de Pablos-Rodríguez P, Guedes Oliva P, Gómez Ferrer Á
… +10 more, Beamud Cortés M, Wong Gutiérrez A, Gutiérrez Castañé C, Calatrava Fons A, Aliaga Patiño J, García Cortés Á, Agustín López J, Collado Serra A, Rodríguez Part V, Casanova Ramón Borja JL
INTRODUCTION: The prognosis of localized prostate cancer (PCa) following radical treatment is generally favorable, although up to 46% of patients may still experience adverse outcomes. The impact of delayed surgery in in...INTRODUCTION: The prognosis of localized prostate cancer (PCa) following radical treatment is generally favorable, although up to 46% of patients may still experience adverse outcomes. The impact of delayed surgery in intermediate-risk (IR) or high-risk (HR) patients remains under discussion. This study evaluates its association with oncological outcomes. MATERIALS AND METHODS: Retrospective study of 2296 patients with IR and HR PCa who underwent radical prostatectomy (RP) between 1986 and 2025. Upgrading, upstaging, positive margins, PSA persistence, and lymph node involvement were analyzed. Waiting time was grouped into <3, 3-6, and >6 months. RESULTS: The median waiting time was 3.5 months. Eighty-five percent of patients were operated on within 6 months. At 5 years, no difference was detected between waiting time and time to biochemical recurrence (BCR) when comparing the <3-month group with the 3-6-month group (HR 0.93; 95% CI 0.76-1.13) and the >6 months group (HR 0.74; 95% CI 0.53-1.04) among IR patients. In HR patients, no differences were observed either: 3-6 months (HR 0.85; 95% CI 0.71-1.01) and >6 months (HR 0.79; 95% CI 0.61-1.03). No increased risk of adverse pathological outcomes was found with longer delays. CONCLUSIONS: A waiting time of ≤6 months was not associated with worse oncological prognosis, supporting its safety in IR or HR PCa.
Gentili G, Paesano N, Barreto M
… +9 more, Castillo G, Mierzwa T, Hernández Méndez A, Falcioni M, Santomil F, Autrán Gómez AM, Tobia-González I, Rodríguez A, en nombre del Grupo de Trabajo del Proyecto PRYUS-CAU
INTRODUCTION: Surgical training in urology has undergone significant transformation due to the increasing complexity of procedures and the integration of advanced technologies. Simulation-based education is recognized as...INTRODUCTION: Surgical training in urology has undergone significant transformation due to the increasing complexity of procedures and the integration of advanced technologies. Simulation-based education is recognized as a fundamental component of residency programs. This study aimed to evaluate the current status of surgical training and the availability of simulation resources for urology residents and early-career urologists in the countries represented by the American Confederation of Urology. METHODS: A descriptive, cross-sectional survey was conducted with 402 participants from 19 countries. The questionnaire included multiple-choice questions addressing demographics, access to surgical procedures, simulation tools, evaluation methods, mentorship, and the impact of the COVID-19 pandemic. RESULTS: The study revealed significant heterogeneity in surgical training. Only 17.9% had access to robotic surgery and 32.8% to prostate enucleation. Over 80% reported the absence of virtual or wet labs at their institutions. Training was based on step-by-step instruction (89.9%), in laparoscopic (45%) and endoscopic (50.7%). However, 15.7% used simulators during surgical procedures. Additionally, 50.6% reported the absence of formal assessment or mentorship. Fellowship training was considered in 84.7%. The COVID-19 pandemic negatively impacted academic (50.3%) and surgical (66.9%) training. CONCLUSIONS: The findings highlight considerable variability in surgical training, limited access to simulation resources, and a general absence of standardized evaluation and mentorship systems. These results emphasize the need to implement structured and equitable training that incorporate simulation, these offer a safe and effective environment for developing surgical skills.
