Disfunción eréctil y YouTube: calidad de los vídeos en español / Erectile dysfunction and YouTube: Quality of videos in Spanish

Introducción: La disfunción eréctil (DE) es una de las enfermedades urológicas más prevalentes, pero los datos de la calidad de su información en redes sociales son escasos. El objetivo de nuestro estudio fue evaluar la calidad de la información sobre DE contenida en los vídeos de YouTube. Material y métodos: Estudio descriptivo transversal de los 50 primeros vídeos en castellano publicados en YouTube, evaluados por tres urólogos mediante dos cuestionarios validados: Patient Education Materials Assessment Tool (PEMAT) y DISCERN, clasificándolos según puntuación DISCERN en calidad pobre y moderada-buena. Resultados: La mediana de duración fue de 2,42 minutos, y la de visualizaciones, de 94.197 (2.313-3.027.890), con 682,5 (0-54.020) «me gusta» y 39 (0-2.843) «no me gusta». La mediana de PEMAT fue del 29% en inteligibilidad y del 29% en factibilidad. Con DISCERN, 27 vídeos (57,4%) fueron de calidad pobre y 20 (42,6%), de calidad moderada-buena. No observamos diferencias significativas entre ambos grupos en duración, visualizaciones, número de «me gusta» o de «no me gusta». Sí existieron diferencias en PEMAT de inteligibilidad y de factibilidad. El 86,7% de los protagonizados por personal médico fueron de calidad moderada-buena (p=0,001). El 85,7% de los que describían el tratamiento fueron de calidad moderada-buena y el 84% de los vídeos no médicos fueron de calidad pobre (p=0,001). Conclusiones: La mayoría de los vídeos sobre DE en YouTube son de calidad pobre. Los vídeos de mayor calidad son aquellos realizados por profesionales, aunque no son los más vistos. Sería importante el desarrollo de medidas para evitar la difusión de desinformación entre los usuarios de redes sociales. (AU)

Introduction: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. Material and methods: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. Results: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes» (0-54,020) and 39 «dislikes» (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes» or «dislikes». There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). Conclusion: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users. (AU)

ChatGPT and most frequent urological diseases: analysing the quality of information and potential risks for patients.

PURPOSE: Artificial intelligence (AI) is a set of systems or combinations of algorithms, which mimic human intelligence. ChatGPT is software with artificial intelligence which was recently developed by OpenAI. One of its potential uses could be to consult the information about pathologies and treatments. Our objective was to assess the quality of the information provided by AI like ChatGPT and establish if it is a secure source of information for patients. METHODS: Questions about bladder cancer, prostate cancer, renal cancer, benign prostatic hypertrophy (BPH), and urinary stones were queried through ChatGPT 4.0. Two urologists analysed the responses provided by ChatGPT using DISCERN questionary and a brief instrument for evaluating the quality of informed consent documents. RESULTS: The overall information provided in all pathologies was well-balanced. In each pathology was explained its anatomical location, affected population and a description of the symptoms. It concluded with the established risk factors and possible treatment. All treatment answers had a moderate quality score with DISCERN (3 of 5 points). The answers about surgical options contain the recovery time, type of anaesthesia, and potential complications. After analysing all the responses related to each disease, all pathologies except BPH achieved a DISCERN score of 4. CONCLUSIONS: ChatGPT information should be used with caution since the chatbot does not disclose the sources of information and may contain bias even with simple questions related to the basics of urologic diseases.

[Erectile dysfunction and YouTube: Quality of videos in Spanish]. / Disfunción eréctil y YouTube: calidad de los vídeos en español.

INTRODUCTION: Erectile dysfunction (ED) is one of the most prevalent urological diseases, but there is limited data about the quality of its information in social networks. The aim of our study was to assess the quality of ED information contained in YouTube videos. MATERIAL AND METHODS: Descriptive study of the first 50 Spanish-language videos, published on YouTube, evaluated by three urologists. We used two validated questionnaires: PEMAT (Patient Education Materials Assessment Tool) and DISCERN. Videos were classified according to DISCERN score into poor or moderate-good quality. RESULTS: The median time duration was 2.42minutes (0.15-3.58), 94,197 views (2,313-3,027,890), 682.5 «likes¼ (0-54,020) and 39 «dislikes¼ (0-2843). The median of PEMAT score was 29% (9%-95.5%) in understandability and 29% (0-95.5%) in actionability. According to DISCERN score 27 videos (57.4%) had poor quality and 20 (42.6%) moderate-good quality. There were no significant differences between the two groups in time duration, views, «likes¼ or «dislikes¼. There were differences in PEMAT score in understandability and actionability. The 86.7% of the moderate-good quality videos were starred by health care provider (P=.001). Also, the 85.7% of videos that describes treatment had moderate-good quality (P=.001). The 84% of the non-medical videos had a poor quality (P=.001). CONCLUSION: Most ED videos on YouTube have poor quality. The highest quality videos are those made by professionals, although they are not the most viewed. It would be important to develop measures to prevent the spread of misinformation among social network users.

