Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada / Undetectable PSA after radical prostatectomy is more likely in low burden N+ prostate cancer patients when an extended lymph node dissection is performed

Objetivos: Analizar la probabilidad de PSA indetectable (< 0,01 ng/ml) tras disección ampliada de los ganglios linfáticos pélvicos (DGLP-ampliada) versus disección estándar de los ganglios linfáticos (GL) pélvicos (DGLP-estándar) en pacientes pN+. Materiales y métodos: Se realizó una investigación en la base de datos institucional de cáncer de próstata para obtener información sobre pacientes que se sometieron a prostatectomía radical (PR) con DGLP, con hallazgos de 3 o menos metástasis ganglionares entre 2007 y 2017. La DGLP ampliada se definió de acuerdo con el número de GL. Los pacientes con un percentil 75 o superior de ganglios linfáticos extraídos conformaron el grupo DGLPa; los pacientes con un percentil 25 o inferior se adjudicaron al grupo DGLPe (DGLP estándar). Se compararon las variables clínicas y patológicas entre ambos grupos. Se utilizaron la prueba de la t de Student para comparar las variables continuas y la prueba de la chi al cuadrado para las variables categóricas. La regresión logística multivariable evaluó la probabilidad de PSA indetectable al tercer mes desde la operación. El método de Kaplan-Meier estimó la probabilidad de recurrencia bioquímica. Las diferencias entre los grupos se compararon mediante la prueba de log-rank. Resultados: De 1.478 pacientes tratados en el periodo considerado, se seleccionó a 95 con 3 o menos metástasis en los ganglios linfáticos. Tras aplicar los criterios de inclusión, 23 pacientes con una mediana de 11 GL extraídos se incluyeron en el grupo PGLPe (percentil 25) y 23 pacientes con > 27 GL se incluyeron en el grupo PGLPa (percentil 75). El tiempo quirúrgico fue más largo para el grupo de DGLPa. Dieciséis pacientes (69,6%) tratados con DGLPa presentaron PSA indetectable tras la operación. En el análisis multivariable, la probabilidad de PSA indetectable a los 3 meses fue mayor en los pacientes tratados con DGLPa (HR = 5,18; IC del 95%, 1,16-23,11; p = 0,03). Conclusiones: Independientemente de las características de la enfermedad, la DGLPa tiene más probabilidades de predecir un PSA indetectable al tercer mes tras la PR

Objectives: To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients. Materials and methods: The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test. Results: 1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3rd month was higher in patients who received an ePLND (HR = 5.18; IC 95% = 1.16-23.11; P = .03). Conclusions: ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics

Undetectable PSA after radical prostatectomy is more likely in low burden N+ prostate cancer patients when an extended lymph node dissection is performed. / Frecuencia de PSA indetectable en pacientes con cáncer de próstata N+ baja carga tras prostatectomía radical y linfadenectomía ampliada.

OBJECTIVES: To analyze the likelihood of undetectable PSA (< 0.01 ng/mL) after extended (ePLND) versus standard pelvic lymph-nodes dissection (sPLND) in pN+ patients. MATERIALS AND METHODS: The institutional prospectively maintained Prostate Cancer Database was queried for patients who underwent radical prostatectomy with PLND and were found with 3or less lymph-nodal metastases between 2007 and 2017. The extension of the PLND was defined according to the number of lymph-nodes (LN) removed. Patients in the 75th or higher percentile of lymph-nodes removed were considered as the ePLND group; patients in the 25th or lower percentile in the sPLND group. Groups were compared in clinical and pathological variables. Student T-test was used for comparing continuous variables; chi-square test was used for categorical variables. Multivariable logistic regression assessed the probability of undetectable PSA at 3rd month postoperatively. Kaplan-Meier method estimated the probability of biochemical recurrence. Differences between the groups were compared by Log-rank test. RESULTS: 1478 patients were treated within the time span considered. 95 with 1 to 3 lymph-nodal metastases were extracted. After accounting for inclusion criteria, 23 patients with a median of 11 LN removed were included in the sPLND group (25th percentile); 23 patients with > 27 LN were included in ePLND group (75th percentile). Surgical time was longer for ePLND. Sixteen patients (69.6%) who underwent ePLND had undetectable PSA postoperatively. At multivariable analysis, the probability of undetectable PSA at 3rd month was higher in patients who received an ePLND (HR=5.18; IC 95%=1.16-23.11; P=.03). CONCLUSIONS: ePLND is more likely to predict undetectable PSA at third month after radical prostatectomy, irrespective of disease characteristics.

