A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications.

OBJECTIVE: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). INCLUSION CRITERIA: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. EXCLUSION CRITERIA: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. RESULTS: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadad-scale) and has a low risk of bias (Cochrane-Handbook). CONCLUSIONS: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

Post-radical prostatectomy predictive factors for biochemical recurrence.

OBJECTIVES: To identify post-prostatectomy prognostic factors for biochemical recurrence (BR). METHODS: We retrospectively analyze a series of patients with clinically localized prostate cancer who were treated with radical prostatectomy (RP)as monotherapy between 1996 and 2007, pN0-pNx, with a minimum of 12 months of follow-up. BR is considered to be persistence or elevation in PSA after RP greater than 0.4 ng/ml on the subsequent determination. Analyzed variables were Gleason Score, pathological stage, surgical margin involvement, capsular involvement, and perineural involvement. We performed univariate and multivariate analysis using the chi squared test and proportional Cox risk model in order to determine the variables associated with BR. RESULTS: We included 693 patients. Mean age was 63.5 years with a mean follow-up of 88.5 months. Mean PSA was 9.2 ng-ml. BR was observed in 218 patients, 43 due to biochemical persistence. More common pathological findings were Gleason score 7 (47.1%), and pathological stage pT2c (60.1%). Mean time to BR was 35.5 months with 91.2% occurring in the first 8 years. On multivariate analysis, Gleason score ≥ 7(4+3), pathological stage pT3b and positive surgical margin were independent predictors of BR. CONCLUSIONS: Gleason Score ≥ 7(4+3), positive surgical margins and pathological stage pT3 are independent prognostic factors associated with BR-free survival.

[Preoperative predictive model for biochemical recurrence in patients with localized prostate cancer treated with radical prostatectomy]. / Modelo predictivo preoperatorio para la recidiva bioquimica en pacientes con cáncer de próstata localizado tratados con prostatectomia radical en monoterapia.

OBJECTIVES: To identify pre-prostatectomy clinical prognostic factors for biochemical recurrence (BR) and to create a predictive model for BR based or predictive clinical variables prior to radical prostatectomy (RP). METHODS: a retrospective case-records study of patients with clinically localized prostate cancer treated with RPas monotherapy pN0-pNx and monitored at least for 12 months between 1996 and 2007. We considered BR the PSA persistence or elevation after RP greater than 0.4 ng/ml. The clinical variables analyzed were PSA, clinical stage and Gleason score from the biopsy (GS). Univariate and multivariate analysis were carried out using the chi squared test and logistic regression to determine the variables associated with BR. In order to estimate BR based on the variables identified we developed a mathematical model and designed an Excel spreadsheet to apply it. Calibration and discrimination were performed using the Hosmer-Lemeshow test and an ROC curve determining the area under the curve. RESULTS: We included 627 patients. The mean age was 64 years with a mean follow- up of 87 months. The mean PSA was 8 ng/ml. 68.6% of patients had a PSA ≤ 10 ng/ml, 53,1% had a GS ≤ 6 and 61,7% had a clinical stage of cT1a-c. BR was observed in 204 (32,5%) patients, 39 due to biochemical persistence. The mean time to BR was 28 months with 89,7% of instances occurring in the first 8 years. On the multivariate analysis, PSA and GS were independent predictors of BR ( p=0.001), while the cT2c stage had a tendency towards statistical significance ( p=0.06). The three variables were included in the equation for the model with different specific weight. Specificity was 93.6%, sensitivity was 36.8% and an overall precision of 75.1%. The model had a predictive capacity of 73% and a p-value < 0.001. CONCLUSIONS: PSA and GS are independent prognostic clinical variables associated with BR-free survival. The predictive model developed allows the risk of BR to be estimated with 73% reliability.

Usefulness of the Memorial Sloan Kettering Cancer Center nomogram in the prognosis of patients treated with radical cystectomy for invasive bladder cancer.

