Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma.

OBJECTIVE: To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI). MATERIALS AND METHODS: Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications. RESULTS: Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR. CONCLUSIONS: Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification.

Indicaciones e histología de 489 orquiectomías analizadas según la edad del paciente / Indications and histology of 489 orchiectomies analyzed by patient age

Objetivo Evaluar indicaciones e histología de nuestra serie de orquiectomías, analizando los resultados dependiendo de la edad del paciente. Métodos Estudio de las orquiectomías realizadas en nuestro centro entre 2005 y 2020 a pacientes mayores de 18 años. Evaluamos: datos demográficos, indicaciones, histología y efectividad del diagnóstico ecográfico según 3 grupos de edad. Resultados Se realizaron 489 orquiectomías, 364 (74%) en los pacientes entre 18-50 años (grupo A), 59 (12%) entre los pacientes de 51-70 años (grupo B) y 66 (13,4%) en mayores de 70 años (grupo C). En el grupo A, 284 (78%) orquiectomías fueron indicadas por sospecha tumoral, 261/284 (91,9%) fueron neoplasias malignas, 253 (89%) germinales. La ecografía testicular tuvo un valor predictivo positivo (VPP) para tumor testicular maligno del 90%. En el grupo B, 34 (57%) orquiectomías fueron indicadas por sospecha tumoral y 25/34 (73,5%) presentaron neoplasias malignas. La ecografía tuvo un VPP para malignidad del 68%. En el grupo C, la orquiepididimitis fue la causa más frecuente de orquiectomía con 30 casos (45,5%). Entre las 20 orquiectomías por sospecha de tumor (30,3%), se encontró malignidad en 6. La ecografía tuvo un VPP para malignidad del 31%. Conclusión En menores de 70 años la indicación principal de orquiectomía fue la sospecha tumoral y en mayores, la orquiepididimitis. Los tumores germinales fueron la histología más frecuente en los menores de 70 años; en los mayores la malignidad fue infrecuente. Con la edad, disminuyó el VPP de la ecografía testicular para neoplasia maligna. En los mayores de 50 años se debería mejorar el proceso diagnóstico antes de indicar orquiectomía por sospecha tumoral (AU)

Objective To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. Methods We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. Results We included 489 orchiectomies, which 364 (74%) belonged to group A (patients between 18-50 years), 59 (12%) to group B (50-70 years) and 66 (14%) to group C (older than 70 years). In group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. Conclusion In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done (AU)

Indications and histology of 489 orchiectomies analyzed by patient age.

OBJECTIVE: To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. METHODS: We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. RESULTS: We included 489 orchiectomies, which 364 (74%) belonged to Group A (patients between 18-50 years), 59 (12%) to Group B (50-70 years) and 66 (14%) to Group C (older than 70 years). In Group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In Group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In Group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. CONCLUSION: In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done.

Los sistemas de clasificación de la OMS de 1973 y 2004 difieren en la predicción de supervivencia entre los pacientes con cáncer de vejiga en estadio T1 / The 1973 WHO and 2004 WHO grading systems are not equal in prediction of survival among stage T1 bladder cancer patients

Introducción y objetivos: El objetivo de este estudio fue analizar el impacto del grado histológico del tumor en la predicción de supervivencia de los tumores primarios T1 G2 y G3 OMS 1973, que han sido clasificados como HG (alto grado) en el sistema de clasificación OMS 2004. Materiales y métodos: Se revisaron retrospectivamente los datos de 481 pacientes con cáncer de vejiga T1HG primario, tratados entre 1986 y 2016 en 2 centros universitarios. Para comparar los grupos se realizaron pruebas de log-rank y análisis de regresión de Cox. Resultados: Noventa y cinco (19,8%) tumores fueron clasificados como G2 y 386 (80,2%) como G3. La mediana de seguimiento fue de 68 meses. Las tasas de recurrencia y progresión fueron 228 (47,5%) y 109 (22,7%) pacientes, respectivamente. Se realizó cistectomía radical en 114 pacientes (23,7%) y hubo 64 (13,3%) casos de muerte cáncer-específica. La tasa de supervivencia libre de recurrencia para G2, G3 y el total de los pacientes fue del 68,7, el 51,2 y el 56,3%, respectivamente, y la para tasa libre de progresión, se obtuvieron unos valores del 89,3, el 73,2 y el 78,1%. Durante todo el período de seguimiento, los pacientes con tumores G3 obtuvieron peores tasas de supervivencia libre de progresión y de recurrencia que los pacientes con tumores G2. En el análisis multivariante, después del ajuste de las características clínicas, el riesgo de recurrencia y progresión para los tumores G3 fue 1,65 y 2,42 veces mayor que para los tumores G2. Conclusiones: Se demostró que los tumores T1G3 se caracterizan por peores tasas de supervivencia libre de progresión y recurrencia en comparación con los cánceres G2

