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OBJECTIVES: To study the possibility of classifying patients with BPS by UPOINT phenotypes and their correlation with the results of different BPS diagnostic tools.MATERIAL AND METHODS: Epidemiological, observational, longitudinal and multicentric study performed according to clinical practice. A total of 319 women with BPS were included, 79 with new diagnosis and 240 in follow-up. Sociodemographic and clinical data were collected together with results of cystoscopy, biopsy and physical examination. Patients completed a 3-day Bladder Diary (3dBD) and Patient Reported Outcomes (PROs). All the patients were classified according to the 6 UPOINT domains and their distribution was described according to the clinical history, diagnostic tests, urinary symptoms and PROs’ scores.RESULTS: 92.8% of the patients had affectation in more than one phenotype, however, there were no remarkable differences in the clinical and sociodemographic variables according to the number of affected domains. The percentage of patients with 3C classification was higher in the urinary (8.2%), organ-specific (9.0%) and neurological (10.9%) phenotypes. Around 90% had high voiding frequency, regardless of the phenotype. The improvement reported by the PROs was superior in the neurological and tenderness phenotypes. The worst scores were associated with a greater number of affected domains. CONCLUSIONS: The present study is the first one carried out in Spain on a phenotypic classification of women with BPS, with data from routine clinical practice. The results point out that patients with several domains affected present more affectation on the BPS, worse HRQoL and higher anxiety.
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INTRODUCTION: Pelvic floor dysfunction (PFD) is expressed by many different symptoms that can affect pelvic floor organs. These symptoms can appear alone or associated. The involvement of different organs and the wide variety of symptoms we have to deal with, has become teamwork essential for diagnosis and treatment of PFD. Currently, multidisciplinary pelvic floor teams are essential when dealing with PFD.OBJECTIVE: The main objective of the article is to analyze characteristics and pathologies of the patients discussed during these multidisciplinary meetings.MATERIAL AND METHODS: This is a descriptive study. Patients followed in the multidisciplinary pelvic floor team at Galdakao-Usansolo Hospital were recruited. We analyzed the patients discussed at the meetings from January 2014 until March 2019.RESULTS: We recruited 55 patients. 89.09% were female and the mean age of the analyzed patients was 55.36 years. The most frequent reasons for medical consultation were pelvic floor prolapses in female (22.45%) and pelvic floor pain in male (33.33%). Association between symptoms occur in 78.18% of the patients. 41.82% of patients were referred to more than 2 specialists and 21.82% needed associated treatments.CONCLUSIONS: Pelvic floor dysfunction is manifested by a combination of symptoms which need different specialists, not only for diagnosis, but also for treatment. This is why multidisciplinary teams have become important for the management of pelvic floor disfunction.
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OBJECTIVE: Aim of our study was to evaluate the effectiveness and safety of the preoperative placement of JJ stent compared to not doing in patients undergoing ureteroscopy for ureteral and kidney stone.MATERIALS AND METHODS: Prospective, observational, multicenter study. Adult patients, who underwent ureteroscopy treatment for ureteral and kidney stone, were recruited from August 2017 to March 2019, in 23 Argentine institutions. The variables analyzed included: demographic data, stone size and location, stone-free rate (SFR) and complications.RESULTS: 580 patients were included. 473 with ureteral stone (309 with and 164 without prior JJ stent) and 107 with kidney stone (77 with and 30 without prior JJ stent). The SFR was higher in the group with previous JJ stent, both in the treatment of ureteral stone (82.2% vs. 90.9%, OR 2.15 (1.17 to 3.96)), and in the treatment of kidney stone (73.3% vs. 89.6%, OR 3.14 (1.02 to 9.61)). No differences were established in the complication rate both in the treatment of ureteral stone (6.1 vs. 6.1%, OR 0.98 (0.45 to 2.19)) and in the treatment of kidney stone (6.7 vs. 5.2%, OR 0.76 (0.13 a 4.46)).CONCLUSIONS: The preoperative placement of JJ stent, increases SFR in the treatment of ureteral and kidney stone, but not decrease the complication rate.
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INTRODUCTION: The active surveillance (AS) of testicular tumors (seminoma and non-seminoma) is the most frequent management option in the stage I disease. Relapses generally occurred within the first 3 years and (5% appear after this time cut-off point is fulfilled. Therefore, the adherence is one of the most important pillars in the AS protocol. The aim of this study is to evaluate the adherence to the AS protocol in a community hospital and, in turn, evaluate the safety of it emphasizing in the relapse-free rate in patients with and without risk factors.MATERIALS AND METHODS: A retrospective study of all the patients included in the AS protocol with seminoma tumors (ST) or non-seminoma tumors (NST) stage I was performed. Postoperative controls were performed according to the NCCN (National Comprehensive Cancer Network) recommendations. Different variables were taken into account, emphasizing in the risk factors: testicular tumor >4cm and the rete testis invasion in the ST, the linfovascular invasion and the percentage>40% of embrionary carcinoma in the NST. Adherence to the AS protocol was evaluated, focusing on those patients who lost it and what time it occurred. RESULTS: A total of 64 patients were included. The median follow-up was 36 months (IC 21-48 months). 12 patients lost the follow-up during the protocol with a median follow-up of 27.5 months (IC 16-30 months). A 21.8% of patients entered in the AS protocol with some associated risk factor.Adherence follow-up was successful in the first year (96.8%) and decreased over time (92.2% at 24 months and 86.3% at 36 months).CONCLUSION: We presented an important adherence to the AS protocol in patients with clinical stage I testicular cancer and in our series there no recurrences after 36 months of follow-up.
