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Publisher: Elsevier   (Total: 3089 journals)

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Showing 1 - 200 of 3089 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 7)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 25, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 86, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 363, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 228, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 24, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 4)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 6)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 21)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 133, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 26, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 26, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 43, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 51, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 8, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 360, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 7, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 30, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 44, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 330, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 5, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 8, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 418, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 16, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 40, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 55, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 49, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 40, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 46, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 201, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 59, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 25, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 34, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 58, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 12)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 164, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  

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Journal Cover Actas Urológicas Españolas (English Edition)
  [2 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 2173-5786
   Published by Elsevier Homepage  [3089 journals]
  • Developments in urologic oncology “OncoForum”: The best of
           2016
    • Authors: F. Gómez-Veiga; A. Alcaraz-Asensio; J. Burgos-Revilla; J.M. Cózar-Olmo
      Pages: 543 - 551
      Abstract: Publication date: November 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 9
      Author(s): F. Gómez-Veiga, A. Alcaraz-Asensio, J. Burgos-Revilla, J.M. Cózar-Olmo
      Objective To put forth new findings of urologic oncology with impact on clinical practice presented during 2016 in the main annual meetings. Acquisition of evidence This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee. Synthesis of evidence In high-risk renal-cell carcinoma after nephrectomy, disease-free survival was significantly greater for sunitinib than placebo group, with adverse events more frequents. In locally advanced and metastatic urotherial carcinoma patients, aletozumab achieved overall response rate in all subgroups of patients, included poor prognostic. In localized prostate cancer, the difference of prostate-cancer-specific mortality among active monitoring, radical prostatectomy and external-beam radiotherapy was not significant (p =0.48). In TERRAIN study, with castration-resistant prostate cancer patients, adverse events was reported in 31% and 23% of patients treated with enzalutamide and bicalutamide, respectively. Moreover, enzalutamide significantly improved median progression-free survival (15.7 months) compared bicalutamide (5.8 months) (p <0.0001). In SRTIVE study, enzalutamide reduced the risk of progression or death by 76% compared with bicalutamide (p <0.001). Conclusions In high-risk renal-cell carcinoma after nephrectomy, sunitinib has been considered as treatment choice. In localized prostate cancer, prostate-cancer-specific mortality was low irrespective of the treatment assigned (active monitoring, radical prostatectomy and external-beam radiotherapy). In metastatic castration-resistant prostate cancer new results of treatment with enzalutamide and abiraterone has been published, which have been shown beneficial effects in metastatic and no metastatic patients.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.08.011
       
  • Risk models for patients with localized renal cell carcinoma
    • Authors: J.M. Velis; F.J. Ancizu; M. Hevia; I. Merino; A. García; P. Doménech; R. Algarra; A. Tienza; J.I. Pascual; J.E. Robles
      Pages: 564 - 570
      Abstract: Publication date: Available online 12 October 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.M. Velis, F.J. Ancizu, M. Hevia, I. Merino, A. García, P. Doménech, R. Algarra, A. Tienza, J.I. Pascual, J.E. Robles
      Introduction We conducted a retrospective analysis of our series to assess the factors that influenced disease-free survival (DFS) and cancer-specific survival (CSS) for patients with localized renal cell carcinoma (RCC). We also created our own risk groups. Material and methods Between January 1990 and December 2012, 596 patients underwent surgery for localized RCC (clear cell, papillary or chromophobe). Using Cox regression models, we analyzed the clinical-pathological variables that influenced DFS and CSS and designed risk groups for DFS and CSS with the variables. Results The median follow-up for the series was 5.96 years. By the end of the study, 112 patients (18.8%) had a recurrence of the disease, with DFS rates of 82%, 77% and 72% at 5, 10 and 15 years, respectively. The independent factors that influenced DFS in the multivariate study were the following: A Furhman grade of 3–4, haematuria, lymphocytic or vascular invasion, the presence of tumor necrosis and a disease stage pT3-pT4. Furthermore, by the end of the study, 57 patients (9.6%) died due to renal cancer, with CSS rates of 92%, 86% and 83% at 5, 10 and 15 years, respectively. The independent factors that influenced CSS in the multivariate study were the following: A Furhman grade of 3–4, perinephric fat invasion and the presence of tumor necrosis. Conclusions Factors in addition to the disease stage pT3-pT4 in patients with localized RCC are important, such as the presence of haematuria and lymphocytic or vascular invasion for DFS. A Furhman grade of 3–4 and the presence of tumor necrosis are especially relevant for DFS and CSS.

      PubDate: 2017-10-18T08:20:17Z
      DOI: 10.1016/j.acuroe.2017.08.007
       
  • Shockwave lithotripsy with music: Less painful and more satisfactory
           treatment
    • Authors: D.G. Ordaz Jurado; A. Budia Alba; P. Bahilo Mateu; M. Trassierra Villa; D. López-Acón; F. Boronat Tormo
      Pages: 584 - 589
      Abstract: Publication date: November 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 9
      Author(s): D.G. Ordaz Jurado, A. Budia Alba, P. Bahilo Mateu, M. Trassierra Villa, D. López-Acón, F. Boronat Tormo
      Introduction The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients’ pain. Material and method A simple, blind randomization was undertaken of patients with kidney and ureter stones attending an ESWL session of 7000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2 questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0–10). Questionnaire B also had a question on satisfaction and comfort (Likert 0–10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2000, 5000 and 7000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X 2/Fisher test and a multiple linear regression model. Results The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. Conclusion Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.08.006
       
  • Diagnostic yield of lumbosacral magnetic resonance imaging requested by
           pediatric urology consultations
    • Authors: M. Fernández-Ibieta; J. Rojas Ticona; V. Villamil; M.J. Guirao Piñera; A. López García; G. Zambudio Carmona
      Pages: 596 - 601
      Abstract: Publication date: November 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 9
      Author(s): M. Fernández-Ibieta, J. Rojas Ticona, V. Villamil, M.J. Guirao Piñera, A. López García, G. Zambudio Carmona
      Objectives In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by pediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism. Patients and methods A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the pediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analyzed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0. Results We analyzed 21 patients during the period 2011–2015. The median age was 6 years (3–10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, p =0.04; OR= 34; 95% CI: 1.5–781 for both endpoints). Conclusions The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, “cramps”) can experience a greater diagnostic yield or positive predictive value.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.08.002
       
  • Ultrasound-guided percutaneous radiofrequency ablation for treating small
           renal masses
    • Authors: E. Trilla; C. Konstantinidis; X. Serres; D. Lorente; J. Planas; J. Placer; C. Salvador; A. Celma; C. Montealegre; J. Morote
      Pages: 497 - 503
      Abstract: Publication date: October 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 8
      Author(s): E. Trilla, C. Konstantinidis, X. Serres, D. Lorente, J. Planas, J. Placer, C. Salvador, A. Celma, C. Montealegre, J. Morote
      Introduction The objective of this study was to analyze and assess the experience with radiofrequency ablation of small renal masses using a contrast-enhanced, ultrasound-guided percutaneous approach for patients who are not suitable for surgical resection and/or who refused surveillance or observation. Material and method From January 2007 to August 2015, 164 treatments were performed on a total of 148 patients. We present the patients’ clinical-radiological characteristics, oncological and functional results in the short and medium term. Results The overall technical success rate was 97.5%, with a successful outcome in 1 session in 100% of the lesions ≤3cm and 92% in lesions measuring 3–5cm. The mean tumor diameter in the patients for whom the treatment was ultimately successful was 2.7cm, while the mean diameter of these in the unsuccessful operations was 3.9cm (p <.05). There were no statistically significant differences in the serum creatinine levels and estimated glomerular filtration rates. Conclusions Despite the low rate of positive renal biopsies in the series, ultrasound-guided percutaneous radiofrequency ablation for treating small renal lesions appears to be an effective and safe procedure with a minimum impact on renal function, an acceptable oncologic control in the short and medium term and a low rate of complications.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.07.003
       
  • Retrograde intrarenal surgery and micro-percutaneous nephrolithotomy for
           renal lithiasis smaller than 2 CM
    • Authors: M. Cepeda; J.H. Amón; J.A. Mainez; B. de la Cruz; V. Rodríguez; D. Alonso; J.M. Martínez-Sagarra
      Pages: 516 - 521
      Abstract: Publication date: October 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 8
      Author(s): M. Cepeda, J.H. Amón, J.A. Mainez, B. de la Cruz, V. Rodríguez, D. Alonso, J.M. Martínez-Sagarra
      Introduction Microperc is the upgraded form of percutaneous nephrolithotomy miniaturization. The aim of this study is to compare prospectively microperc and retrograde intrarenal surgery for the treatment of renal stones smaller than 2cm. Material and methods A comparative prospective study of both techniques was carried out between January 2014 and June 2015. Thirty-five patients were divided in two groups: Group A, 17 patients treated by retrograde intrarenal surgery and Group B, 18 patients treated by microperc. Stone clearance was assessed using CT scan 3 months after surgery. Results Both groups were statistically comparable as demographic variables and stone size was similar (16.76mm Group A vs 15.72mm Group B). Success rate, hospital stay and JJ stenting were similar for both groups. There was no statistically significant difference regarding post-operatory complications: 17.64% Group A vs 5.56% Group B (p =0.062), all of them Clavien I and II. Surgical time was statistically different (63.82min Group A vs 103.24min Group B) as well as hemoglobin drop (0.62g/dl Group A and 1.89g/dl Group B). Conclusion Microperc is an effective and safe procedure for the treatment of renal lithiasis smaller than 2cm, which makes it a good alternative to retrograde intrarenal surgery for this stone size. However, more prospective studies that include a larger cohort are necessary to confirm our results.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.02.015
       
  • Predicting the effectiveness of extracorporeal shock wave lithotripsy on
           urinary tract stones. Risk groups for accurate retreatment
    • Authors: M. Hevia; Á. García; F.J. Ancizu; I. Merino; J.M. Velis; A. Tienza; R. Algarra; P. Doménech; F. Diez-Caballero; D. Rosell; J.I. Pascual; J.E. Robles
      Pages: 451 - 457
      Abstract: Publication date: September 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 7
      Author(s): M. Hevia, Á. García, F.J. Ancizu, I. Merino, J.M. Velis, A. Tienza, R. Algarra, P. Doménech, F. Diez-Caballero, D. Rosell, J.I. Pascual, J.E. Robles
      Introduction Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, safe and effective treatment for urinary tract lithiasis. Its effectiveness varies depending on the location and size of the stones as well as other factors; several sessions are occasionally required. The objective is to attempt to predict its success or failure, when the influential variables are known beforehand. Material and methods We analyzed 211 patients who had had previous CT scans and were treated with ESWL between 2010 and 2014. The influential variables in requiring retreatment were studied using binary logistic regression models (univariate and multivariate analysis): maximum density, maximum diameter, area, location, disintegration and distance from the adipose panniculus. With the influential variables, a risk model was designed by assessing all possible combinations with logistic regression (version 20.0 IBM SPSS). Results The independent influential variables on the need for retreatment are: maximum density >864 HU, maximum diameter >7.5mm and pyelocaliceal location. Using these variables, the best model includes 3 risk groups with a probability of requiring significantly different retreatment: group 1 – low risk (0 variables) with 20.2%; group 2 – intermediate risk (1–2 variables) with 49.2%; and group 3 – high risk (3 variables) with 62.5%. Conclusions The density, maximum diameter and pyelocaliceal location of the stones are determinant factors in terms of the effectiveness of treatment with ESWL. Using these variables, which can be obtained in advance of deciding on a treatment, the designed risk model provides a precise approach in choosing the most appropriate treatment for each particular case.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2016.12.012
       
  • Laparoscopic partial nephrectomy with prior superselective embolization as
           treatment for giant renal angiomyolipoma
    • Authors: A. Husillos Alonso; D. Subirá Ríos; E. Bolufer Moragues; I. Lopez Díez; I. Moncada Iribarren; C. González Enguita
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Husillos Alonso, D. Subirá Ríos, E. Bolufer Moragues, I. Lopez Díez, I. Moncada Iribarren, C. González Enguita
      Objective Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumor extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. Material and methods We present 3 cases of giant angiomyolipoma (10, 12 and 14cm) treated with a combined approach: superselective embolization and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. Results None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. Conclusions The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischemia time.

      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.11.002
       
  • Application of Lean Healthcare methodology in a urology department of a
           tertiary hospital as a tool for improving efficiency
    • Authors: F. Boronat; A. Budia; E. Broseta; J.L. Ruiz-Cerdá; D. Vivas-Consuelo
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F. Boronat, A. Budia, E. Broseta, J.L. Ruiz-Cerdá, D. Vivas-Consuelo
      Objective To describe the application of the Lean methodology as a method for continuously improving the efficiency of a urology department in a tertiary hospital. Material and methods The implementation of the Lean Healthcare methodology in a urology department was conducted in 3 phases: (1) team training and improvement of feedback among the practitioners, (2) management by process and superspecialization and (3) improvement of indicators (continuous improvement). The indicators were obtained from the Hospital's information systems. The main source of information was the Balanced Scorecard for health systems management (CUIDISS). The comparison with other autonomous and national urology departments was performed through the same platform with the help of the Hospital's records department (IASIST). A baseline was established with the indicators obtained in 2011 for the comparative analysis of the results after implementing the Lean Healthcare methodology. Results The implementation of this methodology translated into high practitioner satisfaction, improved quality indicators reaching a risk-adjusted complication index (RACI) of 0.59 and a risk-adjusted mortality rate (RAMR) of 0.24 in 4 years. A value of 0.61 was reached with the efficiency indicator (risk-adjusted length of stay [RALOS] index), with a savings of 2869 stays compared with national Benchmarking (IASIST). The risk-adjusted readmissions index (RARI) was the only indicator above the standard, with a value of 1.36 but with progressive annual improvement of the same. Conclusions The Lean methodology can be effectively applied to a urology department of a tertiary hospital to improve efficiency, obtaining significant and continuous improvements in all its indicators, as well as practitioner satisfaction. Team training, management by process, continuous improvement and delegation of responsibilities has been shown to be the fundamental pillars of this methodology.

      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.11.008
       
  • Validation of the prostate health index in a predictive model of prostate
           cancer
    • Authors: A. Sanchís-Bonet; M. Barrionuevo-González; A.M. Bajo-Chueca; L. Pulido-Fonseca; L.E. Ortega-Polledo; J.C. Tamayo-Ruiz; M. Sánchez-Chapado
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Sanchís-Bonet, M. Barrionuevo-González, A.M. Bajo-Chueca, L. Pulido-Fonseca, L.E. Ortega-Polledo, J.C. Tamayo-Ruiz, M. Sánchez-Chapado
      Objectives To validate and analyze the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker “[-2] pro prostate-specific antigen” using the prostate health index (PHI) in decision making for performing prostate biopsies. Material and methods We isolated serum from 197 men with an indication for prostate biopsy to determine the total prostate-specific antigen (tPSA), the free PSA fraction (fPSA) and the [-2] proPSA (p2PSA). The PHI was calculated as p2PSA/fPSA×√tPSA. We created 2 predictive models that incorporated clinical variables along with tPSA or PHI. The performance of PHI was assessed with a discriminant analysis using receiver operating characteristic curves, internal calibration and decision curves. Results The areas under the curve for the tPSA and PHI models were 0.71 and 0.85, respectively. The PHI model showed a better ability to discriminate and better calibration for predicting prostate cancer but not for predicting a Gleason score in the biopsy ≥7. The decision curves showed a greater net benefit with the PHI model for diagnosing prostate cancer when the probability threshold was 15–35% and greater savings (20%) in the number of biopsies. Conclusions The incorporation of p2PSA through PHI in predictive models of prostate cancer improves the accuracy of the risk stratification and helps in the decision-making process for performing prostate biopsies.

      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.11.006
       
  • Updates on Corynebacterium urealyticum infection
    • Authors: F.M.
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F.M. Sánchez-Martín


      PubDate: 2017-12-08T06:42:44Z
       
  • Analysis of historical articles published in ACTAS UROLÓGICAS
           ESPAÑOLAS
    • Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): M. Pérez-Albacete
      Objective On the 40th anniversary of the edition of Actas Urológicas Españolas, we assess the articles on history to determine the proportion represented, analyzing the study subjects and their relevance, getting to know the authors, the main study centers and the interest that the studies offer for understanding the specialty. Material and methods We extracted as many subjects of historic content from the journal as were published between January 1976 and December 2016. Result There were 103 historical studies representing 3% of the total number of articles, with a mean of 2.57 articles published annually, written by 127 separate urologists. As first author, there were 59 articles, and as coauthors, there were 68. The main activity came from 21 of the main university hospitals in Spain, and 43 of the articles were personal articles signed by a single individual. Their content mainly covers the facts of Spanish urology from the Renaissance to the 20th century, with special emphasis on the profile of Spanish specialists. Data on 22 of these specialists are provided in 37 articles. The evolution of diagnostic and treatment procedures, both medical and surgical, are well reflected, as are a number of diseases. Conclusion Most of the studies are personal works of historical research and represent 3% of the total number of articles. As a whole, the quality is high, and the articles provide data with interesting details and useful reviews, giving them considerable value, as well as forming a precious compendium for the understanding of the history of Spanish urology. These articles are highly recommended reading.

      PubDate: 2017-12-08T06:42:44Z
       
  • A systematic review of the diagnosis and treatment of patients with
           neurogenic hyperactivity of the detrusor muscle
    • Authors: A. Borau; J.M. Adot; M. Allué; S. Arlandis; D. Castro; M. Esteban; J. Salinas
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Borau, J.M. Adot, M. Allué, S. Arlandis, D. Castro, M. Esteban, J. Salinas
      Background Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterized by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. Objective The aim of this study is to standardize the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalized medical care. Acquisition of evidence We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. Synthesis of the evidence In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients’ continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalized based on each patient's needs. Conclusions The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients’ quality of life.

      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.11.004
       
  • Indication for early cystectomy in nonmuscle-invasive bladder cancer.
           Literature review
    • Authors: L. Cogorno Wasylkowski; E. Ríos-González; E. Linares Espinós; A. Leibar Tamayo; L. Martínez-Piñeiro Lorenzo
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): L. Cogorno Wasylkowski, E. Ríos-González, E. Linares Espinós, A. Leibar Tamayo, L. Martínez-Piñeiro Lorenzo
      Context High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumor. The treatment of choice for these tumors is transurethral resection of the bladder tumor followed by a program of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment. Objective To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment. Searching the evidence We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate. Synthesis of the evidence We identified the various prognostic factors associated with tumor progression: the persistence of T1 tumor in re-resection of the bladder tumor, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumors larger than 3cm, the substaging of T1 tumors, the presence of lymphovascular invasion and the presence of a tumor in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumor has a better cancer prognosis than those in which the operation is deferred until the progression. Conclusions In this disease, it is important to individualize the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.

      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.11.005
       
  • Approach of the patient with renal cancer: Is there a collaboration
           between urology and oncology'
    • Authors: F. Sabell Pérez-Salgado; S. Vázquez-Estévez; U. Anido-Herranz; M. Blanco-Parra; F.J. Casas-Nebra; O. Fernández-Calvo; M. Lázaro-Quintela; S. López-García
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F. Sabell Pérez-Salgado, S. Vázquez-Estévez, U. Anido-Herranz, M. Blanco-Parra, F.J. Casas-Nebra, O. Fernández-Calvo, M. Lázaro-Quintela, S. López-García


      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.11.003
       
  • New data on the combined treatment of solifenacin and mirabegron in
           patients with overactive bladder: SYNERGY study
    • Authors: Montero
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2017-12-08T06:42:44Z
       
  • The patient's comorbidity burden correlates with the erectile dysfunction
           severity
    • Authors: E. García-Cruz; A. Carrión; T. Ajami; M. Álvarez; M.Á. Correas; B. García; J.V. García; C. González; J.A. Portillo; J. Romero-Otero; C. Simón; J. Torremadé; F. Vigués; A. Alcaraz
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): E. García-Cruz, A. Carrión, T. Ajami, M. Álvarez, M.Á. Correas, B. García, J.V. García, C. González, J.A. Portillo, J. Romero-Otero, C. Simón, J. Torremadé, F. Vigués, A. Alcaraz
      Objective To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson comorbidity index (CCI). Material and methods Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. Results The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P =.002), and an increase in the CCI score (P <.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P <.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P <.001, R 2 =.426). The severity of ED significantly contributed to this model (P =.011), but total testosterone did not (P =.204). Conclusions The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.

