Bilateral obstructive uropathy secondary to giant periureteral diverticulum.

Bladder diverticula are herniations of the mucosa through the fibers of the bladder muscle connected by necks of variable amplitude. They are often asymptomatic, although they may lead to complications that require a surgical therapeutic approach. We report the case of a patient with bilateral obstructive uropathy secondary to a giant periureteral diverticulum that was treated by diverticulectomy and reimplantation of the left ureter in the bladder.

Tratamiento quirúrgico de la fractura de cuerpos cavernosos con rotura completa de uretra / Surgical treatment of corpora cavernosa fracture with complete urethral rupture

OBJETIVO: Analizar de una manera breve y concisa el diagnóstico y tratamiento de las fracturas de ambos cuerpos cavernosos y uretra.MÉTODOS: Se presenta un caso raro de fractura de ambos cuerpos cavernosos asociada a rotura completa de uretra.RESULTADO/CONCLUSIONES: El diagnóstico de las fracturas de pene puede ser realizado exclusivamente basado en la historia clínica y en los hallazgos de la exploración física. El tratamiento de elección es quirúrgico y tiene como objetivo permitir la micción y restaurar el pene a su estado original para prevenir complicaciones como la disfunción eréctil(AU)

OBJECTIVE: To analyze in a short and concise way the diagnosis and treatment of traumatic fracture of both corpora cavernosa and urethra.METHODS: We present our experience with a rare case of traumatic fracture of both corpora cavernosa associated to complete urethral rupture.RESULTS/CONCLUSIONS: The diagnosis of penile fractures can be done with the clinical history and physical examination only. Surgery is the best treatment, the main objective of which is to enable voiding and restore the anatomy of the penis to prevent complications such as erectile dysfunction(AU)

Key areas in the learning curve for robotic urological surgery: a Spanish multicentre survey.

BACKGROUND: The number of robotic-assisted procedures offered in Spain is rapidly increasing despite a lack of consensus criteria for training and credentialling. OBJECTIVE: This national multicentre study was designed to analyze the different areas of the robotic urological surgery learning curve. MATERIAL AND METHODS: A questionnaire was sent to all 13 urology units in Spain with an active robotics programme requesting information on training and problems encountered. RESULTS: In most centres (n = 11, 84.6%), training programmes were animal-based; cadavers were used at only 2 (15.4%). Proctoring in initial procedures was practiced by 12 groups (92.3%). When initiating the robotics programme, the console was shared at 8 units (61.5%). Prior experience in open and/or laparoscopic surgery was reported by 10 of the groups (76.9%), and experience in open surgery only by 2 (15.4%) or robotic surgery alone by 1 (7.7%). The procedure with which the robotics programme was started in all 13 participating units was radical prostatectomy. The number of cases needed to complete the learning curve for this procedure was 20-25 cases according to 8 (61.5%) surgery teams. CONCLUSIONS: Up until March 26, 2010, 1,692 operations, mostly radical prostatectomies, were conducted using the da Vinci robot in our country.

Surgical repair and analysis of penile fracture complications.

BACKGROUND: The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture. MATERIAL AND METHODS: From 2005 to 2009 the Urology Department of the Hospital Clínico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair. RESULTS: From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1-5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%). CONCLUSIONS: A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.

Nudo intrapiélico de la guía durante la colocación de un catéter doble J. A propósito de un caso / Guide wire knot during double J catherter insertion: Case report

OBJETIVO: Presentar un caso de formación de un bucle intrapiélico en una guía endourológica durante la colocación de un catéter doble J.MÉTODOS: Presentamos el caso de una paciente de 24 años diagnosticada de una masa pélvica que produce uropatía obstructiva, en la que se produjo un nudo en la guía del catéter doble J durante el proceso de colocación, situación que se resolvió finalmente sin recurrir a medidas agresivas. RESULTADOS: Presentamos el caso de una rara complicación de la cateterización de la vía urinaria y su solución, así como una revisión de la literatura al respecto de casos similares.CONCLUSIÓN: Los procesos de derivación endourológica de la vía urinaria no están exentos de complicaciones, de variado origen e importancia, y que pueden requerir medidas agresivas para su resolución(AU)

OBJECTIVE: To report one case of intrapyelic loop of a guide wire during double J catheter insertion.METHODS: We report the case of a 24 year-old female, with the diagnosis obstructive uropathy secondary to pelvic tumor who required double J catheter insertion for urinary diversion. A loop of the guide wire was formed during the procedure which was finally solved without aggressive measures.RESULTS: We report the case of a rare complication appeared during urinary catheter insertion procedure, as well as a review of the current literature.CONCLUSION: The use of guide wires and endourological catheters is not free of complications that may require aggressive measures to be solved(AU)

Long-term outcomes after robotic sacrocolpopexy in pelvic organ prolapse: prospective analysis.

