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Limited data are available on patients with carcinoma in situ (CIS) of the bladder managed according to current clinical practice guidelines.To assess the patterns of recurrence, progression to muscle-invasive bladder cancer (MIBC), and upper tract urothelial carcinoma (UTUC) in patients with CIS, and to compare the effectiveness of adequate versus inadequate bacillus Calmette-Guérin (BCG) immunotherapy.A retrospective analysis of 386 patients with CIS of the bladder with or without associated pTa/pT1 disease treated with BCG between 2008 and 2015.Kaplan-Meier estimations and an inverse probability of treatment weighting (IPTW)-Cox regression were performed to compare recurrence-free survival (RFS) and progression-free survival (PFS) and UTUC incidence over time for patients who received adequate versus inadequate BCG treatment.The median follow-up was 70.5 mo. At 5 and 10 yr, RFS was 82% and 52%, PFS was 93.6% and 75.8%, and UTUC incidence was 1.7% and 2.9%, respectively. Most recurrence (73.6%) and progression (69.1%) events occurred in the first 3 yr of follow-up, while 38.7% of UTUC incident events were recorded after 5 yr of follow-up. IPTW-Cox regression revealed that patients who received BCG treatment had a lower risk of recurrence (hazard ratio [HR] 0.21, 95% confidence interval [CI] 0.13-0.34), progression (HR 0.46, 95% CI 0.25-0.87), and UTUC incidence (HR 0.24, 95% CI 0.09-0.64). Limitations include the retrospective design and potential selection bias.Patients with CIS of the bladder show a high risk of recurrence, progression, and UTUC incidence. Most of these outcomes occur during the first 3 yr of follow-up, but a significant proportion of the events occur at long-term follow-up. Although receipt of adequate BCG treatment improves outcomes, intensive and long-term surveillance may be warranted.We investigated the long-term cancer control outcomes for patients with carcinoma in situ (CIS; cancerous cells that have not spread from where they first formed) of the bladder. Patients with CIS have a high risk of cancer recurrence and progression. Treatment with bacillus Calmette-Guérin (BCG) improves outcomes.

To assess clinical outcomes of patients who underwent simultaneous radical cystectomy (RC) and radical nephroureterectomy (RNU) for panurothelial carcinoma (PanUC).A retrospective analysis of 67 patients who underwent simultaneous RC and unilateral RNU for PanUC, from 1996 to 2017. Kaplan-Meier estimates for remnant urothelium recurrence-free survival (RRFS), metastasis-free survival (MFS), overall survival (OS), and cancer-specific survival (CSS) were performed. Cox multivariate models were constructed.The median follow-up was 38 months, 29.8% of patients had a recurrence, 34.3% had metastasis, 67.2% of patients died from any cause, and 37.3% died from urothelial carcinoma. OS and CSS rates at 5 years were 44% and 61%, respectively. In multivariate analysis, progression to muscle-invasive bladder cancer before surgery, presence of muscle-invasive stages at RC and/or RNU, and prostatic urethra involvement were predictors for worse MFS and CSS. Forty-one patients (61.2%) had an estimated glomerular filtration rate (eGFR)60 ml/min before surgery and the number rose to 56 (83.5%) after surgery; 29.8% patients needed renal function replacement therapy after surgery (16 haemodialysis and 4 renal transplant).Patients with PanUC who undergo simultaneous surgery have adverse oncological (only 4 out of every 10 remain alive at 5 years) and functional outcomes (1 out of 3 will need renal function replacement therapy after surgery). Up to a third of the patients had a recurrence (urethra or contralateral kidney) within 18 months, justifying close surveillance or considering prophylactic urethrectomy. These data should help in counsel on morbidity and life expectancy.

Background: Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation “Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer” was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. Objective: To assess current ADT use before prostate cancer surgery in Europe. Design, setting, and participants: This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. Outcome measurements and statistical analysis: Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. Results and limitations: We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. Conclusions: EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. Patient summary: Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.

