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OBJECTIVE: The objective of this study is to perform an analysis of the patients who underwent middle and distal penile hypospadias repair using the two most widely used techniques in our Pediatric Urol-ogy Unit.MATERIAL AND METHODS: We perform a retrospective analysis of patients with a diagnosis of middle penile and distal penile hypospadias and operated by the Sno-dgrass or Mathieu technique, between 2011 and 2016 ensuring minimal follow-up of one year. We will analyze the use of each one, the results obtained, and the possi-ble factors that could influence their success rate.RESULTS: A total of 80 patients were included in the study, with a median age of 28 months at surgery (Range: 11 to 151). There were 34 patients (42.5%) with Snodgrass technique and there were 46 patients (57.5%) with Mathieu technique. We have not identified statistically significant differenc-es in complications between both surgical techniques. The percentage of fistulas is higher in Snodgrass ure-throplasty (12.1% vs 8.9%), decreasing in the last years of the series, at the same time meatal stenosis is higher in Snodgrass technique (3% vs 2.2%) while the meatal retraction is higher in the urethroplasty of Mathieu (20% vs 15.2%).CONCLUSIONS: The exhaustive selection of patients seems the key in the succesful correction of these types of hypospadias. Despite both techniques are compara-ble in terms of the type of patient in which they could be applied and both techniques present similar rates in terms of fistulas and stenosis/retractions of the neome-atus (most frequent complications in this type of repairs), we consider that the characteristics of the patient should be prioritized before the preference of the surgeon to reach higher success rates.
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INTRODUCTION: Radical cystectomy (RC) with pelvic lymphadenectomy is the treatment of choice in patients with muscle invasive bladder cancer (MIBC).OBJECTIVE: To identify clinical and pathological vari-ables that influence global mortality (GM) and cancer specific mortality (CSM) in patients with urothelial blad-der tumor (UBT) treated with RC.METHODS: Retrospective analysis of 517 patients di-agnosed with UBT and treated with RC between 1986 and 2009. Demographic, clinical, surgical and patho-logical variables, as well as complications and evolution after RC were collected. A comparative analysis was carried out with Chi square and ANOVA test. Survival analysis was performed with the Kaplan-Meier method and the long-rank test. Univariate and multivariate anal-ysis were performed using Cox regression to identify in-dependent predictors of GM and CSM. RESULTS: 91% of the patients were males with a median age of 66 years. The most frequent local pathological stage was pT3 (32.6%), with lymph node involvement in 23.8% of the patients. After a median follow-up of 34 months, 170 patients were alive and 311 had died from any cause (63.5%), being UBT the cause of death in 225 patients (45%). Rates of global survival and cancer specific survival at 5 and 10 years were 45%/34.3% and 52.5%/46.6% respectively. On the multivariate analysis age (p=0.004), ASA (p=0.000), the existence of hydronephrosis (p=0.01), pT (p=0.000) and pN (p=0.003) were identified as independent predictors of GM, as well as pT (p=0.000) and pN (p=0.002) for CSM.CONCLUSIONS: Age, anesthetic risk, presence of hydronephrosis, pT and pN stage were identified as independent predictors of GM, as well as pT and pN stage for CSM.
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OBJECTIVES: To evaluate the current clini-cal practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014.METHODS: A retrospective multicenter study was de-signed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened.Descriptive statistics on variables related to characteris-tics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided.RESULTS: A total of 1156 new cases of PC were ana-lyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤6, 7 and ≥8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/watchful waiting, 423 (36.6%) radical prostatecto-my (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively.CONCLUSIONS: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making.
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INTRODUCTION: Minimal residual dis-ease (MRD) is that which remains after curative therapy for prostate cancer. It has the potential for growth and later cause metastasis. After radical prostatectomy, the detection of circulating prostate cells (CPCs) and bone marrow micro-metastasis could represent different types of MRD. We proposed to determine the biochemical failure free survival rates, the time to biochemical failure after 10 years of follow-up and the presence of CPCs and micro-metastasis in patients treated with RP for pathologically organ confined prostate cancer.METHODS AND PATIENTS: One month after RP mono-therapy for prostate cancer, blood and bone marrow samples were taken to detect CPCs and micro-metas-tasis. Men were classified as: group A (CPC negative and micro-metastasis negative), group B (CPC negative and micro-metastasis positive), group C (CPC positive and micro-metastasis negative), and group D (CPC pos-itive and micro-metastasis positive). All subjects were fol-lowed with serial total PSA levels, recording the time at which failure occurred defined as a serum PSA>0.2ng/ml on two separate occasions. After ten years of fol-low-up for each group Kaplan-Meier survival curves were determined and using an adjusted flexible para-metric model (FP), the Restricted Mean Survival Times for groups A, B, C and D were calculated.RESULTS: 191 men participated, 10-year biochemical failure survival rates were; group A (N=114) with a Ka-plan-Meier of 98.7%; group B (N=39) 65.1%; group C (N=12) 10.4% and in group D (N=28) 12.8%. The Restricted Mean Survival Times (years) were group A: 9.95; group B: 9.45, group C: 5.11 and group D: 6.18 (p-value<0.001 between groups: A versus C, A versus D, B versus C and B versus D). Frequency and time to failure was dependent on the type of MRD, those men CPC positive had a significantly higher failure rate and early failure. Those men only micro-metastasis pos-itive had lower failure rate and late failure when com-pared with men negative for MRD. CONCLUSIONS: CPC positive men have a more ag-gressive disease with increased early failure; those men who are only positive for micro-metastasis are at risk for late or delayed failure. These two forms of measuring MRD represent different stages in the disease progres-sion and may be used to guide clinical treatment deci-sions before increases in PSA levels.
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OBJECTIVES: The purpose of this docu-ment is to establish practical recommendations on neu-rogenic bladder (NB) management based on scientific evidence and medical and nursing perspective in Spinal Cord Injury (SCI) Units as a first multidisciplinary consen-sual approach in Spain.METHODS: This paper reports results from the first mod-ified Delphi consensus building exercise on this proce-dure. A committee of recognised opinion-leaders in re-habilitation and urology with special interest in NB was constituted. A working group formed by rehabilitation doctors, urologists and nursing staff of SCI and Neu-rorehabilitation Units of a number of Spanish hospitals and specialised centres associated with the panel of NB experts have prepared this document.RESULTS: This review provided an overview of the main aspects described by the different clinical guidelines al-ready available and highlighted the need to focus on recommendations in special priority situations in which there was no consensus. In view of the considerable im-pact this condition has on quality of life, patients should be offered help to better understand the disorder and they should be taught how to use the treatment tech-niques to obtain satisfactory results and promote their autonomy.CONCLUSIONS: This article presents a version of guidelines for patients with NB. The guidelines define the clinical profile of patients to provide the best evi-dence-based care and also an overview of the current drug and surgical treatments of NB.
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The treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) has evolved dramatically in the recent years with the approval of several new drugs. Together with other treatment modalities including chemotherapy, hormonal therapy and immunotherapy, radiopharmaceuticals have recently been incorporated to the therapeutic scenario of prostate cancer with the approval of Radium 223 dichloride (Ra-223) for the treatment of mCRPC patients with symptomatic bone metastasis and no visceral metastases. Radiopharmaceuticals have long been used for pain palliation in patients with bone metastases. However, the bone seeking properties and the favourable physical characteristic of alpha emitter radium 223 encouraged the clinical development of the drug, leading to survival advantage in the phase III trial ALSYMPCA. Now the efforts are directed to define the optimal patient selection and drug sequence. In this review, we will provide the best available evidence of mechanism of action, clinical data and future directions of Ra-223 in mCRPC.
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OBJECTIVES: Laparoscopic donor nephrectomy (LDN) is currently replacing open donor nephrectomy (ODN) across the world. Its advantages in terms of patient recovery are well known. We sought to compare surgical outcomes, particularly renal function during the post-nephrectomy period, for renal grafts procured by LDN versus ODN in our center.METHODS: We retrospectively analyzed all cases of living donor nephrectomies performed from 2004 to 2014 at Hospital Universitario La Paz. We compared demographic data; medical background, operative times, post-operative complications, and renal function follow up at 6, 12 and 18-month controls. RESULTS: A total of 114 living donor nephrectomies were performed: 85 LDN and 29 ODN. Demographic characteristics and medical background were similar among both groups, except mean donor age; 41.4 vs 47.4 years (p=0.009) in the LDN and ODN groups respectively. LDN was used predominantly for left kidneys (83 out of 85), and ODN for right kidneys (28 out of 29). Although not significantly, mean operative time was shorter for the LDN group (169.37 vs 181.46 minutes; p=0.2). Mean warm ischemia time was shorter for the ODN group (2.92 vs 2.36 minutes; p=0.28). Differences between post-operative complications were not statistically different between both groups (p=0.19). There were no conversions from LDN to ODN, and no re-admissions were registered. Length of stay was slightly shorter in LDN but not different (4.29 vs 4.92 days; p=0.43). Renal function follow-up, measured with serum creatinine levels showed no difference over time (p=0.67). CONCLUSIONS: Data from our series demonstrate that outcomes and renal function follow up over time were similar among both groups. In expert hands, this altruistic procedure can be performed with a minimally invasive approach without an increased complication rate or compromising renal function in donors.
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OBJECTIVES: To introduce a new technique for the placement of ureteral access sheaths (UAS) when there is failure in standard UAS placement.MATERIALS AND METHODS: Between March 2014 and June 2016, a total of 25 patients had difficulty while UAS placement during F-URS procedures. The placement of UAS in these patients was accomplished by utilizing the technique outlined in this study. The causes of difficulty in UAS placement, kinds of UAS deformation, ureteric injuries, and operation time were recorded for all procedures conducted in this study. RESULTS: The pre-operative and post-operative mean stone sizes, Hgb, urea, and creatinine levels were 10.64 (5-19)mm and 1.8 (2-4)mm (p<0.000); 13.9 (10.50-16.73)g/dL and 12.81 (9.4-16.6)g/dL (p=0.0001); 30.73 (15-48)mg/dL and 28.83 (16-41)mg/dL (p=0.067); 1.07 (0.74-1.79)mg/dL and 1.10 (0.77-1.75)mg/dL (p=0.242), respectively. The causes of difficulty in UAS placement were mainly the failure of insertion at ureteric orifice due to orifice shape and angle (not stenosis) in 18 (72%), narrow ureter in 3 (12%), twisted ureter in 3 (12%) and duplex ureter in 1 (4%) of patients. Angulation deformity with kinking was observed in 10 (40%) of operations. No buckling or kinking due to external force was noted. Providing a smooth insertion force of the F-URS accomplished insertion in patients with angulation deformities without difficulties. Mild mucosal heamorragia was observed in 16 (64%) patients. Mean operation time was 57 minutes and each operation ended with success.CONCLUSIONS: Application of UAS under direct visualization provides a safer UAS placement, makes the F-URS more applicable, and we think this technique decreases the operation time when there is difficulty in UAS placement.
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OBJECTIVES: To investigate the postoperative surgical complications and patient satisfaction with the outside-in transobturator tape (TOT) procedure performed by an experienced surgeon compared to those performed by residents in training.METHODS: Patients who received TOT surgery performed by a resident under supervision of a faculty were included in group 1 (n=31) whereas, patients operated by the same faculty were included in group 2 (n=26). Both groups were compared for demographic data, procedure results, satisfaction rates as well as intraoperative and early postoperative (urinary retention, vaginal erosion, dyspareunia, infection, abnormal discharge) complications. Statistical Package for Social Sciences for Windows was used for statistical analyses. For continuous variables Mann-Whitney U test and for categorical variables Chi-square, Fishers exact tests were used.RESULTS: Stress incontinence in groups 1 and 2 were either completely cured or improved in 87.1% and 84.6%, respectively. The question” Would you like to have an operation like this again?” was answered positively by 26 (83.9%) of patients in group 1 and by 22 (84.6%) in group 2. There was no significant difference between two groups for the complication rates occurred within 90-days period. However, there was a significantly higher groin pain persisting more than three weeks in group 1 (38.7%) compared to group 2 patients (7.7%). CONCLUSIONS: There was statistically significant increased groin pain in the early period in TOT procedures performed by the residents. However, the complications observed in both groups did not affect the success rate or patient satisfaction.
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OBJECTIVES: Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly difficult to diagnose due to an alteration in the common embryologi-cal development of the reproductive and urinary tract, with renal agenesis, double collecting system, renal duplication and horseshoe kidney as urologic abnormalities. Due to its rarity and associated urological alterations, we believe that the urologist should be aware of this syndrome because of its implications.MATERIAL AND METHODS: We present the case of an 18-year-old patient with acute retention of urine associated with Herlyn-Werner-Wunderlinch syndrome. We describe this syndrome after a bibliographic search.RESULTS: In our case, the initial clinical course was exclu-sively urological, with the presentation of voiding bladder dysfunction with subsequent acute retention of urine. Surgi-cal treatment resolved the patient’s initial complication.CONCLUSIONS: In this case, as in others, nonspecific and variable symptoms may delay the diagnosis, which may lead to late complications such as endometriosis, ad-hesion syndrome, collections and infertility. Treatment sup-presses pain, improves reproductive capacity and prevents late complications.
Case Report
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OBJECTIVE: Update of clear cell (tubulo) papillary renal cell carcinoma.METHODS: We provide the only three cases described to date in our hospital.RESULTS: One of the new entities of epithelial renal tumors incorporated by the International Society of Urological Pa-thology (ISUP) in 2013 was the clear cell (tubulo) papillary renal cell carcinoma (RCCtpcc). Although initially was de-scribed under other nomenclatures, it was not until 2013 that it was clearly defined.CONCLUSION: The RCCtpcc is usually a low grade and stage subtype of epithelial RCC. It predominates in the sixth decade of life, although cases have already been described in children and young adults. It has a typical immunohistochemical pattern with positive CK7, vimentine, VT and smooth muscle antigen, and negative CD10. They usually have a low malignant potential.
