"Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience".

Introduction: Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents". Material: Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey. Results: All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS. Conclusion: Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.

Environmental Conditions as Determinants of Kidney Stone Formation.

Urolithiasis is a disease characterized by the presence of stones in the urinary tract, whether in the kidneys, ureters, or bladder. Its origin is multiple, and causes can be cited as hereditary, environmental, dietary, anatomical, metabolic, or infectious factors. A kidney stone is a biomaterial that originates inside the urinary tract, following the principles of crystalline growth, and in most cases, it cannot be eliminated naturally. In this work, 40 calculi from the Don Benito, Badajoz University Hospital are studied and compared with those collected in Madrid to establish differences between both populations with the same pathology and located in very different geographical areas. Analysis by cathodoluminescence offers information on the low crystallinity of the phases and their hydration states, as well as the importance of the bonds with the Ca cation in all of the structures, which, in turn, is related to environmental and social factors of different population groups such as a high intake of proteins, medications, bacterial factors, or possible contamination with greenhouse gases, among other factors.

Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?

BACKGROUND: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center. METHODS: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16-84). The average stone size was 6.71 mm (3-16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%). RESULTS: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever. CONCLUSIONS: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied.

Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?

Background: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center. Methods: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16–84). The average stone size was 6.71 mm (3–16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%). Results: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever. Conclusions: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied (AU)

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL).

OBJECTIVES: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients' subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. RESULTS: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. CONCLUSIONS: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high.

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL)

Objectives: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients’ subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. Results: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. Conclusions: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high (AU)

Recidivant infective lithiasis: Is it possible to defeat them? / Litiasis infectivas recidivantes. ¿Es posible vencerlas?

Acidifying treatment and control of urinary pH may be an effective strategy to address recurrent lithiasic disease secondary to infective calculi. We present the case of a 39-year-old man with bilateral urolithiasis that led to episodes of complicated Reno ureteral colic.After undergoing multiple treatments by retrograde endourological surgery, he presented recurrence and progression of lithiasis disease, finally requiring percutaneous approach for treatment of a coralliform stone, after which he was free of lithiasis. It was then decided to start treatment with an acidifying oral supplement and home pH control by means of an electronic medical device as a complement to the surgeries he underwent, thus achieving stability of the disease, with absence of urinary tract infection or lithiasis recurrence.The patient, with poor adherence to previous treatments, presented in this case a correct follow-up of the treatment, as well as a high level of satisfaction with it.

El tratamiento acidificante y el control del pH urinario pueden constituir una estrategia eficaz para abordar la enfermedad litiásica recurrente secundaria a cálculos infectivos. Presentamos el caso de un varón de 39 años con urolitiasis bilaterales que le condicionaron episodios de cólicos renoureterales complicados.Tras ser sometido a múltiples tratamientos mediante cirugía endourológica retrógrada, presentó recidiva y progresión de enfermedad litiásica, precisando finalmente abordaje percutáneo para tratamiento de un cálculo coraliforme, tras lo cual queda libre de litiasis. Se decide entonces iniciar tratamiento con suplemento oral acidificante y control domiciliario de pH mediante dispositivo médico electrónico como complemento a las cirugías a las que fue sometido, logrando así estabilidad de enfermedad, con ausencia de cuadros de infección urinaria ni recidiva litiásica.El paciente, con mala adherencia a tratamientos previos, presentó en este caso un correcto seguimiento del tratamiento, así como elevado nivel de satisfacción con el mismo.

Litiasis infectivas recidivantes. ¿es posible vencerlas? / Recurrent infectious lithiasis. is it possible to beat them?

El tratamiento acidificante y el control del pHurinario pueden constituir una estrategia eficaz para abor-dar la enfermedad litiásica recurrente secundaria a cálcu-los infectivos. Presentamos el caso de un varón de 39 añoscon urolitiasis bilaterales que le condicionaron episodiosde cólicos renoureterales complicados. Tras ser sometidoa múltiples tratamientos mediante cirugía endourológicaretrógrada, presentó recidiva y progresión de enfermedadlitiásica, precisando finalmente abordaje percutáneo paratratamiento de un cálculo coraliforme, tras lo cual quedalibre de litiasis. Se decide entonces iniciar tratamiento consuplemento oral acidificante y control domiciliario de pHmediante dispositivo médico electrónico como comple-mento a las cirugías a las que fue sometido, logrando asíestabilidad de enfermedad, con ausencia de cuadros deinfección urinaria ni recidiva litiásica. El paciente, con mala adherencia a tratamientos previos,presentó en este caso un correcto seguimiento del tratamien-to, así como elevado nivel de satisfacción con el mismo.(AU)