OBJECTIVE: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. METHODS: We conducted a prospective analysis of our series of robotic sacrocolpopexy. INCLUSION CRITERIA: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. RESULTS: 31 consecutive procedures were included. Mean patient age was 65.2 (50-81) years. Mean operating room time was 186 (150-230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16-33) months. CONCLUSIONS: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.

Progression of null or mild lower urinary tract symptoms indicative of benign prostatic hyperplasia after 2 years of follow-up in non-treated men aged 40 years or older.

OBJECTIVES: After screening men aged 40 years or older for lower urinary tract symptoms (LUTS) indicative of benign prostatic hyperplasia over the years 1999 to 2000, non-treated men with an initial International Prostate Symptoms Score (I-PSS) equal to or lower than 2 were assessed 2 years later for symptom progression. METHODS: A cross-sectional study was conducted in 1999 on 1804 men aged 40 years or older who were living in Madrid. In a telephone interview sociodemographic information was requested and LUTS assessed using the I-PSS. Of 975 men with no LUTS or lower than 2 in this baseline survey, 463 were re-interviewed in 2001. The dependent variable was the change from null/mild to moderate/severe LUTS produced over 2 years. RESULTS: Over the 2-year period, the mean increase in I-PSS score was 2.20 (95% CI, 1.89-2.51). The cumulative incidence of progression from asymptomatic/mild to moderate/severe disease was 9.94% (95% CI, 7.53-13.00). In the multivariate logistic regression model men who lived in a rural setting (OR, 2.70; P = .01) and armed forces, qualified agriculture and fishing workers (OR, 4.11; P = .05) were independently associated with progression. Age and alcohol intake were also found to interact; intake of 0.01-25.99 g/day in men older than 50 years (OR, 0.28; P = .008) was related to a lower frequency of progression than the same alcohol intake in men younger than 50 years (OR, 2.03; P = .380). CONCLUSIONS: After the 2-year period, the incidence of symptom progression was 10% in men aged 40 years or older with an initial I-PSS equal to or lower than 2.

Bladder diverticulum robotic surgery: systematic review of case reports.

INTRODUCTION: We report one case of robot-assisted transperitoneal bladder diverticulectomy and perform a systematic review of published experience. PATIENT AND METHODS: Our patient was a 64-year-old male with a history of lower urinary tract symptoms secondary to benign prostatic enlargement for 6 years with recurrent urinary tract infection. Ultrasound and voiding cystourethrogram showed a 7-cm diverticulum in the posterior bladder wall. After bibliographic search in PubMed/Medline, 17 articles on laparoscopic diverticulectomy and 8 on robotic diverticulectomy were selected. RESULTS: Transperitoneal robot-assisted diverticulectomy was performed with the Da Vinci 4-arm system (Intuitive Surgical Inc., Sunnyvale, Calif., USA) without perioperative complications. Operative time was 80 min and blood loss less than 100 ml. Transurethral prostatic resection combined with Greenlight laser vaporization was performed in a second step. CONCLUSIONS: Robot-assisted bladder diverticulectomy is safe, effective, reproducible and minimally invasive. Cost is higher than for laparoscopic surgery and access to this technology is limited.

[Correlation of bladder thickness on ultrasound with clinical and urodynamic data in symptomatic benign prostatic hyperplasia]. / Correlación del grosor ecográfico vesical con los datos clínicos y urodinámicos en la hiperplasia benigna de próstata (HBP) sintomática.

