Role of the 4Kscore test as a predictor of reclassification in prostate cancer active surveillance.

BACKGROUND: Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. METHODS: Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher's exact test, as appropriate established differences between groups of reclassification. RESULTS: A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. CONCLUSIONS: Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management.

[Laparoscopic ureteral reimplantation in the treatment of urinary tract complications after renal transplantation.] / Reimplante ureteral laparoscópico en el tratamiento de las complicaciones urinarias del trasplante renal.

OBJECTIVES: Laparoscopic ureteral reconstructive surgery is routinely performed , because it demonstrated efficacy and safety profiles similar to open surgery in expert hands. The most frequent surgical complications after transplant are urological, appearing in up to 12,5% of the cases; they can compromise graft function and mortality. The most frequent ones include ureterovesical anastomosis stenosis (2,5-7,5%) and vesicoureteral reflux (0,4-2,2), which present in up to 80% of the cases. METHODS: Technical description of the Lich-Gregoire ureteral reimplantation technique in renal transplant patients. RESULTS: From October 2012 we performed 14 Lich-Gregoire laparoscopic ureteral reimplantations in transplant patients, 9 due to distal ureteral stenosis and 5 for vesicoureteral reflux. There were not open conversions. CONCLUSIONS: Laparoscopic surgery has evolved much allowing the performance on techniques that we could not think of years ago. Renal transplant patients present frequent postoperative complications, so they benefit of minimally invasive surgery such as endoscopy or laparoscopy. The Lich-Gregoire laparoscopic reimplantation in transplant patients is reproducible in Centers with experience both in laparoscopic surgery and transplantation.

Reimplante ureteral laparoscópico en el tratamiento de las complicaciones urinarias del trasplante renal / Laparoscopic ureteral reimplantation in the treatment of urinary tract complications after renal transplantation

OBJETIVO: La cirugía reconstructiva ureteral laparoscópica es realizada de forma rutinaria, ya que ha demostrado una eficacia y perfiles de seguridad similares a los de la cirugía abierta en manos expertas. Las complicaciones quirúrgicas más frecuentes tras el trasplante renal son las urológicas, presentándose hasta en el 12,5% de los casos, pudiendo comprometer la función del injerto y la mortalidad. Las más comunes incluyen la estenosis de la anastomosis urétero-vesical (2,5-7,5%) y el reflujo vésico-ureteral (0,4-2,2%), que puede aparecer hasta en un 80% de casos. MÉTODO: Descripción de la técnica de reimplante laparoscópico tipo Lich-Gregoire en pacientes trasplantados renales. RESULTADOS: Desde octubre de 2012 hasta la actualidad hemos realizado 14 reimplantes ureterales laparoscópicos tipo Lich-Gregoire en pacientes trasplantados, 9 por estenosis ureteral distal y 5 por reflujo vésico-ureteral, en ningún caso ha habido necesidad de reconversión a cirugía abierta. CONCLUSIONES: La cirugía laparoscópica ha evolucionado mucho permitiendo realizar técnicas poco imaginables hace años. Los trasplantados renales presentan complicaciones postoperatorias frecuentes, por lo que son ampliamente beneficiados de la cirugía mínimamente invasiva como la endoscopia o laparoscopia. La técnica del reimplante laparoscópico tipo Lich-Gregoire en pacientes trasplantados renales es reproducible en los centros con experiencia laparoscópica y en trasplantes

OBJECTIVES: Laparoscopic ureteral reconstructive surgery is routinely performed , because it demonstrated efficacy and safety profiles similar to open surgery in expert hands. The most frequent surgical complications after transplant are urological, appearing in up to 12,5% of the cases; they can compromise graft function and mortality. The most frequent ones include ureterovesical anastomosis stenosis (2,5-7,5%) and vesicoureteral reflux (0,4-2,2), which present in up to 80% of the cases. METHODS: Technical description of the Lich-Gregoire ureteral reimplantation technique in renal transplant patients. RESULTS: From October 2012 we performed 14 Lich-Gregoire laparoscopic ureteral reimplantations in transplant patients, 9 due to distal ureteral stenosis and 5 for vesicoureteral reflux. There were not open conversions. CONCLUSIONS: Laparoscopic surgery has evolved much allowing the performance on techniques that we could not think of years ago. Renal transplant patients present frequent postoperative complications, so they benefit of minimally invasive surgery such as endoscopy or laparoscopy. The Lich-Gregoire laparoscopic reimplantation in transplant patients is reproducible in Centers with experience both in laparoscopic surgery and transplantation

The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry.

The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice. RESULTS: We find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10-22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60-0.71). PDF and CUC do not suggest a specific cut-off point of clinical use. METHODS: We select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC). CONCLUSIONS: In our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.

[Urology before illustration. From the Urology of the Royal College of Cadiz to that of the "veneranda" gathering]. / La urología preilustrada. De la Urología del Real Colegio de Cádiz a la de la Veneranda Tertulia.

