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.

Sarcomatoid urothelial bladder carcinoma in adults: Histology, symptomatology, treatments and survival. / Carcinoma urotelial sarcomatoide de vejiga en el adulto: histología, sintomatología, tratamientos y supervivencia.

OBJECTIVE: Sarcomatoid urothelial bladder carcinoma comprises 3% of the tumours of the bladder and is considered one of the most aggressive tumours of the urinary tract. Our aim is to analyse the characteristics of sarcomatoid urothelial bladder carcinoma in adults, its treatments and survival. METHOD: A retrospective study performed between 2000 and 2017 of all the patients with a sarcomatoid urothelial bladder carcinoma in a single centre. We studied the anatomopathological characteristics, symptoms at time of diagnosis, treatment given and survival according to the treatment given. RESULTS: Sixteen patients were diagnosed with sarcomatoid carcinoma, 11 with no heterologous component, one with rhabdomyosarcomatous components, 2 with chondrosarcomatous components and 2 with osteosarcomatous components. The mean age was 74 years (±20) and 88% were smokers. The primary symptom was haematuria, and the least well-tolerated was dysuria together with hypogastric pain. Ninety-four percent of the patients had muscle layer infiltration and 18% had metastases at the time of diagnosis. Thirty-seven percent of the patients were treated by radical cystectomy, thirteen percent by radical cystectomy plus adjuvant chemotherapy, and 50% were treated by palliative transurethral resection to control their symptoms. A survival curve was made with the different treatments given, which showed a mean global survival of 7 months and no statistically significant differences in terms of survival according to the treatment given. CONCLUSIONS: Sarcomatoid urothelial carcinoma is an aggressive disease, of rapid and torpid onset which occurs in patients of advanced age and smokers. There are no established treatment guidelines, and it appears that no treatment influences increased survival. Cystectomy should be evaluated as a treatment alternative for patients whose symptoms are difficult to control. The various heterologous components do not appear to influence the progression of the disease or patient survival.

["FlowSecure" artificial urinary sphincter: a new adjustable artificial urinary sphincter concept with conditional occlusion for stress urinary incontinence]. / Implantación del esfínter urinario artificial "FlowSecure" en uretra bulbar: descripción de la técnica quirúrgica paso a paso.

INTRODUCTION: We have implanted the FlowSecure artificial sphincter for the first time in October 2006. The prototype was originally conceived and designed by Professor Craggs M. D. and Professor Mundy A.R. Preliminary clinical results were reported in nine patients early this year. Our objective is to spread technique for surgical implantation. METHODS: Combined perineal and abdominal incisions are required for exposure of bulbar urethra, creation of a cavity in the para-vesical space and dissection of a pocket under de scrotal wall. A trocar with a stylet is routed from the abdominal incision to the perineal incision to pass the deflated cuff to the perineal site. The cuff is placed around the urethra and secured with Prolene sutures. After refilling the cuff, fluid is removed from the system until the stress relief balloon becomes just indented (atmospheric pressure 0). The pump is placed in the scrotum and the balloons in the paravesical space. RESULTS: We have implanted our first FlowSecure artificial sphincter in a patient with severe stress incontinence following a T.U.R.P. The surgical technique is simple and associated with little handling. He was discharged from hospital 4 days after the procedure and it was decided that pressurisation was unnecessary. DISCUSSION: Surgical implantation of the new FlowSecure artificial urinary sphincter is an easy procedure in males with stress urinary incontinence. Knigth et al. reported 30 to 40 minutes operating time, 4 days mean hospital stay and unnecessary pressurisation procedure in 3 out of their 9 patients. It seems that their results are reproducible.

Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy.

OBJECTIVE: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. MATERIALS AND METHODS: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. RESULTS: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. CONCLUSION: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae.

[Fibroepithelial polyps of the ureter: report of three new cases]. / Pólipos fibroepiteliales del uréter: aportación de tres nuevos casos.

The fibroepithelial polyp of the ureter is a benign tumour with a mesenchymal origin. Since its incidence is low, there are very few cases published in the national literature. Presentation of our series, which consists of three cases seen and treated in our service over the last 10 years. Discussion of the most frequent characteristics seen in this type of disease and emphasis on its great relevance for the differential diagnosis with other causes of ureteral repletion deficiency.

[Utility of inhibin B in the management of male infertility]. / Utilidad de la inhibina B en el manejo del varón infértil.

INTRODUCTION: Inhibin B (INHB) is an hormone produced by Sertoli's cells that exercises a negative feedback on FSH secretion. In this study we analyze its diagnostic value as a marker of spermatogenesis and its prognostic value for testicular sperm extraction in azoospermic patients. MATERIAL AND METHODS: Between June 2003 and April 2007 we studied 504 infertile males in our Fertility Department. Until May 2006 we determined INHB only in patients with a sperm count <10M/ml. Since then INHB was determined in every patient due to the present study. 158 determinations were finally performed using enzymoimmunoassay considering normal values between 80 and 300pg/ml. We correlated INHB values with other hormones, spermatic count and, in case of azoospermia (24 patients), with success/failure of surgical sperm retrieval from testes (TESE) to use for intracytoplasmatic sperm injection (ICSI). RESULTS: A significant correlation was observed between INHB and FSH (r=-0.469, p<0.001) and LH (r=-0.399, p<0.001) but not with testosterone, prolactin, estradiol and SHBG. Sperm count was better correlated with INHB (r=0.247; p<0.003) than with FSH (r: -0.157; p<0.052). INHB and FSH were altered in 57.6% and 42.1% of azoospermia respectively, 42.1% and 11.1% in severe oligospermia (0-2M/ml) and 5% and 3.3% in oligospermia (>2M/ml) and normozoospermia. In azoospemic patients PPV for success in testicular sperm extraction was 81.8 % for normal INHB and 76.6% for normal FSH. NPV for failure of sperm retrieval was 61.6% for low INHB and 63.6% for high FSH. CONCLUSIONS: An inverse correlation exists between INHB and FSH and LH levels. INHB correlates better than FSH with sperm count. In azoospermia and oligospermia (<2M/ml), low INHB is more sensitive to detect testicular damage than high FSH. Normal INHB level predicts better than FSH the success of testicular sperm extraction for ICSI, although the favourable outcome can never be assured.

Carcinoma urotelial sarcomatoide de vejiga en el adulto: histología, sintomatología, tratamientos y supervivencia / Sarcomatoid urothelial bladder carcinoma in adults: Histology, symptomatology, treatments and survival

Objetivo: El carcinoma urotelial sarcomatoide vesical representa el 0,3% de los tumores de vejiga y es considerado unos de los tumores más agresivos del tracto urinario. Nuestro objetivo es analizar las características del carcinoma urotelial sarcomatoide de vejiga en la edad adulta, tratamientos realizados y supervivencia. Método: Estudio retrospectivo entre el año 2000 y el 2017 de todos los pacientes con diagnóstico de carcinoma urotelial sarcomatoide de vejiga en un solo centro. Se analizan características anatomopatológicas, sintomatología en el momento del diagnóstico, tratamiento realizado y supervivencia según tratamiento llevado a cabo. Resultados: Dieciséis pacientes fueron diagnosticados de carcinoma sarcomatoide, 11 sin componente heterólogo, uno con componente rabdomiosarcoma, 2 con componente condrosarcoma y 2 con componente osteosarcoma. La edad media fue de 74 años (± 20) y el 88% eran fumadores. El síntoma principal fue la hematuria y el peor tolerado la disuria conjuntamente con el dolor hipogástrico. El 94% de los pacientes presentaron infiltración de la capa muscular y el 18% metástasis en el momento del diagnóstico. En el 37% de los pacientes se realizó tratamiento mediante cistectomía radical, en el 13% mediante cistectomía radical más quimioterapia adyuvante y en el 50% mediante resección transuretral de forma paliativa para conseguir el control de los síntomas. Se realizó una curva de supervivencia con los diferentes tratamientos realizados, presentando una supervivencia media global de 7 meses y sin observar diferencias estadísticamente significativas en cuanto a la supervivencia según el tratamiento realizado. Conclusiones: El carcinoma urotelial sarcomatoide es una enfermedad agresiva, de evolución rápida y tórpida que se produce en pacientes de edad avanzada y fumadores. No existen pautas de tratamiento establecidas y no parece que ningún tratamiento influya en un aumento de la supervivencia de los pacientes. Se debe de valorar la cistectomía como alternativa de tratamiento en aquellos pacientes de difícil control sintomatológico. Los diferentes componentes heterólogos no parecen influir en la evolución de la enfermedad ni en la supervivencia del paciente

Objective: Sarcomatoid urothelial bladder carcinoma comprises 3% of the tumours of the bladder and is considered one of the most aggressive tumours of the urinary tract. Our aim is to analyse the characteristics of sarcomatoid urothelial bladder carcinoma in adults, its treatments and survival. Method: A retrospective study performed between 2000 and 2017 of all the patients with a sarcomatoid urothelial bladder carcinoma in a single centre. We studied the anatomopathological characteristics, symptoms at time of diagnosis, treatment given and survival according to the treatment given. Results: Sixteen patients were diagnosed with sarcomatoid carcinoma, 11 with no heterologous component, one with rhabdomyosarcomatous components, 2 with chondrosarcomatous components and 2 with osteosarcomatous components. The mean age was 74 years (± 20) and 88% were smokers. The primary symptom was haematuria, and the least well-tolerated was dysuria together with hypogastric pain. Ninety-four percent of the patients had muscle layer infiltration and 18% had metastases at the time of diagnosis. Thirty-seven percent of the patients were treated by radical cystectomy, thirteen percent by radical cystectomy plus adjuvant chemotherapy, and 50% were treated by palliative transurethral resection to control their symptoms. A survival curve was made with the different treatments given, which showed a mean global survival of 7 months and no statistically significant differences in terms of survival according to the treatment given. Conclusions: Sarcomatoid urothelial carcinoma is an aggressive disease, of rapid and torpid onset which occurs in patients of advanced age and smokers. There are no established treatment guidelines, and it appears that no treatment influences increased survival. Cystectomy should be evaluated as a treatment alternative for patients whose symptoms are difficult to control. The various heterologous components do not appear to influence the progression of the disease or patient survival

Abordaje perineal de fístulas rectouretrales tras prostatectomía radical laparoscópica / Perineal approach for rectourethral fistulae after radical laparoscopic prostatectomy

Objetivo: Describir nuestra experiencia con el abordaje perineal para el tratamiento de las fístulas rectouretrales (FRU) tras prostatectomía radical laparoscópica. Materiales y métodos: Realizamos un estudio retrospectivo desde el año 2012 al 2015 presentando 5 casos de FRU tras prostatectomía radical laparoscópica. Todos los casos requirieron cirugías abdominales mayores entre la prostatectomía radical laparoscópica y el tratamiento de la FRU a causa de complicaciones varias. En ningún caso se indicó radioterapia previa o posterior a la reparación. Se realizó abordaje perineal en los 5 casos como primera opción. Un caso requirió una segunda intervención con abordaje combinado (abdominal y perineal) por persistencia de la fístula. Resultados: Tras un mínimo de 12 meses de seguimiento en los 5 casos se ha resuelto la FRU. 2 pacientes presentaron incontinencia urinaria y uno estenosis de la anastomosis que requirió uretrotomía interna. El resto no ha mostrado complicaciones a largo plazo. Conclusión: El abordaje perineal permite un campo quirúrgico sano en pacientes multioperados, obteniendo altas tasas de resolución de la fístula

Objective: To describe our experience with the perineal approach to treat rectourethral fistulae (RUF) after radical laparoscopic prostatectomy. Materials and methods: We performed a retrospective study from 2012 to 2015 presenting 5 cases of RUF after radical laparoscopic prostatectomy. All cases required major abdominal surgery between the radical laparoscopic prostatectomy and the RUF treatment due to various complications. In no case was radiation therapy indicated prior to or after the repair. A perineal approach was performed in the 5 cases as the first option. One case required a second operation with a combined approach (abdominal and perineal) due to persistent fistulae. Results: After a minimum of 12 months of follow-up, 5 cases had resolved the RUF. Two patients presented urinary incontinence, and one patient had an anastomotic stricture that required internal urethrotomy. The other patients had no long-term complications. Conclusion: The perineal approach provides a healthy surgical field in patients who undergo multiple operations, achieving high rates of resolution of the fistulae

Utilidad de la inhibina B en el manejo del varón infértil / Utility of inhibin B in the management of male infertility

Introducción: La inhibina B (INHB) es una hormona producida por las células de Sertoli que ejerce un feedback negativo sobre la secreción de la FSH. En este estudio analizamos su valor diagnóstico como marcador de la espermatogénesis y su valor pronóstico para la recuperación espermática en las azoospermias. Material y métodos: Entre junio de 2003 y abril de 2007 atendimos 504 varones infértiles en nuestro Gabinete de Fertilidad. Hasta mayo de 2006 determinamos la INHB solo a los pacientes con un recuento espermático <10M/ml, a partir de esa fecha a todos por motivo de estudio. En total realizamos 158 determinaciones mediante enzimoinmunoanálisis, considerando cifras normales entre 80–300pg/ml. Correlacionamos los valores obtenidos con los de otras hormonas, con el recuento espermático y, en el caso de las azoospermias (24 pacientes) con el éxito o no de la recuperación espermática de los testículos para la inyección intracitoplasmática de espermatozoides. Resultados: Se observó una correlación significativa de la INHB con la FSH (r=−0,469; p<0,001) y con la LH (r=−0,399; p<0,001), pero no con la testosterona, la prolactina, el estradiol y la SHBG. La concentración espermática se correlacionó mejor con la INHB (r=0,247; p<0,003) que con la FSH (r: −0,157; p<0,052). La INHB y la FSH estuvieron alteradas en el 57,6 y en el 42,1% de las azoospermias, respectivamente, en el 42,1 y en el 11,1% de las oligospermias severas (0–2M/ml) y en el 5 y en el 3,3% de las oligospermias (>2M/ml) y normozoospermias. En las azoospermias el valor predictivo positivo para la recuperación espermática fue de un 81,8% para una INHB normal y de un 76,6% para una FSH normal. El valor predictivo negativo para la ausencia de recuperación fue de un 61,6% para una INHB baja y de un 63,6% para una FSH alta. Conclusiones: Existe una correlación inversa entre los niveles de la INHB y los de la FSH y la LH. La INHB se correlaciona mejor que la FSH con la concentración espermática. En las azoospermias y las oligospermias (<2M/ml) un descenso de la INHB es más sensible para detectar el daño testicular que un aumento de la FSH. La INHB predice mejor que la FSH la recuperación espermática para la inyección intracitoplasmática de espermatozoides, aunque el éxito nunca puede asegurarse (AU)

Introduction: Inhibin B (INHB) is an hormone produced by Sertoli's cells that exercises a negative feedback on FSH secretion. In this study we analyze its diagnostic value as a marker of spermatogenesis and its prognostic value for testicular sperm extraction in azoospermic patients. Material and methods: Between June 2003 and April 2007 we studied 504 infertile males in our Fertility Department. Until May 2006 we determined INHB only in patients with a sperm count <10M/ml. Since then INHB was determined in every patient due to the present study. 158 determinations were finally performed using enzymoimmunoassay considering normal values between 80 and 300pg/ml. We correlated INHB values with other hormones, spermatic count and, in case of azoospermia (24 patients), with success/failure of surgical sperm retrieval from testes (TESE) to use for intracytoplasmatic sperm injection (ICSI). Results: A significant correlation was observed between INHB and FSH (r=−0.469, p<0.001) and LH (r=−0.399, p<0.001) but not with testosterone, prolactin, estradiol and SHBG. Sperm count was better correlated with INHB (r=0.247; p<0.003) than with FSH (r: −0.157; p<0.052). INHB and FSH were altered in 57.6% and 42.1% of azoospermia respectively, 42.1% and 11.1% in severe oligospermia (0–2M/ml) and 5% and 3.3% in oligospermia (>2M/ml) and normozoospermia. In azoospemic patients PPV for success in testicular sperm extraction was 81.8 % for normal INHB and 76.6% for normal FSH. NPV for failure of sperm retrieval was 61.6% for low INHB and 63.6% for high FSH. Conclusions: An inverse correlation exists between INHB and FSH and LH levels. INHB correlates better than FSH with sperm count. In azoospermia and oligospermia (<2M/ml), low INHB is more sensitive to detect testicular damage than high FSH. Normal INHB level predicts better than FSH the success of testicular sperm extraction for ICSI, although the favourable outcome can never be assured (AU)

[Microinfections and kidney lithiasis]. / Microinfecciones y litiasis renal.

OBJECTIVE: The existence of microinfections produced by bacteria of a very small size (nanobacteria) could be a risk factor for stone formation. The results of a study to detect the presence of nanobacteria in calculi are presented. METHODS: 1,000 calculi (excluding struvite calculi) were analyzed by macroscopic and microscopic techniques. RESULTS: Microorganisms were detected in only 5 calculi (0.5%). All these calculi had developed in cavities with low urodynamic efficacy. The microorganisms were located in the center of the calculus and the main component was calcium oxalate monohydrate or uric acid. Ammonium urate/sodium urate were frequently found to be a minor component in the center of the calculus. The only common biochemical urinary alteration observed in these patients was a urinary pH below 5.5; conventional urine cultures were always negative. CONCLUSIONS: Our findings demonstrate that these bacteria can play an important role in the development of calculus by inducing the formation of heterogeneous nucleants of calcium oxalate and uric acid. According to our results, however, this mechanisms is not common and would also be associated to other lithogenic risk factors. It is important to underscore that the majority of patients suffered from stomach ulcers and/or gingivitis which are conditions that could be induced by the same type of microorganisms. Therefore, it can be deduced that similar bacterial factors might be involved in pathologies that have as yet not been related. Further studies are warranted to clearly identify these bacteria.

Implantación del Esfínter Urinario Artificial 'FlowSecure(TM') en uretra bulbar: Descripción de la técnica quirúrgica paso a paso / 'Flowsecure(TM)' artificial urinary sphincter: a new adjustable artificial urinary sphincter concept with conditional occlusion for stress urinary incontinence

Introducción: En Octubre de 2006 se implantó por primera vez en nuestra Institución el nuevo esfínter urinario artificial FlowSecure TM. El prototipo fue concebido y diseñado por los Profesores Craggs MD y Mundy AR y los resultados clínicos preliminares de 9 pacientes fueron publicados a mediados del 2006. Nuestro objetivo es el de difundir la descripción detallada de la técnica quirúrgica para la implantación de esta nueva prótesis. Materiales y métodos: Se requiere una incisión perineal para la exposición de la uretra bulbar y una abdominal para la creación de un espacio paravesical y de un bolsillo escrotal. Se coloca un trocar con un estilete desde la incisión abdominal a la perineal para pasar el manguito desinflado, que se ajusta a la uretra y se asegura con tres puntos de Prolene. Tras volver a llenar el manguito se extrae líquido hasta que se forma una muesca en el reservorio de asistencia al estrés, indicando que el sistema está a presión atmosférica 0. Se coloca entonces la bomba en el escroto y los reservorios en el espacio paravesical. Resultados: El esfínter fue colocado en un paciente con incontinencia de esfuerzo tras una RTU de próstata. La técnica es simple, el paciente se fue de alta al cuarto día y no fue necesario presurizar el sistema porque el paciente recuperó la continencia desde la retirada de la sonda. Discusión: La implantación en uretra bulbar es muy sencilla. Los resultados en este paciente concuerdan con los de Knigth et al., que describen tiempo quirúrgico de 30 a 40 minutos, media de estancia hospitalaria de 4 días y presurización innecesaria en tres de sus nueve pacientes. Parece que la técnica y los resultados son reproducibles

Introduction: We have implanted the FlowSecure artificial sphincter for the first time in October 2006. The prototype was originally conceived and designed by Professor Craggs M. D. and Professor Mundy A.R. Preliminary clinical results were reported in nine patients early this year. Our objective is to spread technique for surgical implantation. Methods: Combined perineal and abdominal incisions are required for exposure of bulbar urethra, creation of a cavity in the para-vesical space and dissection of a pocket under de scrotal wall. A trocar with a stylet is routed from the abdominal incision to the perineal incision to pass the deflated cuff to the perineal site. The cuff is placed around the urethra and secured with Prolene sutures. After refilling the cuff, fluid is removed from the system until the stress relief balloon becomes just indented (atmospheric pressure 0). The pump is placed in the scrotum and the balloons in the paravesical space. Results: We have implanted our first FlowSecure artificial sphincter in a patient with severe stress incontinence following a T.U.R.P. The surgical technique is simple and associated with little handling. He was discharged from hospital 4 days after the procedure and it was decided that pressurisation was unnecessary. Discussion: Surgical implantation of the new FlowSecure artificial urinary sphincter is an easy procedure in males with stress urinary incontinence. Knigth et al. reported 30 to 40 minutes operating time, 4 days mean hospital stay and unnecessary pressurisation procedure in 3 out of their 9 patients. It seems that their results are reproducible