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Publisher: Elsevier   (Total: 3123 journals)

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Showing 1 - 200 of 3120 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 26, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 30, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 379, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 26, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 1)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 237, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, 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)
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Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
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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: 5)
Acute Pain     Full-text available via subscription   (Followers: 13)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 139, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 4)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 9, SJR: 1.054, h-index: 35)
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Advances in Applied Microbiology     Full-text available via subscription   (Followers: 23, 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: 26, 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: 6, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 26, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 9, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 29, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 12)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 7)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 6)
Advances in Drug Research     Full-text available via subscription   (Followers: 23)
Advances in Ecological Research     Full-text available via subscription   (Followers: 47, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 52, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 16)
Advances in Genetics     Full-text available via subscription   (Followers: 17, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 22, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 27)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 10)
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: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 9, 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: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 1.5, h-index: 62)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 370, 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: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 31, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 16)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 45, 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: 338, 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: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 432, 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: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 8)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 4, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 49, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 48, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 48, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 9, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 32, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 31, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 45, 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: 208, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 61, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 24, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 26, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 36, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 60, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 36, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 171, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 12)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 176, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)

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Journal Cover Actas Urológicas Españolas (English Edition)
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   Full-text available via subscription Subscription journal
   ISSN (Print) 2173-5786
   Published by Elsevier Homepage  [3123 journals]
  • 3+4=6' Implications of the stratification of localized Gleason 7
           prostate cancer by number and percentage of positive biopsy cores in
           selecting patients for active surveillance
    • Authors: J.L. Ruiz-Cerdá; L. Lorenzo Soriano; D. Ramos-Soler; L. Marzullo-Zucchet; A. Loras Monfort; F. Boronat Tormo
      Abstract: Publication date: Available online 7 February 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.L. Ruiz-Cerdá, L. Lorenzo Soriano, D. Ramos-Soler, L. Marzullo-Zucchet, A. Loras Monfort, F. Boronat Tormo
      Objective To determine whether the number and percentage of positive biopsy cores identify a Gleason 3+4 prostate cancer (PC) subgroup of similar biologic behavior to Gleason 3+3. Material and method An observational post-radical prostatectomy study was conducted of a cohort of 799 patients with localized low-risk (n =582, Gleason 6, PSA<10ng/ml and cT1c-2a) and favorable intermediate PC (n =217, Gleason 3+4, PSA≤10ng/ml and pT2abc). The Gleason 3+4 tumors were stratified by number (≤3 vs. >3) and by percentage of positive cores (≤33% vs. >33%). We analyzed the tumors’ association with the biochemical recurrence risk (BRR) and cancer-specific mortality (CSM). We conducted various predictive models using Cox regression and estimated (C-index) and compared their predictive capacity. Results With a median follow-up of 71 months, the BRR and CSM of the patient group with Gleason 3+4 tumors and a low number (≤3) and percentage (≤33%) of positive cores were not significantly different from those of the patients with Gleason 6 tumors. At 5 and 10 years, there were no significant differences in the number of biochemical recurrences, the probability of remaining free of biochemical recurrences, the number of deaths by PC or the probability of death by PC between the 2 groups. In contrast, the patients with Gleason 3+4 tumors and more than 33% of positive cores presented more deaths by PC than the patients with Gleason 6 tumors. At 10 years, the probability of CSM was significantly greater. This subgroup of tumors showed a significantly greater BRR (RR, 1.6; p =0.02) and CSM (RR, 5.8, p ≤0.01) compared with the Gleason 6 tumors. The model with Gleason 3+4 stratified by the percentage of positive cores significantly improved the predictive capacity of BRR and CSM. Conclusions Fewer than 3 cores and a percentage <33% of positive cores identifies a subgroup of Gleason 3+4 tumors with biological behavior similar to Gleason 6 tumors. At 10 years, there were no differences in BRR and CSM between the 2 groups. These results provide evidence supporting active surveillance as an alternative for Gleason 3+4 tumors and low tumor extension in biopsy.

      PubDate: 2018-02-14T20:32:41Z
      DOI: 10.1016/j.acuroe.2017.12.005
       
  • Cognitive function in patients on androgen suppression: A prospective,
           multicentric study
    • Authors: J. Morote; Á.J. Tabernero; J.L. Álvarez-Ossorio; J.P. Ciria; J.L. Domínguez-Escrig; F. Vázquez; J. Angulo; F.J. López; R. de La Iglesia; J. Romero
      Abstract: Publication date: Available online 17 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J. Morote, Á.J. Tabernero, J.L. Álvarez-Ossorio, J.P. Ciria, J.L. Domínguez-Escrig, F. Vázquez, J. Angulo, F.J. López, R. de La Iglesia, J. Romero
      Objective To assess the effect of androgen deprivation therapy (ADT) on cognitive performance (CP) in patients with prostate cancer (PCa) after 6 months of treatment with luteinizing hormone-releasing hormone (LHRH) analogs. Material and methods Prospective, observational, multicentre, open-label study of patients diagnosed with nonmetastatic or asymptomatic metastatic PCa scheduled to receive LHRH analogs for ≥6 months. We assessed four CP domains at baseline and after 6 months of ADT: (1) Working memory: Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Subtest (WAIS III-Digit); (2) Visual memory: ad hoc visual memory test; (3) Visuospatial ability: Judgment of Line Orientation (JLO) and Mental Rotation of Three-Dimensional Objects (3D-Rotation); and (4) Nonverbal analytical reasoning: WAIS III Matrix Reasoning Test (WAIS III-MRT). Changes outside the baseline 95% confidence intervals were considered significant. Results A total of 308 patients completed the study. Of these, 245 (79.6%) experienced no statistically significant changes on any test and 63 patients (20.4%) experienced significant changes in ≥1 test. Of these, most presented a change in only one test, distributed evenly between improvements (58 patients; 18.8%) and worsening (56 patients; 18.2%). For individual tests, most patients (87.8–91.8%) had no change from baseline; however, the significant changes (improvement vs. deterioration, respectively) were as follows: WAIS III-Digit (6.3% vs. 5.9%); visual memory (5.3% vs. 5.7%); JLO (5.3% vs. 4.5%); 3D-Rotation (4.1% vs. 4.1%); and WAIS III-MRT (4.8% vs. 5.8%). Conclusions CP in patients with PCa does not appear to be adversely affected by 6 months of LHRH analog administration.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.006
       
  • A systematic review of methods for quantifying serum testosterone in
           patients with prostate cancer who underwent castration
    • Authors: I. Comas; R. Ferrer; J. Planas; A. Celma; L. Regis; J. Morote
      Abstract: Publication date: Available online 17 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): I. Comas, R. Ferrer, J. Planas, A. Celma, L. Regis, J. Morote
      Background The clinical practice guidelines recommend measuring serum testosterone in patients with prostate cancer (PC) who undergo castration. The serum testosterone concentration should be <50ng/dL, a level established by using a radioimmunoassay method. The use of chemiluminescent immunoassays (IA) has become widespread, although their metrological characteristics do not seem appropriate for quantifying low testosterone concentrations. The objective of this review is to analyze the methods for quantifying testosterone and to establish whether there is scientific evidence that justifies measuring it in patients with PC who undergo castration, through liquid chromatography attached to a mass spectrometry in tandem (LC–MSMS). Material and methods We performed a search in PubMed with the following MeSH terms: measurement, testosterone, androgen suppression and prostate cancer. We selected 12 studies that compared the metrological characteristics of various methods for quantifying serum testosterone compared with MS detection methods. Results IAs are standard tools for measuring testosterone levels; however, there is evidence that IAs lack accuracy and precision for quantifying low concentrations. Most chemiluminescent IAs overestimate their concentration, especially below 100ng/dL. The procedures that use LC–MSMS have an adequate lower quantification limit and proper accuracy and precision. We found no specific evidence in patients with PC who underwent castration. Conclusions LC–MSMS is the appropriate method for quantifying low serum testosterone concentrations. We need to define the level of castration with this method and the optimal level related to better progression of the disease.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.003
       
  • Reliability and ordinal alpha
    • Authors: S. Dominguez-Lara
      Abstract: Publication date: Available online 17 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): S. Dominguez-Lara