INTRODUCTION AND OBJECTIVE: uROLOGIC health is a global priority, particularly in Latin America, where access to quality services remains limited. This underscores the importance of collaboration among key societal secto...INTRODUCTION AND OBJECTIVE: uROLOGIC health is a global priority, particularly in Latin America, where access to quality services remains limited. This underscores the importance of collaboration among key societal sectors, including the public, private, and academic domains. The MEDIUVer-UROLATAM model emerges as a university-led urological health strategy aimed at promoting socially impactful health initiatives. It is grounded in core university functions, collaborative work, and a targeted approach to specific social needs. The objective was to demonstrate the utility of the MEDIUVer-UROLATAM model as a framework for facilitating prostate cancer (PCa) detection and prevention actions. MATERIAL AND METHODS: The MEDIUVer model was implemented in three stages through a urological campaign coordinated by the Latin American Institute of Urology (UROLATAM) and the Faculty of Medicine at Universidad Veracruzana. The initiative involved collaboration with the private sector, government agencies, and the community to facilitate the early detection of prostate cancer. Medical evaluations, diagnostic tests, and educational activities were conducted. RESULTS: A total of 1656 individuals were attended, with 1352 urological evaluations performed. The first stage focused on social action, the second strengthened inter-institutional collaboration, and the third incorporated educational research and healthcare services for the transgender population. This approach led to greater stakeholder integration and an expanded social impact. CONCLUSIONS: The MEDIUVer-UROLATAM model is an educational, training, and care-oriented tool for both the general population and healthcare professionals in terms of timely prostate cancer (PCa) detection and prevention.
Farré A, Uleri A, Gallioli A
… +11 more, Baboudjian M, Sanz I, Casadevall M, Hernández P, Territo A, Gavrilov P, Rodríguez Faba O, Huguet J, Gaya JM, Palou J, Breda A
INTRODUCTION: Novel trifecta has been proposed to define surgical success in patients undergoing partial nephrectomy (PN). This study aimed to evaluate its role in predicting survival outcomes and to identify the predict...INTRODUCTION: Novel trifecta has been proposed to define surgical success in patients undergoing partial nephrectomy (PN). This study aimed to evaluate its role in predicting survival outcomes and to identify the predictors of trifecta achievement via a machine-learning based model. METHODS: Data from consecutive patients who underwent minimally invasive PN between 2003 and 2022 were retrospectively analysed. Surgical success was defined through the achievement of novel trifecta (No Clavien-Dindo ≥ 3 postoperative complications, negative surgical margins and <30% reduction in postoperative eGFR). Kaplan-Meier curves were used to assess the impact of trifecta achievement on survival. Automated chi-squared interaction detection (CHAID), a recursive machine-learning algorithm, was applied to predict trifecta achievement. RESULTS: A total of 465 patients were included, with a median follow-up of 72 (IQR 38-108) months. The trifecta was achieved in 73% of cases and was associated with significantly improved overall survival (85% vs. 69.8%; P = .04). Solitary kidney status, patient age, and surgical experience were the most relevant predictors, allowing classification into three clusters. Trifecta rates were 43.6% in cluster #1 (solitary kidney), 71.2% in cluster #2 (non-solitary kidney with surgical experience ≤ 80 cases or >80 cases and patients-age ≥ 65), and 88.5% in cluster #3 (non-solitary kidney, patients-age < 65, surgical experience > 80 cases). CONCLUSIONS: Novel trifecta achievement after PN correlates with overall survival but not with other oncological outcomes. A predictive model was developed, highlighting surgical experience as the only modifiable factor. Tailored perioperative strategies and advanced surgical training may improve trifecta achievement.
