Prognostic Factors in De Novo Metastatic Renal Cell Carcinoma: A Report From the Latin American Renal Cancer Group.

PURPOSE: To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS: Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS: Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION: Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.

[Urinary symptoms and urodynamic findings in argentinian patients with advanced pelvic organ prolapse (POP).] / Características clínicas urinarias y hallazgos urodinámicos en pacientes argentinas con prolapso de órganos pelvianos (POP) en estadío avanzado.

OBJECTIVE: To describe urinary symptoms and urodynamic findings in patients with advanced pelvic organ prolapse. MATERIAL AND METHODS: A descriptive and retrospective evaluation with advanced POP referred for urodynamic test before surgical repair between 2015 and 2017 were included. All patients under went a urogynexam, physical examination, uroflow and urodynamics exam. Clinical features (filling and emptying symptoms, stress incontinence questionnaire (ISIQ-SF) and urodynamics (sensitivity, capacity and hyperactive detrusor, internal sphincter deficiency and voiding symptoms). RESULTS: A total of 170 patients with advanced PRP were evaluated. The most prevalent symptoms were urgency (63%), urinary stream disturbance (64%), incomplete voiding (63%). Mixt urinary incontinence wasthe most commonly reported (30%). Only 11% had anormal urodynamics exam. 36% had a hidden stress incontinence. 47% had voiding symptoms related to infravesical obstruction (30%). CONCLUSIONS: Patients with advanced POP havea wide variety of urinary symptoms such as urgency, voiding dysfunction and mixt urinary incontinence. Urodynamics studies provide relevant information regardingat the bladder dysfunction that may decrease surgical outcomes.

OBJETIVO: Describir las características clínicas urinarias y los hallazgos urodinámicos en pacientes con Prolapso de Órganos Pelvianos (POP) deestadio III-IV. MATERIAL Y MÉTODOS: Realizamos un estudio descriptivo y retrospectivo evaluando a todas las pacientes con POP avanzado (estadío 3-4) derivadas para estudio urodinámico previo a tratamiento quirúrgico entre 2015 y 2017. A todas las pacientes se les realizó un interrogatorio uroginecológico, examen físico, uroflujometría yurodinamia completa. Se evaluaron características clínicas (síntomas de llenado y de vaciado, IOE con cuestionario ISIQ-SF) y urodinámicas (sensibilidad, capacidad, presencia de detrusor hiperactivo, presencia de DEI y disfunción de vaciado). RESULTADOS: Se evaluaron 170 pacientes con POP avanzado (estadio 3-4). Los síntomas más prevalentes fueron urgencia miccional (63,5%), alteración en el chorro miccional (64,7%) y sensación de vaciado incompleto (63,5%). Entre las formas de incontinencia urinaria, la IOM fue la más evidenciada (30%). Solo 11,3% tenían estudio urodinámico normal. Se evidenció 36,5% de IOE oculta y 47,6% de disfunción de vaciado principalmente asociado a obstrucción infravesical (30%). CONCLUSIONES: Los pacientes con POP avanzado presentan una gran variedad de síntomas urinarios principalmente urgencia miccional, trastornos de vaciado e IOM. El estudio urodinámico brinda información importante en la evaluación de la disfunción vesical que puede comprometer los resultados quirúrgicos.

Características clínicas urinarias y hallazgos urodinámicos en pacientes argentinas con prolapso de órganos pelvianos (pop) en estadío avanzado / Urinary clinical characteristics and urodynamic findings in Argentine patients with advanced stage pelvic organ prolapse (POP)

Objetivo: Describir las característicasclínicas urinarias y los hallazgos urodinámicos en pacientes con Prolapso de Órganos Pelvianos (POP) deestadio III-IV.Material y métodos: Realizamos un estudio descriptivo y retrospectivo evaluando a todas las pacientes conPOP avanzado (estadío 3-4) derivadas para estudiourodinámico previo a tratamiento quirúrgico entre 2015y 2017. A todas las pacientes se les realizó un interrogatorio uroginecológico, examen físico, uroflujometría yurodinamia completa. Se evaluaron características clínicas (síntomas de llenado y de vaciado, IOE con cuestionario ISIQ-SF) y urodinámicas (sensibilidad, capacidad,presencia de detrusor hiperactivo, presencia de DEI ydisfunción de vaciado).Resultados: Se evaluaron 170 pacientes con POPavanzado (estadio 3-4). Los síntomas más prevalentesfueron urgencia miccional (63,5%), alteración en el chorro miccional (64,7%) y sensación de vaciado incompleto (63,5%). Entre las formas de incontinencia urinaria, laIOM fue la más evidenciada (30%). Solo 11,3% teníanestudio urodinámico normal. Se evidenció 36,5% deIOE oculta y 47,6% de disfunción de vaciado principalmente asociado a obstrucción infravesical (30%).Conclusiones: Los pacientes con POP avanzadopresentan una gran variedad de síntomas urinarios principalmente urgencia miccional, trastornos de vaciadoe IOM. El estudio urodinámico brinda información importante en la evaluación de la disfunción vesical quepuede comprometer los resultados quirúrgicos.(AU)

