Terapia termal con vapor de agua: variaciones técnicas entre hospitales universitarios españoles y eficacia a 2 años de seguimiento / Water vapor thermal therapy: technical variations among spanish hospitals and efficacy at 2-year follow-up

Objetivo El objetivo de este trabajo es conocer experiencia inicial con la terapia térmica con vapor de agua (TTVA) para hiperplasia benigna de próstata (HBP) en los hospitales universitarios españoles, así como describir las diferencias en cuanto a técnica y seguimiento observadas entre los centros. Materiales y métodos Este estudio multicéntrico observacional retrospectivo recogió características basales, datos quirúrgicos, posoperatorios y seguimiento a los uno, tres, seis, 12 y 24 meses, incluyendo cuestionarios validados, variaciones flujométricas, complicaciones y la necesidad de tratamiento farmacológico y quirúrgico tras el procedimiento. También se analizaron los posibles desencadenantes de retención aguda de orina (RAO) en el posoperatorio. Resultados Se incluyeron un total de 105 pacientes. No se observaron diferencias entre los grupos con y sin RAO con respecto a tiempo de sondaje (cinco y 4,3 días respectivamente, p = 0,178), ni volumen prostático (47,9 y 41,4 g, respectivamente, p = 0,147). La mejoría media a los tres, seis, 12 y 24 meses en cuanto de flujo máximo fue de 5,3, 5,2, 4,2 y 3,8 mL/s, respectivamente. En cuanto a la eyaculación, se observa una mejoría en la misma a partir de los tres meses de seguimiento que se mantiene en el tiempo. Conclusiones El tratamiento mínimamente invasivo de HBP con TTVA presenta buenos resultados funcionales a 24 meses de seguimiento, sin afectación significativa de la función sexual y con una baja incidencia de complicaciones. Existen pequeñas variaciones principalmente en cuanto al posoperatorio inmediato entre los hospitales participantes en el estudio. (AU)

Aim The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. Materials and Methods This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. Results A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, p = 0.178), or prostate volume (47.9 gr and 41.4 gr respectively, p = 0.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8 ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. Conclusions Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period. (AU)

Water vapor thermal therapy: Technical variations among spanish hospitals and efficacy at 2-year follow-up.

AIM: The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. MATERIALS AND METHODS: This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. RESULTS: A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, P=.178), or prostate volume (47.9g and 41.4g respectively, P=.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. CONCLUSIONS: Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period.

Resultados preliminares de un trabajo multicéntrico a nivel nacional para el tratamiento de STUI secundario a hiperplasia benigna de próstata mediante el sistema con vapor de agua Rezum / Preliminary results of a national multicenter study on the treatment of LUTS secondary to benign prostatic hyperplasia using the Rezum steam system

Introducción y objetivo El sistema Rezūm® t/o es una técnica mínimamente invasiva que emplea la inyección intraprostática transuretral de vapor de agua para la ablación del tejido prostático. El objetivo del estudio es reflejar los resultados funcionales a corto plazo y de seguridad obtenidos aplicando la técnica en la práctica clínica real. Material y métodos Estudio prospectivo realizado en 5 hospitales españoles para el tratamiento de STUI secundario a HBP mediante el sistema Rezūm®. Se incluyeron pacientes con lóbulo medio prostático (LM) y portadores de sonda vesical (SV). La valoración pre- y postoperatoria se realizó con los cuestionarios IPSS, IIEF-5 y QoL, los resultados flujométricos y el residuo posmiccional. Se registraron las complicaciones acontecidas, así como la tasa de retratamientos al año de seguimiento. Resultados Un total de 137 pacientes fueron incluidos, presentando 64 pacientes LM y 10 pacientes SV. La media de volumen prostático fue de 50cm3 (15-131). A los 3 meses de seguimiento se objetivó una mejoría estadísticamente significativa tanto del IPSS (−6,37 puntos) como del Qmax (+4,95mL/s) y el QoL (−1,29) que se mantuvo hasta los 12 meses: −10,78 puntos, +4,62mL/s y −2,73 (p<0,001), respectivamente. No se objetivaron cambios significativos en la esfera sexual. Todas las complicaciones fueron de carácter leve (≤ClavienII). La tasa de retratamiento al año fue del 4,3%. Conclusión Los resultados a corto plazo de esta técnica son prometedores, mostrando mejoría en los resultados funcionales, sin repercusión en la esfera sexual y asumiendo complicaciones de carácter leve y corta duración. Sin embargo, son necesarios seguimientos más prolongados para establecer su durabilidad y realizar comparaciones directas con otros tratamientos (AU)

Introduction and objective Rezūm® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. Material and methods Prospective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezūm® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. Results 137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50cm3 (15-131). At 3 months follow-up, significant improvement was observed in IPSS (−6,37 points), Qmax (+4,95mL/s) and QoL (−1,29); and was maintained until 12 months: −10,78 points,+4,62mL/s and −2,73 respectively (p<0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤Clavien II). Retreatment rate at one year was 4%. Conclusion Short-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments (AU)

Preliminary results of a national multicenter study on the treatment of LUTS secondary to benign prostatic hyperplasia using the Rezum® steam system.

INTRODUCTION AND OBJECTIVE: Rezum® system is a minimally invasive transurethral therapy that uses convective water vapor energy to ablate prostatic tissue. The objective is to report 1-year functional and security outcomes obtained by using this technique in real clinical practice. MATERIAL AND METHODS: Prospective study conducted in 5 Spanish hospitals for the treatment of LUTS secondary to BPH using the Rezum® system. Patients with prostatic medium lobe (ML) and urethral catheter carriers were also included. Pre- and post-operative data were collected using IPSS, IIEF-5 and QoL questionnaires, flowmetry and post-void residual volume. Complications and retreatment rate at one-year follow-up were also reported. RESULTS: 137 patients, including 64 with ML and 10 patients with urinary retention were treated. Median prostate volume was 50 cm3 (15-131). At 3 months follow-up, significant improvement was observed in IPSS (-6.37 points), Qmax (+4.95 mL/s) and QoL (-1.29); and was maintained until 12 months: -10.78 points, +4.62 mL/s and -2.73 respectively (p < 0.001). No significant changes were observed in the sexual sphere. All complications were mild (≤ Clavien II). Retreatment rate at one year was 4%. CONCLUSION: Short-term results of this technique are promising, showing improvement in terms of functional outcomes, with no impact on the sexual sphere or complications. Longer term follow-up should include treatment durability and comparison to standard BPH treatments.

Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19 / Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic

INTRODUCCIÓN: Durante la pandemia COVID-19, la actividad nacional de trasplante se ha visto reducida por la sobrecarga del sistema sanitario y la preocupación por la seguridad de los pacientes en esta situación. El objetivo de nuestro trabajo es exponer la actividad de trasplante renal en Cantabria durante el estado de alarma, así como valorar la seguridad del programa de trasplante. MATERIAL Y MÉTODOS: Estudio retrospectivo de los trasplantes renales realizados en nuestro Centro desde el inicio del estado de alarma hasta el inicio del desconfinamiento en Cantabria. Análisis descriptivo de los datos demográficos de receptores y sus donantes, datos intraoperatorios y resultados postoperatorios. Análisis comparativo con los datos del mismo periodo de 2017-2019, mediante los estadísticos χ2 para variables categóricas, T-Student y U de Mann-Whitney en caso de variables cuantitativas de distribución normal y no normal, respectivamente. RESULTADOS: Se realizaron 15 trasplantes renales en el periodo descrito. El 7,5% de pacientes presentaron función renal retrasada (FRR); el 26,6% mostró datos de rechazo agudo; ningún paciente presentó enfermedad por COVID-19. En el análisis comparativo, es llamativo el aumento del número de trasplantes frente a periodos anteriores (15 vs. 5,6), a expensas de donantes de fuera de Cantabria (93,3%). No encontramos diferencias estadísticamente significativas en cuanto a tiempo de isquemia fría (p = 0,77), FRR (p = 0,73), necesidad de diálisis (p = 0,54), o aparición de complicaciones posquirúrgicas (p = 0,61). CONCLUSIONES: La evolución de la pandemia en nuestra región y la adopción de medidas de protección rigurosas han permitido reiniciar el programa de trasplante renal de una forma temprana y segura, aumentando el número de trasplantes realizados frente a años anteriores y manteniendo unos resultados postoperatorios tempranos comparables

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p = 0.77), DRF (p = 0.73), need for dialysis (p = 0.54), or appearance of post-surgical complications (p = 0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results

Percutaneous radiofrequency for the treatment of small renal masses: Analysis of outcomes and complications after 10 years of experience. / Radiofrecuencia percutánea en el tratamiento de masas renales pequeñas: análisis de resultados y complicaciones tras diez años de experiencia.

INTRODUCTION AND OBJECTIVE: The management of renal tumors ≤ 4 cm in elderly population or patients with comorbidities is a challenge, for which ablative therapies are an interesting alternative. The objective is to evaluate in our center the role of percutaneous radiofrequency in the treatment of small renal masses, the associated complications and the results obtained. MATERIAL AND METHODS: Retrospective evaluation of the radiofrequency treatments carried out between April 2010 and April 2020 in our center. Demographic data, associated comorbidities, tumor characteristics, complications and oncological and functional outcomes were reviewed. RESULTS: Fifty-seven tumors were treated in 53 patients. Mean follow-up of 48.2 months. The percentage of complete ablations obtained was of 89.5%. There were 19.3% of complications. According to Clavien-Dindo and SIR classification systems, 3.5% and 5.3% were major complications. A statistically significant association was found between the initial result of ablation and age (p = 0.047), RENAL-m (p = 0.044), the presence of cystic component (p = 0.049) and tumor size (p = 0.01). The cut-off point for size was established at 25 mm (p = 0.012). In multivariate analysis, only size remained as a predictor of initial ablation result (p = 0.01; OR 1.183; CI 95% 1.041-1.345). Cancer-specific survival and 5-year recurrence-free survival were 98.1% and 89.5%, respectively. A mean decrease of MDRD-4 of 6.59 mL/min (p = 0.005) was observed in the first six months after RFA. CONCLUSIONS: Given the excellent oncological and functional results demonstrated, ultrasound-guided percutaneous radiofrequency ablation is an effective and safe treatment for small renal masses in selected patients.

Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic. / Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19.

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p=0.77), DRF (p=0.73), need for dialysis (p=0.54), or appearance of post-surgical complications (p=0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results.

Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19 / Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic

INTRODUCCIÓN: Durante la pandemia COVID-19, la actividad nacional de trasplante se ha visto reducida por la sobrecarga del sistema sanitario y la preocupación por la seguridad de los pacientes en esta situación. El objetivo de nuestro trabajo es exponer la actividad de trasplante renal en Cantabria durante el estado de alarma, así como valorar la seguridad del programa de trasplante. MATERIAL Y MÉTODOS: Estudio retrospectivo de los trasplantes renales realizados en nuestro Centro desde el inicio del estado de alarma hasta el inicio del desconfinamiento en Cantabria. Análisis descriptivo de los datos demográficos de receptores y sus donantes, datos intraoperatorios y resultados postoperatorios. Análisis comparativo con los datos del mismo periodo de 2017-2019, mediante los estadísticos χ2 para variables categóricas, T-Student y U de Mann-Whitney en caso de variables cuantitativas de distribución normal y no normal, respectivamente. RESULTADOS: Se realizaron 15 trasplantes renales en el periodo descrito. El 7,5% de pacientes presentaron función renal retrasada (FRR); el 26,6% mostró datos de rechazo agudo; ningún paciente presentó enfermedad por COVID-19. En el análisis comparativo, es llamativo el aumento del número de trasplantes frente a periodos anteriores (15 vs. 5,6), a expensas de donantes de fuera de Cantabria (93,3%). No encontramos diferencias estadísticamente significativas en cuanto a tiempo de isquemia fría (p = 0,77), FRR (p = 0,73), necesidad de diálisis (p = 0,54), o aparición de complicaciones posquirúrgicas (p = 0,61). CONCLUSIONES: La evolución de la pandemia en nuestra región y la adopción de medidas de protección rigurosas han permitido reiniciar el programa de trasplante renal de una forma temprana y segura, aumentando el número de trasplantes realizados frente a años anteriores y manteniendo unos resultados postoperatorios tempranos comparables

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p = 0.77), DRF (p = 0.73), need for dialysis (p = 0.54), or appearance of post-surgical complications (p = 0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results