Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna / Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia

La hiperplasia benigna de próstata (HBP) es una patología con una alta incidencia. Su diagnóstico y tratamiento son compartidos entre urólogos y médicos de atención primaria. Su manejo consume una enorme cantidad de recursos. La Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Médicos Generales y de Familia (SEMG), la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) y la Asociación Española de Urología (AEU) han elaborado un documento sobre pautas de actuación y seguimiento de la HBP, presentado aquí de manera resumida, en el que se pretende actualizar las guías anteriormente publicadas, en base a las últimas evidencias. Estas nuevas recomendaciones tienen como objetivo principal sensibilizar al médico de atención primaria y ayudarle en la evaluación diagnóstica, el tratamiento y el seguimiento, además de aportar criterios unificados y consensuados de derivación al segundo nivel asistencial (AU)

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level (AU)

[Consensus document on the management and follow-up of the male with lower urinary tract symptoms secondary to benign prostate hyperplasia]. / Documento de consenso sobre pautas de actuación y seguimiento del varón con síntomas del tracto urinario inferior secundarios a hiperplasia prostática benigna.

Benign prostate hyperplasia (BPH) is a high-incidence condition. Its diagnosis and treatment is shared between urologists and Primary Care physicians. Its management uses up a significant amount of resources. The Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of General Practitioners and Family Doctors (SEMG), the Spanish Society of Family and Community Medicine (semFYC), and the Spanish Association of Urology (AEU) have prepared a document on the management and monitoring of BPH, in which the aim is to incorporate the latest evidence in order to update the previously published guidelines, and present them here in condensed form. The main objective of these new recommendations is to raise the awareness of Primary Care physicians and assist them in its diagnostic evaluation, treatment and monitoring, as well as providing unified consensus criteria for referral to the secondary care level.

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

Acetato de abiraterona prequimioterapia. Propuesta de un algoritmo de tratamiento en el carcinoma de próstata resistente a castración / Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer

Contexto: El tratamiento del cáncer de próstata sigue siendo un reto para el urólogo. El control médico en el cáncer de próstata metastásico o localmente avanzado se realiza habitualmente con análogos LHRH y antiandrógenos. Cuando se produce la progresión bioquímica y clínica de la enfermedad diferentes tratamientos han sido propuestos y otros nuevos han cambiado la perspectiva y esperanza de vida de los pacientes. Objetivo: El objetivo de esta revisión es establecer el papel actual del acetato de abiraterona en el tratamiento del cáncer de próstata resistente a la castración y facilitar la toma de decisión del urólogo mediante un algoritmo de tratamiento. Adquisición de la evidencia: Se realiza una búsqueda de la evidencia actual del tratamiento con abiraterona en pacientes con cáncer de próstata metastásico resistente a castración en PubMed, analizando principalmente aquellos estudios diseñados como ensayos clínicos. Además se realiza una revisión y actualización del papel del tratamiento hormonal y de los receptores androgénicos en el cáncer de próstata. Síntesis de la evidencia: Existen en la actualidad fundamentalmente 2 ensayos clínicos que demuestran la eficacia de abiraterona en el cáncer de próstata metastásico con respecto a placebo. En el estudio COU AA-302 se observa un beneficio evidente con abiraterona previo a quimioterapia en pacientes con cáncer de próstata resistente a castración, lo que permite establecer un algoritmo de tratamiento inicial que facilita la toma de decisión por parte del urólogo. Conclusión: Abiraterona es una opción de tratamiento prequimioterapia en pacientes seleccionados con cáncer de próstata metastásico resistente a la castración, aunque debe mejorarse la oferta económica y diseñar más ensayos clínicos multicéntricos para optimizar la relación coste/beneficio

Context: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogs and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients’ perspective and life expectancy. Objective: This review has aimed to establish the current role of abiraterone acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. Acquisition of the evidence: A search of current evidence on Abiraterone treatment in patients with castration-resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. Evidence synthesis: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. Conclusion: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration-resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio

Bladder cancer in Spain 2011: population based study.

