Objectives: To assess the effectivenessand tolerability of treatment with P africanum(P. africanum) in patients with lower urinary tractsymptoms (LUTS) associated with benign prostatichyperplasia (BPH) in routine clinical practice. Material and methods: Cross-sectional observationalstudy in which 115 patients with LUTS/BPHtreated for 6 months with P. africanum (Tebetane® compuesto)in real-world clinical practice conditions wereincluded. The primary objective was to assess thequality of life (QoL) according to changes in the scoresof item 8 of the International Prostate Symptom Score(IPSS) questionnaire (a score ≥ 4 indicates a significantimpairment of QoL). Secondary objectives includedimprovement of urinary symptoms, urinary flow, satisfactionand compliance with treatment as well astolerability. Data were collected in a single scheduledvisit at 6 months of treatment with P. africanum andwere compared with data registered in the medicalrecords at the beginning of treatment. Results: After 6 months of treatment withP. africanum, the percentage of patient with significantimpairment of QoL was 22.6% as compared with45.2% at the initiation of treatment (P 0,-001). Theoverall IPSS score showed a mean decreas of -4,-5points (median -4,0, interquartile range [IQR] -7,-0 to-2,0) and 69 patients (60%) showed a clinically significantimprovement (reduction of ≥ 4 points). Therewere significant decreases in IPSS subscales of storage(mean -1,-8; median -2,-0, IQR -3,-0 to 0 (P 0,-001)and voiding (mean -1,-9; median -2,-0, IQR -3,-0 to 0)(P 0,-001) symptoms. The degree of satisfaction and compliance with treatment was high with mean scores(median) of 6,9 (7,0) and 9,2 (10), respectively in the1-10 visual analogue scale. Treatment-related adverseeffects did not occur. Conclusions: Treatment with P. africanum during6 months improved significantly QoL and LUTS inpatients with BPH, with a high level of satisfaction andcompliance with treatment, without adverse events.
An adequate search strategy is necessaryfor all health professionals, from the trainingprocess to the moments of expertise in their area.The generation of the strategy must be a methodicaland rigorous process, which begins with the researchquestion, then the databases are chosen, the specificdesign of the strategy is continued to finally managethe result in an organized and transparent manner. The ability to perform these strategies is not acquiredovernight, and probably will require the help of someoneexpert at the beginning, however, it is clear that wecan all apply it in our lives as health professionals.
Objective: to assess the capacityof the G8 questionnaire for the detection of frailty inpatients over 75 years of age with metastatic or castrationresistant prostate cancer and the relationshipof the results of this questionnaire with clinical variables,laboratory data, quality of life, functional statusand comorbidity. Material and methods: Patients over the ageof 75 with metastatic or castration-resistant prostatecancer were evaluated using the G8 questionnaire.Those with a G8 15 were subjected to comprehensivegeriatric assessment in order to evaluate the abilityof this questionnaire to predict frailty. We studiedthe relationship between G8 score and functionalstatus (ECOG), comorbidity (Charlson index), qualityof life (FACT-P and EQ5D 3L questionnaires), diseasecharacteristics and common analytical variables. Results: 64 patients were included in the study,of whom 26 scored 15 in the G8 questionnaireand were referred to geriatrics. 89% (23/26) of thepatients with a G8 score pre-fragile and 7 fragile) and only 11% (3/26) wereconsidered robust. The multivariate model showsthat the Charlson index and the EQ5D 3L score areindependent predictors of frailty. The Charlson index(OR=1.68, p=0.022) increases the probability thatthe patient has a G8 score the EQ5D-3L score (OR-0.64, p-0.021) decreases thatprobability. Both quantitative variables were recodedinto binary variables from the most predictivepoint obtained from the ROC curves and included ina model: patients with Charlson index ≥4 (OR=3.17,p=0.047) and those with EQ5D- 3L score (OR=3.35, p=0.037) increased the likelihood of obtaininga G8 scoreconditions (neither Charlson ≥4 nor EQ5D-3L score 15. However, the presence of the two conditions increasesthe probability to 71.5%. Conclusions: The score obtained in the G8questionnaire is a good predictor of frailty in elderlypatients with advanced prostate cancer. Comorbidity,as measured by Charlson's index, and quality of life,as measured by the EQ5D-3L questionnaire, are independentpredictors of frailty (score on the G8 questionnairebelow 15).
Introduction: The increased incidenceof diagnosis of kidney tumours has driveninvestigation in the area. It is known that the risk ofmalignancy is correlated with tumour size, but thereare still no specific and objective parameters to characterizethe degree of aggressiveness and to be ableto guide a treatment reliably. OBJECTIVE: To identify the relationship betweenrenal tumour size and the incidence of tumour aggressivecharacteristics. Patients and methods: A retrospective analysisof our series of renal cancers operated between 1998and 2018 was performed. The specific and cumulativeincidence of aggressive characteristics was studied.The following where considered as aggressive characteristics:Presence of sarcomatoid or epidermoiddifferentiation, tumour necrosis, stage pT3-4, histologicalhigh grade (3-4) and the presence of histologicalaggressive variants. Results: A total of 651 patients that had undergonerenal mass surgery were analysed. In tumours below2 cm the appearance of aggressive characteristicsoccurred in less than 5%. For renal masses greaterthan 2 cm, each centimetre increase correlated with arise in cumulative incidence of 2-3% for each characteristicstudied. Conclusions: In tumours below 2cm and patientswith significant comorbidities active surveillance maybe a reliable alternative to surgery.
