrystalline fracture and splitting of their concentric plates. OXDH breaks up mainly by intercrystalline fractures aided by the fibrillar organic material and phosphocarbonates found in the intercrystalline spaces. Fragmentation in infective stones (AMF and PC) occurs across the intercrystalline surfaces and by intracrystalline fracture. Ammonium urate fragments break up by intracrystalline fractures that run across the equatorial plane of its characteristic acicular microspheres.

The most widespread opinion, and until recently the only option, is that every vesical transitional cancer invading the muscle is, regardless its extent, candidate for radical cystectomy and that in spite of nobody questioning the advantages of partial cystectomy.45 patients with vesical infiltrant cancer T2 or higher, followed between 9 and 258 months and managed with partial cystectomy, were analyzed. Only patients with no radiotherapy were included and only in one patient pre-operative chemotherapy was used.In 8 patients no tumour was found in the specimen (pTO). Tumour grade was pTa in 2; pT1 in 11; pT2 in 5; pT3a in 4; pT3b in 11; and pX in 4 patients. Eight (8) patients had nodal involvement. Twenty-one (21) cases showed bladder relapse. In six (6), vesical infiltrant relapse was associated to metastasis. One case showed vesical relapse, pelvic mass and metastasis, and 4 only metastasis. Extravesical disease-free time and survival are better than in the group treated with radical cystectomy. But this is a highly selected group.With the same prospects of extravesical disease-free time and survival we offer: shorter, less risky surgery with low post-surgical morbidity and mortality and less hospitalization and proportion of late sequela. Better quality of life, with no skin stoma, incontinence or impotence Although the risk of vesical relapse persists, the procedures required to resolve vesical shunt or replacement complications are more aggressive than TUR sufficient to treat most relapses, and when recurrence is infiltrant radical cystectomy may be used as a rescue measure. This is so even now with the profusion of the so-called "mini-invasive" procedures. We believe that neither radio- and/or chemotherapy combinations contribute nothing to partial cystectomy alone. They may even be harmful and have significant side-effects. It is plain that POs are the result of total removal by TUR. Due to the little reliability when defining T, it is very hard to evaluate the contribution of adjuvant measures. Patients with no vesical tumour (pTOs) or pT1-pT2 tumours, and even up to pT3a, should not be included in protocols to evaluate the efficacy of combined cytostatic agents since their use is superfluous. Radiotherapy makes no contribution to this type of tumour in terms of local relapse and apparently has no effect on the metastasis.

To study the utility of PSA density and predicted PSA results in the diagnosis of prostatic cancer using gland volume.500 patients suspected as having prostatic cancer underwent ultrasound-guided transrectal biopsy. Prostate volume and ultrasound characteristics, serum PSA density, predicted PSA and the difference between both were determined.44.8% of the patients showed evidence of cancer in the biopsy specimen. These patients had a significantly smaller prostate. The 0.1 and 0.15 PSA density cutoffs had a sensitivity of 96% and 94%, specificity of 10% and 20% and positive predictive value of 46% and 49%, respectively. The statistical values for PSA difference of 1 and 2 were 94% and 92%, 13% and 18%, 47% and 48%, respectively.PSA density and predicted PSA results could be useful to avoid biopsies in patients with PSA between 4 and 10 ng/ml and no malignant tumor of the prostate.

To analyze and compare the diagnostic yield of transrectal ultrasound versus digital rectal examination (DRE) and PSA.500 patients with a suspicion of carcinoma of the prostate were evaluated by US-guided transrectal biopsy, PSA determination and DRE. The sensitivity, specificity and predictive values of these diagnostic methods, utilized alone or in combination, were analyzed.44.8% of the patients had evidence of cancer in the biopsy specimen. DRE disclosed an indurated prostate in 32% and 45% of the ultrasound scans were suspicious of malignancy (74.2% of those in whom a tumor was demonstrated and 20.4% of those with no tumor, p0.001). DRE, PSA4 ng/ml and transrectal ultrasound had a sensitivity rate of 52%, 93% and 74%, and a specificity of 85%, 10% and 79%, respectively. The highest sensitivity rate was obtained when biopsy was indicated by an indurated prostate on DRE or PSA4 ng/ml or a suspicious transrectal ultrasound scan (96%). The highest diagnostic accuracy, with a specificity of 96%, was obtained in patients with PSA10 ng/ml and positive DRE and transrectal ultrasound.The combined use of the different tests is fundamental to early diagnosis of prostatic cancer. In our experience, transrectal ultrasound was the method which independently obtained the best predictive values, offering a high sensitivity and specificity.

To analyze the prevalence of neoplasms in renal transplant patients and the relative risk for each tumor type according to the immunosuppression regimen.609 renal transplants were reviewed. The risk index was determined by the ratio of the cases observed and predicted.Tumor prevalence was 4.9% (30/609); 6.3% (25/393) were males and 2.3% (5/216) were females. The most common tumors were cutaneous tumors other than melanoma, accounting for 2.4% (15/609), followed by Kaposi's sarcoma, pulmonary epidermoid carcinoma and genitourinary tumors (0.5%) and non-Hodgkin lymphoma (0.3%). Tumor prevalence was 6.8% for the group treated with azathioprine-prednisone and 3.9% for the cyclosporine A-prednisone-treated group. The estimated relative risk of having a neoplasm was 10-fold higher for the males and 4.2-fold higher for the females vs the general population. The mortality rate was 36.6%; specifically tumor-related in 82%. The mortality rate for those with solid tumors was 77.7%. The long-term survival rate for the group that developed a tumor was significantly lower than that of the general population, 75% vs 53%, respectively (p0.05).In this series no significant differences were observed relative to tumor prevalence or type according to the immunosuppression regimen. A recipient of a renal graft has a higher risk of developing a tumor. Cutaneous tumors were the most frequent. The long-term survival is lower for recipients of renal grafts who develop a tumor.

Verrucous carcinoma of the penis accounts for 5-17.8% of total carcinomas in the referred location that are diagnosed in our environment. Six cases of this rare neoplasia have been treated in our service and revised retrospectively. The epidemiological, clinical, diagnostic and therapeutic aspects of our series are analyzed and the issues around them discussed. Eventually, the benign biological behaviour of this tumour warranting conservative surgical treatment is ratified. In selected cases where the therapeutic modalities used do not yield material for histopathological analysis (laser, cryotherapy, etc.) prior obtention of a deep biopsy of the lesion to identify the likely presence of a well differentiated epidermoid carcinoma is imperative. Also, every effort should be made to monitor the cases of associated premalignant conditions.