Acidifying treatment and control of urinarypH may be an effective strategy to address recurrent lithia-sic disease secondary to infective calculi. We present thecase of a 39-year-old man with bilateral urolithiasis thatled to episodes of complicated Reno ureteral colic. Afterundergoing multiple treatments by retrograde endourolog-ical surgery, he presented recurrence and progression oflithiasis disease, finally requiring percutaneous approachfor treatment of a coralliform stone, after which he wasfree of lithiasis. It was then decided to start treatment withan acidifying oral supplement and home pH control bymeans of an electronic medical device as a complement tothe surgeries he underwent, thus achieving stability of thedisease, with absence of urinary tract infection or lithiasisrecurrence.The patient, with poor adherence to previous treatments,presented in this case a correct follow-up of the treatment,as well as a high level of satisfaction with it.(AU)

Estado actual de la formación urológica en España / Current status of Urological Education in Spain

Introducción: La urología es la especialidad médico-quirúrgica que se ocupa del estudio, diagnóstico y tratamiento de las afecciones del aparato urinario y retroperitoneo en ambos sexos y del aparato genital masculino sin límite de edad. El sistema clásico de formación se basa en la imitación de las habilidades y conductas de los tutores, origina variabilidad en la formación entre los diferentes centros y otorga un rol pasivo a los médicos internos residentes (MIR). Marco Legislativo el BOE: El BOE de 2006 establece los contenidos formativos específicos en sus facetas teórica, práctica y científica. Al iniciar el período formativo MIR, el primer año se centra en la formación quirúrgica general y los cuatro restantes de formación específicamente urológica. Este marco legislativo que regula nuestra especialidad es antiguo, sin previsión de renovación, ya que esta se iba a llevar a cabo con el desarrollo del proyecto de troncalidad, actualmente paralizado tras la sentencia del tribunal supremo. Por lo tanto, nos encontramos en una situación de cierta incertidumbre con un marco legal en planes de renovación. Estado actual de la formación: Una encuesta a nivel nacional pone de manifiesto que el grado de participación quirúrgica de los MIR es bajo, así como el entrenamiento en modelos y asistencia a cursos. Además, la autoconfianza que sienten para realizar intervenciones que podrían considerarse de baja complejidad es alta, para actividades como la consulta es moderada y para intervenciones de moderada-alta complejidad es baja. Conclusión: El programa actual de formación es mejorable y susceptible de actualización. Nuevos estudios y esfuerzos deberían orientarse a estandarizar la adquisición de habilidades quirúrgicas y no quirúrgicas, garantizar y facilitar el acceso a cursos de formación quirúrgica, establecer un mínimo de intervenciones requeridas por año y al final de la residencia, fomentar la formación académica, la participación en investigación de los residentes y lograr una evaluación objetiva de la especialidad (AU)

Introduction: Urology is a medical-surgical specialty that deals with the study, diagnosis and treatment of medical and surgical conditions of the urinary tract and retroperitoneum in both sexes and of the male genital tract without age limit. The traditional method of training is based on the imitation of the skills and behaviors of the tutors, creating variability in the training between different centers and giving a passive role to resident internal physicians (MIR). Legislative framework: The 2006 BOE establishes the specific formative content in its theoretical, practical and scientific facets. At the beginning of the MIR training period, the first year focuses on general surgical training and the remaining four on specific urological training. The current legislative framework that regulates our specialty is one of the oldest, with no prospect of renewal, since this would be carried out with the development of the trunk project, currently paralyzed after the judgment of the Supreme Court. Therefore, we are in a situation of uncertainty with a legal framework in renewal plans. Current state of training: a National survey shows the degree of surgical participation of the MIR is low, as well as training on models and course attendance. In addition, the self-confidence they feel for interventions that could be considered of low complexity is high, for activities such as consultation is moderate and for interventions of moderate-high complexity is low. Conclusion: The current training program is upgradeable. New studies and efforts should aim to standardize the acquisition of surgical and non-surgical skills, guarantee access to surgical training courses, establish a minimum of required interventions per year and at the end of residency, foster academic training, participation in research of residents and achieve an objective assessment of the specialty (AU)

[Current status of Urological Education in Spain.] / Estado actual de la formación urológica en España.

