Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Objective: The recently developed technological advances in urology are a challenge, both for the urologists responsible for training activities, as well as for residents. This has led to heterogeneous residency programs; in terms of training and access to these technologies, among the scientific societies of the countries that make up the American Confederation of Urology (CAU, by its Spanish initials). The aim of this study was to collect relevant information and to perform a situational analysis to promote the development of more homogeneous programs for the training of future professionals in urology. Methodology: A closed survey using the CAU EDUCACIÓN platform that included twenty-seven multiple-choice questions between September 2019 and September 2020. Results: The difference between programs was found, above all, in the duration of the residencies, accreditations, the possibility of publication in scientific journals, training modalities, access to technology and subsequent job opportunities. Limitations: The main limitation was the number of participants, which was much lower than the total number of active residents. Despite this, the number of participating countries, the distribution, and the results obtained, allowed us to assess the current training of CAU residents. Conclusion: It is important to gain more insight about residencies in Ibero-America, to establish a specific and uniform plan to ensure proper training, regardless of the unit in which the residency occurs.

Description of clinical case: Three patients with urostomy and permanent double J-stent who had frank, acute and anemia hematuria are presented. All three had received radiotherapy for pelvic oncological pathology with subsequent performance of cystectomy and urostomy for severe radiation cystopathy. In no patient was the CT scan performed for the study of hematuria, requiring urgent arteriography and showing the presence of a ureter-iliac fistula (UIF) at the level of the left common iliac artery, right common iliac artery and right external iliac artery, respectively. After the placement of a covered iliac endovascular prosthesis, instant resolution of the clinical picture was achieved. Relevance: FUI is an exceptional diagnosis requiring the experience of the urologist and the vascular radiologist. This situation can be potentially lethal when presenting a picture of acute frank hematuria and anemia. Clinical implications: Suspecting an IUF, ureteral catheter manipulation should be performed in a catheterization room, where immediate arterial control with percutaneous vascular techniques is readily available. The performance of an arteriography should be immediate, avoiding the performance of a CT due to its low sensitivity. Conclusion: Endovascular treatment with a covered stent is a safe and effective treatment for FUI.

Introduction: Benign prostatic hyperplasia is a disease that affects men variably over time, affecting their lifestyle with irritative and obstructive urinary symptoms. One treatment option is transurethral resection of the prostate. However, there are currently new, innovative and advantageous transurethral techniques. The aim of this review is to contribute to current knowledge of the different functional outcomes and complications of the main transurethral techniques. Methods. A literature review was conducted between December 2021 and January 2022 in the PubMed and Cochrane databases. The quality of the articles was assessed by applying PRISMA 2020 and AGREE on II recommendations. Results. A total of four articles were selected for the final paper. It was determined that there is currently no standard technique for the treatment of benign prostatic hyperplasia; laser enucleation techniques (HoLEP) are a safe option in anticoagulated patients and can be used regardless of prostate size. Conclusions. The present review highlights the literature gaps regarding the selection of a standard transurethral surgical technique for the treatment of obstructive symptoms secondary to benign prostatic hyperplasia. The use of various types of lasers is recommended in view of improved functional outcomes; M-RTUP is associated with more post-surgical bleeding relative to other techniques. Long-term randomized controlled trials with a larger number of comparisons are needed to outline the best technique. However, the treatment of patients with benign prostatic hyperplasia should be highly individualized.

Clinic case: We present an extraordinary case report from a male diagnosed with Inflammatory Myofibroblastic Tumors (IMT) after suddenly presenting with a haemorrhagic shock due to hematuria. He underwent a partial cystectomy to achieve the complete resection and confirm the pathologic diagnosis. After the complete resection, he is free of relapse. Relevance: Our case report shows an extraordinary aggressiveness and a life-threatening disease course. The final pathologic exam confirmed the diagnosis and reported the pathologic correlation with the radiological findings of such an infrequent entity. Clinical implications: Although infrequent, IMT might present aggressively. After the initial clinical and radiological suspicion, finding must be confirmed by the complete resection and the pathologic exam. Conclusion: The early diagnosis enables the complete resection of the tumor, which is the most determinant prognostic factor. Selected patients with unresectable lesions might also benefit from adjuvant treatment with ALK-inhibitors.

