Impacto de los sistemas de nefrometría renal en la valoración de las complicaciones en el tratamiento percutáneo guiado por imagen de las masas renales de pequeño tamaño / Usefulness of renal nephrometry scoring systems in the prediction of complications associated to percutaneous image-guided treatment for small renal masses

Introducción Los tumores renales son un desafío para los profesionales de la salud debido a su creciente prevalencia y complejidad de manejo. El estudio investiga la utilidad de los sistemas de nefrometría renal R.E.N.A.L. score y Padua en la predicción de complicaciones de la crioablación percutánea (CA). Material y métodos El estudio analiza de forma prospectiva a 90 pacientes con carcinoma de células renales (CCR) estadio T1a tratados con crioablación, totalizando 101 tumores. Resultados Se estudiaron 90 pacientes con 101 tumores renales de pequeño tamaño que recibieron terapia crioablativa. Los pacientes tenían una edad media de 68 años y mayoría eran hombres (74,4%). La mayoría de los tumores eran menores a 4 cm (89,1%) y la puntuación media del Padua y R.E.N.A.L. scores fue de 8,65 y 7,35, respectivamente. Se observaron complicaciones en 12 casos. El PADUA y R.E.N.A.L. scores demostraron un poder predictivo moderado (área bajo la curva [AUC] = 0,58 y AUC = 0,63, respectivamente) para las complicaciones poscrioablación. Conclusiones La CA es un tratamiento seguro y efectivo para los tumores renales de pequeño tamaño. Los sistemas de nefrometría renal R.E.N.A.L. y Padua scores tienen un poder predictivo moderado para las complicaciones asociadas a la CA de tumores renales. (AU)

Introduction Due to their increasing prevalence and complex management, renal tumors are challenging for health professionals. The study aims to evaluate the usefulness of R.E.N.A.L. and PADUA nephrometry scores in the prediction of complications after percutaneous cryoablation. Material and methods The study prospectively analyzed 90 patients with 101 stage T1a renal cell carcinoma (RCC) tumors treated with cryoablation. Results Ninety patients with 101 small renal tumors who received cryoablative therapy were investigated. The mean age of the patients was 68 years and 74.4% were male. Most tumors were smaller than 4 cm (89.1%) and the mean PADUA and R.E.N.A.L. scores were 8.65 and 7.35, respectively. Complications were observed in 12 cases. PADUA and R.E.N.A.L. scores demonstrated moderate predictive power (AUC = 0.58 and AUC = 0.63, respectively) for post-cryoablation complications. Conclusions Percutaneous cryoablation is a safe and effective treatment for small renal tumors. The R.E.N.A.L. and PADUA renal nephrometry scores have moderate predictive power for complications associated with percutaneous cryoablation of renal tumors. (AU)

Usefulness of renal nephrometry scoring systems in the prediction of complications associated to percutaneous image-guided treatment for small renal masses.

INTRODUCTION: Due to their increasing prevalence and complex management, renal tumors are challenging for health professionals. The study aims to evaluate the usefulness of R.E.N.A.L. and PADUA nephrometry scores in the prediction of complications after percutaneous cryoablation. MATERIAL AND METHODS: The study prospectively analyzed 90 patients with 101 stage T1a renal cell carcinoma (RCC) tumors treated with cryoablation. RESULTS: Ninety patients with 101 small renal tumors who received cryoablative therapy were investigated. The mean age of the patients was 68 years and 74.4% were male. Most tumors were smaller than 4 cm (89.1%) and the mean PADUA and R.E.N.A.L. scores were 8.65 and 7.35, respectively. Complications were observed in 12 cases. PADUA and R.E.N.A.L. scores demonstrated moderate predictive power (AUC = 0.58 and AUC = 0.63, respectively) for post-cryoablation complications. CONCLUSIONS: Percutaneous cryoablation is a safe and effective treatment for small renal tumors. The R.E.N.A.L. and PADUA renal nephrometry scores have moderate predictive power for complications associated with percutaneous cryoablation of renal tumors.

