Is detrusor underactivity associated with voiding dysfunction after single incision sling surgery?

BACKGROUND: Some women experience voiding dysfunction after stress urinary incontinence (SUI) surgery. We explore if detrusor underactivity (DU) found in urodynamic study (UDS) prior to SUI surgery using an adjustable single incision sling (SIS) may be related to voiding dysfunction after surgery. METHODS: This is a prospective, diagnostic, transversal, single center study comparing voiding dysfunction after SUI surgery with a SIS (Altis®; Coloplast, Humlebæk, Denmark) between women with DU (cases) or normal detrusor (controls). Inclusion criterium was women ≥18 years with SUI/mixed UI (stress predominant) operated between June 2013 and December 2020. Exclusion criteria were: women without UDS prior to surgery or without voiding phase in the P/Q, previous incontinence surgery, POP stage ≥2, neurogenic conditions, other pelvic floor surgery. Urinary symptoms were assessed using structured questions evaluating storage/voiding symptoms. Patients were divided into two groups according to projected Isovolumetric Pressure Index (PIP1) with 30-75 cmH2O indicating normal contractility. RESULTS: A total of 139 women were included, 29 (20.9%) in DU group and 110 (79.1%) in control group. Control and DU groups have shown similar objective (75.5% vs. 71.4% P=0.66) and subjective (85.4% vs. 96.1% P=0.22) success rates, respectively, without statistical differences. Voiding symptoms increased after surgery in both groups (+20.7% DU group vs. +8.1% normal group, P=0.29). More voiding symptoms (persistent/de novo) were found in DU group vs. normal group, but without statistically significant differences. CONCLUSIONS: According to our results, the presence of DU previous to SUI surgery with a SIS (Altis®, Coloplast) has no impact on objective and subjective success rates. On the other hand, patients with preoperative DU showed higher proportion of voiding dysfunction but no statistical difference.

Scrotum Melanoma: Evolution Over One Year in This Unusual Location.

Genitourinary melanoma accounts for 0.1-0.2% of melanoma, the scrotum being its rarest location. We report about an 85-year-old patient who was referred to our outpatient clinic due to the presence of a scrotum black papule for 20 months. Wide local excision was performed, and histology revealed a malignant melanoma. Chest and abdominal CT revealed metastatic disease, so chemotherapy, immunotherapy and radiotherapy were administered. We describe the evolution over 1 year in this unusual location, as well as complications and the currently available therapeutic options to cure this disease.

Central Body Fat Mass Measured by Bioelectrical Impedanciometry But Not Body Mass Index Is a High-Grade Prostate Cancer Risk Factor.

OBJECTIVE: To evaluate the association between body fat mass distribution measured by bioelectrical impedanciometry (BEI) and high-grade prostate cancer (HGPC). METHODS: We prospectively analyze 323 patients who underwent prostate biopsy. BEI was performed prior to biopsy. Prostate cancer (PC) was stratified according to D'Amico classification. For univariate analysis, Student t test was done. For multivariate analysis, bivariate logistic regression was performed using PSA, body mass index (BMI), percentage central body fat, percentage total body fat, and visceral fat as explicative variables for the diagnosis of HGPC. RESULTS: PC was found in 134 patients. Thirty seven (27.2%) were HGPC. This group had higher age, PSA, and percentage central body fat (p = 0.001, p = 0.001, p = 0.04). BMI showed no association with HRPC. Age, PSA, and percentage central body fat (OR 1,123, 95% CI 1,022-1,233, p = 0.001) were independent risk factors. CONCLUSIONS: Central body fat measured by BEI could explain the association between obesity and HGPC better than BMI suggesting the use of this technique to study body fat distribution.

Disfuncion miccional post-braquiterapia en el cáncer prostático / Coiding dysfunction after brachytherapy in patients with prostate cancer

La aparición de síntomas urinarios postbraquiterapia es un hecho muy frecuente, que alcanza su máximo entre el primer y tercer mes postimplante, normalizándose alrededor del año. La incidencia de retención urinaria postimplante oscila entre el 1.5 y el 27%. Un porcentaje bajo de pacientes (0-8.7%) necesitará una cirugía desobstructiva para resolver una retención urinaria prolongada o síntomas obstructivos severos. Los alfabloqueantes pueden ser útiles para aliviar los síntomas urinarios postimplante, aunque no reducen la necesidad de cirugía posterior. Existen varios factores clínicos predictivos de aparición de complicaciones urinarias. Un paciente con puntuación IPSS preimplante alta, próstata de gran tamaño, con signos funcionales obstructivos (Qmax bajo, residuo alto y parámetros urodinámicos de obstrucción), tiene alto riesgo de presentar retención urinaria o síntomas urinarios prolongados. Esto repercutirá claramente en la calidad de vida del paciente, lo que lo hace candidato a otro tipo de terapias. El empleo de una técnica de implantación periférica (que asegure bajas dosis en uretra) y evitar el plano uretral en la inserción de las agujas puede minimizar el daño uretral asociado a la aparición de complicaciones urinarias. La incontinencia postbraquiterapia es una complicación poco frecuente, pero que aumenta de forma dramática en pacientes con RTUP previa o que precisan de la misma para resolver una retención urinaria mantenida. Es fundamental conocer esta circunstancia para informar debidamente al paciente y planificar una RTUP lo más cuidadosa posible(AU)