Introduction: To identify preoperative features that predict ureteral stent placement failure in women with obstructive uropathy secondary to cervical cancer. Methods: Observational, descriptive, analytical study. Clinical registries of patients with diagnosis of obstructive uropathy secondary to cervical cancer were reviewed. Fifty-two patients attended between January 2017 to January 2021 were included. Diagnosis of obstructive uropathy consisted of hydronephrosis or hydroureter in imaging studies and elevation in baseline serum creatinine and blood urea nitrogen with uremic syndrome. An analysis of variables of interest was carried out to assess the association with ureteral stent placement failure. Results: We observed that the overall rate of failed ureteral stent placement was 55.8%. We did not find any differences in baseline characteristics between patients with successful or unsuccessful ureteral stent placement. A higher percentage of patients with failed urinary diversion on admission had a decrease in urinary output (58.6% vs. 30.4%, p=0.04), uremic syndrome (51.7% vs. 21.7%, p=0.02), as well as an increased median serum creatinine (6.6 vs. 2.6 mg/dL, p=0.03) compared to patients with successful ureteral stent placement. An admission serum creatinine cut-off value of 3.4 mg/dL yielded sensitivity of 69% and specificity of 65.2% for unsuccessful ureteral stent placement (AUC=0.674, 95% CI 0-52-0.82; p=0.03). Conclusion: Our data suggest that distal ureteral obstruction evidenced by imaging, regardless of the extent of invasion, is the most important factor related to unsuccessful ureteral stent placement.

Objective: To describe the characteristics of bilateral renal tumors and its impact on postoperative renal function in patients from an institution in Mexico City. Methods: From March 1980 to May 2021, 17 patients underwent surgery for bilateral renal tumors, 12 were synchronous and the rest metachronous. Oncological and functional characteristics were described. Results: Mean age was 46.9+/-13.5 years. Four were women and thirteen men. The size of the "first" tumor was 4.85+/-2.59 cm and the "second" was 5.34+/-3.95 cm. In synchronous tumors, 9 radical and 3 partial nephrectomies were performed for the first tumor and 2 radical and 9 partial for the second tumor (1 patient is still on surveillance for the second tumor). In metachronous patients, 5 radical nephrectomies were performed for the first tumor, and 4 radical and 1 partial for the second tumor. The histological concordance in synchronous and metachronous was 91% and 80%, respectively. The preoperative eGFR was 77.53+30.44 (ml/min/1.73 m2) and postoperative 46.85+38.34, decreasing 35.8% after the second surgery. Follow-up was 88.7+/-44.5 months. Five patients (29.4%) recurred. Overall and disease-free survival were 67.5 and 43 months, respectively. Conclusions: The histological concordance is in line with previous international reports. Postoperative eGFR decline was more significant in metachronous patients in whom the proportion of radical nephrectomies was higher. Therefore, it highlights the importance of performing partial nephrectomies whenever feasible.

Introduction: This study analyzed patients with metabolic syndrome and smokers treated with MV140 vaccine to prevent recurrent UTI.   Material and methods: 342 patients with recurrent UTI received MV140 vaccine between 2017 and 2020 in Barcelona, Spain. Variables analyzed: number of UTI at 3 and 6 months after MV140, age, gender, diabetes mellitus, body mass index, hypertension, total cholesterol, HDL-cholesterol, triglycerides and smoking. Patients were divided in Group 1: metabolic syndrome (2 or more variables), Group 2: no metabolic syndrome (less than 2 variables). On the other hand, patients were classified into smokers and non-smokers. Results: Mean age was 74, 82% were women. At the beginning, 88,9% had 3-5 UTI. Overall effectiveness with MV140 was 72.5% at 3 months and 56.2% at 6 months. Group 1 (36%) presented 0-1 UTI in 78.9% and 62.6% at 3 and 6 months. In Group 2 (64%) the results were 69% and 52.5%. Comparing both groups, no statistically significant differences were observed (p=0,25, p=0,26). Smokers had 77.4% and 61.3% at 3 and 6 months, and non-smokers had 69.3% and 52.7%. There were also no statistically significant differences (p = 0.5, p = 0.36). Group 1 and smoking (28,7%) had 82% at 3 months and 66.3% at 6 months. Group 2 and no smoking (71,3%) reached 60.3% and 52% at 3 and 6 months. There were no statistically significant differences between both groups.   Conclusions: The overall efficacy of MV140 was high and safe, without side effects. Patients with metabolic syndrome and smokers may benefit from this treatment.  