Objetive: To describe urinary symptoms and urodynamic findings in patients with advancedpelvic organ prolapse.Mmaterial and methods: A descriptive and retrospective evaluation with advanced POP referred for urodynamic test before surgical repair between 2015 and2017 were included. All patients underwent a urogynexam, physical examination, uroflow and urodynamicsexam. Clinical features (filling and emptying symptoms, stress incontinence questionnaire (ISIQ-SF) and urodynamics (sensitivity, capacity and hyperactive detrusor,internal sphincter deficiency and voiding symptoms).Results: A total of 170 patients with advanced PRPwere evaluated. The most prevalent symptoms wereurgency (63%), urinary stream disturbance (64%), incomplete voiding (63%). Mixt urinary incontinence wasthe most commonly reported (30%). Only 11% had anormal urodynamics exam. 36% had a hidden stressincontinence. 47% had voiding symptoms related to infravesical obstruction (30%).Conclusions: Patients with advanced POP havea wide variety of urinary symptoms such as urgency,voiding dysfunction and mixt urinary incontinence. Urodynamics studies provide relevant information regardingat the bladder dysfunction that may decrease surgicaloutcomes.(AU)

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group.

BACKGROUND: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

External validation of the Gleason grade group system in Argentinian patients that underwent surgery for prostate cancer.

INTRODUCTION: The aim of this article was to evaluate the effectiveness of the Gleason grade groups (GGG) system on a group of Argentinian patients with prostate cancer (PC) who underwent radical prostatectomy (RP). MATERIAL AND METHODS: We retrospectively studied 262 patients who underwent RP between 1996 and 2014. To determine the performance and validity of the GGG system, a Kaplan-Meier analysis and multivariate analysis with Cox proportional method were performed to evaluate biochemical recurrence, distance metastases and specific cancer mortality. The area under the curve (AUC) was calculated to compare new groups of degrees of the GGG system with the classical scheme of stratification into 3 groups. RESULTS: The median follow-up was 84 months. As the groups ascend, there is less confined organ disease (p <0.001) and greater extraprostatic extension (p <0.001), greater invasion of seminal vesicles (p <0.001) and greater lymph node involvement (p <0.001). The biochemical recurrence-free survival at 5 years was 68%, 55%, 22%, 9%, 0% of the 1-5 groups, respectively. Ten-years cancer-specific survival was 96%, 95%, 78%, 64%, 25% for group 1-5, respectively. In the multivariate analysis, the GGG system is presented as the only independent predictor of biochemical recurrence and specific cancer mortality. The AUC indicates that the GGG system has a higher prognostic discrimination compared to the classic 3-group system (6, 7, ≥8). CONCLUSIONS: The International Society of Urological Pathology (ISUP) GGG system is an independent predictor of biochemical recurrence and mortality from prostate cancer in patients treated with RP. The classification into 5 groups shows greater discrimination in the prognosis than the traditional Gleason classification.

Small renal masses in Latin-American population: characteristics and prognostic factors for survival, recurrence and metastasis - a multi-institutional study from LARCG database.

BACKGROUND: To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. METHODS: A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. RESULTS: PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. CONCLUSIONS: PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.

Clinical score predictive of abdominal leak point pressure (ALPP) <60 cm H2O in the urodynamics study of women with stress urinary incontinence.

OBJECTIVE: The aim of this study was to perform a score predictive of ALPP <60 cm H2O from clinical factors in women with stress urinary incontinence (SUI). STUDY DESIGN: We performed a descriptive and observational study of women referred for a urodynamic study for stress urinary incontinence. Patients were divided into three groups: ALPP: >90 cm H2O, between 60 and 90 cm H2O and <60 cm H2O. A logistic regression study was performed in order to complete clinical predictors of ALPP < 60 cm H2O. Variables that were significant in the multivariate analysis were included in the score. RESULTS: We studied 158 patients: 65 presented ALPP > 90 cm H2O, 64 between 60-90 cm H2O and 29 <60 cm H2O. In the multivariate analysis, were presented as independent predictors of ALPP < 60 cm H2O, the presence of a fixed urethra (p 0.01), empty bladder test positive (p 0.02) and presence of symptoms grade III in the classification of Stamey (p 0.03). The accuracy of the test was: score 0, 42%; score 1, 58%; score 2, 81%. Receiver Operating Characteristic (ROC) analysis for the overall cutoff points revealed an area under the curve of 0,75. CONCLUSIONS: Presence of a fixed urethra, positive empty bladder test and patients with a high degree of SUI symptoms according to the Stamey score are independent clinical predictors of intrinsic sphincter deficiency. This score could represent a useful clinical tool to predict the presence of ALPP <60 cm H2O based on clinical parameters.

