Sistema de puntuación uretral (U-score) simplificado para predecir la uretroplastia anterior compleja / Simplified urethral score system for predicting complex anterior urethroplasty

Objetivo: Evaluar los valores individuales del U-score como factores predictores de la cirugía uretral compleja.Métodos: Estudio transversal que incluye a los pacientes que recibieron una uretroplastia anterior entre 2011 y 2019. Se midieron las variables del U-score (etiología [1-2 puntos], número de estenosis [1-2 puntos], localización anatómica (1-2 puntos) y longitud [1-3 puntos]) de manera individual y total. La complejidad quirúrgica se definió como baja (anastomosis, injerto de mucosa oral y uretroplastia anterior ampliada) y alta (injerto doble de mucosa oral, colgajo y combinación de injerto y colgajo). Los componentes del U-score se incluyeron como predictores de cirugía compleja y como variables principales con estimaciones y comparaciones de los valores de probabilidad individuales. Se establecieron grupos según la probabilidad de riesgo de cirugía compleja.Resultados: Se incluyeron 654 pacientes. La edad media fue de 57,2 años. Se realizó cirugía de baja complejidad en 464 pacientes (259 anastomosis, 144 injertos, 61 uretroplastia anterior aumentada) y de alta complejidad en 190 (53 injerto doble de mucosa oral, 27 colgajo, 110 combinación injerto/colgajo). En el análisis multivariante, la longitud, el número de estenosis y la localización fueron predictores de complejidad. La introducción del U-score como única variable en el modelo univariante predijo una OR de 8,52 (IC 95%: 6,1-11). Los grupos del U-score simplificado obtenidos por probabilidad de complejidad fueron: riesgo bajo (4-5 puntos), riesgo intermedio (6 puntos) y riesgo alto de complejidad (7-9 puntos) La predicción del riesgo de probabilidad de cirugía compleja (IC 95%) para el grupo de riesgo bajo, medio y alto fue de 1,6 (0-2,9), 19,1 (13,8-25,9) y 77,9 (61,6-88,7), respectivamente.Conclusiones: El U-score puede utilizarse como una herramienta predictiva de la cirugía uretral compleja. Presentamos la herramienta de riesgo U-score simplificado para evaluar

Objective: To assess U-score individual values as urethral complex surgery predictors.Methods: Cross-sectional study including patients who received anterior urethroplasty from 2011 to 2019. U-score (etiology (1-2 points), number of strictures (1-2 points), anatomic location (1-2 points) and length (1-3 points)) was measured individually and globally. Surgical complexity was defined as low (anastomotic, buccal mucosal graft, and augmented anterior urethroplasty), and high complexity (double buccal mucosal graft, flap, and graft/flap combination). U-score components were included as complex surgery predictor and as main variable with individual probability values estimations and comparisons. Risk complex surgery probability groups were established.Results: 654 patients were included. Mean age was 57.2 years. Low complexity surgery was performed in 464 patients (259 anastomotic, 144 graft, 61 augmented anterior urethroplasty) and high complexity was done in 190 (53 double buccal mucosa graft, 27 flap, 110 graft/flap comb.). In multivariate analysis length, number of strictures and location were predictors of complexity. Introducing U-Score as only variable in univariate model predicted an OR 8.52 (95%CI 6.1-11). Simplified U-score grouping set obtained by complex probability was: low risk (4-5 points), medium risk (6 points) and high risk of complexity (7-9 points) Predicted risk of complex surgery probability (95%CI) for low, median and high risk group were 1.6 (0-2.9), 19.1 (13.8-25.9) and 77.9 (61.6-88.7), respectively.Conclusions: U-score can be used as a tool to predict complex urethral surgery. We present a simplified U-score risk tool to assess individual complex anterior urethroplasty probability (AU)

Simplified urethral score system for predicting complex anterior urethroplasty.

