Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? In recent years, several nomograms were developed in an effort to decrease the number of unnecessary prostate biopsies. The European SWOP‐PRI and the North American PCPT are among the most popular. However, evidence on the relative predictive accuracy is lacking. A head‐to‐head comparison on the diagnostic accuracy of two previously validated prostate cancer risk predictors on biopsy confirmed the superiority of these tools over PSA alone. Moreover, in the studied population, the European SWOP‐PRI proved to be more accurate than the North American PCPT‐CRC. OBJECTIVE • To compare the diagnostic accuracy of two previously validated prostate cancer risk predictors on biopsy. PATIENTS AND METHODS • In total, 390 consecutive patients submitted to 10‐core systematic transrectal prostate biopsy at our institution were included in this retrospective study. • External validation of a European (European Randomized Study of Screening for Prostate Cancer derived Prostate Risk Indicator; SWOP‐PRI) and a North American (Prostate Cancer Prevention Trial Cancer Risk Calculator; PCPT‐CRC) nomogram was performed. • The predictive accuracy of these online available nomograms was calculated based on the area under the curve derived from receiver–operator characteristic curves and then compared using the DeLong method. RESULTS • Both tools were confirmed to be superior to prostate‐specific antigen alone. Moreover, the SWOP‐PRI (77.9%) displays a 7.96% increase in the predictive accuracy compared to the PCPT‐CRC (69.9%) in a statistically significant fashion (P= 0.002). CONCLUSIONS • The results obtained in the present study confirm the utility of nomograms with respect to biopsy outcome prediction in patients with suspicion of prostate cancer. • In the current sample of patients, the European‐based nomogram appears to be more accurate than the North American nonogram, which lacks information regarding prostate volume and prostatic ultrasonographic lesions. • To our knowledge, this is the first study to compare the accuracy of these popular risk calculators in a specific population.

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Double-J ureteral stent (DJUS) is an important therapeutic tool in endourology. There are well-known frequent complications associated with DJUS placement such as distal and proximal migration within the urinary tract. However, perforation and stent misplacement are uncommon but serious complications of this technique. We present a case of a 63-year-old man who had a misplacement of a DJUS into the inferior vena cava during an elective procedure of ureteral catheterisation. The stent placement was performed under fluoroscopic control and it seemed well positioned. Actually, the DJUS was misplaced in the inferior vena cava after drilling at the level of the crossing of the ureter with the ipsilateral iliac vessels. Diagnosis was incidentally made 3 months after the placement of the stent in a renal CT scan. The patient was always asymptomatic. We performed an endoscopic removal of the ureteral stent, which took place without complications.

Introduction and Objectives Penile prosthesis implantation is a common, well‐established treatment for correcting medical refractory erectile dysfunction. Although more invasive than some of the other currently available therapies, PP surgery has the advantages of high patient satisfaction rates. The aim of this study was to evaluate the surgical results and patient satisfaction after implantation of PP in 25 patients treated at the University Hospital of Coimbra (CHUC). Material and MethodsWe evaluated 25 patients with erectile dysfunction who underwent implantation of PP, inflatable and semi‐rigid, between November 2000 and November 2013. The information was obtained from medical records and telephone interviews and encompassed clinical severity, comorbidity, etiology, PP type, surgical complications, need for reintervention and degree of patient satisfaction. Results88% of patients had severe ED. The main etiologies reported were: multifactorial (46.4%), atherogenic (24%) and neurologic (16%). Most devices implanted were inflatable prostheses (84%). In 80% of the cases there were no complications reported; the rate of re‐intervention was 20%. There were a high percentage of satisfied / very satisfied patients (65%). Discussion/ConclusionPP surgery remains an excellent alternative in restoring erectile function in patients whose medical therapies have failed. Despite its invasive nature, the implementation of PP has proven to be associated with a low rate of complications and a high degree of patient satisfaction.

Introduction. Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them. Materials and Methods. We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases. Results. We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P ¼ .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P ¼ .003) and had a lower GFR (P ¼ .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P ¼ .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P ¼ .004 and .010). Conclusion. The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.

Introduction: Non-muscle invasive (NMI) bladder cancers (BC) account for 75% of BC cases, and most are initially diagnosed and treated with transurethral resection of bladder tumor (TURB). After primary TURB, a repeat resection (rTURB) should be carried out in cases of incomplete resection; however, rTURB is recommended by EAU guidelines in pT1 tumors even when the completeness of the original resection is believed by the surgeon, with reported rates of residual tumor in up to 33%-55% and upstaging in up to 25%. Since the quality of initial resection impacts in the result of a rTURB, these rates are largely dependent on the primary treatment and accurate prediction of completeness, with a probable high variability between surgeons and Centres. Our objectives to determine whether rTURB after initial perceived complete resection would frequently identify residual tumor and if this procedure would improve outcomes in NMIBC patients. Methods: Patients submitted to TURB from 2015 to 2017 were analysed, identifying which underwent rTURB after initial resection without follow-up cystoscopy in between. Primary perception of completeness, stage and grade were correlated with the eventual presence, stage and grade of residual tumor. Results: We analyzed 546 TURB procedures; of these, 275 (50.4%) were for primary bladder cancer. pT1 lesions were found in 85 (30.9%) of primary TURBs; 12 of these were selected for rTURB due to incomplete resection. Of the remaining 73 macros- copically completely resected primary pT1 tumors, 26 (30.6%) underwent elective rTURB. Repeat TURB after complete resection of primary pT1 tumors yielded residual tumor in 11.5% of patients (n= 3). All patients with residual tumor had primary pT1 high grade lesions; no upstaging or upgrading was observed. Patients had similar recurrence rates at 1-year regardless of rTURB. Discussion/Conclusion: Standard practice in primary TURB pro- cedures varies across surgeons and centers and will reflect on residual tumor rates. Indications for rTURB might not be suitable for all patients, and single Centre results should be taken in consideration when selecting patients for rTURB.

Introdução: Pretende-se avaliar que fatores estão associados a um retorno hospitalar inesperado (RHI) após a realização de ressecção transuretral de tumor vesical (RTU-TV). Material e Métodos: Realizado estudo exploratório transversal de todas as RTU-TV realizadas entre 2015-2016. Resultados: Realizaram-se 499 RTU-TV em 389 doentes. Nos primeiros 30 dias após a cirurgia, ocorreu RHI em 16,8% dos casos, com necessidade de reinternamento em 4,2%. A principal causa de RHI foi infeção do trato urinário (ITU) (38,1%). Verificou-se um RHI significativamente superior nos casos de tumor primário, de dimensões tumorais superiores, de RTU-TV incompleta, de necessidade de realização de procedimentos endoscópicos adicionais, de maior duração da cirurgia e da cateterização uretral (CU) e de valores pré-operatórios mais altos de proteína C reativa (PCR) e mais baixos de hemoglobina. Na análise multivariada, verificou-se uma associação forte e independente entre a ocorrência de RHI e duração da cirurgia (OR = 1,016), duração da CU (OR = 1,059), e valores médios de PCR pré-operatória (OR = 1,131). Conclusão: Um RHI precoce após RTU-TV ocorreu em quase 17% dos casos, sobretudo devido a ITU. Por cada minuto de cirurgia adicional, por cada dia adicional de CU e por cada unidade adicional de PCR pré-operatória, existe um aumento do risco de RHI de 1,6%, 5,9% e 13,1%, respetivamente. Sendo a PCR uma variável não modificável, cabe ao cirurgião otimizar o tempo operatório e, sobretudo, a duração da CU de modo a reduzir a probabilidade de RHI.

IntroductionBladder cancer (BC) starts when urinary bladder cells grow abnormally. It is a solid tumour with high recurrence rates. BC is the eight tumour with the highest mortality and the sixth one with the highest incidence in the worldwide. Since the prognostic tools currently available have limitations and acquired changes in specific genes are thought to be significant in the development of bladder tumours, we needed to improve the research in this field of genetic changes associated with the BC. The aim of this study was the characterisation of the genomic profile of bladder tumours using the array-Comparative Genomic Hybridization (aCGH) technique.Material and methodsBladder tumour samples were acquired from 28 patients when they were submitted a transurethral resection of bladder tumour (TURBT). The aCGH was done using an Agilent oligonucleotide microarray 4 × 180K. Bladder tissue samples from non-cancer donors are used as controls. Histopathological information from the patients was analysed and clinical data registered.Results and discussionsA few genomic imbalances were verified, using aCGH – a whole genome technique. In these preliminary outcomes, we did not observe a pattern of chromosomal alterations, as, we did not find imbalances in more than 20% of patients. Moreover, the chromosomes with more frequent copy number losses were 1, 6, 10, 13, 20, 21, 22 and X and the chromosomes with more frequent copy number gains were 1, 11, 13, 18 and 21. Additionally, the sizes of aberrations detected for the same chromosome were often variable between patients.ConclusionThis approach allowed us to identify altered chromosomal regions in bladder cancer comparing to normal tissues. In this way, is possible to map fundamental genes related to disease initiation and progression. The correlation between molecular and clinical-pathological data will be fundamental to identify recognised biomarkers with possible diagnostic and prognostic interest.