ABSTRACT Background Radical prostatectomy (RP) has been used as the main primary treatment for prostate cancer (PCa) for many years with excellent oncologic results. However, approximately 20-40% of those patients has failed to RP and presented biochemical recurrence (BCR). Prostatic specific antigen (PSA) has been the pivotal tool for recurrence diagnosis, but there is no consensus about the best PSA threshold to define BCR until this moment. The natural history of BCR after surgical procedure is highly variable, but it is important to distinguish biochemical and clinical recurrence and to find the correct timing to start multimodal treatment strategy. Also, it is important to understand the role of each clinical and pathological feature of prostate cancer in BCR, progression to metastatic disease and cancer specific mortality (CSM). Review design A simple review was made in Medline for articles written in English language about biochemical recurrence after radical prostatectomy. Objective To provide an updated assessment of BCR definition, its meaning, PCa natural history after BCR and the weight of each clinical/pathological feature and risk group classifications in BCR, metastatic disease and CSM.

Laparoendoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

PURPOSE: To review the literature and present a current picture of the evolution in radical prostatectomy from the laparoscopic point of view. MATERIALS AND METHODS: We conducted an extensive Medline literature search. Articles obtained regarding laparoscopic radical prostatectomy (LRP) and our experience at Institut Montsouris were used for reassessing anatomical and technical issues in radical prostatectomy. RESULTS: LRP nuances were reassessed by surgical teams in order to verify possible weaknesses in their performance. Our basic approach was to carefully study the anatomy and pioneer open surgery descriptions in order to standardized and master a technique. The learning curve is presented in terms of an objective evaluation of outcomes for cancer control and functional results. In terms of technique-outcomes, there are several key elements in radical prostatectomy, such as dorsal vein control-apex exposure and nerve sparing with particular implications in oncological and functional results. Major variations among the surgical teams' performance and follow-up prevented objective comparisons in radical prostatectomy. The remarkable evolution of LRP needs to be supported by comprehensive results. CONCLUSIONS: Radical prostatectomy is a complex surgical operation with difficult objectives. Surgical technique should be standardized in order to allow an adequate and reliable performance in all settings, keeping in mind that cancer control remains the primary objective. Reassessing anatomy and a return to basics in surgical technique is the means to improve outcomes and overcome the difficult task of the learning curve, especially in minimally access urological surgery.

Introduction: Treating patients with invasive transitional cell carcinoma of the bladder remains difficult due to the multiple biological behaviour patterns found in this disease. There is still controversy regarding the use of systemic treatment in invasive bladder carcinoma and the ideal moment for launching perioperative chemotherapy. We present an overview of current trends for systemic treatment of invasive bladder carcinoma. Material and methods: Using MEDLINE, we reviewed relevant English and Spanish language literature published during the last five years, with "chemotherapy in bladder cancer" as keywords. We selected randomized trials, meta-analyses and clinical trials. Results: We obtained a total of 241 articles. Thirty-one of them referred to neoadjuvant and adjuvant chemotherapy in invasive bladder cancer. We classified the articles in three different groups neoadjuvant, adjuvant and neoadjuvant plus chemotherapy. All of that information is displayed in the tables within the text. Conclusions: A multidisciplinary approach to the treatment of invasive bladder cancer is essential to guarantee adequate oncological control. A detailed evaluation and proper selection of each patient is fundamental in determining the best moment to start chemotherapy.

Introducción: El tratamiento del cáncer vesical de células transicionales con invasión muscular sigue siendo difícil, debido a los múltiples patrones de comportamiento biológico que muestra esta enfermedad. Hay controversia en cuanto a la aplicación de tratamiento sistémico en el carcinoma vesical infiltrante y el momento ideal de la indicación de la quimioterapia perioperatoria. Se presenta una visión general de la terapia sistémica en cáncer vesical infiltrante. Material y métodos: Realizamos una búsqueda informática en PubMed limitando la información a los últimos 5 años y seleccionamos artículos en inglés y en español referentes a "chemotherapy in bladder cancer". Se seleccionaron estudios aleatorizados, metaanálisis y ensayos clínicos. Resultados: Obtuvimos 241 artículos. Un total de 31 artículos fueron referentes a quimioterapia neoadyuvante y adyuvante en el carcinoma vesical infiltrante. Agrupamos los artículos en tres grupos según su referencia a neoadyuvancia, adyuvancia o neoadyuvancia y adyuvancia de forma conjunta. Dicha información se encuentra reflejada en las tablas anexas al manuscrito. Conclusiones: El abordaje multidisciplinario en el tratamiento del carcinoma vesical infiltrante es indispensable para garantizar un adecuado control oncológico. La evaluación detallada y la selección adecuada del paciente son la herramienta fundamental para determinar el mejor momento para indicar la quimioterapia.