A multidisciplinary consensus statement on the optimal pharmacological treatment for metastatic hormone-sensitive prostate cancer.

Androgen deprivation therapy (ADT) is the mainstay treatment for metastatic hormone-sensitive prostate cancer (mHSPC). The addition of docetaxel or new hormone therapies (abiraterone, apalutamide, or enzalutamide) improves overall survival and is currently the standard of care. However, the decision on the specific regimen to accompany ADT should be discussed with the patient, considering factors such as possible associated toxicities, duration of treatment, comorbidities, patient preferences, as there is no sufficient evidence to recommend one regimen over the other in most cases. This paper summarizes the evidence on the management of mHSPC and provides consensus recommendations on the optimal treatment in combination with ADT in mHSPC patients, with special attention to the patient's clinical profile.

Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature-Tips and Tricks.

PURPOSE OF REVIEW: Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation. RECENT FINDINGS: Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.

[Gunshot bladder trauma: case report and literature review]. / Traumatismo vesical por arma de fuego: presentación de un caso y revisión de la literatura.

OBJECTIVE: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature. METHODS: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment. RESULTS: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day. CONCLUSIONS: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5-8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients.

[Atypical sites of metastatic renal carcinoma. Literature review]. / Carcinoma renal metastásico de localización atípica. Revisión de la literatura.

OBJECTIVE: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. METHODS: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. RESULTS: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. CONCLUSIONS: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness.