Sergio Fernandez-Pello

• MD - MSc - PhD - FEBU - Urology Specialist
• Facultativo Especialista de Urología at Hospital Universitario de Cabueñes, Gijon

Objective: To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. Material and methods: Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. Results: The mean age of the patients was 65.1 years and prostate v...

Context: Penile cancer is a rare disease but has a significant impact on quality of life. Its incidence is increasing, so it is important to include new and relevant evidence in clinical practice guidelines. Objective: To provide a collaborative guideline that offers worldwide physician and patient guidance for the management of penile cancer....

Background and objective: One-stop clinics have emerged as a tool to optimize the therapeutic management of cancer patients. The main purpose of this study was to assess the role of the one-stop hematuria clinic (OSHC), as compared to a conventional clinic (CC), on the overall and disease-free survival of patients with bladder cancer. Methods: A...

Background Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. Objective To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence. Design, setting...

Objectives The aim of our study is to demonstrate that the Pfannenstiel incision is a reliable option in terms of postoperative complications compared to other types of incisions usually performed for kidney extraction after laparoscopic nephrectomy. Materials and methods Retrospective and comparative study of 256 patients who underwent laparoscop...

The Genitourinary Pathology Society (GUPS; https://www.gupathsociety.org/) and the World Health Organization (WHO) [1], [2] reviewed the 2016 WHO classification of renal neoplasia [3], [4], [5] and provided an update on the entities, including diagnostic criteria, molecular correlates, and updated nomenclature. The fifth edition of the WHO classifi...

Over the past decade, only minor changes have been introduced in the TNM staging system for renal cancer. Conversely, many milestones and modifications in management of the disease have been achieved, especially for patients with locally advanced and metastatic cancers. The European Association of Urology guidelines panel proposes a new TNM classif...

In KEYNOTE-564, adjuvant pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) in localised clear-cell renal cell carcinoma (ccRCC) with a high risk of relapse. In 2021, the European Association of Urology RCC Guidelines Panel issued a weak recommendation for adjuvant pembrolizumab for high-risk ccRCC as defined by the...

Introduction The impact of open versus minimally invasive surgery on recurrence pattern in the management of localized renal cell carcinoma (RCC) remains uncertain. We thus aimed to determine the impact of surgical approach on survival and recurrence pattern. Material and methods This is a multi-institutional, matched cohort study on patients with...

Objectives To assess the severity, evolution, and behaviour of several urinary symptoms in patients with obstructive sleep apnea syndrome (OSAS) before and after the treatment with continuous positive airway pressure (CPAP). Methods A prospective study was performed on patients with a recent diagnosis of sleep apnea confirmed by nocturnal sleep po...

To assess the impact of body mass index (BMI) on peri-operative outcomes of kidney and upper tract robot-assisted surgery. Medical audit of patients who underwent robot-assisted kidney and upper tract cancer surgery at a single institution between 2017 and 2019, categorized on BMI into obese patients with a BMI ≥ 30 kg/m2 and a control group with B...

Context The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel has prepared evidence-based guidelines and recommendations for the management of RCC. Objective To present a summary of the 2022 RCC guideline, which is based on a standardised methodology including systematic reviews (SRs) and provides transparent and rel...

Adjuvant treatment of nonmetastatic high-risk renal cell carcinoma is an unmet medical need. In the past, several tyrosine kinase inhibitor trials have failed to demonstrate an improvement of disease-free survival (DFS) in this setting. Only one trial (S-TRAC) provided evidence for improved DFS with sunitinib but without an overall survival (OS) si...

Objective: To assess the metastasic prostatecancer in the differenctial diagnosis of mediastinal masses. METHODS: To report a case. RESULTS: We present the case of a 78-year-old male patientwith a diagnosis of prostate cancer with a mediastinalmass compatible with prostate metastasis. CONCLUSION: Mediastinum is a very rare site for prostatecancer...

Obesity has been established as a risk factor for renal cell carcinoma (RCC). Recently, studies have described obesity as a probable protecting factor in the metastatic stage of RCC. In this study, we assessed the relationship between body mass index (BMI) and overall survival in patients under systemic therapy.The correlation between BMI and overa...

Objective: To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic gross haematuria. Methods: A retrospective, descriptive and analytic study of the patients that complained of macroscopic hematuria at the one-stop clinic between 2011 and 2018. The complementary tests requ...

The recent randomized controlled phase III CLEAR trial results are the last to complement immune checkpoint inhibitor (ICI)-based doublet combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma. The CLEAR trial demonstrated an improved progression-free survival (PFS), overall survival (OS), and an objective response rat...

INTRODUCTION The transverse hypogastric Pfannenstiel incision is one of the possibilities for specimen extraction after a laparoscopic nephrectomy. Its advantages include low morbidity and a favorable cosmetic result. MATERIAL AND METHODS Retrospective and comparative observational study of 105 patients who underwent nephrectomy in our center. Gro...

Objective To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). Subjects A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across...

Longer follow-up and new trial data from phase 3 randomised controlled trials investigating immune checkpoint blockade (PD-1 or its ligand PD-L1) in advanced clear-cell renal cell carcinoma (RCC) have recently become available. The CheckMate 9ER trial demonstrated an improved progression-free survival (PFS) and overall survival (OS) benefit for the...

Background: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered , regardless of the histological subtype. Objective: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to...

Objective: To assess the importance of long-term close follow-up in patients with breast carcinoma. Materials and methods: To present a case report. Results: A case of a 55-year-old woman with history of lobular carcinoma of the breast is presented. She received neoadjuvant treatment, surgery and complementary chemotherapy and radiotherapy. In...

The COVID-19 pandemic caused by SARS-CoV-2 virus has caused an important health impact that has affected renal cell carcinoma management, among other urology areas. The high cancellation rate of surgeries, including those related to renal cancer, will cause an inevitable healthcare overload and probably a potential negative impact on its oncologica...

European Association of Urology Renal Cell Cancer Guidelines 2020

The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-an...

Objective To report the clinical evolution and the urodynamic behaviour of several lower tract urinary symptoms in patients with obstructive sleep apnea syndrome before and after the treatment with continuous positive airway pressure (CPAP) devices. Methods A prospective study was performed; patients with recent diagnosis of sleep apnea confirmed...

Recent randomised trials have demonstrated a survival benefit for a front-line ipilimu-mab and nivolumab combination therapy, and pembrolizumab and axitinib combination therapy in metastatic clear-cell renal cell carcinoma. The European Association of Urology Guidelines Panel has updated its recommendations based on these studies. Patient summary:...

Context: Little is known about the natural history of sporadic angiomyolipomas (AMLs); there is uncertainty regarding the indications of treatment and treatment options. Objective: To evaluate the indications, effectiveness, harms, and follow-up of different management modalities for sporadic AML to provide guidance for clinical practice. Evide...

Resumen Objetivo Demostrar el potencial impacto urodinámico que puede tener el uso adecuado de presión continua positiva de la vía aérea (CPAP) en pacientes con síndrome de apnea-hipopnea obstructiva del sueño y observar si la posible mejoría de los síntomas de tramo urinario inferior es debida a alguna modificación urodinámica. Métodos Estudio p...

Objective: Modality and frequency of image-based renal cell carcinoma (R.C.C.) follow-up strategies are based on risk of recurrence. Using the R.E.C.U.R.-database, frequency of imaging was studied in regard to prognostic risk groups. Furthermore, it was investigated whether imaging modality utilized in contemporary follow-up were associated with o...

636 Background: Designing adjuvant trials is challenging because of uncertainties of prevalence and outcome of high-risk RCC despite use of validated risk scores. Methods: RECUR is a European multicenter database capturing patient and tumour characteristics, recurrence patterns and survival of all patients treated with (partial) nephrectomy for non...

Context: The European Association of Urology Renal Cell Carcinoma (RCC) Guideline Panel has prepared evidence-based guidelines and recommendations for the management of RCC. Objective: To provide an updated RCC guideline based on standardised methodology including systematic reviews, which is robust, transparent, reproducible, and reliable. Evi...

Objective: Metastatic Renal Cell Carcinoma(RCC) may develop in different anatomical locationsand after a strict follow up within normal limits. We assessthe importance of close follow up in patients with historyof RCC through 3 clinical cases with unusual locations ofmetastatic RCC. Methods: We present 3 cases of metastatic involvementof pituita...

Background The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. Materials and met...

The optimal follow-up (FU) strategy for patients treated for localised renal cell carcinoma (RCC) remains unclear. Using the RECUR database, we studied imaging intensity utilised in contemporary FU to evaluate its association with outcome after detection of disease recurrence. Consecutive patients with nonmetastatic RCC (n = 1612) treated with cura...

The optimal follow-up (FU) strategy for patients treated for localised renal cell carcinoma (RCC) remains unclear. Using the RECUR database, we studied imaging intensity utilised in contemporary FU to evaluate its association with outcome after detection of disease recurrence. Consecutive patients with nonmetastatic RCC (n = 1612) treated with cura...

Context: The objective of evidence-based medicine is to employ the best scientific information available to apply to clinical practice. Understanding and interpreting the scientific evidence involves understanding the available levels of evidence, where systematic reviews and metaanalyses of clinical trials are at the top of the levels-of-evidence...

Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data. Patient summary: The CARMENA trial demonstrates...

Context: The objective of evidence-based medicine is to employ the best scientific information available to apply to clinical practice. Understanding and interpreting the scientific evidence involves understanding the available levels of evidence, where systematic reviews and meta-analyses of clinical trials are at the top of the levels-of-evidenc...

Background: Optimal follow-up (FU) strategy to detect potentially curable (PC) recur- rences after treatment of localised clear cell renal cell carcinoma (ccRCC) is unclear. This study retrospectively analysed a large international database to determine recurrence patterns and overall survival (OS), as part of a wider project to issue recommendatio...

Background: Optimal follow-up (FU) strategy to detect potentially curable (PC) recurrences after treatment of localized clear cell renal cell carcinoma (ccRCC) is unclear. This study retrospectively analysed a large international database to determine recurrence patterns and overall survival (OS), as part of a wider project to issue recommendations...

Background: The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. Materials and m...

637 Background: Cross-sectional imaging (CSI) has emerged as preferred imaging modality for staging and follow-up (FU). Moreover, the 2017 EAU RCC guidelines discourage the use of Chest X-Ray (CXR). In an international database (RECUR) data were collected to compare imaging modalities in contemporary FU, and to explore if more frequent use of CSI t...

BACKGROUND: Although pseudoangiosarcomatous carcinoma is a relatively common morphological carcinoma subtype, mainly of skin squamous carcinomas, it is less frequently found in mucosas and other organs and is very rare in the urinary tract, e.g., urinary bladder, with just a handful of cases reported in the largest series. CASES: We would like to r...

Patient summary: The European Association of Urology guidelines will be updated based on the results of the phase III Checkmate-214 clinical trial. The trial showed superior survival for a combination of ipilimumab and nivolumab (IN), compared with the previous standard of care, in intermediate- and poor-risk patients with metastatic clear cell re...

BACKGROUND: Primary angiosarcomas from the bladder and/or prostate are rare. Due to the more frequent diagnosis of prostate cancer and management with radiotherapy, its incidence is increasing. CASE: We report a case of high-grade angiosarcoma in that location in an 81-year-old man with history of prostatic adenocarcinoma, treated with brachytherap...

Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and periopera...

Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and periopera...

Context: While vascular endothelial growth factor-targeted therapy and mammalian target of rapamycin inhibition are effective strategies in treating clear cell renal cell carcinoma (ccRCC), the most effective therapeutic approach for patients with non-clear cell RCC (non-ccRCC) is unknown. Objective: To systematically review relevant literature...

OBJECTIVE: To assess the importance of management and close follow-up of patients with tuberous sclerosis that associate renal angiomyolipomas. METHODS: To report a case. RESULTS: A 55 years old men with tuberous sclerosis diagnosed in childhood and later finding of bilateral giant renal masses in imaging studies, with significant compromise of ren...

Objective: To assess the importance of management and close follow-up of patients with tuberous sclerosis that associate renal angiomyolipomas. Methods: To report a case. Results: A 55 years old men with tuberous sclerosis diagnosed in childhood and later finding of bilateral giant renal masses in imaging studies, with significant compromise o...

The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked.

Introduction: The failure rate for anti-incontinence surgery ranges from 5% to 80%. There is not actual consensus on the use of artificial urinary sphincter (AUS) as treatment for recurrent urinary incontinence in women. Several authors have shown that AUS can be useful, if the intrinsic sphincteric deficiency is checked. We present the first case...

Schwannoma is a rare slow-growing neurogenic tumor of the nerve sheath origin. They are commonly seen in middle-aged with a female to male ratio of 1:1.2. Here we present three cases of retroperitoneal schwannoma in our urology department. In two cases, we decided surgery management and in one case, we used watchful waiting. After a 3-year follow-u...

Objective: To report two new cases of IgG4-related retroperitoneal fibrosis, a recently described pathology. Methods: We analyze two cases diagnosed in our center and performed a literature review. Result: IgG4 related disease is a recently described entity that includes previously not related pathologies. The clinical manifestations are highl...

Objective: Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. Materials and methods: A retrospective comparative study was...

Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy.

Aim: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. Methods: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopi...

To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuronium-induced neuromuscular blockade (NMB). Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification I-II, undergoing gynecological surgery were included...

Introduction: About 10% of all patients with trauma have urogenital injuries; half of them are caused by blunt trauma and involve the kidney. The treatment of renal trauma is still controversial, but conservative management is increasingly accepted as the preferred approach to most renal injuries. Patients and Methods: Here we present two cases of...

We report the case of an urgent nephrectomy because of a pyonephrosis and sepsis due to an unsuspected sarcomatoid transitional cell carcinoma, an infrequent subtype with a bad oncological prognosis. We present a 58-year-old man assessed by internal medicine for a general syndrome and weakness many months previously. A pyonephrotic kidney was obser...

Background: Adrenal gland involvement by metastatic melanoma can be found in up to 50% of patients with ocular or cutaneous melanomas. Since these tumors are not hormone secreting, they usually present with locally advanced disease. Case: We report on the presence of a bilateral massive metastatic adrenal melanoma in an 80-year-old, symptomatic...

We present the case of a spontaneous subcapsular renal hematoma with increase of the levels of blood pressure in a patient previously normotensive. Patient with abdominal pain, spontaneous without previous trauma. CT showed a right subcapsular kidney hematoma. High levels of blood pressure were noticed at the admission in urology. Page kidney is a...

We report the case of a left laparoscopic nephroureterectomy with the incidental discovery of a non-Hodgkin's lymphoma in one of the lymph nodes of the renal hilum. A laparoscopic nephroureterectomy was decided on for a 64-year-old man. Renal cell carcinoma in the kidney and one lymph node of the renal hilum with non-Hodgkin's lymphoma was found. C...