Impact of a One-Stop Hematuria Clinic on Overall Survival and Bladder Tumor Recurrence.

BACKGROUND AND OBJECTIVE: One-stop clinics have emerged as a tool to optimize the therapeutic management of cancer patients. The main purpose of this study was to assess the role of the one-stop hematuria clinic (OSHC), as compared to a conventional clinic (CC), on the overall and disease-free survival of patients with bladder cancer. METHODS: A five-year follow-up retrospective and single-center study was conducted in patients with primary bladder tumor diagnosed between 2006 and 2015. The primary outcomes were five-year overall survival and one-year relapse rate. RESULTS: A total of 394 patients (160 in OSHC and 234 in CC) were included. No differences were observed in terms of age, sex, smoking habit or risk group between the OSHC and CC groups. The average times from first symptom to diagnosis (24.9 ± 29.1 vs. 100.7 ± 93.6 days) and from first symptom to treatment (70.2 ± 34.0 vs. 155.0 ± 102.9 days) were significantly lower in the OSHC group than in the CC group (p < 0.001 each). There was no significant difference in the five-year survival rate between OSHC and CC (103/160 vs. 150/234, respectively; p = 0.951), although the proportion of relapses during the first year was significantly lower in the OSHC group (35/139, 25.2%) than in the CC one (74/195, 38.0%; p = 0.02). CONCLUSIONS: OSHC significantly reduced the diagnosis and treatment times. The early-relapse rate was significantly lower in the OSHC group, although the five-year survival rate was similar.

Impact of a One-Stop Hematuria Clinic on Overall Survival and Bladder Tumor Recurrence

Background and Objective: One-stop clinics have emerged as a tool to optimize the therapeutic management of cancer patients. The main purpose of this study was to assess the role of the one-stop hematuria clinic (OSHC), as compared to a conventional clinic (CC), on the overall and disease-free survival of patients with bladder cancer. Methods: A five-year follow-up retrospective and single-center study was conducted in patients with primary bladder tumor diagnosed between 2006 and 2015. The primary outcomes were five-year overall survival and one-year relapse rate. Results: A total of 394 patients (160 in OSHC and 234 in CC) were included. No differences were observed in terms of age, sex, smoking habit or risk group between the OSHC and CC groups. The average times from first symptom to diagnosis (24.9 ± 29.1 vs. 100.7 ± 93.6 days) and from first symptom to treatment (70.2 ± 34.0 vs. 155.0 ± 102.9 days) were significantly lower in the OSHC group than in the CC group (p < 0.001 each). There was no significant difference in the five-year survival rate between OSHC and CC (103/160 vs. 150/234, respectively; p = 0.951), although the proportion of relapses during the first year was significantly lower in the OSHC group (35/139, 25.2%) than in the CC one (74/195, 38.0%; p = 0.02). Conclusions: OSHC significantly reduced the diagnosis and treatment times. The early-relapse rate was significantly lower in the OSHC group, although the five-year survival rate was similar (AU)

[Usefulness of contrast enhanced ultrasound for evaluation of cystic renal masses.] / Utilidad de la ecografía con contraste en el estudio de las lesiones renales quísticas.

OBJECTIVE: Contrast enhanced ultrasound(CE) consists of the intravenous injection of gasmicrobubbles and their detection within the kidney in differentphases. CE is more accurate than contrast enhancedtomography for detection of septa and wall thicknessvascularization in cystic renal lesions. The purposes ofthis study are to confirm the usefulness of this tool in thecharacterization of complex cystic renal masses and toassess its histological correlation. MATERIALS AND METHODS: Retrospective observationalstudy of 78 patients with complex or indeterminatecystic renal masses who underwent a CE betweenJanuary 2015 - January 2020. RESULTS: Lesions with high suspicion of malignancy(Bosniak III and IV) were identified in 35 patients(45%). A surgical approach was taken in 23 (30%): 18patients with histology of renal cell carcinoma, and onlyin 4 the histology was benign. CE involved a change intherapeutic management due to better definition of thelesion in 48 patients (61.5%). CE has a sensitivity 100%,specificity 91.5%, PPV 81.8%, NPV 100%, and CE hadan important confidence level showed by the area underthe ROC curve (AUC = 0.968). CONCLUSIONS: CE is a useful tool in the characterizationof complex cystic renal lesions. It allows abetter definition of the Bosniak classification for thoseindeterminate or doubtful cases on CT that couldgenerate a change in the therapeutic attitude in manycases. It has a good image - histology relation.