Eficacia y seguridad de la inyección de onabotulinumtoxin A en pacientes varones con hiperactividad del detrusor tras la cirugía para incontinencia urinaria de esfuerzo / Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery

Introducción y objetivo El uso de la inyección de onabotulinumtoxin A (BoNT-A) en pacientes masculinos con hiperactividad del detrusor (HD) tras la cirugía para la incontinencia urinaria de esfuerzo (IUE) ha sido escasamente descrito. Nuestro objetivo fue evaluar los resultados de este tratamiento en esta población específica.Materiales y métodosAnálisis retrospectivo desde 2010 en pacientes varones que reciben una primera inyección de 100U de BoNT-A para el tratamiento de HD tras someterse a una cirugía previa para la IUE en nuestro departamento. La respuesta al tratamiento se valoró mediante la Escala de Beneficio del Tratamiento: 1) mejoría significativa; 2) mejoría; 3) sin cambios; 4) empeoramiento tras el tratamiento (Escala de Beneficio del Tratamiento 1 o 2: respuesta al tratamiento). Las complicaciones se catalogaron según la clasificación de Clavien-Dindo. Se consideró la continuación del tratamiento si los pacientes habían recibido una inyección de BoNT-A durante los 12 meses previos a la última revisión. Se compararon las variables urodinámicas antes y después del tratamiento.Resultados Se incluyeron 18 pacientes, con una edad mediana de 71,1 (59,1-83,5) años. Doce (66,7%) pacientes refirieron respuesta al tratamiento. Se detectaron 2 (11,1%) complicaciones: retención urinaria que requirió cateterismo intermitente limpio (Clavien-Dindo 2). No se detectaron complicaciones relacionadas con la cirugía previa para la IUE. Quince (83,3%) pacientes recibieron un seguimiento>12 meses (mediana de seguimiento 57 [15-89] meses) y todos habían suspendido el tratamiento al final del seguimiento. Se observó una mejoría significativa en la presencia de HD y en la acomodación vesical en el estudio urodinámico.ConclusiónAunque la mayoría de los hombres con HD después de la cirugía de IUE responden a la inyección intradetrusor de BoNT-A, todos interrumpen el tratamiento por motivos personales. Se trata de un procedimiento seguro, cuya

Introduction and objective The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population.Materials and methods Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared.Results Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance.Conclusion Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication (AU)

Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery.

INTRODUCTION AND OBJECTIVE: The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS: Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100 U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS: Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up >12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION: Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.

Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery. / Eficacia y seguridad de la inyección de onabotulinumtoxin A en pacientes varones con hiperactividad del detrusor tras la cirugía para incontinencia urinaria de esfuerzo.

INTRODUCTION AND OBJECTIVE: The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS: Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS: Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION: Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.

Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe.

PURPOSE: To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS: We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS: A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS: Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.

Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior / Urodynamic findings in Charcot-Marie-Tooth patients with lower urinary tract symptoms

INTRODUCCIÓN: Nuestro objetivo fue describir los síntomas del tracto urinario inferior (STUI) y los hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth (CMT) derivados a nuestro servicio de urología. MÉTODOS: Estudio retrospectivo de los pacientes con CMT diagnosticados en el servicio de neurología de nuestro centro y derivados al servicio de urología desde 2008 por sintomatología del tracto urinario inferior (STUI). Revisamos el tipo de CMT, la edad al diagnóstico, la presencia de comorbilidades que pudieran causar STUI, las características de los mismos, las exploraciones neurológicas y los hallazgos urodinámicos. RESULTADOS: Se remitieron 7 pacientes (3 varones y 4 mujeres) a nuestro servicio por STUI con una mediana de edad al inicio de los STUI de 55 (29-67) años y tiempo medio entre el diagnóstico de la neuropatía y el inicio de los STUI de 14 (1-37) años. Cinco pacientes refirieron clínica de vaciado, 3 incontinencia urinaria y 2 presentaban infecciones urinarias de repetición. Se realizaron 6 estudios urodinámicos, mostrando detrusor acontráctil neurógeno en 2 pacientes, detrusor hipocontráctil en un paciente, retraso en el tiempo de inicio de la micción en un paciente, detrusor hiperactivo en un paciente e incontinencia de esfuerzo en otro paciente. En un caso el estudio fue normal. CONCLUSIÓN: La mayoría de los pacientes con CMT y STUI refieren clínica de vaciado, pudiéndose relacionar con alteraciones urodinámicas, la mayoría en la fase de vaciado. Recomendamos la realización de estudio urodinámico en pacientes con CMT que presenten STUI y soliciten tratamiento o presenten complicaciones asociadas

