Localized high-risk (HR) prostate cancer (PCa) is a heterogeneous disease whose likelihood of a biochemical recurrence, metastatic progression and cancer-related mortality after initial treatment is higher when compared with patients with low (LR) or intermediate-risk (IR) disease. In the past, neoadjuvant therapy has shown an improvement in postoperative oncological variables but failed to demonstrate any survival advantages. With the promising results from novel treatments in metastatic and non-metastatic castration resistant PCa settings, new evidence has appeared in the literature in the neoadjuvant setting. Background/Objectives: To describe the current evidence for different neoadjuvant treatments before a radical prostatectomy in high-risk prostate cancer. Methods: We performed a comprehensive English literature search for original and review articles through January–August 2024, using Pubmed, Medline and ClinicalTrials.gov databases, as well as a comprehensive review of different international guidelines, searching the following terms: “neoadjuvant ADT prostate cancer”, “neoadjuvant ADT”, “prostate cancer surgery” and “neoadjuvant high-risk prostate cancer”. We included 61 papers for the final review. Results and Discussion: Neoadjuvant therapy is not recommended in daily practice by any international guideline. The National Comprehensive Cancer Network (NCCN) guidelines strongly discourage the use of ADT as a neoadjuvant therapy outside of clinical trials. ADT + ARTAs show promising data in phase-II trials, including favorable pCR, MRD, PSA relapse and salvage therapy rates. Clinical trials on chemotherapy, ¹⁷⁷Lu-PSMA, genomic-targeted therapies and markers of response leave room for further evidence acquisition due to their encouraging results. Conclusions: Currently, no phase III data supports systemic neoadjuvant therapy before RP. Phase II studies show promising data for ADT with second-generation agents, including favorable pCR, MRD, PSA relapse and salvage therapy rates.

The incidence of renal mass detection has increased during recent decades, with an increased diagnosis of small renal masses, and a final benign diagnosis in some cases. To avoid unnecessary surgeries, there is an increasing interest in using radiomics tools to predict histological results, using radiological features. We performed a narrative review to evaluate the use of radiomics in renal mass characterization. Conventional images, such as computed tomography (CT) and magnetic resonance (MR), are the most common diagnostic tools in renal mass characterization. Distinguishing between benign and malignant tumors in small renal masses can be challenging using conventional methods. To improve subjective evaluation, the interest in using radiomics to obtain quantitative parameters from medical images has increased. Several studies have assessed this novel tool for renal mass characterization, comparing its ability to distinguish benign to malign tumors, the results in differentiating renal cell carcinoma subtypes, or the correlation with prognostic features, with other methods. In several studies, radiomic tools have shown a good accuracy in characterizing renal mass lesions. However, due to the heterogeneity in the radiomic model building, prospective and external validated studies are needed.

Objective: Ureteral stenosis in renal transplant patients is a frequent urological complication that involves significant morbidity and may compromise graft function. Despite the common use of minimally invasive techniques, surgery continues to be the definitive treatment for ureteral stenosis, and pyeloureteral anastomosis is an infrequent but effective technique in the management of this pathology and has been described as a safe treatment with a low percentage of complications. Methods: This is a retrospective study of patients in whom surgical intervention via pyeloureteral anastomosis was carried out in our center in the last 12 years. A descriptive analysis of perioperative management, complications, and functional results is provided. A comparison of renal function at diagnosis and after surgery was made to evaluate the effectiveness of the procedure. Results: Thirteen patients underwent surgery within the described time frame. Time to diagnosis of stenosis was 60 days [interquartile range (IQR) 31-368]. Creatinine at diagnosis was 2.2 mg/dL [IQR 1.9-3] with a glomerular filtration rate, estimated by the modification of diet in renal disease equation, of 29 mL/min/1.73 m2 [IQR 22.6-34.5]. Of these patients, 92.3% underwent percutaneous nephrostomy, and 38.5% also had a ureteral catheter. The mean duration of surgery was 265 minutes [IQR 240-300], and hospital stay was 9 days [IQR 7.5-16]. A double J was placed in all cases, which was maintained for 36 days [IQR 30-49]. Postoperative complications occurred in 15.4% of patients. Serum creatinine 1 year after surgery was 1.6 ± 0.4 mg/dL. Among the patients, 76.9% had no new pyelocalyceal dilatation on follow-up Doppler ultrasound scans at a mean follow-up time of 12 months. The restenosis rate was 23.1%, and all were successfully treated by endoscopic approach. There was an improvement in renal function figures at 1, 3, 6, and 12 months compared to renal function at diagnosis, both in terms of serum creatinine and glomerular filtration rate, with statistically significant results. Conclusion: Pyeloureteral anastomosis as a reconstructive technique of the urinary tract in renal transplant patients is an effective and reproducible technique with good long-term results. Cite this article as: de la Parra I, Rivas JG, Gutíerrez B, et al. Pyeloureteral anastomosis as a reconstructive technique for post-renal transplant ureteral stenosis. Urol Res Pract. 2023;49(6):406-412.

