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UROLOGY, NEPHROLOGY AND ANDROLOGY (155 journals)                     

Showing 1 - 155 of 155 Journals sorted alphabetically
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access  
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 11)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 42)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 36)
Andrologia     Hybrid Journal   (Followers: 2)
Andrology     Hybrid Journal   (Followers: 4)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 7)
Andrology-Open Access     Open Access  
Annales d'Urologie     Full-text available via subscription  
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access  
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
BANTAO Journal     Open Access  
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 35)
BMC Nephrology     Open Access   (Followers: 9)
BMC Urology     Open Access   (Followers: 15)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 6)
Canadian Urological Association Journal     Open Access   (Followers: 2)
Cancer Urology     Open Access   (Followers: 2)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 5)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 9)
Case Reports in Urology     Open Access   (Followers: 12)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 4)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 19)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Clinical Nephrology and Urology Science     Open Access   (Followers: 6)
Clinical Queries: Nephrology     Hybrid Journal   (Followers: 1)
Cuadernos de Cirugía     Open Access   (Followers: 3)
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 10)
Current Opinion in Urology     Hybrid Journal   (Followers: 12)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 7)
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Full-text available via subscription   (Followers: 38)
European Urology Focus     Hybrid Journal   (Followers: 6)
European Urology Supplements     Full-text available via subscription   (Followers: 15)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Herald Urology     Open Access   (Followers: 2)
Hong Kong Journal of Nephrology     Open Access   (Followers: 3)
Human Andrology     Partially Free   (Followers: 2)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 12)
International Urology and Nephrology     Hybrid Journal   (Followers: 7)
Jornal Brasileiro de Nefrologia     Open Access  
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 1)
Journal of Clinical Urology     Hybrid Journal   (Followers: 14)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 4)
Journal of Nephrology Research     Open Access   (Followers: 3)
Journal of Pediatric Nephrology     Open Access   (Followers: 3)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 12)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 1)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 27)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Translational Neurosciences     Open Access  
Journal of Urology     Full-text available via subscription   (Followers: 53)
Journal of Urology & Nephrology     Open Access   (Followers: 2)
Kidney Disease and Transplantation     Open Access   (Followers: 4)
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 44)
Kidney International Reports     Open Access   (Followers: 3)
Kidney Medicine     Open Access  
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access   (Followers: 1)
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 19)
Nature Reviews Urology     Full-text available via subscription   (Followers: 13)
Nefrología (English Edition)     Open Access  
Nefrología (Madrid)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 12)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 25)
Nephron     Hybrid Journal   (Followers: 4)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 4)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 5)
Open Journal of Urology     Open Access   (Followers: 7)
Open Urology & Nephrology Journal     Open Access  
Pediatric Urology Case Reports     Open Access   (Followers: 7)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 6)
Renal Failure     Open Access   (Followers: 12)
Renal Replacement Therapy     Open Access   (Followers: 4)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access   (Followers: 1)
Revista Urologia Colombiana     Open Access  
Saudi Journal of Kidney Diseases and Transplantation     Open Access   (Followers: 2)
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 8)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 8)
Therapeutic Advances in Urology     Open Access   (Followers: 4)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Ukrainian Journal of Nephrology and Dialysis     Open Access   (Followers: 1)
Uro-News     Hybrid Journal   (Followers: 2)
Urolithiasis     Hybrid Journal   (Followers: 2)
Urologia Internationalis     Full-text available via subscription   (Followers: 2)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 4)
Urologic Nursing     Full-text available via subscription   (Followers: 4)
Urologic Radiology     Hybrid Journal  
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urologie Scan     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 34)
Urology Annals     Open Access   (Followers: 4)
Urology Case Reports     Open Access   (Followers: 3)
Urology Practice     Full-text available via subscription   (Followers: 2)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access   (Followers: 1)
World Journal of Nephrology and Urology     Open Access   (Followers: 15)
World Journal of Urology     Hybrid Journal   (Followers: 12)


Similar Journals
Actas Urológicas Españolas (English Edition)
Number of Followers: 1  
  Full-text available via subscription Subscription journal
ISSN (Print) 2173-5786
Published by Elsevier Homepage  [3201 journals]
  • Preoperative magnetic resonance imaging in predicting early continence
           recovery after robotic radical prostatectomy
    • Abstract: Publication date: Available online 20 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): L. Regis, A. Salazar, M. Cuadras, E. Miret, S. Roche, A. Celma, J. Planas, D. Lorente, J. Placer, E. Trilla, J. Morote Introduction and aimsUrinary incontinence is a common complication after radical prostatectomy. The aim of our study was to describe the preoperative anatomical features using magnetic resonance imaging in order to predict early continence recovery after robotic radical prostatectomy.Material and methods72 patients who underwent robotic radical prostatectomy were prospectively analysed. EPIC questionnaire (1, 6 and 12 mo) and first self-reported continence were used to assess functional outcomes. Membranous urethral length (MUL) and MUL-prostate axis angle (aMULP) were assessed preoperatively on T2 weighted sagittal images.ResultsContinence rate was 67.2%, 92.6% and 95.2% at 1, 6 and 12 months, respectively. Early continence was achieved in patients with the lower aMULP. At 1 month, average aMULP in continent patients was 107.21° (CI 95% 90.3–124.6) vs. 118.5° (CI 95% 117.7–134) in incontinent ones (p = 0.014). At 6 month differences in aMULP among groups were found: 114.24° (CI 95% 104.6–123.9) in continents vs. 142° (CI 