Early 3-month treatment with comprehensive physical therapy program restores continence in urinary incontinence patients after radical prostatectomy: A randomized controlled trial.

AIMS: The objective of this study is to ascertain whether an early three-month treatment with electrotherapy and biofeedback restores continence in urinary incontinence patients after radical prostatectomy (RP). METHODS: Design: The study performed a randomized, controlled trial of parallel and open groups. Configuration: Secondary care, urology department of a university hospital complex. PARTICIPANTS: Patients sent for RP due to prostate cancer (n = 60), 47 patients finally completed the study. INTERVENTIONS: The treatment group (TG) received physiotherapy consisting of electrotherapy and biofeedback, 3 days a week for 3 months, while the control group (CG) received no specific treatment. Both groups received a guide to perform pelvic floor exercises at home. The measurement instruments used were the 1- and 24-hour pad tests and the International Consultation on Incontinence Questionnaire Short-Form. The recording method used was a micturition (urinary) diary. RESULTS: The results of the 1-hour pad test (PT) show statistically significant differences between groups at 3 months (P = .001) and 6 months (P = .001), in favor of those in the TG. Sixty-four percent of patients in the TG recovered continence as against 9.1% in the CG after 3 months in the 1-hour PT, in line with the objective of this study. CONCLUSIONS: An early physiotherapy program helps RP patients with urinary incontinence recover continence after 3 months. Moreover, they lead a better quality life.

Complicaciones de las mallas de polipropileno en el tratamiento de la patología de suelo pélvico femenino / Complications of polypropylene mesh for the treatment of female Pelvic floor disorders

OBJETIVO: Evaluar las complicaciones de las mallas de polipropileno en la patología del suelopélvico femenino.MÉTODOS: Análisis retrospectivo de las pacientes intervenidasen el Servicio de Urología de nuestro hospitalde patología del suelo pélvico: IOE, cistocele, rectoceley enterocele, mediante cirugía mínimamente invasivaentre marzo de 2002 y octubre de 2008.Se valoraron: complicaciones, efectividad de la técnicay distribución del impacto de resultados. Para el análisisestadístico se utilizó el programa SPSS y la curva deimpacto se estimó por el método de Cox.RESULTADOS: Se intervinieron 363 pacientes. De las363 pacientes, 290 (79.9%) padecían de incontinenciade orina de esfuerzo, 37 (10.2%) cistocele, 33 (9.4%)IOE y cistocele, 1(0.3%) IOE y enterocele, 1(0.3%)cistocele y enterocele y 1 (0.3%) cistocele, enteroceley rectocele. Las intervenciones realizadas fueron las siguientes:34 (9.4%) mallas de compartimento anteriory medio, 1 (0.3%) malla de compartimento medio yposterior, 253 (69.7%) TOT, 35 (9.6%) TOT y malla decompartimento anterior y medio, 1 (0.3%) TOT y mallade compartimento medio y posterior, 36 (9.9%) TVT y 3(0.8%) TVT y malla de compartimento anterior y medio.La mediana de seguimiento fue de 36 (3-90) meses.Se complicaron 50 (13.8%) de las pacientes: 21 (42%)síntomas irritativos del tracto urinario inferior, 10 (20%)exteriorización de la malla, 3 (6%) fascitis necrotizantes,3 ( 6%) abscesos en fosa obturatriz , raíz del muslo ovagina, 5 (10%) dolor pélvico crónico, raíz del musloo dispareunia, 2 (4%) hematoma y sangrado, 3 (6%)infecciones urinarias, 1 (2%) intravesicalización de lamalla, 2 (4%) síntomas obstructivos.Globalmente los procedimientos fueron efectivos en350 (96.4%) pacientes. El impacto de las complicacionesse manifestó en los 10 primeros meses después dela intervención. CONCLUSIONES: Las mallas de polipropileno son muyefectivas en el tratamiento de las afecciones del suelopélvico femenino. En poco más del 10% aparecencomplicaciones que se resuelven espontáneamente ocon tratamiento médico en la mayoría de los casos. Untercio de las complicaciones son subsidiarias de cirugíaextirpando total o parcialmente la malla, sin que afecte a los resultados de la intervención (AU)

