Inter-observer variability in male pelvic-floor MRI measurements that might predict post-prostatectomy incontinence.

INTRODUCTION: Current studies are focusing on the relationship between anatomical variables in preoperative prostate MRI and the development of post-prostatectomy incontinence (PPI). Nevertheless, there is little evidence regarding the reliability of these measurements. The objective of this study was to analyze the concordance between urologists and radiologists for anatomical measurements that might be PPI predictors. MATERIAL AND METHODS: Pelvic floor measurements with 3T-MRI were performed by two radiologists and two urologists independently and blindly. Interobserver agreement was determined using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. RESULTS: The concordance was good-acceptable for most measurements, except for the levator ani and puborectalis muscle thickness (some ICC values < 0.20/p value > 0.05). The anatomical parameters with the highest degree of agreement were intravesical prostatic protrusion (IPP) and prostate volume (most of the ICC values > 0.60). The membranous urethral length (MUL) and the angle of the membranous urethra-prostate axis (aLUMP) presented ICC > 0.40. The obturator internus muscle thickness (OIT), urethral width and intraprostatic urethral length presented a fair-moderate degree of agreement (ICC > 0.20). Regarding the agreement between different specialists, the highest degree was obtained for the two radiologists and for urologist 1-radiologist 2 (moderate median agreement), while urologist 2 with each of the radiologists had a regular median agreement. CONCLUSIONS: MUL, IPP, prostate volume, aLUMP, OIT, urethral width and prostatic length show acceptable inter-observer concordance and they would be reliable as possible predictors of PPI. Levator ani and puborectalis muscle thickness show bad agreement. Interobserver agreement might not be greatly influenced by previous professional experience.

Anatomical predictors of long-term urinary incontinence after robot-assisted laparoscopic prostatectomy: A systematic review.

AIMS: There is scarce evidence of anatomical risk factors that might affect long-term post-prostatectomy incontinence (PPI) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). This systematic review aims to identify anatomical measurements in preoperative magnetic resonance imaging (MRI) that might be associated with increased risk of urinary incontinence (UI) 1 year after RALP. METHODS: A comprehensive search on Pubmed and Scopus databases up to November 2020 was performed. Eight articles met the inclusion criteria and were finally selected. RESULTS: The selected studies included 1146 patients. Seven articles focused on membranous urethral length (MUL); all of them related MUL to long-term PPI in univariate analysis and five of them in multivariate analysis. Four studies presented MUL difference to measure the magnitude of the effect. Average MUL (mm) was 15.9 (SD, 2.6), 16.1 (95% confidence interval [CI]: 13.9-18.9), 12.1 (95% CI 9.7-14.9) and 14.5 in continent patients and 13.9 (SD, 2.9), 10 (95% CI: 8.7-12.1), 10.3 (95% CI: 8.7-12.4) and 9.3 in incontinent patients, with statistically significant differences in all cases. Five studies presented the odds ratio as a result; although there was substantial heterogeneity in the methods used to obtain it, there was consistency in finding an inverse association between MUL and PPI. Other measurements including prostatic-urethral angle, membranous urethral thickness, intraprostatic urethral length and intravesical prostatic protrusion have been reported in few studies, and no association with long-term PPI was found. Levator ani muscle thickness was related to long-term PPI in one article. CONCLUSION: Greater MUL on preoperative MRI is associated with lower risk of UI 1 year after RALP.

Clinical course and risk factors for mortality from COVID-19 in patients with haematological malignancies.

BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) in haematological patients (HP) has not been comprehensively reported. METHODS: We analysed 39 patients with SARS-CoV-2 infection and haematological malignancies. Clinical characteristics and outcomes were compared to a matched control group of 53 non-cancer patients with COVID-19. Univariate and multivariate analyses were carried out to assess the risk factors associated with poor outcome. RESULTS: The most frequent haematological diseases were lymphoma (30%) and multiple myeloma (30%). Eighty-seven % HP developed moderate or severe disease. Patients with haematological malignancies had a significantly higher mortality rate compared to non-cancer patients (35.9% vs 13.2%; P = .003 (odds ratio 6.652). The worst outcome was observed in chronic lymphocytic leukaemia patients. Only age >70 years and C reactive protein >10 mg/dl at admission were associated with higher risk of death (odds ratio 34.86, P = .003 and 13.56,P = .03). Persistent viral sheddind was detected in 5 HP. Active chemotherapy, viral load at diagnosis and COVID-19 therapy were not predictors of outcome. CONCLUSION: Mortality of COVID-19 is significantly higher in patients with haematological malignancies compared to non-cancer patients. The impact of persistent viral shedding must be considered in order to re-start therapies and maintain infectious control measures.

