OBJECTIVE: To determine the association between surgical and postoperative outcomes as well as cancer follow-up of patients who underwent radical prostatectomy according to body mass index (BMI). METHODS: An analytical observational study with retrospective data collection was conducted. We reviewed the medical records of all the patients who underwent radical prostatectomy between the years 2012-2014. The analysis of the data included a bivariate model to study the associations between BMI and the surgical procedure, its complications, oncologic outcomes and cancer follow-up. Then, we used multivariate logistic regression analysis to determine if there was an independent association between oncologic outcomes and BMI; the model was adjusted by age, hypertension and diabetes mellitus. RESULTS: 272 patients underwent radical prostatectomy: 98 (36.0%) had normal BMI, 142 (52.2%) were overweight and 32 (11.8%) were obese. The median age was 61 interquartile range (IQR=56-66) years old. There were no statistically significant differences in the preoperative and postoperative outcomes according to BMI. The obese patients had longer operative time (176 minutes, IQR=165.0-195.5); nonetheless, the difference was not statistically significant (p=0.18). There were no complications during the procedure (rectal, vascular or obturator nerve injury). The multivariate analysis showed that age, hypertension and diabetes mellitus were not effect modifiers. CONCLUSIONS: Our study suggests that there are no differences between surgical and postoperative outcomes according to BMI. This study represents a starting point for future research in our population to determine the impact of the BMI on prostate cancer and its management.
OBJECTIVES: Urinary incontinence (UI)is a significant complication after radical prostatectomy(RP). Although sphincter incompetence is consideredthe main cause; bladder dysfunction can contributesubstantially. Our objective was to evaluate the results of the urodynamic study (UDS) in men with UI after radicalprostatectomy and analyze the correlation betweensymptoms and urodynamic parameters.METHODS: We carried out a retrospective studyreviewing the symptoms and urodynamics in patientswith urinary incontinence after RP. We describe thesymptoms, urodynamic findings and we analyze thecorrelation between both.RESULTS: Our study included 74 patients. The mediannumber of pads used per day was 3. 61% reportedurgency, 63% stress urinary incontinence, 11% urgencyurinary incontinence and 26% mixed urinary incontinence.The UDS showed stress urinary incontinence in53% of patients, detrusor overactivity in 53% and,reduced bladder compliance in 43%. Urgency urinaryincontinence was reported in 56% of patients withreduced bladder compliance. Urodynamics showed noincontinence in 16% of patients, of whom 80% showedurgency urinary incontinence.Urodynamics data showing obstruction of the urinarytract was reported in 17% and detrusor hypo oracontractility in 36%. Among patients with obstruction,46% showed incontinence due to detrusor overactivity.The correlation of symptoms and urodynamics showedthat only 31% of patients with stress urinary incontinencehad incontinence due to detrusor overactivity inurodynamics. Among those with mixed urinaryincontinence, urodynamic stress urinary incontinenceonly was found in 42% and 33% incontinence dueto detrusor overactivity only. Finally, among thosewith symptoms of urgency urinary incontinence, theurodynamics showed detrusor overactivity in 27%.CONCLUSIONS: In patients with urinary incontinenceafter radical prostatectomy, there is a high percentageof patients with urinary tract obstruction, detrusoroveractivity and decreased compliance. Moreover, thecorrelation between symptoms and urodynamics is low.
INTRODUCTION: Various authorsargued that the voiding urgency component in mixedurinary incontinence (MUI) is different than urge urinaryincontinence (UUI). In this last case they suggest thatincontinence in MUI could be overdiagnosed in patientswith SUI, misunderstanding the leak as UUI.OBJETIVES: To evaluate clinical and urodynamiccharacteristics of patients with MUI and pure UUI.METHODS: A retrospective study of our urodynamicsdatabase was performed evaluating 450 womenwith MUI and UUI. Patients with neurogenic bladder,fistulae, urethral diverticula, previous urogynecologicsurgery, known infravesical obstruction, previous pelvicradiotherapy, urinary tract infection or psychiatricdrugs intake. A full clinical history, physical exam,uroflowmetry, filling cystometry and pressure flow studywere performed.RESULTS: There is no difference relative to age,menopause and number of births. The presence ofnocturia was bigger in the UUI group (66.4% vs. 46.1%,p 0.0004) the same as increased voiding frequency(53.6% vs. 34.6%, p 0.0006). The presence of urethralhypermobility and SUI in the physical exam was greaterthan MUI, meanwhile the presence of reduced vaginaltrophism was bigger in the UUI group. Differences insensibility or specificity were not found. The presence ofoveractive detrusor was 56.4% in pure UUI vs. 33.2% inMUI (p<0.0001). No differences in pressure flow studywere found.CONCLUSIONS: There is a significant difference in theclinical and urodynamic parameters between patientswith MUI and pure UUI. The urgency in patients withpure UUI could be related to overactive detrusor. It isprobable that many patients with MUI just have pure SUIwhich could lead to positive effects in the outcomes ofanti-incontinence surgery.
