Preliminary results of the external urinary sphincter Uroflex® on the quality of life of patients with male urinary incontinence after prostate surgery: tolerance, severity of incontinence, and quality of life.

PURPOSE: This study aims to establish the ability of the Uroflex® external artificial sphincter to reduce the severity of male urinary incontinence and improve the quality of life of patients with male urinary incontinence. METHODS: A pre-post pilot study was carried out on a sample of 30 patients with male urinary incontinence. Tolerability and satisfaction were assessed by comparing the results of the Pad test, and EQ-5D and KHQ questionnaires before and after 3 months of using Uroflex®. RESULTS: At 3 months, 76.6% of patients continued using Uroflex®. The median score for overall satisfaction with the device was 8 out of 10. Pad test showed a significant reduction in the severity of male urinary incontinence at 3 months (p < 0.001), with resolution of all symptoms in 31% of patients. The KHQ showed a significant improvement in global quality of life (p = 0.003). This was also significant for five of the nine specific dimensions assessed. There was also an improvement in self-rated health using the EQ-5D questionnaire, although not significant (p = 0.075). CONCLUSION: The Uroflex® external urinary sphincter seems to improve the severity of urinary incontinence and quality of life of patients with male urinary incontinence after prostate surgery. These encouraging results will need to be confirmed in larger controlled studies.

Ejaculation Frequency and Prostate Cancer: CAPLIFE Study.

PURPOSE: To evaluate the association between ejaculation frequency (EF) during four stages of life and prostate cancer (PCa) according to tumor aggressiveness, PCa stage, and urinary symptomatology. MATERIALS AND METHODS: A total of 456 incident PCa cases histologically confirmed, and 427 controls aged 40-80 years from the CAPLIFE study were analyzed. This study is a population-based case-control study carried out in the south of Spain. Average EF was measured for: (1) 20s, (2) 30s, (3) 40s, and (4) one year before the interview. EF was categorized into: (1) 0-3, (2) 4, and (3) >4 ejaculations/month. Sociodemographic, lifestyle, and medical information were also collected. To estimate the association between EF and PCa, adjusted ORs (aORs) and 95% CIs were calculated by logistic regression models. RESULTS: A year before the interview, PCa cases ejaculated less frequently than the controls. An inverse association was observed between the EF a year before and PCa, aOR=1.64 (95% CI 1.03-2.61) for men with 4 ejaculations/month, and aOR=2.38 (95% CI 1.57-3.60) for men with 0-3 ejaculations/month, compared to men with >4. The association was higher for cases with ISUP 3-5 (aOR=2.76 [95% CI 1.34-5.67] for men with 0-3 ejaculations/month) or with a locally advanced-metastatic tumor (aOR=4.70 [95% CI 1.55-14.29]). Moreover, men with moderate urinary symptoms and 0-3 ejaculations/month had the highest risk, aOR=3.83 (95% CI 1.84-7.95). CONCLUSIONS: A low EF could be associated with a higher risk of PCa, especially for cases with ISUP 3-5 or with a locally advanced-metastatic tumor.

Salivary Melatonin Rhythm and Prostate Cancer: CAPLIFE Study.

PURPOSE: We analyzed the association between salivary melatonin rhythm and prostate cancer (PCa). MATERIALS AND METHODS: A total of 40 PCa cases and 41 controls from the CAPLIFE study were analyzed to determine the salivary melatonin rhythm through 6 saliva samples. Amplitude (maximum melatonin peak) was categorized as low or high using the cutoff point median of the controls. Acrophase (time of maximum melatonin peak) was classified as early or late using the same criteria. In addition, the following data were collected: characteristics related to sleep habits, and clinical and sociodemographic information. Melatonin rhythms were represented for cases and controls and analyzed according to urinary symptoms, tumor aggressiveness and tumor extension. Variations in melatonin levels were estimated using generalized estimating equations on the ln-transformed values. To estimate the association between amplitude, acrophase and PCa, adjusted odds ratio (aOR) and 95% CI were calculated using logistic regression models. RESULTS: The mean age was 67.0 years (SD 7.3) for cases and 67.5 (SD 5.5) for controls. Melatonin levels were always lower in PCa cases than in controls. On average, melatonin levels in cases were -64.0% (95% CI -73.4, -51.4) than controls. PCa cases had lower amplitude, 26.0 pg/ml (SD 27.8) vs 46.3 pg/ml (SD 28.2; p <0.001). A high amplitude was associated with a decreased risk of PCa, aOR=0.31 (95% CI 0.11, 0.86), while a late acrophase could be increased risk of PCa, aOR=2.36 (95% CI 0.88, 6.27). CONCLUSIONS: Patients with PCa always had lower melatonin levels than men without PCa, independent of urinary symptomatology or extension and aggressiveness of the tumor.