Quality of bladder cancer information on YouTube.

Introduction: YouTube is one of the social networks most widely used as a source of information. However, there are doubts about the scientific quality of the information available. This study aims to characterise this by analysing videos about bladder cancer posted on YouTube. Material and methods: This was a cross-sectional descriptive study of the first 50 Spanish-language videos published on YouTube, leaving 38 for analysis. The videos were evaluated by three urologists using two validated questionnaires: Patient Education Materials Assessment Tool (PEMAT) and DISCERN (quality criteria for consumer health information), classifying them according to the score of the latter, in poor quality (1-2 points) and moderate/good quality (3-5 points). Results: The median PEMAT score was 71.6% (16-5-100%) for understanding and 35.5% (0-100%) for action. According to DISCERN, 26 videos (66.7%) were of poor quality and 12 (30.8%) of moderate/good quality. We found significant differences in terms of PEMAT of understanding (p = 0.004) and action (p = 0.000). In total, 90.9% of those involving medical staff were of low quality, which is paradoxical, but statistically significant (p = 0.01). Furthermore, 52.4% of those describing relevant information were of moderate/good quality, and 94.1% of those not describing relevant information were of poor quality (p = 0.02). Conclusions: More than 60% of the videos published on YouTube about bladder cancer in Spanish are of low quality. This represents an important risk of misinformation for the general public to whom most of them are addressed.

[Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic bladder diseases.] / Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas.

INTRODUCTION: Chronic bladder disorders are a common condition. Endovesical hyaluronic acid is one of the therapeutic options for these patients. It is intended to verify the effectiveness and safety of treatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. MATERIAL AND METHODS: We present a series of 32 patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance, and complications were analyzed, and symptoms before and after treatment were compared. Symptomatic relief achieved with treatment was assessed using the Patient Global Improvement Impression Scale (PGI-I). RESULTS: The median age was 74 years (IQR 60-78) and 65.6% were women. Median follow-up was 10 months (IQR 7-14). Eleven patients were diagnosed with radiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrent cystitis. After treatment, symptoms improved in 81.8% of patients with radical cystitis, 82.3% of patients with BPS/IC, and 75% of the patients with recurrent cystitis. The incidence of hematuria was reduced from 46.9% to 9.4% (p<0.001), filing symptoms from 62.5% to 12.5% (p<0.001) and pain from 40.6% to 12.5% (p= 0.004). 100% of the patients tolerated the treatment well and only 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6% showed total control of symptoms and 15.6% partial control, achieving a greater response in the group of patients with hematuria (73.3%). 61.3% of the patients perceived relief of symptoms after treatment according to the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up. CONCLUSION: Intravesical hyaluronic acid is a safe and effective treatment for filling symptoms, hematuria, and pain in patients with chronic cystopathies. Patients with radiotherapy-induced cystitis seem to especially benefit from treatment.

INTRODUCCIÓN: Las cistopatías crónicas son una patología frecuente. El ácido hialurónico endovesical es una de las opciones terapéuticas para estos pacientes. Se pretende verificar la efectividad y seguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicales.MATERIAL Y MÉTODOS: Se presenta una serie de 32 pacientes que recibieron instilaciones intravesicales de ácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluó mediante la escala de impresión de mejoría global del paciente (PGI-I).RESULTADOS: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fueron diagnosticados de cistitis rádica, 17 de síndrome de dolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitis de repetición. Tras el tratamiento mejoraron los síntomas el 81,8% de los pacientes con cistitis rádica, el 82,3% de los pacientes con SDV/CI y el 75% de los pacientes con cistitis recurrentes. La incidencia de hematuria se redujo del 46,9% al 9,4% (p<0,001), los síntomas de llenado del 62,5% al 12,5% (p<0,001) y el dolor de un 40,6% al 12,5% (p=0,004). El 100% de los pacientes toleró bien el tratamiento y sólo se registraron 2 efectos adversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró un control total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo de pacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamiento según la escala PGI-I. El 88,9% mantiene la mejoría de los síntomas al finalizar el seguimiento.CONCLUSIÓN: El ácido hialurónico intravesical es un tratamiento seguro y efectivo para los síntomas de llenado, hematuria y dolor en pacientes con cistopatías crónicas. Los pacientes con cistitis rádica parecen beneficiarse especialmente del tratamiento.