OBJECTIVE: In this study, the success of the Modified Frailty Index-5 (mFI-5) score in predicting postoperative morbidity in elderly patients who underwent radical cystectomy (RC) for bladder cancer was evaluated, and th...OBJECTIVE: In this study, the success of the Modified Frailty Index-5 (mFI-5) score in predicting postoperative morbidity in elderly patients who underwent radical cystectomy (RC) for bladder cancer was evaluated, and this score was compared with the widely used Charlson Comorbidity Index (CCI) and Geriatric 8 (G8) screening tools. METHODS: Between January 2017 and April 2025, 102 patients aged ≥65 years who underwent open RS for T2-T4a N0M0 bladder cancer were retrospectively reviewed. mFI-5, CCI, and G8 scores were calculated from preoperative data. Patients were divided into two groups based on mFI-5 scores: <2 (Group 1, non-frail) and ≥2 (Group 2, frail). Major complications were defined as Clavien-Dindo (CD) ≥3. Clinical data, complication rates, hospital stay duration, and readmission rates after discharge were compared. RESULTS: Of the patients, 40 (39.2%) were in Group 1 and 62 (60.8%) were in Group 2. The rates of any complications and CD ≥ 3 complications were higher in Group 2 (p = 0.006 and p = 0.018, respectively). In multivariate analysis, mFI-5 ≥ 2 approximately tripled the risk of CD ≥ 3 complications (OR = 3.036; 95% CI 0.966-9.546; p = 0.043). In ROC analysis, the AUC value of mFI-5 for CD ≥ 3 complications was 0.718 (95% CI: 0.613-0.822), which was higher than that of CCI and G8. The AUC value of mFI-5 for predicting readmission was 0.704 (95% CI: 0.599-0.810). CONCLUSION: mFI-5 is a practical frailty assessment tool that predicts postoperative morbidity in elderly RS patients with higher accuracy than CCI and G8.
INTRODUCTION: Focal therapy offers a middle-ground approach for localized prostate cancer, preserving the prostate while avoiding the morbidity of radical treatment. High-Intensity Focused Ultrasound (HIFU) is the most s...INTRODUCTION: Focal therapy offers a middle-ground approach for localized prostate cancer, preserving the prostate while avoiding the morbidity of radical treatment. High-Intensity Focused Ultrasound (HIFU) is the most studied focal modality, with FocalONE representing the most widely adopted modern platform enabling precise image-guided ablation. OBJECTIVE: To systematically assess the oncologic control, functional outcomes, safety, and technological advancements of focal and hemiablation HIFU with an emphasis on the FocalONE platform. METHODOLOGY: This systematic review followed PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Embase, and Cochrane databases identified prospective studies using FocalONE or earlier-generation transrectal HIFU devices for focal or hemiablation in localized prostate cancer. Key outcomes included biopsy negativity, salvage-free survival, urinary continence, erectile function, and complications. Study quality was appraised using the JBI tool. RESULTS: Five prospective studies involving 701 patients were included. Biopsy negativity ranged from 84% to 95%, with salvage-free survival reaching up to 92% at mid-term follow-up. Urinary continence was preserved in 96-100% of patients, and erectile function in 74-95%, with the most favorable functional outcomes consistently observed in FocalONE-based cohorts. Most adverse events were minor (grade I-II), with few serious complications. Compared to focal cryotherapy and irreversible electroporation, HIFU showed comparable cancer control and better or similar functional preservation. PSA density and MRI-visible lesions were strong predictors of success. CONCLUSION: FocalONE-based focal HIFU provides effective cancer control with excellent functional preservation in selected patients. While evidence from earlier-generation devices supports these trends, generalizability across all HIFU platforms remains to be validated. Its precision and safety profile make it a promising alternative between active surveillance and radical therapies, especially in favorable intermediate-risk cases.