The study of the urological activity in the Andalusian occident is contained in the printed and handwritten "Observations" of the records of the Royal Society of Medicine of Seville and the Royal College of Surgery of Cadiz. They encompass the period from 1693 to the first third of the 18th century. By the first of October 1701, the "Veneranda" gathering consolidates and Philip V gives the "royal warrant". The "Royal Society of Medicine and Other Sciences of Seville" starts its medical-surgical path. It should be reminded that all the Andalusian surgery and specially the one from Cadiz (through the Royal College of Surgeons) was present in the Royal Society. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili and many others were founders of this extraordinary event. Surgical training and, by extension, urological training had their root and basement in the anatomical amphitheaters (Seville 1731 and Cadiz 1728), which were considered ungodly by the Church. José Celestino Mutis (1750-53) and Pedro Fernandez Castilla (1741) excluded the university from this new movement. There was and intense relationship between Navy surgeons and the Royal Society, being members since its foundation: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). The main protagonist was Luis Montero, real paradigm with projection to the next century, having a neat French influence altogether with Ramos, both of them being Beaumond's alumni (an anatomist of recognized prestige).

La urología preilustrada. De la urología del Real Colegio de Cádiz a la de la Veneranda Tertulia / Urology before illustration. From the Urology of the Royal College of Cadiz to that of the «veneranda» gathering

El estudio de la actividad urológica del occidente andaluz se encuentra contenido en las «Observaciones» impresas y manuscritas de las Memorias de la Regia Sociedad de Medicina Sevillana y en aquellas pertenecientes al Real Colegio de Cirugía de Cádiz. Comprende un período que abarca desde 1693 hasta el primer tercio del siglo XVIII. Se consolida la Veneranda Tertulia, Felipe V concede «Cédula Real»; es el 1º de Octubre de 1701. Inicia su andadura Médico-Quirúrgica la «Regia Sociedad de Medicina y demás Ciencias de Sevilla». Hay que recordar que toda la cirugía andaluza y especialmente la de Cádiz (a través del Real Colegio de Cirugía) estuvo presente en la Regia Sociedad. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili y otros muchos fueron fundacionales de este extraordinario acontecimiento. La formación quirúrgica y, por ende, la urológica tenía su raíz y fundamento en los anfiteatros anatómicos, (Sevilla 1731) y (Cádiz 1728) definidos «impíos» por la Iglesia. José Celestino Mutis (1750-53) y Pedro Fernández Castilla (1741) aíslan a la Universidad de este nuevo movimiento. Hubo una intensa relación entre Cirujanos de la Armada y la Regia Sociedad, siendo socios desde su fundación: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). Siendo el principal protagonista Luis Montero, verdadero paradigma con proyección hacia la centuria siguiente, de influencia netamente francesa junto con Ramos, ambos alumnos de Beaumond, anatómico de reconocido prestigio (AU)

The study of the urological activity in the Andalusian occident is contained in the printed and handwritten «Observations» of the records of the Royal Society of Medicine of Seville and the Royal College of Surgery of Cadiz. They encompass the period from 1693 to the first third of the 18th century. By the first of October 1701, the «Veneranda» gathering consolidates and Philip V gives the «royal warrant». The «Royal Society of Medicine and Other Sciences of Seville» starts its medical-surgical path. It should be reminded that all the Andalusian surgery and specially the one from Cadiz (through the Royal College of Surgeons) was present in the Royal Society. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili and many others were founders of this extraordinary event. Surgical training and, by extension, urological training had their root and basement in the anatomical amphitheaters (Seville 1731 and Cadiz 1728), which were considered ungodly by the Church. José Celestino Mutis (1750-53) and Pedro Fernandez Castilla (1741) excluded the university from this new movement. There was and intense relationship between Navy surgeons and the Royal Society, being members since its foundation: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). The main protagonist was Luis Montero, real paradigm with projection to the next century, having a neat French influence altogether with Ramos, both of them being Beaumond's alumni (an anatomist of recognized prestige) (AU)

Cólico nefrítico por fibrosis periureteral de metástasis de carcinoma lobulillar de mama / Renal colic arising from periureteral fibrosis from metastasic lobular carcinoma of the breast

OBJETIVOS: Se presenta un raro caso de crisis reno-ureteral izquierda en paciente monorrena izquierda por fibrosis alrededor de pelvis renal y periureteral ocasionada por metástasis de carcinoma lobulillar de mama, en donde las exploraciones complementarias no evidenciaban causa que justificara el cuadro. MÉTODO/RESULTADO: Paciente de 45 años de edad que acude al servicio de urgencias por presentar cuadro de dolor localizado en fosa renal izquierda con irradiación a genitales, edemas parpebrales y oliguria, detectándose en la ecografía abdominal hidronefrosis izquierda; se realiza estudio para hallar la causa obstructiva y no se encuentra en las distintas pruebas de imágenes causa que justifique el cuadro, por lo que se procedió a lumbotomía exploradora liberando a la pelvis y al uréter de la cáscara fibrótica que los cubría. El estudio histológico resolvió el diagnóstico definitivo, apreciándose infiltración de la adventicia ureteral por carcinoma lobulillar de mama. CONCLUSIONES: Habitualmente las metástasis retroperitoneales que provocan obstrucción ureteral ocurren 2 años después al diagnóstico del primario. Nuestro caso es uno de los pocos de la señal y del tamaño de la masa por RM (9). Ocasionalmente se realiza autotrasplante renal y si la obtrucción es unilateral ureterolisis laparoscópica e intraperitonealización ureteral (4). En recurrencias se ha utilizado la azatioprina. El interés de este caso recae en la localización atípica de la FRI, así como su presentación en un hombre joven, sin antecedentes de interés, llamando únicamente la atención la anemia y el aumento de la velocidad de sedimentación eritrocitaria en la analítica (AU)