Impacto del envejecimiento sobre la incidencia y mortalidad de los cánceres urológicos: proyección a 20 años en España / Impact of aging on the incidence and mortality of urological cancers: 20-year projection in Spain

Introducción En el año 2020, en España, se diagnosticaron 282.421 nuevos casos de cáncer, encontrándose las neoplasias urológicas (NU) entre las más frecuentes. El tratamiento del cáncer en personas mayores es todo un reto, debido a su fragilidad y comorbilidades. Para responder a las necesidades que plantean las NU en las personas mayores, es necesaria una adecuada planificación de la enfermedad, comenzando por analizar los registros de cáncer. El objetivo fue, considerando a la población española de más de 65 años, proporcionar un análisis detallado de incidencia y mortalidad de las NU en el año 2020, así como las estimaciones para el año 2040. Material y métodos Las NU que se incluyeron fueron: testículo, vejiga, pene, riñón y próstata. Las estimaciones de incidencia y mortalidad fueron obtenidas de la base de datos GLOBOCAN. Resultados En el año 2020 se diagnosticaron en España 63.278 NU. Exceptuando la neoplasia de testículo, todas las neoplasias se diagnosticaron con mucha mayor frecuencia en el grupo de mayores de 65 años. Para el año 2040 se estima un aumento del 41,5%, alcanzando los 89.507 nuevos casos por año, de los cuales aproximadamente tres cuartas partes tendrán lugar en mayores de 65. El número de fallecidos mayores de 65 aumentará un 60,15% en 2040. Conclusión En las próximas 2 décadas es esperable que los nuevos casos de NU en mayores de 65 años aumenten por encima del 50%. Mayores recursos económicos y humanos, además de equipos multidisciplinares con experiencia y formación geriátrica, serán necesarios (AU)

Introduction In 2020, 282,421 new cases of cancer were diagnosed in Spain, and urological neoplasms (UN) were among the most frequent ones. Cancer treatment in elderly people is challenging due to frailty and comorbidities. Healthcare resources must be optimized in order to meet the needs of treating UN in the elderly, and deep analysis of cancer registries becomes mandatory. The objective of this work was to provide a detailed analysis of the incidence and mortality of UN in patients over 65 years old in the last year 2020 in Spain, as well as the estimates for the year 2040. Material and methods Incidence and mortality estimates were obtained from the GLOBOCAN database. The UN included were testicle, bladder, penis, kidney, and prostate. Results In 2020, 63,278 cases of UN were diagnosed in Spain. Most UN were much more frequent among patients > 65 years old, except for testicular cancers. For the year 2040, an increased incidence of 41.5% is estimated, reaching 89,507 new cases of UN per year, with approximately 3 out of 4 patients over 65 years of age. Deaths in people over 65 will increase by 60.15% in 2040. Conclusion In the next two decades, it is expected that new cases of UN in people over 65 years will rise above 50%. More financial and human resources, as well as multidisciplinary teams with experience and geriatric training, will be necessary (AU)

Impact of aging on the incidence and mortality of urological cancers: 20-year projection in Spain.

INTRODUCTION: In 2020, 282,421 new cases of cancer were diagnosed in Spain, and urological neoplasms (UN) were among the most frequent ones. Cancer treatment in eldery people is challenging due to fragility and comorbidities of these patients. To meet the needs of treating UN in the eldery, it is necessary to optimize healthcare resources, for which a deep analysis of cancer registries becomes mandatory. The objective of this work was to provide a detailed analysis of the incidence and mortality of UN in Spanish people over 65 years old in the last year 2020, as well as the estimates for the year 2040. MATERIAL AND METHODS: Incidence and mortality estimates were obtained from the GLOBOCAN database. The urological neoplasms that were included were: testicle, bladder, penis, kidney and prostate. RESULTS: In 2020, 63,278 cases of UN were diagnosed in Spain. Most UN were much more frequent among patients >65 years old, except for testicular cancers. For the year 2040, an incidence increase of 41.5% is estimated, reaching 89,507 new cases of UN per year, with approximately 3 out of 4 patients being over 65 years old. Deaths in people over 65 will increase by 60.15% in 2040. CONCLUSION: In the next two decades, it is expected that new cases UN in people over 65 years will increase above 50%. For Healthcare systems to face it, greater financial and human resources, as well as multidisciplinary teams with experience and geriatric training will be necessary.