INTRODUCTION: Paraurethral cysts are rare in females and are often incidental findings during routine medical examinations. To date, no standardized approach exists for the surgical management of large cysts, which tend...INTRODUCTION: Paraurethral cysts are rare in females and are often incidental findings during routine medical examinations. To date, no standardized approach exists for the surgical management of large cysts, which tend to cause the most discomfort to patients. OBJECTIVE: To evaluate the effectiveness of surgical treatment for large paraurethral cysts through excision and laser vaporization. METHODS: The study included 49 female patients diagnosed with paraurethral cysts larger than 4 cm in diameter. The patients were divided into two groups: Group 1 (n = 26) underwent excision of the paraurethral cyst, and Group 2 (n = 23) underwent laser vaporization. All patients were monitored throughout their hospitalization. The parameters assessed included operation time, the number and type of intraoperative complications, the duration of bladder catheterization, and the length of hospital stay. RESULTS: Laser vaporization was, on average, 8.6 min shorter than excision (p < 0.05), with a strong correlation between the surgical method and operation time (r = 0.70). Intraoperative complications (bleeding, urethral injury, cyst rupture) occurred 2.8 times less frequently in Group 2 compared to Group 1. The length of hospital stay was 1.3 days shorter following laser vaporization. The correlation between hospital stay duration and surgical method was moderate (r = 0.31). CONCLUSION: Laser vaporization offers significant advantages for the treatment of large paraurethral cysts, including shorter operation time, fewer intraoperative complications, and a faster recovery period. Therefore, laser vaporization should be considered the treatment of choice for large paraurethral cysts.
INTRODUCTION AND OBJECTIVES: Cisplatin is essential for treating urothelial carcinoma but poses a high risk of AKI. Previous studies on CP-AKI risk factors had limitations. Gupta et al. (2020) proposed a simplified risk...INTRODUCTION AND OBJECTIVES: Cisplatin is essential for treating urothelial carcinoma but poses a high risk of AKI. Previous studies on CP-AKI risk factors had limitations. Gupta et al. (2020) proposed a simplified risk score linked to CP-AKI and 90-day survival, though validated only in patients with eGFR ≥50 mL/min. MATERIALS AND METHODS: This single-center retrospective study analyzed 70 patients with urothelial carcinoma treated with cisplatin. Patients with eGFR ≥50 mL/min received full-dose cisplatin (n = 47); those with eGFR 30-49 mL/min received a 75% reduced dose (n = 23), per Japanese guidelines. All received intravenous magnesium. AKI was defined as a ≥ twofold rise in serum creatinine or initiation of renal replacement therapy. The study also evaluated the Gupta score's association with 90-day survival in metastatic cases. RESULTS: AKI occurred in 9.3% of the full-dose group and 4.5% of the reduced-dose group (p = 1.000). Higher Gupta scores were significantly associated with lower 90-day survival (p = 0.003). CONCLUSION: A 75% cisplatin dose reduction in patients with moderate renal impairment appears safe and maintains efficacy without increasing AKI risk. These findings support personalized dosing and highlight the need to refine clinical guidelines. Further prospective studies are warranted.
INTRODUCTION: Limited evidence has been reported on the results of robot-assisted sacrocolpopexy (RASC) related to the type of sutures used. OBJECTIVE: The objective of this study is to analyze the results comparing abso...INTRODUCTION: Limited evidence has been reported on the results of robot-assisted sacrocolpopexy (RASC) related to the type of sutures used. OBJECTIVE: The objective of this study is to analyze the results comparing absorbable with non-absorbable sutures. The primary outcome was mesh related complications and secondary outcomes were anatomical success, early complications and patient satisfaction. METHODS: A prospective, comparative study for the first 123 RASC surgeries performed between December 2016 and June 2022. All patients who underwent robotic sacrocolpopexy were included. No exclusion criteria were established. The procedures were performed by surgeon "A" who used non-absorbable sutures and surgeon "B" who used absorbable sutures. Patient data was collected at baseline, intraoperatively, as well as reporting early complications and mesh-related complications. Anatomic recurrence was defined as patients with POP ≥ 2 on the Baden-Walker scale while the sensation of vaginal bulge determined subjective failure. RESULTS: Non-absorbable sutures were used in 55.3% of the patients while absorbable sutures were used in 44.7% of the patients. The mean follow-up was longer in the absorbable suture group (21.5 vs. 35.3 p < 0.01). No statistically significant differences were found in mesh-complication rate (4.4% vs. 0%, p = 0.16) and in anatomical recurrence and subjective (4.4% vs. 9.1%, p = 0.24). The main limitation of our study was the absence of randomization. CONCLUSIONS: The type of suture used for mesh fixation in RASC does not influence the anatomical outcomes, early complications or mesh-related complications.
