Percutaneous closure of a ruptured right coronary sinus of Valsalva aneurysm that mimics severe aortic regurgitation.

A 34-year-old male was admitted with presumed acute, severe aortic regurgitation. Multimodal imaging was performed and showed a ruptured right coronary sinus of Valsalva aneurysm into the right atrium. He underwent a percutaneous closure of the ruptured sinus of Valsalva aneurysm. The patient had major clinical improvement.

Consecuencias de la fractura de pene: complicaciones y resultados funcionales a largo plazo / Consequences of penile fracture: Complications and long-term functional outcomes

Introducción La fractura de pene (FP) es una urgencia urológica con baja incidencia, por lo que existe poca evidencia de los resultados a largo plazo. Este estudio se centra en las complicaciones postoperatorias y los resultados funcionales a largo plazo en pacientes que han sufrido una FP reparada quirúrgicamente en nuestro centro.Materiales y métodos Los registros clínicos de pacientes sometidos a cirugía urgente por FP en un hospital de tercer nivel entre 2006 y 2020 se revisaron retrospectivamente. Los resultados funcionales se evaluaron con visitas telefónicas voluntarias desde junio del 2020 a febrero del 2021. Se realizó un cribado de sintomatología del tracto urinario inferior mediante el cuestionario IPSS, de función sexual mediante el EHS y el IIEF-5, y de alteraciones morfológicas mediante pregunta directa a los pacientes.ResultadosCuarenta y un pacientes fueron sometidos a cirugía por FP; 11 de ellos además asociaron lesión uretral (mayor incidencia si había lesión de ambos cuerpos cavernosos, 19,4 vs. 80%, p<0,05). Solo un paciente presentó una complicación Clavien-Dindo tipo 3a por dehiscencia de la herida, 4 (13%) tipo 2 y 9 (29%) tipo 1. Realizaron seguimiento a largo plazo 24 pacientes, de los cuales 20 (83,3%) presentaban una función sexual normal. Doce (50%) presentaban un nódulo palpable en la zona de la fractura, 8 (33,3%) curvatura peneana de nueva aparición y un paciente con lesión uretral previa presentó estenosis de uretra.Conclusión En la fractura de pene, hay más incidencia de lesión uretral si se afectan ambos cuerpos cavernosos. Las secuelas funcionales a largo plazo tras la reparación quirúrgica de una FP son poco frecuentes (AU)

Introduction Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center.Materials and method Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5, and morphological alterations by direct questions to patients.ResultsA total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4 vs. 80%, P<.05). Only one patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and one patient with previous urethral injury presented urethral stricture.Conclusion In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare (AU)

Consequences of penile fracture: Complications and long-term functional outcomes.

INTRODUCTION: Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center. MATERIALS AND METHOD: Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5 and morphological alterations by direct questions to patients. RESULTS: A total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4% vs. 80%, p < 0.05). Only 1 patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and 1 patient with previous urethral injury presented urethral stricture. CONCLUSION: In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare.

Eficacia y seguridad de la colagenasa de Clostridium histolyticum en la enfermedad de Peyronie según un protocolo de tratamiento modificado / Efficacy and safety of collagenase Clostridium histolyticum in Peyronie's disease following a modified treatment protocol

Introducción: La colagenasa de Clostridium histolyticum (CCH) es el único medicamento con licencia para el tratamiento conservador en la enfermedad de Peyronie (EP) que ha demostrado eficacia y seguridad en ensayos clínicos. Sin embargo, el protocolo de tratamiento estándar consume tiempo y recursos, por lo que presentamos un nuevo protocolo de tratamiento con CCH con un perfil más rentable. Nuestro objetivo es evaluar su eficacia y su seguridad.Materiales y métodosSe incluyeron pacientes con EP en fase estable, con curvaturas de 30-90°. Se excluyeron curvas ventrales y deformidades complejas. El protocolo de tratamiento consiste en una dosis completa de CCH inyectada a lo largo de la placa de EP formando 2 líneas de 4 inyecciones. Se educó a los pacientes en los ejercicios diarios de modelado del pene. La necesidad de un nuevo ciclo de tratamiento fue reevaluada cada 4semanas hasta un máximo de 8 ciclos o hasta la disminución de la curva de 30°. Para evaluar la eficacia se registraron los cambios en la curvatura y el número de ciclos. Para evaluar la seguridad se registraron los eventos adversos graves relacionados con el tratamiento, incluyendo la rotura de cuerpos cavernosos, hematoma peneano, hematuria e infección local.ResultadosUn total de 31 pacientes fueron tratados bajo el protocolo modificado. La curvatura inicial media fue de 49,84 (±15,83) grados. Se registró mejora en la curvatura en 25 pacientes (80,6%), con una disminución media absoluta de 20,65 (±15,42) grados y relativa del 44%. La curvatura media posterior al tratamiento fue de 30,67 (±17,25) grados. La mayoría de los pacientes requirieron una (19,4%) o dos (54,8%) inyecciones. Ningún paciente presentó eventos adversos graves relacionados con el tratamiento.ConclusionesLos resultados sugieren que el protocolo de tratamiento modificado con CCH es eficaz y seguro, pero se deben realizar más estudios que ayuden a optimizar el protocolo estándar actual. (AU)

Introduction: Collagenase Clostridium histolyticum (CCH) is the only approved treatment for conservative management of Peyronie's disease (PD) that has demonstrated efficacy and safety in clinical trials. However, as the standard treatment protocol is time and resource consuming, we are introducing a new CCH treatment protocol with a more cost-effective profile. Our goal is to evaluate its efficacy and safety.Materials and methodsWe included patients with PD in stable phase, with curvatures of 30-90degrees. Ventral curvatures and complex deformities were excluded. The treatment protocol consists of a full dose of CCH injected along the PD plaque, forming two lines of four injections. Patients were educated in daily penile modeling activities. The need for a new treatment cycle, up to a maximum of 8 cycles or until the 30-degree curve was decreased, was reevaluated every 4weeks. Changes in curvature and number of cycles were recorded to evaluate the efficacy. Regarding safety evaluation, treatment-related adverse events (TRAEs) were recorded, including rupture of the corpora cavernosa, penile hematoma, hematuria, and local infection.ResultsThirty-one patients were treated under the modified protocol. The mean initial curvature was of 49.84 (±15.83) degrees. Curvature improvement was recorded in 25 patients (80.6%), with a mean absolute reduction of 20.65 (±15.42) degrees and relative reduction of 44%. The mean curvature after treatment was 30.67 (±17.25) degrees. Most patients required one (19.4%) or two (54.8%) injections. No patient presented TRAEs.ConclusionsThe results suggest that the modified CCH treatment protocol is effective and safe, but more studies should be carried out to optimize the current standard protocol. (AU)

Efficacy and safety of collagenase Clostridium histolyticum in Peyronie's disease following a modified treatment protocol. / Eficacia y seguridad de la colagenasa de Clostridium histolyticum en la enfermedad de Peyronie según un protocolo de tratamiento modificado.

INTRODUCTION: Collagenase Clostridium histolyticum (CCH) is the only approved treatment for conservative management of Peyronie's disease (PD) that has demonstrated efficacy and safety in clinical trials. However, as the standard treatment protocol is time and resource consuming, we are introducing a new CCH treatment protocol with a more cost-effective profile. Our goal is to evaluate its efficacy and safety. MATERIALS AND METHODS: We included patients with PD in stable phase, with curvatures of 30-90degrees. Ventral curvatures and complex deformities were excluded. The treatment protocol consists of a full dose of CCH injected along the PD plaque, forming two lines of four injections. Patients were educated in daily penile modeling activities. The need for a new treatment cycle, up to a maximum of 8 cycles or until the 30-degree curve was decreased, was reevaluated every 4weeks. Changes in curvature and number of cycles were recorded to evaluate the efficacy. Regarding safety evaluation, treatment-related adverse events (TRAEs) were recorded, including rupture of the corpora cavernosa, penile hematoma, hematuria, and local infection. RESULTS: Thirty-one patients were treated under the modified protocol. The mean initial curvature was of 49.84 (±15.83) degrees. Curvature improvement was recorded in 25 patients (80.6%), with a mean absolute reduction of 20.65 (±15.42) degrees and relative reduction of 44%. The mean curvature after treatment was 30.67 (±17.25) degrees. Most patients required one (19.4%) or two (54.8%) injections. No patient presented TRAEs. CONCLUSIONS: The results suggest that the modified CCH treatment protocol is effective and safe, but more studies should be carried out to optimize the current standard protocol.

Point-of-care lung ultrasound predicts in-hospital mortality in acute heart failure.

BACKGROUND: B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung ultrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined. AIM: To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF. METHODS: Hand-held LUS was used to examine patients with acute HF. LUS was performed in eight chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models. RESULTS: We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal receiver operating characteristic-determined cut-off of ≥19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (area under the curve 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0-18.8, P = 0.02). Patients with ≥19 B-lines had a 4-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37-13.95, P < 0.01). CONCLUSION: In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.

El entorno digital en los trastornos sexuales masculinos: revisión sistemática / The digital environment in men's sexual disorders: A systematic review

Contexto: La revolución de las tecnologías digitales constituye un nuevo escenario para las relaciones médico-paciente y proporciona a los pacientes un espacio de privacidad y acceso universal al conocimiento. Sin embargo, existe poca información acerca del uso de los recursos digitales, así como de sus ventajas e inconvenientes. Objetivos: Explorar el ámbito de la investigación científica en cuanto al uso de recursos digitales relacionados con los trastornos sexuales masculinos y analizar las principales fuentes de información en estos campos. Adquisición de la evidencia: Búsquedas sistemáticas en la literatura científica, páginas web (10 primeros resultados en cada búsqueda de google) y aplicaciones móviles (apps). Las búsquedas combinaron las palabras clave "web" y "app" con "erectile dysfunction", "premature ejaculation", "Peyronie", "male hypogonadism", y "infertility". La calidad de las páginas web y apps fue analizada según indicadores predefinidos. Síntesis de la evidencia: El análisis cualitativo de la literatura científica incluyó 116 artículos, el 47% de los cuales eran estudios basados en encuestas online, el 9% abordaban los tratamientos digitales, el 11% la calidad/seguridad del entorno digital en salud, el 3% la actividad digital, el 21% el empoderamiento de los pacientes y el 9% las ventas de fármacos online. De las 50 páginas web evaluadas, 29 (58%) puntuaron 4 o 5 en una escala Likert de 5 puntos. La búsqueda de apps resultó en 40 apps; únicamente 3 de ellas (8%) aportaban la identidad de algún centro de salud o profesional implicado. Conclusiones: Tanto los pacientes como los profesionales sanitarios pueden beneficiarse de los recursos digitales relacionados con los trastornos sexuales masculinos. No obstante, es necesaria una mayor implicación de la comunidad médica para incrementar la calidad de dichos recursos

Context: The revolution of digital technologies constitutes a new setting for the patient-physician relationship and provides patients with a scenario of privacy and universal access to a vast amount of information. However, there is little information on how digital resources are used and what their advantages and disadvantages are. Objectives: To explore the scope of the scientific research on the use of digital technology related to men's sexual disorders and to analyze the primary sources of digital information related to this field. Acquisition of evidence: Systematic searches of the scientific literature, websites (10 first results in each google search) and mobile applications (apps). The searches combined the keywords "web" and "app" with "erectile dysfunction", "premature ejaculation", "Peyronie", "male hypogonadism", and "infertility". Websites and apps were assessed for quality according to predefined indicators. Synthesis of evidence: The qualitative analysis of the scientific literature included 116 manuscripts; 47% were clinical studies based on online survey, 9% dealt with digital treatments, 11% with quality/safety of digital healthcare environment, 3% with digital activity, 21% with patient empowerment, and 9% with online drug selling. Of 50 websites assessed for quality, 29 (58%) scored 4 or 5 on a 5-point Likert scale. The app search yielded 40 apps; only 3 of them (8%) reported the identity of a health center or healthcare professional involved. Conclusions: Patients and healthcare professionals may benefit from digital resources related to men's sexual disorders; however, a strong commitment by the scientific and healthcare community is essential to increase the quality of these resources

Evaluación del uso de smart glasses en urología: potenciales aplicaciones en los ámbitos hospitalario y quirúrgico / Testing Smart Glasses in urology: Clinical and surgical potential applications

Objetivos: Explorar los potenciales beneficios del uso de smart glasses, dispositivos de visualización manejables en modo manos libres, en el quirófano y en consultas externas en urología. Materiales y métodos: Entre abril y noviembre de 2015 se invitó a 80 urólogos a usar Google Glass en su práctica quirúrgica y clínica diarias, así como a compartirlas con otros urólogos. Los participantes puntuaron la utilidad de estos dispositivos en una escala de 10 puntos y aportaron su percepción sobre los posibles beneficios del dispositivo mediante una entrevista telefónica. Resultados: Durante el periodo de experimentación 240 urólogos utilizaron las smart glasses y los 80 inicialmente invitados puntuaron su utilidad. Las puntuaciones medias de utilidad en el quirófano y en consultas externas fueron de 7,4 y 5,4, respectivamente. La entrevista reveló que las aplicaciones de las smart glasses consideradas más prometedoras en cirugía fueron la proyección de vídeos en tiempo real y reproducción de imágenes estáticas, la realidad aumentada, la navegación laparoscópica y el checklist digital de comprobación de seguridad. En consultas externas los participantes las consideraron útiles como sistemas de visualización para compartir resultados de pruebas, para buscar información en un vademecum digital y para consultar historias clínicas en situaciones de urgencia. Conclusiones. Los urólogos involucrados en nuestra experiencia identificaron diversas utilidades de las smart glasses con beneficios potenciales para su práctica diaria, especialmente en el ámbito de la cirugía urológica. Serán necesarios futuros estudios cuantitativos para explotar las posibilidades reales de las smart glasses y abordar sus limitaciones técnicas, con el fin de conseguir un uso seguro de estos dispositivos en la práctica clínica y quirúrgica

Objectives: We aimed to explore the potential benefits of using smart glasses - wearable computer optical devices with touch-less command features - in the surgery room and in outpatient care settings in urology. Materials and methods: Between April and November 2015, 80 urologists were invited to use Google Glass in their daily surgical and clinical practice, and to share them with other urologists. Participants rated the usefulness of smart glasses on a 10-point scale, and provided insights on their potential benefits in a telephone interview. Results: During the testing period, 240 urologists used smart glasses, and the 80 initially invited rated their usefulness. Mean scores for usefulness in the surgery room and in outpatient clinics were 7.4 and 5.4, respectively. The interview revealed that the applications of smart glasses considered most promising in surgery were live video streaming and static image playback, augmented reality, laparoscopic navigation, and digital checklist for safety verification. In outpatient settings, participants considered the glasses useful as a viewing platform for sharing test results, for browsing digital vademecum, and for checking medical records in emergency situations. Conclusions: Urologists engaged in our experience identified various uses of smart glasses with potential benefits for physician's daily practice, particularly in the urological surgery setting. Further quantitative studies are needed to exploit the actual possibilities of smart glasses and address the technical limitations for their safe use in clinical and surgical practice

La colocación de catéteres doble J con anestesia local en régimen ambulatorio es un procedimiento seguro y eficiente para el manejo de distintas patologías ureterales / Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders

Objetivo: Evaluar los resultados de la colocación de catéteres doble J con anestesia local para el manejo de distintas patologías ureterales. Métodos: Estudio retrospectivo de 45 cateterismos ureterales consecutivos con anestesia local desde enero de 2015 hasta julio de 2016. Se incluyeron pacientes hemodinámicamente estables con una obstrucción o fístula urinaria o para la identificación ureteral durante una cirugía abdominopélvica. Cinco minutos antes del procedimiento se instilaron 10 ml de gel-lidocaína y 50 ml de suero-lidocaína en la vejiga. Se colocaron catéteres 4,8 Fr mediante un cistoscopio flexible de 15,5 Fr y escopia. Se analizaron las características y resultados de los procedimientos. Resultados: Se realizaron 45 procedimientos (33 colocaciones, 12 recambios) en 37 pacientes, de los cuales 40 (89%) fueron exitosos. Con una edad media de 58,6 años (±17,5), se intervinieron 10 hombres (27%) y 27 mujeres (73%). Las principales indicaciones fueron litiasis (37,8%), compresiones extrínsecas del uréter (28,9%) y la localización intraoperatoria ureteral (22,2%). Los intentos infructuosos fueron debidos a la incapacidad para ascender la guía/catéter en 4 casos (8,8%) o para identificar el meato ureteral en uno (2,2%). Ocho pacientes (17,8%) presentaron alguna complicación postoperatoria (7 Clavien I, uno Clavien IIIa). Ningún procedimiento se interrumpió por dolor. El análisis estadístico no encontró ningún factor predictor de éxito. El régimen ambulatorio fue 4 veces más barato. Conclusiones: La colocación de catéteres ureterales se puede realizar de forma eficaz y segura bajo anestesia local en el gabinete de cistoscopias. Este procedimiento podría ahorrar tiempo operatorio, reducir costes y minimizar los efectos secundarios de la anestesia general

Objective: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. Methods: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10 ml of lidocaine gel and 50 ml of lidocaine solution were instilled in the bladder. A 4.8 Fr ureteral stent was placed using a 15.5 Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. Results: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. Conclusions: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia

El peso de la comorbilidad del paciente se correlaciona con la gravedad de la disfunción eréctil / The Patient's Comorbidity Burden Correlates with the Erectile Dysfunction Severity

Objetivo: Explorar la relación entre la disfunción eréctil (DE), los niveles de testosterona y el Índice de comorbilidad de Charlson (ICC). Material y métodos: Estudio transversal en pacientes derivados a la unidad de andrología de 7 hospitales españoles. La DE se diagnosticó y clasificó mediante el International Index of Erectile Function. Los niveles de testosterona, la prevalencia de cada comorbilidad y el ICC se compararon entre pacientes con distintos grados de DE. Además de la correlación entre la testosterona total y el ICC, la influencia de cada comorbilidad y de la severidad de la DE en el ICC se evaluaron mediante una regresión lineal múltiple. Resultados: El estudio incluyó 430 hombres con una media de 61 años de edad. El ICC medio fue 3,5 y la testosterona total 15,2nmol/l; 389 (91%) de los sujetos tenían algún grado de DE: 97 (23%) leve, 149 (35%) leve a moderada, 86 (20%) moderada y 57 (13%) severa. La severidad de la DE se asoció a un nivel menor de testosterona (p = 0,002) y a un mayor ICC (p < 0,001). Los niveles de testosterona fueron significativamente menores en pacientes con obesidad, diabetes, hipercolesterolemia e hipertrigliceridemia (p < 0,05). Sin embargo, únicamente la diabetes y la hipertensión mostraron una relación significativa con la DE. El modelo multivariado, que incluía variables relacionadas con todas las comorbilidades evaluadas, los niveles de testosterona y la severidad de la DE, predijo el ICC (p < 0,001, R2 = 0,426). La severidad de la DE mostró una contribución significativa al modelo (p = 0,011), pero la testosterona total no (p = 0,204). Conclusiones: El ICC se asocia significativamente con la severidad de la DE, pero muestra una correlación débil con los niveles de testosterona

Objective: To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI). Material and methods: Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. Results: The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P = .002), and an increase in the CCI score (P < .001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P < .05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P < .001, R2 = .426). The severity of ED significantly contributed to this model (P = .011), but total testosterone did not (P = .204). Conclusions: The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels

The digital environment in men's sexual disorders: A systematic review. / El entorno digital en los trastornos sexuales masculinos: revisión sistemática.

CONTEXT: The revolution of digital technologies constitutes a new setting for the patient-physician relationship and provides patients with a scenario of privacy and universal access to a vast amount of information. However, there is little information on how digital resources are used and what their advantages and disadvantages are. OBJECTIVES: To explore the scope of the scientific research on the use of digital technology related to men's sexual disorders and to analyze the primary sources of digital information related to this field. ACQUISITION OF EVIDENCE: Systematic searches of the scientific literature, websites (10 first results in each google search) and mobile applications (apps). The searches combined the keywords "web" and "app" with "erectile dysfunction", "premature ejaculation", "Peyronie", "male hypogonadism", and "infertility". Websites and apps were assessed for quality according to predefined indicators. SYNTHESIS OF EVIDENCE: The qualitative analysis of the scientific literature included 116 manuscripts; 47% were clinical studies based on online survey, 9% dealt with digital treatments, 11% with quality/safety of digital healthcare environment, 3% with digital activity, 21% with patient empowerment, and 9% with online drug selling. Of 50 websites assessed for quality, 29 (58%) scored 4 or 5 on a 5-point Likert scale. The app search yielded 40 apps; only 3 of them (8%) reported the identity of a health center or healthcare professional involved. CONCLUSIONS: Patients and healthcare professionals may benefit from digital resources related to men's sexual disorders; however, a strong commitment by the scientific and healthcare community is essential to increase the quality of these resources.

Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders. / La colocación de catéteres doble J con anestesia local en régimen ambulatorio es un procedimiento seguro y eficiente para el manejo de distintas patologías ureterales.

OBJECTIVE: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. METHODS: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10ml of lidocaine gel and 50ml of lidocaine solution were instilled in the bladder. A 4.8Fr ureteral stent was placed using a 15.5Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. RESULTS: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. CONCLUSIONS: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia.

Grafts for Peyronie's disease: a comprehensive review.

The difficulty implicit in combining all the characteristics that an ideal patch to treat Peyronie's disease with a lengthening procedure should have, together with the challenges of comparing results from different series, means that the ideal patch has yet to be determined. Our objective with this review was to determine whether any given patch type is preferable to the others based on the evaluation of the results of published studies. A systematic search of the literature was conducted from PubMed until December 2016. Articles reporting basic research, animal research, reviews or meta-analyses and studies in children were eliminated. Series with patients undergoing some kind of other surgical intervention were only included if results were reported separately. Case reports and series of five patients were excluded. Five variables were selected to evaluate the results: number of patients, follow-up period, straightening rate, shortening rate and post-operative ED rate. For this purpose, 69 papers were included for review, and the outcomes of the use of autologous dermis, tunica vaginalis, dura mater, fascia, saphenous vein, tunica albuginea, buccal mucosa, porcine intestinal submucosa, pericardium, TachoSil® and synthetic materials were presented and analysed separately. The different series published are extremely variable and heterogeneous in terms of the number of patients included, patient selection, follow-up periods, and in the measurement and interpretation of the outcomes analysed. Given these facts, it is not possible to draw any definitive conclusion, homogeneous, prospective studies using validated tools are required to determine which the ideal graft is.

The Patient's Comorbidity Burden Correlates with the Erectile Dysfunction Severity. / El peso de la comorbilidad del paciente se correlaciona con la gravedad de la disfunción eréctil.

OBJECTIVE: To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI). MATERIAL AND METHODS: Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression. RESULTS: The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R2=.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204). CONCLUSIONS: The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.

Testing Smart Glasses in urology: Clinical and surgical potential applications. / Evaluación del uso de smart glasses en urología: potenciales aplicaciones en los ámbitos hospitalario y quirúrgico.

OBJECTIVES: We aimed to explore the potential benefits of using smart glasses - wearable computer optical devices with touch-less command features - in the surgery room and in outpatient care settings in urology. MATERIALS AND METHODS: Between April and November 2015, 80 urologists were invited to use Google Glass in their daily surgical and clinical practice, and to share them with other urologists. Participants rated the usefulness of smart glasses on a 10-point scale, and provided insights on their potential benefits in a telephone interview. RESULTS: During the testing period, 240 urologists used smart glasses, and the 80 initially invited rated their usefulness. Mean scores for usefulness in the surgery room and in outpatient clinics were 7.4 and 5.4, respectively. The interview revealed that the applications of smart glasses considered most promising in surgery were live video streaming and static image playback, augmented reality, laparoscopic navigation, and digital checklist for safety verification. In outpatient settings, participants considered the glasses useful as a viewing platform for sharing test results, for browsing digital vademecum, and for checking medical records in emergency situations. CONCLUSIONS: Urologists engaged in our experience identified various uses of smart glasses with potential benefits for physician's daily practice, particularly in the urological surgery setting. Further quantitative studies are needed to exploit the actual possibilities of smart glasses and address the technical limitations for their safe use in clinical and surgical practice.

Evolución de la técnica quirúrgica en el manejo de la masa renal / Changing patterns in the surgical management of renal masses

