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.

Ischaemic priapism as a presentation of chronic myeloid leukaemia.

OBJECTIVE: To describe ischemic priapism as an atypical presentation of chronic myeloid leukaemia. METHODS / RESULTS: We discuss two patients diagnosed with chronic myeloid leukaemia presenting an episode of priapism, adequately resolved after applying the treatment protocol established in our center. CONCLUSION: Priapism is defined as a persistent erection that persists despite not having sexual stimulus, without involvement of the spongy tissue of the penis. Its debut appearance as a hematologic dyscrasia is a rare event. It is a urological emergency, requiring early multidisciplinary (Urology and Hematology) management, since the speed in treatment will result in good functional results and the preservation of a good quality of life.

PSA levels in patients on hemodialysis treatment.

OBJECTIVES: Standardized prostate-specific antigen (PSA) levels are based upon the general population levels and, although a higher incidence of prostate cancer in patients on hemodialysis (HD)has not been demonstrated, some studies point at the possibility of observing higher PSA levels in this type of patients than in males with preserved renal function. The objective of the present study is to compare PSA levels in males on hemodialysis with those of the population with normal renal function. METHODS: Comparative, transversal study of the variables age, total PSA, free PSA and PSA index in 190 patients with chronic renal disease on hemodialysis treatment (group 1) and 237 subjects without renal disease ( group 2). We carried out a descriptive analysis and a comparative study of the above mentioned variables using the SPSS software. RESULTS: Median age of patients on HD was 55 in cases (47-61)and 59 in controls (54-63.5). Mean total PSA was 1.49 ng/mL [1.24-1.73] in cases and 1.62 ng/mL [1.29-1.95] in controls; mean free PSA was 1.40 ng/mL [0.89-1.91] in group 1 and 2.31 ng/mL [-0.83-5.45] in group 2; mean PSA index was 27.67% [19.91-35.63] in cases and 14.82%[12.79-16.85]] in controls. The comparative study showed differences between the two groups in free PSA (p ≤ 0.007), PSA index (p ≤ 0.000) and total PSA (p ≤ 0.000) in patients under 50 after an age-specific analysis. CONCLUSIONS: Total PSA is higher in patients on HD within the subgroup of patients under 50 with statistically significant but not clinically relevant difference. PSA index is remarkably higher in the group of patients on HD. These data could have clinical implications as far as indications for biopsy is concerned.

Abdominal Aortic Aneurysm Complicated With Aorto-Left Retroaortic Renal Vein Fistula.

We present the case of a male with a fistula from an infrarenal aortic aneurysm to the left renal vein resolved with an endovascular prosthesis. Few cases have been reported in the literature.

[Effectiveness and tolerability of zoledronic acid in the treatment of metastatic prostate cancer]. / Efectividad y tolerabilidad del acido zoledrónico en el tratamiento del cancer de próstata metastásico.

OBJECTIVES: To assess the effectiveness and tolerability of zoledronic acid in prostate cancer patients with bone metastases at the hormone-sensitive (HS) and hormone-independent (HI) stages. MATERIALS AND METHODS: A nationwide, observational, prospective, open and multi-centre trial was devised, with a total of 218 male patients diagnosed with prostate cancer at the HS stage (36%) or HI stage (64%) who were administered zoledronic acid (4 mg/IV/month for 6 months) in addition to their specific oncological treatment. Effectiveness was assessed by the following means: 1) Assessment of the improvement in pain and mobility; 2) Incidence and time to onset of skeletal-related events (SREs) and 3) Analysis of bone markers. Tolerability was assessed by means of registering the number and type of adverse effects. A satisfaction survey was carried out amongst the patients after the end of the trial. RESULTS: Out of the 218 patients, 170 (78%) were evaluable for effectiveness. A decrease in pain ratings at rest and during movement was observed in all patients, whether in the HS or HI groups (p < 0.0001). Improved mobility was observed likewise (p = 0.005), as was quality of life. The global incidence of skeletal events was 11.2%, with a time to onset of SREs of 10.7 months. There were no significant differences observed between HS vs. HI patients. Osteolysis markers (N-telopeptide) decreased significantly with the treatment across both the HS and HI groups. For safety reasons. 212 patients were evaluable (97.2%). The incidence of adverse drug reactions was 16% (34/212) and was found to be significantly higher in HS patients (22.4%) compared with HI patients (11.9%). Overall, the tolerability of zoledronic acid was good, with no significant morbidity in either group (HS and HI). 66% of the patients reported feeling satisfied or very satisfied. CONCLUSIONS: Zoledronic acid proved effective in the relief of pain, improving mobility and quality of life as well as reducing or delaying the occurrence of skeletal-related events in prostate cancer patients presenting metastatic bone disease, regardless of the phase, whether HS or HI, they found themselves in. Tolerability and patient satisfaction were rates as good.

Low-dose-rate brachytherapy for prostate cancer in renal transplant recipients.

PURPOSE: Prostate cancer (PCa) is the most common malignancy among men and one of the most common neoplasms affecting renal transplant recipients (RTRs). The available treatments for localized PCa among the general population (GP), surgery and external beam radiotherapy, carry a risk of damage to the transplanted kidney, the ureters, and the bladder and therefore tend to be avoided by most groups. The objective of this study was to assess the efficacy and feasibility of low-dose-rate brachytherapy (LDR-BT) for PCa in RTRs. METHODS AND MATERIALS: We carried out a retrospective review on all RTRs diagnosed of PCa who had undergone LDR-BT at our institution between 2000 and 2015. Nine patients met these criteria, but 1 did not fulfill the followup. Hence, we analyzed 8 patients. We reviewed all clinical data for PCa and graft function in these patients and compared the results with the GP. RESULTS: Mean baseline prostate-specific antigen was 6.8 ± 1.9 ng/mL. All PCa had a Gleason score of 6 and were classified as low risk according the Europe Association of Urology guidelines. Mean followup after seed implantation was 48 ± 12.8 months. All 8 patients remain free of prostate-specific antigen failure. Five-year progression-free survival, cancer-specific survival, and overall survival rates were 100%, 100%, and 62.5%. There was no specific toxicity associated with LDR-BT, and there were no acute adverse events affecting the graft. CONCLUSIONS: LDR-BT is a feasible and acceptable treatment for localized PCa in RTRs. Oncological outcomes are similar to the GP, and there is minimal toxicity to the renal graft.

Learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. / Curva de aprendizaje en el manejo de los inhibidores de tirosina quinasa como primera línea de tratamiento en pacientes con cáncer renal metastásico.

OBJECTIVES: To analyse the learning curve for the management of tyrosine kinase inhibitors as the first line of treatment for patients with metastatic renal cancer. MATERIAL AND METHODS: We evaluated 32 consecutive patients treated in our department for metastatic renal cancer with tyrosine kinase inhibitors (pazopanib or sunitinib) as first-line treatment between September 2012 and November 2015. We retrospectively analysed this sample. We measured the time to the withdrawal of the first-line treatment, the time to progression and overall survival using Kaplan-Meier curves. The learning curve was analysed with the cumulative sum (CUSUM) methodology. RESULTS: In our series, the median time to the withdrawal of the first-line treatment was 11 months (95% CI 4.9-17.1). The mean time to progression was 30.4 months (95% CI 22.7-38.1), and the mean overall survival was 34.9 months (95% CI 27.8-42). By applying the CUSUM methodology, we obtained a graph for the CUSUM value of the time to withdrawal of the first-line treatment (CUSUM TW), observing 3 well-differentiated phases: phase 1 or initial learning phase (1-15), phase 2 (16-26) in which the management of the drug progressively improved and phase 3 (27-32) of maximum experience or mastery of the management of these drugs. The number of treated patients needed to achieve the proper management of these patients was estimated at 15. CONCLUSIONS: Despite the limitations of the sample size and follow-up time, we estimated (in 15 patients) the number needed to reach the necessary experience in the management of these patients with tyrosine kinase inhibitors. We observed no relationship between the time to the withdrawal of the first-line treatment for any cause and progression.

Evaluation of the Spanish Urological Association quality care indicators in a kidney transplantation programme. / Evaluación de los indicadores de calidad asistencial de la Asociación Española de Urología en un programa de trasplante renal.

INTRODUCTION: Indicators show the presence of a phenomenon and its intensity. They assess the level of quality care and identify potential situations for improvement. Our objective is to assess the 2013 and 2014 quality care indicators of our department's kidney transplantation area. MATERIAL AND METHOD: For 2013 and 2014, we reviewed 88 and 106 kidney transplants and 47 and 66 extractions. We evaluated the quality care indicators developed by the Spanish Urological Association, analysing the results with the SPSS v 21.0 programme. RESULTS: The mean cold ischaemia time (CIT) was 14.96hours in 2013 and 18.07hours in 2014. The CIT was ≤18h in 53% and 56% of cadaveric donor kidneys in 2013 and 2014, respectively. The rate of relevant early onset urinary fistulae was 1.14% and 2.83% for each year. The rate of early transplantectomy due to a vascular complication was 3.41% and 2.83% for 2013 and 2014, respectively. Overall patient survival at 1 year was 100% for both periods, and graft survival at 1 year was 95% and 94.34% for 2013 and 2014, respectively. The rate of living-donor transplantation was 14.77% and 17.92%, and 92.31% and 68.42% of the living-donor extractions were laparoscopic for 2013 and 2014, respectively. Resident medical interns were the first surgeon in 6.67% and 12.64% of the transplantations and in 55.88% and 19.14% of the cadaveric extractions during 2013 and 2014, respectively. CONCLUSIONS: During the evaluated period, all quality care standards in kidney transplantation were met, except for CIT in both years and resident medical intern participation in kidney implantation in 2013. This analysis promotes improvements in quality care, highlighting weak spots that need work.

Conservative treatment of de novo renal carcinoma on kidney graft.

BACKGROUND: De novo renal carcinoma in kidney transplants is an uncommon but not exceptional condition and is of significant importance due to the potential for recipient mortality and graft loss. The aim of our study was to determine the management and outcome of these tumors in our Kidney Transplantation Unit. MATERIAL AND METHODS: We analyzed cases of de novo kidney tumors among patients who underwent transplantation in the last 17 years in our Kidney Transplantation Unit. We detected 3 cases of clear cell carcinoma and 1 case of papillary carcinoma on the graft. We conducted follow-up on the tumor and renal function and analyzed patient responses to changes in immunosuppression. RESULTS: Tumorectomy was performed in all cases, and subsequent transplantectomy was required for patients with papillary carcinoma. None of the patients had relevant surgical complications. We also changed the patients' regimen to a proliferation signal inhibitor or mTOR inhibitor and completely withdrew all anticalcineurin agents. With a mean follow-up of 43.5 months (15-61), the 3 patients with clear cell carcinoma survived with good graft function and with no evidence of tumor recurrence. The patient with papillary carcinoma underwent follow-up at another hospital center. CONCLUSIONS: Conservative surgery along with conversion to a proliferation signal inhibitor appears to be a safe option for treating primary tumors in kidney grafts and offers good oncological and renal function results in the short and medium term.

[Effects of water diuresis on the urinary ph of patients under relapsing lithiasis]. / Efectos de la diuresis acuosa sobre el pH urinario de los pacientes litiásicos recidivantes.

INTRODUCTION: It has been observed that in healthy individuals the increase in urinary flow induced by water overload may be enough to alter the urinary Ph to obtain values considered safe in the prophylaxis of lithogenesis. The aim of the present paper is to determine the effects of water diuresis on the urinary Ph of patients suffering from relapsing lithiasis. MATERIAL AND METHOD: 26 patients were included in the present study. The urinary Ph of all patients was measured along two consecutive days, at 8.30 and again at 12.30, under normal conditions (the first day) and once they had received a water load equivalent to 1.5% of their weight (the second day). RESULTS: The altered mean value of the Ph induced on the first day by the circadian rhythm showed a mean of 0.13 units of Ph, which lacks statistical significance (p > 0.05). However, on the second day we obtained a value of 0.42, which is statistically significant (p < 0.01). The normal tendency after the water overload was towards a positive increase of the Ph in those patients whose urine showed a preload Ph value < 6.1, whereas those individuals with a preload Ph value > 6.48 suffered negative increases. CONCLUSIONS: The increase of diuresis induced by water load proved enough to provoke an increase of urinary Ph when its baseline value is < 6.1, or either a decrease when its baseline value is > 6.48. In both cases, Ph values ranged between 6-6.5 which are considered safe values in the prophylaxis of lithogenesis. The more separated the baseline urinary Ph is from the 6.1-6.48 range, the greater the effect of the water load.

[Biofeedback as a therapeutic alternative in uncoordinated miction]. / El biofeedback como alternativa terapéutica en la micción no coordinada.

The Hinman Syndrome is known as an involuntary unsconscions contraction of the periurethral sphincter during micturition once neurologic disease and anatpmical obstruction are rejected. We report a case of a 23 years old man who was diagnosed of suffering from this syndrome. After the proper studies and left nephroureterectomy for ureterohydronephrosis secondary to long term massive vesicoureteral reflux, we proceeded to treat him with biofeedback and autocatheterisms. Six months after, the patient was asymptomatic with normal micturitions without residue.

[Management of female stress urinary incontinence in a specialized unit]. / Manejo de la incontinencia urinaria femenina de esfuerzo en una unidad especializada.

Urinary exertional incontinence is a very common condition which requires a broad range of therapeutic options being available. Besides, the creation of specialised units in urology is now evident, one of the areas involved being Urogynaecology. To focus the issue of female urinary incontinence, the following should be considered: to begin with, treatment is not imperative, patients must be evaluated on a case-by-case basis, the least invasive principle must prevail, diagnosis must be early, and it should be taken into account that primary and secondary prevention is both possible and necessary. A working pattern was designed accordingly, to sustain therapeutic decisions, which consisted in a detailed anamnesis, complete examination and application of an established diagnostic-therapeutic algorithm. Even so, a therapeutic, medical or surgical decision will be chosen and patients will be monitored at one, four and sixteen months after completion of treatment. To achieve good results in the management of female urinary exertional incontinence it is essential to include a large number of patients. In fact, the key is to establish a close collaboration with the gynaecologists.

[Adrenal metastases of Ewing's sarcoma. Report of one case]. / Metastasis suprarrenal de sarcoma de Ewing. A propósito de un caso.

Adrenal metastases are more frequent than primary adrenal carcinoma. The most frequent are, in this order: breast and lung cancer, stomach and kidney carcinomas, adrenal gland contralateral tumors and melanoma. Less frequent are tumours of the bladder, colon, esophagus, gall bladder, liver, pancreas, prostate, stomach and uterus. The rest of the tumours rarely spread toward adrenal glands. The metastases to the adrenal glands caused by sarcomas are rare and normally they happen in the contest of a massive metastases affecting several organs at the same time. We present a case of a patient affected by adrenal metastases of Ewing's sarcoma who has been referred to us for surgical treatment because it is a unique metastases (there is no sing of more illnesses in other organs at the time of the exploration).

[Retroperitoneal malignant fibrous histiocytoma]. / Histiocitoma maligno fibroso retroperitoneal.

We report a new case of retroperitoneal tumor: a malignant fibrous histiocytoma, in its less aggressive histologic type, the mixoid variety. This is a recently isolated histologic presentation from other sarcomas, with a low incidence, non-specific clinic findings and poor prognosis due to its tendency to reappear and to produce metastasis.

[Retroperitoneal neurilemmona]. / Neurilemoma retroperitoneal.

Schwannoma is an uncommon tumor arising from neural sheath of peripheral nerves. Histological findings showing Antoni A and B zones are the main diagnostic features. We report a new case of a retroperitoneal located one, which is not its most usual place to appear, in a 60 year old male, presenting left flank pain. He received surgical treatment, having a satisfactory evolution.

[Gonadoblastoma in Swyer syndrome]. / Gonadoblastoma en un síndrome de Swyer.

Swyer's syndrome is a pure gonadal dysgenesis with female external genitalia. A likely complication is the appearance of tumour's dysgenetic gonads. This paper studies a case report of gonadoblastoma in a female patient with this syndrome.

[Analysis of renal neoplasms in adult patients under 40]. / Análisis de las neoplasias renales en adultos menores de 40 años.

OBJECTIVES: To analyze within our sample population the number of patients under 40 receiving surgery as a result of renal neoplasm; to describe the characteristics of these patients and compare them with those of adult patients over 40. PATIENTS AND METHODS: We have revised the clinical history of the 379 patients with renal neoplasm who have undergone surgery in our Service from January 1986 through June 2003. Patients were divided into two groups. Group I, formed by 36 subjects (9.5%) < or = 40. Group II includes 343 patients (90.5%) over 40. Data were included in a database created using the software programme Access and were subsequently analysed using the statistical package SPSS. A descriptive analysis was performed and life expectancy was calculated for both groups using the Kaplan-Meier survival curve. RESULTS: 7.3% of the total number of renal cell carcinomas included in our series occurs in patients of or under 40. No significant differences have been observed as regards the distribution per sexes, laterality, size, incidental occurrence, clinical symptoms, anatomopathology, staging or surgical technique employed. However, we have observed differences as regards cancer-specific survival rate after 5 years, being 94.74% in the case of group I and 68.64% in group II (log-rank 0.0338). CONCLUSIONS: The number of patients < or = 40 undergoing surgery as a result of renal cell carcinoma in the sample under study matches other series already published. No statistically significant difference has been observed as regards staging among patients under and over 40. Differences do exist as regards cancer-specific survival rate. In the case of our patients, irrespective of the age group to which they were ascribed, it is more common to diagnose a renal neoplasm incidentally than through the clinical manifestations.

[Carcinosarcoma of the bladder: report of our cases and review of the literature]. / Carcinosarcoma vesical: análisis de nuestra serie y revisión de la literatura.

Carcinosarcomas of the bladder are rare. As a result, the natural history of them and the best methods of treatment remain uncertain. These tumors tend to be rapidly growing, invasive and recur locally. We reviewed our experience with four patients presenting between 1995 and 2002. Epidemiology findings, clinical aspects, histological features, diagnostic methods, treatment and survival are discussed in relation to literature.

[An adrenal pseudocyst. A report of a new case]. / Pseudoquiste adrenal. Presentación de un nuevo caso.

We report the case of a female young woman with an incidental cystic lesion in the left adrenal gland while during a routine study by her gynecologist. The change of the aspect in the content of the lesion, its limit size and a not definitive study of punction went to the surgical act. This was made with preservation of both, adrenal and renal units. The pathological report was adrenal pseudocyst.

[Kluyvera ascorbata. Case report of a patient with Crohn's disease]. / Kluyvera ascorbata. Presentación de un caso en paciente con enfermedad de Crohn.

For the not frequent, we contributed a new case of infection urinary produced by the I generate Kluyvera. We make a bibliographical review, clinical expression of the same and we insisted in a series of peculiarities, you like the appearance give because of the treatment pharmacologic and their intestinals.