Prostatitis: A Review.

PURPOSE OF REVIEW: Pathologies of the prostate in men are one of the most prevalent clinical conditions today [1]. Specifically, pelvic inflammatory disease such as prostatitis can cause symptoms and syndromes different from urological ones, such as bowel or nervous system manifestations. This has a largely negative impact on the quality of life of patients. Therefore, it is convenient to know and update the information about the therapeutic approach to prostatitis, which is a challenge that involves different medical specialties. The aim of this article is to provide summarized and focused evidence to help in the therapeutic approach of patients with prostatitis. A computer-based search of the PubMed and Cochrane Library databases was used to perform a comprehensive literature review on prostatitis, with special interest in recent findings and latest therapeutic guideline recommendations. RECENT FINDINGS: Recent discoveries about the epidemiology and clinical classifications of prostatitis seem to incur in an increasingly individualized and directed management, with the aim of covering all the confluent factors in prostatic inflammatory pathology. In addition, the role of new drugs and combination with phytotherapy open up a range of new treatment possibilities, although future randomized studies will be necessary to better understand how to use all treatment modalities. Despite all the knowledge acquired about the pathophysiology of prostate diseases, and due to their interrelation with other pelvic systems and organs, there are still gaps that make it difficult for us to provide an optimal and standardized treatment in many of our patients. Being aware of the influence of all the factors potentially involved in prostate symptoms is crucial for a correct diagnosis and establishing an effective treatment plan.

The role of device-assisted therapies in the management of non-muscle invasive bladder cancer: A systematic review.

OBJECTIVE: Despite optimal treatment, patients affected by non-muscle invasive bladder cancer (NMIBC) suffer from high risk of recurrence and progression. Intravescical device assisted therapies such as radiofrequency induced thermochemotherapeutic effect (RITE) and electromotive drug administration (EMDA) have shown promising effect in enhancing the effect of intravescical chemotherapies. The aim of the study was to assess clinical outcomes of these two devices in non-muscle invasive bladder cancer. METHODS: A systematic literature review was performed in December 2019 using the Medline, Embase, and Web of Science databases. Only articles published in the last 10 years were considered (2009-2019). The articles were selected using the following keywords association: "bladder cancer" AND "EMDA' AND "synergo" AND "hyperchemotherapy" AND "electromotive drug administration", AND "radiofrequency induced thermochemotherapeutic" AND "RITE". RESULTS: We found 16 studies published in the last ten years regarding the efficacy of RITE (12 studies) and EMDA (4 studies) in the treatment of NMIBC. Both RITE and EMDA showed promising results in the treatment of intermediate and high risk NMIBC as well as in patients affected by recurrent BCa after BCG failure. In high-risk BCG naïve NMIBC patients treated with EMDA recurrence and progression rates were 68% and 95%, respectively. Considering RITE, recurrence and progression range rates were 43%-88% and 62%-97%, respectively. Discordance results were reported regarding its effect on patients with carcinoma in situ. However, only few studies could be compared since differences exist regarding inclusion criteria with high patients' heterogeneity. Considering recurrence after BCG, recurrence and progression range rates were 29%-29.2% and 62%-83% for RITE and 25% and 75% for EMDA, respectively. CONCLUSION: Delivery of intravescical hyperthermia seems to enhance the normal effect of intravescical chemotherapy instillation. Although prospective trials supported its effect on both BCG naïve and BCG failure patients, data are urgently required to validate these findings and to understand its effect on patients with carcinoma in situ. LEVEL OF PROOF: 3.

Multidisciplinary consensus document on the current treatment of bacille Calmette-Guérin-unresponsive non-muscle invasive bladder tumor.

Radical cystectomy is the current treatment of choice for patients with BCG-unresponsive non-muscle invasive bladder tumor (NMIBC). However, the high comorbidity of this surgery and its effects on the quality of life of patients require the investigation and implementation of bladder-sparing treatment options. These must be evaluated individually by the uro-oncology committee based on the characteristics of the BCG failure, type of tumor, patient preferences and treatment options available in each center. Based on FDA-required oncologic outcomes (6-month complete response rate for CIS: 50%; duration of response in responders for CIS and papillary: 30% at 12 months and 25% at 18 months), there is not currently a strong preference for one treatment over another, although the intravesical route seems to offer less toxicity. This work summarizes the evidence on the management of BCG-unresponsive NMIBC based on current scientific evidence and provides consensus recommendations on the most appropriate treatment.

Conservative management of high-grade renal trauma.

INTRODUCTION: Renal trauma is the most common of urological trauma and accounts for up to 5% of all. The AAST scale is the most widely used to assess renal trauma. This study focuses on high-grade trauma, whose treatment has evolved towards a conservative approach, with techniques such as angioembolization. The aim is to describe the evolution in the management of high-grade renal trauma in all patients treated at La Paz University Hospital from 2001 to 2022. METHODS: A descriptive retrospective study was conducted on patients treated at the hospital. The study was divided into two periods (2001-2010 and 2011-2022). A total of 285 patients with renal trauma were collected, of which 54 were high grade. The main variable is the type of management, conservative (embolization) or interventional through nephrectomy. RESULTS: In the completed series, there was a decrease in radical nephrectomy in high-grade renal trauma from 50% to 13.8% over time, with an increase in embolization from 23,1% to 44,8%. In patients with isolated renal trauma, those treated with embolization increased from 28.6% to 69.2%, while those undergoing radical/partial nephrectomy decreased from 42.8% to 7.69%. CONCLUSION: The management of renal trauma has evolved over the years in our center. The number of patients treated by embolization has increased, while the number of complications and nephrectomies has decreased.

Is trimodal therapy the current standard for muscle-invasive bladder cancer?

OBJECTIVE: The aim of this review is to summarize the current evidence and future perspectives of bladder-sparing treatment for MIBC. METHODS: A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords "bladder cancer", "bladder-sparing", "trimodal therapy", "chemoradiation", "biomarkers", "immunotherapy", "neoadjuvant chemotherapy", "radiotherapy". RESULTS: Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to preserve their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly oriented toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes. Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation. CONCLUSIONS: Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.

The use of mannitol in partial and live donor nephrectomy: an international survey.

PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.

Zinner Syndrome with Ectopic Ureter Emptying into Seminal Vesicle.

A 66-year-old male patient in follow-up in the urology department for a non-muscle-invasive bladder cancer was detected by ultrasound to have absence of the left kidney and a cystic, multilobed image at the location of the seminal vesicle. Magnetic resonance imaging reveals left renal agenesis and the existence of multiple cysts in the ipsilateral seminal vesicle that reaches a size of 6.9 × 3.7 cm, as well as a ureteral remnant that opens into the seminal vesicle. The patient does not present urinary symptoms, neither pain with ejaculation nor hematuria. A triad of seminal vesicle cyst, ipsilateral renal agenesis, and ipsilateral ejaculatory duct obstruction is known as Zinner syndrome. Congenital anomalies of the seminal vesicles are rare; some of them are associated with malformations of the upper urinary system. Seminal vesicle cysts are associated with ipsilateral renal agenesis and ectopic or dysplastic ureter. Patients may remain asymptomatic and be diagnosed incidentally or may present with symptoms such as increased urinary frequency, dysuria, recurrent infections, pain with ejaculation, and perineal discomfort.

Current treatments for BCG failure in non-muscle invasive bladder cancer (NMIBC). / Tratamientos actuales tras fracaso a BCG en cáncer de vejiga no músculo-invasivo.

The treatment of choice for high-risk non-muscle invasive bladder cancer (NMIBC) is bacillus Calmette-Guérin (BCG). However, when this fails, the indicated treatment is radical cystectomy. In recent years, trials are being developed with various drugs to avoid this surgery in patients with BCG failure. The aim of this article is to update the treatments under study for bladder preservation in this patient population. Non-systematic review, searching PubMed with the terms "Bladder cancer", "Non-muscle invasive bladder cancer", "NMIBC", "BCG", "BCG-refractory", "Mitomycin C", "MMC", "Hyperthermia", "Electromotive Drug Administration", "EMDA". We used the search engines clinicaltrials.gov and clinicaltrialsregister.eu to find clinical trials. The only intravesical drug approved by the Food and Drug Administration (FDA) for carcinoma in situ (CIS) after failure to BCG is Valrubicin. Recently, the FDA has approved intravenous Pembrolizumab, following the publication of preliminary data from the KEYNOTE-057 study. Atezolizumab has demonstrated similar preliminary efficacy results. Only microwave-induced chemohyperthermia and EMDA-MMC (Electromotive Drug Administration) are recognized as alternatives in European guidelines. Other options under investigation are taxanes and gemcitabine, alone or in combination, recombinant viruses and device-assisted intravesical chemohyperthermia. The results of new drugs are promising, with a large number of trials underway. Knowing the mechanisms of resistance to BCG is essential to explore new therapeutic options.

The role of multiparametric magnetic resonance imaging in the selection and follow-up of patients undergoing active surveillance for prostate cancer. An European Section of Uro-Technology (ESUT) review. / Papel de la resonancia magnética multiparamétrica en la selección y el seguimiento de pacientes en vigilancia activa por cáncer de próstata. Revisión del grupo de Uro-Tecnología (ESUT) de la EAU.

INTRODUCTION: In recent years, active surveillance (AS) has gained popularity as a safe and reasonable option for patients with low-risk, clinically localized prostate cancer. OBJECTIVE: To summarize the latest information regarding the use of mpMRI in the setting of active surveillance (AS) for the management of prostate cancer (PCa). EVIDENCE ACQUISITION: A PubMed-based, English literature search was conducted through February 2020. We selected the most relevant original articles, meta-analyses and systematic reviews that could provide important information. EVIDENCE SYNTHESIS: The great importance of mpMRI of the prostate in the setting of PCa diagnosis is its ability to visualize primarily high-grade cancerous lesions potentially missed on systematic biopsies. In several studies, mpMRI has shown an improved performance over clinically based models for identifying candidates which will benefit the most from AS. Although data on prostate mpMRI during follow-up of men under AS is sparse, it holds the probability to improve significantly AS programs by a more precise selection of optimal candidates, a more accurate identification of disease progression and a reduction in number of biopsies. The goal of reassessment of patients undergoing AS is to find the most effective moment to change attitude to active treatment. CONCLUSION: The value of mpMRI has been recognized due to its high negative predictive value (NPV) for lesion upgrading in low-risk PCa patients. The improvement in imaging detection, and precise diagnosis with mpMRI could reduce misclassifications at initial diagnosis and during follow-up, reducing the number of biopsies.

Prognostic value of urinary cytology for detecting urothelial carcinoma recurrence after radical cystectomy.

INTRODUCTION: Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4-6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival. MATERIAL AND METHODS: Retrospective review of patients who underwent RC for urothelial carcinoma between 2008-2016, with a follow-up of at least 24 months. RESULTS: The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results. CONCLUSION: Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.

Molecular imaging of prostate cancer: Review of imaging agents, modalities, and current status. / Técnicas de imagen molecular en el cáncer de próstata: revisión de radiofármacos, modalidades y evidencia actual.

INTRODUCTION: The clinical course of Prostate cancer (PCa) are markedly diverse, ranging from indolent to highly aggressive disseminated disease. Molecular imaging techniques are playing an increasing role in early PCa detection, staging and disease recurrence. There are some molecular imaging modalities, radiotracers agents and its performance are important in current clinical practice PCa. OBJECTIVE: This review summarizes the latest information regarding molecular imaging of PCa and is designed to assist urologists with ordering and interpreting these modalities and different radiotracers for different patients. EVIDENCE ACQUISITION: A PubMed-based literature search was conducted up to September 2019. We selected the most recent and relevant original articles, metanalysis and reviews that have provided relevant information to guide molecular imaging modalities and radiotracers use. EVIDENCE SYNTHESIS: In this review, we discuss 3 main molecular imaging modalities and 7 radiotracer technologies available. CONCLUSIONS: The use molecular imaging modalities and radiotracers has a unique role in biochemical recurrence and diagnosis of ganglionar and bone progression of PCa. In the present time, no one of these molecular imaging modalities can be recommended over the classical work-up of abdominopelvic CT scan and bone scan, and large-scale and multi-institutional studies are required to validate the efficacy and cost utility of these new technologies.

Magnetic resonance as imaging diagnostic tool in prostate cancer: New evidences-The EAU Section of Uro-Technology position. / La resonancia magnética como herramienta para el diagnóstico del cáncer de próstata: nuevas evidencias y posicionamiento de la ESUT (EAU Section of Uro-Technology).

Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging as the most sensitive and specific imaging tool for detection, lesion characterization and staging of PCa. Therefore, we carried out an updated review of magnetic resonance imaging in the diagnostic PCa reviewing the latest papers published in PubMed.

Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. / Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19.

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option¼ after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.

[Laparoscopic urinary diversions]. / Derivaciones urinarias laparoscópicas.

INTRODUCTION: The treatment of the invasive bladder cancer and the recurrent T1G3 is clearly established in radical cystectomy and pelvic linphadenectomy. One of the fields where the laparoscopic approach implies more doubts is the treatment of bladder cancer, because it requires experience enough in pelvic laparoscopic surgery and the urinary diversion implies great technical difficulties to the laparoscopic approach. OBJECTIVES: The main goal of this article is to report our results with the urinary diversion after laparoscopic radical cystectomy where the ureteral anastomosis has been performed by a laparoscopic approach. METHODS: From January 2005 to December 2007 we have performed 67 laparoscopic radical cistectomies. We conducted 28 laparoscopic urinary diversions with our technique: 7 neobladder with an average age of 54, 85 years and 21 ileal conduit with an average age of 69, 15 years. RESULTS: The averagesurgical time for enterocistoplasty with laparoscopic urethral and ureteral anastomosis is of 5 hours and 30 minutes. For the cutaneous ureteroileostomy with laparoscopic ureteral anastomosis the average surgical time has been of 4 hours and 30 minutes. We have had 1 case of urinary leakage in the laparoscopic neobladder and 3 cases in the laparoscopic ileal conduit (14%). We have not intestinal dehiscence nor ileal-ureteric stenosis. The average hospital stay for laparoscopic neobladder is for the 85% of cases of 13.6 days, and of 11.8 days for the 77.7% of ileal ureteric laparoscopies. DISCUSSION: The laparoscopic radical cystectomy is still a procedure reserved for groups with great experience in laparoscopic surgery. Nowadays, the most accepted procedure by most groups includes perform the cystectomy by a laparoscopic approach and the urinary diversion by an open approach. There is no evidence of the advantages of laparoscopic urinary diversion. It is necessary to perform comparative studies to clearly define the role of laparoscopic surgery in the urinary diversion.

Influence of social networks on congresses of urological societies and associations: Results of the 81th National Congress of the Spanish Urological Association. / Influencia de las redes sociales en congresos de sociedades y asociaciones urológicas: Resultados del 81.° Congreso Nacional de la Asociación Española de Urología.

OBJECTIVE: To measure social network activity during the 81th National Congress of the Spanish Urological Association (AEU) and to compare it with the activity during other congresses of national and international urological associations. MATERIAL AND METHODS: We designed and registered the official hashtag #AEU16 for the 81th National Congress of the AEU on the Symplur website. The following measurements were recorded: number of participants, number of tweets, tweets by participant, tweets per hour and views. RESULTS: The number of participants in the social network activity during the congress was 207. The measurements of activity in Twitter consisted of a total of 1866 tweets, a mean rate of 16 tweets/h, 9 tweets per participant and 1,511,142 views. The activity during the international congresses is as follows: 2016 American Urological Association annual congress (views: 28,052,558), 2016 European Association of Urology annual congress (views: 13,915,994), 2016 Urological Society of Australia and New Zealand (views: 4,757,453), 2015 Société Internationale d'Urologie annual congress (views: 1,023,038). The activity during the national congresses was recorded as follows: 2016 Annual Conference of The British Association of Urological Surgeons (views: 2,518,880), 81th National Congress of the AEU (views: 1,511,142), 109th Congress of l'Association Française d'Urologie (views: 662,828), 67th German Congress of Urology (views: 167,347). We found 10 posts in Facebook and 2 communications via Periscope TV related to #AEU16. CONCLUSIONS: The social network activity during the 81th National Congress of the AEU was notable given the results of this study. The use of social networks has expanded among urological associations, congresses and meetings, giving them a global character.

[Evaluation and treatment of kidney penetrating wounds]. / Evaluation et traitement des plaies pénétrantes du rein.

Penetrating lesions of the kidney are less frequent than closed wounds. However, their incidence has increased these past decades, in relation with the augmentation of urban violence. The main causes of penetrating wounds are knives and firearms, with a related rate of renal lesions more important in the second case. The treatment of renal traumas has evolved these past years. Previously, surgical investigations were systematically indicated in most cases, which was associated with an elevated number of nephrectomies. Today, the development of new diagnostic imaging techniques available in most emergency units allows in certain cases the replacement of therapy by a strict follow-up of the patient, the objective being to preserve the kidney. The principal diagnostic investigation is CT scanning with injection of a contrast product, which is useful to adequately classify renal lesions and to make decision regarding the best first-line therapeutic management. In case of penetrating lesion, the first step is the evaluation of the haemodynamic condition of the patient. In case of haemodynamic instability, immediate surgical investigation is necessary. Conversely, if the patient is stable, CT with delayed imaging must be carried out. For grade I and II renal lesions, therapeutic abstention is recommended. Grade III and IV lesions associated with other intraperitoneal lesions that require emergency laparotomy must be surgically investigated and in these cases, reconstructive surgery or nephrectomy must be considered. Most grade IV lesions associated with a lesion of the renal hilus and grade V lesions must be referred to surgery. Minor renal lesions may not be treated; such cases necessitate a follow-up of the patient that should include successive assessments of the haemoglobin and the haematocrite, together with CT and ultrasonographic investigations aimed at the follow-up of lesion evolution and detection of potential urinomas or prolonged bleedings. The progressive decrease of the haematocrite and arteriovenous fistulae must be treated first by an embolization. Untreated patients with persistent urinary fistulae will undergo, if necessary, ureteral catheterization and percutaneous drainage of the urinoma.

[Development of a laparoscopic radical prostatectomy program in an university center]. / Implantación de un programa de prostatectomía radical laparoscópica.

The aim of this article is to report our experience in setting up a laparoscopic radical prostatectomy programme. We believe that knowledge of the difficulties we faced at the start will be useful for those who wish to implement a programme like ours. We hope that by explaining the steps we took as well as our conclusions and recommendations this difficult task can be made easier.

[Analysis of a laparoscopic radical prostatectomy program with 544 cases]. / Prostatectomía radical laparoscópica. Revisión de la literatura. Nuestra experiencia.

INTRODUCTION: This article reviews the latest publications that refer to Laparoscopic Radical Prostatectomy (LRP) up to 2005, and describes our series of patients for this type of surgery. MATERIALS AND METHODS: After a search of the Internet and consulting journals of renowned prestige, we selected articles that refer to this technique and we summarise the latest developments in LRP. We also present our series of patients. RESULTS: In view of the good oncologic and functional results obtained with LRP, and the possibility of performing hernioplasty as in open surgery, this technique provides a high quality service for patients. CONCLUSIONS: Due to the advances in the safety and quality of this technique, such as the use of robots, 3 CCD cameras, and the surgeon's experience, LRP should be offered to our patients, if it is within our means.