Giant Midline Prostatic Cyst: An Unusual Cause of Acute Urinary Retention.

Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller's cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report.

Giant Midline Prostatic Cyst: An Unusual Cause of Acute Urinary Retention

Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller’s cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report. (AU)

Results of fusion prostate biopsy comparing with cognitive and systematic biopsy.

PURPOSE: Our study aims to determine whether there are differences in the degree of detection of prostate cancer (PCa) and CsPCa between fusion prostate biopsy (FPB), cognitive biopsy (PCB), and randomized, systematic biopsy (SB). METHODS: A retrospective analysis was carried out of 195 patients with suspected PCa at the San Cecilio University Clinical Hospital in Granada who underwent a prostate biopsy between January and December 2021. Patients were divided into three groups: group 1, patients undergoing FPB transperineally with ultrasound BK 3000 (N = 87); group 2, PCB (N = 59) transperineally; and group 3, transrectal SB (N = 49), the latter two, with an ultrasound BK Specto. RESULTS: We found differences in favor of image-directed biopsies (FPB and PCB) with a percentage of positive biopsies of 52.8% and 50%, respectively, compared to 41.4% with SB, but without these differences being significant. Given the controversy in performing prostate biopsies in PI-RADS 3 lesions reported in the literature, a subanalysis was performed excluding the FPB performed for PI-RADS 3 lesions (PI-RADS 4 and 5 are included), finding significant differences when comparing FPB with PCB and SB (group 1, 64% vs group 2, 45.8%; p = 0.05) (group 1, 64% vs group 3, 42.9%; p = 0.035). CONCLUSION: With the results obtained in our series, we conclude that the finding of a PI-RADS 3 lesion in mpMRI should not be an absolute criterion to indicate prostate biopsy. On the other hand, for PI-RADS 4 and 5 lesions, FPB is recommended, which in this case turns out to be superior to PCB and SB.

Adjuvant intravesical treatment in patients with intermediate and high-risk non-muscle-invasive bladder cancer with BCG versus MMC applied with COMBAT or EMDA. Results of a prospective study.

BACKGROUND: Bacillus Calmette-Guerin (BCG) maintenance therapy is the standard adjuvant treatment of high- and intermediate-risk non-muscle-invasive bladder cancer (NMIBC). However, the problems of shortages and the adverse effects, both local and systemic, that it causes lead to the search for alternatives with devices that improve the penetration of intravesical chemotherapeutics. MATERIALS AND METHODS: Prospective observational study was conducted from August 2018 to August 2022. Patients diagnosed with intermediate and high-risk NMIBC without CIS who received one of the following three treatments were included: BCG in induction protocol with six weekly instillations and maintenance with three weekly instillations at months 3, 6, and 12. MMC was applied by Physionizer® 30 device with a current of 20 mA for 30 min was used in an induction protocol of 6 weekly instillations followed by 6 monthly instillations as maintenance (EMDA group). MMC was applied by COMBAT BRS System V2.0 device at 43 ± 0.5 â„ƒ for 60 min was used in an induction protocol of 6 weekly instillations followed by 6 monthly instillations as maintenance (HIVEC group). The primary objective was to compare the 24-month recurrence-free rate between the three groups. The secondary objectives were to evaluate the rate free of progression at 24 months and the degree of toxicity of the treatments. RESULTS: One hundred and eighty-three patients divided into a HIVEC group with sixty-one patients, EMDA group with fifty-nine patients, and BCG group with sixty-three patients. After a mean follow-up of 25 months (IQR 13-36), the 24-month recurrence-free rate was 82.1% for HIVEC, 80% for EMDA, and 84.6% for BCG (p > 0.05), and a progression-free rate at 24 months of 95.6% for HIVEC, 98.3% for EMDA, and 92.9% for BCG (p > 0.05). No statistically significant differences were found between the three groups with respect to the degree of reported adverse events. CONCLUSION: Adjuvant treatment with BCG or MMC applied with COMBAT or EMDA does not present differences in the recurrence-free rate and progression at 24 months in our population of patients with intermediate- and high-risk NMBC without CIS.

