Diagnosis of metastasis in castration-resistant prostate cancer patients: decision algorithm in imaging tests. / Diagnóstico de metástasis en pacientes con cáncer de próstata resistente a la castración: algoritmo de decisión en pruebas de imagen.

INTRODUCTION: In castration-resistant prostate cancer (CRPC), early detection of metastases is essential for the selection of treatment, and prevention of bone complications. However detecting incipient metastases remains a challenge as the conventional radiological tests (bone scintigraphy or computerised tomography) lack sufficient sensitivity. Diagnostic imaging techniques are currently available that have greater sensitivity and specificity, but are little used due to shortfalls in the recommendations. OBJECTIVE: To create an algorithm that indicates the most suitable diagnostic imaging techniques for the different M0 CRPC patient profiles based on the scientific evidence. EVIDENCE ACQUISITION: Meetings were held with eight experts in Urology, Pathological Anatomy, Radiodiagnostics and Nuclear Medicine organised by the Andalusian Association of Urology, in which the recommendations and scientific evidence on each of the diagnostic imaging techniques were reviewed. SUMMARY OF THE EVIDENCE: We present the current recommendations for the detection of metastasis in M0 CRPC patients, the patients that would benefit from early detection, and summarise the evidence to support the use of each of the new techniques. CONCLUSIONS: Techniques such as 18F-Choline PET/CT or DWWB MRI and probably open MRI have been demonstrated to have good sensitivity and specificity for patients with low PSA (<10ng/ml). Their inclusion in routine clinical practice will help improve the early detection of metastasis in CRPC patients.

[Scrotal mass presenting as giant urethral diverticulum]. / Masa escrotal como presentación de divertículo uretral gigante.

Urethral diverticulum in the male is a rare entity that may be congenital or acquired. They are common in paraplegic patients, who are prone to developing this disorder on an acquired basis because of prolonged catheterization. The most common diseases in patients with spinal cord injury are stricture, fistula and diverticula. Patients with diverticula typically present with symptoms of urinary incontinence, dysuria, perineal pain, or a mass on the ventral aspect of the genitalia or perineum. Treatment of choice is always surgical and a complete extirpation should be performed.

[The figure of the head of service (Chairman): what profile should have?]. / La figura del Jefe de Servicio: qué perfil debe de tener?

Great social-health care changes in the short term have been predicted that will seriously affect the departmental structure and care hierarchy of future hospital, universitary, public or private. The Spanish Association of Urology (AEU) wondered whether in these circumstances, in which the welfare and economic management of the hospital so-called "industrial" will dominate over other traditional aspects of the scientific hierarchy, social welfare and teaching of head Urology of service, will change his image, goals, functions, and ultimately its authority. Likewise which must be the attributes of this new generation of department heads. To this end the AEU call a roundtable requesting opinions and comments which are reflected in the enclosed text.

[Laparoscopic surgery training in pelvitrainer and virtual simulators]. / Aprendizaje de la cirugía laparoscópica en pelvitrainer y en simuladores virtuales.

Over the last few decades, there has been a rise in the number of minimally invasive techniques, such as arthroscopy, vascular radiology and our speciality, laparoscopy. Laparoscopy has resulted in a reduction in the damage caused during intervention, with the subsequent reduction in hospital stay, postoperative pain and infections. However, one disadvantage of these techniques is that they require a large investment in instruments and a long and costly training period. In the following chapter, we describe the laparoscopic training process of the medical residents from our Urology Service in the pelvitrainer and virtual simulator.

Invasive treatment trends in urinary calculi in a third level hospital.