INTRODUCTION: Our aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department. METHODS: Retrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings. RESULTS: Seven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 PATIENTS: Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal. CONCLUSIONS: Most of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications

Urodynamic findings in Charcot-Marie-Tooth patients with lower urinary tract symptoms. / Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior.

INTRODUCTION: Our aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department. METHODS: Retrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings. RESULTS: Seven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 patients. Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal. CONCLUSIONS: Most of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications.

Estado actual de la actividad y formación académica de residentes y urólogos jóvenes en España. Resultados de una encuesta nacional / Current status of young urologists and residents' activity and academic training in Spain. National survey results

Objetivo: Conocer el estado actual de la actividad y formación académica de los residentes y urólogos jóvenes en España. Material y métodos: Se diseñó una encuesta anónima de 32 preguntas, desde el Grupo de Trabajo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología (RAEU), dirigida a evaluar la actividad académica de los residentes, definida por: número de comunicaciones a congresos, publicaciones en revistas nacionales e internacionales, rotaciones clínicas dentro de España y en el extranjero, realización de máster, doctorado (PhD), aplicaciones para presentar el examen de la European Board of Urology y competencias en idiomas de residentes. La encuesta fue enviada vía email y difundida vía redes sociales. Resultados: Se obtuvieron 91 respondedores; el 66% afirmaron no tener publicaciones en revistas científicas, el 67% no han realizado rotaciones en el extranjero. Solo el 21% afirmaron presentarse al examen EBU. Solo el 2% de los respondedores han realizado un fellowship, aunque la mayoría (82%) no lo han realizado, pero sí estarían interesados. Sin embargo, el 67% de los respondedores opinan que la relevancia de la actividad académica/investigadora es alta a muy elevada. Conclusiones: Los resultados indican que la actividad académica, la producción científica y la publicación de artículos de los residentes y urólogos jóvenes en España es baja. Así también, la participación en el examen EBU, así como la realización de máster, PhD, rotaciones y fellowship, son bajas. Sin embargo, la valoración de la actividad científica es considerada como muy relevante

Objective: To study the current status of the activity and academic training of residents and young urologists in Spain. Material and methods: From the working group of residents and young urologists of the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. Results: Ninety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. Conclusions: Our results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant

Current status of young urologists and residents' activity and academic training in Spain. National survey results. / Estado actual de la actividad y formación académica de residentes y urólogos jóvenes en España. Resultados de una encuesta nacional.

OBJECTIVE: To study the current status of the activity and academic training of residents and young urologists in Spain. MATERIAL AND METHODS: From the working group of residents and young urologists of the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. RESULTS: Ninety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. CONCLUSIONS: Our results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant.

Estudio retrospectivo de diferentes opciones de tratamiento conservador con Bacilo de Calmette-Guèrin en el carcinoma urotelial vesical T1G3: terapia de mantenimiento / Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy

Objetivo: Comparar diferentes opciones de tratamiento conservador del tumor vesical no músculo-invasivo (TVNMI) T1 de grado alto. El bacilo de Calmette-Guérin (BCG) es el tratamiento intravesical preferido para los tumores T1 de grado alto; sin embargo, algunos expertos aún cuestionan la necesidad de la BCG de mantenimiento. Materiales y métodos: Se analizaron retrospectivamente los datos de 1.039 pacientes con TVNMI T1G3 primario y recurrente. Todos los pacientes fueron tratados mediante una resección transuretral del tumor vesical (RTUTV) completa, con músculo en la muestra y múltiples biopsias de la vejiga. Los pacientes fueron tratados con solo una RTUTV inicial (n = 108), re-RTUTV (n = 153), inducción con 27 mg de BCG (cepa Connaught) (n = 87), inducción con 81 mg de BCG (n = 489) o inducción con 81 mg de BCG + mantenimiento (n = 202). El tiempo hasta la primera recidiva, progresión (a T2 o mayor, o a enfermedad metastásica) y mortalidad específica de la enfermedad se evaluaron mediante la función de supervivencia de Kaplan-Meier y se compararon utilizando la prueba de logaritmo del rango (log-rank) y el modelo multivariado de regresión de Cox de riesgos proporcionales. Resultados: El seguimiento medio fue de 62 ± 39 meses. El riesgo de recurrencia fue significativamente menor en los pacientes tratados con terapia de mantenimiento con 81 mg de BCG que en los otros grupos de tratamiento (p < 0,001). El riesgo de progresión del tumor también fue significativamente más bajo en los pacientes tratados con mantenimiento con BCG que en los pacientes tratados solo con una RTUTV, re-RTUTV y con terapia de inducción con 27 mg de BCG (p = 0,0003). La mortalidad específica de la enfermedad fue significativamente más baja con el mantenimiento con BCG (9,4%) que con solo una RTUTV (27,8%; p = 0,003). Conclusiones: En el caso del TVNMI T1G3, la dosis completa de BCG con mantenimiento va asociada a mejores resultados de recurrencia que otras modalidades de tratamiento conservador. Los resultados de progresión y de supervivencia específica de la enfermedad también fueron mejores con la BCG de inducción, con o sin mantenimiento

Objective: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. Material and methods: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n = 108), re-TURBT (n = 153), induction with 27 mg of BCG (Connaught strain) (n = 87), induction with 81 mg of BCG (n = 489) or induction with 81 mg of BCG + maintenance (n = 202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. Results: The mean follow-up was 62 ± 39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81 mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27 mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003). Conclusions: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance

Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy. / Estudio retrospectivo de diferentes opciones de tratamiento conservador con Bacilo de Calmette-Guèrin en el carcinoma urotelial vesical T1G3: terapia de mantenimiento.

OBJECTIVE: To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. MATERIAL AND METHODS: We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. RESULTS: The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003). CONCLUSIONS: In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance.

Análisis comparativo de la incidencia de cáncer de vejiga en las comunidades de Andalucía, Cataluña y Comunidad de Madrid en el año 2011 / Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011

Objetivos: Estimar la incidencia del cáncer de vejiga (CAV) en las comunidades autónomas que incluyeron mayor número de casos en el registro nacional hospitalario de CAV (Andalucía, Cataluña y Comunidad de Madrid) y describir las diferencias y similitudes clínicas, patológicas y diagnósticas del CAV en estas regiones. Material y métodos: Estudio observacional epidemiológico realizado en el año 2011 en 12 hospitales públicos con área de población de referencia según el Sistema Nacional de Salud. Se recogieron variables sociodemográficas y clínicas de nuevos casos y recidivas con confirmación histopatológica de CAV. La tasa bruta de incidencia se calculó mediante el número de casos diagnosticados en todos los centros participantes respecto al total agregado de población adscrita de cada uno de ellos. Las tasas brutas por edad y sexo se obtuvieron ponderando la población adscrita con la distribución por edad y sexo del Instituto Nacional de Estadística (INE) 2011. Resultados: Las 3 comunidades autónomas registraron el 51% de los 4.285 casos incluidos en el registro nacional, correspondiendo el 42,8% de estos a recidivas. La tasa de incidencia bruta anual para los nuevos episodios fue de 22,6 (IC 95%: 20,7; 24,6) en Andalucía, de 23,5 (IC 95%: 20,9; 26,0) en Cataluña y de 22,0 (IC 95%: 19,9; 24,1) en la Comunidad de Madrid. Conclusiones: Salvo la mayor proporción de fumadores y el menor grado tumoral de las lesiones en Andalucía, las 3 comunidades autónomas estudiadas presentan similitudes en cuanto a características clínicas, comorbilidades, sintomatología de los pacientes y procesos diagnósticos del CAV

Objectives: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. Material and methods: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. Results: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. Conclusions: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

