Prospective study of diagnostic accuracy in the detection of high-grade prostate cancer in biopsy-naïve patients with clinical suspicion of prostate cancer who underwent the Select MDx test.

OBJECTIVES: This study aimed to externally validate the diagnostic accuracy of the Select MDx test for Significant prostate cancer (Sig PCa) (ISUP > 1), in a contemporaneous, prospective, multicenter cohort with a prostate-specific antigen (PSA) between 3 and 10 ng/ml and a non-suspicious digital rectal examination. METHODS AND PARTICIPANTS: For all enrolled patients, the Select Mdx test, the risk calculator ERSPC3 + DRE, and a prostatic magnetic resonance imaging (MRI) were carried out. Subsequently, a systematic 12-core trans-rectal biopsy and a targeted biopsy, in the case of a prostate imaging-reporting and data system (PIRADS) > 2 lesion (max three lesions), were performed. To assess the accuracy of the Select MDx test in the detection of clinically Sig PCa, the test sensitivity was evaluated. Secondary objectives were specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC). A direct comparison with the ERSPC + DRE risk calculator and MRI were also performed. We also studied the predictive ability to diagnose Sig PCa from the combination of the Select MDx test with MRI using clinical decision-curve analysis. RESULTS: There were 163 patients enrolled after meeting the inclusion criteria and study protocol. The Select MDx test showed a sensitivity of 76.9% (95% CI, 63.2-87.5), 49.6% specificity (95% CI, 39.9-59.2), 82.09% (95% CI, 70.8-90.4) NPV, and 41.67% (95% CI, 31.7-52.2) PPV for the diagnosis of Sig PCa. COR analysis was also performed, which showed an AUC of 0.63 (95% CI, 0.56-0.71). There were no differences in the accuracy of Select MDx, ERSPC + DRE, or MRI. The combination of Select MDX + MRI showed the highest impact in the decision-curve analysis, with an NPV of 93%. CONCLUSION: Our study showed a worse performance for the SelectMdx test than previously reported, within a cohort of patients with a PSA 3-10 ng/ml and a normal DRE, with results similar to those from ERSPC + DRE RC and MRI, but with an improvement in the usual PSA pathway. A combination of the Select Mdx test and MRI could improve accuracy, but studies specifically evaluating this scenario with a cost-effective analysis are needed.

[Intraureteral foreign body]. / Cuerpo extraño intraureteral.

OBJECTIVE: We present a rare localization for a foreing body in the urinary system, and review the bibliography to know about it existence, frequency and localization. METHODS: We present the case of a 49 year old woman who referreds she had introduced a metallic objet in her genital area. RESULTS: After the necessary tests, we could see a metallic cylinder. It was 8 cm long and was localized inside the right pelvic ureter. CONCLUSIONS: The presence of strange bodies in the urinary system is a rare urological emergency. Treatment is the key element of the extraction of the least bloody way possible.

[Bilateral obstructive uropathy as clinical presentation of primary bladder lymphoma]. / Uropatía obstructiva bilateral como forma de presentación de linfoma vesical primario.

OBJECTIVE: We report the event of an atypical presentation of primary bladder lymphoma, treated in our hospital, and review the literature of such tumors, representing 0.2% of bladder tumors, being macroscopic hematuria with clots the most frequent reason for patient consultation. METHODS: We report the case of an 83 years old man who went to the emergency room because of oligoanuria of 48 hours of evolution. He was diagnosed of bladder tumor. RESULTS: The pathology turned out to be a primary bladder lymphoma cell B. CONCLUSIONS: Primary bladder lymphoma is a rare entity that presents a similar behaviour to other bladder tumors, having a good response to treatment with chemotherapy.

