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OBJECTIVES: To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers.METHODS: Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant.RESULTS: 75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy. CONCLUSIONS: Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients.
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OBJECTIVES: To perform an external validation of CAPRA-S Score to determine prediction of biochemical recurrence, metastasis and death by PCa after RP in Argentinian population.METHODS: 216 patients were studied. The probability of the score to predict biochemical recurrence after RP was analyzed by the Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survivals were determined by Kaplan method. The accuracy of CAPRA-S score to predict biochemical recurrence, metastasis and death by PCa was made in accordance with Harrells concordance index.RESULTS: Median follow up was 74 months. Biochemical recurrence index increased proportionally with the increment of CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rates were 85%, 54% and 4% respectively. Concordance index (C-Index) for biochemical progression, metastasis and death by PCa were 0.85, 0.90 and 0.90 respectively.CONCLUSIONS: CAPRA-S score is an easily applicable tool and has high predictive accuracy to determine biochemical recurrence, metastasis and death by PCa probabilities in our population. Concordance Index in these variables was higher than 0.85.
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OBJECTIVES: In this study we comparedneutrophil-to-lymphocyte ratio(NLR) and neutrophilto-monocyte ratio(NMR) between patients withprostate cancer after first transrectal ultrasound(TRUS)-guided biopsy and patients with benign prostatehyperplasia(BPH) after second TRUS-guided biyopsy.METHODS: A total of 224 patients who underwentmulti (≥12)-core TRUS-guided biopsy at our clinic forelevated PSA or abnormal digital rectal examination in between January 2008 and March 2015 wereretrospectively analyzed.There were 2 groups. Group1 consisted of 146 patientswith a diagnosis of prostate cancer after the first TRUSguidedbiyopsy and group 2 consisted of 78 patientswith a diagnosis of benign prostate hyperplasia aftersecond TRUS-guided biyopsy. Age, PSA, NLR and NMRvalues were compared between the two groups.RESULTS: There were no statistically significant correlationbetween PSA and NLR( p=0.46). The mean of age,PSA, NLR, NMR values in the group 1 and 2 wererespectively 64.6±7.7 and 61.6±6.9, 6.5±1.9 and5.3±1.2, 2.8±1.5 and 2.3±1.1, 9.2±3.9, 8.1±2.9(p=0.03, p=0.001, p=0.012 and p=0.30).The mean PSA, NLR ,NMR values of the group 1 weresignificantly higher than those in group 2 (p=0.002).Gleason grade and pathological stage weresignificantly increases as NLR increases.CONCLUSION: NLR and NMR in patients with BPHafter second TRUS-guided biopsy were lower than thatof those with a diagnosis of prostate cancer after the firstTRUS-guided biopsy.White blood test subtypes can beconsidered for the decision to perform a second TRUSguidedbiopsy in patients with previous negative biopsywith persistently elevated PSA.
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OBJECTIVE: To identify the prognostic factors influencing the clinical and urodynamics results on symptomatic benign prostatic hypertrophy (BHP) treatment in a series of patients with silodosin therapy from the URAL study.METHODS: A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks.RESULTS: Univariate analysis demonstrated that the variables in relationship with a decrease of urinary symptoms` punctuation postreatment (measured with the IPSS Questionnaire), a maximum peak flow (Q max) postreatment equal or superior to 15 ml/s, a postreatment postvoid residual lower to 100 ml, and a postreatment obstruction index (Bladder Outlet Obstruction Index: BOOI) equal or lower to 20 cm H2O, presented such both as a clinical and urodynamic character. The multivariate analysis demonstrated that a decreased punctuation of IPSS Questionnaire postreatment was in relationship to: a pretreatment cystometry bladder capacity (direct relationship), pretreatment Qmax (direct relationship), pretreatment postvoid residual (inverse relationship), and pretreatment BOOI (inverse relationship).CONCLUSION: The urodynamic study was very useful in the assessment of the prognostic factors in these patients.
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OBJECTIVE: The goal of this study is to analyze whether there is a need for antibiotic prophylaxis in this outpatient procedure.METHODS: Prospective observational non-randomized study including 100 patients divided into two groups:- Group 1: 48 patients receiving 500 mg of ciprofloxacin prophylaxis 1 hour before urethrocystoscopy; - Group 2: 52 patients without antibiotic prophylaxis. Before inclusion of the patients in the study, we checked the absence of urinary tract infection by means of a urinalysis obtained 3 days before the procedure. We analyze: cystoscopy indication, cystoscopy results, presence of comorbidities, urinalysis 7 days after the procedure, and urinary symptoms within 7 days of the procedure. The statistical analysis was performed using SPSS 20.0 and the statistical significance was p≤0.05.RESULTS: The average age of patients in group 1 was 66.7±12.4 versus 65.6±10.8 years in group 2 (p=0.6). There are no differences in the percentage of men/women included in the groups. 14% of patients of group 1 and 12% of group 2 presented bacteriuria, without showing any significant differences. In the multivariate study, it is observed that neither age, nor diabetes, smoking, lower urinary tract symptoms, nor immunosuppression are related with the onset of bacteriuria in the groups.CONCLUSION: We do not consider the use of ciprofloxacin as prophylaxis for flexible cystoscopy is appropriate in this area of health, since it does not reduce the presence of urinary infection or bacteriuria.
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OBJECTIVES: We present our experien- ce in single-stage bilateral retrograde intrarenal surgery (RIRS), analyzing the stone free rate (SFR), surgical time, hospital stay, pre- and post procedure creatinine, stone composition and complications. METHODS: Between April 2012 and February 2016, 24 RIRS were carried out in 12 patients with bilateral renal stones. Patients were 9 men and 3 wo- men with a median age of 47.5 (range: 55), IMC: 23.59 (range: 12.5). RESULTS: Mean number of stones per renal unit was 2.7 (range: 12), mostly located in the renal pelvis (40%), with an average size of 16.08±8.06 mm and an ave- rage stone burden of 258.54±242.59 mm2. The SFR at 3 months was 83.33%. Average operation time was 75 minutes and median hospital stay was 2 days. Three complications were recorded (25%), all of them minor (Clavien I-II). No major complications were recorded (Clavien III-V). CONCLUSIONS: Single-stage bilateral RIRS is a safe and effective tool for the treatment of patients with bila- teral renal stones.
Case Report
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OBJECTIVE: The aim of this article is to describe the surgical technique of laparoscopic resection in malignant tumors greater than 10 cm.METHODS: We present two cases, a 63 year old woman with a left adrenal heterogeneous mass of 11 cm in maximum diameter and an 80 year old man with a left adrenal heterogeneous mass 13 cm in maximum diameter. In both cases excision was performed laparoscopically using 4 trocars and the Alexis® wound retractor for specimen extraction. RESULTS: For the 63 year old woman, the histological result was malignant epithelioid angiomyolipoma, while in the case of the 80 year old man was large cell neuroendocrine carcinoma with possible pulmonary origin.CONCLUSIONS: We believe that laparoscopic surgery of large masses of malignant behavior depends on the capsular integrity and their relationship to adjacent structures rather than tumor size or the internal characteristics of tumor on imaging tests.
Case Report
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OBJECTIVE: Kidney is the most commonlyinjured organ of the genitourinary tract after trauma. Half ofblunt renal injuries are caused by traffic accidents, but sportactivities are also included as frequent causes. Skatebordingis popular among young people but it deserves beingconsidered a potential cause of severe injuries. A numberof published medical reports mainly refer to bone, joint andhead injuries but no cases have been reported on urologicor kidney trauma.METHODS: We present two cases of renal trauma inadolescent males occurred while doing skateboarding.RESULTS: The first patient had a grade 3 renal traumawith urinary extravasation, managed conservatively withureteral stenting. The second patient had a grade 4 to 5renal trauma with cardiovascular instability requiring anurgent nephrectomy.CONCLUSIONS: We would emphasize these cases asan emergent urological warning. Scientific information andmedical education should be addressed from physicians toa targeted population, in order to reduce among teens theincidence of injuries of such at-risk activity.
