Actas urologicas espanolas最新文献

Introduction: To report the results of confirmatory MRI/biopsy in a European cohort of MRI-selected patients with Gleason Grade Group (GG) 2 prostate cancer (PCa) in active surveillance (AS).

Methods: Multicenter study enrolled patients with GG2 PCa managed by AS between 2016-2024. Serial MRI scans were interpreted according to PRECISE recommendations. Diagnostic accuracy of PRECISE score to predict upgrading on confirmatory biopsy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% Confident Intervals (CIs).

Results: A total of 77 patients with GG2 PCa was included, with a PI-RADS 4-5 in 48 patients (63%). On confirmatory MRI, 32 cases were classified as PRECISE 4-5 (42%). On confirmatory biopsy, 39 patients (51%) were downgraded to GG0-1, 27 patients (35%) were GG 2 and upgrading occurred in 11 cases (14%). Sensitivity, specificity, NPV and PPV of the PRECISE score 4-5 to detect upgrading was 63.6% (95%CI 31-89), 62.1% (95%CI, 49-74), 91.1% (95%CI, 82-96) and 21.8% (95%CI, 14-32), respectively. In multivariable Cox hazards regression analysis, downgrading at confirmatory biopsy was significantly associated with a reduced risk of subsequent GG3 reclassification (HR 0.125, 95%CI, 0.277-0.560, p = 0.002) and definitive treatment (HR 0.409, 95%CI, 0.199-0.839, p = 0.015).

Conclusion: MRI selection of patients with GG2 PCa in AS allows better initial characterization of the disease. The absence of progression on MRI indicates a very low risk of grade reclassification, but signs of imaging progression are not always predictive of progression and should not be considered alone for prompting active treatment.

Objective: The Urology Simulation Bootcamp Course (USBC) was developed to address the lack of a structured national programme for practical urological skills training. Feedback from urology colleagues and trainees highlighted the need for focused procedural teaching, particularly in reconstructive urology. In response, a dedicated reconstructive skills module was established within the USBC in 2015. A descriptive report of a structured educational module is presented.

Methods: The module concentrated on four key reconstructive procedures: small bowel anastomosis, stoma formation, uretero-ileal anastomosis, and repair of ureteric and bladder injuries. This hands-on training was delivered with a high faculty-to-trainee ratio, allowing one-to-one mentorship. Faculty recruitment was based on subspecialist expertise and enthusiasm for medical education, ensuring high-quality instruction and one-to-one training. Continuous evaluation and feedback from participants shaped iterative improvements to course content and delivery. Feedback was collated from 2016 onwards, which facilitated the revision of the course over subsequent iterations.

Results: Over eight years, 378 trainees participated in the course. Delegates consistently praised the programme, particularly the individualised mentoring and the quality of tissue models used. The evolving curriculum, informed by systematic feedback, ensured relevance and sustainability. One notable adaptation was reducing the time devoted to small bowel anastomosis in order to expand training on ureteric reimplantation and bladder repair, reflecting delegate preferences and clinical relevance.

Conclusion: Our simulation-based approach to teaching reconstructive urological skills has demonstrated extremely positive results from the delegates consistently over the eight-year period. Focused mentorship and amendments based on feedback have been vital in ensuring a high degree of satisfaction throughout the evolution of the course.

Introduction: Prostate cancer (PCa) remains one of the leading public health challenges among European men. Despite technological advances, its early detection continues to be controversial due to the risk of overdiagnosis and the limited adoption of organized screening programs.

Materials and methods: A review was conducted of scientific literature, institutional reports, and technical documentation from the PRAISE-U project. We describe the key components of its design, implementation and lessons learned at two pilot sites in Spain (Galicia and Manresa), with a focus on personalized strategies and operational efficiency.

Results: Based on the European Union recommendation of 2022, the PRAISE-U project promotes a risk-based screening program that incorporates prostate-specific antigen (PSA), magnetic resonance imaging (MRI) and risk calculators (RC). Galicia and Manresa have developed screening circuits adapted to their health systems. Galicia has managed to invite 7000 of the 12,000 target men in less than a year, integrating digital tools and direct contact strategies. Manresa, from primary care, has developed a coordinated approach focused on accessibility and traceability. Both models prioritize equity, adherence and minimization of overtreatment.

Conclusions: The PRAISE-U project offers an innovative and adaptable framework for PCa screening in Europe. The Spanish experience demonstrates that it is possible to implement effective and risk-focused early detection programs, provided that there is sound planning, technological tools and a collaborative approach between levels of care.