OBJECTIVES: To evaluate the usefulness of the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram for prediction of recurrence probability in our series of patients who have undergone radical cystectomy for bladder cancer. METHODS: 397 patients underwent radical cystectomy for bladder cancer between 1986 and 2005. 165 patients were excluded:21 due to exitus in the immediate postoperative period, 32 due to previous radiation therapy, 6 due to neoadjuvant chemotherapy, 5 due to inability to complete follow-up, 15 that did not undergo lymphadenectomy and 86 who were alive at the time of review with less than 5 years of follow-up. Patients were classified into recurrence risk groups: organ-confined tumors (pT0-2 pN0 ), extra-bladder involvement (pT3-4 pN0) and lymph node involvement (pN+). Survival analysis was performed using the Kaplan-Meier method. Five-year recurrence-free survival by risk groups in our series was compared with the one estimated using the MSKCC nomogram using a ROC curve. RESULTS: We analyzed 232 patients. Follow-up in patients who died of cancer was 25 ± 25 months. For alive patients and those who died of other causes, follow-up was 120 ± 39 months. Pathology studies revealed 42.7% organ-confined tumors , 33.2% with extra-bladder involvement and 24.1% with lymph node involvement. The five-year recurrence free survival analysis according to the Kaplan-Meier method stratified by risk groups was: pT0-2 76%, pT3-4 51%, pN+ 31%. The probability of recurrence free survival according to the MSKCC nomogram in the same risk groups was: 85% ± 5%, 62% ± 10% and 25% ± 13%, respectively. The area under the ROC curve was 0.795 (95% CI 0.739-0.852) CONCLUSION: In our series, the MSKCC nomogram constitutes a useful tool for predicting 5-year cancer free survival in patients who undergo radical cystectomy.

Predictors of success and hospitalization in semi-rigid ureteroscopy for lithiasis as an outpatient procedure.

OBJECTIVES: To analyze the outcomes, predictors of success and predictors of need for hospital admission in our series of patients who underwent ureteroscopy (URS) as a major outpatient surgery (MOS) procedure. METHODS: We carried out a retrospective analysis of 402 patients who had undergone semi-rigid URS for ureteral calculi as a MOS procedure in our center between 2004 and 2012. Patients with previous DJ catheter were excluded. We classified the calculi according to their location (lumbar, pelvic, iliac), size (< or> 1cm) and number (single or multiple). Follow-up was done by plain X-ray of the abdomen and ultrasound one month after surgery. The procedure was considered successful when patients were free from the treated calculi or had ureteral fragments < 3 mm one month after surgery. Univariate and multivariate analyses were carried out to identify the factors involved in success and hospitalization not being required. RESULTS: A total of 269 patients were included. The majority of the stones were single (92.2%), <1 cm in size (76.6%), pelvic (62.1%), and left-sided (57.2%). 89.6% of the procedures were performed as MOS and 82.2% were considered to be successful. In the multivariate analysis, left-sided (p<0.001) and pelvic location of the calculi (p=0,01) were found to be independent predictors for the success of the procedure In terms of hospital admission, the only independent predictor was the presence of intraoperative complications ( p=0.006). CONCLUSIONS: Left-sided and pelvic locations were the independent predictors for the success of the URS. A lack of intraoperative complications was the independent predictor for not requiring hospitalisation.

Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors - A single center study.

PURPOSE: Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. PATIENTS AND METHODS: Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient's record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. RESULTS: 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expß 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expß 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expß 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. CONCLUSIONS: This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.

Prostate cancer pain management: EAU guidelines on pain management.

CONTEXT: The first publication of the European Association of Urology (EAU) guidelines on Pain Management in Urology dates back to 2003. Since then, these guidelines have been revised several times with the most recent update achieved in 2010. OBJECTIVE: Given the scope of the full text guidelines, condensing the entire document was no option in this context. This paper presents a summary of the section of pain management in prostate cancer, a topic considered of direct relevance for the practicing urologist. EVIDENCE ACQUISITION: A multidisciplinary expert panel (urologists, anaesthesiologists, radio-oncologists) compiled this document based on a comprehensive consultation of the literature. Data were identified through a structured search, covering the time frame 2000 through 2010, using Medline and Embase as well as the Cochrane Library of systematic reviews. The scientific papers were weighed by the expert panel and a level of evidence (LE) assigned. Recommendations have been graded as a means to provide transparency between the underlying evidence and the guidance provided. Pain can occur in each stage of prostate cancer. It could be caused by the cancer itself (77%), be related to the cancer treatment (19%) or be unrelated to either (3%). The incidence of pain rises to 90% as patients enter the terminal phase of their illness. The physician's task is to discover and treat the cause of pain and the pain itself, to determine whether or not the underlying cause is treatable, to provide pain relief and palliative care. These tasks more often than not require a multidisciplinary team. Pain management involves mainly pharmacotherapy, including direct anticancer therapy such as androgen deprivation and chemotherapy, as well as analgetics, for instance non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. In case of local impairment due to the cancer or its metastases, primary treatments like surgery, radiotherapy or radionuclides can provide adequate pain relief. In addition, in palliative care, functional, psychosocial and spiritual support are essential components. The EAU guidelines on Pain Management in Urology are available in a number of different formats through the EAU Central Office and the EAU website ( http://www.uroweb.org/guidelines/online-guidelines/ ). CONCLUSION: The mainstay of pain management in prostate cancer is involvement of and collaboration between experts from a number of disciplines to be able to achieve a complete pain evaluation and to offer the full range of treatment options. Prostate cancer-related pain can, in most cases, be managed effectively, but it requires careful monitoring where a balance should be found between pain relief and potential side effects of treatment and quality of life (QoL).

