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OBJECTIVE: Urinary incontinence (UI) is one of the main complications of radical prostatectomy. Multiple studies have attempted to find factors that may predict early recovery of urinary continence in surgically treated patients. The aim of this study is to evaluate the ability of the length of the membranous urethra (LUM) and the intraprostatic urethra (IUL) measured in preoperative by multiparametric prostate resonance imaging (MRI), to predict post-radical prostatectomy urinary con- tinence. MATERIAL AND METHODS: A retrospective study between 2016 and 2018 was conducted. Patients who underwent laparoscopic radical prostatectomy (LRP) and had a previous RMI were included. Different variables were evaluated: age, PSA, BMI, clinical and pathological stage, and the validated questionnaire of urinary incontinence (ICIQ-SF) was performed at 12 months postoperatively. LUM and LUIP were calculated and compared groups (continence vs incontinence) using the Student test (t). A value of p<0.05 was taken as statistically significant. A ROC (Receiver Operating Characteristic) curve was made to predict continence according to LUM and LUIP. RESULTS: Forty-four patients were included. Mean age was 63 years (SD±7.2) and mean PSA was 9.2 ng/dL (SD±5.2). Seventy-five percent presented clinical stage T1c and 43.2% pathological stage pT2cN0. 20.5% (9 patients) presented some degree of UI. The mean LUM was 15.1 mm (SD±5.6) and LUIP 26 mm (SD±10.4). For patients with continence and incontinence, the mean LUM was 18.3 vs 9.5 mm (p=0.0001) and LUIP 31.5 vs 15 mm (p=0.0001) respectively. The area under the curve taking as a value of LUM >10mm was 88% and LUIP>20mm was 86.7%. CONCLUSION: The use of preoperative mpRMN measurement of urethral membrane length and intraprostatic urethra may be useful in significantly predicting post-PR urinary continence.
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INTRODUCTION: Open prostatectomy is an efficacious treatment for Benign Prostatic Hyperpla-sia (BPH), but its complication rates and risk factors for these might vary due to the characteristics of populations and health systems.OBJECTIVE: To determine the frequency of complications and the risk factors for these, in the first three months after open prostatectomy in a hospital in Medellín (Colombia).METHODS: This is a cohort study in which patients undergoing retropubic open prostatectomy were tak-en. Medical records were reviewed to obtain demo-graphic, preoperative, and intraoperative data. The main outcome was the incidence of complications in the first three postoperative months and this was divided into early (day 1 to 7 post-surgery) and late (day 8 to 90 post-surgery) complications. Risk factors were deter-mined by estimating Relative Risks (RR).RESULTS: 191 patients with a median age of 70 years were included. The frequency of complications was 34.5%, 14.6% occurred early and 19.9% late. Risk factors were dyslipidemia (RR: 2.37, 95% CI: 1.25 to 4.47), irrigation time (RR: 1.31, 95% CI: 1.02 to 1.67) and duration of the postsurgical catheter (RR: 1.07, 95% CI: 1.03 to 1.12); general anesthesia was a protective risk factor compared to spinal (RR: 0.47, 95% CI: 0.24 to 0.91).CONCLUSION: The frequency of complications of open prostatectomy with a retropubic approach was within the figures reported in the literature. The risk fac-tors found could be modifiable and considered for the prevention of adverse outcomes. This study provides an updated basis for future comparisons with alternative treatments for BPH.
