ABSTRACT Background: Multiparametric magnetic resonance imaging improves the performance of prostate cancer (PCa) diagnostics through a better selection of patients. Objectives: The aim of the study was to study the detection rate (DR) of systematic and targeted cognitive biopsies in a cohort with the previous negative systematic biopsies. A secondary objective was to describe the value of prostate-specific antigen density (PSAd) in the detection of clinically significant PCa (CSPCa). Methods: We designed a prospective, single-center, and comparative study to determine the DR of systematic and targeted cognitive biopsies. The clinical and pathological characteristics of each patient were described. Results: A total of 111 patients with Prostate Imaging Reporting and Data System lesions > 3 were included in the study. PCa was detected in 41.4% (46 of 111 patients); 42 (91.3%) were detected by systematic biopsy and 30 (65.2%) by targeted biopsy. CSPCa was detected in 26 (23.4%), 23 (88.5%) by systematic biopsy, and 21 (76.9%) by targeted biopsy. PSAd > 0.15 was directly associated with CSPCa. Conclusion: The detection of PCa by systematic biopsy in this series was higher than 80%; hence, its routine use should not be replaced by targeted biopsy, since it continues to be the cornerstone of the diagnosis in patients with prior negative biopsies.

Abstract Objective: Bladder cancer represents the seventh most common cancer with highly variable morbidity and mortality due to detection, treatment and follow-up strategies, with radical cystectomy (RC) being the treatment that offers the best oncological control. A morbidity rate between 30-93% has been reported at 30 days, and mortality greater than 8%. This variability is due to the scarcity of standardized reports using scales such as Clavien-Dindo (CD). Due to the little evidence of publications on complications associated with RC, we decided to make a standardized report of these, using the CD scale of the RCs performed in our hospital, with the goal of finding out the incidence and real severity of these. Materials and methods: A retrospective analysis was made of a prospectively maintained database of RCs performed in our center between 1994 and 2019. All patients over 18 years of age who underwent RC during the study period were included, and all patients with incomplete documentation of the immediate 30 day-postoperative were excluded. Descriptive statistics were used for data presentation. The Kolmogorov-Smirnov test was used to determine the data distribution. An inferential mean comparison analysis was performed using the Student's t-test for variables with normal distribution, and non-parametric tests (Mann-Whitney U-test) for those with non-normal distribution. Results: The mean age of the study population was 61.16 years (SD 10.1). Patients without major complications had a BMI 2.45 kg/m2 lower compared to patients with major complications (95% CI -4.7 to -0.18). Bleeding and surgical time, as well as type of derivation, were not significantly associated with major complications. Study limitations: It was a retrospective study, so the SAS could not be calculated for the entire population. Also, it was a small cohort of patients in a tertiary care center with a restricted number of hospital beds, which considerably reduces the statistical power of the study to find low-frequency events (mortality). Extending the follow-up to more than 30 days could modify the incidence of complications. Originality: Our series is the first to use a standardized system (Clavien-Dindo scale) to report postoperative complications in patients undergoing RC in Mexico. Conclusions: RC continues to be one of the surgeries with the highest morbidity. The use of standardized scales for reporting complications associated with RC would allow us to establish prevention strategies and establish homogeneous surveillance criteria with other specialties.

