Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor.

Background: Pretreatment assessment of patients diagnosed with localized prostate cancer (PCa) is essential for therapeutic decision-making. Currently available staging systems based on prostate-specific antigen (PSA), Gleason score, and clinical stage allow for determining the prognostic characteristics of these patients. Several studies have evaluated the preoperative use of prostate-specific antigen density (PSAD) as a prognostic factor for further risk stratification. To date, the role of PSAD in this setting is still an object of debate. Objectives: The present analysis aimed to assess the predictive potential of PSAD for adverse oncological outcomes after robot-assisted radical prostatectomy (RARP) and to compare its accuracy to preoperative PSA (pPSA). Design and methods: We retrospectively reviewed 427 patients diagnosed with localized PCa who underwent RARP at a single institution between January 2015 and January 2020. Generating receiver operator characteristic (ROC) curves, calculating areas under the curves (AUCs), and using a linear regression model, we analyzed the association of PSAD and pPSA with postoperative positive surgical margins (PSM), Gleason score ⩾ 7, persistent PSA, and biochemical recurrence (BCR), with a median follow-up of 47 months. Results: PSAD showed a significant association with PSM (p < 0.0001), PSA persistence (p < 0.0001), and Gleason ⩾ 7 (p < 0.0001), without being statistically significant in predicting BCR (p = 0.098). The predictive value of PSAD was comparable to pPSA for outcomes of PSA persistence (AUC 0.727 versus 0.771) and Gleason ⩾ 7 (AUC 0.683 versus 0.649). Conclusion: PSAD is a predictive factor for postoperative oncological outcomes of PSM, Gleason score ⩾ 7, and persistence of PSA. Despite the need for further studies, PSAD could be useful as a prognostic parameter in conjunction with established staging systems.

Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor Prostate-specific antigen density (PSAD) has an established role in the diagnostic process of prostate cancer (PCa). However, controversy remains on the assessment of its value as a pretreatment prognostic factor. The aim of our study was to evaluate the predictive ability of PSAD for oncological outcomes in PCa patients treated with robot-assisted radical prostatectomy (RARP) and to compare with the value of preoperative PSA (pPSA). The present analysis showed a significant association of PSAD with positive surgical margins (PSM), Gleason Score >=7 and prostate-specific antigen (PSA) persistence after RARP. Moreover, PSAD demonstrated to perform comparably to pPSA in predicting the outcomes of clinically significant PCa (csPCa) and post-RARP PSA persistence. Therefore, PSAD is considered a preoperative predictive factor potentially useful in conjunction with other previously established prognostic criteria and clinical features.

Robotic colposacropexy. / Colposacropexia robótica.

OBJECTIVES: To review the role of robot- assisted laparoscopic colposacropexy (RALCS) as a treatment for pelvic organ prolapse (POP) accordingly with the available literature and our own experience. METHODS: We have analyzed the studies with the results of robot-assisted colposacropexy (RALCS) and others in which this technique is compared with the abdominal (ACS) and/or the laparoscopic approach (LCS), including our own series. The main data collected are surgical time, blood loss, complications, clinical outcomes, quality of life and the different costs of LCS versus RALCS. We have reviewed the last systematic reviews and meta-analysis. RESULTS: Clinical outcomes were similar within both RALCS and LCS, surgical time was a bit longer for the robot-assisted compared with laparoscopy, blood loss was similar, as complications. The costs of RALCS were significantly higher than those of LCS, although we must conseconsider that the different studies used different variables to measure them. CONCLUSIONS: Considering that comparative studies are necessary, it is reasonable to assume that RALCS is a feasible and secure technique for the treatment of POP.