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

Resumen Introduccion Nuestro objetivo ha sido informar de los resultados oncologicos de pacientes con ERET y antecedentes de neoplasias urologicas que fueron sometidos posteriormente a un trasplante renal (TR). Material y metodo Estudio retrospectivo llevado a cabo en el registro de la Fundacion Puigvert (Barcelona) con 1.200 TR realizados entre 1988 y 2018. Se identificaron 85 neoplasias urologicas que recibieron tratamiento previo al TR en 81 pacientes: 15 (18%) canceres de prostata, 49 (58%) carcinoma de celulas renales (CCR), 19 (22%) carcinomas uroteliales y 2 (2%) canceres de testiculo. Se registraron datos de las caracteristicas basales, la estadificacion del cancer, el tratamiento y el seguimiento, y sobre la cronologia del inicio de dialisis, la inscripcion en la lista de espera y el TR. Los criterios de valoracion fueron la recidiva del cancer, la progresion metastasica, la muerte especifica por cancer y la supervivencia global. Resultados En una mediana de seguimiento de 13,1 anos (2,2-32), se registraron 16/85 (19%) recidivas del cancer, con 3 (4%) progresiones a metastasis y muerte por cancer. La mediana de supervivencia global tras el tratamiento del cancer fue de 25,3 anos y la supervivencia por cancer especifica fue del 95% a los 25 anos. La mediana de tiempo desde el tratamiento del cancer hasta el trasplante de rinon fue de 4,8 anos: 3,7 anos en el cancer de prostata, 3,9 anos en el CCR y 8,8 anos en el cancer vesical. La mediana de tiempo desde el inicio de dialisis hasta el TR fue de 1,8 anos en los pacientes con antecedentes de neoplasia urologica, frente a 0,5 anos en la cohorte total de 1.200 trasplantes renales durante el mismo periodo. Conclusiones Los pacientes con antecedentes de neoplasias urologicas bien seleccionados se pueden beneficiar enormemente del trasplante de rinon con una recidiva del cancer tardia y poco frecuente. Para el cancer de prostata de bajo riesgo y el CCR, podria optimizarse el tiempo de espera, pero se necesitan datos mas solidos en este contexto.

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

Objective: Some attempts have previously been made to stratify patients with CIS for the purpose of risk-adapted clinical management and clinical trial design. In particular, two classification systems have been proposed: clinical classification, comprising primary (P-CIS), concomitant (C-CIS), and secondary (S-CIS) disease, and pathological classification, comprising P-CIS, cTa-CIS, and cT1-CIS. The aim of the present study was to assess the impact of both classifications on BCG response, recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS). Patients and Methods: We performed a retrospective analysis of 386 patients with bladder CIS, with or without associated cTa/cT1 disease, treated with BCG instillations between 2008 and 2015. Patients were stratified according to the two classification systems. Cox multivariate regression models were used to assess the impact of these subtypes on BCG response, RFS, PFS, OS, and CSS. We also performed a cumulative meta-analysis according to PRISMA guidelines. Results: The median follow-up was 70.5 months. According to the clinical classification, 34 (8.8%) patients had P-CIS, 81 (21%) S-CIS, and 271 (70.2%) C-CIS. The pathological classification showed 34 (8.8%) patients to have P-CIS, 190 (49.2%) cTa-CIS, and 162 (42%) cT1-CIS. In the overall cohort, BCG response was reported in 296 (76.7%); 159 (41.2%) had recurrence, 55 (14.2%) had progression, and 67 (17.4%) underwent radical cystectomy. Death from any cause was recorded in 135 (35%) and death from urothelial carcinoma in 38 (9.9%). Cox multivariate regression analysis showed that neither clinical classification nor pathological classification is an independent predictive factor for BCG response, RFS, PFS, OS, or CSS after adjusting for confounders. In the pooled meta-analysis, two studies and the present series were included for evidence synthesis, recruiting a total of 941 patients. We found no statistically significant difference across the groups for both classifications with respect to BCG response, RFS, PFS, and CSS. Conclusions: Currently, the supporting evidence for an impact of clinical classification and pathological classification on oncological outcomes of CIS of the bladder is insufficient to justify their use to guide clinical management or follow-up. (C) 2021 Published by Elsevier Inc.