Síntomas del tracto urinario inferior y función eréctil en pacientes con sospecha de cáncer de próstata / Urinary tract symptoms and erectile function in patients at risk of prostate cancer

Introducción y objetivo: Estimamos que en España se llevan a acabo alrededor de 63.000 biopsias de próstata. No hay datos al respecto del estado funcional de los pacientes que acuden a realizarse dicha prueba, ni de si el resultado de la biopsia responde a un patrón funcional concreto. Planteamos un estudio que resuelva el anterior planteamiento. Material y método: Se incluyeron 1.128 biopsias. Los pacientes cumplimentaban, antes de la biopsia, los cuestionarios: IPSS, IIEF-5 y ICIQ-SF. Se recopilaron de forma prospectiva las variables clínicas, patológicas y los resultados de los cuestionarios. Se procedió a un análisis descriptivo de la muestra a estudio, incluyendo el resultado de los cuestionarios. Se comparó el resultado medio de los cuestionarios en función de la presencia de cáncer en la biopsia. Los síntomas del tracto urinario inferior (STUI) y de disfunción eréctil se categorizaron en grados de severidad, y se calculó la distribución de los mismos en función del resultado de la biopsia y, cuando la biopsia era positiva, del grupo de riesgo clínico. Resultados: La edad media de los pacientes era de 65 años. La tasa de biopsias positivas fue del 32,71%. El 52,2% refirió padecer síntomas del tracto urinario inferior (STUI) moderados y el 13,4% severos. En cuanto a la influencia de los STUI en la CV de los pacientes solo un 12,6% refería que su vida no estaba influenciada por los STUI. El 50,76% padecía algún grado de disfunción eréctil. Según los resultados del ICIQ-SF un 24% de la muestra refería padecer algún tipo de incontinencia urinaria, si bien es cierto que la mayor parte de ellos lo etiquetaba como escapes de escasa cuantía. Los pacientes con cáncer de próstata tenían un IPSS y un IIEF-5 medio menor. No se encontraron diferencias de la tasa diagnóstica de cáncer en función de la seriedad de los síntomas del tracto urinario. Conclusiones: Los pacientes a quienes indicamos una biopsia de próstata padecen con una alta probabilidad STUI, aproximadamente un 50% tiene cierto grado de disfunción eréctil y un 24% problemas de escapes urinarios

Introduction and objective: We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. Material and method: 1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. Results: The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. Conclusions: Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage

Urinary tract symptoms and erectile function in patients at risk of prostate cancer.

INTRODUCTION AND OBJECTIVE: We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. MATERIAL AND METHOD: 1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. RESULTS: The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. CONCLUSIONS: Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

Evaluación de las propiedades psicométricas de la versión en español del cuestionario ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) en España / Assessment of the Psychometric Properties of the Spanish Language Version of Questionnaire ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS)