Bladder cancer recurrence surveillance by urine metabolomics analysis.

Non Muscle Invasive Bladder Cancer (NMIBC) is among the most frequent malignant cancers worldwide. NMIBC is treated by transurethral resection of the bladder tumor (TURBT) and intravesical therapies, and has the highest recurrence rate among solid tumors. It requires a lifelong patient monitoring based on repeated cystoscopy and urinary cytology, both having drawbacks that include lack of sensitivity and specificity, invasiveness and care costs. We conducted an investigative clinical study to examine changes in the urinary metabolome of NMBIC patients before and after TURBT, as well during the subsequent surveillance period. Adjusting by prior probability of recurrence per risk, discriminant analysis of UPLC-MS metabolic profiles, displayed negative predictive values for low, low-intermediate, high-intermediate and high risk patient groups of 96.5%, 94.0%, 92.9% and 76.1% respectively. Detailed analysis of the metabolome revealed several candidate metabolites and perturbed phenylalanine, arginine, proline and tryptophan metabolisms as putative biomarkers. A pilot retrospective analysis of longitudinal trajectories of a BC metabolic biomarkers during post TURBT surveillance was carried out and the results give strong support for the clinical use of metabolomic profiling in assessing NMIBC recurrence.

Lupus nephritis with preserved kidney function associated with poorer cardiovascular risk control: A call for more awareness.

BACKGROUND: Despite the improvement in the prognosis of lupus nephritis (LN), the cardiovascular morbimortality remains high. The early recognition and remission of flares, while trying to avoid the metabolic adverse effects of medication, must be mandatory. AIM: The aim of our study was to assess the cardiovascular (CV) risk profile in a cohort of lupus patients with preserved kidney function after a nephritis episode, compared to patients without a nephritis flare. METHODS: 130 patients diagnosed of SLE (32 with previous nephritis flare and 98 without) were studied in order to evaluate the CV risk profile, despite the preserved kidney function. RESULTS: The most prevalent risk factors were sedentary lifestyle (57.6%), overweight/obesity (38.3%) and dyslipidemia (36%), followed by smoking (32%) and hypertension (16%). Though more than a half (53.1%) was taking CV medication, a high percentage did not reach a therapeutic target value, especially regarding obesity (11.5%) and cholesterol levels (LDL-C of 16%). The prevalence of dyslipidemia (53.1% vs 30.6%), smoking (46.6% vs 27.5%), left ventricular hypertrophy (LVH) (21.4% vs 6.4%) and lower HDL-C (48.6mg/dL vs 55.4mg/dL) were significantly different in the group with previous nephritis flare. Moreover, young patients with lupus nephritis, received more pulses of corticosteroids and cyclophosphamide, had higher prevalence of hypertension, LVH, higher proteinuria, hospital admissions and waist circumference, constituting the subgroup of patients with greater aggregation of CV risk factors. CONCLUSIONS: Patients with previous nephritis flare showed a poor control of CV risk factors despite the preserved renal function, these patients would require a closer therapeutic management.

Apoptotic effect as biomarker of disease, severity and follow-up in interstitial cystitis. / Efecto apoptótico como biomarcador de enfermedad, severidad y seguimiento en la cistitis intersticial.

OBJECTIVE: To determine whether the apoptotic effect test could serve as a biomarker of severity in bladder pain syndrome/interstitial cystitis. MATERIAL AND METHODS: A prospective study was conducted between January 2010 and January 2015, which included 57 patients diagnosed with interstitial cystitis and 49 diagnosed with chronic pelvic pain of gynaecological origin. The urine was exposed to cell cultures, and the urine's capacity for inducing apoptosis in the cultures was analysed. A statistical analysis was then conducted to assess whether the apoptotic effect was associated with the symptoms. RESULTS: After performing an analysis of the association between the degree of apoptotic effect and the symptoms of patients with interstitial cystitis, we observed a significant increase in the mean percentages of apoptosis as the degree of symptom severity increased. After analysing the association between the apoptotic effect and symptoms, we obtained a positive correlation in the patients with interstitial cystitis and a lack of correlation in the patients with chronic pelvic pain of gynaecological origin. The rates of apoptosis increased progressively in the patients with interstitial cystitis as the symptoms increased, while the patients with chronic pelvic pain of gynaecological origin remained stable. CONCLUSIONS: The apoptotic effect of the urine of patients with interstitial cystitis could be a marker of disease, thus differentiating patients with interstitial cystitis from patients with chronic pelvic pain. The effect could also provide an objective measure of symptom severity.

