Prevalencia del síndrome de déficit de testosterona entre varones con disfunción sexual: de la sospecha a la realidad. Un estudio descriptivo transversal / Prevalence of the testosterone deficiency syndrome in males with sexual dysfunction: From suspicion to reality. A descriptive transversal study

Objetivo: Analizar la prevalencia del síndrome de déficit de testosterona (SDT) entre varones asistentes a conferencias de la campaña «Los hombres cambian. A partir de los 40 toca revisión», con signos/síntomas sexuales como sospecha. Objetivo secundario: analizar la relación del déficit de testosterona con la edad, obesidad, comorbilidades, disfunción eréctil (DE) y síntomas. Presentamos los resultados del estudio piloto. Material y método: Estudio descriptivo transversal en varones ≥ 18 años. Se recogieron datos antropométricos, clínicos y de laboratorio, incluida la testosterona total. Se valoró la DE mediante el International Index of Erectile Function (IIEF-5) y los síntomas mediante la escala Aging Males’ Symptoms (AMS). Se calcularonodds ratio para déficit de testosterona (testosterona total ≤ 12 nmol/l) mediante modelos de regresión logística. Resultados: Participaron 450 varones con una edad media de 54,3 ± 9,3 años. El 53,7% presentaba DE y el 19,8% déficit de testosterona. La prevalencia de SDT bioquímico y sintomático fue del 15%. Presentar obesidad o DE dobló la probabilidad de padecer déficit de testosterona; presentar diabetes, depresión/ansiedad o enfermedad coronaria la triplicó. El déficit de testosterona se relacionó con valores inferiores de colesterol HDL y superiores de glucosa y triglicéridos, puntuaciones superiores global y de subdominios del AMS, y mayor frecuencia de síntomas globales y somáticos. Diez de los 17 síntomas fueron más frecuentes. Conclusión: La prevalencia de SDT entre varones ≥ 30 años con sospecha de disfunción sexual es del 15%. Ambos, SDT y DE, estaban infradiagnosticados. El déficit de testosterona se relacionó con un peor estado de salud y más sintomatología. Son necesarias campañas de concienciación (AU)

Objective: the main objective was to assess the prevalence the testosterone deficiency syndrome (TDS) in males attending conferences included in the campaign «Men change as they age. Over 40 it is time for a check up»” based on sexual signs/symptoms as warning signals. The secondary objective was to assess the relationship of testosterone deficiency with age, obesity, co-morbidities, erectile dysfunction (ED) and symptoms. Results of the pilot study are presented. Material and method: descriptive, crossover study among men aged≥18 years. Anthropometric, clinical and laboratory data, including total testosterone values, were collected. The ED and TDS symptoms were assessed using the International Index of Erectile Function (IIEF-5) score and the Aging Males’ Symptoms (AMS) scale, respectively. Logistic regression analyses were performed to calculate the odds ratio for testosterone deficiency (total testosterone≤12nmol/L). Results: a total of 450 men participated in the study. Mean age was 54.3±9.3 years, and ED was present in 53.7%. Prevalence of testosterone deficiency was 19.8%, and that of TDS (biochemical and symptomatic) was 15%. Having obesity or ED doubled the likelihood of testosterone deficiency, while diabetes, depression/anxiety or cardiac disease tripled it. Testosterone deficiency was significantly associated with lower HDL-cholesterol, higher fasting glucose and triglyceride values, higher global and sub-domain AMS scores, and the presence of global and somatic symptoms. Ten out of the 17 AMS symptoms were also more prevalent. Conclusion: prevalence of TDS among men aged ≥30 with a suspicion of sexual dysfunction was 15%. Both TDS and ED were under-diagnosed. Men with testosterone deficiency presented worse health status and more symptoms. Awareness campaigns are needed

Prospective urodynamic model for prediction of urinary incontinence after robot-assisted radical prostatectomy.

OBJECTIVES: To assess the preoperative urodynamic predictors of urinary incontinence (UI) 1 year after robot-assisted radical prostatectomy (RARP) and to design a nomogram capable of predicting its occurrence. MATERIALS AND METHODS: Our prospective study included 58 previously continent patients who underwent RARP, in most cases, bilateral nerve-sparing and bladder neck preservation. A urodynamic examination including a urethral pressure profile was performed preoperatively. Multivariate analysis was used to assess the predictors for the need to use 1 or more pads/day and a nomogram was constructed. RESULTS: There was a 20.6% incidence of UI at 1 year after RARP. Bladder compliance, maximum urethral closure pressure and the development of bladder outlet obstruction, correlated well with the incidence of UI on the multivariate analysis (p = 0.043, 0.001, and 0.05, respectively). CONCLUSION: Bladder compliance <27.8 ml/cm H2O, maximum urethral closure pressure <50.3 cm H2O and the bladder outlet obstruction are independent urodynamic factors correlating with UI after RARP. The new nomogram can objectively predict a patient likelihood of requiring 1 or more pads/day 1 year after RARP with a good accuracy.

