[Can a single value of a perypheric inflammatory response marker predict the response to BCG?] / Ratios neutrófilo/linfocito y plaqueta/linfocito: ¿Se asocian con la respuesta al tratamiento con BCG en tumores vesicales no músculoinvasivos de alto grado?

OBJECTIVES: To evaluate the association of neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses in patients with initial diagnosis of non/muscle invasive bladder tumor high-risk (NMIBC). MATERIAL AND METHODS: Retrospective multicenter study on patients with initial diagnosis of high-grade NMIBC treated with BCG between January 2016 and December 2017. Initially a total of 74 patients were collected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded. Induction BCG (x6) and BCG maintenance schedules were administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR) before BCG instillation were collected. Response to treatment was defined as absence of recurrence and/ or progression. A statistical analysis with T-student, Chi square, ANOVA and ROC curves was performed. RESULTS: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70 year old. All patients had pure urothelial carcinoma, 12 with pTa and 38 with pT1. Median follow-up was 24 months. A total of 28% had a recurrence. No correlation between NLR or PLR and BCG response was observed (p=0.738; p= 0.768). Neither a cut off was established through ROC curves. At multivariate analysis, there was no significative relationship between recurrence and the clinical and blood samples analyzed (sec, age, BMI, NLR, PLR)CONCLUSION: No correlation between NLR and PLR has been reported with BCG response on high-grade NMIBC.

OBJETIVOS: Evaluar la asociación de la ratio neutrófilo/linfocito (RNL) y ratio plaqueta/linfocito (RPL) con la respuesta al tratamiento mediante instilaciones de Bacilo Calmette Guerin (BCG) intravesical, en pacientes con diagnóstico inicial de tumor vesical no músculo-invasivos (TVNMI) de alto riesgo.MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico con pacientes diagnosticados de tumor vesical inicial de alto riesgo y sometidos a instilaciones endovesicales con BCG entre enero 2016 y diciembre 2017. Inicialmente se recogieron 74 pacientes con tumor vesical inicial. Se excluyeron aquellos sin estirpe urotelial pura, con carcinoma in situ (Cis) asociado, con tratamientos corticoideos crónicos y perdidos durante el seguimiento. Instilamos dosis completa de BCG (81mg) con pauta de inducción (6 dosis) y mantenimiento (9 dosis) durante un año. Se recogieron variables demográficas (sexo, edad e índice de masa corporal) y analíticas (RNL y RPL) previas al inicio del tratamiento con BCG. Definimos respuesta al tratamiento como ausencia de recidiva y/o progresión. Se realizó análisis estadístico mediante t de student, Chi cuadrado, ANOVA y curvas ROC. RESULTADOS: La cohorte del estudio incluyó finalmente 50 pacientes: 10 mujeres y 40 varones, con una edad media de 70 años. Todos estos pacientes tenían tumor urotelial puro alto grado, 12 de ellos estadio Ta y 38 estadio T1. El seguimiento mínimo fue de 24 meses, presentando recidiva tumoral un 28% de los pacientes. No se encontró relación entre RNL y éxito de la BCG (p=0,738) ni entre RPL y éxito de BCG (p=0,768). Tampoco pudimos establecer un punto de corte mediante curvas ROC. En el análisis multivariante, no encontramos significación estadística entre la recidiva tumoral y los datos analizados (Variables demográficas: Edad, sexo, índice de masa corporal y variables analíticas: RNL/RPL).CONCLUSIÓN: Pese a lo descrito en la literatura, no hemos encontrado asociación entre la RNL ni la RPL con la respuesta al tratamiento con BCG en TVNMI de alto riesgo.

Ratios neutrófilo/linfocito y plaqueta/linfocito: ¿se asocian con la respuesta al tratamiento con bcg en tumores vesicales no músculoinvasivos de alto grado? / Neutrophil/lymphocyte and platelet/lymphocyte ratios: are they associated with response to bcg treatment in high-grade non-muscle-invasive bladder tumors?

