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Few specialties have gone through as many transitions in the last decades as Urology. Progressive physiology advances in several disease have become part of the urological knowledge. Laparoscopic surgery and ESWL (Extracorporeal Shock Wave Litho- tripsy) wave have completely turn upside down the whole management of disease. The current text provides a back to the future sigh into Urology.
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OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to anoth-er preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks.METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of com-plication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test.RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Mano-sar ® and 94 isolated PAC. A total of 72 patients suf-fered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002).The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC.CONCLUSION: The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of iso-lated PAC.
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OBJECTIVES: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC un- dergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC). MATERIAL AND METHODS: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test. RESULTS: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria. In this group 21.7% achieved undetectable PSA (<0.1 ng/ml) with ADT compared to the non-CRPC group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p=0.000, OR 2.78), Gleason score group 4-5 (p=0.000, OR 2.33), and not to reach undetectable PSA after ADT (p<0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT. CONCLUSIONS: We present a sample of patients with advanced PC in treatment with ADT that shows hetero- geneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA <0.1ng/ml after ADT is presented as an indicator of progression to the CRPC stage.
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OBJECTIVE: To evaluate whether the lower dropout rate of the treatment of overactive bladder (OAB) with mirabegron could generate cost savings to the National Health System (NHS) and lead to quality-adjusted life years (QALYs) gains, compared to the most commonly prescribed antimuscarinics (AM) in Spain (tolterodine, fesoterodine, oxybutynin, solifenacin). METHODS: A probabilistic model (second order Monte Carlo simulation) in a hypothetical cohort of 1,000 patients with OAB and a time horizon of 1 year was carried out. Discontinuation and persistence rates for both mirabegron and AM were obtained from a Spanish ob- servational study in 1798 patients. Unit costs (€ 2018) and utility loss associated with treatment discontinuation were obtained from Spanish public prices and literature, respectively. RESULTS: Persistence rates in patients treated with mira- begron were twice as high compared to AM, leading to a QALY gain of 0.0151 ± 0.0007 per year. Treatment with mirabegron could generate savings of 80.74 ± 4.61 € per patient per year compared to AM, assuming 100% probability of saving. The hypothetical substitution of AM treatment for mirabegron could potentially generate savings of 6.6 million euros (95% CI 3.9-10.1 million euros) to the NHS and 1,238 QALYs gains (CI95% 731; 1,885 QALYs) within a period of 1 year. CONCLUSIONS: The probabilistic model presented showed a greater persistence in patients treated with mirabegron compared to AM, leading to a positive impact in patients quality of life, as well cost savings to the NHS in Spain.
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OBJECTIVES: To Evaluate the severity of symptoms in OAB patients and their outcomes expectations, symptoms management and Health-Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, multicentre, non-interventional, cross-sectional study, conducted by 294 physicians in Spain in clinical practice. Female adult patients with OAB symptoms, newly diagnosed or during follow-up were included. B-SAQ, OABq- SF and an ad-hoc patient expectation questionnaire were completed. Association between expectations, symptom severity and prior treatments was analyzed using Chi- Square. The non-parametric Kruskal-Wallis test was used to analyze the relationship between the intensity of the urgency and the impact of OAB symptoms on HRQoL and between expectative and symptoms characteristics and HRQoL. RESULTS: 1.107 patients were included. Mean age was 58 years. 60.6% were newly diagnosed and urinary urgency was the most frequent symptom reported (93.3%). According the B-SAQ score 58.7% suffered moderated or severe OAB. Expectations in patients without previous treatment about “their symptoms will be cured permanently” were higher than in patients previously treated (p<0.005). The percentage of patients who expected a positive response to treatment decreased while the OAB symptom severity increased (73.9% mild symptoms, 32.5% very severe symptoms; p<0.005). Moreover, patients with higher symptom discomfort were less agree- ment with all expectations (p<0.005), and HRQL was higher in patients with higher expectations (p<0.005). CONCLUSIONS: The expectations of patients with OAB regarding their pathology and the expected out- comes of treatments are related to symptom severity and HRQL.