Comprehensive prediction model of urinary incontinence one year following robot-assisted radical prostatectomy.

OBJECTIVES: Urinary incontinence (UI) still remains one of the major functional complications after robot-assisted radical prostatectomy (RARP). As the cause for UI is multifactorial, it is quite difficult to make a prediction preoperatively. Considering intraoperative and postoperative risk factors, besides the preoperative ones, we designed an incontinence prediction model, administered 1 month after the surgery, in order to identify incontinent patients at 1 year. PATIENTS AND METHODS: We retrospectively reviewed 244 patients who underwent RARP at our institution. Only 209 patients had sufficient data, a 1-year follow-up and were continent preoperatively. The association of UI with the risk factors was assessed by univariable and multivariable regression models. RESULTS: There was a 17.2% global UI rate at 1 year after RARP. Only age-adjusted Charlson comorbidity index, erectile function assessed by International Index of Erectile Function-5, prostate volume, nerve-sparing status and 24-hour urine loss at 1 month correlated with UI (p = 0.032, 0.009, 0.031, 0.018 and <0.001, respectively). The accuracy of the prediction model of UI was 92.8% (c-index), with an area under the curve of 91.9%. CONCLUSION: Age-adjusted Charlson comorbidity index, International Index of Erectile Function-5, prostate volume, nerve-sparing status and 24-hour urine loss at 1 month after RARP can predict an individual's risk of UI at 1 year after RARP with good accuracy. Further external validation is required in order to generalize the use of this model.

[Bilateral obstructive uropathy as clinical presentation of primary bladder lymphoma]. / Uropatía obstructiva bilateral como forma de presentación de linfoma vesical primario.

OBJECTIVE: We report the event of an atypical presentation of primary bladder lymphoma, treated in our hospital, and review the literature of such tumors, representing 0.2% of bladder tumors, being macroscopic hematuria with clots the most frequent reason for patient consultation. METHODS: We report the case of an 83 years old man who went to the emergency room because of oligoanuria of 48 hours of evolution. He was diagnosed of bladder tumor. RESULTS: The pathology turned out to be a primary bladder lymphoma cell B. CONCLUSIONS: Primary bladder lymphoma is a rare entity that presents a similar behaviour to other bladder tumors, having a good response to treatment with chemotherapy.

Uropatia obstructiva bilateral como forma de presentación de linfoma vesical primario / Bilateral obstructive uropathy as clinical presentation of primary bladder lymphoma

OBJETIVO: Dar a conocer un caso de presentación atípica de linfoma vesical primario tratado en nuestro hospital, así como revisar la bibliografía de este tipo de tumores, que representan el 0.2% de los tumores vesicales, siendo su forma de presentación más frecuente la hematuria macroscópica con coágulos.MÉTODOS: Presentamos el caso de un varón de 83 años, que acudió a Urgencias por oligoanuria de 48h de evolución, en el que se diagnosticó un tumor vesical.RESULTADO: La anatomía patológica resulto ser un linfoma vesical primario de células B.CONCLUSIONES: El linfoma vesical primario es una entidad poco frecuente, que cursa de forma indistinguible a otros tumores vesicales, presentando una buena respuesta al tratamiento con quimioterapia(AU)

OBJECTIVE: We report the event of an atypical presentation of primary bladder lymphoma, treated in our hospital, and review the literature of such tumors, representing 0,2% of bladder tumors, being macroscopic hematuria with clots the most frequent reason for patient consultation.METHODS: We report the case of an 83 years old man who went to the emergency room because of oligoanuria of 48 hours of evolution. He was diagnosed of bladder tumor.RESULTS: The pathology turned out to be a primary bladder lymphoma cell B.CONCLUSIONS: Primary bladder lymphoma is a rare entity that presents a similar behaviour to other bladder tumors, having a good response to treatment with chemotherapy(AU)

Holmium laser treatment for low grade, low stage, noninvasive bladder cancer with local anesthesia and early instillation of mitomycin C.

PURPOSE: We evaluated the results of laser photocoagulation of recurrent low stage noninvasive bladder cancer. MATERIALS AND METHODS: The study included 36 patients with a recurrent superficial papillary tumor within 1 year of endoscopic resection. Patients underwent laser photocoagulation of the recurrence under local anesthesia and sedation. They received early instillation of 40 mg mitomycin C and were discharged home without a catheter a few hours after the operation. Patients completed a visual analog scale to quantify the perceived level of pain, including 1--no pain to 10--maximum pain. Patients were reviewed after 3, 6 and 12 months to evaluate tumor recurrence. RESULTS: The mean and median visual analog scale score was 3 points (range 1 to 10). No patient had urinary infection or a catheter at hospital discharge. The incidence of recurrence at 12 months was 25%, mainly in the first 15 cases. CONCLUSIONS: Laser photocoagulation with local anesthesia and sedation is easy to perform and well tolerated. There were no complications and the recurrence rate was similar to that of transurethral resection, as calculated using the recurrence calculator of the 2006 guidelines on TaT1 (nonmuscle invasive) bladder cancer from the European Association of Urology.

[Treatment of childhood lithiasis using extracorporeal shock wave lithotripsy]. / Tratamiento de litiasis infantil mediante litotricia extracorpórea por ondas de choque.

OBJECTIVES: We evaluated the efficiency of extracorporeal shock wave lithotripsy (ESWL) in the treatment of pediatric urolithiasis, analyzing results and complications in our series. METHODS/RESULTS: 20 patients (16 males and 4 females) with ages from 2 to 17 years were evaluated. Twelve patients presented left side lithiasis (60%). The size of the stone was measured in cm2 areas. 6 cases (30%) presented with lower calyx stones and 5 cases (25.9%) with stones in the pelvic ureter. 2 patients required JJ catheter insertion. Mean number of shock waves per session was 2,650 (range: 1,000-3,800). The Dornier Lithotripter S and Dornier MFL-5000 lithotripsy machines were used in the range of 10-120 Kv and 14-23 Kv respectively. Follow-up evaluation was performed at one week and three months from treatment, including abdomen x-ray to obtain fragmentation and elimination percentages. In our series total fragmentation was achieved in 100% of the cases, without any patient with partial fragmentation (fragments > 5 mm). Elimination percentages were satisfactory, with a 65% total elimination and 30% partial elimination (residual fragments < 5 mm) within one week. One patient had no elimination at all. CONCLUSIONS: After the results obtained in our series, we consider external shock wave lithotripsy the first treatment option in cases of pediatric urolithiasis.

Tratamiento de litiasis infantil mediante litotricia extracorpórea por ondas de choque / The treatment of pediatric urolithiasis by extracorporeal shock wave lithotripsy

OBJETIVOS: Tratamos de evaluar la efectividad del tratamiento con litotricia extracorpórea por ondas de choque (LEOC) en la litiasis infantil, analizando los resultados y complicaciones de nuestra serie. MÉTODO/RESULTADOS: Se evaluaron un total de 20 pacientes (16 varones y mujeres) con edades comprendidas entre 2 y 17 años. Doce pacientes presentaron litiasis en el lado izquierdo (60 por ciento). El tamaño del cálculo fue medido en cm2 de superficie. En 6 de los casos (30 por ciento) la litiasis se localizó a nivel calicial inferior y en 5 casos (25,9 por ciento) a nivel de uréter pelviano. Dos pacientes requirieron la colocación de catéter doble J. El número de ondas medio por sesión fue de 2650 (rango: 1000-3800).Los litotriptores utilizados fueron Dornier Lithotripter S y Dornier MFL-5000, utilizando un rango de kilovoltaje de entre 10-120 en la primera y 14-23 en la segunda. Se efectuó una evaluación a la semana y a los 3 meses del tratamiento mediante radiografía simple de abdomen, obteniendo porcentajes de fragmentación y eliminación.En nuestra serie la fragmentación total alcanzó un 100 por ciento de los casos, no objetivando ningún paciente con fragmen tación parcial (fragmentos >5 mm). Los porcentajes de eliminación fueron satisfactorios con un 65 por ciento de eliminación total y una eliminación parcial (quedando fragmentos residuales <5 mm) del 30 por ciento en la primera semana. En 1 paciente no se produjo eliminación alguna. CONCLUSIONES: Tras los resultados obtenidos en nuestra serie, consideramos la LEOC como la primera opción terapéutica a realizar en caso de litiasis infantil (AU)

[Extracorporeal shock-wave lithotripsy as treatment of lithiasis in horseshoe kidney]. / Litotricia extracorpórea por ondas de choque como tratamiento de la litiasis en riñones en herradura.

OBJECTIVES: Horseshoe kidney is the most frequent renal congenital anomaly, with an estimated general population prevalence of 1/400-500. This entity may be asymptomatic for the entire lifetime, or produce symptoms from associated complications such as lithiasis, hydronephrosis, or recurrent infections. The incidence of lithiasis varies between 20% and 80% of the patients. The treatment of lithiasis in this entity is controversial due to problems derived from the anatomy of the kidney and its drainage when stones are treated with external shock wave lithotripsy (ESWL). We tried to evaluate the efficacy of ESWL treatment and to establish the ideal conditions in which this technique may be considered treatment of choice. METHODS & RESULTS: A total of 25 patients were evaluated (17 males and 8 females). Patient age ranged from 8 to 75 year old. Three patients presented with bilateral lithiasis. 27 renal units were treated, 18 of which were left (66.7%) and 7 right. Stone size was measured in cm2 of surface. Lithiasis was located at the renal pelvis in 13 cases (48.1%), and lower calyx in 7 (25.9%). Four patients required JJ stent insertion. Mean number of shock waves per session was 3480 (range 1000-4000). Two Shock wave generators were used for treatment, the Dornier lithotripter S and the Dornier MFL-5000, with a range of 10-120 KV for the first one and 14-23 KV for the second. Follow up KUB X-rays were performed at 3, 6 and 12 months to evaluate fragmentation and elimination rates. In our series total fragmentation was 85.2%, and partial fragmentation (fragments > 6 mm) 14.8%. Elimination rates were satisfactory with 37.4% total elimination, and 48.1% partial elimination (Fragments < 6 mm). 14.8% of the patients had no elimination at all. CONCLUSIONS: We consider ESWL the first therapeutic option for cases of lithiasis with a mean area 4 cm2 or less and pelvic location. In case of great lithiasic areas other therapeutic options should be considered (open surgery or percutaneous nephrolithotomy) either in monotherapy or complementary to ESWL.

Litotricia extracorpórea por ondas de choque como tratamiento de la litiasis en riñones en herradura / External shock wave lithotripsy as treatment for lithiasis in horseshoe kidney

OBJETIVO: El riñón en herradura es la anomalía congénita renal más frecuente con una prevalencia aproximada en la población de 1 de cada 400-500 personas. Dicha entidad puede cursar de forma asintomática durante toda la vida o producir sintomatología derivada de complicaciones como litiasis, hidronefrosis e infecciones recurrentes. La incidencia de litiasis oscila entre un 20 per cent y un 80 per cent de pacientes con dicha anomalía. Se trata de un entidad en la que el tratamiento de elección de las litiasis se encuentra aún en controversia debido a los problemas derivados de la propia anatomía del riñón y su drenaje cuando las litiasis son tratadas con litotricia extracorpórea por ondas de choque (LEOC).Tratamos de evaluar la efectividad del tratamiento con LEOC estableciendo las condiciones ideales en la que dicha técnica puede ser considerada de elección en el tratamiento de estos casos. MÉTODO Y RESULTADO: Se evaluaron un total de 25 pacientes (17 varones y 8 mujeres) con edades comprendidas entre 8 y 75 años. Tres pacientes presentaron litiasis bilateral. Se trataron 27 unidades renales, de las cuales 18 fueron izquierdas (66,7 per cent) y 7 derechas. El tamaño del cálculo fue medido en cm2 de superficie. En 13 de los casos (48,1 per cent) la litiasis se localizó a nivel piélico y en 7 casos (25,9 per cent) en cáliz inferior. Cuatro pacientes requirieron la colocación de catéter doble J. El número de ondas medio por sesión fue de 3480 (rango: 1000-4000).Los generadores utilizados fueron Dornier Lithotripter S y Dornier MFL-5000, utilizando un rango de kilovoltaje de entre 10-120 en la primera y 14-23 en la segunda. Se efectuó una evaluación a los 3, 6 y 12 meses del tratamiento mediante radiografía simple de abdomen, objetivando porcentajes de fragmentación y eliminación. En nuestra serie la fragmentación total alcanzó un 85,2 per cent, quedando con fragmentación parcial (fragmentos >6 mm) un 14,8 per cent.Los porcentajes de eliminación fueron satisfactorios con un 37,4 per cent de eliminación total y una eliminación parcial (fragmentos residuales <6 mm) del 48,1 per cent. En un 14,8 per cent de pacientes no se produjo eliminación alguna. CONCLUSIONES: Consideramos la LEOC como la primera maniobra terapéutica a realizar en caso de litiasis con una superficie media menor de 4 cm2 y localización piélica. En caso de grandes superficies litiásicas deberían considerarse otras opciones terapéuticas (cirugía abierta o nefrolitotomía percutánea) como monoterapia o complementarias al tratamiento con LEOC (AU)