OBJECTIVE: In the following study, we observe the progress of various invasive calculi treatments that have taken place in our hospital in the last 15 years. MATERIAL AND METHOD: We extracted data from our hospital database on patients who underwent extracorporeal shock wave lithotripsy (ESWL), endoscopic surgery and open surgery. We analyzed how the incidence of these treatments has evolved over the last 15 years. We also studied the number of publications in PubMed that reference invasive calculi treatments. RESULTS: From January 1998 to December 2012, a total of 10,947 patients were treated instrumentally for lithiasis, 9,695 of whom (90.4%) underwent ESWL and 1,034 of whom underwent endoscopic or open surgery (9.6%). The incidence of lithotripsy treatments reached its maximum in 2006, with a progressive reduction thereafter. The incidence of endoscopic surgery increased progressively until 2009 and then leveled off. We can see how in recent years there has been a clear increase in the number of studies that have covered endoscopic surgery, with a decreasing number covering ESWL. CONCLUSIONS: In our community, ESWL remains the most widely used invasive treatment for calculi. In recent years, there has been a reduction in the number of ESWL treatments and an increase in the number of endoscopic treatments, with open surgery showing a clearly decreasing trend.

American cranberry (proanthocyanidin 120 mg): its value for the prevention of urinary tracts infections after ureteral catheter placement.

INTRODUCTION: Urinary tract infection (UTI) is among the most frequent complications after urinary tract surgical procedures, mainly when catheter placement is necessary. Although the use of American cranberry has been related with a reduced risk of UTI, there is no study reporting the value of its prevention effect against catheter-associated urinary tract infections. MATERIAL AND METHODS: A prospective trial comparing UTI rate (positive urine culture) among 31 patients with double J catheter (JJ) and adding American cranberry (120 mg) in routine prophylactic therapy, and 31 patients with JJ catheter only receiving routine prophylactic therapy. RESULTS: Regarding general characteristics of the populations no significant difference among groups have been found. Only significant differences have been observed when the variables "cranberry treatment" and "dwell time of JJ catheter" were related. "Dwell time of JJ catheter" was higher in patients with UTI (35.9 compared 28.5 days [P=.03]). UTI percentage was lower in cranberry supplemented patient group (12.9 compared to 38.7% [P=.04]). CONCLUSIONS: We can conclude that American cranberry (120 mg) has an adjuvant effect in the prevention of UTI in patients with JJ catheter after surgery.

Comparative analysis of the incidence of bladder cancer in the communities of Andalusia, Catalonia and Madrid in 2011.

OBJECTIVES: To determine the incidence of bladder cancer (BC) in the autonomous communities that include the largest number of cases in the national hospital BC registry (Andalusia, Catalonia and Madrid) and report the clinical, pathological and diagnostic differences and similarities of BC in these regions. MATERIAL AND METHODS: An observational epidemiological study was performed in 2011 in 12 public hospitals with reference population areas according to the National Health System (Spain). Demographic and clinical variables were collected from new cases and relapses, with histopathologic confirmation of BC. The raw incidence rate was calculated using the number of diagnosed cases in all the participating centers compared with the aggregate total population assigned to each center. The raw rates by age and sex were obtained from the National Institute of Statistics (2011) by weighting the assigned population with the distribution by age and sex. RESULTS: The 3 autonomous communities recorded 51% of the 4285 cases included in the national registration, with relapses corresponding to 42.8% of these cases. The raw annual incidence rate for new episodes was 22.6 (95% CI: 20.7; 24.6) in Andalusia, 23.5 (95% CI: 20.9; 26.0) in Catalonia and 22.0 (95% CI: 19.9; 24.1) in Madrid. CONCLUSIONS: Except for the larger proportion of smokers and lower tumor grade of lesions in Andalusia, the 3 autonomous communities studied are similar in terms of clinical characteristics, comorbidities, patient symptoms and diagnostic processes for BC.

[Retroperitoneal cystic lymphangioma. A silent disease in adults]. / Linfangioma quístico retroperitoneal. Una patología silente en adultos.