Application of Lean Healthcare methodology in a urology department of a tertiary hospital as a tool for improving efficiency. / Aplicación de la metodología Lean healthcare en un servicio de urología de un hospital terciario como herramienta de mejora de la eficiencia.

OBJECTIVE: To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital. MATERIAL AND METHODS: The implementation of the Lean Healthcare methodology in a urology department was conducted in 3 phases: 1) team training and improvement of feedback among the practitioners, 2) management by process and superspecialisation and 3) improvement of indicators (continuous improvement). The indicators were obtained from the Hospital's information systems. The main source of information was the Balanced Scorecard for health systems management (CUIDISS). The comparison with other autonomous and national urology departments was performed through the same platform with the help of the Hospital's records department (IASIST). A baseline was established with the indicators obtained in 2011 for the comparative analysis of the results after implementing the Lean Healthcare methodology. RESULTS: The implementation of this methodology translated into high practitioner satisfaction, improved quality indicators reaching a risk-adjusted complication index (RACI) of 0.59 and a risk-adjusted mortality rate (RAMR) of 0.24 in 4 years. A value of 0.61 was reached with the efficiency indicator (risk-adjusted length of stay [RALOS] index), with a savings of 2869 stays compared with national Benchmarking (IASIST). The risk-adjusted readmissions index (RARI) was the only indicator above the standard, with a value of 1.36 but with progressive annual improvement of the same. CONCLUSIONS: The Lean methodology can be effectively applied to a urology department of a tertiary hospital to improve efficiency, obtaining significant and continuous improvements in all its indicators, as well as practitioner satisfaction. Team training, management by process, continuous improvement and delegation of responsibilities has been shown to be the fundamental pillars of this methodology.

3+4 = 6? Implications of the stratification of localised Gleason 7 prostate cancer by number and percentage of positive biopsy cores in selecting patients for active surveillance. / ¿3 + 4 = 6? Implicaciones de la estratificación del cáncer de próstata localizado Gleason 7 por número y porcentaje de cilindros positivos de biopsia en la selección de pacientes para vigilancia activa.

OBJECTIVE: To determine whether the number and percentage of positive biopsy cores identify a Gleason 3+4 prostate cancer (PC) subgroup of similar biologic behaviour to Gleason 3+3. MATERIAL AND METHOD: An observational post-radical prostatectomy study was conducted of a cohort of 799 patients with localised low-risk (n=582, Gleason 6, PSA <10ng/ml and cT1c-2a) and favourable intermediate PC (n=217, Gleason 3+4, PSA ≤10 ng/ml and pT2abc). The Gleason 3+4 tumours were stratified by number (≤3 vs.>3) and by percentage of positive cores (≤33% vs. >33%). We analysed the tumours' association with the biochemical recurrence risk (BRR) and cancer-specific mortality (CSM). We conducted various predictive models using Cox regression and estimated (C-index) and compared their predictive capacity. RESULTS: With a median follow-up of 71 months, the BRR and CSM of the patient group with Gleason 3+4 tumours and a low number (≤3) and percentage (≤33%) of positive cores were not significantly different from those of the patients with Gleason 6 tumours. At 5 and 10 years, there were no significant differences in the number of biochemical recurrences, the probability of remaining free of biochemical recurrences, the number of deaths by PC or the probability of death by PC between the 2 groups. In contrast, the patients with Gleason 3+4 tumours and more than 33% of positive cores presented more deaths by PC than the patients with Gleason 6 tumours. At 10 years, the probability of CSM was significantly greater. This subgroup of tumours showed a significantly greater BRR (RR, 1.6; P=.02) and CSM (RR, 5.8, P≤.01) compared with the Gleason 6 tumours. The model with Gleason 3+4 stratified by the percentage of positive cores significantly improved the predictive capacity of BRR and CSM. CONCLUSIONS: Fewer than 3 cores and a percentage <33% of positive cores identifies a subgroup of Gleason 3+4 tumours with biological behaviour similar to Gleason 6 tumours. At 10 years, there were no differences in BRR and CSM between the 2 groups. These results provide evidence supporting active surveillance as an alternative for Gleason 3+4 tumours and low tumour extension in biopsy.

Competing risk analysis of mortality in prostate cancer treated with radical prostatectomy. / Análisis de riesgos competitivos de mortalidad en cáncer de próstata tratado mediante prostatectomía radical.

OBJECTIVE: To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP). MATERIAL AND METHOD: An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age (≤65 vs. >65 years) and risk group: low (Gleason score ≤6 and pT2abc); intermediate (Gleason score of 7 and pT2abc) and high (Gleason score of 8-10 or pT3ab). RESULTS: With a median follow-up of 60 months, the overall probability of dying from PC was 3.5%, and the probability of dying from other causes was 9%. A competing effect for MOC was observed. The risk of MOC was almost 3 times greater than that of CSM. This effect remained for all risk groups, although its magnitude decreased progressively according to the risk group level. At 10 years, CSM was only 0%, 1% and 2% for the low, intermediate and high-risk groups, respectively, while the likelihood of MOC was 4%, 4% and 10%, respectively. The mortality risk was shown after 10years of follow-up and was higher for other causes not attributable to PC and for patients older than 65years. CONCLUSIONS: The benefit of RP might be overestimated, given that the risk of MOC is greater than that of CSM, regardless of the age group and risk group, especially after 10years of follow-up. The only parameter that varied was the magnitude of the CSM/MOC ratio. This information could help in choosing the active treatment for patients with LPC and short life expectancies.

Study of the apoptotic effect of urine as a diagnostic biomarker in patients with interstitial cystitis. / Estudio del efecto apoptótico de la orina de pacientes con cistitis intersticial como biomarcador diagnóstico.

INTRODUCTION: The main objective of the study was to assess the apoptotic effect of urine from patients with interstitial cystitis (IC) in cell cultures and to study its value as a diagnostic biomarker for IC. MATERIAL AND METHODS: A prospective study was conducted between January 2010 and January 2015 and included 57 patients diagnosed with IC and 50 healthy patients from the Hospital Clinic of Barcelona and the La Paz University Hospital. The urine of these patients was exposed to cell cultures, and its ability to induce apoptosis in the cultures was analysed. Using flow cytometry, we then measured the degree of apoptosis, quantified by the percentage of cells of the cell cycle in phase sub G0. RESULTS: The cell cultures exposed to the urine of patients with IC had a sub G1 peak and a G2 phase, which was significantly greater than that of the control group, and a significantly lower percentage in the S phase than the control group. The mean apoptosis values in the urine cultures from patients with IC were significantly higher than those of the control group. Using a value >10% of the apoptosis test as a positive result, we observed a specificity of 96% and a positive predictive value of 92%. CONCLUSIONS: The urine of patients with IC exerts an apoptotic effect on tumour cell cultures that is significantly greater than that exerted by the urine of healthy control patients. A≥10% cutoff for the apoptosis test presented very low sensitivity (40%) but had a very high specificity (96%), thereby able to confirm the diagnosis of IC when positive.

Risk estimation of multiple recurrence and progression of non muscle invasive bladder carcinoma using new mathematical models.

OBJECTIVE: To apply new mathematical models according to Non Muscle Invasive Bladder Carcinoma (NMIBC) biological characteristics and enabling an accurate risk estimation of multiple recurrences and tumor progression. The classical Cox model is not valid for the assessment of this kind of events becausethe time betweenrecurrencesin the same patientmay be stronglycorrelated. These new models for risk estimation of recurrence/progression lead to individualized monitoring and treatment plan. MATERIALS AND METHODS: 960 patients with primary NMIBC were enrolled. The median follow-up was 48.1 (3-160) months. Results obtained were validated in 240 patients from other center. Transurethral resection of the bladder (TURB) and random bladder biopsy were performed. Subsequently, adjuvant localized chemotherapy was performed. The variables analyzed were: number and tumor size, age, chemotherapy and histopathology. The endpoints were time to recurrence and time to progression. Cox model and its extensions were used as joint frailty model for multiple recurrence and progression. Model accuracy was calculated using Harrell's concordance index (c-index). RESULTS: 468 (48.8%) patients developed at least one tumor recurrence and tumor progression was reported in 52 (5.4%) patients. Variables for multiple-recurrence risk are: age, grade, number, size, treatment and the number of prior recurrences. All these together with age, stage and grade are the variables for progression risk. Concordance index was 0.64 and 0.85 for multiple recurrence and progression respectively. CONCLUSION: the high concordance reported besides to the validation process in external source, allow accurate multi-recurrence/progression risk estimation. As consequence, it is possible to schedule a follow-up and treatment individualized plan in new and recurrent NMCB cases.

Utilidad de los nuevos esquemas de agrupación de los grados de Fuhrman en la práctica clínica para el tumor renal de células claras / Usefulness of New Schemes to Group Fuhrman Grades in Clinical Practice for Clear Cell Renal Tumour

Objetivo: Evaluar si la re-clasificación de los carcinomas renales de células claras (CRCC) en dos o tres grados de Fuhrman (GF) frente a la clasificación clásica mantiene su valor pronóstico. Material y métodos: Estudio sobre una cohorte de 383 CRCC tratados con nefrectomía radical/parcial (1990-2009). Se analizaron datos demográficos, evolución y supervivencia de los pacientes. Un uropatólogo reasignó los grados de Fuhrman de forma ciega al informe original. Para estudiar si se mantenía el valor pronóstico con las distintas clasificaciones se realizaron tres análisis de regresión múltiple de Cox, categorizando la variable grado en 4 categorías (I-II-III-IV), en tres (I+II-III-IV) y en dos (I+II-III+IV). Las variables explicativas fueron: edad, sexo, tamaño tumoral, estadio y grado. Las variables respuesta fueron: tiempo de supervivencia libre de progresión (recidiva locorregional /metástasis) y de supervivencia cáncer-específica. Resultados: La mediana de supervivencia global fue de 125 meses (IC 95%: 92-159). En los tres análisis multivariantes el grado de Fuhrman demostró valor predictivo independiente (p=0,0001) frente al estadio para la supervivencia libre de progresión y supervivencia cáncer-específica. El valor pronóstico se mantuvo en las nuevas clasificaciones. En la de tres categorías el paso del grado I+II al III presentó un RR: 2,31(p=0,0001) y del grado III al IV un RR: 2,47(p=0,0001) y en la de dos categorías se observó un RR: 2,8 (p=0,001) al pasar del grado I+II al III+IV. Conclusiones: La categorización en dos o tres grupos del grado de Fuhrman mantiene la capacidad predictiva sobre la supervivencia libre de progresión y cáncer-específica. Los grados III y IV presentan evoluciones distintas, por lo que la clasificación en tres categorías parece más adecuada para describir la evolución de estos pacientes (AU)

Objective: To evaluate if re-grading renal cell carcinoma (CRCC) in two or three-tiered grading schemes versus the traditional Fuhrman classification maintains the same prognostic value. Material and methods: A study of a cohort of 383 treated CRCC with radical or partial nephrectomy between 1990-2009 was made. We analyzed the demographic data, evolution and survival of these patients. An uropathologist reassigned the Fuhrman grades blindly to the first classification. In order to study if the prognostic value was maintained with the different classification, three Cox multivariate regression analysis were performed, classifying the variable of grade into four categories: (I-II-III-IV), into three (I+II-III-IV) and into two (I+II-III+IV). The explanatory variables were: age, gender, tumor size, study stage and grade. The response variables were progression-free survival (local-regional recurrence/metastasis) and cancer specific survival time. Results: The median overall survival was 125 months (95% CI: 92-159). In the three multivariate analyses carried out, the Fuhrman classification showed independent predictive value (p=:0.0001) compared to progression-free survival and cancer specific survival. The predictive power was maintained in the new classifications. In the three categories, the changing from grade I+II to III meant RR: 2.31 (p=0.0001) and from grade III to IV RR: 2.47 (p=0.0001) and in two-tiered classification an RR: 2.8 (p=0.001) was found when changing from I+II to III+IV. Conclusions: Our results show that categorizing the Fuhrman grade into three or two-tiered grading schemes provide the same predictive accuracy on progressive free survival and cancer specific survival. Grades III and IV have different outcomes so that the three-tiered classification seems to be more appropriate to described the course of these patients (AU)

Prognostic nomogram for disease-free survival in patients with renal adenocarcinoma.

OBJECTIVE: The aim of this study was to develop a postoperative prognostic nomogram for disease-free survival in patients with renal adenocarcinoma. MATERIALS AND METHODS: A total of 224 patients with organ-confined or locally advanced renal adenocarcinoma were treated with radical or partial nephrectomy. The variables included in the model were age, histological type, pathological stage, Fuhrman grade and DNA ploidy. Tumor recurrence was defined as any clinical evidence of recurrence. The probability of progression-free survival was calculated using the Kaplan-Meier estimate, and multivariate analysis was performed using a Cox regression. The nomogram was created using the data obtained from the Cox regression. RESULTS: Tumor recurrence was detected in 89 patients (39.74%). The median progression-free time in these patients was 9.55 months (range 0-133). Of these patients, 70.9% relapsed during the first 2 years, and only 15 patients (6.9%) were alive but ill at the end of the study. The probability of progression-free survival at 5 and 10 years was 66.64 and 61.97%, respectively. We performed a statistical validation of the model with accurate predictions that were discriminated with a confidence interval of 0.75 (comparing the predicted and actual probability). According to the nomogram obtained, patients with low-grade, diploid, organ-confined tumors would be candidates for follow-up not exceeding 5 years due to the low probability of recurrence (<40 points). CONCLUSION: The nomogram we developed is clinically relevant and can provide prognostic information for both patients and researchers. In addition, it can be used by researchers during the monitoring protocols that categorize patients based on their relative risk of disease progression.

[Usefulness of new schemes to group Fuhrman grades in clinical practice for clear cell renal tumour]. / Utilidad de los nuevos esquemas de agrupación de los grados de Fuhrman en la práctica clínica para el tumor renal de células claras.

OBJECTIVE: To evaluate if re-grading renal cell carcinoma (CRCC) in two or three-tiered grading schemes versus the traditional Fuhrman classification maintains the same prognostic value. MATERIAL AND METHODS: A study of a cohort of 383 treated CRCC with radical or partial nephrectomy between 1990-2009 was made. We analyzed the demographic data, evolution and survival of these patients. An uropathologist reassigned the Fuhrman grades blindly to the first classification. In order to study if the prognostic value was maintained with the different classification, three Cox multivariate regression analysis were performed, classifying the variable of grade into four categories: (I-II-III-IV), into three (I+II-III-IV) and into two (I+II-III+IV). The explanatory variables were: age, gender, tumor size, study stage and grade. The response variables were progression-free survival (local-regional recurrence/metastasis) and cancer specific survival time. RESULTS: The median overall survival was 125 months (95% CI: 92-159). In the three multivariate analyses carried out, the Fuhrman classification showed independent predictive value (p=:0.0001) compared to progression-free survival and cancer specific survival. The predictive power was maintained in the new classifications. In the three categories, the changing from grade I+II to III meant RR: 2.31 (p=0.0001) and from grade III to IV RR: 2.47 (p=0.0001) and in two-tiered classification an RR: 2.8 (p=0.001) was found when changing from I+II to III+IV. CONCLUSIONS: Our results show that categorizing the Fuhrman grade into three or two-tiered grading schemes provide the same predictive accuracy on progressive free survival and cancer specific survival. Grades III and IV have different outcomes so that the three-tiered classification seems to be more appropriate to described the course of these patients.

[Prognostic value of venous tumor thrombus in renal cell carcinoma]. / Análisis del valor pronóstico de la trombosis tumoral venosa en el adenocarcinoma renal.

OBJECTIVE: To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. MATERIAL AND METHODS: A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression. RESULTS: Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=.0042), but not in function on the level of the thrombus (p=.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. CONCLUSIONS: In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.

In vivo aneuploidization during the expansion of renal adenocarcinoma.

BACKGROUND/AIMS: A correlation has been observed between DNA ploidy and other prognostic parameters such as tumor stage and grade. The present study evaluates tumor aneuploidization during renal adenocarcinoma expansion and growth. METHODS: A total of 252 renal tumors were analyzed between 1969 and 2001. Evaluated variables were age, TNM, Fuhrman classification, histology, size and DNA. A tumor was homogeneous when all the samples were diploid or aneuploid, and a heterogeneous tumor was the coexistence of aneuploid and diploid samples, or all-aneuploid with different aneuploid clones. RESULTS: A total of 224 tumors were included (coefficient of variation <8). The DNA study classified 129 (57.6%) as diploid and 95 (42.4%) as aneuploid. The percentage of aneuploid tumors increased significantly with the pathological stage. Both aneuploid patterns were also significantly more frequent in advanced pathological stages. Tumors with multiple aneuploid clones (n = 17) were significantly more frequent in tumors measuring `4 cm. Both aneuploid patterns showed no differences in survival (p = 0.83), indicating that the heterogeneous pattern probably represents an intermediate step between diploid and homogeneous aneuploid tumor status. CONCLUSIONS: The aneuploid pattern is more common in more advanced stages of the disease, with no clear correlation to primary tumor size. This suggests gradual aneuploidization with tumor expansion and growth.

[Watchful waiting in incidental adenocarcinoma of the prostate]. / Actitud expectante en el adenocarcinoma incidental de próstata.

OBJECTIVE: To describe the outcome of patients diagnosed of incidental prostate adenocarcinoma managed by watchful waiting. MATERIAL AND METHODS: We included patients with PSA< 4 ng/mL or higher with previous negative biopsy, who underwent surgery for BPH being diagnosed of incidental prostate adenocarcinoma. We performed a descriptive and retrospective study in patients with this diagnosis between 1992 and 2007. Salvage curative treatment was offered to those patients who progressed. Statistical analysis was performed using SPSS program. Progression variables were: age, preoperative and postoperative PSA, stage, Gleason score, prostate volume, initial treatment, PSA evolution and salvage treatment if necessary. RESULTS: 47 patients were diagnosed of incidental prostatic adenocarcinoma, finding an incidence of 4.25%. The medium follow up was 37 months. Of the patients who opted for watchful waiting, 72.5% remain on it. 11 patients progressed. Postoperative PSA and Gleason score showed up as prognostic variables of progression in T1a stage and postsurgery PSA did so in T1b patients. CONCLUSION: Watchful waiting is a useful option in patients with incidental prostate adenocarcinoma and favourable prognostic criteria. Postoperative PSA and Gleason score can predict progression in T1a stage and postoperative PSA in T1b stage.

Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en mujeres laboralmente activas entre 25–64 años. Estudio EPICC / Analysis of overactive bladder and urinary incontinence in working women aged between 25 and 64 years. EPICC study

Introducción: Los síntomas urinarios de vejiga hiperactiva (VH) e incontinencia urinaria (IU) tienen un elevado impacto personal y económico. Este trabajo se centra en el análisis detallado de VH e IU (sintomatología derivada, hábitos de consulta y consumo de recursos) en una muestra de mujeres laboralmente activas de 25–64 años. Material y métodos: Trabajo enmarcado en el Estudio EPICC de la Asociación española de urología (epidemiológico, observacional, multicéntrico, ámbito nacional) y centrado en el análisis detallado de la muestra de mujeres laboralmente activas de 25–64 años (N=3090) y del subgrupo de mujeres con VH y/o IU (N=307). Resultados: El 4,01% de la muestra presentó únicamente IU, el 2,69% únicamente VH y el 3,24% ambas patologías. Se observó asociación entre la presencia de IU y/o VH e infecciones urinarias frecuentes, hipertensión y diabetes. En la muestra de sujetos con IU y/o VH el 28,01% tenía problemas para retener orina y el 16,94% tenía pérdidas diarias; el 27,36% sufría diariamente deseos incontrolables de orinar; el 57,65% no había consultado al médico, el 35,40% había consultado al especialista, el 23,13% deseaba consultar al especialista en incontinencia; el 28,01% había recibido tratamiento, de ellas al 55,81% se les prescribió fisioterapia y al 25,58% tratamiento farmacológico. Conclusión: Se presentan datos sobre presencia de VH y IU en mujeres laboralmente activas de 25–64 años y sobre la magnitud de las afecciones y uso de recursos sanitarios en sujetos con IU y/o VH, a fin de contribuir al mejor diagnóstico de estos trastornos y manejo de pacientes y recursos (AU)

Introduction: Urinary symptoms Overactive Bladder (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working women aged 25–64. Material and Methods: Study within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working women aged 25–64 (N=3090) and of the subgroup of individuals with VH and/or IU (N=307).Results4.01% of the subjects presented UI alone, 2.69% OAB alone, 3.24% presented both pathologies. There exists association between UI and/or VH presence and frequent urinary infections, hypertension and diabetes. Taking into account individuals with UI and/or OAB, 28.01% had problems to retain urine, and 16.94% suffered leakage daily; 27.36% suffered uncontrollable urge to urinate daily; 57.65% had never sought medical advice, 35.40% had visited an specialist, 23.13% would like to visit an specialist in incontinence; 28.01% had received treatment, from which 55.81% had received physiotherapy and 25.58% pharmacologic treatment. Conclusion: In this study, specific data about VH and IU in working women aged 25–64 are presented, including those referring to the magnitude of these conditions and use of sanitary resources in subjects with UI and/or OAB, aiming at contributing to a better diagnose and handling of patients and resources (AU)

[Analysis of overactive bladder and urinary incontinence in working women aged between 25 and 64 years. EPICC study]. / Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en mujeres laboralmente activas entre 25-64 años. Estudio EPICC.

INTRODUCTION: Urinary symptoms Overactive Bladder (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working women aged 25-64. MATERIAL AND METHODS: Study within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working women aged 25-64 (N=3090) and of the subgroup of individuals with VH and/or IU (N=307). RESULTS: 4.01% of the subjects presented UI alone, 2.69% OAB alone, 3.24% presented both pathologies. There exists association between UI and/or VH presence and frequent urinary infections, hypertension and diabetes. Taking into account individuals with UI and/or OAB, 28.01% had problems to retain urine, and 16.94% suffered leakage daily; 27.36% suffered uncontrollable urge to urinate daily; 57.65% had never sought medical advice, 35.40% had visited an specialist, 23.13% would like to visit an specialist in incontinence; 28.01% had received treatment, from which 55.81% had received physiotherapy and 25.58% pharmacologic treatment. CONCLUSION: In this study, specific data about VH and IU in working women aged 25-64 are presented, including those referring to the magnitude of these conditions and use of sanitary resources in subjects with UI and/or OAB, aiming at contributing to a better diagnose and handling of patients and resources.

[Analysis of overactive bladder and urinary incontinence in males in the age range between 50 and 65 years. EPICC study]. / Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en varones en la franja de edad de los 50 a los 65 años. Estudio EPICC.

INTRODUCTION: The Overactive Bladder syndrome (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working men aged 50-65. MATERIAL AND METHODS: This study is within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working men aged 50-65 (N

Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en varones en la franja de edad de los 50 a los 65 años. Estudio EPICC / Analysis of overactive bladder and urinary incontinence in males in the age range between 50 and 65 years. EPICC study

Introducción: El síndrome de Vejiga Hiperactiva (VH) y la Incontinencia Urinaria (IU) tienen un elevado impacto tanto personal como económico. Este trabajo se centra en el análisis detallado de la VH y la IU (sintomatología derivada y tendencias en consulta y consumo de recursos) en una muestra de varones laboralmente activos de entre 50 y 65 años. Material y métodos: El presente trabajo se enmarca en Estudio EPICC de la Asociación Española de Urología (estudio epidemiológico, observacional, multicéntrico y de ámbito nacional) y se centra en el análisis detallado de las características de la muestra de varones laboralmente activos, con edades comprendidas entre los 50–65 años (N=1071) y del subgrupo de sujetos con VH y/o IU (N=55). Resultados: El 0,56% de la muestra presentó IU, el 3,55% VH y el 1,03% ambas patologías. En la muestra de sujetos con IU y/o VH el 45,45% tiene problemas para retener orina y el 16,36% tiene pérdidas a diario; el 45,45% sufre deseos incontrolables de orinar diariamente; el 23,64% no ha consultado al médico, el 65,45% ha consultado al urólogo, el 14,55% desea consultar al especialista en incontinencia; el 40% ha recibido tratamiento, de ellos el 81,82% recibió tratamiento farmacológico. Conclusión: Se presentan datos específicos sobre presencia de VH y IU en la muestra especificada y sobre la magnitud de las afecciones y uso de recursos sanitarios en sujetos con IU y/o VH, con el fin de contribuir a un mejor diagnóstico de estos trastornos y manejo de pacientes y recursos (AU)

Introduction: The Overactive Bladder syndrome (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working men aged 50-65. Material and methods: This study is within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working men aged 50–65 (N=1071) and of the subgroup of individuals with VH and/or IU (N=55). Results: 0.56% of the subjects presented UI, 3.55% OAB, 1.03% presented both pathologies. Taking into account those individuals with UI and/or OAB, 45.45% had problems to retain urine, and 16.36% suffered leakage daily; 45.45% suffered uncontrollable urge to urinate daily; 23.64% had never sought medical advice, 65.45% had visited an urologist, 14.55% would like to visit an specialist in incontinence; 40% had received treatment, from which 81.82 had received pharmacologic treatment. Conclusion: In this study, specific data about VH and IU in the reported sample are presented, including those referring to the magnitude of these conditions and use of sanitary resources in subjects with UI and/or OAB, aiming at contributing to a better diagnose and handling of patients and resources (AU)