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Showing 1 - 200 of 3042 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: 17, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, 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: 328, 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  
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: 206, 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: 7, 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: 20, 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: 40, 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: 48, 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: 12)
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: 4)
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: 25, 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: 59)
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: 340, 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: 6, 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: 309, 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: 400, 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: 50, 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: 44, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 36, 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: 30, 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: 34, 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: 179, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 55, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
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: 24, 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: 33, 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: 9)
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: 160, 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  
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: 153, 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   (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)
  [2 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 2173-5786
   Published by Elsevier Homepage  [3042 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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
      DOI: 10.1016/j.acuroe.2017.03.006
  • Gleason sum upgrading between biopsy and radical prostatectomy in Chinese
           population: Updated nomograms
    • Authors: H. Xu; P.D. Bai; M.B. Hu; S.H. Mao; W.H. Zhu; J.M. Hu; S.H. Liu; T. Yang; J.Y. Hou; Y. Hu; Q. Ding; H.W. Jiang
      Pages: 162 - 171
      Abstract: Publication date: April 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 3
      Author(s): H. Xu, P.D. Bai, M.B. Hu, S.H. Mao, W.H. Zhu, J.M. Hu, S.H. Liu, T. Yang, J.Y. Hou, Y. Hu, Q. Ding, H.W. Jiang
      Introduction To assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading. Methods The study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8. Results In the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading. Conclusions Updated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation.

      PubDate: 2017-07-18T22:49:32Z
      DOI: 10.1016/j.acuroe.2017.02.004
  • Influence of social networks on congresses of urological societies and
           associations: Results of the 81st National Congress of the Spanish
           Urological Association
    • Authors: J. Gómez-Rivas; M.E. Rodríguez-Socarrás; L. Tortolero-Blanco; M. Garcia-Sanz; M. Alvarez-Maestro; M.J. Ribal; M. Cózar-Olmo
      Pages: 181 - 187
      Abstract: Publication date: April 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 3
      Author(s): J. Gómez-Rivas, M.E. Rodríguez-Socarrás, L. Tortolero-Blanco, M. Garcia-Sanz, M. Alvarez-Maestro, M.J. Ribal, M. Cózar-Olmo
      Objective To measure social network activity during the 81st National Congress of the Spanish Urological Association (AEU) and to compare it with the activity during other congresses of national and international urological associations. Material and methods We designed and registered the official hashtag #AEU16 for the 81st National Congress of the AEU on the Symplur website. The following measurements were recorded: number of participants, number of tweets, tweets by participant, tweets per hour and views. Results The number of participants in the social network activity during the congress was 207. The measurements of activity in Twitter consisted of a total of 1866 tweets, a mean rate of 16 tweets/h, 9 tweets per participant and 1,511,142 views. The activity during the international congresses is as follows: 2016 American Urological Association annual congress (views: 28,052,558), 2016 European Association of Urology annual congress (views: 13,915,994), 2016 Urological Society of Australia and New Zealand (views: 4,757,453), 2015 Société Internationale d’Urologie annual congress (views: 1,023,038). The activity during the national congresses was recorded as follows: 2016 Annual Conference of The British Association of Urological Surgeons (views: 2,518,880), 81st National Congress of the AEU (views: 1,511,142), 109th Congress of l’Association Française d’Urologie (views: 662,828), 67th German Congress of Urology (views: 167,347). We found 10 posts in Facebook and 2 communications via Periscope TV related to #AEU16. Conclusions The social network activity during the 81st National Congress of the AEU was notable given the results of this study. The use of social networks has expanded among urological associations, congresses and meetings, giving them a global character.

      PubDate: 2017-07-18T22:49:32Z
      DOI: 10.1016/j.acuroe.2017.02.006
  • Median raphe cysts in men. Presentation of our experience and literature
    • Authors: V. Navalón-Monllor; M.V. Ordoño-Saiz; F. Ordoño-Domínguez; V. Sabater-Marco; Y. Pallás-Costa; P. Navalón-Verdejo
      Pages: 205 - 209
      Abstract: Publication date: April 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 3
      Author(s): V. Navalón-Monllor, M.V. Ordoño-Saiz, F. Ordoño-Domínguez, V. Sabater-Marco, Y. Pallás-Costa, P. Navalón-Verdejo
      Objectives To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25 years. Material and method We conducted a retrospective study of 28 men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analyzed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. Results The majority of the patients (22; 79%) were asymptomatic and consulted for the esthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent esthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10 years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. Conclusions Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation.

      PubDate: 2017-07-18T22:49:32Z
      DOI: 10.1016/j.acuroe.2017.02.010
  • 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: 2017-07-18T22:49:32Z
      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: 2017-07-18T22:49:32Z
  • 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
  • Comparative study between thulium laser (Tm: YAG) 150W and Greenlight
           laser (LBO: ND-YAG) 120W for the treatment of benign prostatic
           hyperpplasia: Short-term efficacy and security
    • Authors: J.L. Palmero-Martí; J. Panach-Navarrete; L. Valls-González; A. Ganau-Ituren; J. Miralles-Aguado; A. Benedicto-Redón
      Abstract: Publication date: Available online 1 March 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.L. Palmero-Martí, J. Panach-Navarrete, L. Valls-González, A. Ganau-Ituren, J. Miralles-Aguado, A. Benedicto-Redón
      Objective To compare the results of efficacy and safety of thulium laser 150W against Greenlight laser 120W in the treatment of short term benign prostatic hyperplasia (12 months after surgery). Material and methods This is a retrospective observational study where men who underwent the surgical technique of prostate vaporization over a period of four years in our center are included. The homogeneity of the sample was checked, and postoperative complications (acute urinary retention, reentry, need for transfusion), failures per year of surgery (reoperation, peak flow <15ml/s, no improvement in comparing the I-PSS), and decreased PSA were compared a year after surgery. A bivariate analysis using Chi-square and t-Student was carried out. Results 116 patients were treated with thulium and 118 with green laser. The sample was homogeneous for preoperative variables (p >0.05). No differences in complications were observed: in urine acute retention, 4.3% with thulium and 6.8% with green laser (p =0.41); in readmissions, 2.6% with thulium and 1.7% with green laser (p =0.68); in need for transfusion, 2.6% with thulium and 0% with green laser (p =0.12). No differences were observed in the percentage of patients reoperation (1.7% in the group of thulium, 5.1% in the green laser, p =0.28); or in individuals with Qmáx less than 15ml/sec (6.9% with thulium, 6.77% with green laser, p =0.75), or in the absence of improvement in the IPSS (5, 2% with thulium, 3.4% with green laser, p =0.65). There was also no difference in the levels of PSA in ng/mL a year after surgery: with thulium 2.78±2.09 and with green laser 1.83±1.48 (p =0.75). Conclusions Prostate vaporization with thulium laser 150W is comparable to that made with green laser 120W for the treatment of lower urinary tract symptoms caused by BPH, being both effective and safe techniques to 12 months after surgery. Future prospective randomized studies are needed to confirm this conclusion on both techniques.

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.007
  • Expression of proteins FGFR3, PI3K, AKT, p21Waf1/Cip1 and cyclins D1 and
           D3 in patients with T1 bladder tumors: Clinical implications and
           prognostic significance
    • Authors: A.M. Blanca Pedregosa; Á. Sánchez-González; J. Carrasco Valiente; J.M. Ruiz García; E. Gómez Gómez; A. López Beltrán; M.J. Requena Tapia
      Abstract: Publication date: Available online 28 February 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A.M. Blanca Pedregosa, Á. Sánchez-González, J. Carrasco Valiente, J.M. Ruiz García, E. Gómez Gómez, A. López Beltrán, M.J. Requena Tapia
      Objective To determine the differential protein expression of biomarkers FGFR3, PI3K (subunits PI3Kp110α, PI3KClassIII, PI3Kp85), AKT, p21Waf1/Cip1 and cyclins D1 and D3 in T1 bladder cancer versus healthy tissue and to study their potential role as early recurrence markers. Material and method This is a prospective study that employed a total of 67 tissue samples (55 cases of T1 bladder tumors that underwent transurethral resection and 12 cases of adjacent healthy mucosa). The protein expression levels were assessed using Western blot, and the means and percentages were compared using Student's t-test and the chi-squared test. The survival analysis was conducted using the Kaplan–Meier method and the log-rank test. Results Greater protein expression was detected for FGFR3, PI3Kp110α, PI3KClassIII, cyclins D1 and D3 and p21Waf1/Cip1 in the tumor tissue than in the healthy mucosa. However, these differences were not significant for PI3Kp85 and AKT. We observed statistically significant correlations between early recurrence and PI3Kp110α, PI3KClassIII, PI3Kp85 and AKT (P =.003, P =.045, P =.050 and P =.028, respectively), between the tumor type (primary vs. recurrence) and cyclin D3 (p =0.001), between the tumor size and FGFR3 (p =0.035) and between multifocality and cyclin D1 (p =0.039). The survival analysis selected FGFR3 (p =0.024), PI3Kp110α (p =0.014), PI3KClassIII (p =0.042) and AKT (p =0.008) as markers of early-recurrence-free survival. Conclusions There is an increase in protein expression levels in bladder tumor tissue. The overexpression of FGFR3, PI3Kp110α, PI3KClassIII and AKT is associated with increased early-recurrence-free survival for patients with T1 bladder tumors.

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.014
  • Castrate resistant prostate cancer. Consensus recommendations of the
           Spanish Association of Urology
    • Authors: A. Loizaga-Iriarte; I. Lacasa-Viscasillas; N. Senarriaga-Ruiz de la Illa; M. Unda-Urzaiz; A. Rodriguez-Antolin; B. Miñana-Lopez; J.M. Cozar-Olmo
      Abstract: Publication date: Available online 24 February 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Loizaga-Iriarte, I. Lacasa-Viscasillas, N. Senarriaga-Ruiz de la Illa, M. Unda-Urzaiz, A. Rodriguez-Antolin, B. Miñana-Lopez, J.M. Cozar-Olmo

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.001
  • Combination of extracorporeal lithotripsy and flexible ureterorenoscopy
           optimize renal lithiasis therapy
    • Authors: A. Pérez-Lanzac; P. Parra-Serván; C. León-Delgado; Z. Okhunov; A. Lusch; J.L. Álvarez-Ossorio
      Abstract: Publication date: Available online 24 February 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Pérez-Lanzac, P. Parra-Serván, C. León-Delgado, Z. Okhunov, A. Lusch, J.L. Álvarez-Ossorio
      Objective Describe our initial experience in the treatment of renal lithiasis with extracorporeal lithotripsy controlled by simultaneous flexible ureterorenoscopy and combined with holmium laser lithotripsy. Material and methods We performed this novel technique in a previously selected patient with left renal lithiasis, two in the superior calix, two in the medium calix and two in the inferior calix, the biggest of which was placed in medium calix and was 6mm long. We proceeded to an extracorporeal shock wave lithotripsy and a simultaneous flexible ureterorenoscopy for better controlling the fragmentation of the lithiasis with the use of a holmium laser. In the immediate post-operative, an ultrasound was performed and, one month later, a computerized tomography (CT) was done. Results The complete fragmentation of all the lithiasis was obtained and a double-J catheter was placed. After the assessment of the absence of stone fragments by CT the catheter was removed. No intra-operative or post-operative complications were described. Conclusions The technique described is novel, safe and reproducible. The good result obtained through this combined technique increases our interest in continuing with its application and consider it as an option for the treatment of renal lithiasis in our patients.

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.009
  • Treatment of Leydig cell tumors of the testis: Can testis-sparing surgery
           replace radical orchidectomy? Results of a systematic review
    • Authors: G. Bozzini; D. Ratti; L. Carmignani
      Abstract: Publication date: Available online 24 February 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): G. Bozzini, D. Ratti, L. Carmignani
      Introduction The gold standard for Leydig cell tumors (LCTs) is still considered radical orchidectomy, but testis sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results. Acquisition of evidence Studies were identified by searching electronic databases. A bibliographic search covering the period from January 1980 to December 2012 was conducted using PubMed/MEDLINE and EMBASE database. Studies were excluded if they were single case reports, meeting abstracts and conference proceedings. Synthesis of evidence The present analysis is based on a total of 13 studies that fulfilled the predefined inclusion criteria. A total of 247 participants were included in the 13 studies examined in this systematic review. 145 were treated with radical orchiectomy and 102 with TSS. In the radical surgery group, the follow-up varied from 6 to 249 months. In the TSS group, the follow-up varied from 6 to 192 months. Frozen section was performed in a total of 96 patients. Sensitivity was 87.5%. None of the patients treated with TSS presented a metastatic recurrence, while in patients treated with radical orchiectomy three patients presented with metastatic recurrence. In selected cases radical surgery appears excessive and the potential for a shift to TSS as the standard management is gathering momentum. Conclusions The results confirm the favorable course of LCT treated with TSS. The results obtained are encouraging and the concept is attractive to become the standard therapy in all patients and not only in people affected by (sub)fertility or with solitary testis.

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.002
  • Higher number of transrectal ultrasound guided prostate biopsy cores is
           associated with higher blood loss and perioperative complications in robot
           assisted radical prostatectomy
    • Authors: A. Carneiro; A. Sivaraman; R. Sanchez-Salas; I. Nunes-Silva; M. Baghdadi; V. Srougi; E. di Trapani; F. Uriburu Pizzaro; S. Doizi; E. Barret; F. Rozet; M. Galiano; X. Cathelineau
      Abstract: Publication date: Available online 24 February 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Carneiro, A. Sivaraman, R. Sanchez-Salas, I. Nunes-Silva, M. Baghdadi, V. Srougi, E. di Trapani, F. Uriburu Pizzaro, S. Doizi, E. Barret, F. Rozet, M. Galiano, X. Cathelineau
      Introduction The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. Objectives To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). Material and methods A prospectively maintained database of 2054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. Results A total number of 1042 patients in the group 1 (≤12 cores) and 1012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; p =0.03), but high grade complication (Clavien 3–4) were similar (G1 1.4 vs. G2 2.2%; p =0.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; p =0.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. Conclusion Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.003
  • Comparative analysis between percutaneous nephrolithotomy and flexible
           ureteroscopy in kidney stones of 2–3cm
    • Authors: E. Pieras; V. Tubau; X. Brugarolas; J. Ferrutxe; P. Pizá
      Abstract: Publication date: Available online 24 February 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): E. Pieras, V. Tubau, X. Brugarolas, J. Ferrutxe, P. Pizá
      Introduction To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. Material and methods A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. Results There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; p =0.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; p =0.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (p =0.04). The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (p =0.004). The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; p =0.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; p =0.005) and higher readmission rates (7.4% vs. 0%, p =0.05) than the nephrolithotomy group. Conclusions Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2–3cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.

      PubDate: 2017-03-02T14:41:58Z
      DOI: 10.1016/j.acuroe.2017.02.008
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