Resumen Objetivo: El cáncer de vejiga representa el séptimo cáncer más frecuente con una morbimortalidad muy variable debido a estrategias de detección, tratamiento y seguimiento, siendo la cistectomía radical (CR) el tratamiento que ofrece el mejor control oncológico. Se ha reportado una tasa de morbilidad entre un 30-93% a 30 días y una mortalidad mayor al 8%. Esta variabilidad obedece a la escasez de reportes estandarizados utilizando escalas como Clavien-Dindo. Debido a la poca evidencia de publicaciones sobre complicaciones asociadas a CR, decidimos realizar un reporte estandarizado de estas, usando la escala de CD de las CR realizadas en nuestro hospital con la meta de averiguar la incidencia y gravedad real de estas. Materiales y métodos: Análisis retrospectivo de una base mantenida prospectivamente de CR realizadas en nuestro centro entre 1994 y 2019. Se incluyeron todos los pacientes mayores de 18 años, sometidos a una CR en el periodo de estudio y se excluyeron a todos los pacientes con documentación incompleta del postoperatorio inmediato a 30 días. Se utilizó estadística descriptiva para la presentación de los datos. Se aplicó la prueba de Kolmogorov-Smirnov para determinar la distribución de los datos. Se realizó un análisis inferencial de comparación de medias utilizando la prueba T de Student para las variables con distribución normal y con pruebas no paramétricas (prueba de U de Mann-Whitney) para aquellas con distribución no normal. Resultados: La media de edad de la población de estudio fue de 61.16 años (DE 10.1). Los pacientes sin complicación mayor presentaron un IMC de 2.45 kg/m2 menor en comparación con los pacientes con complicación mayor (IC95% -4.7 a -0.18). El sangrado y tiempo quirúrgico, así como el tipo de derivación no se asoció significativamente con la complicación mayor. Limitaciones del estudio: Estudio retrospectivo, por lo que no se le pudo calcular el SAS a la totalidad de nuestra población. Cohorte reducida de pacientes en un centro de tercer nivel de atención con un número restringido de camas en hospitalización, lo cual disminuye de manera considerable el poder estadístico del estudio para encontrar eventos de baja frecuencia (mortalidad). El ampliar el seguimiento a más de 30 días podría modificar la incidencia de complicaciones. Originalidad: Nuestra serie es la primera en utilizar un sistema estandarizado (escala Clavien-Dindo) para reportar complicaciones posquirúrgicas en pacientes sometidos a CR en México. Conclusiones: La CR continúa siendo una de las cirugías con mayor morbilidad. La aplicación de escalas estandarizadas para el reporte de complicaciones asociadas a la CR nos permitiría establecer estrategias de prevención y establecer criterios homogéneos de vigilancia con otras especialidades.

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Abstract Objective: To analyze the microbiology and incidence of antibiotic resistance in patients that underwent transurethral resection of bladder tumor (TURBT) and identify risk factors for urinary tract infection (UTI) after the procedure. Methodological design: A retrospective, analytic, descriptive study on data from 199 patients that underwent TURBT at a tertiary care hospital in Mexico City between 2017-2019. The microbiologic characteristics of isolation frequency and drug-resistance pattern were analyzed before and after the procedure. Binary logistic regression was carried out to identify independent risk factors for UTI. Results: Of the 199 patients evaluated, 28 (14%) had a positive urine culture (PUC) before the procedure and the most frequently isolated uropathogens were Escherichia coli (48%), Enterococcus faecalis (24%), and Proteus mirabilis (7%). UTI after TURBT was reported in the 20 patients (10%) that made up group 1. The most frequent pathogen was E. coli (45%), which was resistant to trimethoprim/sulfamethoxazole (60%) and ciprofloxacin (40%). Other isolated pathogens were E. faecalis (27%) and P. mirabilis (9%). The control group included the 179 (90%) patients that did not have a UTI. PUC was statistically significant in relation to necrosis (p=0.001) and muscle-invasive bladder cancer (p=0.03). In the multivariate analysis, PUC was associated with UTI after TURBT (OR 7.04 [95% CI 2.11-23.29]). Limitations: A retrospective study with information limited to that in the case records. Originality and value: There are few articles on TURBT-associated UTI in the international literature and none in Mexico, the present study being the first. Conclusions: The prevalence of UTI after TURBT was 10%. Pre-procedure PUC was the most highly associated risk factor for UTI after TURBT. The most frequently isolated uropathogens were E. coli, E. faecalis, and P. mirabilis. E. coli was most resistant to trimethoprim/sulfamethoxazole (60%) and ciprofloxacin (40%).