OBJETIVO: La ecografía con contraste(EC) consiste en la inyección intravenosa demicroburbujas de gas y su detección dentro del riñón endistintas fases. En las lesiones renales quísticas la EC esmás sensible que la tomografía con contraste para valorarla vascularización de septos y tabiques. Los objetivosde este trabajo son confirmar la utilidad de esta técnicaen la caracterización de las lesiones renales quísticascomplejas y estudiar su relación anatomo-patológica MATERIAL Y MÉTODOS: Estudio observacionalretrospectivo de 78 pacientes con masas renales quísticascomplejas o dudosas en los que se les realizó una ECentre enero 2015 ­ enero 2020. RESULTADOS: En 35 pacientes (45%) se identificaronlesiones con alta sospecha de malignidad (BosniakIII y IV). En 23 (30%) se tomó una actitud quirúrgica: 18con anatomía patológica de carcinoma de células renalesy 4 con anatomía patológica benigna. En 48 pacientes(61,5%) supuso un cambio de actitud terapéuticadebido a la mejor definición de la lesión. La EC presentóuna sensibilidad 100%, especificidad 91,5%, VPP 81,8%,VPN 100%, con un nivel confianza diagnóstica mostradopor el área bajo la curva ROC (AUC = 0,968).CONCLUSIÓN: La EC es una herramienta útil en lavaloración de quistes renales complejos. Permite unamejor definición de la clasificación Bosniak para aquelloscasos indeterminados o dudosos en TC, que implicóun cambio de actitud terapéutica en muchos casos. Además,presenta una buena relación imagen-histología.

Utilidad de la ecografía con contraste en el estudio de las lesiones renales quísticas / Usefulness of contrast enhanced ultrasound for evaluation of cystic renal masses

OBJETIVO: La ecografía con contraste (EC) consiste en la inyección intravenosa demicroburbujas de gas y su detección dentro del riñón endistintas fases. En las lesiones renales quísticas la EC esmás sensible que la tomografía con contraste para valorar la vascularización de septos y tabiques. Los objetivosde este trabajo son confirmar la utilidad de esta técnicaen la caracterización de las lesiones renales quísticascomplejas y estudiar su relación anatomo-patológicaMATERIAL Y MÉTODOS: Estudio observacionalretrospectivo de 78 pacientes con masas renales quísticas complejas o dudosas en los que se les realizó una ECentre enero 2015 – enero 2020.RESULTADOS: En 35 pacientes (45%) se identificaron lesiones con alta sospecha de malignidad (BosniakIII y IV). En 23 (30%) se tomó una actitud quirúrgica: 18con anatomía patológica de carcinoma de células renales y 4 con anatomía patológica benigna. En 48 pacientes (61,5%) supuso un cambio de actitud terapéuticadebido a la mejor definición de la lesión. La EC presentóuna sensibilidad 100%, especificidad 91,5%, VPP 81,8%,VPN 100%, con un nivel confianza diagnóstica mostradopor el área bajo la curva ROC (AUC = 0,968).CONCLUSIÓN: La EC es una herramienta útil en lavaloración de quistes renales complejos. Permite unamejor definición de la clasificación Bosniak para aquellos casos indeterminados o dudosos en TC, que implicóun cambio de actitud terapéutica en muchos casos. Además, presenta una buena relación imagen-histología. (AU)