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OBJECTIVES: The pathological examination of vasectomy specimens to confirm the presence of vas deferens is usually simple and is done by routine hematoxylin and eosin staining. Use of immunohistochemical techniques can aid to the diagnosis in those cases with artifacts of the epithelium, and they are also useful to differentiate vas deferens from blood vessel. We have investigated the usefulness of CD31, CD34, ERG and PAX8 for these purposes. MATERIAL AND METHODS: 81 sections from vasectomy specimens in which any section showed some kind of epithelial artifact were analyzed. Immunohistochemistry was performed with monoclonal antibodies for CD31 (clone JC70), CD34 (clone QBEnd/10), ERG (clone EPR3864) and PAX8 (clone MRQ-50). Evaluation of the vas deferens and vascular endothelial staining was done. RESULTS: Histologically, vas deferens epithelium was well-preserved in 18 sections (22.2%), denuded in 6 (7.4%), crushed or distorted in 48 sections (59.3%), detached in 5 (6,2%), and misplaced out of the vas deferens lumen in 4 (4.9%). In most of the sections the epithelium showed weak (86.4%) or moderate (9.9%) CD31 cytoplasmic staining, as well as strong nuclear PAX8 reactivity in all of the sections, exhibiting a granular pattern in the detached or artifacted epithelium. CD34 and ERG were negative in the epithelium. Capillary vessel endothelium in the vas deferens wall showed strong cytoplasmic positivity for CD31 and CD34, as well as nuclear ERG reactivity, being PAX8 negative. CONCLUSIONS: PAX8 is a useful antibody to confirm the presence of vas deferens in artifacted vasectomy specimens. CD34 and ERG are negative in the epithelium, and, otherwise, they are expressed by vascular endothelium, with the advantage of nuclear staining pattern for ERG. CD31, a classic endothelial marker, is not so specific as it had been stated as it shows weak or moderate expression in the vas deferens epithelium.
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OBJECTIVE: The objective of our study is to stablish the scientific quality of the available informa-tion in YouTube about erectile dysfunction (ED).MATERIAL AND METHODS: We searched on YouTube three terms (“Problemas de Erección” (PE), “Impotencia” (I) y “Disfunción Eréctil” (DE)). The sixteen first videos from each term were selected for the analysis. Two in-dependent urologists reviewed all videos and classified all of them in scientific evidence-based (SEB) or not sci-entific evidence-based (NSEB) according to the current literature. In the subgroup analysis we compare: number of visits, duration, time of publication, source and type of information.RESULTS: After excluding the repeated links and non-con-cordant videos between both urologists, we analysed 147 videos. The Kappa statistic was 0.89 (95% CI 0.85-0.96). 37% were considered SEB and 63% were considered NSEB. The median of reproductions in the SEB group was 24.356 (96-126.410) and 44.416 for NSEB (190-10.318.642); this difference was sta-tistically significant. The median duration was 254 sec-onds (46-984) for the SEB group and 228 seconds for the NSEB (23-2.880); the median time of publication was 42 (16-103) months for the SEB group and 29 (11-134) months for the other one. 83% of SEB videos were published in health networks and television programs, while 58% of NSEB were published in user blogs. The SEB videos show more information about pathophysiol-ogy, aetiology, endothelial dysfunction, diagnosis and treatment than NSEB (p<0.001).CONCLUSIONS: 37% of the videos were considered SEB. The NSEB videos were significantly more played than SEB group.
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OBJECTIVES: Urinary pH is a decisive factor in several pathologies, thereby an informative marker employed in treatment decisions. Although ex-tensively used, the urinary pH dipstick test may not be sufficiently accurate or precise for clinical decisions and more robust methodologies need to be considered. In this study, we compare pH measurements when using a portable medical device and different dipstick tests.MATERIALS AND METHODS: Four pH dipstick brands and a Lit-Control® pH Meter were tested using commer-cial buffer solutions with seven distinct pH values rep-resenting the physiological range in urine (4.66; 5.0; 5.5; 6.0; 7.0; 7.5; 8.0). A statistical analysis was performed to assess the correlation of measured versus real values, together with validity measures as resolution, precision and accuracy.RESULTS: Validity measures stated the superiority of the portable pH meter, with a reduced dispersion of data and more exact values. Additionally, correlation analysis demonstrate that the pH values obtained with the pH meter were the closest to the buffers’ real pH values.CONCLUSION: The detailed comparative study pre-sented here reveal the superiority of a portable pH meter to several of the most used dipstick brands in the clinic. Lit-Control® pH Meter represents a reliable alternative when a monitoring of urinary pH is needed, as may hap-pen during the screening of diseases or treatment moni-toring in the clinic, as well as during the self-monitoring by the patient under professional supervision at home.
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OBJECTIVES: To compare the urinary NGAL levels with serum creatinine levels as an early biomarker for renal injury in rats with bladder outlet ob-struction (BOO).METHODS: Twenty male Wistar Albino rats divided into 4 groups. In each group basal serum creatinine and urinary NGAL levels were evaluated. In Group 1 (Sham/Control group) only laparotomy was performed. In Group 2 (14th day partial BOO) and Group 3 (28th day partial BOO) partial obstruction and in Group 4 (Complete BOO) complete obstruction was performed. Serum creatinine levels and urinary NGAL levels were evaluated in Group 4 on the third day of the study, in Group 2 on the 14th day and in Group 3 and Group 1 on the 28th day. Urethra, ureters and kidneys were excracted by laparotomy and evaluated for histopatho-logic examination.RESULTS: The increase in plasma creatinine levels af-ter obstruction was statistically significant in Group 4 (p<0.05). There was significant difference between the groups in urinary NGAL levels after obstruction (p<0.05). Post-obstruction urinary NGAL levels was highest in Group 4 and it was statistically significant when compared to beginning levels (p<0.05). In Group 3, increase in urinary NGAL levels were higher (p<0.05) with no increase in plasma creatinine levels after obstruction. CONCLUSIONS: It can be concluded that urinary NGAL levels might be an early biomarker for renal dys-function in partial bladder outlet obstruction which may cause renal impairment through upper urinary tract inju-ry. Therefore, urinary NGAL may play role during the treatment choice and follow-up in BOO patients.
Case Report
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Mesalazine (5-aminosalicylic acid, 5-ASA), is an anti-inflammatory drug well-established as first-line treatment in the management of inflammatory bowel dis-ease. Nephritic colic has been described as an uncommon side effect, but very few mesalazine nephrolithiasis have been published in the literature, probably due to its underdi-agnosis for not using appropriate methodology for calculi analysis. We present two cases of lithiasis in patients treat-ed with mesalazine at high dosage, an adverse effect to be taken into account as a drug lithiasis and which is not even mentioned in the patient information leaflet.
Case Report
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INTRODUCTION: Bladder Cancer (BC) is 11th most common malignancy. In terms of pathology, the vast majority of patients suffer from transitional cell carcino-ma. Apart from this common type of BC, there are many morphological subtypes with different oncological charac-teristics. Plasmacytoid BC is a well-recognized subtype of BC with great diagnostic importance as it usually presents in locally advanced or even metastatic stage. OBJECTIVE: The objective of this study was to evaluate our experience in diagnosing and treating patients with this rare BC subtype.METHODS: A retrospective analysis of 5 patients diag-nosed with plasmacytoid BC in our department during the years 2014-2016 was performed. Transurethral resection of the tumors was performed in all patients and pathology diagnosis of plasmacytoid variant was based on several morphologic and immunohistochemical parameters. Stag-ing included abdominal and thoracic CT.RESULTS: 3 of 5 patients were diagnosed with metastat-ic disease. These patients were referred to the oncology department. 2 patients presented with non-metastatic BC after initial staging and thus a radical cystectomy was per-formed. Follow up of all patients was carried out and their survival was recorded.CONCLUSIONS: We concluded that despite the fact that the plasmacytoid variant of BC is rare, it is important to take into account the pathologic and clinical features of this tumor in order to manage the optimal treatment of this poor prognosis cancer.