Night Shift Work, Chronotype, Sleep Duration, and Prostate Cancer Risk: CAPLIFE Study.

To analyze the association between prostate cancer (PCa) risk and night shift work, chronotype, and sleep duration in the context of a population-based case-control study of incident prostate cancer in Spain, a total of 465 PCa cases and 410 controls were analyzed. Selection criteria were: (i) age 40-80 years, and (ii) residence in the coverage area of the reference hospitals for ≥6 months before recruitment. Exposure variables were: (i) night shift work (permanent or rotating); (ii) chronotype: morning, neither, or evening (Munich ChronoType Questionnaire) and (iii) sleep duration according to the recommendations of the American National Sleep Foundation. PCa aggressiveness was determined according to the International Society of Urology Pathology classification. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression models. Night shift work was associated with PCa, aOR = 1.47 (95% CI 1.02-2.11), especially for rotating night shifts, aOR = 1.73 (95% CI 1.09-2.75). The magnitude of the association between ever night work and PCa was higher in evening subjects with aOR = 3.14 (95% CI 0.91-10.76) than in morning chronotypes with an aOR = 1.25 (95% CI 0.78-2.00). Working night shifts, especially rotating night shifts, could increase PCa risk. This risk may be higher in people with an evening chronotype.

Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer.

The etiology of prostate cancer (PCa) remains largely unknown. Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) cancer prevention recommendations and its relationship to PCa was evaluated. A total of 398 incident PCa cases and 302 controls were included. The selection criteria for both cases and controls were: (i) age between 40-80 years; and (ii) residence in the coverage area of the reference hospitals for 6 months or more prior to recruitment. A score to measure the compliance with the recommendations of 2018 WCRC/AICR criteria was built. The level of compliance was used as a continuous variable and categorized in terciles. The aggressiveness of PCa was determined according to the ISUP classification. Adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) were estimated using multivariable logistic regression models. A slight protective tendency was observed between the level of compliance with the preventive recommendations and PCa risk, aOR = 0.81 (95% CI 0.69-0.96) for the total cases of PCa. This association also was observed when the aggressiveness was considered. In addition, limiting consumption of "fast foods", sugar-sweetened drinks, and alcohol were independently associated with lower risk of PCa.

Furan and p-xylene as candidate biomarkers for prostate cancer.

BACKGROUND: Prostate cancer (PCa) is the most frequently diagnosed noncutaneous malignant tumor among males in the Western world. Prostate-specific antigen has been considered the most important biomarker for PCa detection; however, it lacks specificity, leading to the search for alternative biomarkers. Volatile organic compounds (VOCs) are released during cell metabolism and can be found in exhaled breath, urine, and other fluids. VOCs have been used in the diagnosis of lung, breast, ovarian, and colorectal cancers, among others. The objective of this study was to identify urinary VOCs that may be sensitive and specific biomarkers for PCa. METHODS: The study included 29 patients with PCa and 21 with benign prostatic hyperplasia. Urine samples were obtained from all participants before and after prostate massage. VOCs were identified by gas chromatography-mass spectrometry. IBM SPSS Statistics v.20 was used for statistical analysis. Sample normality and homogeneity of variances were studied and, according to the distribution normality, ANOVA or the Kruskal-Wallis test was applied to evaluate significant differences between groups. The Pearson test was used to establish correlations. RESULTS: Fifty-seven VOCs were identified. Samples gathered before prostate massage showed significant between-group differences in urinary levels of furan (P≤ 0.001), 2-ethylhexanol (P = 0.032), 3,5-dimethylbenzaldehyde (P = 0.027), santolin triene (P = 0.032), and 2,6-dimethyl-7-octen-2-ol (P = 0.003). Samples gathered after prostate massage showed significant differences in urinary levels of furan (P≤ 0.001), 3- methylphenol (P = 0.014), p-xylene (P = 0.002), phenol (P≤ 0.001), and 2-butanone (P = 0.001). CONCLUSIONS: Significant differences between PCa and BPH patients were found in urinary levels of certain VOCs both before and after prostate massage, supporting the proposal that VOCs may serve as PCa-specific biomarkers.