Efectividad y seguridad del ácido hialurónico intravesical para el control de los síntomas en cistopatías crónicas / Effectiveness and safety of intravesical hyaluronic acid for symptom control in chronic cystopathies

Introducción: Las cistopatías crónicas son una patología frecuente. El ácido hialurónicoendovesical es una de las opciones terapéuticas paraestos pacientes. Se pretende verificar la efectividad yseguridad del tratamiento con instilaciones intravesicales de ácido hialurónico en pacientes con síntomas vesicalesMaterial y métodos: Se presenta una serie de 32pacientes que recibieron instilaciones intravesicales deácido hialurónico. Se analizaron las características demográficas, tolerancia y complicaciones, y se compararon los síntomas antes y después del tratamiento. El alivio sintomático conseguido con el tratamiento se evaluómediante la escala de impresión de mejoría global delpaciente (PGI-I). Resultados: La mediana de edad fue de 74 años (IQR60-78), siendo el 65,6% mujeres. La mediana de seguimiento fue 10 meses (IQR 7-14). Once pacientes fuerondiagnosticados de cistitis rádica, 17 de síndrome dedolor vesical/cistitis intersticial (SDV/CI) y 4 de cistitisde repetición. Tras el tratamiento mejoraron los síntomasel 81,8% de los pacientes con cistitis rádica, el 82,3%de los pacientes con SDV/CI y el 75% de los pacientescon cistitis recurrentes. La incidencia de hematuria seredujo del 46,9% al 9,4% (p<0,001), los síntomas dellenado del 62,5% al 12,5% (p<0001), y el dolor de un40,6% al 12,5% (p=0,004). El 100% de los pacientestoleró bien el tratamiento y sólo se registraron 2 efectosadversos (infección del tracto urinario y retención agudade orina). Durante el seguimiento un 65,6% mostró uncontrol total de los síntomas y un 15,6% un control parcial, consiguiendo una respuesta mayor en el grupo depacientes con hematuria (73,3%). El 61,3% de los pacientes percibió alivio de los síntomas tras el tratamientosegún la escala PGI-I. El 88,9% mantiene la mejoría delos síntomas al finalizar el seguimiento.Conclusión: El ácido hialurónico intravesical es untratamiento seguro y efectivo para los síntomas de llenado, hematuria y...(AU)

Introduction: Chronic bladder disorders are a common condition. Endovesical hyaluronicacid is one of the therapeutic options for these patients.It is intended to verify the effectiveness and safety oftreatment with intravesical instillations of hyaluronic acidin patients with bladder symptoms. Material and methods: We present a series of 32patients who received intravesical instillations of hyaluronic acid. Demographic characteristics, tolerance,and complications were analyzed, and symptoms before and after treatment were compared. Symptomaticrelief achieved with treatment was assessed using thePatient Global Improvement Impression Scale (PGI-I).Results: The median age was 74 years (IQR 60-78)and 65.6% were women. Median follow-up was 10months (IQR 7-14). Eleven patients were diagnosed withradiotherapy-induced cystitis, 17 with bladder pain syndrome/interstitial cystitis (BPS/IC), and 4 with recurrentcystitis. After treatment, symptoms improved in 81.8%of patients with radical cystitis, 82.3% of patients withBPS/IC, and 75% of the patients with recurrent cystitis.The incidence of hematuria was reduced from 46.9% to9.4% (p<0.001), filling symptoms from 62.5% to 12.5%(p<0.001), and pain from 40.6% to 12.5% (p=0.004).100% of the patients tolerated the treatment well andonly 2 adverse effects were recorded (urinary tract infection and acute urine retention). During follow-up, 65.6%showed total control of symptoms and 15.6% partialcontrol, achieving a greater response in the group ofpatients with hematuria (73.3%). 61.3% of the patientsperceived relief of symptoms after treatment accordingto the PGI-I scale. 88.9% maintained symptomatic improvement at the end of the follow-up.Conclusion: Intravesical hyaluronic acid is a safeand effective treatment for filling symptoms, hematuria,and pain in patients with chronic cystopathies. Patientswith radiotherapy-induced cystitis seem to especiallybenefit from treatment.

Dermatofibrosarcoma protuberans in atypical inguinal location: Diagnosis, treatment and follow-up scheme. / Dermatofibrosarcoma protuberans de localización atípica inguinoescrotal: diagnóstico, tratamiento y esquema de seguimiento.

OBJECTIVE: To review dermatofibrosarcoma protuberans (DFSP), which is a soft tissue neoplasm of the skin that can rarely affect the genitals. MATERIAL AND METHOD: We report a case of inguinal DFSP in a 40-year-old male who presented a slow-growing mass adjacent to the spermatic cord. RESULTS: After extensive surgical resection pathological analysis confirmed the diagnosis of DFSP with resection margins affected, so reoperation with margin exeresis and inguinal orchiectomy was required. CONCLUSIONS: DFSP is rarely localized in the inguinoescrotal region and it requires wide excision and sometimes orchiectomy.