Introduction and objectives: The aim of this study was to analyse prognostic impact of tumour histological grade on survival differences between primary G2 and G3 WHO1973 stage T1 tumours which were graded as HG according to WHO2004 grading system. Materials and methods: Data from 481 patients with primary T1HG bladder cancer who were treated between 1986 and 2016 in 2 university centres were retrospectively reviewed. Log-rank test and Cox regression analysis was performed to compare the groups. Results: 95 (19,8%) tumours were classified as G2 and 386 (80,2%) were G3. Median follow-up was 68 months. The recurrence was observed in 228 (47,5%), and progression in 109 patients (22,7%). Radical cystectomy was performed in 114 pts (23,7%) and there were 64 (13,3%) cancer specific deaths. Recurrence-free rates at 5-years follow-up for G2, G3 and all patients were 68,7%, 51,2% and 56,3% and progression-free rates were 89,3%, 73,2% and 78,1% respectively. For total observation period patients with G3 tumours presented also worse recurrence-free, and progression-free survival levels than patients with G2 tumours. In multivariate analysis, after adjustment for clinical features, the risk of recurrence and progression for G3 tumours was 1,65 and 2,42 fold higher than for G2 tumours. Conclusions: It was shown that G3 T1 tumours are characterized by worse recurrence free and progression free survivals when compared to G2 cancers

The 1973 WHO and 2004 WHO grading systems are not equal in prediction of survival among stage T1 bladder cancer patients. / Los sistemas de clasificación de la OMS de 1973 y 2004 difieren en la predicción de supervivencia entre los pacientes con cáncer de vejiga en estadio T1.

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyse prognostic impact of tumour histological grade on survival differences between primary G2 and G3 WHO1973 stage T1 tumours which were graded as HG according to WHO2004 grading system. MATERIALS AND METHODS: Data from 481 patients with primary T1HG bladder cancer who were treated between 1986 and 2016 in 2university centres were retrospectively reviewed. Log-rank test and Cox regression analysis was performed to compare the groups. RESULTS: 95 (19,8%) tumours were classified as G2 and 386 (80,2%) were G3. Median follow-up was 68 months. The recurrence was observed in 228 (47,5%), and progression in 109 patients (22,7%). Radical cystectomy was performed in 114 pts (23,7%) and there were 64 (13,3%) cancer specific deaths. Recurrence-free rates at 5-years follow-up for G2, G3 and all patients were 68,7%, 51,2% and 56,3% and progression-free rates were 89,3%, 73,2% and 78,1% respectively. For total observation period patients with G3 tumours presented also worse recurrence-free, and progression-free survival levels than patients with G2 tumours. In multivariate analysis, after adjustment for clinical features, the risk of recurrence and progression for G3 tumours was 1,65 and 2,42 fold higher than for G2 tumours. CONCLUSIONS: It was shown that G3 T1 tumours are characterized by worse recurrence free and progression free survivals when compared to G2 cancers.

HIF pathway and c-Myc as biomarkers for response to sunitinib in metastatic clear-cell renal cell carcinoma.

