Article
Knowledge map
Save
INTRODUCTION: Surgical site infection is the most common nosocomial infection in Spain. The use of surgical antibiotic prophylaxis (SAP) in clinical practice is frequently inadequate, confirming the need to adopt prevention strategies for this kind of infections. In this sense, promoting actions to improve the SAP in order to reduce surgical site infections is an unavoidable commitment of every surgical department. OBJECTIVE: To evaluate the adequacy of the PAQ after PAQ system implementation based on the use of prophylaxis protocols in compliance with the quality indicators established in the Urology Department.MATERIALS AND METHODS: Retrospective observational study of the SAP of the surgical procedures performed in the Urology Service of a Spanish tertiary-level hospital.An intervention based on the introduction of the prophylaxis protocols was performed. Each prophylaxis kit contains sufficient antibiotic doses to perform an adequate PAQ with a registration form where the administration of doses is recorded. A period of pre-intervention (2005-2010) and post-intervention (2012-2017) were established and the differences in the values were determined in the following six quality indicators: indication of SAP (indicated and administered prophylaxis), antibiotic selection (according to established protocol), dose and route of administration (therapeutic dose and intravenous route), time of administration of the first dose (between 15 min and 1 hour before the surgical incision), intraoperative dose (necessary if the surgery is prolonged more than twice the half-life of the antibiotic or there is significant bleeding) and duration (not to exceed 24 hours). RESULTS: Compliance with the selection of the antibiotic, the time of administration of the first dose, the duration of prophylaxis and the overall adequacy of the SAP increased after the introduction of prophylaxis protocols (p <0.001).CONCLUSIONS: The use of prophylaxis protocols promotes an adequate SAP as it facilitates the appropriate antibiotic selection (active substance, dose and route) and helps to prevent SAP from being unnecessarily prolonged.
Article
Knowledge map
Save
OBJECTIVE: The aim of this study is to evaluate the influence of laparoscopy in patients with renal cancer treated with radical nephrectomy in terms of surgical time, hospital stay, postoperative complications and survival. MATERIAL AND METHODS: Retrospective study of 570 patients with renal cancer treated with radical nephrectomy in stage ≤pT3a. Differences between groups were analysed using ANOVA test for quantitative variables and Chi squared test for qualitative. In order to evaluate possible risk factors for longer hospital stay and surgical time, multivariate analysis was performed (lineal regression). For complications we performed binary logistic regression. Overall survival (OS), recurrence free survival (RFS) and cancer specific survival (CSS) were estimated using Kaplan Meier and compared using Log Rank test. Univariate and multivariate analysis was performed using Cox regression in order to identify independent risk factors for overall, cancer specific and recurrence mortality. RESULTS: Two cohorts: 361 (63.3%) open radical nephrectomies (ORN) and 209 (36.7%) laparoscopic (LRN). Surgical time was longer in LRN (p=0.001) globally. After the period when the learning curve was over these differences were no longer significant. Hospital stay was shorter in LRN (p=0.0001). cT stage (p=0.005) and surgical access (p=0.001) acted as independent risk factors for longer surgical time. 33,5% (121 patients) of the ORN had some sort of postoperative complication vs. 11% (23 patients) in the LRN group (p=0.0001). These differences were observed in the Clavien-Dindo’s grade II group. Independent risk factors for postoperative complications observed were: ASA≥III (OR=1.82, p=0.004) and stage pT3a (OR=2.29, p=0.0001). Laparoscopy acted as a protective factor for complications (OR=0,26, p=0.0001). Surgical access did not influence RFS (HR=0.87, p=0.50), CSS (HR=0.69, p=0.12). CONCLUSIONS: Laparoscopic access to RN in patients with renal cancer in ≤pT3a stage increased surgical time only in the first years, reduced hospital stay and postoperative complications and did not influence RFS, OS or CSS.
Article
Knowledge map
Save
OBJECTIVE: To compare the impact on overall survival (OS) of laparoscopic nephroureterectomy (LNU) vs open nephroureterectomy (ONU) in patients with locally advanced upper tract transitional cell carcinoma (UTTCC) (pT3-pT4).MATERIAL AND METHODS: Sixty-six patients underwent LNU/ONU at our institution between March 2001 and August 2016 (36 ONU and 30 LNU) with confirmed UTTCC diagnosis. Demographic, histological and survival variables were extracted. The statistical analysis was performed using Chi-square test, Exact Ficher test, log-rank test and Cox regression analysis. RESULTS: The median time of follow-up was 14.3 months (Q1-Q3 6.6, 38.8). No differences were found between both groups in terms of demographic or pathology variables. The median survival time was 11.6 months (IQR 5.0- 18.2) in the ONU group and 33.8 months (IQR 2.5-65.2) in the LNU group. The 5y OS rate was 14% in the ONU group and 37% in the LNU group. Surgical approach, ASA or pT and the multifocality showed a statistically significant association with OS.CONCLUSION: Our study shows an association between the surgical approach and OS, with increased mortality associated to the ONU.
