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OBJECTIVES: To assess the adherence to the antibiotic prophylaxis protocol in patients undergoing prostate surgery and evaluate the effect of antibiotic prophylaxis on surgical site infections (SSI).MATERIAL AND METHODS: A prospective cohort study was carried out between January 2009 and September 2016. The global compliance with the antibiotic prophylaxis protocol was evaluated studying the items: time of onset, route of administration, antibiotic prescribed, duration and dose. Percentages of adequacy are described. The incidence of infection was calculated after 30 days of follow-up. Relationship between the adequacy to the protocol and the surgical site infection are described with the relative risk.RESULTS: A total of 595 patients were studied. The global adequacy was 93.8%. The leading cause of inadequacy was the time of onset 3%. The incidence of surgical site infection was 1%. No relationship between the inadequacy of antibiotic prophylaxis and surgical site infection (RR=1.1%; 95%CI: 1.0-1.2) was found. No relationship between the procedure (laparoscopic or open surgery) and surgical site infection (RR=0.4%; 95%CI: 0.1-1.9) was found. CONCLUSIONS: The adequacy of antibiotic prophylaxis was high. The incidence of surgical site infection was low and compliance of antibiotic prophylaxis contributes to diminish surgical site infection incidence.
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OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes in video-endoscopic inguinal lymphadenectomy (VEIL). METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower- rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results.
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INTRODUCTION: Minimal residual disease (MRD) is that which persists after curative treatment for prostate cancer. It has the potential to grow and cause metastasis. The detection of circulating prostate cells (CPCs) and bone marrow micro-metastasis could represent different sub-types of MRD.OBJECTIVE: To determine biochemical failure free survival and time to failure, the presence of circulating prostate cells and bone marrow micro-metastasis in men treated for low risk prostate cancer.HYPOTHESIS: The presence of MRD and not the treatment modality determines the results of therapy.METHODS: Blood and bone marrow samples were taken one month after completing treatment to detect CPCs and micro-metastasis. Patients were classified into three groups; A: CPC negative, micro-metastasis negative, B: CPC negative, micro-metastasis positive and C: CPC positive. Biochemical failure was defined as a PSA >0.2ng/ml after radical prostatectomy and >2.0ng/ml post nadir after radiotherapy. After 10 years of follow up the Kaplan-Meier survival curve was determined and using a flexible adjusted parametric model the mean restricted survival time (MRST) was calculated for all groups. RESULTS: 343 men participated, 183 post surgery and 160 post radiotherapy, 181 (53%) had clinical stage T1 and 162 (47%) clinical stage T2a. There were no differences in treatment results between prostatectomy and radiotherapy. T1 patients had a significantly lower frequency of MRD than T2 patients (20% versus 67% p<0.001). Patients negative for MRD (Group A) had a 97% 10-year survival rate and a MRST to failure of 9.9 years. Men with only micro-metastasis (Group B) had a survival rate similar to Group A during the first five years, afterwards there was increasing treatment failure (late failure). Men positive for CPCs had a high risk of early failure.CONCLUSIONS. The treatment results of surgery and radiotherapy are similar and depend on the sub-type of MRD. Men negative for MRD could be considered cured with a biochemical failure free survival of >95% at 10 years. The sub-type of MRD determines early or late failure and could be useful in the risk classification of patients after curative treatment.
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OBJECTIVES: To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS).METHODS: A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated.RESULTS: Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD).CONCLUSIONS: The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.