Objetivos: Evaluar las propiedades psicométricas de la versión en castellano del cuestionario ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS): factibilidad (porcentaje de cumplimentación y efecto suelo y techo), fiabilidad (test-retest), validez convergente (vs. Cuestionario de Autoevaluación del Control de la Vejiga [CACV] y vs. International Prostate Symptom Score [I-PSS]) y validez de criterio (según presencia o no de síntoma). Material y métodos: Estudio observacional, no intervencionista y multicéntrico. Participaron 223 pacientes varones de 18-65 años con síntomas del tracto urinario inferior (STUI), predominantemente de llenado. Los pacientes cumplimentaron el ICIQ-MLUTS (test-retest), el I-PSS y el CACV y refirieron sus síntomas urinarios en visita única, a excepción de un subgrupo de 49 pacientes que lo cumplimentaron 15 días después para evaluar la fiabilidad test-retest. El cuestionario contiene 13 ítems en 2 subescalas: Vaciado (V), de 0-20, e Incontinencia (I), de 0-24. Resultados: Porcentaje de pacientes que responden a todos los ítems: 98,84%. Efecto suelo, 0%, y techo menor de 6% en las 2 subescalas del cuestionario. Fiabilidad test-retest: el coeficiente de correlación intraclase (CCI) osciló entre 0,66 y 0,88, salvo en Retardo. El kappa muestra buen acuerdo, entre 0,60 y 0,81, a excepción de Nicturia. Validez convergente: la correlación (Spearman) entre las puntuaciones de las subescalas del cuestionario y el resto de medidas es estadísticamente significativa (p < 0,01 y p < 0,05). Validez de criterio: diferencias estadísticamente significativas (p < 0,05) entre las puntuaciones en el ICIQ-MLUTS de los pacientes que refieren los síntomas respecto a los que no. Conclusión: El ICIQ-MLUTS versión en español muestra adecuada factibilidad, fiabilidad y validez

Objectives: To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): feasibility (% of completion and ceiling/ground effects), reliability (test-retest), convergent validity (vs. Bladder Control Self-Assessment Questionnaire [BSAQ] and vs. International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms). Materials and methods: This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients who completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0 to 20 and Incontinence symptoms (I) from 0 to 24. Results: Percentage of patients who completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (p < 0.01 and p < 0.05). Criterion validity: Statistically significant differences (p < 0.05) between scores on ICIQ-MLUTS, from patients who refer experiencing symptoms and those who do not. Conclusion: The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity

Assessment of the psychometric properties of the Spanish language version of questionnaire ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS).

OBJECTIVES: To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): Feasibility (% of completion and ceiling/ground effects), reliability (Test-retest), convergent validity (vs Bladder Control Self-Assessment Questionnaire [BSAQ] and vs International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms). MATERIAL AND METHODS: This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients that completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0-20 and Incontinence symptoms (I) from 0-24. RESULTS: Percentage of patients that completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (P < .01 and P < .05). Criterion validity: Statistically significant differences (P < .05) between scores on ICIQ-MLUTS, from patients that refer experiencing symptoms and those who do not. CONCLUSION: The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity.

Diagnóstico no invasivo del cáncer de próstata: marcadores séricos y en orina / Non-invasive diagnosis of prostate cancer: serum and urine markers

El gran número de biomarcadores que la investigación básica plantea en distintos escenarios clínicos de cáncer de próstata (CaP) exige de la comunidad científica un rigor en su desarrollo molecular y clínico para la selección de aquellos que puedan aportar información diagnóstica o pronóstica a los nomogramas de factores clínico-patológicos establecidos. El CaP necesita por su prevalencia y heterogenicidad un diagnóstico más dirigido, la caracterización de su potencial maligno y la monitorización de sus múltiples tratamientos. En este artículo de revisión pretendemos repasar la reciente incorporación de nuevos biomarcadores séricos y en orina en el manejo clínico de este tumor, haciendo hincapié en aquellos con mayor desarrollo clínico (AU)

The great number of biomarkers basic research is presenting in different clinical scenarios of prostate cancer demands the scientific community rigor in their molecular and clinical development for the selection of those which could supply diagnostic and prognostic information for the established nomograms of clinical-pathological factors. Prostate cancer, due to its prevalence and heterogeneity, needs a more directed diagnosis, characterization of malignant potential and monitoring of its multiple therapies. In this review article we try to go over the recent incorporation of new serum and urine markers in the clinical management of this tumor, emphasizing those with greater clinical development (AU)

¿Está justificada la cistectomía radical en pacientes mayores de 75 años? / Is radical cystectomy justified in patients over 75 years old?

