Do candidates for penile implant prefer their doctors or another implanted patient as their information source? Results of a pilot study.

INTRODUCTION: Erectile dysfunction incidence is about 19-26 cases for every 1000 men/year, requiring about 20,000 penile implants/year. There is high demand for information on the part of patients, however, there is a lack of evidence about the sources of information prior to penile implant and the figure of the Expert Patient (EP) has never been described in this area. AIMS: To evaluate the sources of information used by candidates for penile implant as well as to describe the role of the EP as an information source. METHODS: Pilot study of candidates for penile prosthesis. Patients already implanted attending for exchange or reallocation surgery were excluded. Each patient had an interview with an EP, and commercial documentation was given. Each source of information was evaluated in a face-to-face interview. SPSS™ version 20.0 was used. MAIN OUTCOME MEASURES: The EP was evaluated by the International Index of Erectile Function, the Generalized Anxiety Disorder 7 questionnaire, and the Erectile Dysfunction Inventory of Treatment Satisfaction. Each source of information was evaluated by a non-validated 6-section questionnaire. RESULTS: Ten patients were included. Mean age was 60±10.3 years. Medical interview with the urologist resulted in a global value and truthfulness score of 9.2±.9 and 9.8±.4, respectively. Commercial information had a global score of 8.5±.9 and a truthfulness score of 8.6±.6, while the internet had 6.8±.8 points for global value and 7.2±1 for truthfulness. The global score of the EP was 8.7±1.2 points and their veracity scored 9.6±.5 points. CONCLUSIONS: The urologist remains the main source of information for patients with erectile dysfunction candidates for penile prosthesis implant. However, the EP is an alternative and could be a key pillar in presurgical counselling.

Hematopoyesis extramedular mediastínica en paciente con beta-talasemia mayor / Mediastinal extramedullary hematopoiesis in patient with beta-thalassemia major

No disponible

Mid-term safety and efficacy of the ALTIS® single-incision sling for female stress urinary incontinence: less mesh, same results.

OBJECTIVE: To analyse the mid-term safety and efficacy of the ALTIS® single-incision sling (Coloplast Corp., Minneapolis, MN, USA) for female stress urinary incontinence (SUI). PATIENTS AND METHODS: We conducted a prospective, single-arm, unsponsored, observational single-centre trial in a cohort of patients undergoing SUI surgery with the ALTIS procedure. All patients were diagnosed according to clinical reports, physical exploration and urodynamics. Body mass index (BMI) was categorised according to World Health Organization classification. Valsalva leak-point pressure (VLPP) was categorised in three groups: <60, 60-90 and >90 cmH2 O. Patients were evaluated postoperatively at 1, 6, 12 and 24 months with physical examination, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and satisfaction visual scale (SVS; score 0-10). Adverse events were assessed at each visit. Multivariate analysis for risk factors of surgery failure was performed. RESULTS: We recruited 110 women, with a mean (SD) follow-up of 22.34 (10.34) months. Regarding efficacy, 91 patients (82.7%) were objectively cured and 97 (88.2%) were subjectively cured. Regarding VLPP and BMI, no differences were seen between groups (P > 0.05). There was a ~20% decrease in urge UI (P = 0.04). No variable showed to be an independent risk factor for ALTIS failure (P > 0.05). Overall, nearly 96% of the women reported 9 or 10 points on the SVS. A total of 24 patients (21.8%) had some kind of complication. No mesh erosion was reported in any patient. CONCLUSIONS: The ALTIS sling demonstrated to be an effective and safe procedure for SUI in the mid-term setting. Objective and subjective cure rates are at least comparable to 'gold standard' procedures with a minimal rate of self-limiting non-surgical complications.

Analysis of the Efficacy and Safety of Increasing the Energy Dose Applied Per Session by Increasing the Number of Shock Waves in Extracorporeal Lithotripsy: A Prospective and Comparative Study.

PURPOSE: To evaluate the efficacy and safety of increasing the energy dose in treating urinary lithiasis with extracorporeal lithotripsy through an expanded number of Shock Waves Per Session (SWPS). MATERIALS AND METHODS: a randomized, prospective, and comparative study was performed with patients with renal or ureteral lithiasis from 2011 to 2014. Two groups were studied: Group A (n = 136), treated with 3500 SWPS, and Group B (n = 171), subjected to an expanded treatment with 7000 SWPS. Patients were considered stone free when there was no lithiasis or it were less or equal to 4 mm after treatment. Variables related to the patient, stones, treatment, and complications were collected. RESULTS: The global SFR was 75.0% and 87.7% in Groups A and B, respectively (p = 0.004). In renal location, the SFR was higher in Group B (74.1% vs 90.7%, p = 0.003) regardless of the size. In the ureteral location, there were differences in the pelvic only (73.7% vs 95.2%). There were no differences in either the complication rate (27.2% vs 25.7%, p = 0.77), or the severity between the two groups. The variable "number of SWPS" was seen to be an independent predictor of the resolution of lithiasis, having the probability of resolving lithiasis 2.62 (CI 95% = 1.40-4.89) times greater when applying 7000 SWPS. CONCLUSION: In our study, increasing the energy dose applied through an expanded number of SWPS has been shown to be more effective than standard regimens with a similar safety profile. However, more clinical studies on different types of lithotripters are required to confirm these results.

Principales características clínicas y de supervivencia en una serie de tumores testiculares primarios / Clinical and survival patterns among patients with primary testicular cancer

Objetivo. Realizar un análisis descriptivo en pacientes diagnosticados de cáncer testicular primario y valorar posibles factores predictores de recidiva tumoral, con el fin de establecer seguimientos individualizados. Material y métodos. Estudio longitudinal retrospectivo con una cohorte de 91 pacientes intervenidos de orquiectomía radical por tumor testicular primario entre enero del 2004 y diciembre del 2014. Las variables analizadas fueron: motivo de consulta, características ecográficas, marcadores tumorales (AFP, LDH Y β-HCG), estadio tumoral, anatomía patológica, tratamiento y presencia de recaída. Para el estudio de la recaída se han realizado una curva de Kaplan-Meier y una regresión logística para valorar factores predictores. Resultados. La edad media fue de 31,8±10,4 años. El motivo de consulta más frecuente fue masa indolora (71,1%), seguido de dolor testicular (24,4%). En la ecografía la mayoría presentaban una masa única (78,3%) y heterogénea (85,4%). El 71,4% de los casos se encontraban en estadio I, el 24,2% en estadio II y 4,4% en estadio III. En 55 pacientes se realizó únicamente orquiectomía radical, en 34 se asoció quimioterapia y en 2 se aplicó radioterapia. Durante el tiempo de seguimiento han recaído 14 pacientes (15,38%) y ha habido un fallecimiento. De las 14 recaídas, 9 ocurrieron durante el primer año. El único factor predictor de recidiva detectado fue un nivel elevado de β-HCG. Conclusión. El cáncer testicular suele diagnosticarse en un estadio localizado y tiene altas tasas de curación. Las recidivas aparecen habitualmente en los primeros años de seguimiento y el único factor predictor hallado en nuestra experiencia es una β-HCG elevada (AU)

Objective. To perform a descriptive study in patients diagnosed with testicular cancer and analyze the potential risk factors in order to establish an individualized follow up. Material and methods. We performed a longitudinal retrospective study from January 2004 to December 2014 in 91 patients with testicular cancer. They underwent to radical orchiectomy due to testicular cancer at our center. We analyzed the reason for consultation, ultrasound characteristics, tumor markers (AFP, LDH and bHGC), tumor stage, pathology, treatment and relapses during the follow up. To analyze the risk factors, we used the Kaplan Meier curve and logistic regression. Results. The mean age was 31.8±10.4. The most frequent reason for consultation was painless lump (71.1%), following by testicular pain (24.4%). The main scrotal ultrasound feature was solitary tumor (78.3%) and heterogeneous (85.4%). The stage I was present in 71.4% of the cases, 24.2% were stage II and 4.4% were stage III. Regarding the treatment, 55 patients underwent to radical orchiectomy, 34 received adjuvant chemotherapy and 2 adjuvant radiotherapy. 14 (15.38%) patients had a relapse and one patient died from testicular cancer. Nine relapses from fourteen have been during the first year after the initial treatment. We only found that a bHCG high level is a predictive factor of relapse. Conclusion. Testicular cancer is diagnosed in an early stage and it has a high cure rate. The relapse has been during the first year of follow up. In our experience, we identified bHCG high level as predictor factor (AU)

Urodynamic findings in amyotrophic lateral sclerosis patients with lower urinary tract symptoms: Results from a pilot study.

AIMS: To determine lower urinary tract symptoms (LUTS) prevalence and urodynamic findings in amyotrophic lateral sclerosis (ALS) patients treated in our hospital. METHODS: Cross-sectional and descriptive study on a cohort of ALS patients. Validated questionnaires (ICIQ-SF, IPSS, and OAB-V8) were self-administered in order to evaluate the presence of LUTS. Symptoms were classified as clinically significant (csLUTS), if any of following scores, IPSS > 7, ICIQ-SF > 0, or OAB-V8 ≥ 8, were present. Urodynamic study was offered to csLUTS patients. Physical examination and prostate ultrasound were also performed. RESULTS: Fifty five of seventy nine (70%) ALS patients accepted to participate in the study. Only 24/55 (43.6%) patients met criteria for csLUTS and 13 patients reported urgency urinary incontinence (26.3%). Most of csLUTS patients complained of mixed symptoms (82.6%). QoL measured by IPSS was 2.1 ± 1.5, 20% scoring as mostly dissatisfied or unhappy. Average QoL ICIQ-SF scoring was 3.17 ± 3, 33% complained of moderate to severe bother. Ten of twenty four (41.7%) csLUTS patients consented to UDS. The most frequent finding was detrusor overactivity with obstruction due to non-relaxing external sphincter (five patients) or bladder neck (two patients). Two patients showed normal bladder filling but non-relaxing external sphincter during voiding. UDS was normal in one patient. CONCLUSIONS: In this small pilot study we found a high prevalence of csLUTS in ALS which are mainly related to a combination of voiding and storage symptoms. In most patients, symptoms are caused by overactive detrusor combined with non-relaxing sphincter. Severity of symptoms and impact in QoL is only moderate but in a subset of patients can be considerable. Neurourol. Urodynam. 36:626-631, 2017. © 2016 Wiley Periodicals, Inc.

Malignant Triton Tumor of the Kidney. New Location Not Previously Reported.

Malignant triton tumor (MTT) is a variant of the peripheral nerve sheath tumor. It is very uncommon but shows an aggressive course and limited survival. Half of the cases present symptoms related to neurofibromatosis type 1 disease. There is no standardized treatment, but multimodal approach is the best option. We present the case of a primary MTT located in the kidney, in a 43-year-old woman who received neoadjuvant chemotherapy as first-line treatment followed by surgical resection and adjuvant chemotherapy.

Local Treatment of Penile Prosthesis Infection as Alternative to Immediate Salvage Surgery.

INTRODUCTION: Penile prosthesis (PP) is the established treatment for patients with erectile dysfunction (ED) who do not respond to phosphodiesterase inhibitors and intracavernosal injections. In general, these devices have been largely successful but there are not free of serious complication such as PP infection (PPI). PPI requires immediate surgical removal or salvage rescue of the PP. AIM: In this report, we present two clinical cases with inflatable PP (IPP) treated locally with antibiotic and high pressure irrigation and then avoid the PP removal or salvage rescue. METHODS: We present two patients with PPI in our institution and literature review. MAIN OUTCOME MEASURES: Resolution of the two cases. RESULTS: Patient A (A) was 44 years old and patient B (B) 51 years old presented PPI after three weeks (A) and eight weeks (B). Both patients were diabetic. Physical exploration revealed an open scrotal incision at its margin with a clear discharge. The rest of the incision and scrotum were clean and dry. They had not scrotum pain/tenderness or systemic/septic symptoms. The bacterial culture of the incisional drainage revealed a Staphylococcus aureus (A) and Staphylococcus epidermidis (B). In both cases, we performed an excision of the tissue around the pump with a high pressure pulsed irrigation (Interpulse; Stryker Corp, Kalamazoo, MI, USA). For the irrigation we used three different solutions that included povidone-iodine, antibiotics (gentamicin plus vancomicin), and hydrogen peroxyde. Finally, we performed a multilayered surgical closure with the use of aspirate drainage over 24 hours and intravenous antibiotics. The patients had a total resolution of its symptoms after 20 months (A) and 36 months (B), and the IPP worked properly. CONCLUSION: This treatment could be an option for to perform specific patients with local IPP infection without systemic symptoms instead of surgical removal.

Detection of prostate cancer using a voltammetric electronic tongue.

A simple method based on the multivariate analysis of data from urine using an electronic voltammetric tongue is used to detect patients with prostate cancer. A sensitivity of 91% and a specificity of 73% were obtained to distinguish the urine from cancer patients and the urine from non-cancer patients.

Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs.

OBJECTIVE: To evaluate the clinic characteristics, diagnosis, management, and costs of the adult acute scrotum in the emergency room (ER). Acute scrotum is a syndrome characterized by intense, acute scrotal pain that may be accompanied by other symptoms. It is usual in children and commonly found as well in adults, with different causal pathologies between these groups. METHODS: Between November 2013 and September 2014, 669 cases of adult acute scrotum who presented to our ER were prospectively analyzed. Patients under 15 years of age were excluded. Patient age, reason for consultation, investigations performed, final diagnosis, management, and costs were evaluated. For the statistical analysis, the Mann-Whitney, Kruskal-Wallis U, and chi-square tests were used. RESULTS: A total of 669 cases of acute scrotum were analyzed. The mean age at presentation was 40.2 ± 17.3 years. The most presented diagnoses were orchiepididymitis (28.7%), epididymitis (28.4%), symptoms of uncertain etiology (25.1%), and orchitis (10.3%). Diagnostic tests were carried out in 57.8% of cases. Most cases were treated as outpatients (94.2%), with 5.83% admitted and 1% undergoing surgical treatment. Overall, 13.3% of patients represented to the ER. Abnormal results in blood and urine tests were more common among older patients and infectious pathologies. The average cost generated by an acute scrotum ER consult was 195.03€. CONCLUSION: Infectious pathologies are the most common causes of acute scrotum at ER. Abnormal blood and urine tests are unusual and are more common in older patients and infectious pathologies.

[Metastatic urinary bladder involvement in breast cancer]. / AFECTACIÓN VESICAL METASTÁSICA DEL CÁNCER DE MAMA.

OBJECTIVE: To contribute to the literature with three unusual cases of primary breast tumor with metastasis to the urinary bladder. METHODS: Presentation of the three clinical cases and bibliographic review. RESULTS: Three women, with an average age of 49.3 years, were diagnosed with invasive lobular breast carcinoma. Two of them suffered from hematuria after being diagnosed with breast cancer. The third patient was diagnosed incidentally after a routine CT scan. Upon diagnosis of the bladder metastases, they already had metastasis in other locations. The treatment of the three cases was palliative. The cause of death was due to additional pathologies. CONCLUSIONS: The presence of bladder metastases due to breast cancer is infrequent. The appearance of urinary tract symptoms in these patients requires a diagnostic study in order to rule out metastases.