Comparative analysis of short - term functional outcomes and quality of life in a prospective series of brachytherapy and Da Vinci robotic prostatectomy.

INTRODUCTION: There is a growing interest in achieving higher survival rates with the lowest morbidity in localized prostate cancer (PC) treatment. Consequently, minimally invasive techniques such as low-dose rate brachytherapy (BT) and robotic-assisted prostatectomy (RALP) have been developed and improved. Comparative analysis of functional outcomes and quality of life in a prospective series of 51BT and 42Da Vinci prostatectomies DV Materials and Methods: Comparative analysis of functional outcomes and quality of life in a prospective series of 93 patients with low-risk localized PC diagnosed in 2011. 51patients underwent low-dose rate BT and the other 42 patients RALP. IIEF to assess erectile function, ICIQ to evaluate continence and SF36 test to quality of life wee employed. RESULTS: ICIQ at the first revision shows significant differences which favour the BT group, 79% present with continence or mild incontinence, whereas in the DV group 45% show these positive results. Differences disappear after 6 months, with 45 patients (89%) presenting with continence or mild incontinence in the BT group vs. 30 (71%) in the DV group. 65% of patients are potent in the first revision following BT and 39% following DV. Such differences are not significant and cannot be observed after 6 months. No significant differences were found in the comparative analysis of quality of life. CONCLUSIONS: ICIQ after surgery shows significant differences in favour of BT, which disappear after 6 months. Both procedures have a serious impact on erectile function, being even greater in the DV group. Differences between groups disappear after 6 months.

Shorter prostatic urethral length in preoperative Magnetic Resonance Imaging is associated with higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

Climacturia is defined as the leakage of urine during orgasm and it is an adverse effect of radical prostatectomy. Our goal was to determine if various preoperative MRI pelvic floor measurements were associated with the risk of climacturia following robot-assisted laparoscopic radical prostatectomy. For this purpose, we conducted a prospective study involving 57 patients who underwent robot-assisted laparoscopic radical prostatectomy. MRI measurements were analysed by 2 urologists and 2 radiologists. Follow-up was carried out at 3, 6, and 12 months using the Parra orgasmic function questionnaire. We analysed all measurements, along with other patient, surgery, and tumour characteristics, classifying patients into two groups based on the presence or absence of climacturia. A logistic regression model was applied among statistically significant variables. STROBE recommendations were taken into consideration. Shorter prostatic urethral length was associated with higher risk of climacturia at 3 months, OR = 0.83 (95%CI 0.688-0.98) (p = 0.024). Patients with climacturia at 6 months had greater median urethral width [12.66 mm, interquartile range (IQR): 11.77-13.55 vs 12.13 mm, IQR 11.08-13.18] (p = 0.02). Patients with climacturia at 12 months had a higher proportion of preoperative lower urinary tract symptoms (57.14% vs. 20%) (p = 0.026). In the logistic regression, the history of lower urinary tract symptoms was associated with a higher risk of climacturia, OR = 6.07 (95% CI 1.342-26.03) (p = 0.023). In conclusion, shorter prostatic urethral length in preoperative MRI and a history of lower urinary tract symptoms were associated with a higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy.

[Endosalpingiosis of the bladder. A case report]. / Endosalpingiosis vesical. Presentación de un caso.

OBJECTIVE: To describe a case of endo-salpingiosis of bladder and review of the literature. METHOD: A 38 years old women referred to an outpatient urology clinic with postmenstrual voiding symptoms. RESULTS: We studied her and ultrasound imaging detects tumor that was confirmed by cystoscopy. She is diagnosed of endosalpingiosis of the bladder after transurethral resection, and a CT shows a consistent mass next to left adnexal with high probablility of being an endometrioma. CONCLUSIONS: Endosalpingiosis of the bladder is a rare disease that occurs in young women with cyclic urinary symptoms. The implantation of tubular tissue in the bladder is diagnosed and treated definitively by tumor excision and anatomopathologic examination.

Randomized and Open Trial to Assess the Effectiveness of the Guided Pelvic Floor Exercises Pre-Radical Robotic Prostatectomy on the Improvement of Urinary Incontinence. Initial Results.

INTRODUCTION AND OBJECTIVES: Radical prostatectomy has an impact on urinary continence. Many factors are involved in continence. The objective of this study is evaluate the effect of guided Pelvic Floor Exercises prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence compared with written information. MATERIAL AND METHOD: randomized study of 62 patients who are waiting for PRR. They were rondomized in two groups: experimental group (exercises guided by a physiotherapist) or a control group (written information). Primary objective was the continence rate measured by pad test and ICIQ-SF one month after the intervention, Secondary objectives were incontinence severity, quality of life with SF-36 and KHQ questionnaires and the correlation between incontinence and quality of life. RESULTS: We found no differences in continence rate between groups after the intervention. We found differences in "emotional problems" and "personal relationships", in favor of the control group. There is a correlation between the amount of urine leakage and age, urgency and all the domains of the KHQ questionnaire except general quality of life, as well as in the areas "energy/fatigue" and "social function" of the SF-36. CONCLUSIONS: Physiotherapist-guided exercises before RRP do not seem to offer advantages compared to written information, in terms of the incontinence rate and its severity one month after the surgery. Urinary incontinence is correlated with age, urgency, and deterioration in quality of life.

Metabolic bone disease in patients diagnosed with inflammatory bowel disease from Spain.

BACKGROUND: The objective of this study was to analyse the prevalence of metabolic bone disease (MBD) in a cohort of Southern European patients with inflammatory bowel disease (IBD) and to identify associated risk factors in this population. METHODS: We conducted a retrospective, both cross-sectional and longitudinal study of MBD, assessed by dual energy X-ray absorptiometry (DXA), among patients diagnosed with IBD and previously recognized risk factors for this complication from two referral Spanish institutions. RESULTS: A total of 612 patients (58.6% diagnosed with Crohn's disease) were included. Mean (SD) age was 44.9 (14.7) years; 71.7% of patients received at least one tapered dosage of corticosteroids before first DXA. MBD and osteoporosis were diagnosed in 66.4% and 21.4% of patients, respectively. At baseline, male gender, menopause and ulcerative colitis were found as independent risks factors for osteoporosis, whereas age, more than three IBD-related hospitalizations and previous steroid treatment were found as independent risks factors for MBD. A total of 261 patients had at least a second DXA and were included in the longitudinal study; median follow up was 56.4 months. Logistic regression model identified menopause, ulcerative colitis and baseline lumbar DXA T-score value, but not steroid treatment, as risk factors for worsening ⩾1 SD in follow-up DXA T-score. According to guidelines, all patients under treatment with corticosteroids received calcium and vitamin D supplements. CONCLUSION: MBD is a frequent complication in south-European IBD patients. Routine evaluation of bone density when risk factors are present, as well as calcium plus D vitamin prophylaxis in patients under corticosteroid treatment should be recommended.

