Percutaneous radiofrequency ablation is an effective treatment option for small renal masses, comparable to partial nephrectomy.

OBJECTIVES: The standard therapy for small renal masses (SRMs) remains partial nephrectomy (PN), which is associated with relatively high morbidity and complication rate. Therefore, percutaneous radiofrequency ablation (PRFA) emerges as an alternative therapy. This study aimed to compare the efficacy, safety, and oncological outcomes of PRFA versus PN. METHODS: A multicenter non-inferiority study with retrospective analysis of 291 patients with SRMs (N0M0), who underwent PN or PRFA (2:1), recruited prospectively from two hospitals in the Andalusian Public Health System, Spain, between 2014 and 2021. Comparisons of treatment features were evaluated using the t test, Wilcoxon-Mann-Whitney U test, chi-square test, Fisher test, and Cochran-Armitage trend test. Kaplan-Meier curves depicted overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) rates in the overall study population. RESULTS: A total of 291 consecutive patients were identified; 111 and 180 patients underwent PRFA and PN, respectively. Median follow-up time was 38 and 48 months, and mean hospitalization days were 1.04 and 3.57 days, respectively. The variables underpinned with high surgical risk were significantly increased in PRFA compared to those in PN (mean age was 64.56 and 57.47 years, the solitary kidney presence was 12.6% and 5.6%, ASA score ≥ 3 was 36% and 14.5%, respectively). The rest of oncological outcomes were comparable amongst PRFA and PN. Patients undergoing PRFA did not improve OS, LRFS, and MFS compared to those undergoing PN. Limitations comprise retrospective design and limited statistical power. CONCLUSION: PRFA for SMRs in high-risk patients is non-inferior in terms of oncological outcomes and safety compared to PN. CLINICAL RELEVANCE STATEMENT: Our study has a direct clinical application as it proves that radiofrequency ablation is an effective and uncomplicated therapeutic option for patients with small renal masses. KEY POINTS: •There are non-inferiority results in overall survival, local recurrence-free survival, and metastasis-free survival between PRFA and PN. •Our two-center study showed that PRFA is non-inferior to PN in oncological outcomes. •Contrast-enhanced power ultrasound-guided PRFA provides an effective therapy for T1 renal tumors.

Update on the treatment of metastatic renal cell carcinoma.

Metastatic renal cell cancer (mRCC) management has undergone a paradigm shift in recent decades. The first revolution came with the emergence of vascular endothelial growth factor inhibitors; there was a second wave with the unprecedented success of checkpoint inhibitors, and then the latest approach, which is becoming the new care standard in mRCC, of combining these two strategies in different ways. Updated results of Checkmate-214 after 42 mo of follow-up were consistent with previously published results showing the superiority of nivolumab/ipilimumab over sunitinib in progression free survival (PFS), overall survival (OS), and objective response rate (ORR) in intermediate and high-risk patients. However, several studies presented at the American Society of Clinical Oncology 2020 suggested that the best place, and so far, the only one for nivolumab/ipilimumab is the frontline setting. The update on Keynote-426 after 23 mo of follow-up showed no superiority of pembroli-zumab/axitinib over sunitinib in favorable-risk mRCC, suggesting that it should no longer be the first line of choice in low-risk patients. Finally, the phase III Checkmate 9ER trial results revealed the superiority of nivolumab/cabozantinib vs sunitinib in PFS, OS, and ORR, providing a new first-line option among all International Metastatic RCC Database Consortium risk patients. Some phase II clinical trials also presented this year showed promising results with new combination therapies such as nivolumab/sitravatinib, cabozantinib/atezolizumab, and lenvatinib/pembrolizumab, providing promising grounds upon which to start phase III studies. In addition, other works are using novel therapeutic agents with different mechanisms of action, including telaglenastat (a glutaminase inhibitor), entinostat [an inhibitor of histone deacetylases (HDACs)], and olaparib and talazoparib, poly(ADP-ribose) polymerase inhibitors widely used in other tumors. However, some questions regarding mRCC management still need to be addressed, such as head-to-head comparisons between the current options, treatment sequencing, non-clear cell mRCC, and the role of biomarkers to ascertain the best treatment choice.

Análisis de la calidad de la información sobre disfunción eréctil en YouTube / Analysis of the quality of the information on the erectile dysfunction in YouTube

OBJETIVO: Nuestro objetivo es analizar la calidad de la información disponible en YouTube acerca de la disfunción eréctil. MATERIAL Y MÉTODOS: Realizamos una búsqueda en YouTube usando los términos "Problemas de Erección" (PE), "Impotencia" (I) y "Disfunción Eréctil" (DE); incluimos los 60 primeros vídeos para cada uno de ellos. Dos urólogos revisaron de forma independiente los videos clasificándolos en "Basados en evidencia científica" (BEC) y "No basados en evidencia científica" (NBEC) según la bibliografía actual. Se describen y comparan el número de visitas, la duración, el tiempo publicado, la información médica y el origen de cada vídeo por grupos. RESULTADOS: Analizamos 147 videos tras eliminar los repetidos y no concordantes. El índice Kappa fue 0,89 (IC95% 0,82-0,96). El 37% se consideraron BEC y el 63% NBEC. La mediana de reproducciones en el grupo BEC fue 24.356 (rango 96-126.410) y 44.416 entre los NBEC (190-10.318.642), siendo esta diferencia estadísticamente significativa. La mediana de duración fue 254 segundos (46-984) y 228 segundos (23-2.880) respectivamente; la mediana de tiempo publicado fue de 42 meses en los BEC (16-103) y de 29 en los NBEC (11-134). El 83% de los vídeos BEC provenían de webs de salud y programas de televisión, mientras que el 58% de los NBEC procedían de blogs. Los vídeos BEC trataban más de fisiopatología, etiología, disfunción endotelial, diagnóstico y tratamiento frente a los NBEC (p < 0,001). CONCLUSIÓN: Del total de videos revisados, el 37% se consideraron BEC. Los videos NBEC se reprodujeron más veces que los BEC

