PURPOSE: To evaluate the long-term efficacy of prostate cancer control and complication rates, in the elderly, after focal therapy with high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: Between June 1997 and March 2000, patients with localized prostate cancer were included into a focal therapy protocol. Inclusion criteria were: PSA < 10 ng/mL, < 3 positive biopsies with only 1 lobe involved, clinical stage < T2a, Gleason score < 7 (3+4), negative CT scan and bone scan. Hemi-ablation of the prostate was performed with the Ablatherm(R) device. Survival, complication rates and urinary continence were evaluated. Control biopsies were performed at 1 year. Treatment failure was defined as a positive biopsy or need for salvage therapy. RESULTS: Twelve patients with a mean age 70 years were included. Median follow-up was 10 years. Control prostate biopsies were negative in 11/12 (91%) patients. Overall survival was 83% (10/12) and cancer specific survival was 100% at 10 years. Two patients died from other causes. Recurrence free survival was 90% (95% CI; 0.71-1) at 5 years, and 38% (95% CI; 0.04-0.73) at 10 years. Five patients had salvage therapy with repeat HIFU (n = 1) or hormonal therapy (n = 4) and all salvage patients were alive at 10 years. No patients developed lymph node or bone metastasis. No patients suffered from urinary incontinence. International Prostate Symptom Score was stable at 1 year. Complications included two urinary tract infections and one episode of acute urinary retention. CONCLUSIONS: Hemi-prostate ablation with HIFU can be safely performed in selected elderly patients with adequate long-term cancer control and low complication rates. Results from larger prospective studies using improved imaging techniques and extensive biopsy protocols are awaited.

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.

Objectives: To review the literature and present a contemporary image of androgen deprivation for prostate cancer. Methods: We conducted a PubMed search on intermittent androgen deprivation. Articles obtained on intermittent androgen deprivation (IAD) and the experiences at Institut Montsouris were used for the review. Results: IAD is an approach to hormonal deprivation that holds effective cancer control while preventing the morbidity associated with continuous androgen blockade. IAD nuances have been assessed by urological community teams in order to verify its possible potential benefits. Evidence based approach supports the idea of IAD as a standard of therapy for advanced prostate cancer requiring hormone deprivation. Variation among medical teams' criteria for the treatment and surveillance await standardization. Conclusions: Reassessing the gold standard of hormonal blockade in advanced prostate cancer is mandatory. The undeniable evolution of IAD needs to be embraced by the urological community.

Objetivo: Revisar la bibliografía y presenter una visión contemporánea del bloqueo androgénico en el cáncer de próstata. Métodos: llevamos a cabo una búsqueda bibliográfica en PubMed sobre bloqueo androgénico intermitente (BAI). Para la elaboración del presente artículo utilizamos los artículos obtenidos y la experiencia del Instituto Mutualista Montsouris. Resultados: El BAI es un abordaje del tratamiento de deprivación androgénica que mantiene un control oncológico eficaz y a la vez evita la morbilidad asociada con el bloqueo androgénico continuo. Los matices del BAI han sido evaluados por la comunidad urológica para verificar sus posibles beneficios. Un abordaje basado en la evidencia apoya la idea del BAI como un tratamiento estándar en cáncer de próstata avanzado que necesite bloqueo androgénico. Las variaciones entre los equipos médicos en los criterios de tratamiento y vigilancia están a la espera de estandarización. Conclusiones: Es necesario revisar el "Gold Standard" del bloqueo androgénico en cáncer de próstata avanzado. La evolución innegable del BAI necesita que la comunidad urológica lo abrace.

Objectives: Frequently, the term "quality of life" has been used to justify personal and professional decisions in all fields of medicine. Nowadays, quality of life studies are based on development and validation of sensitive measures of patient outcomes, incorporating functional status and perceived health status. Thus, quality of life has become an outcome as important as survival and effectiveness. Methods: A systematic review using Pubmed and Medline was performed, searching for papers concerning health related quality of life and urology. The most relevant articles where questionnaires and interviews were described and validated were listed. Results: Based on psychometric proprieties, a search between 1970 and 2007 identified a total of 25 recommendable articles with generic inventories and specific modules that have been developed, validated and used in clinical practice or research. Historical aspects, quality of life concepts, validation of questionnaires and structured interviews, and most used instruments in generic health-related quality of life, general urology and urological oncology have been discussed. Conclusions: A brief review of historic background of health related quality of life and urology was performed.

Objetivo: Con frecuencia, el término "calidad de vida" había sido utilizado para justificar decisiones personales y profesionales en todos los campos de la medicina. Hoy en día, el estudio de la calidad de vida se basa en el desarrollo y la validación de mediciones sensibles de los resultados de los pacientes incorporando el estado funcional con la percepción del estado de salud. Así, la calidad de vida (CV) se ha convertido en un resultado tan importante como la supervivencia y la eficacia. Métodos: Una revisión sistemática usando Pubmed y Medline fue realizada, buscando artículos referentes a calidad de vida relacionados con la salud y la urología. Los artículos más relevantes donde los cuestionarios y las entrevistas fueron descritos y validados han sido listados y revisados. Resultados: Una búsqueda entre 1970 y 2007 identificó un total de 25 artículos relacionados recomendables. De acuerdo con propiedades de la psicometría, los cuestionarios genéricos y los módulos específicos que se han desarrollado, validado y utilizado en la práctica e investigación clínica. Los aspectos históricos, definiciones relacionadas con la calidad de vida, validación de cuestionarios y estructuración de entrevistas, han sido utilizados en instrumentos que relacionan la calidad de vida a la salud general, urología general y la oncología urológica. Conclusiones: Se realizo una revisión bibliográfica acerca de los aspectos históricos sobre calidad de vida y el estado de salud y como se interrelacionan en el área de la urología, verificándose su importancia actual en la práctica médica.

PURPOSE: To assess the current treatment of metastatic renal cell carcinoma, focusing on medical treatment options. MATERIAL AND METHODS: The most important recent publications have been selected after a literature search employing PubMed using the search terms: advanced and metastatic renal cell carcinoma, anti-angiogenesis drugs and systemic therapy; also significant meeting abstracts were consulted. RESULTS: Progress in understanding the molecular basis of renal cell carcinoma, especially related to genetics and angiogenesis, has been achieved mainly through of the study of von Hippel-Lindau disease. A great variety of active agents have been developed and tested in metastatic renal cell carcinoma (mRCC) patients. New specific molecular therapies in metastatic disease are discussed. Sunitinib, Sorafenib and Bevacizumab increase the progression-free survival when compared to therapy with cytokines. Temsirolimus increases overall survival in high-risk patients. Growth factors and regulatory enzymes, such as carbonic anhydrase IX may be targets for future therapies. CONCLUSIONS: A broader knowledge of clear cell carcinoma molecular biology has permitted the beginning of a new era in mRCC therapy. Benefits of these novel agents in terms of progression-free and overall survival have been observed in patients with mRCC, and, in many cases, have become the standard of care. Sunitinib is now considered the new reference first-line treatment for mRCC. Despite all the progress in recent years, complete responses are still very rare. Currently, many important issues regarding the use of these agents in the management of metastatic renal cancer still need to be properly addressed.