BACKGROUND: Clear-cell renal cell carcinoma (ccRCC) is a heterogeneous disease with a different clinical behavior and response to targeted therapies. Differences in hypoxia-inducible factor (HIF) expression have been used to classify von Hippel-Lindau gene (VHL)-deficient ccRCC tumors. c-Myc may be driving proliferation in HIF-2α-expressing tumors in a growth factor-independent manner. OBJECTIVE: To explore the HIF-1α, HIF-2α and c-Myc baseline expression as potential predictors of sunitinib outcome as well as the effectiveness and safety with sunitinib in patients with metastatic ccRCC in routine clinical practice. METHODS: This was an observational and prospective study involving 10 Spanish hospitals. Formalin-fixed, paraffin-embedded primary tumor samples from metastatic ccRCC patients who received sunitinib as first-line treatment were analyzed. Association between biomarker expression and sunitinib treatment outcomes was evaluated. Kaplan-Meier method was applied to measure progression-free survival (PFS) and overall survival. RESULTS: Eighty-one patients were included: median PFS was 10.8 months (95% CI: 7.4-13.5 months), median overall survival was 21.8 months (95% CI: 14.7-29.8 months) and objective response rate was 40.7%, with 7.4% of patients achieving a complete response. Molecular marker staining was performed in the 69 available tumor samples. Significant association with lower PFS was identified for double c-Myc/HIF-2α-positive staining tumors (median 4.3 vs 11.5 months, hazard ratio =2.64, 95% CI: 1.03-6.80, P=0.036). A trend toward a lower PFS was found in positive c-Myc tumors (median 5.9 vs 10.9 months, P=0.263). HIF-1α and HIF-2α expression levels were not associated with clinical outcome. CONCLUSION: These preliminary results suggest that predictive subgroups might be defined based on biomarkers such as c-Myc/HIF-2α. Further validation with more patients will be needed in order to confirm it. Outcomes with sunitinib in metastatic ccRCC in daily clinical practice resemble those obtained in clinical trials.

Resonancia magnética multiparamétrica y cáncer de próstata: ¿qué hay de nuevo? / Multiparametric magnetic resonance imaging and prostate cancer: what's new?

La resonancia magnética multiparamétrica (RMmp) prostática ha tenido recientemente un extenso desarrollo, convirtiéndose en una herramienta clave en el diagnóstico y la toma de decisiones terapéuticas en relación al carcinoma prostático (CaP). El rápido desarrollo tecnológico, así como de lectura (PIRADS V2), exigen una permanente actualización del conocimiento en esta área. El objetivo de este artículo es presentar una revisión actualizada sobre los aspectos técnicos, los modelos de lectura y las indicaciones de la RMmp prostática en relación al CaP, en el marco de una visión multidisciplinaria. Actualmente está establecida la utilidad de la RMmp ante un antígeno específico de próstata elevado y una biopsia prostática previa negativa; para estadificación tumoral; en la evaluación de candidatos a vigilancia activa; en la planificación de tratamientos focales y para la evaluación de la recurrencia tumoral. Otras indicaciones, como su uso en pacientes con sospecha de CaP pero sin biopsia previa, aunque se realizan en algunos centros, aún requieren una exhaustiva valoración coste-beneficio para extender su empleo (AU)

Prostatic multi-parametric magnetic resonance imaging (MP-MRI) has recently had a wide development becoming a key tool in the diagnostic and therapeutic decisions in prostate cancer (Pca). The fast development both in technology and in reading (PIRADS V2) requires a continuous updating of knowledge within this area. The aim of this article is to present an updated revision of technical aspects, reading patterns and prostatic MP-MRI in Pca, with a multidisciplinary approach. Currently guidelines establish the use of the MP-MRI when there is a high PSA and a negative prostatic biopsy; tumor staging; evaluation in candidates to active surveillance; focal treatments plans and tumoral recurrence evaluation. Although it is used in other indications in some centers, like its use in patients suspicious of Pca but with no previous biopsy, there is still the need of a cost/benefit assessment for its use to be wider (AU)

Acumulación de adipocitos en el cuerpo cavernoso: primera evidencia clínica e implicaciones fisiopatológicas en la disfunción eréctil / Adipocyte accumulation in corpus cavernosum: first clinical evidence and pathophysiological implications in erectile dysfunction

