Search

Resumen Contexto y objetivo Conocer las ultimas evidencias sobre Urologia oncologica de tumores de prostata, rinon y vejiga, analizando su impacto en la practica clinica diaria, ademas de los esquemas futuros a medio y largo plazo. Materiales y metodos Se revisan los resumenes sobre Uro-Oncologia presentados en los Congresos del ano 2020 (EUA, AUA, ASCO, ESMO y ASTRO), las publicaciones de mayor impacto y especialmente las nuevas lineas de desarrollo y avance en Uro-Oncologia valoradas por el comite de OncoForum. Resultados El uso de los radioligandos de antigeno de membrana especifico de prostata en el diagnostico de cancer de prostata puede tener gran cabida y utilidad en los proximos anos gracias a su mejor sensibilidad y especificidad. La caracterizacion genetica del tumor es importante tanto a nivel germinal como somatico, dado que las mutaciones en BRCA2 son especialmente importantes por su significado en riesgo. El diseno de estudio mas conveniente a nivel de cancer genitourinario es el ensayo controlado aleatorizado multiple de cohortes. La aplicacion del big data traera mejoras en procesos, ahorros en costes sanitarios y una potenciacion de los estudios en vida real gracias a la facilidad de comparacion, gestion y almacenamiento de datos. Conclusiones El uso de las nuevas tecnicas diagnosticas con ligandos de antigeno de membrana especifico de prostata aportara una modalidad diagnostica mas completa y el aumento de los estudios del perfil genetico del tumor y la calidad de los estudios realizados. La aplicacion practica de la inteligencia artificial mejorara el tratamiento del cancer genitourinario.

Objective Review the latest evidence on urologic oncology on kidney, bladder and prostate tumors. Methods 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. Results 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-Guerin, 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. Conclusions 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.

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.

Additional file 1. Supplementary table: Case series of XGP (more than 10 cases).

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.

OBJECTIVE To put forth new findings of urologic oncology with impact on clinical practice presented during 2017 in the main annual meetings. METHODS 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. RESULTS 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

OBJECTIVE To put forth new findings of urologic oncology with impact on clinical practice presented during 2016 in the main annual meetings. ACQUISITION OF EVIDENCE 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. SYNTHESIS OF EVIDENCE 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

Resumen Objetivo Conocer las ultimas evidencias sobre urologia oncologica de tumores de prostata, rinon y vejiga, analizando su impacto en la practica clinica diaria, ademas de los esquemas futuros a medio y largo plazo. Adquisicion de la evidencia Se revisan los resumenes sobre cancer de prostata, renal y vejiga presentados en los congresos del ano 2016 (EAU, AUA, ASCO, ESMO y ASTRO) y las publicaciones de mayor impacto en este periodo que recibieron mayor valoracion por parte del comite del OncoForum. Sintesis de la evidencia En pacientes con carcinoma renal localizado de alto riesgo tras nefrectomia la enfermedad libre de progresion fue significativamente mayor para sunitinib que para el grupo placebo, con eventos adversos mas frecuentes. En pacientes con cancer de vejiga localmente avanzado o metastasico aletozumab obtuvo tasas de repuesta global en todos los subgrupos de pacientes, incluidos aquellos con mal pronostico. En pacientes con cancer de prostata localizado la diferencia de mortalidad cancer especifica entre prostatectomia radical, radioterapia o seguimiento activo no fue significativa (p = 0,48). En el estudio TERRAIN, con pacientes con cancer de prostata resistente a la castracion, se comunicaron eventos adversos graves en el 31% y el 23% de los pacientes tratados con enzalutamida y bicalutamida, respectivamente. Ademas, enzalutamida mejoro significativamente la supervivencia libre de progresion (1,57 meses) en comparacion con bicatulamida (5,8 meses) (p Conclusiones En pacientes con cancer renal de alto riesgo tras nefrectomia se ha evaluado sunitinb como opcion de tratamiento. En pacientes con cancer de prostata localizado la mortalidad cancer especifica fue baja, independientemente del tratamiento asignado (prostatectomia radical, radioterapia o seguimiento activo). En cancer de prostata resistente a la castracion se han publicado nuevos resultados de la eficacia y seguridad de enzalutamida y abiraterona, que han mostrado efectos beneficiosos en pacientes metastasicos y no metastasicos.

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.