95% 126.5–157.6) in incontinents (p = 0.015). At 12 month, continent group showed a significantly higher preoperative aMULP. aMULP was revealed as the only independent predictor of urinary continence at 6 mo in multivariate analysis, OR 0.007 (CI 95% 0.002–0.012), p = 0.012.ConclusionsPreoperative anatomical parameters assessment prior surgery can help to identified those patients will achieve early continence recovery and it supports therapeutic decisions making.ResumenIntroducción y objetivosLa incontinencia urinaria es una de las principales complicaciones tras la prostatectomía radical. El objetivo del estudio fue describir las características anatómicas, evaluadas preoperatoriamente mediante resonancia magnética, que permitan predecir la recuperación precoz de la continencia urinaria tras la prostatectomía radical asistida por robot.Material y métodosSe analizó prospectivamente a 72 pacientes tratados mediante prostatectomía radical asistida por robot. Los resultados funcionales se evaluaron mediante los cuestionarios EPIC (1, 6 y 12 meses) y la fecha de primera continencia autoinformada. La longitud de la uretra membranosa (LUM) y el ángulo entre la LUM y el eje prostático (aLUMP) fueron evaluados preoperatoriamente en imágenes sagitales ponderadas en T2.ResultadosLa tasa de continencia fue del 67,2, el 92,6 y el 95,2% a 1, 6 y 12 meses, respectivamente. Los pacientes con valores de aLUMP inferiores alcanzaron continencia urinaria temprana: al mes, los continentes habían tenido una aLUMP media de 107,21° (IC del 95% 90,3-124,6), mientras que entre los que presentaban incontinencia era de 118,5° (IC del 95% 117,7-134); p = 0,014. Hemos encontrado diferencias en el aLUMP entre los grupos según la continencia a los 6 meses: ángulo en continentes de 114,24° (IC del 95% 104,6-123,9), mientras que en los incontinentes había sido 142° (IC del 95% 126,5-157,6), p = 0,015. A los 12 meses, los continentes tenían una LUM preoperatoria significativamente superior a los incontinentes. En el análisis multivariante solamente el aLUMP fue un predictor independiente de continencia urinaria a los 6 meses OR 0,007 (IC del 95% 0,002-0,012), p = 0,012.ConclusionesLa evaluación de parámetros anatómicos preoperatorios previos a la cirugía puede ayudar a definir qué pacientes recuperarán la continencia urinaria precozmente, auxiliando a la toma de decisiones terapéuticas.
  • Cognitive function assessment in elderly patients with overactive bladder
           treated with transdermal oxybutynin
    • Abstract: Publication date: Available online 18 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): C. Müller-Arteaga, J.E. Batista-Miranda, C. Zubiaur Libano, R. El Khoury Moreno, G. Morales Solchaga, J. Casas Nebra, M. Leva Vallejo, O. Gonzalez Garcia, C. Errando-Smet, S. Arlandis-Guzman Introduction and objectivesOlder patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin.Materials and methodsObservational, retrospective, multicentre study in patients with overactive bladder aged 65–80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky–Green test, were assessed.ResultsFrom 85 eligible patients, 70 completed the assessment (mean age: 71.4 ± 4.5; BMI: 28.7 ± 3.1 kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0–1.5), Clock-Drawing Test (0 points; 95%CI: 0.0–0.0). A statistically significant improvement (p 
  • Postoperative pain and cosmetic results of minilaparoscopic nephrectomy
           compared to the conventional technique
    • Abstract: Publication date: Available online 16 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): A. Pérez-Lanzac, E.J. Romero, J.L. Alvarez-Ossorio IntroductionIn recent years urology has been focussing on less invasive forms of laparoscopy with less impact on the abdominal wall. The minilaparoscopy (ML) is promising in this regard. Our objective is to compare the results of a series of patients who underwent minilaparoscopic nephrectomy with another series who underwent conventional laparoscopy (CL).Material and methodsWe chose 8 nephrectomies performed by mini-laparoscopy in a single hospital (NmL group) from a total of 110 patients included in multiple centres and compared them retrospectively with a contemporary series of 16 patients who underwent CL (NL group). From 1 to 3 3 mm and 5 mm trocars were used for the NmL and the NL, respectively, one 10 mm trocar in the pararectal edge of a Pfannenstiel incision and another 11 mm paraumbilical trocar for the optics. Age, BMI, ASA, complications, analgesic requirements in the postoperative period and cosmetic satisfaction were recorded using the Patient Scar Assessment Questionnaire (PSAQ), one month after the intervention.ResultsBoth groups were comparable and there were no differences in terms of surgery time, number of ports used, hospital stay or intra-and postoperative complications. In only one patient from the NmL group, a 3 mm trocar had to be replaced by a 5 mm trocar and one patient in the NL group was converted to hand-assisted surgery due to severe adherences. The patients in the NmL group had less postoperative pain on the VAS (±0 vs. 4 ± 25, p = 0.05) and were more satisfied with their appearance on the PSAQ (8.5 ± 1.4 vs. 16.6 ± 3.1, p = 0.05) compared to the NL group.ConclusionsThe results obtained with the ML instrument were similar to those obtained by CL, but with the advantages of less postoperative pain and better cosmetic results.ResumenIntroducciónEn los últimos años la urología se ha orientado a formas menos invasivas de laparoscopia con un menor impacto en la pared abdominal. Entre ellas ha surgido de una forma prometedora la minilaparoscopia (ML). Nuestro objetivo es comparar los resultados de una serie de pacientes intervenidos de nefrectomía minilaparoscópica y otra mediante laparoscopia convencional (LC).Material y métodosSeleccionamos en un único hospital 8 nefrectomías realizadas por minilaparoscopia (grupo NmL) de un total de 110 pacientes incluidos en múltiples centros y las comparamos retrospectivamente con una serie contemporánea de 16 pacientes intervenidos por LC (grupo NL). Se emplearon de 1 a 3 trocares de 3 mm y de 5 mm para la NmL y NL, respectivamente, un trocar de 10 mm en el borde pararrectal de una incisión de Pfannenstiel y otro de 11 mm paraumbilical para la óptica. Se recogieron la edad, el IMC, el ASA, las complicaciones, los requerimientos analgésicos en el postoperatorio y la satisfacción cosmética mediante el Patient Scar Assessment Questionnaire (PSAQ) al mes de la intervención.ResultadosAmbos grupos fueron comparables y no presentaron diferencias en cuanto al tiempo quirúrgico, número de puertos empleados, estancia hospitalaria y complicaciones intra y postoperatorias. Solo en un paciente del grupo NmL un trocar de 3 mm requirió ser substituido por otro de 5 mm y un paciente del grupo NL fue convertido a cirugía mano-asistida por intensas adherencias. Los pacientes del grupo NmL presentaron menos dolor postoperatorio en la escala EVA (± 0 vs. 4 ± 25, p = 0,05) y mejor satisfacción en la apariencia en el PSAQ (8,5 ± 1,4 vs. 16,6 ± 3,1, p = 0,05) respecto al grupo NL.ConclusionesLos resultados obtenidos con el instrumental de ML fueron semejantes a los obtenidos por LC, pero con las ventajas de un menor dolor postoperatorio y mejores resultados cosméticos.