Estrategias terapéuticas para el tratamiento de la prostatitis crónica/síndrome de dolor pélvico crónico / Therapeutic strategies for the treatment of chronic prostatitis / chronic pelvic pain syndrome

La prostatitis crónica/síndrome de dolor pélvico crónico es una enfermedad con una repercusión sobre la calidad de vida que en ocasiones es equiparable a la de los pacientes con infarto de miocardio, diabetes mellitus, etc. Durante años, la terapia médica estándar se ha realizado con antiinflamatorios no esteroideos, alfa-bloqueantes y antibióticos. Con el objetivo de analizar las alternativas terapéuticas existentes en la actualidad se ha llevado a cabo una búsqueda bibliográfica en PubMed de los artículos publicados hasta marzo del 2014, encontrando diversas terapias para el tratamiento de la prostatitis crónica/síndrome de dolor pélvico crónico como modificaciones en los estilos de vida, fitoterapia, extractos bacterianos orales inmunoestimulantes, acupuntura, terapia miofascial y biofeedback, terapias neuromoduladoras, ondas de choque extracorpóreas, fármacos con efecto sobre el sistema nervioso central y periférico, terapias cognitivo-conductuales y terapias térmicas. Aunque muchos de estos estudios muestran a priori unos resultados satisfactorios, son necesarios ensayos clínicos controlados y aleatorizados con el objetivo de determinar la efectividad real así como la durabilidad de estos tratamientos en el tiempo (AU)

The chronic prostatitis/chronic pelvic pain syndrome is a disease with an impact on quality of life which is sometimes comparable to that of patients with myocardial infarction, diabetes mellitus, etc. For years, the standard medical therapy was performed with non steroidal anti-inflammatory, alpha-blockers and antibiotics. In order to analyze existing therapeutic alternatives at the moment, a comprehensive literature search in PubMed database was conducted for articles published up to March 2014 data, founding several therapies for the treatment of chronic prostatitis/chronic pelvic pain syndrome as changes in lifestyle, herbal medicine, oral immunostimulant bacterial extracts, acupuncture, myofascial therapy and biofeedback, neuromodulatory therapies, extracorporeal shockwave, medications known to affect the central and peripheral nervous system, cognitive-behavioral therapies and thermal therapies. Although many of these studies show a priori satisfactory results, controlled randomized clinical trials are necessary to determine the actual effectiveness and durability of these treatments over time (AU)

Drenaje transperineal ecodirigido de un absceso prostático. A propósito de un caso y revisión de la literatura / Ultrasound-guided transperineal drainage of prostatic abscess. A case report and literature review

El absceso prostático es un proceso poco común que se ha asociado a sondajes permanentes, instrumentación genitourinaria, prostatitis crónicas, diabetes mellitus, síndrome de inmunodeficiencia adquirida, hemodiálisis u otras condiciones que comprometan la inmunidad. Actualmente Escherichia coli y otros agentes gramnegativos son los principales responsables en el desarrollo de los abscesos prostáticos. La ecografía transrectal es considerada una prueba sensible para el diagnóstico, así como para adoptar una actitud terapéutica. El tratamiento estándar del absceso prostático, en la mayoría de los casos, consiste en una amplia cobertura antibiótica y drenaje del absceso mediante diferentes técnicas y vías de acceso. Presentamos el caso de un paciente de 74 años con un absceso prostático producido por Enterococcus faecalis, el cual fue tratado con antibioterapia y drenaje percutáneo transperineal ecodirigido (AU)

