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.

European Association of Urology biochemical recurrence risk groups after radical prostatectomy: External validation and identification of independent risk factors for progression and death.

BACKGROUND: The EAU proposed a progression and death risk classification in patients with biochemical recurrence after radical prostatectomy (PR). OBJECTIVE: To validate the EAU BCR-risk classification in our setting and to find factors related to progression and death. MATERIAL AND METHODS: Multicenter, retrospective, observational study including 2140 patients underwent RP between 2011 and 2015. Patients with BCR were identified and stratified in low risk (PSA-DT >1yr and pGS <8) or high-risk (PSA-DT ≤1yr or pGS ≥8) grouping. PSA and metastatic free survival (PSA-PFS, MFS), cancer specific survival (CSS) and overall survival (OS) were calculated (Kaplan Meier curves and log-rank test). Independent risk factors were identified (Cox regression). RESULTS: 427 patients experienced BCR (32.3% low-risk and 67.7% high-risk). Median PSA-PFS was 135,0 mo (95% CI 129,63-140,94) and 115,0 mo (95% CI 104,02-125,98) (p<0,001), for low and high-risk groups, respectively. There were also significant differences in MFS and OS. The EAU BCR risk grouping was independent factor for PSA-progression (HR 2.55, p 0.009). Time from PR to BCR, was an independent factor for metastasis onset (HR 0.43, 95% CI 0.18-0.99; p 0.044) and death (HR 0.17, 95% CI 0.26.0.96; 23 p 0.048). Differences in MFS (p 0.001) and CSS (p 0.004) were found for <12, ≥12-<36 and ≥36 months from PR to BCR. Others independent factors were early salvage radiotherapy and PSA at BCR. CONCLUSIONS: High-risk group is a prognostic factor for biochemical progression, but it has a limited accuracy on MP and death in our setting. The inclusion of other factors could increase its predictive power.

Single-port robot-assisted retroperitoneal surgery: A feasible approach.

INTRODUCTION: The concept of surgery through a single incision has been pursued in the field of minimal invasion for the treatment of different pathologies. This, added to a retroperitoneal approach, implies less aggression for the patient at different levels. We describe the first cases of single-port robot-assisted retroperitoneal surgery (SP-RARS) in our country using the da Vinci Xi® system. MATERIAL AND METHODS: We present two cases of patients with right adrenal masses larger than 4 cm. The first case was a 55-year-old woman with an incidental diagnosis of angiomyolipoma, and the second case was a 62-year-old man with a non-functioning adrenal adenoma. Both cases were operated through a single 4-cm subcostal incision using the da Vinci Xi® system, annulling arm 4 without reallocating laterality on the surgeon's console. RESULTS: Both surgeries were performed with console times of 75 and 150 min, respectively, with access and docking times below 30 min. Bleeding was less than 100 cc in both surgeries without the need to make accessory incisions or leave a drainage tube. The surgical specimens were removed through the same initial incision without the need for enlargement. Postoperative intravenous analgesia was not necessary in any case (VAS 0) and hospital stay was less than 24 h in both patients without reporting any complications. CONCLUSIONS: SP-RARS is a feasible approach using the da Vinci Xi® system.

The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy.

INTRODUCTION AND OBJECTIVE: Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. MATERIAL AND METHODS: Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. RESULTS: 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. CONCLUSIONS: Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.

Non-metastatic castration-resistant prostate cancer: management recommendations.

INTRODUCTION AND OBJECTIVE: Survival and quality of life (QoL) of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) deteriorate significantly when they develop metastases. New generation antiandrogens (apalutamide, enzalutamide and darolutamide) can prolong metastasis-free survival (MFS) and overall survival (OS) in these patients, maintaining their QoL. MATERIAL AND METHODS: After the performance of a systematic review of the literature, a scientific committee reached a consensus on simple and practical recommendations to consolidate and improve the management of patients with nmCRPC in urology consultations. RESULTS: Recommendations are made on the frequency of PSA determination and imaging tests in patients with nmCRPC. The importance of co-morbidities in patients with nmCRPC is also highlighted, and recommendations are also made on functional and QoL assessment that can be carried out during urology consultations. The efficacy, safety, and effects on QoL of new generation antiandrogens are reviewed. CONCLUSIONS: To evaluate treatment of patients with nmCRPC, it is necessary to consider co-morbidities and QoL, in addition to age. New generation antiandrogens are a safe and effective treatment option for patients with nmCRPC. The recommendations of this review can be helpful in optimizing the management of nmCRPC patients in urology consultations.

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ±â€¯16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ±â€¯13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ±â€¯18 mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. / Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

[Kaposis sarcoma in a renal graft]. / Sarcoma de Kaposi sobre injerto renal.

