Evaluación del valor predictivo negativo de la resonancia magnética multiparamétrica de próstata al combinar su puntuación con parámetros del antígeno prostático específico en pacientes con PSA en zona gris / The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

Objetivo Calcular el valor predictivo negativo (VPN) de la resonancia magnética multiparamétrica (RMmp) de próstata negativa, definida como la ausencia de lesiones en las imágenes, cuando se combina con la densidad del PSA (DPSA) y el índice PSA libre/total (PSA l/t) en pacientes cuyo PSA se encuentra en la zona gris (4-10mg/ml). Métodos Se analizaron 191 pacientes con niveles de PSA entre 4 y 10mg/ml y RMmp negativa. El VPN de la RMmp negativa se calculó de acuerdo con un nivel de DPSA<0,15ng/ml/ml, un índice PSA l/t>0,15 y una combinación de ambos. Los pacientes se dividieron en 3 grupos de riesgo según estos dos parámetros, de la siguiente manera: • DPSA 0,01-0,07ng/ml/ml e índice PSA l/t≥25 en el grupo de bajo riesgo. • DPSA 0,08-0,15ng/ml/ml e índice PSA l/t 0,15-0,24 en el grupo de riesgo intermedio. • DPSA>0,15ng/ml/ml e índice PSA l/t<15 en el grupo de riesgo alto. Resultados El VPN de la RMmp negativa fue del 92,6% para el carcinoma de próstata clínicamente significativo (CPCS). El VPN aumentó al 97,5% en el grupo de riesgo bajo, y disminuyó al 33,3% en el de riesgo alto. El resultado al combinar la RMmp negativa con la DPSA<0,15ng/ml/ml fue muy similar al de su combinación con el PSA l/t>15. Conclusión el índice PSA l/t también podría utilizarse para aumentar el VPN de la RMmp, al igual que la DPSA. No recomendamos evitar la biopsia de próstata con una DPSA>0,15ng/ml/ml y un índice PSA l/t<0,15. Sin embargo, se requieren estudios controlados aleatorizados con más pacientes para confirmar los hallazgos de nuestro estudio. (AU)

Objective To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods One hundred ninety-one patients with PSA levels between 4-10mg/ml and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/ml/ml, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters: • PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio ≥25 in a low-risk group. • PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group. • PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high-risk group, Results NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD <0.15 ng/ml/ml and f/t PSA>15. Conclusion f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study. (AU)

Giant Midline Prostatic Cyst: An Unusual Cause of Acute Urinary Retention

Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller’s cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report. (AU)

¿Tiene el tratamiento previo con inhibidores de la 5-alfa reductasa repercusión en la enucleación prostática con láser holmium? Resultados de un estudio prospectivo observacional y revisión de la literatura / Evaluating the effects of preoperative treatment with 5-alpha reductase inhibitors in holmium laser enucleation of the prostate

Introducción y objetivos Los pacientes tratados con HoLEP frecuentemente han recibido tratamientos previos, incluyendo los inhibidores de la 5-alfa-reductasa (5ARI). Nuestro objetivo es evaluar el efecto del tratamiento previo con 5ARI en los parámetros perioperatorios y del postoperatorio immediato en pacientes tratados con HoLEP. Materiales y métodos Se ha llevado a cabo un estudio retrospectivo utilizando una base de datos recogida prospectivamente, de todos los pacientes tratados con HoLEP en nuestro centro entre enero de 2017 y enero de 2023. Se han analizado los gramos de resección, la eficiencia de enucleación y morcelación (gramos enucleados/tiempo de enucleación y gramos de morcelación/tiempo de morcelación), las complicaciones postoperatorias, el tiempo de hospitalización y el descenso de hemoglobina. Resultados Se han incluido 327 pacientes; 173 de ellos (52,9%) fueron tratados con 5ARI. Entre los parámetros perioperatorios estudiados para determinar la eficiencia no se encontraron diferencias. No se observaron diferencias en las complicaciones peri o postoperatorias, estancia hospitalaria o descenso de hemoglobina. Conclusiones El uso de 5ARI no tuvo repercusión en el postoperatorio immediato de los pacientes tratados con HoLEP. En nuestra cohorte el uso de 5ARI no ha demostrado alterar la eficiencia quirúrgica, ni en la enucleación ni en la morcelación. Futuros estudios multicéntricos serán necesarios para corroborar estos hallazgos. (AU)

Introduction and aim Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP. Material and Methods A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed. Results A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop. Conclusions Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings. (AU)

Effect of Intravenous Injection of Remazolam on Stress Response and Analgesic Effect in Patients with Transurethral Resection of the Prostate: A Single-Centre Study

Background: The reasonable selection of anaesthesia methods and drugs is the key to ensuring the perioperative safety of patientswith the transurethral resection of the prostate (TURP). The effect of intravenous remazolam injection on stress response andanalgesic effect in patients with transurethral prostate cancer electrotomy were explored.Methods: The medical records of 160 patients with prostatic hyperplasia who underwent TURP in Tianjin hospital from November2020 to November 2022 were selected for retrospective analysis. Five patients who did not meet the study conditions wereexcluded, and 155 patients were finally included. According to anaesthesia schemes, the patients were divided into the observationgroup (OBG, n = 76, routine surgical anaesthesia and intravenous remazolam injection) and control group (COG, n = 79,routine surgical anaesthesia). Postoperative eye-opening times were recorded for both groups. The groups were compared interms of anaesthetic effects, stress indexes, haemodynamic indexes, and use of postoperative analgesic drugs at different times,and adverse reactions were observed.Results: The anaesthesia onset time and eye-opening time in the OBG were shorter than those in the COG (p < 0.001). The heartrate and mean arterial pressure of the OBG during anaesthesia induction were higher than those in the COG (p < 0.001). TheOBG showed significantly lower noradrenaline and cortisol levels than the COG 1, 12 and 24 h after surgery (p < 0.001). Thetime of first pressing in the analgesic pump in the OBG was later than that in the COG, and the total consumption of sufentanil was less than that in the COG (p < 0.001). The total incidence of adverse reactions in the OBG was lower than that in the COG(p < 0.05). (AU)

Predictive Value of Preoperative Prostate Health Index and Serum Testosterone Testing for Biochemical Recurrence after Radical Prostatectomy for Non-Metastatic Prostate Cancer

Objective: To analyse the predictive value of prostate health index (PHI) combined with serum testosterone after radical prostatectomy(RP) for prostate cancer (PCa).Methods: A total of 132 PCa patients who received RP treatment from January 2016 to December 2019 were selected, retrospectively.And then these patients were divided into biochemical recurrence (BCR) group (n = 51) and non-biochemical recurrence(non-BCR) group (n = 81) based on whether BCR was present after RP. Basic data of PCa patients were collected, and preoperativeprostate health index (PHI) and serum testosterone levels were measured in both groups. Logistic regression analysiswas used to analyse the influencing factors of BCR after RP. The predictive value of PHI and serum testosterone on BCR afterRP was analysed using the receiver operating characteristic (ROC) curve. The Kaplan–Meier method was used to plot survivalcurves, and log rank test was used to analyse the differences between survival curves.Results: The BCR rate of patients in this study was 38.64% (51/132). Single-factor analysis showed that BCR after RP in PCapatients was associated with prostate-specific antigen (PSA), Gleason score, pathological stage, postoperative adjuvant therapy,testosterone and PHI (p < 0.05). Logistics regression analysis showed that PSA >20 ng/mL, Gleason score (8 scores), pathologicalstage pT3, increased PHI and increased testosterone were independent risk factors for BCR after RP. ROC curve analysisshowed that the area under curve (AUC) of PHI and serum testosterone predicting BCR after RP alone and in combination were0.769, 0.725 and 0.906, respectively. Kaplan–Meier survival analysis showed that preoperative high PHI and low testosteroneare negatively correlated with recurrence-free survival rate. (AU)

Application of Real-Time Ultrasound ElastographyCombined with Prostate Calcification in Differential Diagnosis of Prostate Cancer

Objective: This study aimed to explore the clinical and differential diagnostic value of real-time ultrasound elastography combinedwith transabdominal prostate calcification in prostate cancer (PCa).Methods: This study retrospectively analysed the clinical pathological data of 97 patients with PCa and 105 patients with benignprostatic hyperplasia (BPH) diagnosed by postoperative pathology in our hospital from May 2020 to May 2021; Comparativelyanalysed the clinical data of the two groups, including the elastic strain ratio, elastic image compression index, types of prostatecalcification and calcification diameter; And used logistic regression analysis to screen out the independent risk factors for identifyingPCa and BPH.Results: No significant difference in age, body weight, body mass index, location of calcification and calcification diameter wasobserved between the two groups (p > 0.05), and overt differences in elastic strain ratio, elastic image compression index, typesof calcification, and testosterone were found between the PCa group and BPH group (p < 0.05). Logistic regression analysisshowed that the elastic strain ratio, elastic image compression index and types of calcification were independent risk factors foridentifying PCa (p < 0.05). The area under curve value of combined diagnosis under receiver operating characteristic curve wasas high as 0.756 (95% CI: 0.691–0.813), with a sensitivity of 67.60% and a specificity of 76.30%.Conclusions: A certain correlation is observed amongst elastic strain ratio, elastic image compression index, types of prostatecalcification and the occurrence and development of PCa. The application of real-time ultrasound elastography combined withthe detection of transabdominal prostate calcification in clinical diagnosis can improve the detection rate of PCa, which has animportant clinical application value. (AU)

Analysis of Influencing Factors of Sepsis after Prostate Biopsy: A Meta-Analysis

Objective: This study aimed to conduct a systematic review of studies investigating the influencing factors of sepsis in patientsfollowing prostate biopsy and to provide clinical references for the prevention and reduction of sepsis occurrence.Methods: A comprehensive computer search was performed on multiple databases, including PubMed, Web of Science, Embase,and Scope. The search period extended from the inception of each database to September 2023. Two independent researchersscreened the literature, extracted data, evaluated the risk of bias, and conducted a meta-analysis using R software. The includedstudies comprised cohort and case-control studies, and the inverse variance method was utilized to combine odds ratio (OR)values with corresponding 95% confidence intervals (CIs).Results: The analysis included a total of 22 studies involving 374,021 patients. Meta-analysis results indicated that targetedprophylactic antibiotics (OR = 0.48, 95% CI [0.23, 0.98]), combined use of antibiotics (OR = 0.44, 95% CI [0.25, 0.76]), historyof antibiotic use (OR = 2.54, 95% CI [1.49, 4.31]), and diabetes (OR = 2.95, 95% CI [1.25, 6.98]) may be influential factors forsepsis after prostate biopsy. However, factors such as biopsy procedure, positive biopsy, and previous biopsy did not exhibit asignificant association with sepsis after prostate biopsy.Conclusions: Targeted prophylactic antibiotics, combined use of antibiotics, history of antibiotic use, and diabetes are identifiedas influential factors for sepsis in patients after prostate biopsy. However, due to limitations in the quantity and quality of theincluded studies, further high-quality research is necessary to validate these findings. (AU)

Ictericia no obstructiva como síndrome paraneoplásico del carcinoma de próstata: revisión sistemática de casos publicados / Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases

El síndrome de Stauffer es un síndrome paraneoplásico (SPN) en el que se produce una afectación hepática; clásicamente se ha relacionado con tumores renales, pero también con otros tumores como el adenocarcinoma de próstata (ACP). Nuestro objetivo es llevar a cabo una revisión sistemática de los casos publicados asociados al cáncer de próstata. El número de artículos cribados en la revisión bibliográfica fue de 357, de los cuales 25 cumplieron los criterios de inclusión. Todos los casos publicados de síndrome de Stauffer en pacientes con ACP estaban en estadio metastásico. El SPN se resolvió en 3 de cada 4 pacientes cuando se instauró el tratamiento dirigido al cáncer de próstata. La aparición del SPN en pacientes ya diagnosticados de ACP, niveles no elevados de bilirrubina total y la no resolución del SPN se presentaron como factores de mal pronóstico. (AU)

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment. (AU)

Review of imaging techniques for evaluating morphological and functional responses to the treatment of bone metastases in prostate and breast cancer

Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.

Long term erectile function results of radical perineal prostatectomy / Resultados de la prostatectomía radical perineal sobre la función eréctil a largo plazo

Introduction: Although many patients are being treated by radical prostatectomy (RP), there is still insufficient information about the changes in long-term erectile function after RP. Our aim is to examine long term, up to 5 year erectile function status of patients after Radical Perineal Prostatectomy (RPP).Materials and methods: One hundred and thirty-two patients, who underwent bilateral nerve-sparing Radical Perineal Prostatectomy (RPP) in between January 2012 and January 2017, with preoperative age≤70, prostate volume<80g, transrectal ultrasound (TRUS) guided biopsy Gleason score (GS)<7, prostate specific antigen (PSA) value<10ng/mL, and cT stage≤2 (N0, M0) were included into this study. Exclusion criteria were previous cardiovascular diseases, serious chronic renal and/or hepatic insufficiency, neurological diseases, uncontrolled diabetes mellitus, and severe lung diseases. Patients who received additional treatment (hormonal and/or radiotherapy) after RPP were also excluded from the study group. Erectile function was evaluated before surgery and at postoperative 3rd, 12th, and 60th months. Patients with an “International Index of Erectile Function (IIEF) – 5” score of ≥21 and patients whose IIEF-5 scores were between 16 and 20 but responded as “yes” to the “Sexual Encounter Profile (SEP) – 2” and “SEP-3” questions were accepted as having normal erectile function.Results: Out of the 132 patients, 96 (72.7%) of the patients were found to be potent in the first postoperative year. A total of 118 patients were evaluated at the end of 5 years. Eighty seven (73.7%) patients had normal erectile function according to our criteria. (AU)

Introducción: Aunque muchos pacientes son tratados mediante prostatectomía radical (PR), existe poca información acerca de los cambios de la función eréctil a largo plazo tras una PR. Nuestro objetivo fue examinar el estatus de la función eréctil a largo plazo, de hasta cinco años, de los pacientes tras una prostatectomía radical perineal (PRP).Materiales y métodos: Incluimos en el presente estudio a ciento treinta y dos pacientes sometidos a PRP bilateral con preservación de nervios entre enero de 2012 y enero de 2017, con edad preoperatoria ≤ 70, volumen prostático <80g, puntuación de Gleason (GS) de biopsia transrectal ecoguiada (TRUS) (GS)<7, valor de antígenos específicos prostáticos (PSA) <10 ng/ml, y estadio cT ≤ 2 (N0, M0). Los criterios de exclusión fueron enfermedades cardiovasculares previas, insuficiencia renal crónica y/o hepática graves, enfermedades neurológicas, diabetes mellitus incontrolada, y enfermedades pulmonares graves. También se excluyó del grupo de estudio a los pacientes que recibieron tratamiento adicional (hormonal y/o radioterapia) tras PRP. La función eréctil fue evaluada antes de la cirugía y a los 3, 12 y 60 meses postoperatorios. Los pacientes cuya puntuación IIEF-5 (International Index of Erectile Function) fue≥21 y los pacientes cuyas puntuaciones IIEF-5 se situaron entre 16 y 20 pero respondieron “sí” a las preguntas SEP-2 (Sexual Encounter Profile) y SEP-3 fueron aceptados como pacientes con función eréctil normal.Resultados: De los 132 pacientes, 96 (72,7%) de ellos reflejaron potencia durante el primer año postoperatorio. Se evaluó a un total de 118 pacientes al cabo de cinco años. Ochenta y siete (73,7%) pacientes tuvieron función eréctil normal con arreglo a nuestros criterios. (AU)

La próstata líquida / The liquid prostate

No disponible

Asociación inusual de malacoplaquia y adenocarcinoma prostático / An unusual association of malakoplakia and adenocarcinoma of the prostate

La malacoplaquia es un proceso inflamatorio crónico causado por un defecto lisosomal en la digestión bacteriana. El trastorno, aunque raro, aparece con mayor frecuencia en pacientes con disfunción inmunitaria y en aparato genitourinario. La vejiga es el sitio más comúnmente afectado, aunque se han informado casos con involucro de otros órganos, incluyendo la glándula prostática. Desde una perspectiva clínica, la lesión puede simular tumores malignos durante la exploración física y en estudios de imagen, en particular en próstata, por lo que el diagnóstico diferencial suele ser desafiante. Su expresión morfológica se caracteriza histológicamente por agregados histiocíticos con inclusiones basófilas intracitoplasmáticas, compuestas por sales de calcio y hierro. Se presenta un caso que fue diagnosticado en biopsia transrectal como adenocarcinoma acinar con suma de Gleason 5 + 5 = 10. En la prostatectomía se evidenció la asociación excepcional de malacoplaquia prostática difusa y un foco de adenocarcinoma acinar Gleason 3 + 4 = 7.(AU)

Malakoplakia is a chronic inflammatory process caused by a lysosomal defect in bacterial digestion. Although rare, it occurs more frequently in the genitourinary tract and in patients with immune dysfunction. The bladder is the most commonly affected site, although cases have been reported in other organs, including the prostate gland. Clinically, this lesion can be confused with malignant tumours, both on physical examination and imagining techniques. This is particularly pronounced in the prostate, making the differential diagnosis challenging. Histologically, characteristic aggregates of histiocytes with basophilic intracytoplasmic inclusions composed of calcium and iron salts are found. We present a case diagnosed on transrectal biopsy as acinar adenocarcinoma with a Gleason 5 + 5 = 10 score. Prostatectomy revealed an unusual association of diffuse prostate malakoplakia and an area of acinar adenocarcinoma with a Gleason score of 3 + 4 = 7.(AU)

Vapoenucleación prostática con láser Tulio. ¿Es igual de segura y efectiva en pacientes ancianos? Análisis por puntuación de propensión de los resultados funcionales y perioperatorios tempranos / Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes

Objetivo: Evaluar la seguridad y efectividad de la vapoenucleación prostática con laser Tulio (TuLEP) en una cohorte seleccionada de pacientes ancianos en comparación con pacientes «más jóvenes».Material y métodosSe realizó un análisis retrospectivo de los pacientes consecutivos que se sometieron a TuLEP entre septiembre de 2018 y febrero de 2020. Tras aplicar los criterios de inclusión/exclusión, los pacientes se estratificaron según el punto de corte de 75 años sugerido por la OMS: el grupo A incluyó a los pacientes < 75 años; el grupo B incluyó a los pacientes > 75 años.La evaluación preoperatoria incluyó una consulta con el urólogo, el valor del antígeno prostático específico (PSA), el International Prostate Symptom Score (IPSS) y quality of life (QoL), ecografía transrectal para estimar el volumen prostático (PVol) y uroflujometría para evaluar los valores preoperatorios de maximum urinary flow rate (Qmax) y average urinary flow rate (Qave), así como el volumen residual postmiccional (PVR). Se analizaron los datos perioperatorios y postoperatorios con un seguimiento de 3 meses.ResultadosTras el análisis de puntuación de propensión, 51 pacientes fueron emparejados 1:1 frente a otros 51 con base en PVol, PSA, Qmax, IPSS y QoL. Los pacientes eran comparables al inicio excluyendo la edad 65 (IQR 59-70) vs. 79 (IQR 77-82) años, Grupo A vs. grupo B, respectivamente (valor p < 0,001).No se encontraron diferencias en cuanto al descenso de la hemoglobina, la tasa de complicaciones, el tiempo de cateterismo y la duración de la estancia hospitalaria. Los pacientes del grupo A (más jóvenes) experimentaron una mejora significativamente mayor en cuanto al valor absoluto de Qmax, Qave y ΔQmax a los 30 días. A los 90 días de seguimiento, las diferencias entre los grupos desaparecieron.Durante los 90 días de seguimiento, no se encontraron diferencias significativas en la tasa de reingreso ni se requirieron reintervenciones. (AU)

Purpose: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to “younger” patients.Materials and MethodsWe performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old.Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up.ResultsAfter propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001).No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared.Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. (AU)

Concordancia del puntaje gleason entre la biopsia prostática por punción con la pieza quirúrgica post prostatectomía radical en el hospital Carlos Andrade marín desde enero / Concordance of the Gleason score between the prostate biopsy by puncture with the post-radical prostatectomy surgical piece at the Carlos Andrade Marín hospital since January

Introducción: El cáncer de próstataes la segunda neoplasia más frecuente en hombres. Labiopsia prostática es el pilar fundamental para la decisión terapéutica, los resultados histopatológicos de lapieza quirúrgica difieren de los obtenidos en la biopsiaprostática de diagnóstico generando sub estadificacióno sobre estadificación en los pacientes. Materiales y métodos: Este estudio recolecta datos de un universo de 147 pacientes que se realizaronprostatectomía radical asistida por robot en el HospitalCarlos Andrade Marín en el periodo enero 2016 adiciembre 2018, se realiza un análisis estadístico conla prueba estadística chi cuadrado con un nivel de significancia del 5%. Resultados: El porcentaje de acuerdo de la biopsiaprostática con el resultado histopatológico de la piezaquirúrgica es del 49%, la sobre estadificación se encuentra en el 14% y la sub estadificación en el 35%.El patrón Gleason más encontrado en este estudio esel 6 (3+3) tanto en biopsia prostática como en la pieza quirúrgica de prostatectomía radical. Existen en estegrupo de estudio 3 pacientes con cáncer de próstataevanescente.Conclusiones: El acuerdo de la biopsia prostática en relación a la pieza quirúrgica de prostatectomíaradical se encuentra en relación a la reportada en estudios internacionales, la sobre estadificación no representa un mayor problema de salud ya que los pacientes se podrían beneficiar de la prostatectomía radicalpero la sub estadificación podría conllevar la decisiónde no brindar al paciente un tratamiento curativo desu enfermedad para ser derivado a un protocolo devigilancia activa. El Cáncer de próstata evanescenteen este grupo de estudio es explicado por el uso debloqueo hormonal con acetato de leuprolide previo altratamiento quirúrgico en dos pacientes y a una escasa invasión tumoral en la muestra de histopatología deltercer paciente.(AU)

Introduction: Prostate cancer is thesecond most common neoplasm in men. The prostatebiopsy is the fundamental support for the therapeuticdecision, the histopathological results of the surgicalpiece differ from those obtained in the diagnostic prostate biopsy generating under-staging or over-staging inpatients. Materials and methosd: This study collects datafrom a total of 147 patients who underwent radicalrobot-assisted prostatectomy at the Carlos AndradeMarín Hospital in the period January 2016 to December 2018, a statistical analysis is performed by the Chisquared test with a significance level of 5%. REsults: The percentage agreement of prostate biopsy with the histopathological result of the surgical piecewas 49%, over-staging was 14% and under-staging was35%. The Gleason score most commonly found in thisstudy was 6 (3 + 3) both in prostate biopsy and in theradical prostatectomy surgical piece. There were 3 patients with vanishing prostate cancer in this study group. Conclusions: The agreement of the prostate biopsyin relation to the surgical piece of radical prostatectomyis in the context of that reported in international studies,over staging does not represent a major health problemsince patients could benefit from the radical prostatectomy but under-Staging could lead to the decision not toprovide the patient a curative treatment of his disease tobe referred to an active surveillance protocol.Vanishing prostate cancer in this study group is explained by the use of hormonal blockade with leuprolideacetate prior to surgical treatment in two patients and alow tumor invasion in the histopathology sample of thethird patient.(AU)

Infectious complications after transrectal prostate biopsy is increased in patients with chronic idiopathic constipation / Las complicaciones infecciosas tras la biopsia prostática transrectal aumentan en pacientes con estreñimiento idiopático crónico

Objetive: This study aims to compareinfectious complications after a prostate biopsy in patients with or without chronic idiopathic constipation(CIC). Methods: Six hundred and sixty-three patients whounderwent a transrectal ultrasound-guided biopsy (TRUSBx) of the prostate between 2012 and 2018 wereevaluated prospectively. Patients were divided into twogroups according to their CIC status and monitored forcomplications. CIC was defined by the Rome III criteria.Multivariate analysis was performed to assess the riskfactors. Results: Thirty-five patients (5.8%) developed a urinarytract infection (UTI) while sepsis occurred in only threecases (0.5%). CIC was found as a risk factor for infection. Infection occurred in 18.1% of the men with CICcompared to 2.3% of those without CIC (p=0.001).Sepsis occurred in 1.4% of the men with CIC comparedto vs 0.2% of those without CIC (p=0.68). In multivariateanalysis, CIC (OR of 9.27 and 95% CI 4.40-19.54,p<0.05) and Diabetes Mellitus (OR of 3.11 and 95%CI 1.52-6.36, p=0.002) were associated with an increased risk factor of UTI and sepsis. Conclusions: We demonstrated that CIC is an important risk factor of infection after a prostate biopsy.Prevention is important to minimize complications afterthis very common worldwide procedure.(AU)

Objetivo: Este estudio tiene como objetivo comparar las complicaciones infecciosas después deuna biopsia de próstata en pacientes con o sin estreñimiento idiopático crónico (CIC). Métodos: Se evaluó prospectivamente a seiscientos sesenta y tres pacientes que se sometieron a una biopsiade próstata guiada por ecografía transrectal (TRUS-Bx)entre 2012 y 2018. Los pacientes se dividieron en dosgrupos según su estado CIC y se monitorizaron paradetectar complicaciones. El CIC fue definido por loscriterios de Roma III. Se realizó un análisis multivariadopara evaluar los factores de riesgo. Resultados: Treinta y cinco pacientes (5,8%) desarrollaron una infección del tracto urinario (ITU), mientrasque la sepsis se produjo en sólo tres casos (0,5%). CICse encontró como un factor de riesgo de infección. Lainfección ocurrió en el 18,1% de los hombres con CICen comparación con el 2,3% de los que no tenían CIC(p=0,001). La sepsis ocurrió en el 1,4% de los hombres con CIC en comparación con el 0,2% de los queno tenían CIC (p=0,68).En el análisis multivariado, CIC (OR de 9,27 e IC del95% 4,40-19,54, p <0,05) y Diabetes Mellitus (OR de3,11 e IC del 95% 1,52-6,36, p=0,002) se asociaroncon un mayor factor de riesgo de ITU y septicemia. Cnclusión: Demostramos que la CIC es un factor de riesgo importante de infección después de unabiopsia de próstata. La prevención es importante paraminimizar las complicaciones después de este procedimiento muy común en todo el mundo.(AU)

Impacto del cáncer de próstata en el sistema nervioso: dos casos diferentes y revisión de la literatura / Impact of prostate cancer on the nervous system: two different cases and a review of the literature

Presentamos dos casos diferentes de afecta-ción del sistema nervioso por cáncer de próstata. Sabemosque las metástasis atípicas también pueden afectar linfáti-cos supraclaviculares, glándula suprarenal y testículos. Enestos dos casos presentamos lugares atípicos que afectanel sistema nervioso. Debemos tener en cuenta que a vecesla forma de presentación de los síntomas pueden confun-dirse con otras patologías. En algunas oportunidades estetipo de pacientes jamás han hecho un chequeo urológico yen nuestra sagacidad como médicos llegamos a encontrarel origen del problema: la próstata.(AU)

We present two different cases of involve-ment of the nervous system due to prostate cancer. Weknow that atypical metastases can also affect supraclavic-ular lymphatics, adrenal gland and testicles. In these caseswe present atypical places in the nervous system. We musttake into account that sometimes the shape the presentationof symptoms can be confused with other pathologies. Insome cases, this type of patient has never had a urologicalcheck-up and in our sagacity as doctors we come to findthe origin of the problem: the prostate.(AU)

Ga-PSMA-11 PET/TC en la recidiva bioquímica oculta del carcinoma de próstata, con 18F-Colina PET/TC negativa. Valoración preliminar de su uso clínico / Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use

Objetivo: Valorar la utilidad de los estudios 68Ga-PSMA PET/TC en la práctica clínica de los pacientes con recidiva bioquímica oculta de carcinoma de próstata, con estudios de imagen radiológicos y 18F-Colina PET/TC negativos o no concluyentes.Material y métodosobservacional retrospectivo y de exactitud diagnóstica. Se seleccionaron los primeros 14 pacientes con antecedentes de carcinoma de próstata, tratados con intención curativa y que presentaban sospecha de recidiva bioquímica con valores bajos de antígeno prostático específico (PSA) (< 3 ng/mL). Los estudios de imagen, ecografía prostática, tomografía computarizada (TC) y/o resonancia magnética (RM) pélvica eran negativos, y todos ellos tenían un 18F-Colina PET/TC negativo o no concluyente. Se derivó a todos los pacientes para realizarse un 68Ga-PSMA-11 PET/TC. Protocolo: Dosis 2,2 MBq/kg, 20 mg de furosemida en el minuto 0. Imágenes PET/TC desde calota craneal hasta el tercio proximal de muslos a los 60 min, e imágenes tardías a las tres horas, si precisara.ResultadosEn nueve de los 14 pacientes (64,2%) el 68Ga-PSMA-11 PET/TC consiguió localizar la recidiva bioquímica oculta, y en todos ellos hubo cambios en la actitud terapéutica. En cuatro de los 14 pacientes (28,5%) el 68Ga-PSMA-11 PET/TC resultó negativo o no concluyente, se prosiguió con la actitud vigilante con controles de PSA y estudios de imagen, según los protocolos habituales. Estos pacientes presentaban los valores más bajos de PSA (inferiores a 1 ng/mL). Uno de los estudios 68Ga-PSMA-11 PET/TC fue no concluyente, informándose la presencia de una dudosa adenopatía iliaca derecha. (AU)

Objective: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18F-Choline PET/CT imaging studies.Material and methodsRetrospective observational and diagnostic accuracy. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (< 3 ng/ml) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT.All patients were referred to 68Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 MBq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 hours if needed.ResultsThe 68Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them.Four patients (28.5%) obtained a negative or inconclusive 68Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/ml).One of the 68Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. (AU)

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal / Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

Introducción: La lesión rectal es una complicación infrecuente de la prostatectomía radical laparoscópica extraperitoneal. El desarrollo de fístulas uretrorrectales (FUR), a partir de lesiones rectales, resulta uno de los problemas más temidos y de más compleja resolución en urología.Material y métodosEntre 2013 y 2020 hemos intervenido a un total de cinco pacientes con FUR tras prostatectomía radical endoscópica extraperitoneal, mediante un abordaje perineal utilizando la interposición de material biológico. Todas las fístulas presentaron un diámetro menor de 6 mm en la endoscopia y se encontraban a menos de 6 cm del margen anal.ResultadosLa media de edad de los pacientes fue 64 años. Todos los pacientes llevaban al menos tres meses de derivación intestinal y urinaria previas. Bajo anestesia general, y con el paciente en posición de litotomía forzada mediante un acceso perineal, se realizó fistulorrafia e interposición de material biológico de origen porcino (dermis porcina liofilizada [Permacol®, Medtronic]). La duración media de la cirugía fue de 174 min (140-210). La mayoría de los pacientes fueron dados de alta al tercer día postoperatorio. La sonda vesical se mantuvo una media de 40 días (30-60). Previa a la retirada de la misma, se realizó cistografía y enema opaco con Gastrografin®, que mostró resolución de la fístula en todos los casos.ConclusionesLa interposición de material biológico procedente de dermis porcina mediante abordaje perineal es una alternativa segura y con buenos resultados en pacientes sometidos a fistulorrafia uretrorrectal tras prostatectomía radical. (AU)

Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology.Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin.ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases.ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy. (AU)

Prostatic artery embolization for the management of benign prostatic hyperplasia/ lower urinary tract symptoms in elderly patients unfit for surgery: our initial experience / Embolización arteria prostática para el manejo de la hiperplasia benigna de próstata/síndrome tracto urinario inferior en pacientes añosos no candidatos a cirugía: nuestra experiencia inicial

OBJECTIVE: To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery. MATERIALS AND METHODS: 17 elderly patients with moderate to severe LUTS/BPH were included in the study and treated with prostatic artery embolization. The patients were evaluated by transrectal ultrasonography (to assess prostate size), IPSS, and PVR urine volume preoperatively and 6 months after the procedure. RESULTS: The mean age of patients was 76.67 ± 7.69. The mean prostate volume was 139.8 ± 81.83 g. The mean preoperative IPSS and PVR were 23 ± 5.4, and 94.43 ± 88.94 ml, respectively. The mean operative time was 90 minutes. Only three patients suffered from postoperative complications (two patients suffered from urinary tract infection and one patient had partial penile necrosis). At 6 months follow up, there was a significant reduction in the prostate volume (101 ± 73.65 cc), IPSS (12.5 ± 3.65), and PVR urine volume (48.64 ± 43.55). CONCLUSION: prostatic artery embolization is a safe and effective non-surgical alternative treatment of BPH/ LUTS particularly in elderly patients with multiple comorbidities

OBJETIVO: Evaluar la seguridad y eficacia de la embolización arteria prostática en el manejo de STUI secundarios a HBP en pacientes añosos no candidatos a cirugía. MATERIAL Y MÉTODOS: 17 pacientes añosos con STUI moderados/severos fueron incluidos en el estudio y tratados con ambolización de la arteria prostática. Los pacientes fueron evaluados con ecografía transrectal (para determinar el tamaño prostático), IPSS, y residuo post-miccional preoperatorio y a los 6 meses del procedimiento. RESULTADOS: La edad mediana de los pacientes fue de 76,67 ± 7,69. EL volumen prostático medio fue de 139,8 ± 81,83 g. EL IPSS preoperatorio y RPM medio fueron de 23 ± 5,4, y 94,43 ± 88,94 ml, respectivamente. El tiempo quirúrgico medio fue de 90 minutos Solamente 3 pacientes tuvieron complicaciones postoperatorias (2 pacientes tuvieron una infección tracto urinario y un paciente tuvo una necrosis peneana). A los 6 meses de seguimiento, hubo una reducción significativa del volumen prostático (101 ± 73,65 cc), IPSS (12,5 ± 3,65), y RPM volumen orina (48,64 ± 43,55). CONCLUSIONES: La embolización de la arteria prostática es un procedimiento seguro y efectivo como una alternativa no quirúrgica al tratamiento de HBP/STUI particularmente en pacientes añosos con múltiples comorbilidades