Objetivos: Evaluar la asociación de laratio neutrófilo/linfocito (RNL) y ratio plaqueta/linfocito(RPL) con la respuesta al tratamiento mediante instilaciones de Bacilo Calmette Guerin (BCG) intravesical, enpacientes con diagnóstico inicial de tumor vesical nomúsculo-invasivos (TVNMI) de alto riesgo.Material y métodos: Estudio retrospectivo multicéntrico con pacientes diagnosticados de tumor vesicalinicial de alto riesgo y sometidos a instilaciones endovesicales con BCG entre enero 2016 y diciembre2017. Inicialmente se recogieron 74 pacientes contumor vesical inicial. Se excluyeron aquellos sin estirpeurotelial pura, con carcinoma in situ (Cis) asociado, con tratamientos corticoideos crónicos y perdidos durante elseguimiento. Instilamos dosis completa de BCG (81mg)con pauta de inducción (6 dosis) y mantenimiento (9 dosis) durante un año. Se recogieron variables demográficas (sexo, edad e índice de masa corporal) y analíticas(RNL y RPL) previas al inicio del tratamiento con BCG.Definimos respuesta al tratamiento como ausencia derecidiva y/o progresión. Se realizó análisis estadísticomediante t de student, Chi cuadrado, ANOVA y curvasROC.Resultados: La cohorte del estudio incluyó finalmente50 pacientes: 10 mujeres y 40 varones, con una edadmedia de 70 años. Todos estos pacientes tenían tumorurotelial puro alto grado, 12 de ellos estadio Ta y 38estadio T1. El seguimiento mínimo fue de 24 meses,presentando recidiva tumoral un 28% de los pacientes.No se encontró relación entre RNL y éxito de la BCG(p=0,738) ni entre RPL y éxito de BCG (p=0,768). Tampoco pudimos establecer un punto de corte mediantecurvas ROC.En el análisis multivariante, no encontramos significación estadística entre la recidiva tumoral y los datos analizados (Variables demográficas: Edad, sexo, índice demasa corporal y variables analíticas: RNL/RPL).Conclusion: Pese a lo descrito en la literatura, nohemos encontrado asociación entre la RNL ni la RPL con...(AU)

Objetives: To evaluate the associationof neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses inpatients with initial diagnosis of non/muscle invasivebladder tumor high-risk (NMIBC).Materials and methods: Retrospective multicenterstudy on patients with initial diagnosis of high-gradeNMIBC treated with BCG between January 2016 andDecember 2017. Initially a total of 74 patients werecollected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded.Induction BCG (x6) and BCG maintenance scheduleswere administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR)before BCG instillation were collected. Response totreatment was defined as absence of recurrence and/or progression. A statistical analysis with T-student, Chisquare, ANOVA and ROC curves was performed.Results: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70year old. All patients had pure urothelial carcinoma, 12with pTa and 38 with pT1. Median follow-up was 24months. A total of 28% had a recurrence. No correlationbetween NLR or PLR and BCG response was observed(p=0.738; p= 0.768). Neither a cut off was established through ROC curves.At multivariate analysis, there was no significative relationship between recurrence and the clinical and bloodsamples analyzed (sec, age, BMI, NLR, PLR)Conclusion: No correlation between NLR and PLRhas been reported with BCG response on high-gradeNMIBC.(AU)

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.

Urinary tract infections and post-operative fever in percutaneous nephrolithotomy.

PURPOSE: To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. MATERIALS AND METHODS: Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (>38.5°C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses. RESULTS: Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found in urine of the 350 patients (6.5%). Of the patients with negative pre-operative urine cultures, 8.8% developed a fever post-PCNL, in contrast to 18.2% of patients with positive urine cultures. Fever developed more often among the patients whose urine cultures consisted of Gram-negative micro-organisms (19.4-23.8%) versus those with Gram-positive micro-organisms (9.7-14.5%). Multivariate analysis indicated that a positive urine culture (odds ratio [OR] = 2.12, CI [1.69-2.65]), staghorn calculus (OR = 1.59, CI [1.28-1.96]), pre-operative nephrostomy (OR = 1.61, CI [1.19-2.17]), lower patient age (OR for each year of 0.99, CI [0.99-1.00]), and diabetes (OR = 1.38, CI [1.05-1.81]) all increased the risk of post-operative fever. Limitations include the use of fever as a predictor of systemic infection. CONCLUSIONS: Approximately 10% of PCNL-treated patients developed fever in the post-operative period despite receiving antibiotic prophylaxis. Risk of post-operative fever increased in the presence of a positive urine bacterial culture, diabetes, staghorn calculi, and a pre-operative nephrostomy.