      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.013
       
  • Office stent placement under local anesthesia is a safe and efficient
           procedure for the management of multiple ureteral disorders
    • Authors: A. Carrion; M. D’Anna; M. Costa-Grau; P. Luque; E. García-Cruz; A. Franco; A. Alcaraz
      Abstract: Publication date: Available online 17 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Carrion, M. D’Anna, M. Costa-Grau, P. Luque, E. García-Cruz, A. Franco, A. Alcaraz
      Objective To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. Methods Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10ml of lidocaine gel and 50ml of lidocaine solution were instilled in the bladder. A 4.8Fr ureteral stent was placed using a 15.5Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analyzed. Results A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. Conclusions Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.009
       
  • Where do we come from and where are we going in the treatment of premature
           ejaculation'
    • Authors: Montero
      Abstract: Publication date: Available online 17 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Alcántara Montero


      PubDate: 2018-01-25T19:06:32Z
       
  • Update on the role of endovesical chemotherapy in nonmuscle-invasive
           bladder cancer
    • Authors: M. Unda-Urzaiz; J.M. Fernandez-Gomez; J.M. Cozar-Olmos; A. Juárez; J. Palou; L. Martínez-Piñeiro
      Abstract: Publication date: Available online 11 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): M. Unda-Urzaiz, J.M. Fernandez-Gomez, J.M. Cozar-Olmos, A. Juárez, J. Palou, L. Martínez-Piñeiro


      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.001
       
  • Visceral and gastrointestinal complications in robotic urologic surgery
    • Authors: G. Velilla; C. Redondo; R. Sánchez-Salas; F. Rozet; X. Cathelineau
      Abstract: Publication date: Available online 10 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): G. Velilla, C. Redondo, R. Sánchez-Salas, F. Rozet, X. Cathelineau
      Introduction With the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and gastrointestinal complications could be life-threatening. Objectives To identify the main gastrointestinal injuries that occur in a robot-assisted urologic surgery. To know the overall incidence and how is their management. Acquisition of the evidence Search in PubMed of articles related to visceral and gastrointestinal complications in robot-assisted urology surgery, written in English or Spanish. Relevant publications as well literature reviews and chapters from books were reviewed. Synthesis of the evidence Along with vascular injuries, visceral and gastrointestinal lesions are among most dangerous complications. A complete preoperative study to individualize each patient characteristics and the correct use of imaging could help us to avoid complications in the first place. To know all the risky steps in the different robotic urologic procedures will let us anticipate the damage. Knowledge of main and most dangerous injuries in the different abdominal and pelvic organs is fully recommended. Early diagnosis and evaluation of lesions will let us an acute management during surgery. Recognition delay could change a repairable injury into a life-threatening situation. Conclusions Despite the undeniable benefits of robotic approach, there are minor and major gastrointestinal injuries that all urologic surgeons must know. Those related with trocar placement are especially important. Immediate diagnosis and management is mandatory.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.002
       
  • Prospective study comparing laparoscopic and open radical cystectomy:
           Surgical and oncological results
    • Authors: C. Esquinas; J.M. Alonso; E. Mateo; A. Dotor; A.M. Martín; J.F. Dorado; I. Arance; J.C. Angulo
      Abstract: Publication date: Available online 10 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): C. Esquinas, J.M. Alonso, E. Mateo, A. Dotor, A.M. Martín, J.F. Dorado, I. Arance, J.C. Angulo
      Introduction Laparoscopic radical cystectomy with lymphadenectomy and urinary diversion is an increasingly widespread operation. Studies are needed to support the oncological effectiveness and safety of this minimally invasive approach. Patients and methods A non-randomized, comparative prospective study between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) was conducted in a university hospital. The main objective was to compare cancer-specific survival. The secondary objective was to compare the surgical results and complications according to the Clavien–Dindo scale. Results We treated 156 patients with high-grade invasive bladder cancer with either ORC (n =70) or LRC (n =86). The mean follow-up was 33.5±23.8 (range 12–96) months. The mean age was 66.9+9.4 years, and the male to female ratio was 19:1. Both groups were equivalent in age, stage, positive lymph nodes, in situ carcinoma, preoperative obstructive uropathy, adjuvant chemotherapy and type of urinary diversion. There were no differences between the groups in terms of cancer-specific survival (log-rank; p =0.71). The histopathology stage was the only independent variable that predicted the prognosis. The hospital stay (p =0.01) and operative transfusion rates (p =0.002) were less for LRC. The duration of the surgery was greater for LRC (p <0.001). There were no differences in the total complications rate (p =0.62) or major complications (p =0.69). The risk of evisceration (p =0.02), surgical wound infection (p =0.005) and pneumonia (p =0.017) was greater for ORC. The risk of rectal lesion (p =0.017) and urethrorectal fistulae (p =0.065) was greater for LRC. Conclusion LRC is an equivalent treatment to ORC in terms of oncological efficacy and is advantageous in terms of transfusion rates and hospital stays but not in terms of operating room time and overall safety. Studies are needed to better define the specific safety profile for each approach.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.004
       
  • Controversy in the use of prostate cancer antigen 3 in Latin America and
           the Caribbean
    • Authors: J. Saldaña-Gallo; J.A. Grandez-Urbina
      Abstract: Publication date: Available online 10 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J. Saldaña-Gallo, J.A. Grandez-Urbina


      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.012
       
  • Endoscopic treatment of urethrodeferential reflux in children
    • Authors: B. Fernández Bautista; A. Parente Hernández; R. Ortiz Rodríguez; L. Burgos Lucena; J.M. Angulo Madero
      Abstract: Publication date: Available online 10 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): B. Fernández Bautista, A. Parente Hernández, R. Ortiz Rodríguez, L. Burgos Lucena, J.M. Angulo Madero
      Introduction Urethrodeferential reflux is an underdiagnosed condition, and there is no consensus on its treatment. Our objective is to show our experience in the minimally invasive treatment of this disease using endoscopy. Material and methods We present 8 patients with recurrent suppurative orchitis due to urethrodeferential reflux treated endoscopically during the period 2008–2013. All patients presented unilateral orchitis. The minimum number of episodes of orchitis per patient prior to the operation was 3. The endoscopic treatment consists of ureteroscopy, locating the ejaculatory orifices and conducting an intraoperative contrast study to demonstrate the urethrodeferential reflux. Subejaculatory dextranomer/hyaluronic acid was subsequently injected in all the cases. Results The mean surgical time was 15min, and the procedure was outpatient for all patients. There were no postoperative complications, and the patients had good clinical progression. Only one case required a second injection of dextranomer/hyaluronic acid. The follow-up of these patients showed a complete resolution of the epididymitis and good testicular development, with a follow-up longer than 4 years in all cases. Conclusion We propose this form of treatment as a minimally invasive, easily reproducible alternative that shows good long-term results in our small series of patients.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.010
       
  • Pelvic exenteration for gynecologic malignancies: Postoperative
           complications and oncologic outcomes
    • Authors: A. Romeo; M.I. Gonzalez; J. Jaunarena; M.E. Zubieta; G. Favre; J.C. Tejerizo
      Abstract: Publication date: Available online 10 January 2018
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Romeo, M.I. Gonzalez, J. Jaunarena, M.E. Zubieta, G. Favre, J.C. Tejerizo
      Introduction and objective To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies. Materials and methods Between 2008 and 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer. Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed. Results Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, while 8 received a neobladder and 3 a cutaneous ureterostomy. Postoperative complications were divided in 2 groups, early (<30 days) and late complications (>30 days). A total of 25 patients (71.4%) had one or more early complications; 16 (45.7%) had fever due to a urinary tract infection, pyelonephritis or intra-abdominal collection; 2 (5.7%) developed a vesicovaginal fistula; 4 (11.4%) a rectovaginal fistula; 3 (8.5%) acute kidney failure and one (2.85%) uronephrosis. Regarding to late complications, 8 patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had acute renal insufficiency, 3 (8,6%) rectovaginal fistula and one (2.85%) urinary fistula. Mean follow up time was 20.3 month (2–60). A total of 22 patients (62.8%) were free of disease. Another 13 (37.1%) patients relapsed. Only 4 (11.4%) patients died after pelvic exenteration due to underlying disease. Conclusion Pelvic exenteration has a high rate of complications and morbidity, but can be the last curative opportunity in patients with recurrent or persistent gynecologic malignancies. This procedure should be performed by multidisciplinary, experienced teams in a tertiary medical center.

      PubDate: 2018-01-25T19:06:32Z
      DOI: 10.1016/j.acuroe.2017.12.007
       
  • Developments in urologic oncology “OncoForum”: The best of
           2016
    • Authors: F. Gómez-Veiga; A. Alcaraz-Asensio; J. Burgos-Revilla; J.M. Cózar-Olmo
      Pages: 543 - 551
      Abstract: Publication date: November 2017
      Source:Actas Urológicas Españolas (English Edition), Volume 41, Issue 9
      Author(s): F. Gómez-Veiga, A. Alcaraz-Asensio, J. Burgos-Revilla, J.M. Cózar-Olmo
      Objective To put forth new findings of urologic oncology with impact on clinical practice presented during 2016 in the main annual meetings. Acquisition of evidence This document reviews abstracts on prostate, kidney and bladder cancer presented at the congresses of 2016 (EAU, AUA, ASCO, ESMO and ASTRO) and publications with the highest impact in this period valued with the highest scores by the OncoForum committee. Synthesis of evidence In high-risk renal-cell carcinoma after nephrectomy, disease-free survival was significantly greater for sunitinib than placebo group, with adverse events more frequents. In locally advanced and metastatic urotherial carcinoma patients, aletozumab achieved overall response rate in all subgroups of patients, included poor prognostic. In localized prostate cancer, the difference of prostate-cancer-specific mortality among active monitoring, radical prostatectomy and external-beam radiotherapy was not significant (p =0.48). In TERRAIN study, with castration-resistant prostate cancer patients, adverse events was reported in 31% and 23% of patients treated with enzalutamide and bicalutamide, respectively. Moreover, enzalutamide significantly improved median progression-free survival (15.7 months) compared bicalutamide (5.8 months) (p <0.0001). In SRTIVE study, enzalutamide reduced the risk of progression or death by 76% compared with bicalutamide (p <0.001). Conclusions In high-risk renal-cell carcinoma after nephrectomy, sunitinib has been considered as treatment choice. In localized prostate cancer, prostate-cancer-specific mortality was low irrespective of the treatment assigned (active monitoring, radical prostatectomy and external-beam radiotherapy). In metastatic castration-resistant prostate cancer new results of treatment with enzalutamide and abiraterone has been published, which have been shown beneficial effects in metastatic and no metastatic patients.

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

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

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

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

      PubDate: 2017-11-27T05:52:13Z
      DOI: 10.1016/j.acuroe.2017.07.003
       
  • Trends in the management of urolithiasis in Latin America, Spain and
           Portugal: Results of a survey in the Confederación Americana de Urología
           (CAU)
    • Authors: J.C. Angulo; N. Bernardo; H. Zampolli; M.A. Rivero; H. Dávila; J. Gutiérrez
      Abstract: Publication date: Available online 11 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.C. Angulo, N. Bernardo, H. Zampolli, M.A. Rivero, H. Dávila, J. Gutiérrez
      Objective To describe the trends in the current management of urolithiasis in the Confederación Americana de Urología (CAU) setting to recognize patterns of clinical practice and identify educational needs. Material and method An online survey was created with 31 multiple-choice questions (Spanish and Portuguese) through www.caunet.org, which revealed demographic data, patterns of clinical practice and approaches for specific clinical conditions. Results A total of 463 practitioners from Brazil, Mexico, Argentina, Spain, Colombia, Chile and other countries (3.96% of the members of CAU) completed the survey. All participants performed some type of urolithiasis treatment: 98.5% performed semirigid ureteroscopy (URS), 83.8% performed percutaneous nephrolithotomy (PCNL), 78.2% performed flexible URS, and 67.2% performed extracorporeal lithotripsy. The youngest physicians tended to perform PCNL (p <0.001), and the proportion of users of flexible URS was greater in the Portuguese countries (p =0.037). The main energy source was laser (60.7%). Small-caliber PCNL was performed by 15.3% of the respondents, more often in university hospitals (p <0.01) and by older practitioners (p <0.01). Only 3.2% of the respondents used percutaneous access to the kidney guided exclusively by ultrasound, especially the older practitioners (p <0.001). The supine position was used by 40.4% of the respondents, more often in Spain (p <0.001) and in the university setting (p =0.017). PCNL without nephrostomy was practiced by 3.9% of the respondents. For flexible URS, 19.2% of the respondents did not use ureteral access sheaths, and the older practitioners preferred thinner caliber sheaths (p <0.001). Conclusions The management of lithiasis in the CAU setting follows a profile similar to that recognized in the European and American clinical guidelines, although there are interesting variations based on the practitioner's age and preferences. We identified potential areas for improvement in small-caliber PCNL and ultrasound-guided puncture.

      PubDate: 2017-12-18T19:24:19Z
      DOI: 10.1016/j.acuroe.2017.11.007
       
  • Laparoscopic partial nephrectomy with prior superselective embolization as
           treatment for giant renal angiomyolipoma
    • Authors: A. Husillos Alonso; D. Subirá Ríos; E. Bolufer Moragues; I. Lopez Díez; I. Moncada Iribarren; C. González Enguita
      Abstract: Publication date: Available online 6 December 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): A. Husillos Alonso, D. Subirá Ríos, E. Bolufer Moragues, I. Lopez Díez, I. Moncada Iribarren, C. González Enguita
      Objective Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumor extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. Material and methods We present 3 cases of giant angiomyolipoma (10, 12 and 14cm) treated with a combined approach: superselective embolization and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. Results None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. Conclusions The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischemia time.

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

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

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


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

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

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

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


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


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

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

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

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

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

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


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

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

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


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


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


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

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


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

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


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

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

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

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


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

      PubDate: 2017-09-08T23:42:02Z
      DOI: 10.1016/j.acuroe.2017.08.003
       
  • Efficacy of low-intensity shock wave therapy for erectile dysfunction: A
           systematic review and meta-analysis
    • Authors: J.C. Angulo; I. Arance; M.M. de las Heras; E. Meilán; C. Esquinas; E.M. Andrés
      Abstract: Publication date: Available online 10 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): J.C. Angulo, I. Arance, M.M. de las Heras, E. Meilán, C. Esquinas, E.M. Andrés
      Context The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. Objective To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature. Acquisition of evidence Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3–6 months from the start of the therapy. Summary of the evidence The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, −2.92; p =0.000), to a greater degree than placebo (SDM, −0.99; p =0.000). The IIEF-EF at 3–6 months for the treated patients was significantly greater than baseline (SDM, −2.78; p =0.000). Only one study compared the efficacy of placebo at 3–6 months vs baseline (SDM, −9.14). The comparison between LISW and placebo favors active treatment (SDM, 2.53; p =0.000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3–6 months. Conclusions According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction.

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

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.002
       
  • The use of bovine serum albumin-glutaraldehyde tissue adhesive (BioGlue®)
           for tumor bed closure following open partial nephrectomy
    • Authors: Z. Bahouth; S. Halachmi; S. Shprits; Y. Burbara; O. Avitan; I. Masarwa; B. Moskovitz; O. Nativ
      Abstract: Publication date: Available online 9 August 2017
      Source:Actas Urológicas Españolas (English Edition)
      Author(s): Z. Bahouth, S. Halachmi, S. Shprits, Y. Burbara, O. Avitan, I. Masarwa, B. Moskovitz, O. Nativ
      Objectives To report the results of the use of Bovine Serum Albumin-Glutaraldehyde tissue adhesive (BioGlue®) for tumor bed closure in open nephron-sparing surgery (NSS). Materials and methods The cohort included 255 patients with enhancing renal mass who underwent open NSS. We used open flank approach, with in situ hypothermia and enucleation of the tumor. For tumor bed closure, we used the BioGlue® sealant for tumor bed filling, without suturing the edges. Results Mean patients’ age was 65.4 years. 5.1% of patients had pre-operative chronic renal failure. Mean renal mass diameter was 4.2±1.6cm and mean R.E.N.A.L nephrometry score was 8.0±1.6. Mean ischemia time was 21.8±7.6. Mean estimated blood loss was 42±82ml and only two patients required blood transfusion. Urine leak and pseudo-aneurysm were recorded in two and one patient, respectively. None of the operations were converted to radical nephrectomy. The average change between post-operative and pre-operative eGFR (Δ=−1.7ml/min) was insignificant in a mean follow-up of 30.1±29.6 months. The 10-year recurrence-free survival rate was 99% and the 10-year overall survival rate was 85%. Conclusions The use of BioGlue® alone for hemostasis after NSS is a feasible and safe alternative to classical suturing. Its use enables satisfactory functional outcome and could potentially reduce ischemia time.

      PubDate: 2017-08-14T19:17:43Z
      DOI: 10.1016/j.acuroe.2017.07.005
       
 
 
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