Introduction and objectives: The management of stage T1 renal cell carcinoma (RCC) has shifted toward nephron-sparing surgery (NSS) and minimally invasive surgery (MIS), but contemporary, country-level data from Spain are scarce. We sought to describe real-world treatment patterns for T1 RCC across Spanish centres.

Material and methods: Multicentre retrospective descriptive study using the Spanish National Registry of Localized Renal Cancer during 2024. Adults with clinical stage T1 renal masses treated with surgery, ablation or active surveillance (AS) were included. Descriptive statistics were applied. Primary outcomes were management strategy, surgical approach, type of procedure and pathological results; secondary outcomes included intraoperative details.

Results: A total of 1121 patients were analysed (71.5% cT1a). Management consisted of surgery in 82.6%, ablation in 9.5% and AS in 7.3%. Among operated patients, partial nephrectomy (PN) accounted for 65.0% overall (74.5% in cT1a; 46.7% in cT1b). MIS predominated (92.3%: 58.4% laparoscopic, 33.9% robotic). The leading reason to perform radical nephrectomy (RN) was technical infeasibility (56.8%). Median warm ischaemia time was 16 min (IQR 0-23). Histology showed clear cell RCC 61.1% and benign lesions 12.4%. Final pathology was pT1a 66.1%, pT1b 25.2%; upstaging occurred in 8.6% (mainly pT3a), more frequently in cT1b.

Conclusions: In Spain, most T1 RCCs are treated surgically with a high adoption of PN for cT1a and widespread MIS. RN remains common in cT1b primarily for anatomical/technical reasons, suggesting variability in access to robotic platforms and subspecialised teams. These data provide a national benchmark and support initiatives to optimise NSS access, resource allocation, and referral pathways.

Introduction: Prostate cancer (PCa) is the most common malignancy among men and currently ranks as the second leading cancer worldwide in terms of incidence. In 2021, a total of 35,764 new cases were diagnosed. The development of new imaging tools such as multiparametric magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography (PET-PSMA) has enabled the exploration of less invasive diagnostic strategies in clinically significant prostate cancer. However, performing radical prostatectomy without a prior biopsy remains an exceptional practice, scarcely documented and highly controversial.

Objective: To report a series of Mexican cases undergoing radical prostatectomy without prior biopsy, using PET-PSMA and mpMRI as the main diagnostic tools, and to propose a preliminary risk stratification model based on SUVmax values: the "M&M's PSMA SCORE SUVmax".

Materials and methods: Retrospective, observational, multicenter study of 18 patients treated between 2021 and 2024. Clinical variables, imaging findings, and histopathological results were analyzed. Sensitivity, positive predictive value (PPV), and correlation between SUVmax and ISUP grade were calculated.

Results: All cases confirmed clinically significant adenocarcinoma. PET-PSMA showed 100% sensitivity and PPV; mpMRI showed 93.3% sensitivity and 100% PPV. A positive correlation was found between SUVmax and ISUP grade (r = 0.84; P = .038). A preliminary classification based on SUVmax cut-off points was proposed.

Conclusions: This series suggests that, in selected contexts, PET-PSMA and mpMRI could support surgical decision-making even without prior biopsy. However, prospective studies are needed to validate both this strategy and the proposed stratification system.

Introduction and objectives: Local recurrence after radiotherapy for prostate cancer poses a significant clinical challenge, and the lack of robust comparative evidence limits clear therapeutic guidance. This study aimed to assess oncological outcomes of salvage radical prostatectomy (SRP) versus salvage cryoablation (SCA) in patients with localized radio-recurrent disease.

Materials and methods: A retrospective, single-centre cohort study was conducted including hormone-sensitive prostate cancer patients with local recurrence after external beam radiotherapy or brachytherapy, treated between 2007 and 2024. The primary endpoint was biochemical recurrence-free survival (BCR-FS) at 3 and 5 years. Secondary endpoints included additional treatment-free survival (AT-FS), metastasis-free survival (MFS), and recurrence predictors. Kaplan-Meier and multivariate logistic regression analyses were performed.

Results: A total of 56 patients were included: 32 treated with SRP and 24 with SCA. Median follow-up was significantly longer in the SCA group (8.2 vs. 3.8 years, P < .05). BCR-FS at 3 and 5 years was 47% and 37% in the SCA group and 43% and 32% in the SRP group (P > .05). Five-year AT-FS was 40% (SCA) vs. 55% (SRP; P = .32), and MFS was 85% (SCA) vs. 83% (SRP; P = .92). A Gleason score ≥ 8 at recurrence was independently associated with higher risk of recurrence (OR 7.7; 95% CI: 1.3-47; P = .02).

