Photovaporization of the prostate with GreenLight™ laser 180 W XPS versus transurethral resection of the prostate with monopolar energy for the treatment of benign prostatic enlargement: a cost-utility analysis from a healthcare perspective.

PURPOSE: To assess the cost-utility of the photovaporization of the prostate (PVP) with GreenLight™ laser 180 W XPS compared to transurethral resection of the prostate with monopolar energy (M-TURP) for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) from a healthcare perspective in Colombia. METHODS: We designed a Markov model to compare four health states following treatment with either PVP or M-TURP to estimate expected costs and outcomes. We used the results of the only randomized clinical trial published to date comparing PVP versus M-TURP to estimate surgical outcomes, complications, re-operation and re-intervention rates. Time horizon was defined at 2 years with four cycles of 6 months each. Resource-use estimation involved a random selection of clinical records from a local institution and cost list from public healthcare system. Costs were obtained in Colombian pesos and converted to US dollars. Threshold was defined at three-times the Colombian gross domestic product (GDP) per capita. Quality-adjusted-life-years (QALYs) were used based on the utilities of the available literature. Uncertainty was analyzed with deterministic and probabilistic models using a Monte Carlo simulation. RESULTS: Patients who underwent PVP gained 1.81 QALYs compared to 1.59 with M-TURP. Costs were US$6797.98 and US$7777.59 for M-TURP and PVP, respectively. Incremental cost-effectiveness ratio was US$4452.81 per QALY, favoring PVP as a cost-effective alternative in our context. CONCLUSIONS: In Colombia, with current prices, PVP is cost-effective when compared to M-TURP for LUTS due to BPE for a 2-year time horizon.

Novel homozygous mutation in a colombian patient with persistent müllerian duct syndrome: expanded phenotype.

The anti-Müllerian hormone triggers the regression of uterus and fallopian tubes in male embryos; if there are problems in the synthesis or action of this protein, Müllerian structures persist in an otherwise phenotypic male. The most frequent clinical presentation of Persistent Mullerian Duct syndrome is cryptorchidism and inguinal hernia. The few cases reported in adults are incidental findings or inguinal hernias. However, we present an adult male with history of bilateral cryptorchidism with unsuccessful orchidopexy, who presents with a large abdominal mass with the finding of a seminomatous tumor and persistence of Müllerian structures, in whom the variant c.916delC (p.Leu306Cysfs*29) in the AMHR2 gene not previously reported was documented.

Effectiveness of the Remeex system™ in Colombian women with recurrent stress urinary incontinence or intrinsic sphincter deficiency.

INTRODUCTION AND HYPOTHESIS: We report our experience with the Remeex system™ in women with recurrent stress urinary incontinence (SUI) or intrinsic sphincter deficiency (ISD). METHODS: A multicenter retrospective study was conducted in women who underwent an adjustable sling procedure between 2011 and 2016. We used urodynamic studies (UDS) preoperatively and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and cough stress test (CST) pre- and postoperatively. Primary outcomes were subjective (no leakage reported by the patient) and objective (no leakage during CST) cure and improvement rates (reduction of ≥4 points in ICIQ-SF). Descriptive and inferential statistics were employed. RESULTS: A total of 50 patients were included. Mean age was 62 years (SD ± 11.35). Median follow-up was 19.5 months [interquartile range (IQR) 12.95-41.38]. Urinary incontinence (UI) was described as moderate and severe by 8 (16%) and 42 (84%) patients, respectively, and 25 (50%) had stress-predominant mixed urinary incontinence (MUI). Objective and subjective cure rates were 90% and 48%, respectively, while 82% of patients achieved improvement. Impact of UI on quality of life (QoL) improved from 10 (IQR 9-10) to 2 (IQR 0-5) (p < 0.0001). Clavien-Dindo II complications occurred in 14 (28%) patients, and one (2%) had IIIa. Tape erosion occurred in one (2%) patient, and five (10%) required readjustments. Logistic regression identified MUI [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.02-10.89] and vaginal atrophy (OR 4.2, 95% CI 1.06-16.03) as predictors of low subjective cure rate. CONCLUSIONS: Adjustable slings represent a valuable and safe option in the management of recurrent SUI or ISD, with improvement in QoL. Results should be carefully interpreted due to our small sample and retrospective design.

Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high - risk prostate cancer.

OBJECTIVES: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). MATERIALS AND METHODS: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. RESULTS: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. CONCLUSIONS: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.

Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center.

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC. METHODS: Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated. RESULTS: A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%). CONCLUSIONS: In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

Impact of Rectal Swabs on Infectious Complications after Transrectal Prostate Biopsy.

OBJECTIVES: To determine the impact of rectal swabs (RSs) on infectious complications (IC) following prostate biopsy (PB). METHODS: A retrospective cohort study was conducted including all patients subjected to PB between 2009 and 2013. Group B consisted of patients with a RS and group A of patients without. RS reported the presence of gram-positive or negative germs, sensitive or resistant to ciprofloxacin. Antimicrobial prophylaxis was adjusted to the result. Frequency of IC in each group was determined. RESULTS: Group B had 548 (47.20%) patients and group A 613 (52.80%). From group B, 250 (45.62%) of the RSs showed fluoroquinolone (FQ)-resistant germs. Forty nine (16.44%) patients with sensitive germs vs. 147 (59.51%) with resistant germs had a history of previous FQ treatment (p < 0.0001). IC were observed in 33 (5.49%) patients from group A and in 7 (1.28%) patients from group B (p < 0.0001), requiring hospitalization in 4.99 vs. 1.28%, respectively. IC and hospital admissions were reduced in 76.68 and 74.34%, respectively, following the implementation of RS. CONCLUSIONS: RS and targeted antibiotic prophylaxis prior to PB was associated with a significant reduction in IC and hospital admissions. Ceftriaxone could be an alternative in cases of known resistance. Past history of FQ treatment is associated with increased resistance.

Efficacy of antibiotic prophylaxis in patients undergoing cystoscopy: a randomized clinical trial.

OBJECTIVE: To establish the efficacy of antibiotic prophylaxis prior to cystoscopy in outpatients in decreasing the incidence of post-procedure urinary tract infection. STUDY DESIGN AND SETTING: A randomized clinical trial in patients (men and women) older than 18 who underwent cystoscopy for any non-urgent indication. The intervention was Levofloxacin 500 mg single dose, and the control was placebo 500 mg single dose made with similar characteristics. The primary outcome was urinary tract infection (UTI) measured 3-10 days after the procedure. It was performed as per protocol analysis. RESULTS: Hundred and thirty-eight patients in each study arm completed the trial. The incidence of UTI in the intervention group was 0.7% and in the placebo group was 3% (p = 0.17), and no significant differences were found. The incidence of asymptomatic bacteriuria in the intervention group was 5.8% and in the control group was 14.5% (p = 0.01). CONCLUSIONS: No significant differences were found in the use of prophylactic antibiotic compared to placebo to reduce the incidence of UTI in patients who undergo cystoscopy as an outpatient procedure with sterile urine demonstrated by urine culture.

MicroRNAs as Potential Liquid Biopsy Biomarker for Patients with Castration-Resistant Prostate Cancer.

Purpose: To identify micro-RNAs (miRNAs) expression profiles in peripheral blood plasma that could play a role as potential biomarkers in patients who progressed to castration-resistant prostate cancer (CRPC). Liquid biopsy analysis of miRNAs is a fast-developing field with a considerable likelihood to predict tumor progression and metastasis by targeting genes involved in oncogenesis. Patients and Methods: Differential expression analysis of miRNAs profile in CRPC patients was performed by creating small RNA libraries of circulating miRNAs using HiSeq2500 Illumina platform. A secondary analysis of aligned reads with miRNA identification and quantification was performed using miARmaSeq. Using the Bowtie algorithm, the selected variants were compared to reference nucleotide sequence GRCh38 and miRbase. Novel miRNA sequences were structurally analyzed using mirDeep2®. Results: A total of 16 patients with CRPC were included for analysis. Identified circulating miRNAs were hsa-miR-885-3p, hsa-miR-4467, hsa-miR-4686, hsa-miR-146a-3p, hsa-miR-6514-5p. Genes identified as regulated by these miRNAs were GPR56, BDNF, CTNND1, C17orf62, and DTNA. Conclusion: We explored the miRNA expression profile in patients with CRPC, identifying five miRNAs implicated in the regulation of genes involved in prostate cancer (PCa) oncogenesis and progression. We also found miRNA 855-3p in peripheral blood for the first time, which has a critical role in tumor growth mechanisms and higher expression profile than in healthy individuals.

[Obesity and radical prostatectomy: The enigma continues.] / Asociación entre obesidad, prostatectomía radical y pronóstico oncológico: un enigma que sigue vigente.

OBJECTIVE: To determine the association between surgical and postoperative outcomes as well as cancer follow-up of patients who underwent radical prostatectomy according to body mass index (BMI). METHODS: An analytical observational study with retrospective data collection was conducted. We reviewed the medical records of all the patients who underwent radical prostatectomy between the years 2012-2014. The analysis of the data included a bivariate model to study the associations between BMI and the surgical procedure, its complications, oncologic outcomes and cancer follow-up. Then, we used multivariate logistic regression analysis to determine if there was an independent association between oncologic outcomes and BMI; the model was adjusted by age, hypertension and diabetes mellitus. RESULTS: 272 patients underwent radical prostatectomy: 98 (36.0%) had normal BMI, 142 (52.2%) were overweight and 32 (11.8%) were obese. The median age was 61 interquartile range (IQR=56-66) years old. There were no statistically significant differences in the preoperative and postoperative outcomes according to BMI. The obese patients had longer operative time (176 minutes, IQR=165.0-195.5) nonetheless, the difference was not statistically significant (p=0.18). There were no complications during the procedure (rectal, vascular or obturator nerve injury). The multivariate analysis showed that age, hypertension and diabetes mellitus were not effect modifiers. CONCLUSIONS: Our study suggests that there are no differences between surgical and postoperative outcomes according to BMI. This study represents a starting point for future research in our population to determine the impact of the BMI on prostate cancer and its management.

[Efficacy of lycopene intake in primary prevention of prostate cancer: a systematic review of the literature and meta-analysis.] / Eficacia del consumo de licopenos en la prevenciín primaria de cáncer de próstata: una revisión sistemática de la literatura y meta­análisis.

OBJECTIVE: To evaluate the efficacy of lycopene intake in primary prevention of prostate cancer (PCa). METHODS: A systematic search of the literature was conducted in March 2015 and the articles published between the years 1990-2015 were reviewed. The following search terms were used: prostate cancer, prostatic neoplasm, lycopene, prevention, effectiveness and efficacy (MeSH). Publications including research in humans, written in English and whose texts were accessible were reviewed. The types of studies included were: clinical trials, cohort and case-control studies. We found 343 articles; of these, 27 were included in the systematic review. After the latter were rigorously analyzed, 23 were included in the meta-analysis using the pooled odds ratios (OR) and risk ratios (RR) of case-control and cohort studies, respectively, and their confidence intervals (95% CI), using random-effects models with Review Manager 5.2. RESULTS: Out of the 27 articles included in the systematic review, 22 were case-control and 5 were cohort studies. For the case-control studies, the total number of patients with PCa was 13,999 and the total number of controls 22,028. Cohort studies included 187,417 patients and PCa was diagnosed in 8,619 of these. The metaanalysis determined an OR = 0.94 (IC 95% 0.89-1.00) and RR = 0.9 (IC 95% 0.85-0.95) of PCa related with lycopene and/or raw or cooked tomatoes intake. CONCLUSIONS: Although our study found that there is a statistically significant inverse association between lycopene intake and PCa, the magnitude of this association is weak and comes solely from observational studies, which do not allow recommending its use as a standard of practice. High-quality randomized clinical trials are required to clarify current evidence.

Desafíos de la educación médica en cirugía / Challenges of medical education in surgery

Los procesos educativos orientados a la formación de los médicos que trabajarán en las especialidades quirúrgicas se ven afectados por diferentes desafíos que deben ser reconocidos claramente para poder plantear respuestas a ellos. Se realizó una revisión de la literatura buscando artículos con temas relacionados y se identificó que los retos se concentran en cuatro áreas: rápida evolución de la tecnología y mayor complejidad, escaso recurso humano docente capacitado, falta de instituciones de salud con vocación docente y currículos cuya estructura no responde a los factores diferenciadores de los programas de residencia cuyo componente primordial es el quirúrgico. Las soluciones a estos retos requieren de una acción coordinada de todos los actores involucrados si se desea realmente resolver los problemas de salud del mundo actual.

The educational processes designed to train medical practitioners in surgical specialties have been affected by a series of challenges. Through a literature review, four challenges were identified: rapid evolution of technology, scarce human resources trained for surgical education, lack of health institutions with teaching vocation, and curriculums that do not favor the needed distinctive factors of resi-dency programs with surgical components. The solutions to these challenges require coordination between the parts involved in the medical education community. A necessary effort, if the health problems of today are to be solved.

Carta al Editor en referencia al articulo "Percepción de acoso o discriminación durante la residencia de urología en Colombia" / Letter to the Editor in reference to the article "Perception of harassment or discrimination during urology residency in Colombia"

Apreciado Editor de la Revista Urología Colombiana, respecto al artículo titulado "Percepción de acoso o discriminación durante la residencia de urología en Colombia" considero relevante hacer las siguientes precisiones dado el impacto de sus conclusiones una vez sea conocido por una población tan amplia como es la esperada en este medio de difusión: En primer lugar el propósito de evaluar la percepción de los sujetos de una situación determinada delimita claramente el resultado a la subjetividad del individuo y por consiguiente confiere una gran debilidad interpretativa de los hallazgos cuando estos se comparan con mediciones objetivas. No se puede evaluar mediante una encuesta de doce preguntas cuya estructura y validez son cuestionables las percepciones en campos tan heterogéneos como el acoso laboral, el abuso en el campo laboral o la discriminación por género y acoso sexual. Desde los años 80 se han venido desarrollando instrumentos en diferentes idiomas y validados en español que permiten realizar una aproximación más metódica a la resolución de preguntas de investigación que por su relevancia e implicaciones debe ser realizada con la mayor rigurosidad posible.

Dear Editor of the Revista Urología Colombiana, regarding the article entitled "Perception of harassment or discrimination during urology residency in Colombia" I consider it relevant to make the following clarifications given the impact of its conclusions once it is known by such a wide population as expected in this media: First of all the purpose of evaluating the perception of the subjects of a given situation clearly delimits the result to the subjectivity of the individual and therefore confers a great interpretative weakness of the findings when these are compared with objective measurements. It is not possible to evaluate perceptions in fields as heterogeneous as workplace harassment, abuse in the workplace or gender discrimination and sexual harassment by means of a twelve-question survey whose structure and validity are questionable. Since the 1980s, instruments have been developed in different languages and validated in Spanish that allow a more methodical approach to the resolution of research questions which, due to their relevance and implications, should be carried out as rigorously as possible.

Urological Cancer Treatment by a Multidisciplinary Teamthroughout the Covid-19 Pandemic: What Have We Learned? / Tratamiento del cáncer urológico por un equipo multidisciplinario durante la pandemia de Covid-19: ¿Qué hemos aprendido?

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by themultidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. Themedian age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.

Introduccion La atención del cáncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornó más importante en la pandemia por Covid-19, en que las opciones para tratar el cáncer urológico están influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncológicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19. Métodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtención de un consenso sobre el tratamiento del paciente, los pacientes fueron programados según el riesgo individual de posponer el manejo. Se midió la puntuación de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, "Médicamente necesario, sensibles al tiempo"). Todos los pacientes respondieron el cuestionario de autoevaluación del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugía. Se estimó la tasa de supervivencia libre de Covid-19. Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos tenían Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugía oncológica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 años (RIC: 59 a 94 años), la puntuación mediana en el MeNTS de la cohorte tratada quirúrgicamente fue de 35 puntos (RIC: 31 a 47 puntos). Conclusiones La evaluación y el tratamiento del cáncer urológico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institución mostraron que la mayoría de los pacientes podrían ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.

Analysis of Correlation and Agreement between the Uroflowmetry and the International Prostate Symptom Score in Patients after retropubic Radical Prostatectomy: A Multicenter Prospective Study[*] / Análisis de correlación y concordancia entre la uroflujometría y la escala internacional de síntomas prostáticos posterior a prostatectomía radical retropúbica: estudio multicéntrico prospectivo

Objectives Patients undergoing retropubic radical prostatectomy (RRP) may suffer from lower urinary tract symptoms (LUTS). We aim to characterize LUTS and to evaluate the correlation and agreement between uroflowmetry and the International Prostate Symptom Score (IPSS) in patients after RRP in two reference centers. Methods An observational multicenter prospective study was conducted between December 2015 and September 2016. Patients with at least 12-months of follow-up after RRP were included; these were evaluated with uroflowmetry and the IPSS. Results A total of 90 patients were included. The mean follow-up was of 54.6 months (standard deviation [SD] = 27.52), and the mean age was 65 (SD = 6.85) years old. The mean IPSS was 7.41 (SD = 6.29), with 33.3% (n = 54) of the patients with moderate symptoms and 6.7% (n = 6) with severe symptoms. A total of 50% (n = 45) of the patients had normal uroflowmetry. Patients with an abnormal/equivocal result in the uroflowmetry had a mean of 9.31 (SD = 7.03) points in the IPSS versus 5.51 (SD = 4.82) in patients with a normal uroflowmetry result (p < 0.01). The level of agreement between mild versus moderate-to-severe LUTS and normal uroflowmetry versus abnormal/equivocal was 61.1% (k = 0.22, p = 0.04). We found that a score ≥ 10 in the IPSS had a level of agreement of 65.6% (k = 0.31, p = 0.0004). Conclusions We consider that although the IPSS cannot replace uroflowmetry and vice versa, these tests are complementary and may be useful tools in the evaluation of patients with LUTS after RRP.

Objetivos Los pacientes en quienes se realiza prostatectomía radical retropúbica (PRR) pueden sufrir de síntomas del tracto urinario inferior (STUIs). El propósito es poder caracterizar STUI y correlacionarlos con la uroflujometría y la Escala Internacional de Síntomas Prostáticos (IPSS por sus siglas en inglés). Métodos Se realizó un estudio multicéntrico prospectivo entre Diciembre de 2015 y Septiembre de 2016. Se incluyeron todos los pacientes con un seguimiento mínimo de 12 meses después de la PRR. Estos fueron evaluados con uroflujometría e IPSS. Resultados Se incluyeron un total de 90 pacientes. El seguimiento promedio fue de 54,6 meses (desviación estándar [DE] = 27,52), la edad promedio fue de 65 años (DE 6,85). El promedio de la puntuación en la IPSS fue de 7,41 (DE = 6,29) con 33,3% de los pacientes con síntomas moderados y 6,7% con síntomas severos. El 50% de los pacientes tuvieron una uroflujometría normal. Los pacientes con resultado anormal o equívoco en la uroflujometría presentaron un promedio de 9,31 (DE = 7,03) en la puntuación de la IPSS, versus 5,51 (DE = 4,82) en pacientes con una uroflujometría normal (p < 0,01). El nivel de concordancia entre los STUIs leves y moderados/severos y uroflujometría normal versus anormal/equívoca fue de 61,1% (k = 0,22, p = 0,04). Se encontró que un puntaje ≥ 10 en la IPSS tiene un nivel de concordancia del 65,6% (k = 0.31, p = 0.0004). Conclusiones Se considera que aunque la IPSS no puede reemplazar la uroflujometría y viceversam, estas pruebas son complementarias, y son herramientas útiles en la evaluación de pacientes con STUIs después de la PRR.

Novel homozygous mutation in a colombian patient with persistent müllerian duct syndrome: expanded phenotype

ABSTRACT The anti-Müllerian hormone triggers the regression of uterus and fallopian tubes in male embryos; if there are problems in the synthesis or action of this protein, Müllerian structures persist in an otherwise phenotypic male. The most frequent clinical presentation of Persistent Mullerian Duct syndrome is cryptorchidism and inguinal hernia. The few cases reported in adults are incidental findings or inguinal hernias. However, we present an adult male with history of bilateral cryptorchidism with unsuccessful orchidopexy, who presents with a large abdominal mass with the finding of a seminomatous tumor and persistence of Müllerian structures, in whom the variant c.916delC (p.Leu306Cysfs*29) in the AMHR2 gene not previously reported was documented.

Prostatectomía radical y calidad de vida: resultados en un centro de alta complejidad / Radical Prostatectomy and Quality of Life: Results in a Center of High Complexity

La prostatectomía radical (PR), es el procedimiento quirúrgico de elección cuando se trata de dar manejo con intención curativa al cáncer de próstata localizado. Fue el primer tratamiento quirúrgico descrito para el cáncer de próstata y ha sido realizado por más de 100 años. Tiene como ventaja importante frente a la radioterapia el permitir la estadificación precisa con el estudio patológico del espécimen quirúrgico; sin embargo, tiene algunas desventajas como la necesidad de hospitalización y recuperación post operatoria intrahospitalaria, la posibilidad de una resección incompleta y el riesgo de incontinencia urinaria y de disfunción eréctil, entre otras.1­3 La frecuencia de complicaciones y secuelas descrita en la literatura es variable, con amplios rangos según las diferentes series y autores disponibles.

Radical prostatectomy (PR) is the surgical procedure of choice when it comes to managing localized prostate cancer with curative intent. It was the first surgical treatment described for prostate cancer and has been performed for over 100 years. However, it has some disadvantages such as the need for hospitalization and in-hospital post-operative recovery, the possibility of incomplete resection and the risk of urinary incontinence and erectile dysfunction, among others.1-3 The frequency of complications and sequelae described in the literature is variable, with wide ranges according to the different series and authors available.

Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high - risk prostate cancer

ABSTRACT Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). Materials and Methods: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. Results: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.

Histological Findings in Very Low Risk Prostate Cancer Patients Managed with Radical Prostatectomy / Hallazgos histopatológicos en pacientes con cáncer de próstata con criterios de muy bajo riesgo llevados a prostatectomía radical

Objectives: lo describe the histológica] findings in patients with prostate cáncer (PCa) dmically dassifíed as very low risk who underwent treatment with radical prostatectomy (RP). Material and methods: A retrospective observational study was conducted. Clinical records of patients who underwent RP between 2007'2015 who met Epstein criteria for very low risk disease were reviewed. Histológica! diagnosis was described and analyzed to determine ¿f such criteria predicted very low risk. Results: A total of 609 records were reviewed; 83 (13.6%) met Epstein's criteria. Mean age was 59 (SD±7) years and median PSA at diagnosis was 5.4 ng'dl (IQR 4.3 ­ 6.8). Pathology showed a median tumor volume of 4% (IQR 1 ­ 10%). Gleason score was 3+3 in 55 (66.3%) cases, but 28 (33.7%) were redassified to a greater score. Two (2.4%) patients were redassified as pT3a, 80 (96.4%) as pT2 and 1 (1.2%) was found to be pTO. In those subjected to pelvic lymphadenectomy (42.2%) no positive lymph nodes were found. Conclusions: Up to one-third of the patients dinically classmed with very low risk PCa had a greater Gleason score. Only 3% had locally advanced tumors, which is comparable to previous studies. Epstein's criteria seem to be adequate in predicting organ-conñned disease.

Objetivo: Describir los hallazgos de la patología definitiva de los pacientes inicialmente clasificados con tumores de muy bajo riesgo que fueron llevados a prostatectomía radical (PR). Materiales y métodos: Estudio observacional retrospectivo. Se revisaron las historias clínicas de pacientes llevados a PR entre enero de 2007 y diciembre de 2015. Se describieron y analizaron los hallazgos histopatológicos posquirúrgicos, con el objetivo de determinar si cumplir con dichos criterios eran predictores de enfermedad órgano'confinada y de bajo riesgo. Resultados: Se revisaron 609 historias clínicas de pacientes llevados a PR, de las cuales 53 (13,6%) casos cumplían con criterios de muy bajo riesgo. La media de edad de estos pacientes fue de 59 (DE ± 7) años y la mediana de PSA al diagnóstico fue de 5,4 (RIQ 4,3'6,8) ng'dl. En la patología definitiva, la mediana del volumen tumoral fue del 4% (RIQ: 1'10%). El puntaje de Gleason fue de 3 + 3 en 55 (66,3%) pacientes, mientras que 28 (33,7 %) fueron reclasificados a uno mayor Solo 2 (2,4%) pacientes se reclasificaron como pT3a, 80 (96,4 %) pacientes fueron clasificados como pT2 y un (1,2 %) paciente fue reclasificado como pTO. No se evidenció compromiso ganglionar en ninguno de los pacientes llevados a linfadenectomía. Conclusión: Los hallazgos demuestran que hasta una tercera parte de los pacientes con tumores inicialmente clasificados como de muy bajo riesgo tienen puntajes de Gleason mayor en la patología definitiva; sin embargo, solo el 3 % tienen tumores localmente avanzados, lo cual es consistente con lo reportado en la literatura mundial. Los criterios de Epstein son adecuados para predecir la presencia de tumores órgano-confinados.

Diez años de experiencia en la realización de biopsias por saturación / 10-Year experience in performing saturation prostate biopsy

Objetivo: Identificar la tasa de detección de cáncer de próstata en pacientes en quienes se realizaron biopsias por saturación en el Hospital Universitario San Ignacio desde enero del 2005 hasta febrero del 2015. Métodos: En el Hospital Universitario San Ignacio se han realizado 114 biopsias por saturación. Para este estudio se llevó a cabo un análisis univariado de las variables a estudio. Se obtuvo la asociación por medio del T-test y del test de Wilcoxon con una significancia de 0,05. Por último, se corrió un modelo de regresión para predecir un resultado positivo para cáncer de próstata. Resultados: La tasa de detección de cáncer de próstata fue del 16,7 %, y de estos el 84 % fueron categorizados como significativos. En promedio, se obtuvieron 19 muestras de tejido. El número de biopsias previas, el número de muestras, el volumen de la próstata y la densidad del PSA presentaron valores estadísticamente significativos. Conclusiones: La biopsia por saturación en Colombia presenta una tasa de detección de cáncer de próstata del 16,7 %, de las cuales el 84 % fueron significativas.

Objective: Identify the prostate cancer detection rate in patients in whom underwent a saturation prostate biopsy as a rebiopsy from January 2005 to February 2015 at San Ignacio Hospital. Materials and methods: In San Ignacio hospital were performed from January 2005 to February 2015, 114 saturation biopsies. The investigators made a univariate analysis of the variables. The association between the variable was evaluated based on the T-test and Wilcoxon test. P < 0.05 was considered statistically significant. Finally, a regression model was performed to predict significant variables for prostate cancer. Results: The cancer detection rate using saturation prostate biopsy was 16.7% of which 84% were categorized as significant. A mean of 19 cores were obtained. There were statistically significant differences between patients with prostate cancer and healthy patients in the number of previous biopsies, number of samples, prostate volume and PSA density. Conclusion: Saturation prostate biopsy in our study has a prostate cancer detection rate of 16.7% and 84% of them were significant in this cohort of patients.

[Usefulness of bone-specific alkaline phosphatase for bone metastases detection in prostate cancer]. / Utilidad de la fosfatasa alcalina ósea en la detección de metástasis óseas en cáncer de próstata.

OBJECTIVES: To assess the clinical usefulness of bone-specific alkaline phosphatase (B-AKP) to detect or rule out bone metastases in patients with prostate cancer. METHODS: Between November 2001 and July 2003 111 patients with the diagnosis of prostate adenocarcinoma were evaluated to rule out bone metastases. Bone metastases were studied after clinical suspicion, PSA value higher than 10 ng/ml, or Gleason score higher than 7. Bone scan was used as detection test. Patients were tested for serum B-AKP with a reference value equal or higher than 30ng/ml. The sensitivity, specificity, positive predictive value and negative predictive value of B-AKP were measured in comparison to bone scan as the gold standard. RESULTS: 111 patients with the diagnosis of prostate adenocarcinoma were evaluated to rule out bone metastases. Mean age was 69.70 years (50-83 years). Average B-AKP value was 29.28 ng/ml (9-56 ng/ml). Bone scan was positive in 31 patients. Among these 31, 26 patients had positive B-AKP and five negative. AP patients had negative bone scan. From this AP patients, B-AKP was positive in 17 and negative in 63. The sensitivity of the test was 83.8%. The specificity was 78%. Positive predictive value was 60% and negative predictive value was 92%. CONCLUSIONS: Bone alkaline phosphatase is a greatly useful test for the study of patients with prostate cancer in whom bone metastases are suspected either to confirm them or to rule out their presence.