Sellado intravesical del uréter terminal en la nefroureterectomía / Intravesical sealing of distal uréter in nephroureterctomy

OBJETIVO: Estudiar la eficacia y fiabilidad de una nueva técnica mínimamente invasora para el tratamiento del uréter terminal en la nefroureterectomía por tumor urotelial, tanto abierta como laparoscópica.MÉTODOS: Estudio retrospectivo observacional de 14 pacientes a los que se practicó la técnica de sellado intravesical del uréter terminal y desinserción endoscópica del mismo previamente a la nefroureterectomía (11 laparoscópicas, 3 abiertas) indicada por tumor de urotelio superior durante el periodo de julio de 2003 a noviembre de 2007. El procedimiento se llevó a cabo en 11 varones y 3 mujeres con edad media de 59,5 (rango: 35-70 años). El tumor asentó en la pelvis renal en 12 casos, y en el uréter proximal en 2 casos. El estadio correspondió a Ta - T1 en 10 pacientes, T2 en 3 y T3 en 1 caso. El grado tumoral fue G3 en 9 casos y G2 en los 5 restantes.La desinserción se realizó mediante un cuchillete de Collins. Para evitar el contacto de la orina con el espacio retroperitoneal se procedió al cierre precoz del meato mediante una grapa introducida a través de un puerto transvesical.RESULTADOS: El tiempo quirúrgico total de la nefroureterectomía fue de 231,15 minutos (rango: 200-340). La tasa de complicaciones para la intervención valorada globalmente (nefroureterectomía) fue de 28,4%, y la tasa de las relacionadas solo con este procedimiento técnico (cierre transvesical del meato y desinserción) fue de 14,2%.Todos los pacientes fueron dados de alta tras la retirada de la sonda vesical, siendo la estancia hospitalaria media de 10,14 días (rango: 6-22).Con un seguimiento medio de 25,3 meses (rango: 12-64) no hemos registrado recidivas locales en el retroperitoneo. En un paciente hubo recidiva vesical. Otro paciente desarrolló una metástasis en glándula suprarrenal que se trató satisfactoriamente(AU)

CONCLUSIONES: El cierre precoz del uréter terminal mediante grapa transvesical previo a su desinserción endoscópica en la nefroureterectomía constituye una técnica segura desde el punto de vista oncológico, con una tasa de complicaciones aceptable, que evita el segundo tiempo abierto para el manejo del uréter terminal(AU)

OBJECTIVES: To study the effectiveness and reliability of a new minimally invasive technique for the treatment of the terminal ureter in nephroureterectomy due to transitional cell carcinoma, both in open and laparoscopic procedures.METHODS: Observational retrospective study of 14 patients that underwent intravesical sealing and endoscopic excision of terminal ureter, before ureterectomy (11 laparoscopic, 3 open), due to an upper urinary tract tumor, between July 2003 and November 2007. This procedure was performed on 11 males and 3 females, average age 59.5 years, (range: 35-70). The tumor settled on the renal pelvis in 12 cases and on the proximal ureter in 2. Stage was Ta – T1 in 10 patients, T2 in 3, and T3 in 1. Tumor grade was G3 in 9 cases and G2 in 5.Excision was carried out with a Collins knife. In order to avoid contact between the urine and retroperitoneal space, the meatus was quickly sealed with a clip introduced by means of a transvesical trocar.RESULTS: Total surgical time of nephroureterectomy was 231.15 minutes (range 200-340). Global complication rate for the procedure was 28.4%, but the rate for the cases associated with this technique (meatus sealing and disinsertion) was 14.2%.All patients were discharged after removing bladder catheter. Mean hospital stay was 10.14 days (range: 6-22).After an average follow-up of 25.3 months (range: 12-64), no retroperitoneal recurrence has been reported. One of the patients had bladder recurrence and another one developed metastasis to the suprarenal gland that was treated satisfactorily.CONCLUSIONS: Quick sealing of distal ureter by transvesical application of a clip before its endoscopic excision in nephrourecterectomy is a sound technique from an oncological point of view, with an acceptable complication rate that avoids a second open time to manage distal ureter(AU)

