Consenso de la Asociación Española de Urología sobre el uso de mallas en la cirugía del prolapso de órganos pélvicos / Consensus statement of the Spanish Association Of Urology on the use of meshes in pelvic organ prolapse

INTRODUCCIÓN: Recientemente la Food and Drug Administration ha prohibido el uso de mallas transvaginales para el tratamiento quirúrgico de los prolapsos de órganos pélvicos (POP) en Estados Unidos. Esto ha suscitado una repercusión a escala mundial en el manejo de la patología del suelo pélvico por parte de los diferentes especialistas. OBJETIVO: Lograr un consenso sobre el uso de mallas en el tratamiento quirúrgico de los POP. ADQUISICIÓN DE DATOS/EVIDENCIA: Se organizó un Comité de expertos de la Asociación Española de Urología (AEU) para una revisión de la literatura y analizar la seguridad y eficacia del uso de mallas de polipropileno en la cirugía de los POP. RESULTADOS/EVIDENCIA DE LA LITERATURA: La evidencia refleja que el uso de mallas, comparado con el uso de tejidos nativos, ofrece una mejor eficacia a expensas de nuevas complicaciones y una mayor tasa de revisiones quirúrgicas, siendo estas menores en manos de cirujanos expertos. CONCLUSIONES: La cirugía del POP debe ser realizada por cirujanos con experiencia, adecuadamente formados y en centros de referencia. El paciente debe recibir una información correcta acerca de las diferentes opciones de tratamiento. Las mallas transvaginales solo deben indicarse en casos complejos y en recidivas tras cirugía del POP. PROPUESTA AEU: Creación de una guía clínica y de un registro nacional para la evaluación a largo plazo. Elaboración de un Consentimiento Informado a disposición de todos los profesionales y pacientes, así como un plan de formación específico para conseguir una mejor capacitación en la cirugía compleja del suelo pélvico

INTRODUCTION: Recently the Food and Drug Administration has banned the use of transvaginal meshes for the surgical treatment of pelvic organ prolapse (POP) in the United States. This has caused a worldwide impact on the management of pelvic floor pathology by different specialists. OBJECTIVE: To achieve a consensus on the use of meshes in the surgical treatment of POPs. ACQUISITION OF DATA/EVIDENCE: A Committee of experts of the Spanish Association of Urology (AEU) was organized to review the literature and analyze the safety and efficacy of the use of polypropylene meshes in POP surgery. RESULTS/EVIDENCE FROM THE LITERATURE: The evidence reflects that the use of meshes, compared to the use of native tissues, offers better efficacy at the expense of new complications and a higher rate of surgical reviews, these being minor in the hands of expert surgeons. CONCLUSIONS: POP surgery must be performed by experienced surgeons, properly trained and in referral centers. The patient should receive correct information about the different treatment options. Transvaginal meshes should only be indicated in complex cases and in recurrences after POP surgery. AEU PROPOSAL: Creation of a clinical guideline and a national registry for long-term evaluation. Preparation of an Informed Consent available to all professionals and patients, as well as a specific training plan to achieve better training in complex pelvic floor surgery

Consensus statement of the Spanish Association Of Urology on the use of meshes in pelvic organ prolapse. / Consenso de la Asociación Española de Urología sobre el uso de mallas en la cirugía del prolapso de órganos pélvicos.

INTRODUCTION: Recently the Food and Drug Administration has banned the use of transvaginal meshes for the surgical treatment of pelvic organ prolapse (POP) in the United States. This has caused a worldwide impact on the management of pelvic floor pathology by different specialists. OBJECTIVE: To achieve a consensus on the use of meshes in the surgical treatment of POPs. ACQUISITION OF DATA/EVIDENCE: A Committee of experts of the Spanish Association of Urology (AEU) was organized to review the literature and analyze the safety and efficacy of the use of polypropylene meshes in POP surgery. RESULTS/EVIDENCE FROM THE LITERATURE: The evidence reflects that the use of meshes, compared to the use of native tissues, offers better efficacy at the expense of new complications and a higher rate of surgical reviews, these being minor in the hands of expert surgeons. CONCLUSIONS: POP surgery must be performed by experienced surgeons, properly trained and in referral centers. The patient should receive correct information about the different treatment options. Transvaginal meshes should only be indicated in complex cases and in recurrences after POP surgery. AEU PROPOSAL: Creation of a clinical guideline and a national registry for long-term evaluation. Preparation of an Informed Consent available to all professionals and patients, as well as a specific training plan to achieve better training in complex pelvic floor surgery.