Conductive hyperthermic chemotherapy versus electromotive drug administration of mitomycin C as intravesical adjuvant treatment of patients with intermediate or high-risk non-muscle invasive bladder cancer.

BACKGROUND: Devices that increase the penetration of intravesical chemotherapeutic agents have been developed as alternatives to the use of bacillus Calmette-Guérin, in short supply at a time of increasing global incidence of non-muscle invasive bladder cancer (NMIBC). We performed a prospective observational study to compare 2 of these devices in the treatment of patients with high- and intermediate-risk NMIBC. The primary endpoint was the recurrence-free rate. Secondary endpoints were the rate of progression and adverse events. METHODS: After undergoing transurethral bladder resection, 98 patients were selected to receive 1 of 2 treatments: hyperthermic intravesical chemotherapy (HIVEC) treatment with 40 mg of mitomycin C (MMC) using Combat BRS System V2.0 at 43 ± 0.5°C and 200 ml/min for 60 minutes (56 patients) or electromotive drug administration (EMDA) with 40 mg of MMC at 20 mA for 30 minutes (42 patients). The treatment schemes were similar: 6 weekly instillations as induction and 6-monthly instillations as maintenance. The recurrence rates were evaluated at 6 and 12 months and the progression rates at 12 months. RESULTS: The recurrence-free rate at 12 months was 91,1% in the HIVEC group and 88.1% in the EMDA group (P ≥ 0.05). After the 12-month follow-up, only 1 progression occurred in each treatment group. In terms of adverse events, no significant differences were found between the treatments. CONCLUSIONS: HIVEC and EMDA techniques are comparable in terms of recurrence, progression and adverse events at 12 months in the treatment of patients with high- and intermediate-risk NMIBC.

[Adaptation of surgery practice during the Covid-19 pandemic. Ureteroscopy in outpatient surgery.] / Ureterorrenoscopias en régimen ambulatorio. Adaptación del protocolo por la pandemia Covid-19.

OBJECTIVE: The World Health Organizationdeclared a pandemic status due to the COVID-19 disease caused by the new coronavirus SARS-Cov-2 in March 2020. This caused high health pressure that hashad an impact on the Spanish National Health System and Granada has been one of the most affected provincesnationwide. The high healthcare pressure derived from it has had an impact on the National Health System throughout the Spanish territory, with Granada beingone of the most affected provinces nation wide. The increase in the admissions of patients with COVID-19 in such a short time has forced us to optimize hospital resources, prioritizing them in patients with COVID-19 and oncological or urgent pathology. In this context, the increasingly frequent and recurrent lithiasis is treated conservatively. However, the prolongation of the pandemic situation poses the challenge of offering definitive treatment to these patients. MATERIAL AND METHODS: We present the rearrangement performed in our Lithotripsy Unit with the aim of developing a comprehensive and alternative protocol for performing ureteroscopies on an outpatient basis, assuming the patient from admission to hospital discharge, with the collaboration of the Anesthesiology service. RESULTS: In this new protocol, 35 ureteroscopies were performed without noticing intraoperative complications or during the recovery period developed in the Day Hospital integrated within the Lithotripsy Unit. CONCLUSIONS: The redistribution of our resources has allowed us to continue performing ureterorenoscopies on an outpatient basis without the need to use hospital beds and reducing the traffic of patients within the hospital itself with an adequate safety profile.

OBJETIVO: En marzo de 2020, la organización mundial de la salud declaró el estado de pandemia por la enfermedad COVID-19 ocasionada por el nuevo coronavirus SARS-Cov-2. La alta presión asistencial derivada de la misma, ha repercutido en el Sistema Nacional de Salud en todo el territorio español, siendo Granada una de las provincias más afectadas a nivel nacional. El aumento de ingresos de pacientes con esta enfermedad en tan corto periodo de tiempo, nos ha obligado a optimizar los recursos hospitalarios priorizándolos en los pacientes afectos de COVID-19 y patología oncológica o urgente. En este contexto, la enfermedad litiásica, cada vez más frecuente y recurrente es manejada de forma conservadora. Sin embargo, la prolongación en el tiempo de la situación de pandemianos plantea el reto de ofrecer un tratamiento definitivoa estos pacientes. MATERIAL Y MÉTODOS: Exponemos la reordenaciónrealizada en nuestra Unidad de Litotricia con el objetivode desarrollar un protocolo integral y alternativo derealización de ureteroscopias en régimen ambulatorioasumiendo el paciente desde su ingreso hasta su altahospitalaria, con la colaboración del servicio de Anestesiologíay Reanimación. RESULTADOS: Se realizan 35 ureteroscopias en estenuevo protocolo sin advertir complicaciones intraoperatoriasni durante el periodo de recuperación desarrolladoen el Hospital de Día integrado dentro de la Unidadde Litotricia. CONCLUSIONES: La redistribución de nuestros recursosnos ha permitido continuar realizando de maneraordinaria ureterorrenoscopias en régimen ambulatoriosin necesidad de usar camas de hospitalización y disminuyendoel tránsito de pacientes dentro del propiohospital con un adecuado perfil de seguridad.

[Assessment of radiopaque kidney stone treatment: Combination of extracorporeal shock wave lithotripsy and Fagolitos Plus®. Preliminary case control description.] / Evaluación del tratamiento de litiasis renal radiopaca mediante la combinación de litotricia extracorpórea por ondas de choque y Fagolitos Plus®. Estudio preliminar de casos y controles.

INTRODUCTION: The nutritional supplement called Fagolitos plus® contains hydroxycitric acid as main component, in addition to zinc, magnesium, vitamin A and vitamin B6. It is necessary to study new molecules as chemolytic treatment in calcium lithiasis or that facilitate its fragmentation with the help of other instrumental treatments. OBJECTIVE: The objective of this study is to evaluate the effectiveness of the combined treatment of Fagolitos plus® and extracorporeal lithotripsy in the fragmentation of the lithiasis. MATERIAL AND METHODS: Retrospective case-control study includes 88 patients with lithiasis. Group 1: Treated with 1 session of extracorporeal lithotripsy and Fagoliths plus®. Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were: Age, sex, body mass index, maximum diameter of the stone, area of the stone, hounsfield units of the stone measured by axial tomography, location of the stone, result after 1 session of extracorporeal wave lithotripsy shock [complete fragmentation, partial fragmentation (presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus®, days of treatment with Fagolitos plus® and energy shock wave applied to lithiasis. Results were analyzed with SPSS 20.0, p≤0.05. RESULTS: The mean age of the patients included in the study is 53.81 ± 12.62 years in group 1 compared to 56.53 ± 12.37 years in group 2, p=0.31. According to the distribution by sex, there were no statistically significant differences (p=0.5), including 24 men and 24 women in group 1 and 23 men and 17 women in group 2. The mean of body mass index of the patients in group 1 was 28.39 ± 2.27 kg/m2 in group 1 versus 28.39 ± 3.03 kg/m2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm in group 1 compared to 13.15 ± 5.49 mm in group 2, p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm2 in group 1 compared to 141.91 ± 80.95 mm2 in group 2, p=0.3. The Hounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to 1143.15 ± 172.24 in group 2, p=0.06. Relation to fragmentation, complete fragmentation was observed in 66.7% of group 1 patients, compared to 41% of group 2 patients (p=0.02), between 20-30 days after the first session of Extracorporeal Lithotripsy evaluated by means of a simple X-ray of the Abdomen. CONCLUSIONS: The administration of Fagolitos plus® concomitant to extracorporeal lithotripsy could increase its effectiveness in lithiasis fragmentation, requiring clinical trials and prospective studies to confirm these findings.