Factores que predicen el desarrollo de metástasis óseas por cáncer de próstata: recomendaciones de seguimiento y opciones terapéuticas / Factors that predict the development of bone metastases due to prostate cancer: Recommendations for follow-up and therapeutic options

Contexto: El cáncer de próstata representa un problema de salud pública en España y en el mundo occidental. En las fases avanzadas de la enfermedad la afectación ósea es prácticamente constante, asociada a una notable morbilidad. El objetivo de este trabajo es realizar una revisión de los factores pronósticos utilizados en la práctica clínica habitual que predicen el desarrollo de metástasis óseas y analizar las opciones de seguimiento y tratamiento en estos perfiles de pacientes. Adquisición de evidencia: Realizamos una revisión de la literatura sobre los factores útiles en el contexto de terapia de intención curativa; incluimos los valores clínicos clásicos al diagnóstico (PSA, estadio clínico, Gleason de la biopsia) factores patológicos (estadio pT, márgenes, invasión de vesículas, volumen tumoral, afectación ganglionar) y la cinética de PSA en sus diferentes contextos, así como parámetros histológicos y moleculares. Síntesis de evidencia: El grado de diferenciación tumoral «Gleason» y el PSA son los factores predictivos más importantes en la predicción de metástasis óseas en pacientes con intención curativa. Factores cinéticos como TDPSA < 8 meses o PSA > 10 ng/ml en la situación de CPRC son factores predictivos de desarrollo de metástasis. El ácido zoledrónico y el denosumab han demostrado su efectividad para el tratamiento de la enfermedad ósea en estudios aleatorizados. Conclusiones: Existen factores predictivos dentro de la práctica clínica habitual que permiten reconocer el «paciente riesgo» para el desarrollo de enfermedad metastásica ósea. Los tratamientos actualmente disponibles, ácido zoledrónico o denosumab, pueden ayudarnos en el manejo de paciente con riesgo de desarrollo de metástasis o metastásico, aumentando la calidad de vida y disminuyendo los eventos esqueléticos

Context: Prostate cancer is a public health problem in Spain and in the Western world. Bone involvement, associated to significant morbidity, is practically constant in the advanced stages of the disease. This work aims to review the prognostic factors used in the usual clinical practice that predict the development of bone metastases and to analyze the follow-up and treatment option in these patient profiles. Acquiring of evidence: We performed a review of the literature on the useful factors in the context of therapy with intention to cure. We included the classical clinical values in the diagnosis (PSA, clinical stage, Gleason score on the biopsy) pathological factors (pT stage, margins, bladder invasion, tumor volume, lymph node involvement) and PSA kinetics in their different contexts and the histological and molecular parameters. Synthesis of evidence: The tumor differentiation «Gleason» score and PSA are the most important predictive factors in the prediction of bone metastases in patients with intention to cure. Kinetic factors such as PSA doubling time (TDPSA) < 8 months or PSA > 10 ng/ml in the case of castration-resistant prostate cancer (CPRC), are predictive factors for the development of metastasis. Zoledronic acid and denosumab have demonstrated their effectiveness for the treatment of bone disease in randomized studies. Conclusions: There are predictive factors within the usual clinical practice that make it possible to recognize the «patient at risk» to develop bone metastatic disease. The currently available treatments, zoledronic acid or denosumab, can help us in the management of the patient at risk of developing metastasis or metastatic patient, increasing the quality of life and decreasing skeletal events

Factors that predict the development of bone metastases due to prostate cancer: Recommendations for follow-up and therapeutic options.