Objetivo: Modelos animales han demostrado que existe una asociación entre disfunción eréctil y acumulación de grasa bajo la albugínea del pene, pudiendo provocar fuga venosa y pérdida de rigidez del pene. En este estudio se llevó a cabo una comparación de la histología de los cuerpos cavernosos bajo la albugínea de pacientes con disfunción eréctil refractarios a tratamiento médico sometidos a implante de prótesis de pene, y pacientes con enfermedad de Peyronie, sin disfunción eréctil, sometidos a corporoplastia. Materiales y métodos: Se incluyeron 17 pacientes con disfunción eréctil y 14 pacientes potentes con enfermedad de Peyronie. Se recolectaron muestras de tejido cavernoso bajo la túnica albugínea en cada cirugía, las cuales fueron analizadas por un uropatólogo en búsqueda de adipocitos subalbugíneos. Se llevó a cabo un análisis bivariado para comparar características de ambos grupos. Se calcularon las odds ratio con un modelo multivariado de regresión logística. Un valor de p < 0,05 fue considerado significativo. Resultados: Once pacientes (11/17) en el grupo de disfunción eréctil presentaron adipocitos en la histología, mientras solo un paciente (1/14) lo presentó en el grupo control (p < 0,05). El análisis multivariado mostró una odds ratio de 40,72; IC 95%: 2,28-727,29 (p = 0,012). Conclusiones: Alteraciones en los andrógenos provocan cambios estructurales en el pene, llevando a apoptosis y desdiferenciación de músculo trabecular hacia adipocitos. Este es el primer estudio prospectivo en humanos que muestra una asociación entre grasa subalbugínea y disfunción eréctil. La fuga venosa secundaria a este fenómeno podría influir en la disfunción eréctil, especialmente en pacientes que no responden a tratamiento médico

Objectives: Animal models have shown that erectile dysfunction is associated with adipocyte accumulation under tunica albugínea, which could be involved in venous leakage and loss of penile rigidity. In the current sudy, we compared the histology of the penile sub-albuginean region of drug-refractory erectile dysfunction patients undergoing penile prosthesis implantation with potent patients with Peyronie's disease undergoing curvature correction procedures. Materials and methods. Seventeen refractory erectile dysfunction patients and fourteen potent patients with Peyronie's disease were recruited. Sub-albuginean tissue samples were taken in each surgery. An expert uropathologist analysed each section. A bivariate analysis was performed. Multivariate logistic regression was used to calculate adjusted odds ratios; P value <.05 was considered significant. Results: Eleven patients (11/17) in the case group presented cavernous fat cell accumulation, while only one patient (1/14) in the control group presented this finding (P < .05). Adjusted odds ratio for erectile dysfunction was 40.72; 95% CI 2.28-727.29 (P = .012). Conclusions: Different studies have shown that androgen disruption could be involved in penile structural changes, leading to trabecular smooth muscle apoptosis and trans or de-differentiation into adipocytes. This is the first prospective study in humans to report an association between erectile dysfunction and sub-albuginean adipocyte accumulation. Venous leakage secondary to this phenomenon could be a factor in the pathophysiology of erectile dysfunction, especially in patients that do not respond to medical therapy

Multiparametric magnetic resonance imaging and prostate cancer: what's new? / Resonancia magnética multiparamétrica y cáncer de próstata: ¿qué hay de nuevo?

Prostatic multi-parametric magnetic resonance imaging (MP-MRI) has recently had a wide development becoming a key tool in the diagnostic and therapeutic decisions in prostate cancer (Pca). The fast development both in technology and in reading (PIRADS V2) requires a continuous updating of knowledge within this area. The aim of this article is to present an updated revision of technical aspects, reading patterns and prostatic MP-MRI in Pca, with a multidisciplinary approach. Currently guidelines establish the use of the MP-MRI when there is a high PSA and a negative prostatic biopsy; tumor staging; evaluation in candidates to active surveillance; focal treatments plans and tumoral recurrence evaluation. Although it is used in other indications in some centers, like its use in patients suspicious of Pca but with no previous biopsy, there is still the need of a cost/benefit assessment for its use to be wider.

Vimentin over-expression and carbonic anhydrase IX under-expression are independent predictors of recurrence, specific and overall survival in non-metastatic clear-cell renal carcinoma: a validation study.

PURPOSE: Clinical outcomes prognostic markers are awaited in clear-cell renal carcinoma (ccRCC) to improve patient-tailored management and to assess six different markers' influence on clinical outcomes from ccRCC specimen and their incremental value combined with TNM staging. MATERIALS AND METHODS: This is a retrospective, multicenter study. One hundred and forty-three patients with pT1b-pT3N0M0 ccRCC were included. Pathology specimens from surgeries were centrally reviewed, mounted on a tissue micro-array and stained with six markers: CAIX, c-MYC, Ki67, p53, vimentin and PTEN. Images were captured through an Ultra Fast Scanner. Tumor expression was measured with Image Pro Plus. Cytoplasmic markers (PTEN, CAIX, vimentin, c-MYC) were expressed as surface percentage of expression. Nuclear markers (Ki67, p53) were expressed as number of cells/mm2. Clinical data and markers expression were compared with clinical outcomes. Each variable was included in the Cox proportional multivariate analyses if p < 0.10 on univariate analyses. Discrimination of the new marker was calculated with Harrell's concordance index. RESULTS: At median follow-up of 63 months (IQR 35.0-91.8), on multivariate analysis, CAIX under-expression and vimentin over-expression were associated with worse survival (recurrence, specific and overall survival). A categorical marker CAIX-/Vimentin+ with cutoff points for CAIX and vimentin of 30 and 50 %, respectively, was designed. The new CAIX-/Vimentin+ marker presented a good concordance and comparable calibration to the reference model. Limitations are the retrospective design, the need for external validation and the large study period. CONCLUSION: Using an automated technique of measurement, CAIX and vimentin are independent predictors of clinical outcomes in ccRCC.

