The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry.

The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice. RESULTS: We find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10-22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60-0.71). PDF and CUC do not suggest a specific cut-off point of clinical use. METHODS: We select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC). CONCLUSIONS: In our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.

Our experience in the treatment of male stress urinary incontinence with the male Remeex system.

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment. METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with postprostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ranged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day. RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinence Impact Questionnaire (7) scores before surgery and 6 months after diminished from 68+/-7 to 10+/-3. All patients are very satisfied. CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results.

Nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo masculina mediante cabestrillo suburetral regulable tipo Remeex / Our experience in the treatment of male stress urinary incontinence with the male remeex system

OBJETIVO: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo postprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, sus indicaciones terapéuticas, técnica de implantación y su adecuado ajuste.MÉTODO: Desde marzo de 2007 hasta enero de 2009 hemos intervenido a cinco varones afectos de incontinencia urinaria de esfuerzo postprostatectomía con edades comprendidas entre 57 y 71 años (media 66 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida y de un tiempo de evolución entre 2 y 10 años (media 3,5 años), precisando todos ellos entre 5 y 8 compresas diarias.RESULTADOS: Todos los pacientes se mantienen secos en un tiempo de seguimiento medio de 15,4 meses (rango 6-28 meses), precisando ocasionalmente 2 de ellos compresa de seguridad si realizan ejercicio intenso. La puntuación del Incontinence Impact Questionnaire (IIQ 7) realizado antes de la intervención y a los 6 meses después, pasa de 68 ± 7 puntos a 10 ± 3, siendo el grado de satisfacción muy elevado.CONCLUSIONES: El SRM constituye una opción terapéutica válida para la incontinencia postprostatectomía, siendo una técnica reproducible, de fácil ejecución, que permite su reajuste mediante una pequeña incisión suprapúbica bajo anestesia local y en régimen ambulatorio estricto, con una baja tasa de complicaciones proporcionando unos resultados excelentes y duraderos(AU)

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment.METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with post-prostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ran-ged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day.RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinen-ce Impact Questionnaire (7) scores befo-re surgery and 6 months after diminished from 68±7 to 10±3. All patients are very satisfied.CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results(AU)

La resección transuretral de próstata bajo anestesia local y sedación es segura y bien tolerada / Transurethral resection of the prostate under local anesthesia-sedation

El actual envejecimiento de la población comporta un incremento del número de varones afectados de hiperplasia benigna de próstata (HBP) con diversas enfermedades asociadas que limitan su tratamiento quirúrgico. Por otra parte, la creación de nuevas unidades de cirugía mayor ambulatoria (CMA) en España es un hecho imparable, pues cada vez es mayor el número de servicios de urología que se integran en este sistema organizativo de la asistencia quirúrgica. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local y sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico, así como en pacientes seleccionados susceptibles de ser intervenidos en régimen ambulatorio. Consideramos que tanto la incisión transuretral de próstata como la resección transuretral de próstata realizadas bajo anestesia local y sedación son métodos seguros, eficaces y bien tolerados, los cuales, aunque puedan emplearse en pacientes muy seleccionados en régimen de CMA, están fundamentalmente indicados en pacientes años os y cuando el riesgo quirúrgico- anestésico es elevado, ya que pueden ser realizados como cirugía de estadía breve.

La resección transuretral de próstata bajo anestesia local y sedación es segura y bien tolerada / Transurethral resection of the prostate under local anesthesia-sedation

El actual envejecimiento de la población comporta un incremento del número de varones afectados de hiperplasia benigna de próstata (HBP) con diversas enfermedades asociadas que limitan su tratamiento quirúrgico. Por otra parte, la creación de nuevas unidades de cirugía mayor ambulatoria (CMA) en España es un hecho imparable, pues cada vez es mayor el número de servicios de urología que se integran en este sistema organizativo de la asistencia quirúrgica. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local y sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico, así como en pacientes seleccionados susceptibles de ser intervenidos en régimen ambulatorio. Consideramos que tanto la incisión transuretral de próstata como la resección transuretral de próstata realizadas bajo anestesia local y sedación son métodos seguros, eficaces y bien tolerados, los cuales, aunque puedan emplearse en pacientes muy seleccionados en régimen de CMA, están fundamentalmente indicados en pacientes años os y cuando el riesgo quirúrgico- anestésico es elevado, ya que pueden ser realizados como cirugía de estadía breve.(AU)

La Meatoplastia dorsal para el tratamiento de la estenosis de meato en pacientes con balanitis xerótica obliterante / Dorsal meatoplasty for the treatment of meatal stenosis in patients with balanitis xerotica obliterans

OBJETIVO: Poner de manifiesto nuestra experiencia en el tratamiento de la estenosis de meato secundaria a balanitis xerótica obliterante mediante la técnica de meatoplastia dorsal. MÉTODOS: Hemos realizado meatoplastia dorsal a 15 pacientes afectos de estenosis de meato balánico secundaria a liquen escleroso y atrófico. Todos los casos fueron intervenidos bajo anestesia local realizando plastia mediante incisión en V invertida según la técnica original de Malone. RESULTADOS: En todos los pacientes intervenidos se objetivó una mejoría flujométrica así como un excelente resultado estético y escasa incidencia de micción dispersa, existiendo un elevado índice de satisfacción evaluado mediante la realización de un cuestionario. CONCLUSIONES: La meatoplastia dorsal con incisión en V invertida es una técnica de fácil ejecución, que permite ser realizada bajo anestesia local, evita la aparición de hipospadias postoperatorio y proporciona excelentes resultados estéticos y funcionales con un bajo índice de recidivas, por lo que consideramos que debe de incluirse en la cartera de procedimientos habituales del urólogo (AU)

