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Objectives: Multiparametric magnetic resonance imaging (mpMRI) is a useful tool to diagnose prostate cancer (PCa) but its cost is not negligible. In order to reduce costs and minimize time to diagnosis, it is necessary to establish which patients benefit the most from doing mpMRI prior to prostate biopsy (PB). Our aim was to test if mpMRI still predicts PCa and clinically significant PCa (csPCa) in patients with high clinical suspicion of cancer, defined as prostate specific antigen (PSA) > 10 ng/ml, PSA-Density (PSAD) > 0.15 ng/ml/cc or suspicious digital rectal examination (DRE). Materials and methods: We retrospectively collected data on 206 patients who underwent mpMRI before PB at our Department from January 2017 to July 2018. mpMRI results were classified using Prostate Imaging Reporting and Data System (PI-RADS) version 2. In primary analysis, we evaluated the association of mpMRI with PCa and csPCa and stratified this model for low and high clinical suspicion of cancer. In secondary analysis, we determined the rate of negative PB results in patients with high suspicion of cancer and compared theses rates with those obtained if only those with PI-RADS 3-5 would be biopsied. Results: In primary analysis and overall, mpMRI was predictive of PCa and csPCa. In stratified analysis, mpMRI was still significantly associated with csPCa in patients with PSA > 10 ng/ml and PSAD > 0.15 ng/ml/cc, but not in those with suspicious DRE. In secondary analysis, negative result rates were lower if only patients with PI-RADS 3-5 were biopsied, even in subgroups with high suspicion of cancer based on PSA and PSAD. In patients with suspicious DRE, however, the rate of negative results did not change significantly if only patients with PI-RADS 3-5 were biopsied. Conclusions: mpMRI is still useful in predicting csPCa in patients with PSA > 10 ng/mL and PSAD > 0.15 ng/ml/cc. If DRE is suspicious, though, mpMRI might be no longer useful in the prediction of PCa.

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Introduction This study aimed to compare trainees’ laparoscopic performance concerning the peg-transfer (PT) and needle-guidance (NG) exercises after watching the original European Basic Laparoscopic Urologic Skills (E-BLUS) video or after watching a video-mentored tutorial (VMT) with ‘tips and tricks’, narration and didactic illustrations. Material and methods An experimental, unblinded, parallel, 2-intervention, 2-period randomized trial with an allocation ratio of 1:1 was conducted. Forty-two participants were randomized into 2 groups. Prior to task initiation, Group 1 watched the VMT in both trials and Group 2 watched, firstly, the original E-BLUS examination video and, in the second trial, the VMT. Each participant performed 2 trials for each exercise. Outcome measures were task time and total number of errors. Results In the first period, participants who visualized the PT and NG VMT had fewer errors than participants who visualized the E-BLUS video (p = 0.001 and p = 0.014, respectively). In the second period, after watching the VMT, a decrease in the total number of errors in PT and NG exercises was observed in the participants who previously watched the E-BLUS video (p = 0.001 and p = 0.002, respectively). In the second period, a decrease in median task time was observed for Group 1 and 2 after watching the PT VMT (p ≤0.001 and p = 0.003, respectively) and NG VMT (p = 0.005 and p = 0.01, respectively). Conclusions The use of VMT can lead to a smaller number of errors and, if coupled with deliberate practice, could lead to a shorter task time in exercise performance among participants with no previous laparoscopic experience.

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HighlightsVesicoureteral reflux presenting for the first time in adults is rare.The diagnosis should be suspicious in adult patients with recurrent Pyelonephritis without recognizable cause.Endoscopic treatment with bulking agents is a minimally invasive technique with good results for adult vesicoureteral reflux.

RESUMOIntrodução: O tabagismo é um importante fator de risco para o desenvolvimento, recorrência e progressão do cancro da bexiga. Este estudo pretendia analisar os hábitos tabágicos após o diagnóstico em doentes com cancro da bexiga. Adicionalmente, foi avaliado o reconhecimento do tabagismo como fator de risco e a atuação médica na promoção da cessação tabágica. Smoking was acknowledged as a risk factor by 74.4% of the sample, with only 51.3% of ever smokers and 24.4% of non-smokers recognizing smoking as the leading risk factor (p = 0.008). The presence of other household smokers were significantly higher in patients who continued smoking (40%) than in ex-smokers after diagnosis (4.2%) (p = 0.005). The majority of smokers at diagnosis (83.1%) were advised to quit by their urologist, but only one smoker (1.7%) was offered any specific intervention to aid in cessation. Discussion: Smoking is not recognized as the leading risk factor for bladder cancer. This limited awareness, associated with the known difficulties in quitting smoking and the observed lack of smoking cessation interventions, may account for the high current smoking prevalence, albeit in line with other studies. Conclusion: This study highlights the need for efficient smoking cessation programs directed to bladder cancer patients. Keywords: Smoking; Smoking Cessation; Urinary Bladder Neoplasms INTRODUÇÃOO cancro da bexiga (CB) é uma das neoplasias malignas mais frequente do trato urinário, com uma incidência 3 -4 vezes mais elevada nos homens do que nas mulheres. [1][2][3] É o sétimo cancro mais frequente no mundo, com aproximadamente 336 000 novos casos estimados/ano, em particular nos países desenvolvidos.2,4 Em Portugal, segundo dados do relatório de doenças oncológicas, o CB tem a oitava maior taxa de incidência, tendo sido responsável pela morte de 940 doentes no ano de 2014, valor que manifesta uma tendência de crescimento face aos anos anteriores. 5O CB é um dos principais carcinomas associados ao tabaco; estudos epidemiológicos evidenciam uma relação consistente entre o tabagismo e o risco de CB, responsável por mais de 50% dos casos nos países desenvolvidos. 1,[6][7][8][9] Os ex-fumadores e os fumadores apresentam um risco duas e quatro vezes superior, respetivamente, com maiores incrementos deste consoante a intensidade e a duração do consumo. 7,9 O consumo de tabaco no contexto oncológico não é apenas relevante pelo seu potencial carcinogénico. A evidência científica atual aponta para um pior prognóstico, maior risco de recorrência e de progressão nos doentes

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