Adipocyte accumulation in corpus cavernosum: First clinical evidence and pathophysiological implications in erectile dysfunction. / Acumulación de adipocitos en el cuerpo cavernoso: primera evidencia clínica e implicaciones fisiopatológicas en la disfunción eréctil.

OBJECTIVES: Animal models have shown that erectile dysfunction is associated with adipocyte accumulation under tunica albugínea, which could be involved in venous leakage and loss of penile rigidity. In the current sudy, we compared the histology of the penile sub-albuginean region of drug-refractory erectile dysfunction patients undergoing penile prosthesis implantation with potent patients with Peyronie's disease undergoing curvature correction procedures. MATERIALS AND METHODS: Seventeen refractory erectile dysfunction patients and fourteen potent patients with Peyronie's disease were recruited. Sub-albuginean tissue samples were taken in each surgery. An expert uropathologist analysed each section. A bivariate analysis was performed. Multivariate logistic regression was used to calculate adjusted odds ratios; P value<.05 was considered significant. RESULTS: Eleven patients (11/17) in the case group presented cavernous fat cell accumulation, while only one patient (1/14) in the control group presented this finding (P<.05). Adjusted odds ratio for erectile dysfunction was 40.72; 95% CI 2.28-727.29 (P=.012). CONCLUSIONS: Different studies have shown that androgen disruption could be involved in penile structural changes, leading to trabecular smooth muscle apoptosis and trans or de-differentiation into adipocytes. This is the first prospective study in humans to report an association between erectile dysfunction and sub-albuginean adipocyte accumulation. Venous leakage secondary to this phenomenon could be a factor in the pathophysiology of erectile dysfunction, especially in patients that do not respond to medical therapy.

Preguntas y respuestas sobre resonancia magnética multiparamétrica prostática: todo lo que el urólogo debe conocer / Questions and answers on prostate multiparameter magnetic resonance imaging: Everything a urologist should know

Contexto: Durante muchos años, la detección del carcinoma prostático (CaP) y su manejo terapéutico se basó fundamentalmente en el antígeno prostático específico, el tacto rectal y la biopsia prostática. Sin embargo, estos parámetros poseen conocidas limitaciones. La resonancia magnética multiparamétrica (RMmp) prostática ha tenido en los últimos años un extenso desarrollo, aportando información morfológica y funcional. El objetivo es presentar una revisión actualizada de los alcances y las limitaciones de la RMmp prostática en relación con el CaP, en el marco de una visión multidisciplinaria. Adquisición de evidencia: Se realizó una revisión de la literatura en PubMed, de los artículos referidos a «RMmp/Estadificación/CaP/detección/vigilancia activa/planificación terapéutica/posterapeútica». Se incluyeron 4 revisiones sistemáticas y otros artículos publicados en revistas de alto factor de impacto dentro del área de Radiología y Urología. Síntesis de evidencia: La RMmp aporta información morfológica y funcional respecto al CaP. Esta información está integrada en el modelo de lectura Prostate Imaging Reporting and Data System, clasificándose la probabilidad de carcinoma clínicamente significativo en una escala del 1 al 5. Actualmente está establecida la utilidad de la RMmp en pacientes con antígeno prostático específico elevado y biopsia prostática previa negativa; estadificación tumoral en casos seleccionados; evaluación en los pacientes candidatos a vigilancia activa; planificación de tratamientos focales y evaluación de la persistencia o recurrencia tumoral. Conclusiones: La RMmp actualmente cumple un papel relevante en el diagnóstico y la toma de decisiones terapéuticas del CaP. El uso aún más extendido de la técnica requerirá una valoración coste/beneficio