Resumen Objetivo: Investigar la incidencia, microbiología y resistencia antibiótica en pacientes sometidos a resección transuretral de vejiga (RTUV) e identificar factores de riesgo para infección de vías urinarias (IVU) después de procedimiento. Diseño metodológico: Estudio retrospectivo, descriptivo y analítico de 199 pacientes sometidos a RTUV en un hospital de tercer nivel en Ciudad de México entre 2017-2019. Se analizaron las características microbiológicas de frecuencia de aislamiento y patrón de resistencia antes y después del procedimiento. Se realizó regresión logística binaria para identificar factores de riesgo independientes a IVU. Resultados: Se analizaron 199 pacientes, de estos 28 pacientes (14%) presentaron un urocultivo prequirúrgico positivo (UPP), los uropatógenos más frecuentemente aislados fueron Escherichia coli (48%), Enterococcus faecalis (24%) y Proteus mirabilis (7%). Se reportó IVU después de RTUV en 20 pacientes (10%) los cuales conformaron el grupo 1. El patógeno más frecuente fue E. coli (45%), el cual era resistente a trimetoprima/sulfametoxazol (60%) y ciprofloxacino (40%). Otros patógenos aislados fueron E. faecalis(27%) yP. mirabilis(9%). En el grupo control se incluyeron 179 (90%) pacientes ya que no presentaron IVU. Se encontró diferencia significativa en la presencia de UPP y necrosis (p=0.001), al igual que en presencia de cáncer músculo-invasor (p=0.03). En el análisis multivariado el UPP se asoció a IVU después de RTUV (OR 7.04 [95% IC 2.11-23.29]). Limitaciones: Estudio retrospectivo limitado a información reportada en expediente. Originalidad y valor: Existe poca literatura acerca de IVU asociadas a RTUV a nivel mundial, en México no hay información, siendo este estudio único en su campo. Conclusiones: La prevalencia de IVU después de RTUV fue de 10%. El factor de riesgo con mayor asociación fue el UPP para IVU después de RTUV. Los uropatógenos más frecuentemente aislados fueron E. coli,E. faecalisyP. mirabilis. Trimetoprima/sulfametoxazol (60%) y ciprofloxacino (40%) fueron los antibióticos con mayor resistencia para E. coli.

ABSTRACT Purpose: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. Material and Methods: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. Results: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. Conclusions: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

ABSTRACT Purpose: To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period. Material and Methods: A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects. Results: Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services. Conclusions: During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.

Abstract The COVID-19 pandemic has forced the modification of medical attention around the world, to reserve the greatest amount of resources for the treatment of patients with SARS-CoV-2 infection. Urology departments, just like the rest of the surgical services, have had to adapt to this situation, reducing the medical attention given to different illnesses and only selecting and attending to emergency consultations, procedures, and surgeries, or to oncologic maladies that cannot be postponed. The aim of the present review was to make recommendations regarding outpatient consultation management and the correct selection of surgeries and procedures. The postponement of the majority of non-urgent procedures should continue until the COVID-19 pandemic is controlled in Mexico.

Resumen La pandemia por COVID-19 ha obligado a modificar la atención médica alrededor del mundo con la finalidad de reservar la mayor cantidad de recursos para la atención de pacientes infectados por el SARS-CoV-2. Los departamentos de urología al igual que el resto de los servicios quirúrgicos han tenido que adaptarse a esta situación disminuyendo la atención de los distintos padecimientos, seleccionando y atendiendo solamente los motivos de consulta, los procedimientos y las cirugías que sean urgentes o por padecimientos oncológicos inaplazables. El objetivo de la siguiente revisión es hacer algunas recomendaciones para el manejo de la consulta externa y la correcta selección de cirugías y procedimientos. La postergación de la mayor parte de los procedimientos no urgentes deberá continuar hasta que la pandemia por COVID-19 en México esté controlada.