Primary retroperitoneal tumours may arise from different structures as neural, mesodermal, urogenital ridge, or embryonic remnant tissues. Lymphangioma is a rare benign tumour of the lymphatic tissue. They result from a developmental failure of the lymphatic system. Although benign, they can compress and infiltrative vital structures. The size of the lesion is more important than its location to the symptomatology development. Intraabdominal and retroperitoneal lymphangioma are the rarest tumour, specially when occurring in adults. The tumour can occur at any age and most are asymptomatic. Preoperative diagnosis is facilitated by ultrasonography and computed tomography. In order to correctly diagnose of these neoplasms it is essential to carry on ultrasound and CT examination. Treatment of choice is always surgical and a complete extirpation should be performed, unless vital structures were are involved.

[Intraocular metastatic renal carcinoma presenting as progressive unilateral blindness]. / Carcinoma renal metastásico intraocular. Ceguera unilateral progresiva como forma de presentación.

Clear cell renal carcinoma is the most common histological type, representing 70-80% of all renal carcinomas. Metastases are already present in about 25-30% of patients at the time of diagnosis of renal cell carcinoma. Ocular metastasis is extremely rare.

[Giant stone in a Bricker urinary diversion. Obstruction uropathy as the presenting form]. / Litiasis gigante en derivación urinaria tipo Bricker. Uropatía obstructiva como forma de presentación.

Bowel is used in urological surgery to replace the bladder, either as a conduit to drain urine to the abdominal wall as a urinary stoma or refashioned to form a substitute bladder. Many factors contribute to stone formation, being urinary stasis, mucus production and bacteriuria the most important. Metabolic changes induced by exposure of segments of the alimentary tract to urine promote struvite, calcium oxalate and calcium phosphate stone formation. Generally, the majority of patients with stones in a urinary diversion can be treated with minimally invasive techniques. Open surgical removal is considered when other modality of treatments cannot be accomplished safely and expeditiously.

Treatment of gynecomastia in patients with prostate cancer and androgen deprivation.

CONTEXT: Gynecomastia, defined as benign proliferation of glandular breast tissue has a prevalence of 32% to 72% in the male. In the urology setting, it is associated to patients with prostate cancer and hormone treatment with a prevalence of 15% in the case of complete hormone blockage and 75% in monotherapy. The different options of treatment in prostate cancer have changed in recent decades. Thus, we have focused on this subject to evaluate the different therapy options of hormone manipulation induced gynecomastia in prostate cancer patients. OBJECTIVE: To synthesize the available evidence on the different therapeutic options in prostate cancer patients who develop gynecomastia due to the use of nonsteroidal antiandrogens and to generate a diagnostic algorithm and treatment. ACQUISITION OF EVIDENCE: Using the PICO type structured search strategy (Patient or problem, Intervention, Comparison, Outcome or result) in the data bases of PubMed-Medline and Cochrane, identification was made of the relevant studies related to the treatment of gynecomastia in Prostate Cancer patients treated with nonsteroidal antiandrogens. SYNTHESIS OF EVIDENCE: We have found 3 possible therapeutic options for the treatment of gynecomastia and mastodynia in patients with hormone deprivation therapy for prostate cancer. The 10Gy radiotherapy would be an option for the treatment of gynecomastia, although not all the patients need prophylactic treatment since only 50% report moderate-severe discomfort. Another option is the use of drugs such as tamoxifen 20mg/day that lead to a significant decrease in the mammary effects. CONCLUSIONS: Gynecomastia and mastodynia, given their high incidence, make the physical examination a fundamental tool for all patients before initiating treatment with antiandrogens. The use of tamoxifen 20mg/day is the best treatment and prevention option against gynecomastia and mastodynia, while in the case of long-course established gynecomastia, surgery is the gold standard.

Urodynamic assessment of bladder and urethral sphincter function before and after robot-assisted radical prostatectomy.