Context: For many years, the detection of prostate cancer (PC) and the management of its therapy have been based primarily on prostate-specific antigen, rectal examination and prostate biopsy. However, these parameters have known limitations. Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer has undergone extensive development in recent years, providing morphological and functional information. The aim of this study is to present an updated review of the scope and limitations of prostatic mpMRI for PC, in the framework of a multidisciplinary vision. Acquisition of evidence: We conducted a literature review (in PubMed) of articles referencing «mpMRI/staging/ PC/detection/active surveillance/therapy planning/post-therapy». We included 4 systematic reviews and other articles published in high impact-factor journals within the field of radiology and urology. Summary of the evidence: MpMRI provides morphological and functional information concerning PC. This information is integrated into the Prostate Imaging Report and Date System, classifying the probability of clinically significant carcinoma on a scale from 1 to 5. The usefulness of mpMRI is currently being established for patients with high prostate-specific antigen levels and prior negative prostate biopsy; tumour staging in selected cases; assessment of patients who are candidates for active surveillance; the planning of focal treatments; and the assessment of tumour persistence and recurrence. Conclusions: MpMRI currently fills a relevant role in the diagnosis and therapeutic decision-making of PC. More widespread use of the technique requires a cost/benefit analysis

Follow-up after focal therapy in renal masses: an international multidisciplinary Delphi consensus project.

PURPOSE: To establish consensus on follow-up (FU) after focal therapy (FT) in renal masses. To formulate recommendations to aid in clinical practice and research. METHODS: Key topics and questions for consensus were identified from a systematic literature research. A Web-based questionnaire was distributed among participants selected based on their contribution to the literature and/or known expertise. Three rounds according to the Delphi method were performed online. Final discussion was conducted during the "8th International Symposium on Focal Therapy and Imaging in Prostate and Kidney Cancer" among an international multidisciplinary expert panel. RESULTS: Sixty-two participants completed all three rounds of the online questionnaire. The panel recommended a minimum follow-up of 5 years, preferably extended to 10 years. The first FU was recommended at 3 months, with at least two imaging studies in the first year. Imaging was recommended biannually during the second year and annually thereafter. The panel recommended FU by means of CT scan with slice thickness ≤3 mm (at least three phases with excretory phase if suspicion of collecting system involvement) or mpMRI. Annual checkup for pulmonary metastasis by CT thorax was advised. Outside study protocols, biopsy during follow-up should only be performed in case of suspicion of residual/persistent disease or radiological recurrence. CONCLUSIONS: The consensus led to clear FU recommendations after FT of renal masses supported by a multidisciplinary expert panel. In spite of the low level of evidence, these recommendations can guide clinicians and create uniformity in the follow-up practice and for clinical research purposes.

Questions and answers on prostate multiparameter magnetic resonance imaging: Everything a urologist should know. / Preguntas y respuestas sobre resonancia magnética multiparamétrica prostática: todo lo que el urólogo debe conocer.

CONTEXT: For many years, the detection of prostate cancer (PC) and the management of its therapy have been based primarily on prostate-specific antigen, rectal examination and prostate biopsy. However, these parameters have known limitations. Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer has undergone extensive development in recent years, providing morphological and functional information. The aim of this study is to present an updated review of the scope and limitations of prostatic mpMRI for PC, in the framework of a multidisciplinary vision. ACQUISITION OF EVIDENCE: We conducted a literature review (in PubMed) of articles referencing "mpMRI/staging/ PC/detection/active surveillance/therapy planning/post-therapy". We included 4 systematic reviews and other articles published in high impact-factor journals within the field of radiology and urology. SUMMARY OF THE EVIDENCE: MpMRI provides morphological and functional information concerning PC. This information is integrated into the Prostate Imaging Report and Date System, classifying the probability of clinically significant carcinoma on a scale from 1 to 5. The usefulness of mpMRI is currently being established for patients with high prostate-specific antigen levels and prior negative prostate biopsy; tumour staging in selected cases; assessment of patients who are candidates for active surveillance; the planning of focal treatments; and the assessment of tumour persistence and recurrence. CONCLUSIONS: MpMRI currently fills a relevant role in the diagnosis and therapeutic decision-making of PC. More widespread use of the technique requires a cost/benefit analysis.