[Long-term follow-up of antegrade endopyelotomy. Factors that influence the outcome]. / Seguimiento a largo plazo de la endopielotomía anterógrada. Factores que influyen en el resultado.

OBJECTIVE: To find out the outcomes of endopyelotomy alter a long-term follow-up and determine the variables that may influence the results. MATERIAL AND METHODS: We review the results obtained in 77 patients that underwent antegrade endopyelotomy with ureteropelvic junction obstruction, after 10-year follow-up. We used the Kaplan-Meier curve in order to determine the probable failure rate at a certain point. We took measurements of the pyelocalix area and studied its shape to find out the influence of hydronephrosis in the outcomes. Other variables, such as renal function, previous surgery, lithiasis and renal malformation associated, were analysed. RESULTS: Mean follow-up was 149.26 months. Faliure rate probability was 26.9, 34.5 and 36.8% a year, 5 years and 10 years later, respectively. Major failure concentration occurred in the first 20 months. Mean pyelocalix area success was 19.70 +/- 8.32 cm2 vs 30.19 +/- 11.07 cm2 of failure, (p=0,018). There were no differences between the values of the shape factor in either success and failure. (0,87 vs 0.88, p= 0.135, respectively). Renal function (45.1% success vs 40,9% failure, p=0,625), previous surgery (62% success after previous surgery vs 64.7% first procedure, p=0.843), and lithiasis associated (69.3% success through lithiasis vs 61.1% without lithiasis, p=0.541) did not affect the outcomes. Concomitance of hydronephrosis and renal malformation affected the outcomes negatively. CONCLUSION: Endopyelotomy success rate reduces long-term follow-up, however, after the fifth year it becomes stable. Selecting cases to apply this technique according to the value of hydronephrosis area could improve the results.

Seguimiento a largo plazo de la endopielotomía anterógrada. Factores que influyen en el resultado / Long-term follow-up of antegrade endopyelotomy. Factors that influence the outcome

Objetivo: Conocer los resultados de la endopielotomía con un seguimiento a largo plazo y determinar las variables que influyen en los mismos. Material y Métodos: Se revisan los resultados de la endopielotomía anterógrada realizada en 77 pacientes con obstrucción de la unión pieloureteral (OUPU) con un seguimiento superior a 10 años. Se utilizó la curva de Kaplan-Meier para conocer la probabilidad de fracaso en un determinado momento. Se realizó planimetría del área pielocalicial y se estudio su factor de forma para conocer la influencia de la hidronefrosis en el resultado. Se estudiaron otras variables como el grado de función renal, cirugía previa, coexistencia de litiasis y malformación renal asociada. Resultados: El seguimiento medio fue de 149,26 meses. La probabilidad de fracaso fue de 26,9%, 34,5% y 36,8% al año, 5 años y 10 años respectivamente. La mayor concentración de fracasos se produjo dentro de los 20 primeros meses. El área pielocalicial media en los éxitos fue de 19,70±8,32 cm2 vs 30,19±11,07 cm2 en los fracasos, (p=0,018).No hubo diferencias entre los valores del factor de forma en los éxitos y en los fracasos (0,87 vs 0,88, p= 0,135, respectivamente). La función renal (45,1% en éxitos vs 40,9% en fracasos, p=0,625), la cirugía previa (62% de éxito con cirugía previa vs 64,7% en primarias, p=0,843), y la asociación con litiasis (69,3% éxito con litiasis vs 61,1% sin litiasis, p=0,541) no influyeron el resultado. La concomitancia de hidronefrosis y malformación renal afectó negativamente el resultado. Conclusión: La tasa de éxito de la endopielotomía disminuye en seguimientos a largo plazo, si bien a partir del quinto año se mantiene estable. Seleccionar casos para esta técnica de acuerdo al área de la hidronefrosis podría mejorar el resultado (AU)