OBJECTIVES: To assess the complications of polypropylene mesh in the treatment of female pelvicfloor disorders.METHODS: Retrospective study of patients with pel-vicfloor pathology (SUI, cystocele, rectocele, enteroce-le)undergoing pelvic floor intervention with surgical meshesfrom March 2002 to October 2009.We evaluated complications, effectiveness of thetechnique and distribution of the impact of the results.For statistical analysis SPSS software was used and thecurve of impact was estimated by Cox model.RESULTS: We analyzed 363 patients. Of these 363patients, 290 (79.9%) suffered from Stress Urinary Incontinence,37 (10.2%) cystocele, 33 (9.4%) SUIand cystocele, 1 (0.3%) SUI and enterocele, 1 (0.3%)cys-tocele and enterocele and 1 (0.3%) cystocele,enteroce-le and rectocele. The interventions done were:34 (9.4%) anterior and middle compartment meshes,1 (0.3%) middle and posterior compartment meshes,1 (0.3%) TOT and middle and posterior com-partmentmesh, 36 (9.9%) TVT and 3 (0.8%) TVT and anteriorand middle compartment mesh. The median fo-llow-upwas 36 (3-90) months.50 patients (13.8%) presented complications: 21 (42%)had lower urinary tract irritative symptoms, 10 (20%)externalization of the mesh, 3 (6%) necrotizing fascitis,3 (6%) obturator fossa, thigh root or vaginal abscess, 5(10%) chronic pelvic pain, thigh pain or dyspareunia, 2(4%) bruising and bleeding, 3 (6%) urinary tract infections,1 (2%) mesh entering bladder and 2 (4%) obstructivesymptoms.The procedures were effective in 350 (96.4%) patients.The impact of complications was manifested in the first 10 months after surgery. CONCLUSIONS: Polypropylene meshes are very effective in the treatment of female pelvic floor disorders.Approximately 10% of the patients had complicationsthat resolved spontaneously or with medical treatment inmost cases. One third of the complications are subsidiariesof surgery, by removing the mesh totaly or partialy, without affecting the intervention results (AU)

Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular / Prostate cancer, antiandrogen treatment and cardiovascular risk

Objetivo: Comprobar si las tablas de riesgo cardiovascular (RCV) habitualmente empleadas soncapaces de identificar el incremento de riesgo producido por la terapia de bloqueo androgénico(BA) en los pacientes con cáncer de próstata (CP).Diseño: Estudio de cohortes retrospectivo.Emplazamiento: Centros de salud urbanos y rurales de la provincia de Ourense.Participantes: Pacientes diagnosticados de CP que tenían prescrito tratamiento de BA entre losaños 2007 y 2008.Mediciones principales: Se registró edad, residencia (rural/urbana), estadificación (Gleason),procedimiento diagnóstico y, al comienzo y fin del seguimiento, perfil lipídico, presión arterial,diagnóstico de diabetes mellitus, tabaquismo, uso de fármacos hipotensores e hipolipemiantes,e índices Framingham calibrado y ATP III. Se registraron los eventos cardiovasculares (ECV) alo largo del seguimiento. Cada paciente fue su propio control. Para calcular los índices al finaldel período no se consideró el incremento de edad. Los índices se compararon utilizando la tde Student para muestras apareadas (SPSS 15.0).Resultados: Se incluyeron 209 casos. La media (DE) de edad fue de 73,8 (8,0) años, con un 64,6%de casos urbanos. Los índices al inicio y a los 12 meses de seguimiento fueron: Framingham 9,0(4,6) y 9,2 (4,8) (p = 0,5); ATP III 14,2 (1,7) y 14,2 (1,7) (p = 0,9).Conclusión: Las tablas de RCV no permiten valorar adecuadamente el incremento del riesgoasociado a la terapia de bloqueo androgénico en cáncer de próstata(AU)

Aim: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk causedby androgen deprivation therapy (ADT) in patients with prostate cancer (PCa).Design: Retrospective cohort study.Location: Urban and rural health centres in the province of Ourense.Participants: Patients diagnosed with PCa who had been prescribed treatment for ADT between2007 and 2008.Main measures: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, atthe beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus,smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATPIII indexes, were determined. Cardiovascular events were recorded during the follow-up. Eachpatient was his own control. Increasing age was not used in the calculation of the scores atthe end of the follow up period. The scores were compared using the t-test for paired samples(SPSS 15.0).Results: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6%of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0(4.6) and 9.2 (4.8) (P = 0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P = 0.9).Conclusion: CVR charts do not assess the increased risk associated with androgen deprivationtherapy in prostate cancer(AU)

[Prostate cancer, antiandrogen treatment and cardiovascular risk]. / Cáncer de próstata, terapia antiandrogénica y riesgo cardiovascular.