[Is there a correlation between abdominal leak pressure point, incontinence severity and quality of life in patients with stress urinary incontinence?] / Existe una correlación entre punto de presión de pérdida abdominal, severidad de incontinencia y calidad de vida?

OBJECTIVES: To evaluate if there is a correlation between the abdominal leak pressure point (ALPP) of the urodynamic study and several tools to evaluate severity and quality of life associated to stress urine incontinence (SUI). METHODS: Prospective correlation study of women referred to urodynamic study for stress urinary incontinence in Centro Urológico Profesor Bengió between September 2014 and October 2015. Anamnesis, physical examination (where the SUI was demonstrated), ICIQSF urine incontinence questionnaire and incontinence impact questionnaire (IIQ-7) were performed to every patient. Uroflowmetry and complete urodynamic study were performed in all cases. Intrinsic sphincter deficiency (ISD) was defined as ALPP value ≤ 60 cm H2O. The relation between abdominal leak pressure point (ALPP) and incontinence severity measurements and quality of life (daily protectors, Sandvik score, ISIQ-SF score and short IIQ7 score) was evaluated with the Spearman coefficient correlation. RESULTS: 105 females were studied. Mean ALPP was 84 H2O cm (30-170). 21 and 84 patients had ALPP values lower and higher than 60 H2O cm respectively. There were no differences between the groups when general and demographic characteristics were evaluated. No correlation between ALPP and incontinence severity measurements was demonstrated: daily protectors (ρ 0.10; p NS), Sandvik severity score (ρ 0.05; p NS), ISIQ-SF score (ρ 0.0004; p NS) and IIQ7 Score (ρ 0.06; p NS). When patients with IED (ALPP ≤ 60 cm H2O) and those without IED DEI (ALPP > 60 cm H2O) were analyzed, there was no statistically significant difference between the groups in the comparison according to severity and quality of life questionnaires. CONCLUSIONS: In this series, there is not a significant correlation between abdominal leak pressure point and severity and quality of life measurements in patients with stress urinary incontinence.

¿Existe una correlación entre punto de presión de pérdida abdominal, severidad de incontinencia y calidad de vida? / Is there a correlation between abdominal leak pressure point, incontinence severity and quality of life in patients with stress urinary incontinence?

OBJETIVOS: Evaluar si existe correlación entre el punto de presión de pérdida abdominal (ALPP) del estudio urodinámico y diversas herramientas para evaluar severidad y calidad de vida asociada a incontinencia de orina de esfuerzo (IOE). MÉTODOS: Estudio prospectivo y de correlación en mujeres derivadas para estudio urodinámico por incontinencia de orina de esfuerzo en el Centro Urológico Profesor Bengió entre septiembre de 2014 y octubre de 2015. A todas las pacientes se les realizó interrogatorio, examen físico (donde se evidenció IOE), cuestionario de incontinencia urinaria ICIQ-SF y cuestionario de impacto de incontinencia (IIQ-7). En todos los casos se les realizó uroflujometría y estudio urodinámico completo. Se definió deficiencia esfinteriana intrínseca (DEI) cuando el valor de ALPP fue ≤ a 60 cm H2O. La relación entre punto de presión de perdida abdominal (ALPP) y las mediciones de severidad de incontinencia y calidad de vida (protectores diarios, score de Sandvik, score ISIQ-SF y score IIQ7 corto) fue evaluada con el coeficiente de correlación de Spearman. RESULTADOS: Se estudiaron 105 mujeres. La media de ALPP fue 84 cm H2O (30-170). Los pacientes con ALPP menor y mayor a 60 cm H2O fueron 21 y 84 respectivamente. No existen diferencias entre los grupos al evaluar características generales y demográficas. No evidenciamos alguna correlación entre ALPP y las mediciones de severidad de incontinencia: protectores diarios (ρ 0,10; p NS), score de severidad de Sandvik (ρ 0,05; p NS), score ISIQ-SF (ρ 0,0004; p NS) y Score IIQ7 (ρ 0,06; p NS). Al analizar los pacientes con DEI (ALPP ≤ 60 cm H2O) de aquellos sin DEI (ALPP > 60 cm H2O) no evidenciamos diferencias estadísticamente significativas entre los grupos al ser comparados según cuestionarios de severidad y calidad de vida. CONCLUSIONES: En nuestra serie, no existe una correlación significativa entre el punto de presión de pérdida abdominal y las mediciones de severidad y calidad de vida de pacientes con incontinencia de orina de esfuerzo