INTRODUCTION: Prostate cancer is a significant global health issue. Prostate biopsy remains the gold standard for diagnosis. However, the impact of biopsy tissue length on diagnostic performance remains controversial. Th...INTRODUCTION: Prostate cancer is a significant global health issue. Prostate biopsy remains the gold standard for diagnosis. However, the impact of biopsy tissue length on diagnostic performance remains controversial. This study investigates the relationship between biopsy tissue length and diagnostic efficacy, introducing a new parameter, "unit volume biopsy length," to optimize clinical practice. METHODS: A retrospective analysis was conducted on the clinical data of 301 patients who underwent prostate biopsy. The biopsy tissue length and unit volume biopsy length were compared between patients with positive and negative results, and their impact on the detection rate of prostate cancer was analyzed to obtain the optimal threshold for unit volume biopsy length. RESULTS: Among the 301 patients, 130 (43.19%) had positive results, while 171 had negative results. The median unit volume biopsy length in the positive group was 0.39 cm/mL, which was significantly higher than that in the negative group (0.28 cm/mL; P < 0.05). When the unit volume biopsy length exceeded 0.39 cm/mL, the detection rate of prostate cancer significantly increased (OR 2.879, 95% CI 1.728-4.796), with positive rates of 58.58% and 32.94% in the groups above and below the threshold, respectively (P < 0.05). CONCLUSION: Unit volume biopsy length significantly affects the detection rate of prostate cancer. It is recommended that at least 0.39 cm of biopsy tissue be obtained per milliliter of prostate tissue to ensure adequate screening.
INTRODUCTION: Circulating RNAs (cfRNAs) have emerged as promising biomarkers in liquid biopsy for prostate cancer (PCa). However, the lack of standardization in their analysis and the heterogeneity across available studi...INTRODUCTION: Circulating RNAs (cfRNAs) have emerged as promising biomarkers in liquid biopsy for prostate cancer (PCa). However, the lack of standardization in their analysis and the heterogeneity across available studies limit clinical application. OBJECTIVE: To evaluate the diagnostic and prognostic utility of the total concentration of cell-free circulating small RNA (cf-sRNA) and microRNA (cf-miRNA) in plasma and urine from PCa patients using accessible techniques, without identifying specific miRNAs. MATERIALS AND METHODS: Prospective, longitudinal study including 143 men (111 with PCa and 32 healthy controls). Plasma and urine cf-sRNA and cf-miRNA levels were quantified with an Agilent 2100 Bioanalyzer. Levels were correlated with clinical features, tumor stage, and progression to metastatic castration-resistant PCa (mCRPC). A longitudinal follow-up was conducted in a metastatic subgroup. RESULTS: Plasma and urine levels of cf-miRNA and cf-sRNA were significantly higher in patients with advanced PCa, particularly in those who progressed to mCRPC (p < 0.05). During follow-up, a significant increase in plasma cf-miRNA was observed after treatment (p = 0.031), as well as an increase in the relative percentage of cf-miRNA in urine (p = 0.012). CONCLUSIONS: Total quantification of cf-miRNA in plasma and urine is an accessible strategy with potential value as a dynamic biomarker for PCa monitoring and prognosis. Its use could complement current diagnostic tools, although further studies are required to validate its utility in clinical practice.