      PubDate: 2017-12-08T06:42:44Z
      DOI: 10.1016/j.acuroe.2017.03.012
       
  • Treatment options and predictive factors for recurrence and
           cancer-specific mortality in bladder cancer after renal transplantation: A
           multi-institutional analysis
    • Authors: O. Rodriguez Faba; J. Palou; H. Vila Reyes; L. Guirado; A. Palazzetti; P. Gontero; F. Vigués; J. Garcia-Olaverri; J.M. Fernández Gómez; J. Olsburg; C. Terrone; A. Figueiredo; J. Burgos; E. Lledó; A. Breda
      Abstract: Publication date: Available online 20 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): O. Rodriguez Faba, J. Palou, H. Vila Reyes, L. Guirado, A. Palazzetti, P. Gontero, F. Vigués, J. Garcia-Olaverri, J.M. Fernández Gómez, J. Olsburg, C. Terrone, A. Figueiredo, J. Burgos, E. Lledó, A. Breda
      Objectives Bladder cancer (BC) in the transplanted population can represent a challenge owing to the immunosuppressed state of patients and the higher rate of comorbidities. The objective was to analyze the treatment of BC after renal transplant (RT), focusing on the mode of presentation, diagnosis, treatment options and predictive factors for recurrence. Material and methods We conducted an observational prospective study with a retrospective analysis of 88 patients with BC after RT at 10 European centers. Clinical and oncologic data were collected, and indications and results of adjuvant treatment reviewed. The Kaplan–Meier method and uni- and multivariate Cox regression analyses were performed. Results A total of 10,000 RTs were performed. Diagnosis of BC occurred at a median of 73 months after RT. Median follow-up was 126 months. Seventy-one patients (81.6%) had non-muscle invasive bladder cancer, of whom 29 (40.8%) received adjuvant treatment; of these, six (20.6%) received bacillus Calmette-Guérin and 20 (68.9%) mitomycin C. At univariate analysis, patients who received bacillus Calmette-Guérin had a significantly lower recurrence rate (p =.043). At multivariate analysis, a switch from immunosuppression to mTOR inhibitors significantly reduced the risk of recurrence (HR 0.24, 95% CI: 0.053–0.997, p =.049) while presence of multiple tumors increased it (HR 6.31, 95% CI: 1.78–22.3, p =.004). Globally, 26 patients (29.88%) underwent cystectomy. No major complications were recorded. Overall mortality (OM) was 32.2% (28 patients); the cancer-specific mortality was 13.8%. Conclusions Adjuvant bacillus Calmette-Guérin significantly reduces the risk of recurrence, as does switch to mTOR inhibitors. Multiple tumors increase the risk.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.05.008
       
  • Bacterial colonization of penile prosthesis after its withdrawal due to
           mechanical failure
    • Authors: B. Etcheverry-Giadrosich; J. Torremadé-Barreda; L. Pujol-Galarza; F. Vigués-Julià
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): B. Etcheverry-Giadrosich, J. Torremadé-Barreda, L. Pujol-Galarza, F. Vigués-Julià
      Introduction Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. Objective To analyze the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. Materials and method A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single center. We analyzed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. Results Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22–36.43). Conclusion In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.10.009
       
  • Antibiotic activity and concentrations in clinical samples from patients
           with chronic bacterial prostatitis
    • Authors: V. Heras-Cañas; B. Gutiérrez-Soto; H. Almonte-Fernández; A. Lara-Oya; J.M. Navarro-Marí; A. Garrido-Frenich; F. Vázquez-Alonso; J. Gutiérrez-Fernández
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): V. Heras-Cañas, B. Gutiérrez-Soto, H. Almonte-Fernández, A. Lara-Oya, J.M. Navarro-Marí, A. Garrido-Frenich, F. Vázquez-Alonso, J. Gutiérrez-Fernández
      Objectives Chronic bacterial prostatitis (CBP) is the most common urological disease in patients younger than 50 years, whose long-standing symptoms could be related to an inappropriate therapeutic regimen. The objective was to analyze the sensitivity of microorganisms isolated from patients with CBP and measure the weekly antibiotic concentrations in serum, semen and urine. Material and methods For the antibiotic sensitivity study, 60 clinical isolates were included between January 2013 and December 2014 from semen samples from patients with microbiologically confirmed CBP. Broth microdilution was performed on the samples. For the antibiotic concentration study from January to May 2014, urine, blood and semen samples were collected weekly, over 4 weeks of treatment from 8 patients with positive cultures for CBP. The concentrations were measured using ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Results The antibiotics fosfomycin and nitrofurantoin had the highest activity (95.2% in both cases). The mean antibiotic concentrations in semen during the 4 weeks studied were as follows: 1.68mg/L, 8.30mg/L, 2.61mg/L, 0.33mg/L and 2.90mg/L, respectively, for patients 1 to 5, who were treated with levofloxacin; 1.625mg/L for patient 6, who was treated with ciprofloxacin; 2.67mg/L for patient 7, who was treated with ampicillin; and 1.05mg/L for patient 8, who was treated with doxycycline. Higher concentrations were obtained in the urine samples than in serum and semen, the latter 2 of which were comparable. Conclusions Fosfomycin is proposed as the primary alternative to the empiric treatment of CBP due to its high in vitro activity. The antibiotic concentration in semen was higher than the minimal inhibitory concentration against the aetiological agent, although microbiological negativisation was not always correlated with a favorable clinical outcome.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.10.007
       
  • Radiation therapy for oligorecurrence in prostate cancer. Preliminary
           results of our centre
    • Authors: C. González-Ruiz de León; M. Ramírez-Backhaus; M. Sobrón-Bustamante; J. Casaña; L. Arribas; J. Rubio-Briones
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. González-Ruiz de León, M. Ramírez-Backhaus, M. Sobrón-Bustamante, J. Casaña, L. Arribas, J. Rubio-Briones
      Introduction and objective There is growing interest in the use of more aggressive therapeutic modalities for treating metastatic prostate cancer. In this study, we examine the use of stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate cancer. We analyzed the biochemical response and toxicity of patients who underwent this therapy at our centre. Material and method We selected patients who experienced oligorecurrence between January 2015 and December 2016 and were administered SBRT. The association of androgen deprivation (AD) was left in each case to the decision of the tumor committee. We describe the clinical situation at diagnosis of oligorecurrence, the treatment administered and the biochemical response. We considered a biochemical response to be a 50% reduction in the absolute prostate-specific antigen (PSA) readings. Results SBRT was administered to 11 patients with bone (82%) and/or lymph node oligometastasis (18%). The treatment regimen for bone oligometastasis was 27Gy divided into 3 sessions, while the treatment for lymph node oligometastasis reached 70Gy. Seven patients had no treatment at the time of diagnosis, 2 were in the castration-resistant phase, 1 patient was in the off phase of intermittent AD, and 1 patient had adjuvant AD for pN1. Seven patients presented a biochemical response with a PSA reduction of 75-100%. The response was not assessable in 4 patients due to the continuing adjuvant AD. With a mean follow-up of 10.5 months, only 2 patients had progressed. Grade 1 gastrointestinal toxicity was detected in only 1 patient. Conclusion Our data suggest that the use of SBRT in carefully selected patients with metastatic oligorecurrence of prostate cancer can achieve biochemical response and potentially delay progression and the use of systemic treatments.

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.10.008
       
  • 5α-reductase inhibitors and depression
    • Authors: Montero
      Abstract: Publication date: Available online 12 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2017-11-16T09:31:26Z
       
  • Predictors of urinary and rectal toxicity after external conformed
           radiation therapy in prostate cancer: Correlation between clinical, tumor
           
    • Authors: C.M. Martínez-Arribas; C. González-San Segundo; P. Cuesta-Álvaro; F.A. Calvo-Manuel
      Abstract: Publication date: Available online 12 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C.M. Martínez-Arribas, C. González-San Segundo, P. Cuesta-Álvaro, F.A. Calvo-Manuel
      Objective To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors. Method A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumor and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance. Results The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented hemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (p =0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses >45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy. Conclusions The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy.