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

INTRODUCTION AND OBJECTIVE:Robot-assisted kidney transplantation (RAKT) has been shown promising results in grafts coming from living donation. However, this technique has two main limitations. Fir...

Resumen Objetivos Comparar los resultados oncologicos de dos tecnicas quirurgicas abiertas y dos endoscopicas para el manejo del ureter distal durante nefroureterectomia laparoscopica (NUL). Material y metodos Revision retrospectiva de 152 pacientes sometidos a NUL por tumor del tramo urinario superior entre 2007 y 2014. Se analizo el potencial impacto de distintas tecnicas de desinsercion abierta (extravesical vs. intravesical) y endoscopica (reseccion meato con evacuacion de fragmentos vs. rodete perimeatico) sobre el desarrollo de recidiva vesical, extraurotelial y supervivencia cancer-especifica (SCE). Resultados Un total de 152 pacientes con edad media de 69,9 anos (±10,1) fueron sometidos a NUL. Se reportaron 62 pTa-T1 (41%), 35 pT2 (23%) y 55 pT3-4 (36%). Treinta y dos fueron bajo grado (21,1%) y 120 alto grado (78,9%). Se realizo desinsercion endoscopica en 89 casos (58,5%), 32 con reseccion (36%) y 57 con rodete (64%), y abierta en 63 (41,5%), 42 intravesical (66,7%) y 21 extravesical (33,3%). Con mediana de seguimiento de 32 meses (3-120), 38 pacientes (25%) desarrollaron recidiva vesical, 42 extraurotelial (27,6%) y 34 murieron por tumor (22,4%). En el analisis univariante, el tipo de tecnica endoscopica no se relaciono con recidiva vesical (p = 0,961), extraurotelial (p = 0,955) ni SCE (p = 0,802). El abordaje abierto extravesical no se relaciono con recidiva vesical (p = 0,12) pero si con aumento de recidiva extraurotelial (p = 0,045) y menor SCE (p = 0,034) respecto al intravesical. Conclusiones El subtipo de desinsercion endoscopica no influye en los resultados de la NUL. La desinsercion abierta extravesical es una tecnica mas compleja que la intravesical y podria empeorar los resultados oncologicos.

Objectives To compare the oncological outcomes between two open surgical techniques and two endoscopic approaches for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU). Material and methods Retrospective review of 152 patients submitted to LRNU for the management of upper urinary tract tumors between 2007 and 2014. We analyzed the potential impact of two different open surgical (extravesical vs intravesical) and two endoscopic (resection of ureteral orifice and fragment removal vs endoscopic bladder cuff) techniques on the development of bladder recurrence, distant/local recurrence and cancer-specific survival (CSS). Results A total of 152 patients with a mean age of 69.9 years (±10.1) underwent LRNU. We reported 62 pTa-T1 (41%), 35 pT2 (23%) and 55 pT3-4 (36%). Thirty-two were low grade (21.1%) and 120 high grade (78.9%). An endoscopic approach was performed in 89 cases (58.5%), 32 with resection (36%) and 57 with bladder cuff (64%), and open approach in 63 (41.5%), 42 intravesical (66.7%) and 21 extravesical (33.3%). Within a median follow-up of 32 months (3–120), 38 patients (25%) developed bladder recurrence, 42 distant/local recurrence (27.6%) and 34 died of tumor (22.4%). In the univariate analysis, the type of endoscopic technique was not related to bladder recurrence (p = 0.961), distant/local recurrence (p = 0.955) nor CSS (p = 0.802). The open extravesical approach was not related to bladder recurrence (p = 0.12) but increased distant/local recurrence (p = 0.045) and decreased CSS (p = 0.034) compared to intravesical approach. Conclusions LRNU outcomes are not dependant on the type of endoscopic approach performed. The open extravesical approach is a more difficult technique and could worsen the oncological outcomes when compared to the intravesical.

Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. Setting: Online Delphi survey and consensus conference. Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. Outcome measurements and statistical analysis: Statements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), 7–9 (agree). A priori (level 1) consensus was defined as 70% agreement and 15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). Results and limitations: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. Conclusions: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach, The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO.

Since its introduction more than 40 years ago, adjuvant treatment with BCG (Bacillus Calmette-Guérin) for non-muscle invasive bladder cancer (NMIBC) continues to be the treatment recommended in the highrisk group, and one of the most successful immunotherapies for cancer treatment. However, up to 20% of patients will progress to muscle-invasive disease after BCG treatment. On the other hand, we are facing a shortage of BCG supply worldwide. Despite its extensive clinical use, there is no clear certainty of the mechanism of action of BCG, and controversy persists regarding to the most effective dose and strains, as well as their usefulness in combined treatments with other drugs and with devices that could facilitate their action on the bladder. This article historically reviews the impact that has had BCG in the treatment of NMIBC, the current guidelines in terms of doses, strains and treatments combination, and the future that will happen with the results of the ongoing clinical trials with systemic immunotherapy, vaccines and gene therapy.Desde su introducción hace más de 40 años, el tratamiento adyuvante con BCG (Bacilo Calmette-Guérin) para el tumor vesical no-músculo invasivo (TVNMI) sigue siendo el tratamiento de elección en el grupo de alto riesgo, y una de las inmunoterapias para el cáncer de mayor éxito. Sin embargo, hasta el 20% de los pacientes progresarán a enfermedad músculo-invasiv adespués del tratamiento con BCG. Por otra parte,nos encontramos ante una escasez de suministro de BCG a nivel mundial. A pesar de su extenso uso clínico, no existe una clara certeza del mecanismo de acción de la BCG, y todavía persiste controversia en cuanto a las dosis y cepas más eficaces, así como su utilidad en tratamientos combinados con otros fármacos y con dispositivos que podrían facilitan su acción en la vejiga. En este artículo se revisa históricamente el impacto que ha tenido la BCG en el tratamiento del TVNMI, las directrices actuales en cuanto a dosis, cepas y tratamientos de combinación, y el futuro que acontecerá con los resultados de los ensayos clínicos sobre inmunoterapia sistémica, inmuno moduladores, vacunas y terapia génicaen el TVNMI.

Purpose: To describe the technique as well as the oncological and functional outcomes of partial salvage prostatic cryoablation (SCAP) in the treatment of local recurrent prostate cancer after primary radiotherapy. Materials and methods: The indications for partial SCAP were: PSA10 years and PSA doubling time >12 months. Cryoablation was performed with the Precise© device (Galil MedicalⓇ, Arden Hills, Minnesota, USA). Results: Fourteen patients underwent partial SCAP from 09/2010 to 09/2018. Primary treatment consisted of: 29% brachytherapy and 71% EBRT with concomitant androgen deprivation therapy (ADT) in 50%. Median time to recurrence was 8.5 years [3.2–19.3]. At the time of cryotherapy, median age was 72 years [58–84], Charlson was 3 [1–6] and serum PSA was 4.2 [2.2–9.0]. Mean procedure time was 90 min [60–120]. Median hospital stay and catheter duration were respectively 2 days [2–6] and 8 days [3–14]. Median biochemical disease-free survival was 4.4 years and 71% of the patients were free of third-line treatment at the time of evaluation. No patient developed metastasis, and all were alive at the time of the last evaluation. De novo urinary incontinence was reported in one patient and de novo erectile dysfunction in one patient. Conclusions: Partial SCAP was an alternative to salvage prostatectomy and whole gland ablation for highly selected patients with locally recurrent PCa after radiotherapy. It significantly avoided or at least delayed the need for ADT.

Introduction: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). Material and method: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. Results: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period Conclusions: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed. (C) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

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

Resumen Contexto Un articulo original correctamente redactado informa sobre lo que se hizo, por que se hizo, como se hizo, que resulto de lo que se hizo y que significa lo que se hizo. Muchos articulos no son capaces de comunicar sus resultados de forma eficaz. Objetivo Describir las caracteristicas de las partes de un articulo original y dar recomendaciones practicas para evitar los errores mas comunes en muestro medio. Adquisicion de la evidencia Se realizo una busqueda sistematica de los terminos «como escribir un articulo cientifico», «estructura del articulo original» y «publicar un articulo» en las bases de datos PubMed y SCOPUS. Se analizo la estructura de un articulo original y las caracteristicas de sus partes y se elaboraron consejos para la publicacion de un articulo. Sintesis de la evidencia Deben leerse las guias para autores de la revista. Habitualmente, el articulo original sigue la estructura IMRAD: Introduccion, Metodos, Resultados y Discusion. La introduccion expone concisamente por que se hizo el trabajo. En la seccion de metodos es necesaria una explicacion detallada de como se realizo el trabajo. Los resultados deben exponerse de forma clara, ayudandose de tablas sin repetir informacion. La discusion explica la relevancia de los resultados y los contrasta con los obtenidos por otros autores. Deben incluirse las limitaciones y una conclusion respaldada por los resultados. Conclusiones Escribir un articulo original correctamente requiere practica. Para que sea publicado debe estar respaldado por un buen trabajo de investigacion.

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

The authors regret that a co-author was mistakenly missed from the authorship. The following co-author should have been included in the authorship: Peter-Paul M. Willemse Department of Oncological Urology, University Medical Center, Utrecht Cancer Center, Utrecht, The Netherlands

BackgroundAlthough guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.ObjectiveTo bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DesignA steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference.SettingOnline Delphi survey and consensus conference.ParticipantsThe European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.Outcome measurements and statistical analysisStatements were ranked by experts according to their level of agreement: 1–3 (disagree), 4–6 (equivocal), and 7–9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).Results and limitationsOverall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease.ConclusionsThese consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach.Patient summaryThis report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.

Objective To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. Materials and methods A total of 646 patients were treated by surgery for clinically localized renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. Results During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011–2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011–2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all p Conclusions At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.

Resumen Objetivo Describir la evolucion de la tecnica quirurgica para el manejo de las masas renales en un centro espanol e identificar los factores asociados con la decision de nefrectomia parcial (NP). Materiales y metodos Un total de 646 pacientes fueron tratados quirurgicamente por tumores renales localizados entre enero de 2004 y diciembre de 2012. Las tecnicas quirurgicas incluyeron la nefrectomia radical (NR) abierta, NP abierta, NR laparoscopica y NP laparoscopica. Se compararon las caracteristicas basales y las proporciones de los pacientes tratados por diferentes tecnicas mediante estadisticos descriptivos y se determinaron las tendencias anuales en la proporcion de procedimientos realizados. Se calculo la proporcion de probabilidades (OR) y los intervalos de confianza del 95% para evaluar variables clinicas predictivas de NP. Resultados Durante el periodo de 9 anos, la proporcion de NP aumento respecto a la NR, pasando del 21 al 55%. Los procedimientos abiertos disminuyeron gradualmente a favor de abordajes minimamente invasivos (83% en 2004; 4% en 2011-2012). Aunque el tamano tumoral medio no cambio significativamente durante el periodo de estudio, la NP laparoscopica se convirtio en el procedimiento mas realizado en 2011-2012 (un 49% de todos los procedimientos). Las variables clinicas independientemente predictivas de NP fueron puntuacion ASA, funcion renal basal y tamano tumoral (todas las p Conclusiones En nuestra institucion, la evolucion en el manejo de las masas renales ha establecido la NP como la opcion quirurgica mas frecuente. Aunque la NP se utilizo cada vez mas durante el periodo de estudio, se observo un aumento paralelo de los abordajes minimamente invasivos tanto para NR como para NP.

Background: The peak incidence of bladder cancer (BCa) occurs at 85 years but data on treatment and outcome are sparse in this age group. We aimed to compare the outcomes of high-grade nonmuscle invasive BCa (HG NMIBC) and muscle invasive BCa (MIBC) treated with standard therapies vs. palliative management in patients >85 years. Methods: Retrospective multicenter study of 317 patients > 85 years who underwent transurethral resection (TURB) for de novo BCa between 2014 and 2016. Standard management consisted in following EAU-guidelines and palliative in monitoring patients without applying oncological treatments after TURB. Low-grade tumors were not compared because all of them were considered to have followed a standard management. Results: Median age was 87 years (85-97). ASA-score was as follows: II, 34.7%; III, 52.1%; IV, 13.2%. Pathological examination showed: 86 Low-grade NMIBC (27.1%), 156 HG NMIBC (49.2%), and 75 MIBC (23.7%). Median follow-up of the series was 21 months (3-61) and median overall survival (OS) 29 (24-33). Among HG NMIBC, 77 patients (49.4%) received standard treatments (BCG, restaging TURB) and 79 (50.6%) palliative management. Among MIBC, 24 (32%) received standard management (cystectomy, radiotherapy, chemotherapy) and 51 (68%) palliative. Applying standard management in HG NMIBC was an independent prognostic factor of OS (44 months vs. 24, HR 1.95; P = 0.013) and decreased the emergency visit rate (33% vs. 43%). In MIBC, the type of management was not a related to OS (P = 0.439) and did not decrease the emergency visit rate (33% vs. 33%). ASA and Charlson-score were not predictors of OS in HG NMIBC (P = 0.368, P = 0.386) and MIBC (P = 0.511, P = 0.665). Conclusions: Chronological age should not be a contraindication for applying standard therapies in NMIBC. In MIBC the survival is low regardless of the type of management. The lack of correlation between OS and ASA or Charlson-score raises the necessity of a geriatric assessment for selecting the best treatment strategy. (C) 2019 Elsevier Inc. All rights reserved.

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

Context A correctly drafted original article gives information on what was done, why it was done, how it was done, the result of what was done, and the significance of what was done. Many articles fail to report their results effectively. Objective To describe the characteristics of an original article and to give practical recommendations to prevent the most common errors in our environment. Evidence acquisition We performed a systematic search of the terms “how to write a scientific article”, “structure of the original article” and “publishing an article” in the databases PubMed and SCOPUS. We analyzed the structure of an original article and the characteristics of its parts and prepared advice on the publication of an article. Evidence synthesis The journal's guidelines for authors should be read. It is usual for the original article to follow the IMRAD structure: Introduction, Methods, Results and Discussion. The introduction states briefly why the study was performed. The methods’ section should give a detailed explanation of how the study was performed. The results should be clearly presented, with the help of tables, without repeating information. The discussion explains the relevance of the results and contrasts them with those of other authors. Any limitations and a conclusion supported by the results must be included. Conclusions Writing an original article correctly requires practice and it must be supported by a good research work in order to be published.

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

Resumen Objetivo Analizar la relacion entre el indice de comorbilidad de Charlson ajustado por edad (ICCa) y los resultados anatomopatologicos de las resecciones transuretrales (RTU) de tumores vesicales (TV) de novo. Material y metodos Se recogieron los datos de 208 pacientes que, entre 2007 y 2008, fueron tratados mediante una RTU de un TV de novo. Se recogieron las variables edad, genero, consumo de tabaco, comorbilidades evaluadas segun el ICCa (puntuacion y tasa de mortalidad), estadio patologico, grado tumoral y riesgo de recurrencia y progresion. Se analizo la relacion entre las variables preoperatorias y las caracteristicas patologicas finales. Se realizo el estudio multivariante con aquellas variables significativas (p Resultados La edad media fue 69,5 ± 12. Un 77% fueron hombres. El ICCa medio fue 6,4 ± 2,5. El resultado anatomopatologico final mostro un Tx, T0, Ta, T1 y T≥2 en el 5,3; 6,7; 31,7; 26,9 y 28,8%, respectivamente. El 33,3% fueron de bajo grado y el 66,7% de alto grado. Un 14,3% se asocio con CIS. Entre los TV no musculo invasivos, el 34,7% fueron de bajo riesgo de recurrencia y progresion, el 18,1% intermedio y el 47,2% de alto riesgo. Los pacientes con un ICCa igual o superior a 5 presentaron un mayor numero de TV musculo invasivos (RR: 2,29; 1,1-4,8; p = 0,032), de tumores de alto grado (RR 3,1; IC: 1.6-6; p = 0,001) y de tumores de alto riesgo de recurrencia y progresion (RR: 2,9; IC: 1,4-5,9; p Conclusion El ICCa esta relacionado con las caracteristicas patologicas de los TV de novo. Pacientes con mayor comorbilidad pueden presentar tumores mas agresivos, por lo que el ICCa podria ser util en la practica clinica al identificar a pacientes con peor pronostico.

Objective To analyze the relationship between the age-adjusted Charlson comorbidity index (aCCI) and pathological outcomes of transurethral resection of de novo bladder tumors (BT). Material and methods Data from 208 patients who underwent a transurethral resection (TUR) of a de novo BT between 2007 and 2008 were collected. We recorded the following variables: age, sex, tobacco consumption, comorbidities assessed according to the aCCI (score and mortality rate), disease stage, tumor grade and risk of recurrence and progression. The relationship between the preoperative variables and the final pathological characteristics was analyzed. The multivariate study was conducted with the significant variables ( p Results The mean age of the patients was 69.5 ± 12 years, and 77% were men. The mean aCCI was 6.4 ± 2.5. The final pathology results showed a Tx, T0, Ta, T1 and ≥T2 in 5.3, 6.7, 31.7, 26.9, and 28.8% of the cases, respectively. 33.3% of the tumors were low-grade and 66.7% were high-grade. 14.3% of the tumors were associated with carcinoma in situ. Among those non musculo-invasive bladder tumor (non-MIBT), 34.7% had a low risk of recurrence and progression, 18.1% had an intermediate risk and 47.2% had a high risk. The patients with a aCCI ≥5 had an increased number of MIBT (RR: 2.29; 1.1–4.8; p = .032), high-grade tumors (RR: 3.1; CI: 1.6–6; p = .001) and tumors with a high risk of recurrence and progression (RR: 2.9; CI: 1.4–5.9; p Conclusion The aCCI is related to the pathological characteristics of de novo BT. Patients with greater comorbidity can present more aggressive tumors. The aCCI could therefore be useful in clinical practice for identifying patients with worse prognosis.

Introduction: Local recurrence (LR) after radical cystectomy (RC) for bladder cancer has a bad prognosis. Treatment options include chemotherapy, radiation therapy and surgical excision, but few data is available on the advantages of surgery for these patients. Patients and Methods: We evaluated our series of 8 selected patients who underwent surgery for locally recurrent bladder cancer after RC. Results: The median time to recurrence after cystectomy was 20.8 months. The complications rate and severity were not negligible. Pathology report confirmed urothelial carcinoma with negative margins in all patients. After LR treatment, 4 patients recurred locally for a second time and 3 developed distant metastasis. They all died after a median follow-up of 10.4 months. One patient remained disease free after 14 months. Conclusions: The prognosis of patients with LR is poor regardless of surgical treatment and reflects the aggressive biological nature of urothelial tumors.

Objectives To analyze the predictors for bladder recurrence (BR) after nephroureterectomy (NU) for upper urinary tract tumors (UUTT), as well as its pathological characteristics, outcomes and impact on survival. Material and methods Retrospective study of 117 patients who underwent laparoscopic nephroureterectomy by UUTT between 2007 and 2012 at our center. The potential predictors for BR were analyzed using Cox regression; Kaplan–Meier curves were employed to study survival. Results The sample was composed of 85 men (73%) and 32 women (27%), with a mean age of 70 years. After a mean follow-up of 26 months, 23 patients presented BR (19.6%). In the multivariate analysis, sex (p = 0.003; HR [female], 3.8) and the location of the UUTT in the distal ureter (p = 0.002; HR, 4.8) were independent predictors for BR. The median time to BR was 8 months. Fifteen patients presented a nonmuscle-invasive BR (65.2%), and 8 presented a muscle-invasive BR (34.8%). All BRs, except for 2, appeared during the first 2 years. Five cases with nonmuscle-invasive BR presented a new BR. Six patients with muscle-invasive BR died before it could be determined whether cause of death was the BR or an UUTT relapse. The onset of BR showed no repercussion on the survival of patients with UUTT. Conclusions Sex (female) and the location of the UUTT (distal ureter) are predictors for BR after NU. Patients with these characteristics might benefit from adjuvant intravesical treatment and closer monitoring. The onset for RV has no impact on the survival of patients with UUTT.