Real-world prostate-specific antigen reduction and survival outcomes of metastatic hormone-sensitive prostate cancer patients treated with apalutamide: An observational, retrospective, and multicentre study.

Background: Metastatic hormone-sensitive prostate cancer (mHSPC) treatment has changed drastically during the last years with the emergence of androgen receptor-targeted agents (ARTAs). ARTA combined with androgen deprivation therapy has demonstrated better oncological and survival outcomes in these patients. However, the optimal choice among different ARTAs remains uncertain due to their analogous efficacy. Objectives: The objective of this study was to describe prostate-specific antigen (PSA) response and oncological outcomes of patients with mHSPC treated with apalutamide. Material and methods: Medical records from three different hospitals in Spain were used to conduct this study. Patients diagnosed with mHSPC and under apalutamide treatment were included between March 2021 and January 2023. Data regarding PSA response, overall survival (OS), and radiographic progression-free survival (rPFS) were collected and stratified by metastasis volume, timing, and stating. Results: 193 patients were included; 34.2% of patients were de novo mHSPC, and the majority was classified as m1b. The 18-month OS and rPFS were 92.5% and 88.9%, respectively. Patients with PSA levels ≤0.2 ng/ml showcased an 18-month OS rate of 98.7%, contrasting with 65.3% for those with PSA >0.2 ng/ml. Similar trends emerged for rPFS (97.4% and 53.7%, respectively). When differentiating between low-volume and high-volume metastasis, the OS rate stood at 98.4% and 80.7%, respectively, while the rPFS rates were 93% and 81.6%, respectively. No significant differences were found between groups stratified by metastasis timing. Conclusion: This real-world study on patients with mHSPC treated with apalutamide plus androgen deprivation therapy revealed robust oncological outcomes, aligning with the emerging evidence. The study's hallmark finding highlights the significance of rapid and deep PSA response as a predictor of improved oncological and survival outcomes.

A Combined Approach: Laparoscopic Partial Bladder Prior Transurethral Resection for Bladder Endometriosis-Case Report and Surgical Video Presentation.

OBJECTIVE: Bladder endometriosis is the presence of stroma and endometrial glands in the thickness of the detrusor muscle. The main symptoms it produces are dysuria and hematuria whose intensity is directly proportional to the size of the nodule. It is a difficult entity to diagnose for which physical examination is essential. Treatment can be medical, with hormonal therapies, or surgical by transurethral resection of the nodule and laparoscopic partial cystectomy. METHODS: To show a clinical case and review the literature about the technique used. RESULTS: A 29-year-old patient diagnosed with bladder endometriosis in which a combined approach was decided by laparoscopic partial cystectomy after transurethral resection: the patient came to our office for chronic pelvic pain, dysuria, dysmenorrhea, and a physical examination that showed a painful nodule on the anterior side of the vagina. A transvaginal ultrasound, magnetic resonance imaging, and cystoscopy confirm the diagnosis of bladder endometriosis. After a review of the literature on the management of this entity, the patient's clinic, and reproductive desires, the combined approach with excellent results was decided. Dysmenorrhea and dysuria disappeared, preserving the fertility of the patient who became pregnant 6 months after the intervention. CONCLUSION: The use of the combined approach allows to reduce the limitations of both techniques separately.

Immunological Risk Stratification of Bladder Cancer Based on Peripheral Blood Natural Killer Cell Biomarkers.

