Impacto de la prostatectomía radical en los resultados urodinámicos de pacientes con cáncer de próstata tratados con radioterapia de intensidad modulada / Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy

Introducción y objetivos Evaluar el efecto de la prostatectomía radical y la edad en los resultados urodinámicos antes y después de la radioterapia de intensidad modulada administrada a pacientes con cáncer de próstata. Materiales y métodos La muestra incluyó a 40 pacientes con cáncer de próstata, 22 de los cuales habían sido sometidos a prostatectomía radical. Se midieron y compararon los parámetros urodinámicos antes y después de una media de 4,2 meses de radioterapia. La radioterapia externa se administró mediante técnicas de terapia de arco volumétrico modulado y de radioterapia de intensidad modulada. Resultados No se vieron cambios significativos en los parámetros de uroflujometría. En el caso de la cistomanometría los datos no mostraron un aumento de la incontinencia urinaria de esfuerzo secundaria, pero sí un incremento del 7% en la incontinencia urinaria de urgencia. Hubo cambios estadísticamente significativos en la reducción de la capacidad vesical, con un deseo miccional fuerte, con urgencia miccional y también en la presión del detrusor con un deseo miccional normal. Además, el estudio de presión/flujo reveló una reducción estadísticamente significativa del volumen de orina residual. Conclusiones El efecto de la prostatectomía y la edad varía según la evolución del estudio urodinámico. Hubo una reducción significativa del volumen de orina residual, así como de la presión del detrusor, con un deseo miccional normal en los pacientes sin prostatectomía y en aquellos menores de 75 años. Además de un aumento en la incontinencia de urgencia, también se produjo un empeoramiento significativo del resultado urodinámico de llenado vesical y una disminución de la capacidad vesical cistomanométrica, con un deseo miccional fuerte y urgencia miccional. Ninguno de estos factores se vio afectado por la edad o la prostatectomía (AU)

Introduction and objectives To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. Materials and methods The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. Results Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. Conclusions The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy (AU)

Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy.

INTRODUCTION AND OBJECTIVES: To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. MATERIALS AND METHODS: The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. RESULTS: Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. CONCLUSIONS: The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.

Comparative analysis of the expression of metalloproteases (MMP-2, MMP-9, MMP-11 and MMP-13) and the tissue inhibitor of metalloprotease 3 (TIMP-3) between previous negative biopsies and radical prostatectomies. / Análisis comparativo de la expresión de metaloproteasas (MMP-2, MMP-9, MMP-11 y MMP-13) y del inhibidor tisular de la metaloproteasa 3 (TIMP-3) entre las biopsias previas negativas y las prostatectomías radicales.

Metalloproteases (MMPs) and tissue inhibitor of metalloprotease-3 (TIMP-3) have been associated to the risk of having cancer and tumor aggressiveness. When facing the difficulties of prostate cancer diagnosis, the expression of MMPs and TIMP-3 in negative biopsies could be helpful to evaluate a diagnostic suspicion. Our objective is to carry out a comparative study of the expression of MMPs and TIMP-3 in previous negative biopsies and radical prostatectomies (RP). MATERIAL AND METHODS: Retrospective analysis of a hospital-based cohort including 21 patients with suspicion of prostate carcinoma, whose expressions of MMP-2, 9, 11 and 13 and TIMP-3 were evaluated by immunohistochemistry in the tumor area from previous negative biopsies and RP. RESULTS: Immunohistochemical staining values (Score) for MMPs (-11 and -13) and TIMP-3 showed no significant differences when comparing the areas of negative biopsies where tumors subsequently developed with those of the RP. However, we did observe a significant difference in the increased expression of MMP-2 (P=.002) and MMP-9 (P=.001) in the tumor area of the RP with respect to the corresponding area of the previous negative biopsy. CONCLUSIONS: Our data indicate a higher overall expression of MMP-2 and MMP-9 in the tumor area of the RP compared to the corresponding areas of the negative previous biopsy, which seems to be associated to the process of malignant transformation.

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.