Prevalence of lower urinary tract symptoms and overactive bladder in men and women over 18 years old: The Colombian overactive bladder and lower urinary tract symptoms (COBaLT) study.

AIMS: To estimate the prevalence of LUTS and overactive bladder (OAB) in the Colombian population. METHODS: A cross-sectional, population-based study was conducted in men and women ≥18 years using directed interviews and self-administered questionnaires in five main cities in Colombia. A sample size of 1054 subjects was estimated (prevalence of LUTS/OAB 15%, CI 95%, statistical power 80%, precision 3%). We used a multi-stage probabilistic sampling technique to randomly select individuals in the community, stratified by socioeconomic status, gender, and age. We used the 2002 ICS and 2010 IUGA/ICS definitions as well as validated questionnaires in Spanish. Descriptive statistics were employed. RESULTS: A total of 1060 participants were included. Mean age was 42 (range 18-89) years. The prevalence of at least one LUTS was 84%, while overactive bladder was reported by 31.8% participants. Among individuals with at least one LUTS, 13.2% would feel "mostly unsatisfied," "unhappy," or "terrible" to spend the rest of their lives with their current urinary condition. Nocturia was the most prevalent LUTS (55.3%), followed by urgency (46.4%) and frequency (45.8%). Urge, stress, and mixed urinary incontinence were reported by 15.3%, 8.6%, and 7% of participants, respectively. CONCLUSIONS: LUTS are highly prevalent in the Colombian population and severely affect quality of life. This is the first study conducted in Colombia and Latin America focused on evaluating LUTS in men and women of all age groups of interest using a multi-stage probabilistic sampling technique. These results may have a significant influence on health decision-making and assessment of future therapies.

Trends in pelvic organ prolapse management in Latin America.

AIMS: To describe practice patterns and perspectives regarding pelvic organ prolapse (POP) management among urologists, gynecologists, and urogynecologists in Latin America (LATAM). METHODS: A cross-sectional study was conducted from April to September 2016 using a 37-item internet-based survey applied to members of urologic and gynecologic associations from 18 countries. Participants were asked about their background and practice patterns. Descriptive statistics were employed. RESULTS: A total of 673 responses were obtained. Most came from Colombia (33.6%) and Brazil (24.7%). The number of practitioners who perform at least one POP procedure per month and were eligible to finish the survey was 529 (78.6%), out of which 323 (61.0%) were urologists, 156 (29.5%) gynecologists, and 50 (9.5%) urogynecologists. Mesh-based POP repairs were used by 57.1% of participants. Out of non-mesh users, the most frequent vaginal procedures were sacrospinous fixation (30%), colporrhaphy (25%), and uterosacral fixation (12%). Regarding the impact of FDA warnings, 75.2% participants indicated that the use of mesh has declined, and 41.9% considered this has had a negative effect in the use of incontinence tapes as well. Only two physicians reported legal disputes related to mesh procedures, and 75.8% said they would still indicate mesh repairs in certain cases. CONCLUSIONS: This is the first report on POP practice patterns in LATAM. Preferences regarding surgical management of POP are not very different from international trends. Despite intense scrutiny and media exposure, mesh-based procedures are still largely used in LATAM.

Photoselective Vaporization with KTP 180-W Green Laser for the Treatment of Lower Urinary Symptoms Secondary to Benign Prostatic Enlargement: Effectiveness and Safety at Midterm Follow-Up.

OBJECTIVES: To determine safety, efficacy, and improvement in patient's quality of life (QoL) with 180-W green light laser prostate photovaporization in medium-term follow-up. METHODS: Observational descriptive analysis. All the patients who were treated with photoselective vaporization with potassium titanyl phosphate crystal 180-W green laser between January 2012 and February 2014 were included. The primary outcome was the change of the International Prostate Symptom Score (IPSS). A descriptive analysis was conducted. Statistic inference was made using nonparametric measurements according to the findings. The Wilcoxon signed-rank test was applied to paired data. Finally, survival curves were used to determine the effectiveness. RESULTS: Two hundred one subjects were included. The mean follow-up was 13.1 months (2-28). Prostate volume was 75.46 ml (30-240). Mean surgical time was 73.29±29.74 minutes, laser time was 44.27±21.03 minutes, and the mean energy used was 271.5±140.1 kJ. Postoperative indwelling catheter time was 15.81±8.87 hours. IPSS decreased 12.79 points, from 19.13±7.79 to 6.34±5.91 (p=0.0001). QoL question of the IPSS shows improvement from 4.16 to 1.27 (p=0.00001). In a maximum follow-up period of 28 months, 85.2% of patients showed an improvement of four points in IPSS. Visual scale of improvement perception showed an increase from 36.49 to 89.84 (p=0.0001). No major complications were reported. CONCLUSION: Prostate photoselective vaporization with a 180-W green light laser is a safe and effective treatment option for patients with lower urinary symptoms secondary to benign prostate enlargement.

Efficacy of robotic-assisted prostatectomy in localized prostate cancer: a systematic review of clinical trials.

Background. Radical prostatectomy is an effective treatment for clinically localized prostate cancer. The three approaches in current use have been extensively compared in observational studies, which have methodological limitations. Objective. To compare the efficacy and safety of three radical prostatectomy approaches in patients with localized prostate cancer: open, laparoscopic, and robotic-assisted laparoscopic surgery. Materials and Methods. A systematic review of the literature was carried out. Databases MEDLINE, EMBASE, LILACS, and CENTRAL were searched for randomized clinical trials that directly compared two or more radical prostatectomy approaches. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent researchers using Cochrane Collaboration's tools. Results. Three trials were included. In one study, laparoscopic surgery was associated with fewer blood loss and transfusion rates than the open procedure, in spite of longer operating time. The other two trials compared laparoscopic and robotic-assisted surgery in which no differences in perioperative outcomes were detected. Nevertheless, robotic-assisted prostatectomy showed more favorable erectile function and urinary continence recovery. Conclusion. At the present time, no clear advantage can be attributed to any of the existing prostatectomy approaches in terms of oncologic outcomes. However, some differences in patient-related outcomes favor the newer methods. Larger trials are required.