BACKGROUND: Bladder cancer (BC) is highly immunogenic. Bacillus Calmette-Guérin (BCG) immunotherapy offers the best results in non-muscle-invasive BC (NMIBC). Natural killer cells (NKcs) play decisive roles in BCG-mediated immune response and in general cancer immune-surveillance. OBJECTIVE: To analyze killer-cell immunoglobulin-like receptors (KIRs), their human leukocyte antigen class-I (HLA-I) ligands, and the expression of DNAX Accessory Molecule-1 (DNAM-1/CD226) on peripheral blood (PB) NKcs, to identify useful predictive biomarkers in BC. DESIGN, SETTING, AND PARTICIPANTS: KIR/HLA-ligand genotypes were compared between 132 BC, 201 other solid cancers, 164 plasma cell disorders, and 615 healthy Caucasoid controls. CD226 expression was evaluated by flow cytometry. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: KIR/HLA-I interactions and CD226 expression on NKcs (CD226high or CD226low) were compared across study groups, cancer stages, treatments, and progression-free and overall survival of patients, using chi-square, analysis of variance/post hoc, Kaplan-Meier/log-rank, and regression analyses. RESULTS AND LIMITATIONS: Three immunological risk groups were identified: low risk (KIR2DL1-L2+L3-/C1C1- and KIR2DL1+L2+L3+/C1C1+), intermediate risk (rest), and high risk (KIR2DL5+/HLA-C*16+ and KIR2DL1+L2+L3-), which displayed different 10-yr progression-free rates (83.3%, 48.6%, and 0%, respectively; p<0.001) and survival rates (83.3%, 54.3%, and 6.2%, respectively; p<0.001) for muscle-invasive T2/T4, and 10-yr progression-free rates (100%, 81.6%, and 50%, respectively; p<0.05) for NMIBC-T1 treated with BCG. Immunological risk stratification had an independent prognostic value to just histological staging for survival (hazard ratio=2.93, p<0.00001, Harrell C-statistic=0.779). CD226 expression on PB NKcs improved immunological stratification in intermediate-risk T1-T4 BC patients, with survival rates of 94.1% and 66.7% for CD226high and CD226low (p<0.05), respectively. CONCLUSIONS: Immunological risk stratification will complement BC histopathology to improve risk stratification and guide the selection of personalized treatments. Understanding of the molecular mechanisms of NKc tumor immune surveillance will enable the development of future NKc-based therapies. PATIENT SUMMARY: This work describes a peripheral blood test that aids in our understanding of the immune defense mechanisms against bladder cancer, is useful for classifying patient risk, and will guide personalized treatments.

Conservative management is a reasonable option in intraperitoneal bladder rupture.

OBJECTIVE: To demonstrate that conservative management of intraperitoneal bladder rupture is a safe option. METHOD: We report two cases of intraperitoneal bladder rupture, one spontaneous and another after urological manipulation. A 28-year-old man with acute abdomen after a heavy alcohol intake, and an 83-year-old woman with abdominal distention after a transurethral resection of the bladder. RESULT: Both cases were treated with intraperitoneal fluid evacuation and maintenance of urinary catheter without incidents. CONCLUSIONS: Conservative management with drainage of ascites in combination with a radiological studies and optimal antibiotic treatment can prevent more invasive maneuvers such as exploratory laparotomy or laparoscopy.

El manejo conservador de la rotura vesical intraperitoneal es una opción razonable / Conservative Management is a Reasonable Option in Intraperitoneal Bladder Rupture

OBJETIVO: Demostrar que el manejo conservador de la rotura vesical intraperitoneal es una opción segura. MÉTODO: Presentamos dos casos de rotura vesical intraperitoneal, uno espontáneo y otro tras manipulación urológica. Un varón de 28 años de edad con abdomen agudo tras una ingesta abundante de alcohol y una mujer de 83 años con distensión abdominal tras una resección transuretral vesical. RESULTADO: Ambos casos se trataron con evacuación del líquido intraperitoneal y mantenimiento de sonda vesical sin incidencias. CONCLUSIONES: El manejo conservador con drenaje de la ascitis en combinación con un estudio radiológico óptimo y tratamiento antibiótico puede evitar maniobras más invasivas como la laparotomía o la laparoscopia exploradoras

OBJECTIVE: To demonstrate that conservative management of intraperitoneal bladder rupture is a safe option. METHOD: We report two cases of intraperitoneal bladder rupture, one spontaneous and another after urological manipulation. A 28-year-old man with acute abdomen after a heavy alcohol intake, and an 83-year-old woman with abdominal distention after a transurethral resection of the bladder. RESULTS: Both cases were treated with intraperitoneal fluid evacuation and maintenance of urinary catheter without incidents. CONCLUSIONS: Conservative management with drainage of ascites in combination with a radiological studies and optimal antibiotic treatment can prevent more invasive maneuvers such as exploratory laparotomy or laparoscopy

Must we still be worried about multiple arteries in kidney transplantation?

BACKGROUND: Multiple renal arteries in kidney grafts have been associated with an increased rate of vascular and urologic complications. Our objective is to compare the outcome of transplanted patients who receive a single pedicle kidney with those who receive a multiple arterial graft. OBJECTIVES: To find our the differences in the outcome and complications in patients undergoing kidney transplantation with one single artery or with multiple arteries. PATIENTS AND METHODS: We analyzed 147 kidney transplantations, (all performed in our hospital over a 3 year period). population divided into two groups: group A for those who presented with only one renal artery, or group B for those with more than one renal artery. Homogeneous vascular reconstructions and implantation rules were applied in all patients. We compared the rates of renal failure between the two groups, urinary and vascular complications, patient and graft survivals and the levels of creatinine clearance during the first year of post-transplantation. RESULTS: No significant differences were found between the two groups regarding to the values analyzed. CONCLUSIONS: As many other authors, we do believe that the presence of multiple renal arteries in kidney grafts should not be considered as a predictive factor of transplantation failure.