OBJECTIVES: The development of urinary symptoms after brachytherapy is very frequent, reaching a maximum between the first and third month after the implant and returning back to normal around one year. The incidence of acute urinary retention varies between 1.5 and 27%. A low percentage of patients (0-8.7%) will need surgery to solve an extended urinary retention or severe obstructive voiding symptoms. Alphablockers may be useful to alleviate voiding symptoms after the implant, although they do not reduce the need for surgery.There are several predictive clinical factors for development of urinary complications. A patient with high IPPS score before implant, large size prostate, obstructive functional signs (Low Q max, high postvoid residual, and obstruction urodynamic parameters) has a high risk for urinary retention or extended urinary symptoms. This has repercussion on the quality of life of the patient, making them candidates to other therapies. The performance of a peripheral implant technique (guaranteeing low doses at urethra) and avoiding the urethral plane when inserting the needles may minimize urethral damage associated with development of urinary complications. Urinary incontinence after brachytherapy is a rare complication, but its frequency increases dramatically after transurethral resection of the prostate or requiring it to solve a sustained urinary retention. It is fundamental to know this circumstance to inform the patient adequately and to plan the most careful TURP(AU)

[Voiding dysfunction after brachytherapy in patients with prostate cancer]. / Disfunción miccional post-braquiterapia en el cáncer prostático.

OBJECTIVES: The development of urinary symptoms after brachytherapy is very frequent, reaching a maximum between the first and third month after the implant and returning back to normal around one year. The incidence of acute urinary retention varies between 1.5 and 27% . A low percentage of patients (0-8.7% ) will need surgery to solve an extended urinary retention or severe obstructive voiding symptoms. Alphablockers may be useful to alleviate voiding symptoms after the implant, although they do not reduce the need for surgery. There are several predictive clinical factors for development of urinary complications. A patient with high IPPS score before implant, large size prostate, obstructive functional signs (Low Q max, high postvoid residual, and obstruction urodynamic parameters) has a high risk for urinary retention or extended urinary symptoms. This has repercussion on the quality of life of the patient, making them candidates to other therapies. The performance of a peripheral implant technique (guaranteeing low doses at urethra) and avoiding the urethral plane when inserting the needles may minimize urethral damage associated with development of urinary complications. Urinary incontinence after brachytherapy is a rare complication, but its frequency increases dramatically after transurethral resection of the prostate or requiring it to solve a sustained urinary retention. It is fundamental to know this circumstance to inform the patient adequately and to plan the most careful TURP.

Clasificación, etiología, diagnóstico y tratamiento de las prostatitis. Otros tipos de prostatitis / Classification, etiology, diagnosis and treatment of prostatitis. Other types of prostatitis. Acute and chronic prostatitis

El síndrome "prostatitis" representa una entidad nosológica con una prevalencia muy relevante y, por tanto, con unas connotaciones enormes en cuanto a impacto económico, sanitario y de calidad de vida para los pacientes. Con una sintomatología ambigua, métodos de diagnóstico controvertidos y tratamientos largos y de resultados irregulares, se ha convertido en una de esas patologías que, sin comprometer la vida del paciente, resultan un tanto incómodas tanto para el paciente como para el profesional que intenta ayudarle y no siempre lo consigue. Aunque en la mayoría de los casos se acepta una etiología infecciosa, existen serias controversias tanto respecto a los métodos diagnósticos utilizados como a la interpretación de los mismos. Recientemente, el National Institutes of Health de Estados Unidos ha propuesto una nueva clasificación de esta patología que sustituye a la otra vigente en los últimos 20 años y que, en principio, permitiría una mejor aproximación al diagnóstico y tratamiento de esta patología tan insidiosa

Prostatitis is a highly prevalent nosologic entity and hence has an enormous financial impact on health systems as well as negative repercussions on patients' quality of life. The symptoms are ambiguous, diagnostic methods are controversial and treatments are long and produce inconsistent results; consequently, although not life-threatening, prostatitis has become one of those diseases that is difficult both for the patient and for the physician who attempts to help, sometimes without success. Although an infectious etiology is accepted in most cases, there are major controversies about both the diagnostic methods used and their interpretation. Recently the National Institutes of Health in the USA has proposed a new classification of this disease to substitute that used for the last twenty years. This new classification may provide a more effective approach to the diagnosis and treatment of this insidious disease

[Classification, etiology, diagnosis and treatment of prostatitis. Other types of prostatitis. Acute and chronic prostatitis]. / Clasificación, etiología, diagnóstico y tratamiento de las prostatitis. Otros tipos de prostatitis.

Prostatitis is a highly prevalent nosologic entity and hence has an enormous financial impact on health systems as well as negative repercussions on patients' quality of life. The symptoms are ambiguous, diagnostic methods are controversial and treatments are long and produce inconsistent results; consequently, although not life-threatening, prostatitis has become one of those diseases that is difficult both for the patient and for the physician who attempts to help, sometimes without success. Although an infectious etiology is accepted in most cases, there are major controversies about both the diagnostic methods used and their interpretation. Recently the National Institutes of Health in the USA has proposed a new classification of this disease to substitute that used for the last twenty years. This new classification may provide a more effective approach to the diagnosis and treatment of this insidious disease.

[Urinary tract infection in pregnancy and menopause]. / Infección urinaria en el embarazo y menopausia.

OBJECTIVES: To review the topic of urinary tract infections (UTI) during pregnancy and menopause. UTI during pregnancy and menopause have great relevance in the field of urologic infections; during pregnancy because of the particularities involved in its diagnosis and treatment and potential consequences to the fetus and mother; menopausal UTI because this group of women is numerous and represents a growing section of the general population pyramid, due to the aging of population in developed countries associated with longer life expectancies and grater demand for quality of life. METHODS AND RESULTS: We performed a bibliographic review combined with our personal experience. During pregnancy there are several functional and anatomical changes that condition not only a higher risk of UTI, but also an additional treatment difficulty due to antimicrobial pharmacokinetics alterations and potential damage to the fetus. Despite efforts to find an easy, fast and reliable test for bacteriuria detection, urine culture continues to be the first diagnostic test for its detection and follow up during pregnancy. Penicillin derivates and cephalosporins continue to be the first choice because their lack of adverse effects on either fetus or mother. Alternative options like phosphomicin and aztreonam although they show low toxicity there is need for more studies supporting their suitability for the treatment of pregnancy UTIs. Menopausal female UTI have their different features from those in younger women. Hormonal alterations derived from gonadal atrophy associate functional changes in the vaginal ecosystem, making it prone to enterobacteriaceae colonization as a first step up to the urinary tract. This associated with genitourinary tract anatomical alterations inherent t aging make UTI extraordinary prevalent in this growing segment of population. Treatment lines focus on hormonal alteration correction and proper antimicrobial prophylaxis and vaccines in a close future. CONCLUSIONS: UTIs during pregnancy and menopause have differential features that require different diagnostic and treatment approaches.

Tratamiento de la litiasis renal cálcica. LEOC, NLP, cirugía abierta / Treatment of renal calcium stones: ESWL, PNL, open surgery

OBJETIVO: El objetivo del siguiente trabajo es una revisión y exposición, tanto de nuestra experiencia como de la literatura y del tratamiento actual de la litiasis renal cálcica. MÉTODOS: Se evalúan los resultados e indicaciones terapéuticas con los siguientes resultados y conclusiones. RESULTADOS/CONCLUSIONES: La litiasis piélica es la indicación ideal de la LEOC con tasas de resolución que fluctúan del 33 al 90 por ciento, influyendo sobre todo el tamaño del cálculo y también su composición. En la litiasis calicial los resultados son superponibles a la litasis piélica, excepto en los situados en cáliz inferior, en la que la tasa global de resolución completa oscila del 50 al 75 por ciento, mientras que con el tratamiento con NLP se alcanzan cifras del 90 por ciento, además cuando el ángulo infundíbulo-piélico es menor de 90º la tasa de resolución es aún menor. En la litiasis intradiverticular la tasa de resolución oscila entre el 4-58 por ciento obteniéndose los mejores resultados cuando el cálculo es pequeño y el cuello del divertículo es visible en la urografía. La litiasis coraliforme es la más compleja y por tanto la que más dificultades ofrece en el tratamiento con LEOC, sólo en el coraliforme tipo I su tratamiento con ondas de choque ofrece unos buenos resultados con un 72 por ciento de limpieza y una media de 3,5 sesiones por paciente (AU)