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Showing 1 - 200 of 3043 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 20, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 18, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 83, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, 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: 331, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, 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   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 211, 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: 9, 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: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 23, 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: 3)
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: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 8, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, 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: 16, 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: 25, 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: 10, 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 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: 24, 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: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, 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 Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
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: 41, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, 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: 40, 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: 47, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
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: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 25)
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: 35, 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: 5)
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: 7, 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 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: 7, 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: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 60)
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 Research     Full-text available via subscription   (Followers: 343, 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: 15)
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: 43, 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: 307, 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: 405, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 53, 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: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 6)
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  
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)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 7, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 38, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 16, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 33, 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: 191, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 3)
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: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 26, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, 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: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 55, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 10)
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: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 162, 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: 11)
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  
Animal Behaviour     Hybrid Journal   (Followers: 157, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 1, SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

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Journal Cover Actas Urológicas Españolas (English Edition)
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   Full-text available via subscription Subscription journal
   ISSN (Print) 2173-5786
   Published by Elsevier Homepage  [3043 journals]
  • Medical–surgical activity and the current state of training of urology
           residents in Spain: Results of a national survey
    • Authors: M.E. Rodríguez-Socarrás; J. Gómez Rivas; M. García-Sanz; L. Pesquera; L. Tortolero-Blanco; M. Ciappara; A. Melnick; J. Colombo; G. Patruno; Á. Serrano-Pascual; J. Bachiller-Burgos; J.M. Cozar-Olmo
      Pages: 391 - 399
      Abstract: Publication date: July–August 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 6
      Author(s): M.E. Rodríguez-Socarrás, J. Gómez Rivas, M. García-Sanz, L. Pesquera, L. Tortolero-Blanco, M. Ciappara, A. Melnick, J. Colombo, G. Patruno, Á. Serrano-Pascual, J. Bachiller-Burgos, J.M. Cozar-Olmo
      Objectives To determine the actual state of medical–surgical activity and training for urology residents in Spain. Material and method We designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015–January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. Results The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20h a week, and 43 of these even less than 10h. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. Conclusions Efforts should be directed toward standardizing the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.05.002
  • Costs and hospital procedures in an urology department of a tertiary
           hospital. Analysis of groups related by their diagnosis
    • Authors: F. Boronat; I. Barrachina; A. Budia; D. Vivas Consuelo; M.C. Criado
      Pages: 400 - 408
      Abstract: Publication date: July–August 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 6
      Author(s): F. Boronat, I. Barrachina, A. Budia, D. Vivas Consuelo, M.C. Criado
      Introduction The health care system has management tools available in hospitals that facilitate the assessment of efficiency through the study of costs and management control in order to make a better use of the resources. Objective The aim of the study was the calculation and analysis of the total cost of a urology department, including ambulatory, hospitalization and surgery activity and the drafting of an income statement where service costs are compared with income earned from the Government fees during 2014. Materials and methods From the information recorded by the Economic Information System of the Department of Health, ABC and top-down method of cost calculation was applied by process care activity. The cost results obtained were compared with the rates established for ambulatory and hospital production in the Tax Law of the Generalitat Valenciana. The production was structured into outpatient (external and technical consultations) and hospital stays and surgeries (inpatient). Results A total of 32,510 outpatient consultations, 7527 techniques, 2860 interventions and 4855 hospital stays were made during 2014. The total cost was 7,579,327€; the cost for outpatient consultations was 1,748,145€, 1,229,836 Euros for technical consultations, 2,621,036€ for surgery procedures and 1,980,310€ for hospital admissions. Considered as income the current rates applied in 2014 (a total of 15,035,843€), the difference between income and expenditure was 7,456,516€. Conclusions The economic balance was positive with savings over 50% and a mean adjusted hospitalization stay rate (IEMAC) rate of 0.67 (33% better than the standard). CMA had a favorable impact on cost control.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.05.001