OBJECTIVE: To assess U-score individual values as urethral complex surgery predictors. METHODS: Cross-sectional study including patients who received anterior urethroplasty from 2011 to 2019. U-score (etiology (1-2 points), number of strictures (1-2 points), anatomic location (1-2 points) and length (1-3 points)) was measured individually and globally. Surgical complexity was defined as low (anastomotic, buccal mucosal graft, and augmented anterior urethroplasty), and high complexity (double buccal mucosal graft, flap, and graft/flap combination). U-score components were included as complex surgery predictor and as main variable with individual probability values estimations and comparisons. Risk complex surgery probability groups were established. RESULTS: 654 patients were included. Mean age was 57.2 years. Low complexity surgery was performed in 464 patients (259 anastomotic, 144 graft, 61 augmented anterior urethroplasty) and high complexity was done in 190 (53 double buccal mucosa graft, 27 flap, 110 graft/flap comb.). In multivariate analysis length, number of strictures and location were predictors of complexity. Introducing U-Score as only variable in univariate model predicted an OR 8.52 (95%CI 6.1-11). Simplified U-score grouping set obtained by complex probability was: low risk (4-5 points), medium risk (6 points) and high risk of complexity (7-9 points) Predicted risk of complex surgery probability (95%CI) for low, median and high risk group were 1.6 (0-2.9), 19.1 (13.8-25.9) and 77.9 (61.6-88.7), respectively. CONCLUSIONS: U-score can be used as a tool to predict complex urethral surgery. We present a simplified U-score risk tool to assess individual complex anterior urethroplasty probability.

Seguridad y eficacia de la uretroplastia según grupos etarios / Safety and efficacy of urethroplasty based on age groups

Objetivo: Analizar los resultados y las complicaciones posturetroplastia estratificando a los pacientes por edades. Como objetivo secundario, analizamos el impacto de la complejidad de la cirugía en cada grupo etario.Material y métodosSe trata de un estudio de cohortes, retrospectivo, donde se incluyó a todos los pacientes masculinos a quienes se les practicó uretroplastia entre enero de 2011 y diciembre de 2018. La información se obtuvo de la historia clínica electrónica. Los pacientes se agruparon en menores de 60 años, de 60 a 79 años y mayores de 80 años. Se evaluaron diferentes variables como antecedentes, comorbilidades, cirugías previas, complejidad de la cirugía. Se determinó la supervivencia libre de reestenosis y las complicaciones presentadas en cada grupo, según la clasificación de Clavien Dindo. Se utilizó el programa SPSS® para el análisis estadístico.ResultadosSe incluyeron un total de 783 pacientes. El seguimiento promedio fue de 19 meses. La sobrevida estimada a dos años libre de reestenosis en la población menor a 60, de 60 a 79 y mayor de 80 años fue de 87, 87 y 93,9% (IC 95%), respectivamente. En el análisis univariado, el grupo etario no fue una variable predictora de reestenosis. La realización de cirugía compleja es el único factor predictor de recidiva, aumentando el riesgo en un 60% (HR 1,64 IC 95% 1,05-2,56 p = 0,029). Se presentó una tasa general de complicaciones del 30,8%, siendo el 62% Clavien menor a dos. No encontramos asociación entre la frecuencia de las mismas y la edad. (AU)

Objective: To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group.Material and methodsThis is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients’ electronic health records. Patients were grouped as follows: < 60 years, 60-79 years and > 80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis.ResultsA total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. (AU)

Safety and efficacy of urethroplasty based on age groups.

OBJECTIVE: To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group. MATERIAL AND METHODS: This is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients' electronic health records. Patients were grouped as follows: <60 years, 60-79 years and >80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis. RESULTS: A total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. CONCLUSIONS: Urethroplasty is safe and effective regardless of age group. There are no statistically significant differences in outcomes and complications shown by the age group comparison. There were no significant differences when analyzing the impact of complex surgeries among the different age groups. The data indicate that age alone should not be taken as an absolute exclusion criterion for patients needing urethral reconstruction.

Prevalencia y factores de riesgo del comportamiento anormal estereotipado aerofagia en el caballo criollo colombiano / Prevalence and Risk Factors of Abnormal Stereotyped Crib-Biting Behavior in the Colombian Creole Horse

RESUMEN La aerofagia es la estereotipia clásica más común en los equinos, con una etiología poca entendida; sin embargo, se reconoce por ser de naturaleza multifactorial. Además, se ha asociado con efectos negativos sobre la salud de los equinos portadores. El objetivo de este estudio fue describir los factores de riesgo y la frecuencia de presentación de la aerofagia en una población de caballos criollos colombianos (CCC). Fueron encuesta-dos 42 criaderos, entre los que se presentó un total de 1063 CCC (488 machos y 575 hembras). De esta población, el 5,27% (56 animales) fue plenamente identificado con aerofagia. Esta prevalencia fue superior a la mayoría de otros reportes de Sur América. La aerofagia, posiblemente obedeció tanto a factores inherentes al animal como a factores externos relacionados con el manejo; sin embargo, se requiere el diseño de estudios longitudinales sobre prácticas de manejo y de líneas dentro de la raza para cuantificar y validar la información relacionada con la posible predisposición genética o racial a la aerofagia y a otras estereotipias y comportamientos anormales observados en estos animales.

ABSTRACT Crib-biting is the most common classic stereotype in equines, with a poorly understood etiology; however, it is recognized for being multifactorial in nature. Furthermore, it has been associated with negative effects on the health of horses. The objective of this study was to describe the risk factors and the frequency of presentation of crib-biting in a population of Colombian Creole Horses (CCC by its Spanish acronym). We surveyed Forty-two properties, which meant a total of 1063 CCC (488 males and 575 females). Of this population, 5,27% (56 animals) were fully identified with crib-biting. This prevalence was higher than most other reports in South America. Crib-biting is possibly due to both inherent of the animal and external factors related to management; however, the design of longitudinal studies on management practices and genetic lines within the breed is required to quantify and validate the information related to the possible genetic or racial predisposition for this and other stereotypes and abnormal behaviors observed in horses.

Safety and efficacy of urethroplasty based on age groups. / Seguridad y eficacia de la uretroplastia según grupos etarios.

OBJECTIVE: To analyze the results and complications after urethroplasty based on patient age groups. As secondary objective, we analyzed the impact of operative complexity on each age group. MATERIAL AND METHODS: This is a retrospective cohort study that include male patients who underwent urethroplasty between January 2011 and December 2018. Data was obtained from the patients' electronic health records. Patients were grouped as follows: < 60 years, 60-79 years and > 80 years. Variables evaluated were history, comorbidities, previous surgeries and operative complexity. Restenosis-free survival and complications presented in each group were determined according to the Clavien-Dindo classification system. The SPSS® program was used for statistical analysis. RESULTS: A total of 783 patients were included, and the mean follow-up was 19 months. The estimated 2-year restenosis-free survival in the population under 60, 60-79 and over 80 years was 87, 87 and 93.9% (IC 95%), respectively. Univariate analysis showed that the age group was not a predictor of restenosis. Complex surgery is the only predictor of recurrence, increasing the risk by 60% (HR 1.64, 95% CI 1.05-2.56, p = 0.029). There was an overall complication rate of 30.8%, and 62% of these were Clavien ≤ II. We found no association between the frequency of complications and age. CONCLUSIONS: Urethroplasty is safe and effective regardless of age group. There are no statistically significant differences in outcomes and complications shown by the age group comparison. There were no significant differences when analyzing the impact of complex surgeries among the different age groups. The data indicate that age alone should not be taken as an absolute exclusion criterion for patients needing urethral reconstruction.

Postoperative urinary extravasation does not impact anterior urethroplasty surgical outcomes: a Latin American large cohort study.

OBJECTIVE: To determine the prevalence of postoperative urinary extravasation (POUE) following anterior urethroplasty, to analyze factors associated with its occurrence, and to study the impact of POUE on surgical success. MATERIALS AND METHODS: Retrospective cohort study including all male patients who have undergone a urethroplasty at our center between 2011 and 2018. Subjects with posterior location stricture, those who did not undergo routine radiographic follow-up, or patients with inadequate follow-up were excluded. Urinary extravasation was defined as presence of evident contrast extravasation on the postoperative voiding cystourethrogram (VCUG). Impact was determined as "need-for-reoperation". Uni- and multivariate analysis were performed to determine clinical and demographic variables associated with occurrence of extravasation and postoperative stricture. RESULTS: A total of 783 men underwent a urethroplasty and 630 fulfilled inclusion criteria. Urinary extravasation prevalence was 12.2%, and there was a "need-for-reoperation" in 1.1% of cases. On uni- and multivariate analysis, greatest stricture length (HR: 1.07 (1-1.2), p = 0.05) and penile urethral location (HR: 2.29 (1.1-4.6), p = 0.021) showed to be POUE predictors. POUE did not show to be a risk factor for postoperative stricture (HR: 1.57, 95% CI (0.8-3), p = 0.173). However, reoperation group  showed to be a risk factor (HR: 6.6, 95% CI 1.4-31, p = 0.019). CONCLUSIONS: Prevalence of POUE was 12.2%. Stricture length and penile urethral strictures were POUE predictors. POUE occurrence with successful conservative management did not appear to have impact on urethroplasty outcomes as it did not predict re-stricture. POUE was reoperation cause in 1.1% of total cases.