Giant Midline Prostatic Cyst: An Unusual Cause of Acute Urinary Retention.

Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller's cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report.

Preliminary results of the external urinary sphincter Uroflex® on the quality of life of patients with male urinary incontinence after prostate surgery: tolerance, severity of incontinence, and quality of life.

PURPOSE: This study aims to establish the ability of the Uroflex® external artificial sphincter to reduce the severity of male urinary incontinence and improve the quality of life of patients with male urinary incontinence. METHODS: A pre-post pilot study was carried out on a sample of 30 patients with male urinary incontinence. Tolerability and satisfaction were assessed by comparing the results of the Pad test, and EQ-5D and KHQ questionnaires before and after 3 months of using Uroflex®. RESULTS: At 3 months, 76.6% of patients continued using Uroflex®. The median score for overall satisfaction with the device was 8 out of 10. Pad test showed a significant reduction in the severity of male urinary incontinence at 3 months (p < 0.001), with resolution of all symptoms in 31% of patients. The KHQ showed a significant improvement in global quality of life (p = 0.003). This was also significant for five of the nine specific dimensions assessed. There was also an improvement in self-rated health using the EQ-5D questionnaire, although not significant (p = 0.075). CONCLUSION: The Uroflex® external urinary sphincter seems to improve the severity of urinary incontinence and quality of life of patients with male urinary incontinence after prostate surgery. These encouraging results will need to be confirmed in larger controlled studies.

Efficacy of conduction hyperthermia in the treatment of non-muscle invasive bladder cancer: A systematic review.

INTRODUCTION: Intravesical treatment for non-muscle invasive bladder cancer (NMIBC) aims to reduce recurrences and stop progression. Hyperthermia-enhanced chemotherapy with devices like COMBAT BRS, Unithermia, and BR-TRG-I is a promising alternative to conventional Bacillus de Calmette Guerin (BCG) therapy. OBJECTIVE: To systematically review the efficacy of hyperthermia generated by conduction devices in the treatment of NMIBC. MATERIAL AND METHODS: The review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. A search was performed in the PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov databases. Two reviewers independently assessed the eligibility of candidate studies and abstracted data from studies that met the inclusion criteria. The primary endpoint was assessment of recurrence. Secondary objectives included evaluation of treatment progression and safety. RESULTS: Thirty studies meeting inclusion criteria underwent data extraction. In intermediate-risk NMIBC patients, COMBAT versus mitomycin C (MMC) in normothermia revealed no superiority in reducing recurrence or progression. High-risk NMIBC patients using COMBAT achieved similar or superior outcomes to BCG. BR-TRG-I demonstrated superior results over normothermia in intermediate- and high-risk NMIBC patients. Unithermia proved less effective than BCG in high-risk NMIBC. Progression outcomes were promising with COMBAT and BR-TRG-I, but comprehensive analysis was limited due to inconsistent assessment across studies. Adverse events were primarily mild-moderate, with some device-specific differences. CONCLUSIONS: Studies on conduction hyperthermia present great variability, which do not allow us to determine the superiority of 1 device over another in terms of recurrence, progression, and/or adverse effects. Further research with consistent administration protocols is crucial for definitive conclusions.

Electromotive Drug Administration Chemotherapy with Mitomycin C Versus Bacillus Calmette-Guerin for the Treatment of Non-Muscle Invasive Bladder Cancer.

BACKGROUND: Devices that increase the penetrance of intravesical chemotherapeutics are emerging as alternatives to classical Bacillus Calmette Guérin (BCG) treatment. OBJECTIVE: To compare the efficacy of mitomycin C applied with the electromotive drug delivery device (MMC-EMDA) versus BCG in patients with intermediate and high-risk non-muscle-invasive bladder cancer (NMIBC) without carcinoma in situ (CIS). METHODS: Prospective non-randomized study in which 47 patients received MMC-EMDA (40 mg of MMC diluted in 50 mg of distilled water at 20 mA for 30 min. Regimen of 6 weekly and then 6 monthly instillations) and 48 patients received BCG (50 mg of OncoCITE® diluted in 50 ml of normal saline for 60 min. Regimen of 6 weekly instillations and then 3 weekly instillations at months 3, 6 and 12). The primary endpoint was the recurrence-free rate (RFR) at 24 months. Secondary endpoints were time to recurrence and progression-free rate (PFR) at 24 months follow-up. RESULTS: Baseline patient assessment and mean follow-up time were similar in both groups (MMC-EMDA group: 26.4 months; BCG group: 28.4 months (p = 0.44)). The RFR at 24 months was 80.9% for the MMC-EMDA group and 77.1% for the BCG group (p = 0.969). The mean time to recurrence was 12.5 months in the MMC-EMDA group and 14 months in the BCG group (p = 0.681). At 24 months, PFR was 97.9% in the MMC-EMDA group and 93.8% in the BCG group (p = 0.419). CONCLUSIONS: No differences were found between MMC-EMDA and BCG treatments in patients with high-risk and intermediate-risk NMIBC without CIS.