INTRODUCCIÓN: El complemento nutricional denominado Fagolitos plus® contiene como principal componente ácido hidroxicítrico, además de zinc, magnesio, vitamina A y vitamina B6. Es necesario estudiar nuevas moléculas como tratamiento quimiolítico en litiasis cálcica o que faciliten su fragmentación con la ayuda de otros tratamientos instrumentales. OBJETIVO: El objetivo de este estudio es evaluar la efectividad del tratamiento combinado de Fagolitos plus® y Litotricia extracorpórea en la fragmentación de la litiasis.MATERIAL Y MÉTODOS: Estudio retrospectivo de casos y controles, incluye 88 pacientes con litiasis. Grupo 1: Tratados con 1 sesión de litotricia extracorpórea y Fagolitos plus®. Grupo 2: Tratados con 1 sesión de litotricia extracorpórea. Las variables analizadas fueron: Edad, sexo, índice de masa corporal, diámetro máximo de la litiasis, área de la litiasis, unidades hounsfield de la litiasis medida por Tomografía axial, localización de la litiasis, resultado tras 1 sesión de Litotricia extracorpórea por ondas de choque [fragmentación completa, fragmentación parcial (presencia de un fragmento mayor a 5 mm) y ausencia de fragmentación (mismo tamaño de la litiasis)], efectos adversos acontecidos tras la toma de Fagolitos plus®, días de tratamiento con Fagolitos plus® y energía de ondas de choque aplicada a la litiasis. Se analizaron resultados con SPSS 20.0, p≤0,05. RESULTADOS: La edad media de los pacientes incluidos en el estudio es de 53,81 ± 12,62 años en el grupo 1 frente a 56,53 ± 12,37 años en el grupo 2, p=0,31. Según la distribución por sexos, tampoco existen diferencias estadísticamente significativas (p=0,5), incluyendo 24 hombres y 24 mujeres en el grupo 1 y 23 hombres y 17 mujeres en el grupo 2. El índice de masa corporal medio de los pacientes del grupo 1 fue de 28,39 ± 2,27 kg/m2 en el grupo 1 frente a 28,39 ± 3,03 kg/m2 en el grupo 2, p=0,9. El diámetro máximo de la litiasis fue de 11,5 ± 3,91 mm en el grupo 1 frente a 13,15 ± 5,49 mm en el grupo 2, p=0,1. El área de la litiasis medida por tomografía computarizada fue de 104,74 ± 70,56 mm2 en el grupo 1 frente a 141,91 ± 80,95 mm2 en el grupo 2, p=0,3. Las unidades Hounsfield medidas por tomografía de la litiasis en el grupo 1 fue de 1061,98 ± 213,68 frente a 1143,15 ± 172,24 en el grupo 2, p=0,06. En relación con la fragmentación, se observó fragmentación completa en el 66,7% de los pacientes del grupo 1, frente al 41% de los pacientes del grupo 2 (p=0,02) entre 20-30 días tras la primera sesión de Litotricia Extracorpórea evaluado mediante Radiografía simple de Abdomen. CONCLUSIONES: La administración de Fagolitos plus® concomitante a la Litotricia extracorpórea podría aumentar su efectividad en la fragmentación de la litiasis, siendo necesarios ensayos clínicos y estudios prospectivos que confirmen estos hallazgos.

Evaluación del tratamiento de litiasis renal radiopaca mediante la combinación de litotricia extracorpórea por ondas de choque y fagolitos plus. Estudio preliminar de casos y controles / Evaluation of the treatment of radiopaque renal lithiasis through the combination of extracorporeal lithotripsy by shock waves and phagoliths plus. Preliminary case-control study

Objetivo: El objetivo de este estudio es evaluar la efectividad del tratamiento combinado de Fagolitos plus® yLitotricia extracorpórea en la fragmentación de la litiasis.Material y métodos: Estudio retrospectivo de casosy controles, incluye 88 pacientes con litiasis. Grupo 1:Tratados con 1 sesión de litotricia extracorpórea y Fagolitos plus ®. Grupo 2: Tratados con 1 sesión de litotriciaextracorpórea. Las variables analizadas fueron: Edad, sexo, índice de masa corporal, diámetro máximo dela litiasis, área de la litiasis, unidades hounsfield de lalitiasis medida por Tomografía axial, localización de lalitiasis, resultado tras 1 sesión de Litotricia extracorpóreapor ondas de choque [fragmentación completa, fragmentación parcial (presencia de un fragmento mayor a5 mm) y ausencia de fragmentación (mismo tamaño dela litiasis)], efectos adversos acontecidos tras la toma deFagolitos plus ®, días de tratamiento con Fagolitos plus ®y energía de ondas de choque aplicada a la litiasis. Seanalizaron resultados con SPSS 20.0, p≤0,05. Resultados: La edad media de los pacientes incluidos en el estudio es de 53,81 ± 12,62 años en elgrupo 1 frente a 56,53 ± 12,37 años en el grupo 2,p=0,31. Según la distribución por sexos, tampoco existen diferencias estadísticamente significativas (p=0,5),incluyendo 24 hombres y 24 mujeres en el grupo 1 y23 hombres y 17 mujeres en el grupo 2. El índice demasa corporal medio de los pacientes del grupo 1 fuede 28,39 ± 2,27 kg/m 2 en el grupo 1 frente a 28,39± 3,03 kg/m2 en el grupo 2, p=0,9. El diámetro máximo de la litiasis fue de 11,5 ± 3,91 mm en el grupo1 frente a 13,15 ± 5,49 mm en el grupo 2, p=0,1.El área de la litiasis medida por tomografía computarizada fue de 104,74 ± 70,56 mm 2 en el grupo 1frente a 141,91 ± 80,95 mm2 en el grupo 2, p=0,3.Las unidades Hounsfield medidas por tomografía de lalitiasis en el grupo 1 fue de 1061,98 ± 213,68 frentea 1143,15 ± 172,24 en el grupo 2, p=0,06...(AU)

Objetive: The objective of this study is to evaluatethe effectiveness of the combined treatment of Fagolitosplus® and extracorporeal lithotripsy in the fragmentationof the lithiasis.Material and methods: Retrospective case-control study includes 88 patients with lithiasis. Group 1:Treated with 1 session of extracorporeal lithotripsy andFagoliths plus ® . Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were:Age, sex, body mass index, maximum diameter of thestone, area of the stone, hounsfield units of the stonemeasured by axial tomography, location of the stone,result after 1 session of extracorporeal wave lithotripsy.shock [complete fragmentation, partial fragmentation(presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus ® ,days of treatment with Fagolitos plus ® and energyshock wave applied to lithiasis. Results were analyzedwith SPSS 20.0, p≤0.05.Results: The mean age of the patients included in thestudy is 53.81 ± 12.62 years in group 1 compared to56.53 ± 12.37 years in group 2, p=0.31. Accordingto the distribution by sex, there were no statisticallysignificant differences (p=0.5), including 24 men and24 women in group 1 and 23 men and 17 women ingroup 2. The mean of body mass index of the patientsin group 1 was 28.39 ± 2.27 kg/m 2 in group 1 versus 28.39 ± 3.03 kg/m 2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm ingroup 1 compared to 13.15 ± 5.49 mm in group 2,p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm 2 in group 1 comparedto 141.91 ± 80.95 mm 2 in group 2, p=0.3. TheHounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to1143.15 ± 172.24 in group 2, p=0.06.Relation to fragmentation, complete fragmentation wasobserved in 66.7% of group 1 patients, compared to...(AU)