Background and Objectives: Prostate cancer (PCa) is a common disease, with a significant number of patients initially diagnosed with locoregional or distant metastases. This is why it is essential to have imaging tests with sufficient sensitivity and specificity. Given the recognized limitations of traditional imaging methods, PSMA-PET has emerged as a promising tool that may revolutionize the management of PCa. Material and Methods: We conducted a comprehensive literature review from August to October 2023 using databases and a review of key clinical guidelines on the topic, focusing on the sensitivity and specificity of PSMA-PET, its use in detecting lymph node metastases (LNm), its integration into nomograms, its comparison with conventional imaging and current guideline recommendations. Results: After considering the search strategy, as well as the inclusion and exclusion criteria, four articles and five guidelines were particularly considered in this review. Most of them suggest high specificity and limited sensitivity for ⁶⁸Ga-PSMA-PET, with increased detection rates compared to conventional imaging modalities, especially in high-risk PCa patients. However, it cannot replace an extended pelvic lymph node dissection (ePLND) at this time. Conclusions: Although the enhanced sensitivity and specificity of PSMA-PET relative to conventional imaging modalities offers a more precise evaluation of disease extent, prospective studies demonstrating a survival benefit are currently lacking; therefore, caution is advised when making therapeutic decisions.

Background and Objectives: Prostate cancer (PCa) is a common disease with a significant amount of patients first diagnose with locoregional or distant metastases. This is why it is essential to have imaging tests with sufficient sensitivity and specificity. Having traditional imaging methods with recognized limitations, PET-PSMA is born as a weapon to revolutionize the management of PCa. Material and Methods: We made a comprehensive literature review from August to October 2023 using databases and also a review of key clinical guidelines with the topic, focusing on sensitivity and specificity on PSMA-PET, its use in detecting lymph node metastases (LNm), integration into nomograms, comparison with conventional imaging and current guideline recommendations. Results: After considering search strategy, inclusion and exclusion criteria; 4 articles and 5 guidelines were particularly taken into account in this review. Most of them conclude with high specificity and limited sensitivity for 68Ga-PSMA-PET, increasing detection rates with respect to conventional imaging modalities, specially in high-risk PCa patients; but it cannot replace an extended pelvic lymph node dissection (ePLND) at this time. Conclusions: Although PSMA-PET enhanced sensitivity and specificity over conventional imaging modalities offer a more precise evaluation of disease extent; currently, prospective studies demonstrating a survival benefit are lacking, so caution is advised when making therapeutic decisions.

The classification of patients studied for haematuria into risk groups is important for early diagnosis of urinary tract cancers and optimising healthcare resources. This study aims to evaluate the role of the IDENTIFY calculator in the initial study of these patients and its use for classifying patients into risk groups. A study of patients with haematuria was performed from June 2020 to June 2022. They were classified into risk groups using the IDENTIFY calculator. Final diagnosis of bladder neoplasia between the risk groups was compared. Receiver operating characteristic (ROC) curves were calculated according to the percentage of risk obtained with the calculator and the final diagnosis of bladder neoplasia. We included 255 patients. Imaging tests were positive for bladder cancer in 39 patients (15.3%). Transurethral resection of bladder tumour was performed in 39 cases; 4 were negative, 18 cases Ta, 2 cases T1, 14 cases T2, and one case carcinoma in situ (CIS). The final diagnosis was bladder neoplasia in 35 patients (13.8%). These patients were classified as: one low risk (2.9%), 4 intermediate risk (11.4%), and 30 high risk (85.7%); p <0.001. ROC curves were calculated, with an AUC (area under curve) of 0.89; p <0.001. Patients classified into the high-risk group were more frequently diagnosed with bladder cancer than other risk groups. The IDENTIFY risk calculator is a simple and easy-to-use tool with acceptable discrimination in the diagnosis of urinary tract tumours, specifically bladder cancer.