OBJECTIVE: To evaluate the cost-effectiveness of mirabegron in comparison to the antimuscarinic drugs tolterodine, solifenacin and fesoterodine, in the treatment of urgency, increased micturition frequency and urinary incontinence in patients with overactive bladder (OAB).MATERIAL AND METHODS: A Markov model in Excel, with a time horizon of 5 years was developed from the National Health System and societal perspective. Clinical effectiveness was estimated from a clinical trial (SCORPIO) and a network meta-analysis. Unit costs were obtained from Spanish sources. The effectiveness of the treatments was measured as quality adjusted life-years (QALY). Deterministic and probabilistic sensitivity analyses were performed.RESULTS: For the 5-year time horizon, the incremental cost per patient with mirabegron 50 mg versus tolterodine was € 195.52 and € 157.42, from the National Health System (NHS) and societal perspectives respectively, with a gain of 0.0127 QALY with mirabegron. Consequently, the cost of gaining a QALY with mirabegron versus tolterodine was 15,432 € and 12,425 € respectively. The probability that mirabegron would be cost-effective at a willingness to pay threshold of € 30,000 was: 70% (NHS) and 71% (society) versus tolterodine; 94% (NHS and society) versus solifenacin 5 mg; 84% (NHS) and 84.5% (society) versus solifenacin 10 mg; 96% (NHS and society) versus fesoterodine 4 mg; 98% (NHS) and 99% (society) versus fesoterodine 8 mg. The highest probability that mirabegron would be cost-effective at a willingness to pay threshold of € 20.000 and € 25.000 per QALY gained, is obtained versus fesoterodine 4 mg and 8 mg from both NHS and society perspectives.CONCLUSIONS: The treatment of patients with OAB with mirabegron 50 mg is likely to be cost-effective compared to treatment with antimuscarinics.
INTRODUCTION: Prostate re-biopsy does not guarantee detection of prostate cancer (PC), sometimes leading to overdiagnosis of clinically insignificant tumors. The present study shows the incidence of PC in our hospital and analyzes the distribution of risk groups and prognosis depending in the diagnosis obtained by first biopsy vs rebiopsy.OBJECTIVES: 1. To know the incidence of Prostate Cancer (PC) in patients biopsied in our hospital during the years 2014, 2015 and 2016 as well as the distribution by risk and prognosis groups.2. To know if there are significant differences in the distribution of risk and prognostic groups among patients diagnosed of PC by first biopsy vs rebiopsies in our hospital in the years 2014, 2015 and 2016.MATERIALS AND METHODS: A longitudinal retrospective descriptive and analytical study was performed with 496 patients undergoing prostate biopsy (PB) in our hospital between January 1st 2014 and December 31st 2016. We analyze the results of prostate biopsy, Gleason score and distribution by prognosis group to verify if there were significant differences between first biopsy vs prostate biopsy.RESULTS: The rate of positive PB in first biopsy was 38.3% compared to 26.8% in rebiopsy. There were significant differences (p=0.01). In our series we diagnosed in first biopsy 71.8% of significant PC and the 90% of the of bad or very bad prognosis PC (groups 4 and 5 according to the ISUP classification).CONCLUSIONS: There are significant differences in the diagnosis of prostate cancer between a first biopsy and a rebiopsy. Tumors diagnosed by rebiopsies have a better prognosis than those diagnosed by first biopsy. We must adopt mechanisms to increase the diagnostic yield of re-biopsies.
OBJECTIVES: Tissue array (TA) technology is widely used as a method for the in situ investigation of tissue markers in cancer studies. A limitation of this tech-nique is the high price of tissue arrayers. We describe two easy and non-expensive manual methods, that have produced small and medium format arrays.MATERIAL AND METHODS: 16 TAs were manually constructed from conventional paraffin blocks using two different techniques. For the first method, a 16G Tru-Cut needle whose bevel edge had been cut, was used to make the holes in the donor blocks (80 cases) and the receptor ones (resulting in 2 TAs each one with 55 cases and two with 25 cases). In the second technique, a 4 mm-diameter punch for cutaneous biopsies was applied to the donor blocks (obtaining 210 cylinders from 108 blocks) and to the receptor ones (12 TAs). Hematoxy-lin-eosin, immunohistochemical and in situ hybridization stains were performed on sections from these TAs.RESULTS: The tissue loss rate in the sections obtained from the TAs constructed with the first method was 26.5%, but as two cylinders were included from each case, at least one of them was retained. There was not any loss of tissue in the sections from the TAs constructed with the second method. The results of all of the stains performed were successful.CONCLUSIONS: These two manual methods of elab-oration of TAs result rather simple and they are econom-ical. The tissue loss rate is significant in the first method but it can be compensated embedding more than one cylinder from each donor block. There was not any problem in the sectioning of the TAs constructed with the second method.
Testicular microlithiasis (TM) is an un-common urologic condition incidentally diagnosed by scrotal ultrasound. It has been associated with different diseases, such as Klinefelter`s syndrome, testicular at-rophy, cryptorchidism, testicular torsion, and infertility. However, it can also present in healthy males that have no associated risk factors. Currently, TM is most often detected thanks to the superior resolution of today’s ultra-sound equipment, compared with former models. In the 1990s, TM was considered a benign condition with no important clinical relevance, but later reports associat-ed it with the development of testicular neoplasias and infertility. Thus, many authors recommended periodic surveillance with tumor markers and ultrasound imaging, with some even promoting the use of testicular biopsy. The aim of this article is to clearly and specifically pres-ent current information about testicular microlithiasis, to establish both diagnostic and follow-up indications.
OBJECTIVES: According to the World Health Organization (WHO) definition, infertility is “the failure of a sexually active, non-contracepting couple to achieve pregnancy in one year” and is a complicated disorder with its medical, psychosocial and economic aspects. There is some proof that vitamin D deficiency has important effects on the male reproductive system. There are numerous animal trials and a limited number of human trials investigating this topic. In our study, the purpose is to consider vitamin D deficiency as a cause of infertility and investigate the relationship of serum vita-min D levels and infertility primarily in our region where exposure to sunlight is relatively low.MATERIALS AND METHODS: Between 01.10.2014 and 01.05.2015, 103 patients between the ages 20-40 that applied because of infertility were included in the study as the study group, and fertile male patients between the ages 20-40 that applied for reasons oth-er than infertility were included as the control group. A detailed anamnesis was obtained and physical ex-aminations were performed in all patients participating in the study. The ages, duration of marriage, primary diagnoses and presence of other diseases were ques-tioned, semen analyses were performed. The serum tes-tosterone, vitamin D, Ca (Calcium), follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels were tested after a 12 hour fasting period between 10:00 and 12:00 in the morning.RESULTS: There was no significant difference between the study group and control group in demographic fea-tures and serum testosterone levels. Vitamin D deficien-cy was detected in 89 (86.4%) patients of the study group and 33 (66%) of the control group. A significant difference of vitamin D deficiency rates was detected between the groups (p<0.05).CONCLUSION: It has been shown that vitamin D has important functions in the male reproductive system. In patients with vitamin D deficiency, the semen parame-ters are affected negatively and vitamin replacement is required.
OBJECTIVE: Urethrorrhagia after radical prostatectomy(RP) is very uncommon, regardless of the sur-gical approach used. Arterio-urethral fistula formation be-tween internal pudendal artery branches(IPA) and bulbar urethra is an exceptional finding. METHODS: We report what we consider the first series of two cases (one has already been published) of urethrorrha-gia after open retropubic RP due to urethrovascular fistula formation with its origin in the IPA or in one of its terminal branches.RESULTS: Both cases were diagnosed with contrast-en-hanced CT, confirmed with arteriography, and they were treated with superselective transarterial embolization(STE) with spongostan. After 5 years, the first case maintains erectile function using tadalafil on demand. The other case is in the 2nd postoperative month.CONCLUSION: Severe urethrorrhagia after RP is an ex-ceptional complication. The existence of an arterio-urethral fistula must be considered when both urethrorrhagia and abnormal bulbar enhancement in CT are present. Arteriog-raphy allows to confirm the diagnosis, most frequently in-volving IPA distal branches. STE is an effective and safe treatment.
OBJECTIVE: Even though there is no estab-lished standard therapy for Eosinophilic cystitis (EC), the series of cases guide us in the treatment of patients. We report our therapeutic experience with hydrodistention and complementary methods. In order to establish a standard treatment in patients with EC.METHODS: Retrospective review of the clinical history of a patient diagnosed with eosinophilic cystitis.RESULTS: A 66-year-old woman presented female urethral syndrome 1 year before and was initially treated as a chronic cystitis. After further investigations including cystos-copy and bladder biopsy, she was diagnosed with EC. Urothelial mucosa bleeding was evidenced and cauteriza-tion and hydrodistention were performed. After the surgical treatment, corticosteroids and antibiotics were initiated. The maintenance treatment was continued with Vitamin C, Maurita flexuosa and Peumus boldus. The patient’s condi-tion has been improving and she is still asymptomatic one year later.CONCLUSION: The efficacy of treatment with hydrodisten-tion, corticosteroids and antibiotics showed positive results in short and long term in this patient. Vitamin C, Maurita flexuosa and Peumus boldus showed favorable results in EC maintenance treatment.
OBJECTIVE: We present two rare cases of bladder xanthomata associated with transitional cell carci-noma.METHOD AND RESULTS: Cases description and selection of related pictures. Review of the existing literature.CONCLUSIONS: Xanthomata are non-neoplastic lesions consisting of group of foamy lipidstoring histiocytes in the dermis of skin or in the lamina propria of mucosa. Urinary bladder is an uncommon localization for these lesions and their etiology isn’t still well understood, being variably as-sociated with abnormalities of lipid metabolism. Although sometimes they are described in association with urothelial neoplasms, they were not believed to have any biological neoplastic potential and so they are treated consequently.