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OBJECTIVE: Hemoxigenase 1 (HO-1) is an enzyme that has anti-apoptotic and proliferative ef-fects on tumor cells. However, there is little epidemiologi-cal and clinical evidence on the role of HO-1 in urologic tumors. Objective: To determine if there is correlation between the expression of HO-1 and the histological characteristics, evolution, Disease Free Survival (DFS) and cancer mortality in Clear Cell Renal Cell Carcino-ma (cRCC).MATERIALS AND METHODS: A retrospective study in-cluding 34 patients (9 women and 25 men) with cRCC from the “Servicio de Urología del Policlínico Neuquén” (Argentina) throughout 2003-2008. The expression of HO-1 by Immunohistochemistry (IHC) was determined. The statistical analysis was performed using the Student’s T test and Pearson correlation coefficient (p≤0.05).RESULTS: HO-1 was expressed in the epithelial cells of the tubules from normal kidney tissue and in the cyto-plasm of cRCC tumor cells. There were no differences in the HO-1 expression related to the gender, age, tumor size, stage of disease and 5 years DFS. High Fuhrman cRCC had a greater expression of HO-1 compared with low Fuhrman cRCC (p≤0.05). The score of immunostain-ing for HO-1 was greater in those tumors located in the mesorrenal area, which coincidentally presented a more advanced stage of the disease.CONCLUSIONS: Overexpression of HO-1 in tumors located in the interpolar zone and with high Furhman grade suggest that HO-1 could be a good adjunctive marker for the aggressiveness of the cRCC.
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INTRODUCTION: The Holmium laser is the most used energy source in flexible ureterrenoscopy (URSf). The Lumenis Pulse 120H® laser has a higher system energy, a higher energy per pulse and a higher repetition frequency in relation to other types of lasers, which offers advantages in the treatment of lithiasis.OBJECTIVE: To analyze the results that we have obtai-ned with the use of the Lumenis Pulse120H® laser in patients treated by intrarenal retrograde surgery (RIRS). As secondary objectives there are: the study of the de-mographic variables of the patients, the characteristics of the stones and the complications associated with the procedure.MATERIAL AND METHODS: An observational, retros-pective study of the first 26 patients treated by RIRS and Lumenis Pulse 120H® laser has been performed in our Service between August 2018 and February 2019. The size of the lithiasis was measured on the simple ra-diography and the CT, in addition, the volume of the lithiasis was calculated. For the realization of RIRS, 8.5 Fr digital flexible ureterorenoscope (Olympus®) and the Holmium Lumenis 120H® laser with 200 micron laser fibers from Lumenis® were used. Statistical analysis was performed with the SPSSv21 system.RESULTS: A total of 26 patients with renal lithiasis have been analyzed. The median age was 55.15 years (40.67-67.05). 57.7% of the patients had prior surgical treatment of lithiasis. Thirteen patients presented the litia-sis in the renal pelvis, ten in the Upper Calicial Group (GCS), fifteen in the Middle Calicial Group (GCM) and eighteen in the Lower Calicial Group (GCI). The median of the lithiasic volume was 1826.41 mm3. Our overall success rate was 80.8% (100% success in lithiasis less than 2 cm and 85.7% in lithiasis between 2-3 cm). Five patients presented complications, of which 4 were Cla-vien II and 1 Clavien IIIb. No significant results were found between the lithiasic size and the presence of complications (p = 0.128).CONCLUSIONS: The use of the Lumenis Pulse 120H® laser is an useful tool for the treatment of kidney stones by RIRS, due to his efficiency in the fragmentation and dusting, taking into account that very large lithiasic mas-ses require, in a high percentage of cases, more than one treatment session.
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OBJECTIVE: The exstrophy-epispadias complex (EEC) ranges from distal epispadias to cloacal exstrophy, with serious repercussions on the quality of life of patients. However, reconstructive surgery offers the opportunity to reach adulthood and consider motherhood. The objective of this work is to assess the uro-gynecological characteristics and the risks that pregnant women have with EEC. MATERIALS AND METHOD: Retrospective study of 50 patients diagnosed with EEC and treated in a reference center for this pathology, born between 1968 and 2000. Their medical records were reviewed and all demographic, pathological and gynecological data were collected. RESULTS: 37 patients have the inclusion criteria and of these 8 achieved 17 pregnancies (90% spontaneous and 10% through IVF). 10 were successful (50% at term) and 7 were abortions, 87.5% of which were in the first trimester. Urinary tract infection (UTI) was the most frequent complication (41.6%) and the most severe was intestinal occlusion. None of the patients presented renal function impairment during the gestation or dilation of the pathological upper urinary tract (UUT). 62.5% of the patients presented genital prolapses after pregnancies, 80% of which were grade III and IV. 87.5% were dry in the follow-up after their pregnancies. CONCLUSION: Pregnancy in the EEC patients is high risk and it is crucial that the follow-up is carried out by a specialized and integrated multidisciplinary team to minimize complications.
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OBJECTIVES: To assess the relationship between prostate cancer and thiol/disulphide homeostasis as an important indicator of oxidative stress. METHODS: After ethics committee approval (546/2015); 388 patients aged between 46-75 years who underwent transrectal ultrasound guided prostate biopsy in three different centers between July 2015- 2016 owing to serum prostate specific antigen (PSA) levels ≥2.5 ng/ml and/or abnormal digital rectal examination were involved in this study. The plasma levels of thiol/disulphide homeostasis parameters were compared in patients with and without prostate cancer. RESULTS: The mean age of the patients was 62.9±7 years. In patients with prostate cancer (n=130, 33.5%) the mean plasma levels of native thiol and total thiol were lower (332.9 vs 362.1 μmol/L and 363 vs 392.6 μmol/L, p=0.001). Plasma disulphide levels were not statistically different between the groups (15 vs 15.3 μmol/L, p=0.936). In prostate cancer group; patients with Gleason score ≥7 had lower plasma native thiol levels than patients with Gleason score<7 (321.3 vs 342.6 μmol/L, p=0.029) while there were no significant differences in total thiol and disulphide levels (352.3 vs 371.9 μmol/L, ptotal Thiol =0.064 and 15.5 vs 14.6 μmol/L, pdisulphide =0.933). CONCLUSIONS: Lower plasma levels of thiol in patients with prostate cancer and high Gleason score is a noteworthy result. We believe that our results should be supported by further studies.
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OBJECTIVES: This study aims to investigate longitudinal changes in sexual functions (SF), anxiety status, and health-related quality of life (HRQoL) after shock wave lithotripsy (SWL) in male urolithiasis patients. METHODS: Between February 2015 and April 2017, 85 consecutive male patients with kidney or ureter stones and treated with SWL were included. Patients were evaluated for SF, anxiety status, and HRQoL with questionnaire forms before and at the third month after SWL. Correlation between baseline and third-month scores of International Index of Erectile Function-15 (IIEF- 15) subdomains and anxiety was evaluated. Uni- and multivariable linear regression analyses were used to identify changes in IIEF-15 subdomain scores at three months. RESULTS: Mean age was 42.80 ± 9.42 years. Significantly decreased IIEF-15 subdomain scores, increased anxiety and Short Form-36 (SF-36) subdomain scores were achieved at three months (p<0.05, for each). The baseline median values of erectile function (IIEFEF), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), intercourse satisfaction (IIEF-IS), and overall satisfaction (IIEF-OS) were 26, 9, 8, 12, and 8, respectively. The same scores were 26, 9, 6, 9, and 8 at month 3, respectively. According to multivariable analysis, the difference in Beck Anxiety Inventory (BAI) scores was an independent risk factor for both changing in IIEF-SD and IIEF-IS (b= -0.094, 95%CI: -0.179 – -0.009, p=0.030 and b= -0.197, 95%CI: -0.350 – -0.044, p=0.012, respectively). The difference in the State Anxiety (STAISA) scores was an independent risk factor for changing in IIEF-IS (b= -0.075, 95%CI: -0.146 – -0.004, p=0.039). CONCLUSIONS: SWL may lead to impaired SF related to treatment-driven anxiety and significantly improve HRQoL of male patients in short term.
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OBJECTIVES: Renal access in percutaneous nephrolithotomy (PCNL) may be obtained via a pre-existing nephrostomy tube (NT) tract; however, emergent NTs are not always ideal for subsequent surgery. We sought to determine the rate of NT tract usability and assess factors related to the usability of emergently placed NTs. METHODS: A retrospective review was performed of UC San Diego subjects undergoing percutaneous renal surgery between January 2016 and October 2018. Demographics and peri-operative variables were collected. The primary outcome was the usability of NT tract for dilation and instrumentation. “Usable” indicated a tract in which PCNL could be completed; “unusable” indicated lack of dilation and the requirement of additional tract(s) for PCNL. RESULTS: 35 PCNL cases had previous emergently placed NT which were indwelling at time of percutaneous surgery. 51% of these NT tracts (18/35) were deemed usable and dilated for PCNL. No significant difference was seen between usable and unusable NT groups for number of dilated tracts during PCNL (p=0.13), or either the location of indwelling NT (p=0.96) or renal stones (p=0.95). In the usable NT tract cohort PCNL access was via the lower pole 56% of the time, whereas when previous NT tracts were deemed unusable, a separate upper-pole access was obtained intra-operatively 53% of the time (p<0.01). CONCLUSIONS: Pre-existing, emergent NTs served as sufficient PCNL access tracts in over half of recorded cases. Contrary to recently published reports, the utility of pre-existing NTs appears to vary among health systems. Other variables, including the desired location of PCNL appear to directly influence the likelihood of NT tract usability.
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OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and underwent one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.001). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.
Case Report
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OBJECTIVE: The recto-vesical fistula (FRV) that follows a radical prostatectomy is an unusual complication and involves a difficult management. A wide variety of surgical aggressive repair techniques are described in literature, including end-colostomy. Furthermore, non-invasive procedures are barely documented. We present 2 cases with an early diagnosis of postoperative FRV resolved with minimally invasive treatment, with the aim to place these techniques in the therapeutic range. MATERIAL AND METHODS: In both two cases, the diagnosis of VRF was clinical and radiological. First symptoms occurred heterogeneously since one of the fistulas was secondary to rectal perforation and second was evident after removing the bladder catheter in a uneventful postoperative period. Exploration techniques showed low diameter fistulous orifices in both cases. The conservative treatment consisted in the use of transrectal endoscopic approach and minimally invasive techniques for the closure of the fistulous orifice and a prolonged use of the bladder catheter. RESULTS: The two patients were followed up at least 36 months, confirming the resolution of the recto-vesical fistula by cystography and CT. During the follow-up, no patient has required symptomatic treatment or other specific care up to date. CONCLUSIONS: The conservative treatment of the VRF constitutes a non-aggressive alternative to the series of complex surgeries currently used to repair this iatrogenic pathology. The endoscopic closure of iatrogenic fistulas should be claimed as a therapeutic opportunity, although, more experience is needed to state this treatment as a gold standard technique.
Case Report
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OBJECTIVE: : Horseshoe kidney is the most common renal fusion anomaly. Its peculiar anatomical char-acteristics increase the risk of lithiasis formation and always entails a surgical challenge for its treatment.MATERIAL AND METHODS: We present the cases of men with horseshoe kidneys diagnosed by CT one case of a large pyelic lithiasis with others of a smaller size in the ca-lyces, and the other of a big solitary lithiasis in renal pelvis.RESULTS: We performed a laparoscopic pyelolitectomy to remove the pyelic lithiasis and we used a flexible cysto-scope through a trocar to extract the calyceal stones. The postoperative period was uneventful without evidence of urinary leakage or residual lithiasis. CONCLUSIONS: The laparoscopic approach to lithiasis is a suitable alternative in especially complex cases such as horseshoe kidney. The use of a flexible cystoscope al-lows to navigate through the renal cavities and extract the lithiasis which cannot be accessed through laparoscopic instruments, improving the efficiency of this approach.