Clinical case: Hybrid renal tumor is defined as that neoplasm whose components are given by the presence of oncocytes (oncocytoma) and chromophobe cells whose preoperative diagnosis is challenging due to its great similarity with typical oncocytoma. Its modalities of presentation include hereditary and sporadic, the first being the most frequent, associated with the involvement of other organs such as the skin and the lungs. Clinical implications: We present the case of a 9-year-old female patient, a primary school student, who was incidentally found to have a mass on the left flank, not painful on palpation, fixed, of approximately 8 cm, for which Ultrasound, abdominal tomography, and renal angiotomography were performed, confirming the presence of a large, well-defined left renal mass, heterogeneous by area of ​​central necrosis, with no evidence of infiltration to adjacent structures or vascular invasion whose histopathological report revealed hybrid renal oncocytoma, for which is taken to laparoscopic total nephrectomy, presenting adequate evolution in its follow-up. Relevance: Familiarizing ourselves with the spectrum of renal masses in schoolchildren is of vital importance since they are benign neoplasms, which prevents the use of necessary measures. Conclusion: Rapid identification allows timely surgical lesions with less morbidity in patients, so it is important that different specialists know their imaging findings.

Clinical case: Leiomyomas are benign mesenchymal tumors that rarely affect the urinary tract. The widespread use of imaging studies has increased its detection in asymptomatic patients. Materials and methods: Descriptive analysis of patients with a histopathological diagnosis of urinary tract leiomyoma at the Hospital General de Albacete between 2012 and 2020.   Results: We identified 7 cases (2 renal leiomyomas, 4 bladder leiomyomas and 1 case with bladder and renal leiomyoma). In the renal leiomyoma, the mean age was 79 years and, in the bladder, 39 years. Most of the renal leiomyomas were presented as an incidental finding in the intraoperative kidney transplant study and bladder leiomyomas as a radiological finding. There was a predominance of the female sex in both types of leiomyomas. The mean renal tumor size was 0.73 cm and 4.75 cm in the bladder. Definite diagnosis was made by renal biopsy and bladder biopsy-transurethral resection. Histologically, they were made up of smooth muscle cells arranged in intertwined fascicles without mitosis, nuclear atypia or tumor necrosis. Nephrectomy and partial cystectomy were the main surgical treatment. During follow-up, no recurrence or complication was detected in any patient.   Conclusions: Imaging studies guide us to the diagnosis, but the definitive diagnosis requires a histopathological and immunohistochemical study. The type of surgery depends on the size and location of the leiomyoma. His prognosis is good.

Objective: To describe 6 cases of penile cancer and examine their surgical management in a tertiary level hospital. Methods: Retrospective and descriptive study of penile cancer cases from april 2020 to may 2022 at the Hospital de Especialidades Eugenio Espejo in the city of Quito. Only cases with complete clinical history, confirmatory histopathological diagnosis and post-surgical controls were included. Results: We describe 6 patients with penile cancer with an average age of 69 years. In the histopathological study, five patients were diagnosed with squamous cell carcinoma and one with nodular melanoma. The most frequent location was on the glans penis in four individuals. According to TNM classification, two patients were stratified as T3Nx, one as T3N1, one as T3N2, one as T4 and one as T4bN3b. In half of the cases, the treatment of choice was total penectomy plus bilateral inguinal lymphadenectomy. Conclusions: Although penile cancer is a rare pathology, the identification of risk factors and primary lesions can help in the early diagnosis of cancer, thus avoiding metastasis to structures adnexal to the penis and consequent penectomies.