Introduction: Non-traumatic ruptureof the pyeloureterocaliceal system (PUC) is anuncommon clinical entity. The most frequent cause isureteral obstruction due to lithiasic pathology, whichis present in up to 75%. To our knowledge, there isno description in the literature of the possible factorsassociated with this event. Our objective is to analyzethe variables associated with intravenous contrastextravasation in patients with renal colic due to singleureteral lithiasis. MATERIALS AND METHODS: We performed aretrospective, descriptive analysis of a series ofpatients who, in the context of renal colic, presentedendovenous contrast extravasation throughthe urinary system in computed tomography (CT).Patients with single ureteral lithiasis without otherassociated pathology were included. A comparisonof the samples from the group with contrast leakage(group 1) with an equal number of consecutiveCT scans without contrast leakage (group 2) in patientswith renal colic lithiasis was performed in alogistic regression model to identify risk factors forcontrast leakage. Results: There were 117 cases of contrast leakagefrom January 2013 to July 2018. Eighty-sixpercent of the lithiases were 5 mm and 79% werelocated in the lower ureter. 72% of patients presentedwith intrarenal pelvis. In the univariate analysisboth location in lower ureter, lithiasis 5 mm, andintrarenal pyelic anatomy increased the probabilityof extravasation. In multivariate model, 5 mmlithiasis increased five times the risk of extravasationcompared to larger ones, the location in distalureter increased three times and the anatomy withintrarenal pelvis increased two times compared toother location and extrarenal pelvis, respectively, ina statistically significant way the risk of presentingcontrast leakage. Conclusion: In this series, we found an increasedrisk of contrast leakage in a lithiasic renalcolic in patients with intrarenal pelvic anatomy,with lithiasis less than or equal to 5 mm and locatedin the lower ureter.
Introduction and objectives: Penile strangulation is a rare urological emergencyin our country, although not in others. Since the firstSpanish publication in 1952, 21 publications havebeen reported that have never been reviewed. The objectives of this article are to review theSpanish series and provide 2 new cases. Materials and methods: A retrospective studyof penile ring strangulation in Spain between 1952and 2019 is carried out and 2 cases are contributed.The search for articles in Medline was done withdifferent key words in English: penile incarceration,penile strangulation, constriction penis, metallic ringsand Spanish and in Google with the Spanish ones: estrangulaciónde pene. The data of the variables studiedwere analyzed using descriptive statistics. Results: We found 21 Spanish articles on penilestrangulation by rings. These included 25 patientswith a mean age of 45.4 years (range 24-82). Ringswere metallic in 21 patients (84%), non-metallic in 3(12%) and data were unavailable in 1 (4%). The purposeof the ring was to prolong sexual activity in 36%,masturbation in 12%, due to psychiatric disease 12%,alcoholism 8%, accident and incontinence 8%, andthis data was not available in 24%. Strangulation evolutiontime ranged from 2 hours to 14 days (averageof 51 hours). The ring was cut with shears in 34.7%and with saws in 17.3%. The urologist did not need tocollaborate in 68% of cases. The cities with the mostrecorded cases were Barcelona with 5 (20%) andGranada with 4 (16%). Conclusions: Penile strangulation is a seriousurological emergency. The metal ring section requiresprecision instruments. The collaboration oftraumatologists and firemen can be of great help. Itwould be advisable to have the Dremel Saw availablein hospitals.
Objectives: To investigate the correlationsbetween forkhead box D1 (FOXD1) expressionand clinicopathological characteristics of bladdercancer and influence on the biological behaviors ofbladder cancer cells. Methods: The overall survival rate of 87 bladdercancer patients was evaluated to explore the predictivevalue of FOXD1. The expressions of FOXD1 in 87 bladdercancer tissues and 26 adjacent tissues were measuredthrough immunohistochemistry, and the correlationsbetween FOXD1 expression and clinicopathologicalcharacteristics of patients were analyzed. FOXD1 mimicand FOXD1 siRNA were mixed and transferred intoT24 cells to construct FOXD overexpression and knockdowncell lines. Cell counting kit-8, wound-healing andTranswell migration assays were performed to detectcell proliferation, migration and invasion. RESULTS: Prediction using bioinformatics websiteshowed that FOXD1 was highly expressed inbladder cancer tissues. The overall survival rate wassignificantly lower in bladder cancer patients withhigh FOXD1 expression than that in those with lowexpression (Psignificantly higher in bladder cancer tissues thanthat in adjacent tissues. The expression of FOXD1in bladder cancer tissues had no significant differencesamong patients with different gender, agesand tumor sizes, but significant differences amongthose with different tumor numbers, clinical stagesand histological grades (PNC group, the proliferation, migration and invasionof bladder cancer cells were significantly promotedin FOXD1 group and suppressed in si-FOXD1group (PCONCLUSIONS: FOXD1 is highly expressed in bladdercancer tissues and cells, being closely associatedwith the development and progression of bladder cancer.It facilitates the proliferation, migration and invasionof cells and carcinogenesis. FOXD1 may be a newtarget for bladder cancer therapy.
OBJECTİVE: Classical transverse, verticalabdominal or thoracoabdominal incisions inpediatric patients are frequently used to removelarge abdominal tumors such as hepatoblastomaand neuroblastoma. We present our initial experienceson our patients who was operated by modifiedMakuuchi incision. MATERİALS AND METHODS: We used this incisionin 6 cases with large abdominal tumors (1 hepatoblastomaand 5 neuroblastoma and/or ganglioneuroma) between January 2019 and August 2020.RESULTS: These patients had previously receivedchemotherapy according to appropiate protocol. Theexposure of surgical field was perfect with this incisionand dissection of the tumors was easily performed.Complete removal of large abdominal tumors was successfullyachieved in the patients although the masseshave close proximity and adhesions with importantstructures and organs. There was serous collection in2 patients and it resolved spontaneously. No wound infection, hernia or wound dehiscence was observedduring a mean follow-up of 9.6 months (ranged from3 to18 months). CONCLUSİON: According to our preliminary experiences, the Modified Makuuchi incision provides a niceexposure for removal of large abdominal tumors to thesurgeons and is well tolerated by children.
Objective: To study the prognosticvalues of preoperative neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) for patients with muscle-invasive bladder cancer (MIBC) undergoing radicalcystectomy. Methods: The clinical data of 186 MIBC patientsreceiving radical cystectomy from January 2013 toOctober 2015 were collected. Receiver operating characteristic(ROC) curves were plotted based on preoperativeNLR, PLR and LMR as well as survival of patientswithin 5 years after surgery. The NLR, PLR and LMRvalues of patients with different clinicopathologicalcharacteristics were described by frequencies.Recurrence-free survival curve was plotted using theKaplan-Meier method, and survival curves were comparedby the log-rank test. Independent risk factorsfor recurrence were explored by multivariate logistic regression analysis. NLR, PLR and LMR were utilizedto establish the recurrence risk scoring model, and theaccuracy for predicting recurrence was assessed byROC curves. Results: NLR groups had significantly differentpathological grade, T stage, lymph node metastasisand tumor number. The differences in age,pathological grade, T stage, lymph node metastasisand tumor number were significant between PLRgroups. Gender, pathological grade, T stage, lymphnode metastasis, tumor number and tumor sizehad significant differences between LMR groups(Pfree survival rate between NLR≥2.45 andNLRand PLRLMR≥3.72 and LMR33.61%) (Ptumor number, lymph node metastasis, NLR, PLRand LMR were independent risk factors for MIBCpatients. After these factors were included into therecurrence risk scoring model, the area under ROCcurve was 0.821. Conclusions: Preoperative NLR, PLR and LMRare potential biomarkers for determining the prognosisof MIBC patients, and the combination of independent risk factors may work better for prognosticevaluation.
We present the case of a 72-year-oldman who underwent laparoscopic radical cystectomywith 8po Bricker urinary diversion in 2016 for muscle-invasive bladder cancer. During his follow-upswith our stomatotherapist, the patient started to developperistomal granulomas. Our aim is to eliminate the granulomas formed and prevent the appearanceof new lesions by controlling the urinary pH throughthe administration of Lit-Control® pH Down. The useof Lit-Control® pH Down in our patient has succeededin lowering urinary pH, eliminating part of the peristomalgranulomas, and improving urinary parameterssuch as urine odour and colour.
Introduction: Lymphoepitheliomalikedifferentiation is a rare histological variant of urothelialbladder carcinoma, therefore its prognosis and treatmentare not clearly defined. A retrospective study of 5cases in the last 10 years in our center was performed. Case report: cystectomy was performed in 4 of5 because they were non-metastatic muscle-invasivetumors at diagnosis, in the 5th TURB + BCG because itwas non-muscle-invasive. 2 patients received chemotherapyand 1 adjuvant radiotherapy, and 1 immunotherapyafter relapse. 2 had a pure lymphoepithelioma-like pattern, 2 predominant and 1 focal. Discussion: In predominant or pure forms, agood response to treatment with TURB and adjuvantchemotherapy has been described, even superior tocystectomy, as it is a variant with a very favorable responseto platinum. Immunotherapy is currently onlyindicated as second-line treatment. Conclusions: adjuvant treatment plays an importantrole as it is a highly chemosensitive variant, but more studies are needed to define the best therapeuticstrategy.