  • The anatomical limits and oncological benefit of lymphadenectomy in muscle
           invasive bladder cancer
    • Authors: A. Guijarro; V. Hernández; C. Llorente
      Pages: 284 - 291
      Abstract: Publication date: June 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 5
      Author(s): A. Guijarro, V. Hernández, C. Llorente
      Background Lymphadenectomy is part of standard treatment for muscle invasive bladder cancer. The objective of this review is to provide an up-to-date review on the available scientific evidence in this field. Acquisition of evidence We conducted a literature review in PubMed of relevant articles up to the present (2016). We found a systematic review published in 2014 that included the comparative studies published up to that year, and we updated the review with new relevant publications since that date. Synthesis of the evidence The number of lymph nodes is not the best indicator for determining the quality of the lymphadenectomy given that the number can vary depending on numerous factors that depend not only on the surgeon but also on the patient and on the pathologist. The definition of standard anatomical territories and a meticulous extraction of the lymph nodes in these territories are more reproducible than the numbers of nodes removed. The optimal extension of lymphadenectomy is a topic of debate. The evidence published to date indicates that any extension of lymphadenectomy is better than not performing it, although it appears that limited lymphadenectomy is insufficient for the oncological control of the disease and that superextended lymphadenectomy provides no oncological benefit versus extended lymphadenectomy. Conclusions Despite a certain amount of controversy in terms of the optimal extension of lymphadenectomy, performing lymphadenectomy in all cases appears to be recommendable according to the available evidence. Extended lymphadenectomy provides greater oncological benefit than more limited dissections, while more extensive lymphadenectomies are not recommended.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.04.001
  • Initial experience with the new da Vinci single-port robot-assisted
    • Authors: R. Ballestero Diego; S. Zubillaga Guerrero; D. Truan Cacho; C. Carrion Ballardo; G. Velilla Diez; P. Calleja Hermosa; J.L. Gutierrez Banos
      Pages: 333 - 337
      Abstract: Publication date: June 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 5
      Author(s): R. Ballestero Diego, S. Zubillaga Guerrero, D. Truan Cacho, C. Carrion Ballardo, G. Velilla Diez, P. Calleja Hermosa, J.L. Gutierrez Banos
      Objective To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. Material and methods We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. Results Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262min (range, 230–300). Discussion In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.04.006
  • Systematic review of renal carcinoma prognostic factors
    • Authors: D. Lorente; E. Trilla; A. Meseguer; J. Planas; J. Placer; A. Celma; C. Salvador; L. Regis; J. Morote
      Pages: 215 - 225
      Abstract: Publication date: May 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 4
      Author(s): D. Lorente, E. Trilla, A. Meseguer, J. Planas, J. Placer, A. Celma, C. Salvador, L. Regis, J. Morote
      Context and objectives The natural history of renal cell carcinoma is heterogeneous. Some scenarios can be found in terms of clinical presentation, clinical evolution or type of recurrence (local/metastatic). The aim of this publication is to analyze the most important prognostic factors published in the literature. Evidence acquisition A literature review ob published papers was performed using the Pubmed, from first Motzer's classification published in 1999–2015, according to PRISMA declaration. Search was done using the following keywords: kidney neoplasm, kidney cancer, renal cell carcinoma, prognostic factors, mortality, survival and disease progression. Papers were classified according to level of evidence, the number of patients included and the type of study performed. Evidence synthesis The evolution in the knowledge of molecular pathways related to renal oncogenesis and the new targeted therapies has left to remain obsolete the old prognostic models. It is necessary to perform a continuous review to actualize nomograms and to adapt them to the new scenarios. Conclusions Is necessary to perform a proper external validation of existing prognostic factors using prospective and multicentric studies to add them into the daily urologist clinical practice.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.03.010
  • Influence of the location and number of metastases in the survival of
           metastatic prostatic cancer patients
    • Authors: A. Guijarro; V. Hernández; J.M. de la Morena; I. Jiménez-Valladolid; E. Pérez-Fernández; E. de la Peña; C. Llorente
      Pages: 226 - 233
      Abstract: Publication date: May 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 4
      Author(s): A. Guijarro, V. Hernández, J.M. de la Morena, I. Jiménez-Valladolid, E. Pérez-Fernández, E. de la Peña, C. Llorente
      Introduction The prognosis of patients diagnosed with metastatic prostate cancer seems to be modulated by factors such as the number and site of metastases. Our objective is to evaluate survival outcomes according to the number and site of metastases in our series of metastatic patients over the last 15 years. Materials and methods A retrospective analysis was performed on patients diagnosed between 1998 and 2014. We analyzed overall survival and progression-free survival, depending on the number and location of metastases on patients with newly diagnosed metastatic prostate cancer. Other potential prognostic factors were also evaluated: age, clinical stage, PSA at diagnosis, Gleason, PSA nadir, time till PSA nadir and first-line or second-line treatment after progression. Results We analyzed a series of 162 patients. The mean age was 72.7yr (SD: 8.5). The estimated median overall survival was 3.9yr (95% CI 2.6–5.2). The overall survival in patients with only lymph node metastases was 7yr (95% CI 4.1–9.7), 3.9 (95% CI 2.3–5.5) in patients with only bone metastases, 2.5yr (95% CI 2–2.3) in lymph nodes and bone metastases, and 2.2yr (95% CI 1.4–3) in patients with visceral metastases (p <0.001). In multivariate analysis, the location of metastasesis significantly associated with overall survival and progression-free survival. The number of metastases showed no association with survival. Conclusions The site of metastases has a clear impact on both overall survival and progression-free survival. Patients with only lymph node involvement had a better prognosis. The number of metastases showed no significant impact on survival in our series.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.03.001
  • Muscle function of the pelvic floor in healthy and puerperal women and
           with pelvic floor dysfunction
    • Authors: M.A. Castro-Pardiñas; M. Torres-Lacomba; B. Navarro-Brazález
      Pages: 249 - 257
      Abstract: Publication date: May 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 4
      Author(s): M.A. Castro-Pardiñas, M. Torres-Lacomba, B. Navarro-Brazález
      Objectives To understand the function of the pelvic floor muscles (PFM) at different ages in healthy women and in puerperal women with pelvic floor dysfunctions (PFD) and to ascertain whether there are differences among them. Material and methods A descriptive cross-sectional study was conducted between June 2014 and September 2016 and included 177 women, 70 of whom had no symptoms of PFD, 53 primiparous mothers in late postpartum and 54 with PFD. The function of the PFM was measured through vaginal palpation (quality of the contraction); manometry (force); dynamometer (tone, strength, and response to stretching), and surface electromyography (neuromuscular activity and resistance). Results The healthy women showed superior values for PFM tone, maximum strength, neuromuscular activity and resistance than the puerperal mothers and the women with PFD (p <0.01). The puerperal women and those with PFD showed similar functional PFM values (p >0.05). The muscle function of the healthy women did not vary significantly with age, except in the case of tone, which was lower in the women older than 46 years (p =0.004). Conclusions Age and births decrease the baseline tone of the PFM in healthy women. Therefore, lower strength, resistance and neuromuscular activity appear to be the main difference between the PFM of women with PFD and the PFM of healthy women.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.03.004
  • Satisfaction and treatment adherence in erectile dysfunction in the medium
           and long term
    • Authors: J. Panach-Navarrete; A. Morales-Giraldo; C. Ferrandis-Cortés; F. García-Morata; J.C. Pastor-Lence; J.M. Martínez-Jabaloyas
      Pages: 258 - 266
      Abstract: Publication date: May 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 4
      Author(s): J. Panach-Navarrete, A. Morales-Giraldo, C. Ferrandis-Cortés, F. García-Morata, J.C. Pastor-Lence, J.M. Martínez-Jabaloyas
      Introduction The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term. Material and methods A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal–Wallis test to compare means. Results The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (p =0.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (p =0.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months). Conclusions The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.03.005
  • Robot-assisted radical cystoprostatectomy: Analysis of the complications
           and oncological and functional aspects
    • Authors: A. Kanashiro; J.M. Gaya; J. Palou; L. Gausa; H. Villavicencio
      Pages: 267 - 273
      Abstract: Publication date: May 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 4
      Author(s): A. Kanashiro, J.M. Gaya, J. Palou, L. Gausa, H. Villavicencio
      Objectives To review our experience in robot-assisted radical cystectomy, assessing the complications and oncological and functional results. Materials and methods From 2007 to 2014, we performed 67 robot-assisted radical cystectomies combined with lymphadenectomy in 61 cases. The operations were performed on 37 patients due to muscle-invasive tumors and on 30 due to high-risk nonmuscle-invasive tumors. Urinary diversion was conducted extracorporeally, using a Studer neobladder in 47 cases. Results The mean blood loss was 300mL. No case required conversion to open surgery. The median number of lymph nodes extracted was 16 (range 3–33). Pathology revealed 16 pT0, 15 pTis, -pT1-pTa and 44 muscle-invasive tumors, 8 pN+ and 1 with positive margins. The mean hospital stay was 9 days. With a median follow-up of 16 months, 9 (13%) patients were readmitted after the discharge, most for infections associated with the vesical catheter and other catheters. Forty patients (59.7%) presented complications (most were Clavien grade 1–2). There was recurrence during the follow-up in 4 cases (6%), and 4 (5.9%) patients died from cancer. Nineteen (28.3%) patients had complications after 30 days, most of which were urinary tract infections. Of the 47 patients with a neobladder, 45 (96%) had proper daytime continence and 42 (89%) had proper nighttime continence. Ninety percent and 64% of the patients with previously normal sexual function and reduced sexual function, respectively, were able to preserve sexual function with or without drug treatment. Conclusions Robot-assisted radical cystectomy plus lymphadenectomy, with extracorporeal reconstruction of the urinary diversion, offers good oncological and functional results without increasing the number of complications.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.03.006
  • 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; M. Poza; D. Alonso; J.M. Martínez-Sagarra
      Abstract: Publication date: Available online 9 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      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: 2017-08-14T19:17:43Z
      DOI: 10.1016/s1569-9056(17)30480-3
  • 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
  • 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
      Abstract: Publication date: Available online 9 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      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: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.003
  • 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
      Abstract: Publication date: Available online 5 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      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: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2016.12.012
  • Benefit of nephrectomy for treating metastatic renal cell carcinoma
    • Authors: J.M.
      Abstract: Publication date: June 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 5
      Author(s): C. González-Ruiz de León, P. Pellejero-Pérez, A. Quintás-Blanco, J. García-Rodríguez, C. Álvarez-Fernández, J.M. Fernández-Gómez
      Introduction Systemic treatment for metastatic renal cell carcinoma (mRCC) has changed with the new therapies, and it is not clear if nephrectomy (NEP) has a survival benefit in this kind of patients. Objective To investigate if NEP associated to systemic treatment improves overall survival (OS) and progression-free survival (PFS). Material and methods A retrospective, observational, descriptive study of 45 patients with diagnosis of mRCC between 2006 and 2014. Advanced cases with only palliative care were excluded, also patients with solitary metastasis who were managed with surgical resection. Results Finally 34 patients were treated with systemic treatment. Twenty-six also with surgery associated. Seventy percent were intermediate/low risk at the Motzer classification and >80% Karnofsky performance status. PFS was 7m. NEP improves PFS (10 vs. 4m). High risk Motzer decreased PFS (p < 0.001). The OS was 11.5m. Patients with Karnofsky performance status >80, intermediate or low risk Motzer treated with NEP and mTOR as second line treatment, increased the OS (14 vs. 3m, p = 0.0001; 14 vs. 6m, p = 0.001; and 9 vs. 5m, p = 0.003, respectively). In the multivariate analysis only NEP (p =0.006; HR 4.5) and intermediate/low risk at the Motzer classification (p = 0.020; HR 8.9) demonstrated significant improvement in OS. Conclusions Patients treated with NEP associated to systemic treatment and with an intermediate/low risk in the Motzer classification had a better PFS and OS. The OS also improves in patients treated with mTOR in second line, and Karnofsky performance status >80% in the univariate study, but not in the multivariable one.