Objetivo: Describir la evolución de la técnica quirúrgica para el manejo de las masas renales en un centro español e identificar los factores asociados con la decisión de nefrectomía parcial (NP). Materiales y métodos: Un total de 646 pacientes fueron tratados quirúrgicamente por tumores renales localizados entre enero de 2004 y diciembre de 2012. Las técnicas quirúrgicas incluyeron la nefrectomía radical (NR) abierta, NP abierta, NR laparoscópica y NP laparoscópica. Se compararon las características basales y las proporciones de los pacientes tratados por diferentes técnicas mediante estadísticos descriptivos y se determinaron las tendencias anuales en la proporción de procedimientos realizados. Se calculó la proporción de probabilidades (OR) y los intervalos de confianza del 95% para evaluar variables clínicas predictivas de NP. Resultados: Durante el período de 9 años, la proporción de NP aumentó respecto a la NR, pasando del 21 al 55%. Los procedimientos abiertos disminuyeron gradualmente a favor de abordajes mínimamente invasivos (83% en 2004; 4% en 2011-2012). Aunque el tamaño tumoral medio no cambió significativamente durante el período de estudio, la NP laparoscópica se convirtió en el procedimiento más realizado en 2011-2012 (un 49% de todos los procedimientos). Las variables clínicas independientemente predictivas de NP fueron puntuación ASA, función renal basal y tamaño tumoral (todas las p < 0,05). Conclusiones: En nuestra institución, la evolución en el manejo de las masas renales ha establecido la NP como la opción quirúrgica más frecuente. Aunque la NP se utilizó cada vez más durante el período de estudio, se observó un aumento paralelo de los abordajes mínimamente invasivos tanto para NR como para NP

Objective: To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. Materials and methods: A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. Results: During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P < .05). Conclusions: At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen

Un mayor índice de comorbilidad de Charlson se relaciona con características más agresivas de los tumores vesicales de novo / A higher Charlson comorbidity index is related to more aggressive characteristics in de novovesical tumours

Objetivo: Analizar la relación entre el índice de comorbilidad de Charlson ajustado por edad (ICCa) y los resultados anatomopatológicos de las resecciones transuretrales (RTU) de tumores vesicales (TV) de novo. Material y métodos: Se recogieron los datos de 208 pacientes que, entre 2007 y 2008, fueron tratados mediante una RTU de un TV de novo. Se recogieron las variables edad, género, consumo de tabaco, comorbilidades evaluadas según el ICCa (puntuación y tasa de mortalidad), estadio patológico, grado tumoral y riesgo de recurrencia y progresión. Se analizó la relación entre las variables preoperatorias y las características patológicas finales. Se realizó el estudio multivariante con aquellas variables significativas (p < 0,05) en el análisis univariante. Resultados: La edad media fue 69,5 ± 12. Un 77% fueron hombres. El ICCa medio fue 6,4 ± 2,5. El resultado anatomopatológico final mostró un Tx, T0, Ta, T1 y T≥2 en el 5,3; 6,7; 31,7; 26,9 y 28,8%, respectivamente. El 33,3% fueron de bajo grado y el 66,7% de alto grado. Un 14,3% se asoció con CIS. Entre los TV no músculo invasivos, el 34,7% fueron de bajo riesgo de recurrencia y progresión, el 18,1% intermedio y el 47,2% de alto riesgo. Los pacientes con un ICCa igual o superior a 5 presentaron un mayor número de TV músculo invasivos (RR: 2,29; 1,1-4,8; p = 0,032), de tumores de alto grado (RR 3,1; IC: 1.6-6; p = 0,001) y de tumores de alto riesgo de recurrencia y progresión (RR: 2,9; IC: 1,4-5,9; p < 0,001). Conclusión: El ICCa está relacionado con las características patológicas de los TV de novo. Pacientes con mayor comorbilidad pueden presentar tumores más agresivos, por lo que el ICCa podría ser útil en la práctica clínica al identificar a pacientes con peor pronóstico

Objective: To analyze the relationship between the age - adjusted Charlson Comorbidity Index (aCCI) and pathological outcomes of transurethral resection of de novo bladder tumours (BT). Material and methods: Data from 208 patients who underwent a transurethral resection (TUR) of a de novo BT between 2007 and 2008 were collected. We recorded the following variables: age, sex, tobacco consumption, comorbidities assessed according to the ICCa (score and mortality rate), disease stage, tumour grade and risk of recurrence and progression. The relationship between the preoperative variables and the final pathological characteristics was analyzed. The multivariate study was conducted with the significant variables (P<.05) from the univariate analysis. Results: The mean age of the patients was 69.5 ± 12 years, and 77% were men. The mean ICCa was 6.4 ± 2.5. The final pathology results showed a Tx, T0, Ta, T1 and T ≥2 in 5.3, 6.7, 31.7, 26.9, and 28.8% of the cases, respectively. 33.3% of the tumours were low-grade and 66.7% were high-grade. 14.3% of the tumours were associated with carcinoma in situ. Among those non musculo-invasive bladder tumour (non-MIBT), 34.7% had a low risk of recurrence and progression, 18.1% had an intermediate risk and 47.2% had a high risk. The patients with a ICCa ≥5 had an increased number of MIBT (RR: 2.29; 1.1-4.8; P=.032), high-grade tumours (RR: 3.1; CI: 1.6-6; P=.001) and tumours with a high risk of recurrence and progression (RR: 2.9; CI: 1.4-5.9; P<.001). Conclusion: The ICCa is related to the pathological characteristics of de novo BT. Patients with greater comorbidity can present more aggressive tumours. The ICCa could therefore be useful in clinical practice for identifying patients with worse prognosis

A higher Charlson comorbidity index is related to more aggressive characteristics in de novo vesical tumours.

OBJECTIVE: To analyze the relationship between the age--adjusted Charlson Comorbidity Index (aCCI) and pathological outcomes of transurethral resection of de novo bladder tumours (BT). MATERIAL AND METHODS: Data from 208 patients who underwent a transurethral resection (TUR) of a de novo BT between 2007 and 2008 were collected. We recorded the following variables: age, sex, tobacco consumption, comorbidities assessed according to the ICCa (score and mortality rate), disease stage, tumour grade and risk of recurrence and progression. The relationship between the preoperative variables and the final pathological characteristics was analyzed. The multivariate study was conducted with the significant variables (P<.05) from the univariate analysis. RESULTS: The mean age of the patients was 69.5 ± 12 years, and 77% were men. The mean ICCa was 6.4 ± 2.5. The final pathology results showed a Tx, T0, Ta, T1 and T ≥ 2 in 5.3, 6.7, 31.7, 26.9, and 28.8% of the cases, respectively. 33.3% of the tumours were low-grade and 66.7% were high-grade. 14.3% of the tumours were associated with carcinoma in situ. Among those non musculo-invasive bladder tumour (non-MIBT), 34.7% had a low risk of recurrence and progression, 18.1% had an intermediate risk and 47.2% had a high risk. The patients with a ICCa ≥ 5 had an increased number of MIBT (RR: 2.29; 1.1-4.8; P=.032), high-grade tumours (RR: 3.1; CI: 1.6-6; P=.001) and tumours with a high risk of recurrence and progression (RR: 2.9; CI: 1.4-5.9; P<.001). CONCLUSION: The ICCa is related to the pathological characteristics of de novo BT. Patients with greater comorbidity can present more aggressive tumours. The ICCa could therefore be useful in clinical practice for identifying patients with worse prognosis.

Changing patterns in the surgical management of renal masses.

OBJECTIVE: To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. MATERIALS AND METHODS: A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. RESULTS: During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P<.05). CONCLUSIONS: At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.

Feasibility and safety of conservative surgery for the treatment of spermatic cord leiomyosarcoma.

OBJECTIVES: To assess the feasibility and the safety of conservative surgery to treat spermatic cord leiomyosarcoma. METHODS: Patients undergoing inguinoscrotal exploration in 10 different Urological Centers with diagnosis of leiomyosarcoma were enrolled. Preoperative evaluation included physical examination, Scrotal US, Abdominal CT and Scrotal MRI in selected cases. Patients underwent organ sparing surgery or orchiectomy in case of intraoperative FSE was positive for a local infiltration. Data collected were: age, presence of infiltration, length of the lesion, number of lesions, definitive histological outcome, pre and postoperative testosterone level. Follow up was performed with abdomen CT scan and scrotal US. RESULTS: From January 2007 to December 2013, 23 patients (mean age: 64.7 yrs) were diagnosed with spermatic cord leiomyosarcoma. Each patients underwent scrotal US. 10 patients underwent radical orchiectomy and 13 patients underwent conservative surgery. Mean follow up was 36.5 months. 5 patients (21.7%) developed a recurrent disease, 18 patients (78.3%) had a negative follow up (mean time: 40.8 months). Statistical analysis reveals that there is a significant correlation between number of lesions, length of the lesions and recurrent disease. CONCLUSIONS: Spermatic cord leiomyosarcoma is a rare disease. Conservative surgical treatment of spermatic cord leiomyosarcoma is a feasible therapeutic option for small, single and not infiltrating lesion.