Comparative analysis of short - term functional outcomes and quality of life in a prospective series of brachytherapy and Da Vinci robotic prostatectomy

ABSTRACT Introduction There is a growing interest in achieving higher survival rates with the lowest morbidity in localized prostate cancer (PC) treatment. Consequently, minimally invasive techniques such as low-dose rate brachytherapy (BT) and robotic-assisted prostatectomy (RALP) have been developed and improved. Comparative analysis of functional outcomes and quality of life in a prospective series of 51BT and 42Da Vinci prostatectomies DV Materials and Methods Comparative analysis of functional outcomes and quality of life in a prospective series of 93 patients with low-risk localized PC diagnosed in 2011. 51patients underwent low-dose rate BT and the other 42 patients RALP. IIEF to assess erectile function, ICIQ to evaluate continence and SF36 test to quality of life wee employed. Results ICIQ at the first revision shows significant differences which favour the BT group, 79% present with continence or mild incontinence, whereas in the DV group 45% show these positive results. Differences disappear after 6 months, with 45 patients (89%) presenting with continence or mild incontinence in the BT group vs. 30 (71%) in the DV group. 65% of patients are potent in the first revision following BT and 39% following DV. Such differences are not significant and cannot be observed after 6 months. No significant differences were found in the comparative analysis of quality of life. Conclusions ICIQ after surgery shows significant differences in favour of BT, which disappear after 6 months. Both procedures have a serious impact on erectile function, being even greater in the DV group. Differences between groups disappear after 6 months.

Adhesión en molares permanentes hipomineralizados. Puesta al día / Dental adhesion in permanent hipomineralized molars. Update

El síndrome incisivo molar o MIh se describe como una hipomineralización de origen sistémico que afecta de 1 a 4 de los primeros molares permanentes y que se asocia frecuentemente con alteraciones de los incisivos, siendo su aparición cada vez más frecuente. Los dientes afectados van a presentar un aumento de su contenido proteico y una disminución del contenido mineral. El tratamiento del MIh supone un reto para el odontólogo. Las características clínicas de este desorden, como la ruptura posteruptiva o la formación de cavidades atípicas, complican la obtención de un resultado duradero. Los últimos estudios apuntan a que los sistemas adhesivos de autograbado consiguen una fuerza de adhesión mayor que otros sistemas. El pretratamiento de la lesión puede producir un aumento de la fuerza adhesiva, aunque los resultados observados no permiten estandarizar este procedimiento. Las opciones más prometedoras son el hipoclorito sódico y las resinas infiltrantes. La mejor opción terapéutica para el MIh actualmente consiste en la realización de una reconstrucción con resina compuesta, utilizando un sistema adhesivo de autograbado, valorando la posibilidad de realizar un pretratamiento con hipoclorito sódico o resinas infiltrantes (AU)

The molar incisor syndrome (MIh) is described as a hypomineralization of systemic origin affecting 1 to 4 of the first permanent molars that is frequently associated with alterations of the incisors, and its appearance is increasing. Affected teeth will file a raise of its protein content and decreased mineral content. The treatment of MIh is a challenge for the dentist. The clinical features of this disorder, as posteruptive rupture or the formation of atypical cavities complicate obtaining a lasting result. Recent studies suggest that selfetching adhesive systems achieve a greater adhesion force than other systems. Pretreatment of injury may result in increased adhesive strength, although the observed results do not allow to standardize this procedure. The most promising options are sodium hypochlorite and infiltrating resins. The best therapeutic option for MIh is currently performing a reconstruction with composite resin using a self-etching adhesive system, seeing the possibility of pretreatment with sodium hypochlorite or infiltrating resins (AU)

Endosalpingiosis vesical. Presentación de un caso / Endosalpingiosis of the bladder. A case report

OBJETIVO: Descripción de un caso de endosalpingiosis vesical y revisión de la literatura. MÉTODO: Mujer de 38 años derivada a consultas de urología con clínica miccional postmenstrual. RESULTADOS: Se valora en consulta y se detecta en ecografía imagen tumoral que se confirma con cistoscopia. Se diagnostica de endosalpingiosis vesical tras resección transuretral, objetivándose en TAC posterior masa dependiente de anejos izquierdos compatible con endometrioma. CONCLUSIONES: La endosalpingiosis vesical es una patología poco frecuente que se presenta en mujeres jóvenes con clínica miccional cíclica. La implantación de tejido tubárico en la vejiga se diagnostica y trata de forma definitiva mediante exéresis de la lesión y estudio anatomopatológico (AU)