[Primary testicular lymphoma. Two new case reports]. / Linfoma testicular primario. A propósito de 2casos nuevos.

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease.

[Salvage surgery of hydraulic penile prosthesis by modified Mulcahy protocol. Case report and literature review]. / Cirugía de rescate de extrusión de prótesis hidráulica de pene mediante protocolo de Mulcahy modificado. Revisión de la literatura a propósito de un caso.

The extrusion of a penile prosthesis is an indicator of infection and implies its removal, causing fibrosis and shortening of the penis. We present a 62-year-old man, to whom we implanted a hydraulic prosthesis, and three weeks later we underwent salvage surgery by extrusion of the activation pump. After removing the prosthesis, we wash the cavities with four dilutions. The 1st to 50% of hydrogen peroxide; the 2nd to 50% of povidone iodine; the 3rd with 1 g of cefazolin and 40 mg of tobramycin, the 4th with 80 mg of gentamicin and 500 mg of vancomycin. In the act we implanted a malleable prosthesis bathed in antibiotic solutions. The postoperative period was satisfactory. A year later, the patient presents an adequate penile length and aesthetic appearance, maintaining satisfactory sexual relations. Surgical rescue by washing with antiseptic solutions and a malleable prosthesis implant, minimizes the risk of reinfection, preserving sexual function.

[Glandectomy with cutaneous thigh graft]. / Glandectomía con injerto cutáneo de muslo.

Penile cancer is a neoplasm that predominantly affects males in the sixth decade of life, with an incidence of .3-1 per 100,000. Traditionally, the treatment of the primary lesion has consisted of total or partial amputation of the penis. However, the psychological and functional impact has influenced the development of preservation techniques We present 2males with lesions on the glans diagnosed by biopsy of squamous cell carcinoma. The patients underwent glandectomy and reconstruction with free thigh skin graft. The pathological anatomy was superficial squamous cell carcinoma. 6 months later the patients are free of disease and satisfied with the result of the intervention In our opinion, this technique enables an adequate cosmetic and functional result without affecting oncological control and without increasing morbidity or operative time.

Renocolic fistula as a complication of radiofrequency in the treatment of renal cell carcinoma.

METHOD: Beyond postoperative suspicion, retrograde pyelogram was performed, the images of which are displayed, and demonstrated the fistula. RESULTS: Treatment has been definitive nephrectomy after failed attempt to seal the fistula with suture and TachoSil. CONCLUSIONS: Although radiofrequency ablation can be a valid technique for treating small renal tumors in patients with high morbidity, it is not without significant complications as described in this case, despite the precautions taken.

[Laparoscopic management of horseshoe kidney stones.] / Tratamiento laparoscópico de la litiasis en el riñón en herradura.

OBJECTIVE: Horseshoe kidney is the most common renal fusion anomaly. Its peculiar anatomical characteristics increase the risk of lithiasis formation and always entails a surgical challenge for its treatment. MATERIAL AND METHODS: We present the cases of men with horseshoe kidneys diagnosed by CT one case of alarge pyelic lithiasis with others of a smaller size in the calyces, and the other of a big solitary lithiasis in renal pelvis. RESULTS: We performed a laparoscopic pyelolitectomy to remove the pyelic lithiasis and we used a flexible cystoscope through a trocar to extract the calyceal stones. The postoperative period was uneventful without evidence of urinary leakage or residual lithiasis. CONCLUSIONS: The laparoscopic approach to lithiasisis a suitable alternative in especially complex cases such as horseshoe kidney. The use of a flexible cystoscope allows to navigate through the renal cavities and extract the lithiasis which cannot be accessed through laparoscopic instruments, improving the efficiency of this approach.

OBJETIVO: El riñón en herradura constituyela anomalía de la fusión más frecuente. Sus características anatómicas incrementan la formación de litiasis y dificultan su resolución. MATERIAL Y MÉTODOS: Presentamos dos varones con riñones en herradura diagnosticados mediante TC abdominal en un caso de litiasis piélica de 5 cm y en el otro de una litiasis en pelvis renal con otras caliciales más pequeñas. Realizamos una pielolitectomía laparoscópica extrayendo las litiasis piélicas utilizamos introducimos un cistoscopio flexible por un trocar para extraer las litiasis caliciales. RESULTADOS: El postoperatorio cursó sin incidencias y retiramos el catéter doble jota 3 semanas después sin evidenciar fuga urinaria ni litiasis residual, encontrándose los pacientes 6 meses después sin litiasis. CONCLUSIONES: El abordaje laparoscópico de la litiasis constituye una alternativa en los casos complejos como en el riñón en herradura. Utilizar un cistoscopio flexible permite navegar en las cavidades renales aumentando la eficacia del abordaje.

[Long term results of congenital penile curvature treated with cavernosa corpora rotation.] / Seguimiento a largo plazo de la incurvación peneana congénita tratada mediante rotación de los cuerpos cavernosos.

INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corporacavernosa, which causes difficulty in penetration, requiring surgical correction when inter course is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer. PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to inter course, were operated in a period of 36 months. Prior to the intervention,we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature throughself-photographs in three projections. By subcoronal approach,we perform denudation of the penis. On both sides of the urethra we incised Buck's fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test.  RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length,(p=0.08). Nine patients assured that they would under go the same intervention again. CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, main tainingits long-term results.

INTRODUCCIÓN: La incurvación peneana congénita (IPC) es un trastorno originado por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos, que condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. OBJETIVO: Analizar los resultados del tratamiento quirúrgico de la IPC mediante rotación de los cuerpos cavernosos(RCC) descrita y modificada por Shaeer. PACIENTES Y MÉTODOS: Diez pacientes diagnosticados de IPC con imposibilidad para el coito, fueron intervenidos en un período de 36 meses. Previo a la intervención aplicamos el cuestionario IIEF-5, medimos la longitud del pene y el ángulo de incurvación mediante autofotografías en tres proyecciones. Mediante abordaje subcoronal realizamos el denudamiento del pene. A ambos lados de la uretra incidimos la fascia de Buck y liberamos el paquete vasculonervioso desde la cara ventral hasta dorsal. Generamos una erección artificial evidenciando la incurvación. En la cara dorsal deambos cuerpos cavernosos realizamos dos incisiones longitudinales en la capa longitudinal externa de la túnica albugínea. Suturamos los bordes internos y externosde ambas incisiones entre sí con una sutura continuade monofilamento irreabsorbible de 4/0, comprobando mediante una erección artificial la corrección de la incurvación. Los pacientes fueron dados de alta al día siguiente de la intervención. Al sexto mes se determinaron la longitud e incurvación peneanas, y el cuestionario IIEF-5. Para la comparación de medias utilizamos el test de la U de Mann-Whitney. RESULTADOS: La edad media fue 26,8 años. El seguimiento promedio fue 20,7 meses (12-31) y la mediana 24. Antes de la intervención la incurvación media fue 68,5° (50-90°); la longitud media 14,2 cm (10-18) yel IIEF-5 de 21. Tras la intervención la longitud media fue 13,7 cm, la incurvación residual 25. No existieron diferencias estadísticamente significativas entre la longitud peneana pre y postquirúrgica,(p=0,08). Nueve pacientes aseguraron que volverían asometerse a la misma intervención. CONCLUSIONES: La RCC constituye una alternativa terapéutica eficaz a las técnicas de plicatura o alargamiento de la túnica albugínea para el tratamiento de la IPC, manteniendo sus resultados a largo plazo.

[Comparison of monopolar versus bipolar transurethral resection of the prostate: Evaluation of the impact on sexual function]. / Comparación entre resección monopolar vs. resección bipolar transuretrales de próstata y su impacto sobre la función sexual.

OBJECTIVES: To assess the effects of monopolar transurethral resection of the prostate (M-TURP) and bipolar TURP (B-TURP) on overall sexual function. METHODS: From December 2014 to September 2016, 100 eligible candidates with benign prostatic hyperplasia were prospectively recruited and randomized 1:1 into M-TURP/B-TURP arms (58 and 42 patients, respectively) and followed up at 1, 3 and 6 months. A univariate and multivariate analyses using the chi-squared test and a logistic regression model were performed. We recorded the age, medical conditions such as hypertension and diabetes, history of smoking, preoperative prostatic volume, prostatic symptoms scale, sexual function assessment, surgeon experience, resected grams, percentage of resected tissue and presence of retrograde ejaculation. Prostatic symptoms and erectile function (EF) assessment were quantified using self-administered IPSS scores and IIEF-5, respectively, at baseline and in each subsequent visit. RESULTS: Mean age was 66 years (50-82). No statistical differences were found between both groups regarding medical comorbidities, preoperative IPSS and IIEF-5. Mean prostatic volume was 37.2 cm3 (10-68) and mean amount of resected tissue was 11.75g (6-58). At baseline 77,6% of patients has severe LUTS, and 50% has moderate-severe erectile dysfunction. Univariate analyses show that in both groups, history of diabetes mellitus, age and preoperative IIEF-5 were associated with poor EF. However, multivariate analyses revealed that age was the only factor associated with a poor EF. These results were similar at 3 and 6 postoperative months. We did not find an association between surgeon experience, source of energy employed or percentage of resected tissue with the development of postoperative retrograde ejaculation (52%). At first postoperative month, 44% of patients were still referring moderate prostatic symptoms and 50% had severe erectile dysfunction maintained at 6 months in both groups. CONCLUSIONS: There were no differences between the source of energy employed and changes on overall sexual function. Age is the only factor associated with a poor EF status.

Post void incontinence secondary to female urethral diverticulum. / Incontinencia postmiccional secundaria a diverticulo uretral femenino.

A 38 year old woman with nopast medical or surgical history of interest,derived by occasional dysuria and post voidincontinence by her family doctor, with negativeurine culture...

Mujer de 38 años sin antecedentesmédico-quirúrgicos de interés, remitida porsu médico de familia por disuria ocasional eincontinencia postmiccional, con sistemáticode orina negativo...

Different spatial pattern of municipal prostate cancer mortality in younger men in Spain.

BACKGROUND: Prostate cancer (PC) primarily affects elderly men. However, the specific features of cases diagnosed at younger ages (<65 years) suggest that they may represent a different clinical subtype. Our aim was to assess this suggestion by contrasting the geographical PC mortality and hospital admissions patterns in Spain for all ages to those in younger men. METHODS: The Spanish National Institute of Statistics supplied data on PC mortality, hospital admission, and population data. We estimated the expected town-specific number of deaths and calculated the standardized mortality ratios. Spatial autoregressive models of Besag-York-Mollié provided smoother municipal estimators of PC mortality risk (all ages; <65 years). We computed the provincial age-standardized rate ratios of PC hospital admissions (all men; <60 years) using Spanish rates as the reference. RESULTS: A total of 29,566 PC deaths (6% among those <65 years) were registered between 2010-2014, with three high-mortality risk zones: Northwest Spain; Southwest Andalusia & Granada; and a broad band extending from the Pyrenees Mountains to the north of Valencia. In younger men, the spatial patterns shared the high risk of mortality in the Northwest but not the central band. The PC hospital discharge rates confirmed a North-South gradient but also low mortality/high admission rates in Madrid and Barcelona and the opposite in Southwest Andalusia. CONCLUSION: The consistent high PC mortality/morbidity risk in the Northwest of Spain indicates an area with a real excess of risk. The different spatial pattern in younger men suggests that some factors associated with geographical risk might have differential effects by age. Finally, the regional divergences in mortality and morbidity hint at clinical variability as a source of inequity within Spain.

Curva de aprendizaje de la ecografía renal en una unidad docente pluriprofesional / Renal ultrasound learning curve performed in a multiprofessional teaching unit

Introducción: El objetivo de esta experiencia fue analizar un módulo formativo inserto en la práctica asistencial de un departamento de urología con la participación de enfermeras especializadas en ecografía urológica como monitoras. Material y métodos: Participaron en el estudio 12 estudiantes de medicina carentes de cualquier conocimiento de ultrasonografía. Su formación corrió a cargo de dos enfermeras con gran experiencia en ecografía. Después de dos sesiones de entrenamiento, se analizó la concordancia entre sus hallazgos en la exploración de los riñones y los de un urólogo especialista. Para analizar la experiencia desde todos los puntos de vista, se exploró el grado de aceptación del módulo formativo por parte de los usuarios y la tolerancia de los profesionales involucrados en términos de síndrome de desgaste profesional (SDP). Por último, se calcularon los costes. Resultados: El coeficiente kappa de concordancia entre el experto y los estudiantes fue bueno (≥ 0,67) en el 58,3% de los casos. No se detectaron rasgos de SDP entre los involucrados en la experiencia. La participación de las enfermeras como monitoras redujo el coste del operativo en un 25% en comparación con los costes en los que se podría haber incurrido caso de docentes urólogos senior. Conclusiones: Las enfermeras pueden proporcionar los rudimentos de la formación en ecografía a legos en la materia. La exploración de individuos con cálculos renales o ureterohidronefrosis se traduce en una mayor concordancia entre observadores. El usuario involucrado acepta de buen grado la experiencia. El operativo resulta inocuo para el personal participante.

Introduction: The objective of this experience was to analyze a training module inserted in the care practice of an urology department, with the participation of nurses specialized in urological ultrasound as monitors. Material and methods: Twelve medical students with no knowledge of ultrasonography participated in the study. His training was carried out by two nurses with extensive experience in ultrasound. After two training sessions, the agreement between their kidney examination findings and those of a specialist urologist was analyzed. To analyze the experience from all points of view, the degree of acceptance of the training module by the users was explored, as well as the tolerance of the professionals involved in terms of professional burnout syndrome (PBS). Finally, the costs of the operation were calculated. Results: The kappa coefficient of agreement between the expert and the students was good (≥ 0.67) in 58.3% of the cases. No traits of PBS were detected among involved in the experience. The participation of nurses as monitors reduced the cost of the operation by 25% compared to the costs that could have been incurred if they had been senior urologist teachers. Conclusions: Nurses can provide the rudiments of sonography training to laymen. Examination of individuals with kidney stones or ureterohydronephrosis results in greater interobserver agreement. In general, the user involved willingly accepts the experience. The operation is harmless for the participating staff.

Cirugía de rescate de extrusión de prótesis hidráulica de pene mediante protocolo de Mulcahy modificado. Revisión de la literatura a propósito de un caso / Salvage surgery of hydraulic penile prosthesis by modified Mulcahy protocol. Case report and literature review

La extrusión de una prótesis peneana es indicador de infección e implica su retirada, provocando fibrosis y acortamiento del pene.Presentamos el caso de un varón de 62 años, al que implantamos una prótesis hidráulica, y tres semanas después sometimos a cirugía de rescate por extrusión de la bomba de activación. Tras extraer la prótesis, lavamos las cavidades con cuatro diluciones. La primera al 50% de agua oxigenada; la segunda al 50% de povidona yodada; la tercera con 1 g de cefazolina y 40 mg de tobramicina, la cuarta con 80 mg de gentamicina y 500 mg de vancomicina. En el acto implantamos una prótesis maleable bañada en las soluciones antibióticas.El posoperatorio fue satisfactorio. Un año después, presenta una adecuada longitud peneana y aspecto estético, manteniendo relaciones sexuales satisfactorias.El rescate quirúrgico mediante el lavado con soluciones antisépticas e implante de prótesis maleable, minimiza el riesgo de reinfección, preservando la función sexual. (AU)

The extrusion of a penile prosthesis is an indicator of infection and implies its removal, causing fibrosis and shortening of the penis.We present a 62-year-old man, to whom we implanted a hydraulic prosthesis, and three weeks later we underwent salvage surgery by extrusion of the activation pump. After removing the prosthesis, we wash the cavities with four dilutions. The 1st to 50% of hydrogen peroxide; the 2nd to 50% of povidone iodine; the 3rd with 1 g of cefazolin and 40 mg of tobramycin, the 4th with 80 mg of gentamicin and 500 mg of vancomycin. In the act we implanted a malleable prosthesis bathed in antibiotic solutions.The postoperative period was satisfactory. A year later, the patient presents an adequate penile length and aesthetic appearance, maintaining satisfactory sexual relations.Surgical rescue by washing with antiseptic solutions and a malleable prosthesis implant, minimizes the risk of reinfection, preserving sexual function. (AU)

Linfoma testicular primario. A propósito de 2casos nuevos / Primary testicular lymphoma. Two new case reports

El linfoma testicular primario es una entidad muy poco frecuente; sin embargo, su curso clínico es desfavorable, con una elevada tasa de recaídas y baja supervivencia. A propósito de su baja prevalencia, presentamos 2casos con la actualización en el tratamiento y evolución. (AU)

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease. (AU)

A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications

ABSTRACT Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.