Kaposi's sarcoma is an infrequent tumor of unknown cause, but with a higher impact in immune depressed individuals, particularly in HIV and transplant patients. It usually appears as a benign cutaneous lesions, while the invasive visceral form is uncommon with malignant evolution and wit rare remission. We present a patient with a Kaposi's sarcoma localised in a renal graft and bad response even when immuno suppression was discontinued.

Safety and efficacy of various strains of bacille Calmette-Guérin in the treatment of bladder tumours in standard clinical practice. / Eficacia y seguridad de distintas cepas de BCG en el tratamiento del tumor vesical en práctica clínica habitual.

BACKGROUND: The natural progression of bladder tumours (nonmuscle-invasive bladder cancer [NMIBC]) is recurrence with a high rate of progression. Bacille Calmette-Guérin (BCG) has been shown effective in reducing these rates, but there are few comparative studies between strains. MATERIAL AND METHODS: An observational, prospective and multicentre registry studied 433 patients with a 12-month follow-up visit from 961 registered patients, assessing disease-free survival (DFS), progression-free survival (PFS) cancer-specific survival (CSS) and adverse effects. We studied the Tice, Russian, Tokyo, Connaught and RIVM strains. RESULTS: The sociodemographic data, NMIBC history, comorbidities, size, number, stage, grade, associated carcinoma in situ and transurethral resection were well balanced. DFS: There were 85 relapses (19.6%). The median DFS time was 20months. When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). LPS: There were 33 cases of progression (7.62%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.69). CSS: Seven patients died (1.68%). When comparing the various strains, we detected no statistically significant differences (log-rank test; P=.93). In terms of safety, 33.3% of the patients presented some type of adverse effect, mostly lower urinary symptoms (no urinary tract infections) <48h, >48h and haematuria. According to the Common Toxicity Criteria of the European Organisation for Research and Treatment of Cancer, 92.7% of the patients were grade1. There were no statistically significant differences between the strains. CONCLUSIONS: In this intermediate analysis, the risk of recurrence, progression, specific death and safety were independent of the BCG strain employed.

[Clinicopathological study of incidental cancer prostate in patients undergoing surgery for symptomatic diagnosis of BPH]. / Estudio clínico-patológico sobre el cancer de próstata incidental en pacientes intervenidos bajo el supuesto diagnóstico de HBP sintomática.

UNLABELLED: OBJECTIVES-INTRODUCTION: Retrospective study of a series of patients with prostate surgery (suprapubic prostate adenomectomy -APS-, and prostate transurethral resection -RTU-P-) for presumed BPH symptomatic non-respondent to the conservative medical treatment. Analysis of prevalence, incidence, clinical-pathological, treatment, tumor progression and evolution of the patients with incidental prostate cancer (CPI) detected. MATERIAL AND METHODS: 1593 patients with prostate surgery (APS and RTU-P) during 6 years (1996-2001) were revised. APS 35%, RTU-P 65%. Revision of all pathological anatomy of surgical specimens and the evolutions of the patients with CPI. RESULTS: 78 CPI; Prevalence 4,89%; Incidence 13 cases/year. Mean age 73.6 years. Digital rectal examination was normal in 100%, mean PSA 6 ng/ml (0.5-30). Group APS: 25 CPI (32%); prevalence 4.55%; incidence 4 cases/year; mean PSA 7.7 ng/ml (2.8-30); mean weight resection 65 gs. Group RTU-P: 53 CPI (68%); prevalence 5,07%; incidence 9 cases/year; mean PSA 5.2 ng/ml (0,5-29); mean weight resection 20 gs. 22% biopsy previously by high PSA, mean PSA 14 ng/ml (4,8-30). Gleason average 5 (mean 4.8), rank 3-8. pTla 66%, pTlb 33%. TREATMENT: 57% follow-up watched without treatment (wait and see); 18% hormonal treatment; 3% finasteride; 9% Radical Prostatectomy; 9% radiotherapy. Follow Lost 4%. Mean follow-up 47.19 months (12-96). Tumor progression 13.3% (10 patients). Specific CPI mortality 2.6% (2 patients). CONCLUSIONS: We didn't observe significant differences between the prevalence of CPI in both groups (APS and RTU-P). The detected tumours were mainly well differentiated and in stage pTla. In more than half of the cases an expectant attitude without treatment was decided. 13,3% of tumor progression after 47.19 months of follow mean and specific CPI mortality 2.6%.

[Idiopathic retroperitoneal fibrosis: combined steroid and endourologic treatment]. / Fibrosis retroperitoneal idiopática: tratamiento combinado esteroideo y endourológico.

Review of 7 patients with idiopathic retroperitoneal fibrosis (IRF), treated with a combination of corticosteroids (6-methyl-prednisolone) and endourological procedures. The presentation symptom was lumbar pain in all 7 cases. Mean creatinine (Cr) levels were 5.4 mg/dl, with mean erythrocyte sedimentation rate (ESR) of 114. Three (43%) patients were positive to rheumatoid factor (RF) and had raised IgG. Definite diagnosis was achieved in all cases by CAT, including puncture biopsy in 1; all 7 (100%) cases were bilateral. With an average follow-up of 3 years, clinical evolution is satisfactory in all 7 cases. Mean control Cr is 1.2 mg/dl and mean ESR 19. CAT showed disappearance of fibrotic plaque in all cases. One patient relapsed when maintenance therapy was discontinued but responded again to a new therapy course. No steroid therapy-related complications were seen. The association of conservative steroid therapy and endourological procedures is a very low morbidity, sensible alternative in the management of benign retroperitoneal fibrosis where CAT and MNR are the primary diagnostic techniques.

[Renal transplantectomy]. / Trasplantectomia renal.

During the first ten years (1981-1990) of our organ transplantation program a total of 395 Renal Transplants (RTx) have been carried out in our Unit, 90 of which in 88 patients had to be subsequently transplantectomized. In 32 of them the reason was acute rejection (35%) including 7 renal rhexis, and in 30 chronic rejection (33%) (1 rhexis). There were 22 (24%) (1 rhexis) vascular complications leading to such procedure. The technique was chosen mainly depending on the amount of time elapsed between transplantation and transplantectomy, performing 47 subcapsular and 43 extracapsular manoeuvres. The complications developed were 7 (7.7%), mostly haemorrhagic. Our attitude when faced with non-functioning grafts due to chronic rejection is the complete withdrawal of immunosuppression performing transplantectomy only in the event of arterial hypertension or in the presence of symptoms of acute rejection overimposition.

[Surgical management of renal cell carcinoma with vena cava-right atrium thrombus]. / Cirugía del carcinoma renal con trombo tumoral en vena cava-aurícula.

Historically the presence of a thrombus in vena cava was associated with worse prognosis in patients with renal cell carcinoma, and the effective of surgery limited. However a extensive tumor thrombi can be present without evidence of lymph node and distant metastasis, an aggressive surgical approach with curative intent is justified. We retrospectively reviewed 25 patients with renal cell carcinoma and thrombus in vena cava and they underwent radical nephrectomy and thrombectomy. The IRM allowed to know the level of the thrombus into vena cava in all patients: 56% level I, 8% level II, 26% level III. There were 14 pT3b, 8 pT3c, 3 pT4, and 48% N+. The rate of complications was 36% and there were 4 perioperative death (16%). Patients without lymph node and no distant metastasis had a mean survival of 64% 46%, 37% to 2, 3, 4 years respectively. Patients with lymph node invasive an distant metastasis the prognosis was poor. We no noted correlation between level thrombus and prognosis.

[Emphysematous pyelonephritis: report of a case and review of the literature]. / Pielonefritis enfisematosa: presentación de un caso y revisión de la literatura.

Emphysematous pyelonephritis is a necrotizing renal parenquima infection, which is diabetes mellitus related in almost all cases. This is life threatening and has a high mortality rates despite aggressive management. The most important thing in management is a high diagnostic suspicious and also a rapid treatment, which means nephrectomy. We expose a case giving especial importance to clinical and image diagnose as treatment and evolution. We also make a literature review trying to understand this entity and find pathways for its therapeutic management.

[Bladder metastases of pulmonary carcinoma. A report of 2 cases]. / Metástasis vesicales de carcinoma pulmonar. Presentación de dos casos.

Metastatic vesical tumours caused by blood- or lymph-borne neoplasias from any part of the body are extremely uncommon (less than 1% of vesical tumours), and even within this group lung tumours are the origin in a very small number of cases. Diagnosis usually happens in advanced stages due to the limited symptomatology exhibited. This paper refers two cases of vesical metastatic neoplasias from lung tumours, one an oat-cell anaplastic carcinoma and one epidermoid. Also, in the first one there was the peculiarity of haematuria being the early manifestation which lead to the diagnosis of lung neoplasia.

[Neural crest derived retroperitoneal tumors. General review]. / Tumores retroperitoneales derivados de la cresta neural. Revisión de conjunto.

Presentation of a series of 14 cases of neural crest derived tumours located in the retroperitoneal space in adult patients (five pheochromocytoma, six paraganglioma, two ganglioneuroma, and one neuroblastoma), and review and update of the diagnostic and therapeutic aspects. All pheochromocytoma cases presented high BP and the classic triad of sudation, tachycardia and headaches, as well as high levels of blood and urine catecholamines and/or their metabolites. CAT, ultrasound scanning and 123MIBG were the main diagnostic techniques used. All four paraganglioma were functioning and generally located surrounding both kidneys (one case was paired). No malignancy was found in any of the 11 tumours while controls remain with normal BP and normal levels of urine catecholamine metabolites. None of the two ganglioneuromas showed specific signs and symptoms but were diagnosed accidentally. The one neuroblastoma was juxtavesical showing a highly unfavourable evolution in spite of radical surgery, radiotherapy and multiple chemotherapy and the patient died within 16 months with local recurrence and haematogenous dissemination to bones and lungs.

[Conservative surgery for renal carcinoma]. / Cirugía conservadora en el carcinoma renal.

OBJECTIVES: To report on our experience in conservative surgery for renal cell carcinoma, pointing at indications, surgical techniques and results. We also make a review of the literature. MATERIAL AND METHODS: From 1975 until 1997, 231 patients underwent surgical treatment of renal cell carcinoma. In 17 cases conservative surgery was done. 11 patients were male and 6 female, with age range 33-78 years. Polar nephrectomy was done in 4 cases and tumorectomy in 13 cases. The indication was elective in 10 cases, and imperative in 7 due to: 4 bilateral carcinomas, 1 chronic renal failure, 1 von Hippel Lindau disease and 1 tumor associated with surgical lithiasis of the kidney. RESULTS: 58.8% of the patients did not have clinical symptoms and the diagnose was incidental. The average size of the tumors was 3.8 cm. The pathological stage was: 3 cases T1N0M0 and 12 T2N0M0. All the T1 cases had an incidental diagnose. The complications were: 1 urinary fistula, 1 haematoma, and 1 case of postoperative fever. All these complications were solved in a conservative way. We had tumoral recurrence in one patient affected with von Hippel Lindau disease. It appeared 4 years after the surgical procedure and required radical nephrectomy. One patient died 24 months after surgery because of causes not related with renal tumor. The rest of the patients are alive, with no tumoral recurrence, within an average follow-up of 49.6 months. None of the patients needed dialysis. CONCLUSIONS: Our experience, though not great is enough to demonstrate the benefits of conservative surgery for renal cell carcinoma. Partial nephrectomy in selected patients and with the appropriate surgical technique offers short-term results similar to those obtained with radical nephrectomy. It is indispensable to make the resection and intraoperative pathological study of a margin of renal parenchyma surrounding the tumor, and also to examine the whole surface of the kidney to search for satellite tumoral nodules. It is very important to do a close follow up of these patients after the surgery.

[A solitary cerebellar metastasis: a diagnostic exercise]. / Metástasis cerebelosa solitaria: un ejercicio diagnóstico.

Presentation of a solitary cerebellar mass lead us to think about the presence of a primary tumour or the possibility of a pulmonary, mammary or digestive metastasis. However, once discarded these origins, is necessary to search the primary neoplasms in less frequent organs. Approximately, 5% of all intracranial metastasis have it's origin in a renal cancer. These lesions generally appear at the supratentorial area and within a generalized disease. In the other hand, the presentation of a solitary cerebellar metastasis from a renal carcinoma without affectation of other organs is a very unusual fact. We present a case of these characteristics discussing about diagnostic, therapeutic and prognostic aspects of this unpredictable tumor.

[Paravesical tumor of adrenal gland residues]. / Tumor paravesical de restos adrenales.

Presentation of one case of ectopic suprarenal tissue residues' tumour found at paravesical level. The singularity of this diagnosis, unless hormonally active, or when very large in size, as well as its various locations is recalled. Ultrasound, CAT and hormone characterization are the mainstays to achieve clinical diagnosis. Surgery is always the course adopted. Only when such an option is unsuitable, drugs are used to block the steroidogenesis.

[Double-barreled wet colostomy: analysis of a urinary diversion]. / Colostomía húmeda en doble barra: análisis de una derivación.

We analyse our experience in performing the wet colostomy, also called urocolostomy and present seven cases treated at our hospital in which this was used. We present: a) three women, one underwent an urocolostomy as a result of a myelomeningocele with urinary and fecal incontinence, another because of a pelvic malignancy, and the third after developing a post radiotherapy cysto-proctitis; b) four men, one underwent this surgical procedure as a result of a traumatic paraplegia with multiple urinary fistulae and neurogenic bladder, the other three were secondary to pelvic malignancies (two bladder and one sigmoid malignacies). The outcome was fine in all cases with no pyelonephritis or metabolic imbalances; in all cases it represented a good option for these patients.