Colposacropexia robótica / Robotic colposacropexy

OBJETIVOS: Revisaremos la posición actual de la colposacropexia realizada mediante laparoscopia asistida por robot como manejo de los prolapsos de órganos pélvicos (POP), aportando las distintas evidencias publicadas en las revisiones disponibles en la literatura actual y nuestra propia serie. MÉTODOS: Comparamos según las series disponibles y la propia experiencia de nuestro Servicio la técnica robótica con otros abordajes disponibles en el arsenal terapéutico actual. Se recogen los datos referentes a tiempo quirúrgico, pérdida sanguínea, complicaciones, resultados clínicos, calidad de vida y coste de las dos técnicas en las últimas revisiones sistemáticas y metanálisis publicados. RESULTADOS: Los resultados clínicos de corrección de los POP con ambos abordajes son similares, el tiempo quirúrgico sigue siendo algo mayor con el acceso robótico con una estimación de pérdida de sangre durante el procedimiento similar. La incidencia de complicaciones intra o postoperatorias también es similar en ambas técnicas. El acceso robótico sigue presentando un coste mayor que el laparoscópico. CONCLUSIONES: Aunque se precisan más estudios comparativos con los otros abordajes disponibles, se debe reconocer al abordaje robótico como una técnica factible, reproducible y segura

OBJECTIVES: To review the role of robot-assisted laparoscopic colposacropexy (RALCS) as a treatment for pelvic organ prolapse (POP) accordingly with the available literature and our own experience. METHODS: We have analyzed the studies with the results of robot-assisted colposacropexy (RALCS) and others in which this technique is compared with the abdominal (ACS) and/or the laparoscopic approach (LCS), including our own series. The main data collected are surgical time, blood loss, complications, clinical outcomes, quality of life and the different costs of LCS versus RALCS. We have reviewed the last systematic reviews and meta-analysis. RESULTS: Clinical outcomes were similar within both RALCS and LCS, surgical time was a bit longer for the robot-assisted compared with laparoscopy, blood loss was similar, as complications. The costs of RALCS were significantly higher than those of LCS, although we must consider that the different studies used different variables to measure them. CONCLUSIONS: Considering that comparative studies are necessary, it is reasonable to assume that RALCS is a feasible and secure technique for the treatment of POP

Una intervención para mejorar la adecuación de las canalizaciones desde atención primaria a un servicio de urología / An intervention to improve the adequacy of referrals from primary care to a department of urology

Objetivo: Este estudio analiza el efecto de dos intervenciones puestas en funcionamiento para mejorar la adhesión a los términos de un protocolo de derivación desde atención primaria a un servicio de urología. Material y método: El programa incluyó la activación de recursos de comunicación y la celebración de reuniones conjuntas. Los términos “adecuado” e “inadecuado” se utilizaron para diferenciar las derivaciones que se ajustaron al protocolo de las que no. Para este estudio se analizó la adecuación al protocolo antes de la activación del programa (T0) y transcurridos 6 meses desde la primera (T1) y la segunda (T2) reunión. Para analizar tendencias en la adecuación se llevó a cabo un análisis lineal de tendencias. Resultados: Se analizó la adecuación de 6.088 derivaciones. En T0, se consideró adecuado el 58% de las derivaciones. La adecuación mejoró en T1 (el 70,6 frente al 58% en T0; c2 < 0,001). En T2, el 75,4% de las derivaciones se ajustó al protocolo. En general (T0 frente a T2), se confirmó una mejoría del 17,4% en la adecuación de las derivaciones (c2 < 0,001).Además, se confirmó una tendencia temporal hacia derivaciones más adecuadas (z = 9,62; p < 0,001). Dado lo anecdótico de la utilización de los sistemas de comunicación, no fue posible un análisis matemático de su efecto en la adecuación. Conclusiones: Las actividades educativas son útiles para mejorar la adecuación de las derivaciones. Son posibles tasas estables. La activación de sistemas de comunicación puede resultar superflua si la accesibilidad está garantizada (AU)

Introduction: This study analyses the effect of two interventions implemented in order to improve adherence to the terms of a protocol for referring patients from primary care to a urology department. Material and method: A telephone counselling line for professionals was implemented, and joint training sessions were held (twice, at six-month intervals). The terms “appropriate” and “inappropriate” were used to identify referrals complying with the locally developed protocol and those that did not, respectively. Referral appropriateness at baseline (T0) was compared with that six months after the first (T1) and second (T2) meeting. Linear trend analysis was used to test for trends in adequacy across the study. Results: Appropriateness of 6,088 consecutive referrals was analysed. At T0, 58% of the referrals (2810/4841) were judged to be “appropriate”. Adequacy improved significantly at T1 (70.6% vs. 58% at T0; c2 < 0.001). At T2, 75.4% of the referrals met the terms of the protocol; the difference between results at T1 and T2 was not statistically significant (c2 = 0.06). Overall (T0 vs. T2), a 17.4% improvement was confirmed (c2 < 0.001). A trend toward more appropriate referrals was detected over time (Mantel-Haenszel test for linear trend, z = 9.62; p < 0.001). As the use of communication resources was anecdotal, mathematical analysis of its effect on adequacy could not be performed. Conclusions: Training activities are worthwhile for improving referral adequacy. Stableates over time are possible. Using communication resources may be unnecessary if accessibility is guaranteed (AU)

An intervention to improve the adequacy of referrals from primary care to a department of urology.

INTRODUCTION: This study analyses the effect of two interventions implemented in order to improve adherence to the terms of a protocol for referring patients from primary care to a urology department. MATERIAL AND METHOD: A telephone counselling line for professionals was implemented, and joint training sessions were held (twice, at six-month intervals). The terms "appropriate" and "inappropriate" were used to identify referrals complying with the locally developed protocol and those that did not, respectively. Referral appropriateness at baseline (T0) was compared with that six months after the first (T1) and second (T2) meeting. Linear trend analysis was used to test for trends in adequacy across the study. RESULTS: Appropriateness of 6,088 consecutive referrals was analysed. At T0, 58% of the referrals (2810/4841) were judged to be "appropriate". Adequacy improved significantly at T1 (70.6% vs. 58% at T0; chi2 < 0.001). At T2, 75.4% of the referrals met the terms of the protocol; the difference between results at T1 and T2 was not statistically significant (chi2 = 0.06). Overall (T0 vs. T2), a 17.4% improvement was confirmed (chi2 < 0.001). A trend toward more appropriate referrals was detected over time (Mantel-Haenszel test for linear trend, z = 9.62; p < 0.001). As the use of communication resources was anecdotal, mathematical analysis of its effect on adequacy could not be performed. CONCLUSIONS: Training activities are worthwhile for improving referral adequacy. Stable rates over time are possible. Using communication resources may be unnecessary if accessibility is guaranteed.

Utilidad del láser en el tratamiento de las estenosis uretrales / The usefulness of laser in the treatment of urethral stenosis

Introducción: La uretrotomía óptica fue introducida por Sachse (lj en 1973 y se ha comprobado una tasa de recurrencia de 75-80% a largo plazo. Esto estimuló la búsqueda de nuevas terapias con una menor incidencia de recurrencia. Se intentaron varios tipos de láser: Nd:YAG, KTP, Argón, Ho:YAG, diodo... Desde finales de los 70 diferentes tipos de láser se han venido utilizando en el tratamiento de las estenosis uretrales. Objetivo: Describir la utilidad de la energía láser en las estenosis uretrales, fundamentalmente recurrentes y analizar la experiencia existente con los diferentes tipos de láser (diodo, Nd:Yag, Holmium, KTP, Argon, etc). Métodos: Hemos realizado una revisión sistemática de la bibliografía, basada en una búsqueda en Medline y análisis detallado de los artículos seleccionados. Conclusiones: 1). El uso del láser en el tratamiento de las estenosis uretrales se revela por el momento como una alternativa válida, eficaz y segura, al menos a medio plazo, a la uretrotomía óptica; sin embargo por el momento no se ha demostrado que sea mejor que esta. 2). La elección del tratamiento es cirujano dependiente, y ninguna técnica ha mostrado claramente ser superior a las demás. 3). Se precisan estudios prospectivos a largo plazo, con un mayor número de pacientes y con mayor seguimiento. 4). La tecnología láser es cara y no está disponible en todos los centros (AU)

Introduction: Optical urethrotomy was introduced by Sachse (1) in 1973 and it has a registered long-term recurrence rate of 75-80%. This stimulated the search for new therapies with less recurrences. Several types of láser were tried: Nd:YAG, KTP, Argon, Ho:YAG, diode,... Since the end of the '70s various types of láser are being used for the treatment of ureteral stenosis. Objectives: To describe the usefulness of the láser energy in the treatment of ureteral stenosis, mainly recurrent stenosis and to analyze the current experience with various types of láser (diode, nd:yag, holmium, argon,...) Methods: We performed the systematic review of the bibliography, based on a medline search, and a detailed analysis of the selected articles. Conclusions: 1) the use of láser in the treatment of urethral stenosis is on the a valid, effective, and safe alternative option to optical urethrotomy, at least in the mid term; nevertheless, it has not demonstrated to date being better than that. 2) The election of treatment is surgeon dependent and, and no single technique has demonstrated to be clearly better than the others. 3) Prospective long-term studies with larger numbers of patients and longer follow-up are necessary . 4) láser technology is extensive and it is not available in all centers (AU)

[The usefulness of laser in the treatment of urethral stenosis]. / Utilidad del láser en el tratamiento de las estenosis uretrales.

INTRODUCTION: Optical urethrotomy was introduced by Sachse in 1973 and it has a registered long-term recurrence rate of 75-80%. This stimulated the search for new therapies with less recurrences. Several types of laser were tried: Nd:YAG, KTP, Argon, Ho:YAG, diode,... Since the end of the '70s various types of laser are being used for the treatment of ureteral stenosis. OBJECTIVES: To describe the usefulness of the laser energy in the treatment of ureteral stenosis, mainly recurrent stenosis and to analyze the current experience with various types of laser (diode, nd:yag, holmium, argon,...) METHODS: We performed the systematic review of the bibliography, based on a medline search, and a detailed analysis of the selected articles. CONCLUSIONS: 1) The use of laser in the treatment of urethral stenosis is on the a valid, effective, and safe alternative option to optical urethrotomy, at least in the mid term; nevertheless, it has not demonstrated to date being better than that. 2) The election of treatment is surgeon dependent and, and no single technique has demonstrated to be clearly better than the others. 3) Prospective long-term studies with larger numbers of patients and longer follow-up are necessary. 4) Laser technology is extensive and it is not available in all centers.

[Systematic review about the usefulness and prognostic value of the p53 oncoprotein and proliferation marker Ki-67 for upper urinary tract transitional cell carcinoma]. / Revisión sistemática sobre la utilidad y el valor pronóstico de la oncoproteína p53 y el marcador de proliferación Ki-67 en el car- cinoma de células transicionales del tracto urinario superior.

OBJECTIVES: To perform a systematic review on the expression and prognostic value of the p 53 oncoprotein and Ki 67 proliferation marker in transitional cell carcinoma of the upper urinary tract. METHODS: A systematic review of cohort, prospective and retrospective studies from 1/1/1990 to 11/24/2003 has been undertaken, performing a bibliographic search both manual and electronic in the main databases. 632 works were found using the keywords "ureter, renal and pelvis tumor", and 14 with "ureter, renal and pelvis tumor, and immunohistochemical". RESULTS: 509 patients were studied; they were selected from 7 retrospective studies about the usefulness of p53 and Ki 67 in transitional cell carcinoma of the upper urinary tract published between 1995 and 2002 (three Spanish studies, three Japanese and one North American). Each one analyzes between 37 and 121 cases, with a mean age of 66.8 years (range 63.0-74.7) and a predominance of male sex in 100% of the studies. The pyelocalyceal site was the most frequent in these series. Treatment is another issue taken into consideration in this papers, being nephroureterectomy the most frequently found. The p53 and Ki 67 percentage expression in various studies has been related to clinical and histological factors. Only 5 studies performed a multivariate analysis using Cox regression models. Three of them deal with Ki 67 and two with p53, although one of the p53 studies associates cyclin E determinations. Only two out of three studies about Ki 67 were considered evaluable, because multivariate analysis was not performed in the other one. CONCLUSIONS: 1) There are a few studies and they are very heterogeneous in terms of design, selection criteria, follow-up, and use of prognostic variables. 2) The analyzed studies establish that oncoprotein p53 and proliferation marker Ki 67 are prognostic factors for transitional cell carcinoma of the upper urinary tract, and 3) To perform a meta-analysis was deemed not indicated because of the heterogeneicity of the studies found in our search.