  • Clinical and basic evidence on the use of autologous platelet-rich plasma
           in erectile dysfunction: A detailed update
    • Abstract: Publication date: Available online 16 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): J.A. Grandez-Urbina, R. Pichardo-Rodriguez
  • The role of STAT3 protein as a prognostic factor in the clear cell renal
           carcinoma. Systematic review
    • Abstract: Publication date: Available online 16 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): D. Lorente, E. Trilla, A. Meseguer, J. Arevalo, S. Nemours, J. Planas, J. Placer, A. Celma, C. Salvador, L. Regis, I. Schwartzmann, J. Morote Context and objectiveThere have been significant advances in the knowledge of renal carcinogenesis in the last years. Nowadays, renal tumours are classified according to their genetic profile and specific treatments based on the identification of therapeutic targets have also been developed. However, no prognostic markers have yet been identified. The aim of this review is to analyze literature that has evaluated the expression of the STAT3 protein as a molecular marker in clear cell renal carcinoma (ccRCC).Evidence acquisitionIn January 2018 a systematic review was conducted in Pubmed, Cochrane library and Sciencedirect databases, from papers published from 1990. Search terms were “renal cell carcinoma” and “STAT3” or “STAT-3” and prognostic factor. Following the principles of the PRISMA declaration and the PICO selection strategy, original articles with series of patients diagnosed with localized or metastatic ccRCC, and where the activity of STAT3 is analyzed as a prognostic marker, were selected. A total of 132 publications were identified, of which 10 were finally revised, for they met the inclusion criteria.Evidence synthesisSTAT3 activation (phosphorylation) through Ser727 is important during ccRCC development and progression. PSTAT3 expression seems to be a prognostic marker and an antiangiogenic-resistance marker in metastatic patients. There is little evidence as prognostic marker in patients with localized disease.ConclusionsSTAT3 (Ser 727) expression in the nucleus of the ccRCC cells can be a prognostic marker and an antiangiogenic-resistance marker. Current scientific evidence is limited and more studies are needed to demonstrate its usefulness.ResumenContexto y objetivoEn los últimos años se han producido avances significativos en el conocimiento de la carcinogénesis renal. Hoy en día los tumores renales se clasifican en función de su perfil genético, y además se han desarrollado tratamientos específicos basados en la identificación de dianas terapéuticas. Sin embargo, todavía no se han identificado marcadores pronósticos. El objetivo de esta revisión es analizar la literatura que ha evaluado la expresión de la proteína STAT3 como marcador molecular en el carcinoma renal de célula clara (ccRCC).Adquisición de evidenciaEn enero de 2018 se realizó una búsqueda sistemática de la literatura en Pubmed, Cochrane Library y Sciencedirect de las publicaciones realizadas desde 1990. Los términos de búsqueda fueron renal cell carcinoma and STAT3 or STAT-3 and prognostic factor. Se siguieron los principios de la declaración PRISMA y la estrategia de selección PICO, seleccionándose los artículos originales con series de pacientes diagnosticados de ccRCC localizado o metastásico, donde se analiza la actividad de STAT3 como marcador pronóstico. Se identificaron 132 publicaciones de las que finalmente se han revisado 10 por cumplir los criterios de inclusión.Síntesis de evidenciaLa activación (fosforilación) de STAT3 (pSTAT3) en el residuo Ser727 es importante en el desarrollo y progresión de ccRCC. La expresión de pSTAT3 parece ser un marcador pronóstico y predictor de resistencia a algunos tratamientos en pacientes con enfermedad diseminada. Existe poca evidencia de su utilidad como un marcador pronóstico en pacientes con enfermedad localizada.ConclusionesLa expresión de pSTAT3(Ser727) en el núcleo de las células del ccRCC puede ser un marcador pronóstico y de respuesta al tratamiento en pacientes con ccRCC. La evidencia científica actual es limitada y son necesarios más estudios que demuestren su utilidad.
  • Infections related to healthcare in patients hospitalized in a Urology
           service: Resistance patterns and adequacy of empirical antibiotic
           treatment as a prognostic factor
    • Abstract: Publication date: Available online 16 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): R. Benítez-Sala, J. Medina-Polo, J. Justo-Quintas, J. Gil-Moradillo, S. Pérez-Cadavid, A. Arrébola-Pajares, R. Sopeña-Sutil, A. Lara-Isla, M. Alonso-Isa, D.A. González-Padilla, E. García-Rojo, N. Miranda-Utrera, L. Aguilar-Gisbert, Á. Tejido-Sánchez ObjectivesTo evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved.MethodA prospective observational study was carried out on patients of both sexes older than 16 years, admitted by any urological process during a period of 4 years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analyzed.ResultsOut of 6546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E. coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E. coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment.ConclusionsThe selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P. aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria.ResumenObjetivosEvaluar la idoneidad de la antibioterapia empírica en IRAS y los patrones de resistencia a antibióticos de los microorganismos responsables, así como la incidencia de mortalidad y factores de riesgo en relación con IRAS.MétodoDurante un periodo de 4 años se realiza un estudio prospectivo observacional sobre todos los pacientes de ambos sexos y mayores de 16 años ingresados por cualquier proceso urológico. Se evalúan la incidencia y las características de las IRAS y se analiza el microorganismo causante y sus resistencias, la antibioterapia empírica inicial y si esta precisó modificación, y las tasas de mortalidad.ResultadosDe un total de 6.546 pacientes, el 6,3% sufrieron IRAS, correspondiendo el 70,5% a infección del tracto urinario y el 22,1% a infección de la herida quirúrgica. E. coli, Enterococcus spp., Klebsiella spp. y P. aeruginosa fueron los más frecuentemente implicados (25,1, 17,5, 13,5 y 12,3%, respectivamente). E. coli y Klebsiella spp. fueron productoras de betalactamasas de espectro extendido (BLEE) en el 24,7 y el 47,8%, respectivamente. El 4,3% de Klebsiella y el 33,3% de Pseudomonas eran resistentes a carbapenemes. La resistencia global a quinolonas fue del 50% aproximadamente. Los antibióticos más frecuentemente usados de forma empírica fueron cefalosporinas de tercera y cuarta generación (33,6%) y carbapenemes (28,2%). Se obtuvo una tasa global de adecuación de antibioterapia empírica del 82,9%. La tasa de mortalidad en los pacientes con IRAS fue del 2,2%, frente al 0,3% en los pacientes sin infección. En un análisis multivariable, las variables que se asociaron a mayor riesgo de mortalidad fueron el aislamiento de enterobacterias productoras de BLEE y el tratamiento antibiótico empírico inadecuado.ConclusionesLa selección de la antibioterapia empírica fue bastante precisa. Se está observando un aumento de IRAS por microorganismos multirresistentes, como enterobacterias BLEE o P. aeruginosa multirresistentes. El riesgo de mortalidad aumenta con una antibioterapia empírica inicial inadecuada o cuando el microorganismo responsable es una enterobacteria BLEE.
  • Intraprostatic ethanol injection as an alternative therapy in patients
           with benign prostatic hyperplasia
    • Abstract: Publication date: Available online 16 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): A.R. Espinoza IntroductionBenign prostatic hyperplasia is a high prevalence worldwide pathology. Amongst its therapeutic options, there are minimally invasive techniques that use locally injected substances (such as ethanol), which produce a chemoablation of this organ.ObjectiveThe present work aims to evaluate the efficacy of intraprostatic ethanol injection in the treatment of benign prostatic hyperplasia.Material and methodsA prospective study was carried out, consisting of patients with symptomatic benign prostatic hyperplasia, who were injected with 95% ethanol transrectally, in a 25% prostate volume dose, divided into 3 punctures per each lobe. Follow-up time was 12 months.ResultsThe procedure was well tolerated. The mean urethrovesical catheter stay time was 10.68 days (CI 8.61–13.75, range 3–30). The score on the international scale of prostatic symptoms improved by 47.58% (p  0.05); prostatic volume was reduced by 35.03% (p  0.05) The maximum urinary flow was increased by 84.83% (p  0,05); redujo el volumen prostático en un 35,03% (p < 0,05) y el residuo posmiccional en un 58,61% (p> 0,05), así como aumentó el flujo urinario máximo en un 84,83% (p < 0,05). Los efectos secundarios más frecuentes fueron hematuria, síntomas irritativos e infección.ConclusionesLa inyección intraprostática de etanol puede ser una alternativa no quirúrgica efectiva en el tratamiento de pacientes con hiperplasia prostática benigna.
  • Comparison between percutaneous nephrolithotomy and flexible ureteroscopy
           for the treatment of 2 and 3 cm renal lithiasis
    • Abstract: Publication date: Available online 16 March 2019Source: Actas Urológicas Españolas (English Edition)Author(s): Á.A. Fernández Alcalde, M. Ruiz Hernández, V. Gómez dos Santos, C. Sánchez Guerrero, D.E. Diaz Pérez, F. Arias Fúnez, I. Laso García, G. Duque Ruiz, F.J. Burgos Revilla Context and objectivesThe first-line treatment for>2 cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (FURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2–3 cm stones.Material and methodsSystematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the paediatric population or with 3 cm stones, were excluded.Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the FURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomised prospective.ResultsStone-free rate ranged between 47.0% and 95.0% for the FURS and between 87.0% and 100% for the PNL. The complication rate was 8.8–29.0% in the FURS and 11.9–27.0% in the PNL. FURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL.ConclusionsThe stone-free rate was higher for PNL, although the FURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations.ResumenContexto y objetivosEl tratamiento de primera elección para litiasis> 2 cm es la nefrolitotomía percutánea (NLP), dejando a la ureteroscopia flexible (URS-F) como una segunda opción. En la presente revisión se evaluaron la tasa libre de litiasis y las complicaciones de ambas técnicas en el tratamiento de litiasis de tamaño entre 2 y 3 cm.Material y métodosRevisión sistemática de estudios que compararon las dos técnicas. Fueron excluidos aquellos estudios que no fueran comparativos, los realizados en población pediátrica o con litiasis menores de 2 cm o mayores de 3 cm.Dos investigadores realizaron independientemente la búsqueda, obteniendo 5 estudios que abarcaban un total de 815 pacientes: 252 pertenecieron al grupo de URS-F y 563 al de NLP. Cuatro fueron retrospectivos y uno fue prospectivo no aleatorizado.ResultadosLa tasa libre de litiasis osciló entre el 47,0 y el 95,0% para la URS-F y entre el 87,0 y el 100% para la NLP. La tasa de complicaciones fue del 8,8-29,0% en la URS-F y del 11,9-27,0% en la NLP. La URS-F requirió un número mayor de procedimientos y tuvo un menor descenso de hemoglobina y ascenso de creatinina en comparación con la NLP.ConclusionesLa tasa libre de litiasis fue mayor en la NLP, aunque la URS-F podría alcanzar unos resultados comparables a expensas de realizar varios procedimientos. Ambas técnicas tienen una frecuencia de complicaciones similar, pero con más alteraciones analíticas posquirúrgicas en el grupo de NLP.
  • Differences in overall survival and cancer-specific survival in high-risk
           prostate cancer patients according to the primary treatment
    • Abstract: Publication date: March 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 2Author(s): J. Caño-Velasco, F. Herranz-Amo, G. Barbas-Bernardos, L. Polanco-Pujol, J. Hernández-Cavieres, E. Lledó-García, C. Hernández-Fernández Introduction and objectivesThere is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC).Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT + HT)).Material and methodsA retrospective study of 286 HRLPC patients diagnosed between 1996 and 2008, treated by RP (n = 145) or RT + HT (n = 141).Survival was assessed using the Kaplan–Meier method. Significant differences between the different variables were analysed using the log-rank test. A uni and multivariate Cox regression analysis was performed to identify risk factors.ResultsThe median follow-up was 117.5 (IQR 87–158) months. The OS was longer (p = 0.04) in the RP patients, while there were no differences (p = 0.44) in CSS between either group.The type of primary treatment was not related to OS or CSS. Age (p = 0.002), the onset during follow-up of a 2nd tumour (p = 0.0001), and stage cT3a (p = 0.009) behaved as independent predictive variables of OS. None of the variables behaved as an independent predictive variable of CSS, although biochemical recurrence after rescue treatment (p = 0.058), and the onset of a 2nd tumour during follow-up showed a significant trend to statistical significance, the latter reducing specific cancer mortality (HR .16, 95%CI 0.02–1.18, p = 0.07).ConclusionsPrimary treatment did not relate to OS or CSS in patients with HRPC.ResumenIntroducción y objetivosNo existe evidencia de alto nivel sobre qué tratamiento primario proporciona una ventaja de supervivencia global (SG) y supervivencia cáncer específica (SCE) en cáncer de próstata localizado de alto riesgo (CPAR).Nuestro objetivo es analizar las diferencias en supervivencia, así como sus factores predictores, en este grupo de pacientes según su tratamiento primario (prostatectomía radical [PR] o radioterapia y bloqueo androgénico [RT + HT]).Material y métodosEstudio retrospectivo de 286 pacientes con CPAR diagnosticados entre 1996-2008, tratados mediante PR (n = 145) o RT + HT (n = 141).La supervivencia se evaluó con el método de Kaplan-Meier. La existencia de diferencias significativas entre las distintas variables se analizó mediante el test de log-rank. Para la identificación de factores de riesgo se utilizó un análisis uni y multivariante mediante regresión de Cox.ResultadosLa mediana de seguimiento fue de 117,5 (IQR 87-158) meses. La SG fue mayor (p = 0,04) en los pacientes con PR, mientras que no existieron diferencias (p = 0,44) en la SCE entre ambos grupos.El tipo de tratamiento primario no se relacionó con la SG ni SCE. La edad (p = 0,002), la aparición durante el seguimiento de un segundo tumor (p = 0,0001) y el estadio cT3a (p = 0,009) se comportaron como variables predictoras independientes de SG. Ninguna de las variables se comportó como variable predictora independiente de SCE, aunque la recidiva bioquímica tras tratamiento de rescate (p = 0,058) y la aparición de un segundo tumor durante el seguimiento presentaron una tendencia importante a la significación estadística, reduciendo este último la mortalidad cáncer específica (hazard ratio 0,16, intervalo de confianza del 95% 0,02-1,18, p = 0,07).ConclusionesEl tratamiento primario no se relacionó con la SG ni SCE en pacientes con CPAR.
  • Impact of the baseline study with penile doppler ultrasound in patients
           with prostate cancer before radical prostatectomy
    • Abstract: Publication date: March 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 2Author(s): J. Muñoz-Rodríguez, N. Hannaoui, A. Domínguez, C. Centeno, V. Parejo, M.A. Rosado, J. Prats, S. Navarro IntroductionGiven the high prevalence of erectile dysfunction in male population between 40 and 70 years old and the effect of radical prostatectomy on this domain, it is important to perform a baseline study.Material and methodsPrior radical prostatectomy, erectile function has been assessed prospectively in 112 prostate cancer patients using the erectile function (EF) domain of the International Index of Erectile Function (EF-IIEF), Erectile Hardness Score (EHS) and a penile doppler ultrasound (PDUS). Comorbidities and Charlson index were collected. The EORTC QLQ C-30 and PR-25 tests were administered.ResultsAccording to EF-IIEF questionnaire, 50.9% of patients showed normal EF and EHS grade 3–4 erection was achieved in the 75.9%. PDUS was normal only in 28.6% of patients and 51.8% showed arterial insufficiency. We found a significant association (p 
  • Bladder pain syndrome: Prevalence and routine clinical practice in women
           attending functional urology and urodynamics units in Spain
    • Abstract: Publication date: March 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 2Author(s): G. Morales-Solchaga, C. Zubiaur-Libano, L. Peri-Cusí, J.M. Adot-Zurbano, S. Arlandis-Guzmán, A. Franco-de Castro, C. Castillejo, Grupo de Investigación de Resultados en Salud en Urología Funcional y Urodinámica (Grupo IFU) Introduction and objectivesBladder pain syndrome (BPS) is classified as a rare chronic debilitating disease and its diagnosis presents a challenge because its symptoms overlap with those associated with overactive bladder syndrome. The aim of the routine study was to estimate the prevalence of BPS and discover to study the profile of symptoms and clinical practice for patients attending functional urology and urodynamics units.Material and methodsAn epidemiological study in which 37 functional urology and urodynamics units in Spain participated. The prevalence was studied in both sexes. Clinical practice was evaluated for 319 women with BPS (new diagnosis or under review). Clinical and sociodemographic data were collected retrospectively. The results were studied of urine tests, cystoscopy, biopsy, physical examination, bladder diary, and those of the four available questionnaires: Patient Perception of Bladder Condition; Bladder Pain/Interstitial Cystitis Symptom Score; EuroQoL-5 Dimensions-5L and Patient Global Impression of Severity.ResultsFive point four percent (503) of the patients who attended these units (9312) had a diagnosis of BPS (90% [453] females). The tests that were performed most according to the clinical history and anamnesis were: urine test, bladder ultrasound and cystoscopy. The most common symptoms/comorbidities were: pain in the bladder region, increased urinary frequency, nocturia, anxiety and depression. Diagnostic assessment determined pain on hydrodistension (86.9%), positive biopsy (59.2%), myofascial pelvic pain (28.4%), urological phenotype (97.8%), and increased urinary frequency (88.7%). The questionnaires reflected how much the quality of life of these patients was affected.ConclusionsThe prevalence of BPS in functional urology and urodynamics units in Spain is low. No homogeneity was observed in terms of diagnosis between the different participating centers. Therefore, a common methodology is required for the management of patients with BPS in these units, with tools specific to this disorder.ResumenIntroducción y objetivosEl síndrome de dolor vesical (SDV) está catologado como enfermedad rara y su diagnóstico representa un desafío debido al solapamiento de sus síntomas con los asociados al síndrome de vejiga hiperactiva. El objetivo fue estimar la prevalencia del SDV y conocer el perfil de síntomas y la práctica clínica en pacientes que acuden a unidades de Urología Funcional y Urodinámica.Material y métodosEstudio epidemiológico en el cual participaron 37 unidades de Urología Funcional y Urodinámica de España. La prevalencia se estudió considerando ambos sexos. Se evaluó la práctica clínica en 319 mujeres con SDV (nuevo diagnóstico o en revisión). Se recogieron retrospectivamente datos clínicos y sociodemográficos. Se analizaron los resultados de análisis de orina, cistoscopia, biopsia, exploración física, diario miccional, así como de los 4 cuestionarios disponibles: Patient Perception of Bladder Condition; Bladder Pain/Interstitial Cystitis Symptom Score; EuroQoL-5 Dimensions-5L y Patient Global Impression of Severity.ResultadosEl 5,4% (503) de los pacientes que acudieron a estas unidades (9.312) tenían diagnóstico de SDV (90% [453] mujeres). Las pruebas más realizadas según historia clínica y anamnesis fueron: análisis de orina, ecografía vesical y cistoscopia. Los síntomas/comorbilidades más frecuentes fueron: dolor en la región vesical, frecuencia miccional aumentada, nicturia, ansiedad y depresión. La evaluación diagnóstica determinó dolor en hidrodistensión (86,9%), biopsia positiva (59,2%), dolor miofascial pélvico (28,4%), fenotipo urológico (97,8%) y frecuencia miccional aumentada (88,7%). Los cuestionarios reflejaron el elevado grado de afectación de la calidad de vida de estos pacientes.ConclusionesLa prevalencia del SDV en las unidades de Urología Funcional y Urodinámica en España es baja. No se observa homogeneidad en cuanto al diagnóstico entre los diferentes centros participantes. Por ello, sería necesario establecer una metodología común de manejo de pacientes con SDV en estas unidades, con herramientas específicas para esta patología.
  • Diagnosis of metastases in castration-resistant prostate cancer patients:
           Decision algorithm in imaging tests
    • Abstract: Publication date: March 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 2Author(s): A. Juárez-Soto, J.M. Garín-Ferreira, A. Rodríguez-Fernández, J.L. Tirado-Hospital, M.T. González-Serrano, J. Moreno-Jiménez, R. Medina-López, V. Baena-González IntroductionIn castration-resistant prostate cancer (CRPC), early detection of metastases is essential for the selection of treatment, and prevention of bone complications. However detecting incipient metastases remains a challenge as the conventional radiological tests (bone scintigraphy or computerised tomography) lack sufficient sensitivity. Diagnostic imaging techniques are currently available that have greater sensitivity and specificity, but are little used due to shortfalls in the recommendations.ObjectiveTo create an algorithm that indicates the most suitable diagnostic imaging techniques for the different M0 CRPC patient profiles based on the scientific evidence.Evidence acquisitionMeetings were held with eight experts in Urology, Pathological Anatomy, Radiodiagnostics and Nuclear Medicine organised by the Andalusian Association of Urology, in which the recommendations and scientific evidence on each of the diagnostic imaging techniques were reviewed.Summary of the evidenceWe present the current recommendations for the detection of metastasis in M0 CRPC patients, the patients that would benefit from early detection, and summarise the evidence to support the use of each of the new techniques.ConclusionsTechniques such as 18F-Choline PET/CT or DWWB MRI and probably open MRI have been demonstrated to have good sensitivity and specificity for patients with low PSA (
  • Comment to: “Transcutaneous stimulation of the posterior tibial nerve
           for treating refractory urge incontinence of idiopathic and neurogenic
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): A. Alcántara Montero, C. Müller-Arteaga
  • Three-year interim results of overall and progression-free survival in a
           cohort of patients with prostate cancer (GESCAP group)
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): J.M. Cózar, B. Miñana, F. Gómez-Veiga, A. Rodríguez-Antolín, GESCAP Group AimsTo describe the 3-year progression-free survival (PFS), overall survival (OS) and disease-specific mortality in the prospective prostate cancer GESCAP cohort, as well as the progression to castration resistance in patients on hormone therapy.Material and methodsProspective, observational, epidemiological, multicentre study. Of the 4087 patients recruited, 3843 were evaluable. The variables analysed were the risk group (localised, locally advanced, lymph involvement, metastatic), age, prostate-specific antigen (PSA) levels, Gleason score and initial treatment. Kaplan Meier survival analysis, the log-rank test and the Cox model were used to evaluate the survival data.ResultsThree-year PFS was 81.4% and OS was 92.4%. During the 3 years of follow-up, 303 patients died (7.9%), 110 of them (36.3%) due to disease-related causes. The probability of castration resistance for all patients on hormone therapy (n = 715) was 14.2%: 5%, 9.9%, 26.1% and 44.4% in localised, locally advanced, lymph involvement and metastatic cancer, respectively (log-rank p 
  • Effectiveness of the “cognitive” biopsy in the diagnosis of prostate
           cancer in patients with a previous negative biopsy
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): G. Barbas Bernardos, F. Herranz Amo, E. de Miguel Campos, A. Luis Cardo, A. Herranz Arriero, J. Caño Velasco, M.J. Cancho Gil, J. Jara Rascón, J. Mayor de Castro, C. Hernández Fernández IntroductionEvaluation of the effectiveness of cognitive biopsy (CB) in patients with clinical suspicion of prostate cancer (PC), and at least one negative biopsy (TRB).Material and methodRetrospective study of 144 patients with at least one previous TRB and magnetic resonance imaging (MRI). The MRI nodules were classified based on PI-RADS v2 grouping pZa, pZpl and pZpm as the peripheral zone (PZ), Tza, Tzp and CZ as the transitional zone (TZ), and the AS zones as the anterior zone (AZ). A biopsy was indicated for nodules ≥PI-RADS 3. Uni and multivariate analysis was undertaken (logistic regression) to identify variables relating to a PI-RADS 3 tumour on biopsy.ResultsThe median age was 67 (IQR: 62–72) years, the median PSA was 8.2 (IQR: 6.2–12) ng/ml. A nodule was identified on MRI in the PZ in 97 (67.4%) cases, in the TZ in 29 (20.1%), and in the AZ in 41 (28.5%). PC was diagnosed on biopsy in 64 (44%) patients. The cancer rate in the PI-RADS 3 lesions was 17.5% (7/40), in the PI-RADS 4 47.3% (35/73), and in the PI-RADS 5 lesions it was 73.3% (22/29) (p = 0.0001). Multivariable analysis with variables that could influence the biopsy result in patients with PI-RADS 3: none (age, PSA, number of previous biopsies, rectal examination, PSAD, prostate volume or number of extracted cylinders) behaved as an independent tumour predictor.ConclusionsThe diagnostic performance of CB in patients with at least one previous negative biopsy was 44%, increasing according to the PI-RADS grade, and low in PI-RADS 3. No clinical variable predictive of cancer was found in patients with PI-RADS 3.ResumenIntroducciónEvaluación de la efectividad de la biopsia cognitiva (BC) en los pacientes con sospecha clínica de cáncer de próstata (caP) y al menos una biopsia negativa (BTR).Material y métodoAnálisis retrospectivo de 144 pacientes con al menos una BTR y una resonancia magnética nuclear (RMN) previa. Los nódulos de la RMN se clasificaron según la clasificación PI-RADS v2 agrupando pZa, pZpl y pZpm como zona periférica (ZP), Tza, Tzp y CZ como zona transicional (ZT) y áreas AS como zona anterior (ZA). Se indicó biopsia en nódulos ≥ PI-RADS 3. Se llevó a cabo análisis uni y multivariante (regresión logística) tratando de identificar variables relacionadas con tumor en biopsia de PI-RADS 3.ResultadosLa mediana de edad fue de 67 (IQR: 62-72) años, la de PSA 8,2 (IQR: 6,2-12) ng/ml. Se identificó nódulo en la RMN en la ZP en 97 (67,4%) casos, en la ZT en 29 (20,1%) casos y en ZA en 41 (28,5%) casos. Se diagnosticó caP en la biopsia en 64 (44%) pacientes. En PI-RADS 3 se obtuvo un 17,5% (7/40) de cáncer, PI-RADS 4 un 47,3% (35/73) y en los PI-RADS 5 un 73,3% (22/29) (p = 0,0001). Análisis multivariable con variables que pudieran influir en el resultado de la biopsia en pacientes con PI-RADS 3: ninguno (edad, PSA, número de biopsias previas, tacto rectal, PSAD, volumen prostático ni número de cilindros extraídos) se comportó como factor predictor independiente de tumor.ConclusionesEl rendimiento diagnóstico de la BC en pacientes con al menos una biopsia previa negativa fue del 44% incrementándose según el grado de PI-RADS, siendo en PI-RADS 3 bajo. No se identificó ninguna variable clínica predictora de caP en pacientes con PI-RADS 3.
  • Incidence of second tumours in high risk prostate cancer patients
           according to the primary treatment applied
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): J. Caño-Velasco, F. Herranz-Amo, G. Barbas-Bernardos, L. Polanco-Pujol, E. Lledó-García, C. Hernández-Fernández Introduction and objectivesThe onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours.Material and methodsA retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n = 145) or radiotherapy and androgen blockade (n = 141). The homogeneity of both series was analyzed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours.ResultsThe median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (p = 0.29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR = 2.41, 95% CI: 1.31–4.34, p = 0.005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors.ConclusionsThe onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled.ResumenIntroducción y objetivosLa aparición de segundos tumores primarios en pacientes con cáncer de próstata de alto riesgo debe tenerse en cuenta en la evolución natural de la enfermedad. Nuestro objetivo es evaluar la influencia del tratamiento primario con intención curativa de dichos pacientes en el desarrollo de segundos tumores primarios.Material y métodosEstudio retrospectivo de 286 pacientes diagnosticados entre 1996 y 2008, tratados mediante prostatectomía radical (n = 145) o radioterapia y bloqueo androgénico (n = 141). La homogeneidad de ambas series fue analizada con el test de la Chi-cuadrado para las variables cualitativas y la t de Student para las cuantitativas. Se realizó un análisis multivariante mediante regresión de Cox, para evaluar si el tipo de tratamiento primario influía en el desarrollo de segundos tumores.ResultadosLa mediana de edad fue de 66 años, y la mediana de seguimiento de 117,5 meses. Al final del seguimiento, 60 pacientes (21%) habían desarrollado un segundo tumor primario. En el grupo de prostatectomía se localizó en la pelvis en 13 (9%) casos y en 8 (5,7%) casos en los tratados con radioterapia y hormonoterapia (p = 0,29). Las localizaciones más frecuentes por órganos fueron: colorrectal en 17 (28,3%) pacientes, pulmón en 11 (18,3%) y vejiga en 6 (10%) pacientes. En el análisis multivariable, los tratados con radioterapia y hormonoterapia duplicaban el riesgo de segundo tumor (HR = 2,41, IC95%: 1,31-4,34; p = 0,005) con respecto a los pacientes tratados con prostatectomía. La edad y la radioterapia de rescate no se comportaron como factores predictores independientes.ConclusionesLa aparición de un segundo tumor primario se relacionó con el tratamiento primario administrado; así, los tratados con radioterapia y privación androgénica multiplicaron por más de 2 su riesgo.
  • A new approach to laparoscopic implantation of artificial urinary
           sphincter: Vesicovaginal approach to the bladder neck
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): M. Ruiz-Hernández, L. López-Fando, J.M. Gómez de Vicente, M.A. Jiménez-Cidre, M.D. Sánchez-Gallego, J. Lorca-Álvaro, D. Díaz-Pérez, F.J. Burgos-Revilla IntroductionThe artificial urinary sphincter (AUS) is not used extensively in the treatment of female urinary stress incontinence (USI) due to the poor reproducibility of the techniques used. We describe a new approach to laparascopic implantation, of which dissection of the vesicovaginal space is an essential step. This enables an approach under direct vision to the posterior surface of the bladder neck.Material and methodsWe present two cases where this approach was used. A transperitoneal approach was made in the Trendelenburg position. The main steps were: creating the vesicovaginal space until identifying the bladder neck, creating two laterovesical spaces, communicating these with the vesicovaginal space, and dissecting the anterior surface of the bladder neck, attempting to preserve the pubovesical ligament. The cuff and reservoir were inserted through the 12 mm infraumbilical trocar. The connections were externalized through a left suprapubic incision and a subcutaneous tunnel created up to the labia majora where the activation pump was placed. The procedure was completed with closure of the peritoneum. It is essential to use a vaginal valve to facilitate dissection.ResultsSurgery time: 140 and 135 min, with no intraoperative complications. After removing the urinary catheter, one patient had elevated postvoid residual urine volume, which was managed conservatively. Hospital stay: 72 h. At 3 and 9 months the patients were fully continent.ConclusionsWe present the preliminary results of laparoscopic implantation of an AUS through a vesicovaginal approach to the posterior surface of the bladder neck, which might reduce potential complications that have been observed after the routine techniques.ResumenIntroducciónEl esfínter urinario artificial (EUA) no está extendido en el tratamiento de la incontinencia urinaria de esfuerzo (IUE) femenina debido a la baja reproducibilidad de las técnicas empleadas. Describimos un nuevo abordaje de implante laparoscópico, cuyo paso fundamental consiste en disecar el espacio vesicovaginal. Esto permite una aproximación bajo visión directa a la cara posterior del cuello vesical.Material y métodosPresentamos dos casos realizados con esta aproximación. Se realiza un abordaje transperitoneal en posición de Trendelenburg. Los principales pasos son: creación del espacio vesicovaginal hasta identificar el cuello, creación de dos espacios laterovesicales, comunicación de los mismos con el espacio vesicovaginal y disección de la cara anterior del cuello intentando preservar el ligamento pubovesical. El manguito y reservorio se introducen a través del trocar infraumbilical de 12 mm. Por una incisión suprapúbica izquierda se externalizan las conexiones y se crea un túnel subcutáneo hasta el labio mayor, donde se coloca la bomba de activación. Finaliza el procedimiento con el cierre del peritoneo. Es fundamental la utilización de una valva vaginal para facilitar la disección.ResultadosTiempo quirúrgico: 140 y 135 min, sin complicaciones intraoperatorias. Tras la retirada de la sonda vesical una paciente presentó residuo posmiccional elevado que se manejó de forma conservadora. Estancia hospitalaria: 72 h. A los 3 y 9 meses, las pacientes presentaron continencia total.ConclusionesPresentamos resultados preliminares de implante laparoscópico de EUA mediante la aproximación vesicovaginal a la cara posterior del cuello, que podría disminuir las potenciales complicaciones observadas con las técnicas habituales.
  • Long-term safety and efficacy of mirabegron and solifenacin in combination
           compared with monotherapy in patients with overactive bladder: SYNERGY II
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): A. Alcántara Montero
  • 5-alpha reductase inhibitors: New evidences on benefits and harms beyond
           benign prostatic hyperplasia
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): A. Alcántara Montero, C. Müller-Arteaga
  • Urethral reconstruction in patients previously treated with
           Memokath™ urethral endoprosthesis
    • Abstract: Publication date: January–February 2019Source: Actas Urológicas Españolas (English Edition), Volume 43, Issue 1Author(s): J.C. Angulo, J. Pankaj, I. Arance, S. Kulkarni PurposeTo evaluate the role and success rate of urethral reconstruction in patients with urethral stricture previously treated with thermos-expandable Memokath™ urethral endoprosthesis.Materials and methodA case series of patients with urethral stricture and Memokath™ endoprosthesis treated with urethroplasty is presented. Reconstruction was decided due to stricture progression or complications derived from primary stent treatment. Age, stricture and stent length, time between stent placement and urethroplasty, mode of stent retrieval, type of urethroplasty, complications and voiding parameters before and after urethroplasty were evaluated. Successful outcome was defined as standard voiding, without need of any postoperative procedure.ResultsEight cases with bulbar urethra stricture were included. Memokath™ was endoscopically retrieved before urethroplasty in 6 (75%) and by open urethrotomy at the time of urethroplasty in 2 (25%). Technique of urethroplasty was dorso-lateral onlay buccal mucosa graft in 5 (62.5%) cases and excision and primary anastomosis, anastomotic urethroplasty, and dorsal onlay buccal mucosa graft in one (12.5%) case each. There was no failure at 26 ± 21.5 months median follow-up. Total IPSS, QoL, Qmax and postvoid residual significantly improved (p 
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Heriot-Watt University
Edinburgh, EH14 4AS, UK
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