INTRODUCTION: Affectation of the bladder after open prostatectomy is demonstrated. Decrease in bladder capacity and bladder compliance, detrusor hyper-or hypo-activity and voiding dysfunction are observed. We propose to investigate the effects of robotic surgery on bladder and sphincter function through the comparative study of preoperative and postoperative urodynamic values 3 months after prostatectomy. MATERIAL AND METHODS: Prospective study of 32 consecutive patients undergoing robotic prostatectomy. They all underwent urodynamic study one month before the intervention and 3 months after the radical prostatectomy. RESULTS: Twenty five percent of patients undergoing robotic prostatectomy showed detrusor hyperactivity accompanied by a decrease in bladder compliance of 30.2 to 21.8 ml/cmH2O. Urethral profile showed diminished functional length of 67 to 44 mm and decreased maximum urethral pressure of 48.5 to 29.3 cmH2O. After robotic prostatectomy 21.8% of patients had detrusor hypoactivity, obstruction decreased between 28.1% to 12.5%. CONCLUSIONS: Decreased bladder compliance, detrusor hypo- or hyperactivity and obstruction improvement observed in the study of the flow pressure have been associated with sphincter involvement. It is part of the complex of lower urinary tract dysfunction that occurs after robotic prostatectomy.

[Comparison of the operation time and complications between conventional and robotic-assisted laparoscopic pyeloplasty]. / Comparación del tiempo operatorio y complicaciones entre la pieloplastia laparoscópica convencional y robótica.

OBJECTIVE: To compare the different times into which the convention and robotic-assisted laparoscopic pyeloplasty can be divided. To compare the rate of complications between both procedures. MATERIAL AND METHODS: A retrospective study was performed of the patients diagnosed of pyeloureteral junction stenosis and treated with convention and robotic laparoscopic pyeloplasty with more than one year of follow-up. All of the interventions were recorded and visualized. The different times in which the pyeloplasty can be divided were measured. All of the peri- and post-operative complications that occurred by the patients were collected. The non-parametric tests of Kolmogorov-Smirnov and Mann-Whitney U-Test for independent samples were applied using a significance level of 0.05. RESULTS: A total of 50 patients were validated. Thirty three were treated with convention laparoscopy and 17 with robotic laparoscopy. The suture time, total intervention time and time of hospital stay were lower with a statistically significant difference in the robotic-assisted pyeloplasty. The robotic pyeloplasty had a lower percentage of complications (76.5% vs 48.5%). The most frequent complications were urinary infections, in relationship to the double J. Two restenoses occurred in the conventional laparoscopy and one in the robotic-assisted. Success rate was 93.9% for the conventional laparoscopy and 94.1% for the robotic-assisted one. CONCLUSIONS: Although the success rate is similar in both procedures, the robotic pyeloplasty is a very fast procedure and has lower rates of complications than the conventional laparoscopy.

Diagnóstico de metástasis en pacientes con cáncer de próstata resistente a la castración: algoritmo de decisión en pruebas de imagen / Diagnosis of metastases in castration-resistant prostate cancer patients: Decision algorithm in imaging tests

Introducción: En el cáncer de próstata resistente a la castración (CPRC), la detección precoz de las metástasis es fundamental para la selección del tratamiento y la prevención de complicaciones óseas. Sin embargo, la detección de metástasis incipientes sigue siendo un reto dado que las pruebas radiológicas convencionales (gammagrafía ósea o tomografía computarizada) no tienen suficiente sensibilidad. Actualmente se dispone de técnicas diagnósticas por la imagen con mayor sensibilidad y especificidad cuya implantación es sin embargo escasa, debido a discrepancias en las recomendaciones. Objetivo: Elaborar un algoritmo que indique las técnicas diagnósticas por la imagen más idóneas para diferentes perfiles de pacientes con CPRC M0 según la evidencia científica. Adquisición de la evidencia: Reuniones de 8 expertos en Urología, Anatomía Patológica, Radiodiagnóstico y Medicina Nuclear organizadas por la Asociación Andaluza de Urología en las que se revisaron las recomendaciones y la evidencia científica acerca de cada una de las técnicas diagnósticas por la imagen. Síntesis de la evidencia: Se presentan las recomendaciones actuales para la detección de metástasis en pacientes con CPRC M0, los pacientes que se beneficiarían de una detección precoz y se resume la evidencia que apoya el uso de cada una de las nuevas técnicas. Conclusiones: Técnicas como la PET/TC 18F-colina o la RMCC/D y probablemente la RMA han demostrado tener una buena sensibilidad y especificidad en pacientes con PSA bajo (< 10 ng/ml). Su incorporación en la práctica clínica habitual contribuirá a mejorar la detección precoz de metástasis en pacientes con CPRC

Introduction: In castration-resistant prostate cancer (CRPC), early detection of metastases is essential for the selection of treatment, and prevention of bone complications. However detecting incipient metastases remains a challenge as the conventional radiological tests (bone scintigraphy or computerised tomography) lack sufficient sensitivity. Diagnostic imaging techniques are currently available that have greater sensitivity and specificity, but are little used due to shortfalls in the recommendations. Objective: To create an algorithm that indicates the most suitable diagnostic imaging techniques for the different M0 CRPC patient profiles based on the scientific evidence. Evidence acquisition: Meetings were held with eight experts in Urology, Pathological Anatomy, Radiodiagnostics and Nuclear Medicine organised by the Andalusian Association of Urology, in which the recommendations and scientific evidence on each of the diagnostic imaging techniques were reviewed. Summary of the evidence: We present the current recommendations for the detection of metastasis in M0 CRPC patients, the patients that would benefit from early detection, and summarise the evidence to support the use of each of the new techniques. Conclusions: Techniques such as 18F-Choline PET/CT or DWWB MRI and probably open MRI have been demonstrated to have good sensitivity and specificity for patients with low PSA (< 10 ng/ml). Their inclusion in routine clinical practice will help improve the early detection of metastasis in CRPC patients

[Prostatic enucleation with holmium laser]. / Enucleación prostática con láser holmium.

OBJECTIVES: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser. METHODS: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate (HoLEP) in our center. RESULTS: The results are: mean hospital stay 1.8 days (range 1-15 days, median 1.8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group. CONCLUSIONS: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures.

Comparación del tiempo operatorio y complicaciones entre la pieloplastia laparoscópica convencional y robótica / Comparison of the Operation Time and Complications between Conventional and Robotic-Assisted Laparoscopic Pyeloplasty

Objetivo: Comparar los diferentes tiempos en que podemos dividir la pieloplastia laparoscópica convencional y robótica. Comparar la tasa de complicaciones entre ambos procedimientos. Material y métodos: Estudio retrospectivo de los pacientes diagnosticados de estenosis de la unión pieloureteral tratados mediante pieloplastia laparoscópica convencional y robótica con más de un año de seguimiento. Se han grabado y revisualizado todas las intervenciones. Se han medido los diferentes tiempos en que podemos dividir la pieloplastia. Se han recogido todas las complicaciones peri y postoperatorias presentadas por los pacientes. Se aplicaron las pruebas no paramétricas de Kolmogorov-Smirnov y la U de Mann-Whitney para muestras independientes utilizando un nivel de significación de 0.05. Resultados: Han sido válidos 50 pacientes, 33 tratados con laparoscopia convencional y 17 mediante laparoscopia robótica. El tiempo de sutura, tiempo total de la intervención y la estancia hospitalaria han sido menores con una diferencia estadísticamente significativa en la pieloplastia robótica. La pieloplastia robótica ha presentado menor porcentaje de complicaciones (76,5% vs. 48,5%). Las complicaciones más frecuentes fueron las infecciones urinarias, en relación al doble J. Se han producido 2 reestenosis en la laparoscopia convencional y 1 en la robótica. Tasa de éxitos del 93,9% para la laparoscopia convencional y de 94,1% para la robótica. Conclusiones: Aunque la tasa de éxitos es similar en ambos procedimientos, la pieloplastia robótica es un procedimiento más rápido y tiene menos tasas de complicaciones que la laparoscopia convencional (AU)

Objective: To compare the different times into which the convention and robotic-assisted laparoscopic pyeloplasty can be divided. To compare the rate of complications between both procedures. Material and methods: A retrospective study was performed of the patients diagnosed of pyeloureteral junction stenosis and treated with convention and robotic laparoscopic pyeloplasty with more than one year of follow-up. All of the interventions were recorded and visualized. The different times in which the pyeloplasty can be divided were measured. All of the peri- and post-operative complications that occurred by the patients were collected. The non-parametric tests of Kolmogorov-Smirnov and Mann-Whitney U-Test for independent samples were applied using a significance level of 0.05. Results: A total of 50 patients were validated. Thirty three were treated with convention laparoscopy and 17 with robotic laparoscopy. The suture time, total intervention time and time of hospital stay were lower with a statistically significant difference in the robotic-assisted pyeloplasty. The robotic pyeloplasty had a lower percentage of complications (76.5% vs 48.5%). The most frequent complications were urinary infections, in relationship to the double J. Two restenoses occurred in the conventional laparoscopy and one in the robotic-assisted. Success rate was 93.9% for the conventional laparoscopy and 94.1% for the robotic-assisted one. Conclusions: Although the success rate is similar in both procedures, the robotic pyeloplasty is a very fast procedure and has lower rates of complications than the conventional laparoscopy (AU)

Tendencia en los tratamientos invasivos en la litiasis urinaria en un hospital de tercer nivel / Invasive treatment trends in urinary calculi in a third level hospital

Objetivo: En el siguiente trabajo se revisa la evolución de los diferentes tratamientos invasivos de la litiasis que se ha producido en nuestro hospital en los últimos 15 años. Material y método: Se han extraído de la base de datos de nuestro hospital los pacientes intervenidos de litotricia extracorpórea por ondas de choque (LEOC), de cirugía endoscópica y de cirugía abierta y se ha analizado cómo ha evolucionado la incidencia de estos tratamientos en los últimos 15 años. Así mismo se ha estudiado el número de publicaciones en PubMed que hacen referencia a los tratamientos invasivos de la litiasis. Resultados: Desde enero de 1998 hasta diciembre de 2012 se han tratado instrumentalmente de litiasis un total de 10.947 pacientes, 9.695 pacientes (90,4%) de LEOC y 1.034 pacientes de cirugía (9,6%), endoscópica o abierta. La incidencia de tratamientos con litotricia ha tenido su máximo en 2006, presentando posteriormente una disminución progresiva. La incidencia de la cirugía endoscópica ha aumentado progresivamente hasta 2009 para luego mantenerse. Vemos cómo en los últimos años existe un aumento claro de los artículos que tratan de cirugía endoscópica, disminuyendo los trabajos de LEOC. Conclusiones: La LEOC sigue siendo en nuestro medio el tratamiento invasivo para la litiasis más empleado. En los últimos años ha habido una disminución de los tratamientos de LEOC y un aumento de los tratamientos endoscópicos, presentando la cirugía abierta una clara tendencia a la baja

Objective: In the following study, we observe the progress of various invasive calculi treatments that have taken place in our hospital in the last 15 years. Material and method: We extracted data from our hospital database on patients who underwent extracorporeal shock wave lithotripsy (ESWL), endoscopic surgery and open surgery. We analyzed how the incidence of these treatments has evolved over the last 15 years. We also studied the number of publications in PubMed that reference invasive calculi treatments. Results: From January 1998 to December 2012, a total of 10,947 patients were treated instrumentally for lithiasis, 9,695 of whom (90.4%) underwent ESWL and 1,034 of whom underwent endoscopic or open surgery (9.6%). The incidence of lithotripsy treatments reached its maximum in 2006, with a progressive reduction thereafter. The incidence of endoscopic surgery increased progressively until 2009 and then leveled off. We can see how in recent years there has been a clear increase in the number of studies that have covered endoscopic surgery, with a decreasing number covering ESWL. Conclusions: In our community, ESWL remains the most widely used invasive treatment for calculi. In recent years, there has been a reduction in the number of ESWL treatments and an increase in the number of endoscopic treatments, with open surgery showing a clearly decreasing trend

Evaluación de la calidad de vida de la braquiterapia vs prostatectomia robotizada en pacientes con carcinoma prostático localizado. Revisión sistemática / Quality of life after brachytherapy or robot-assisted radical prostatectomy for localized prostate cancer

OBJETIVO: Efectuar una revisión sistemática de la literatura evaluando la calidad de vida y complicaciones de la prostatectomía robotizada (PR) frente a la braquiterapia permanente a bajas dosis (BPBD) en pacientes con cáncer de próstata (PCa) localizado. MÉTODOS: Se realizó una búsqueda sistematizada en Pubmed, EMBASE y Cochrane, Centre for Reviews and Dissemination, Emergency Care Research Institute, Web of Knowledge, Technology Evaluation Center, Clinical Evidence, Uptodate, Hayes y Drug Effectiveness Review Project. Se incluyeron las revisiones sistemáticas y estudios prospectivos que comparaban PR frente a BPBD en varones con PCa localizado y confirmado. La variable de resultado principal fue la calidad de vida y la variable secundaria, la tasa de complicaciones. RESULTADOS: Se incluyeron 3 revisiones sistemáticas y 4 estudios prospectivos. PR mostró mejores resultados vs BPBD para el dominio físico del cuestionario SF-12 (p <0,01) y una recuperación más rápida a las puntuaciones previas a la cirugía. BPBD mejoró las puntuaciones para la función urinaria y sexual medidas con el cuestionario UCLA-PCI vs PR durante los tres primeros años de seguimiento (p < 0,001). La tasa de pacientes con incontinencia urinaria en el primer año de seguimiento resultó a favor de BPBD (88,0% vs 84,5%, p < 0,001). No se encontraron diferencias en las puntuaciones para la función intestinal en los tres primeros años posintervención (p = 0,02). Las principales complicaciones de la BPBD fueron la toxicidad gastrointestinal (GI) y genitourinarias (GU), aunque la tasa de eventos ponderada de los estudios incluidos no fue analizada. CONCLUSIÓN: La BPBD ha mostrado una mejora en las puntuaciones para la calidad de vida relacionada con la función urinaria y sexual en pacientes con PCa localizado frente a la PR en los tres primeros años posintervención

OBJECTIVES: To perform a systematic bibliographic review of the literature assessing the quality of life and complications of robotic prostatectomy (RP) versus low-dose rate brachytherapy (LDR-BT) in patients with localized prostate cancer (PCa). METHODS: A systematic search was conducted in PubMed, EMBASE and Cochrane, Centre for Reviews and Dissemination, Emergency Care Research Institute, Web of Knowledge, Technology Evaluation Center, Clinical vidence, Uptodate, Hayes and Drug Effectiveness Review Project. Systematic reviews and prospective studies comparing RP to LDR-BT in men with localized PCa were included. The primary outcome was quality of life and the secondary endpoint complications rate. RESULTS: Three systematic reviews and four prospective studies were included. RP showed better results than LDR-BT for SF-12-physical domain (p <0.01) and faster recovery to pre-operative scores. LDR-BT improved scores for UCLAPCI questionnaire-urinary and sexual domains compared to RP during the first three years of follow-up (p <0.001). First postoperative year urinary incontinence rate was favorable for LDR-BT (88.0% vs 84.5%, p <0.001). No differences for intestinal function scores for the first three post-intervention years (p = 0.02) were found. Major complications of LDR-BT were gastrointestinal and genitourinary toxicity, although pooled weighted events rate of the studies was not analyzed. CONCLUSIONS: LDR-BT improves quality of life in terms of urinary and sexual function in patients with localized PCa vs RP during the first three years post-intervention