      PubDate: 2017-08-14T19:17:43Z
  • 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
    • 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
  • Transcutaneous stimulation of the posterior tibial nerve for treating
           refractory urge incontinence of idiopathic and neurogenic origin
    • Authors: C. Valles-Antuña; M.L. Pérez-Haro; C. González-Ruiz de León; A. Quintás-Blanco; E.M. Tamargo-Diaz; J. García-Rodríguez; A. San Martín-Blanco; J.M. Fernandez-Gomez
      Abstract: Publication date: Available online 8 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. Valles-Antuña, M.L. Pérez-Haro, C. González-Ruiz de León, A. Quintás-Blanco, E.M. Tamargo-Diaz, J. García-Rodríguez, A. San Martín-Blanco, J.M. Fernandez-Gomez
      Objective To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. Material and methods We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30min. Results Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. Conclusions TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.

      PubDate: 2017-07-09T21:50:38Z
      DOI: 10.1016/j.acuroe.2017.01.003
  • 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
  • Comparing groups with an effect size and confidence intervals approach: A
    • Authors: S.A. Dominguez-Lara
      Abstract: Publication date: Available online 5 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): S.A. Dominguez-Lara

      PubDate: 2017-07-09T21:50:38Z
      DOI: 10.1016/j.acuroe.2017.03.011
  • Total phallic reconstruction using radial forearm free flap after
           iatrogenic penile amputation
    • Authors: J.C. Angulo; I. Arance; C. Gómez-Llorens; C. Esquinas; C. Gómez-Martín; J.L. Fernández-Cañamaque
      Abstract: Publication date: Available online 5 July 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.C. Angulo, I. Arance, C. Gómez-Llorens, C. Esquinas, C. Gómez-Martín, J.L. Fernández-Cañamaque
      Introduction The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. Material and methods A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customized inflatable prosthesis a year later. Results During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10h and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the esthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. Conclusions Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customized prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.

      PubDate: 2017-07-09T21:50:38Z
      DOI: 10.1016/j.acuroe.2017.06.004
  • 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
  • Chemotherapy should not yet be considered in patients with
           hormone-sensitive metastatic prostate cancer
    • Abstract: Publication date: Available online 31 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): B. Miñana López

      PubDate: 2017-06-01T23:35:04Z
  • Muscle invasive bladder cancer: Prognostic factors, follow-up and
           treatment of relapses
    • Authors: C. Hernández-Fernández; F. Herranz-Amo; M. Moralejo-Gárate; D. Subirá-Ríos; J. Caño-Velasco; G. Barbas-Bernardos
      Abstract: Publication date: Available online 31 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. Hernández-Fernández, F. Herranz-Amo, M. Moralejo-Gárate, D. Subirá-Ríos, J. Caño-Velasco, G. Barbas-Bernardos
      Context Bladder cancer is the cause of more than 150,000 deaths per year. The overall rate of survival is approximately 45%, with a 10-year recurrence-free rate of 50–59%, with no changes in the last decade. Objective Due to a lack of agreement on the follow-up of cystectomy or on a uniform treatment when faced with the various types of recurrence, we have analyzed the most recent literature in an attempt to unify the criteria for the diagnosis and treatment of bladder cancer. Acquisition of evidence Review of Spanish and English publications in the medical literature in the last 10 years, highlighting the most significant series in terms of the number of patients, follow-up time, as well as the existing meta-analyses. Synthesis of the evidence Recurrence after cystectomy can occur in the urinary apparatus (upper urinary tract or distal urethra) and local (cystectomy bed) and/or distant metastases. Despite strict control, more than 60% of the relapses are discovered based on symptoms and not by the routine follow-up test. Locoregional and distant relapses are more common the more advanced the stage at the time of cystectomy, going from 11–21% in pT2N0 to 52–72% when there is lymphocytic N+ involvement. Recurrence in the urethra and/or upper urinary track has other prognostic factors such as multiplicity, the presence of Cis and involvement of prostatic stroma. There are various treatments for tumor relapses. Increasingly, the patient's comorbidity is considered when deciding on the therapeutic strategy. Treatments are typically multimodal and include surgery, radiotherapy and chemotherapy. Conclusion The follow-up of patients who undergo cystectomy should be individualized, taking into account the prognostic factors of recurrence and the patient's comorbidity, assuming that in some cases, multimodal treatment is indicated.

      PubDate: 2017-06-01T23:35:04Z
      DOI: 10.1016/j.acuroe.2016.07.010
  • Impact of locally advanced or metastatic prostate cancer on the quality of
    • Authors: I. López-Calderero; L. López-Fando; E. Ríos-González; P. Maisonobe; E. Hernández-Yuste; M. Sarmiento-Jordán
      Abstract: Publication date: Available online 31 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): I. López-Calderero, L. López-Fando, E. Ríos-González, P. Maisonobe, E. Hernández-Yuste, M. Sarmiento-Jordán
      Objective The aim of this study was to assess the health-related quality of life of patients with prostate cancer in advanced phases to obtain additional information on the patients’ health. The growing interest in understanding the patient's perspective and the scarcity of prospective studies of this population motivated this research study. Material and methods We present an observational study performed on 131 urology consultations, with a sample of 601 patients with locally advanced or metastatic prostate cancer, assessed during 2 visits: baseline and at 12 months. We collected demographic, clinical, quality-of-life (PROSQoLI and EuroQoL-5D-5L questionnaires) and anxiety/depression (HADS questionnaire) endpoints. Results The mean age (SD) was 73.8 (8.2) years, and 87.2% of the participants were retired or pensioners. Some 58.7% of the patients presented locally advanced prostate cancer. Urinary symptoms were the most common, decreasing significantly after 1 year (p <0.05). Urinary problems and fatigue were the most affected measures, and pain/discomfort was the dimension present in most patients (65.3%). According to the linear regression model, asthenia and pain were 2 of the factors most closely related to a poorer quality of life. The presence of anxiety/depression was low. Finally, the health condition as assessed by the clinician was more positive than when assessed by the patients. Conclusions This study broadens the scarce information on the quality of life of the population with advanced prostate cancer, information of use for the clinical management of these patients.