Valores de referencia para el cuestionario CAVIPRES-30, un cuestionario global sobre la calidad de vida relacionada con la salud de pacientes con cáncer de próstata / Reference values for the CAVIPRES-30 questionnaire, a global questionnaire on the health-related quality of life of patients with prostate cancer

Objetivo: Definir y establecer los valores de referencia del cuestionario CAVIPRES-30, un cuestionario de la calidad de vida relacionada con la salud específica para pacientes con cáncer de próstata. Material y métodos: El cuestionario CAVIPRES-30 fue administrado a 2.630 hombres con cáncer de próstata incluidos por 238 urólogos del sistema de sanidad español. Se llevaron a cabo análisis descriptivos de los datos sociodemográficos y clínicos, y análisis multivariados para corroborar que las variables estratificadas se asociaban de forma independiente y estadísticamente significativa a la puntuación global del cuestionario. Resultados: Las variables de tiempo desde el diagnóstico de la enfermedad, tanto si el paciente tenía pareja estable como si no, y si estaba o no recibiendo tratamiento sintomático, se asociaron de forma independiente y estadísticamente significativa (p < 0,001) a la puntuación global del cuestionario. La tabla de valores de referencia del cuestionario CAVIPRES-30 contiene diferentes tipos de información sobre el perfil de cada paciente: tamaño muestral, estadísticas descriptivas con respecto a la puntuación global y el valor de alfa de Cronbach (entre 0,791 y 0,875); los valores del cuestionario están reportados en deciles. Conclusiones: Los resultados de este estudio aportan nuevas evidencias con respecto a la idoneidad y utilidad del cuestionario CAVIPRES-30 como instrumento para evaluar individualmente la calidad de vida del cáncer de próstata

Objective: Define and establish the reference values of the CAVIPRES-30 questionnaire, a health related quality of life questionnaire specific for prostate cancer patients. Materials and methods: The CAVIPRES-30 was administered to 2630 males with prostate cancer included by 238 Urologist belonging to the Spanish National Healthcare System. Descriptive analysis on socio-demographic and clinical data was performed, and multivariate analyses were used to corroborate that stratification variables were statistically significantly and independently associated to the overall score of the questionnaire. Results: The variables, time since diagnosis of the illness, whether the patient had a stable partner or not, and whether he was undergoing symptomatic treatment or not were statistically, significantly, and independently associated (p < 0.001) to the overall score of the questionnaire. The reference values table of the CAVIPRES-30 questionnaire is made up of different kinds of information of each patient profile: sample size, descriptive statistics with regard to the overall score, Cronbach's alpha value (between 0.791 and 0.875) and the questionnaire's values are reported by deciles. Conclusions: The results of this study provide new proof as to the suitability and usefulness of the CAVIPRES-30 questionnaire as an instrument for assessing individually the quality of life of prostate cancer patients

Reference values for the CAVIPRES-30 questionnaire, a global questionnaire on the health-related quality of life of patients with prostate cancer.

OBJECTIVE: Define and establish the reference values of the CAVIPRES-30 Questionnaire, a health related quality of life questionnaire specific for prostate cancer patients. MATERIAL AND METHODS: The CAVIPRES-30 was administered to 2,630 males with prostate cancer included by 238 Urologist belonging to the Spanish National Healthcare System. Descriptive analysis on socio-demographic and clinical data were performed, and multivariate analyses were used to corroborate that stratification variables were statistically significantly and independently associated to the overall score of the questionnaire. RESULTS: The variables Time since diagnosis of the illness, whether the patient had a Stable partner or not, if he was, or not, undergoing Symptomatic treatment were statistically significantly and independently associated (P < .001) to the overall score of the questionnaire. The reference values table of the CAVIPRES-30 questionnaire is made up of different kinds of information of each patient profile: sample size, descriptive statistics with regard to the overall score, Cronbach's alpha value (between .791 and .875) and the questionnaire's values are reported by deciles. CONCLUSIONS: The results of this study contribute new proof as to the suitability and usefulness of the CAVIPRES-30 questionnaire as an instrument for assessing individually the quality of life of prostate cancer.

Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata como medida de la calidad de vida de los pacientes con cáncer de próstata en España: aplicación a la actividad diaria / CAVIPRES questionnaire as a meassurement of quality of life in patients with prostate cancer in Spain: Daily clinical practice aplication

Introducción: El cáncer de próstata (CP) supone el tumor más frecuente en los varones ancianos. A pesar de no ser responsable directo del fallecimiento, implica una merma importante en la calidad de vida de los pacientes. Diversos cuestionarios han sido adaptados al castellano para medir la calidad de vida relacionada con la salud (CVRS) de los pacientes con CP. Objetivos: Descripción del contenido y aplicabilidad del Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata (CAVIPRES), tanto en su versión corta para la actividad clínica asistencial como su versión extendida para los protocolos de investigación. Material y métodos: Se realiza una detallada revisión de las distintas áreas relacionadas con la calidad de vida de los pacientes con CP que recoge el CAVIPRES y se compara con los cuestionarios de CVRS adaptados disponibles. Resultados: El CAVIPRES recoge información del apoyo social y de pareja, aspectos psicológicos del paciente, así como expectativas de vida frente a la evolución de la enfermedad junto a los parámetros clásicos sintomatológicos comunes al resto de los cuestionarios disponibles adaptados. Conclusión: El CAVIPRES en su versión corta es un método adecuado, factible, válido, fiable y sensible al cambio en la evaluación de la CVRS de los pacientes con CP. La versión extendida de este es válida para su utilización en la investigación clínica. Ambos cuestionarios han sido donados a la Asociación Española de Urología por Abbott y se encuentran disponibles en la página web de la asociación (www.aeu.es) (AU)

Introduction: Prostate cancer (PC) states as the most frequent tumor in elderly patients. Although no direct involvement in death-related, PC entails an important lost in patient's quality of life. There are several questionnaires adapted to Spanish in order to measure the health-related quality of life (HRQoL) in PC patients. Objectives: To describe the content and feasibility of the Spanish CAVIPRES questionnaire both in its short version to the clinical daily practice and also in the extended version to be used in the investigational protocols. Materials and methods: A detailed review of the different quality of life-related aspects of PC patients gathered in the questionnaire and a cross-comparison with other adapted HRQoL available is been performed. Results: The HRQoL CAVIPRES questionnaire gathers information regarding social and partner support, psychological conditions of the patients, and also life expectancies against disease outcome together with classical symptomatic parameters as other available and adapted questionnaires. Conclusion: The CAVIPRES questionnaire in its short version is an adequate, feasible, valid, reliable and sensitive to change in the measurement of HRQoL in PC patients. The extended version is valid to be used in clinical research of PC patients. Both versions have been donated by Abbott to the Spanish Association of Urology (AEU) and are available at AEU web site (www.eau.es) (AU)

[CAVIPRES questionnaire as a measurement of quality of life in patients with prostate cancer in Spain: Daily clinical practice application]. / Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata como medida de la calidad de vida de los pacientes con cáncer de próstata en España: aplicación a la actividad diaria.

INTRODUCTION: Prostate cancer (PC) states as the most frequent tumor in elderly patients. Although no direct involvement in death-related, PC entails an important lost in patient's quality of life. There are several questionnaires adapted to Spanish in order to measure the health-related quality of life (HRQoL) in PC patients. OBJECTIVES: To describe the content and feasibility of the Spanish CAVIPRES questionnaire both in its short version to the clinical daily practice and also in the extended version to be used in the investigational protocols. MATERIALS AND METHODS: A detailed review of the different quality of life-related aspects of PC patients gathered in the questionnaire and a cross-comparison with other adapted HRQoL available is been performed. RESULTS: The HRQoL CAVIPRES questionnaire gathers information regarding social and partner support, psychological conditions of the patients, and also life expectancies against disease outcome together with classical symptomatic parameters as other available and adapted questionnaires. CONCLUSION: The CAVIPRES questionnaire in its short version is an adequate, feasible, valid, reliable and sensitive to change in the measurement of HRQoL in PC patients. The extended version is valid to be used in clinical research of PC patients. Both versions have been donated by Abbott to the Spanish Association of Urology (AEU) and are available at AEU web site (www.eau.es).

[Acute scrotum and Schönlein-Henoch purpura: report of 2 new cases]. / Escroto agudo y púrpura de Schönlein-Henoch: presentación de dos nuevos casos.

OBJECTIVE: To report two additional cases of Schönlein-Henoch purpura that developed acute scrotum. METHODS: Two patients with Schönlein-Henoch purpura that developed acute scrotum in the course of the disease are presented. The literature is briefly reviewed and discussed. RESULTS/CONCLUSIONS: Schönlein-Henoch purpura is a systemic vasculitis with involvement of the genital area in 15% of the cases and must be distinguished from testicular torsion. The clinical features, the findings at physical examination and scrotal ultrasound evaluation should suffice to make the correct diagnosis and avoid surgery. However, if the findings are inconclusive, techniques using isotopes and/or echo-Doppler can be utilized. If these are not available, exploratory scrototomy should not be delayed. Excellent response is achieved with steroid therapy.

[Squamous carcinoma of the prostate]. / Carcinoma escamoso de próstata.

A primary squamous cell carcinoma occurring in the prostate of 84 year-old man is described. The patient died of local progression six months after diagnosis. Review of the literature suggests that such a cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therapy.

Carcinoma escamoso de próstata / Squamous cell carcinoma of the prostate

Presentamos un caso de carcinoma escamoso primario de próstata en un varón de 84 años. El paciente falleció a los seis meses del diagnóstico por progresión local de la neoplasia. La revisión de la literatura sugiere que tal tipo de tumor es raro, muy agresivo, y responde pobremente a cualquier tipo de tratamiento. (AU)

[An intrascrotal epidermoid cyst: apropos a case]. / Quiste epidermoide intraescrotal: a propósito de un caso.

We report a case of simple epidermoid cyst of the scrotum. Complete excision was performed transcrotally and the presence of epidermoid cyst confirmed by histopathological examination. Epidermoid cyst of the scrotum is a rare disease and only 10 cases have been reported. Simple excision was sufficient for treatment of this very rare lesion. The patient is now in the follow-up period.

[Occult primary testicular tumor or burnt testicular tumor. Apropos of a case]. / Tumor testicular primario oculto o tumor testicular fundido. A propósito de un caso.

OBJECTIVES: A case of impalpable primary testicular tumor or burned out testicular tumor is described, with special reference to its unusual form of presentation and histopathological characteristics. The rarity of this tumor type and the difficulties encountered in making the differential diagnosis prompted us to report on this case. METHODS/RESULTS: A case of impalpable primary testicular tumor is described in a patient with normal tests on physical examination, who had consulted for progressive respiratory failure from pulmonary metastasis. CONCLUSIONS: Impalpable primary testicular tumor should be suspected in patients with extragonadal germ cell tumor and normal testes on physical examination. We underscore the importance of the tumor markers and ultrasound in making the diagnosis.

[Treatment of acute urine retention caused by benign prostatic hypertrophy with an LH-RH agonist (Goserelin)]. / Tratamiento de la retención aguda de orina debida a hipertrofia benigna de próstata con un agonista LH-RH (Goserelina).

Nineteen patients seen for AUR secondary to benign prostate hypertrophy and with high surgical risk, were treated with an LH-RH agonist (GOSERELIN). After six months of treatment a 43.28% decrease in the prostate volume was seen, Improvement, i.e., spontaneous miction, was achieved in 46.6% patients, although post-mictional volumes remained high.

[Effect of digital rectal examination on PSA]. / Efecto del tacto rectal sobre el PSA.

A prospective randomized study on 100 patients was conducted to determine the effect of the rectal digital examination on prostate specific antigen (PSA) serum concentration. The control group consisted of 50 patient, all with two PSA determinations with no urological manipulation between them. The study group had 50 patient, who underwent digital examination 24 hours before the second PSA determination. Mean difference in PSA concentration in the study group is 0.84 ng/ml, compared to 0.0048 ng/ml in the control group (p << 0.05). Only 7 patients with initial PSA within the normal range (0.0-0.4 ng/ml) had a second PSA higher than 4.0 ng/ml. Only a patient with initial PSA lower than 4.1 ng/ml, had a second PSA higher than 10.1 ng/ml. This minimal change is independent of the initial concentration and the diagnosis (benign prostate hyperplasia, prostate adenocarcinoma or chronic prostatitis). Though changes are statistically significant they are not clinically so because the 0.84 increase is irrelevant. Based on these data we believe rectal digital examination has no effect on PSA serum levels.

[Transperineal drainage of prostatic abscess]. / Drenaje transperineal de un absceso prostático.

The availability of antibiotics has made prostatic abscess an uncommon disease. A case of prostatic abscess is described. The etiopathogenesis, clinical features, diagnosis and treatment of this disease entity are discussed.

[Renal cystic adenocarcinoma]. / Adenocarcinoma quístico renal.

Contribution of one case of renal cystic adenocarcinoma which presented as a large cystic mass that did not meet the plain cyst requirements. Certainty diagnosis was achieved by the high rise in intracystic LDH. The value of the radiological tests, as well as the limited value of a negative cytology are discussed.

[Cystolysis. Supratrigonal denervation]. / Cistolisis. Denervación supratrigonal.

CI is an entity with obscure etiopathogenesis and difficult to manage. This essay contributes three cases, out of a series of 25, were cytolisis was performed. Results after six months follow-up are very encouraging, since pain has disappeared in all cases and pollakiuria has been radically reduced.