AIM: To assess if cardiovascular risk (CVR) charts are able to identify the increased risk caused by androgen deprivation therapy (ADT) in patients with prostate cancer (PCa). DESIGN: Retrospective cohort study. LOCATION: Urban and rural health centres in the province of Ourense. PARTICIPANTS: Patients diagnosed with PCa who had been prescribed treatment for ADT between 2007 and 2008. MAIN MEASURES: Age, residence (rural/urban), staging (Gleason), diagnostic procedure and, at the beginning and end of follow-up, lipid profile, blood pressure, diagnosis of diabetes mellitus, smoking, use of antihypertensive and lipid-lowering drugs, and Framingham calibrated and ATP III indexes, were determined. Cardiovascular events were recorded during the follow-up. Each patient was his own control. Increasing age was not used in the calculation of the scores at the end of the follow up period. The scores were compared using the t-test for paired samples (SPSS 15.0). RESULTS: A total of 209 cases were included. The mean (SD) age was 73.8 (8.0) years, with 64.6% of urban cases. The scores at baseline and at 12 months of follow-up were: Framingham 9.0 (4.6) and 9.2 (4.8) (P=0.5), ATP III 14.2 (1.7) and 14.2 (1.7) (P=0.9). CONCLUSION: CVR charts do not assess the increased risk associated with androgen deprivation therapy in prostate cancer.

[Wünderlich s syndrome: importance of diagnostic imaging]. / Síndrome de Wünderlich: importancia del diagnóstico por imagen.

INTRODUCTION: Wünderlich's Syndrome is a spontaneous retroperitoneal haemorrhage characterised by sudden lumbar pain, tangible mass in the lumbar region and signs of hypovolaemic shock. CASE REPORT: A 65 year-old female presented the classic triad indicating Wünderlich's syndrome. Imaging techniques with three-dimensional reconstruction enabled us to determine the diagnosis and aetiology, and aided in determining the treatment. DISCUSSION: We emphasise the importance of imaging methods in diagnosing and choosing treatment for Wünderlich s Syndrome.

Síndrome de Wünderlich: importancia del diagnóstico por imagen / Wünderlich´s syndrome: importance of diagnostic imaging

Introducción: El síndrome de Wünderlich es una hemorragia retroperitoneal espontánea, caracterizada por dolor lumbar de inicio brusco, tumoración lumbar palpable y signos de shock hipovolémico. Caso clínico: Mujer de 65 años de edad que se presenta con la tríada clínica del síndrome de Wünderlich. Las técnicas de imagen empleadas, con reconstrucciones tridimensionales, permitieron establecer el diagnóstico y la etiología y facilitaron el tratamiento (la decisión actitud terapéutica). Discusión: Destacamos la importancia de las técnicas de imagen para el diagnóstico y el enfoque terapéutico del síndrome de Wünderlich (AU)

Introduction: Wünderlich’s Syndrome is a spontaneous retroperitoneal haemorrhage characterised by sudden lumbar pain, tangible mass in the lumbar region and signs of hypovolaemic shock. Case report: A 65 year-old female presented the classic triad indicating Wünderlich’s syndrome. Imaging techniques with three-dimensional reconstruction enabled us to determine the diagnosis and aetiology, and aided in determining the treatment. Discussion: We emphasise the importance of imaging methods in diagnosing and choosing treatment for Wünderlich´s Syndrome (AU)

Tratamiento del cáncer de próstata con intención curativa según la edad y la esperanza de vida / Treatment with curative intention of prostate cancer depending on age and life expectancy

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[Local recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva local después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of radiotherapy to the prostatic bed in patients with biochemical recurrence prostate cancer after radical prostatectomy. METHODS: We analyse the outcomes of 292 patients who underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average follow-up of 36 months (range 6 months to 12 years). We detected biochemical recurrence (PSA > 0.20 ng/ml) in 75 (26%) patients. 75 patients with biochemical recurrence, 9 (12%) were diagnosed of local recurrence by the following criteria: a) First PSA obtained 6 weeks after radical prostatectomy < 0.20 ng/ml. b) Time to biochemical recurrence > 6 months. c) Prostate specific antigen doubling time > 6 months. d) Prostate specific antigen velocity after radical prostatectomy < 0.75 ng/ml/year. e) Prostate specific antigen level after radical prostatectomy < 2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy to the prostate bed. RESULTS: Of all 9 patients with local recurrence, 8(88.8%) have complete response with a mean follow-up of 30 months (12-36 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months in 7 patients and 12 months in 1 patient. Significant adverse effects associated to radiotherapy were not observed. CONCLUSIONS: Salvage radiotherapy may be beneficial in selected patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

Recidiva local después de la prostatectomía radical y radioterapia de rescate / Local recurrence after radical prostatectomy and salvage radiotherapy

OBJETIVO: Evaluar la eficacia de laradioterapia en el lecho prostático en pacientes concáncer de próstata y fracaso bioquímico después de laprostatectomía radical.MÉTODOS: Analizamos los resultados de 292 pacientesa los que se le practicó prostatectomía radical porcancer de próstata localizado T1-T2, entre Enero de1992 y Junio de 2003, con un seguimiento medio de36 meses(rango 6 meses a 12 años). Se detecta fracasobioquímico(PSA > 0.20 ng/ml) en 75(26%)pacientes. De los 75 pacientes con fracaso bioquímico,9(12%) se diagnosticó de recidiva local siguiendolos siguientes criterios: a/ Primer PSA obtenido a las 6semanas de la intervención 6 meses. c/ Tiempo deduplicación del PSA > 6 meses. d/ Velocidad de PSAdespués de la prostatectomía radical <0.75/ng/ml/año. e/ Nivel de PSA después de laprostatectomía radical < 2.5 ng/ml. Los 9 pacientesdiagnosticados de recidiva local reciben una dosismedia de 56.42 Gy en el lecho prostático.RESULTADOS: De los 9 pacientes diagnosticados derecidiva local, en 8(88.8%) se obtuvo una respuestacompleta durante una mediana de seguimiento de 30meses(12-36 meses). El tiempo entre la radioterapia yla respuesta, en los pacientes con respuesta completa,fue inferior a los 3 meses en 7 pacientes y a 12 mesesen 4 pacientes. No se observaron efectos adversosimportantes secundarios a la radioterapia.CONCLUSIONES: La radioterapia de rescate puedeser beneficiosa en un seleccionado grupo de pacientescon recidiva local. La cinética del PSA después de laprostatectomía radical es útil para distinguir las recidivaslocales de las metástasis a distancia

OBJETIVE: To evaluate the efficacy ofradiotherapy to the prostatic bed in patients withbiochemical recurrence prostate cancer after radicalprostatectomy.METHODS: We analyse the outcomes of 292 patientswho underwent radical prostatectomy for localizedprostate cancer T1-T2 between January 1992 and June2003, with an average folow-up of 36 months (range6 months to 12 years). We detected biochemical recurrence(PSA > 0.20 ng/ml) in 75(26%) patients. 75 patientswith biochemical recurrence, 9 (12 %) were diagnosedof local recurrence by the following criteria: a) First PSAobtained 6 weeks after radicalprostatectomy 6 months. c) Prostate specific antigen doublingtime > 6 months. d) Prostate specific antigen velocityafter radical prostatectomy < 0.75 ng/ml/year. e)Prostate specific antigen level after radical prostatectomy< 2.5 ng/ml. The 9 patients diagnosed of local recurrencereceived an average dose of 56.42 Gy to the prostatebed.RESULTS: Of all 9 patients with local recurrence,8(88.8%) have complete response with a mean followupof 30 months (12-36 months). The time between theradiotherapy and the response, in patients with completeresponse, was lower than 3 months in 7 patients and12 months in 1 patient. Significant adverse effectsassociated to radiotherapy were not observed.CONCLUSIONS: Salvage radiotherapy may be beneficialin selected patients with local recurrence. The characteristicsof prostate specific antigen elevation are useful indistinguishing men with local recurrence from those withdistant metastases

[Prognostic factors of prostate cancer: usefulness of Ki-67 expression in preoperative biopsies]. / Factores pronósticos del cáncer de próstata: utilidad de la expresión del Ki67 en las biopsias preoperatorias.

OBJECTIVES: To evaluate the usefulness of Ki-67 expression in preoperative diagnostic biopsies to predict prostate cancer biochemical relapse after radical prostatectomy. METHODS: We analyze the expression of Ki-67 in ultrasound guided biopsies of 103 patients who underwent radical prostatectomy. Mean follow-up was 3.4 years (1.3-8.8 yr.). We correlated biochemical progression with traditional prognostic factors such as PSA (> 10/< or = 10), Gleason (> or = 7/< 7), pT classification (pT3/pT 0-2), and the immunohistochemical prognostic factor Ki-67 (> 3%/< or = 3%). RESULTS: 71/103 (69%) patients did not have progression and 32 (31%) had biochemical progression. Mean preoperative PSA was 10.7 ng/ml in patients without progression and 20.90 ng/ml in patients with biochemical progression (p = 0.0001). Mean Gleason score was 6.03 in patients without progression and 6.75 in patients with biochemical progression (p = 0.0001). Ki-67 expression was 3.95% in patients without progression in comparison to 5.05% of patients with biochemical progression. 12/67 (17.9%) of pT 0-2 tumors and 20/36 (55.6%) pT3 tumors progressed (p = 0.0001). Multivariate analysis indicates that there is not relationship between Ki-67 (> 3% < or = 3%) in preoperative biopsy specimens and prostate cancer biochemical progression after radical prostatectomy (p = 0.204). CONCLUSIONS: The immunohistochemical prognostic factor Ki-67 (> 3%/< or = 3%) in preoperative biopsies is less effective than classic factors, PSA (> 10/< or = 10), Gleason score (> or = 7/< 7) and pT classification (pT3/pT 0-2), to predict prostate cancer biochemical progression after radical prostatectomy.