OBJECTIVES: To evaluate if there is a correlation between the abdominal leak pressure point (ALPP) of the urodynamic study and several tools to evaluate severity and quality of life associated to stress urine incontinence (SUI). METHODS: Prospective correlation study of women referred to urodynamic study for stress urinary incontinence in Centro Urológico Profesor Bengió between September 2014 and October 2015. Anamnesis, physical examination (where the SUI was demonstrated), ICIQSF urine incontinence questionnaire and incontinence impact questionnaire (IIQ-7) were performed to every patient. Uroflowmetry and complete urodynamic study were performed in all cases. Intrinsic sphincter deficiency (ISD) was defined as ALPP value ≤60 cm H2O. The relation between abdominal leak pressure point (ALPP) and incontinence severity measurements and quality of life (daily protectors, Sandvik score, ISIQ-SF score and short IIQ7 score) was evaluated with the Spearman coefficient correlation. RESULTS: 105 females were studied. Mean ALPP was 84 H2O cm (30-170). 21 and 84 patients had ALPP values lower and higher than 60 H2O cm respectively. There were no differences between the groups when general and demographic characteristics were evaluated. No correlation between ALPP and incontinence severity measurements was demonstrated: daily protectors (>0.10; p NS), Sandvik severity score (>0.05; p NS), ISIQ-SF score (>0.0004; p NS) and IIQ7 Score (>0.06; p NS). When patients with IED (ALPP >60 cm H2O) and those without IED DEI (ALPP > 60 cm H2O) were analyzed, there was no statistically significant difference between the groups in the comparison according to severity and quality of life questionnaires. CONCLUSIONS: In this series, there is not a significant correlation between abdominal leak pressure point and severity and quality of life measurements in patients with stress urinary incontinence

Comparación de los síntomas de vejiga hiperactiva en mujeres con incontinencia urinaria mixta e incontinencia urinaria de urgencia pura / Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence

INTRODUCCIÓN: Diversos autores han argumentado que el componente de urgencia miccional en incontinencia urinaria mixta (IOM) es diferente a la incontinencia de urgencia pura (IOU). En este caso ha sugerido que la incontinencia en IOM puede ser sobrediagnosticada en pacientes con IOE que malinterpretan su pérdida como IOU. OBJETIVOS: Evaluar las características clínicas y urodinámicas de pacientes con IOM e IOU pura. MÉTODOS: Realizamos un estudio retrospectivo de nuestra base de datos de urodinamia evaluando 450 mujeres con IOM e IOU. Se excluyeron pacientes con vejiga neurogénica, fístulas, divertículo uretral, cirugía uroginecológica previa, obstrucción infravesical conocida, radioterapia pélvica previa, infección del tracto urinario e ingesta de psicofármacos. A todos se les realizó historia clínica completa, examen físico, uroflujometría, cistometría de llenado y estudio presión flujo. RESULTADOS: No existen diferencias en relación a edad, menopausia y número de partos. La presencia de nicturia fue mayor en el grupo de IOU (66,4% vs. 46,1%, p 0,0004) al igual que el aumento de la frecuencia miccional (53,6% vs. 34,6%, p 0,0006). Al examen físico la presencia de hipermovilidad uretral e IOE fue mayor en el grupo de IOM, mientras que la presencia de trofismo vaginal reducido fue mayor en IOU. No encontramos diferencias en la sensibilidad y capacidad vesical. La presencia de detrusor hiperactivo fue de 56,4% en IOU pura vs. 33,2% de IOM (p < 0,0001). No encontramos diferencias en estudio presión flujo. CONCLUSIONES: Existen diferencias significativas en los parámetros clínicos y urodinámicos entre pacientes con IOM e IOU pura. La urgencia en pacientes con IOU pura estaría más relacionada con detrusor hiperactivo. Es probable que muchos pacientes con IOM solo tengan IOE pura, lo que llevaría a efectos positivos en los resultados de cirugía antiincontinencia

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. Objetives: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p < 0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery

[Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence.] / Comparación de los síntomas de vejiga hiperactiva en mujeres con incontinencia urinaria mixta e incontinencia urinaria de urgencia pura.

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. OBJETIVES: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.

[Impact of tumor diameter on prognosis in patients with renal cancer stage pT3a.] / Impacto pronóstico del diámetro tumoral en pacientes con cáncer renal estadío pT3a.

