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Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate. Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA). Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months. Results: PSAD showed a significant association with PSM (p < 0.0001), PSA persistence (p < 0.0001), and Gleason ⩾ 7 (p < 0.0001), without being statistically significant in predicting BCR (p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649). Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.

Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor Prostate-specific antigen density (PSAD) has an established role in the diagnostic process of prostate cancer (PCa). However, controversy remains on the assessment of its value as a pretreatment prognostic factor. The aim of our study was to evaluate the predictive ability of PSAD for oncological outcomes in PCa patients treated with robot-assisted radical prostatectomy (RARP) and to compare with the value of preoperative PSA (pPSA). The present analysis showed a significant association of PSAD with positive surgical margins (PSM), Gleason Score >=7 and prostate-specific antigen (PSA) persistence after RARP. Moreover, PSAD demonstrated to perform comparably to pPSA in predicting the outcomes of clinically significant PCa (csPCa) and post-RARP PSA persistence. Therefore, PSAD is considered a preoperative predictive factor potentially useful in conjunction with other previously established prognostic criteria and clinical features.

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BACKGROUND: SARS-CoV-2 virus requires host proteases to cleave its spike protein to bind to its ACE2 target through a two-step furin-mediated entry mechanism. Aprotinin is a broad-spectrum protease inhibitor that has been employed as antiviral drug for other human respiratory viruses. Also, it has important anti-inflammatory properties for inhibiting the innate immunity contact system. METHODS: This was a multicentre, double-blind, randomized trial performed in four Spanish hospitals comparing standard treatment versus standard treatment + aprotinin for patients with COVID-19 between 20 May 2020 and 20 October 2021. The primary efficacy outcomes were length of hospital stay and ICU admission. The secondary endpoints were each of the primary efficacy outcomes and a composite of oxygen therapy, analytical parameters and death. Safety outcomes included adverse reactions to treatment during a 30-day follow-up period. Treatment was given for 11 days or till discharge. RESULTS: With almost identical analytical profiles, significant differences were observed in treatment time, which was 2 days lower in the aprotinin group (p = .002), and length of hospital admission, which was 5 days shorter in the aprotinin group (p = .003). The incidence of discharge was 2.19 times higher (HR: 2.188 [1.182-4.047]) in the aprotinin group than in the placebo group (p = .013). In addition, the aprotinin-treated group required less oxygen therapy and had no adverse reactions or side effects. CONCLUSION: Inhaled aprotinin may improve standard treatment and clinical outcomes in hospitalized patients with COVID-19, resulting in a shorter treatment time and hospitalization compared with the placebo group. The administration of aprotinin was safe.

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INTRODUCTION: First cases of COVID-19 were reported in China on December 2019 and rapidly spread globally. The explosive increase in number of cases requiring hospitalization has led to a delay in a big number of surgical interventions, including oncologic surgeries. Collateral effects of this increase means a challenge for urologists, who have been forced to redistribute their resources. Due to its poor pronostic, patients suffering from by upper tract urinary tumours will be negatively affected by this pandemic. METHODS: A non sistematic review was performed using literature published until May 23, 2020, using "Uppertract urothelial tumours", "COVID-19" and "nephroureterectomy".as keywords. The resulting manuscript was critically revised by national authors in order to establish common criteria about treatment and follow up. EVIDENCE SYNTHESIS: Four studies were identified that assessed the impact of delaying radical nephrouretrectomy as curative treatment. These studies showed that surgery delays decrease overall survival and cancer specific survival rates in high-risk groups. On the other hand, delaying radical nephrouretrectomy due to ureteroscopy did not affect survival in cohorts of patients with predominately low-grade disease. CONCLUSIONS: A delay in curative treatment of upper tract urothelial tumours for more than three months results in adverse outcomes as overal survival and cancer specific survival. Hence, it is important to prioritize the timely care of this group of patients as far as COVID-19 pandemic allows it.