Introducción y objetivos: La cistectomía radical es el tratamiento de elección en el tumor vesical infiltrante. Los objetivos de este trabajo son evaluar las complicaciones intraoperatorias y postoperatorias de la cistectomía radical, así como el intervalo libre de enfermedad y supervivencia cáncer especifica en pacientes con edad superior a 75 años y compararlos con los resultados en pacientes de menor edad. Material y Métodos: Entre agosto de 1980 y octubre de 2004, se realizaron 495 cistectomías radicales. De ellas se excluyeron las cirugías realizadas con intención paliativa. Los pacientes fueron divididos en dos grupos: menores de 75 años (grupo control) y pacientes con edad igual o superior (grupo mayores de 75 años). En todos los casos se realizó cistectomía radical y linfadenectomía pélvica. Resultados: Se evaluaron 402 pacientes, de los cuales 39 fueron pacientes mayores de 75 años (edad media: 76 años) y 363 pacientes control (edad media: 62 años), con una media de seguimiento de 38 y 64 meses respectivamente. Treinta y un pacientes mayores de 75 años (80,4%) y 211 pacientes control (58,2%) tuvieron un tumor no-órgano confinado (pT3-pT4) (p=0,0096). Diez pacientes mayores de 75 años (28,6%) y 111 pacientes control (31,4%) tenían ganglios positivos (p=0,84). No hubo diferencias en la tasa de complicaciones quirúrgicas (p=0.08), reintervención (p=0,58) y mortalidad postoperatoria (p=0,28). Once pacientes mayores de 75 años (28%) y 50 pacientes control (13,8%) tuvieron alguna complicación médica postoperatoria (p=0,03). Catorce pacientes mayores de 75 años (35,9%) y 104 pacientes control (39,4%) murieron debido a su tumor (p=0,73), sin diferencias en la supervivencia cáncer específica ni en el tiempo hasta la progresión. Conclusiones: La cistectomía radical es un tratamiento adecuado en pacientes mayores de 75 años, sin diferencias con la población general en relación a las complicaciones quirúrgicas, intervalo libre de enfermedad y supervivencia cáncer específica. No obstante, es necesario evaluar la comorbilidad preoperatoria dado el aumento de complicaciones médicas postoperatorias (AU)

Introduction and objectives: Radical cystectomy is the standard treatment for invasive bladder cancer. The objectives are to evaluate intraoperative and postoperative complications and to determine overall disease-free interval and overall time to progression in patients over tha age of 75 and to compare these with younger patients. Material and methods: Between august 1980 and october 2004 , 495 patients underwent radical cistectomy. Patients with palliative surgery were excluded. Patients were divided in two groups according to age: control group (<75 years old) and elderly group (>=75 years old). Results: Four hundred and two patients were evaluated: 39 patients (35 male and 5 female) in the elderly group and 363 in the control group (321 males and 42 females). Mean age was 76 (range: 75-82) and 62 (range: 35-74) respectively. Mean followup was 38 months in the elderly group and 64 months in the control group. Thirty one patients (80.4%) in the elderly group and 211 patients (58.2%) in the control had non organ-confined tumour in cystectomy specimen (pT3-pT4) (p=0.0096) and ten patients (28.6%) in the elderly and 111 patients (31.4%) in the control group had positive nodes(p=0.84).There were no differences in postoperative surgical complications (p=0.08), postoperative reoperation rate (p=0.58) and postoperative mortality (p=0.28) in both groups. During postoperative time, 11 patients(28%) in the elderly group and 50 patients (13.8%) in the control had medical complications (p=0.03).Fourteen patients (35.9%) in the elderly group and 104 patients (39.4%) in the control group died due to tumour during follow-up(p=0.73). Kaplan-Meier survival curve revealed no differences between two groups in overall disease-free interval and overall time to progression. Conclusions: Radical cystectomy is a safe and effective treatment in elderly patients with invasive bladder cancer. It is necessary to evaluate co-morbidity in this group because there is an increase in postoperative medical complications. There were no differences between the two groups in overall disease-free interval and overall time to progression (AU)

[Urinary bacteriologic study prior to endoscopic urologic surgery]. / Estudio bacteriológico de la orina previa a la cirugía urológica endoscópica.

