Increasing Annual Cancer Incidence in Patients Age 20-49 Years: A Real-Data Study.

PURPOSE: Data from population-based studies have shown an increased incidence of certain types of neoplasms in patients younger than 50 years (early-onset cancer [EOC]); however, little information is derived from other real-world data sources. In a nonpopulation registry, we analyzed changes in the incidence of several neoplasms in successive generations. METHODS: This cross-sectional study included all patients with a cancer diagnosis registered in one university hospital in Málaga, Spain, between 1998 and 2021, and 18 neoplasms were analyzed. For each neoplasm, the proportion of patients younger than 50 years and age 50 years and older (late-onset cancer [LOC]) of the total number of patients diagnosed each year was determined. In addition, the age limit was lowered to 45-40 years. Changes in these proportions between each year and the following year were assessed by calculating the annual percentage change (APC), and a final assessment of these changes was performed by determining the average APC (AAPC). RESULTS: Of the 24,596 patients, 5,466 (22.2%) had EOC, and 19,130 (77.8%) had LOC. The incidence of all tumors increased throughout the study period in both age groups. The AAPC increase was higher in patients with EOC than in those with LOC for the following neoplasms: head and neck (6.1% v 4.6%), colon (11.0% v 8.2%), testicular (16.3% v -13.1%), non-Hodgkin lymphoma (8.4% v 5.9%), rectum (16.1% v 6.8%), kidney (27.8% v 20.1%), and sarcoma (43.4% v 28.6%). This increase was confirmed in patients younger than 45 years and 40 years. CONCLUSION: Our results are consistent with the data published for most tumor sites analyzed. This global public health problem requires the utmost attention to decrease excess cancer in young patients.

A sequence variant at 4p16.3 confers susceptibility to urinary bladder cancer.

Previously, we reported germline DNA variants associated with risk of urinary bladder cancer (UBC) in Dutch and Icelandic subjects. Here we expanded the Icelandic sample set and tested the top 20 markers from the combined analysis in several European case-control sample sets, with a total of 4,739 cases and 45,549 controls. The T allele of rs798766 on 4p16.3 was found to associate with UBC (odds ratio = 1.24, P = 9.9 x 10(-12)). rs798766 is located in an intron of TACC3, 70 kb from FGFR3, which often harbors activating somatic mutations in low-grade, noninvasive UBC. Notably, rs798766[T] shows stronger association with low-grade and low-stage UBC than with more aggressive forms of the disease and is associated with higher risk of recurrence in low-grade stage Ta tumors. The frequency of rs798766[T] is higher in Ta tumors that carry an activating mutation in FGFR3 than in Ta tumors with wild-type FGFR3. Our results show a link between germline variants, somatic mutations of FGFR3 and risk of UBC.

[Laparoscopic treatment of varicocele]. / Tratamiento del varicocele por laparoscopia.

OBJECTIVES: Current trends in the treatment of varicocele are focused on outpatient procedures of high and complete ligature of the spermatic vascular pedicle or percutaneous embolization. Laparoscopic varicocelectomy competes with them and other minimally invasive techniques such as chemical or thermal sclerosing therapy of the spermatic veins. METHODS: We perform a bibliographic review of the Spanish and Anglo-Saxon literature with the aim of evaluating the real weight of the laparoscopic technique, and at the same time show our personal experience. RESULTS: We found 8 papers in Spanish and 187 in English. Although the interest for laparoscopic varicocelectomy among Spanish urologists is very low, in other countries there is moderate interest for it, being in competition, though in disadvantage, with other outpatient minimally invasive techniques performed under local or regional anesthesia. CONCLUSIONS: Microlaparoscopy improves the overall position of this technique, mainly in cases of bilateral varicocele whenever an "en bloc" ligature of the spermatic artery and vein is performed.

[Laparoscopic pyeloplasty]. / Pieloplastia laparoscópica.

OBJECTIVES: To review indications, results and endourologic alternatives to the pyeloplasty technique. METHODS: We describe the surgical technique proposed by Schluesser et al., which was applied to 9 patients in our series. Another 4 patients underwent a simple laparoscopic pyelolisis. RESULTS: Results obtained with laparoscopic dismembered pyeloplasties are completely comparable with those obtained with the conventional Anderson Hynes Pyeloplasty. Outcomes were very favourable in 7/9 patients in the series; another one shows a discrete improvement and the other one did not return for control. Is does not happen the same with pyelo-ureterolysis. Two of them had a good outcome, other two remain the same, and another one has not had his control yet. CONCLUSIONS: After 8 years, laparoscopic pyeloplasty has consolidated as the elective technique in cases of recoverable hydronephrosis, secondary to crossing vessels or which have a redundant renal pelvis. A few important modifications to the technique have been proposed; exceptions are that it can also be done by retroperitoneoscopy and that in some cases equally good results may be obtained with the Fenger's laparoscopic pyeloplasty.

Pieloplastia laparoscópica / Laparoscopic pyeloplasty

Objetivos: Revisar las indicaciones, resultados y variantes propuestas a la técnica de la pieloplastia en este campo de la Endourología. Métodos: Se describe la técnica quirúrgica propuesta por Schuessler y colaboradores, y que fue aplicada a 9 pacientes de nuestra serie. A otros 4 se les realizó simple pieloureterolisis laparoscópica. Resultados: Los resultados que se obtienen con las pieloplastias desmembradas laparoscópicas son completamente superponibles a los que se obtienen con la pieloplastia convencional de Anderson Hynes. Siete de los 9 pacientes a los que se les practicó esta técnica evolucionaron muy favorablemente. Otro presenta una mejoría discreta y otro no ha vuelto a control. No ocurre lo mismo con las pieloureterolisis. Dos evolucionaron bien, otros 2 siguen igual y otro está aun pendiente de control. Conclusiones: Tras 8 años de existencia, la pieloplastia laparoscópica se ha consolidado como la técnica de elección en los casos de hidronefrosis recuperables, motivadas por cruces vasculares o que presentan una pelvis renal redundante. Pocas modificaciones de importancia han sido propuestas a la técnica, salvo que también puede realizarse también por lumboscopia y que en algunos casos se obtienen resultados igualmente buenos con la pieloplastia laparoscópica tipo Fenger (AU)

Abordaje laparoscópico a través de trócares ópticos / Laparoscopic approach with visualizing trocars

OBJETIVO: La laparoscopia en Urología no ha experimentado el desarrollo alcanzado en otras especialidades quirúrgicas. Ello hace que el urólogo medio no posea suficiente soltura en el uso de los trócares laparoscópicos, dificultad que se acrecienta con el hecho de que en ocasiones debe preferir los abordajes extraperitoneales (preperitoneoscopia y retroperitoneoscopia). MÉTODO: Los autores exponen su experiencia con el uso de diferentes trócares ópticos, describiendo con detalle las ventajas e inconvenientes de cada uno de ellos en los distintos tipos de abordajes. RESULTADOS: Sus preferencias se centran en los trócares ópticos activos, los cuales, además de ser muy seguros, permiten una cómoda disección roma de los espacios pre y retroperitoneales. Su mayor inconveniente es su precio. pues se trata de instrumentos no reutilizables. CONCLUSIONES: Últimamente se decantan más por el uso de los trócares ópticos reutilizables de cánula helicoidal, los cuales son muy seguros para abordajes transperitoneales, aunque algo menos para los extraperitoneales. Su ventaja, al margen de su menor coste es que infringen un menor daño al atravesar la pared abdominal (AU)