Cost-effectiveness analysis of fesoterodine flexible dose in newly diagnosed patients with overactive bladder in routine clinical practice in Spain.

OBJECTIVE: To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice. PATIENTS AND METHODS: Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros. Quality-adjusted life-years (QALYs) were obtained from overactive bladder questionnaire-short form. Univariate and probabilistic sensitivity analyses were carried out. RESULTS: Three hundred and ninety symptomatic OAB patients treated with fesoterodine and newly diagnosed (141 in fast escalating group and 249 in standard escalating) were analyzed. Adjusted health care total costs were not statistically different; difference -€4.1 (confidence interval: -153.3; 25.1) P=0.842. QALYs were higher in fast escalating to high dose vs standard escalating group, resulting in a cost of -€16,020/QALY gained for fast escalating vs standard escalating group. CONCLUSION: When the cost-effectiveness threshold is set at a maximum value of €30,000/QALY gained, fesoterodine fast escalating group was cost-effective vs standard escalating group 67.6% of the time. The treatment with fesoterodine, in female patients newly diagnosed, fast escalating to 8 mg was a cost-effective option relative to escalating traditionally from 4 to 8 mg, in the management of OAB in routine clinical practice, from the Spanish National Health System perspective.

Safety study of umbilical single-port laparoscopic radical prostatectomy with a new DuoRotate system.

BACKGROUND: Laparoendoscopic single-site (LESS) radical prostatectomy (RP) has been performed through different approaches. A new DuoRotate manual system developed by Richard Wolf (KeyPort; Richard Wolf GmbH, Knittlingen, Germany) can be applied to RP. OBJECTIVES: Our aim was to describe the surgical technique and report early outcomes of KeyPort LESS-RP to determine if this procedure is feasible and safe. DESIGN, SETTING, AND PARTICIPANTS: Prospective study performed between October 2011 and January 2012 to standardize LESS-RP. A total of 31 procedures were performed (10 with and 21 without neurovascular preservation, 8 with and 23 without pelvic lymph node dissection). SURGICAL PROCEDURE: LESS-RP was performed using the methods outlined in the manuscript. All patients underwent LESS RP by the same surgical team. Access was achieved via a tri-channel reusable KeyPort and one 3.5-mm extra port to facilitate urethrovesical anastomosis and drainage extraction. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Preoperative, perioperative, and pathologic outcomes data are presented. RESULTS AND LIMITATIONS: The mean age of the patients was 64 yr; mean body mass index: 30.7 kg/m(2); mean prostate-specific antigen level: 7 ng/ml; mean operative time: 207 min; and mean estimated blood loss: 258 ml. The average length of stay was 2.9 d and visual analog pain score (range: 0 [no pain] to 10) at day 2 was 1.2. Five focal positive margins (16.7%) were encountered (4.4% for pT2 and 57.1% for pT3). Five cases (16.7%) were pT2a, 3 (10%) were pT2b, 15 (50%) were pT2c, and 7 (23.3%) were pT3a. Lymph node dissection results were negative in all patients. Major complications occurred in two patients (6.5%) (hypercapnia with respiratory acidosis and rectourethral fistula) and minor complications in four (12.9%) (atrial fibrillation, orchitis, transfusion, and vomiting). No case required additional analgesia. Incision was totally hidden in the umbilicus. Study limitations included short follow-up (mean: 20.2 ± 4.1 wk), premature functional data, and absence of a comparative cohort. CONCLUSIONS: The KeyPort system allows performance of umbilical RP with few complications, a low positive-margin rate, excellent aesthetic results, and very low postoperative pain levels.

Feasibility of lymphadenectomy in laparoscopic radical cystectomy.

OBJECTIVES: The number of lymph nodes obtained through lymphadenectomy during radical cystectomy has prognostic and therapeutic value. We analyzed the number of nodes obtained during laparoscopic radical cystectomy to assess whether this approach allows satisfactory lymphadenectomy. METHODS: A total of 80 consecutive laparoscopic radical cystectomies with lymphadenectomy were performed by the same surgical team from 2005 to 2008. The male/female ratio was 5.7:1, the mean age was 65.3 years (range 47-87), and average body mass index was 26.7 kg/m(2) (range 20.6-40.1). Iliac-obturator lymphadenectomy up to the aortic bifurcation was performed after excising and pocketing the bladder. We analyzed the total number of lymph nodes identified by the pathologist and investigated a possible correlation with the variables presumably related to anatomic characteristics and other circumstances. RESULTS: The mean operative time of this step was 32 minutes (range 17-70). Minor vascular morbidity was present in 5 cases (6.25%). The average number of lymph nodes obtained was 22.3 (range 7-74, median 21). In 75 cases (93.8%), ≥10 nodes were obtained, and in 33 cases (41.2%), lymph node metastasis was diagnosed. No association or correlation was found in the number of nodes extracted regarding age, body mass index, or number of positive nodes. Also, no differences were found in association with gender, use of induction therapy, or the indication for cystectomy. CONCLUSIONS: Laparoscopic lymphadenectomy performed at radical cystectomy achieved an adequate number of lymph nodes. This technique did not entail an important increase in the duration of surgery. The complication rate was low. In experienced hands, laparoscopic lymphadenectomy is feasible and seems a secure oncologically correct procedure.

Surgical approach to a large left adrenocortical mass with associated tumour thrombosis of the left renal vein: preservation of the ipsilateral kidney.

A sixty-years-old male with diagnosis of a left adrenal mass (146 x 99 x 126 mm) with associated tumour thrombosis of the left renal vein with no clear signs of thrombosis of the inferior vena cava was admitted for elective surgery Finally an adrenalectomy and excision of tumour thrombus preserving the ipsilateral kidney was made. Despite of the complex vascular management, this kind of approaches allow to preserve normal renal function in patients with future nephrotoxic treatment like cisplatin.

Radical laparoscopic salvage prostatectomy: medium-term functional and oncological results.

AIM: To analyze the surgical, functional, and oncological results of radical laparoscopic salvage prostatectomy in local postradiotherapy recurrence. PATIENTS AND METHODS: Between May 2005 and April 2007, we treated nine patients with radical laparoscopic salvage prostatectomy. Five patients had received prior treatment with brachytherapy and the other four with external radiotherapy. The average age of the patients was 59.3 years (range 51-68). The average preoperative prostate-specific antigen was 9.1 ng/mL (range 2.6-30). The average follow-up period was 26.8 months (range 15-39). RESULTS: The average duration of surgery was 170 minutes (from 120 to 240). There was no need to resort to open surgery or transfusions. There were no cases of rectal injuries. Four cases were pT2c, 1 pT3a, 3 pT3b, and 1 pT4a. The Gleason score was 7 in three cases, 8 in two cases, and 9 in another four. Two patients had nodal metastasis. Postoperative prostate-specific antigen was undetectable in seven of the nine patients. Two patients experienced biochemical recurrence 16 and 13 months after the surgery. After a minimum follow-up period of 15 months, they were free from recurrence. There were no cases of urethrovesical anastomotic stenosis. Three patients manifested severe incontinence (more than two diapers per day), which was corrected in two cases by implanting an artificial sphincter. The other six patients required 0 to 1 pads/day. Before the surgery, only one of the five potential patients maintained his erectile function. CONCLUSIONS: Radical laparoscopic salvage prostatectomy is a complex technique that seems to allow attaining high and long-lasting rates of biochemical remission in patients with local postradiotherapy recurrence. Although there is less morbidity in our series in comparison with the anastomotic stenosis and rectal injuries rate published in radical retropubic salvage prostatectomy, more extensive comparative studies are required to confirm this fact.

Incidental pelvic mass identified during ultrasound-guided transrectal needle biopsy of the prostate.

OBJECTIVE: Herein we report an additional case of a seminal vesicle cyst with ipsilateral renal agenesis and ectopic ureter in an asymptomatic individual with a normal examination. METHODS: We review the literature on retrovesical mas regarding the embryology, evaluation, management and treatment.. RESULTS/CONCLUSIONS: Seminal vesicle cysts with ipsilateral renal agenesis and ectopic ureter may appear as an incidental mass by transrectal ultrasound.