      PubDate: 2017-06-01T23:35:04Z
      DOI: 10.1016/j.acuroe.2017.05.005
  • Comparative study of the B-SAQ, OAB-V8 and OAB-V3 questionnaires as
           screening tools for overactive bladders in clinical practice
    • Authors: J.C. Angulo; M.P. Calderín; Y. Fernández; M. González; E. Gómez; M.B. Herreros; P. Peñasco; M. Zapatero; J.F. Dorado
      Abstract: Publication date: Available online 31 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.C. Angulo, M.P. Calderín, Y. Fernández, M. González, E. Gómez, M.B. Herreros, P. Peñasco, M. Zapatero, J.F. Dorado
      Objective To compare the capacity shown by 3 self-assessment questionnaires validated in Spanish (B-SAQ, OAB-V8 and OAB-V3) for the screening of patients with overactive bladder (OAB) in clinical practice. Material and method A noninterventional observational study was conducted of men and women older than 30 years evaluated in primary care consultations. The clinical diagnosis of OAB was conducted through a case history review, physical examination, urine analysis, ultrasonography and voiding diary. The presence of coping strategies and discomfort was investigated. The differential diagnosis was established in patients with symptoms not due to OAB. We assessed the correlation between the clinical tests and diagnosis (kappa<0.4 poor; 0.4–0.6 moderate; >0.6 good; >0.8 excellent) and ROC curves to define the capacity to screen the assessed questionnaires. Results A total of 411 patients were investigated. OAB was detected in 207 (50.4%) patients, other causes for the lower urinary tract symptoms were detected in 63 (15.3%), and 141 (34.3%) patients had no diagnosis. The voiding diary suggested OAB in 197 (47.9%) patients. The correlation between the clinical diagnosis and the diagnosis based on the voiding diary was 0.702. The correlation between the clinical diagnosis and B-SAQ, OAB-V8 and OAB-V3 was 0.59, 0.673 and 0.732, respectively. The area under the curve (AUC) was 0.799 for B-SAQ; 0.837 for OAB-V8 and 0.867 for OAB-V3 (OAB-V3 vs. OAB-V8, p =0.02; OAB-V3 vs. B-SAQ, p <0.0001). The AUC for the voiding diary was 0.852 (OAB-V3 vs. diary, p =0.47). Conclusions OAB-V3 is a simple questionnaire with excellent performance for screening OAB in a specific population and that is superior to the OAB-V8 and B-SAQ. The accuracy of the voiding diary for the same indication is equivalent to that of the OAB-V3 in our setting.

      PubDate: 2017-06-01T23:35:04Z
      DOI: 10.1016/j.acuroe.2017.05.003
  • Comment to “Costs and hospital procedures in an urology department of a
           tertiary hospital. Analysis of groups related by their diagnosis”
    • Abstract: Publication date: Available online 30 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. González-Enguita

      PubDate: 2017-06-01T23:35:04Z
  • Future perspectives in pharmacological treatment of overactive bladder
    • Authors: Montero
      Abstract: Publication date: Available online 30 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero

      PubDate: 2017-06-01T23:35:04Z
  • Metalloproteinase 11, potential marker and molecular target in advanced
           and castration-resistant prostate cancer. Culture study of peritumoral
    • Authors: J.M. Fernandez-Gomez; N. Eiro; J.J. García-Rodríguez; A. Quintás-Blanco; C. Gonzalez-Ruiz de León; M.L. Perez de Haro; F. Vizoso-Piñero
      Abstract: Publication date: Available online 28 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.M. Fernandez-Gomez, N. Eiro, J.J. García-Rodríguez, A. Quintás-Blanco, C. Gonzalez-Ruiz de León, M.L. Perez de Haro, F. Vizoso-Piñero
      Objective To analyze the expression of metalloprotein 11 (MMP11) in cultured fibroblasts obtained from human prostate tumors with different clinical and pathological characteristics. Material and methods For this study we analyzed samples of transrectal prostate biopsies from tumors with different characteristics, treated with or without androgen deprivation (AD). After optimization of the culture method, fibroblasts were isolated and cultured to perform the study (PCR) of MMP11 mRNA. Results Finally, 37 cases were studied: 5 samples of benign prostatic hyperplasia, 14 cases with localized neoplasms (7 high-risk according to the D’Amico classification), 5 with metastasic tumors (bone metastases), and 13 treated with AD therapy, of which 6 fulfilled the requirements to be defined as resistant to castration. In tumors without AD therapy, MMP11 expression was significantly higher (p =0.001) in fibroblasts of higher grade tumors. A significant (p =0.001) correlation was found between PSA and expression of MMP11 in fibroblast s and a significant increase of MMP11 expression in metastatic tumors. In tumors with AD therapy, a significantly greater expression of MMP11 was observed in resistant to castration patients than in those sensitive to castration (p =0.003). Conclusion In advanced prostate tumors or in stages of increased tumor aggressiveness, the production of MMP11 by fibroblasts is significantly greater than in non-metastatic tumors or in AD sensitive tumors.

      PubDate: 2017-06-01T23:35:04Z
      DOI: 10.1016/j.acuroe.2017.05.004
  • Diagnosis and treatment for clinically localized prostate cancer.
           Adherence to the European Association of Urology clinical guidelines in a
           nationwide population-based study – GESCAP group
    • Authors: F. Gómez-Veiga; A. Rodríguez-Antolín; B. Miñana; C. Hernández; J.F. Suárez; J.M. Fernández-Gómez; M. Unda; J. Burgos; A. Alcaraz; P. Rodríguez; R. Medina; J. Castiñeiras; C. Moreno; E. Pedrosa; J.M. Cózar
      Abstract: Publication date: Available online 28 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): F. Gómez-Veiga, A. Rodríguez-Antolín, B. Miñana, C. Hernández, J.F. Suárez, J.M. Fernández-Gómez, M. Unda, J. Burgos, A. Alcaraz, P. Rodríguez, R. Medina, J. Castiñeiras, C. Moreno, E. Pedrosa, J.M. Cózar
      Objective To assess the adherence to European Association of Urology (EAU) guidelines in the management of prostate cancer (PCa) in Spain. Patients and methods Epidemiological, population-based, study including a national representative sample of 3918 incident patients with histopathological confirmation during 2010; 95% of the patient's sample was followed up for at least one year. Diagnosis along with treatment related variables (for localized PCa – low, intermediate, high and locally-advanced by D’Amico risk stratification) was recorded. Differences between groups were tested with Chi-squared and Kruskal–Wallis tests. Results Mean (SD) age of PCa patients was 68.48 (8.18). Regarding diagnostic by biopsy procedures, 64.56% of all patients had 8–12 cores in first biopsy and 46.5% of the patients over 75 years, with PSA<10ng/ml were biopsied. Staging by computer tomography (CT) or bone scan (BS) was used for determining tumor extension in 60.09% of high-risk cases and was applied differentially depending on patients’ age; 3293 (84.05%) patients received a treatment for localized PCa. Radical prostatectomy was done in 1277 patients and 206 out of these patients also had a lymphadenectomy, being 4.64% low-risk, 22.81% intermediate-risk and 36.00% high-risk patients; 86.08% of 1082 patients who had radiotherapy were treated with 3D or IMRT and 35.77% received a dose ≥75Gy; 419 patients were treated with brachytherapy (BT): 54.81% were low-risk patients, 22.84% intermediate-risk and 12.98% high-risk. Hormonotherapy (HT, n =521) was applied as single therapy in 9.46% of low-risk and 17.92% of intermediate-risk patients. Additionally, HT was combined with RT in 14.34% of lower-risk patients and 58.26% of high-risk patients, and 67.19% low-intermediate risk with RT and/or BT received neoadjuvant/concomitant/adjuvant HT. Finally, 83.75% of high-risk patients undergoing RT and/or BT also received HT. Conclusions Although EAU guidelines for PCa management are easily available in Europe, the adherence to their recommendations is low, finding the highest discrepancies in the need for a prostate biopsy and the diagnostic methods. Improve information and educational programs could allow a higher adherence to the guidelines and reduce the variability in daily practice ( ISRCTN19893319).

      PubDate: 2017-06-01T23:35:04Z
      DOI: 10.1016/j.acuroe.2017.05.006
  • Survey on graduate education in the Confederación Americana de Urología:
           Opinions and reality
    • Authors: J.C. Angulo; H. Davila; R. Vela
      Abstract: Publication date: Available online 11 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.C. Angulo, H. Davila, R. Vela
      Objective Quality graduate medical training is a concern of Confederación Americana de Urología (CAU), the third largest urological society worldwide. It is important to analyze the diversity in the state training programs and the feasibility and implications of conducting a common CAU program. Material and methods A 20-item questionnaire was distributed to the directors of national societies who are members of the CAU concerning the graduate urological training in their institutions. Results A total of 28 presidents and expresidents representing 21 countries responded, the total number of independent states that constitute the confederation. In this setting, 664 residents start their training program every year, in an area that treats 645.4 million inhabitants, with an active professional force of 16,752 specialists. We present data on the realities of the training (length of the program, core curriculum) and occupation (job access, possible flow between countries) and on how accreditation and re-certification of specialists in these countries are conducted. We also present the opinions on the feasibility of a joint CAU degree, as well as a number of its implications. Conclusions The actual graduate training in the CAU setting is heterogeneous in its programs and in its accreditation and re-certification methods. There is a strong desire to achieve joint degrees, except in Spain and Portugal. To enable joint certification, there will need to be intervention on numerous aspects and levels, redefining the desire for healthcare coverage in each country and considering the possible flow of specialists.

      PubDate: 2017-05-12T21:07:17Z
      DOI: 10.1016/j.acuroe.2017.04.004
  • Mucinous tubular and spindle cell carcinoma. An uncommon renal neoplasm
           with favorable prognosis
    • Abstract: Publication date: Available online 4 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): Á. Gutiérrez-Domingo, A. García-Escudero

      PubDate: 2017-05-07T18:40:48Z
  • Future perspectives in the medical treatment of benign prostatic
    • Authors: Montero
      Abstract: Publication date: Available online 4 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero

      PubDate: 2017-05-07T18:40:48Z
  • From the definition to the social impact of premature ejaculation. Expert
    • Authors: N. Cruz-Navarro; R. Prieto-Castro; F. Cabello-Santamaría; F. García-José; A. Fernández-Lozano; M. Larrazábal-Murillo; A. Martín-Morales; F. Sánchez-Sánchez; C. San Martín-Blanco; J. Viladoms-Fuster
      Abstract: Publication date: Available online 2 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): N. Cruz-Navarro, R. Prieto-Castro, F. Cabello-Santamaría, F. García-José, A. Fernández-Lozano, M. Larrazábal-Murillo, A. Martín-Morales, F. Sánchez-Sánchez, C. San Martín-Blanco, J. Viladoms-Fuster

      PubDate: 2017-05-07T18:40:48Z
      DOI: 10.1016/j.acuroe.2016.09.006
  • Cultural adaptation to Spanish (Spain) of the “overactive bladder-family
           impact measure (OAB-FIM)” questionnaire
    • Authors: S. Arlandis Guzmán; E. Martínez Cuenca; R. Martínez García; M.A. Bonillo García; J. Rejas; E. Broseta-Rico
      Abstract: Publication date: Available online 2 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): S. Arlandis Guzmán, E. Martínez Cuenca, R. Martínez García, M.A. Bonillo García, J. Rejas, E. Broseta-Rico
      Objective The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. Methods The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. Results The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20–28% and 0–16%. The mean time for completing the questionnaire was 5.2min (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948 and 0.839. The correlations with similar scales in the family were moderate-high (0.407–0.753) or small-moderate with those administered to the patient (0.004–0.423). Conclusion We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability.