OBJECTIVES: Primary: to assess the use ofsimulators in prostate digital rectal examination and bladdercatheterization on mental workload and the level ofconfidence in medical students. Secondary: to analyzestudent satisfaction and skills acquired by students withsimulators.METHODS: We conducted a prospective, randomizedstudy on medical students. Participants were divided intotwo groups: Group 1 (G1) (only the explanation) andgroup 2 (G2) (explanation + simulator workshop). Forworkload assessment, the validated NASA-TLX questionnairewas completed. The acceptability of the activity,the degree of confidence and the skills acquired werealso evaluated.RESULTS: A total of 28 students participated in the practiceof prostate examination. All participants reporteda higher level of confidence after the theoretical explanation.34 students participated in the bladder catheterizationworkshop and all of them increased their confidenceafter the activity. The G2 showed better scoreson the acquired skills exam than the G1. Most studentsconsidered positive the incorporation of these models intheir learning. According to the NASA-TLX results, lessfrustration is experienced with the use of simulators inboth activities.CONCLUSIONS: The implementation of simulators inthe training of students may improve their level of confidence,reducing frustration when performing these explorationsin the future and improving care quality.
OBJECTIVE: To report and compare the clinical outcomes after varicocele treatment managed by open surgery, laparoscopic approach and embolization, with an emphasis in terms of recurrence, complication rate and length of surgery.METHODS: 2 different Portuguese Centers collected pre and postoperative data of patients submitted to varicocele treatment. Over a period of 8 years, 251 cases were evaluated retrospectively and 161 were included and further divided in procedure-related groups. Patients older than 35 years-old were excluded. Laparoscopic Palomo (without artery-sparing technique), artery-sparing Open Palomo surgery and retrograde percutaneous embolization were performed. As outcome measures recurrence/persistence, postoperative hydrocele and other complications were analyzed. Patients were followed a mean of 11.84 months. RESULTS: In the 72 cases in the laparoscopy group, varicocele persisted in 7% and hydrocele developed in 18%. In the 41 patients who underwent retrograde percutaneous embolization recurrent varicoceles were identified in 17% and 10% presented postoperative hydroceles. Of the 48 patients who underwent suprainguinal retroperitoneal open surgery with artery preservation, varicocele recurred in 17%, while hydroceles developed in 6%. The overall success rate, defined as absence of recurrence or persistence of the varicocele during follow-up, was 87.6%. Comparison of reactive hydrocele and recurrence rates with the variables of age, degree of varicocele and length of follow-up showed that both parameters were statistically dependent on the duration of postoperative surveillance (p<0.05).CONCLUSIONS: Comparison of all 3 groups did not revealed significant differences in varicocele recurrence and hydrocele formation (p>0.05). Pairwise group comparison showed that open surgery with artery preservation and retrograde embolization might carry a higher risk of recurrence/persistence compared to laparoscopic mass ligation of the spermatic vessels. On the other hand, the laparoscopic approach with en bloc ligation of the spermatic vessels may be associated with a higher risk of secondary hydrocele. According to our data varicocele embolization appears to be slightly less successful than laparoscopy, with similar overall complication rate. Most varicocele recurrences and postoperative hydrocele formation are seen in patients with more than 12 months of follow-up so appropriate length of postoperative surveillance is deemed necessary in these patients.
OBJECTIVE: We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics. METHODS: Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord. RESULTS: Case 1: 65 year old male, presented a left large scrotal mass of 20 x 14 x 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 x 14 x 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence. CONCLUSIONS: Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary.
OBJECTIVES: Primary renal liposarcoma is an unusual malignant mesenchymal tumor. In this context, all the previous reports were based on cases with insufficient data regarding the natural history of the disease. We decided to fill this gap, reporting the largest single institution series of patients with primary RL and a review of the already available literature. METHODS: We describe 3 cases with radiologically and histologically-confirmed RL out of 3,224 surgeries performed for primary kidney cancers over 28 years (1987-2015, 0.09%) at a single tertiary care center.RESULTS: Patients underwent open radical nephrectomy with an anterior transperitoneal access with complete resection of the retroperitoneal mass and retroperitoneal lymph node dissection; all patients died from tumor progression after a mean time of 45 months.CONCLUSIONS: In conclusion, RL is a very rare mesenchymal renal tumor, with sporadic cases reported. We reported the largest case series of primary RL. The most appropriate approach for RL is nephrectomy with complete resection of all the neoplastic tissue. Stringent follow-up scheme is required due to a high rate of disease recurrence and progression. The role of adjuvant and salvage therapy remains to be investigated.