A Systematic Review of Clinical Trials Assessing Sexuality in Hysterectomized Patients.

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.

[Androgen deprivation therapy in advanced prostate cancer. Multicenter study.] / Terapia de deprivación androgénica en cáncer de próstata avanzado. Estudio multicéntrico.

OBJECTIVES: Advanced prostate cancer (PC) is a frequent entity. The objectives of this paper are the presentation of a sample of patients with PC undergoing treatment with androgen deprivation therapy (ADT) in usual clinical practice and the determination of parameters associated with the development of resistance to castration (CRPC). MATERIAL AND METHODS: Multicenter, observational, retrospective study that analyzes patients treated with ADT from January 2016 to January 2017. Descriptive analysis of the most relevant clinical variables and univariante analysis and progression times by Kaplan-Meier test. RESULTS: Sample of 952 patients. At PC diagnosis median age 74 years. Median PSA at PC diagnosis 23 ng/ml, when begining ADT 20.2 ng/ml. 80.2% of patients were biopsied at PC diagnosis: 28.2% Gleason score group 1, 38.7% groups 2 and 3 and 33.1% groups 4 and 5. Initial treatment of PC: 75.9% ADT, radical prostatectomy 8.4% and radiotherapy 15.1%. Of the 952 patients, 281 (29.6%) fulfilled CRPC criteria.In this group 21.7% achieved undetectable PSA (group in which it was 59.9%. Increased probability of progression to CRPC in: PSA >30ng/ml at PC diagnosis (p=0.000, OR 2.78), Gleason score group 4-5 (p=0.000, OR 2.33), and not to reach undetectable PSA after ADT (p <0.001, OR 3.32). The initial ADT group presents progression to metastatic CRPC more rapidly in unfavourable histology and when not reached undetectable PSA after ADT. CONCLUSIONS: We present a sample of patients with advanced PC in treatment with ADT that shows heterogeneity in usual clinical practice. In our sample, elevated PSA at PC diagnosis, unfavorable histology and failure to achieve a PSA<0.1 ng/ml after ADT is presented as an indicator of progression to the CRPC stage.

OBJETIVO: El cáncer de próstata (CP) avanzado es una entidad frecuente. Los objetivos de este trabajo son la presentación de una serie de pacientes con CP en tratamiento con Terapia de Deprivación Androgénica (TDA) en práctica clínica habitual y la determinación de parámetros asociados al desarrollo de resistencia a la castración (CPRC).MATERIAL Y MÉTODOS: Estudio multicéntrico,  observacional, retrospectivo que analiza pacientes tratados con TDA desde enero 2016 hasta enero 2017. Análisis descriptivo de las variables clínicas más relevantes, análisis univariante y supervivencia libre de progresión mediante test Kaplan-Meier. RESULTADOS: Muestra 952 pacientes. Al diagnóstico del CP edad mediana 74 años. Mediana de PSA al diagnóstico de CP 23 ng/ml, al inicio TDA 20,2 ng/ml. El 80,2% de pacientes tenían biopsia al diagnóstico del CP: 28,2% grado pronóstico Gleason grupo 1, 38,7% grados 2 y 3 y 33,1% grados 4 y 5. Tratamiento inicial del CP: 75,9% TDA, prostatectomía radical 8,4% y radioterapia 15,1%.De los 952 pacientes, 281 (29,6%) cumplían criterios de CPRC. En este grupo el 21,7% alcanzó PSA indetectable (<0,1 ng/ml) con la TDA 20,2  frente al grupo no CPRC en el que lo alcanzaron el 59,9%. Encontramos mayor probabilidad de progresión a CPRC en pacientes con PSA al diagnóstico de CP >30 ng/ml (p=0,000, OR 2,78), grado pronóstico Gleason grupos 4-5 (p=0,000, OR 2,33) y en aquellos que no alcanzan PSA indetectable tras TDA (p<0,01, OR 3,32) variables que se relacionan con los tiempos de progresión a CPRC y especialmente al estadio metastásico. CONCLUSIONES: Se presenta una serie de pacientes CP avanzado en tratamiento con TDA que muestra heterogeneidad de características y de manejo según práctica clínica habitual. En nuestra serie el PSA elevado al diagnóstico, histología desfavorable y no alcanzar un PSA<0,1 ng/ml tras la TDA se presentan como indicadores de progresión a estadio CPRC.

[Technical and peri-operative differences between the transvesical and extravesical approach in laparoscopic repair of vesico-vaginal fistula.] / Diferencias técnicas y peri-operatorias entre el abordaje transvesical y extravesical en la reparación laparoscópica de la fístula vesico-vaginal.

OBJECTIVE: In the laparoscopic/robotic repair (L/R R) of Vesico-vaginal Fistulas (VVF) two types of transvesical and extravesical approaches are used.However, no direct comparisons exist between both surgical approaches Moreover, a lack of clinical guidelines is currently ongoing. Therefore, the selection of the type of approach is based on the preferences of the surgeon without considering the characteristics of each case.In order to provide recommendations for the selection of the appropriate technique for each patient, we designed a study that identifies and evaluates differences between the Transvesical and Extravesical approaches in the L/R R of the VVF. PATIENTS AND METHODS: A total of 9 patients withVVF were included. Four patients underwent transvesicaltechnique and the rest the Extravesical technique. Thevariables in each group were recorded. Surgical stepswere selected with technical differences to be analyzed(identification of the fistula, dissection of the vesico-vaginalplane, cystotomy, maneuvers of exposure and cystorrhaphy). RESULTS: Short operative times and catheterization times were recorded in the Extravesical approach. Intraoperative blood loss was minimal in both groups, the hospital stay was very similar and no peri and post-operativec omplications were reported. In all cases the fistula was resolved and there have been no recurrences in a mean follow-up of 35 months. Technically, Extravesical approach minimizes the size of the cystotomy, decreases suture time, does not require maneuvers for adequate exposure, and simplifies cystorrhaphy with respect to Transvesical technique, at the expense of requiring further dissection and having a slight difficulty in locating the fistula. Transvesical technique simplifies the locationof the fistula and allows better intravesical visualization. CONCLUSION: In the L/R R of the VVF, the Extravesicaltechnique offers technical and perioperative advantages,so it must be the technique of choice for most VVFwith indication of abdominal approach. Transvesicaltechnique should be reserved for recurrent, recurrent,inflammatory fistulas, with difficulties identifying the fistulous orifice, close to ureteric orifice and with imminent need for ureteral reimplantation.

OBJETIVO: En la reparación laparoscópica/robótica (RL/R) de las Fístulas Vesico-vaginales (FVV) se emplean dos tipos de abordajes el Transvesical y el Extravesical, sin embargo no existen comparaciones directas entre ambos abordajes ni tampoco disponemos de guías clinicas, por lo cual la selección del tipo de abordaje se basa en las preferencias del cirujano sin considerarse las características de cada caso. Con el objetivo de definir recomendaciones para la selección de la técnica apropiada para cada paciente, diseñamos un estudio que identifique y evalúe las diferencias entre los abordajes Transvesical y Extravesical en la RL/R de la FVV.PACIENTES Y MÉTODOS: Un total de 9 pacientes con FVV fueron incluídas. A cuatro pacientes se les realizó técnica Transvesical y el resto la técnica Extravesical. Se registraron las variables en cada grupo. Se seleccionaron los pasos quirúrgicos con diferencias técnicas para ser analizados (identificación de la fístula, disección del plano vesico-vaginal, cistotomía, maniobras de exposición y cistorrafia). RESULTADOS: Se registraron menores tiempos quirúrgicos y tiempos de sondaje en el abordaje Extravesical. El sangrado intraoperatorio fue mínimo en ambos grupos,la estancia hospitalaria fue muy semejante y tampoco se reportaron complicaciones peri y post-operatorias. En todos los casos se resolvió la fístula y no han habido recurrencias en una media de seguimiento superior 35 meses. Técnicamente la vía Extravesical minimiza el tamaño de la cistotomía, disminuye el tiempo de sutura,no requiere de maniobras para la exposición adecuada,y simplifica la cistorrafia con respecto a la técnica Transvesical, a expensas de requerir mayor disección y tener una discreta dificultad para localizar la fístula.La técnica Transvesical simplifica la localización de la fístula y permite mejor visualización intravesical.CONCLUSIÓN: En la RL/R de la FVV, la técnica Extravesical ofrece ventajas técnicas y perioperatorias, por lo cual debe ser la técnica de elección para la mayoría de las FVV con indicación de abordaje abdominal. La técnica Transvesical se debe reservar para fístulas recurrentes,múltiples, inflamatorias, de dificil localización del orificio fistuloso, con excesiva proximidad de los meatos y con inminente necesidad de reimplante ureteral.

Lateral-based Anterior Vaginal Wall Flap in the Treatment of Female Urethral Stricture: Efficacy and Safety.

BACKGROUND: Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used-the Blandy's technique-has resulted in our cases in a retrusive meatus and an inward urinary stream. OBJECTIVE: To show the efficacy and safety of an alternative vaginal wall flap urethroplasty. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional observational study was undertaken in a single University Hospital. Nine female patients previously diagnosed with urethral stricture at our institution underwent open surgery from 1993 to 2015. They were contacted and agreed to undergo a medical examination. SURGICAL PROCEDURE: A ventral lateral-based anterior vaginal wall flap urethroplasty inspired by the Orandi technique for male urethroplasty was performed. MEASUREMENTS: A chart review was performed. RESULTS AND LIMITATIONS: The mean age was 56 yr (41-78 yr). The mean follow-up was 80.7 mo (12-198). All patients had relief of symptoms. The meatus of all patients stayed in an orthotopic position without any impact on the direction of the urinary stream. The average caliber of the urethra increased from 10.8 Fr (6-18 Fr) to ≥20 Fr. Peak flow improved from a mean of 6.8ml/s (3-11ml/s) to 21ml/s (14-35ml/s). No patient developed stricture recurrence or de novo stress urinary incontinence. There were no other immediate or delayed complications. All patients achieved a better score on the Patient Global Impression of Improvement questionnaire. CONCLUSIONS: Our study, with the same limitations that the few studies published in this field had, that is the few patients included, demonstrates that lateral anterior vaginal wall flap urethroplasty is an effective technique, offering durable results without apparent complications. PATIENT SUMMARY: We studied an alternative surgical technique for the treatment of female urethral stricture. We conclude that it is safe and effective with no apparent complications and good long-term results.