      PubDate: 2017-05-07T18:40:48Z
      DOI: 10.1016/j.acuroe.2017.04.005
  • Molecular imaging for prostate cancer: Performance analysis of 68Ga-PSMA
           PET/CT versus choline PET/CT
    • Authors: L. Michaud; K.A. Touijer
      Abstract: Publication date: Available online 2 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): L. Michaud, K.A. Touijer
      Introduction There is a need for a precise and reliable imaging to improve the management of prostate cancer. In recent years the PET/CT with choline has changed the handling of prostate cancer in Europe, and it is commonly used for initial stratification or for the diagnosis of a biochemical recurrence, although it does not lack limitations. Other markers are being tested, including the ligand of prostate-specific membrane antigen (PSMA), that seems to offer encouraging prospects. The goal of this piece of work was to critically review the role of choline and PSMA PET/CT in prostate cancer. Evidence acquisition A systematic literature review of databases PUBMED/MEDLINE and EMBASE was conducted searching for articles fully published in English on the PET marker in prostate cancer and its clinical application. Evidence synthesis and discussion It seems as 68Ga-PSMA PET/CT is better than PET/CT in prostate cancer to detect primary prostate lesions, initial metastases in the lymph nodes and recurrence. However, further research is required to obtain high-level tests. Also, other PET markers are studied. Moreover, the emergence of a new PET/MR camera could change the performance of PET imaging.

      PubDate: 2017-05-07T18:40:48Z
      DOI: 10.1016/j.acuroe.2017.04.002
  • Thulium laser enucleation (ThuLEP) versus transurethral resection of the
           prostate in saline (TURis): A randomized prospective trial to compare
           intra and early postoperative outcomes
    • Authors: G. Bozzini; M. Seveso; S. Melegari; O. de Francesco; N.M. Buffi; G. Guazzoni; M. Provenzano; A. Mandressi; G. Taverna
      Abstract: Publication date: Available online 2 May 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): G. Bozzini, M. Seveso, S. Melegari, O. de Francesco, N.M. Buffi, G. Guazzoni, M. Provenzano, A. Mandressi, G. Taverna
      Objective To compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. Methods The study randomized 208 consecutive patients with BPH to ThuLEP (n =102) or TURis (n =106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). Results The patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70minutes, P =.123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dl, P =.005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P=.011), irrigation volume (29.4 vs 69.2l, P =.002), and hospital stay (1.7 vs 5.2 days, P =.016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. Conclusion ThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up.

      PubDate: 2017-05-07T18:40:48Z
      DOI: 10.1016/j.acuroe.2016.06.012
  • PCA3 as a second-line biomarker in a prospective controlled randomized
           opportunistic prostate cancer screening programme
    • Authors: J. Rubio-Briones; J. Casanova; F. Martínez; J.L. Domínguez-Escrig; A. Fernández-Serra; R. Dumont; M. Ramírez-Backhaus; A. Gómez-Ferrer; A. Collado; L. Rubio; A. Molina; M. Vanaclocha; D. Sala; J.A. Lopez-Guerrero
      Abstract: Publication date: Available online 30 April 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J. Rubio-Briones, J. Casanova, F. Martínez, J.L. Domínguez-Escrig, A. Fernández-Serra, R. Dumont, M. Ramírez-Backhaus, A. Gómez-Ferrer, A. Collado, L. Rubio, A. Molina, M. Vanaclocha, D. Sala, J.A. Lopez-Guerrero
      Objectives PCA3 performance as a single second line biomarker is compared to the European Randomized Study of Screening for Prostate Cancer risk calculator model 3 (ERSPC RC-3) in an opportunistic screening in prostate cancer (PCa). Material and methods 5199 men, aged 40–75 years, underwent prostate-specific antigen (PSA) screening and digital rectal examination (DRE). Men with a normal DRE and PSA ≥3ng/ml had a PCA3 test done. All men with PCA3 ≥35 underwent an initial biopsy (IBx) – 12 cores. Men with PCA3 <35 were randomized 1:1 to either IBx or observation. We compared them to those obtained with ERSPC RC-3. Results PCA3 test was performed on 838 men (16.1%). In PCA3(+) and PCA3(–) groups, global PCa detection rates were 40.9% and 14.7% with a median follow-up (FU) of 21.7 months (p < 0.001). In the PCA3(+) arm (n =301, 35.9%), PCa was identified in 115 men at IBx (38.2%). In the randomized arm, 256 underwent IBx and PCa was found in 46 (18.0%) (p < 0.001). The biopsy-sparing potential would have been 64.1% as opposed to 76.6% if we had used ERSPC RC-3. However, the estimated false negative cases for HGPCa would have been reduced by 37.1% (89–56 patients). Moreover, if we had applied PCA3 -35 to avoid IBx, 14.7% PCa and 9.1% of clinical significant PCa patients would not have been diagnosed during this FU. Conclusions When PCA3 -35 is used as a second-line biomarker when PSA ≥3ng/ml and DRE is normal, IBx could be avoided in 12.5% less than if ERSPC RC-3 is used and would reduce the false negative cases by 36.2%. At a FU of 21.7 months, this dual protocol would miss 9.1% of clinically significant PCa, so strict FU is mandatory with established biopsy criteria based on PSA and DRE in cases with PCA3 <35.

      PubDate: 2017-05-02T14:30:56Z
      DOI: 10.1016/j.acuroe.2017.04.003
  • Effect of 5α-reductase inhibitors on sexual function: New
    • Authors: Montero
      Abstract: Publication date: Available online 1 April 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero

      PubDate: 2017-04-04T06:17:52Z
  • Renal cell carcinoma in Latin America: Do we know the relationship between
           demographic changes and the impact on our population?
    • Authors: J.A. Grandez-Urbina; R. Arias-Nolazco
      Abstract: Publication date: Available online 31 March 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.A. Grandez-Urbina, R. Arias-Nolazco

      PubDate: 2017-04-04T06:17:52Z
      DOI: 10.1016/j.acuroe.2017.03.009
  • Global vision system in laparoscopy
    • Authors: I. Rivas-Blanco; E. Sánchez-de-Badajoz; I. García-Morales; J.M. Lage-Sánchez; P. Sánchez-Gallegos; C.J. Pérez-del-Pulgar; V.F. Muñoz
      Abstract: Publication date: Available online 31 March 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): I. Rivas-Blanco, E. Sánchez-de-Badajoz, I. García-Morales, J.M. Lage-Sánchez, P. Sánchez-Gallegos, C.J. Pérez-del-Pulgar, V.F. Muñoz
      Objective The main difficulty in laparoscopic or robot-assisted surgery is the narrow visual field, restricted by the endoscope's access port. This restriction is coupled with the difficulty of handling the instruments, which is due not only to the access port but also to the loss of depth of field and perspective due to the lack of natural lighting. In this article, we describe a global vision system and report on our initial experience in a porcine model. Material and methods The global vision system consists of a series of intraabdominal devices, which increase the visual field and help recover perspective through the simulation of natural shadows. These devices are a series of high-definition cameras and LED lights, which are inserted and fixed to the wall using magnets. The system's efficacy was assessed in a varicocelectomy and nephrectomy. Results The various intraabdominal cameras offer a greater number of intuitive points of view of the surgical field compared with the conventional telescope and appear to provide a similar view as that in open surgery. Areas previously inaccessible to the standard telescope can now be reached. The additional light sources create shadows that increase the perspective of the surgical field. Conclusion This system appears to increase the possibilities for laparoscopic or robot-assisted surgery because it offers an instant view of almost the entire abdomen, enabling more complex procedures, which currently require an open pathway.

      PubDate: 2017-04-04T06:17:52Z
      DOI: 10.1016/j.acuroe.2017.03.007
  • Comparative study of hybrid laparoendoscopic single-site (LESS) partial
           nephrectomy and conventional multiport laparoscopy
    • Authors: C. Redondo; C. Esquinas; E. Meilán; A. García-Tello; I. Arance; J.C. Angulo
      Abstract: Publication date: Available online 31 March 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. Redondo, C. Esquinas, E. Meilán, A. García-Tello, I. Arance, J.C. Angulo
      Objective To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Material and method Hybrid LESS technique with auxiliary 3.5mm trocar (n =20) was compared with conventional multiport laparoscopy (n =26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. Results Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P =0.09) and benign histology (P =0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P =0.006) and hospital stay (P =0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. Conclusions Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes.

      PubDate: 2017-04-04T06:17:52Z
      DOI: 10.1016/j.acuroe.2017.03.003
  • A comparison of 3 on-line nomograms with the detection of primary
           circulating prostate cells to predict prostate cancer at initial biopsy
    • Authors: N.P. Murray; C. Fuentealba; E. Reyes; O. Jacob
      Abstract: Publication date: Available online 31 March 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): N.P. Murray, C. Fuentealba, E. Reyes, O. Jacob
      Introduction The use of nomograms which include the PSA may improve the predictive power of obtaining a prostate biopsy (PB) positive for cancer. We compare the use of three on-line nomagrams with the detection of primary malignant circulating prostate cells (CPCs) to predict the results of an initial PB in men with suspicion of prostate cancer. Methods and patients Consecutive men with suspicion of prostate cancer underwent a 12 core TRUS prostate biopsy; age, total serum PSA, percent free PSA, family history, ethnic origin and prostate ultrasound results were used for risk assessment using the online nomograms. Mononuclear cells were obtained by differential gel centrifugation from 8ml of blood and CPCs were identified using double immunomarcation with anti-PSA and anti-P504S. A CPC was defined as a cell expressing PSA and P504S and defined as negative/positive. Biopsies were classified as cancer/no-cancer. Areas under the curve (AUC) for each parameter were calculated and compared and diagnostic yields were calculated. Results 1223 men aged >55 years participated, 467 (38.2%) had a biopsy positive for cancer of whom 114/467 (24.4%) complied with the criteria for active observation. Area under the curve analysis showed CPC detection to be superior (p <0.001), avoiding 57% of potential biopsies while missing 4% of clinically significant prostate cancers. Conclusions The CPC detection was superior to the nomograms in predicting the presence of prostate cancer at initial biopsy; its high negative predictive value potentially reduces the number of biopsies while missing few significant cancers, being superior to the nomograms in this aspect. Being a positive/negative test the detection of CPCs avoids defining a cutoff value which may differ between populations.

      PubDate: 2017-04-04T06:17:52Z
      DOI: 10.1016/j.acuroe.2017.03.002
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