      PubDate: 2017-11-16T09:31:26Z
      DOI: 10.1016/j.acuroe.2017.10.005
       
  • Prevalence of urinary incontinence and its relation with sedentarism in
           Spain
    • Authors: J.L.
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): R. Leirós-Rodríguez, V. Romo-Pérez, J.L. García-Soidán
      Objectives To determine the prevalence of urinary incontinence in the elderly Spanish population of both sexes and identify a possible relationship between physical activity habits and the presence of urinary incontinence in the elderly. Material and methods We used data from 8146 individuals older than 60 years (age range, 60–94 years), from which data from a 15-year cohort were obtained. Of these, 4745 (58.2%) were women and 3401 (41.8%) were men. We analyzed the presence of urinary incontinence, physical activity habits and the influence of other variables such as sex, age, weight and body mass index. Results We detected a prevalence of urinary incontinence of 15% for the women and 11.6% for the men. Those with urinary incontinence had a greater average age, weight and body mass index than the healthy participants. At the same time, the patient group with incontinence showed more sedentary habits compared with the healthy participants. Conclusions A strong relationship was observed between the body mass index and prevalence of urinary incontinence. Urinary incontinence was also related to attitudinal aspects such as physical inactivity, a behavior that predisposes the elderly to developing incontinence. For the first time, we observed a reduction in the prevalence of incontinence compared with previous studies.

      PubDate: 2017-11-16T09:31:26Z
       
  • Comment to «Prospective study comparing laparoscopic and open
           adenomectomy: Surgical and functional»
    • Authors: Sancha
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F. Gómez Sancha


      PubDate: 2017-11-16T09:31:26Z
       
  • Treatment algorithm proposal for patients with drug resistant overactive
           bladder syndrome
    • Authors: Montero
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2017-11-16T09:31:26Z
       
  • Appreciation to the reviewers of Actas Urológicas Españolas
    • Authors: J.M.
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.M. Fernández Gómez


      PubDate: 2017-11-16T09:31:26Z
       
  • The management of the acute ischemic priapism: A state of the art review
    • Authors: M. Falcone; A. Gillo; M. Capece; A. Raheem; D. Ralph; G. Garaffa
      Abstract: Publication date: Available online 11 November 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): M. Falcone, A. Gillo, M. Capece, A. Raheem, D. Ralph, G. Garaffa
      Objective To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP). Acquisition of evidence A systematic search for the terms “penile prosthesis”, “priapism”, “impotence”, “fibrosis”, “downsized prosthesis cylinders”, and “patient satisfaction” has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases. Synthesis of evidence Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.

      PubDate: 2017-11-16T09:31:26Z
      DOI: 10.1016/j.acuroe.2017.10.003
       
  • Sodium glucose cotransporter 2 inhibitors and males lower urinary tract
           symptoms, an aspect to consider
    • Authors: Montero
      Abstract: Publication date: Available online 18 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2017-09-20T05:51:22Z
       
  • Is there room for luminal-basal urothelial cell population
           quantification'
    • Authors: G.R. Passos; J.A. Camargo; K.L. Ferrari; G.C. Franch; A.E. Nowill; L.O. Reis
      Abstract: Publication date: Available online 15 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): G.R. Passos, J.A. Camargo, K.L. Ferrari, G.C. Franch, A.E. Nowill, L.O. Reis
      Purpose Three cell layers compose the urothelium: basal, intermediate and luminal (“umbrella cells”) and different diseases might arise from different cell populations. The aim of this study is to analyze the quantification ability of such cell populations by using four different protocols. Methods Twenty male rats (Wistar) were randomized in four groups of five animals: scraping, enzymatic 30, 45 and 60min. The cells were isolated, analyzed by flow cytometer and data processed by BD FACSDIVA™ software. Results The urothelium was separated in two cell populations that are different in size and complexity. The group that showed more efficiency in cells dissociation and cells separation was enzymatic protocol 45min. Conclusions Enzymatic protocol 45min was able to isolate urothelial cell populations and might be explored as potential prognostic tool, patient selection and therapeutic target in urothelial diseases. Future studies should validate the potential clinical application to the proposed rational of luminal-basal paradigm in the urothelial cancer as hope for individualized approach.

      PubDate: 2017-09-20T05:51:22Z
      DOI: 10.1016/j.acuroe.2017.07.004
       
  • Comment to: “Management and follow-up of the male with lower urinary
           tract symptoms secondary to benign prostate hyperplasia”
    • Authors: Montero
      Abstract: Publication date: Available online 13 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2017-09-15T05:22:37Z
       
  • Adjuvant intravesical treatment for non-muscle invasive bladder cancer:
           The importance of the strain and maintenance
    • Authors: F. Guerrero-Ramos; A. Lara-Isla; J. Justo-Quintas; J.M. Duarte-Ojeda; F. de la Rosa-Kehrmann; F. Villacampa-Aubá
      Abstract: Publication date: Available online 12 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F. Guerrero-Ramos, A. Lara-Isla, J. Justo-Quintas, J.M. Duarte-Ojeda, F. de la Rosa-Kehrmann, F. Villacampa-Aubá
      Background and objective Intravesical Bacillus Calmette-Guérin (BCG) is essential for preventing recurrence and progression of Non-muscle invasive bladder cancer (NMIBC). The aim of our study was to compare the efficacy and toxicity of the Connaught and Tice strains, as well as the importance of the maintenance schedule. Material and methods We retrospectively reviewed 110 patients with NMIBC who underwent adjuvant endovesical treatment. The patients were distributed into 3 groups, based on whether the treatment was with the Connaught strain, the Tice strain or both sequentially. We calculated the recurrence-free survival rate in each group and compared the patients who completed the maintenance treatments against those who did not. To identify the predictors of recurrence, we performed a multivariate analysis. We also assessed the toxicity by analyzing the onset of BCGitis, urinary urgency, fever, urinary tract infection and treatment withdrawal due to adverse effects. Results We found no differences in the efficacy parameters. The patients in the Connaught group completed the maintenance to a lesser extent (38.4 vs. 72% for the Tice group and 76.3% for both strains group; p =0.010). The patients who completed the maintenance had better recurrence-free survival at 60 months (88.5 vs. 74.2%; p =0.036), regardless of the strain used. The following risk factors of recurrence were identified by multivariate analysis: size larger than 3cm, more than 3 implants and not completing the manteinance. Patients under therapy with Connaught strain had a higher rate of BCGitis, with no differences in the other events studied. Conclusion Completing the maintenance phase is essential, regardless of the strain employed. The Connaught strain has a greater risk of BCGitis, and a sequential regimen could be useful in certain scenarios.

      PubDate: 2017-09-15T05:22:37Z
      DOI: 10.1016/j.acuroe.2017.08.008
       
  • Usefulness of GATA-3 as a marker of seminal epithelium in prostate
           biopsies
    • Authors: J.A. Ortiz-Rey; D. Chantada-de la Fuente; M.Á. Peteiro-Cancelo; C. Gómez-de María; M.P. San Miguel-Fraile
      Abstract: Publication date: Available online 6 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.A. Ortiz-Rey, D. Chantada-de la Fuente, M.Á. Peteiro-Cancelo, C. Gómez-de María, M.P. San Miguel-Fraile
      Objectives The incidental presence of seminal vesicle epithelium in prostate needle biopsies is generally recognizable through routine microscopy. However, it can sometimes be erroneously interpreted as malignant due to its architectural and cytological characteristics, and immunohistochemistry can be useful for correctly identifying the seminal epithelium. Our objective was to analyze the potential usefulness of GATA-3 as a marker of seminal epithelium. Material and methods Through immunohistochemistry with a monoclonal anti-GATA-3 antibody (clone L50-823), we studied seminal vesicle sections from 20 prostatectomy specimens, 12 prostate needle biopsies that contained seminal vesicle tissue and 68 prostate biopsies without seminal vesicle epithelium, 36 of which showed adenocarcinoma. Results Staining for GATA-3 was intense in the 20 seminal vesicles of the prostatectomy specimens and in the 12 prostate needle biopsies that contained seminal epithelium. In the 60 biopsies without a seminal vesicle, GATA-3 was positive in the prostate basal cells and even in the secretory cells (57 cases), although with less intensity in 55 of the cases. One of the 36 prostatic adenocarcinomas tested positive for GATA-3. Conclusions The intense immunohistochemical expression of GATA-3 in the seminal vesicle epithelium can help identify it in prostate biopsies. This marker is also positive in the basal cells of healthy prostates and, with less intensity, in the secretory cells. Positivity, weak or moderate, is observed on rare occasions in prostatic adenocarcinomas.

