Bladder cancer in Spain 2011: population based study.

PURPOSE: We estimate the annual incidence of bladder cancer in Spain and describe the clinical profile of patients with bladder cancer enrolled in a population based study. MATERIALS AND METHODS: Using the structure of the Spanish National Health System as a basis, in 2011 the AEU (Spanish Association of Urology) conducted this study with a representative sample from 26 public hospitals and a reference population of 10,146,534 inhabitants, comprising 21.5% of the Spanish population. RESULTS: A total of 4,285 episodes of bladder cancer were diagnosed, of which 2,476 (57.8%) were new cases and 1,809 (42.2%) were cases of recurrence, representing an estimated 11,539 new diagnoses annually in Spain. The incidence of bladder cancer in Spain, age adjusted to the standard European population, was 20.08 cases per 100,000 inhabitants (95% CI 13.9, 26.3). Of patients diagnosed with a first episode of bladder cancer 84.3% were male, generally older than 59 years (81.7%) with a mean ± SD age of 70.5 ± 11.4 years. Of these patients 87.5% presented with some type of clinical symptom, with macroscopic hematuria (90.8%) being the most commonly detected. The majority of primary tumors were nonmuscle invasive (76.7%) but included a high proportion of high grade tumors (43.7%). According to the ISUP (International Society of Urologic Pathology)/WHO (2004) classification 51.1% was papillary high grade carcinoma. Carcinoma in situ was found in 2.2% of primary and 5.8% of recurrent cases. CONCLUSIONS: The incidence of bladder cancer in Spain, age adjusted to the standard European population, confirms that Spain has one of the highest incidences in Europe. Most primary nonmuscle invasive bladder cancer corresponded to high risk patients but with a low detected incidence of carcinoma in situ.

[Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia]. / Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna.

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level.

[Age's influence in superficial bladder cancer's behaviour]. / Influencia de la edad en el comportamiento de los carcinomas uroteliales superficiales.

INTRODUCTION: Transitional bladder cancer is infrequent in younger people. The tumor's aggressiveness in this population is subject of discussion. We present our experience. MATERIAL & METHOD: 551 primary tumors, with at least one year of follow-up. Group A (less than 41 years old), Group B (bigger than 40 years old). We compare, stage, grade, lymphatic permeation, multiplicity, recurrence, progression, sex, T.L.E. (time free of disease), volume. We do uni and multivariate analysis. RESULTS: 17 tumors in younger than 41 years (2.1%). The recurrence rate is 11.8% in Group A and 36% in Group B (p .041). Progression rate: 0% in A and 4.1% in B (p .253). In Group A, T1 tumors (13.3% vs. 39%), G2 tumors (0% vs. 36.7%); withouts in lymphatic permeation (0% vs. 35%) and solitary tumors (13.3% vs. 35.3%) have statistically less recurrence. In univariate analysis we appreciate statistical differences in relation with grade (p .002) and sex (p .011). In multivariate analysis, stage, "group of age" and prophylactic treatment are independent variables for recurrence, and grade for progression. CONCLUSIONS: In younger than 41 years old: Less pathologic aggressivity (0% G3); Group of age is independent prognostic variable for recurrence, but not p for progression, despite a "less aggressive behaviour": 11.8% recurrence, 0% progression; T.L.E. bigger (one year more); Higher incidence in women (41% vs. 11%); Less recurrence in T1 tumors (13.3% vs. 39%), G2 tumors (0% vs. 36.7%) and solitary tumors (13.3% vs. 35.32%).

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

[Uretero-intestinal anastomosis. Our experience. The simpler... the better]. / Anastomosis ureterointestinales. Nuestra experiencia. Cuanto más simple ... mejor.

INTRODUCTION: There are many techniques describe for ureteroenteric anastomoses. We present our experience with three of them inorder to reduce the stenosis rate. METHOD AND MATERIAL: We have done radical cystectomy in 77 patients. Urinary diversion with small bowel in 20 patients (Paduana ileal neobladder) and dstubulized ureterosigmoidostomy (MainzII) in 55. Initially, we used Le Duc technique, afterward Ricard technique and actually bivalva technique (direct). RESULTS: We have performed Le Duc in 38%, Ricard in 31% and "bivalva" in 27%. Median follow-up are 37.7 months, 19.9 months and 10 months respectively. Stenosis: 16.7% with Le Duc; 20.5% with Ricard and 9.1% with bivalva technique. Renal anulation: 10.4% with Le Duc; 10.3% with Ricard and 0% with bivalva (p .000). CONCLUSIONS: In our experience, the less stenosant anastomose is BivalvaIn one. The simpliest technique, the best results. The rate of stenosis is higher when the upper urinary tract is dilatated pre-surgery, independently of the anastomosis technique.

[Adrenal gland myelolipoma: diagnostic and therapeutic aspects]. / Mielolipoma suprarrenal: aspectos diagnósticos y terapéuticos.

Presentation of a case of suprarenal myelolipoma, pre-operatively diagnosed through sonography and CAT due to endocrine inactivity, as shown by the laboratory tests carried out. There is also a literature review and the analysis of the clinical, diagnostic and therapeutic aspects regarding this disorder.

[Epithelial polyp of the posterior urethra]. / Pólipo epitelial de uretra posterior.

A case of posterior urethra polyp located at the veru montanum is reported in an adult with azoospermia. Deferentvesiculography, testes biopsy, transrectal echography and urethroscopy were carried out. Following diagnosis, a tumour endoscopic resection was performed. After reviewing the literature, no other cases of posterior urethra polyp presenting the reported clinical picture was found. Also, aspects related to clinic, diagnostic procedures and therapeutical approach are reported.

[Abscess of the prostate: intracavitary echography and echo-guided drainage]. / Absceso de próstata: ecografía endocavitaria y drenaje ecodirigído.

We submit the present paper three cases of prostate abscess. The various aspects related to ethiopathogeny, clinic, and current diagnostic procedures are analyzed emphasixing the use of endocavitary echography, as well as the different therapeutic approaches that can be used, with particular attention to ecomonitored aspirative drainage.

[Verrucous carcinoma of the penis]. / Carcinoma verrucoso de pene.

The present work reports one case of penis verruciform carcinoma. Such neoplastic process is considered to be a variation of the scaly carcinoma with specific histopathological features. Clinical and histopathological as well as therapeutic aspects (conservative or radical surgical therapy, depending on the evolutive stage and laser electrocoagulation) were analyzed.

[Value of the diuretic isotopic renogram in the follow-up of the upper urinary tract after cystectomy and urinary diversion using intestine]. / Valor del renograma isotópico diurético en el seguimiento de la vía urinaria superior tras cistectomía y derivación urinaria con intestino.

INTRODUCTION: In our experience we often observe urinary upper tract dilatation after urinari diversion with bowel. To spare useful approaches and therapeutics we have used diuretic renogram. MATERIAL AND METHOD: 26 patients with urinary diversion (Mainz II or Paduana ileal neobladder). We performance ultrasound, urography and diuretic renogram. RESULTS: Follow-up is between 1 y 4 years. After urinary diversion, 54% of the upper tracts are dilated but only 39.3% of them are obstructed in the diuretic renogram. Normal urographic tracts are normal or have good response in the diuretic renogram. Results goes on in the time. CONCLUSIONS: Diuretic renogram is a useful tool in the diagnosis of upper urinary tract obstruction after urinary diversion.

[Extraperitoneal bladder rupture caused by diverticular pathology]. / Rotura vesical extraperitoneal espontánea por patología diverticular.

In this study we offer a case of spontaneous extraperitoneal vesical rupture and we analyse the etiopathogenic factors that are going to determine the genesis of the process, the diagnostic means used as well as the therapeutic attitude to be followed on the basis of the patient's clinical picture and the bladder level where the rupture has occurred.

[Primary lymphoma of the testicle]. / Linfoma primario de testículo.

Case report of a testicular lymphoma. A diagnosis of primary neoplasia of the testis was made since no involvement to the lymphoreticular system in any other organ was demonstrated. We review the clinical, diagnostic and therapeutical aspects and make a note on the rarity of our case, a type T tumour, due to the exceptional nature of this variety within primary lymphomas of the testis.

[Renal adenocarcinoma in a girl 13 years old]. / Adenocarcinoma renal en una niña de trece años.

Case report of a renal adenocarcinoma in a 13 year-old girl found during the study of a painless, gross haematuria of several months evolution. Apart from a review of signs and symptoms, diagnosis, therapeutical approach and other issues related to this tumour, the authors insist on the significance gross haematuria has in children presenting symptoms that should alert the medical profession about a possible neoplasia of this features, in spite of its rare occurrence.

[The BTA test in the diagnosis of bladder tumors. Usefulness in the hospital setting]. / Test de bta en el diagnóstico de los tumores vesicales. Utilidad en un medio hospitalario.

We show our results in the diagnostic and follow-up of the bladder tumors comparing de BTA test with Void Cytology, in order to substitute this with the former. We performed BTA test, Void Cytology (of the same sample) and abdominal ultrasound to 133 patients. They are divided in three groups: 45 with bladder tumor, 16 healthy controls, 72 in follow-up with and without prophylaxis. The sensibility and specificity in tumor's group were similar. In controls' and follow-up's groups the void cytology specificity was superior. There is a high number of false positives in the follow-up group with a large number of "white" cystoscopes. A high number of false positives was seen if the BTA test was done in he first three months of follow-up. In the subgroup in prophylaxis with cystostatic there weren't false positives. We conclude that BTA test is useful in the diagnostic of bladder tumor but not in the follow-up, especially in the first three months.

[Melanoma of the female urethra: a very infrequent tumor]. / Melanoma de uretra femenina: un tumor muy infrecuente.

Case report of a melanoma of the urethra in a 75-year old female patient. A few months after diagnosis the patient died of multiple lung metastasis. This is a review of the clinical and diagnostic aspects of the neoplasia highlighting the therapeutical options that albeit debatable seem to be quite clear as to the master lines to follow.

[Rectal injury during radical surgery of bladder and/or prostate]. / La lesión del recto en el transcurso de la cirugía radical de la vejiga y/o próstata.

Contribution of 42 patients, aged 57 to 69 (mean age 58) with infiltrant vesical neoplasia who underwent radical cystoprostatectomy according to the technique described by P.C. Walsh (38/42) or radical cystectomy with hysterectomy (4/42). Neoplasia stages were as follows: 7 T2G-III; 13 T3aGII: 15 T3aG-III and 7 T3bG-III. Ten (10) patients, aged between 48 and 70 (mean age 57), with prostate neoplasia who were performed radical prostatectomy using the technique described by the above author, were also ascribed to the last group. Prostate neoplasias were at the following stages: 4 T2c; 5 T3a and 1T3b. T3 stages had been given hormonal therapy prior to the procedure. No patient received radiotherapy. Rectal injury occurred in 2 of the 52 (2/52) patients described. One was a female patient who was being performed cystectomy and hysterectomy plus double adnexectomy. Urinary by-pass in this case was C.F.C. detubulized ureterosigmoidostomy. The second case was a male patient undergoing radical prostatectomy. In both cases pre- and post-operative discharge colostomy was performed. Suture of rectal injury was also done in the patient where colostomy was performed during the procedure. The authors emphasise that no rectal injury that may take place during radical prostatectomy or cystoprostatectomy should be disregarded. They raise and answer questions of great practical interest such as: Is simple suture of the rectum enough? Should the omentum be used in rectal repair? Is it indispensable to perform discharge colostomy? and, is prognosis more serious when the gut is not prepared?

[Randomized prospective study comparing BCG and BCG plus oral tegafur in the prevention of stage T1 superficial tumors of the bladder. Results after 2.5 years]. / Estudio aleatorio prospectivo comparando BCG y BCG más Tegafur oral en la profilaxis de los tumores superficiales de vejiga estadio T1. Resultados a dos años y medio.

We present our experience in eighty patients with superficial bladder cancer stage T1. They have been randomized to receive BCG 27 mg weekly x 6 and monthly until complete one year (Group A) or the same schedule plus Tegafur 800 mg daily until complete one year. Results are similar in both groups. With a median follow up of two years and a half, 33% in Group A and 20% in Group B have had recurrence; 7.6% in group A and 3% in group B have had progression in stage. Differences are not significant in both cases. Tolerance of Tegafur is good with only 11% of secondary effects. We concluded that there are no differences in both treatments but there is a trend to better results with combinant therapy. It is necessary more patients to achieve definitive results.

[Lymphatic invasion of the bladder wall in T1 superficial bladder carcinoma. Prognostic value]. / Permeación linfática de la pared vesical en el carcinoma superficial de vejiga t1. Valor pronóstico.

INTRODUCTION: It is not usual to use as prognostic factor the bladder lymphatic vessels invasion. METHOD & MATERIAL: 519 T1 bladder tumors with complete resection and follow up of one year at least. Prophylaxis with 81 mg of BCG weekly during six weeks in 54%. RESULTS: Follow up without recurrence of 38 months. 49%. Tumour recurrence of 49% and progression of 7%. 5.8% of the tumours are L1 and 70.7% L0. There are significative statistic relation between lympatic invasion and progression (p. 005), tumoral grade (p. 000) and actual situation (p. 02). 23% of the L1 tumours progressed vs 5% of L0. Prophylaxis with BCG reduces progression risk (33% without treatment vs 16 with BCG (p n.s.)). In multivariate analysis, resected volume (p. 024) and prophylactic treatment are independent variables for recurrence and lymphatic vessels invasion (p. 0478) and tumoral grade (p. 092) for progression. CONCLUSIONS: 1) L1 tumours has more probabilities of progression. 2) BCG disminishes progression rate but this is not statistical significative. 3) We need new markers to select which L1 tumours will progress.

[DNA ploidy determination with flow cytometry, Ki-67 index, and overexpression of p53 protein in 121 T1 superficial bladder carcinoma. Retrospective study. Correlation with classic variables]. / Determinación de ploidía de ADN mediante citometría de flujo, índice Ki-67 y sobreexpresión de proteína P53 en 121 carcinomas superficiales de vejiga T1. Estudio retrospectivo. Correlación con las variables clásicas.

OBJECTIVE: Observe the correlation between Ki-67 label index, p53 expression and flow cytometry-DNA ploidy with the classic variables (grade, lymphatic permeation, multiplicity, volume, primary). MATERIAL AND METHOD: 121 superficial bladder tumors T1. 10% Cut-off level for Ki-67 and p53. Aneuploidy is defined as a tumor with DNA index different of 1 or more than 20% in G2-M phase. RESULTS: Statistical correlation with grade and lymphatic permeation. Ki-67 label index and p53 expression can distinguish between G1, G2 vs G3 and Lx, L0 vs. L1. The volume correlates with positivity to p53. CONCLUSIONS: Aneuploidy and positivity to Ki-67 and p53 increase with grade and lymphatic permeation.

[C.F.C.-type ureterosigmoidostomy. Results]. / Ureterosigmoidostomía tipo C.F.C. Aportación de resultados.

This paper presents the results obtained with a C.F.C. type ureterosygmoidostomy technique described by us. A total of 25 patients aged between 52 and 74 years (mean age, 65 years), 23 (23/25) male and 2 (2/25) female were evaluated. 24 of the total 25 patients had infiltrant neoplasia of the bladder (pT2: 8; pT3a: 12; pT3b: 4) which was graded as moderately differentiated (G2: 10) or undifferentiated (G3: 14). The remaining patient, a female, had tuberculous microbladder. Male patients underwent radical cystoprostatectomy (23/25); while in two females traditional cystectomy was performed (2/25). Patients with neoplasia of the bladder (24/25) were performed bilateral lymphadenectomy prior to radical surgery. All 25 patients were performed C.F.C. type ureterosygmoidostomy (Actas Urol Esp 20: 324, 1996). Follow-up of patients was carried out over a mean period of 27 months (July 1994-October 1997). The complications reported were 4 cases of ureterointestinal stricture and one stercoral fistula. The strictures were resolved with endoscopic techniques and the fistula through discharge colostomy. Death (6/25) occurred as a result of the tumour progression, and in no case was related to the surgical technique. All patients showed daytime continence (100%), and 22/25 were also continent during the nighttime (88%): there were occasional leaks in 5/25 (20%). No metabolic disorders were seen in any of the patients. (All patients were given drug therapy to prevent metabolic acidosis).