INTRODUCCIÓN: Los primeros casos de la enfermedad por coronavirus (Coronavirus Disease 19, también denominada COVID-19) aparecieron en China en diciembre de 2019, desde donde se extendieron al resto del mundo. La rápida aparición de casos y el alto volumen de pacientes que han requerido hospitalización han provocado la demora de un gran número de intervenciones quirúrgicas, incluidas las cirugías oncológicas. Todo ello está suponiendo un reto para los servicios de urología de todo el mundo, y obliga a una redistribución de sus recursos. Los pacientes con tumores del tracto urotelial superior (TUS), en muchos casos de mal pronóstico, se pueden ver potencialmente afectadospor esta situación.MATERIAL Y MÉTODOS: Se realizó una búsqueda no sistemática en web y en PubMed utilizando las palabras clave "Upper tract urothelial tumours", "COVID-19" , "nephroureterectomy". Se realizó una revisión narrativa de la literatura incluyendo solo artículos y documentos escritos en lengua española e inglesa. Se remitió el documento a varios autores nacionales expertos en patología del urotelio superior, con el fin de unificar criterios y experiencias para llegar a un rápido consenso sobre la importancia relativa de las distintas actividades, problemas y soluciones. EVIDENCIA CIENTÍFICA: Diversos estudios tratan de determinar el impacto que presenta el retraso en la realización de la nefroureterectomía como tratamiento curativo, siendo el punto de corte de 3 meses en la mayoría de ellos. Tres de ellos concluyen que dicha demora implica una disminución de la supervivencia global y cáncer específica, mientras que el retraso de la nefroureterectomía radical debido a la realización de ureterorrenoscopia (URS) como tratamiento conservador en tumores de bajo grado no parece tener impacto en la supervivencia. CONCLUSIONES: El retraso en el tratamiento de los tumores del TUS a 3 meses supone una disminución de la supervivencia global y cáncer específica. Por ello, el tratamiento de esta patología no debería demorarse, en la medida en que los recursos hospitalarios y la alerta sanitaria por COVID-19 lo permita.

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INTRODUCCIÓN: Los primeros casos de la enfermedad por coronavirus (Coronavirus Disease 19, también denominada COVID-19) aparecieron en China en diciembre de 2019, desde donde se extendieron al resto del mundo. La rápida aparición de casos y el alto volumen de pacientes que han requerido hospitalización han provocado la demora de un gran número de intervenciones quirúrgicas, incluidas las cirugías oncológicas. Todo ello está suponiendo un reto para los servicios de urología de todo el mundo, y obliga a una redistribución de sus recursos. Los pacientes con tumores del tracto urotelial superior (TUS), en muchos casos de mal pronóstico, se pueden ver potencialmente afectadospor esta situación. MATERIAL Y MÉTODOS: Se realizó una búsqueda no sistemática en web y en PubMed utilizando las palabras clave "Upper tract urothelial tumours", "COVID-19", "nephroureterectomy". Se realizó una revisión narrativa de la literatura incluyendo solo artículos y documentos escritos en lengua española e inglesa. Se remitió el documento a varios autores nacionales expertos en patología del urotelio superior, con el fin de unificar criterios y experiencias para llegar a un rápido consenso sobre la importancia relativa de las distintas actividades, problemas y soluciones. EVIDENCIA CIENTÍFICA: Diversos estudios tratan de determinar el impacto que presenta el retraso en la realización de la nefroureterectomía como tratamiento curativo, siendo el punto de corte de 3 meses en la mayoría de ellos. Tres de ellos concluyen que dicha demora implica una disminución de la supervivencia global y cáncer específica, mientras que el retraso de la nefroureterectomía radical debido a la realización de ureterorrenoscopia (URS) como tratamiento conservador en tumores de bajo grado no parece tener impacto en la supervivencia. CONCLUSIONES: El retraso en el tratamiento de los tumores del TUS a 3 meses supone una disminución de la supervivencia global y cáncer específica. Por ello, el tratamiento de esta patología no debería demorarse, en la medida en que los recursos hospitalarios y la alerta sanitaria por COVID-19 lo permita

