Comparación entre abordajes quirúrgicos de prostatectomía radical en nuestra serie, más allá de los resultados oncológicos y funcionales / Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes

Objetivos Evaluar los resultados de la prostatectomía radical asistida por robot (PRAR), y compararlos con los de la cirugía abierta (PRA) y laparoscópica (PRL). El interés no solo radica en los resultados oncológicos y funcionales de la serie, sino en la evaluación de la calidad de vida (QoL), la recuperación postoperatoria y la satisfacción personal de los pacientes con la intervención (PR), fundamentalmente. Métodos Se realizaron 685 PR en nuestro centro entre 2011-2018 (17,8% PRA, 22,2% PRL y 60% PRAR). Los pacientes fueron evaluados prospectivamente mediante seguimiento hasta abril de 2020, y con la realización un cuestionario múltiple a los 12 meses post-PR, que incluía ICIQ-SF, SHIM, IPSS, IQL y preguntas sobre el dolor, la recuperación postoperatoria y la satisfacción del paciente (SP). También se recogieron datos basales y postoperatorios relacionados con el paciente y el tratamiento, y se realizaron regresiones logísticas binomiales para las comparaciones 1 vs. 1 (PRA vs. PRAR y PRL vs. PRAR). Resultados Los pacientes tratados con PRAR tienen en general menos comorbilidades, menos agresividad tumoral, un requerimiento de mayor tiempo operatorio y un número mayor de márgenes quirúrgicos positivos que los pacientes tratados con PRA y PRL. Sin embargo, la PRAR supera a la PRA en: días de estancia hospitalaria (OR: 0,86; IC 95%: 0,80-0,94), disminución de hemoglobina (OR: 0,38; IC 95%: 0,30-0,47), tasas de transfusión (OR: 0,18; IC 95%: 0,09-0,34), complicaciones tempranas (p=0,001), IQL (OR: 0,82; IC 95%: 0,69-0,98), función eréctil (OR: 0,41; IC 95%: 0,21-0,79), manejo del dolor (OR: 0,82; IC 95%: 0,75-0,89), recuperación postoperatoria (p<0,001) y elección de un abordaje diferente (OR: 5,55; IC 95%: 3,14-9,80). La PRAR es superior a la PRL en: continencia urinaria (OR: 0,55; IC 95%: 0,37-0,82), IPSS (OR: 0,96; IC 95%: 0,93-0,98) (AU)

Objectives To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. Methods Six hundred eighty-five RPs were performed in our center between 2011-2018 (17.8% ORP, 22.2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs. 1 comparisons (ORP vs. RARP and LRP vs. RARP). Results RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital say (days) (OR: 0.86; 95% CI: 0.80-0.94), hemoglobin loss (OR: 0.38; 95% CI: 0.30-0.47), transfusion rate (OR: 0.18; 95% CI: 0.09-0.34), early complications (P=.001), IQL (OR: 0,82; 95% CI: 0.69-0.98), erectile function (OR: 0.41; 95% CI: 0.21-0.79), pain control (OR: 0.82; 95% CI: 0.75-0.89), postoperative recovery (P<.001) and choice of a different approach (OR: 5.55; 95% CI: 3.14-9.80). RARP is superior to LRP in: urinary continence (OR: 0.55; 95% CI: 0.37-0.82), IPSS (OR: 0.96; 95% CI: 0.93-0.98), IQL (OR: 0.76; 95% CI: 0.66-0.88), erectile function (OR: 0.52; 95% CI: 0.29-0.93), postoperative recovery (P=.02 and .004), PS (P=.005; 0.002; and .03) and choice of a different approach (OR: 7.79; 95% CI: 4.63-13.13) (AU)

Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes.

OBJECTIVES: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. METHODS: Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). RESULTS: RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13). CONCLUSIONS: The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.

La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente / Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy

Introducción: Con el avance de la cirugía laparoscópica y robótica, la profilaxis tromboembólica en los procedimientos urológicos se han basado clásicamente en la experiencia de otras especialidades quirúrgicas. En este trabajo se realiza un análisis de la actualidad de las recomendaciones, basado en un estudio pormenorizado de las guías clínicas europeas y en la bibliografía, aplicando las recomendaciones de tromboprofilaxis a la práctica urológica diaria. Objetivos: Elaborar unas recomendaciones generales aplicables a los pacientes quirúrgicos en urología, evitando la aparición de eventos tromboembólicos en el periodo perioperatorio. Optimizar la medicación y el ajuste en pacientes crónicos y conocer qué pacientes son candidatos a terapias puente. Material y métodos: Se ha realizado una revisión de la literatura disponible y de las guías clínicas europeas. Se analizan los artículos de consenso más recientes realizando una revisión de la bibliografía disponible y los estudios y revisiones en los que se basan las guías europeas de tromboprofilaxis en urología. Resultados: La profilaxis tromboembólica se debe emplear en aquellas cirugías que requieran abordajes abdominales, encamamiento prolongado o enfermedades oncológicas. Las terapias puente con heparinas de bajo peso molecular deben ser reducidas. Los pacientes en tratamiento crónico se pueden beneficiar de terapias puente en casos concretos. Conclusiones: El empleo de heparinas, tan habitual en la práctica clínica, puede ser excesivo según las guías actuales. La aparición de nuevos fármacos anticoagulantes, los cuales poseen antagonistas directos, permiten la reducción de los tiempos de reintroducción de la medicación crónica y un control más eficaz del sangrado

Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases

Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy. / La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente.

INTRODUCTION: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. OBJECTIVES: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. MATERIAL AND METHODS: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. RESULTS: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases. CONCLUSIONS: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.

Optimization of a Banker Box System to Rear and Release the Parasitoid Habrobracon hebetor (Hymenoptera: Braconidae) for the Control of Stored-Product Moths.

Pyralid moths, such as Ephestia kuehniella (Zeller) or Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae), are among the pests of most concern in mills and food industries worldwide. One option for their control, which presents an alternative to the application of insecticides, is the release of natural enemies. Habrobracon hebetor (Say) (Hymenoptera: Braconidae) is a larval parasitoid of pyralid moths that is commercially available for augmentative release in storehouses. They are delivered as adults that limit their performance. To improve their quality when released at the target location, a banker box has been developed consisting of a rearing box that optimizes the release of the parasitoid. In the present study, the nonpest larvae Galleria mellonella (L.) (Lepidoptera: Pyralidae) have been used as a host, substituting for E. kuehniella larvae which were used in the previous design. The best results were obtained when a mixture of two larval sizes of the host were offered to the female parasitoid, producing five times more adults than with E. kuehniella larvae. Quality of the released parasitoids was optimal because they were delivered in the pupal stage inside the rearing box and adults began to emerge in situ. The banker box released adult parasitoids over a prolonged period of approximately 25 d at the target location. The use of this banker box may significantly help in the biological control of stored-product moths.

Elliptic Fourier Analysis in the Study of the Male Genitalia to Discriminate Three Macrolophus Species (Hemiptera: Miridae).

Within the genus Macrolophus (Heteroptera: Miridae), the species M. costalis (Fieber), M. melanotoma (Costa) and M. pygmaeus (Rambur) are present in the Mediterranean region on a wide variety of plant species. While M. costalis can easily be separated from the other two by the black tip at the scutellum, M. pygmaeus and M. melanotoma are cryptic species, extremely similar to one another in external traits, which has resulted in misidentifications. M. pygmaeus is an efficient biological control agent, both in greenhouse and field crops. The misidentification of these cryptic species could limit the effectiveness of biological control programs. Although the morphology of the left paramere of the male genitalia has been used as a character for identification of these two cryptic species, there is controversy surrounding the reliability of this character as a taxonomic tool for these species. Using geometric morphometric techniques, which are a powerful approach in detecting slight shape variations, the left parameres from these three Macrolophus species were compared. The paramere of M. costalis was larger and had a different shape to that of M. melanotoma and M. pygmaeus; however, no differences in size or shape were found between the left paramere of M. melanotoma and that of M. pygmaeus. Therefore, our results confirm that this character is too similar and it cannot be used to discriminate between these two cryptic species.

Encapsulated Essential Oils as an Alternative to Insecticides in Funnel Traps.

Pheromone-lured funnel traps are widely used for pest monitoring and mass trapping in agricultural fields and stores. DDVP vapona (dichlorvos), the insecticide of choice as a killing agent inside traps, has been banned, and research on new products is being pursued. Essential oils (EO) could be an alternative if properly formulated. To test their potential, beads of encapsulated coriander and basil EO were tested in funnel traps in stores of almonds and pet foods during 2 mo. The number of adult moth (Plodia interpunctella (Hübner) and Ephestia kuehniella Zeller) dead captures was similar with either coriander or basil EO beads and with vapona tablets while there were more insects alive in the control. These preliminary results indicate a good potential for the development of such natural products as an alternative to synthetic insecticides to include them inside funnel traps.

Taxonomic identification of Macrolophus pygmaeus and Macrolophus melanotoma based on morphometry and molecular markers.

Two Macrolophus species, M. melanotoma (=M. caliginosus) and M. pygmaeus, have been referred to as efficient predators of several key pests on vegetable crops in Europe. However, due to the great morphological similarity of these species, they have been confused, with important consequences for inoculative releases of these predators in greenhouses and for the conservation of their natural populations on greenhouse and outdoor crops. In this work, we developed tools to identify these morphologically very similar species. We first confirmed the specific status of two Macrolophus populations collected on their respective host plants (Dittrichia viscosa and tomato) through crossing experiments. Then, using multivariate morphometric analysis, we proposed a linear discriminant function that combines head measurements separating males from the two species without error. Finally, we designed specific primers for a mitochondrial DNA region that were able to distinguish field-collected Macrolophus individuals through conventional PCR. In conclusion, the tools developed in the present study will allow reliable identification of the Macrolophus species present in crops and in the native flora that are the source of populations that colonise them. They will also allow correct identification of mass reared Macrolophus to be introduced in greenhouse crops in inoculative releases.

Cuticular hydrocarbons discriminate cryptic Macrolophus species (Hemiptera: Miridae).

Macrolophus pygmaeus is commercially employed in the biological control of greenhouse and field vegetable pests. It is morphologically undistinguishable from the cryptic species M. melanotoma, and this interferes with the evaluation of the biological control activity of M. pygmaeus. We analysed the potential of cuticular hydrocarbon composition as a method to discriminate the two Macrolophus species. A third species, M. costalis, which is different from the other two species by having a dark spot at the tip of the scutellum, served as a control. Sex, diet and species, all had significant effects in the cuticular hydrocarbon profiles, but the variability associated to sex or diet was smaller than among species. Discriminant quadratic analysis of cuticular hydrocarbons confirmed the results of previous molecular genetic studies and showed, using cross-validation methods, that M. pygmaeus can be discriminated from M. costalis and M. melanotoma with prediction errors of 6.75% and 0%, respectively. Therefore, cuticular hydrocarbons can be used to separate M. pygmaeus from M. melanotoma reliably.

Monogamy and polygamy in two species of mirid bugs: a functional-based approach.

Multiple mating in females is widespread among insects in spite of the risk of predation, disease acquisition and/or physical injury that may occur. One common consequence of female polyandry is competition among sperm from two or more males within the female to fertilize the ova. This competition is an evolutionary driving force that determines a series of adaptations in both males and females. In this work, we examine some behavioral, morphological and physiological characteristics of males and females of two Heteropteran species that are related to their monoandrous/polyandrous mating behavior. Females of Macrolophus pygmaeus (Het. Miridae), the monoandrous species, were coy about accepting a male partner, spent a short time in copula, and received only a small volume of ejaculate. Even so, with only one mating event, they received enough sperm to fertilize most of their ova (21 days after mating all females were still fertile). In contrast, females of Nesidiocoris tenuis (Het. Miridae), the polyandrous species, readily accepted any mating partner, spent a long time in copula and received a large volume of ejaculate. However, these latter females soon ran out of sperm and needed to mate periodically in order to maintain a sufficient sperm supply to fertilize their eggs. As predicted, based on current theory (Simmons, 2001b), an increased investment in spermatogenesis was detected in N. tenuis with relation to M. pygmaeus. The males of the polyandrous species had larger accessory reproductive glands, seminal vesicles, testes and sperm cells than those of the monoandrous species.

Risk of damage to tomato crops by the generalist zoophytophagous predator Nesidiocoris tenuis (Reuter) (Hemiptera: Miridae).

Nesidiocoris tenuis (Reuter) (Hem. Miridae) is a native zoophytophagous predator of the Mediterranean region, and its populations colonize tomato crops when they are not heavily treated with insecticides. This generalist predator has a high capacity for controlling insect pests, and it is currently commercially produced and released in some areas to control Bemisia tabaci (Gennadius) (Hem. Aleyrodidae). However, its status as a pest and/or as beneficial is controversial. Therefore, the aim of this study was to evaluate the risk of damage to tomatoes in extreme conditions of prey scarcity, as well as high predator populations. Three predator densities were tested in a greenhouse cage experiment during a summer tomato crop. The crop did not display any negative effect caused by the predators during the first six weeks of interaction, independently of the density released. However, subsequently, the effect was dramatic, both on the vegetative growth of the plant and on the production of fruits. The reduction in vegetative growth was located at truss eight and it was expressed mainly by a lower number of leaves and a shorter length of the shoot above the truss. There was a significant reduction of yield with a lower number of fruits collected and a smaller mean weight, although this was not observable until truss seven. It seems that feeding on the plant by this mirid bug competed with the vegetative growth and fruiting processes of the plant in the extreme conditions of prey shortage maintained in our experiment.