Uropatia obstructiva bilateral como forma de presentación de linfoma vesical primario / Bilateral obstructive uropathy as clinical presentation of primary bladder lymphoma

OBJETIVO: Dar a conocer un caso de presentación atípica de linfoma vesical primario tratado en nuestro hospital, así como revisar la bibliografía de este tipo de tumores, que representan el 0.2% de los tumores vesicales, siendo su forma de presentación más frecuente la hematuria macroscópica con coágulos.MÉTODOS: Presentamos el caso de un varón de 83 años, que acudió a Urgencias por oligoanuria de 48h de evolución, en el que se diagnosticó un tumor vesical.RESULTADO: La anatomía patológica resulto ser un linfoma vesical primario de células B.CONCLUSIONES: El linfoma vesical primario es una entidad poco frecuente, que cursa de forma indistinguible a otros tumores vesicales, presentando una buena respuesta al tratamiento con quimioterapia(AU)

OBJECTIVE: We report the event of an atypical presentation of primary bladder lymphoma, treated in our hospital, and review the literature of such tumors, representing 0,2% of bladder tumors, being macroscopic hematuria with clots the most frequent reason for patient consultation.METHODS: We report the case of an 83 years old man who went to the emergency room because of oligoanuria of 48 hours of evolution. He was diagnosed of bladder tumor.RESULTS: The pathology turned out to be a primary bladder lymphoma cell B.CONCLUSIONS: Primary bladder lymphoma is a rare entity that presents a similar behaviour to other bladder tumors, having a good response to treatment with chemotherapy(AU)

Cuerpo extraño intraureteral / Intraureteral foreign body

OBJETIVO: Presentar una localización atípica de cuerpos extraños en el interior del aparato urinario, así como revisar en la bibliografía su existencia, frecuencia y localización.MÉTODOS: Presentamos el caso de una mujer de 49 años, que refiere la introducción de un objeto metálico en el área genital.RESULTADO: Tras la realización de las pruebas complementarias pertinentes, se objetiva un cilindro metálico de 8 cm de longitud, localizado en el interior del uréter pelviano derecho.CONCLUSIÓN: La presencia de cuerpos extraños en el interior del aparato urinario es una rara urgencia urológica, su tratamiento fundamental consiste en la extracción del elemento de la manera menos cruenta posible(AU)

OBJECTIVE: We present a rare localization for a foreing body in the urinary system, and review the bibliography to know about it existence, frequency and lo-calization.METHODS: We present the case of a 49 year old woman who referreds she had introduced a metallic objet in her genital area.RESULTS: After the necessary tests, we could see a metallic cylinder. It was 8 cm long and was localized inside the right pelvic ureter.CONCLUSIONS: The presence of strange bodies in the urinary system is a rare urological emergency. Treatment is the key element of the extraction of the least bloody way possible(AU)

Holmium laser treatment for low grade, low stage, noninvasive bladder cancer with local anesthesia and early instillation of mitomycin C.

PURPOSE: We evaluated the results of laser photocoagulation of recurrent low stage noninvasive bladder cancer. MATERIALS AND METHODS: The study included 36 patients with a recurrent superficial papillary tumor within 1 year of endoscopic resection. Patients underwent laser photocoagulation of the recurrence under local anesthesia and sedation. They received early instillation of 40 mg mitomycin C and were discharged home without a catheter a few hours after the operation. Patients completed a visual analog scale to quantify the perceived level of pain, including 1--no pain to 10--maximum pain. Patients were reviewed after 3, 6 and 12 months to evaluate tumor recurrence. RESULTS: The mean and median visual analog scale score was 3 points (range 1 to 10). No patient had urinary infection or a catheter at hospital discharge. The incidence of recurrence at 12 months was 25%, mainly in the first 15 cases. CONCLUSIONS: Laser photocoagulation with local anesthesia and sedation is easy to perform and well tolerated. There were no complications and the recurrence rate was similar to that of transurethral resection, as calculated using the recurrence calculator of the 2006 guidelines on TaT1 (nonmuscle invasive) bladder cancer from the European Association of Urology.