PURPOSE: We estimate the annual incidence of bladder cancer in Spain and describe the clinical profile of patients with bladder cancer enrolled in a population based study. MATERIALS AND METHODS: Using the structure of the Spanish National Health System as a basis, in 2011 the AEU (Spanish Association of Urology) conducted this study with a representative sample from 26 public hospitals and a reference population of 10,146,534 inhabitants, comprising 21.5% of the Spanish population. RESULTS: A total of 4,285 episodes of bladder cancer were diagnosed, of which 2,476 (57.8%) were new cases and 1,809 (42.2%) were cases of recurrence, representing an estimated 11,539 new diagnoses annually in Spain. The incidence of bladder cancer in Spain, age adjusted to the standard European population, was 20.08 cases per 100,000 inhabitants (95% CI 13.9, 26.3). Of patients diagnosed with a first episode of bladder cancer 84.3% were male, generally older than 59 years (81.7%) with a mean ± SD age of 70.5 ± 11.4 years. Of these patients 87.5% presented with some type of clinical symptom, with macroscopic hematuria (90.8%) being the most commonly detected. The majority of primary tumors were nonmuscle invasive (76.7%) but included a high proportion of high grade tumors (43.7%). According to the ISUP (International Society of Urologic Pathology)/WHO (2004) classification 51.1% was papillary high grade carcinoma. Carcinoma in situ was found in 2.2% of primary and 5.8% of recurrent cases. CONCLUSIONS: The incidence of bladder cancer in Spain, age adjusted to the standard European population, confirms that Spain has one of the highest incidences in Europe. Most primary nonmuscle invasive bladder cancer corresponded to high risk patients but with a low detected incidence of carcinoma in situ.

Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer.

CONTEXT: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogues and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients' perspective and life expectancy. OBJECTIVE: This review has aimed to establish the current role of Abiraterone Acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. ACQUISITION OF THE EVIDENCE: A search of current evidence on Abiraterone treatment in patients with castration- resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. EVIDENCE SYNTHESIS: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. CONCLUSION: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio.

Correlación del cociente PSA complex/PSA total con el cociente PSA libre/PSA total, sensibilidad y especificidad de ambos marcadores para el diagnóstico del cáncer de prostata / Correlation between the Complex PSA/total PSA Ratio and the Free PSA/total PSA Ratio, Sensitivity and Specificity of Both Markers for the Diagnosis of Prostate Cancer

Objetivo: Comparamos el comportamiento del cociente PSA complex/PSA total porcentual (PSAc%) frente al cociente PSA libre/PSA total (PSAl%) y analizamos ambos marcadores en su utilidad para el diagnóstico del cáncer de próstata. Material y métodos: Se midieron los niveles de PSA total (PSAt), PSA libre (PSAl), PSA complex (PSAc), PSAl% y PSAc% en 158 pacientes. Noventa y ocho (62%) fueron biopsiados si presentaban PSAt ≥3 ng/dl y PSAl% < 20, PSAt > 10, tacto rectal sospechoso o nódulo ecográfico sospechoso. Se realizó un análisis de regresión lineal y de regresión Passing-Bablock. Se calcularon las curvas ROC para estudiar la sensibilidad y especificidad del PSAl% y PSAc% y se compararon entre ellas. Se analizaron los diagnósticos de cáncer de próstata por el PSAl% y el PSAc% aplicando el test χ2. Resultados: El coeficiente de correlación (r) fue bueno, 0,7447 (p < 0,0001) y el índice de determinación (r2) fue de 0,5. El resultado del análisis Passing-Bablock fue una pendiente de 1.658 (1.452 a 1.897) e intersección de 2.044 (−0,936 a 5.393). El punto de corte óptimo de PSAl%, ≤ 14.7854, mostró una sensibilidad del 89,29% (IC 95%; 0,642-0,823) y una especificidad del 54,29% (IC 95%; 0,642-0,823) y el punto de corte óptimo de PSAc%, > 89.7796, una sensibilidad del 71,43% (IC 95%; 0,616-0,802) y una especificidad del 71,43% (IC 95%; 0,616-0,802). No hubo diferencias significativas al comparar las áreas bajo la curva de ambos marcadores (p = 0,59). El VPP del PSAl% fue menor respecto al PSAc% (45,7% vs 71%). Conclusión: Existe una buena correlación entre el PSAl% y PSAc%. El PSAc% ha demostrado una mayor especificidad y eficacia que el PSAl% en el diagnóstico del cáncer de próstata (AU)