OBJECTIVES: To present our experience in the treatment of meatal stenosis secondary to balanitis xerotica obliterans with the dorsal meatoplasty technique. METHODS: We have performed dorsal meatoplasty in 15 patients suffering stenosis of the penile meatus secondary to balanitis xerotica obliterans. All cases were performed under local anesthesia, using an inverted V incision plasty following the original of technique from Malone. RESULTS: All patients showed an improvement in uroflowmetry as well as an excellent aesthetic result, with low incidence of scattered urinary stream; there was a high satisfaction index evaluated by a questionnaire. CONCLUSIONS: Dorsal meatoplasty with inverted V incision is an easy-to-perform technique, which may be done under local anesthesia, avoids the development of post-operative hypospadias, and achieves excellent aesthetic and functional results with a low recurrence rate; therefore, we consider it should be included in the list of frequently performed procedures of the urologist (AU)

[Dorsal meatoplasty for the treatment of meatal stenosis in patients with balanitis xerotica obliterans]. / La meatoplastia dorsal para el tratamiento de la estenosis de meato en pacientes con balanitis xerótica obliterante.

OBJECTIVES: To present our experience in the treatment of meatal stenosis secondary to balanitis xerotica obliterans with the dorsal meatoplasty technique. METHODS: We have performed dorsal meatoplasty in 15 patients suffering stenosis of the penile meatus secondary to balanitis xerotica obliterans. All cases were performed under local anesthesia, using an inverted V incision plasty following the original of technique from Malone. RESULTS: All patients showed an improvement in uroflowmetry as well as an excellent aesthetic result, with low incidence of scattered urinary stream; there was a high satisfaction index evaluated by a questionnaire. CONCLUSIONS: Dorsal meatoplasty with inverted V incision is an easy-to-perform technique, which may be done under local anesthesia, avoids the development of post-operative hypospadias, and achieves excellent aesthetic and functional results with a low recurrence rate; therefore, we consider it should be included in the list of frequently performed procedures of the urologist.

[Primary bladder neck obstruction in males]. / Obstrucción primaria del cuello vesical en el varon.

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical, radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8 +/- 3.2 cc/s, being the voiding detrusor pressure 98 +/- 25 cm H2O, with significant post void residual volume in 21 patients (188 +/- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority.

Obstrucción primaria del cuello vesical en el varón / Primary bladder nexk obstruction in males

OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente modalidad de obstrucción funcional infravesical. MÉTODO: Durante los últimos 10 años hemos diagnosticado y tratado a 32 varones afectos de esta entidad. Se evalúan los diversos tratamientos previos recibidos así como el tiempo transcurrido hasta la realización del diagnóstico. Se valoran las manifestaciones clínicas, radiológicas, endoscópicas y urodinámicas así como los resultados obtenidos con la administración de bloqueadores alfa-adrenérgicos y con la incisión transuretral endoscópica del cuello vesical. RESULTADOS: La edad de los pacientes osciló entre 26 y 48 años (media 38,2). Todos ellos presentaban síntomas significativos del tacto urinario inferior de larga evolución, habiendo recibido diversos tratamientos inespecíficos. El estudio flujométrico evidenció un pico de flujo medio de 9,8 ± 3,2 cc/s, siendo la presión del detrusor durante el vaciado de 98 ± 25 cm H20, existiendo un residuo postmiccional significativo en 21 pacientes de 188 ± 62 cc. Con tratamiento médico mediante la administración de bloqueadores alfa-adrenérgicos únicamente obtuvimos mejorías subjetivas significativas en 4 pacientes. En 21 casos realizamos incisión unilateral endoscópica del cuello vesical, obteniendo mejorías objetivas y subjetivas en todos ellos. CONCLUSIONES: La incisión endoscópica del cuello vesical representa el tratamiento de elección de esta disfunción, siendo imperativo informar al paciente del riesgo de eyaculación retrógrada como secuela postoperatoria, ya que esta entidad ocurre en sujetos jóvenes, en los que la fertilidad puede ser una prioridad

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical , radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8+- 3.2 cc/s, being the voiding detrusor pressure 98+- 25 cm H2O, with significant post void residual volume in 21 patients (188+- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority

[Symptomatic hydronephrosis during pregnancy]. / Acerca de la hidronefrosis sintomática en la gestante.

OBJECTIVES: Hydronephrosis is common during pregnancy, affecting 90% of pregnant women. It is usually asymptomotic, but a small percentage of patients show clinical symptoms requiring treatment. We want to report our experience in the diagnosis and treatment of symptomatic obstructive uropathy in pregnant women. METHODS: We retrospectively evaluate the results obtained in 162 pregnant women suffering symptomatic hydronephrosis who received care at our department over the last 12 years. RESULTS: Conservative treatment was effective in most patients, 39 patients required more aggressive therapy. Thirty-five patients underwent insertion of a doubleJ catheter, 2 patients percutaneous nephrostomy, and another 2 ureteroscopy and extraction of ureteral lithiasis. CONCLUSIONS: The most frequent etiology of symptomatic hydronephrosis during pregnancy is external compression by the gravid uterus, followed by ureteral lithiasis. We consider conservative treatment as the treatment of choice, leaving ureteral double J cotheter insertion or percutaneous nephrostomy for the refractory cases. Ureteroscopy is a new diagnostic and therapeutic option when other less aggressive meosures fail.