OBJECTIVE: To determine the prognostic impact that tumor size has in patients with pathological renal cancer stage pT3a. METHODS: Retrospective, descriptive study evaluating 261 patients diagnosed with renal cancer pathological stage pT1-3aN0M0 between 1995 and 2013. Clinical and pathological characteristics were evaluated in each group. A ROC curve was used to determine the optimum cutting point of tumor size in relation to the death by cancer. Metastasis-free survival and cancer specific survival were evaluated by the Kaplan Meier method and the differences between the groups were evaluated by the Log Rank test. Multivariate Cox regression analysis was used to evaluate the relationship of tumor size and survival of these patients. RESULTS: 261 patients were studied, 166 of which (63.6%) were Stage pT1a-b, 49 (18.8%) pT2 and 46 (17.6%) pT3a. Patients with pT3a tumors had higher proportion of symptomatic tumors (56.5% vs 33.6% p 0.003), tumor size (7.1 cm vs 5.5 cm; 0.0007), Fuhrman grade 3-4 (52.2% vs 19.1% p 0.0001), coagulative necrosis (62.8% vs 28.8% p 0.0001), distance metastasis (39.1% vs 14.9%; p 0.0001) and death by cancer (23.9% vs 8.9%; p 0.003) when compared with localized tumors (pT1-2). The ROC curve demonstrated that a cut-off point of 7cm is the ideal tumor size to determine renal cancer mortality. Metastasis-free survival at 5 year was 90% for tumors pT1a-b, 71% for pT2, 83% for pT3a <7cm and 48% for pT3a >7cm, with significant statistical differences (Log-rank test <0.001). In the multivariate analysis, only pT3a >7cm stage was an independent predictor of death by renal cancer. CONCLUSIONS: Although perirenal fat invasion and renal vein invasion (pT3a stage) are accepted as prognostic factors, to differentiate this category by tumor size could improve its predictive quality. The tumor diameter (7cm) should be applied to pT3a tumors in order to improve the accuracy of TNM system.

Impacto pronóstico del diámetro tumoral en pacientes con cáncer renal estadío pT3a / Impact of tumor diameter on prognosis in patients with renal cancer stage pT3a

OBJETIVO: Determinar el impacto pronóstico que tiene el tamaño tumoral en pacientes con cáncer renal estadio patológico pT3a. MÉTODOS: Estudio retrospectivo, descriptivo donde se evaluaron 261 pacientes con diagnóstico de cáncer renal estadío patológico pT1-3aN0M0 entre 1995 y 2013. En cada grupo se evaluaron características clínicas y patológicas. Para determinar el punto de corte óptimo del tamaño tumoral en relación a la muerte por cáncer se utilizó una curva ROC. La supervivencia libre de metástasis y la supervivencia cáncer específico, fueron evaluados por el método de Kaplan Meier y las diferencias entre los grupos fueron evaluadas por el Log Rank test. El análisis multivariado de regresión de Cox fue utilizado para evaluar la relación del tamaño tumoral en la supervivencia de estos pacientes. RESULTADOS: Se estudiaron 261 pacientes de los cuales 166 (63,6%) son estadío pT1a-b, 49 (18,8%) pT2 y 46 (17,6%) pT3a. Los pacientes con tumores pT3a presentaron mayor proporción de tumores sintomáticos (56,5% vs 33,6%; p 0,003), diámetro tumoral (7,1 cm vs 5,5 cm; p 0,0007), grado de Fuhrman 3-4 (52,2% vs 19,1%; p 0,0001), necrosis coagulativa (62,8% vs 28,8%; p 0,0001), metástasis a distancia (39,1% vs 14,9%; p 0,0001) y muerte por cáncer (23,9% vs 8,9%; p 0,003) al ser comparados con tumores localizados (pT1-2). Por medio de una curva ROC evidenciamos que un punto de corte de 7cm es el tamaño tumoral ideal para determinar mortalidad por cá7ncer renal. La supervivencia libre de metástasis a los 5 años fue 90% para tumores pT1a-b, 71% para pT2, 83% para pT3a <7cm y 48% para pT3a > 7cm, con diferencias estadísticamente significativas (Log rank test <0,001). En el análisis multivariado, evidenciamos al estadío pT3a >7cm como el único factor predictivo independiente de muerte por cáncer renal. CONCLUSIONES: Aunque la invasión de la grasa perirrenal y la invasión de la vena renal (estadío pT3a) son factores pronósticos aceptados, discriminar esta categoría según el tamaño tumoral podría mejorar su calidad predictiva. Nuestros datos demuestran que el diámetro tumoral (7cm) debería ser aplicado a tumores pT3a con el fin de mejorar la exactitud del sistema TNM

OBJECTIVE: To determine the prognostic impact that tumor size has in patients with pathological renal cancer stage pT3a. METHODS: Retrospective, descriptive study evaluating 261 patients diagnosed with renal cancer pathological stage pT1-3aN0M0 between 1995 and 2013. Clinical and pathological characteristics were evaluated in each group. A ROC curve was used to determine the optimum cutting point of tumor size in relation to the death by cancer. Metastasis-free survival and cancer specific survival were evaluated by the Kaplan Meier method and the differences between the groups were evaluated by the Log Rank test. Multivariate Cox regression analysis was used to evaluate the relationship of tumor size and survival of these patients. RESULTS: 261 patients were studied, 166 of which (63.6%) were Stage pT1a-b, 49 (18.8%) pT2 and 46 (17.6%) pT3a. Patients with pT3a tumors had higher proportion of symptomatic tumors (56.5% vs 33.6%; p 0.003), tumor size (7.1 cm vs 5.5 cm; 0.0007), Fuhrman grade 3-4 (52.2% vs 19.1%; p 0.0001), coagulative necrosis (62.8% vs 28.8%; p 0,0001), distance metastasis (39.1% vs 14.9%; p 0.0001) and death by cancer (23.9% vs 8.9%; p 0.003) when compared with localized tumors (pT1-2). The ROC curve demonstrated that a cut-off point of 7cm is the ideal tumor size to determine renal cancer mortality. Metastasis-free survival at 5 year was 90% for tumors pT1a-b, 71% for pT2, 83% for pT3a <7cm and 48% for pT3a >7cm, with significant statistical differences (Log-rank test <0.001). In the multivariate analysis, only pT3a >7cm stage was an independent predictor of death by renal cancer. CONCLUSIONS: Although perirenal fat invasion and renal vein invasion (pT3a stage) are accepted as prognostic factors, to differentiate this category by tumor size could improve its predictive quality. The tumor diameter (7cm) should be applied to pT3a tumors in order to improve the accuracy of TNM system

OAB score: A clinical model that predicts the probability of presenting overactive detrusor in the urodynamic study

ABSTRACT Purpose To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population. Materials and Methods A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD. Results presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were urgency, urgency incontinence, nocturia, absence of SUI symptoms, diabetes mellitus, reduction of vaginal trophism and bladder capacity below 150 mL. The probability of IDC diagnosis increases as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity was 71% and specificity 72%. The area under the curve of OAB score was 0.784 (p>0.001). Conclusions OAB score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone to predict overactive detrusor.

OAB score: a clinical model that predicts the probability of presenting overactive detrusor in the urodynamic study.

PURPOSE: To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population. MATERIALS AND METHODS: A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD. RESULTS: presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were urgency, urgency incontinence, nocturia, absence of SUI symptoms, diabetes mellitus, reduction of vaginal trophism and bladder capacity below 150 mL. The probability of IDC diagnosis increases as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity was 71% and specificity 72%. The area under the curve of OAB score was 0.784 (p>0.001). CONCLUSIONS: OAB score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone to predict overactive detrusor.

Evaluation of microvascular invasion as a prognostic factor in the progression of non-metastatic renal cancer.

INTRODUCTION: The aim of this study was to describe the prognostic impact of microvascular invasion (MVI) in patients with non-metastatic renal cell cancer. MATERIAL AND METHODS: We carried out a retrospective, descriptive and analytical study of patients with non-metastatic renal cell carcinoma who had undergone a radical or partial nephrectomy. Patients were divided according to the presence of MVI. In each group, clinical and pathological characteristics were evaluated. Metastasis-free and cancer-specific survival was evaluated by the Kaplan Meier method. The multivariate analysis was performed with Cox proportional method in order to predict risk factors of metastasis and cancer-specific mortality. RESULTS: A total of 221 patients with a median of 40-month long follow-up were evaluated. Patients with MVI+ were 40 (18%) while those with MVI - were 181 (82%). In the univariate analysis, the presence of MVI had a strong correlation with symptomatic tumors (OR 3.56; p 0.0003), tumor size (OR 12.08; p <0.0001), nuclear grade (OR 6.99; p <0.0001), pathological stage (OR 35.8; p <0.0001), distance metastasis (OR 4.16; p 0.0001), and death by cancer (OR 4.7; p 0.0004). However, in the multivariate analysis it is not presented as an independent predictor of metastasis (HR 0.45; p 0.11) or cancer-specific mortality (HR 0.93; p 0.91). CONCLUSIONS: In our series, MVI is associated with unfavorable tumors characteristics. In spite of this, it does not seem to be an independent predictor for metastasis and death by non-metastatic renal cancer.

Impacto de la rehabilitación del piso pelviano en la calidad de vida de mujeres con incontinencia urinaria / Impact of Pelvic Floor Rehabilitation on the Quality of Life of Women with Urinary Incontinence

Objetivos: Evaluar el impacto en la calidad de vida de mujeres con diversos tipos de incontinencia urinaria, en quienes se realizó un programa de entrenamiento de la musculatura del piso pelviano (EMPP). Materiales y métodos: Se llevó a cabo un estudio retrospectivo, descriptivo y analítico que evaluó a mujeres con incontinencia urinaria derivadas al Centro Urológico Profesor Bengió para realizar rehabilitación del piso pelviano entre enero de 2014 y diciembre de 2015. Todas las pacientes recibieron EMPP como primera línea de tratamiento. La calidad de vida fue evaluada mediante cuestionarios validados, entre los que se realizó UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) versión corta e IQoL (Incontinence Quality of Life). Las variables continuas fueron comparadas a través de pruebas pareadas de T test y las categóricas por el método de chi cuadrado (X2 ). Las puntuaciones fueron evaluadas previo y posterior al EMPP. Se definió una p<0,05 como estadísticamente significativa. Resultados: La población en estudio se remitió a 82 pacientes. La mejoría subjetiva expresada por las pacientes en una escala de 0-10 fue de 6,33 (desvío estándar [DE]=2,42) con una mediana de 7. En la población general existe una declinación en el cuestionario UDI-6 (-2,6; p<0,0001), IIQ-7 (-2,4; p=0,0001) y un aumento en IQoL (11,35; p<0,0001). En los diferentes tipos de incontinencia urinaria (esfuerzo, urgencia y mixta) también se observó una mejoría individual en todos los cuestionarios en cada tipo de incontinencia urinaria, excepto en el cuestionario IQoL (p=0,34) en pacientes con incontinencia de orina de esfuerzo. Conclusiones: El EMPP representa una terapia no invasiva efectiva en el tratamiento de diversas formas de incontinencia de orina, produciendo un impacto favorable en la calidad de vida de mujeres que padecen esta patología.(AU)

Objectives: To assess the impact on the quality of life in women with different types of urinary incontinence, who was a training of the musculature of the pelvic floor muscle (TMPP) program. Materials and methods: Was a retrospective, descriptive and analytical study evaluated women with urinary incontinence derived for rehabilitation of pelvic floor between January 2014 and December 2015. All patients received TMPP as first line treatment. Quality of life was evaluated performing validated questionnaires, which was carried out: UDI-6 (Urogenital Distress Index), IIQ-7 (Incontinence Impact Questionnaire) short version and IQoL (Incontinence Quality of Life). Continuous variables were compared through the categorical and paired T test tests by chi square (X2 ) method. Scores were assessed pre and post the TMPP. Defined a p<0.05 as statistically significant. Results: The study population was referred to 82 patients. Subjective improvement expressed by patients on a scale of 0-10 was 6.33 (standard deviation [SD]=2.42) with a median of 7. In the general population, there is a decline in the UDI-6 questionnaire (-2.6; p<0.0001), IIQ-7 (-2.4; p=0.0001) and an increase in the IQoL (11.35; p<0.0001). In the different types of urinary incontinence (stress, urgency and mixed) also find an individual improvement in all the questionnaires in each type of urinary incontinence, except in questionnaire IQoL (p=0.34) in patients who are stress urinary incontinence. Conclusions: The TMPP represents a therapy effective non-invasive in the treatment of various forms of urinary incontinence producing a positive impact on the quality of life of women living with this disease.(AU)

¿Existen diferencias clínicas, patológicas y evolutivas del cáncer renal en relación con la edad? / Are there Clinical, Pathological and Evolutionary Differences in Renal Cancer Related to Age?

Objetivos: Evaluar las características clínicas, patológicas y evolutivas en diferentes grupos etarios con cáncer renal. Materiales y métodos: Se llevó a cabo un análisis retrospectivo, descriptivo y analítico de 269 pacientes con carcinoma de células renales. Los pacientes fueron divididos en tres grupos de acuerdo con la edad al momento del diagnóstico: <50 años, entre 50 y 65 años y >65 años. En cada grupo se evaluaron características clínicas (edad, sexo, presencia de manifestaciones clínicas), patológicas (diámetro tumoral, tipo histológico, estadío patológico [TNM 2009], grado histológico, presencia de necrosis coagulativa, invasión microvascular, presencia de elementos sarcomatoides, compromiso de la grasa periférica, compromiso vascular macroscópico de vena renal o cava inferior e invasión ganglionar) y presencia de metástasis a distancia al diagnóstico. El análisis univariado de las variables categóricas fue realizado por el método de chi cuadrado o test de Fischer según correspondiera; las variables continuas fueron calculadas según el test de Student. Los puntos principales del trabajo, la sobrevida libre de metástasis y la sobrevida cáncer-específica fueron evaluados mediante el método de Kaplan-Meier y las diferencias entre los grupos fueron evaluadas por el Log-Rank test. Resultados: De los 269 pacientes estudiados, 40 (14,88%) corresponden a <50 años, 136 (50,55%) corresponden a pacientes entre 50 y 65 años y 93 (34,57%) corresponden a pacientes >65 años de edad. No existieron diferencias significativas al evaluar variables clínicas. Los pacientes <50 años presentaron mayor número de nefrectomías parciales (p=0,04), menor grado histológico (p=0,05), necrosis coagulativa (p=0,002), infiltración de la grasa periférica (p=0,02) y compromiso ganglionar (p=0,05). La sobrevida libre de metástasis a 5 años en pacientes <50 años fue del 95%; en los grupos entre 50-65 años y >65 años fue del 70% y el 71%, respectivamente, con diferencias significativas (Log-Rank test=0,004). De la misma manera, al comparar la sobrevida cáncerespecífica a 5 años entre los grupos se pudo evidenciar que las diferencias también fueron significativas a favor de pacientes <50 años (<50 años del 98%, 50-65 años del 79% y >65 años del 83%; Log-Rank test=0,02). Conclusiones: En nuestra serie, los pacientes >50 años de edad se asociaron a características patológicas y evolutivas desfavorables al ser comparados con pacientes de menor edad. Sin embargo, creemos que el seguimiento no debiera limitarse exclusivamente a la edad, sino que debiera incluir el resultado de todas las variables pronósticas de malignidad en cáncer renal (AU)

Objectives: To evaluate clinical, pathological and evolutionary characteristics in different age groups with renal cancer. Materials and methods: A retrospective, descriptive and analytics analysis of 269 patients with renal cell cancer was made. Patients were divided in three groups according to age at the moment of diagnosis: <50 years old, between 50 y 65 years old and >65 years old. In each group clinical (age, sex, presence of clinical manifestations), pathological (tumor diameter, histological type, pathological stage (TNM2009), histological grade, presence of coagulative necrosis, microvascular invasion, presence of sarcomatoid elements, peripheral fat compromise, renal vein or inferior cava vein macroscopic vascular compromise, and nodes invasion) characteristics and presence of distance metastasis at diagnosis were evaluated. Univariated analysis of categorical variables was made by Chi square or Fischer test just as correspond; continuous variables were calculated by Student test. Main points, metastasis free and cancer-specific survival, were evaluated by Kaplan-Meier method and differences between groups by the Log-Rank test. Results: Of 269 patients studied, 40 (14.88%) were <50 years old group, 136 (50.55%) between 50 and 65 years old group and 93 (34.57%) >65 years old group. There are no significative differences when we evaluate clinical variables. Patients in <50 years old group had higher number of nephron-sparing surgery (p=0.04), lower histological grade (p=0.05), coagulative necrosis (p=0.002), peripheral fat invasion (p=0.02) and node invasion (p=0.05). Metastasis free survival at 5 years in this group was 95%; in 50-65 years old group and >65 years old group was 70% and 71%, respectively, with significant differences (Log-Rank test=0.004). Likewise, when we compared cancer-specific survival at 5 years between groups, we demonstrate that differences are significant in favor of patients younger than 50 years old (<50 years old 98%, 50-65 years old 79% and >65 years old 83%; Log-Rank test=0.02). Conclusions: In our series, age >50 years old is associated with unfavorable pathological and evolutionary characteristics to be compared with younger patients. However, we believe that the follow-up should not be limited only to the age but should include the results of all prognostic variables of malignancy in kidney cancer. (AU)

[Is CAPRA-S score a valid tool in our environment to predict biochemical recurrence, metastasis and death after radical prostatectomy?] / ?Es el Score CAPRA­S una herramienta válida en nuestro medio para predecir recurrencia bioquímica, metástasis y muerte posterior a prostatectomía radical?

OBJECTIVES: To perform an external validation of CAPRA-S Score to determine prediction of biochemical recurrence, metastasis and death by PCa after RP in Argentinian population. METHODS: 216 patients were studied. The probability of the score to predict biochemical recurrence after RP was analyzed by the Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survivals were determined by Kaplan method. The accuracy of CAPRA-S score to predict biochemical recurrence, metastasis and death by PCa was made in accordance with Harrells concordance index. RESULTS: Median follow up was 74 months. Biochemical recurrence index increased proportionally with the increment of CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rates were 85%, 54% and 4% respectively. Concordance index (C-Index) for biochemical progression, metastasis and death by PCa were 0.85, 0.90 and 0.90 respectively. CONCLUSIONS: CAPRA-S score is an easily applicable tool and has high predictive accuracy to determine biochemical recurrence, metastasis and death by PCa probabilities in our population. Concordance Index in these variables was higher than 0.85.