OBJETIVO: Realizar una revisión del dermatofibrosarcoma protuberans (DFSP), que es una neoplasia de los tejidos blandos de la piel que en raras ocasiones puede afectar a los genitales.MATERIAL Y MÉTODO: Presentación de un caso de DFSP inguinal en un varón de 40 años que presentó una masa de crecimiento lento adyacente al cordón espermático. RESULTADOS: Tras resección quirúrgica amplia el análisis anatomopatológico confirmó el diagnóstico de DFSP con márgenes de resección afectos, por lo que precisó reintervención con exéresis de márgenes y orquiectomía inguinal. CONCLUSIONES: El DFSP es poco frecuente en la región inguinoescrotal y requiere exéresis amplia y en ocasiones orquiectomía.

Dermatofibrosarcoma protuberans de localización atípica inguinoescrotal: diagnóstico, tratamiento y esquema de seguimiento / Dermatofibrosarcoma protuberans of atypical inguinoscrotal location: diagnosis, treatment and follow-up scheme

Objetivo: Realizar una revisión del dermatofibrosarcoma protuberans (DFSP), que es una neoplasiade los tejidos blandos de la piel que en raras ocasionespuede afectar a los genitales.Material y método: Presentación de un caso de DFSPinguinal en un varón de 40 años que presentó una masade crecimiento lento adyacente al cordón espermático.Resultados: Tras resección quirúrgica amplia el análisisanatomopatológico confirmó el diagnóstico de DFSP conmárgenes de resección afectos, por lo que precisó reintervención con exéresis de márgenes y orquiectomía inguinal.Conclusiones: El DFSP es poco frecuente en la regióninguinoescrotal y requiere exéresis amplia y en ocasionesorquiectomía.(AU)

Objetive: To review dermatofibrosar comaprotuberans (DFSP), which is a soft tissue neoplasm of theskin that can rarely affect the genitals.Material and methods: We report a case of inguinalDFSP in a 40-year-old male who presented a slow-growingmass adjacent to the spermatic cord.Results: After extensive surgical resection pathologicalanalysis confirmed the diagnosis of DFSP with resectionmargins affected, so reoperation with margin exeresis andinguinal orchiectomy was required.Conclusions: DFSP is rarely localized in the inguinoescrotal region and it requires wide excision and sometimesorchiectomy.(AU)

Prediction of infection caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: development of a clinical decision-making nomogram.

OBJECTIVE: This study aimed to assess the population at risk of infection by extended-spectrum beta-lactamase (ESBL)-producing organisms, using clinical criteria. MATERIALS AND METHODS: All urine cultures positive for Enterobacteriaceae in a Spanish hospital department from January 2010 to 2014 were reviewed. All isolates with ESBL-positive strains were collected, and isolates received during the first week of each month with ESBL-negative strains from symptomatic patients hospitalized or admitted to the emergency room. Multivariate analysis of the factors involved was undertaken and a nomogram developed to predict the probability of infection by ESBL-producing microorganisms. RESULTS: The study included 1524 patients with urinary tract infection (UTI): 416 ESBL-positive and 1108 ESBL-negative. In univariate analysis, risk factors were: male gender (p = 0.036), age (p < 0.0001), nursing home (p < 0.0001), previous antimicrobial therapy (p < 0.0001) or hospitalization (p < 0.0001), diabetes (p < 0.0001), chronic renal insufficiency (p < 0.0001), severe underlying disease (p < 0.0001), neoplasia (p = 0.0005), urological (p < 0.0001) and non-urological invasive procedure (p = 0.0003), recurrent UTI (p < 0.0001), urological (p < 0.0001) or abdominal surgery (p < 0.0001) and permanent urethral catheter (p < 0.0001). In multivariate analysis, the data set was split into a development cohort of 1067 patients and a validation cohort of 457 cases. A nomogram was developed to predict the probability of infection by ESBL-producing bacteria, which included seven variables: age (p < 0.0001), gender (p = 0.004), nursing home (p < 0.0001), previous antimicrobial therapy (p = 0.04) or hospitalization (p < 0.0001), recurrent UTI (p < 0.0001) and non-urological invasive procedure (p = 0.005). The discriminative accuracy was 0.79 (95% confidence interval 0.77-0.83). CONCLUSIONS: A nomogram was developed that predicts the risk of infection by ESBL-producing Enterobacteriaceae with reasonable accuracy. It could improve clinical decision making and enable more efficient empirical treatment.

