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Objectives: To describe the natural history of AML, the clinical results and the need for treatment during long-term follow-up of renal AML., Methods: Retrospective study of patients diagnosed with AML by computed tomography or nuclear magnetic resonance between 2001 and 2019, with at least two follow-up images. Clinical and imaging variables, need for intervention, complications and follow-up time were recorded. Statistical analysis was performed using SPSS 22.0., Results: 111 patients and 145 AML were included. The median follow-up was 6.17 years (range 0.7-18.1, IQR 11.8-12.2). The median tumor size at diagnosis was 13 mm (IQR 7.5-30), with 24 (16.4%) being ≥ 4 cm. Most presented as an incidental finding (85.5%); in 3 (2.1%) cases, the presentation was as a spontaneous retroperitoneal hematoma. The main indication for intervention was size ≥ 4 cm in 50%. Eighteen (12%) patients received a first intervention, being urgent in 3. Embolization was performed in 15 cases and partial nephrectomy in 3. The need for reintervention was recorded in five: two underwent partial nephrectomy and two total nephrectomy; one patient required a new urgent embolization. Of the non-operated patients, 43% decreased in size or did not change, while 57% increased, with the median annual growth being 0.13 mm (IQR - 0.11 to 0.73). There were no differences in the median growth in tumors measuring ≥ 4 cm (0.16 mm) at diagnosis vs. < 4 cm (0.13 mm) (p = 0.9)., Conclusions: The findings of this study suggest that AML typically demonstrate a slow-progressing clinical course during long-term follow-up. Moreover, our observations, which cast doubt on tumor size as a reliable predictor of adverse clinical outcomes, advocate for a less intensive monitoring strategy in both monitoring frequency and choice of imaging modality., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

In a subset analysis of data from a 6-month, multicenter, non-interventional study, we compared change in symptoms and quality of life (QoL), and treatment tolerability, in men with moderate to severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving tamsulosin (TAM, 0.4 mg/day) or the hexanic extract of Serenoa repens (HESr, 320 mg/day) as monotherapy. Symptoms and QoL were assessed using the IPSS and BII questionnaires, respectively. Patients in the treatment groups were matched using two statistical approaches (iterative and propensity score matching). Within the iterative matching approach, data was available from a total of 737 patients (353 TAM, 384 HESr). After 6 months, IPSS scores improved by a mean (SD) of 5.0 (4.3) points in the TAM group and 4.5 (4.7) points in the HESr group (p = 0.117, not significant). Improvements in QoL were equivalent in the two groups. TAM patients reported significantly more adverse effects than HESr patients (14.7% vs 2.1%; p < 0.001), particularly ejaculation dysfunction and orthostatic hypotension. These results show that HESr is a valid treatment option for men with moderate/severe LUTS/BPH; improvements in urinary symptoms and QoL were similar to those observed for tamsulosin, but with considerably fewer adverse effects., (© 2021. The Author(s).)

Objectives: Offer some recommendations or guidelines during the evolution of the COVID-19 pandemic in terms of diagnosis, treatment and follow-upin the field of Reconstructive Urology. MATERIAL AND METHOD: The document is based on the evidence on SARS/Cov-2 and the authors' experience in managing COVID-19 in their institutions, including specialists from Andalusia, Madrid, Cantabria,the Valencian Community and Catalonia. A web and PubMed search was performed using "SARS-CoV-2", "COVID-19", "COVID-19 Urology", "COVID19 urology complications", "COVID-19 reconstructive surgery".A narrative review of the literature was carried out (5/17/2020) and after the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria and reach a quick consensus. Finally, a definitive version was made, agreed by all the authors (5/22/2020). RESULTS: The authors defined the following surgical priorities for Urological Reconstructive Surgery: Emergency/Urgency (life-threatening or emergencies still in anormal situation), Elective Urgency/High priority (potentially dangerous pathology if postponed for more than 1month), Elective Surgery/Intermediate priority (pathology with little probability of being dangerous but it is recommended not to delay more than 6 months), Delayed surgery/Low priority (non-dangerous pathology if it is postponed for more than 6 months). According to this classification, the Working Group agreed on the distribution of the different surgical scenarios of Reconstructive Urology. In addition, consensus was reached on recommendations regarding the diagnosis and follow-up of pathology in the field of Reconstructive Urology. CONCLUSIONS: Tools should be implemented to facilitate the gathering of the medical visit and diagnostic tests. Redistribution of surgical procedures based on priority degrees is necessary during the pandemic and transition period. The use of telemedicine is essential forfollow-up, by computer, telephone or videoconference.

Objective: To analyze the presenting features, diagnosis and management of uncommon cystic lesions located at the midline of the prostate., Methods: From 1990 to 1999, 8 patients with medial prostatic cyst were treated in our hospital. Vesicorenal ultrasound evaluation was the first procedure that was performed and was diagnostic in most of the cases. Only those patients that underwent surgery required admission to hospital., Results: The most common presenting features were irritative and obstructive voiding syndromes. Treatment achieved cure or clinical improvement., Conclusions: Vesicorenal ultrasound assessment is the first procedure that should be considered in the diagnosis of this disease. Before ascribing the symptoms to a prostate cyst, other urological conditions with more prognostic relevance should be excluded. Treatment should be instituted only in the symptomatic patients and should be individualized according to the characteristics of each case.

Objective: To review our experience with Leydig cell tumor of the testis and compare our findings with those reported in the literature., Methods: The clinical records of patients with Leydig cell tumor of the testis that were treated in our hospital were reviewed. This study analyzed patient age, reason for consultation, previous history of testicular pathology, size and location of the tumor, US pattern, histological findings, hormone analysis, semen analysis, treatment and clinical course., Results: 7 patients had Leydig cell tumor of the testis, accounting for 2.1% of the testicular tumors treated in our hospital. The mean age at the time of diagnosis was 40 years. The presenting features were enlarged testis, gynecomastia, sexual dysfunction or incidental finding during testicular US assessment for cryptorchidism. Most of the tumors were hypoechoic and showed hypervascularization. Hormone analysis was abnormal in 4 patients and showed reduced testosterone and increased serum estradiol levels. The initial semen analysis showed azoospermia, severe oligozoospermia or cryptozoospermia in 4 patients. Six patients had previously undergone orchidectomy via the inguinal approach and one patient had undergone tumor resection. At 41 months mean follow-up, the tumor has been demonstrated to be benign., Conclusions: Leydig cell tumor of the testis usually presents as a testicular mass, accompanied or preceded by hormonal changes in 20% of the cases, with feminization in the adult and masculinization in the child. The lesions are always benign in children and in 90% of the adult patients. The US features are usually hypoechoic. The histological criteria for malignancy do not always correlate with the clinical features. Malignancy is established by the presence of metastasis at the time of diagnosis or during follow-up. There is currently no effective treatment for the metastasis. Following orchidectomy, the clinical hormonal manifestations return/remit in 90% of the cases.

Objective: To review our series of patients with the growing teratoma syndrome (GTS) and to compare our results with those reported in the literature., Methods: We reviewed the clinical records of our series of patients with GTS for age, location of the tumor mass before and after chemotherapy, clinical stage according to the Royal Marsden Hospital Classification, histological pattern of the primary tumor, number and type of surgical procedures performed and clinical course., Results: There were 17 patients with GTS, accounting for 4.9% of the patients with nonseminomatous germ cell testicular tumors treated in our hospital. The mean age at the time of diagnosis was 23 years. The site of the lesions was the same as that of the prechemotherapy metastasis in all cases. Histological analysis of the primary tumor showed mature teratoma in 11, ectodermal sinus tumor in 8, and both histological types in 4. By stage, 11 patients were stage II and 6 were stage IV. A total of 33 surgical procedures were performed: 25 retroperitoneal lymphadenectomy (7 with retrocrural involvement), 4 thoracotomy with segmental lung resection, 2 resection of supraclavicular adenopathy, 1 resection of liver metastasis, and 1 resection of inguinal adenopathy. The 25 retroperitoneal lymphadenectomy performed due to GTS account for 16.2% of the 154 retroperitoneal lymphadenectomies that were performed during the same time period. Follow-up showed recurrence in 10 patients (58.8%); 7 had mature teratoma and 3 had malignant tumor., Conclusions: Mature teratoma lesions can appear in different sites, the most frequent being the retroperitoneum and lung. These lesions can appear before or during chemotherapy or after a disease-free interval. The treatment of choice is resection of the mass, if possible in a single session to prevent malignant degeneration or compression of the adjacent structures. We institute treatment early since an increase in size will make surgical treatment difficult, compromise organs and favor recurrence.

Objective: To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder., Methods/results: After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion., Conclusions: Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.