INTRODUCTION: This study aimed to assess long-term trends in bladder cancer incidence in Spain from 1992 to 2021, using Age-Period-Cohort (A-P-C) modelling to disentangle the contributions of age, period, and cohort effe...INTRODUCTION: This study aimed to assess long-term trends in bladder cancer incidence in Spain from 1992 to 2021, using Age-Period-Cohort (A-P-C) modelling to disentangle the contributions of age, period, and cohort effects. METHODS: An ecological trend study was conducted using data from the Global Burden of Disease (GBD) 2021 Study via the Global Health Data Exchange. Age- and sex-specific incidence counts for Spain (1992-2021) were analyzed. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs). A-P-C modelling assessed net and local drifts, as well as cohort and period rate ratios using 5-year age groups and calendar periods. RESULTS: From 1992 to 2021, 377,430 male and 66,191 female BC cases were estimated. In men, age-adjusted incidence declined (AAPC = -0.6 %), driven by favourable birth cohort and period effects. In women, a modest decline (AAPC = -0.3%) masked a mid-century cohort effect, with increased risk in those born between 1957 and 1967-consistent with a delayed tobacco epidemic. Incidence rose with age in both sexes, though male-to-female incidence ratios narrowed in older groups. CONCLUSION: BC incidence in Spain reflects complex, sex-specific temporal dynamics. While male incidence is decreasing, women show persistent cohort-specific increases. These trends underscore the importance of sex-sensitive public health strategies targeting modifiable risk factors, particularly tobacco use.
INTRODUCTION: Renal transplantation is the renal replacement therapy of choice in patients with end-stage chronic kidney disease. Major urological complications such as urinary leakage, ureteral stricture and urinary tra...INTRODUCTION: Renal transplantation is the renal replacement therapy of choice in patients with end-stage chronic kidney disease. Major urological complications such as urinary leakage, ureteral stricture and urinary tract infection, usually occur in the first three months post-transplantation and lead to a higher morbidity and mortality and lower graft function. OBJECTIVE: To evaluate the impact of double J catheter colocation on major urological complications in extravesical ureteroneocystostomy in renal recipients. METHODS: Open clinical trial. The study included renal transplant recipients who underwent extravesical ureteroneocystostomy with trans-surgical placement of double J catheter compared to extravesical ureteroneocystostomy without trans-surgical catheter placement. The study variables were urinary leakage, ureteral stricture, urinary tract infection, surgical complications and graft function. RESULTS: 84 patients were included, 42 patients in the study group and 42 in the control group, who had a mean follow-up of 10.7 months. Of the urological complications presented: 4 (4.8%) patients with urinary leakage, all in the non-catheter group (RR 0.475 95% CI 0.377-0.598, p = 0.04); 2 (2.4%) patients with ureteral stricture, one in each group (RR 1 95% CI 0. 246-4.066, p = 1.0); and 20 (23.8%) patients with urinary tract infection, being 9 (21.4%) patients in the control group and 11 (26.2%) in the study group (RR 1.135 CI 95% 0.710-1.817, p = 0.608). No differences regarding graft function were observed. CONCLUSION: Our study showed a significant reduction in the incidence of urinary leakage with prophylactic ureteral catheter use, although no significant association was observed with other complications such as ureteral stricture or surgical complications. Furthermore, its use was not significantly associated with urinary tract infections or graft dysfunction.
OBJECTIVE: To demonstrate the impact of demographic data on the clinical outcomes of patients with emphysematous pyelonephritis (EPN) treated at our center, and to present the results obtained-particularly through the co...OBJECTIVE: To demonstrate the impact of demographic data on the clinical outcomes of patients with emphysematous pyelonephritis (EPN) treated at our center, and to present the results obtained-particularly through the comparison of drainage methods-in the largest patient group possible. MATERIALS AND METHODS: This retrospective single-center study included 54 EPN patients treated at a tertiary care hospital. Inclusion required symptoms of upper urinary tract infection and gas in the renal parenchyma, collecting system, or perinephric space on abdominal CT. Data on demographics, urinary tract stones, labs, imaging (Huang and Tseng classification), hospital and intensive care unit (ICU) stay, and mortality were analyzed by initial treatment, drainage method, and platelet count. Patients with at least 6 months of follow-up were assessed for infection recurrence, renal function loss, and delayed nephrectomy. RESULTS: Advanced age was associated with increased ICU need and mortality (respectively p = 0.047, p = 0.039). Diabetes was associated with longer hospital stays compared to those without DM (14 vs. 7.5 days, p = 0.015). Thrombocytopenia was linked to higher rates of non-functioning kidneys (66.7%) and delayed nephrectomy (33.3%). No significant differences in morbidity or mortality were found between drainage methods (percutaneous vs. DJ stent). More male patients had advanced-stage disease, though this did not impact outcomes. CONCLUSION: EPN is an emergency urological situation with high rate of mortality. Therefore, early diagnosis and appropriate management are crucial to decrease morbidity and mortality. Patient management approaches can be improved with growing evidence and prospective data with future studies.