Tumor de células de la granulosa testicular de tipo adulto. Presentación de un nuevo caso y revisión de la literatura / Adult type granulosa cell testicular tumor. Case report and bibliographic review

OBJETIVO: Describir y conocer los tumores de células de la granulosa testicular del adulto (TCG) (clasificado como tumores del estroma y cordones sexuales de las gónadas) ya que conforman una variante rara con pocos casos publicados y de comportamiento clínico poco conocido. Método; Presentación de un nuevo caso de TCG testicular del adulto en un varón de 59 años, asintomático, con hallazgo ecográfico de una masa intratesticular de 3,3 cm heterogénea, con áreas sólidas y quísticas; marcadores tumorales y estudio de extensión negativos. RESULTADO: Confirmación del caso con análisis anatomopatológico e inmunohistoquímico, similar a su homólogo ovárico. CONCLUSIONES: El TCG del adulto, es un tumor infrecuente de comportamiento incierto. Aunque suele cursar con buen pronóstico, se ha descrito su potencial metastásico incluso años después de la orquiectomía, por lo que requiere un seguimiento a largo plazo

OBJECTIVE: To describe the adult type granulosa cell testicular tumors (classified as sex cord-stromal tumor) due to their behavior, hardly known with a small number of cases reported. METHOD: We report a new case of a 59-year-old man presenting an adult type granulosa cell tumor of the testis (AGCTT), painless, with a 3.3 centimeter intratesticular heterogeneous mass on ultrasound, with solid and cystic areas. Serum tumor markers and extension study were negative. RESULTS: Histologic and inmunohistochemical studies confirmed an AGCTT, similar to its ovarian counterpart. CONCLUSION: AGCTT are rare neoplasms with unpredictable behavior. Their metastatic potential has been described, reason why they need a long follow-up; however, they usually have a good prognosis

[Adult type granulosa cell testicular tumor. Case report and bibliographic review.] / Tumor de células de la granulosa testicular de tipo adulto. Presentación de un nuevo caso y revisión de la literatura.

OBJETIVE: To describe the adult type granulosa cell testicular tumors (classified as sex cordstromal tumor) due to their behavior, hardly known with a small number of cases reported. METHOD: We report a new case of a 59-year-old man presenting an adult type granulosa cell tumor of the testis (AGCTT), painless, with a 3.3 centimeter intratesticular heterogeneous mass on ultrasound, with solid and cystic areas. Serum tumor markers and extension study were negative. RESULTS: Histologic and inmunohistochemical studies confirmed an AGCTT, similar to its ovarian counterpart. CONCLUSION: AGCTT are rare neoplasms with unpredictable behavior. Their metastatic potential has been described, reason why they need a long follow-up; however, they usually have a good prognosis.

Two-Port Laparoscopic Reconstructive Surgery of the Urinary Tract with Reusable Umbilical System (Hybrid Less): A Proof of Concept Study.

OBJECTIVES: We compared perioperative results and complications of reconstructive surgery of the urinary tract performed using a multichannel platform through the umbilicus and one additional 3.5-mm with a cohort of patients simultaneously treated with conventional 4-port laparoscopy. MATERIALS AND METHODS: Matched-pair study comparing perioperative outcomes, postoperative visual analogue pain scale (VAPS) and morbidity of 2-port (n = 20) and 4-port (n = 10) laparoscopic reconstructive urological surgery. Preoperative and perioperative data compared included demographics, type of surgery, operative time, blood loss, decrease in serum hemoglobin, operative complications, length of stay and postoperative complications according to Clavien-Dindo classification. RESULTS: There was no significant difference between groups regarding age, gender, body mass index, American Society of Anesthesiologists score, type of surgery, operative time, operative complications and intraoperative or postoperative transfusion. Estimated blood loss was lower using reduced-port approach. VAPS at postoperative day one was significantly lower for 2-port approach and so was the length of stay. Patient satisfaction with the wound was higher for 2-port surgery. Differences were not observed in number and severity of postoperative complications. CONCLUSIONS: Urological reconstructive operations can be safely performed using the hybrid laparoendoscopic single-site umbilical approach, resulting in lower blood loss, higher patient satisfaction and lower postoperative pain, which also facilitate earlier hospital discharge, than the same reconstructive procedures performed through multiport conventional laparoscopy.

Two-Port Approach Compared to Standard Laparoscopic Radical Cystectomy.