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OBJECTIVES: To evaluate the association of neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses in patients with initial diagnosis of non/muscle invasive bladder tumor high-risk (NMIBC).MATERIAL AND METHODS: Retrospective multicenter study on patients with initial diagnosis of high-grade NMIBC treated with BCG between January 2016 and December 2017. Initially a total of 74 patients were collected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded. Induction BCG (x6) and BCG maintenance schedules were administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR) before BCG instillation were collected. Response to treatment was defined as absence of recurrence and/or progression. A statistical analysis with T-student, Chi square, ANOVA and ROC curves was performed.RESULTS: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70 year old. All patients had pure urothelial carcinoma, 12 with pTa and 38 with pT1. Median follow-up was 24 months. A total of 28% had a recurrence. No correlation between NLR or PLR and BCG response was observed (p=0.738; p= 0.768). Neither a cut off was established through ROC curves.At multivariate analysis, there was no significative relationship between recurrence and the clinical and blood samples analyzed (sec, age, BMI, NLR, PLR)CONCLUSION: No correlation between NLR and PLR has been reported with BCG response on high-grade NMIBC.
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OBJECTIVE: To evaluate the quality of the contrast images obtained with a Primovist® (gadoxetate disodium) Magnetic Resonance Image in order to diagnose benign, malignant and malformations in the urinary tract. MATERIAL AND METHODS: A retrospective image and diagnosis review of Primovist® MRI studies performed in liver insufficient patients without apparent renal abnormalities was done, in order to evaluate the urinary tract for irregularities.RESULTS: A total of 117 Primovist® MRI studies performed between july 2014 and November 2018 were reviewed, 5 were excluded because they were incomplete. The average age was 59.6 ± 16.6 years old. The following diagnosis were encountered: 36 simple cysts, 6 perirenal fibrosis after pyelonephritis, 1 renal cancer, 1 renal atrophy, 1 proximal uretheric flexure, 1 bilateral hydronephrosis due to lower urinary obstruction because of benign prostatic hyperplasia and 1 complex cyst. No MRI study was indicated with suspicions of renal abnormalities. Relevant images are included that demonstrate the capability of Primovist® MRI to diagnose renal abnormalities.CONCLUSION: Even though none of the Primovist® MRI studies was done with suspicious of renal abnormalities it was possible to diagnose incidental benign, malignant and malformations of the urinary tract. This study shows how Primovist® MRI can be useful contrast study for urinary tract irregularities.
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INTRODUCTION: Prolactin (PRL) binds its receptor (PRLR) and stimulates cell proliferation, differentiation and survival in prostate cancer (PCa) cell lines via STAT5a, MAPK and AKT.OBJECTIVE: To evaluate the expression of PRL and PRLR in normal and tumor prostate tissues with different Gleason patterns. METHODS: Samples of normal, benign prostatic hyperplasia and PCa with different Gleason patterns were selected from radical prostatectomy. The intensity, location and percentage of stained cells for PRL and PRLR were evaluated by Immunohistochemistry. Co-localization was observed by confocal microscopy RESULTS: PRL was expressed diffusely and with a mild intensity in the cytoplasm of normal and tumor prostate luminal cells. Its expression only augmented in the Gleason 3 pattern (p 0.0001). The immunostaining intensity and the percentage of positive cells for PRLR did not vary between normal and tumor tissues. However, the location of the PRLR was modified by the tumorigenic process. In non-tumor tissues, PRLR expression was mostly in plasma membrane in the apical zone of epithelial cells. In tumor tissues, it was expressed in intracellular vesicles. The co-localization of PRL and PRLR was demonstrated in normal and tumor tissues suggesting that PRL could be acting in an autocrine and paracrine manner.CONCLUSION: PRL and its receptor were present in the cytoplasm of the epithelial cells of the normal and tumor prostate gland. In tumor tissues, the change in the location and appearance of cryptic PRLRs that store PRL may keep active the different signaling pathways related to cell proliferation and survival.
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OBJECTIVES: This study was aimed at assessing the ability of ischemia-modified albumin (IMA) to predict renal injury by associating biochemical, functional, and pathological findings with various degrees of ureteral obstruction.METHODS: Twenty-four rats were randomized into three groups, and their blood was sampled to determine the creatinine and IMA values and renal scintigraphy was done at the start and on postoperative day 7. In the sham group, the ureter was untouched; in the partial group, the ureter was gently embedded into the psoas muscle; and in the complete group, the ureter was completely ligated. The extent of renal injury was scored pathologically, and all parameters were statistically evaluated.RESULTS: IMA was significantly associated with functional changes, creatinine values, and pathology scores (r = -0.729, r = 0.771, r = 0.827 respectively; p < 0.001). The postoperative IMA values of the partial and complete group were significantly higher than the respective preoperative values (p < 0.001, p < 0.001; p < 0.05, respectively). Additionally, the postoperative IMA values of the complete group were significantly higher than that of the sham and partial groups (p < 0.001, p = 0.001; p < 0.05, respectively).CONCLUSIONS: IMA, which is strongly associated with renal functional and pathological variations, appears to be a valuable parameter for predicting renal injury and may warn clinicians before the irreversible phases of obstructive uropathy occur. More extensive studies with human participants may prove advantageous.
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OBJECTIVES: To describe first clinical results in term of safety, complications and short term efficacy of temporary placement of UVENTA urethral stent in the treatment of urethral and bladder neck strictures.METHODS: UVENTA urethral stent (Taewoong Medical) is a temporary self expandable covered metallic stent. Anti-migration system and different radial force distribution are the two main innovations. This is a retrospective evaluation of UVENTA stent temporary placements for urethral diseases in two urological Centers. RESULTS: 15 patients underwent UVENTA stent placement between 2016 and 2018. Stent placement was easy and quick in all cases. Considering indwelling period: one patient reported urethral pain related to the stent in the first month, three patients had urinary infection treated with antibiotics; temporary stress incontinence was noted in 21% of bulbar-membranous stents; stent migrations was noted in 3 out of 4 bladder neck cases whereas no bulbar-membranous stents migrated. At removal no significant incrustation, stone or tissue ingrowth were noted, as well as new proximal or distal strictures. Stent removal was uncomplicated in all cases. Median follow up is 9.5 months (6-24). Considering strictures overall success rate is 73% (11/15): 82% for bulbar urethra (9/11) and 50% for bladder neck (2/4).CONCLUSIONS: UVENTA urethral stent showed a satisfying safety profile with few and low grade complications. Absence of migration and damage on healthy mucosa are main achievements. Further cases are needed to confirm these results and to really explore its efficacy.
Case Report
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Uric acid renal stones are a frequent and important part of our clinical practice. Conservative treatment through diet and urine alkalinization with citrate and teobromina seem a promising combination for treatment of those stones. We show on our cases a complete resolution of staghorn stone at 12 weeks of allopurinol and lit-control pH Up treatment, without adverse events and avoiding surgical treatment.
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OBJECTIVE: Description of two incidental cases of bladder paraganglioma in women and review of the published literature.METHODS: A bibliographic search was carried out in Medline over the last 10 years according to the terms “urinary bladder” and “paraganglioma”.RESULTS: Bladder paraganglioma (BP) accounts for less than 0.06% of bladder tumors and 10% of all paragangliomas. It may be sporadic or associated with hereditary predisposition syndromes such as Hereditary Paraganglioma-Pheochromocytoma Syndrome. Due to its rarity, there are no recommendations for treatment and monitoring but, their risk of malignancy forces a long-term follow up. The study of germinal mutations through massive sequencing ruled out the association with a hereditary syndrome. Initial management included early reassessment by cystoscopy, transurethral bladder resection (TURB) and imaging.CONCLUSIONS: Bladder paragangliomas are rare tumors that can be associated to hereditary syndromes. Its treatment and follow – up must be based on a multidisciplinary approach.
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INTRODUCTION: Urethral insertion of foreign bodies is an infrequent emergency, being it exceptionally rare in prepubertal children. Both clinical presentation and the introduced elements are varied. Although sexualabuse and mental disorders must always be considered, these events are mainly related to the children’s own body self-discovery without any sexual connotation. Endourologic approach is the treatment of choice while the need for conventional surgery is unusual.OBJECTIVE: To review clinical and therapeutic aspects of the insertion of urethral foreign bodies in early childhood, and to report two new clinical cases.MATERIALS AND METHODS: A 7-year-old boy and a 5-year-old boy, brought to emergency for referring the insertion of a metallic foreign body in the urethra. Both were oligosymptomatic, and the diagnosis was confirmed by radiology. They were treated with an endourological approach without any complications.CONCLUSION: The introduction of foreign bodies in the urinary tract is an unusual problem in prepubertal children. Theirs approach must be individualized, not only limited to the removal of the foreign body but also to the exclusion of child abuse and psychiatric disorders.