OBJECTIVE: The objective of our study is to stablish the scientific quality of the available information in YouTube about erectile dysfunction (ED). MATERIAL AND METHODS: We searched on YouTube three terms ("Problemas de Erección" (PE), "Impotencia" (I) y "Disfunción Eréctil" (DE)). The sixteen first videos from each term were selected for the analysis. Two independent urologists reviewed all videos and classified all of them in scientific evidence-based (SEB) or not scientific evidence-based (NSEB) according to the current literature. In the subgroup analysis we compare: number of visits, duration, time of publication, source and type of information. RESULTS: After excluding the repeated links and non-concordant videos between both urologists, we analysed 147 videos. The Kappa statistic was 0.89 (95% CI 0.85-0.96). 37% were considered SEB and 63% were considered NSEB. The median of reproductions in the SEB group was 24.356 (96-126.410) and 44.416 for NSEB (190-10.318.642); this difference was statistically significant. The median duration was 254 seconds (46-984) for the SEB group and 228 seconds for the NSEB (23-2.880); the median time of publication was 42 (16-103) months for the SEB group and 29 (11- 134) months for the other one. 83% of SEB videos were published in health networks and television programs, while 58% of NSEB were published in user blogs. The SEB videos show more information about pathophysiology, aetiology, endothelial dysfunction, diagnosis and treatment than NSEB (p < 0.001). CONCLUSIONS: 37% of the videos were considered SEB. The NSEB videos were significantly more played than SEB group

[Analysis of the quality of the information on the erectile dysfunction in YouTube.] / Análisis de la calidad de la información sobre disfunción eréctil en YouTube.

OBJECTIVE: The objective of our study is to stablish the scientific quality of the available information in YouTube about erectile dysfunction (ED). MATERIAL AND METHODS: We searched on YouTube thrree terms ("Problemas de Erección" (PE), "Impotencia"(I) y "Disfunción Eréctil" (DE)). The sixteen first videos from each term were selected for the analysis. Two independent urologists reviewed all videos and classified all of them in scientific evidence-based (SEB) or not scientific evidence-based (NSEB) according to the current literature. In the subgroup analysis we compare: number of visits, duration, time of publication, source and type of information. RESULTS: After excluding the repeated links and non-concordant videos between both urologists, we analysed 147 videos. The Kappa statistic was 0.89 (95% CI0.85-0.96). 37% were considered SEB and 63% were considered NSEB. The median of reproductions in the SEB group was 24.356 (96-126.410) and 44.416 for NSEB (190-10.318.642); this difference was statistically significant. The median duration was 254 seconds(46-984) for the SEB group and 228 seconds for the NSEB (23-2.880); the median time of publication was 42 (16-103) months for the SEB group and 29 (11-134) months for the other one. 83% of SEB videos were published in health networks and television programs,while 58% of NSEB were published in user blogs. The SEB videos show more information about pathophysiology,aetiology, endothelial dysfunction, diagnosis and treatment than NSEB (p<0.001). CONCLUSIONS: 37% of the videos were consideredSEB. The NSEB videos were significantly more playedthan SEB group.

OBJETIVO: Nuestro objetivo es analizar la calidad de la información disponible en YouTube acerca de la disfunción eréctil.MATERIAL Y MÉTODOS: Realizamos una búsqueda en YouTube usando los términos "Problemas de Erección" (PE), "Impotencia" (I) y "Disfunción Eréctil" (DE); incluimos los 60 primeros vídeos para cada uno de ellos. Dos urólogos revisaron de forma independiente los videos clasificándolos en "Basados en evidenciacientífica" (BEC) y "No basados en evidencia científica" (NBEC) según la bibliografía actual. Se describen y comparan el número de visitas, la duración, el tiempo publicado, la información médica y el origen de cada vídeo por grupos. RESULTADOS: Analizamos 147 videos tras eliminar los repetidos y no concordantes. El índice Kappa fue 0,89 (IC95% 0,82-0,96). El 37% se consideraron BEC y el 63% NBEC. La mediana de reproducciones en el grupo BEC fue 24.356 (rango 96-126.410) y 44.416 entre los NBEC (190-10.318.642), siendo esta diferencia estadísticamente significativa. La mediana de duración fue 254 segundos (46-984) y 228 segundos(23-2.880) respectivamente; la mediana de tiempo publicado fue de 42 meses en los BEC (16-103) y de 29 en los NBEC (11-134). El 83% de los vídeos BEC provenían de webs de salud y programas de televisión,mientras que el 58% de los NBEC procedían de blogs.Los vídeos BEC trataban más de fisiopatología, etiología,disfunción endotelial, diagnóstico y tratamiento frente a los NBEC (p<0,001).CONCLUSIÓN: Del total de videos revisados, el 37% se consideraron BEC. Los videos NBEC se reprodujeron más veces que los BEC.