CONTEXT: Prostate cancer is a public health problem in Spain and in the Western world. Bone involvement, associated to significant morbidity, is practically constant in the advanced stages of the disease. This work aims to review the prognostic factors used in the usual clinical practice that predict the development of bone metastases and to analyze the follow-up and treatment option in these patient profiles. ACQUIRING OF EVIDENCE: We performed a review of the literature on the useful factors in the context of therapy with intention to cure. We included the classical clinical values in the diagnosis (PSA, clinical stage, Gleason score on the biopsy) pathological factors (pT stage, margins, bladder invasion, tumor volume, lymph node involvement) and PSA kinetics in their different contexts and the histological and molecular parameters. SYNTHESIS OF EVIDENCE: The tumor differentiation "Gleason" score and PSA are the most important predictive factors in the prediction of bone metastases in patients with intention to cure. Kinetic factors such as PSA doubling time (TDPSA) < 8 months or PSA > 10 ng/ml in the case of castration-resistant prostate cancer (CPRC), are predictive factors for the development of metastasis. Zoledronic acid and denosumab have demonstrated their effectiveness for the treatment of bone disease in randomized studies. CONCLUSIONS: There are predictive factors within the usual clinical practice that make it possible to recognize the "patient at risk" to develop bone metastatic disease. The currently available treatments, zoledronic acid or denosumab, can help us in the management of the patient at risk of developing metastasis or metastatic patient, increasing the quality of life and decreasing skeletal events.

Tratamiento del tumor vesical no músculo infiltrante frente al problema de disponibilidad de bacilo de Calmette-Guerin. Consenso de un panel de expertos españoles / Treatment of Non Muscle Invasive Bladder Tumor Related to the Problem of Bacillus Calmette-Guerin Availability. Consensus of a Spanish Expert’s Panel

Contexto: Desde junio de 2012 se ha producido una falta de disponibilidad de la cepa Connaught a nivel mundial. En diciembre de 2012 se reunió en la sede de la Asociación Española de Urología un grupo de expertos para analizar esta situación y plantear alternativas. Objetivo: Exponer el trabajo realizado por dicha comisión y las recomendaciones resultantes. Adquisición de la evidencia: Se ha realizado una actualización de las principales evidencias existentes en el tratamiento de los tumores de medio y alto riesgo, con especial referencia a las relacionadas con el empleo de BCG y sus posibles alternativas en virtud de la diferente disponibilidad de BCG. Síntesis de la evidencia: En tumores de alto riesgo de progresión debe considerarse la cistectomía inmediata cuando no se disponga de BCG, con reducción de dosis o alternancia con quimioterapia como medidas de ahorro cuando la disponibilidad sea reducida. En los tumores de medio riesgo de progresión puede emplearse quimioterapia, si bien cuando se asocia un alto riesgo de recidiva BCG estaría indicado si hubiera disponibilidad del mismo con las normas de ahorro citadas. El BCG requiere mantenimiento para preservar su efectividad, siendo necesario optimizar la aplicación de la quimioterapia endovesical y utilizar sistemas que incrementen su penetración en la pared vesical (EMDA) si estuvieran disponibles. Conclusiones: Ante la escasa disponibilidad de BCG ha sido preciso consensuar una serie de recomendaciones que han sido publicadas en la página Web de la Asociación Española de Urología (AU)

Context: Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. Objective: To present the work performed by said committee and the resulting recommendations. Acquisition of evidence: An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. Evidence synthesis: In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. Conclusions: Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology (AU)

Treatment of non muscle invasive bladder tumor related to the problem of bacillus Calmette-Guerin availability. Consensus of a Spanish expert's panel. Spanish Association of Urology.

CONTEXT: Since June 2012, the has been a worldwide lack of available of the Connaught strain. In December 2012, a group of experts met in the Spanish Association of Urology to analyze this situation and propose alternatives. OBJECTIVE: To present the work performed by said committee and the resulting recommendations. ACQUISITION OF EVIDENCE: An update has been made of the principal existing evidence in the treatment of middle and high risk tumors. Special mention has been made regarding the those related with the use of BCG and their possible alternative due to the different availability of BCG. EVIDENCE SYNTHESIS: In tumors with high risk of progression, immediate cystectomy should be considered when BCG is not available, with dose reduction or alternating with chemotherapy as methods to economize on the use of BCG when availability is reduced. In tumors having middle risk of progression, chemotherapy can be used, although when it is associated to a high risk of relapse, BCG would be indicated if available with the mentioned savings guidelines. BCG requires maintenance to maintain its effectiveness, it being necessary to optimize the application of endovesical chemotherapy and to use systems that increase its penetration into the bladder wall (EMDA) if they are available. CONCLUSIONS: Due to the scarcity of BCG, it has been necessary to agree on a series of recommendations that have been published on the web page of the Spanish Association of Urology.