Objective: To compare the behaviour of the PSAcomplex/PSAtotal percentage (PSAc%) against the PSA free/PSA total (PSAl%) and analyse both markers for their usefulness in diagnosing prostate cancer. Material and methods: We measured total PSA (PSAt), free PSA (PSAl), complex PSA (PSAc), PSAl% and PSAc% levels in 158 patients. Of these, 98 (62%) were biopsied for presenting PSAt ≥3 ng/dl and PSAl% < 20, PSAt > 10, suspicious rectal examination or suspicious ultrasound node. We performed linear regression and Passing-Bablok regression analyses. The ROC curves were calculated to study the sensitivity and specificity of PSAl% and PSAc% and were compared to each other. The prostate cancer diagnoses were analysed by PSAl% and PSAc% by applying the χ2 test. Results: The correlation coefficient (r) was good (0.7447, P <0 .0001), and the index of determination (r2) was 0,5. The result of the Passing-Bablok analysis was a slope of 1.658 (1.452 to 1.897) and an intersection of 2.044 (−0,936 to 5.393). The optimal cutoff for PSAl% (≤ 14.7854) showed a sensitivity of 89.29% [95% CI, 0,642-0,823] and a specificity of 54.29% (95% CI, 0,642-0,823). The optimal cutoff for PSAc% (>89.7796) had a sensitivity of 71.43% (95% CI, 0,616-0,802) and a specificity of 71.43% (95% CI, 0,616-0,802). There were no significant differences when comparing the areas under the curve of both markers (P = 0.59). The PPV of PSAl% was less than that of PSAc% (45.7% vs. 71%). Conclusion: There was a good correlation between PSAl% and PSAc%. PSAc% has demonstrated greater specificity and efficacy than PSAl% in the diagnosis of prostate cancer (AU)

Correlation between the complex PSA/total PSA ratio and the free PSA/total PSA ratio, sensitivity and specificity of both markers for the diagnosis of prostate cancer.

OBJECTIVE: To compare the behaviour of the PSAcomplex/PSAtotal percentage (PSAc%) against the PSA free/PSA total (PSAl%) and analyse both markers for their usefulness in diagnosing prostate cancer. MATERIAL AND METHODS: We measured total PSA (PSAt), free PSA (PSAl), complex PSA (PSAc), PSAl% and PSAc% levels in 158 patients. Of these, 98 (62%) were biopsied for presenting PSAt≥3 ng/dl and PSAl%<20, PSAt>10, suspicious rectal examination or suspicious ultrasound node. We performed linear regression and Passing-Bablok regression analyses. The ROC curves were calculated to study the sensitivity and specificity of PSAl% and PSAc% and were compared to each other. The prostate cancer diagnoses were analysed by PSAl% and PSAc% by applying the χ(2) test. RESULTS: The correlation coefficient (r) was good (0.7447, P<.0001), and the index of determination (r(2)) was 0,5. The result of the Passing-Bablok analysis was a slope of 1.658 (1.452 to 1.897) and an intersection of 2.044 (-0,936 to 5.393). The optimal cutoff for PSAl% (≤14.7854) showed a sensitivity of 89.29% [95% CI, 0,642-0,823] and a specificity of 54.29% (95% CI, 0,642-0,823). The optimal cutoff for PSAc% (>89.7796) had a sensitivity of 71.43% (95% CI, 0,616-0,802) and a specificity of 71.43% (95% CI, 0,616-0,802). There were no significant differences when comparing the areas under the curve of both markers (P=.59). The PPV of PSAl% was less than that of PSAc% (45.7% vs. 71%). CONCLUSION: There was a good correlation between PSAl% and PSAc%. PSAc% has demonstrated greater specificity and efficacy than PSAl% in the diagnosis of prostate cancer.