Article
Knowledge map
Save
OBJECTIVE: To describe the initial experience in our center on targeted prostate biopsies (TB) using Magnetic Resonance imaging/ultrasonography (MRI/US) fusion and to compare PCa detection with systematic biopsies (SB). PATIENTS AND METHODS: A retrospective, descriptive and comparative study was conducted on the first 94 men who underwent TB using MRU/US fusion in our center since February 2017 to March 2018. All patients underwent a protocol of 6-12 cores of systematic biopsies (SB) (except 9) and 2-6 targeted cores on the MRI index lesion. The Hitachi/HiVision Preirus equipment was used with RVS software (Real-time virtual sonography) and a biplane transducer for the fusion imaging procedure. Clinically significant PCa (csPCa) was defined as: at least one core with a Gleason score of 3+4. RESULTS: The proportion of patients diagnosed with PCa was higher in TB compared with SB (p=0.035) and the mean of core performed for diagnosis was lower in TB compared with SB (p<0.001). A trend towards an improved detection of csPCa in TB compared to SB was observed (p=0.063).CONCLUSIONS: The MRI/US fusion targeted biopsies (TB) showed a higher detection rate of PCa, with less cores taken for diagnosis and a tendency to better identification of csCaP compared to SB.
Article
Knowledge map
Save
OBJECTIVE: The management of stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy. MATERIAL AND METHODS: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017 and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystic kidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age and gender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification. RESULTS: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hours after surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II). CONCLUSION: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decision making.
Article
Knowledge map
Save
OBJECTIVE: Among western males, prostate cancer is the most frequent oncological disease. Since the widespread of PSA, diagnoses in younger adults is increasing. The aim of this study is to analyze pathological features and biochemical recurrence event in patients ≤55 years who underwent robotic radical prostatectomy (RRP) surgery.MATERIAL AND METHODS: A study with a cohort of 510 patients operated between November 2012 and February 2017 in a tertiary centre is provided. A total of 460 are included in the analysis. Variables include PSA, biopsy Gleason score, prostate weight, final specimen Gleason score, pT and surgical margins. Biochemical recurrences during the follow-up are obtained. Statistical analysis with Chi2, Student’s t test, Kaplan-Meier and log-rank (SPSS24.0) comparing the ≤55 years patients with older age group is performed.RESULTS: 8.3% (38) of the patients were ≤55 years. The mean PSA among the younger group was 8.54ng/ml while in the older was 8.18ng/ml (p=0.13). The biopsy Gleason scores showed similar distribution in both age groups. 52.6% (20) of the young group presented an upgrading in the final Gleason, vs 49.1% (207) among the elderly (p=0.79). The average prostate weight was higher among elderly patients (54.29g vs. 40.50g P=0.001). 84.2% (32) of prostate cancers in young group corresponded to pT2 stages compared to 81.3% (343) in the elder (p=0.66). The presence of positive surgical margins was similar in both groups. The mean follow-up time was 45 months regardless of age. In 21.1% (8) of the young group, biochemical recurrence was detected compared to 17.1% (72) among the elderly (p=0.53). There were no differences in the biochemical recurrence-free survival recorded in both groups (p=0.53).CONCLUSION: In our study population, patients ≤55 years treated with RRP did not present differences in the pathologic features of prostate cancer or in biochemical recurrence rates in comparison to the group of older patients.
Article
Knowledge map
Save
OBJECTIVES: Although it is a well known condition that presence of testicular microlithiasis (TM) with the co-occurrence of specific risk factors such as his-tory of previous germ cell testicular cancer (GCTC), in-fertility, undescended testes or atrophic testes have high risks for GCTC development,TM is still a controversial topic. Its effects on oncological outcomes have still not been investigated in detail. In this study, we aimed to evaluate whether the presence of TM has an effect on GCTC prognosis and oncological outcomes. METHODS: Seventy five patients among 93 patients who underwent radical orchidectomy between January 2010 and February 2016 were selected and divided into two groups. Group I consisted of 51 patients with-out TM. Group II consisted of 24 patients with TM. Each groups were compared in terms of demographic datas, prognostic risk factors, complete blood count parame-ters and oncological outcomes.RESULTS: During the median follow-up of 58 (1-106) months, a significantly higher local recurrence rate (54.2% vs. 3.9%, p<0.001), distant metastasis rate (58.3% vs. 5.9%, p<0.001) and lower cancer-spe-sific survival rate (45.8% vs. 94.1%, p<0.001) were observed in patients with TM. In this group, the duration of recurrence-free survival (47.65±9.45 vs.101.96±2.80 months, p<0.001), metastasis-free survival (49.50±8.88 vs. 100.00±3.36 months, p<0.001) and cancer-specific survival (54.37±8.76 vs. 100.19±3.25 months, p<0.001) were also statisti-cally lower. In multivariate analysis, β-hCG, LDH, neutro-phil/lymphocyte ratio, monocyte/lymphocyte ratio and the presence of undescended testis were found as inde-pendent predictive factors for local recurrence, distant metastasis and cancer-specific survival. Red blood cell distribution width and the presence of testicular micro-lithiasis were found to be independent predictive factors for local recurrence.CONCLUSION: According to our results, bilateral TM was associated with higher rates of local recurrence, distant metastasis and cancer spesific mortality in pres-ence of risk factors, regardless of classic or limited mi-crolithiasis.
