Efficacy of Doppler-guided hemorrhoidal artery ligation with mucopexy, in the short and long terms for patients with hemorrhoidal disease.

BACKGROUND: Several studies comparing Doppler-guided hemorrhoidal artery ligation (DG HAL) with or without mucopexy with hemorrhoidopexy and hemorrhoidectomy techniques show no difference in short-term efficacy. The aim of this study was to evaluate efficacy of DG HAL with mucopexy (DG HAL+m) in the long term (beyond 5 years) for patients with hemorrhoidal disease. METHODS: A retrospective observational study was conducted on patients with symptomatic hemorrhoidal disease of any stage treated with DG HAL m at our outpatient colorectal surgery unit in April 2009-April 2013. Patients were followed clinically for 1 month and with a questionnaire until 5 years after surgery or until they underwent a second surgery for recurrent hemorrhoids. RESULTS: Of 150 patients who underwent DG HALm during the study period 50 (33.3%) were lost to follow-up. A total of 100 patients (47 women, 53 men) were analysed. The average age was 50 (± 12) years. Twenty-six patients (17.3%) had had one or more prior procedures. The mean length of hospital stay was 2.2 days (median = 2 days; range = 1-8 days). No major complications were described. There were no deaths. At 5 years the mean bleeding, local discomfort and pain scores were significantly improved. Thirty-six patients (35.6%) had a recurrence during the follow-up period, and 20 (19.8%) of them underwent reoperation. The mean time between the operation and the second procedure was 36 months (median 27.4 months). The majority (61.4%) of patients were satisfied with the procedure. CONCLUSIONS: Despite the low invasiveness of DG HALm the low morbidity associated with the procedure and the satisfactory functional outcomes, the long-term recurrence rate can be very high. However, only about half of the patients who experienced a recurrence needed a second operation.

Factores de riesgo en el fracaso de la reparación quirúrgica del prolapso de suelo pelviano / Risk Factors in the Failure of Surgical Repair of Pelvic Organ Prolapse

Introducción: La cirugía del prolapso de órganos pelvianos (POP) presenta resultados variables de recurrencia y complicaciones. El objetivo es analizar nuestros resultados para conocer los factores que se asocian al fracaso anatómico y funcional tras la corrección con malla del POP. Material y métodos: Estudio retrospectivo de 69 pacientes intervenidas de POP en nuestro centro. Se registró la edad, IMC, número de partos, cirugía pélvica previa, menopausia, calidad de vida, incontinencia urinaria, frecuencia-urgencia asociada y presencia de POP de alto grado, compartimentos reparados, mallas usadas, uretrosuspensión e histerectomía vaginal durante la cirugía y las complicaciones. Se evaluó a las pacientes al mes, a los 6 y 12 meses, considerando fracaso de la cirugía si se extruyó la malla, si la paciente no estaba satisfecha o si recidivó. Se describe la muestra, se analizan la relación de las variables analizadas mediante análisis univariante (Chi cuadrado y U Mann-Whitney) y se estudia qué variables pueden tener valor predictivo en el fracaso de la reparación (regresión logística múltiple). Resultados: En 17 casos la cirugía se consideró fracaso al año de seguimiento. El IMC (29,6±2,03 vs 27,1±3,32), número de partos (3,4±0,71 vs 2,8±1,88), la menopausia, la presencia de frecuencia-urgencia y el número de mallas se asociaron al fracaso del tratamiento. Las variables independientes predictivas de fracaso según la regresión logística fueron: IMC, número de partos y la presencia de urgencia-incontinencia. Conclusión: El sobrepeso-obesidad, el número de partos previos y la sintomatología de incontinencia-urgencia preexistente son factores asociados al fracaso anatómico y funcional tras la reparación del POP (AU)

Introduction: Pelvic organ prolapse (POP) surgery has variable results of recurrence and complications. We have aimed to analyze our outcomes in order to know the factors associated with anatomical and functional failure in POP surgery. Material and methods: A retrospective study of 69 patients who underwent POP surgery at our hospital was performed. Registered variables were: Age, BMI, number of deliveries, previous pelvic surgery, menopause, quality of life, urinary incontinence, associated frequency-urgency symptoms, high POP stage, vaginal compartments repaired, type of mesh, urethro-suspension and vaginal hysterectomy during POP surgery and its complications. Patients were evaluated at 1, 6 and 12 months post-surgery. The technique was considered as failed when relapse or mesh erosion occurred and when the patient is not satisfied or there was relapse. The sample is described, analyzing the relationship of the variables studied by univariate analysis (Chi square and Mann-Whitney U test) and a study was made of which variables may have predictive value in the failure of the repair (multiple logistic regression). Results: Surgery failed in 17 patients during the follow-up at one year. BMI (29.6±2.03 vs 27.1±3.32), delivery number (3.4±0.71 vs. 2.8±1.88), menopause, frequency- urgency symptoms and number of vaginal compartments repaired were associated with treatment failure although only BMI, delivery number and frequency-urgency symptoms were defined as independent predictive variables when the logistic regression was carried out. Conclusions: Overweightness-obesity, previous delivery number and frequency-urgency symptoms before surgery are factors associated to anatomical and functional failure after POP repair (AU)

[Risk factors in the failure of surgical repair of pelvic organ prolapse]. / Factores de riesgo en el fracaso de la reparación quirúrgica del prolapso de suelo pelviano.

INTRODUCTION: Pelvic organ prolapse (POP) surgery has variable results of recurrence and complications. We have aimed to analyze our outcomes in order to know the factors associated with anatomical and functional failure in POP surgery. MATERIAL AND METHODS: A retrospective study of 69 patients who underwent POP surgery at our hospital was performed. Registered variables were: Age, BMI, number of deliveries, previous pelvic surgery, menopause, quality of life, urinary incontinence, associated frequency-urgency symptoms, high POP stage, vaginal compartments repaired, type of mesh, urethro-suspension and vaginal hysterectomy during POP surgery and its complications. Patients were evaluated at 1, 6 and 12 months post-surgery. The technique was considered as failed when relapse or mesh erosion occurred and when the patient is not satisfied or there was relapse. The sample is described, analyzing the relationship of the variables studied by univariate analysis (Chi square and Mann-Whitney U test) and a study was made of which variables may have predictive value in the failure of the repair (multiple logistic regression). RESULTS: Surgery failed in 17 patients during the follow-up at one year. BMI (29.6±2.03 vs 27.1±3.32), delivery number (3.4±0.71 vs. 2.8±1.88), menopause, frequency- urgency symptoms and number of vaginal compartments repaired were associated with treatment failure although only BMI, delivery number and frequency-urgency symptoms were defined as independent predictive variables when the logistic regression was carried out. CONCLUSIONS: Overweightness-obesity, previous delivery number and frequency-urgency symptoms before surgery are factors associated to anatomical and functional failure after POP repair.

Tratamiento combinado con radioterapia externa y hormonoterapia en los pacientes con cáncer de próstata localmente avanzado: factores predictivos de toxicidad genitourinaria / Combined External Radiotherapy and Hormone Therapy in Patients with Locally Advanced Prostate Cancer: Predictive Factors of Genitourinary Toxicity

Introducción: una opción de tratamiento del cáncer de próstata localmente avanzado es la radioterapia combinada con la ablación androgénica. Revisamos los resultados de eficacia y toxicidad del tratamiento combinado en un grupo de pacientes tratados con esta terapia combinada en nuestra institución. Material y método: estudio retrospectivo de 80 pacientes con cáncer prostático localmente avanzado tratados con radioterapia externa y hormonoterapia neoadyuvante (dos meses) y adyuvante (24 meses). Se realiza un estudio descriptivo de las variables clínico-patológicas y de los efectos secundarios. Evaluamos la respuesta al tratamiento mediante el PSA nadir y recidiva bioquímica. Analizamos la toxicidad aguda y crónica genitourinaria, intentando establecer qué factores influyen en su aparición mediante análisis uni y multivariante (regresión logística múltiple). Resultados: la media de edad fue 68 ± 5,81 años, el PSA inicial 20,05 ±1 6,27 ng/ ml y el volumen prostático medio 43,7 ± 27,57 cc. El 33% fueron estadio T3a y el 66% T3b. El Gleason fue < 7 en el 39%, 7 en el 46% y ≥ 8 en el 15%. Tras un seguimiento medio de 44,4 meses se detectó recidiva bioquímica en tres casos. La toxicidad aguda postirradiación genitourinaria apareció en el 90% (35% tardía) y gastrointestinal en el 75% (32% tardía). El análisis univariante muestra relación entre el volumen prostático y los síntomas urinarios previos con la toxicidad genitourinaria aguda y crónica. Estos se confirman como factores predictivos independientes de toxicidad geniturinaria en el análisis de regresión logística. Conclusiones: la hormono-radioterapia es una opción válida para el tratamiento del cáncer localmente avanzado con resultados óptimos a corto plazo, aunque no está exenta de efectos secundarios. La sintomatología urinaria previa y el volumen prostático pueden predecir la toxicidad genitourinaria (AU)

Introduction: Radiotherapy and androgen deprivation are an established treatment option for locally advanced prostate cancer. We evaluate outcomes in efficacy and toxicity for patients treated with this combined therapy at our institution. Methods: A retrospective study of 80 patients with locally advanced prostate cancer treated with radiotherapy combined with neo-adjuvant (2 months) and adjuvant (24 months) androgen deprivation. We studied the clinical variables and side effects. We evaluated treatment outcomes using PSA nadir and biochemical failure, and recorded acute and late gastrointestinal and urinary toxicity. We assessed the correlation between clinical variables and urinary toxicity by means of univariate and multivariate analyses (multiple logistic regression). Results: The mean patient age was 68 ± 5.81 years; the initial PSA was 20.05 ± 16.27 ng/ ml and the mean prostate volume 43.7 ± 27.57 cc. The clinical stage was T3a in 33% and T3b in 66%. The Gleason score was <7 in 39%, 7 in 46% and ≥8 in 15%. The mean follow-up was 44.4 months and biochemical failure was observed in 3 cases. Acute urinary toxicity was recorded in 90% of the patients (chronic in 35%) and acute gastrointestinal toxicity in 75% (late in 32%). In a univariate analysis, prostate volume and urinary symptoms were statistically correlated to acute and late urinary toxicity. Both prostate volume and urinary symptoms were independently associated with an increase in urinary toxicity in the logistic regression analysis. Conclusions: Hormone-radiotherapy is a valid option to locally treat advanced prostate cancer with optimal short-term outcomes, although it is not devoid of side effects. Prostate volume and urinary symptoms before treatment can predict genitourinary toxicity (AU)

[Combined external radiotherapy and hormone therapy in patients with locally advanced prostate cancer: predictive factors of genitourinary toxicity]. / Tratamiento combinado con radioterapia externa y hormonoterapia en los pacientes con cáncer de próstata localmente avanzado: factores predictivos de toxicidad genitourinaria.

INTRODUCTION: Radiotherapy and androgen deprivation are an established treatment option for locally advanced prostate cancer. We evaluate outcomes in efficacy and toxicity for patients treated with this combined therapy at our institution. METHODS: A retrospective study of 80 patients with locally advanced prostate cancer treated with radiotherapy combined with neo-adjuvant (2 months) and adjuvant (24 months) androgen deprivation. We studied the clinical variables and side effects. We evaluated treatment outcomes using PSA nadir and biochemical failure, and recorded acute and late gastrointestinal and urinary toxicity. We assessed the correlation between clinical variables and urinary toxicity by means of univariate and multivariate analyses (multiple logistic regression). RESULTS: The mean patient age was 68 ± 5.81 years; the initial PSA was 20.05 ± 16.27 ng/ ml and the mean prostate volume 43.7 ± 27.57 cc. The clinical stage was T3a in 33% and T3b in 66%. The Gleason score was <7 in 39%, 7 in 46% and ≥8 in 15%. The mean follow-up was 44.4 months and biochemical failure was observed in 3 cases. Acute urinary toxicity was recorded in 90% of the patients (chronic in 35%) and acute gastrointestinal toxicity in 75% (late in 32%). In a univariate analysis, prostate volume and urinary symptoms were statistically correlated to acute and late urinary toxicity. Both prostate volume and urinary symptoms were independently associated with an increase in urinary toxicity in the logistic regression analysis. CONCLUSIONS: Hormone-radiotherapy is a valid option to locally treat advanced prostate cancer with optimal short-term outcomes, although it is not devoid of side effects. Prostate volume and urinary symptoms before treatment can predict genitourinary toxicity.