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Competing Interests: The authors declare no conflict of interest.

Introduction: Ureteral stent placement during laparoscopic pyeloplasty is a common procedure in pediatric patients. Although an apparently safe maneuver, ascending placement of the stent can lead to complex removal or repositioning reinterventions., Objective: In this study we compare two methods for intraoperative verification of correct positioning., Study Design: Prospective observational study collecting data on laparoscopic pyeloplasties in pediatric patients in our center over three years. We carried out descriptive and univariate comparative analyses. Data were compared between ultrasound and reflux visualized by the catheter after intraoperative salineinjection into the bladder through the urethral catheter. We recorded time to catheter visualization in both ultrasonography and in reflux from the start of bladder instillation, as well as bladder volume at the time of placement verification with each method., Results: Data were collected from 20 patients (15 male and 5 female) with a median age of 48 months. Pyeloplasty was successful in 100% of the sample (as observed by ultrasound and MAG-3), while one patient had postoperative leak requiring nephrostomy placement. Correct distal positioning of the ureteral stent could be verified by intraoperative ultrasound and reflux in all cases. Using reflux, the bladder volume needed to verify correct positioning exceeded the age-related maximum in half the cohort, while on ultrasound, the stent was visualized in the bladder without reaching the maximum bladder capacity for age in any case (p = 0.02 comparing percentages). Likewise, mean time to verification was lower with ultrasound than with reflux (61.8 s versus 115 s), but without these differences reaching statistical significance (p = 0.14)., Discussion: The present study is the first to compare two methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasties in pediatric patients. Our results show that both intraoperative ultrasound and visualization of reflux are useful methods, although ultrasound requires a lower volume of saline instilled through the bladder catheter for verification. This work can be very useful for the daily clinical practice of urologists and pediatric surgeons., Conclusions: Both intraoperative ultrasound and visualization of reflux are useful methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasty of pediatric patients. With ultrasound, a smaller volume is required to check for reflux. Although ultrasound is faster for verification, there are no differences in procedural times., Competing Interests: Conflicts of interest The authors declare that they have no conflict of interest., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: In this study we used nuclear magnetic resonance spectroscopy in prostate tissue to provide new data on potential biomarkers of prostate cancer in patients eligible for prostate biopsy., Material and Methods: Core needle prostate tissue samples were obtained. After acquiring all the spectra using a Bruker Avance III DRX 600 spectrometer, tissue samples were subjected to routine histology to confirm presence or absence of prostate cancer. Univariate and multivariate analyses with metabolic and clinical variables were performed to predict the occurrence of prostate cancer., Results: A total of 201 patients, were included in the study. Of all cores subjected to high-resolution magic angle spinning (HR-MAS) followed by standard histological study, 56 (27.8%) tested positive for carcinoma. According to HR-MAS probe analysis, metabolic pathways such as glycolysis, the Krebs cycle, and the metabolism of different amino acids were associated with presence of prostate cancer. Metabolites detected in tissue such as citrate or glycerol-3-phosphocholine, together with prostate volume and suspicious rectal examination, formed a predictive model for prostate cancer in tissue with an area under the curve of 0.87, a specificity of 94%, a positive predictive value of 80% and a negative predictive value of 84%., Conclusions: Metabolomics using HR-MAS analysis can uncover a specific metabolic fingerprint of prostate cancer in prostate tissue, using a tissue core obtained by transrectal biopsy. This specific fingerprint is based on levels of citrate, glycerol-3-phosphocholine, glycine, carnitine, and 0-phosphocholine. Several clinical variables, such as suspicious digital rectal examination and prostate volume, combined with these metabolites, form a predictive model to diagnose prostate cancer that has shown encouraging results., (© 2024 The Authors. The Prostate published by Wiley Periodicals LLC.)