BACKGROUND AND OBJECTIVES: Two-port laparoscopic radical cystectomy (LRC) using a multichannel platform through the umbilicus and one additional 10-mm in the right iliac fossa has been recently described. We compare the perioperative and early results of this technique with a cohort of patients simultaneously treated in our institution with four-port LRC and a 7 to 10 cm midline incision. MATERIALS AND METHODS: A matched-pair study comparing perioperative outcomes, postoperative visual analog pain scale (VAPS), and morbidity of two-port (n=30) and four-port (n=30) LRC. Preoperative and perioperative data analyzed and compared included demographics, type of urinary diversion, operative time, blood loss, transfusion requirements, decrease in serum hemoglobin, operative complications, analgesic needs, length of stay, number of nodes removed, and other pathologic information. Complications in the first 3 months were evaluated according to the Clavien-Dindo classification. RESULTS: There was no significant difference between the two groups regarding patient age, gender, body-mass index, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, tumor stage, percent of positive nodes, positive margin rate, number of nodes retrieved, proportion of neobladders, secondary carcinoma in situ, incidental prostate cancer, or need of systemic chemotherapy. Median operative time was 20 minutes higher in the two-port procedure, but this difference was not statistically significant (p=0.2). Estimated blood loss and differential hemoglobin change were lower in the two-port technique (each p=0.03), but no difference was detected regarding the intraoperative or postoperative transfusion rate. Length of hospital stay was also equivalent. Differences were not observed either in the number or severity of complications. VAPS at days 2, 3, and 5 was significantly lower for two-port LRC (p<0.01). CONCLUSIONS: Two-port LRC performed through an umbilical platform and an accessory 10-mm port seems technically equivalent to standard four-port LRC. Perioperative outcomes regarding hospital stay and complications are tantamount. Diminished blood loss and, especially, less postoperative pain favor the reduced-port approach in this complex urologic minimally invasive procedure.

Two-port laparoscopic radical cystectomy with reusable umbilical system: a feasibility study.

OBJECTIVE: To describe the technique and report outcomes of laparoscopic radical cystectomy using 2 ports (2-port LRC) for muscle-invasive bladder cancer. PATIENTS AND METHODS: Prospective study was performed between November 2011 and October 2012 to standardize 2-port LRC, lymph node dissection, and urinary diversion. Twenty patients were intervened (8 ileal conduit, 12 neobladder) and followed up for >1 yr. Median follow-up was 75.5 weeks (interquartile range, 65.2-86 weeks). A reusable system placed through the umbilicus and laparoscopic curved instruments with double rotation, plus one 10-mm extra port placed in the right iliac fossa were used. Neobladder or conduit was performed extracorporeally. Preoperative, perioperative, and pathologic outcomes and long-term security data are presented. RESULTS: Median age was 69.5 years; body mass index, 27.4 kg/m(2); operative time, 335 minutes; estimated blood loss, 337 mL; hospital stay, 9 days; intraoperative transfusion rate, 10%; and visual analog pain score, 3 at day 3. Surgical margin was positive in a case (5%); 3 (15%) were pT0, 2 (10%) pT1, 5 (25%) pT2, 6 (30%) pT3a, 3 (15%) pT3b, and 1 (5%) pT4. The number of nodes removed was 18.5 (interquartile range, 16-29.2), 4 (20%) positive. Complications were major in 2 (10%; fecal peritonitis and urinary sepsis) and minor in 4 (20%; ileus and 3 postoperative transfusion) cases. No case required additional analgesia. Incision was totally hidden in the umbilicus. Continence rate in neobladders was 91.7% at daytime and 75% at nighttime. Study limitation was the absence of a comparative cohort. CONCLUSION: Umbilical 2-port LRC is feasible with good oncologic and functional outcomes, low postoperative pain, and absence of abdominal wall complications. Difficulties have slowed laparoendoscopic single-site radical cystectomy, but umbilical 2-port LRC is a very acceptable alternative for minimally invasive surgery of muscle-invasive bladder cancer.

Umbilical laparoendoscopic urological surgery with a novel reusable device.

OBJECTIVE: The aims of this study were to present cumulative experience with umbilical laparoendoscopic urological surgery using a reusable device and to evaluate outcomes and complications in the first 100 patients. MATERIAL AND METHODS: Patients undergoing umbilical surgery with the KeyPort system and DuoRotate instruments (Richard Wolf, Knittlingen, Germany) were evaluated prospectively. Demographic, intraoperative and postoperative data were assessed. RESULTS: Between October 2011 and July 2012, 79 pelvic (66 radical prostatectomy, 10 radical cystectomy, one diverticulectomy, one bilateral orchiectomy, one ureter reimplantation) and 21 renal (seven radical nephrectomy, six partial nephrectomy, five nephroureterectomy, two pyeloplasty, one pyelolithotomy) surgeries were performed through the umbilicus using this platform. Follow-up was 56.7 ± 12.6 weeks (mean ± SD). Mean age was 64.3 ± 10.3 years, body mass index 29 ± 4.6 kg/m(2), operative time 232 ± 106 min and estimated blood loss 260 ± 95 ml. Conversion to standard multiport laparoscopy was not necessary. An accessory port was used in 87 cases to facilitate suturing and conduct drainage extraction. Postoperative complications occurred in 24 cases (six Clavien grade I, 12 grade II, one grade IIIa, two grade IIIb, two grade IVa, one grade IVb). Mean hospital stay was 4.2 ± 4 days. Total transfusion rate was 10%. Mean visual analogue pain scale at day 2 was 2.1 ± 1.3 (0-10). Visual analogue wound satisfaction scale at month 1 was 9.2 ± 0.6 (0-10). No cancer-related events occurred during follow-up. Late complications (4%) were not related to the surgical approach. CONCLUSIONS: Umbilical KeyPort surgery is technically feasible for a great variety of procedures, both ablative and reconstructive. This access offers adequate surgical outcomes, scarce postoperative pain and security for the patient in the short term. Its reusable nature implies a noticeable economic advantage.

