OBJECTIVES: The questionnaire International Prostate Symptom Score (IPSS) is well known and used in clinical practice as diagnostic tool and allows for obtaining a total score regarding the severity of the urinary symptoms. The objective of this analysis is to determine if the IPSS storage score (sum of the punctuation of the questions 2, 4 and 7) could be a predictive variable of the impact on quality of life. MATERIALS AND METHODS: Post-hoc analysis of an epidemiological, multicenter, cross-sectional study in male patients, ≥18 years old with ≥6 micturitions and ≥1 urgency and/or ≥2 nocturia and/or ≥1 daily incontinence episodes recruited by 291 urologists across Spain. Sociodemographic variables, symptoms reported by patients (IPSS) and clinical variables were collected. The impact of voiding symptoms (IPSS-V) and storage symptoms (IPSS-S) on the quality of life, measured using the Overactive Bladder questionnaire Short Form (OABq-SF HRQoL), was evaluated using multivariate regression models (linear and logistic).RESULTS: 958 patients, whose mean score (standard deviation) of the OABq-SF HRQoL was 57.9 (18.3), were included in the study. 55.6% received drug treatment for urinary symptoms. 616 patients (64.4%) reported a puntuation >3 in the item 8 of the IPSS. The adjusted analysis showed a significant reduction in the quality of life of -1.1 (p<0.001) and -3.3 (p<0.001) points associated with the worsening of the symptoms of voiding and storage respectively. This worsening was also associated with a minor risk of satisfaction (OR=1.14; p<0.001 and 1.36; p<0.001) for the voiding and storage symptoms respectively.CONCLUSION: In patients with mixed LUTS both components show a negative effect on the quality of life, with a greater impact of the storage symptoms.
OBJECTIVE: To present the evolution in the diagnosis and treatment of urethral stricture, after performing 300 surgical procedures over urethral meatus, penile and bulbar urethra along 20 years, contrasting two surgical periods: from 1997-2006 to 2007-2016.MATERIAL AND METHODS: A retrospective review of 495 medical records between 1997-2016 was conducted. All the patients treated with urethroplasty were included and those who underwent internal urethrotomy, stents or dilatations plus those with strictures due to prostate cancer treatment or orthotopic neobladder were excluded. RESULTS: 300 patients were selected: 100 patients within the first period (1997-2006) and 200 within the second (2007-2016). The median follow-up was 36 months (range 12-60). In relation to the surgical techniques, among the most employed, four are outstanding so their results can be compared in both periods: termino-terminal urethroplasty, penile flap urethroplasty and the buccal mucosa in penile or bulbar urethroplasty. Other techniques were incorporated during the second period. The best outcomes were provided by end’to end urethroplasty with 90 and 92% success. Over the second period, buccal mucosa indications were consolidated with an increase use from 16% to 56%. Were considered as successful those patients that did not need any endoscopic procedure and reporting excellent urinary flow without low urinary tract symptoms. CONCLUSIONS: A trend towards an increased usage of open surgery vs urethrotomy is observed. Buccal mucosa graft has been consolidated as a reconstructive technique. End-to end urethroplasty seems to provide the best functional outcomes.
OBJECTIVE: In the laparoscopic/robotic repair (L/R R) of Vesico-vaginal Fistulas (VVF) two types of transvesical and extravesical approaches are used. However, no direct comparisons exist between both surgical approaches Moreover, a lack of clinical guidelines is currently ongoing. Therefore, the selection of the type of approach is based on the preferences of the surgeon without considering the characteristics of each case. In order to provide recommendations for the selection of the appropriate technique for each patient, we designed a study that identifies and evaluates differences between the Transvesical and Extravesical approaches in the L/R R of the VVF.PATIENTS AND METHODS: A total of 9 patients with VVF were included. Four patients underwent transvesical technique and the rest the Extravesical technique. The variables in each group were recorded. Surgical steps were selected with technical differences to be analyzed (identification of the fistula, dissection of the vesico-vaginal plane, cystotomy, maneuvers of exposure and cystorrhaphy).RESULTS: Short operative times and catheterization times were recorded in the Extravesical approach. Intraoperative blood loss was minimal in both groups, the hospital stay was very similar and no peri and post-operative complications were reported. In all cases the fistula was resolved and there have been no recurrences in a mean follow-up of 35 months. Technically, Extravesical approach minimizes the size of the cystotomy, decreases suture time, does not require maneuvers for adequate exposure, and simplifies cystorrhaphy with respect to Transvesical technique, at the expense of requiring further dissection and having a slight difficulty in locating the fistula. Transvesical technique simplifies the location of the fistula and allows better intravesical visualization.CONCLUSION: In the L/R R of the VVF, the Extravesical technique offers technical and perioperative advantages, so it must be the technique of choice for most VVF with indication of abdominal approach. Transvesical technique should be reserved for recurrent, recurrent, inflammatory fistulas, with difficulties identifying the fistulous orifice, close to ureteric orifice and with imminent need for ureteral reimplantation.
OBJECTIVE: The primary objective of this product evaluation involved obtaining assessments from patients following the use of the Onli™ intermittent cath-eter (IC) 17cm and 40cm; and opinions from clinicians on its use for catheterization based on its design fea-tures. The inability to access the right catheter is often why patients discontinue intermittent self-catheterization (1). Design factors play an important role in the likeli-hood of using and remaining compliant to an IC device. The secondary objective of this product evaluation was to assess if the ease-of-learning and ease-of-use of Onli intermittent catheter, would support patient adherence to a catheterization treatment plan.METHODS: A multi-center, unblinded evaluation was executed in 10 different SCI Units across Spain. Reha-bilitation physicians and nurses recruited patients with neurogenic bladder disorder and used IC’s. The patients used 30 catheters in according to their standard of care. A total of 100 subjects were enrolled into the study (78 male and 22 female). RESULTS: 90% of clinicians agreed that the “ease-of-learning” and “ease-of-use” of the Onli intermittent cath-eter has the potential to support patient adherence to a catheterization plan. 80% of patients found learning curve for catheter usage easy, and 69% found it easier than their current catheter. A total of 89% of patients reported insertion of the catheter as easy or very easy; with 91% reporting removal easy or very easy. CONCLUSION: Results of the current evaluation sup-port increased adherence to a self-cath treatment plan. The IC was described as easy to teach and learn; with 77% of patients indicating that if the IC was available they would be likely or very likely to use it. Other design attributes of the IC were found to lend to the preference for the selection of the product.
INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corpora cavernosa, which causes difficulty in penetration, requiring surgical correction when intercourse is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer.PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to intercourse, were operated in a period of 36 months. Prior to the intervention, we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature through self-photographs in three projections. By subcoronal approach, we perform denudation of the penis. On both sides of the urethra we incised Buck’s fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test.RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature <20° and the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length, (p=0.08). Nine patients assured that they would undergo the same intervention again.CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, maintaining its long-term results.
OBJECTIVES: This prospective study aimed to investigate the expression of the androgen re-ceptor (AR) and the estrogen receptor-β (ER-β) in foreskin tissues in boys with and without distal hypospadias.METHODS: Thirty boys with distal hypospadias were evaluated. Fifteen boys who underwent elective circum-cision over a period of 18 months served as the control group. The presence of AR and ER-β in foreskin tissues was investigated immunohistochemically. RESULTS: The percentages of AR in epithelial cells were 18.9 ± 27.3% in the hypospadias group and 3.3 ± 5.3% in the circumcision group, and the difference be-tween the groups was significant (p=0.034). Of the stromal cells, 19.5 ± 26.8% in the hypospadias group and 2.6 ± 4.4% in the circumcision group were positively stained for AR (p=0.004). In the hypospadias group, significantly higher stromal cell percentage of ER-β was found compared to that in the control group (24 ± 24.5% and 1.3 ± 1.1%, respectively, p<0.0001). Moreover, epithelial cell percentage of ER-β was higher in the hypospadias group than that in the control group, and the respective values were 6.8 ± 10.1% and 0.9 ± 1.3% (p<0.0001).CONCLUSION: The percent of AR and ER-β expres-sion were higher in hypospadias-affected foreskin than in the normal foreskin. Whether the normal function of these receptors reveals, there is a need for more detailed studies.
OBJECTIVES: In this study, we aimed to define the clinico-radiological data and treatment op-tions for intratesticular epidermoid cysts (IEC).MATERIALS AND METHODS: We retrospectively re-viewed the medical records of the patients that under-went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded. RESULTS: A total of 20 patients with IEC were identi-fied. While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with patho-logically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients un-derwent partial orchiectomy (76.5%). The mean size of the IEC was 17.7x15.1 mm (range, 26x10 mm). IECs were mostly located in the middle pole of the testes (10 of 17 patients, 58.8%).CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest re-ported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.
OBJECTIVES: The aim of this study was to evaluate relationship between preoperative Prognostic Nutritional Index (PNI) values and tumor stage and to identify predictive value of PNI in patients with primary bladder cancer (BC).METHODS: A total of 164 patients with primary blad-der cancer were retrospectively analyzed using institu-tional bladder cancer database between January 2008 and January 2018. The PNI was calculated using pre-operative blood sample results. According to pathologi-cal results, the patients were divided into groups as pTa (n=94), pT1 (n=54), and pT2 (n=16) and further into subgroups as Group 1 (pTa patients, n=94) and Group 2 (pT1 + pT2 patients, n=70). Subgroups were com-pared statistically in terms of PNI values and indepen-dent risk factors were evaluated using Backward Step-wise multivariate logistic regression analysis. RESULTS: Of patients, 145 (88.4%) were males and 19 (11.6%) were females with a mean age of 66.46±10.57 (range, 36 to 93) years. Mean total peripheral lympho-cyte count was 2.11±0.71 (×109/L), mean serum albu-min was 4.11±0.53 (gr/dL), and mean PNI score was 51.66±6.36. There was a statistically significant differ-ence in serum albumin levels and PNI scores according to tumor stages (p=0.008 and p=0.003, respectively). There was a statistically significant difference in mean serum total protein, albumin, and PNI scores (p<0.01, for all). Tumor size, tumor grade, PNI, carcinoma in situ, and atypical variant status were independent risk factors for predicting tumor stage.CONCLUSIONS: Our study results demonstrate that PNI is a potential preoperative predictor of tumor stage and is an independent risk factor for predicting tumor stage in patients with primary bladder cancer. Lower PNI levels are associated with high stage disease.
OBJECTIVES: The aim of this study is to evaluate the efficacy, safety and postoperative outcomes of the recently developing endoscopic techniques of Bi-Vap (Richard Wolf®) saline vaporization of the prostate and bipolar plasmakinetic TURP in BPE over 90 ml. METHODS: In total, we included 147 patients treat-ed with BiVap (Richard Wolf®) saline vaporization of the prostate (n=75) and bipolar plasmakinetic TURP (n=72). The inclusion criteria were Qmax ≤10 mL/s, IPSS ≥16, and prostate volume over 90 ml. Operation, hospitalization and catheter removal time were noted. Postoperative complications including urinary tract infection, transient hematuria, severe dysuria, and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative month 3. Preoperative and postoperative values of IPSS score, QoL score, IIEF-5, PVR, Qmax and Qave were compared. Statistical analyses were performed using SPSS 18.0 program and statistical significance was set at p<0.05.RESULTS: The groups were similar with respect to pre-operative age, height, weight, creatinine, PSA, prostate volume, IPSS score, Qmax, Qave, QoL score, PVR and IIEF-5 values. The mean operation time was significantly higher (<0.001). Length of stay and time to catheter removal were significantly lower (<0.001) in group 2 compared to group 1. The groups were similar regard-ing at postoperative month 3 IPSS score, Qmax, Qave, QoL score, PVR and IIEF-5 values. The only exception was the rate of severe dysuria, which was significantly higher in group 2.CONCLUSION: Both BiVap (Richard Wolf®) saline vaporization of the prostate and bipolar plasmakinetic TURP are safe and highly effective minimal invasive techniques, which can be used in the surgical treatment of BPE over 90 ml. Although the longer operation time and higher rate of postoperative irritative symptoms, Bi-Vap (Richard Wolf®) saline vaporization of the prostate seems to be a potential alternative to other techniques with shorter length of stay and time to catheter removal.
OBJECTIVE: Kidney cancer is around 2-3% of malignant tumours in adults. It has an important tendency to metastasize, being the most affected organs lungs, liver, brain, bone and adrenal glands. The pancreas is a rare site of kidney metastasis, with an incidence of 1-2.8%. The aim of this paper is to analyze the clinical diagnosis, treatment and prognosis of the pancreatic metastasis secondary to kidney cancer.METHOD: We present a retrospective descriptive analysis of 6 cases of pancreatic metastasis of primary kidney cancer diagnosed at Cruces University Hospital since 2011. We describe the cases individually also making a global analysis of the pathology and literature review. RESULTS: Two of the patients had pancreatic and extrapancreatic metastatic lesions, being treated systemic treatment without adjacent surgery. They showed an overall worse prognosis. The rest of the patients had only pancreatic disease, rational for surgical removal of all masses without need of further adjuvant treatment. The results after surgery were encouraging, with longer overall survival, progression free survival and better quality of life. CONCLUSIONS: Pancreatic metastases of kidney cancer are very rare and they can appear several years after nephrectomy. Patients with history of kidney cancer should be followed for long term after surgery. When metastases are limited to the pancreas, radical surgery has longer overall survival, progression free survival and better quality of life outcomes.