Introduction: Ureteropelvic junction obstruction (UPJO) is the most common cause of congenital hydronephrosis. Techniques such as laparoscopic pyeloplasty (LP) have gained in popularity over recent years. Although some retrospective studies have compared minimally invasive reconstructive techniques with open surgery for treatment of UPJO in infants, results remain controversial due to the small sample size in most of these studies., Objective: To verify whether the benefits of minimally invasive pyeloplasty (MIP) observed in adults and children over 2 years of age also apply to infants., Methods: A systematic review of the literature was performed according to PRISMA recommendations. We searched databases of MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. We excluded studies in which patient cohorts were outside the age range between 1 and 23 months of age (infants). Studies should evaluate at least one of the following outcomes: average hospital stay, operative time, follow-up time, complications, post-surgical catheter use, success rate and reintervention rate. The quality of the evidence was assessed with the ROBINS-I tool., Results: In total, 13 studies were selected. 3494 patients were included in the meta-analysis, of whom 3054 underwent OP, while the remaining 440 were part of the group undergoing MIP. The mean difference in hospital days was -1.16 lower the MIP group (95 % CI; -1.78, -0.53; p = 0.0003). Also, our analysis showed a significantly shorter surgical time in the group who underwent OP, with a mean operative time of 119.92 min, compared to 137.63 min in the MIP group (95 % CI; -31.76, -6.27; p = 0.003). No statistically significant between-group differences were found respect to follow-up time, complications, post-surgical catheter use, success rate and reintervention rate., Conclusion: This systematic review with meta-analysis has shown that laparoscopic/robotic pyeloplasty in infants is a safe technique with similar success rates to open surgery. Nonetheless, randomized clinical trials with longer follow-up are needed to consolidate these results with more robust scientific evidence., Competing Interests: Conflict of interest The authors declare that does not exist an interest conflict., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: The objective of the study was to establish a possible relationship between mitomycin-C (MMC) and bacillus Calmette-Guérin (BCG) treatments and quality of life impairment., Material and Methods: Quasi-experimental, prospective, and longitudinal study including patients undergoing adjuvant treatment in NMIBC. The Short form-12 (SF-12) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to measure quality of life. Questionnaire scores were compared between cases with MMC and BCG before induction (M1), at 4 weeks (M2) and at 2 months (M3)., Results: Of the 90 patients enrolled, 54 were in the BCG group and 36 in the MMC group. It was found that BCG patients had worse perceived physical quality of life compared to MMC patients in M2 (OR:2.59, p=0.046). In addition, significant changes were found in the urinary quality of life of patients on MMC treatment between the different time points (UDI-6 score: 33.33 in M1, 27.78 in M2 and 16.67 in M3, p=0.001)., Conclusions: There are no differences in urinary quality of life between patients treated with MMC and BCG. Patients with MMC show a significant recovery of urinary quality of life from the completion of the induction course, which becomes even more significant after 2 months. In addition, BCG-treated patients have worse physical quality of life after 4 weeks of treatment than those treated with MMC., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of this study was to compare the Isiris TM cystoscope with a common reusable flexible cystoscope in terms of patient perceived pain and endoscopy time in the ureteral stent removal setting., Materials and Methods: A non-randomized prospective study comparing the Isiris TM single-use cystoscope with a reusable flexible cystoscope. A visual analogue scale (VAS) was used for pain assessment and endoscopy time was recorded in seconds. Univariate and multivariate analyses were performed to assess the correlation between endoscope type and clinical variables with VAS score and endoscopy time., Results: A total of 85 patients were included in the study: 53 in the disposable cystoscope group and 32 in the reusable cystoscope group. Ureteral stent extraction was successful in all cases. The mean VAS score was similar between groups (single-use group was 2.09 +/- 2.53 vs 2.53 +/- 2.14 in the reusable cystoscope group) ( p = 0.13). Same was observed endoscopy time (74.92 +/- 74.45 s. in the single-use group vs 98.87 +/- 153.33 s. in the reusable group) ( p = 0.07). Age (coefficient β = -0.36, p < 0.04) and body mass index (BMI) (coefficient β = -0.22, p < 0.02) were inversely correlated with perceived pain during ureteral stent removal, measured by VAS score., Conclusions: Ureteral catheter removal with a flexible cystoscope is a well-tolerated procedure in patients. Older age and high BMI are associated with better intervention tolerance. Use of a single-use flexible cystoscope is comparable to that of a common flexible cystoscope in terms of pain and endoscopy time.

Introduction: In this work, we present two cases of heminephrectomies with postoperative findings of cystic lesions in the bed of the excised renal segment., Material and Methods: Description of the clinical cases, therapeutic management and description of the ultrasound findings. A review of the published cases was carried out., Results: We present a case of open heminephrectomy due to atrophy of the upper hemirrenal in a case of ureterocele, and another case with bilateral lower heminephrectomy in a case of vesicoureteral reflux disease. In the first case, the cystic lesion disappeared during follow-up, while in the second, the cysts remained stable. In none of the cases published in the literature was it necessary to perform any intervention to resolve the cysts., Conclusions: The appearance of cystic lesions in the heminephrectomy bed in pediatric patients is a radiological finding that occurs frequently. Due to its favorable evolution, without the need for additional procedures for its resolution, we do not consider the presence of these lesions as a complication after heminephrectomy.

Introduction: In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event., Material and Methods: We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction., Results: This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient's progress was satisfactory., Conclusion: Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.

Introduction: The renal trauma is present in a 5% of all trauma cases. In the most common causes, conservative treatment can be performed. It is reported a case of renal trauma due to metal sick that required surgical management. It is considered that this is a rare clinical case with urgent surgical management that is not usual in this type of trauma. In addition, it is an example of quick decision-making since the patient's life depends on them., Case Report: A 69-year-old man was referred to our institution for polytrauma. In contrast-enhanced computed tomography, renal, intestinal and great vessel were suspected, so an urgent surgical treatment was decided. During surgery, radical nephrectomy was performed due to perforation of the right kidney by a metal stick., Conclusions: Although conservative treatment of renal trauma can be performed in most cases, it must be taken into account that radical nephrectomy is a possible option when the kidney cannot be preserved.

Introduction: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression., Objective: To report a case of granulomatous cystitis in a patient receiving BCG intravesical therapy for urothelial carcinoma., Material and Methods: A 63-year-old man underwent BCG treatment for a bladder tumor with pathological diagnosis of T1G3 urothelial carcinoma. Five months later, trans urethral resection (TUR) of bladder was performed for an erythematous lesion, with results of post-BCG cystitis. Two years later, the patient presented with hematuria and with suspicious findings in the cystoscopy (extensive fibrin-covered and calcified lesions in the bladder) and a bladder TUR was done., Results: The histopathological study showed granulomatous cystitis with necrosis and the presence of BAAR compatible with post-BCG origin. In the mycobacterial culture, M. bovis grew, and treatment was initiated. A cystography was performed on suspicion of a microbladder on CT with secondary vesicoureteral reflux, confirmed in this test. It was decided to perform a radical cystectomy. Histopathology reported post-BCG granulomatous cystitis and prostatitis., Conclusions: After BCG treatment, if symptoms or images are suggestive of granulomatous cystitis, a study of mycobacterial infection should be started to avoid the development of complications, such as the microbladder as in the case we present.

Introduction: We show the ability of early ultrasound after surgery to show the success of endoscopic puncture of the ureterocele., Method: Description of the clinical cases, therapeutic management and description of the ultrasound findings., Results: We present two infants aged 1 and 4 months who underwent endoscopic puncture of ectopic ureteroceles during a period of 3 months at our institution. The first case was operated urgently for urinary sepsis, while the second was punctured to preserve renal function. In both cases, ultrasound was performed two hours after surgery, and the ultrasound findings were recorded. In both patients, the ureterocele was considered resolved one year after the puncture., Conclusions: Findings such as puncture notch, flap-like collapse of the walls, decrease in ureterohydronephrosis, or disappearance of debris in the upper tract, are ultrasound signs that are visualized in the immediate postoperative period of endoscopic puncture of the ureterocele. Thus, early ultrasound is useful for early monitoring of endoscopic treatment of ureterocele.

Renal cell carcinoma is the most common type of kidney cancer, representing 90% of kidney cancer diagnoses, and the deadliest urological cancer. While the incidence and mortality rates by renal cell carcinoma are higher in men compared to women, in both sexes the clinical characteristics are the same, and usually unspecific, thereby hindering and delaying the diagnostic process and increasing the metastatic potential. Regarding treatment, surgical resection remains the main therapeutic strategy. However, even after radical nephrectomy, metastasis may still occur in some patients, with most metastatic renal cell carcinomas being resistant to chemotherapy and radiotherapy. Therefore, the identification of new biomarkers to help clinicians in the early detection, and treatment of renal cell carcinoma is essential. In this review, we describe circRNAs related to renal cell carcinoma processes reported to date and propose the use of some in therapeutic strategies for renal cell carcinoma treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Osca-Verdegal, Beltrán-García, Górriz, Martínez Jabaloyas, Pallardó and García-Giménez.)

Introduction: The study aimed to present the outcomes of an endoureterotomy series using the Lovaco technique for the treatment of ureterointestinal strictures. Factors influencing the success or failure of this technique were also determined., Materials and Methods: Data were collected from all endoureterotomies for ureterointestinal strictures performed in a single-center between 2017 and 2020. Clinical variables and characteristics of the stricture were recorded in each case, and success was defined as the complete resolution of ureterohydronephrosis. Univariate analysis was used to correlate the variables recorded with procedural success or failure., Results: A total of 25 patients were recruited: 16 with strictures on the left side, 5 on the right, and 4 bilateral. With the first endoureterotomy, 52% of the cases (13 patients) were resolved, and in patients undergoing a second intervention 64% success (16 patients) was achieved. Infectious complications occurred in 23.3% of surgeries. Stricture length, poor renal function, and left side involvement were associated with endoureterotomy failure., Conclusions: Endoureterotomy with the Lovaco technique is a useful method in the setting of ureterointestinal strictures, achieving complete resolution of the obstruction in more than 60% of cases. Factors that can negatively affect the success of the procedure include stricture length, poor renal function, and left side involvement.

Objective: The objective of thisstudy is to review three cases using urokinase in patientswith urinary catheter obstructed by clots, aswell to carry out a review of the published literature. METHODS: It was done a review of three casesfrom 2019 to 2020 who required urokinase due tourinary catheters obstructed by clots in our department.In addition, a reference search was performedin Pubmed. RESULTS: The first case was a woman with metastaticbreast carcinoma who required nephrostomyplacement. The second case was a renal trauma thatrequired bladder catheterization. The third case wasa male with a benign ureteric obstruction who requirednephrostomy placement due to sepsis. After instillationswith urokinase, the first two cases respondedadequately, while the third was unsuccessful. CONCLUSIONS: Urokinase may be an effectiveand well-tolerated therapy in the treatment of coagulatedurinary catheters that does not respond toother measures.

Objective: The treatment of the ectopic ureter in the pediatric patient must be individualized in each caseMETHOD: Description of clinical cases, therapeutic management and evolution of patients., Results: We present four pediatric patients with ectopic ureters who underwent surgery. We describe a case of laparoscopic nephroureterectomy, one of laparoscopic uretero-ureterostomy, one of bilateral ureteral reimplantation and another of unilateral reimplantation. The discussion about the diagnosis and different surgical treatments of each case is deepened., Conclusions: We present four cases of pediatric patients with ectopic ureters, treated by different surgeries. We present how was the preoperative diagnosis and the importance of individualizing the surgical treatment in eachc ase. Aspects recently described in the context of ureteralectopy, such as diagnostic evaluation by MRI or the role of minimally invasive techniques in treatment, should be taken into account in its management.

Although reconstructive surgery is the most accepted treatment for ureteral injury, there are reports of cases where endourologic treatment led to correct resolution of the problem. We present the case of a female patient aged 72-year-old who was previously underwent sacralcolpopexy because of anterior vaginal compartment prolapse. The patient underwent surgery to remove the mesh, due to the pain she had had since it was placed. A mid-line laparotomy was performed removing completely the mesh. At 48 hours after intervention, the patient started feeling an intense pain in the left renal fossa that was not relieved with anti-inflammatories and morphic drugs. In the diagnostic ureteroscopy, it was found iatrogenic suture of the ureter. Due to the availability of holmium laser, an endoureterotomy was performed in the 12h central position on the tip, with laser parameters of 1J-10Hz. A 6F ureteral stent was maintained for one month. During follow-up, the patient remained asymptomatic and without dilation of the left system on imaging tests. Although we accept that open reconstruction is the gold standard treatment for ureteral trauma, we describe holmium laser endoureterotomy as a promising technique to consider in the event of ureteral intraluminal ligation.

Objective: To describe the case of a patient with subcutaneous inguinal recurrence of penile cancer without lymph node involvement., Methods: Description of a clinical case and review of the literature on the subject., Results: We present the case of a 72-year-old man with penile cancer and extranodal inguinal extension that affected subcutaneous cell tissue, with a history of negative sentinel lymph node and subsequently without invasion of the regional lymph nodes in lymphadenectomy after chemotherapy. The patient presented disease progression despite multimodal treatment., Conclusion: Extranodal inguinal involvement in penile cancer may occur despite a history of negative sentinel lymph node. The evolution of the patient we presented was disastrous despite the multimodal treatment carried out.

Objectives: The goal of this work was to study the relationship between presence of varicocele and testosterone serum levels in adulthood., Methods: A comparative, cross-sectional study of 387 men who consulted for erectile dysfunction. Age, body mass index (BMI), diabetes (DM), and presence of varicocele were related to testosterone levels through uni- and multi-variate analysis., Results: A total of 248 cases (70.8%) had no varicocele, 46 (13.1%) had grade I varicocele, 36 (10.3%) grade II, and 20 (5.7%) grade III. The mean total testosterone levels were 4.77 ng/mL in the non-varicocele group and 4.34 ng/mL in the varicocele group ( p  = .91), while free testosterone levels were 69.81 and 73.24 pg/mL ( p  = .18), respectively. In the multivariate analysis, BMI> = 30 was related to low total testosterone levels (OR: 2.94, p  < .001) and low free testosterone (OR: 2.01, p  = .01), while advanced age associated with low levels of free testosterone (OR: 1.04, p  < .001)., Conclusions: We were not able to establish a relationship between the presence of varicocele and decreased serum testosterone levels. Other factors already described, such as obesity and age, were related to low levels of total and free testosterone.

Background: Ureterointestinal stenosis is a frequent complication after radical cystectomy, occurring in up to 10%-12% of cases. Endoscopic treatment of complete stenosis has been described through double access, with antegrade flexible ureteroscopy and simultaneous retrograde endoscopy through the intestinal diversion. We present a case of endoscopic treatment without use of antegrade ureteroscopy. Case Presentation: A 52-year-old man underwent surgery for peritoneal carcinomatosis secondary to mucinous adenocarcinoma. Ileocecal resection, omentectomy, sigmoidectomy, rectal resection, cystoprostatectomy, and ileal duct were performed. He had a complicated postoperative period because of enterocutaneous fistulas, peritonitis, and secondary intention wall closure, needing multiple surgeries. Four months later, he was diagnosed with left ureteroinestinal stenosis, for which endoscopic management was the chosen treatment. Intraoperative diagnosis was complete stenosis. To locate the stenosis, methylene blue was instilled using a percutaneous ureteral catheter. With a resectoscope inserted through the ileal duct, the stenosis was observed and opened using cold knife and Collins knife. The stenosis was resolved satisfactorily. Conclusion: Endoscopic management of complete ureterointestinal stenosis is a viable treatment option. Although stenosis localization has previously been described with two endoscopes using transillumination, we demonstrate another localization technique using methylene blue., Competing Interests: No competing financial interests exist., (Copyright 2020, Mary Ann Liebert, Inc., publishers.)

Background and Objective: The objective was to determine the prevalence of erectile dysfunction in men over 40 years of age and their relationship with frequent pathologies in Primary Care., Patients and Methods: Three hundred two men (40-79 years) were included. Anthropometric medical history, habits and parameters were determined. They were given the international prostate symptomatology questionnaire (IPSS), the male sexual health questionnaire (SHIM) and the Goldberg test for anxiety and depression. The prevalence of erectile dysfunction was determined and the relationship of the different variables obtained by univariate and multivariate analysis was studied., Results: The prevalence of erectile dysfunction was 36%. Older patients, smokers, with abdominal obesity, hypertensive, diabetic, at risk of depression or with voiding symptoms had lower scores on the sexual health questionnaire. According to the multivariate analysis, the risk of suffering from erectile dysfunction increased with age, if the person was diabetic, or if there was voiding symptomatology., Conclusion: Age, diabetes mellitus and the presence of voiding symptoms are factors associated with erectile dysfunction in the field of Primary Care., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Purpose: The COVID-19 pandemic which has affected Spain since the beginning of 2020 compels us to determine recomendations for the practice of Andrology in present times., Materials and Methods: A web search is carried out in English and Spanish and a joint proposal is defined by experts in Andrology from different regions of Spain., Results: Most diagnostic and therapeutic procedures in Andrology can be safey postponed during the COVID-19 pandemic. Online consultations and outpatient surgeries must be encouraged. Andrologic emergencies and penile cancer management should be considered high priority, and should be diagnosed and treated promptly even in the most severe phases of the pandemic.

Objective: To determine possible risk factors for accidental nephrostomy tube dislodgement and compare two different tube types in this context in patients with chronic catheters. Materials and Methods: We conducted a retrospective study of long-term patients with nephrostomy tube. We performed a comparative analysis, studying the possible variables that were related to catheter dislodgement. In addition, a subanalysis was also carried out comparing different catheter designs (Pigtail and Foley) in case this could be related to the dislodgement. Results: Two hundred five cases were collected. A total of 51.2% of cases had a pigtail nephrostomy and 48.8% Foley type, and accidental dislodgement occurred in 26.3% of cases. In multivariate analysis, we observed that first time nephrostomy tube placement entailed higher risk of accidental dislodgement than successive placements (odds ratio [OR] 1.95, confidence interval [CI] 1.01-3.74, p  = 0.04). In the pigtail-type catheter patient subgroup, tubes placed by a resident were more prone to accidental dislodgement than those placed by an attending physician (OR 3.39, CI 1.29-8.91, p  = 0.01), while first episode cases were more likely to have become dislodged than in a subsequent event (OR 3.17, CI 1.17-8.57, p  = 0.02). In addition, the mean (in days) until nephrostomy tube dislodgement in cases where this occurred was 20.32 ± 3.52 for pigtail and 60.92 ± 5.15 for Foley ( p  < 0.01 in Kaplan-Meier's test). Conclusion: Nephrostomy tube displacement in long-term patients is a common problem. Some factors associated with the catheter could increase the risk of involuntary displacement, such as being a first event or being inserted by less experienced resident doctors. In addition, pigtail type nephrostomies tend toward accidental dislodgement earlier than Foley ones.

Introduction: The objective of the study was to determine the factors independently related with the development of castration resistance (CR) in prostate cancer (PC) in the medium term., Material and Methods: 155 patients diagnosed with metastatic PC with a follow-up of up to 39 months. Data taken from the National PC Registry. The evaluated variables were age, PSA, nadir PSA, Gleason, perineural invasion, TNM stages, and ADT type (intermittent/continuous)., Results: Mean follow-up 26,2±13,4 months. 47.1% developed early CR, with mean time until onset of 12,2±8,7 months. Univariate analysis the mean PSA was correlated with CR (290±905,1 ng/mL in non CR, 519,1±1437,2 ng/mL in CR, P<.001), mean age (73,3±8,3 years in non CR, 69,1±9,3 in CR P=.01), mean PSA nadir (15,5±57,3ng/mL in non CR, 15,9±23,7 ng/mL in CR, p<0,001), Gleason (in ≥8, HR:2,11. 95% CI: 1.22-3.65, p=0.006), and T stage (in T3-T4, HR: 2.85. 95% CI: 1.57-5.19, P<.001). Multivariate analysis the independent variables associated to CR are age (HR: 0.96. 95% CI: 0.94-0.99, P=.01), PSA nadir (HR: 1.65. 95% CI: 1,43-1,91, P<.001), and T3-T4 stage (HR: 2.11. 95% CI: 1.10-4.04, P=.02)., Conclusions: PSA nadir and T3-T4 tumor stage at diagnosis are associated to an increased risk of developing CR. In addition, age at diagnosis is shown as a variable that decreases risk. Therefore, an older age would be associated with lower risk probability of CR in the medium term., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Ureteral realignment using a ureteral stent can be an alternative treatment in cases of complete ureteral transection and may avoid the need for reconstructive surgery. The combined access can help the passage of the guidewire through the injured area and the threading of the urinary system of the patient. We present a case of a 38-year-old man with multiples abdominal surgeries, who underwent a complete ureteral section treated with ureteral realignment with combined access. The subsequent evolution was favourable, with resolution of the ureteral injury at the acute time, and without the presence of long-term obstruction. Although we must accept that the standard treatment of the complete ureteral transection is reconstruction and anastomosis, in cases such as the one prsented, with multiple abdominal surgeries and whenever it is technically feasible, ureteral realignment may be a treatment option.

Introduction: OHVIRA syndrome is a rare entity characterized by renal and Mullerian anomalies. The objective of the video is, through a clinical case, to discuss the importance of diagnosis, management and treatment, to avoid the complications that this syndrome entails, and to improve the long-term prognosis., Materials and Methods: We report the case of a 10-year-old girl who consulted for abdominal pain, being diagnosed with OHVIRA syndrome. We describe the diagnosis and the surgical technique. In addition, we perform a systematic review in PubMed to report the published literature of this topic and we show the optimal management of this pathology., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objectives: To investigate the expression of several immunohistochemical (IHC) markers and their predictive ability for the recurrence-free and progression-free survival of papillary urothelial bladder cancer (UBC) pTa/pT1 G2 (WHO 1973) compared to classical anatomo-clinical variables using a multidimensional analysis., Materials and Methods: A population-based cohort of 213 primary stage UBC (pTa/pT1) G2 (WHO 1973) was evaluated by classic anatomopathological variables and characterized by immunohistochemistry (23 IHC markers, representative of different oncogenic pathways). The most important variables as a predictor of recurrence-free and progression-free survival were selected using multidimensional statistical models, such as random survival forests and least absolute shrinkage and selection operator (. Recurrence and progression-free survival of the previously selected variables were also calculated., Results: Mean follow-up was 58 ± 33.5 months. Recurrence and progression rates were 54.5% (n = 116) and 17,4% (n = 37), respectively. The most influential variables in the low recurrence-free survival were in order: number of resected tumors, high expression of Ki67 (>10%), Cyclin D1 (>10%), and low cytoplasmic staining of p16INK4a. Regarding low progression-free survival, the most important variables were Ki67 (>15%), multicentric tumor arrangement and Survivin nuclear expression (>20%). Kaplan-Meier and cox-regression model analyses showed that the variables selected by multidimensional models were able to discriminate the clinical outcome., Conclusions: Ki67 index is the most useful IHC marker, since it can improve the prediction of both recurrence and progression-free survival in papillary UBC pTa/pT1 G2 (WHO 1973). There are other markers, whose utility is specific to recurrence-free survival, such as Cyclin D1 and p16INK4a or in progression-free survival, such as Survivin., (Copyright © 2018. Published by Elsevier Inc.)

Introduction: We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery., Methods: We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered., Results: A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5°C (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02)., Conclusions: Those patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.

Objective: To describe holmium laser endoureterotomy with the Lovaco technique for the treatment of ureterointestinal stenosis. This common problem after cystectomy represents a surgical challenge, with endourological techniques being useful in this context. We present a technique that has been described before, but which we consider useful and decisive. The key points and difficult aspects of the technique are shown, along with our experience with it., Methods: We collected data on cases of ureterointestinal stenosis treated using holmium laser endoureterotomy with the Lovaco technique, in a prospective manner, between January 2017 and January 2018. Intraoperative data, postoperative complications, and success rate were recorded. Cases, where there was an improvement of renal function, and the cause that led to surgery was resolved, were considered to be successful., Results: Nine endoureterotomies were performed in 7 male patients (2 bilateral), all of them had an ileal conduit. The average age was 68 years, and the average surgery time was 75 minutes. There were no intraoperative complications in any surgery. One patient was readmitted to the hospital 48 hours after discharge, due to febrile urinary tract infection. Of the 7 patients, 1 died shortly after surgery due to a tumor, and another has a short follow-up time. Of the remaining 5 patients, we have considered surgery to have an 80% success rate. The minimum follow-up was 4 months, the maximum was 13 months., Conclusion: We consider endoureterotomy with the Lovaco technique a useful and decisive surgery for the treatment of ureterointestinal stenosis, being a reproducible technique. In comparison to other similar techniques, it has advantages such as being safer and not requiring the use of flexible material. The use of holmium laser allows a precise incision and good visibility. Larger series and a longer follow-up are needed to obtain weighty conclusions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: To study the relationship between quantitative mRNA determination (hTERT) in patients with bladder tumor, history of bladder tumor, and in subjects without a history of this neoplasia., Material and Methods: A prospective randomized controlled study with 91 subjects included. The value of mRNA-hTERT N was determined in 63 patients with a history or suspicion of bladder tumor and in 28 controls. Urine samples were sent for evaluation of the mRNA level (hTERT), the cytological study and the NMP22 result., Results: Differences were observed in mean hTERT N levels in each of the groups: tumor presence 21.33+/- 40.66, tumor history 2.16+/- 2.67, controls 0.9+/- 1, 75 (p<0.001). In patients with tumor, there was no difference in mean hTERT N levels between the different grades and stages, although there was a tendency: low grade tumor 9.04+/- 16.95, high grade 28.95+/- 48.36 (p=.069), stage Ta 10.33+/- 19.39, T1 17.88+/- 27.14, T2 54.8+/- 74.05 (p=.056). In addition, the sensitivity of hTERT N was superior to that of other test (76%), although specificity and positive and negative predictive values were better for cytology (94%, 88.4% and 72.3% respectively) and NMP22 (88%, 80.6% and 73.3% respectively)., Conclusions: hTERT N mRNA levels in urine were higher in patients with bladder tumors compared to patients with a history of bladder tumor and with negative cystoscopy, as well as in the control group. This determination showed a higher diagnostic yield compared with the detection of NMP22 and urinary cytology., (Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term., Material and Methods: A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means., Results: The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P=.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P=.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months)., Conclusions: The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates., (Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In the literature it is shown that the use of PSA is occasionally wrong, by requesting this marker in very young or very old men, and repeated measurements in short periods of time. The main objective of this study was to describe the use of PSA in daily practice by primary care physicians in our area, dealing with aspects such as the importance of patient age, the value in the screening for prostate cancer, or the subjective beliefs about its usefulness. A secondary objective was the comparison of use, and beliefs among doctors who claim to know PSA well, and those who do not., Patients and Methods: A descriptive and comparative study was conducted using questionnaires that were handed to primary care doctors in all health centres in our area. A descriptive analysis was performed and response rates among doctors who thought they had enough information about PSA, and those who did not, were compared using the Chi-squared test., Results: A total of 103 questionnaires were received from the physicians, with 83.5% claiming to have sufficient knowledge about the PSA. The professionals in this latter group request PSA at an earlier age (P=.029), with a higher frequency (P=.011) and have more doubts about its usefulness (P=.009) than those with less knowledge. Almost half (49.5%) said they request less than 50 determinations per year, and 33% between 50 and 100. More than half (53.4%) of doctors would not request the first PSA on a patient until their 50s, and up to 49% request it up to 80 years. The true value of PSA has been established many times by 64.1% of requesters, and 29.1% believe it is unhelpful in the diagnosis of cancer., Conclusions: In our study, 64% of primary care physicians have considered the true value of the PSA several times, and 29% believe it to be of little use in the diagnosis of prostate cancer. In addition, some data suggest it has limited use due to the fact that 50% made less than 50 PSA requests per years, and 28% of the professionals would never request it on a male without urinary symptoms. In this study, it has been observed that those professionals who claim not to have enough information about the PSA make more requests in patients of an older age, and consider that it is of limited use as a marker., (Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Erectile dysfunction and low sexual desire are multifactorial diseases. The decrease in testosterone levels is one of the causes, but the effect of estradiol is not well known. Moreover, study has shown that the testosterone/estradiol ratio has more influence over sexuality than does estradiol alone. The aim of the study was to determine whether the balance between testosterone and estradiol has any relation to some aspects of sexual function. It was an ambispective study of 230 patients with urological problems unrelated to sexuality. They underwent a detailed history and hormone study including total, free, bioavailable testosterone and estradiol. They completed the Sexual Health Inventory for Men and questions 11 and 12 of the IIEF15 were used to assess impairment in sexual desire. The T/E ratio was calculated, and the relationship between the different parameters and erectile function and sexual desire were studied by univariate and multivariate analysis. The mean age was 66.32 ± 8.17 years. The percentage of patients with erectile dysfunction was 60.9% (7% severe, 14.3% moderate, 12.6% mild to moderate and 27% mild) and decreased sexual desire was 46.5%. Age, free and biodisponible testosteron were the only variables with a positive linear association with erectile dysfunction and decreased sexual desire. Age was the only independent variable for both, erectile dysfunction and sexual desire, in the multiple linear regression. There was no association between a testosterone/estradiol imbalance and an alteration in erectile function and sexual desire. Consequently, in the clinical study of these patients, it is not necessary to request estradiol in the laboratory analyses.

Objective: The aim of this study is to determine which cancer and demographic criteria influence the indication for surgery (radical prostatectomy) or radiation therapy (external or brachytherapy) in the treatment of prostate cancer., Material and Methods: An analysis of the 2714 patients of the 2010 National Prostate Cancer Registry treated with curative intent. The analysed variables were age, prostate-specific antigen (PSA), prostate volume, the number of biopsy cores, the percentage of positive cores, the stage, Gleason score, the type of pathologist, the presence of perineural invasion and the study centre. We analysed the association among these variables and the type of treatment (surgery vs. radiation therapy/brachytherapy), using a univariate analysis (Student's t test and chi-squared) and a binary multiple logistic regression., Results: The 48.12% of the patients (1306/2714) were treated with surgery, and 51.88% (1,408/2,714) underwent radiation therapy/brachytherapy. Differences were observed between the patients treated with prostatectomy and those treated with radiation therapy/brachytherapy (p<.05) in age (63.50±6.5 vs. 69.0±6.7), PSA (8.76±16.97 vs. 13.21±15.88), biopsied cores, percentage of positives cores (30.0±22 vs. 38.7±29), Gleason score (G6: 53.9% vs. 46.1%; G7: 45% vs. 55% G8-10: 26.6%, 73.4%), stage (localised: 50% vs. 50%; locally advanced: 14.6% vs. 85.4%), perineural invasion and hospital centre. In the multivariate analysis, the selected independent variables were age, PSA, percentage of positives cores, stage, Gleason score and hospital centre., Conclusion: According to our study, age, tumour aggressiveness and stage and the centre where the patient will be treated affect the selection of curative treatment for prostate cancer., (Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To expose the features related to the diagnosis, therapy and follow-up of paratesticular sarcomas, through the presentation of three cases with different histologies., Methods: Description of the clinical cases, surgical management, and pathological results of the surgical specimens., Results: We present three cases of paratesticular sarcomas, one case being a rhabdomyosarcoma and two liposarcomas. Two patients underwent a single successful surgery, while the third one required a second intervention after recurrence. Today all three patients are free of disease., Conclusions: Malignant paratesticular sarcomas are infrequent neoplasias in urology. It is essential that the urologist is aware of this possibility when faced with a paratesticular tumor, since radicalness of surgery will be the most decisive factor in the success of the treatment. Adjuvant therapies must be individualized in each case, and the follow-up after surgery should be close, given the poor evolution of these tumors in many cases.

Objective: Prostate cores from transrectal biopsies are usually sent in separate vials for pathological processing. Although this is a common practice, there are controversial studies on its usefulness. We wanted to compare the rate of prostate cancer diagnosis between processing samples in 2 containers and processing them in individual containers to see if there are differences. Our secondary objective was to check the rate of diagnosis of various tumour subtypes in each of the 2 groups., Material and Methods: A retrospective observational study was conducted of 2,601 cases of prostate biopsies. Ten cores were extracted in each biopsy. We divided the sample into 2 groups: biopsies sent in 2 containers to the department of pathology (left and right lobes) or sent in 10 (one for each cylinder), according to the different criteria used in our centre in the past. We then classified the cases according to the absence of neoplasia, insignificant tumour (involvement of just 1 cylinder, <5%, Gleason score<7), Gleason 6 or Gleason≥7. A bivariate statistical analysis was performed using the chi-squared test., Results: A total of 1,777 participants were included in the 2-container group, and 824 were included in the 10-container group. We diagnosed a rate of 32.4% of cancers in the 2-container group and 40% in the 10-container group, a difference that was statistically significant (P<.001). The insignificant carcinomas were diagnosed more often in the 2-container group than in the 10-container group (6.4% vs. 4.3%, respectively; P=.03). Samples with a Gleason score of 6 were diagnosed more often in the 10-container group than in the 2-container group (11.9% vs. 8.1%, respectively; P=.002). The same occurred with the Gleason score≥7 (23.8% in the 10-container group vs. 17.9% in the 2-container group; P<.001)., Conclusions: We diagnosed more prostate cancers when sending biopsied cores in individual containers. Once the procedure was conducted, we also observed in our series a reduction in the diagnoses of insignificant carcinoma to the detriment of an increased diagnosis of not insignificant carcinomas., (Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: PSA is a frequently used marker in the daily clinical practice for the diagnosis and management of prostate cancer. We analysed the use of PSA in our health department in patients with and without prostate cancer diagnosis., Methods: The registry of all PSA petitions in our health department during 2011 and 2012 was used. Demographic data were used to establish each year's population and the data corresponding to the prevalence of prostate cancer patients, performing a descriptive study. Thus, the use of PSA in patients with or without prostate cancer was studied., Results: 25.700 PSA petitions are issued annually in our department over a total of 67.000 males older than 45. This entails a cost of 332.815 Euros annually. Within the group of patients with no prostate cancer diagnosis, it was noticed that the percentage of individuals with at least one annual PSA petition per decade of age is of 23% in males in their fifties, 40% in their sixties, 46% in their seventies, and 36% in their eighties or successive decades. Furthermore, in these cancer-free patients, around 3.800 annual petitions fall on individuals over 75 and with PSA under 4 ng/ml, from which 20% are repeated petitions over the same individual in the same year. Over 1100 males under 45 have an annual PSA. Regarding the average PSA value for decade of age in cancer-free patients, it is of 0.89 +/- 0.4 ng/ml in the forties decade, 1.26 +/- 1.07 ng/ml in the fifties, 1.67 +/- 1.38 ng/ml in the sixties, 1.96 +/- 1.78 ng/ml in the seventies, and 2.24 +/- 2.16 ng/ml in the eighties. We ascertained, also, that for every 144 PSA petitions one prostate cancer case is diagnosed. Regarding the use of this marker in cancer patients, 1.800 petitions are destined to patients follow up annually, and over 200 fall on the newly diagnosed cases., Conclusions: Even though annually less than 50% of males get PSA petitions in any decade of age, its use is sometimes incorrect, including repeated petitions in a short period of time or in individuals of extreme age.