Initial experience of umbilical laparoendoscopic single-site nephron-sparing surgery with KeyPort and DuoRotate system.

OBJECTIVES: To present the feasibility of laparoendoscopic single-site (LESS) nephron-sparing surgery (NSS) using new reusable umbilical single-port system and instruments. METHODS: A prospective study was performed to evaluate operative data and patient outcomes after LESS-NSS with KeyPort®, a tri-channel single-port placed through a 2.5-cm umbilical incision, and specific DuoRotate® instruments. Patient characteristics, operative time, estimated blood loss (EBL), complications, visual analog pain scale (VAPS), and visual analogue wound satisfaction scale (VAWSS) scores were registered. RESULTS: Six consecutive nonselected patients with indication of NSS and normal contralateral kidney were offered LESS-NSS. An accessory 3.5 mm port that facilitated renoraphy and unclamped technique was used in 4 (66.7%) cases each. Median tumor maximum size was 4.0 (1-7.5) cm; age 64 (31-76) years; body mass index 28.4 (22.1-39.3) kg/m(2); operative time 233.5 (140-250) min; EBL 500 (200-500) mL; difference in hemoglobin 2.3 (0.1-4.6) g/dL. VAPS at day 2 was 0.7/10 and the median length of stay 3 (2-4) days. One case (16.7%) needed transfusion. None required conversion to standard laparoscopy or use of other additional ports. Postoperative complications occurred in 3 (50%) and major complications in 1 (16.7%). Incisions were totally hidden in the umbilicus. Pathology revealed angiomyolipoma (3), renal cell carcinoma (2), and chronic inflammation (1). Tumor margins were negative in all cases with malignancy. VAWSS at first month was 9.4 (8.1-10). At a median follow-up of 24 (10-32) weeks, no patient developed complications related to the approach. CONCLUSIONS: Umbilical LESS-NSS through a new single-port system of reusable nature, with or without the help of an accessory port and occasionally without clamping, can be effectively and very economically performed with minimum postoperative pain. Good candidates are patients with presumed benign renal masses that appreciate the cosmetic advantage of the approach.

Safety study of umbilical single-port laparoscopic radical prostatectomy with a new DuoRotate system.

BACKGROUND: Laparoendoscopic single-site (LESS) radical prostatectomy (RP) has been performed through different approaches. A new DuoRotate manual system developed by Richard Wolf (KeyPort; Richard Wolf GmbH, Knittlingen, Germany) can be applied to RP. OBJECTIVES: Our aim was to describe the surgical technique and report early outcomes of KeyPort LESS-RP to determine if this procedure is feasible and safe. DESIGN, SETTING, AND PARTICIPANTS: Prospective study performed between October 2011 and January 2012 to standardize LESS-RP. A total of 31 procedures were performed (10 with and 21 without neurovascular preservation, 8 with and 23 without pelvic lymph node dissection). SURGICAL PROCEDURE: LESS-RP was performed using the methods outlined in the manuscript. All patients underwent LESS RP by the same surgical team. Access was achieved via a tri-channel reusable KeyPort and one 3.5-mm extra port to facilitate urethrovesical anastomosis and drainage extraction. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Preoperative, perioperative, and pathologic outcomes data are presented. RESULTS AND LIMITATIONS: The mean age of the patients was 64 yr; mean body mass index: 30.7 kg/m(2); mean prostate-specific antigen level: 7 ng/ml; mean operative time: 207 min; and mean estimated blood loss: 258 ml. The average length of stay was 2.9 d and visual analog pain score (range: 0 [no pain] to 10) at day 2 was 1.2. Five focal positive margins (16.7%) were encountered (4.4% for pT2 and 57.1% for pT3). Five cases (16.7%) were pT2a, 3 (10%) were pT2b, 15 (50%) were pT2c, and 7 (23.3%) were pT3a. Lymph node dissection results were negative in all patients. Major complications occurred in two patients (6.5%) (hypercapnia with respiratory acidosis and rectourethral fistula) and minor complications in four (12.9%) (atrial fibrillation, orchitis, transfusion, and vomiting). No case required additional analgesia. Incision was totally hidden in the umbilicus. Study limitations included short follow-up (mean: 20.2 ± 4.1 wk), premature functional data, and absence of a comparative cohort. CONCLUSIONS: The KeyPort system allows performance of umbilical RP with few complications, a low positive-margin rate, excellent aesthetic results, and very low postoperative pain levels.