Infecciones de transmisión sexual en el varón: actitud práctica diagnóstico-terapéutica / STDs in men: diagnostic-therapeutic practical attitude

Las infecciones de transmisión sexual (ITS) son un grupo de enfermedades que afectan a la población que mantiene actividad sexual. Su distribución es muy amplia y afecta a ambos géneros. Para las uretritis por clamidia, ureaplasma y gonococo se utilizan cada vez más las pruebas de ampliación genómica como el test de reacción en cadena de la polimerasa (PCR). La balanitis por gardnerella y candida se diagnostican con cultivo de secreción y se tratan con terapia médica. Para el diagnóstico de la sifilis siguen en vigor las pruebas (reagínicas) como VDRL y las RPR y las treponémicas (no reagínicas) como FTA y TPHA. El tratamiento de todas ellas es antibiótico e incluye a las parejas. El herpes simple (VHS) se diagnostica clínicamente. La serología confirma el diagnóstico. El tratamiento con antivirales mejora el pronóstico. El virus del papiloma humano (VPH) se trata con eliminación química o física de las lesiones. El molusco contagioso se extirpa mecánicamente. En este trabajo se revisa el diagnóstico y el tratamiento práctico de las principales ITS que afectan al género masculino (AU)

Sexually Transmitted Infections (STIs) are a group of diseases affecting population that keeps sexual activity. Their distribution is very wide and affects both sexes. For urethritis chlamydia, ureaplasma and gonococcus genomic tests enlargement as test chain reaction (PCR) are used increasingly. The gardnerela and candida balanitis are diagnosed with secretion culture and treated with medical therapy. For the diagnosis of syphilis remain in reaginic and no reaginic tests). Treatment of these is antibiotic and includes couples. Herpes simplex virus (HSV) is diagnosed clinically. Serology confirms the diagnosis. Antiviral treatment improves prognosis. The Human Papilloma Virus (HPV) is treated with chemical or physical removal of the lesions. Molluscum contagiosum is removed mechanically. In this paper practical diagnosis and treatment of major ITS affecting male is reviewed (AU)

Terapia focal en cáncer de próstata. Racionalidad, indicaciones y selección / Focal Therapy for Prostate Cancer. Rationale, Indications and Selection

Contexto: El tratamiento del cáncer de próstata localizado está sujeto a gran controversia en lo referente a sus posibilidades de tratamiento, radical o seguimiento activo. El objetivo de este trabajo es analizar la racionalidad de la terapia focal, selección de tumores y pacientes en el entorno de las alternativas existentes. Adquisición de evidencia: Revisamos la literatura actual en Medline, relacionada con las ventajas e inconvenientes sobre el tratamiento de cáncer de próstata localizado, así como la información publicada sobre la terapia focal en referencia a la selección de tumores, características e indicaciones para terapia focal. Síntesis de evidencia: Los tumores de bajo riesgo, PSA < 10-15, Gleason ≤ 6, junto con las biopsias guiadas apoyadas con la resonancia magnética nuclear (RMN) y la unilateralidad deben ser el estándar para dicha selección. Existen dudas sobre la conveniencia de la terapia focal en los casos de bilateridad o aquellos de Gleason 3 + 4 o PSA > 15. Conclusiones: La terapia focal puede ser una alternativa para tratar el cáncer de próstata localizado, si bien algunos de sus aspectos diagnósticos y de selección deberán ser definidos por estudios prospectivos, que esperamos nos puedan aportar conocimiento sobre la indicación de la terapia focal

Context: The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection. Evidence acquisition: Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumor selection, characteristics and indications cited in MEDLINE search were reviewed. Summary of evidence: Focal therapy standardized criteria must be: low risk tumors, PSA < 10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3 + 4 or PSA > 15. Conclusions: Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy

Altered gene expression signature of early stages of the germ line supports the pre-meiotic origin of human spermatogenic failure.