OBJECTIVE: The objectives of this study are to know the incidence of preoperative bacteriuria in patients undergoing endoscopic urologic surgery, to analyze the most frequent microorganisms appearing in the cultures and their resistance to antibiotics in order to select the most appropriate prophylactic one for our population, and to determine the risk factors related to postoperative bacteriuria or sepsis of urologic origin. MATERIAL AND METHODS: 449 patients undergoing endoscopic urologic surgery were included in the study. Urinary samples were collected for culture prior to prophylactic antibiotic administration and again a week after bladder catheter removal once the antibiotic treatment was finished. Variables related to an increase in infectious complications were analyzed. Special attention was paid to postoperatory incidences, mainly those of infectious nature. RESULTS: Preoperative bacteriuria was found in 66 out of 428 patients (15.4%). It was found to be related to age, sex, previous infection episodes, diabetes mellitus, indwelling catheter and to the pathology for which operation was indicated. The most frequently found microorganism was Escherichia Coli. Resistance to prophylactic antibiotic was found in 37.9% of patients with preoperatory bacteriuria. Postoperatory bacteriuria, observed in 22.0% of the patients was exclusively related to preoperatory bacteriuria. 2.9% of patients showed sepsis of urinary origin criteria during hospital staying, and it was found to be exclusively related to length of surgery and neither to preoperatory bacteriuria nor to indwelling catheter time or the "inappropriate" prophylactic antibiotic use in these cases. CONCLUSIONS: A good part of patients who underwent endoscopic surgery showed preoperatory bacteriuria, responsible for postoperative bacteriuria in less than 25% of the cases. The length of surgery seemed to be the only related cause whit sepsis of urinary origin.

Estudio bacteriológico de la orina previa a la cirugía urológica endoscópica / Urinary bacteriologic study prior to endoscopic urologic surgery

Objetivo: Los objetivos de este estudio son conocer la incidencia de bacteriuria preoperatoria en pacientes que van a ser sometidos a intervenciones urológicas por vía endoscópica, analizar los microorganismos más frecuentes que aparecen en los cultivos y sus resistencias a los antibióticos, para así seleccionar el antibiótico profiláctico más apropiado para nuestra población y determinar qué factores de riesgo están relacionados con la aparición de bacteriuria o sepsis urinaria en el postoperatorio. Material y Método: Se incluyeron en el estudio a 449 pacientes a los que se les iba a someter a cirugía urológica endoscópica. Se recogieron muestras de orina para su cultivo antes de la administración del antibiótico profiláctico y se volvieron a tomara la semana de retirar la sonda vesical, ya sin tratamiento antibiótico. Se analizaron las variables que podían estar relacionadas con la mayor incidencia de complicaciones infecciosas. Se prestó especial atención a las incidencias del postoperatorio, y sobre todo, a las de naturaleza infecciosa. Resultados: Se detectó bacteriuria preoperatoria en 66 de 428 pacientes (15,4%). Esta se asoció a la edad, el sexo, la historia de infecciones previas, la existencia de diabetes mellitus, la presencia de sonda vesical y a la patología que indicaba la intervención quirúrgica. El tipo de microorganismo más frecuente fue Escherichia coli (43,1%). En el 37,9% de los pacientes con bacteriuria preoperatoria el microorganismo fue resistente al antibiótico utilizado profilácticamente para la intervención quirúrgica. Apareció bacteriuria postoperatoria en el 22% de los pacientes, lo que se asoció únicamente a la presencia de bacteriuria preoperatoria. El 2,9% de los pacientes tuvieron criterios de sepsis de origen urinario durante la estancia hospitalaria. La sepsis se asoció únicamente a la duración de la cirugía y no a la presencia de bacteriuria preoperatoria, ni con los días de permanencia de la sonda, y ni a la utilización, en estos casos, de un antibiótico profiláctico “no apropiado”. Conclusión: Una parte importante de los pacientes sometidos a cirugía endoscópica presentan bacteriuria preoperatoria, aunque fue responsable de la bacteriuria posoperatoria en menos del 25% de los casos. La duración de la cirugía parece ser la única causa relacionada con la sepsis de origen urinario (AU)

Objective: The objectives of this study are to know the incidence of preoperative bacteriuria in patients undergoing endoscopic urologic surgery, to analyze the most frequent microorganisms appearing in the cultures and their resistance to antibiotics in order to select the most appropriate prophylactic one for our population, and to determine the risk factors related to postoperative bacteriuria or sepsis of urologic origin. Material and Methods: 449 patients undergoing endoscopic urologic surgery were included in the study. Urinary samples were collected for culture prior to prophylactic antibiotic administration and again a week after bladder catheter removal once the antibiotic treatment was finished. Variables related to an increase in infectious complications were analyzed. Special attention was paid to postoperatory incidences, mainly those of infectious nature. Results: Preoperative bacteriuria was found in 66 out of 428 patients (15.4%). It was found to be related to age, sex, previous infection episodes, diabetes mellitus, indwelling catheter and to the pathology for which operation was indicated. The most frequently found microorganism was Escherichia Coli. Resistance to prophylactic antibiotic was found in 37.9% of patients with preoperatory bacteriuria. Postoperatory bacteriuria, observed in 22.0% of the patients was exclusively related to preoperatory bacteriuria. 2.9% of patients showed sepsis of urinary origin criteria during hospital staying, and it was found to be exclusively related to length of surgery and neither to preoperatory bacteriuria nor to indwelling catheter time or the “inappropriate” prophylactic antibiotic use in these cases. Conclusions: A good part of patients who underwent endoscopic surgery showed preoperatory bacteriuria, responsible for postoperative bacteriuria in less than 25% of the cases. The length of surgery seemed to be the only related cause whit sepsis of urinary origin (AU)

[Treatment of post radical prostatectomy erectile dysfunction with sildenafil in a non-selected group of patients]. / Tratamiento de la disfunción eréctil tras prostatectomía radical con sildenafilo en un grupo no seleccionado de pacientes.

OBJECTIVE: To evaluate erectile disfunction (ED) after radical prostatectomy in a non selected group of patients and their response to sildenafil. METHODS: We included our patients who were operated on between 1998 and 2001. The patients filled in a modification of IIEF (mIIEF) before the RP operation. We tried sildenafil with doses of 100 mg in 3 different periods: 3-6, 12 and 18-24 months after the RP operation. In the event of a complete response they filled in the mIIEF again. RESULTS: The mean age of the patients was 62.8 years old and the mean observation period was 31.7 months. Only 111 (62%) of the total number of patients operated on wanted treatment and only 90 took sildenafil in the proposed protocol; 27 (30%), 18 (20%) and 45 (50%) patients had a complete response, a partial response or no response to the sildenafil respectively. The mIIEF showed 6.5+/-5.7 points less than the mIIEF pre-treatment. In the univariate analysis, the preservation of bundles, the presence of a previous partial response and the presence of the previous tumescence were significantly related to the complete response; however, only tumescence kept its value in the multivariate study. CONCLUSIONS: Urologists must involve themselves in the early rehabilitation of the erectile function even in those patients where preservation of the NVB was not possible. One must always try to preserve, uni or bilaterally, whenever the patient desires preservation of EF. The response to sildenafil is better after the first year and in patients who have previous tumescence.

Tratamiento de la disfunción eréctil tras prostatectomía radical con sildenafilo en un grupo no seleccionado de pacientes / Treatment of post radical prostatectomy erectile dysfunction with sildenafil in a non-selected group of patients

FUNDAMENTO: Conocer la disfunción eréctil (DE) tras prostatectomía radical en un grupo no seleccionado de pacientes y su respuesta al sildenafilo. MÉTODOS: Incluimos a nuestros pacientes operados entre 1998 y 2001. Los pacientes rellenaron una modificación del IIEF (mIIEF) antes de la PR. Probamos sildenafilo a dosis de 100 mg en 3 periodos diferentes: 3-6, 12 y 18-24 meses tras la PR. En caso de respuesta completa volvieron a rellenar el mIIEF. RESULTADOS: La edad media fue de 62,8 años y el seguimiento medio de 31,7 meses. Sólo 111 (62%) del total de pacientes operados quisieron tratamiento y tan solo 90 tomaron sildenafilo en el régimen propuesto; 27 (30%), 18 (20%) y 45 (50%) tuvieron una respuesta completa, parcial o no tuvieron respuesta al sildenafilo respectivamente. El periodo más frecuente de respuesta completa fue entre los 18-24 meses. El mIIEF mostró 6,5±5,7 puntos menos respecto al mIIEF pre tratamiento. En el análisis univariado, la preservación de bandeletas (BNV), la presencia de respuesta parcial previa y la presencia de tumescencia previa se relacionaron significativamente con la respuesta completa; sin embargo, solo la tumescencia mantuvo su valor en el estudio multivariado. CONCLUSIONES: El urólogo debe implicarse en la rehabilitación precoz de la FE incluso en los pacientes en los que no se ha podido realizar preservación de las BNV. Esta se debe intentar uni o bilateralmente siempre que el paciente desee preservar FE. La respuesta al sildenafilo es mejor a partir del primer año y mejor en aquellos que presentan tumescencia previa

OBJECTIVE: To evaluate erectile disfunction (ED) after radical prostatectomy in a non selected group of patients and their response to sildenafil. METHODS: We included our patients who were operated on between 1998 and 2001. The patients filled in a modification of IIEF (mIIEF) before the RP operation. We tried sildenafil with doses of 100 mg in 3 different periods: 3-6, 12 and 18-24 months after the RP operation. In the event of a complete response they filled in the mIIEF again. RESULTS: The mean age of the patients was 62.8 years old and the mean observation period was 31.7 months. Only 111 (62%) of the total number of patients operated on wanted treatment and only 90 took sildenafil in the proposed protocol; 27 (30%), 18 (20%) and 45 (50%) patients had a complete response, a partial response or no response to the sildenafil respectively. The mIIEF showed 6.5±5.7 points less than the mIIEF pre-treatment. In the univariate analysis, the preservation of bundles, the presence of a previous partial response and the presence of the previous tumescence were significantly related to the complete response; however, only tumescence kept its value in the multivariate study. CONCLUSIONS: Urologists must involve themselves in the early rehabilitation of the erectile function even in those patients where preservation of the NVB was not possible. One must always try to preserve, uni or bilaterally, whenever the patient desires preservation of EF. The response to sildenafil is better after the first year and in patients who have previous tumescence

[Spurious renal tumor: acute lobar nephronia]. / Tumor renal espúreo: nefronía lobar aguda (NLA).

OBJECTIVE: To report a case of acute lobar nephronia, an unusual form of localized renal infection, and review the literature with special reference to the clinical features, ultrasound and CT findings that distinguish this condition from other renal masses (abscess, infected cyst and renal carcinoma). METHODS/RESULTS: A female patient presented at the emergency services with symptoms and signs compatible with pyelonephritis. An admission abdominal ultrasound scan demonstrated a solid mass in the left inferior renal pole. CT showed a renal mass with peripheral enhancement after infusion of contrast and central striation. Blood and urine analyses were compatible with renal infection. Acute lobar nephronia was suspected and antibiotic treatment was administered. Control ultrasound and CT examinations performed one month after instituting antibiotic treatment showed the mass had disappeared. CONCLUSIONS: Acute lobar nephronia should be considered in all patients with a renal mass detected during an episode of urinary infection. Correlation of the clinical and radiological findings, and resolution of the mass with appropriate antibiotic therapy will confirm the diagnosis.

Current management of calculi in horseshoe kidneys.

OBJECTIVES: To assess treatment options for calculi in horseshoe kidneys and the impact of extracorporeal shockwave lithotripsy (ESWL) on the management of renal stones. MATERIAL AND METHODS: From June 1971 to January 1998, 52 patients with horseshoe kidneys and calculi received treatment at our Urologic Stone Unit. There were 40 men (77%) and 12 women (23%). Average patient age was 41 years (range: 10-70 years). Clinical onset, treatment received and outcome were evaluated retrospectively. A successful outcome was defined as a patient without residual calculi or with fragments <0.4 cm in size. RESULTS: Clinical onset was mainly low back pain in 37 patients (71%). Eighty-nine stones were treated, i.e. an average of 1.7 treatments per patient. Before the ESWL era (May 1987), we performed two heminephrectomies, 16 pyelolithotomies, 12 pyelolithotomies combined with ureteropyeloplasty and one percutaneous nephrolithotomy. Since the advent of ESWL, seven pyelolithotomies and three pyelolithotomies combined with ureteropyloplasty have been done. ESWL was used to treat 48 calculi. In three cases the patient was placed in the prone position due to difficulties in stone focusing. In 37 cases (77%) patients were either rendered stone-free or had residual fragments <0.4 cm in size. Urinary diversion for obstruction was carried out in two cases (4%). CONCLUSIONS: At present ESWL is the first-choice treatment for calculi in horseshoe kidneys. It involves no significant focusing difficulties and is associated with a low incidence of obstructive complications. Open surgery is indicated in cases of stone-related pyeloureteral stenosis and in the presence of calculi >2-2.5 cm in size.

[Ileovesical fistula in Crohn's disease]. / Fístula ileovesical en la enfermedad de Crohn.

OBJECTIVE: To discuss the clinical presentation, complementary evaluation procedures and treatment of ileovesical fístula, an uncommon complication of Crohn's disease. METHODS/RESULTS: After the clinical presentation, complementary evaluation procedures were performed to confirm the diagnosis in all cases. Treatment was based on the patient's general condition; surgery was performed in two cases and one case was carefully followed. CONCLUSIONS: Ileovesical fístula is an uncommon complication of Crohn's disease. Occasionally, the urological symptoms may precede the digestive symptoms, therefore this condition should be suspected particularly if the complementary evaluation procedures are not very sensitive. Surgery is the treatment of choice.

[Bladder malacoplakia: 14-year follow-up of a case]. / Malacoplaquia vesical: seguimiento de un caso a 14 años.

OBJECTIVE: To describe the clinical findings, treatment and results of long-term follow-up of a case of malacoplakia of the bladder. METHODS/RESULTS: After diagnostic endoscopic evaluation, transurethral resection of the lesion was performed and antibiotic therapy was administered. The same treatment was repeated 4 years later. During the following 10 years, the patient had a yearly endoscopic evaluation that showed no recurrence of the lesion. CONCLUSIONS: Transurethral resection combined with antibiotic therapy is effective in the treatment of malacoplakia of the bladder. The importance of long-term follow-up of the patient is emphasized.

Renal hematoma as a complication of extracorporeal shock wave lithotripsy.

OBJECTIVE: To evaluate risk factors, clinical presentation, therapeutic management, and treatment of residual stones and subsequent development of renal hematoma following Extracorporeal Shock Wave Lithotripsy (ESWL). MATERIAL AND METHODS: A retrospective review was made of 31 post-ESWL renal hematoma cases diagnosed between May 1987 and June 1996. Lithotripsy treatments were outpatient procedures without anaesthesia. Our center has three electromagnetic sources, two with biplane X-ray centering and one ultrasound-guided (SIEMENS Lithostar II, SIEMENS Lithostar System C and SIEMENS Lithostar Ultra, respectively). We analysed findings from patient history, physical examination, blood analysis, and renovesical sonographs. Follow-up involved periodical checks, blood analyses and renovesical sonographs, scheduled first at three-month intervals and later at six-month intervals. RESULTS: Our center performed 21 699 lithotripsies on a total of 10 953 patients in this period. Thirty-one renal hematomas were diagnosed, giving an incidence rate of 0.28%. Twenty-four patients presented clinical onsets and the commonest symptom for consultation was low back pain (74%). Eleven patients of this group (46%) were hypertensive. All patients received conservative treatment. With a mean follow-up time of 18 months, ultrasound showed persistent hematoma in 11 patients (36%). There were residual stones in 71% of patients; further lithotripsy was performed on seven patients with no clinical or ultrasonographic signs of change in the hematoma. CONCLUSIONS: Renal hematoma post-ESWL is a rare complication. Main risk factors are hypertension, clotting disorders and previous ESWL sessions. Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones.