Assessment of changes in sexual function in patients undergoing endoscopic surgery for upper urinary tract lithiasis.

OBJECTIVE: To evaluate the effect of endoscopic surgery on sexual function in patients with upper urinary tract (UUT) lithiasis. MATERIAL AND METHODS: We conducted an observational, prospective, longitudinal study with a single cohort of cases undergoing ureteroscopy (URS), retrograde intrarenal surgery (RIRS), or endoscopic combined intrarenal surgery (ECIRS). Patients' sexual response was assessed with questionnaires in the 30 days prior to surgery, and at one and three months after surgery. The International Index of Erectile Function (IIEF-t) was used in male patients, and the Female Sexual Function Index (FSFI) was used in female patients. RESULTS: Seventy patients -34 men and 36 women- completed the study. Among men, the IIEF-t did not show significant difference between baseline scores (64.1 ± 7.50) and those obtained at 3 months (63.8 ± 9.51), with a non-significant decrease (p = 0.054) at the first month (61.4 ± 10.4). Subdomains did not worsen at 3 months, and desire (IIEF-SD) improved from 7.3 ± 1.9 to 8.0 ± 1.8. Among women, the FSFI-t did not change significantly after surgery: baseline score (27.3 ± 4.1), 1-month score (26.8 ± 3.7) and 3-month score (27.5 ± 4.2). No subdomain worsened at the third month. CONCLUSION: Endoscopic surgery for UUT is a safe technique in both sexes with no negative effect on sexual function. There are no differences between the baseline IIEF-t and FSFI-t scores and those obtained at 3 months.

Women in urology: what is their current situation in Spain?

OBJECTIVE: To analyze the current state of women in urology in Spain. MATERIAL AND METHODS: Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Characteristics of the survey and its results were analyzed. RESULTS: In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (p < 0.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, p = 0.789), and the group of female residents against male residents (p = 0.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (p = 0.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female Department Chiefs. CONCLUSIONS: Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal.

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours.

INTRODUCTION: During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression-free survival rates and tumoral relapse specific characteristics. METHODS: Retrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. RESULTS: Median follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. CONCLUSION: BCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

Evolution and current status of the management of functional and pelvic floor pathology in the hospitals of the Community of Madrid.

INTRODUCTION AND OBJECTIVE: Pelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals' resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. MATERIAL AND METHODS: The survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. RESULTS: The number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). CONCLUSIONS: Multidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized.

Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success.

OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.

Fifty ways to improve presentations in urology. / Cincuenta consejos para mejorar las presentaciones en urología.

BACKGROUND: Our profession permanently demands intercommunication of medical knowledge among colleagues; either in small environments such as hospitals or at larger ones such as congresses or academic courses. New technologies such as PowerPoint® are not developed enough to provide good presentations, and its employment does not always grant effective results. OBJECTIVE: In order to improve our academic presentations, we present several tools that may help us avoid the most common mistakes. EVIDENCE ACQUISITION: Literature search in PubMed and Google Scholar. We have divided the analysis into 3 sections: structure of the presentation, slide design, presentation to the audience. Each section includes a list of 50 short tips. RESULTS: Fifty tips following the study objectives. CONCLUSIONS: The scientific evidence that supports the information on how to improve presentations is mostly based on expert opinions. However, almost every work agrees that presentations must use simple structures which does not make them less scientific; their content must be developed for a specific audience, and it must be the speaker, not the slides, who captures the audience attention. Making a simple and didactic presentation of complex content supported by multimedia tools is one of the speaker's highest intellectual challenges of these days.

Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery. / Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido.

OBJECTIVE: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. MATERIAL AND METHOD: We analysed the authors' first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. RESULTS: We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. CONCLUSIONS: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues.

Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma. / Nefrectomía parcial laparoscópica previa embolización supraselectiva como tratamiento de angiomiolipomas renales gigantes.

OBJECTIVE: Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. MATERIAL AND METHODS: We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. RESULTS: None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. CONCLUSIONS: The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.

Prognostic factors for vesical relapse in patients with upper urothelium tumours treated with surgery. / Factores pronósticos de recidiva vesical en los pacientes con tumor de urotelio superior tratados con cirugía.

OBJECTIVE: To identify the prognostic factors for vesical relapse in patients with tumours of the upper urothelium treated with surgery. MATERIAL AND METHODS: We conducted a retrospective analysis of patients with tumours of the upper urothelium who underwent surgery between 1999 and 2011 at our centre (139 patients). We collected demographic, clinical, diagnostic and pathological variables, as well as the treatment, complications and progression. A descriptive analysis was performed using the chi-squared test for categorical variables and the ANOVA test for continuous variables. We also performed a univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered when P<.05. All calculations were performed with SPSS Statistics version 21. RESULTS: During the follow-up, 26.6% of the patients (37 cases) showed vesical relapse. Some 19.6% of the patients with no history of bladder tumours showed a bladder tumour relapse compared with 48.6% of the patients with a history of bladder tumours (P<.001). In the multivariate analysis, only the presence of bladder tumours prior to or concomitant with the upper urinary tract tumour diagnosis was identified as an independent predictor of bladder tumour relapse (P=.007). CONCLUSION: In our series, only the presence of a prior or synchronous bladder tumour behaved as an independent predictor of bladder tumour relapse in patients with tumours of the upper urothelium treated with surgery.

Urology at the European university: adaptations to the Bologna Plan. The model of the Autonomous University of Madrid.

The fundamental objective of the Convergence Plan of Bologna is to normalize, harmonize and standardize the teaching of medicine in European medical schools by implementing a similar curriculum. This objective assumes the presence of Urology as a university discipline in all European medical schools. At the same time, the teaching techniques and subject distributions have been modified, emphasizing practical teaching and active participation of the student in the acquisition of expertise and skills. This approach enhances the curricular presence of Urology and requires increased dedication from the teaching staff. These staff members, with limited face-to-face and classroom time, must inform and educate medical students on the broad healthcare commitment of urology as a surgical/medical specialty. The adaptation of the numerous European medical schools to the Bologna Plan raises a number of problems that can be easily overcome, as can be seen in the plan designed by the Faculty of Medicine at the Universidad Autonoma de Madrid.

[Adequacy of urology departments in a health care model of hospitals network]. / Adecuación de Servicios de Urología en un Modelo Asistencial de Red de Hospitales.

UNLABELLED: The traditional health care model is currently facing new health requirements. The implementation of integrated urologic health systems can be one of the possible solutions to these needs. It is mandatory to explore a new health care model, which includes structural and organizational changes. The adequacy of the urology departments of IDCsalud-Madrid network hospitals, creating URORed, is a new system adaptable to constant changes, in order to offer professionalism and quality health care. OBJECTIVE: To describe the administrative/clinic management in the urology service of a health care model of Hospitals network (URORed at IDCsalud. Madrid), that has been included in a model of an Integrated network in a health care service. METHODS: In the period between November 2007 to October 2014, the urology departments of IDCsalud Madrid Group, have been included in a new organizational system, including 4 hospitals, currently with 27 urologists. Each center offers specific urologic services, sharing benefits and human resources. The same directive line leads all centers. RESULTS: The model offers an integrated and uniform urologic service to a specific population of 811.390 habitants (Population Census 2012), with capability to treat specific urologic diseases and to perform a correct clinical follow-up. CONCLUSIONS: Belonging to a health care model in network involves a change of attitude. It creates an organizational change, based on the processes and the results, which enables control of the management analytically, detecting the points that need to be optimized as well as those that are satisfactory. It implies developing a culture of learning and cooperation, so that the processes are fluent and have quality, to create clinical and technological projects in favor of new resource-generating research, based on the needs of the joint management of the hospitals network. The complexity of this model requires a work focused on the human resources, their concerns and their ability to coordinate actions to get results in terms of quality health care and professionalism.

Residency in urology and training in kidney transplantation. Results of a national survey.

OBJECTIVES: To determine the current state of kidney transplantation (KT) training in a country that is leader in organ donation and transplantation. MATERIAL AND METHODS: We conducted an online survey by e-mail to 138 urology residents. The survey contained 5 sections: affiliation, training in KT, interest in KT, residents of transplant centers and residents of nontransplant centers. RESULTS: Sixty-five residents responded, 47.1% of the urologists in training surveyed, representing 28 cities and 15 provinces. Fifty-five percent (n=36) of the respondents deemed the KT training offered during their residency as insufficient, and 85% (n=55) demanded more resources. More than half were not confident in their abilities to perform transplantation surgery over the course of their residency (n=35). Nineteen percent of the residents considered KT an important discipline in their residency, with a mean score of 56.2 (1-100). Among the residents of the transplant centers (69.2%, n=45), 73% (n=33) considered KT when choosing a center for their residency. Of the surveyed residents from nontransplant centers (30.7%, n=20), 45% (n=9) do not perform an external rotation in KT. CONCLUSIONS: The surveyed residents demand more training in KT. The most common situation is to end a residency without having performed a complete KT. KT is considered an asset when selecting a resident medical intern position and commonly they are part of the transplantation team. The majority of residents are trained in centers with less than 75 transplants/year. External rotations in KT are not the rule in centers where transplantation is not performed.

Focal therapy in prostate cancer: the current situation.

UNLABELLED: Prostate cancer is one of the most significant pathologies in the field of urology. The adoption of screening strategies and improvements in biopsies have resulted in an increase in early-stage tumour detection. Radical global therapies provide very good oncological results in localised prostate cancer. However, excess treatment in low- and, in some cases, intermediate-risk groups affects the quality of life of these patients. In the case of localised prostate cancer, focal therapies offer a minimally invasive option with good results with respect to established treatments. Although this is currently not a standard treatment, it represents the therapeutic approach with the greatest potential. THIS LITERATURE REVIEW HAS THE FOLLOWING OBJECTIVES: to define selection criteria for patients who are candidates for focal therapy, to assess the current situation and results of the different therapeutic options, and to define procedures in cases of recurrence and for follow-ups. We concluded that focal therapy is a viable therapeutic alternative for localised prostate cancer, specifically cryosurgery and high-intensity targeted ultrasound, which have acceptable oncologic results and a lower comorbidity compared with global treatments. Studies with a high level of scientific evidence are still needed to validate these results. ACQUISITION OF EVIDENCE: A search was carried out on the Medline (PubMed), EMBASE, Web of Science and Cochrane databases of all papers published before 31 July 2013. We included clinical studies and literature reviews that evaluated primary focal therapy for prostate cancer confirmed by biopsy and excluded focal rescue therapy studies. The keywords used were focal therapy and prostate cancer. Initially, we found 42 articles; 15 studies were excluded because they did not meet the minimum criteria for inclusion. A total of 1350 cases were treated throughout 27 studies.