Intraparenchymal renal artery aneurysms are uncommon and represent less than 10% of all renal artery aneurysms. They are caused by trauma or iatrogenic injury, and their rupture can lead to life-threatening hemorrhage. We report the case of a 48-year-old male with history of left solitary kidney and orthotopic neobladder, who presented with massive hematuria 7 days after nephrostomy tube placement because of obstructive uropathy and acute renal failure due to ureteroileal stricture. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with superselective endovascular embolization, achieving maximal parenchymal preservation.

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.

Objective 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.

Objective 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. Methods 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. Results 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. Conclusions 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.

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.

The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localised prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies.A systematic literature review was conducted of the treatment of localised prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D'Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer.After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomised. The patients' mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6-100% for cryotherapy and 96-100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86-100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9-100%) and total therapy (39%). HIFU showed potency rates of 89%, 52-80% and 33-78% for focal therapy, hemiablation and total therapy, respectively.Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centres with high volumes of patients.

Objective 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). Methods 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. Results 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. Conclusions 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.

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.

Objective 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). Methods 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. Results 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 PSA > 10 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. Conclusions 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.

Objetivo: Destacar lo más relevante de las reuniones anuales 2010 de la Asociación Europea de Urología (European Association of Urology [EAU]), la Asociación Americana de Urología (American Urological Association [AUA]), la Sociedad Americana de Oncología Clínica (American Society of Clinical Oncology [ASCO]) y la Sociedad Americana de Oncología Radioterápica (American Society for Therapeutic Radiology and Oncology [ASTRO]). Métodos: Un grupo de expertos en urología oncológica seleccionó los resúmenes más relevantes de los 4 congresos. Posteriormente, los revisores valoraron los hallazgos en relación con su impacto presente y futuro sobre la práctica clínica. Este documento recoge los resúmenes con mayor puntuación. Resultados: Se han considerado relevantes los siguientes mensajes. En cáncer de próstata pT3 la radioterapia (RT) postoperatoria mejora el control local y supervivencia libre de progresión bioquímica, sin impacto significativo sobre las metástasis a distancia y la supervivencia global. En pacientes con cáncer vesical sin invasión muscular y con riesgo de recurrencia intermedio, la quimioterapia de mantenimiento no aumentó la supervivencia sin recurrencia después de resección transuretral. No hay evidencia de efecto sinergista de la combinación temsirolimus/ bevacizumab para pacientes con carcinoma de células renales metastásico sin tratamiento previo. En el protocolo SWENOTECA V para el tratamiento del cáncer testicular de células germinales seminomatoso se interrumpió la RT adyuvante, porque la preocupación por la inducción de cánceres secundarios superaba a la reducción de las recidivas. Conclusiones: En el 2010 han surgido nuevos datos sobre el diagnóstico y tratamiento en urología oncológica, gracias al interesante trabajo de diferentes estudios. Objective: 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. Methods: 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. Results: 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. Conclusions: In 2010, new data was produced on the diagnosis and treatment in oncological urology, thanks to the interesting work of different trials.

Objetivo: Destacar lo más relevante de las reuniones anuales 2010 de la Asociación Europea de Urología (European Association of Urology [EAU]), la Asociación Americana de Urología (American Urological Association [AUA]), la Sociedad Americana de Oncología Clínica (American Society of Clinical Oncology [ASCO]) y la Sociedad Americana de Oncología Radioterápica (American Society for Therapeutic Radiology and Oncology [ASTRO]). Métodos: Un grupo de expertos en urología oncológica seleccionó los resúmenes más relevantes de los 4 congresos. Posteriormente, los revisores valoraron los hallazgos en relación con su impacto presente y futuro sobre la práctica clínica. Este documento recoge los resúmenes con mayor puntuación. Resultados: Se han considerado relevantes los siguientes mensajes. En cáncer de próstata pT3 la radioterapia (RT) postoperatoria mejora el control local y supervivencia libre de progresión bioquímica, sin impacto significativo sobre las metástasis a distancia y la supervivencia global. En pacientes con cáncer vesical sin invasión muscular y con riesgo de recurrencia intermedio, la quimioterapia de mantenimiento no aumentó la supervivencia sin recurrencia después de resección transuretral. No hay evidencia de efecto sinergista de la combinación temsirolimus/ bevacizumab para pacientes con carcinoma de células renales metastásico sin tratamiento previo. En el protocolo SWENOTECA V para el tratamiento del cáncer testicular de células germinales seminomatoso se interrumpió la RT adyuvante, porque la preocupación por la inducción de cánceres secundarios superaba a la reducción de las recidivas. Conclusiones: En el 2010 han surgido nuevos datos sobre el diagnóstico y tratamiento en urología oncológica, gracias al interesante trabajo de diferentes estudios.

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.

Purpose. Transitional cell carcinoma (TCC) affecting the graft after renal transplantation is a very infrequent way of presentation of this tumor. Our aim is to present our single institution experience with 2 cases, as well as to perform a review of the literature about this tumor after the transplant.Materials and Methods. TCC of the graft developed in 2 of 1365 patients from 1977 to 2010, both cases in women. Data were analyzed for incidence, clinical presentation, treatment, and outcomes.Results. Both cases occurred in 2 mid-age women and resulted to be high grade and locally advanced TCCs, representing an incidence of 0,14% (2/1365). Clinical presentation was urinary obstruction for the first case and incidental ultrasound finding for the second. Preoperative staging was made with CT, cytology, pyelography, ureterorenoscopy, and biopsy. Treatment performed was nephroureterectomy of the graft with bladder cuff and regional lymphadenectomy. Pathological examination showed in both cases a locally advanced and high grade urothelial carcinoma of the pelvis allograft. After 24 and 14 months of followup, both patients are disease free.Conclusions. TCC of the kidney graft is an infrequent tumor that has only been reported in a few cases in the literature. It usually appears at a lower age, more often locally advanced, and with poor differentiation. A multidisciplinary approach to treatment should be required in these cases.

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.

It's been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C-reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2, 10, tumoral necrosis factor alpha (TNFalpha), CRP and ET-1.Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF alpha, ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure.The comparative analysis between groups demonstrated a significant increase in levels of CRP (1.44+/-0.88 vs 1.32+/-0.14 mg/dl, p=0.046), TNF alpha (131.14+/-41.37 vs 57.19+/-23.71 pg/ml, p0.001) and ET-1 (0.91+/-0.49 vs 0.56+/-0.5 fmol/ml, p=0.001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group.Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established.

An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.

Simultaneous kidney and pancreas transplant is a good treatment for both renal and pancreas insufficiency. Experimental apply of genitourinary tract for pancreas implantation is reported in this work.Twenty animals aged as average 5.5 monts (SD 1.1) and an average weight of 53 kgr were submitted to this protocol. In the day 1 a left nephrectomy is completed and the graft is perfused with University of Wisconsin solution. A partial pancreatectomy is completed at following, isolation of pancreatic islets by colagenase enzymatic digestion. Islets are dryed with Ditizone and culptured for 24 hours at 37 degrees C and 5% CO2. Day-2 a right nephrectomy is performed and orthotopic renal autotransplant using the left kidney is completed. Pancreatic islets are transplanted in 4 different locations of the genitourinary tract: renal subcapsular space, bladder submucosae, testis parenchyma and vas deferens. Day-7, all the animals were sacrifized to complete pathological study.Viable islets were isolated in bladder submucosae and testis after transdeferential injection.

It has been demonstrated that abdominal high-pressure and the use of CO2 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output (CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model.We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery.Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54 + 1.26 l/min., p0.,001); a descent of the systemic vascular resistances (1118.81 + 302.52 vs. 663.37 + 81.45 dynes .s.cm5, p0.001) and an increase of blood pressure (66.5 + 11.52 vs. 80.25 + 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73 + 41.69 vs. 291.7 + 51.52 ml/min., p0.001) and a decrease of portal flow (973.67 + 131.70 vs. 546.83 + 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00 + 94.71 vs. 133.33 + 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used.Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups.

The increase of intraabdominal pressure to 10 mmHg provokes a decrease of renal blood flow (RBF). Pneumoperitoneum during laparoscopic techniques with intra-abdominal pressure (IAP) to 15 mmHg, results in a decrease in RBF, urine output and glomerular filtration rate (GFR).Analyze the changes in RBF, urine output an GFR in a porcine experimental model during open vs laparoscopic nephrectomy.30 pigs (medium weigh= 22.6+3.2 Kg) were divided into two groups: Laparoscopic nephrectomy was performed using 15 pigs and open nephrectomy in 15 pigs, following a living donor nephrectomy autotransplantation model. Study parameters were urine volume and GFR baseline values, 30 and 60 minutes during nephrectomy. RBF was measured using an electromagnetic flow catheter around the main renal artery during the initial 60 minutes of nephrectomy.The laparoscopic technique was associated with a significant reduction of RBF (80+2.7 vs 262+3 ml/min) (p0.005), diuresis (42%) and GFR (38%), vs the open group.Laparoscopic nephrectomy involves a significant reduction of RBF, GFR and diuresis, which is potentially transcendent in living donor nephrectomy and kidney transplantation.