Cirugía del tracto urinario en pacientes con carcinomatosis peritoneal ovárica tratadas con citorreducción y quimioterapia intraperitoneal intraoperatoria hipertérmica / Urinary tract surgery in patients with ovarian peritoneal carcinomatosis treated with cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy

Introducción El objetivo del presente trabajo es describir nuestra experiencia en la cirugía del uréter y la vejiga en pacientes con carcinoma de ovario primario y recurrente sometidas a procedimientos de peritonectomía y administración de quimioterapia intraperitoneal intraoperatoria hipertérmica (HIPEC).Pacientes y método Sobre una base de datos prospectiva construida al comienzo del programa de carcinomatosis peritoneal en nuestro centro, se seleccionaron aquellas pacientes en las que fue preciso realizar maniobras quirúrgicas sobre uréter distal o la vejiga. Siete pacientes cumplían este requisito y fueron incluidas en el estudio. Desde diciembre de 2007 hasta abril de 2011 fueron incluidas para la realización de citorredución de máximo esfuerzo y HIPEC 81 pacientes diagnosticadas de carcinoma de ovario primario o recurrente. Resultados En siete pacientes, con una mediana de edad de 46 años (40-71), fue necesaria la realización de algún gesto quirúrgico sobre el uréter o la vejiga. Cuatro pacientes fueron intervenidas por recurrencia de la enfermedad ovárica y en otras 3 pacientes la indicación fue el rescate quirúrgico, tras cirugía no óptima en otro centro. En 4 de ellas existía afectación tumoral directa del tracto urinario inferior. Tres pacientes (42%) de la serie desarrollaron al menos una complicación postoperatoria. Conclusión La realización de procedimientos de peritonectomía que incluye la eventual resección del uréter o la vejiga y la posterior aplicación de HIPEC en un grupo seleccionado de pacientes con diseminación peritoneal por carcinoma de ovario puede realizarse con cifras razonables de morbilidad postoperatoria. Estos gestos quirúrgicos pueden ser necesarios para la consecución de una cirugía óptima (AU)

Introduction The objective of the present work is to describe our experience in the surgery of the ureter and bladder in patients with primary and recurrent ovarian cancer subjected to peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC).Patients and method Those patients who required surgical procedures on the distal ureter or bladder, were selected from a prospective data base constructed at the beginning of the peritoneal carcinomatosis program in our centre. Seven patients fulfilled this requirement and were included in the study. A total of 81 patients diagnosed with primary or recurrent ovarian cancer from December 2007 to April 2011 were included for maximum effort cytoreduction and HIIC. ResultsIt was necessary to perform some surgical manoeuvre on the ureter or bladder in seven patients, with a median age of 46 years (40-71). Four patients were operated on due to recurrence of the ovarian disease and in the other 3 patients the indication was surgical rescue after non-optimal surgery in another centre. There was direct tumour involvement of the lower urinary tract in 4 of them. Three patients (42%) in the series developed at least one postoperative complication. Conclusion The performing of peritonectomy procedures that include the eventual resection of the ureter or bladder, and the subsequent application of HIIC in a selected group of patients with peritoneal dissemination due to an ovarian carcinoma can be done with reasonable rates of postoperative morbidity. These surgical procedures may be necessary to achieve optimal surgery (AU)

Hematuria por fístula arteriovenosa congénita tratada con embolización / Hematuria due to congenital arteriovenous fistula treated with embolization

OBJETIVO: Presentar un caso de una patología rara, como es una malformación arteriovenosa que causa hematuria, que puede suponer una urgencia urológica.MÉTODO: Describimos la historia clínica, la exploración física, las pruebas complementarias realizadas y sus resultados, así como el tratamiento aplicado a un paciente varón adolescente que acude a urgencias por hematuria anemizante sin patología conocida que la justificase.RESULTADOS: Se llega al diagnóstico de fístula arteriovenosa renal congénita y se realiza su embolización percutánea, cediendo la hematuria posteriormente.CONCLUSIONES: Las fístulas arteriovenosas de origen no-traumático son raras y más aún si debutan con macrohematuria. Este es un ejemplo que supuso una urgencia vital y fue posible tratarla mediante embolización percutánea, evitando otros procedimientos más invasivos(AU)

OBJECTIVE: To report a rare case that supposed an emergency. It is a case of hematuria caused by an arteriovenous fistula.METHODS: We describe the background, clinical exploration, complementary exams and their results, as well as the treatment applied in an adolescent with hematuria.RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization, with immediate stop of the hematuria.CONCLUSION: Non-traumatic renal arteriovenous fistulae are infrequent and even more if they appear with gross hematuria. We present the case of an emergency caused by one of them which was treated by percutaneous embolization, avoiding surgery(AU)

Hematuria por fístula arteriovenosa congénita tratada con embolización / Hematuria secondary to congenital arteriovenous fistula treated with embolization

OBJETIVO: Presentar un caso de una patología rara, como es una malformación arteriovenosa que causa hematuria, que puede suponer una urgencia urológica.MÉTODO: Describimos la historia clínica, la exploración física, las pruebas complementarias realizadas y sus resultados, así como el tratamiento aplicado a un paciente varón adolescente que acude a urgencias por hematuria anemizante sin patología conocida que la justificase. RESULTADOS: Se llega al diagnóstico de fístula arteriovenosa renal congénita y se realiza su embolización percutánea, cediendo la hematuria posteriormente.CONCLUSIONES: Las fístulas arteriovenosas de origen no-traumático son raras y más aún si debutan con macrohematuria. Este es un ejemplo que supuso una urgencia vital y fue posible tratarla mediante embolización percutánea, evitando otros procedimientos más invasivos(AU)

OBJECTIVE: To report a rare case of hematuria caused by an arteriovenous fistula which may be a urological emergency.METHODS: We describe the medical history, physical examination, complementary tests performed and their results, as well as the treatment applied in an adolescent with hematuria.RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization with immediate stop of hematuria.CONCLUSION: Non-traumatic renal arteriovenous fistulae are rare, even more if they present with gross hematuria. We present a case of a life-threatening emergency caused by one of them the treatment of which was possible by embolization, avoiding surgery(AU)

Hematuria secondary to congenital arteriovenous fistula treated with embolization.

OBJECTIVE: To report a rare case of hematuria caused by an arteriovenous fistula which may be a urological emergency. METHODS: We describe the medical history, physical examination, complementary tests performed and their results, as well as the treatment applied in an adolescent with hematuria. RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization with immediate stop of hematuria. CONCLUSION: Non-traumatic renal arteriovenous fistulae are rare, even more if they present with gross hematuria. We present a case of a life-threatening emergency caused by one of them the treatment of which was possible by embolization, avoiding surgery.

Retrocaval ureter in children. Case report and bibliographic review.

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases. METHOD: We present a case of retrocaval ureter and a revision of the literature. RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MR). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis. CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated.

Uréter retrocavo en el niño: a propósito de un caso y revisión de la literatura / Retrocaval ureter in children. Case report and bibliographic review

OBJETIVO: El uréter retrocavo es una patología poco frecuente debida a una alteración en el desarrollo embriológico de la vena cava inferior. Se manifiesta normalmente con clínica de obstrucción ureteral y el tratamiento en los casos sintomáticos, es quirúrgico.MÉTODO: Presentamos un caso clínico de uréter retrocavo y realizamos una revisión de la literatura.Palabras clave: Uréter. Anomalías genitourinarias. Vena cava inferior. Ureteroureterostomía.RESULTADOS: Paciente de 9 años que consulta por hematuria macroscópica. La Urografía intravenosa (UIV) sugiere el diagnóstico de uréter retrocavo derecho, lo que se confirma con estudio de resonancia magnética nuclear (RMN). Realizamos ureteroureterostomía y decruzamiento de vena cava inferior con buena evolución, confirmada por UIV.CONCLUSIONES: El uréter retrocavo es una anomalía fácilmente diagnosticable y con posibilidad de tratamiento eficaz. Debe evaluarse la posibilidad de otras malformaciones asociadas(AU)

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases.METHOD: We present a case of retrocaval ureter and a revision of the literature.RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MRI). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis.CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated(AU)

Invaginación ileocólica en linfoma de Burkitt / Ileocolic invagination in Burkitt lymphoma

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