Do PHI and PHI density improve detection of clinically significant prostate cancer only in the PSA gray zone?

Objectives: Prostate health index (PHI) is a predictive biomarker of positive prostate biopsy. The majority of evidence refers to its use in the PSA gray zone (4-10 ng/mL) and negative digital rectal exam (DRE). We aim to evaluate and compare the predictive accuracy of PHI and PHI density (PHId) with PSA, percentage of free PSA and PSA density, in a wider range of patients for the detection of clinically significant prostate cancer (csPCa).

[Prostatic high resolution micro-ultrasound (MUS) imaging.].

Objective: Prostate cancer (PCa) diagnosis has improved with multiparametric magnetic resonance (mpMRI) and new more specific biomarkers. However, mpMRI has some limitations such as variability, long learning curve and high cost. More progress is needed in the PCa diagnosis scenario, and it is here where high resolution micro-ultrasound (MUS) imaging system emerge.

How to build a robotic program.

Objective: Advancements in the robotic surgical technology have revolutionized the standard of care for many surgical procedures. The purpose of this review is to focus on the different issues involved in developmental phase of starting a robotic program and to evaluate the important considerations in developing this program at a given healthcare institution.

Methods & Results: Although every hospital might desire a robotic program, there are many requirements needed to uphold a successful and self-sustainable program in the current healthcare market.

[BCG therapy in NMIBC: How much and for how long?.].

Bladder cancer is the 9th most prevalent cancer in the world. It is divided into muscle invasive bladder cancer (MIBC) and non muscle invasive bladder cancer (NMIBC). Over 75% belong to the second group and it will be classified according to the risk of progression and recurrence.

[Current status of extracorporeal shock wave lithotripsy in urinary lithiasis.].

Over the last decade, urinary lithiasis' prevalence has dramatically increased due to diet and lifestyle changes, growing 10.6% and 7.1% in men and women respectively.

Key areas in the learning curve for robotic urological surgery: a Spanish multicentre survey.

Background: The number of robotic-assisted procedures offered in Spain is rapidly increasing despite a lack of consensus criteria for training and credentialling.

Objective: This national multicentre study was designed to analyze the different areas of the robotic urological surgery learning curve.

Material And Methods: A questionnaire was sent to all 13 urology units in Spain with an active robotics programme requesting information on training and problems encountered.

[Vascular erectile dysfunction].

Vascular etiology is present in up to 60% of the patients with erectile dysfunction (ED). Both small vessel disease, such as that in diabetes mellitus, and arteriosclerosis of bigger size arteries, as in hypertension, cause arterial insufficiency and erectile dysfunction. Tobacco smoking alters the arterial hemodynamics in the penis, causing erectile dysfunction in a high percentage of advanced age smokers: pelvic arteries fibrosis and stenosis accelerates the existing arteriosclerosis.

[Renal cirsoid aneurysm (congenital arteriovenous fistula): a rare cause of severe hematuria].

Objective: Congenital arteriovenous fistulas are an exceptional clinical feature. Although they are frequently asymptomatic, their presentation as severe hematuria pose an excellent diagnostic exercise and often immediate therapeutic action.

Methods/results: We report the case of a 75-year-old female patient presenting with severe hematuria producing anaemia, high blood pressure and congestive heart failure.

[New position for laparoscopic pyeloplasty. Our experience].

Objectives: To share our experience performing laparoscopic pyeloplasty and our contributions to this surgery.

Methods: Between March 2004 and January 2006 we have performed 12 laparoscopic pyeloplasties in 12 patients. We modified our technique as we found difficulties during operations.

[Robotic renal surgery: pyeloplasty].

The treatment of ureteropyelic junction (UPJ) obstruction offers a perfect sketch of the parallel evolution of the availability of technology and changes in surgical proceedings. From the open Anderson-Hynes pyeloplasty, passing through percutaneous or retrograde endopyelothomy with various instruments, to the laparoscopic approach, technology and human talent have found a field for development in this reconstructive procedure. Robotic surgery is young and starts to define its role in urology surgery.

[Concurrent tumors in a patient with giant hydronephrosis].

Objectives: Giant hydronephrosis, defined as the presence of a liquid volume over 1000 ml within the urinary collector system, is a rare clinical entity, the diagnosis of which is an excellent exercise because it lacks of a defined clinical presentation.

Methods/results: We report the case of a 66-year-old male under study for a suspicious digestive tumor due to a long lasting clinical picture with severe cachexia, asthenia, anemia, constipation, and abdominal mass. Radiological tests showed a great right hydronephrosis secondary to a culculus in the ureteral-pelvic junction.

[Penile incarceration by multiple metal rings].

Objective: Penile incarceration is an infrequent clinical reality. Diagnosis is evident in most cases, and the challenges are to find the best way to retrieve the constrictive ring and repair the damage. Nevertheless, this event being curious has motivated us to report it.

[Unusual retrovesical cystic lesion: appendiceal mucocele].

Objective: Retrovesical cystic lesions are uncommon, although its incidence is growing due to the use of current diagnostic techniques. Its clinical features are unspecific and can mimic other conditions of the lower urinary tract making the differential diagnosis of this disease entity is difficult. A case of appendiceal mucocele, an unusual retrovesical lesion, is presented.