OBJECTIVE: Contrast enhanced ultrasound (CE) consists of the intravenous injection of gasmicrobubbles and their detection within the kidney in different phases. CE is more accurate than contrast enhanced tomography for detection of septa and wall thicknessvascularization in cystic renal lesions. The purposes ofthis study are to confirm the usefulness of this tool in thecharacterization of complex cystic renal masses and toassess its histological correlation.MATERIALS AND METHODS: Retrospective observational study of 78 patients with complex or indeterminate cystic renal masses who underwent a CE betweenJanuary 2015 – January 2020.RESULTS: Lesions with high suspicion of malignancy (Bosniak III and IV) were identified in 35 patients(45%). A surgical approach was taken in 23 (30%): 18patients with histology of renal cell carcinoma, and onlyin 4 the histology was benign. CE involved a change intherapeutic management due to better definition of thelesion in 48 patients (61.5%). CE has a sensitivity 100%,specificity 91.5%, PPV 81.8%, NPV 100%, and CE hadan important confidence level showed by the area under the ROC curve (AUC = 0.968). CONCLUSIONS: CE is a useful tool in the characterization of complex cystic renal lesions. It allows abetter definition of the Bosniak classification for those indeterminate or doubtful cases on CT that couldgenerate a change in the therapeutic attitude in manycases. It has a good image – histology relation. (AU)

[Gross hematuria and usefulness of urinary cytology: Experience at hematuria one stop clinic.] / Citología de orina por lavado y hematuria macroscópica monosintomática: experiencia sobre su utilidad en una consulta de alta resolución.

OBJECTIVE: To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic gross haematuria. METHODS: A retrospective, descriptive and analytic study of the patients that complained of macroscopic hematuria at the one-stop clinic between 2011 and 2018. The complementary tests requested were: kidney/bladder ultrasounds, urethrocystoscopy and urinary instrumentalized cytology. All the urine cytology samples were examined by the same pathologist. RESULTS: 1122 patients were reviewed with ultrasonography and cystoscopy. Bladder tumor was detected in 354 patients (31.5%) and other urological malignancies were found in 33 cases (2.9%). Urinary instrumentalized cytologies were collected in 804 patients (71.4%), being positive in 236 cases (29.4%). Sensitivity and specificity of urinary cytology for urothelial tumor detection were 55.1% and 85.7%, respectively. Cytology was positive in 181 patients (52.1%) with visible bladder tumors through cystoscopy, in 7 patients (0.87%) without visible bladder tumors. In 433 patients with ultrasonography and cystoscopy both negative, urine cytology was performed with a negative result (38.6%). CONCLUSION: The usefulness of instrumentalized urinary cytology to diagnose urothelial tumors is restricted in terms of monosymptomatic gross haematuria one stop clinic. It allows the diagnosis of a very limited number of cases tumors and leaves a significant number of them out. In case of gross hematuria and negative imaging, urine cytology can be requested as a differed complementary.

OBJETIVO: Evaluar la precisión y rentabilidad diagnósticas de la citología urinaria por lavado en el estudio inicial de la hematuria macroscópica monosintomática en el contexto de una consulta de alta resolución.MÉTODOS: Estudio retrospectivo, descriptivo y analítico de las pruebas diagnósticas solicitadas en la consulta de hematuria de alta resolución entre 2011 y 2018. Se evaluaron la ecografía de aparato urinario, la uretrocistoscopia y particularmente la citología de orina por lavado vesical. Las muestras de citología urinaria fueron revisadas por el mismo patólogo. RESULTADOS: 1122 pacientes con ecografía y cistoscopia. Se detectó tumor vesical en 354 pacientes (31,5%) y otros tumores urológicos en 33 casos (2,9%). Se recogió citología urinaria por lavado en 804 pacientes (71,4%), siendo positiva en 236 casos (29,4%). La sensibilidad y especificidad de la citología urinaria para detectar tumor urotelial fue del 55,1%, y del 85,7%, respectivamente. En los pacientes con tumor vesical visible por cistoscopia la citología fue positiva en 181 pacientes (52,1%). En los casos sin tumor vesical visible hubo 7 pacientes (0,87%) con citología positiva. En 433 pacientes con ecografía y cistoscopia negativas se recogió citología urinaria cuyo resultado fue negativo (38,6%).CONCLUSIÓN: La citología urinaria por lavado tiene una utilidad limitada en el estudio inicial de la hematuria macroscópica de una consulta de alta resolución. Permite el diagnóstico de un reducido número de tumores uroteliales, obviando un porcentaje significativo de ellos. En caso de hematuria macroscópica monosintomática y pruebas de imagen negativas, la citología urinaria podría usarse como prueba complementaria diferida.