INTRODUCTION: The localized renal cell carcinoma (RCC) is the eighth most common tumour in Spain. While surgical resection remains the gold standard for treatment, some elderly and frail patients may not be suitable cand...INTRODUCTION: The localized renal cell carcinoma (RCC) is the eighth most common tumour in Spain. While surgical resection remains the gold standard for treatment, some elderly and frail patients may not be suitable candidates for this procedure. In selected cases, ablative therapies provide less invasive alternatives. Recent research has highlighted the potential of Stereotactic Body Radiotherapy (SBRT) as a non-invasive, well-tolerated, and effective treatment for RCC. This review aims to examine recent advances in SBRT for localized RCC, focusing on patient selection, treatment modalities and delivery, as well as efficacy and tolerance assessment. MATERIAL AND METHODS: A narrative literature review of English articles using Pubmed, Scopus, Cochrane, Google Scholar and Science Direct databases was performed focusing on prospective and relevant retrospective studies. Search terms included "kidney cancer", "renal cell carcinoma", "stereotactic radiotherapy", "radiofrequency ablation", "cryoablation", "microwave ablation", "SBRT" and "SABR". RESULTS: Studies have reported local control rates ranging from 80% to 100% with SBRT. The decline in glomerular filtration rate following SBRT is approximately -10 to -13 mL/min over the years. Common toxicities are rare and are mostly classified as CTCAE grade I. CONCLUSION: Based on available evidence, SBRT appears to be a viable option for patients with localized RCC who are not surgical candidates, given its high local control rate and favorable safety profile. Therefore, some indications for its use in clinical practice have been purposed according to the available evidence and recommending a case by case discussion in a uro-oncology multidisciplinary setting to optimize patient selection and treatment planning.
Vicente Palacio E, Bosch Knape P, Tarragón Gabarro S
… +10 more, Centeno Álvarez C, de Verdonces Román L, Sanchez I Puy A, Juaneda Castell B, Cuadrench Solorzano S, Sotelo Burillo E, Marco Pérez LM, Sabiote Rubio L, Salinas Duffo D, Peña González JA
OBJECTIVE: To assess whether chronic pelvic pain presents specific qualitative traits, as described by patients, that can guide identification of its underlying clinical phenotype. MATERIALS AND METHODS: A retrospective...OBJECTIVE: To assess whether chronic pelvic pain presents specific qualitative traits, as described by patients, that can guide identification of its underlying clinical phenotype. MATERIALS AND METHODS: A retrospective study including 157 patients (81 men, 76 women), interviewed systematically by a single evaluator using a structured 10-item table aimed at identifying three possible phenotypes. The correlation between the predicted phenotype (based solely on anamnesis) and the final phenotype (established through physical examination, treatment response, and clinical evolution) was analyzed. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated by phenotype and sex. The diagnostic relevance of each question was assessed, and statistical significance was tested using the Chi-square test. RESULTS: In women, the proportion of predicted phenotypes confirmed as final was: 64.5% bladder, 19.7% myofascial, 30.2% neuropathic. In men: 8.6% bladder, 81.5% myofascial, 23.5% neuropathic. Women-bladder: Se 0.92, Sp 0.74, PPV 0.90, NPV 0.72, AUC 0.82. Myofascial: Se 0.44, Sp 0.93, PPV 0.79, NPV 0.75, AUC 0.76. Neuropathic: Se 0.36, Sp 0.98, PPV 0.89, NPV 0.79, AUC 0.51. Men-bladder: Se 0.57, Sp 0.83, PPV 0.21, NPV 0.96, AUC 0.81. Myofascial: Se 0.75, Sp 0.75, PPV 0.93, NPV 0.41, AUC 0.75. Neuropathic: Se 0.29, Sp 1.00, PPV 1.00, NPV 0.80, AUC 0.64. CONCLUSIONS: A structured anamnesis may help identify the clinical phenotype underlying chronic pelvic pain (bladder, myofascial, or neuropathic).
INTRODUCTION: The management of non-muscle invasive bladder cancer (NMIBC) failing Bacillus Calmette-Guérin (BCG) therapy remains challenging. The European Association of Urology (EAU) has standardized definitions of BCG...INTRODUCTION: The management of non-muscle invasive bladder cancer (NMIBC) failing Bacillus Calmette-Guérin (BCG) therapy remains challenging. The European Association of Urology (EAU) has standardized definitions of BCG failure. We aim to evaluate oncological outcomes in patients undergoing radical cystectomy (RC) for NMIBC following BCG failure, as defined by the EAU. METHODS: Retrospective study analyzed 93 patients with NMIBC who underwent RC between 2011 and 2021 after BCG therapy failure. Patients were stratified into 4 groups: clinical NMIBC, clinical progression, subclinical progression (understaged), and pathological NMIBC (pNMIBC) groups. Oncological outcomes included cancer-specific survival (CSS) and overall survival (OS). Kaplan-Meier and logistic regression analyses were used to evaluate outcomes and predictors of disease progression. RESULTS: Among 93 patients, 64 (68.8%) had clinical NMIBC, and 29 (31.2%) showed clinical progression to muscle-invasive bladder cancer (MIBC) prior to RC. Of those with clinical NMIBC, 46 (71.9%) were confirmed as pNMIBC and 18 (28.1%) had subclinical progression. Patients with pNMIBC had significantly better 5-year CSS (95.5%) and OS (77.6%) compared to those with clinical (CSS 70.4%, OS 50.2%) or subclinical progression (CSS 64.1%, OS 43.8%). cT1 with conco-mitant carcinoma in situ and prostatic urethral involvement were independent predictors of muscle-invasive disease at RC. CONCLUSIONS: Patients treated at an appropriate stage show superior survival outcomes com-pared to those with progression. These findings underscore the importance of timely surgical intervention in BCG-unresponsive NMIBC and support early RC in select high-risk patients to improve long-term prognosis.
OBJECTIVES: To compare the diagnostic performance of cognitive fusion biopsy and/or standard systematic biopsy performed following multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (P...OBJECTIVES: To compare the diagnostic performance of cognitive fusion biopsy and/or standard systematic biopsy performed following multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer (PCa), and to assess the standalone diagnostic value of mpMRI. MATERIALS AND METHODS: Initially, 1153 patients undergoing PBx from 2017 to 2022 were chosen. Patients were divided into three groups: those with standard PBx without mpMRI (1st group), those with standard PBx after mpMRI (2nd group) and those with standard and cognitive fusion PBx after mpMRI (3rd group). The correlations of general PCa and clinically significant PCa (csPCa) detection rates and Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) scores were evaluated. RESULTS: The overall PCa detection rate was highest in group 2 (47%). Additionally, the malignancy rate in group 3 was significantly higher compared to group 1 (P < .05). Though the csPCa rate was higher in the third group (40%) compared to the other groups, no significant difference was identified. As the PI-RADS score increased, the malignancy rates appeared to increase. The rate of high-risk patients in the group with cognitive fusion biopsy performed (11, 17%) was higher compared to the second group (P < .05). CONCLUSIONS: Multiparametric MRI is valuable in prostate cancer diagnosis, particularly for lesion detection and biopsy guidance in patients with high PI-RADS scores. However, in our study, the addition of cognitive fusion biopsy did not significantly increase the detection rate of csPCa. Further prospective randomized studies are needed to clarify its diagnostic value.