Autovaccine-Based Immunotherapy: A Promising Approach for Male Recurrent Urinary Tract Infections.

BACKGROUND: Recurrent Urinary Tract Infections (UTIs) in men range from 0.9 to 2.4/1000 individuals in younger men to 7.7/1000 in those over 85, significantly impacting their quality of life. Preventive strategies include autovaccines, but limited evidence exists for males. METHODS: A prospective monocentric, open-label observational study was conducted from August 2018 to August 2021, with follow-up until August 2023 including patients with recurrent UTIs treated with immunotherapy. We evaluated the incidence rate of UTIs per year, the incidence rate of episodes after two or three rounds of the autovaccine, and quality of life measured with the IPSS-QoL questionnaire. RESULTS: A total of 49 patients fulfilled inclusion criteria. The mean age was 72 years (±15), and the median 61. The evolution of UTIs number of episodes after the autovaccine rounds: -37.74% for the first round from 5.3 to 3.3; -33.33% for the second round from 3.3 to 2.2; -45.45% for the third round from 2.2 to 1.2. The mean IPSS score improved from 10.69 to 7.27 after the treatment (32%). The mean QoL subscore enhancement was from 4.22 to 1.92 (54%). With a mean follow-up of 3 years, only nine patients required retreatment. CONCLUSION: Autovaccine treatment significantly reduced the number of UTI episodes, with a cumulative effect observed after multiple rounds of treatment, demonstrating an enhancement in QoL and with sustained effectiveness and a low need for retreatment.

A High-Efficiency Consultation Improves Urological Diagnosis in Patients with Complex LUTS-A Pilot Study.

(1) Background: The diagnosis of moderate-severe lower urinary tract symptoms (LUTS) is not easy due to the complexity of the micturition act. Sequential diagnostic tests can be time consuming due to waiting lists. Thus, we developed a diagnostic model combining all the tests in a single one-stop consultation. (2) Methods: In a prospective pilot study in patients with complex LUTS, they received all diagnostic tests (ultrasound, uroflowmetry, cystoscopy, pressure-flow study) in a single consultation and by the same doctor. Patients' results were compared with those from a 2021 paired cohort that underwent the classical sequential diagnostic pathway. (3) Results: Per patient, the high-efficiency consultation saved: 175 days of waiting, 60 min doctor time and 120 nursing assistant time and over 300 euros on average. The intervention also saved 120 patient journeys to the hospital, lowering the total carbon footprint by 145.86 kg CO2. In one-third of the patients, performing all the tests within the same consultation contributed to reaching a more appropriate diagnosis and thus more effective treatment. Patients' satisfaction was high, with good tolerability. (4) Conclusions: The high-efficiency urology consultation improves waiting times, therapeutic decisions and the degree of patient satisfaction while optimizing the use of resources and generating savings for the health system.

Classification of cystic structures located at the midline of the prostate: our experience.

OBJECTIVES: Between January 1994 and February 2002, 9086 men underwent biplane TRUS at our institution for a variety of reasons. 781 of the 9086 men (8.6%) showed evidence of one or more intraprostatic cystic lesions. We propose a new classification of cystic structures located at the midline of the prostate. MATERIAL AND METHODS: We have designed a methodology that reclassifies cystic structures located at the prostate midline through the ultrasonically guided transrectal aspiration of the cystic structure, the analysis of the PSA level of the aspirated fluid and the presence of spermatozoa, radiological studies (cyst injection with contrast medium, vasography, retrograde and/or voiding cystourethrography and utricle injection with contrast medium) and endoscopic studies (cystourethroscopy). RESULTS: Upon completion of the methodology, we have classified and defined these structures as the following: simple prostatic cysts, cysts of the müllerian ducts, megautricle, megautricle with inclusion of the ejaculatory ducts, "pseudocystic" dilation of the ejaculatory ducts and utriculoceles. CONCLUSIONS: This new classification of cystic structures located at the prostate midline is simple, useful and steers one away from any possible confusion.

[Effectiveness and safety of the treatment with sildenafil (Viagra) in patients with erectile dysfunction and arterial hypertension]. / Efectividad y seguridad del tratamiento con Sildenafilo (Viagra) en pacientes con disfunción eréctil e hipertensión arterial.

OBJECTIVES: To evaluate the efficacy and safety of sildenafil in the treatment of erectile dysfunction in hypertensive patients taking antihypertensive drugs, and to investigate factors associated to treatment failure. METHODS: Observational prospective study comparing two groups of patients suffering from erectile dysfunction with or without hypertension. Patients were evaluated by anamnesis, physical examination, blood tests, and the International Index of Erectile Function (IIEF). Blood pressure was measured before and after treatment with an automatic digital oscillometric device. RESULTS: Erections improved in 88.2% and 91.7% of the patients with an without hypertension respectively. On the initial visit 55.2% of all patients had severe dysfunction, which was reduced after sildenafil treatment to 4.7%. Diastolic arterial blood pressure, evaluated in random measures, was slightly reduced after starting treatment with Viagra. No significant adverse events were registered. CONCLUSIONS: Oral treatment with sildenafil in patients with erectile dysfunction and hypertension is effective, well-tolerated and does not produce pharmacologic interactions with antihypertensive drugs.

Efectividad y seguridad del tratamiento con Sildenafilo (Viagra®) en pacientes con disfunción eréctil e hipertensión arterial / Efficacy and safety of Sildenafil (Viagra®) in patients with erectile dysfunction and high blood pressure

OBJETIVO: Evaluar la efectividad y la seguridad de sildenafilo en el tratamiento de la disfunción eréctil (DE) en pacientes con hipertensión arterial (HTA) en tratamiento con antihipertensivos y analizar otros factores asociados al fracaso terapéutico. MÉTODOS: Se realizó un estudio prospectivo, observacional y comparativo incluyendo un grupo de pacientes (N=85) afectos de DE e HTA frente otro (N=85) con solo DE. Los pacientes han sido evaluados con anamnesis, examen físico, analítica de bioquímica y hemograma, a parte se realizó el cuestionario Indice Internacional de Función Eréctil (IIEF) para evaluar la respuesta al tratamiento con sildenafilo. En ambos grupos se han realizado tomas de la tensión arterial antes y después del tratamiento con Viagra. RESULTADOS: Después el tratamiento se observó mejoría de la erección en un 88,2 por ciento y 91,7 por ciento de pacientes con o sin HTA respectivamente. Según el IIEF en la visita basal el 55,2 por ciento de toda la muestra examinada presentaba DE severa que se ha reducido después de tratamiento con sildenafilo al 4,7 por ciento. La presión arterial diastólica (PAD), evaluada en tomas casual, se redujo levemente después de empezar el tratamiento con Viagra.No se determinaron efectos adversos importantes. CONCLUSIONES: El tratamiento oral con sildenafilo en pacientes con DE e HTA es eficaz, bien tolerado y no determina interacción farmacológica con la medicación antihipertensiva (AU)

Comparison of the efficacy and safety of 90 mg versus 20 mg fluoxetine in the treatment of premature ejaculation.

PURPOSE: We compare the efficacy and side effects of 90 mg fluoxetine once weekly versus 20 mg fluoxetine as single oral therapy for patients complaining of premature ejaculation without evident organic causes. MATERIALS AND METHODS: The study comprised 80 patients with a mean age of 36 years with premature ejaculation who presented to the urology clinic of 3 hospitals in Barcelona. Pretreatment evaluation included history and physical examination, International Index of Erectile Function (IIEF), Meares-Stamey test and ejaculatory latency time evaluation. The patients were randomized into treatment groups receiving 1 capsule of 90 mg fluoxetine a week (group 1) and 1 capsule of 20 mg fluoxetine a day (group 2) for 3 months. The 4-month followup included: ejaculatory latency time measurement, IIEF and partner sexual satisfaction. RESULTS: Mean pretreatment ejaculatory latency times for groups 1 and 2 were 0.48 minute (range 0 to 2.10) and 0.50 minute (0 to 2.04), respectively. After 3 months of treatment of weekly and daily administration of fluoxetine mean ejaculatory latency time was 3.57 and 3.37 minutes, respectively (p >0.01). Partner sexual satisfaction and IIEF rate were greater with 90 mg fluoxetine but no statistical difference was found. Nausea, insomnia and headache were reported side effects but no significant difference was noted between 90 and 20 mg fluoxetine. CONCLUSIONS: In men with premature ejaculation 90 mg fluoxetine weekly may be regarded as an effective and safe treatment.

Unusual surgical approach to the treatment of renal cell carcinoma extending into the right atrium through the inferior vena cava.

We report an unusual surgical management of renal cell carcinoma with inferior vena cava and right atrial thrombosis. Successful management is dependent upon preoperative assessment to determine the extent of the disease, tumor thrombi has not infiltrated the walls of the vena cava, and a well planned surgical resection.

Ligasure versus sutures in bladder replacement with Montie ileal neobladder after radical cystectomy.

OBJECTIVES: Electrocoagulation became an indispensable tool for surgeons. Ligasure is a computer-based, temperature-controlled bipolar electrocoagulation system designed as an alternative to suture ligatures, staplers, hemoclips and ultrasonic coagulators for legating vessels and tissue bundles. Our aim was to analyse the procedure time and intraoperative blood loss of the ileal neobladder in a series of 30 highly selected patients. PATIENTS AND METHODS: From March 1999 to May 2002, 30 patients (all men), 47 to 74 years old (mean age 57) with good performance status (American Society of Anesthesiology score 1 and 2) underwent radical cystectomy for bladder cancer and Montie ileal neobladder reconstruction, using standard surgical technique, with the exception of 15 patients that the Ligasure device was used for haemostasis. RESULTS: Procedure time was significantly less in the Ligasure arm 170 minutes (range: 150 min - 200 min ) versus 220 minutes (range: 160 min - 250 min) in the suture arm (p < 0.001). Blood loss was significantly less in the Ligasure arm an average 849 cc (range: 820 cc - 900 cc) versus 968 cc (range: 1110 cc - 897 cc) in the suture arm p < 0.02). There was no post-operative hemorrhage or return to the operating room in either arm. Two patients, one in each arm, received two units of blood for a slowly decreasing hematocrit on postoperative day 3. There was no evidence of collateral tissue injure and no injuries to the urinary or intestinal tract in either arm. CONCLUSIONS: Ligasure is a safe and effective alternative to sutures in cystectomy and bladder replacement, resulting in decreased blood loss and significant time saving.

Clinical follow-up after subinguinal varicocele ligation to treat pain.

OBJECTIVE: To evaluate the usefulness of surgical treatment in patients with chronic orchialgia associated with varicocele and those for whom conservative treatment (jockstrap, non-steroidal anti-inflammatory drugs (NSAIDs) and restricted physical activity) was not effective. The response to spermatic vein ligation performed subinguinally with local anaesthesia was assessed in 25 patients with chronic testicular pain and varicocele as the only associated causal factor. Patient age, grade (according to Doppler study) and location of the varicocele, duration and degree of pain, response to treatment using an analogous pain scale pre- and post-surgery and complications pre- and post-surgery were recorded. Mean patient age was 28 years (range: 17-57) and time of pain evolution 14 months (range: 3-72). The varicocele was left-sided in 19 patients, bilateral in 4 and right-sided in 2, and grade III in 14 cases, grade II in 6 and grade I in 5. Subinguinal ligation of the spermatic vein was performed under local anaesthesia on an ambulatory basis in all cases. RESULTS: Twenty-two of the 25 patients (88%) reported resolution or evident improvement in their pain. The mean value on the pre-surgical pain scale was 64 (30-80). After a mean postoperative follow-up period of three months, the pain was reduced to a mean of 12. No perioperative complications were recorded; a post-operative hydrocele appeared in one case and the varicocele persisted in another. CONCLUSIONS: Ligation of the spermatic vein performed on an outpatient basis using a subinguinal approach and local anaesthesia is an effective treatment for chronic varicocele-associated testicular pain for patients in whom other therapeutic measures have failed.