Giant Midline Prostatic Cyst: An Unusual Cause of Acute Urinary Retention

Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller’s cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report. (AU)

Corporoplasty under local anesthesia: Cost-effective improvement of the surgical treatment of Peyronie's disease / Corporoplastia bajo anestesia local: mejora del coste-efectividad del tratamiento quirúrgico de la enfermedad de Peyronie

Introduction and objectives: Peyronie's disease produces penile curvature that leads, in certain cases, to difficulties in having satisfactory sexual relations. The objective of this study is to evaluate the functional and cost-effectiveness results obtained in the surgical treatment of penile curvature due to Peyronie's disease under local anesthesia, comparing them with those performed under a general–spinal anesthesia regimen. Material and methods: Two groups of patients undergoing corporoplasty are compared according to the type of anesthesia used. Group 1 consists of 32 patients who underwent major outpatient surgery and under local anesthesia from June 2016 to June 2019. Their data are collected prospectively. Group 2 consists of 30 patients who underwent surgery under general/spinal anesthesia with hospital admission, from January 2013 to December 2015, with their data collected retrospectively. Anesthetic and surgical procedure, postoperative functional results, degree of satisfaction and hospital costs between both groups are analyzed, considering p≤0.05 as statistical significance and analyzing the results with the SPSS 20.0 program. Results: Of the 32 patients included in group 1, none required admission for intra or postoperative complications. In both groups, an improvement of the PDQ-test was observed without statistically significant differences, with the degree of global satisfaction above 95% in both groups. There were also no differences in the appearance of complications secondary to the anesthetic procedure or the hospital regime. We observed differences in hospital costs, being 44% lower for the group performed with local anesthesia. (AU)

Introducción y objetivos: La enfermedad de Peyronie produce una curvatura del pene que conduce, en ciertos casos, a dificultades para tener relaciones sexuales satisfactorias. El objetivo de este estudio es evaluar los resultados funcionales y de coste-efectividad obtenidos en el tratamiento quirúrgico de la curvatura peneana por enfermedad de Peyronie bajo anestesia local, comparándolos con los conseguidos bajo un régimen de anestesia general-raquídea. Material y métodos: Se comparan 2 grupos de pacientes sometidos a corporoplastia según el tipo de anestesia utilizada. El grupo 1 está formado por 32 pacientes que se sometieron a cirugía mayor ambulatoria y bajo anestesia local desde junio de 2016 a junio de 2019. Sus datos se recogen de forma prospectiva. El grupo 2 está formado por 30 pacientes intervenidos bajo anestesia general/raquídea con ingreso hospitalario, desde enero de 2013 hasta diciembre de 2015, con sus datos recogidos de forma retrospectiva. Se analiza el procedimiento anestésico y quirúrgico, los resultados funcionales postoperatorios, el grado de satisfacción y los costos hospitalarios entre ambos grupos, considerando p≤0,05 como significación estadística y analizando los resultados con el programa SPSS® 20.0. Resultados: De los 32 pacientes incluidos en el grupo 1, ninguno requirió ingreso por complicaciones intra o postoperatorias. En ambos grupos se observó una mejora en el test PDQ sin diferencias estadísticamente significativas, con un grado de satisfacción global superior al 95% en ambos grupos. Tampoco hubo diferencias en la aparición de complicaciones secundarias al procedimiento anestésico o al régimen hospitalario. Observamos diferencias en los costos hospitalarios, siendo un 44% menor para el grupo en el que se utilizó anestesia local. (AU)

Hiperparatiroidismo en pacientes con litiasis. Influencia del déficit de 25-OH vitamina D / Hyperparathyroidism in patients with stones. Influence of deficit 25-OH vitamin D

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Usefulness of measuring renal papillae in Hounsfield units in stone - forming patients

ABSTRACT Introduction: The aim of this work is to study the density of the renal papillae in stone-forming patients and to determine its usefulness. Materials and Methods: This study included a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single episode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Groups 1 and 2. Statistical analysis was performed using SPSS 20.0. Results: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (P=00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8HU [area under the curve, 0.881 (95% CI; 0.804-0.958); P=0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. Conclusion: The measurement of renal papillary density could be useful in predicting recurrent stone-formers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.

Evaluación del tratamiento de litiasis renal radiopaca mediante la combinación de litotricia extracorpórea por ondas de choque y fagolitos plus. Estudio preliminar de casos y controles / Evaluation of the treatment of radiopaque renal lithiasis through the combination of extracorporeal lithotripsy by shock waves and phagoliths plus. Preliminary case-control study

Objetivo: El objetivo de este estudio es evaluar la efectividad del tratamiento combinado de Fagolitos plus® yLitotricia extracorpórea en la fragmentación de la litiasis.Material y métodos: Estudio retrospectivo de casosy controles, incluye 88 pacientes con litiasis. Grupo 1:Tratados con 1 sesión de litotricia extracorpórea y Fagolitos plus ®. Grupo 2: Tratados con 1 sesión de litotriciaextracorpórea. Las variables analizadas fueron: Edad, sexo, índice de masa corporal, diámetro máximo dela litiasis, área de la litiasis, unidades hounsfield de lalitiasis medida por Tomografía axial, localización de lalitiasis, resultado tras 1 sesión de Litotricia extracorpóreapor ondas de choque [fragmentación completa, fragmentación parcial (presencia de un fragmento mayor a5 mm) y ausencia de fragmentación (mismo tamaño dela litiasis)], efectos adversos acontecidos tras la toma deFagolitos plus ®, días de tratamiento con Fagolitos plus ®y energía de ondas de choque aplicada a la litiasis. Seanalizaron resultados con SPSS 20.0, p≤0,05. Resultados: La edad media de los pacientes incluidos en el estudio es de 53,81 ± 12,62 años en elgrupo 1 frente a 56,53 ± 12,37 años en el grupo 2,p=0,31. Según la distribución por sexos, tampoco existen diferencias estadísticamente significativas (p=0,5),incluyendo 24 hombres y 24 mujeres en el grupo 1 y23 hombres y 17 mujeres en el grupo 2. El índice demasa corporal medio de los pacientes del grupo 1 fuede 28,39 ± 2,27 kg/m 2 en el grupo 1 frente a 28,39± 3,03 kg/m2 en el grupo 2, p=0,9. El diámetro máximo de la litiasis fue de 11,5 ± 3,91 mm en el grupo1 frente a 13,15 ± 5,49 mm en el grupo 2, p=0,1.El área de la litiasis medida por tomografía computarizada fue de 104,74 ± 70,56 mm 2 en el grupo 1frente a 141,91 ± 80,95 mm2 en el grupo 2, p=0,3.Las unidades Hounsfield medidas por tomografía de lalitiasis en el grupo 1 fue de 1061,98 ± 213,68 frentea 1143,15 ± 172,24 en el grupo 2, p=0,06...(AU)

Objetive: The objective of this study is to evaluatethe effectiveness of the combined treatment of Fagolitosplus® and extracorporeal lithotripsy in the fragmentationof the lithiasis.Material and methods: Retrospective case-control study includes 88 patients with lithiasis. Group 1:Treated with 1 session of extracorporeal lithotripsy andFagoliths plus ® . Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were:Age, sex, body mass index, maximum diameter of thestone, area of the stone, hounsfield units of the stonemeasured by axial tomography, location of the stone,result after 1 session of extracorporeal wave lithotripsy.shock [complete fragmentation, partial fragmentation(presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus ® ,days of treatment with Fagolitos plus ® and energyshock wave applied to lithiasis. Results were analyzedwith SPSS 20.0, p≤0.05.Results: The mean age of the patients included in thestudy is 53.81 ± 12.62 years in group 1 compared to56.53 ± 12.37 years in group 2, p=0.31. Accordingto the distribution by sex, there were no statisticallysignificant differences (p=0.5), including 24 men and24 women in group 1 and 23 men and 17 women ingroup 2. The mean of body mass index of the patientsin group 1 was 28.39 ± 2.27 kg/m 2 in group 1 versus 28.39 ± 3.03 kg/m 2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm ingroup 1 compared to 13.15 ± 5.49 mm in group 2,p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm 2 in group 1 comparedto 141.91 ± 80.95 mm 2 in group 2, p=0.3. TheHounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to1143.15 ± 172.24 in group 2, p=0.06.Relation to fragmentation, complete fragmentation wasobserved in 66.7% of group 1 patients, compared to...(AU)

¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible? / Usefulness of antimicrobial prophylaxis with ciprofloxacin prior to flexible cystoscopy

Background: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. Aim: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. Material and Methods: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. Results: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. Conclusions: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.

Tratamiento de la litiasis reno-ureteral con litotricia extracorpórea con ondas de choque. Resultados y complicaciones con el equipo Dornier Gemini EMSE 220f-XXP / Treatment of uretero-renal stones with shock wave lithotripsy. Results and complications with the dornier gemini emse 220f-XXP

Objetivos: La litotricia extracorpórea por ondas de choque es una opción terapéutica mínimamente invasiva para el tratamiento de las litiasis reno-ureterales. El objetivo de este trabajo es analizar los resultados y complicaciones del tratamiento con litotricia extracorpórea con ondas de choque con el dispositivo de última generación Dornier Gemini(R) generador EMSE 220f-XXP en pacientes con litiasis renal y ureteral. Material y métodos: Estudio retrospectivo en el que se incluyen 377 pacientes con litiasis renal o ureteral con indicación de tratamiento con litotricia extracorpórea con ondas de choque. Se analizan las siguientes variables que incluyen la edad, sexo, índice de masa corporal, tamaño litiásico, localización de la litiasis, presencia de derivación urinaria, número de sesiones de litotricia, número de ondas de choque, tiempo de escopia, energía de las ondas, coeficiente de energía focal aplicada, coeficiente de eficiencia, fragmentación litiásica, expulsión litiásica, litiasis residual, presencia de calle litiásica y complicaciones. Se analizan los resultados con programa SPSS 17.0 considerando significación estadística p≤0,05. Resultados: De los 377 pacientes, 213 fueron hombres y 164 mujeres, con edad media 51,28 ± 12,77 años. El tamaño medio de las litiasis en diámetro máximo fue de 11,77 ± 6,13 mm. Se produce fragmentación de la litiasis en el 81,9% de los casos, con un porcentaje de litiasis residual tras la primera sesión de 58,7% y una tasa de expulsión total o parcial de fragmentos litiásicos del 68,3%, con un éxito global al finalizar las sesiones de litotricia del 69,8%. El Coeficiente de Eficiencia global fue de 0,42, más elevado en cáliz superior 0,51 y más bajo en cáliz medio 0,35, con diferencias significativas (p < 0,05). Las únicas diferencias encontradas se observan según tamaño litiásico (≤10 mm de diámetro máximo con respecto a >10mm) en relación al éxito del tratamiento con litotricia (75% versus 64,6%, (p = 0,006). Conclusión: El tratamiento con litotricia extracorpórea en litiasis de pequeño tamaño y en pacientes bien seleccionados obtiene buenos resultados con un bajo índice de complicaciones independientemente del sexo y del índice de masa corporal

Objectives: Extracorporeal shock wave lithotripsy is a minimally invasive therapeutic option for the treatment of renal-ureteral lithiasis. The aim of this study was to analyze the results and complications of shock wave extracorporeal lithotripsy treatment with the Dornier Gemini (R) Generator EMSE 220f-XXP device in patients with renal and ureteral lithiasis. Material and methods: Retrospective study including 377 patients with renal or ureteral lithiasis with indication for treatment with extracorporeal shock wave lithotripsy. The following variables were analyzed, age, sex, body mass index, lithiasis size, lithiasis location, presence of urinary diversion, number of lithotripsy sessions, number of shock waves, fluoroscopy time, wave energy, applied focal energy coefficient, efficiency coefficient, lithiasic fragmentation, lithiasic clearance, residual lithiasis, presence of lithiasis and complications. The results were analyzed with SPSS 17.0 considering statistical significance p≤0.05. RESULTS: Of the 377 patients, 213 were men and 164 women, with a mean age of 51.28 ± 12.77 years. The mean size of the stones in maximum diameter was 11.77 ± 6.13 mm. Lithiasis fragmentation occurred in 81.9% of cases, with a percentage of residual lithiasis after the first session of 58.7% and a total or partial expulsion rate of lithiasis fragments of 68.3%, with global success at the end of sessions of lithotripsy of 69.8%.The overall Efficiency Ratio was 0.42, higher in upper calyx 0.51 and lower in medium calyx 0.35, with significant differences (p<0.05). The only differences were found in relation to the success of lithotripsy treatment (75% versus 64.6%, p=0.02), according to lithiasis size (≤10 mm maximum diameter in comparison to >10 mm). In patients with a DJ catheter there is a higher percentage of residual lithiasis (p=0.006). Conclusions: Treatment with extracorporeal lithotripsy in small lithiasis and in well-selected patients obtains good results with a low rate of complications regardless of sex and body mass index

Calcium renal lithiasis: metabolic diagnosis and medical treatment / Litiase renal cálcica: diagnóstico metabólico e tratamento médico

Calcium renal lithiasis is a frequent condition that affects the worldwide population and has a high recurrence rate. Different metabolic changes may trigger the onset of calcium stone disorders, such as hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia and others. There are also other very prevalent disorders that are associated with calcium calculi, such as arterial hypertension, obesity and loss of bone mineral density. A correct diagnosis needs to be obtained through examining the serum and urinary parameters of mineral metabolism in order to carry out adequate prevention and treatment of this condition. Once the metabolic diagnosis is known, it is possible to establish dietary and pharmacological treatment that may enable monitoring of the disease and prevent recurrence of stone formation. Some advances in treating this pathological condition have been made, and these include use of sodium alendronate in patients with calcium renal lithiasis and osteopenia/osteoporosis, or use of a combination of a thiazide with a bisphosphonate. In summary, calcium renal lithiasis often requires multidrug treatment with strict control and follow-up of patients.

Litíase renal cálcica é uma doença comum que afeta a população no mundo todo e tem alta taxa de recorrência. Diferentes alterações metabólicas podem desencadear o aparecimento de distúrbios de pedras de cálcio, como hipercalciúria, hiperoxalúria, hiperuricosúria, hipocitratúria e outros. Existem também doenças altamente prevalentes associadas à doença de cálculo de cálcio, como hipertensão, obesidade e perda de densidade óssea mineral. Para realizar prevenção e tratamento adequados, é necessário diagnóstico correto, examinando o metabolismo mineral sérico e urinário. Depois de conhecer o diagnóstico metabólico, é possível estabelecer um tratamento dietético e farmacológico que permita controlar a doença e prevenir a recorrência de cálculos biliares. Há alguns avanços no tratamento dessa doença e incluem o uso de alendronato de sódio em pacientes com nefrolitíase de cálcio e osteopenia/osteoporose, ou a combinação de um tiazídico com um bifosfonato. Em resumo, litíase renal cálcica exige, muitas vezes, um tratamento multidroga com rigorosos controle e acompanhamento de pacientes.

Alteración de la excreción urinaria de calcio en pacientes sometidos a deprivación androgénica por cáncer de próstata. Resultados preliminares de un estudio piloto / Altered urinary calcium excretion in prostate cancer patients subjected to androgen deprivation. Preliminary pilot study results

OBJETIVOS: La terapia de deprivación androgénica en el cáncer de próstata se relaciona con la aparición de diferentes efectos adversos. En el ámbito metabólico destacan la aparición de osteoporosis y síndrome metabólico. El objetivo de este estudio es analizar los marcadores de riesgo litógeno a los 3 meses de haber iniciado tratamiento con análogo LHRH. MÉTODOS: Estudio piloto que incluye a 15 pacientes con cáncer de próstata subsidiarios de tratamiento con deprivación androgénica que se realiza con goserelina 10,8 mg trimestral. Se realiza estudio en sangre y orina de marcadores de riesgo litógeno, marcadores óseos y metabólicos, así como estudio de criterios de síndrome metabólico. Análisis estadístico con programa SPSS 17.0, considerando p≤0,05 como significación estadística. RESULTADOS: La edad media de los pacientes incluidos fue de 72,46 ± 6,61 años. Se observó un aumento significativo del porcentaje de síndrome metabólico a los 3 meses de tratamiento (20% versus 46,7%; p < 0,05), así como del índice de resistencia a la insulina (1,87 versus 2,96; p = 0,01). Destaca un aumento de los marcadores de remodelado óseo, así como un aumento significativo de la calciuria (9,46 versus 14,57 mg/dl; p = 0,008), del índice de excreción urinario de calcio (0,10 versus 0,13 mg/dl FG; p = 0,01) y del cociente calcio/creatinina de ayunas (0,107 versus 0,195; p = 0,007), sin modificaciones en otros marcadores de riesgo litógeno. CONCLUSIÓN: La terapia de deprivación androgénica puede inducir a corto plazo incremento de la calciuria, fundamentalmente de ayunas, en este tipo de pacientes en posible relación con alteración del metabolismo óseo

OBJECTIVES: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue. METHODS: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant. RESULTS: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers. CONCLUSIONS: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism

Deprivación androgénica en cáncer de próstata y riesgo de aparición de litiasis renal. Resultados de un estudio de casos y controles / Androgen deprivation therapy in prostate cancer and risk of developing renal calculi: Results of a case-control study

Antecedentes y objetivo: El tratamiento de privación androgénica en el cáncer de próstata se asocia a la aparición de diferentes efectos adversos, entre los que se encuentran la osteoporosis y el síndrome metabólico. Ambos están relacionados con la aparición de nefrolitiasis. El objetivo de este estudio es analizar la aparición de nefrolitiasis en pacientes sometidos a este tratamiento con análogos LHRH. Pacientes y métodos: Estudio de casos y controles en el que se incluyeron un total de 85 pacientes divididos en 2 grupos: el grupo 1 estaba formado por 41 pacientes con tratamiento de privación androgénica y el grupo 2 por 44 pacientes sin tratamiento de privación androgénica. Resultados: En el grupo 1 se produjo litiasis de nueva aparición en 12 casos (29,3%) frente a 2 casos en el grupo 2 (4,5%) (p = 0,0001), a los 4,4 años de comenzar el tratamiento de privación androgénica. La odds ratio estimada fue de 8,69 (IC al 95% 1,81-41,76). Conclusión: Parece existir relación entre el tratamiento con análogos LHRH y la litiasis; no obstante, son precisos estudios prospectivos a largo plazo con control metabólico para poder establecer las causas que expliquen la aparición de este fenómeno (AU)

Background and objective: Androgenic deprivation therapy in prostate cancer is associated with the onset of different adverse effects, including osteoporosis and metabolic syndrome. Both are related to the onset of nephrolithiasis. The objective of this article is to study the incidence of renal stones in patients undergoing androgen deprivation therapy with LHRH analogue. Patients and methods: Case-control study including a total of 85 patients divided into 2 groups: group 1, with 41 patients on androgen deprivation therapy, and group 2, with 44 patients not receiving androgen deprivation therapy. Results: New-onset lithiasis was observed in 12 cases (29.3%) in group 1 compared to 2 cases (4.5%) in group 2 (P = .0001), 4.4 years after starting the androgen deprivation therapy. The estimated odds ratio was 8.69 (95% CI 1.81-41.76). Conclusion: The incidence of renal stones could be increased in patients receiving treatment with analogue LHRH. However, long-term prospective studies with a metabolic control are required to be able to establish the causes explaining the development of this phenomenon in patients undergoing treatment with androgen deprivation therapy (AU)

Factores etiopatogénicos de los diferentes tipos de urolitiasis / Etiopathogenic factors of the different types of urinary litiasis

En este artículo de revisión se analizan los principios etiopatogénicos de la formación de la litiasis urinaria. A nivel renal, como consecuencia de procesos que lesionan el urotelio se producen calcificaciones a nivel de la papila y de los conductos de Bellini que pueden ser causantes de la formación del cálculo renal. Con la mejora de las pruebas de imagen, fundamentalmente micro-TAC es posible detectarlas y podemos ser capaces de anticiparnos a la formación de la litiasis. Como bien conocemos, existen diferentes factores que influyen en la formación del cálculo y que dependerán de la composición de la misma. En la litiasis cálcica es fundamental reseñar la modificación de los tipos de hipercalciuria, actualmente distinguimos dos tipos en lugar de tres, gracias al cociente calcio/creatinina de ayunas, diferenciándose hipercalciuria absortiva e hipercalciuria de ayunas. En la hipercalciuria de ayunas es importante destacar la relación que existe entre este factor y la pérdida de densidad mineral ósea en pacientes con litiasis renal cálcica recidivante, siendo por tanto preceptivo el estudio del metabolismo óseo mediante marcadores de remodelado óseo y densitometría ósea en este tipo de pacientes. Respecto a los otros factores que intervienen en la formación de la litiasis cálcica debemos hacer especial hincapié en la hipercalciuria y su creciente aumento por su relación con la obesidad y el síndrome metabólico, así como la hipocitraturia, presente en un porcentaje importante de pacientes y relacionada en algunos casos con acidosis metabólica y también osteopenia-osteoporosis. Con respecto a la litiasis de ácido úrico hay que destacar que el pH urinario es el factor más determinante y que por tanto el control y las modificaciones del mismo serán fundamentales en la prevención de este tipo de litiasis. En la litiasis infectiva es obligatorio la presencia de gérmenes que desdoblen la urea, generándose iones de amonio, capaces de lesionar el urotelio y de formar litiasis de fosfato amónico magnésico fundamentalmente. En cuanto a la litiasis de cistina, poco frecuente, clásicamente dividida en 3 tipos, ha pasado a dividirse en tipo A y B en función del gen mutado y resulta más útil su medición directa en orina de 24 horas que realizar test de screening que tienen baja sensibilidad. En líneas generales, hemos tratado de dar una visión de conjunto de los diferentes tipos de litiasis haciendo hincapié en aquellos puntos más interesantes desde el punto de vista clínico para el urólogo

In this review, we analyze the etiopathogenic principles of urinary lithiasis formation. In the kidney, calcifications that may cause renal lithiasis are produced as a consequence of processes that injury the urothelium at the papilla and Bellini´s ducts. With the improvement of imaging techniques, mainly micro CT scan, it is possible to detect them and we may be able to anticipate to the formation of lithiasis. As we well know, there are different factors that influence the formation of the calculi depending on their composition. In calcium lithiasis it is key to review the modification of the categories of hypercalciuria, we currently distinguish two types instead of three, thanks to the fasting calcium/ creatinine ratio, differentiating absorptive hypercalciuria and fasting hypercalciuria. In the fasting hypercalciuria, it is important to emphasize the relationship between this factor and the loss of bone mineral density in patients with recurrent renal calcic lithiasis, so that in this kind of patients it is compulsory the study of bone metabolism by bone remodelling markers and bone densitometry. Regarding the other factors that participate in the formation of calcium lithiasis we should specially emphasize on hypercalciuria and its growing increase because of its relationship with obesity and metabolic syndrome, as well as hipocitraturia, present in an important percentage of patients and related in some cases with metabolic acidosis and osteopenia-osteoporosis too. In relation to uric acid lithiasis it should be highlighted that urinary pH is the most determinant factor and, therefore, its control and modifications would be paramount for prevention of this type of lithiasis. In the infectious lithiasis, the presence of germs that split urea is mandatory. They generate ammonia ions with the ability to injure the urothelium and to form magnesium ammonium phosphate lithiasis mainly. Regarding cystine lithiasis, rare, it was classically divided in three types and now passed to be classified in type A and B depending on the muted gene, and it is more useful to perform direct 24-hour urine measurement than screening tests which have low sensitivity. In general, we tried to give a comprehensive view of the various types of lithiasis emphasizing the most interesting clinical points for the urologist

El cociente calcio/creatinina de ayunas en pacientes con litiasis cálcica y su relación con la hipercalciuria y el metabolismo fosfocálcico / The fasting calcium/ creatinine ratio in patients with calcium stones and the relation with hypercalciuria and phosphocalcium metabolism

OBJETIVO: Determinar la importancia del cociente calcio/creatinina de ayunas en pacientes con litiasis cálcica y su relación con la hipercalciuria y metabolismo fosfocálcico. MÉTODOS: Estudio transversal que incluye 143 pacientes divididos en dos grupos según calcio/creatinina en ayunas. Grupo 1:66 pacientes (calcio/creatinina<0,11); Grupo 2:77 pacientes (calcio/creatinina>0,11). Se realiza estudio comparativo entre grupos de parámetros del metabolismo fosfo-cálcico y excreción de marcadores litogénicos en orina. Estudio de correlación lineal calciuria- calcio/creatinina en ayunas. Estudio estadístico con SPSS 17.0, considerando p≤0,05. RESULTADOS: Destaca en los pacientes del grupo 2 una excreción aumentada de calcio en orina de 24 h respecto grupo 1 (229,3 vs 158,1; p = 0,0001) y de calcio/citrato (0,47 vs 0,34; p = 0,001). Existe correlación lineal positiva y significativa entre niveles de calcio en orina de 24 h y cociente calcio/creatinina en ayunas (R=0,455; p = 0,0001) y se establece un punto de corte en 0,127 del cociente (sensibilidad 72% y especificidad 66%) para determinar hipercalciuria (excreción mayor 260 mg en 24 h). CONCLUSIONES: La elevación del calcio/creatinina en ayunas determina mayor excreción de calcio en 24 h, aunque la sensibilidad y especificidad para determinar hipercalciuria no es elevada

OBJECTIVE: To determine the importance of fasting calcium/creatinine ratio in patients with calcium stones and its relation with hypercalciuria and phospho-calcium metabolism. METHODS: Cross-sectional study including 143 patients divided into two groups according to fasting calcium/creatinine. Group 1: 66 patients (calcium/ creatinine0.11). A comparative study is performed between groups including phospho-calcium metabolism parameters and excretion of urinary lithogenic markers. Linear correlation studying calciuria and fasting calcium/ creatinine was performed. SPSS 17.0 statistical analysis software was used, considering p≤0.05. RESULTS: It is noteworthy that group 2 had increased 24 h urine calcium excretion in comparison to group 1 (229.3 vs 158.1; p = 0.0001) and calcium/citrate (0.47 vs 0.34; p = 0.001). There is a positive and significant correlation between calcium levels in 24 h urine and fasting calcium/creatinine (R=0.455; p = 0.0001) and a cutoff is set at 0.127 (sensitivity 72%, specificity 66%) to determine hypercalciuria (>260 mg in 24 h). CONCLUSIONS: Increased fasting calcium/creatinine determines increased 24 hours calcium excretion, although the sensitivity and specificity to determine hypercalciuria is not high

Percepción del dolor en cistoscopia flexible con el uso de lidocaína intrauretral / Perception of pain in flexible cystoscopy using intraurethral lidocaine

OBJETIVO: La cistoscopia flexible es una técnica utilizada en el diagnóstico de la patología del tracto urinario inferior. El objetivo de este estudio es evaluar la eficacia del anestésico local intrauretral en la percepción del dolor en el paciente. MÉTODOS: Estudio observacional prospectivo no aleatorizado que incluye 142 hombres a los que se realiza cistoscopia flexible. Se dividen en dos grupos en función del uso o no de anestésico local intrauretral (Grupo 1: 70 hombres con anestésico intrauretral [lidocaína 2%]; Grupo 2: 72 hombres sin anestésico intrauretral). Se analiza escala visual analógica y cuestionario del dolor. Análisis estadístico con SPSS 17.0 y significación estadística p≤0,05. RESULTADOS: La edad media del grupo 1 fue de 64,7±10,3 años frente a 66,7±10,8 años en el grupo 2, sin diferencias significativas. La puntuación en la escala visual analógica en el grupo 1 fue 2,23±2,20 frente a 1,69±1,74 en el grupo 2 (p = 0,1). La intensidad del dolor total y actual en el cuestionario del dolor fue de 1,81 ± 0,87 y 1,66 ± 1,65, respectivamente, en el grupo 1 y de 1,72 ± 0,72 y 1,21±1,45, respectivamente, en el grupo 2 (no diferencias significativas). Tras dividir a los pacientes en función de una puntuación en la escala visual analógica ≤ 2, se observa que la causa que motivó la cistoscopia es un factor independiente asociado a la percepción del dolor, incrementando el riesgo de percibir más dolor en 1,89. CONCLUSIÓN: El uso de anestésico local como lubricante previo a cistoscopia flexible no parece disminuir el dolor y consideramos que no está indicado de rutina en esta técnica diagnóstica

OBJECTIVE: The aim of this study is to evaluate the efficacy of a local intraurethral anesthetic on the pain perceived by the patient during flexible cystoscopy. METHODS: An observational, prospective, nonrandomized, study was conducted on 142 males subjected to a flexible cystoscopy. The patients were divided into two groups: Group 1: 70 patients with intraurethral anesthetic (lidocaine 2%), and Group 2:72 patients without intraurethral anesthetic. The results were scored on a visual analog scale and a pain questionnaire and analyzed. The statistical analysis was performed using SPSS 17.0 and with a statistical significance of p ≤ 0.05. RESULTS: The mean age of Group 1 was 64.7 ± 10.3 years compared to 66.7 ± 10.8 years in Group 2, with no significant differences. The score on the visual analog scale in Group 1 was 2.23 ± 2.20 versus 1.69 ± 1.74 in Group 2 (p = 0.1). The overall and current pain intensity in the pain questionnaire was 1.81 ± 0.87 and 1.66 ± 1.65, respectively, in Group 1, and 1.72 ± 0.72 and 1.21 ± 1.45, respectively, in Group 2 (no significant differences). After dividing the patients into groups according to a visual analog scale score ≤ 2, it was observed that the cause that led to cystoscopy was an independent factor associated with the perception of pain, increasing the risk of perceiving more pain by 1.89. CONCLUSIÓN: The use of local anesthetic as a lubricant prior to flexible cystoscopy does not appear to reduce pain, and we consider that its routine use is not indicated

Estudio prospectivo no aleatorizado sobre el uso de profilaxis antibiótica en la uretrocistoscopia flexible / Prospective non-randomized study on the use of antibiotic prophylaxis with ciprofloxacin in flexible urethrocystoscopy

OBJETIVO: La uretrocistoscopia flexible es un procedimiento que se realiza de rutina en urología para el seguimiento de tumores vesicales y como diagnóstico en pacientes con síntomas del tracto urinario inferior y hematuria entre otra sintomatología. El objetivo de este estudio es analizar la necesidad o no de profilaxis antibiótica en este procedimiento ambulatorio. MÉTODOS: Estudio observacional prospectivo no aleatorizado en el que se incluyen 100 pacientes divididos en dos grupos: - Grupo 1: 48 pacientes con profilaxis de 500 mg de ciprofloxacino 1 h antes de la uretrocistoscopia; - Grupo 2: 52 pacientes sin profilaxis antibiótica. Previamente a la inclusión en el estudio se comprueba ausencia de infección urinaria mediante urocultivo obtenido 3 días antes del procedimiento. Se analiza indicación de cistoscopia, resultado de cistoscopia, presencia de comorbilidades, urocultivo a los 7 días, síntomas urinarios durante los 7 días siguientes. Análisis estadístico con SPSS 20.0 y significación estadística p≤0,05. RESULTADOS: La edad media de los pacientes del grupo 1 fue de 66,7±12,4 años versus 65,6±10,8 años del grupo 2 (p = 0,6). No hubo diferencias en el porcentaje de hombres/mujeres incluidos entre los grupos. El 14% de los pacientes del grupo 1 presentó bacteriuria frente al 12% del grupo 2, sin diferencias significativas. En el estudio multivariante, se observa que ni la edad, diabetes, tabaquismo, síntomas del tracto urinario inferior ni inmunosupresión se relacionan con la aparición de bacteriuria entre grupos. CONCLUSIÓN: El uso de ciprofloxacino como profilaxis en la cistoscopia flexible no lo consideramos indicado en nuestra área de salud, ya que no disminuye la presencia de infección urinaria o bacteriuria

OBJECTIVE: The goal of this study is to analyze whether there is a need for antibiotic prophylaxis in this outpatient procedure. METHODS: Prospective observational non-randomized study including 100 patients divided into two groups: - Group 1: 48 patients receiving 500 mg of ciprofloxacin prophylaxis 1 hour before urethrocystoscopy; - Group 2: 52 patients without antibiotic prophylaxis. Before inclusion of the patients in the study, we checked the absence of urinary tract infection by means of a urinalysis obtained 3 days before the procedure. We analyze: cystoscopy indication, cystoscopy results, presence of comorbidities, urinalysis 7 days after the procedure, and urinary symptoms within 7 days of the procedure. The statistical analysis was performed using SPSS 20.0 and the statistical significance was p≤0.05. RESULTS: The average age of patients in group 1 was 66.7±12.4 versus 65.6±10.8 years in group 2 (p = 0.6). There are no differences in the percentage of men/women included in the groups. 14% of patients of group 1 and 12% of group 2 presented bacteriuria, without showing any significant differences. In the multivariate study, it is observed that neither age, nor diabetes, smoking, lower urinary tract symptoms, nor immunosuppression are related with the onset of bacteriuria in the groups. CONCLUSION: We do not consider the use of ciprofloxacin as prophylaxis for flexible cystoscopy is appropriate in this area of health, since it does not reduce the presence of urinary infection or bacteriuria

Tratamiento con hidroclorotiazida y alendronato en pacientes con litiasis y pérdida de densidad mineral ósea. Evolución de la calciuria y metabolismo óseo en el tratamiento médico / Treatment with hydrochlorothiazide and alendronate in patients with stones and bone mineral density loss. Evolution of bone metabolism and calciuria with medical treatment

OBJETIVO: El tratamiento de la litiasis cálcica está basado en dieta y medidas farmacológicas como el uso de tiazidas y otros fármacos. El objetivo de este estudio es valorar el efecto de hidroclorotiazida y alendronato sobre la calciuria y densidad mineral ósea en pacientes con litiasis cálcica. MÉTODOS: Estudio observacional prospectivo que incluye 77 pacientes con litiasis cálcica recidivante divididos en 2 Grupos según tratamiento recibido. Grupo 1: 36 pacientes tratados con alendronato 70 mg/semanal; Grupo 2: 41 pacientes tratados con hidroclorotiazida 50 mg/día. Todos los pacientes reciben recomendaciones de dieta e ingesta de líquidos. Se estudia y analiza entre otras variables la densidad mineral ósea, marcadores de remodelado óseo y calciuria antes y después de 2 años de tratamiento. Estudio estadístico con programa SPSS 17.0, significación estadística p < 0.05. RESULTADOS: No existen diferencias estadísticamente significativas en la distribución por sexo ni en la edad de los pacientes entre Grupos. En el Grupo 1 se observa descenso estadísticamente significativo en el b-crosslaps y mejoría en la densidad mineral ósea, junto con disminución de la calciuria tras 2 años de tratamiento. En el Grupo 2 se aprecia disminución estadísticamente significativa de calciuria y calcio/creatinina en ayunas, además de mejoría en la densidad mineral ósea tras 2 años de tratamiento médico. En el Grupo 1 existe una mejoría más evidente y significativa de la densidad mineral ósea respecto al 2, así como descenso del b-crosslaps. Sin embargo, en el Grupo 2 el descenso de la calciuria y calcio/creatinina es más significativo que en el Grupo 1. CONCLUSION: El tratamiento con hidroclorotiazida además de descender la calciuria produce una mejoría de la densidad mineral ósea, aunque no en el mismo rango que el tratamiento con alendronato

OBJECTIVES: Treatment of calcium stones is based on diet and pharmacological measures such as the use of thiazides and other drugs. The aim of this study is to assess the effect of alendronate on hydrochlorothiazide on urinary calcium and bone mineral density in patients with calcium stones. METHODS: Prospective observational study involving 77 patients with relapsing calcium stones divided into 2 groups according to treatment received. Group 1: 36 patients treated with alendronate 70 mg/week; Group 2: 41 patients treated with hydrochlorothiazide 50 mg/day. All patients receive diet recommendations and fluid intake. Studied and analyzed among other variables were bone mineral density, bone turnover markers and calciuria before and after 2 years of treatment. Statistical study with SPSS 17.0, statistical significance p < 0.05. RESULTS: No statistically significant differences in the distribution by sex or age of the patients between groups. In group 1 statistically a significant decrease was observed in the b-crosslaps and improvement in bone mineral density, along with decreased urinary calcium after 2 years of treatment. In Group 2 statistically significant decrease in urinary calcium and fasting calcium/creatinine was seen, along with improvement in bone mineral density after 2 years of treatment. In group 1, there is a more obvious and significant improvement in bone mineral density compared to 2 and b-crosslaps decrease. However, in group 2 the decrease in urinary calcium and calcium/creatinine was more significant than in group 1. CONCLUSION: Treatment with thiazide decrease calciuria and produces an improvement in bone mineral density, although not in the same range as treatment with alendronate

Tratamiento médico expulsivo de la litiasis ureteral con bloqueadores adrenérgicos alfa / Expulsive medical treatment of ureteral stone with adrenergic alfa-blockers

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