[Referral criteria for benign prostatic hyperplasia in primary care.Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina General, Sociedad Española de Medicina de Familia y Comunitaria, Asociación Española de Urología]. / Criterios de derivación en hiperplasia benigna de próstata para atención primaria. Sociedad Española de Médicos de Atención Primaria, Sociedad Española de Medicina General, Sociedad Española de Medicina de Familia y Comunitaria, y la Asociación Española de Urología.

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with alpha-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with alpha-blockers or 5alpha-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with alpha-blockers, or the sixth month with 5alpha-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10 ng/ml or PSA>4 ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication.

Sobre la hipertrofia benigna de próstata / No disponible

No disponible

Criterios de derivación en hiperplasia benigna de próstata para atención primaria / Referral criteria for benign prostatic hyperplasia in primary care

La hiperplasia benigna de próstata (HBP) es una enfermedad con alta prevalencia entre los varones de más de 50 años que requiere una continuidad asistencial entre los 2 niveles existentes en nuestro país, el de atención primaria (AP) y el de atención especializada; motivo por el que era necesario consensuar unos criterios de derivación o de continuidad que sirvan de orientación a ambos colectivos. La historia clínica del paciente, el Índice Internacional de Síntomas Prostáticos (IPSS, International Prostate Symptom Score), el tacto rectal y el antígeno prostático específico (PSA, prostate-specific antigen) son herramientas accesibles en el ámbito de la AP que permiten un diagnóstico adecuado de la HBP. Conscientes de tal necesidad, las sociedades científicas de atención primaria (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina General [SEMG] y Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) y la Asociación Española de Urología (AEU) elaboraron este documento de consenso. A los pacientes con IPSS<8 se los deberá mantener en vigilancia y evaluar anualmente; en los pacientes con IPSS 8-20, si el tamaño de la próstata es pequeño, se recomienda el tratamiento con bloqueadores alfa y evaluación al primer y tercer mes, si el tamaño de la próstata es grande se recomienda el tratamiento con bloqueadores alfa o inhibidores de la 5-alfa-reductasa y evaluación al tercery sexto mes, y en el caso de pacientes con próstata grande y PSA>1,5 ng/ml se recomienda el tratamiento combinado y la evaluación al primer y sexto mes. En este documento se establecen unos criterios de derivación al urólogo claros, que facilitan el tratamiento de este tipo de pacientes...(AU)

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with á-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with á-blockers or 5á-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with á-blockers, or the sixth month with 5á-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10ng/ml or PSA>4ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication (AU)

Criterios de derivación en hiperplasia benigna de próstata para atención primaria / Referral criteria for benign prostatic hyperplasia in primary care

La hiperplasia benigna de próstata (HPB) es una enfermedad con alta prevalencia entre los varones de más de 50 años que requiere una continuidad asistencial entre los 2 niveles existentes en nuestro país, el de atención primaria (AP) y el de atención especializada; motivo por el que era necesario consensuar unos criterios de derivación o de continuidad que sirvan de orientación a ambos colectivos. La historia clínica del paciente, el Índice Internacional de Síntomas Prostáticos (IPSS, International Prostate Symptom Score), el tacto rectal y el antígeno prostático específico (PSA, prostate-specific antigen) son herramientas accesibles en el ámbito de la AP que permiten un diagnóstico adecuado de la HBP. Conscientes de tal necesidad, las sociedades científicas de atención primaria (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina General [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) y la Asociación Española de Urología (AEU) elaboraron este documento de consenso. A los pacientes con IPSS<8 se los deberá mantener en vigilancia y evaluar anualmente; en los pacientes con IPSS 8-20, si el tamaño de la próstata es pequeño, se recomienda el tratamiento con bloqueadores alfa y evaluación al primer y tercer mes, si el tamaño de la próstata es grande se recomienda el tratamiento con bloqueadores alfa o inhibidores 5-alfa-reductasa y evaluación al tercer y sexto mes, y en el caso de pacientes con próstata grande y PSA 41,5 ng/ml se recomienda el tratamiento combinado y la evaluación al primer y sexto mes. En este documento se establecen unos criterios de derivación al urólogo claros, que facilitan el tratamiento de este tipo de pacientes. Se derivarán al urólogo aquellos pacientes con HBP que no presenten mejoría al tercer mes de tratamiento con bloqueadores alfa, o al sexto mes de tratamiento con inhibidores 5-alfa-reductasa. Se derivarán también los pacientes con síntomas del tracto urinario inferior en los que se observe algún hallazgo patológico durante el tacto rectal, IPSS >20, PSA >10 ng/ml o PSA >4 ng/ml y PSA libre <20% o pacientes con edades <50 años y sospecha de HBP, así como aquellos pacientes con alguna complicación urológica(AU)

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with alpha-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with alpha-blockers or 5alpha-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with alpha-blockers, or the sixth month with 5á-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10 ng/ml or PSA>4 ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication(AU)

Cadherina E, Catenina Beta, Antígeno Ki-67 y proteína p53 en el pronóstico de la recidiva tumoral en los tumores superficiales de vejiga T1 / Prognostic value of E-Cadherina, Beta Catenin, K1, Ki-67 antigen and p53 protein in the superficial bladder tumors

Introducción: La historia natural del carcinoma superficial de vejiga (CSV) se caracteriza por su alta tasa de recidivas y por la capacidad de progresar a estadios infiltrantes. Vamos a investigar la capacidad de predicción de recidiva tumoral de la proteína p53, el antígeno Ki-67 y las moléculas de adhesión celular Cadherina E y Catenina Beta Material y método: 88 tumores T1 con una mediana de tiempo libre de enfermedad de 36 meses. Han recibido tratamiento profiláctico con BCG 81 mg. semanal durante seis semanas el 58% de la serie. Para p53 y Ki-67 se estableció el nivel de 10% de células teñidas para considerar positivo el tumor. Para Cadherina E y Catenina se han establecido dos grupos: uno con los valores 0-4 (negativo), y otro con los valores 5-8 (positivo). Resultados: Han recidivado el 31% de los tumores y progresado a estadio infiltrante el 3% La expresión de Ki-67 se correlaciona con grado (p ,002) y permeación linfática (p ,028). La multiplicidad tumoral con la falta de expresión de Cadherina E y Catenina Beta. Sólo la expresión de Ki-67 (p .049) y la de Catenina Beta (p .039) alcanzan significación estadística. En el estudio multivariante sólo la falta de expresión de Catenina Beta muestra tener valor pronóstico independiente para recidiva (p .049; O.R : 2,4-6,9) Conclusiones: Los marcadores más útiles son Ki-67 y Catenina Beta. Sólo la Catenina Beta muestra un valor independiente para recidiva tumoral. Los tumores que no expresan Catenina Beta o Cadherina E tienen un menor tiempo libre de recidiva

Introduction: The natural history of the superficial carcinoma of bladder is characterized by his high rate of recurrence and by the aptitude to progress to higher stages. We are going to investigate the capacity of prediction for tumor recurrence of protein p53, antigen Ki-67, E Cadherin and Beta Catenin Material and method: 88 T1 tumors with a median of free time of disease of 36 months. 58% of the serie has received prophylactic treatment with BCG 81 mg. weekly for six weeks. Cut-oof level for For P53 and Ki-67 is 10 % of stained cells. For E Cadherin and Beta Catenin we have established two groups: one with the values 0-4 (negative), and other one with the values 5-8 (positive). Results: Recurrence rate 31 %, stage progression 3 %. Ki-67 expression is correlated with grade (p .002) and lymphatic permeation (p .028). Multiplicity is correlated with lack( of Cadherin and Catenin´s expression. Only Ki-67 expression (p .049) and lack of Beta Catenin expression (p .039) reach statistical significance. In multivariant study only lack of Beta Catenin’s expression shows independent recurrence value (p .049; O.R: 2,4-6,9) Conclusions: The most useful prognmostic markers are Ki-67 and Catenina Beta Only Beta Catenin Beta shows independent value for tumour recurrence. Tumors wich lack expression for Catenin B or Cadherin E have lower recurrence free time

[Age's influence in superficial bladder cancer's behaviour]. / Influencia de la edad en el comportamiento de los carcinomas uroteliales superficiales.

INTRODUCTION: Transitional bladder cancer is infrequent in younger people. The tumor's aggressiveness in this population is subject of discussion. We present our experience. MATERIAL & METHOD: 551 primary tumors, with at least one year of follow-up. Group A (less than 41 years old), Group B (bigger than 40 years old). We compare, stage, grade, lymphatic permeation, multiplicity, recurrence, progression, sex, T.L.E. (time free of disease), volume. We do uni and multivariate analysis. RESULTS: 17 tumors in younger than 41 years (2.1%). The recurrence rate is 11.8% in Group A and 36% in Group B (p .041). Progression rate: 0% in A and 4.1% in B (p .253). In Group A, T1 tumors (13.3% vs. 39%), G2 tumors (0% vs. 36.7%); withouts in lymphatic permeation (0% vs. 35%) and solitary tumors (13.3% vs. 35.3%) have statistically less recurrence. In univariate analysis we appreciate statistical differences in relation with grade (p .002) and sex (p .011). In multivariate analysis, stage, "group of age" and prophylactic treatment are independent variables for recurrence, and grade for progression. CONCLUSIONS: In younger than 41 years old: Less pathologic aggressivity (0% G3); Group of age is independent prognostic variable for recurrence, but not p for progression, despite a "less aggressive behaviour": 11.8% recurrence, 0% progression; T.L.E. bigger (one year more); Higher incidence in women (41% vs. 11%); Less recurrence in T1 tumors (13.3% vs. 39%), G2 tumors (0% vs. 36.7%) and solitary tumors (13.3% vs. 35.32%).

Influencia de la edad en el comportamiento de los carcinomas uroteliales superficiales / Age's influence in superficial bladder cancer's behaviour

Introducción: El carcinoma urotelial de vejiga es infrecuente en la población joven. Existe debate sobre la menor o igual agresividad de estos tumores en esta población. Presentamos nuestra experiencia. Material y método: 551 tumores primarios, todos con seguimiento superior a un año salvo recidiva. Dividimos la serie en dos grupos: menores de 41 años (grupo A) y mayores de 40 años (Grupo B). Comparamos: estadio, grado, permeación linfática, multiplicidad, recidiva, progresión, sexo, T.L.E. (tiempo libre de enfermedad), volumen tumoral. Realizamos análisis estadístico uni y multivariado de las variables Resultados: 17 tumores en menores de 41 años (31 años). T.L.E. 54 meses en el Grupo A y 39 en el grupo B (p .028) Recidivan el 11,8% del Grupo A y el 36% del grupo B (p .041) Progresan el 0% del A y el 4,1% del B (p .253) En el Grupo A los tumores T1 (13,3% frente a 39%), los tumores G2 (0% frente a 36,7%); sin permeación linfática (0% frente a 35%) y los tumores únicos (13,3% frente a 35,3%) recidivan significativamente menos. En el estudio univariado apreciamos diferencias estadísticamente significativas respecto a grado (p .002), sexo (p .011) En el multivariado son variables independientes para recidiva el estadio, “Grupo de Edad”, el realizar tto. profiláctico con BCG. Para progresión sólo el grado tiene valor pronóstico independiente. Conclusiones: En los menores de 41 años: - Menor agresividad histológica (0% G3) - La edad es un factor pronóstico independiente de recidiva pero no de progresión a pesar de un comportamiento menos “agresivo”: - 11,8% de recidiva - 0% progresión - T.L.E. mayor (un año más) - Mayor incidencia en mujeres (41% frente 11%) - Menor recidiva de los tumores T1 (13,3% frente a 39%), los tumores G2 (0% frente a 36,7%) y los tumores únicos (13,3% frente a 35,32%)

Introduction: Transitional bladder cancer is infrequent in younger people. The tumor´s agresiveness in this poulation is subject of discussion.. We present our experience. Material & method: 551primary tumors, with at least one year of follow-up. Group A (less than 41 years old), Group B (bigger than 40 years old). We compare, stage, grade, lymphatic permeation, multiplicity, recurrence, progression, sex, T.L.E. (time free of disease), volume. We do uni and multivariate analysis. Results: 17 tumors in youngers than 41 years (2,1%) The recurrence rate is 11,8% in Group A and 36% in Group B (p .041) Progresión rate: 0% in A and 4,1% in B (p .253) In Group A, T1 tumors T1 (13,3% vs. 39%), G2 tumors (0% vs. 36,7%); withoutsin lymphatic permeation (0% vs a 35%) and solitary tumors (13,3% vs. 35,3%) have statistically less recurrence In univariate analysis we apreciate statitsticaly differences in relation with grade (p .002) and sex (p .011). In multivariate analysis, stage, “group of age” and prophylactic treatment are independent variables for recurrence, and grade for progression Conclusions: In youngers than 41 years old: - Less patologic agressivity (0% G3) - Group of age is independent prognostic variable for recurrence, but not pfor progression, despite a “less agressive behaviour”: - 11,8% recurrence - 0% progression - T.L.E. bigger (one year more) - Higher incidence in women (41% vs. 11%) - Less recurrence in T1 tumors (13,3% vs. 39%), G2 tumors (0% vs 36,7%) and solitary tumors (13,3% vs 35,32%)

[Value of the diuretic isotopic renogram in the follow-up of the upper urinary tract after cystectomy and urinary diversion using intestine]. / Valor del renograma isotópico diurético en el seguimiento de la vía urinaria superior tras cistectomía y derivación urinaria con intestino.

INTRODUCTION: In our experience we often observe urinary upper tract dilatation after urinari diversion with bowel. To spare useful approaches and therapeutics we have used diuretic renogram. MATERIAL AND METHOD: 26 patients with urinary diversion (Mainz II or Paduana ileal neobladder). We performance ultrasound, urography and diuretic renogram. RESULTS: Follow-up is between 1 y 4 years. After urinary diversion, 54% of the upper tracts are dilated but only 39.3% of them are obstructed in the diuretic renogram. Normal urographic tracts are normal or have good response in the diuretic renogram. Results goes on in the time. CONCLUSIONS: Diuretic renogram is a useful tool in the diagnosis of upper urinary tract obstruction after urinary diversion.

[Uretero-intestinal anastomosis. Our experience. The simpler... the better]. / Anastomosis ureterointestinales. Nuestra experiencia. Cuanto más simple ... mejor.