INTRODUCTION: Urology is a medicalsurgical specialty that deals with the study, diagnosis and treatment of medical and surgical conditions of the urinary tract and retroperitoneum in both sexes and of the male genital tract without age limit. The traditional method of training is based on the imitation of the skills and behaviors of the tutors, creating variability in the training between different centers and giving a passive role to resident internal physicians (MIR). LEGISLATIVE FRAMEWORK: The 2006 BOE establishes the specific formative content in its theoretical, practical and scientific facets. At the beginning of the MIR training period, the first year focuses on general surgical training and the remaining four on specific urological training. The current legislative framework that regulates our specialty is one of the oldest, with no prospect of renewal, since this would be carried out with the development of the trunk project, currently paralyzed after the judgment of the Supreme Court. Therefore, we are in a situation of uncertainty with a legal framework in renewal plans. CURRENT STATE OF TRAINING: a National survey shows the degree of surgical participation of the MIR is low, as well as training on models and course attendance. In addition, the self-confidence they feel for interventions that could be considered of low complexity is high, for activities such as consultation is moderate and for interventions of moderate-high complexity is low. CONCLUSION: The current training program is upgradeable. New studies and efforts should aim to standardize the acquisition of surgical and non-surgical skills, guarantee access to surgical training courses, establish a minimum of required interventions per year and at the end of residency, foster academic training, participation in research of residents and achieve an objective assessment of the specialty.

[Cystic displasia of the testis. Review of literature]. / Displasia quística de rete testis: revisión de la literatura.

OBJECTIVE: Review this pathology nowadays. METHODS: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. RESULTS: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. CONCLUSION: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors.

[Clinical presentation of renal cell carcinoma in renal transplant]. / Presentación clínica del carcinoma de células renales en el trasplante renal.

OBJECTIVES: To analyze the clinical presentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft. METHODS: Analysis of the cases described in our centre and review of current literature. RESULTS: RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment. CONCLUSIONS: The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are originated in the graft. The clinical presentation of the primitive RCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft.

Displasia quística de rete testis: revisión de la literatura / Cystic displasia of the testis. Review of literature

Objetivo: Revisión de la Displasia Quística de Rete Testis en el momento actual. Material y Métodos: Búsqueda bibliográfica en la base de datos Medline/PubMed del término “Cystic dysplasia of the testis”, con análisis de las revisiones bibliográficas encontradas. Resultados: La displasia quística de rete testis (DQRT) es una rara enfermedad benigna, asociada a malformaciones del tracto urinario superior. Su manifestación clínica más frecuente es el aumento de tamaño testicular, demostrándose la presencia de los quistes ecográficamente. No existe consenso en el tratamiento, optándose en la mayoría de los casos por la confirmación anatomopatológica con conservación del parénquima testicular. Conclusión: La DQRT es una enfermedad que debe ser tenida en cuenta en el diagnóstico diferencial de la masa escrotal infantil (AU)

Objetive: Review this pathology nowadays. Methods: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. Results: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. Conclusion: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors (AU)

Presentación clínica del carcinoma de células renales en el trasplante renal / Clinical presentation of renal cell carcinoma in renal transplant

OBJETIVO: Analizar la presentación clínica y la actitud terapéutica ante la afectación del injerto por un Carcinoma de células renales (CCR).MÉTODOS: Análisis de los casos descritos en nuestro Centro y revisión de la literatura actual.RESULTADOS: El CCR presenta una incidencia superior en los pacientes trasplantados, afectando en menos del 10% al injerto. La ausencia de inervación hace que habitualmente sea un hallazgo casual durante el seguimiento, aunque su presentación puede llegar a ser como un abdomen agudo en caso de rotura del injerto. El tratamiento convencional es la trasplantectomía, realizándose en los últimos años la nefrectomía parcial con buenos resultados. La modificación de la inmunosupresión es una medida habitual tras el tratamiento.CONCLUSIONES: La incidencia de CCR post-TR en nuestra serie es del 0,7%, originándose el 22% de los mismos en el injerto. La presentación clínica del CCR primitivo del injerto es variable. La nefrectomía parcial es técnicamente posible y oncológicamente segura en el tratamiento del CCR del injerto renal(AU)

OBJECTIVES: To analyze the clinical pre-sentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft.METHODS: Analysis of the cases described in our cen-tre and review of current literature.RESULTS: RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment.CONCLUSIONS: The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are origi-nated in the graft. The clinical presentation of the primitivaveRCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft(AU)

Carcinoma vesical linfoepitelioma-like: revisión de la literatura y aportación de un nuevo caso / Bladder lymphoepithelioma-like carcinoma. Bibliographic review and case report