OBJECTIVE: To describe a case of endosalpingiosis of bladder and review of the literature. METHOD: A 38 years old women referred to an outpatient urology clinic with postmenstrual voiding symptoms. RESULTS: We studied her and ultrasound imaging detects tumor that was confirmed by cystoscopy. She is diagnosed of endosalpingiosis of the bladder after transurethral resection, and a CT shows a consistent mass next to left adnexal with high probablility of being an endometrioma. CONCLUSIONS: Endosalpingiosis of the bladder is a rare disease that occurs in young women with cyclic urinary symptoms. The implantation of tubular tissue in the bladder is diagnosed and treated definitively by tumor excision and anatomopathologic examination (AU)

Manejo laparoscópico transperitoneal de la enfermedad litiásica: experiencia en un hospital de tercer nivel / Transperitoneal laparoscopic management of urinary tract stone disease: experience in a third level hospital

OBJETIVO: Analizar la relación existente entre trombocitosis y hematocrito prequirúrgicos y supervivencia en nuestra serie de pacientes tratados quirúrgicamente por adenocarcinoma renal.MÉTODO: Estudio retrospectivo con análisis descriptivo estadístico de 139 pacientes intervenidos quirúrgicamente en nuestro servicio en los últimos 4 años por adenocarcinoma renal. 116 (83,45%) presentaban al diagnóstico un estadio clínico localizado, y 23 (16,54%) un estadio localmente avanzado o metastásico. Fueron recogidos datos relativos a tiempo de seguimiento y supervivencia, características iconográficas e histológicas del tumor y parámetros analíticos. Los datos fueron analizados con estadístico SPSS.RESULTADOS: El recuento plaquetario medio previo a la intervención quirúrgica fue de 260930 cels/mm3. El hematocrito medio prequirúrgico fue de 41,10%. Se encontró una relación estadísticamente significativa (p=0,04) entre el recuento plaquetario al diagnóstico y la supervivencia. Pacientes con recuentos plaquetarios superiores a 350000/mm3 presentaban una supervivencia más baja (OR: 2,94; IC 95% 1,04- 8,27). Se objetivó una relación significativa (p=0,049) entre el hematocrito al diagnóstico y la supervivencia. A mayor hematocrito disminuyó el riesgo de muerte (OR: 0,92; IC 95% 0,85- 0,99). La supervivencia global en nuestro grupo fue del 88,4%. El análisis multivariante de la misma no arrojó datos estadísticamente significativos debido al escaso número de éxitus.CONCLUSIONES: La presencia de recuentos plaquetarios elevados o niveles de hematocrito bajos al diagnóstico se relacionan, en esta serie y de forma no independiente, con una disminución de la supervivencia en nuestro grupo de pacientes intervenidos por adenocarcinoma renal. Serían necesarios estudios con mayor seguimiento y muestras más amplias para aseverar estos hallazgos(AU)

OBJECTIVE: To examine the connection between preoperative thrombocytosis and hematocrit and survival in a group of patients operated for renal cell carcinoma.METHODS: Retrospective study with descriptive and statistical analysis of 139 patients with renal cell carcinoma treated surgically over the last 4 years in our Urology clinical unit. 116 (83,45%) were diagnosed at a localized clinical stage, whereas 23 (16,54%) presented as locally advanced or metastatic disease. We collected data about survival and time on surveillance, imaging and histological characteristics of the tumor and analytical parameters. Data were analyzed by the SPSS statistical software.RESULTS: The average platelet count and hematocrit before surgery were 260,930 cells/mm3 and 41.10%, respectively. We found a statistical correlation between platelet count at the time of diagnosis and survival. Patients with platelet counts higher than 350,000 cells/mm3 had a poor survival (OR: 2.94; CI 95% 1.04- 8.27). We also found that patients with high hematocrit at diagnosis presented a lower risk of death (OR: 0.92; CI 95% 0.85- 0.99). The global survival at the end of the study was 88.4%. Multivariate analysis did not show any significant result because of the low number of deaths.CONCLUSION: The presence of high platelet count or low hematocrit correlate with poor survival in a group of surgically treated renal cell carcinoma patients. Nevertheless more studies with longer surveillance and higher number of patients are needed(AU)