INTRODUCTION: First cases of COVID-19 were reported in China on December 2019 and rapidly spread globally. The explosive increase in number of cases requiring hospitalization has led to a delay in a big number of surgical interventions, including oncologic surgeries. Collateral effects of this increase means a challenge for urologists, who have been forced to redistribute their resources. Due to its poor pronostic, patients suffering from by upper tract urinary tumours will be negatively affected by this pandemic. METHODS: A non sistematic review was performed using literature published until May 23, 2020, using "Upper tract urothelial tumours", "COVID-19" and "nephroureterectomy". as keywords. The resulting manuscript was critically revised by national authors in order to establish common criteria about treatment and follow up. EVIDENCE SYNTHESIS: Four studies were identified that assessed the impact of delaying radical nephrouretrectomy as curative treatment. These studies showed that surgery delays decrease overall survival and cancer specific survival rates in high-risk groups. On the other hand, delaying radical nephrouretrectomy due to ureteroscopy did not affect survival in cohorts of patients with predominately low-grade disease. CONCLUSIONS: A delay in curative treatment of upper tract urothelial tumours for more than three months results in adverse outcomes as overal survival and cancer specific survival. Hence, it is important to prioritize the timely care of this group of patients as far as COVID-19 pandemic allows it

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OBJECTIVE: Nephron sparing surgery is the gold standard in cT1 renal tumor. In order to perform a safe and effective surgery is essential a good radiological study. 3D printing is a new tool that allows the creation of virtual and physical trustworthy 3D reproduction of organs or anatomical structures of patients. METHOD: Non systematic review of PubMed database about the usefulness of 3D printing in renal surgery. RESULTS: 3D printing has a potential use in surgery planning, resident education and improving the communication and understanding of our patients. CONCLUSION: Today the number of publications and the use of these technique are still low. 3D printing is a useful tool in order to improve communication with patients and has a potential role in resident education. 3D printing technology could be useful in surgically complex cases since provides an exact model of the organ and the lesion before the intervention allowing a better surgery planning to the surgeon.

OBJETIVO: La nefrectomía parcial es la técnica de elección en tumores renales cT1. La realización de técnicas de imágenes de alta calidad es fundamental para realizar una cirugía segura y eficaz. La impresión 3D es una herramienta novedosa que permite la realización de reproducciones fidedignas, tanto virtuales como físicas, de órganos y estructuras anatómicas.MÉTODO: Revisión no sistemática de la literatura publicada en PubMed Database sobre la utilidad de la impresión tridimensional en la cirugía renal. RESULTADOS: La impresión 3D tiene un potencial uso en la planificación de la intervención quirúrgica, la formación de residentes y la mejora de la comunicación y comprensión de los pacientes.CONCLUSIÓN: El número de publicaciones respecto al uso de la impresión 3D es escaso. Se trata de una herramienta útil que permite mejorar la comunicación con los pacientes y tiene un potencial papel en la formación de los residentes. La impresión 3D puede ser una herramienta útil a la hora de afrontar cirugías renales complejas, ya que proporciona un modelo exacto del órgano y de las lesiones previo a la intervención, permitiendo mejorar la estrategia quirúrgica del cirujano.

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Transrectal ultrasound has been a diagnostic method for diagnosis of prostate cancer for more than 30 years. It increased its options after the incorporation of MRI in the 90s. The association of real-time ultrasound with anatomical and functional data of multiparametric magnetic resonance imaging (mpMRI) has changed the prostate cancer scenario and presumably will modify the therapeutic alternatives. OBJECTIVES AND METHODS: In the following non systematic review of the literature, we present the current situation of different types of fusion biopsy, the initial preclinical and clinical results as well as the data collected in the different meta-analyses. RESULTS: Although "in bore" biopsy has shown the best sensitivity, its economic and accessibility problems make it the least widespread. Cognitive biopsy is one of the most widespread despite being the one that provides the least objective results. Fusion biopsies with Software Platform are being developed as the most reproducible and affordable in our environment. The data in the literature is still insufficient to establish what is the best software. There are many points of controversy such as number of cores, approach, associated systematic biopsies and possible connotations when assessing the therapeutic attitude. CONCLUSION: None of the Software platforms have demonstrated superiority in the diagnosis of cancer, although their results are superior to those obtained through standard and cognitive biopsy and are more affordable than the "In bore" biopsy. It is necessary to standardize the publications to be able to compare results (classification of risk in resonance, number of cores, approach). The diagnosis of cancer guided by MRI should be a factor to consider in therapeutic decision nomograms. The next challenge is the incorporation of these systems in the protocols of active surveillance and Focal Therapy.

La ecografía Transrectal (TR), método de diagnóstico del cáncer de próstata (CAP) desde hace más de 30 años, ha visto incrementadas sus opciones tras la incorporación de la resonancia en los años 90. La asociación de ecografía a tiempo real con datos anatómicos y funcionales de resonancia magnética multiparamétrica (RMmp) ha cambiado el escenario del diagnóstico de CAP y modificará las alternativas terapéuticas.OBJETIVO y MÉTODO: Con el siguiente resumen no sistemático de la literatura, se presenta la situación actual de las distintas modalidades de biopsia fusión, los resultados preclínicos y clínicos iniciales, así como los datos recogidos en los distintos meta-análisis.RESULTADOS: Si bien la Biopsia "in bore" es la que ha demostrado una mayor sensibilidad, sus inconvenientes económicos y de accesibilidad la convierten en el menos extendido. La Biopsia cognitiva es uno de los más extendidos a pesar de ser el que aportan menos resultados objetivos. Las Biopsias fusión con Plataforma Software se están incorporando en nuestro medio como las más reproducibles y asequibles. Los datos son aún insuficientes para poder establecer cuál es el mejor software. Son muchos los puntos de controversia (número de cores, vía de abordaje, biopsias sistemáticas asociadas) y las posibles connotaciones en la elección del tratamiento.CONCLUSIÓN: Ninguna de las plataformas de Software ha demostrado su superioridad si bien sus resultados son superiores a los obtenidos mediante Biopsia estándar y cognitiva y es más asequible que la biopsia "In bore". Es necesario estandarizar las publicaciones para poder comparar los resultados (clasificación de riesgo en resonancia, número de cores, abordaje). El diagnóstico de cáncer mediado por RMN deber ser un factor a tener en cuenta en los nomogramas de decisión terapéutica. El siguiente reto es la incorporación de estos sistemas en los protocolos de vigilancia activa y Terapia Focal.

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Objetivo: La nefrectomía parcial es la técnica de elección en tumores renales cT1. La realización de técnicas de imágenes de alta calidad es fundamental para realizar una cirugía segura y eficaz. La impresión 3D es una herramienta novedosa que permite la realización de reproducciones fidedignas, tanto virtuales como físicas, de órganos y estructuras anatómicas. Método: Revisión no sistemática de la literatura publicada en PubMed Database sobre la utilidad de la impresión tridimensional en la cirugía renal. Resultados: La impresión 3D tiene un potencial uso en la planificación de la intervención quirúrgica, la formación de residentes y la mejora de la comunicación y comprensión de los pacientes.Conclusión: El número de publicaciones respecto al uso de la impresión 3D es escaso. Se trata de una herramienta útil que permite mejorar la comunicación con los pacientes y tiene un potencial papel en la formación de los residentes. La impresión 3D puede ser una herramienta útil a la hora de afrontar cirugías renales complejas, ya que proporciona un modelo exacto del órgano y de las lesiones previo a la intervención, permitiendo mejorar la estrategia quirúrgica del cirujano

Objective: Nephron sparing surgery is the gold standard in cT1 renal tumor. In order to perform a safe and effective surgery is essential a good radiological study. 3D printing is a new tool that allows the creation of virtual and physical trustworthy 3D reproduction of organs or anatomical structures of patients.Method: Non systematic review of PubMed database about the usefulness of 3D printing in renal surgery.Results: 3D printing has a potential use in surgery planning, resident education and improving the communication and understanding of our patients. Conclusion: Today the number of publications and the use of these technique are still low. 3D printing is a useful tool in order to improve communication with patients and has a potential role in resident education.3D printing technology could be useful in surgically complex cases since provides an exact model of the organ and the lesion before the intervention allowing a better surgery planning to the surgeon

