Autovaccine-Based Immunotherapy: A Promising Approach for Male Recurrent Urinary Tract Infections.

BACKGROUND: Recurrent Urinary Tract Infections (UTIs) in men range from 0.9 to 2.4/1000 individuals in younger men to 7.7/1000 in those over 85, significantly impacting their quality of life. Preventive strategies include autovaccines, but limited evidence exists for males. METHODS: A prospective monocentric, open-label observational study was conducted from August 2018 to August 2021, with follow-up until August 2023 including patients with recurrent UTIs treated with immunotherapy. We evaluated the incidence rate of UTIs per year, the incidence rate of episodes after two or three rounds of the autovaccine, and quality of life measured with the IPSS-QoL questionnaire. RESULTS: A total of 49 patients fulfilled inclusion criteria. The mean age was 72 years (±15), and the median 61. The evolution of UTIs number of episodes after the autovaccine rounds: -37.74% for the first round from 5.3 to 3.3; -33.33% for the second round from 3.3 to 2.2; -45.45% for the third round from 2.2 to 1.2. The mean IPSS score improved from 10.69 to 7.27 after the treatment (32%). The mean QoL subscore enhancement was from 4.22 to 1.92 (54%). With a mean follow-up of 3 years, only nine patients required retreatment. CONCLUSION: Autovaccine treatment significantly reduced the number of UTI episodes, with a cumulative effect observed after multiple rounds of treatment, demonstrating an enhancement in QoL and with sustained effectiveness and a low need for retreatment.

A High-Efficiency Consultation Improves Urological Diagnosis in Patients with Complex LUTS-A Pilot Study.

(1) Background: The diagnosis of moderate-severe lower urinary tract symptoms (LUTS) is not easy due to the complexity of the micturition act. Sequential diagnostic tests can be time consuming due to waiting lists. Thus, we developed a diagnostic model combining all the tests in a single one-stop consultation. (2) Methods: In a prospective pilot study in patients with complex LUTS, they received all diagnostic tests (ultrasound, uroflowmetry, cystoscopy, pressure-flow study) in a single consultation and by the same doctor. Patients' results were compared with those from a 2021 paired cohort that underwent the classical sequential diagnostic pathway. (3) Results: Per patient, the high-efficiency consultation saved: 175 days of waiting, 60 min doctor time and 120 nursing assistant time and over 300 euros on average. The intervention also saved 120 patient journeys to the hospital, lowering the total carbon footprint by 145.86 kg CO2. In one-third of the patients, performing all the tests within the same consultation contributed to reaching a more appropriate diagnosis and thus more effective treatment. Patients' satisfaction was high, with good tolerability. (4) Conclusions: The high-efficiency urology consultation improves waiting times, therapeutic decisions and the degree of patient satisfaction while optimizing the use of resources and generating savings for the health system.

Efficacy and Safety of the Hexanic Extract of Serenoa repens vs. Watchful Waiting in Men with Moderate to Severe LUTS-BPH: Results of a Paired Matched Clinical Study.

We investigated changes in symptoms and quality of life (QoL) in men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving the hexanic extract of Serenoa repens (HESr) and compared results with a matched group on watchful waiting (WW). Data was from a real-world, open-label, prospective, multicenter study. This sub-group analysis included patients with moderate-to-severe symptoms receiving either the HESr 320 mg/daily for six months (HESr) or who remained untreated for LUTS/BPH (WW). Changes in urinary symptoms and QoL were measured by IPSS and BII questionnaires. Two statistical approaches (iterative matching and propensity score pairing) were used to maximize between-group comparability at baseline. Tolerability was assessed in the HESr group. After iterative matching, data for analysis was available for 783 patients (102 WW, 681 HESr). IPSS scores improved by a mean (SD) of 3.8 (4.4) points in the HESr group and by 2.2 (4.5) points in the WW group (p = 0.002). Changes in BII score were 1.8 (2.4) points and 1.0 (2.2) points, respectively (p < 0.001). Three patients (0.9%) treated with the HESr reported mild adverse effects. Moderate-severe LUTS/BPH patients treated for six months with the HESr showed greater improvements in symptoms and QoL than matched patients on WW, with a very low rate of adverse effects.

[Non- PSA serum markers for the diagnosis of PCa]. / Marcadores séricos no-PSA en el diagnóstico del cáncer de próstata.

Prostate cancer (PCa) is the most common male malignancy in our population. Over the past two decades, the prostate specific antigen (PSA) has been widely used for screening, diagnosis and monitoring of prostate cancer. Routine use of PSA has been continuing subject to controversy due to its limited specificity, which is derived from the fact that serum PSA levels are produced in a variety of non-neoplastic conditions. The shortcomings in sensitivity and specificity of PSA have promoted the search for new biomarkers to improve diagnostic performance. The ultimate goal is to get those diagnosing clinically significant prostate tumors and to individualize treatment in this disease. Among the biomarkers studied in prostate cancer we could found tissue biomarkers as well as serum or urine biomarkers. In this paper we proceed to review those serum biomarkers not related to PSA that have been published in the literature.

Marcadores séricos no-PSA en el diagnóstico del CaP / Non- PSA serum markers for the diagnosis of PCa

El cáncer de próstata (CaP) es la neoplasia del varón más común en nuestra población. Durante las dos últimas décadas, el antígeno específico prostático (PSA) se ha utilizado ampliamente para el cribado, diagnóstico y seguimiento del CaP. El uso rutinario de PSA ha sido objeto de continua controversia debido a su limitada especificidad, que se deriva del hecho de que los niveles séricos de PSA elevados se producen en una variedad de condiciones no neoplásicas. Las carencias en sensibilidad y especificidad del PSA han promovido la búsqueda de nuevos biomarcadores para mejorar el rendimiento diagnóstico. El objetivo final es conseguir el diagnóstico de aquéllos tumores de próstata clínicamente significativos y poder individualizar el tratamiento en esta enfermedad. Dentro de los biomarcadores estudiados en cáncer de próstata encontramos biomarcadores tisulares, séricos y urinarios. En el siguiente trabajo procedemos a una revisión pormenorizada de aquellos marcadores séricos no relacionados con PSA que se han publicado en la literatura

Prostate cancer (PCa) is the most common male malignancy in our population. Over the past two decades, the prostate specific antigen (PSA) has been widely used for screening, diagnosis and monitoring of prostate cancer. Routine use of PSA has been continuing subject to controversy due to its limited specificity, which is derived from the fact that serum PSA levels are produced in a variety of non-neoplastic conditions. The shortcomings in sensitivity and specificity of PSA have promoted the search for new biomarkers to improve diagnostic performance. The ultimate goal is to get those diagnosing clinically significant prostate tumors and to individualize treatment in this disease. Among the biomarkers studied in prostate cancer we could found tissue biomarkers as well as serum or urine biomarkers. In this paper we proceed to review those serum biomarkers not related to PSA that have been published in the literatura

The evolution of CT diagnosed papillae tip microcalcifications: can we predict the development of stones?

OBJECTIVES: To determine the incidence of computed tomography (CT) identifiable Randall plaques in a CT explored population; to determine the clinical relevance of this radiological finding by a 7-year follow-up; to determine a cut point to identify a population with high risk of developing calcium stone disease (SD). MATERIALS AND METHODS: Retrospective study of all patients explored by abdominal CT in our center between January and March 2005. INCLUSION CRITERIA: age 30-60 years and no SD. Papillae attenuation was measured on nonenhanced CT in Hounsfield units (HU) and the mean of all papillae was calculated. Patients were re-evaluated after 7 years to identify calcium stone formers. Anamnesis and already available CT, ultrasound, kidney, ureter, and bladder radiograph (KUB) or intravenous urography (IVU) images performed as part of their follow-up were used. In patients with no follow-up, ultrasound and KUB were to be performed. Pearson correlation, Student t-test, and the receiver operator curve were used for statistical analysis. RESULTS: A total of 362 patients fulfilled the inclusion criteria and were analyzed; 12 developed calcium SD after 7 years. A significant difference was encountered between the papillae attenuation of stone formers (SF) versus non-SF (47.2HU vs. 35.5HU, p=0.001). There was good correlation between papillae attenuation and the possibility of developing SD (R=0.87). An optimal cut point of 43HU with a sensitivity of 81% and specificity of 97%, area under the curve 0.91, separated SF and non-SF. CONCLUSION: Patients with high papillae density have a higher risk of developing SD. A cut point of 43HU could accurately be used to identify a high-risk population.

Measurement of waist circumference for retrospective studies - Prospective validation of use of CT images to assess abdominal circumference / Cómo obtener la circunferencia abdominal para estudios retrospectivos-validación prospectiva del uso de imágenes de tomografía axial computarizada para evaluar el perímetro abdominal

INTRODUCTION: To validate the use of supine position and CT images for assessing abdominal circumference (AC). METHOD: A prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September 2012.AC was measured four times: ·1. Standing. ·2. While lying on the CT table. ·3. On CT images with a skin contour line, using OsiriX software. ·4. On CT images with an ellipse perimeter formula, using RAIM Alma 2010 software. Measurements 1 and 2 were sequentially done by the same trained nurse before abdominal CT just above the iliac crest, while measurements 3 and 4 were done on the last abdominal CT slice not showing the iliac bone. Student's t tests and Q-Q and Bland-Altman plots were used for statistical analysis. RESULTS: A total of 102 patients were recruited. Mean age, 60 (35-78) years. Mean BMI, 25 (18-39) kg/m2. Mean AC, 93.2 (73-135) cm. No significant differences were found between the four ACs measured (Student's t test, P = 0.83). Q-Q and Bland-Altman plots showed good overlapping for the low and central values (73-110 cm) with a greater scatter for extremely high values. For the ellipse estimation, R2 was 0.987 with a mean error of 0.4 cm and a stretch dispersion between 1.1 and -0.3 cm. Conclusion Supine (either measured or estimated on CT images by free hand elliptical ROI or ellipse formula) and standing measurements appear to be equivalent for abdominal circumferences < 110 cm

OBJETIVO: Validar el uso de la posición supina y de imágenes de TAC para la evaluación de la circunferencia abdominal (AC). MÉTODO: Estudio prospectivo de pacientes consecutivos sometidos a TAC abdominal programada en nuestro centro entre el 17-25 de septiembre de 2012. La AC se midió 4 veces: ·1. Bipedestación. ·2. Posición supina sobre la mesa de TAC. ·3. En imágenes de TAC con una línea siguiendo el contorno de la piel. ·4. En imágenes de TAC mediante la fórmula del perímetro de la elipse. Las mediciones 1 y 2 se realizaron por el mismo enfermero de manera secuencial antes de la TAC abdominal, justo por encima de la cresta ilíaca, y las mediciones 3 y 4 en imágenes TAC, en el último corte por encima de la cresta ilíaca. Se utilizaron los test de «t» de Student, Q-Q y Bland y Altman. RESULTADOS: Se incluyeron 102 pacientes. La edad media fue de 60 años (35-78), el IMC medio de 25 kg/m2 (18-39), y la AC media de 93,2 cm (73-135). No se encontraron diferencias significativas entre los 4 AC medidos («t» de Student p = 0,83). En los análisis Q-Q y Bland-Altman se encontró para las 4 mediciones un buen solapamiento de los valores bajos y centrales (73-110 cm), con una mayor dispersión para los valores muy altos. Hubo muy buena correlación entre AC en bipedestación y estimado mediante el perímetro elíptico (R = 0,987), con media de error de 0,4 cm y dispersión de -0,3-1,1 cm. CONCLUSIÓN: La medición de la AC en bipedestación y en decúbito supino (ya sea medida o estimada en imágenes de TAC) parece ser equivalente para perímetros abdominales < 110 cm

Measurement of waist circumference for retrospective studies - prospective validation of use of CT images to assess abdominal circumference.

INTRODUCTION: To validate the use of supine position and CT images for assessing abdominal circumference (AC). METHOD: A prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September 2012. AC was measured four times: Measurements 1 and 2 were sequentially done by the same trained nurse before abdominal CT just above the iliac crest, while measurements 3 and 4 were done on the last abdominal CT slice not showing the iliac bone. Student's t tests and Q-Q and Bland-Altman plots were used for statistical analysis. RESULTS: A total of 102 patients were recruited. Mean age, 60 (35-78) years. Mean BMI, 25 (18-39) kg/m(2). Mean AC, 93.2 (73-135) cm. No significant differences were found between the four ACs measured (Student's t test, P=0.83). Q-Q and Bland-Altman plots showed good overlapping for the low and central values (73-110 cm) with a greater scatter for extremely high values. For the ellipse estimation, R(2) was 0.987 with a mean error of 0.4 cm and a stretch dispersion between 1.1 and -0.3 cm. CONCLUSION: Supine (either measured or estimated on CT images by free hand elliptical ROI or ellipse formula) and standing measurements appear to be equivalent for abdominal circumferences <110 cm.

Air cystoscopy is superior to water cystoscopy for the diagnosis of active hematuria.

PURPOSE: We evaluated the clinical use of air cystoscopy, including its possible advantages and disadvantages over water cystoscopy. MATERIALS AND METHODS: Two independent observers prospectively studied consecutive patients who underwent water cystoscopy first and then air cystoscopy at our center from May to September 2012. The indication for rigid cystoscopy in the operating room was noted independently by either observer. Findings after rigid cystoscopy were correlated with the results of flexible water and air cystoscopy using the Pearson correlation and Student t-test. RESULTS: Included in the study were 57 patients with active hematuria, of whom 36 had bladder cancer, and 257 with a history of bladder tumor. The cause of bleeding was clearly identified on water cystoscopy in 22 patients (38%), including tumors in 17 and prostate bleeding in 5, and by air cystoscopy in 49 (86%), including tumors in 32 and prostate bleeding in 17. For diagnosing bladder tumors air cystoscopy had higher sensitivity than water cystoscopy (88% vs 47%, p=0.003) and similar specificity (97% vs 100%, p=0.93). In the 295 patients without hematuria there was no difference in the indication compared to that identified on rigid cystoscopy (43 vs 43, p=1.0). Water cystoscopy revealed more small papillary tumors than air cystoscopy but the number was not significantly different (76 vs 67, p=0.26). All such implants identified on water cystoscopy alone were less than 2 mm. No complication specifically related to air cystoscopy was noted. CONCLUSIONS: We found no statistical difference between water and air cystoscopy in patients without hematuria. Air cystoscopy had higher sensitivity and specificity for diagnosing active hematuria while adding almost no specific complications to the procedure.

Abdominal computed tomography--a new tool for predicting recurrent stone disease.

PURPOSE: To evaluate whether CT-identified Randall plaques can be used to foresee the recurrence of stone disease (SD); to define a cut point that could identify a high-risk population. MATERIALS AND METHODS: A retrospective study of patients attended for SD from January 2004 to December 2009 was conducted. Study population was patients with a first episode of calcium SD that was diagnosed by abdominal CT. Papillae tip attenuation was measured in Hounsfield units (HU) on unenhanced abdominal CT images. Patients with recurrent SD were identified; t test, Pearson correlation, and receiver operating characteristic (ROC) curve analysis were used. RESULTS: A total of 543 patients were evaluated; 187 fulfilled the criteria and were included, and 49 (26.2%) had recurrent SD. Mean follow-up: 5 years (3-7 years). Papillae tip attenuation was significantly higher in the recurrent group (46.2 HU vs 40.1 HU, P=0.01) and correlated well with the possibility of developing SD (R=0.83). Attenuation >43 HU showed a ROC curve area under the curve=0.87 with sensitivity=77% and specificity=84% separating patients with a RR=8.7 of development of recurrent SD. The number of papillae >43 HU correlated with recurrent SD (RR=11.2 for ≥3 papillae vs <3 papillae with density >43 HU). CONCLUSIONS: The presence of the Randall plaques can be used as a marker for predicting SD recurrence. A cut point of 43 HU could be used to identify a high-risk population.

Síndrome de Cushing y recidiva de un cáncer de próstata con antígeno prostático específico indetectable / Cushing syndrome and prostate cancer recurrence with undetectable prostate-specific antigen

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Validation of Randall's plaque theory using unenhanced abdominal computed tomography.

OBJECTIVE: To determine whether nephrolithiasis is associated with radiographic changes in renal papillae. MATERIALS AND METHODS: We performed a prospective study comparing papillae attenuation in a stone-forming group (SFG) and a healthy stone-free control group (CG). The SFG inclusion criteria were active stone disease diagnosed by abdominal computed tomography and stone analysis showing calcium composition. For the CG, we included living kidney donors without stone disease. Papillae tip attenuation was measured using nonenhanced computed tomography scans in Hounsfield units (HUs) for an area with a mean size of 0.1 cm(2). The mean density of the 3 caliceal groups was calculated for each kidney. Student's t test was used for statistical analysis, and the receiver operating characteristic curve was used to determine a threshold separating the CG and SFG. RESULTS: A total of 134 SFG and 134 CG patients met the inclusion criteria. The SFG and CG had similar demographic characteristics. Unilateral lithiasis was encountered in 92 patients (68.6%). The mean HU density of the papillae of the affected side in the SFG was significantly greater than in the CG (43.9 HU vs 33.9 HU, P = .001). No significant difference was seen between the affected and unaffected side in the SFG (43.9 HU vs 42.9 HU, P = .56). The receiver operating characteristic analysis showed an area under the curve of 0.91, with an optimal threshold at 40 HU and a specificity of 92% and a sensitivity of 91%. CONCLUSION: The density of the renal papilla significantly increased in the SFG in both the affected and the nonaffected kidneys compared with the CG. These findings suggest the presence of calcium deposits in the papillae, validating Randall's theory.

Unenhanced CT findings can predict the development of urinary calculi in stone-free patients.

OBJECTIVES: To determine if calcium deposits in the papillae can be identified by unenhanced computed tomography (uCT) even before renal stones develop. METHODS: A retrospective review of 413 patients with calculi identified 31 patients (stone-forming group) with a history of urinary tract calculi with a calculus demonstrated by uCT and a stone-free uCT before calculi had developed. The control group (n = 31) was composed of live kidney donors with no history of calculi and a stone-free uCT. CT attenuation was measured in all CTs using two regions of interest of 0.05 cm(2) and 0.1 cm(2) over the tip and the neighbouring area of the papillae. Student's and Wilcoxon t-tests were used for comparing results in the two groups. RESULTS: The attenuation of the tip of the papilla was higher in the stone-forming group when compared to the controls after (45.2 HU versus 32.1 HU, P = 0.001) and even before frank calculi had developed (44.2 HU versus 32.1 HU, P = 0.003). There was no significant difference in papillary attenuation in the stone group before and after calculi had developed (45.2 HU versus 44.2 HU, P = 0.82). CONCLUSION: Stone-forming patients exhibit higher papillary density even before calculi develop. This could define a population at risk of developing calculi.

Quality of life of multiple sclerosis patients: translation and validation of the Spanish version of Qualiveen.

PURPOSE: Up until now there were no specific questionnaire translated into Spanish for evaluating urinary disorder specific health-related quality of life (HRQoL) associated with multiple sclerosis (MS). Qualiveen is recommended by the European Association of Urology guidelines as a tool for evaluating neurogenic lower urinary tract dysfunction. The objective was to translate the Qualiveen into Spanish, adapt it cross-culturally and validate it against the currently available tools. MATERIALS AND METHODS: A bidirectional translation of Qualiveen was undertaken by professional translators. One hundred two Spanish MS patients were sent the Qualiveen and the ICIQ-SF questionnaires twice within a month. The questionnaires were sent and received by mail and reviewed when the patients came for the scheduled visit. RESULTS: Eighty-one patients participated. The validation study showed that the Spanish version of Qualiveen has good internal consistency with Cronbach's coefficient superior to 0.80 for all the questionnaire's subdomains and also for the entire Qualiveen demonstrating high discriminative power. Also the test-retest analysis proved internal stability of the Qualiveen (kappa coefficient between 0.81 and 0.89). Finally, all the Qualiveen scores correlated with the ICIQ-SF final score. CONCLUSIONS: The Spanish version of Qualiveen functions similarly to the English language version retaining its discriminating power. It has shown it could be a valid instrument for discriminating between patients in a cross-sectional survey, as well as for measuring within subject changes over time thus evaluating the extent to which MS patients' HRQoL is impaired by urinary-related problems.