      PubDate: 2017-09-08T23:42:02Z
      DOI: 10.1016/j.acuroe.2017.08.009
       
  • Small-caliber percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision
           algorithm
    • Authors: J.H. Amón Sesmero; M. Cepeda Delgado; B. de la Cruz Martín; J.A. Mainez Rodriguez; D. Alonso Fernández; V. Rodriguez Tesedo; D.A. Martín Way; J. Gutiérrez Aceves
      Abstract: Publication date: Available online 5 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.H. Amón Sesmero, M. Cepeda Delgado, B. de la Cruz Martín, J.A. Mainez Rodriguez, D. Alonso Fernández, V. Rodriguez Tesedo, D.A. Martín Way, J. Gutiérrez Aceves
      Introduction The progressive reduction in the caliber of the tract in percutaneous kidney surgery to the point of miniaturization has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). Objective To provide an update on the various techniques of small-caliber nephrolithotomy (SC-PCNL) analyze their efficacy, safety and indications and determine their degree of implantation at this time. Material and methods We performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. Results The use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. Conclusions The indications for PCNL are expanding to small stone sizes due to the miniaturization of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis.

      PubDate: 2017-09-08T23:42:02Z
      DOI: 10.1016/j.acuroe.2017.08.001
       
  • Primary signet ring cell carcinoma of the prostate with response to
           abiraterone
    • Authors: F. Sáez Barranquero; B. Herrera Imbroda
      Abstract: Publication date: Available online 5 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F. Sáez Barranquero, B. Herrera Imbroda


      PubDate: 2017-09-08T23:42:02Z
      DOI: 10.1016/j.acuroe.2017.08.005
       
  • Prognostic factors for vesical relapse in patients with upper urothelium
           tumours treated with surgery
    • Authors: J. Aragón Chamizo; F. Herranz Amo; C. Hernández Fernández; C. González Enguita
      Abstract: Publication date: Available online 5 September 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J. Aragón Chamizo, F. Herranz Amo, C. Hernández Fernández, C. González Enguita
      Objective To identify the prognostic factors for vesical relapse in patients with tumours of the upper urothelium treated with surgery. Material and methods We conducted a retrospective analysis of patients with tumours of the upper urothelium who underwent surgery between 1999 and 2011 at our centre (139 patients). We collected demographic, clinical, diagnostic and pathological variables, as well as the treatment, complications and progression. A descriptive analysis was performed using the chi-squared test for categorical variables and the ANOVA test for continuous variables. We also performed a univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered when p <0.05. All calculations were performed with SPSS Statistics version 21. Results During the follow-up, 26.6% of the patients (37 cases) showed vesical relapse. Some 19.6% of the patients with no history of bladder tumours showed a bladder tumour relapse compared with 48.6% of the patients with a history of bladder tumours (p <0.001). In the multivariate analysis, only the presence of bladder tumours prior to or concomitant with the upper urinary tract tumour diagnosis was identified as an independent predictor of bladder tumour relapse (p =0.007). Conclusion In our series, only the presence of a prior or synchronous bladder tumour behaved as an independent predictor of bladder tumour relapse in patients with tumours of the upper urothelium treated with surgery.

      PubDate: 2017-09-08T23:42:02Z
      DOI: 10.1016/j.acuroe.2017.08.003
       
  • Reflections on lower urinary tract symptoms in older population: Proposal
           for a different classification
    • Authors: A. Alcántara Montero; F.J. Brenes Bermúdez
      Abstract: Publication date: Available online 12 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero, F.J. Brenes Bermúdez


      PubDate: 2017-08-24T20:06:13Z
      DOI: 10.1016/j.acuroe.2017.07.009
       
  • Shock wave therapy for erectile dysfunction: The lack of evidence at the
           Latin America and Caribbean level
    • Authors: J. Saldaña-Gallo; J.S. Torres-Román; J.A. Grandez-Urbina
      Abstract: Publication date: Available online 10 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J. Saldaña-Gallo, J.S. Torres-Román, J.A. Grandez-Urbina


      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2016.10.001
       
  • New technique for nephron-sparing surgery in polar tumors. A modification
           of the Kim technique
    • Authors: C. Ameri; F.M. Lopez; G.J. Vitagliano; H. Rios Pita; J.M. Guglielmi; L. Blas
      Abstract: Publication date: Available online 10 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. Ameri, F.M. Lopez, G.J. Vitagliano, H. Rios Pita, J.M. Guglielmi, L. Blas
      Introduction and objectives Nephron-sparing surgery (NSS) is the indication, provided it is feasible and meets the international treatment guidelines. One of the objectives of performing NSS is to reduce the ischemia time as much as possible. We propose a surgical technique for treating polar renal tumors and those larger than 4cm based on the principle of the technique described by Kim in 1964. Method The technique performs a continuous circular suture on the base of the tumor, achieving compression of the renal pole without vascular clamping, facilitating haemostasis and avoiding the blind transfixion performed in Kim's original technique. We selected 28 patients for the implementation of the technique. Results The patients’ mean age was 56 years (30–69). The RENAL scores were as follows: 12 of low complexity, 12 of moderate complexity and 4 of high complexity. The mean surgical time was 109minutes (75–140), and the mean estimated blood loss was 120mL (50–300mL). No positive margins were identified, and no patients required blood transfusions. The mean stay was 3.7 days (2–6). There were no Clavien grade 2 or higher complications. There were 3 Clavien 1 complications (fever). The difference in glomerular filtration rate was –0.71mL/min/m2. The pathology was malignant in 26 cases, 19 of them clear-cell carcinomas. Two cases were reported as oncocytomas. Conclusion The proposed technique showed acceptable results, with a low rate of complications in the patient group.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.008
       