Feasibility of lymphadenectomy in laparoscopic radical cystectomy.

OBJECTIVES: The number of lymph nodes obtained through lymphadenectomy during radical cystectomy has prognostic and therapeutic value. We analyzed the number of nodes obtained during laparoscopic radical cystectomy to assess whether this approach allows satisfactory lymphadenectomy. METHODS: A total of 80 consecutive laparoscopic radical cystectomies with lymphadenectomy were performed by the same surgical team from 2005 to 2008. The male/female ratio was 5.7:1, the mean age was 65.3 years (range 47-87), and average body mass index was 26.7 kg/m(2) (range 20.6-40.1). Iliac-obturator lymphadenectomy up to the aortic bifurcation was performed after excising and pocketing the bladder. We analyzed the total number of lymph nodes identified by the pathologist and investigated a possible correlation with the variables presumably related to anatomic characteristics and other circumstances. RESULTS: The mean operative time of this step was 32 minutes (range 17-70). Minor vascular morbidity was present in 5 cases (6.25%). The average number of lymph nodes obtained was 22.3 (range 7-74, median 21). In 75 cases (93.8%), ≥10 nodes were obtained, and in 33 cases (41.2%), lymph node metastasis was diagnosed. No association or correlation was found in the number of nodes extracted regarding age, body mass index, or number of positive nodes. Also, no differences were found in association with gender, use of induction therapy, or the indication for cystectomy. CONCLUSIONS: Laparoscopic lymphadenectomy performed at radical cystectomy achieved an adequate number of lymph nodes. This technique did not entail an important increase in the duration of surgery. The complication rate was low. In experienced hands, laparoscopic lymphadenectomy is feasible and seems a secure oncologically correct procedure.

The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion.

OBJECTIVES: To analyze whether C-reactive protein (CRP) predicts the need for urgent urinary diversion in patients with renal colic and urolithiasis. CRP may help in the differential diagnosis of complicated hydronephrosis. METHODS: Prospective study done on 110 consecutive patients with renal colic secondary to upper urinary tract calculi admitted in the emergency room. Clinical and analytical data were collected. Criteria for emergency drainage had been established in advance, based on the risk of sepsis, renal failure, persistence of pain, and findings on computed tomography scan. CRP was blindly determined using immunoturbidimetric assay on the Integra 700 analyzer. Statistical analysis included Mann-Whitney test, Cox multivariate analysis, and receiver operating characteristic curves, to determine optimum cut-off points to decide drainage based on laboratory data. RESULTS: Mean CRP value was 47.6 mg/L (CI, 31.4-63.8), 139.6 mg/L (CI, 13-183.1) in 29 patients treated with diversion and 14.67 mg/L (CI, 6.7-22.5) in the control group (P <.001). Age, sex, rate of patients with hypertension, history of cardiovascular disease, leukocyte total count, and serum creatinine differed between groups (P <.05). Regression analysis revealed CRP (P <.0001) and age (P = .0001) were predictive of urinary diversion. Receiver operating characteristic analysis revealed 68.4% area under the curve for creatinine, 68.8% for leukocytosis, and 86.8% for CRP. A cut-off point for CRP of 28 mg/L achieved optimum sensitivity (75.8%) and specificity (88.9%) for determining the decision for drainage. CONCLUSIONS: Determination of CRP in patients with renal colic due to urolithiasis provides an objective and useful parameter for deciding placement of urinary stent, which is even more valuable than leukocytosis or seric creatinine level.

[Preliminary data of the Spanish contribution to the European Randomized Study on Screening of Prostate Cancer (ERSPC)]. / Datos preliminares de la contribución española al estudio randomizado europeo de screening del cancer de próstata (ERSPC).

OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detection and PSA diagnostic yield, staging, therapeutic management and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 24 16 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3%) and 24 in the control arm (82.8%), p = 0.254 . Metastatic disease was found in six patients (4.2% out of 142), 3 in the screening arm ( 2.7%) and three in the control arm (10.3%), p = 0.187. Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41.6%), 10 in the control arm (34.5%). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant tendency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms.