Tumor Budding: Prognostic Value in Muscle-invasive Bladder Cancer.

OBJETIVES: To assess if "tumor budding" (TB) behaves as a poor prognostic factor in muscle-invasive bladder carcinoma (MIBC). TB is the presence of tumor cells isolated or in small groups of fewer than 5 cells located at the tumor invasion front. MATERIAL AND METHODS: Retrospective study of 106 patients with MIBC who underwent radical cystectomy. A cytokeratin AE1/AE3 immunostaining was applied to identify and quantify TB by the "hot-spot" method. The variables evaluated were: age, gender, Tumour, Node, Metastasis Classification (TNM) stage, associated Carcinoma in situ, differentiation degree, tumor size, tumor location, lymphatic, venous or perineural invasion, p53, Ki67, molecular subtype (basal/luminal) and chemotherapy. Main variables were overall and cancer-specific survival. RESULTS: The mean follow-up time was 47 ± 46.45 months. The mean TB count was 32.3 ± 25.9 "buds." The ROC curve established 14 "buds" as the cut-off point: the median survival rate for the "low-grade TB" group (≤14 "buds") was 69.5 months, and for the "high-grade TB" group (>14 "buds") was 18.5 months (P= .003). In the multivariate analysis, independent predictive variables regarding mortality were: age, TB, and TNM stage. Patients with more than 14 "buds" had 2.27 times more risk of mortality, 95%CI:1.19-4.34, P = .013. In addition, the risk of mortality rises progressively as the number of "buds" increases, at a rate of 2% per "bud." CONCLUSION: According to our results, TB becomes an independent predictor factor for cancer-specific mortality in MIBC, with a cut-off point of 14 "buds."

[New strategies and protocols in SWL.] / Nuevas estrategias y protocolos en LEOC.

OBJECTIVE: An update of the new treatment strategies in extracorporeal lithotripsy as a valid therapeutic alternative in the management of urinary calculi. METHODS: We performed a search and review of the most recent literature which responded to the terms "best practices", "update", "optimization", "practice pattern" in lithotripsy. Only articles written in English or Spanish were selected. RESULTS: The use of a stepwise voltage ramping during extracorporeal lithotripsy with or without pause before the first rise of energy, a decreased delivery rates and the use of a higher number of shock waves per session are shown as alternatives to improve the effectiveness with optimum safety profile. CONCLUSIONS: Extracorporeal lithotripsy is still an effective and minimally invasive treatment, and it has an important role in the treatment of urolithiasis. New treatment strategies are being developed to increase the effectiveness with a similar safety profile.

Nuevas estrategias y protocolos en LEOC / New strategies and protocols in SWL

OBJETIVO: Actualizar las nuevas estrategias de tratamiento con litotricia extracorpórea (LEOC) como una alternativa terapéutica vigente en el manejo de la litiasis urinaria.MÉTODOS: Se ha realizado una revisión de la literatura más reciente cuya búsqueda respondía a los términos 'mejores prácticas', 'update', 'optimization', 'practicepattern' en litotricia. Sólo fueron seleccionadas aquellas escritas en lengua inglesa o española. RESULTADOS: La disminución de la frecuencia de liberación de las ondas de choque, la aplicación de un escalonamiento progresivo en la dosis aplicada con o sin pausa previo al primer ascenso de la energía, y la utilización de un mayor número de ondas de choque por sesión se muestran como alternativas que mejoran la efectividad con un perfil de seguridad óptimo para el paciente. CONCLUSIONES: La LEOC es un tratamiento efectivo y mínimamente invasivo, que mediante la aplicación de una técnica adecuada todavía tiene un papel relevante en el tratamiento de la litiasis urinaria. Nuevas estrategias de tratamiento en LEOC están siendo desarrolladas para aumentar la efectividad, sin incrementar los riesgos para el paciente

OBJECTIVE: An update of the new treatment strategies in extracorporeal lithotripsy as a valid therapeutic alternative in the management of urinary calculi. METHODS: We performed a search and review of the most recent literature which responded to the terms 'best practices', 'update', 'optimization', 'practice pattern' in lithotripsy. Only articles written in English or Spanish were selected. RESULTS: The use of a stepwise voltage ramping during extracorporeal lithotripsy with or without pause before the first rise of energy, a decreased delivery rates and the use of a higher number of shock waves per session are shown as alternatives to improve the effectiveness with optimum safety profile. CONCLUSIONS: Extracorporeal lithotripsy is still an effective and minimally invasive treatment, and it has an important role in the treatment of urolithiasis. New treatment strategies are being developed to increase the effectiveness with a similar safety profile

Impacto en la calidad de una vida de los pacientes con catéter doble J / Impact in the quality of life of the patients with double J catheter

OBJETIVO: Los catéteres doble J se usan frecuentemente para permitir la diuresis entre riñón y vejiga, pero su presencia tiene un importante impacto en la calidad de vida (CdV) de los pacientes. Nuestro objetivo en este trabajo es describir dicho impacto y recoger aquellas medidas que pueden paliar los síntomas relacionados con su uso. MÉTODOS: Se ha realizado una búsqueda de artículos en las fuentes bibliográficas Cochrane library, Uptodate, Pubmed, Tripdatabase, seleccionando publicaciones entre 2000-2015 y las guías europeas EAU 2016. Se seleccionaron aquellos estudios que evaluaron la calidad de vida con catéteres doble J y las posibles soluciones. RESULTADOS: Se incluyeron 6 estudios cualitativos sobre calidad de vida, 6 ensayos clínicos sobre nuevos diseños en catéteres doble J, y 3 revisiones sistemáticas. La mayoría de los estudios utilizaron el cuestionario USSQ de calidad de vida. Se describen los principales problemas, siendo los mas frecuentes e importantes los síntomas de llenado y dolor. Entre las posibles soluciones se encuentran modificaciones en diseño y composición del catéter y sobre todo el uso de alfa-bloqueantes y anticolinérgicos para mejorar la CdV. CONCLUSIÓN: Los catéteres doble J presentan una importante repercusión sintomática y deterioro en la CdV lo cual hace necesario una indicación adecuada, limitar su duración y utilizar todas aquellas medidas tecnológicas y farmacológicas para paliar sus efectos

OBJECTIVE: Double J ureteral stents are frequently used to allow free diuresis from the kidney to the bladder, but their presence has a major impact on patient`s quality of life (QoL). Our aim is to describe such impact, and to describe possible solutions that can alleviate the symptoms associated with their use. METHODS: Systematic search in bibliographic sources including Cochrane library, UpToDate, Pubmed, Tripdatabase, selecting publications between 2000-2015, and also the EAU European guidelines (2016). Studies that assessed QoL with double J stents and possible solutions were selected. RESULTS: We included 6 qualitative studies on QoL, 6 clinical trials of double J catheters new designs, and 3 systematic reviews. Most studies used the USSQ (QoL) questionnaire and main problems are described, being storage symptoms and pain the most frequent and important. Possible solutions include modifications in design and composition of the catheter and specially, the use of alpha-blockers and anticholinergics to improve QoL. CONCLUSION: Double J stents have an important symptomatic impact that impairs QoL. They should be used under appropriate indication; their duration should be limited and we must employ all the technological and pharmacological approaches to mitigate their effects