  • Immunohistochemical study of the neural development transcription factors
           (TTF1, ASCL1 and BRN2) in neuroendocrine prostate tumors
    • Authors: E. Rodríguez-Zarco; A. Vallejo-Benítez; S. Umbría-Jiménez; S. Pereira-Gallardo; S. Pabón-Carrasco; A. Azueta; R. González-Cámpora; P.S. Espinal; A. García-Escudero
      Abstract: Publication date: Available online 10 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): E. Rodríguez-Zarco, A. Vallejo-Benítez, S. Umbría-Jiménez, S. Pereira-Gallardo, S. Pabón-Carrasco, A. Azueta, R. González-Cámpora, P.S. Espinal, A. García-Escudero
      Objective Prostatic small-cell neuroendocrine carcinoma is an uncommon malignancy that constitutes 0.5–1% of all prostate malignancies. The median cancer-specific survival of patients with prostatic small-cell neuroendocrine carcinoma is 19 months, and 60.5% of the patients have metastatic disease. Neural development transcription factors are molecules involved in the organogenesis of the central nervous system and of neuroendocrine precursors of various tissues, including the suprarenal gland, thyroid glands, lungs and prostate. Material and methods We present 3 cases of this uncommon condition, applying the new World Health Organisation criteria. We conducted studies through hematoxylin and eosin staining and analysed the expression of the neural development transcription factors achaete-scute homolog like 1, thyroid transcription factor 1 and the class III/IV POU transcription factors, as a new research line in the carcinogenesis of prostatic neuroendocrine tumors. Results In case 1, there was no TTF1 immunoexpression. Cases 2 and 3 had positive immunostaining for ASCL1, and Case 1 had negative immunostaining. BRN2 immunostaining was negative in case 1 and positive in cases 2 and 3. Conclusion The World Health Organisation does not recognise any molecular or genetic marker with prognostic value. ASCL-1 is related to the NOTCH and WNT signaling pathways. ASCL-1, TTF1 and BRN2 could be used for early diagnosis and as prognostic factors and therapeutic targets.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.007
       
  • Efficacy of low-intensity shock wave therapy for erectile dysfunction: A
           systematic review and meta-analysis
    • Authors: J.C. Angulo; I. Arance; M.M. de las Heras; E. Meilán; C. Esquinas; E.M. Andrés
      Abstract: Publication date: Available online 10 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.C. Angulo, I. Arance, M.M. de las Heras, E. Meilán, C. Esquinas, E.M. Andrés
      Context The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. Objective To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature. Acquisition of evidence Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3–6 months from the start of the therapy. Summary of the evidence The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, −2.92; p =0.000), to a greater degree than placebo (SDM, −0.99; p =0.000). The IIEF-EF at 3–6 months for the treated patients was significantly greater than baseline (SDM, −2.78; p =0.000). Only one study compared the efficacy of placebo at 3–6 months vs baseline (SDM, −9.14). The comparison between LISW and placebo favors active treatment (SDM, 2.53; p =0.000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3–6 months. Conclusions According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.001
       
  • Androgen deprivation in prostate cancer and the long-term risk of fracture
    • Authors: S. Ojeda; M. Lloret; A. Naranjo; F. Déniz; N. Chesa; C. Domínguez; P.C. Lara
      Abstract: Publication date: Available online 9 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): S. Ojeda, M. Lloret, A. Naranjo, F. Déniz, N. Chesa, C. Domínguez, P.C. Lara
      Objectives To determine the rate of bone mass loss and the risk of fracture induced by androgen deprivation therapy in patients with prostate cancer. Material and methods Prospective study in 2 phases. In the first phase, demographic variables, FRAX®, bone mineral density and clinical fractures were collected, before starting the therapy and up to 1 year after ending the therapy. In the second phase, we conducted a telephone interview a mean of 8.5 years after the start of the study to assess new fractures. Results We included 150 patients with a mean age of 67 years and a mean therapy duration of 24 months. Before starting the treatment, 62 patients (41%) showed osteoporosis or low bone mass in the densitometry. After the first year of treatment, the bone mineral density decreased a mean of 3.7% and 2.1% in the lumbar spine and femoral neck, respectively. At the end of the second and third year, the loss rate was lower. During the first phase of the study, 4 patients (2.7%) experienced a fracture. In the telephone interviews with 80 patients (53%), only 1 had experienced a fracture. Conclusions In the patients with prostate cancer and androgen deprivation therapy, greater bone loss occurred during the first year. When the treatment did not exceed 2 years, the absolute risk of fracture was low, and clinical fractures were uncommon in the short and long term.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.002
       
  • Prevalence of metabolic syndrome and its association with lower urinary
           tract symptoms and sexual function
    • Authors: M. Plata; J.I. Caicedo; C.G. Trujillo; Á.M. Mariño-Alvarez; N. Fernandez; A. Gutierrez; F. Godoy; M. Cabrera; J.G. Cataño-Cataño; D. Robledo
      Abstract: Publication date: Available online 9 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): M. Plata, J.I. Caicedo, C.G. Trujillo, Á.M. Mariño-Alvarez, N. Fernandez, A. Gutierrez, F. Godoy, M. Cabrera, J.G. Cataño-Cataño, D. Robledo
      Objectives To estimate the frequency of metabolic syndrome (MetS) in a daily urology practice and to determine its association with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Material and methods A retrospective study was conducted. Data from all male patients aged ≥40 years who attended our outpatient urology clinic from 2010 to 2011 was collected. Prevalence of MetS was determined, and LUTS and ED were assessed. A logistic model was used to determine possible associations, controlling for confounders and interaction factors. Results A total of 616 patients were included. MetS was observed in 43.8% (95% CI 39.6–48.3). The bivariate model showed an association between MetS and LUTS (p <0.01), but not between MetS and ED. The logistic model showed an association between MetS and the International Prostate Symptom Score (IPSS), while controlling for other variables. Patients exhibiting moderate LUTS had a greater risk for MetS than patients with mild LUTS (OR 1.83, 95% CI 1.14–2.94). After analyzing for individual components of MetS, positive associations were found between diabetes and severe LUTS (OR 1.3, 95% CI 1.24–7.1), and between diabetes and ED (OR 2.57, 95% CI 1.12–5.8). Conclusion This study was able to confirm an association between MetS and LUTS, but not for ED. Specific components such as diabetes were associated to both. Geographical differences previously reported in the literature might account for these findings. Given that MetS is frequent among urological patients, it is advisable that urologists actively screen for it.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.006
       
  • The use of bovine serum albumin-glutaraldehyde tissue adhesive (BioGlue®)
           for tumor bed closure following open partial nephrectomy
    • Authors: Z. Bahouth; S. Halachmi; S. Shprits; Y. Burbara; O. Avitan; I. Masarwa; B. Moskovitz; O. Nativ
      Abstract: Publication date: Available online 9 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): Z. Bahouth, S. Halachmi, S. Shprits, Y. Burbara, O. Avitan, I. Masarwa, B. Moskovitz, O. Nativ
      Objectives To report the results of the use of Bovine Serum Albumin-Glutaraldehyde tissue adhesive (BioGlue®) for tumor bed closure in open nephron-sparing surgery (NSS). Materials and methods The cohort included 255 patients with enhancing renal mass who underwent open NSS. We used open flank approach, with in situ hypothermia and enucleation of the tumor. For tumor bed closure, we used the BioGlue® sealant for tumor bed filling, without suturing the edges. Results Mean patients’ age was 65.4 years. 5.1% of patients had pre-operative chronic renal failure. Mean renal mass diameter was 4.2±1.6cm and mean R.E.N.A.L nephrometry score was 8.0±1.6. Mean ischemia time was 21.8±7.6. Mean estimated blood loss was 42±82ml and only two patients required blood transfusion. Urine leak and pseudo-aneurysm were recorded in two and one patient, respectively. None of the operations were converted to radical nephrectomy. The average change between post-operative and pre-operative eGFR (Δ=−1.7ml/min) was insignificant in a mean follow-up of 30.1±29.6 months. The 10-year recurrence-free survival rate was 99% and the 10-year overall survival rate was 85%. Conclusions The use of BioGlue® alone for hemostasis after NSS is a feasible and safe alternative to classical suturing. Its use enables satisfactory functional outcome and could potentially reduce ischemia time.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.005
       
  • Is extracorporeal shock wave lithotripsy a current treatment for
           urolithiasis' A systematic review
    • Authors: P. Bahílo Mateu; A. Budía Alba; E. Liatsikos; M. Trassierra Villa; J.D. López-Acón; D. de Guzmán Ordaz; F. Boronat Tormo
      Abstract: Publication date: Available online 21 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): P. Bahílo Mateu, A. Budía Alba, E. Liatsikos, M. Trassierra Villa, J.D. López-Acón, D. de Guzmán Ordaz, F. Boronat Tormo
      Introduction Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. Acquisition of evidence We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarize the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. Analysis of the evidence Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33–91.5% at 3 months was reached with ESWL, while a rate of 90.4–100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5–82.2% at 3 months was reached with ESWL, while a rate of 79–94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. Conclusion There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

      PubDate: 2017-07-26T06:33:24Z
      DOI: 10.1016/j.acuroe.2017.01.001
       
  • Systematic review of perioperative outcomes and complications after open,
           laparoscopic and robot-assisted radical cystectomy
    • Authors: A. Palazzetti; R. Sanchez-Salas; P. Capogrosso; E. Barret; N. Cathala; A. Mombet; D. Prapotnich; M. Galiano; F. Rozet; X. Cathelineau
      Abstract: Publication date: Available online 8 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Palazzetti, R. Sanchez-Salas, P. Capogrosso, E. Barret, N. Cathala, A. Mombet, D. Prapotnich, M. Galiano, F. Rozet, X. Cathelineau
      Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications.

      PubDate: 2017-07-09T21:50:38Z
      DOI: 10.1016/j.acuroe.2017.06.001
       
  • OnabotulinumtoxinA in urinary incontinence: Prospective study of a case
           series
    • Abstract: Publication date: Available online 8 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Martín-Martínez, A. Fernández-Mederos, J.Á. García-Hernández
      Objective To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. Method We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta-3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. Results A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity (p <0.0001) and reduced maximum pressure of the detrusor (p <0.0001). In terms of the safety profile, 8 (3.9%) patients had self-limiting haematuria during the procedure, which resolved spontaneously, and 9 (4.4%) patients had acute urinary retention that required intermittent catheterisation. Conclusions This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment.

      PubDate: 2017-07-09T21:50:38Z
       
  • Role of PET-CT with 18F-fluorocholine in biochemical recurrence after
           treatment of prostate cancer with curative intent
    • Authors: I. Puche-Sanz; E. Triviño-Ibáñez; F. Vázquez-Alonso; J.M. Llamas-Elvira; J.M. Cózar-Olmo; A. Rodríguez-Fernández
      Abstract: Publication date: Available online 8 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): I. Puche-Sanz, E. Triviño-Ibáñez, F. Vázquez-Alonso, J.M. Llamas-Elvira, J.M. Cózar-Olmo, A. Rodríguez-Fernández
      Objectives To analyze the ability of the PET-CT with 18F-fluorocholine (18F-FCH) to detect disease on biochemical recurrence after treatment with curative intent. To determine the clinical variables that would be able to optimize the test's diagnostic yield. Material and methods A retrospective study of PET-CTs with 18F-fluorocholine performed on 61 patients with prostate cancer who had undergone treatment with curative intent and met the criteria for biochemical recurrence. The results of the PET-CT were categorized into positive or negative and were validated using pre-established criteria. The relationship between the result of the PET-CT and the initial PSA nadir, PSA trigger, rising PSA velocity (PSAva) and PSA doubling time (PSAdt). The relationship between the metastatic sites on the PET-CT and the remaining variables was analyzed. Results There was a 34.4% detection rate of the disease. The initial PSA, PSA nadir, PSA trigger and PSAva showed statistically significant differences according to the result of the PET-CT. The best discriminatory cut-off point between a positive or negative PET-CT for PSA trigger and PSAva was 3.5ng/ml and 0.25ng/ml/month respectively. The PSAdt was significantly lower in patients with remote disease compared to patients with localized disease (5.1 vs 16.8 months, p =0.01). The probability that the PET-CT would detect remote disease vs localized disease was 3.2 times higher if the PSAdt was under 6 months (80% vs 20%, OR: 3.2, p =0.02). In the multivariate analysis, only the initial PSA and not having undergone radical prostatectomy were demonstrated as independent predictive factors of a positive PET-CT result. Conclusions The PET-CT with 18F-FCH can detect disease in a high percentage of patients with biochemical recurrence and provides information on its anatomical location. PSA kinetics and the patient's previous treatment are key variables in increasing the test's diagnostic.

      PubDate: 2017-07-09T21:50:38Z
      DOI: 10.1016/j.acuroe.2017.06.002
       
  • Experimental murine model of renal cancer
    • Authors: B. Padilla-Fernández; M.B. García-Cenador; P. Rodríguez-Marcos; J.F. López-Marcos; P. Antúnez-Plaza; J.M. Silva-Abuín; D. López-Montañés; F.J. García-Criado; M.F. Lorenzo-Gómez
      Abstract: Publication date: Available online 8 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): B. Padilla-Fernández, M.B. García-Cenador, P. Rodríguez-Marcos, J.F. López-Marcos, P. Antúnez-Plaza, J.M. Silva-Abuín, D. López-Montañés, F.J. García-Criado, M.F. Lorenzo-Gómez
      Introduction The objective of this study was to determine the reproducibility in a murine model of renal tumors of various histological strains that could be useful for investigating the response to target drugs. Material and methods Development and analysis of the “in vivo” model: tumor xenograft of renal cell carcinomas with Balb/c nude athymic mice. Nontumourous human renal tissue was implanted in the interscapular region of 5 mice, chromophobe renal cell carcinoma was implanted in 5 mice (which, after checking its growth, was prepared for implantation in another 10 mice) and Fuhrman grade 2 clear cell renal cell carcinoma (CCRCC) was implanted in 5 mice (which was also subsequently implanted in 10 mice). We monitored the tumor size, onset of metastases and increase in size and number of tumors. When the size had reached a point greater than or equal to locally advanced or metastatic carcinoma, the animals were euthanised for a pathological and immunohistochemical study and a second phase of implantation. Results The subcutaneous xenograft of the healthy tissue did not grow. The animals were euthanised at 6 months and no renal tissue was found. The chromophobe renal cell carcinoma cells grew in the initial phase (100%); however, in the second phase, we observed a chronic lymphomonocyte inflammatory reaction and a foreign body reaction. The CCRCC grew at 5–8 months both in the first and second phase (100%), maintaining the tumor type and grade. Conclusions The model with athymic Balb/c nude mice is useful for reproducing CCRCC, with the same histological characteristics and aggressiveness as native human tumors, promoting the development of the second experimental phase.

      PubDate: 2017-07-09T21:50:38Z
      DOI: 10.1016/j.acuroe.2017.06.003
       
  • Comment to “Benign prostatic hyperplasia and lower urinary tract
           symptoms. A review of current evidence”
    • Authors: Montero
      Abstract: Publication date: Available online 4 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2017-07-09T21:50:38Z
       
 
 
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