OBJECTIVES: Our objective is to verify the diagnostic usefulness of ultrasound measurement of the thickness of the bladder wall, and the correlation with clinical/ urodynamic findings in patients with symptomatic BPH. METHODS: We performed a prospective cross-sectional study (cross-sectional study '') in a series of 74 males (age chi= 72.4 S = 7.1 (56-84 years) with symptomatic BPH. Patients completed the IPSS and determined the plasma level of PSAt (ng / ml). Before performing the urodynamic study, was determined by transabdominal ultrasonography (3.5 MHz transducer): prostate volume (cc) by the ellipsoid formula, and bladder wall thickness (mm) measured on the anterior bladder wall. Statistical analysis was performed using ANOVA, the Pearson correlation, and ROC curve. RESULTS: It was a significant correlation of the sonographic thickness of the bladder wall with the IPSS (p = 0001, r = 0.38) (parameter in turn highly correlated with prostate volume and PSA (p = 0.01, r = 0.62)), as well as the detrusor hyperactivity (p = 0.03, r =0.21), cut off ROC curve: 3.85 mm. Instead, it was not shown a significant correlation between the sonographic thickness of the bladder wall and the urodynamic diagnosis of obstruction (Abrams and number Griffths p = 0223, r = 0.14) or the detrusor contractile power, measured in power at peak flow (Pw) (p = 0642 r =- 0.55), nor with age (p = 0303, r = 0.12). Neither correlation was observed with other non-invasive urodynamic measures (the maximum urinary flow flowmetry (p = 0318, r = 0.12) and percentage postmicturition residual (p = 0696, r = 0.05)). CONCLUSIONS: The ultrasound measurement of bladder wall thickness, although it has not proved useful ness in our series in the diagnosis of the voiding phase (lower urinary tract obstruction and detrusor contractility impairment), on the contrary it can be introduced as a diagnostic technique for non-invasive studies in the alterations of the filling phase, in the form of detrusor hyperactivity in also patients with symptomatic BPH, and present a significant correlation with prostate growth.

Correlación del grosor ecográfico vesical con los datos clínicos y urodinámicos en la hiperplasia benigna de próstata (HBP) sintomática / Correlation of bladder thickness on ultrasound with clinical and urodynamic data in symptomatic benign prostatic hiperplasia

OBJETIVO: Nuestro objetivo es comprobar la utilidad diagnóstica de la medida del grosor ecográfico de la pared vesical, y establecer la correlación con los hallazgos clínicos y urodinámicos, en pacientes con HBP sintomática.MÉTODOS: Se realizó un estudio transversal prospectivo (“cross-sectional study”) en una serie de 74 varones, (edad χ=72,4 S=7,1 (56-84 años), con HBP sintomática. Los pacientes rellenaron el cuestionario IPSS y se determinó el nivel plasmático de PSAt (ng/ml). Antes de realizar el estudio urodinámico, se determinó mediante ecografía transabdominal (transductor de 3,5 MHz), el volumen prostático (cc) mediante la fórmula del elipsoide, y el grosor de la pared vesical (mm), medido en la cara anterior. El análisis estadístico se realizó utilizando el ANOVA, el coeficiente de correlación de Pearson, y se construyó una curva de rendimiento diagnóstico (curva ROC).RESULTADOS: Se demostró una correlación significativa del grosor ecográfico de la pared vesical con el IPSS (p=0,001; r=0,38) (parámetro a su vez altamente correlacionado con el volumen prostático y con el PSA (p=0,01, r=0,62)), así como con la hiperactividad del detrusor (p=0,03, r=0,21), punto de corte de la curva ROC: 3,85 mm. En cambio, no se demostró una correlación significativa entre el grosor ecográfico de la pared vesical y el diagnóstico urodinámico de obstrucción (número de Abrams y Griffths p=0,223, r=0,14), ni con la potencia contráctil del detrusor, medida en la potencia a flujo máximo (Pw) (p=0,642 r=-0,55), ni con la edad (p=0,303; r=0,12). Tampoco se demostró correlación con otras medidas no invasivas urodinámicas (flujo miccional máximo de la flujometría libre (p=0,318; r=0,12) y porcentaje del residuo postmiccional (p=0,696; r=0,05))(AU)

CONCLUSIONES: La medida ecográfica del grosor de la pared vesical, aunque no ha demostrado su utilidad, en nuestra serie, para el diagnóstico de la fase miccional (obstrucción del tracto urinario inferior y afectación contráctil del detrusor), sí por el contrario, puede ser introducida como técnica diagnóstica no invasiva de las alteraciones de la fase de llenado, en la forma de hiperactividad del detrusor, en los pacientes con HBP sintomática, presentando además correlación significativa con el crecimiento prostático(AU)

OBJECTIVES: Our objective is to verify the diagnostic usefulness of ultrasound measurement of the thickness of the bladder wall, and the correlation with clinical/ urodynamic findings in patients with symptomatic BPH.METHODS: We performed a prospective cross-sectional study (cross-sectional study “) in a series of 74 males (age χ= 72.4 S = 7.1 (56-84 years) with symptomatic BPH. Patients completed the IPSS and determined the plasma level of PSAt (ng / ml). Before performing the urodynamic study, was determined by transabdominal ultrasonography (3.5 MHz transducer): prostate volume (cc) by the ellipsoid formula, and bladder wall thickness (mm) measured on theanterior bladder wall. Statistical analysis was performed using ANOVA, the Pearson correlation, and ROC curve.RESULTS: It was a significant correlation of the sonographic thickness of the bladder wall with the IPSS (p = 0001, r = 0.38) (parameter in turn highly correlated with prostate volume and PSA (p = 0.01, r = 0.62)), as well as the detrusor hyperactivity (p = 0.03, r = 0.21), cut off ROC curve: 3.85 mm. Instead, it was not shown a significant correlation between the sonographic thickness of the bladder wall and the urodynamic diagnosis of obstruction (Abrams and number Griffths p = 0223, r = 0.14) or the detrusor contractile power, measured in power at peak flow (Pw) (p = 0642 r =- 0.55), nor with age (p = 0303, r = 0.12). Neither correlation was observed with other non-invasive urodynamic measures (the maximum urinary flow flowmetry (p = 0318, r = 0.12) and percentage postmicturition residual (p = 0696, r = 0.05))(AU)

CONCLUSIONS: The ultrasound measurement of bladder wall thickness, although it has not proved useful ness in our series in the diagnosis of the voiding phase (lower urinary tract obstruction and detrusor contractility impairment), on the contrary it can be introduced as a diagnostic technique for non-invasive studies in the alterations of the filling phase, in the form of detrusor hyperactivity in also patients with symptomatic BPH, and present a significant correlation with prostate growth(AU)

[High dynamic risk cystoceles]. / Cistoceles de alto riesgo urodinamico.

OBJECTIVES: To assess the bladder compliance in a series of cystoceles referred for urodynamic study. METHODS: Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200) RESULTS: All cases of cystocele whith low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract(LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual. CONCLUSIONS: Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations.

Cistocele de alto riesgo urodinámico / High dynamic risk cystoceles

OBJETIVO: Comprobar la acomodación vesical de una serie de cistoceles remitidos para estudio urodinámico.MÉTODOS: Se realizó un estudio retrospectivo de una serie de pacientes con cistocele, sometidos a historia clínica, estudio vídeo-urodinámico, RMN del suelo pélvico y tracto urinario inferior, ecografía urológica y cistoscopia. Se excluyeron los casos con disfunción neurógena e infección urinaria. La terminología siguió los criterios de la ICS, cuando no se especifica lo contrario. La serie comprende a 3.333 casos de cistocele de los que 616 casos corresponden a cistoceles grado III. Los casos con acomodación vesical disminuida correspondieron a 3 casos, esto es el 0,009 % del total (1 por mil) y el 0,5 % de los cistoceles grado III (1 por 200)RESULTADOS: Todos los casos de cistocele de baja acomodación, se asociaron a sensación de bulto en vagina y síntomas funcionales del tracto urinario inferior. Ninguna refería incontinencia urinaria a la tos. En estas pacientes también se demostraron alteraciones urodinámicas de la fase miccional tipo hipo/acontractilidad del detrusor y residuo postmiccional. Las pacientes fueron sometidas a distintas técnicas vaginales y abdominales de corrección del cistocele (con cirugía anti-incontinencia preventiva), obteniendo una desaparición del bulto en vagina, mejoría de los síntomas funcionales del tracto urinario inferior, con normalización de la acomodación vesical y contractilidad del detrusor, y con desaparición del residuo postmiccional.CONCLUSIONES: Aunque no son frecuentes los cistoceles de alto riesgo, habrá que descartarlos ante cistoceles de alto grado, que aparte de la baja acomodación vesical, presentan un detrusor hipo/acontráctil y residuo postmiccional. La cirugía correctora del cistocele, no sólo reduce el prolapso y mejora los síntomas funcionales del tracto urinario inferior, sino que normaliza las alteraciones urodinámicas(AU)

OBJECTIVES: To assess the bladder compliance in a series of cystoceles referred for urodynamic study.METHODS: Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200)RESULTS: All cases of cystocele whit low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract (LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual.CONCLUSIONS: Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations(AU)

[Multidisciplinary development of robotic surgery in a University Tertiary Hospital: Organization and outcomes]. / Desarrollo multidisciplinario de la cirugía robótica en un hospital universitario de tercer nivel: organización y resultados.

BACKGROUND: Da Vinci system (Intuitive Surgical) is a surgical telemanipulator providing many technical advantages over conventional laparoscopic approach (3-D vision, ergonomics, highly precise movements, endowrist instrumentation...) and it is currently applied to several specialties throughout the world since 2000. The first Spanish public hospital incorporating this robotic technology was Hospital Clinico San Carlos (HCSC) in Madrid, in July 2006. We present the multidisciplinary organization and clinical, research and training outcomes of the Robotic Surgery Plan developed in the HCSC. MATERIAL AND METHODS: Starting from joint management and joint scrub nurses team, General and Digestive Surgery, Urology and Gynaecology Departments were progressively incorporated into the Robotic Surgery Plan, with several procedures increasing in complexity. A number of intra and extra-hospital teaching and information activities were planned to report on the Robotic Surgery Plan. RESULTS: Between July 2006 and July 2008, 306 patients were operated on: 169 by General Surgery, 107 by Urology and 30 by Gynaecology teams. The outcomes showed feasibility and a short learning curve. The educational plan included residents and staff interested in robotic technology application. CONCLUSION: The structured and gradual incorporation of robotic surgery throughout the PCR-HCSC has made it easier to learn, to share designed infrastructure, to coordinate information activities and multidisciplinary collaboration. This preliminary experience has shown the efficiency of an adequate organization and motivated team.

Valoración urodinámica en el cáncer de próstata con incontinencia / Urodynamic evaluation in prostate cancer patients with urinary incontinence

OBJETIVO: Puesta al día sobre la valoración urodinámica en los pacientes con cáncer de próstata que presentan incontinencia.MÉTODOS: Revisión de los estudios urodinámicos en pacientes con cáncer de próstata que padecen incontinencia, sea cual sea el tratamiento efectuado.RESULTADOS: La información más numerosa sobre estudios urodinámicos en los pacientes con cáncer de próstata e incontinencia se refiere a la incontinencia post-prostatectomía. Son mucho más escasos los trabajos referidos a pacientes radiados y postratamiento farmacológico.CONCLUSIÓN: El estudio urodinámico en estos pacientes puede ayudar a aclarar los mecanismos etiopatogénicos de la incontinencia, a tratar de predecir factores de riesgo pre tratamiento y ayudar a la toma de decisión terapeútica. Son necesarios más estudios, sobre todo en pacientes sometidos a radioterapia, para evaluar con mayor profundidad los mecanismos implicados en las alteraciones del tracto urinario inferior que se producen en estos pacientes(AU)

OBJECTIVES: Update on the urodynamic evaluation in patients with prostate cancer who have incontinence.METHODS: To review the urodynamic studies in prostate cancer patients who suffer from incontinence, irrespective of the treatment carried out.RESULTS: The largest amount of information on urodynamic studies in patients with prostate cancer and incontinence was found in those with post-prostatectomy incontinence. There is much more limited work on irradiated patients, and after medical treatment.CONCLUSION: The urodynamic study in these patients may help clarify the etiopathogenic mechanisms of incontinence, try to predict risk factors before treatment and help the therapeutic decision making. Further studies are needed, especially in patients undergoing radiotherapy, to further assess the mechanisms involved in lower urinary tract abnormalities that occur in these patients(AU)

[Prognostic factors for survival in patients with transitional bladder cancer treated with radical cystectomy]. / Factores pronósticos en la supervivencia de los pacientes con carcinoma transicional de vejiga tratados con cistectomía radical.

PURPOSE: To recognize clinical and pathological variables that influence in bladder cancer specific mortality in patients with transitional bladder cancer treated with radical cystectomy. MATERIAL AND METHOD: Retrospective analysis of 333 patients with transitional bladder cancer treated with radical cystectomy. Variables included during pre-cystectomy, peri-cystectomy and post-cystectomy period were analyzed. Four groups were defined based on pathological state: a) Organ-confine bladder cancer without lymph node metastasis (pT0-2, pN0); b) Extravesical desease without lymph node metastasis (pT3-4, pN0); c) Bladder cancer with lymph node metastasis (pT0-4, pN+); d) No data of lymph node affection (pT0-4, pNx). Univariate analysis and two models of multivariate analysis were performed including the risk group as a variable in one the latest. RESULTS: Mean follow up was 52.6 +/- 51 (2-221) months with a median of 31 months. Pathological state pT0 was observed in 7.2% of the patients, 12% were pT1, 26.7% pT2, 34.5% pT3 and 10.5% pT4. Lymph node metastasis was detected in 20.7% of the patients. Lymph node metastasis increased according to pathological state rises. Five and 10 years specific survival was 57% and 54% respectively. CONCLUSIONS: Local pathological state, lymph node status and risk groups were independent predictive factors for bladder cancer specific survival. Risk group association is a reliable method to predict bladder cancer specific survival and to identify the suitable patient group to get benefit from adjuvant therapy.

Desarrollo y validación del primer cuestionario español de calidad de vida en pacientes con cáncer de próstata, basado en la percepción del paciente / Development and validation of the first spanish questionnaire of quality of life in patients with prostate cancer, based on the patient’s perception

Introducción: Asegurar calidad de vida relacionada con la salud (CVRS) durante la supervivencia del paciente con cáncer de próstata (CaP) es primordial. El desarrollo de cuestionarios específicos de CVRS facilita evaluar el impacto de la enfermedad, de su tratamiento y aspectos de percepción del paciente (preocupaciones, expectativas e intereses) que podrían pasar desapercibidos. Objetivos: Desarrollar y validar el primer cuestionario español de CVRS específico para pacientes con CaP. Materiales y métodos: El cuestionario CAVIPRES tuvo 3 fases de desarrollo: 1-generación de ítems (investigación documental, sesión de expertos y 2 grupos de discusión con pacientes), 2-reducción de ítems (encuesta auto administrada con el precuestionario y análisis clinimétrico y psicométrico), 3: validación del cuestionario (estudio observacional con 2 entrevistas al paciente que completaba los tests CAVIPRES, SF-36 y UCLA-PCI y análisis de propiedades psicométricas en términos de validez, fiabilidad y sensibilidad al cambio).Resultados: La fase 1 generó un precuestionario de 75 potenciales ítems. En la fase 2, 412 pacientes respondieron a la versión preliminar y se excluyeron 35 ítems. En la fase 3, 436 pacientes respondieron a la versión prevalidada. Se obtuvo un cuestionario de 30 ítems para investigación clínica (CAVIPRES-30). El CAVIPRES-30 mostró viabilidad (ítems perdidos <4%), factibilidad (efecto techo: 0% y efecto suelo: 0% en la puntuación global), alta fiabilidad en cuanto a consistencia interna (alfa=0,77) y a fiabilidad re-test (CCI=0,92). Hubo una buena correlación entre CAVIPRES y los tests SGF-36 y UCLA-PCI para dimensiones semejantes. Conclusión: El cuestionario CAVIPRES-30 es un instrumento factible, fiable y sensible al cambio, útil en la investigación clínica del cáncer de próstata (AU)

Background: To ensure health related quality of life (HRQOL) during the survival of patients with prostate cancer (PCa) is apriority. The development of specific HRQOL questionnaires aids to assess the disease impact, its treatment and the patient’s perception (concerns, expectations and interests) that might go unnoticed. Objectives: To develop and validate the first Spanish HRQL questionnaire specific for patients with PCa. Materials and methods: The questionnaire CAVIPRES had 3 phases of development:1.-generation of items (literature research, expert meeting and 2 focus groups with patients), 2.- reduction of items (self-administered survey with a preliminary version and clinimetric and psychometric analyses), 3: validation of the questionnaire (observational study with 2 visits where patients completed the CAVIPRES, SF-36 and UCLA-PCI tests and analysis of psychometric properties in terms of validity, reliability and sensitivity to change).Results: A preliminary list of 75 potential items was obtained in phase 1.412 patients were recruited and answered this preliminary version in phase 2. 35 items were deleted. 436 patients responded to the definitive-30-ítems obtained version (CAVIPRES-30) in Phase 3. CAVIPRES-30 showed feasibility (items lost <4%, ceiling effect: 0% floor effect: 0% in the overall score),high reliability in terms of internal consistency (alpha = 0.77) and re-test reliability (ICC = 0.92). There was a good correlation between tests CAVIPRES and SGF-36 and UCLA-PCI for similar domains. Conclusion: The questionnaire CAVIPRES-30 is a feasible, reliable and sensitive to change, useful in clinical research for prostate cancer (AU)

[Prevalence of lower urinary tract symptoms related with benign prostatic hyperplasia. Study of 1804 men aged 40 or older in Madrid]. / Prevalencia de síntomas del tracto urinario inferior relacionados con la hiperplasia benigna de próstata. Estudio de 1804 hombres de 40 años o más residentes en Madrid durante 1999-2000.

INTRODUCTION: Lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH) are present nowadays in approximately 20 to 30% of the Spanish male population from the age of 50 onwards. The purpose of this study was to assess clinical and epidemiological characteristics of patients with LUTS. METHODS: A cross-sectional study was performed, between 1999 and 2000, among 1,804 men aged 40 or older who were living in Madrid. Subjects were interviewed by telephone; socio-demographic information was requested and the presence of LUTS was assessed using the International Prostate Symptoms Score. Informed consent was requested, Association between qualitative variables was evaluated by chi2 or Fisher's test. A logistic regression model was performed to control confusion. RESULTS: Prevalence of moderate/severe LUTS was 16.6% (95%CI: 14.8-18.3). Nearly 90% of the subjects consumed olive oil, 71.5% alcohol, 63.1% did not smoke and 96.9% did not consume drugs. A 27.7% of the subjects had hypertension and 8.8% referred diabetes. Men aged 70 or older had a threefold increased frequency of serious symptoms compared to younger men (OR: 3.31; 95%CI: 2.10-5.22). Low level of studies increased this frequency by a factor of 2.2 (95%CI: 1.42-3.46) and men who consumed only seed oil had twice more serious symptoms than those who consumed olive oil (OR: 1.86; 95%CI: 0.98-3.55). CONCLUSIONS: Family history of urological diseases, age, low level of studies, hypertension, diabetes and seed oil consumption were independently associated with more serious symptoms, while medium alcohol consumption and mild smoking habit were associated with slighter symptoms.

Factores pronósticos en la supervivencia de los pacientes con carcinoma transicional de vejiga tratados con cistectomía radical / Prognostic factors for survival in patients with transitional baldder cancer treated with radical cystectomy

Objetivo: conocer las variables clínicas y patológicas que influyen en la mortalidad cáncer-específica de los pacientes con carcinoma transicional de vejiga tratados mediante cistectomía radical (CR).Material y Método: análisis retrospectivo de 333 pacientes con cáncer transicional de vejiga tratados mediante CR. Se analizaron variables agrupadas en el período pre-cistectomía, peri-cistectomía y de seguimiento. Se definieron 4 grupos de riesgo en función del estadio patológico: a) Enfermedad localizada vesical sin afectación ganglionar (pT0-2, pN0); b) Enfermedad extravesical sin afectación ganglionar (pT3-4, pN0); c) Enfermedad con afectación ganglionar (pT0-4, pN+); d) Sin datos sobre la afectación ganglionar (pT0-4, pNx). Realizamos un análisis univariante y dos modelos de multivariante con y sin los grupos de riesgo descritos. Resultados: La media de seguimiento de la serie fue de 52,6 ± 51 (2-221) meses con una mediana de 31 meses. Un 7,2%de los pacientes presentó estadio pT0, 12% pT1, 26,7% pT2, 34,5% pT3 y un 19,5% pT4. El 20,7% de los pacientes tenían metástasis ganglionares (pN+). La supervivencia cáncer específica a los 5 años fue del 57% y del 54% a los 10 años. Conclusiones: El estadio patológico, la afectación ganglionar y los grupos de riesgo se comportaron como factores predictivos independientes para la supervivencia cáncer-específica. La asociación por grupos de riesgo permite predecir de una forma más fiable el riesgo de fallecer por cáncer de vejiga e identificar a los pacientes en los que la cistectomía resulta un tratamiento insuficiente y que se podrían beneficiar de un tratamiento adyuvante (AU)

Purpose: to recognize clinical and pathological variables that influence in bladder cancer specific mortality in patients with transitional bladder cancer treated with radical cystectomy. Matherial and Method: retrospective analysis of 333 patients with transitional bladder cancer treated with radical cystectomy. Variables included during pre-cystectomy, peri-cystectomy and post-cystectomy period were analyzed. Four groups were defined based on pathological state: a) Organ-confine bladder cancer without lymph node metastasis(pT0-2, pN0); b) Extravesical desease without lymph node metastasis (pT3-4, pN0); c) Bladder cancer with lymph nodemetastasis (pT0-4, pN+); d) No data of lymph node affection (pT0-4, pNx). Univariate analysis and two models of multivariate analysis were performed including the risk group as a variable in one the latest. Results: Mean follow up was 52.6 ± 51 (2-221) months with a median of 31 months. Pathological state pT0 was observed in 7.2% of the patients, 12% were pT1, 26.7% pT2, 34.5% pT3 and 10.5% pT4. Lymph node metastasis was detected in20.7% of the patients. Lymph node metastasis increased according to pathological state rises. Five and 10 years specific survival was 57% and 54% respectively. Conclusions: Local pathological state, lymph node status and risk groups were independent predictive factors for bladder cancer specific survival. Risk group association is a reliable method to predict bladder cancer specific survival and to identify the suitable patient group to get benefit from adjuvant therapy (AU)

Prevalencia de síntomas del tracto urinario inferior relacionados con la hiperplasia benigna de próstata. Estudio de 1804 hombres de 40 años o más residentes en Madrid durante 1999-2000 / Prevalence of lower urinary tract symptoms related with benign prostatic hyperplasia. Study of 1804 men aged 40 or older in Madrid

Introducción: Los síntomas del tracto urinario inferior (STUI) asociados con la hiperplasia benigna de próstata están presentes en el 20-30% de la población española masculina de 50 años o más. El objetivo de este estudio es analizar las características clínicas y epidemiológicas de los pacientes con STUI. Material y métodos: Estudio transversal realizado entre los años 1999 y 2000 en 1804 hombres de 40 años o más residentes en Madrid. Mediante entrevista telefónica se recabó información sociodemográfica de los participantes y se evaluó la presencia de STUI mediante el I-PSS (International Prostate Symptoms Score). La asociación entre variables cualitativas se evaluó con el test χ2 o el exacto de Fisher. Se ajustó un modelo de regresión logística para evaluar la probabilidad de tener STUI moderados/severos controlando la confusión. Resultados: La prevalencia de STUI moderados/severos fue del 16,6% (IC95%: 14,8-18,3). Cerca del 90% de los participantes consumían aceite de oliva, el 71,5% alcohol, el 63,1% no fumaba y el 96,9% no consumían drogas. Un 27,7% refería hipertensión y un 8,8% diabetes. Los hombres de 70 años o más tenían una frecuencia de STUI moderados/severos tres veces mayor que los hombres más jóvenes (OR: 3,31; IC95%: 2,10-5,22). El nivel bajo de estudios, frente al alto, mostró una frecuencia 2,2 veces mayor de STUI moderados/severos (IC95%: 1,42-3,46), así como el consumo de aceite de semillas, frente al de oliva (OR: 1,86; IC95%: 0,98-3,55). Conclusiones: La historia familiar de enfermedades urológicas, la edad, el nivel bajo de estudios, la hipertensión, la diabetes y el consumo de aceite de semillas se asociaron de forma independiente con la presencia de STUI más severos, mientras el consumo moderado de alcohol y tabaco se asoció de forma independiente a la presencia de STUI leves (AU)

Introduction: Lower urinary tract symptoms (LUTS) related with benign prostatic hyperplasia (BPH) are present nowadays in approximately 20 to 30% of the Spanish male population from the age of 50 onwards. The purpose of this study was to assess clinical and epidemiological characteristics of patients with LUTS. Methods: A cross-sectional study was performed, between 1999 and 2000, among 1,804 men aged 40 or older who were living in Madrid. Subjects were interviewed by telephone; socio-demographic information was requested and the presence of LUTS was assessed using the International Prostate Symptoms Score. Informed consent was requested. Association between qualitative variables was evaluated by χ2 or Fisher’s test. A logistic regression model was performed to control confusion. Results: Prevalence of moderate/severe LUTS was 16.6% (95%CI: 14.8-18.3). Nearly 90% of the subjects consumed olive oil, 71.5% alcohol, 63.1% did not smoke and 96.9% did not consume drugs. A 27.7% of the subjects had hypertension and 8.8% referred diabetes. Men aged 70 or older had a threefold increased frequency of serious symptoms compared to younger men (OR: 3.31; 95%CI: 2.10-5.22). Low level of studies increased this frequency by a factor of 2.2 (95%CI: 1.42-3.46) and men who consumed only seed oil had twice more serious symptoms than those who consumed olive oil (OR: 1.86; 95%CI: 0.98-3.55). Conclusions: Family history of urological diseases, age, low level of studies, hypertension, diabetes and seed oil consumption were independently associated with more serious symptoms, while medium alcohol consumption and mild smoking habit were associated with slighter symptoms (AU)