Conclusions: SRP and SCA showed similar oncological outcomes. Gleason ≥ 8 was the only factor related to poor outcomes. Given the low chance of cure after salvage therapies, SCA may be an adequate option in these patients.

Introduction: The management of metastatic prostate cancer (MPC) is complex and requires timely, coordinated decision-making across multiple specialties. Multidisciplinary team meetings (MDMs) have been increasingly adopted to optimize treatment planning, yet evidence regarding their impact on objective clinical outcomes in genitourinary cancers remains limited.

Methods: This retrospective, single-center cohort study compared two periods of MPC care: before MDM implementation (2018-2019) and after implementation (2021-2022). Patients were identified through institutional records. Demographic data, treatment timelines, therapeutic choices, and follow-up patterns were collected. Primary outcomes included time to clinical oncology consultation, time to treatment initiation, systemic therapy use, and follow-up adherence.

Results: One hundred thirty-nine patients were included, 72 in the 2018-2019 period and 67 in the 2021-2022 period. There was a significant reduction in the time taken to consult clinical oncology (P < .05) and to start treatment (P < .05). Systemic therapy started predominantly in the castration-sensitive setting (70.2% vs 14.3%; P < .001). The MDM promoted a higher quality of treatment, with a greater prescription of docetaxel and novel antiandrogens (95.7% vs 64.3%; P = .001) and zoledronic acid in the castration-resistant phase (92.5% vs 79.2%; P = .047). The MDM discussion optimized follow-up, with loss to follow-up observed in only 7.5% of cases (P < .001).

Conclusion: The implementation of multidisciplinary team meetings significantly improved the timeliness, quality, and adherence to oncological care for patients with metastatic prostate cancer. MDMs should be incorporated as a standard component of care in institutions managing this population.

Introduction: Prostate cancer (PCa) screening based on prostate-specific antigen (PSA) testing has represented a major milestone in early detection; however, it has also prompted considerable debate due to the risks of overdiagnosis and overtreatment. This review examines the evolution of PCa screening, highlighting its main challenges and emerging approaches aimed at achieving more accurate and individualized detection.

Methods: A narrative review of the literature was conducted using databases such as PubMed and Google Scholar, applying MeSH terms related to screening, overdiagnosis, and prostate cancer. Clinical studies, systematic reviews, and recent guidelines pertinent to the topic were included.

Results: The PLCO, ERSPC, and Göteborg trials provide complementary insights into the impact of PSA-based screening, with outcomes ranging from limited benefit to significant reductions in PCa-specific mortality. Based on these this findings, a paradigm shift toward risk-stratified screening strategies has been advocated. The incorporation of new tools such as magnetic resonance imaging, blood and urine biomarkers, risk calculators, and artificial intelligence-based algorithms has improved diagnostic accuracy. These strategies reduce unnecessary biopsies and focus on the detection of clinically significant disease. Current guidelines recommend individualized assessment based on factors such as age, baseline PSA levels, family history, and comorbidities.

Conclusion: The future of PCa screening resides in personalized medicine, in which the integration of clinical, imaging, and molecular parameters will enable a more efficient approach, minimizing unnecessary interventions and improving overall patient outcomes.

Introduction and objectives: Whole-body bone mineral content (BMC) and bone mineral density (BMD) can provide comprehensive information about the health of the whole body. This study aimed to assess whether BMC and BMD are potentially associated with self-reported kidney stones.

Materials and methods: Multiple logistic regression analysis was used to investigate the potential association between BMC/BMD and kidney stones. Subgroup analysis and interaction tests were used to examine the stability of the relationship. Restricted cubic spline plots were used to examine the dose-response relationship. Saturation effect and threshold effect analyses were used to assess inflection points in the dose-response relationship.

Results: The study population consisted of 8030 adults. Compared with those with low BMD levels, the prevalence of kidney stones was lower in those with high BMD levels (6.55% vs. 10.87%, P = 0.0001). After adjusting for all covariates, there was a negative association between whole-body BMC and kidney stones (OR = 0.06, 95% CI = 0.02-0.25; P < 0.0001), and between whole-body BMD and kidney stones (OR = 0.19, 95% CI = 0.08-0.45; P = 0.0002). Subgroup analyses and interaction tests identified diabetes and smoking as significant influences. In the non-smoking population, a non-linear relationship was shown between BMD and kidney stones (non-linear P value = 0.039).

Conclusions: BMC and BMD were inversely associated with the prevalence of kidney stones in U.S. adults. Although causality cannot be established, these findings suggest that bone health assessment may help identify individuals at higher risk of kidney stones, especially among smokers and patients with diabetes.