Impacto de la pandemia en la actividad de las unidades de cirugía reconstructiva urológica y de andrología en España durante el estado de alarma (COVID-19) en 2020: resultados de una encuesta nacional / The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units’ practice during the state of alarm in 2020: National survey

Introducción: El estado de alarma debido a la COVID-19 revolucionó la actividad asistencial y quirúrgica. Dentro de la enfermedad urológica, aquellas consideradas «demorables» como la andrológica y la reconstructiva sufrieron un retraso considerable en su atención. Material y métodos: En mayo de 2020, tras haber superado casi la primera ola de la pandemia y en pleno estado de alarma, se envió una encuesta con 24 ítems a 120 urólogos integrados en los Grupos de Cirugía Reconstructiva Urológica y Andrología de la Asociación Española de Urología (AEU) para conocer la repercusión asistencial sobre la actividad clínica y quirúrgica en ambas subespecialidades. Resultados: Se alcanzó una tasa de respuesta del 75,8% con 91 encuestas recibidas. Previo al estado de alarma, el 49,5% disponía de uno a 2 quirófanos semanales, el 71,4% afrontaba una lista de espera quirúrgica de entre 3 y 12 meses, y el 39,6% atendía entre 20 y 40 pacientes semanales en consulta. Durante el estado de alarma, el 95,6% recibió directrices sobre cirugías a realizar, priorizando la cirugía urgente y la oncológica. En el 85,7% de los centros no se realizó ninguna cirugía andrológica ni reconstructiva. Alrededor del 50% de las consultas no fueron presenciales, recurriendo a la telemedicina (teléfono o e-mail) en la mayoría de los casos. Conclusiones: Las repercusiones de la pandemia sobre las enfermedades andrológicas y las candidatas a cirugía reconstructiva fueron muy importantes. Tras casi 2 años del inicio de la pandemia, aún queda por determinar el verdadero impacto final en nuestro sistema sanitario (AU)

Introduction: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as «non-urgent» (andrology and reconstructive surgery) were postponed or even unattended. Material and methods: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. Results: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). Conclusions The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined (AU)

The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units' practice during the state of alarm in 2020: National survey.

INTRODUCTION: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as "non-urgent" (andrology and reconstructive surgery) were postponed or even unattended. MATERIAL AND METHODS: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. RESULTS: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). CONCLUSIONS: The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.

[The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units' practice during the state of alarm in 2020: National survey]. / Impacto de la pandemia en la actividad de las unidades de cirugía reconstructiva urológica y de andrología en España durante el estado de alarma (COVID-19) en 2020: resultados de una encuesta nacional.

Introduction: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as «non-urgent¼ (andrology and reconstructive surgery) were postponed or even unattended. Material and methods: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. Results: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). Conclusions: The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.

Surgical Wound Dehiscence in Kidney Transplantation: Risk Factors and Impact on Graft Survival.

BACKGROUND: Surgical wound dehiscence (SWD) is a frequent complication after kidney transplantation (KT) but there is not enough evidence of its impact on graft survival. METHODS: A retrospective cohort study including all KT patients with SWD in our center from January 2015 to July 2020 was performed. A case-control study was performed and for each case of SWD, 2 controls were selected (2:1). To identify risk factors for SWD, a logistic regression analysis was carried out and a multivariable Cox regression was used to describe risk factors for graft survival. RESULTS: In our center, 503 KT were performed, and 39 patients presented SWD. They were older (62.1 vs 57.1 years; P = .030), most had diabetes mellitus (59% vs 28.6%; P = .002) and their body mass index was higher (31 vs 26.9 kg/m2; P < .001). In multivariable logistic regression analysis, diabetes mellitus (P = .024) and a body mass index ≥30 kg/m2 at time of transplantation (P = .018) were predictors of SWD. A higher rate of delayed graft function was described in SWD (P = .013) and it was associated with a longer hospital stay (20.9 vs 15 days; P = .004). Graft survival was lower in patients with SWD (P = .036). In multivariable Cox regression analysis, time in renal replacement therapy (P = .020) and SWD (P = .028) were predictors of shorter graft survival. CONCLUSION: SWD is a risk factor for graft survival. The presence of diabetes mellitus and a higher body mass index are predictors for the appearance of this complication.

Tratamiento empírico de la oligoastenoteratozoospermia idiopática / Empiric therapy for idiopathic oligoasthenoteratozoospermia

El factor masculino supone el 50% de las causas de infertilidad en parejas infértiles, siendo en más del 30% de origen desconocido. En estos casos, el tratamiento médico empírico puede plantearse como una opción previa a la aplicación de una técnica de reproducción asistida. El tratamiento empírico puede dividirse en 2 categorías: hormonal, tales como gonadotropinas, antiestrógenos e inhibidores de la aromatasa, y antioxidante, tales como vitaminas, oligoelementos y carnitinas, entre otros. Aunque la evidencia científicamente aceptable es limitada debido a la ausencia de grandes ensayos clínicos aleatorizados y controlados, revisiones sistemáticas y metaanálisis recientemente publicados muestran que el tratamiento con gonadotropinas, antiestrógenos y antioxidantes resulta en un aumento de la tasa de embarazos y nacidos vivos y en una mejora en los parámetros seminales. Es por ello que, en determinadas situaciones, el tratamiento médico empírico para la infertilidad idiopática puede considerarse con el objetivo de mejorar la calidad seminal y consecuentemente el potencial fértil espontáneo

Male infertility accounts for 50% of the causes of infertile couples, being more than 30% of unknown etiology. In these cases, empiric treatment can be an option prior to the application of assisted reproduction techniques. Empiric treatment can be categorized as hormonal, such as gonadotropins, antiestrogens and aromatase inhibitors, and antioxidant, with vitamins, trace elements and carnitine, among others. Although scientifically acceptable evidence is limited due to the absence of large randomized and controlled clinical trials, recent systematic reviews and meta-analyses show that treatment with gonadotropins, antiestrogens and antioxidants increases pregnancy and live birth rates and improves seminal parameters. Empiric medical treatment for idiopathic infertility can be considered in specific cases in order to improve semen quality and spontaneous fertility

Empiric therapy for idiopathic oligoasthenoteratozoospermia. / Tratamiento empírico de la oligoastenoteratozoospermia idiopática.

Male infertility accounts for 50% of the causes of infertile couples, being more than 30% of unknown etiology. In these cases, empiric treatment can be an option prior to the application of assisted reproduction techniques. Empiric treatment can be categorized as hormonal, such as gonadotropins, antiestrogens and aromatase inhibitors, and antioxidant, with vitamins, trace elements and carnitine, among others. Although scientifically acceptable evidence is limited due to the absence of large randomized and controlled clinical trials, recent systematic reviews and meta-analyses show that treatment with gonadotropins, antiestrogens and antioxidants increases pregnancy and live birth rates and improves seminal parameters. Empiric medical treatment for idiopathic infertility can be considered in specific cases in order to improve semen quality and spontaneous fertility.

Minilaparoscopia en urología: revisión sistemática / Minilaparoscopy in urology: Systematic review

Contexto: En los últimos años las intervenciones urológicas por minilaparoscopia (ML) han experimentado un auge. Objetivo: Realizar una revisión sistemática de la evidencia publicada sobre la ML y su papel actual en la urología. Adquisición de evidencia: Se realizó una búsqueda en Medline desde octubre 1983 hasta diciembre de 2016 siguiendo los criterios PRISMA. Un total de 6 artículos comparativos y 13 series fueron seleccionadas para este manuscrito. Síntesis de evidencia: Tan solo un estudio fue aleatorizado, 4 estudios fueron prospectivos y comparativos y la mayor parte fueron series de casos intervenidos con instrumental de 3mm. La intervención más frecuente fue la adrenalectomía, seguida de la nefrectomía, donante vivo y pieloplastia. Además se operaron otras enfermedades menores como decorticaciones quísticas, pielolitotomías, linfadenectomías, varicocelectomías u orquiectomías. Discusión: En los últimos años ha habido importantes mejoras técnicas en el material de ML. La mayoría de los procedimientos fueron de cirugía reconstructiva y por abordaje transperitoneal, incrementándose paulatinamente el número de casos de cirugía oncológica. Solo un 36,8% de las series evaluaron los resultados cosméticos con cuestionarios validados y un 68,4% de los estudios emplearon la escala visual analógica para medir el dolor postoperatorio. Conclusiones: El nivel de evidencia de la mayoría de los estudios publicados es bajo. La ML es una técnica reproducible para la cirugía urológica y segura incluso para las intervenciones de grandes masas quirúrgicas. Sus resultados cosméticos y de dolor postoperatorio son superiores a los de la laparoscopia convencional, si bien estas conclusiones deben ser tomadas con cautela dadas las limitaciones de los estudios actuales

Context: There has been a boom in recent years in urological procedures using minilaparoscopy (ML). Objective: To conduct a systematic review of the published evidence on ML and its current role in urology. Acquisition of evidence: We performed a search on MedLine spanning October 1983 to December 2016 according to PRISMA criteria. A total of 6 comparative articles and 13 series were selected for this manuscript. Summary of the evidence: Only 1 study was randomised, 4 studies were prospective and comparative, and most were case series in which the operations were performed with 3-mm instruments. The most common procedures were adrenalectomy, followed by nephrectomy, living donor and pyeloplasty. Other minor conditions were also operated on, including cyst decortications, pyelolithotomies, lymphadenectomies, varicocelectomies and orchiectomies. Discussion: There have been significant technical improvements in recent years in the materials of ML. Most procedures were for reconstructive surgery and by transperitoneal approach, with a gradually increasing number of cases of oncologic surgery. Only 36.8% of the series assessed the cosmetic results with validated questionnaires, and 68.4% of the studies used the visual analogue scale to measure pain during the postoperative period. Conclusions: The level of evidence of most published studies is low. ML is a reproducible technique for urological surgery and is safe even for operations on large surgical masses. The procedure's cosmetic and pain results after surgery are superior to those of conventional laparoscopy, although these conclusions should be taken with caution given the limitations of the current studies

Minilaparoscopy in urology: Systematic review. / Minilaparoscopia en urología: revisión sistemática.

CONTEXT: There has been a boom in recent years in urological procedures using minilaparoscopy (ML). OBJECTIVE: To conduct a systematic review of the published evidence on ML and its current role in urology. ACQUISITION OF EVIDENCE: We performed a search on MedLine spanning October 1983 to December 2016 according to PRISMA criteria. A total of 6 comparative articles and 13 series were selected for this manuscript. SUMMARY OF THE EVIDENCE: Only 1 study was randomised, 4 studies were prospective and comparative, and most were case series in which the operations were performed with 3-mm instruments. The most common procedures were adrenalectomy, followed by nephrectomy, living donor and pyeloplasty. Other minor conditions were also operated on, including cyst decortications, pyelolithotomies, lymphadenectomies, varicocelectomies and orchiectomies. DISCUSSION: There have been significant technical improvements in recent years in the materials of ML. Most procedures were for reconstructive surgery and by transperitoneal approach, with a gradually increasing number of cases of oncologic surgery. Only 36.8% of the series assessed the cosmetic results with validated questionnaires, and 68.4% of the studies used the visual analogue scale to measure pain during the postoperative period. CONCLUSIONS: The level of evidence of most published studies is low. ML is a reproducible technique for urological surgery and is safe even for operations on large surgical masses. The procedure's cosmetic and pain results after surgery are superior to those of conventional laparoscopy, although these conclusions should be taken with caution given the limitations of the current studies.

Cirugía de puerto único transumbilical con instrumentos laparoscópicos convencionales en riñón en herradura / Transumbilical Single Port Surgery With Conventional Laparoscopic Instruments in Horseshoe Kidney

Introducción: La cirugía laparoscópica está teniendo una evolución natural a disminuir la agresión quirúrgica sobre la pared abdominal, sin merma de los resultados curativos y funcionales. Aunque en desarrollo, la cirugía monopuerto ha supuesto un avance en este sentido. Material y métodos: Presentamos la primera cirugía de pielolitectomía laparoscópica por puerto único en riñón en herradura, usando instrumentos rígidos convencionales. Paciente de 18 años con IMC de 19 que en las pruebas de imagen (urograma y tomografía computarizada) presenta un riñón en herradura con litiasis coraliforme izquierda y discreta ectasia calicial. Se extrae la litiasis mediante acceso umbilical con artilugio monopuerto e instrumentos rígidos convencionales. Resultados: La cirugía se completó sin complicaciones. El tiempo quirúrgico fue 110 min y el sangrado 50 cc. Al abrir el sistema urinario hubo extravasación de orina purulenta que condicionó fiebre en el postoperatorio de 38 ◦C. Durante la intervención se colocó catéter doble J por abordaje percutáneo. Fue dada de alta al tercer día de estancia. Conclusión: El acceso laparoscópico monopuerto para la cirugía de pielolitectomía en un riñón en herradura es una alternativa razonable. El uso de instrumentos convencionales rígidos facilita el desarrollo de esta cirugía con una buena triangulación, sin conflicto de manos y seguridad para el paciente (AU)

Introduction: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. Material and methods: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. Results: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 ◦C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. Conclusion: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney isa reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient (AU)

Transumbilical single port surgery with conventional laparoscopic instruments in horseshoe kidney.

INTRODUCTION: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. MATERIAL AND METHODS: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. RESULTS: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. CONCLUSION: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient.

[New perspectives of treatment with fesoterodine fumarate in patients with overactive bladder]. / Nuevas perspectivas de tratamiento con el fumarato de fesoterodina en pacientes con vejiga hiperactiva.

OBJECTIVE: Evaluate the effect of the treatment with fesoterodine fumarate in patients with overactive bladder, as an alternative in case of failure of the usual anticholinergic treatment, due to either lack of therapeutic efficacy or due to intolerance to side effects. MATERIAL AND METHOD: A retrospective review of 158 patients with overactive bladder was carried out. The patients were divided into two groups; the first group; 56 patients where the anticholinergic treatment showed to be ineffective, and the second group; 102 patients who presented intolerance to anticholinergic side effects. RESULTS: For the first group where fesoterodine fumarate was used to improve effectiveness of the anticholinergics, improvement in the components of urinary urgency (p=0.001), insufficient emptying (p=0.001), incontinence (p=0.009), and in the number of pads/day (p<0.001) was detected. As to the second group where fesoterodine fumarate was used as an alternative to anticholinergics to avoid side effects, a high reduction in the incidence of dry mouth (p<0.001) and constipation (p=0.015) was seen, as well as a significant clinical improvement. CONCLUSION: Fesoterodine fumarate is an optimal treatment option when the clinical response to anticholinergics has not been satisfactory, either by the lack of therapeutic action or by intolerance to side effects, and especially when the treatment is expected to be long.

Nuevas perspectivas de tratamiento con el fumarato de fesoterodina en pacientes con vejiga hiperactiva / New Perspectives of Treatment With Fesoterodine Fumarate in Patients With Overactive Bladder

Objetivos: Valorar el efecto del empleo del fumarato de fesoterodina como rescate ante un tratamiento previo fallido con anticolinérgicos en pacientes con vejiga hiperactiva, por falta de efectividad terapéutica o por intolerancia a los efectos secundarios. Material y métodos: Revisión retrospectiva de 158 pacientes afectos de vejiga hiperactiva que se distribuyeron en 2 grupos, uno donde el fumarato de fesoterodina se empleó como rescate ante una inefectividad del anticolinérgico previo (n=56) y otro donde se empleó ante una intolerancia manifiesta al mismo (n = 102). Resultado: sEn el grupo en el que se empleó como rescate a una inefectividad, se apreció una mejoría en los componentes de urgencia miccional (p = 0,001), vaciado insuficiente (p = 0,001) e incontinencia de esfuerzo (p = 0,009), y en el número de compresas/día (p<0,001). En el grupo en el que se empleó como fármaco de segunda línea ante efectos secundarios a otros anticolinérgicos se apreció una reducción en la incidencia de sequedad de boca (p<0,001) y de estreñimiento (p = 0,015), además de una mejora clínica significativa. Conclusiones: El fumarato de fesoterodina es una alternativa de tratamiento válida si los resultados con otros anticolinérgicos previamente no han sido satisfactorios, bien sea por falta de efecto terapéutico esperado, bien por intolerancia a los efectos secundarios, sobre todo cuando el tratamiento se plantea prolongado (AU)

Objective: Evaluate the effect of the treatment with fesoterodine fumarate in patients with overactive bladder, as an alternative in case of failure of the usual anticholinergic treatment, due to either lack of therapeutic efficacy or due to intolerance to side effects. Material and method: A retrospective review of 158 patients with overactive bladder was carried out. The patients were divided into two groups; the first group; 56 patients where the anticholinergic treatment showed to be ineffective, and the second group; 102 patients who presented intolerance to anticholinergic side effects. Results: For the first group where fesoterodine fumarate was used to improve effectiveness of the anticholinergics, improvement in the components of urinary urgency (p=0.001), insufficient emptying (p=0.001), incontinence (p=0.009), and in the number of pads/day (p<0.001) was detected. As to the second group where fesoterodine fumarate was used as an alternative to anticholinergics to avoid side effects, a high reduction in the incidence of dry mouth (p<0.001) and constipation (p=0.015) was seen, as well as a significant clinical improvement. Conclusion: Fesoterodine fumarate is an optimal treatment option when the clinical response to anticholinergics has not been satisfactory, either by the lack of therapeutic action or by intolerance to side effects, and especially when the treatment is expected to be long (AU)