Objetivo: El carcinoma linfoepitelial o carcinoma linfoepitelioma-like es un raro tumor cuya histología recuerda a los linfoepiteliomas de la nasofaringe. Se ha descrito su presencia en múltiples localizaciones, pero en la vejiga tan sólo se han descrito 55 casos en la literatura. Presentamos un nuevo caso de carcinoma linfoepitelial vesical y hacemos una revisión de todos los publicados anteriormente, con la intención de definir sus características e intentar obtener una pauta terapéutica y pronóstica aplicable a esta patología. Métodos: Se ha revisado la literatura relativa al carcinoma linfoepitelial y se han analizado las características epidemiológicas, los tratamientos recibidos y la evolución de los 56 casos publicados (incluido el nuestro), tanto de forma global como en función de los subtipos histológicos, según la clasificación de Amin y cols. Resultados: Se han descrito 56 casos, 40 en hombres y 16 mujeres, con una media de edad de 69 años. Se diagnosticaron 19 del subtipo puro (33,9%), 20 del predominante (35,7%) y 11 del focal (19,6%) sin indicarse la histología en 6 de ellos (10,7%). En cuanto a los estadíos tumorales, el 10,7% (6) fueron T1, el 57,1% (32) fueron T2 y el 30,4% (17) fueron T3. En el 58,9% de los casos el tratamiento fue la RTU, en el 35,7% la cistectomía radical y en el 5,4% la cistectomía parcial. Un 42,9% no recibieron tratamiento adyuvante, un 30,4% recibieron quimioterapia y un 19,6% radioterapia. La supervivencia global con una media de seguimiento de 34,5 meses, y una mediana de 25 fue de 67,9%, un 64,3% libres de enfermedad. Si diferenciamos por subtipos histológicos, el 84,3% de los puros, el 100% de los predominantes y el 76,7% de los focales se presentaron con histologías infiltrantes (T2/T3). Un 78,9% de los puros, un 45% de los predominantes y un 45,5% de los focales fueron tratados con RTU. El 83% de los puros recibió tratamiento adyuvante, mientras que el 60% de los predominantes y el 63% de los focales no recibieron ninguna adyuvancia. La supervivencia libre de enfermedad en los estadíos T2/T3 fue de 87,5% para los puros con una mediana de seguimiento de 39 meses, del 75% para los predominantes con una mediana de 22 meses y del 0% para los focales con una mediana de 18 meses. Conclusiones: En el momento actual no se puede definir un protocolo terapéutico especifico para los pacientes afectos de carcinoma linfoepitelial vesical, aunque teniendo en cuenta la aparente buena evolución de los subtipos puro y predominante y la mala del subtipo focal, parece que la RTU podría ser una buena alternativa en determinados pacientes con histología pura o predominante, incluso en estadíos infiltrantes. En cambio, en el subtipo focal el tratamiento radical con cistectomía y adyuvancia sistémica parece la mejor alternativa (AU)

Objective: Lymphoepithelial-carcinoma or lymphoepithelioma-like carcinoma is a rare tumour, the histology of which remembers nasal pharyngeal is lymphoepitheliomas. Their presence has been described in multiple localizations, but only 55 cases have been described in the bladder. We present a new case of bladder lymphoepithelial carcinoma and performed a review of all published cases, with the aim of defining its characteristics and try to obtain a therapeutic and prognostic guide applicable to this disease. Methods: We reviewed the literature related to lymphoepithelial carcinoma and epidemiological characteristics, treatments administered, and outcomes of the 56 published cases (including ours) have been analyzed, both globally and as a function of histological subtypes following the classification of Amin et al. Results: 56 cases have been described, 40 males and 16 women, with a mean age of 69 years. Nineteen of the pure subtype (33.9%), 20 of the predominant type (35.7%) and I I focal (19.6%) were diagnosed, without any indications of histology in six of them (10.7%). Regarding tumor stages: 10.7% (6) were TI, 57. I% (32) T2, and 30.4% (I7) T3. 58.9% of the cases underwent transurethral resection (TUR), 35.7% radical cystectomy, and 5.4% partial cystectomy. 42.9% did not receive any adjuvant treatment, 30.4% received chemotherapy, and I9.6% radiotherapy. Overall survival was 67.9%, 64.3% disease-free, with a mean and median follow up of 34.5 and 25 months respectively. If we differentiate histological subtypes, 84.3% of the pure, 100% of the predominant, and 76.7% of focal presented infiltration (T2/T3). 78.9% of the pure, 45% of the predominant and 45.5% of the focal underwent TUR. 83% of the pure receive adjuvant treatment, whereas 60% of the predominant and 63% of the focal types did not receive any adjuvant treatment. Disease-free survival for stages T2/T3 was 87.5% for the pure with a median follow up of 39 months, 75% for the predominant with a median follow-up of 22 months and 0% for the focal with a median follow-up of I8 months. Conclusions: Currently, no specific therapeutic protocol can be established for patients with bladder lymphoepithelial carcinoma, although taking into consideration the apparent good outcome of the pure and predominant subtypes and the bad outcome of the focal subtype, it seems that TUR may be a good alternative in selected patients with pure our predominant histology, even with infiltrative stages. Oppositely, radical treatment with cystectomy and systemic adjuvant treatment seems to be the best choice for focal subtypes (AU)