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OBJECTIVES: To compare the antibiotic susceptibility of Escherichia coli (E. coli) between community-acquired acute bacterial prostatitis (CA-ABP) and ABP following transrectal ultrasound-guided prostate biopsy (Bx-ABP).METHODS: A total of 4,383 patients underwent prostate biopsy from January 2005 to June 2014. Among these patients, 34 had Bx-ABP; of which 22 patients had E. coli identified in their urine or blood culture. E. coli was also identified in 91 out of 209 patients with CA-ABP in urine or blood culture. We investigated patient and microbiological characteristics.RESULTS: The Bx-ABP (59.1%) group showed a higher bacteremia prevalence than the CA-ABP group (13.2%) (p<0.001). Significant differences in the antibiotic sensitivity to E. coli between the two groups were observed for fluoroquinolone, cephalothin, and gentamicin. The antibiotic sensitivity of fluoroquinolone in the Bx-ABP group was only 27.3%. Amikacin, imipenem, meropenem, amoxicillin/clavulanic acid, and piperacillin/tazobactam showed more than 95% antibiotic sensitivity in both groups. Bx-ABP was an independent predictive factor for bacteremia by multivariate analysis.CONCLUSIONS: E. coli in Bx-ABP showed a higher incidence of antibiotic resistance and bacteremia than those in CA-ABP. Carbapenem may be a treatment of choice for patients suspected of having sepsis. Considering the recent emergence of carbapenem-resistant bacteria, piperacillin/tazobactam or amikacin may be considered.
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OBJECTIVES: In this research, we designed a cognitive fusion(CF) prostate biopsy(PB) (CFPB) technique by examining the multiparametric MRI of prostate (MP_MRI-P) images in a smart-phone near the trans-rectal ultrasound (TRUS) device, and examined the results.METHODS: Between January 2011 and January 2017, a total of 344 men who had PB enrolled in this study. Group 1 had a minimum of a 12-core standard TRUS PB (TRUSPB). Group 2 had CFPB while examining the MP_MRI-P images in a smartphone near the TRUS device. A minimum 12 cores + cognitive targeted 1-3 biopsy were taken. The detection of Pca and significant Pca in group 1 and 2 were evaluated and compared. Then, the effect of MP_MRI-P findings on the detection of prostate cancer (Pca) and significant Pca were evaluated. RESULTS: Group 1 and 2 included 138 and 206 patients. After the PB, 45(32.8%) and 33(23%) patients ingroup 1, and 74(35.9%) and 60(29%) patients in-group 2 were detected to have Pca and significant Pca, respectively (p=0.001 for both). Higher PIRADS caused significant detection of Pca and significant Pca (p=0.004 and 0.002). Nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.001 and 0.001). Especially, when PSA was <10ng/ml, higher PIRADS and nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.02 and 0.019 for PIRADS, and p=0.01 and 0.042 for nodules).CONCLUSIONS: In the advanced hands with our new technique, the CFPB using prebiopsy MP_MRI-P seems to be an effective method to detect Pca and significant Pca.
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OBJECTIVES: Enuresis is one of the most frequently seen psycho-social problems in childhood, which causes anxiety and stress in the child, thus affecting his/her self-respect and quality of life. The aim of the study was to determine the role of bladder function or psychologic factors or both as factors causing enuresis.METHODS: This study on pediatric patients with primary enuresis included 30 patients with monosymptomatic nocturnal enuresis (MonoNE), 30 patients with polysymptomatic nocturnal enuresis (PolyNE), and 30 healthy controls, making a total of 90 subjects with an age range of 8-18. In all subjects, the levels of serum and urinary Brain-Derived Neurotrophic Factor (BDNF) were measured, in addition to urinary creatinine levels and calculated as BDNF/Cr ng/mg creatinine (BDNF/Cr).RESULTS: The serum BDNF results of the PolyNE group (0.949±0.587) were significantly lower than those of the control group (1.158±0.587) (p=0.014). The urinary BDNF results of the PolyNE group (1.107±0.360) were significantly higher than those of both the MonoNE (0.657±0.272) and the control (0.670±0.271) groups (p<0.0001). The BDNF/Cr results of the PolyNE group (1.472±0.714) were significantly higher than those of the MonoNE group (0.956±1.017) and the control group (0.931±0.618) (p=0.044 and p=0.032, respectively).CONCLUSIONS: In addition to bladder-specific problems, it is possible for anxiety and psychological stress-induced problems to occur in PolyNE. Therefore, in addition to the increasing number of studies on the bladder in enuresis, further studies on the neurogenic and psychogenic aspects of enuresis should be carried out.