Resumen La aloína es una antraquinona presente en una amplia variedad de productos alimenticios que se elaboran a base de sábila, la cual puede provocar efectos laxantes y su ingestión prolongada incrementa el riesgo de cáncer gastrointestinal. En este estudio, se validaron parámetros de una metodología de extracción y análisis de la aloína, por medio de cromatografía líquida con detector de arreglo de diodos (HPLC-DAD). Se determinó la concentración de la aloína en 14 productos comerciales, consumidos en Costa Rica. Los valores de calidad evaluados fueron la linealidad (R = de 0,9995 a 0,99995), la reproducibilidad (porcentaje de recuperación = de 96,7 % a 99,9 %), la precisión intradía (coeficiente de variación = de 0,24 % a 1,47 %), la precisión interdía (coeficiente de variación = de 1,65 % a 2,68 %), el límite de detección (de 0,063 mg/L a 0,228 mg/L), el límite de cuantificación (de 0,126 mg/L a 0,452 mg/L) y la selectividad (≤ 0,063 mg/L). La mayoría de los productos alimenticios evaluados mostró una concentración por debajo del valor máximo permitido (10 mg/L); se encontraron valores entre los 0,2 ± 0,1 mg/L y 4,8 ± 0,1 mg/L de aloína, con una desviación estándar promedio de 0,41 mg/L. Las muestras líquidas presentaron valores más altos que el resto de las matrices. 2 de las muestras (RU/BT1/39A y RU/BT1/45B) fueron reportadas con concentraciones mayores al valor máximo permitido (14,2 ± 0,1 mg/L y 19,0 ± 0,1 mg/L) de aloína. El consumo de estos productos podría llegar a tener un efecto perjudicial, a largo plazo, en la salud, ya que sobrepasan el límite mencionado anteriormente. Palabras clave: Aloe vera; aloína; HPLC; antraquinonas; validación.

Resumo A aloína é uma antraquinona presente em uma ampla variedade de produtos alimentares elaborados a base de babosa, podendo causar efeitos laxantes e sua ingestão prolongada aumenta o risco de cancro gastrointestinal. Neste estudo, os parâmetros de uma metodologia de extração e análise de aloína foram validados por meio de cromatografia líquida com detector de arranjos de diodos (HPLC-DAD). A concentração de aloína foi determinada em 14 produtos comerciais, consumidos na Costa Rica. Os valores de qualidade avaliados foram a linearidade (R = de 0,9995-0 a 0,99995), a reprodutibilidade (percentagem de recuperação = 96,7% a 99,9%), a precisão intra-dia (coeficiente de variação = 0,24% a 1,47%), a precisão inter-dia (coeficiente de variação = 1,65% a 2,68%), o limite de detecção (0,063 mg/L a 0,228 mg/L), o limite de quantificação (de 0,126 mg/L a 0,452 mg/L) e a seletividade (≤ 0,063 mg / L). A maioria dos produtos alimentares avaliados apresentou concentração abaixo do valor máximo permitido (10 mg/L); foram encontrados valores entre 0,2 ± 0,1 mg/L e 4,8 ± 0,1 mg/L de aloína, com um desvio padrão médio de 0,41 mg/L. As amostras líquidas apresentaram valores mais altos que o restante das matrizes. 2 das amostras (RU / BT1 / 39A e RU / BT1 / 45B) foram relatados com concentrações mais elevadas do que o valor máximo permitido de aloína (14,2 ± 0,1 mg / L e 19,0 ± 0,1 mg / L). O consumo desses produtos poderia ter um efeito prejudicial sobre a saúde em longo prazo, uma vez excedido o limite mencionado anteriormente. Palavras-chave : Aloe vera; aloína; HPLC; antraquinonas; validação

Abstract Aloin is an anthraquinone found in a wide variety of food products made from aloe, which can cause laxative effects and prolonged ingestion increases the risk of gastrointestinal cancer. In this study, parameters for aloin analysis and extraction methodology were validated using High Performance Liquid Chromatography with Diode-Array Detection (HPLC-DAD). Aloin concentration was determined in 14 commercial products consumed in Costa Rica. The quality values evaluated were linearity (R = from 0.9995 to 0.999995), reproducibility (recovery percentage = from 96.7% to 99.9%), intra-day precision (coefficient of variation = from 0.24% to 1.47%), inter-day precision (coefficient of variation = from 1.65% to 2.68%), limit of detection (from 0.063 mg/L to 0.228 mg/L), limit of quantification (from 0.126 mg/L to 0.452 mg/L) and selectivity (≤ 0.063 mg/L). The majority of the evaluated food products showed a concentration below the maximum value allowed (10 mg/L), with values between 0.2 ± 0.1 mg/L and 4.8 ± 0.1 mg/L of aloin, with an average standard deviation of 0.41 mg/L. Liquid samples presented higher values than the rest of the matrices. Two of the samples (RU/BT1/39A and RU/BT1/45B) were reported with concentrations higher than the maximum aloin value allowed (14.2 ± 0.1 mg/L and 19.0 ± 0.1 mg/L). The consumption of these products could have a long-term harmful effect on health, since they exceed the limit mentioned above. Keywords: Aloe vera; aloin; HPLC; anthraquinones; validation.

Abstract Objectives: To analyze the relationship between erectile dysfunction and metabolic syndrome in a group of Mexican patients, study the influence of other morbidity factors on erectile dysfunction, and define the specific metabolic syndrome components most associated with erectile dysfunction severity. Materials and methods: A descriptive, cross-sectional study was conducted on a group of 86 adult Mexican patients previously diagnosed with erectile dysfunction. Participants were classified as presenting with or not presenting with metabolic syndrome. Anthropometric, biochemical, and clinical parameters were determined and erectile dysfunction severity, alcohol or tobacco consumption, and depressive behavior were identified through validated questionnaires. The results were compared between the two groups. Results: The anthropometric measures, laboratory values, and clinical characteristics were significantly different between the two groups. More patients with severe and moderate erectile dysfunction were identified in the group with metabolic syndrome. Of the metabolic syndrome components, glycated hemoglobin >5.7% and fasting glucose >110 mg/dl were significantly associated with the development of erectile dysfunction. Limitations: The size of our study sample was a limitation, as was the observational and cross-sectional study design. Originality: Our study results suggest that metabolic syndrome contributed to the progression of erectile dysfunction in the Mexican sample analyzed, with hyperglycemia being the most strongly associated factor. Conclusions: Metabolic syndrome components were shown to aggravate erectile dysfunction, particularly the lack of glycemic control. The inclusion of fasting glucose and glycated hemoglobin as complementary biochemical screening in patients with erectile dysfunction should be assessed.

Resumen Objetivos: analizar la relación entre la Disfunción eréctil y el Síndrome metabólico en un grupo de pacientes mexicanos, estudiar la influencia de otros factores de morbilidad en la Disfunción eréctil y definir los componentes específicos de Síndrome metabólico más asociados con la severidad de la Disfunción eréctil. Métodos: se realizó un estudio descriptivo y transversal en 86 pacientes mexicanos adultos con Disfunción eréctil. Los participantes fueron clasificados con o sin Síndrome metabólico. La gravedad de la Disfunción eréctil, el consumo de alcohol o tabaco, y el comportamiento depresivo se identificaron a través cuestionarios validados y se compararon entre ambos grupos, así como parámetros antropométricos, bioquímicos y clínicos de interés. Resultados: los valores antropométricos y de laboratorio, y características clínicas fueron significativamente diferentes entre los grupos. Se identificaron más pacientes afectados por Disfunción eréctil severa y moderada en el grupo con Síndrome metabólico. Entre los componentes del Síndrome metabólico, la hemoglobina glicosilada >5.7% y la glucosa en ayunas >110 mg/dl se asociaron significativamente con el desarrollo de Disfunción eréctil. Limitaciones: el tamaño de muestra y la naturaleza transversal del diseño. Originalidad: nuestro estudio proporciona evidencia que sugiere que el Síndrome metabólico contribuye a la progresión de la Disfunción eréctil en esta muestra de mexicanos, siendo la hiperglucemia el factor más asociado. Conclusiones: los componentes de Síndrome metabólico agravan la Disfunción eréctil, particularmente el descontrol glucémico. Resulta relevante la inclusión de glucosa en ayunas y hemoglobina glicosilada a modo de análisis complementario en pacientes con Disfunción eréctil.

ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.

Abstract OBJECTIVES: To determine the incidence of bladder perforation detected during transurethral resection of the bladder due to urothelial cancer and its association with risk factors, diagnosis, treatment, and prevention to reduce complications that modify patient outcome, increasing the risk for recurrence, progression, and metastasis. MATERIALS AND METHODS: A retrospective and prospective study was conducted on patients that underwent transurethral resection of the bladder due to non-muscle-invasive urothelial cancer at the Urology Service of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, within the time frame of 1987 to February 2017. Cases of bladder perforation detected during the procedure were described, and the demographic and clinical variables were evaluated. RESULTS: Of the 556 patients that underwent transurethral resection of the bladder, 7 had detected bladder perforation: 4 were cases of extraperitoneal perforation and 3 were intraperitoneal. One patient with extraperitoneal perforation presented with extravesical recurrence that was treated conservatively. CONCLUSIONS: The incidence of bladder perforations found in our study was low. It was associated with age, tumor grade, and number of resected tumors, but not with BMI. Unlike descriptions in the literature, extravesical recurrence was not associated with intraperitoneal perforation. The urologist should be aware of the complications of the procedure and treat them opportunely.

Resumen OBJETIVO: Determinar la incidencia de perforaciones vesicales advertidas durante la resección transuretral de vejiga por cáncer urotelial y su asociación con factores de riesgo, diagnóstico, tratamiento y prevención, con la finalidad de evitar complicaciones que modifiquen el pronóstico del paciente y, a su vez, el riesgo de recurrencia, progresión y metástasis. MATERIALES Y MÉTODOS: Estudio retrospectivo y prospectivo llevado a cabo en pacientes a quienes se efectuó resección transuretral de vejiga por cáncer urotelial no músculo invasor, atendidos en el servicio de Urología del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, de 1987 a febrero de 2017. Se describen los casos de perforación vesical advertida durante el procedimiento, considerando variables demográficas y clínicas. RESULTADOS: De 556 pacientes con resección transuretral de vejiga, se encontraron 7 casos de perforación vesical advertida: 4 con perforación extraperitoneal y 3 intraperitoneal, además de un caso de recurrencia extravesical en un paciente con perforación extraperitoneal tratada conservadoramente. CONCLUSIONES: La incidencia de perforaciones vesicales advertidas es baja, no se asocian propiamente con el IMC del paciente, pero sí con la edad, el grado y número de tumores resecados. La recurrencia extravesical no se asocia con perforación intraperitoneal, contrario a lo descrito. El urólogo debe considerar y atender de manera oportuna las complicaciones de este procedimiento.

Abstract Background: Most testicular lesions are detected at the early stage and up to 10-20% of them are benign. Frozen section examination (FSE) has proven to be reliable for evaluating testicular lesions. The diagnosis of benign histology can prevent unnecessary radical orchiectomy and its complications. Objective: To evaluate the diagnostic accuracy of FSE of equivocal malignant testicular masses (EMTMs), as well as the short and long-term complications associated with that procedure. Materials and methods: A retrospective study was conducted between 2005 and 2015 at a tertiary care center on patients that underwent testicular exploration through FSE due to EMTM. Diagnostic accuracy measures were obtained, and the short and long-term complications were recorded. The study design was carried out following the STARD (Standards for Reporting of Diagnostic Accuracy) recommendations. Results: Twenty-three patients were included in the study. Median follow-up was 10 months (interquartile range: 60). A total of 73.9% of the lesions were benign and 26.1% were malignant. There were no diagnostic changes in relation to the FSE and definitive pathology reports. Diagnostic accuracy measures were 100%. The degree of concordance between the FSE and definitive malignancy reports was statistically significant (κ = 1.0, p < 0.05). As a result of the benign FSE report, 12 radical orchiectomies (70.6%) were prevented. Three patients (12.5%) had grade I complications. In the long term, 2 patients presented with testicular atrophy. No malignant formations were observed during follow-up in the patients that did not undergo radical orchiectomy as a result of the benign FSE report. Conclusion: Testicular frozen section examination is a reliable technique in equivocal malignant lesion management and is associated with low-grade complications.

Resumen Antecedentes: La mayor parte de las lesiones testiculares se detectan en etapa temprana. En 10 a 20% de los casos pueden ser benignas. La biopsia por congelamiento ha demostrado ser confiable para evaluar lesiones testiculares. El diagnóstico de histología benigna puede evitar orquiectomías radicales innecesarias y sus complicaciones. Objetivo: Evaluar la precisión diagnóstica de la biopsia por congelamiento de lesiones testiculares malignas equívocas, las complicaciones a corto y largo plazos asociadas con este procedimiento. Materiales y métodos: Estudio retrospectivo efectuado de 2005 a 2015 en un centro hospitalario terciario, en pacientes con exploración testicular con biopsia por congelamiento debido a lesiones testiculares malignas equívocas. Se obtuvieron medidas de precisión diagnóstica. Se registraron las complicaciones a corto y largo plazo. El diseño del estudio se realizó siguiendo las recomendaciones STARD (Standards for Reporting of Diagnostic Accuracy, por sus siglas en inglés). Resultados: Se incluyeron 23 pacientes, con una mediana de seguimiento de diez meses (Rango Intercuartil: 60). 73.9% y 26.1% de las lesiones fueron benignas y malignas, respectivamente. No se observaron cambios en el diagnóstico entre el reporte de la BC y el reporte definitivo de patología. Las medidas de precisión diagnóstica tuvieron un valor de 100%. El grado de concordancia entre la BC y el reporte definitivo de malignidad, fue estadísticamente significativo (κ = 1.0, p <0.05). Debido al reporte benigno de la biopsia por congelamiento, se evitaron 12 orquiectomías radicales. Tres pacientes (12.5%) tuvieron complicaciones grado I. Se encontró atrofia testicular, a largo plazo, en 2 pacientes. En los pacientes que no se sometieron a orquiectomía radical por reporte benigno de biopsia por congelamiento, no se detectaron formaciones malignas durante el seguimiento. Conclusión: La biopsia testicular por congelamiento representa una técnica confiable en el manejo de lesiones malignas equívocas y está asociada con complicaciones de bajo grado.

Abstract Prostate cancer is the most frequent tumor found in men worldwide and in Mexico in particular. Age and family history are the main risk factors. The diagnosis is made by prostate biopsy in patients with abnormalities detected in their prostate-specific antigen (PSA) levels or digital rectal exam (DRE). This article reviews screening and diagnostic methods as well as treatment options for patients diagnosed with prostate cancer.

Resumen El cáncer de próstata es el tumor más frecuente en hombres a nivel mundial, y de manera específica en México. Los principales factores de riesgo son la edad y la historia familiar. El diagnóstico se obtiene por medio de biopsia prostática en pacientes detectados por anormalidades en el antígeno prostático o tacto rectal. En este artículo se hace una discusión de los métodos de tamizaje, diagnóstico y opciones de tratamiento en pacientes con diagnóstico de cáncer de próstata.