Objective: To find out the outcomes of endopyelotomy alter a long-term follow-up and determine the variables that may influence the results. Material and Methods: We review the results obtained in 77 patients that underwent antegrade endopyelotomy with ureteropelvic junction obstruction, after 10- year follow-up. We used the Kaplan-Meier curve in order to determine the probable failure rate at a certain point. We took measurements of the pyelocalix area and studied its shape to find out the influence of hydronephrosis in the outcomes. Other variables, such as renal function, previous surgery, lithiasis and renal malformation associated, were analysed. Results: Mean follow-up was 149.26 months. Faliure rate probability was 26.9, 34.5 and 36.8% a year, 5 years and 10 years later, respectively. Major failure concentration occurred in the first 20 months. Mean pyelocalix area success was 19.70±8.32 cm2 vs 30.19±11.07 cm2 of failure, (p=0,018). There were no differences between the values of the shape factor in either success and failure. (0, 87 vs 0.88, p= 0.135, respectively). Renal function (45.1% success vs 40,9% failure, p=0,625), previous surgery (62% success after previous surgery vs 64.7% first procedure, p=0.843), and lithiasis associated (69.3% success through lithiasis vs 61.1% without lithiasis, p=0.541) did not affect the outcomes. Concomitance of hydronephrosis and renal malformation affected the outcomes negatively. Conclusion: Endopyelotomy success rate reduces long-term follow-up, however, after the fifth year it becomes stable. Selecting cases to apply this technique according to the value of hydronephrosis area could improve the results (AU)

Nuevas perspectivas de la laserterapia / New perspectives for laser therapy

Hacemos en este trabajo una revisión de las tendencias actuales y de las nuevas perspectivas del uso del láser en urología, analizando los diferentes campos en los que se ha utilizado esta energía. En litotricia, el láser ha modificando los algoritmos terapéuticos de la litiasis ureteral. Además, su posibilidad de empleo en ureteroscopia flexible está permitiendo realizar la litotricia intracorpórea «in situ» a nivel renal. Nuevos láseres como el Erbium: YAG, más eficaces y más inocuos que el holmium están actualmente en desarrollo. La investigación en nuevas fibras, más flexibles, económicas y duraderas es el próximo reto en este campo. En HBP, si bien el láser KTP ha conseguido una difusión extraordinaria para un determinado tipo de volumen prostático, nuevos láseres como el Thulium y el Diodo, dada la precisión de su corte, compiten con el Holmium en el terreno enucleación prostática. La aplicación del láser en la terapia fotodinámica del cáncer urológico y en la soldadura de tejidos constituyen en la actualidad nuevos objetivos de investigación prometedores (AU)

We review the current trends and new perspectives of the use of laser in urology, analyzing different fields in which this energy has been used. In lithotripsy, the laser has modified the therapeutic algorithms for ureteral lithiasis. Moreover, the possibility of using laser with flexible ureteroscopes is enabling the performance of intracorporeal in situ renal lithotripsy. New lasers such as Erbium:yag, more effective and more innocuous than holmium are currently under development. The research in new fibers, more flexible, economic and long-lasting is the next challenge in this field. In BPH, although the KTP laser has obtained and extraordinary diffusion for a certain type of prostate volume, new lasers such as thulium and diode, are in competition with holmium laser in the field of prostatic enucleation due to their precise cut. The application of laser in photodynamic therapy for urological cancers and tissue welding are currently new promising objectives of research (AU)

[New perspectives for laser therapy]. / Nuevas perspectivas de la laserterapia.

We review the current trends and new perspectives of the use of laser in urology, analyzing different fields in which this energy has been used. In lithotripsy, the laser has modified the therapeutic algorithms for ureteral lithiasis. Moreover, the possibility of using laser with flexible ureteroscopes is enabling the performance of intracorporeal in situ renal lithotripsy. New lasers such as Erbium:yag, more effective and more innocuous than holmium are currently under development. The research in new fibers, more flexible, economic and long-lasting is the next challenge in this field. In BPH, although the KTP laser has obtained and extraordinary diffusion for a certain type of prostate volume, new lasers such as thulium and diode, are in competition with holmium laser in the field of prostatic enucleation due to their precise cut. The application of laser in photodynamic therapy for urological cancers and tissue welding are currently new promising objectives of research.

Tácticas y trucos de endourología en el aparato urinario superior. Trucos en meato-trayecto intramural / No disponible

No disponible

Tácticas y trucos de endourología en el aparato urinario superior. Tácticas en riñón: cirugía percutánea / No disponible

No disponible

Tácticas y trucos de endourología en laparoscopia. Tácticas en laparoscopia. Retroperitonoscopia en riñón suprarrenal / No disponible

No disponible

Tácticas y trucos de endourología en laparoscopia. Miscelánea en laparoscopia / No disponible

No disponible

[Intraoperative complications and morbidity of laparoscopic radical prostatectomy (LRP) during the learning curve]. / Complicaciones intraoperatorias y morbilidad de la prostatectomía radical laparoscópica (PRL) durante el periodo de aprendizaje.

OBJECTIVES: To analyze the complications and morbidity during our learning curve of laparoscopic radical prostatectomy (LRP) and compare them with other published series. METHODS: We review the 25 first laparoscopic radical prostatectomies performed in our department, evaluating the operative technique and other features such as surgical time, blood loss, complications and conversion to open surgery. We also evaluate morbidity, postoperative hospital stay, and functional features such as potency and continence. RESULTS: LRP was completed in 22 patients. Overall intraoperative complication rate was 32%. 3 cases were converted to open surgery due to technical difficulties or intraoperative complications. We had complications in 4 patients, that were not severe (bladder injury 2 cases, and epigastric artery injury another 2) and where solved without difficulties during the operation. The most severe intraoperative complication was related to the anesthesia procedure at the time of extubation of a patient who required tracheotomy. There were no severe postoperative complications, being leakage from the anastomosis the most common (7 cases). All of them were managed conservatively, although this resulted in a mean hospital stay of 10.8 days. 2 patients required endoscopic procedures in the immediate postoperative time for bladder catheter repositioning. All patients suffered erectile dysfunction and the continence rate at 3 months was 77.2%. CONCLUSIONS: Although LRP is a long operation and difficult during the learning curve, its complication rate is acceptable because they are not severe and can be managed in a relatively easy way.

[Ureteroscopy in the follow-up protocol for upper urinary tract urothelial tumors treated endoscopically]. / La ureteroscopia en el protocolo del seguimiento del tumor del urotelio superior tratado por via endoscópica.

OBJECTIVES: To evaluate the role of ureteroscopy (rigid and flexible) in the follow-up protocol for transitional cell tumors treated conservatively in our department by endourological procedures, and to review the articles on this topic available in the literature. METHODS: From February 1997 to June 2003, 10 patients (12 renal units) with upper urinary tract urothelial tumor treated conservatively by endourological procedures were followed by cytology, cystoscopy, retrograde ureteropyelography, and ureteroscopy (rigid and flexible), quarterly during the first year, semi-annually during the second year, and yearly thereafter in order to detect tumor recurrence. RESULTS: Mean follow-up was 31.9 months (R 14-65). Two patients died: one because of a previous metacronous bladder tumor and the other after distant progression. One patient was lost to followup. A total of 42 ureteroscopies were performed (31 flexible and 11 rigid). Flexible ureteroscopy was performed in 6 patients and rigid ureteroscopy in three; neither was feasible in one patient so that follow-up was done by cytology, cystoscopy and urography. Tumor recurrence was detected in 2 patients but ureteroscopy did not inform about tumor stage. Flexible ureteroscopy failed in another patient in which rigid ureteroscopy was feasible. Although this latter was technically easier to perform, procedure discomfort was worse. CONCLUSIONS: The follow-up of transitional cell tumors of the upper urinary tract should be very strict because of the high risk of tumor relapse. Ureteroscopy, mainly flexible, is standing out as the most effective procedure to watch these tumors.