Isthmocele correction: resectoscopic, laparoscopic or both?

Background: An isthmocele is a myometrial defect in the site of the caesarean scar. In symptomatic women with abnormal uterine bleeding and secondary infertility, surgical correction can be considered. Most authors advocate that when there's a residual myometrium ≥ 3mm it can be corrected through resectoscopic approach and when < 3mm the treatment should be laparoscopic, eventually guided by diagnostic hysteroscopy. Both these techniques have important limitations; therefore, the authors propose combining both techniques, in the same procedure, in order to overcome them. Objectives: To demonstrate the advantages of a surgical technique for correction of an isthmocele using both resectoscopic and laparoscopic resection. Material and Methods: A stepwise demonstration of the technique with narrated video footage. Main outcome measures: Intraoperative data and outcomes in the patient's follow-up. Results: One month after the surgery the patient was asymptomatic, reporting a resolution of the uterine abnormal bleeding, and the ultrasound showed a full correction of the isthmocele. Conclusion: A combination of resectoscopic and laparoscopic resection, in correcting bigger isthmoceles, is a good option to fully excise all the fibrotic tissue. Learning objective: This video aims to demonstrate the benefits of using a technique combining resectoscopic and laparoscopic resection for correcting larger isthmoceles.

Eficacia y seguridad de la inyección de onabotulinumtoxin A en pacientes varones con hiperactividad del detrusor tras la cirugía para incontinencia urinaria de esfuerzo / Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery

Introducción y objetivo El uso de la inyección de onabotulinumtoxin A (BoNT-A) en pacientes masculinos con hiperactividad del detrusor (HD) tras la cirugía para la incontinencia urinaria de esfuerzo (IUE) ha sido escasamente descrito. Nuestro objetivo fue evaluar los resultados de este tratamiento en esta población específica.Materiales y métodosAnálisis retrospectivo desde 2010 en pacientes varones que reciben una primera inyección de 100U de BoNT-A para el tratamiento de HD tras someterse a una cirugía previa para la IUE en nuestro departamento. La respuesta al tratamiento se valoró mediante la Escala de Beneficio del Tratamiento: 1) mejoría significativa; 2) mejoría; 3) sin cambios; 4) empeoramiento tras el tratamiento (Escala de Beneficio del Tratamiento 1 o 2: respuesta al tratamiento). Las complicaciones se catalogaron según la clasificación de Clavien-Dindo. Se consideró la continuación del tratamiento si los pacientes habían recibido una inyección de BoNT-A durante los 12 meses previos a la última revisión. Se compararon las variables urodinámicas antes y después del tratamiento.Resultados Se incluyeron 18 pacientes, con una edad mediana de 71,1 (59,1-83,5) años. Doce (66,7%) pacientes refirieron respuesta al tratamiento. Se detectaron 2 (11,1%) complicaciones: retención urinaria que requirió cateterismo intermitente limpio (Clavien-Dindo 2). No se detectaron complicaciones relacionadas con la cirugía previa para la IUE. Quince (83,3%) pacientes recibieron un seguimiento>12 meses (mediana de seguimiento 57 [15-89] meses) y todos habían suspendido el tratamiento al final del seguimiento. Se observó una mejoría significativa en la presencia de HD y en la acomodación vesical en el estudio urodinámico.ConclusiónAunque la mayoría de los hombres con HD después de la cirugía de IUE responden a la inyección intradetrusor de BoNT-A, todos interrumpen el tratamiento por motivos personales. Se trata de un procedimiento seguro, cuya

Introduction and objective The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population.Materials and methods Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared.Results Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance.Conclusion Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication (AU)

Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery.

INTRODUCTION AND OBJECTIVE: The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS: Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100 U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS: Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up >12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION: Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.

Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery. / Eficacia y seguridad de la inyección de onabotulinumtoxin A en pacientes varones con hiperactividad del detrusor tras la cirugía para incontinencia urinaria de esfuerzo.

INTRODUCTION AND OBJECTIVE: The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS: Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS: Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION: Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.

Photocatalytic inactivation of dual- and mono-species biofilms by immobilized TiO2.

Biofilms formed by different bacterial species are likely to play key roles in photocatalytic resistance. This study aims to evaluate the efficacy of a photocatalytic immobilized nanotube system (TiO2-NT) (IS) and suspended nanoparticles (TiO2-NP) (SS) against mono- and dual-species biofilms developed by Gram-negative and Gram-positive strains. Two main factors were corroborated to significantly affect the biofilm resistance during photocatalytic inactivation, i.e., the biofilm-growth conditions and biofilm-forming surfaces. Gram-positive bacteria showed great photosensitivity when forming dual-species biofilms in comparison with the Gram-positive bacteria in single communities. When grown onto TiO2-NT (IS) surfaces for immobilized photocatalytic systems, mono- and dual-species biofilms did not exhibit differences in photocatalytic inactivation according to kinetic constant values (p > 0.05) but led to a reduction of ca. 3-4 log10. However, TiO2-NT (IS) surfaces did affect biofilm colonization as the growth of mono-species biofilms of Gram-negative and Gram-positive bacteria is significantly (p ≤ 0.05) favored compared to co-culturing; although, the photocatalytic inactivation rate did not show initial bacterial concentration dependence. The biofilm growth surface (which depends on the photocatalytic configuration) also favored resistance of mono-species biofilms of Gram-positive bacteria compared to that of Gram-negative in immobilized photocatalytic systems, but opposite behavior was confirmed with suspended TiO2 (p ≤ 0.05). Successful efficacy of immobilized TiO2 for inactivation of mono- and dual-species biofilms was accomplished, making it feasible to transfer this technology into real scenarios in water treatment and food processing.

Validation of a Patient Global Assessment for extent, severity and impact to define the severity strata for the Self Assessment Vitiligo Extent Score (SA-VES).

BACKGROUND: The Self Assessment Vitiligo Extent Score (SA-VES) is a validated, patient-reported outcome measure to assess the body surface area affected with vitiligo. Information on how to translate the obtained score into extent, severity and impact strata (mild-moderate-severe) is still lacking. Stratification is helpful to define inclusion criteria for trials, enables comparison and pooling of trial results and can be used for epidemiological research. OBJECTIVES: The aim was to develop extent, severity and impact strata for the SA-VES based on validated anchor-based questions. METHODS: In total, 315 patients with vitiligo (non-segmental; age ≥ 16) recruited at the Ghent University Hospital (Belgium) completed a questionnaire that was conducted in cooperation with the Dutch Society for vitiligo patients to ensure content validity. First three anchor questions included in the questionnaire [Patient Global Assessment (PtGA) for vitiligo extent, severity and impact] were assessed for content validity, construct validity and intrarater reliability. Subsequently, the PtGAs were used to stratify the SA-VES based on ROC analysis. RESULTS: For all PtGAs (PtGA extent, PtGA severity, PtGA impact), at least 75% of hypotheses evaluated for construct validity were confirmed. Intrarater reliability of all PtGAs was good to excellent (ICCs PtGA extent: 0.623; PtGA severity: 0.828; PtGA impact: 0.851). The optimal cut-off values of the SA-VES between the three global categories (mild/limited - moderate - severe/extensive) were 1.05% and 6.45% based on PtGA extent, 2.07% and 4.8% based on PtGA severity and 2% and 3.35% based on PtGA impact. CONCLUSION: This study provides the first guide for the interpretation of the numerical output obtained by the SA-VES (vitiligo extent) and enables the translation into a global vitiligo grading for extent, severity and impact. As patients' interpretation of vitiligo extent, severity and impact may vary amongst patients worldwide, future international studies will be required.

Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior / Urodynamic findings in Charcot-Marie-Tooth patients with lower urinary tract symptoms

INTRODUCCIÓN: Nuestro objetivo fue describir los síntomas del tracto urinario inferior (STUI) y los hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth (CMT) derivados a nuestro servicio de urología. MÉTODOS: Estudio retrospectivo de los pacientes con CMT diagnosticados en el servicio de neurología de nuestro centro y derivados al servicio de urología desde 2008 por sintomatología del tracto urinario inferior (STUI). Revisamos el tipo de CMT, la edad al diagnóstico, la presencia de comorbilidades que pudieran causar STUI, las características de los mismos, las exploraciones neurológicas y los hallazgos urodinámicos. RESULTADOS: Se remitieron 7 pacientes (3 varones y 4 mujeres) a nuestro servicio por STUI con una mediana de edad al inicio de los STUI de 55 (29-67) años y tiempo medio entre el diagnóstico de la neuropatía y el inicio de los STUI de 14 (1-37) años. Cinco pacientes refirieron clínica de vaciado, 3 incontinencia urinaria y 2 presentaban infecciones urinarias de repetición. Se realizaron 6 estudios urodinámicos, mostrando detrusor acontráctil neurógeno en 2 pacientes, detrusor hipocontráctil en un paciente, retraso en el tiempo de inicio de la micción en un paciente, detrusor hiperactivo en un paciente e incontinencia de esfuerzo en otro paciente. En un caso el estudio fue normal. CONCLUSIÓN: La mayoría de los pacientes con CMT y STUI refieren clínica de vaciado, pudiéndose relacionar con alteraciones urodinámicas, la mayoría en la fase de vaciado. Recomendamos la realización de estudio urodinámico en pacientes con CMT que presenten STUI y soliciten tratamiento o presenten complicaciones asociadas

INTRODUCTION: Our aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department. METHODS: Retrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings. RESULTS: Seven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 PATIENTS: Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal. CONCLUSIONS: Most of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications

Urodynamic findings in Charcot-Marie-Tooth patients with lower urinary tract symptoms. / Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior.

INTRODUCTION: Our aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department. METHODS: Retrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings. RESULTS: Seven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 patients. Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal. CONCLUSIONS: Most of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications.

Evaluación de la función cognitiva en pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdémica / Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin

Introducción y objetivos: Los pacientes mayores con vejiga hiperactiva bajo tratamiento antimuscarínico son especialmente susceptibles al deterioro cognitivo. El objetivo fue evaluar los cambios a corto plazo en la función cognitiva de pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdérmica. Materiales y métodos: Estudio observacional retrospectivo multicéntrico en pacientes entre 65 y 80 años de edad, con vejiga hiperactiva, que reciben tratamiento con oxibutinina transdérmica. Antes y después de un mes de tratamiento, se evaluó la función cognitiva mediante el test de alteración de memoria y el test del dibujo del reloj, los cambios en los síntomas con cuestionarios validados, la percepción del paciente ante su respuesta al tratamiento utilizando la escala de beneficio del tratamiento y la adherencia al tratamiento con el test de Morisky-Green modificado. Resultados: De 85 pacientes elegibles, 70 completaron la evaluación (promedio de edad: 71,4 ± 4,5; IMC: 28,7 ± 3,1 kg/m2). No se observó deterioro cognitivo tras un mes de tratamiento con oxibutinina transdérmica: Test de alteración de memoria (+1 punto; IC 95%: 0-1,5), test del dibujo del reloj (0 puntos; IC 95%: 0-0). Se observó una mejoría estadísticamente significativa (p < 0,001) en todos los síntomas de almacenamiento urinario, excepto en la incontinencia de esfuerzo. Hubo una mejora en el cuestionario de autoevaluación de control de la vejiga (grado de los síntomas: -2,27; IC 95%: -2,8, -1,7; p < 0,001; grado de molestias: -2,73; IC 95%: -3,3, -2,1; p < 0,001). El 70% de los pacientes informaron una condición de vejiga estable o mejorada según el cuestionario de Percepción de la Condición de la Vejiga del Paciente. El 72,8% de los pacientes informó que sus problemas urinarios habían mejorado o mejorado notablemente con un 84,3% de adherencia al tratamiento. Conclusiones: No se observó deterioro cognitivo en pacientes de edad avanzada tras de un mes de tratamiento con oxibutinina transdérmica. Los síntomas de incontinencia urinaria mejoraron y hubo una adecuada adherencia al tratamiento

Introduction and objectives: Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. Materials and methods: Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed. Results: From 85 eligible patients, 70 completed the assessment (mean age: 71.4 ± 4.5; BMI: 28.7 ± 3.1 kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (p < 0.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: -2.27; 95%CI: -2.8, -1.7; p < 0.001; bother score: -2.73; 95%CI: -3.3, -2.1; p < 0.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. Conclusions: No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence

Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin. / Evaluación de la función cognitiva en pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdémica.

INTRODUCTION AND OBJECTIVES: Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. MATERIALS AND METHODS: Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed. RESULTS: From 85 eligible patients, 70 completed the assessment (mean age: 71.4±4.5; BMI: 28.7±3.1kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (P<.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: -2.27; 95%CI: -2.8, -1.7; P<.001; bother score: -2.73; 95%CI: -3.3, -2.1; P<.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. CONCLUSIONS: No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence.

Influence of incubation conditions on the formation of model biofilms by Listeria monocytogenes and Salmonella Typhimurium on abiotic surfaces.

AIMS: This research aims to develop strongly adherent and mature model biofilms (on a 20 cm² polystyrene surface) for two pathogenic species, i.e. Listeria monocytogenes and Salmonella Typhimurium. These model biofilms can be used as standards to study biofilms or to study/compare the influence of different inactivation technologies. METHODS AND RESULTS: Three influencing factors on the formation of biofilms are investigated, i.e. growth medium, incubation temperature and incubation time, which are three easily controllable environmental factors. Optical density measurement and plate counts were used to evaluate the adherence and the maturity of the biofilms, respectively. Confocal laser scanning microscopy was used to verify most important findings obtained with previously mentioned assays. Results indicated that mature and strongly adherent L. monocytogenes biofilms are obtained following 13 h of incubation at 30°C with BHI as growth medium. For S. Typhimurium, an incubation period of 19 h at 25°C was required with 20-fold diluted TSB as growth medium. CONCLUSIONS: Based on previously mentioned assays, a protocol for the formation of reproducible model biofilms was obtained. SIGNIFICANCE AND IMPACT OF THE STUDY: The developed model biofilms can be applied as a standard to study biofilms (in different research fields) and their subsequent inactivation by different methods. In addition, the results of this study could be used to control biofilm formation (e.g. by setting a maximum allowed surface temperature).

Diagnóstico y tratamiento del paciente varón con síntomas del tracto urinario inferior en España - Estudio MERCURY. ¿Seguimos los urólogos las recomendaciones de las guías europeas? / Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines?

Objetivos: Conocer el manejo de pacientes varones con síntomas del tracto urinario inferior (STUI) y evaluar el seguimiento de las recomendaciones de las guías de la Asociación Europea de Urología en España. Material y métodos: El estudio MERCURY, epidemiológico y transversal, con 227 unidades de urología participantes en España, evaluó a pacientes varones con STUI mixtos predominantemente de llenado, de los cuales se recogió información sociodemográfica, clínica y de consumo de recursos de los 6 meses anteriores. Adicionalmente, mediante un caso clínico teórico, los investigadores describieron su actitud sobre el manejo de los STUI mixtos con predominio de llenado persistentes tras un tratamiento inicial, en cuanto a pruebas diagnósticas y aproximación terapéutica en la primera y la segunda visita. Las opciones proporcionadas para el manejo de los STUI estaban alineadas con las recomendaciones de la Asociación Europea de Urología. Resultados: Se evaluaron 610 pacientes, de los cuales el 87,7% consumió algún recurso sanitario debido a: visitas al urólogo (79,7%), determinación del PSA (76,6%) y tratamiento con alfabloqueante (37,5%) y alfabloqueante más antimuscarínico (37,2%). En el caso clínico teórico, la actitud del urólogo en la elección de pruebas diagnósticas y tratamiento farmacológico fue principalmente: determinación del PSA (97,7%), tacto rectal (91,4%) y tratamiento con alfabloqueantes en monoterapia (56,6%) en la primera visita; flujometría (48,9%), diario miccional (40,3%) y tratamiento con alfabloqueante más antimuscarínico (70,6%) en la segunda visita. Conclusiones: La actitud de los urólogos en España para el manejo del paciente varón con STUI mixtos predominantemente de llenado se ajusta a las recomendaciones de las guías clínicas europeas

Objectives: To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. Material and methods: MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. Result: 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. Conclusions: Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines

State of the art of nonthermal and thermal processing for inactivation of micro-organisms.

Despite the constant development of novel thermal and nonthermal technologies, knowledge on the mechanisms of microbial inactivation is still very limited. Technologies such as high pressure, ultraviolet light, pulsed light, ozone, power ultrasound and cold plasma (advanced oxidation processes) have shown promising results for inactivation of micro-organisms. The efficacy of inactivation is greatly enhanced by combination of conventional (thermal) with nonthermal, or nonthermal with another nonthermal technique. The key advantages offered by nonthermal processes in combination with sublethal mild temperature (<60°C) can inactivate micro-organisms synergistically. Microbial cells, when subjected to environmental stress, can be either injured or killed. In some cases, cells are believed to be inactivated, but may only be sublethally injured leading to their recovery or, if the injury is lethal, to cell death. It is of major concern when micro-organisms adapt to stress during processing. If the cells adapt to a certain stress, it is associated with enhanced protection against other subsequent stresses. One of the most striking problems during inactivation of micro-organisms is spores. They are the most resistant form of microbial cells and relatively difficult to inactivate by common inactivation techniques, including heat sterilization, radiation, oxidizing agents and various chemicals. Various novel nonthermal processing technologies, alone or in combination, have shown potential for vegetative cells and spores inactivation. Predictive microbiology can be used to focus on the quantitative description of the microbial behaviour in food products, for a given set of environmental conditions.

Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines? / Diagnóstico y tratamiento del paciente varón con síntomas del tracto urinario inferior en España - Estudio MERCURY. ¿Seguimos los urólogos las recomendaciones de las guías europeas?

OBJECTIVES: To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. MATERIAL AND METHODS: MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. RESULT: 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. CONCLUSIONS: Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines.

Impact of food model (micro)structure on the microbial inactivation efficacy of cold atmospheric plasma.

The large potential of cold atmospheric plasma (CAP) for food decontamination has recently been recognized. Room-temperature gas plasmas can decontaminate foods without causing undesired changes. This innovative technology is a promising alternative for treating fresh produce. However, more fundamental studies are needed before its application in the food industry. The impact of the food structure on CAP decontamination efficacy of Salmonella Typhimurium and Listeria monocytogenes was studied. Cells were grown planktonically or as surface colonies in/on model systems. Both microorganisms were grown in lab culture media in petri dishes at 20°C until cells reached the stationary phase. Before CAP treatment, cells were deposited in a liquid carrier, on a solid(like) surface or on a filter. A dielectric barrier discharge reactor generated helium-oxygen plasma, which was used to treat samples up to 10min. Although L. monocytogenes is more resistant to CAP treatment, similar trends in inactivation behavior as for S. Typhimurium are observed, with log reductions in the range [1.0-2.9] for S. Typhimurium and [0.2-2.2] for L. monocytogenes. For both microorganisms, cells grown planktonically are easily inactivated, as compared to surface colonies. More stressing growth conditions, due to cell immobilization, result in more resistant cells during CAP treatment. The main difference between the inactivation support systems is the absence or presence of a shoulder phase. For experiments in the liquid carrier, which exhibit a long shoulder, the plasma components need to diffuse and penetrate through the medium. This explains the higher efficacies of CAP treatment on cells deposited on a solid(like) surface or on a filter. This research demonstrates that the food structure influences the cell inactivation behavior and efficacy of CAP, and indicates that food intrinsic factors need to be accounted when designing plasma treatment.

Prevalencia de síntomas del tracto urinario inferior de llenado en pacientes varones que acuden a consulta de urología en España. La urgencia urinaria como predictor de calidad de vida / Prevalence of storage lower urinary tract symptoms in male patients attending Spanish urology office. Urinary urgency as predictor of quality of life

Introducción: Se buscó conocer el perfil sintomático de pacientes varones con síntomas del tracto urinario inferior (STUI) que acuden a consulta de urología en España, y el impacto en la calidad de vida relacionada con la salud (CVRS). Materiales y métodos: Estudio nacional, epidemiológico, transversal. Incluyó 291 consultas de urología. La prevalencia de STUI de llenado se investigó en 25.482 varones. Se recogieron datos sociodemográficos y clínicos de un subgrupo de 1.015 pacientes con STUI de llenado que completó los cuestionarios IPSS, OABq-SF y PPBC. Se analizó el impacto de la urgencia urinaria en la CVRS. Resultados: La prevalencia de STUI de llenado fue 41%, aumentando con la edad: 14,1%, 41,5% y 60,8% de los pacientes con 18-49, 50-64 y ≥ 65 años, respectivamente. De los 1.015 pacientes seleccionados solo el 2,6% presentaba exclusivamente síntomas de llenado. La gravedad de los síntomas (IPSS) aumentó con la edad. La nocturia, la frecuencia y la urgencia fueron los síntomas más frecuentes y con más impacto en la CVRS (IPSS y OABq-SF). El número de episodios de urgencia se correlacionó inversamente con la CVRS (r = −0,773; p < 0,0001). En el análisis multivariado solo el IPSS y el OABq-SF de molestias fueron predictores significativos de CVRS (p < 0,001). Conclusión. Existe una alta prevalencia de STUI de llenado entre los pacientes que acuden a consulta de urología en España. La gravedad de la urgencia (número de episodios de urgencia) predijo una peor calidad de vida del paciente

Introduction: The study sought to determine the symptomatic profile of men with lower urinary tract symptoms (LUTS) who visited a urology clinic in Spain and its impact on their health-related quality of life (HRQL). Materials and methods: A national, epidemiological cross-sectional study was conducted and included 291 urology clinics. The prevalence of storage LUTS was investigated in 25,482 men. The study collected sociodemographic and clinical data from a subgroup of 1015 patients with storage LUTS who filled out the International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire Short Form (OABq-SF) and Patient Perception of Bladder Condition (PPBC) questionnaires. The impact of urinary urgency on HRQL was analysed. Results: The prevalence of storage LUTS was 41%, increasing with age: 14.1%, 41.5% and 60.8% for patients aged 18-49, 50-64 and ≥ 65 years, respectively. Of the 1015 selected patients, only 2.6% had storage symptoms exclusively. Symptom severity (IPSS) increased with age. Nocturia, frequency and urgency were the most common symptoms and had the most impact on HRQL (IPSS and OABq-SF). The number of urgency episodes was inversely correlated with the HRQL (r = −.773; P < .0001). In the multivariate analysis, only the IPSS and OABq-SF bother scores were significant predictors of HRQL (P < .001). Conclusion: Storage LUTS are highly prevalent among patients attending urology clinics in Spain. The severity of the urgency (number of urgency episodes) predicted a poorer quality of life for the patient

Prevalence of storage lower urinary tract symptoms in male patients attending Spanish urology office. Urinary urgency as predictor of quality of life. / Prevalencia de síntomas del tracto urinario inferior de llenado en pacientes varones que acuden a consulta de urología en España. La urgencia urinaria como predictor de calidad de vida.

INTRODUCTION: The study sought to determine the symptomatic profile of men with lower urinary tract symptoms (LUTS) who visited a urology clinic in Spain and its impact on their health-related quality of life (HRQL). MATERIALS AND METHODS: A national, epidemiological cross-sectional study was conducted and included 291 urology clinics. The prevalence of storage LUTS was investigated in 25,482 men. The study collected sociodemographic and clinical data from a subgroup of 1015 patients with storage LUTS who filled out the International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire Short Form (OABq-SF) and Patient Perception of Bladder Condition (PPBC) questionnaires. The impact of urinary urgency on HRQL was analysed. RESULTS: The prevalence of storage LUTS was 41%, increasing with age: 14.1%, 41.5% and 60.8% for patients aged 18-49, 50-64 and ≥65 years, respectively. Of the 1015 selected patients, only 2.6% had storage symptoms exclusively. Symptom severity (IPSS) increased with age. Nocturia, frequency and urgency were the most common symptoms and had the most impact on HRQL (IPSS and OABq-SF). The number of urgency episodes was inversely correlated with the HRQL (r=-.773; P<.0001). In the multivariate analysis, only the IPSS and OABq-SF bother scores were significant predictors of HRQL (P<.001). CONCLUSION: Storage LUTS are highly prevalent among patients attending urology clinics in Spain. The severity of the urgency (number of urgency episodes) predicted a poorer quality of life for the patient.

Isomerization and Oligomerization of Truncated and Mutated Tau Forms by FKBP52 are Independent Processes.

The aggregation of the neuronal Tau protein is one molecular hallmark of Alzheimer's disease and other related tauopathies, but the precise molecular mechanisms of the aggregation process remain unclear. The FK506 binding protein FKBP52 is able to induce oligomers in the pathogenic Tau P301L mutant and in a truncated form of the wild-type human Tau protein. Here, we investigate whether FKBP52's capacity to induce Tau oligomers depends on its prolyl cis/trans isomerase activity. We find that FKBP52 indeed can isomerize selected prolyl bonds in the different Tau proteins, and that this activity is carried solely by its first FK506 binding domain. Its capacity to oligomerize Tau is, however, not linked to this peptidyl-prolyl isomerase activity. In addition, we identified a novel molecular interaction implying the PHF6 peptide of Tau and the FK1/FK2 domains of FKBP52 independent of FK506 binding; these data point toward a non-catalytic molecular interaction that might govern the effect of FKBP52 on Tau.

Subtelomeric DNA hypomethylation is not required for telomeric sister chromatid exchanges in ALT cells.

Most human tumor cells acquire immortality by activating the expression of telomerase, a ribonucleoprotein that maintains stable telomere lengths at chromosome ends throughout cell divisions. Other tumors use an alternative mechanism of telomere lengthening (ALT), characterized by high frequencies of telomeric sister chromatid exchanges (T-SCEs). Mechanisms of ALT activation are still poorly understood, but recent studies suggest that DNA hypomethylation of chromosome ends might contribute to the process by facilitating T-SCEs. Here, we show that ALT/T-SCE(high) tumor cells display low DNA-methylation levels at the D4Z4 and DNF92 subtelomeric sequences. Surprisingly, however, the same sequences retained high methylation levels in ALT/T-SCE(high) SV40-immortalized fibroblasts. Moreover, T-SCE rates were efficiently reduced by ectopic expression of active telomerase in ALT tumor cells, even though subtelomeric sequences remained hypomethylated. We also show that hypomethylation of subtelomeric sequences in ALT tumor cells is correlated with genome-wide hypomethylation of Alu repeats and pericentromeric Sat2 DNA sequences. Overall, this study suggests that, although subtelomeric DNA hypomethylation is often coincident with the ALT process in human tumor cells, it is not required for T-SCE.

Esfinter urinario artificial: abordaje transescrotal / Artificial urinary sphicter

Se presenta un caso clínico de paciente masculino con insuficiencia esfinteriana genuina y disfunción eréctil posterior a una prostatectomía radical, revisando en detalle el estudio urodinámico y sus hallazgos. Se realiza un abordaje combinado transescrotal para la colocación simultánea del esfínter AMS 800 y de la prótesis de pene AMS 700, describiendo resultados y seguimiento posterior. Se realiza una revisión bibliográfica de los esfínteres colocados por vía transescrotal, descripción de la técnica quirúrgica e indicaciones y se comparan resultados con los obtenidos en nuestro centro. Demostrando que la vía transescrotal es plausible pero con indicaciones precisas y que aún sus resultados son inferiores a los descritors para la vía perineal

We prresent a case of post prostatectomy incontinence and erectile dysfunction, reviewing its urodynamic findings. Using a combined transcrotal approach, is implanted an AMS 800 penile prosthesis on the same procedure, describing results and follow up. We have done a review of the literature involving the transcrotal approach, describing the surgical technique and its indications, comparing the results with the ones obtained in our centre and demonstrating that the transcrotal approach is possible, but with its specific indications and still with weaker results that the perineal approach