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Background & Objectives: We aimed to evaluate the risk of progression in high-grade T1 (HGT1) tumors using tumor budding (TB) and other standard clinical and histological features. TB is defined as an isolated cancer cell or a cluster composed of fewer than 5 cells scattered in the stroma and is usually used as a strong predictor of lymph node metastasis in T1 colorectal cancer., Methods: This is an observational longitudinal cohort study involving 168 consecutive patients with HGT1 between 2013 and 2016. Cox regression was performed to analyze the relationship between the clinical and histological features and progression. All slides were blindly assessed by 2 genitourinary pathologists. Budding was determined to be positive when the number of buds was equal to or greater than 6., Results: The median age was 75 years; 152 (90.5%) patients were men, and 49 (29.2%) were positive for TB. At a median follow-up time of 35 months, 33 patients (19.6%) showed progression. Progression was observed in 32.7% of the patients positive for TB and in only 14.3% of those who were negative (p = 0.006). TB was significantly associated with the endoscopic tumor pattern (TP) (papillary/solid) and lymphovascular invasion (LVI). Univariate analysis showed that TB, carcinoma in situ (CIS), TP, LVI, sub-staging, and BCG induction predict progression. The multivariate analysis showed that TB (p = 0.032, hazard ratio 2.1), CIS, TP, and lack of BCG induction were significant for progression., Conclusions: TB is a new and significant pathological variable for predicting progression in HGT1 tumors and can be easily introduced in clinical practice. Its inclusion in the TNM system should be carefully considered, as it may aid early cystectomy decisions., (© 2021 S. Karger AG, Basel.)

Introduction and Objectives: Pyeloplasty has always been the treatment of choice for ureteropelvic junction obstruction at our center, where a laparoscopic approach has been used in the last 4 years to perform this procedure. Results of open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) performed at our center in the past 8 years are compared, and our laparoscopic procedure is described., Materials and Methods: Pyeloplasties performed at our center from June 2000 to June 2008 were retrospectively reviewed. Clinical presentation, involved kidney function, operating time, intraoperatory bleeding, presence of kidney stones or crossing vessels, length of hospital stay, possible complications, and results obtained were analyzed in each case., Results: Thirty pyeloplasties were performed, 15 OP and 15 LP (50%). Mean operating time was 167.6 minutes for LP (100-240) and 106 minutes for OP (75-180) (P< .0001). Mean hospital stay was 6.6 days (4-16) for LP and 9.1 days for OP (5-26) (P.05). Intraoperative bleeding was negligible in all patients and no peroperative complications occurred. However, 9 patients (30%) experienced postoperative complications, 5 out of 15 LPs (33.3%) and 4 out of 15 OPs (26.7%) (P.05). Urinary fistula was the most common complication, occurring in 3 of the 30 patients (10%). Procedure was successful in all 15 patients undergoing OP (100%) and in 14 of the 15 patients undergoing LP (93.3%) (P.05)., Conclusions: LP is currently the procedure of choice at our center because of its lower morbidity and similar results to OP, despite the need for a certain laparoscopic skill and a usually longer operating time., (Copyright 2009 AEU. Published by Elsevier España, S.L. All rights reserved.)

Objectives: Laparoscopic radical cystectomy has been developed after the expansion of laparoscopic radical prostatectomy. This technique makes possible a minimally invasive approach to muscle-invasive bladder cancer with less blood loss and faster postoperative recovery., Methods: From September 2004 to January 2007, 54 laparoscopic radical cystectomies were performed, 48 of them in stage T2, from which 43 (90%) were male and 5 (10%) female patients. Mean age was 64 years (27-881. Lymphadenectomy was carried out by laparoscopic approach in all cases, with a mean of 13 nodes obtained (4-24). Urinary diversion was done through the incision needed to extract the specimen in all cases but one that was completed completely intracorporeally; constructing a Bricker-type ureteroileostomy in 30 (62%) cases, orthotopic neobladder (Vesica Ileale Padovana) in 17 cases (35%), and cutaneous ureterostomy in 1 case (2%)., Results: Mean surgical time for the whole procedure was 287 minutes (180-480), 270 minutes for Bricker-type derivation cases and 316 minutes for neobladder cases. Blood transfusion rate was 25%. Mean ileal paralysis was 5 days (2-10) with a mean hospital stay of 13 days (6-34) for Bricker cases and 16 days (8-30) for neobladder cases. Oncological control, after a mean follow-up of 10,8 months (0,4-30), showed a cancer-specific survival of 90% with a mean survival time of 28 months (95% CI 26-30). Global mean survival was 79% with a mean survival of 26 months (95% CI 23-29)., Conclusions: Laparoscopic radical cystectomy is a feasible technique that offers some advantages. It allows excision with less blood loss and an easier postoperative period. Randomized studies should demonstrate these advantages to confirm this approach as the technique of choice. Urinary diversion performed through the laparotomy incision, necessary to extract the specimen, optimizes derivation results and whole surgical time without reducing the beneficial effects of the laparoscopic exeresis.

Introduction: We describe and evaluate the results of our mentor training program for laparoscopic radical Prostatectomy (LRP)., Material and Methods: From March 2004 through December 2005, we have performed 105 (LRP). Three groups have been analysed: Group 1: The mentor as the first surgeon with the trainee acting as the assistant. Group 2: The trainee as the first surgeon with the mentor acting as the assistant. Group 3: The trainee as the first surgeon with another trainee/resident as the assistant. We have evaluated operative, postoperative data and surgical/oncological control., Results: There was no statistical difference in mean operative time in Groups 2 and 3 (200'-198'), but there was a difference from Group 1 (148,4') (p<0,05) we have observed a progressive operative time decrease only in Group 1. Blood loss, surgical-oncological control, pathological stage and hospital stay have been similar in the three groups., Conclusions: Skills for LRP can be effectively and safely taught by the presence of an experienced mentor. Waiting for long term results according to potency and continence, it was not associated to higher patient risk, neither to a worse surgical/oncologic outcome. We consider that this program is reproducible and allows a shorter learning curve.

Introduction: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP)., Material and Methods: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI)., Results: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed., Conclusion: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

Laparoscopic surgery can be said to have come of age when it was first indicated for cancer conditions. Advances in this field are largely due to the French school, which has made it a standard practise in prostate cancer. It complies with the principles required for cancer as well as conventional surgery, but it remains to be verified whether its long-term results, both from tumoral and functional perspectives, are not only similar to those of classical surgery, but even better. In fact, increasing numbers of clinical groups are incorporating this technique in their daily work.

Objectives: To report one case of renal trauma in a patient with horseshoe kidney treated conservatively by superselective embolization., Methods: We report the case of a 19 year old male presenting at the emergency room with macroscopic hematuria and severe abdominal pain after a motor vehicular accident., Results: IV contrast CT scan showed a horseshoe kidney with a fracture in the area between the lower pole of the left kidney and the isthmus, with active bleeding and a big retroperitoneal hematoma extended to pelvis. Retarded exams showed contrast extravasation compatible with significant urinoma. Renal arteriography was performed, showing a double renal pedicle on each kidney and a common caudal lumbar-renal trunk giving accessory branches to both kidneys' lower poles and contrast extravasation compatible with active bleeding. The lumbar-renal trunk was selectively catheterized reaching the left kidney and isthmus branches which were embolized. Retrograde catheterization of the urinary tract with a straight ureteral catheter was performed to facilitate drainage of the urinoma. This catheter was subsequently removed after control CT scan showing complete resolution of the urinoma and no bleeding. Control CT scan three months after embolization demonstrated complete resolution of the hematoma. No late complications appeared. Renal function and blood pressure have been completely normal after 12 months of follow-up., Conclusions: Horseshoe kidney is a rare congenital malformation. This clinical case demonstrates that conservative treatment is a still the gold standard treatment for renal trauma, even in kidneys with congenital anomalies.

Objective: To present a new case of hydatid cyst of the kidney with a difficult radiographic diagnosis., Material and Methods: We describe the clinical, diagnosis and treatment of a complex renal mass and its histological confirmation after surgery. Review of the literature., Conclusions: kidney's hydatidose is an unusual placement of this pathology. It is important to take care in the differential diagnosis in the context of complexes renal masses. There are some diagnosis procedures which can help us to establish it. Surgery is the treatment of choice in the majority of the cases.

Objective: To describe an atypical presentation of von Hippel-Lindau disease., Material and Methods: We present the clinical, diagnostic and treatment of the urological signs of this disease, which has overcoat a neurological management, in a young man with familiar history of it., Conclusions: The basic knowledge of the von Hippel-Lindau disease is important for the urologist because the urological signs of it, are common and they make up one of the most important causes of morbility and mortality.

Objective: To present a new case of inflammatory pseudotumor of the urinary bladder., Material and Methods: We describe the clinical, diagnostic and treatment of a new case of inflammatory pseudotumor of the urinary bladder in a 22 years old man without urological history., Conclusions: The inflammatory pseudotumor of the bladder is a rare benign lesion of unknown etiology. The most important histopathological differential diagnosis to consider is the rabdomyosarcoma. The immunohistochemistry study is basic in the diagnostic, characterization and differentiation of both pathologies. His benign development force us to a conservative management always it is possible.

Introduction and Objectives: To present our experience with Hydroflex and Dynaflex self-contained inflatable penile prosthesis., Material and Methods: Between october 1988 and december 2000 a total of 63 men underwent implantation of 8 Hydroflex and 55 Dynaflex penile prosthesis. The follow-up period ranged from 12 and 127 months (mean 54.5)., Results: A total of 124 cylinders were implanted (in 2 cases only 1 cylinder was implanted). During implantation 3 corpora cavernosun ruptures were present, but implantation was possible in 2. Specific complication rates after implantation were as follow: early infection, 3 patients (4.7%); late infection, 1 patient (1.6%); pain that needed readmission 2 cases (3.2%); mechanical device failure, 7 cylinders in 6 men (mean time 83.5 months). 7 men (11.1%) needed prolonged teaching time to operate the prosthesis. Only 6 men (9.5%) wer dissatisfied with the prosthesis. It was possible to change only 1 cylinder when needed., Conclusions: Self-contained inflatable prosthesis brings good results on long time use. The mechanical malfunction rate is low and it is possible to change only one cylinder if needed. An important number of patients need intensive and prolonged teaching time to obtain a successful result.

We report a case of a man with a severe penile injure caused by a metallic ring placed in the penile shaft for 48 hours, it coursed with partial urethral section and ischemia of the whole penile skin and dartos. It was solved with surgical excision of all death tissue and posterior reconstruction using a forearm free flap, the vascular supply came from epigastric vessels, we used hair-free skin from forearm for the urethroplasty. Ethetic and functional results obtained are successful.

Objective: To evaluate the treatment of urinary calculi in renoureteral malformations., Methods: From April 1988 to December 2000, we have treated 158 patients with renoureteral malformations (36 horseshoe kidneys, 32 caliceal diverticula, 2 megacaliosis, 2 crossed renal ectopy, 3 polycystosis, 7 hydrocalyx, 24 complete duplex ureter, 18 incomplete duplex ureter, 22 ureterocele, 2 segmental megaureter)., Results: Renoureteral malformations were diagnosed in 158 of 19,000 patients that were treated in our stone unit from April 1988 and December 2000. Horseshoe kidney: 54% of the patients treated by ESWL are stone-free; PNL was performed in 2 patients and conventional surgery in another 2 patients. Caliceal diverticulum: 42% of the patients treated by ESWL are stone-free; 3 patients underwent conventional surgery. Other renal malformations: 62% of the patients treated by ESWL are stone-free. Ureteral malformations: duplex ureter and megaureter: 82% of the patients treated by ESWL are stone-free. Ureterocele: due to the poor results achieved by ESWL, we performed endoscopic transurethral meatotomy., Conclusions: These results indicate that ESWL alone can be considered to be the treatment of choice for small calculi in patients with renal malformations, although we consider it to be mandatory to perform individual assessment of the urinary tract and stone size in these patients in order to choose the best therapeutic option. The same criteria for the normal urinary tract can be applied in ureteral malformations except ureteroceles, for which we advocate performing endoscopic surgery for stone removal.

The arterial pseudoaneurysms are an infrequent complication or renal transplantation. Depending on her localization, are divided in intra and extrarenal. The first are relacionated with the practice of percutaneous needly biopsy. The seconds are associated with defects of vascular anastomose or infection onsurgical area (with relative precocious presentation). Presentation of case of a iliac pseudoaneurysm in non-functional kidney allograft embolizated ten years before. This pathology, for this clinic gravity, requires urgent surgical treatment.

Presentation of case of patient with macroscopic anemic hematuria caused for the presence of a fistula between the external iliac artery and the ureter. After the diagnosis, a treatment with endovascular mangement was made. The arterioureteral fistulae are a very rare entie, which supposes a vital emergency. The diagnosis depend upon the clinical evidences (complementary explorations rarely provide specific findings). Classic treatment is bases on open surgery, while endovascular treatment may be an alternative with less aggressiveness.