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OBJECTIVES: To evaluate the impact of common Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene mutations, 5T polymorphism and presence of severe Cystic Fibrosis (CF) on fertility outcomes with Assisted Reproductive Techniques (ART) in patients presenting Congenital Bilateral Absence of Vas Deferens (CBAVD). METHODS: A comparative observational cohort study was performed from 2002 to 2018 with 51 patients with diagnosis of CBAVD. Presence of CFTR mutations and 5T, CF, pregnancy and newborn rates were analyzed. RESULTS: 80.4% percent had some mutation of CFTR gene being ΔF508 the most common (51%). The most frequently described genotype was the 7T/9T (31.4%) with the presence of 5T polymorphism in up to 25.5% of cases. Global newborn rates were 34% in the group using partner spermatozoa. When comparing 5T presence, we observed a decrease in newborn rates when carrying this mutation, without obtaining statistical significance (newborn rate: 5T/non-5T: 7.1/28%, p 0.45). No differences were found when comparing presence of severe CF, common CFTR gene mutations and ICSI-related parameters. CONCLUSION: The analysis of the presence of 5T polymporphism in CBAVD patients may add information when predicting the outcome of assisted reproductive techniques.
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OBJECTIVE: To report the finding of malleable penile prosthesis extension tips in an ectopic position.METHOD: We retrospectively analyzed two clinical cases of ectopic finding of prosthetic implant extension tips and performed a bibliographic review.RESULTS: In the cases described, conservative behavior was decided given the absence of signs, symptomatology and the efficacy of the normally positioned implant. CONCLUSION: The migration of the penile prosthetic implant is a very uncommon complication, more so the finding of a tip extension in an ectopic position. Reports in the literature on the behavior to follow in this type of complications are absent.
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OBJECTIVE: Intrarenal stenosis, even caliceal diverticula or neck diverticular stenosis, associated with lithiasis are infrequent therefore their management is a challenge. The aim of this article is to report two cases who underwent retrograde intrarenal surgery and Holmium laser as a modern technological tool, proposing a new gold standard.METHODS: We report 2 cases of intrarenal stenosis associated with lithiasis managed with flexible videoureteroscope (STORZ) and Holmium laser (CALCULASE II). One case presented a caliceal diverticulum and the other a caliceal ostium stenosis secondary to previous percutaneous surgery. The ostium was incised with laser to access the diverticulum in the first case and in the second case a dilatation was required. Lithiasis treatment was performed with laser. Disease free rate was defined when the cavity completely disappeared and lithiasis fragments were less than 2 mm on CT Scan one month after procedure. RESULTS: Surgical time were 60 and 82 minutes for cases 1 and 2, respectively. Both patients evolved satisfactorily with 8 hours hospital stay and without perioperative complications. The disease-free rate was 100%.CONCLUSION: Flexible videoureterorrenoscopy and Holmium laser for the management of intrarenal stenosis are highly effective and safe with the advantages of less perioperative complications, less invasiveness and being an outpatient procedure compared to percutaneous surgery.
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OBJECTIVE: Signet ring cell carcinoma (SRCC) of the prostate is very a rare tumor. It is comprised of cells that are similar to signet ring cell tumors of the gastrointestinal tract. Diagnosis requires histopathology and also elimination of the adenocarcinomas of other organs. To our knowledge 157 cases have been reported in the literature. MATERIAL AND METHODS: We retrospectively searched in tumor registries from Hospital Aleman de Buenos Aires to identify all prostate cancer since 1990. We analyzed the following variables: age at diagnosis, median prostate-specific antigen (PSA) level, stage, global survival, among others. A review of the literature was done and compared with this series of cases.RESULTS: We identified 5 cases. In our series we found: Mean age 77.8 years (SD 3.2), Median PSA level 18 ng/ml (Range 10.6-331 ng/ml), 3/5 (60%) localized disease and 2/5 (40%) with distant disease at diagnosis. Median survival of 23 months. Comparing with other series we found patients of older age and lower median survival.CONCLUSION: Primary Signet ring cell carcinoma of the prostate is a rare and aggressive histological variant of adenocarcinomas of the prostate. Treatment is the same as classical adenocarcinoma with an emphasis on aggressive multimodal treatment.
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