Article
Knowledge map
Save
OBJECTIVES: The concurrence of Per-sistent Müllerian Duct Syndrome and transverse testicular ectopia is rare. The risk of damage to the vas deferens and the deferential blood supply hinders some surgeons from complete excision of potentially malignant Mülleri-an duct remnants. METHODS: We present a unique surgical technique of Persistent Müllerian Duct Syndrome in a patient with right inguinal hernia accompanying transverse testicular ectopia.RESULTS: During exploration, both testes were detected in the right inguinal canal. When the hernia sac was opened, a primitive uterus and fallopian tubes without fimbria were identified confirming Persistent Müllerian Duct Syndrome. A 4 Fr catheter was placed into the os of the Müllerian duct remnants via the verumontanum orifice, and then a urethral catheter was placed. The full-thickness excision of proximal Müllerian duct rem-nants were performed. The distal part of Müllerian duct remnants was layed open and only mucosa was excised for preserving vas deferens. Resection was completed just above its junction with the urethra with the aid of 4 Fr catheter marked at centimeter intervals and the cuff was oversewn. High ligation for right inguinal hernia and bilateral orchidopexy were performed. CONCLUSIONS: Removal of Müllerian duct remnants is advised in order to reduce the jeopardy of malignan-cy, urinary tract infections, stones and hematuria. On the other hand, excision down to urethra which can compro-mise the integrity and vascularity of the vas deferens is diffucult, even in experienced surgical hands. Complete excision of these structures by mucosectomy of the distal part of remnant which lay closed to vas deferens is a safe and effective method. Cystoscopy assistance and placement of a catheter into MDRs were essential for the complete excision of this mucosa. To the best of our knowledge, cystoscopy assisted mucosectomy in Per-sistent Müllerian Duct Syndrome has not been reported previously.
Article
Knowledge map
Save
OBJECTIVES: Although the association between 5 alpha reductase inhibitors used for the treat-ment of both androgenetic alopecia and benign prostat-ic hyperplasia and their side effects is well established, the impact of dutasteride on testicular structure is not clear. To evaluate the alterations in spermatogenesis and serum FSH, LH, testosterone and dihydrotestosterone concentrations along with the oxidative status in testes and blood of the rats treated with daily dutasteride.METHODS: A total of 18 male Sprague-Dawley rats have been divided into 2 groups as control (n=8) and dutasteride (n=10). After chronically administered, rats were sacrificed and their testes were harvested for his-topathological and biochemical evaluation. Johnsen’s criteria were used to assess spermatogenesis. Serum hormone concentrations and levels of reactive oxygen species (ROS) in both testicular tissue and serum were measured by ECLIA and ELISA, respectively. Results were compared with Mann- Whitney U test.RESULTS: DHT (7.35 ± 0.35 vs. 10.54 ± 0.95, p<0.001) and LH levels (0.32 ± 0.009 vs. 0.43 ± 0.01, <0.001) were significantly lower in treatment group compared with controls whereas testosterone lev-els were higher in dutasteride arm (3.41 ± 1.12 vs. 1.52 ± 0.34, p<0.001). Johnsen score, serum FSH lev-els, serum and tissue ROS levels were similar between the two groups.CONCLUSIONS: According to our results, administra-tion of dutasteride does not appear to modify spermato-genesis and oxidative burden in rats. Further investiga-tions are required to confirm our findings.
Article
Knowledge map
Save
OBJECTIVE: To present our results of first 12 patients on whom we performed gasless robotic per-ineal radical prostatectomy (r-PRP).METHODS: We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multipara-metric magnetic resonance imaging was performed for all patients to exclude local advanced disease. Demo-graphic characteristics, technical details, and intra and postoperative data were analyzed.RESULTS: The mean age of the patients was 62.6 ± 6 years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-spe-cific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean con-sole time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean ure-thral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respec-tively.CONCLUSIONS: Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospec-tive randomized and comparative studies are required with large patient series.
Case Report
Knowledge map
Save
INTRODUCTION AND OBJECTIVES: Urethral-vesical and bladder foreign bodies by electric cables are the most uncommon.The objectives of this article are to present the first worldwide case of urethro-vesical foreign body by the cable of a video game and to review the 5 Spanish publications.CLINICAL CASE: 14-year-old male attending the emergency department for urethral cable retention, urethralgia, hypogastric pain and malodorous urine incontinence. Simple abdominal radiography showed a ball of retained cable in the bladder coming out through the meatus. He was operated on by performing a cystotomy. He was discharged 24 hours later.CONCLUSIONS: Urethral and bladder foreign bodies by electric wire are a rare pathology. They can be due to different motivations. The treatment consists of the extraction of the cable, which can be carried out by endoscopic or open surgery depending on the size and morphology of the cable. It is advisable to study the mental state of these patients.