The molecular basis of spermatogenic failure (SpF) is still largely unknown. Accumulating evidence suggests that a series of specific events such as meiosis, are determined at the early stage of spermatogenesis. This study aims to assess the expression profile of pre-meiotic genes of infertile testicular biopsies that might help to define the molecular phenotype associated with human deficiency of sperm production. An accurate quantification of testicular mRNA levels of genes expressed in spermatogonia was carried out by RT-qPCR in individuals showing SpF owing to germ cell maturation defects, Sertoli cell-only syndrome or conserved spermatogenesis. In addition, the gene expression profile of SpF was compared with that of testicular tumour, which is considered to be a severe developmental disease of germ cell differentiation. Protein expression from selected genes was evaluated by immunohistochemistry. Our results indicate that SpF is accompanied by differences in expression of certain genes associated with spermatogonia in the absence of any apparent morphological and/or numerical change in this specific cell type. In SpF testicular samples, we observed down-regulation of genes involved in cell cycle (CCNE1 and POLD1), transcription and post-transcription regulation (DAZL, RBM15 and DICER1), protein degradation (FBXO32 and TM9SF2) and homologous recombination in meiosis (MRE11A and RAD50) which suggests that the expression of these genes is critical for a proper germ cell development. Interestingly, a decrease in the CCNE1, DAZL, RBM15 and STRA8 cellular transcript levels was also observed, suggesting that the gene expression capacity of spermatogonia is altered in SpF contributing to an unsuccessful sperm production. Altogether, these data point to the spermatogenic derangement being already determined at, or arising in, the initial stages of the germ line.

Perfil de expresión génica en el cáncer de próstata: identificación de marcadores candidatos para el diagnóstico no invasivo / Gene expression profiles in prostate cancer: Identification of candidate non-invasive diagnostic markers

Objetivo: Analizar los perfiles de expresión génica del cáncer de próstata (CaP) e identificar los genes diferencialmente expresados. Determinar si la expresión diferencial en tejido se mantiene en muestras de orina-posmasaje prostático (PMP). Material y métodos: Un total de 46 muestras de tejido prostático (36 de pacientes con CaP y 10 controles) y 158 orinas-PMP (113 de pacientes con CaP y 45 controles) se recogieron entre diciembre de 2003 y mayo de 2007. Se utilizaron microarrays de ADN para identificar los genes diferencialmente expresados entre las muestras de tejido tumorales y las controles. Diez genes fueron seleccionados para la validación técnica de los microarrays en las mismas muestras tisulares mediante PCR cuantitativa (RT-qPCR). Se seleccionaron 42 genes para ser validados en muestras de orina-PMP mediante RT-qPCR. Resultados: El gráfico de escalado multidimensional mostró una clara separación entre las muestras de tejido tumorales y las controles. Se han identificado 1.047 genes diferencialmente expresados (FDR ≤ 0,1) entre los 2 grupos. La correlación entre los datos de microarrays y RT-qPCR fue alta (r = 0,928, p < 0,001). Trece genes mantuvieron el mismo sentido de expresión diferencial al ser analizados en orinas-PMP y 4 de ellos (HOXC6, PCA3, PDK4 y TMPRSS2-ERG) mostraron diferencias de expresión estadísticamente significativas entre orinas-PMP tumorales y controles (p < 0,05). Conclusión: Existe un perfil de expresión génica diferencial en el CaP. Aunque la extrapolación de la expresión génica obtenida en tejido prostático a orina-PMP se debe realizar con precaución, el análisis del tejido prostático permite la identificación de nuevos biomarcadores para diagnóstico no invasivo del CaP

Objective: To analyze gene expression profiles of prostate cancer (PCa) with the aim of determining the relevant differentially expressed genes and subsequently ascertain whether this differential expression is maintained in post-prostatic massage (PPM) urine samples. Material and methods: Forty-six tissue specimens (36 from PCa patients and 10 controls) and158 urine PPM-urines (113 from PCa patients and 45 controls) were collected between December 2003 and May 2007. DNA microarrays were used to identify genes differentially expressed between tumour and control samples. Ten genes were technically validated in the same tissue samples by quantitative RT-PCR (RT-qPCR). Forty two selected differentially expressed genes were validated in an independent set of PPM-urines by qRT-PCR. Results: Multidimensional scaling plot according to the expression of all the microarray genes showed a clear distinction between control and tumour samples. A total of 1047 differentially expressed genes (FDR≤0.1) were indentified between both groups of samples. We found a high correlation in the comparison of microarray and RT-qPCR gene expression levels (r = 0.928,P < 0.001). Thirteen genes maintained the same fold change direction when analyzed in PPM urine samples and in four of them (HOXC6, PCA3, PDK4 and TMPRSS2-ERG), these differences were statistically significant (P < 0.05). Conclusion: The analysis of PCa by DNA microarrays provides new putative mRNA markers for PCa diagnosis that, with caution, can be extrapolated to PPM-urines