Citología de orina por lavado y hematuria macroscópica monosintomática: experiencia sobre su utilidad en una consulta de alta resolución / Urine cytology by washing and monosymptomatic macroscopic hematuria: experience on its usefulness in a high-resolution consultation

Obejtivo: Evaluar la precisión y rentabilidad diagnósticas de la citología urinaria por lavadoen el estudio inicial de la hematuria macroscópica monosintomática en el contexto de una consulta de altaresolución.Métodos: Estudio retrospectivo, descriptivo y analítico de las pruebas diagnósticas solicitadas en la consulta de hematuria de alta resolución entre 2011 y 2018.Se evaluaron la ecografía de aparato urinario, la uretrocistoscopia y particularmente la citología de orina porlavado vesical. Las muestras de citología urinaria fueronrevisadas por el mismo patólogo. Resultados: 1122 pacientes con ecografía y cistoscopia. Se detectó tumor vesical en 354 pacientes(31,5%) y otros tumores urológicos en 33 casos (2,9%).Se recogió citología urinaria por lavado en 804 pacientes (71,4%), siendo positiva en 236 casos (29,4%).La sensibilidad y especificidad de la citología urinaria para detectar tumor urotelial fue del 55,1%, y del85,7%, respectivamente. En los pacientes con tumor vesical visible por cistoscopia la citología fue positiva en181 pacientes (52,1%). En los casos sin tumor vesicalvisible hubo 7 pacientes (0,87%) con citología positiva.En 433 pacientes con ecografía y cistoscopia negativas se recogió citología urinaria cuyo resultado fue negativo (38,6%).Conclusión: La citología urinaria por lavado tieneuna utilidad limitada en el estudio inicial de la hematuriamacroscópica de una consulta de alta resolución. Permite el diagnóstico de un reducido número de tumores uroteliales, obviando un porcentaje significativo de ellos.En caso de hematuria macroscópica monosintomáticay pruebas de imagen negativas, la citología urinariapodría usarse como prueba complementaria diferida.(AU)

Objetive: To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic grosshaematuria.Methods: A retrospective, descriptive and analyticstudy of the patients that complained of macroscopic hematuria at the one-stop clinic between 2011 and2018. The complementary tests requested were: kidney/bladder ultrasounds, urethrocystoscopy and urinaryinstrumentalized cytology. All the urine cytology sampleswere examined by the same pathologist.Reslts: 1122 patients were reviewed with ultrasonography and cystoscopy. Bladder tumor was detected in354 patients (31.5%) and other urological malignancieswere found in 33 cases (2.9%). Urinary instrumentalizedcytologies were collected in 804 patients (71.4%), being positive in 236 cases (29.4%). Sensitivity and specificity of urinary cytology for urothelial tumor detectionwere 55.1% and 85.7%, respectively. Cytology waspositive in 181 patients (52.1%) with visible bladdertumors through cystoscopy, in 7 patients (0.87%) withoutvisible bladder tumors. In 433 patients with ultrasonography and cystoscopy both negative, urine cytology wasperformed with a negative result (38.6%).Conclusion: the usefulness of instrumentalized urinary cytology to diagnose urothelial tumors is restrictedin terms of monosymptomatic gross haematuria one stopclinic. It allows the diagnosis of a very limited numberof cases tumors and leaves a significant number of themout. In case of gross hematuria and negative imaging,urine cytology can be requested as a differed complementary.(AU)