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La ecografía Transrectal (TR), método de diagnóstico del cáncer de próstata (CAP) desde hace más de 30 años, ha visto incrementadas sus opciones tras la incorporación de la resonancia en los años 90. La asociación de ecografía a tiempo real con datos anatómicos y funcionales de resonancia magnética multiparamétrica (RMmp) ha cambiado el escenario del diagnóstico de CAP y modificará las alternativas terapéuticas. Objetivo y método: Con el siguiente resumen no sistemático de la literatura, se presenta la situación actual de las distintas modalidades de biopsia fusión, los resultados preclínicos y clínicos iniciales, así como los datos recogidos en los distintos meta-análisis. Resultados: Si bien la Biopsia "in bore" es la que ha demostrado una mayor sensibilidad, sus inconvenientes económicos y de accesibilidad la convierten en el menos extendido. La Biopsia cognitiva es uno de los más extendidos a pesar de ser el que aportan menos resultados objetivos. Las Biopsias fusión con Plataforma Software se están incorporando en nuestro medio como las más reproducibles y asequibles. Los datos son aún insuficientes para poder establecer cuál es el mejor software. Son muchos los puntos de controversia (número de cores, vía de abordaje, biopsias sistemáticas asociadas) y las posibles connotaciones en la elección del tratamiento. Conclusión: Ninguna de las plataformas de Software ha demostrado su superioridad si bien sus resultados son superiores a los obtenidos mediante Biopsia estándar y cognitiva y es más asequible que la biopsia "In bore". Es necesario estandarizar las publicaciones para poder comparar los resultados (clasificación de riesgo en resonancia, número de cores, abordaje). El diagnóstico de cáncer mediado por RMN deber ser un factor a tener en cuenta en los nomogramas de decisión terapéutica. El siguiente reto es la incorporación de estos sistemas en los protocolos de vigilancia activa y Terapia Focal

Transrectal ultrasound has been a diagnostic method for diagnosis of prostate cancer for more than 30 years. It increased its options after the incorporation of MRI in the 90s. The association of real-time ultrasound with anatomical and functional data of multiparametric magnetic resonance imaging (mpMRI) has changed the prostate cancer scenario and presumably will modify the therapeutic alternatives. Objectives and methods: In the following non systematic review of the literature, we present the current situation of different types of fusion biopsy, the initial preclinical and clinical results as well as the data collected in the different meta-analyses. Results: Although "in bore" biopsy has shown the best sensitivity, its economic and accessibility problems make it the least widespread. Cognitive biopsy is one of the most widespread despite being the one that provides the least objective results. Fusion biopsies with Software Platform are being developed as the most reproducible and affordable in our environment. The data in the literature is still insufficient to establish what is the best software. There are many points of controversy such as number of cores, approach, associated systematic biopsies and possible connotations when assessing the therapeutic attitude. Conclusion: None of the Software platforms have demonstrated superiority in the diagnosis of cancer, although their results are superior to those obtained through standard and cognitive biopsy and are more affordable than the "In bore" biopsy. It is necessary to standardize the publications to be able to compare results (classification of risk in resonance, number of cores, approach). The diagnosis of cancer guided by MRI should be a factor to consider in therapeutic decision nomograms. The next challenge is the incorporation of these systems in the protocols of active surveillance and Focal Therapy

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BACKGROUND: There is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases.The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions. METHODS: A randomised controlled trial was carried out across 20 health centres in Bilbao (Basque Country, Spain) to assess the impact of home telemonitoring on in-home chronic patients compared with standard care. The study lasted for one year. Fifty-eight in-home patients, diagnosed with heart failure (HF) and/or chronic lung disease (CLD), aged 14 or above and with two or more hospital admissions in the previous year were recruited. The intervention consisted of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight, body temperature and the completion of a health status questionnaire using PDAs. Alerts were generated when pre-established thresholds were crossed. The control group (CG) received usual care. The primary outcome measure was the number of hospital admissions that occurred at 12 months post-randomisation. The impact of telemonitoring on the length of hospital stay, use of other healthcare resources and mortality was also explored. RESULTS: The intervention group (IG) included 28 patients and the CG 30. Patient baseline characteristics were similar in both groups. Of the 21 intervention patients followed-up for a year, 12 had some admissions (57.1%), compared to 19 of 22 controls (86.4%), being the difference statistically significant (p = 0.033, RR 0.66; 95%CI 0.44 to 0.99). The mean hospital stay was overall 9 days (SD 4.3) in the IG versus 10.7 (SD 11.2) among controls, and for cause-specific admissions 9 (SD 4.5) vs. 11.2 (SD 11.8) days, both without statistical significance (p = 0.891 and 0.927, respectively). Four patients need to be telemonitored for a year to prevent one admission (NNT). There were more telephone contacts in the IG than in the CG (22.6 -SD 16.1- vs. 8.6 -SD 7.2-, p = 0.001), but fewer home nursing visits (15.3 -SD 11.6- vs. 25.4 -SD 26.3-, respectively), though the difference was not statistically significant (p = 0.3603). CONCLUSIONS: This study shows that telemonitoring of in-home patients with HF and/or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay. Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN89041993.

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