INTRODUCTION: There are many techniques describe for ureteroenteric anastomoses. We present our experience with three of them inorder to reduce the stenosis rate. METHOD AND MATERIAL: We have done radical cystectomy in 77 patients. Urinary diversion with small bowel in 20 patients (Paduana ileal neobladder) and dstubulized ureterosigmoidostomy (MainzII) in 55. Initially, we used Le Duc technique, afterward Ricard technique and actually bivalva technique (direct). RESULTS: We have performed Le Duc in 38%, Ricard in 31% and "bivalva" in 27%. Median follow-up are 37.7 months, 19.9 months and 10 months respectively. Stenosis: 16.7% with Le Duc; 20.5% with Ricard and 9.1% with bivalva technique. Renal anulation: 10.4% with Le Duc; 10.3% with Ricard and 0% with bivalva (p .000). CONCLUSIONS: In our experience, the less stenosant anastomose is BivalvaIn one. The simpliest technique, the best results. The rate of stenosis is higher when the upper urinary tract is dilatated pre-surgery, independently of the anastomosis technique.

Anastomosis ureterointestinales. Nuestra experiencia. Cuanto más simple...Mejor / Ureteroenteric anastomoses. Our experience. The simpliest, the best

INTRODUCCIÓN: Están descritas numerosas técnicas para el reimplante ureterointestinal. Presentamos nuestra evolución con tres de ellas con la intención de disminuir la incidencia de estenosis. MATERIAL Y MÉTODO: 77 pacientes a los que hemos realizado cistectomía radical y derivación urinaria con intestino delgado en 20 pacientes (neovejiga tipo Paduana) o con sigma destubulizado en 57 (Mainz II). Inicialmente realizábamos anastomosis según técnica de Le Duc, posteriormente puño de camisa (Ricard) y actualmente anastomosis tipo bivalva. RESULTADOS: Hemos realizado anastomosis tipo Le Duc en el 38 por ciento y puño de camisa en el 31 por ciento, bivalva en el 27 por ciento de las vías urinarias. Seguimiento medio 37,7 meses, 19,5 meses, y 10 meses respectivamente. Estenosis: 16,7 por ciento con técnica Le Duc; 20,5 por ciento con técnica Ricard; 9,1 por ciento con técnica Bivalva. Anulación renales: 10,4 por ciento con técnica Le Duc; 10,3 por ciento con técnica Ricard; 0 por ciento con técnica Bivalva (p .000).CONCLUSIONES: En nuestra experiencia la anastomosis menos estenosante es la tipo bivalva. A mayor sencillez de técnica mejores resultados. La tasa de estenosis es siempre mayor cuando la vía está dilatada previa a la derivación, independientemente de la técnica utilizada (AU)

Valor del renograma isotópico diurético en el seguimiento de la vía urinariasuperior tras cistectomía y derivación urinaria con intestino / Diuretic isotopic renogram in the follow-up of the upper urinary tract after intestinal urinary diversion

INTRODUCCIÓN: En nuestra experiencia es frecuente la dilatación de la vía urinaria superior tras la derivación urinaria con intestino. Para ahorrar actitudes terapéuticas innecesarias y distinguir que vías están dilatadas funcionalmente y cuales secundarias a estenosis ureterointestinal hemos utilizado el renograma isotópico diurético. MATERIAL Y MÉTODO: 26 pacientes a los que se les ha realizado derivación intestinal bien tipo Mainz II bien tipo Paduana. Realizamos ecografía abdominal, urografía intravenosa, renograma diurético y urografía intravenosa. RESULTADOS: El seguimiento oscila entre 1 y 4 años. El 54 por ciento de las vías tras derivación están dilatadas, de las cuales sólo el 39,3 por ciento muestran patrón obstructivo en el renograma diurético, confirmándose la estenosis en el manejo endourológico de la misma. Las vías urográficamente normales son normales o responden a diurético en el renograma. El 75 por ciento de las vías anuladas funcionalmente en el urograma están anuladas en el renograma. Los resultados se mantienen a lo largo del seguimiento de estos enfermos. CONCLUSIONES: El renograma diurético es útil para distinguir que vía dilatada está obstruida de cual no lo está. Los resultados se mantienen en el tiempo (AU)