Prostatic abscess is a rare process that has been associated with permanent catheterization, genitourinary instrumentation, chronic prostatitis, diabetes mellitus, acquired immunodeficiency, hemodialysis or other conditions that compromise immunity syndrome. Currently, Escherichia coli and other Gram negative agents are primarily responsible for the development of prostatic abscess. Transrectal ultrasound is considered a sensitive test for the diagnosis as well as the therapeutic approach. Standard treatment of prostatic abscess, in most cases, consisting of a wide spectrum antibiotics and abscess drainage using different techniques and paths. We report the case of a patient of 74 years with a prostatic abscess caused by Enterococcus faecalis which was treated with antibiotics and ultrasound-guided transperineal percutaneous drainage (AU)

Evolution of the resistance to antibiotics of bacteria involved in urinary tract infections: a 7-year surveillance study.

BACKGROUND: We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period. METHODS: A retrospective analysis was performed of the identification and antibiogram data. RESULTS: A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillin-tazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period. CONCLUSIONS: Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.

Fractura testicular por traumatismo cerrado / Testicular fracture by closed trauma

No disponible

Urachal anomalies in children: surgical or conservative treatment?

OBJECTIVE: To shed light on the current controversy regarding the best treatment option for managing urachal anomalies in children. PATIENTS AND METHODS: A retrospective follow-up of a case series comprising 13 children who were diagnosed with urachal anomalies was performed. All cases were diagnosed between 2000 and 2011 and followed up at the Pediatric Urology Unit of San Cecilio University Hospital in Granada (Spain). Information about the baseline and follow-up variables was collected from clinical records. RESULTS: Nine of the 13 patients were symptomatic (6 patients with urachal cysts and 3 patients with urachal persistency). Conservative management was originally used in all but one case. During follow-up, reinfection appeared in two cases, and these patients were treated surgically. Spontaneous resolution was achieved in eight cases (61.5%). Two children with persistent urachal cysts are still being followed (4 and 6 years after the diagnosis), although ultrasound monitoring reveals a gradual reduction in the size of the cysts. The median time between diagnosis and resolution was 16.5 months. CONCLUSION: With the exception of cases in which there is a clear indication for surgery (i.e. reinfection), a conservative approach based on regular monitoring may be useful.

Abscesos testiculares: abordaje quirúrgico. A propósito de 2 casos / Surgical approach to testicular abscesses: A report of 2 cases

El absceso testicular es una enfermedad poco frecuente, y la mayoría de los casos son una complicación de casos avanzados o no tratados de orquiepididimitis. Los síntomas clínicos y la exploración física no siempre permiten un diagnóstico de certeza, ya que el dolor y la inflamación limitan la palpación correcta del contenido escrotal. De ahí que la ecografía escrotal sea la técnica de imagen de primera elección para determinar la naturaleza de una masa escrotal y también para detectar la presencia de abscesos escrotales. Aunque el tratamiento inicial es médico, en ocasiones hay que recurrir a la orquiectomía. El objetivo de este trabajo es proponer el abordaje inguinal para el tratamiento quirúrgico de los abscesos testiculares, el cual permite mantener aislado el proceso infeccioso y evitar la «violación del escroto» en caso de tratarse de un tumor. Presentamos 2 casos de absceso testicular tratados de manera satisfactoria mediante orquiectomía inguinal (AU)

Testicular abscess is a rare condition that often arises due to complications of untreated or advanced orchiepididymitis. Clinical symptoms and physical exam do not always provide an accurate diagnosis because the pain and swelling often limit adequate palpation of the scrotal contents. Therefore, scrotal ultrasound is the imaging technique of choice to determine the nature of the scrotal mass and also to detect presence of scrotal abscesses. Although initial treatment is medical, it is sometimes necessary to resort to orchiectomy. This purpose of this paper is to propose inguinal approach for the surgical treatment of testicular abscesses. This approach makes it possible to maintain the infectious process isolated and thus avoid ‘‘violation of the scrotum’’ in the case of a tumor.We report two cases of testicular abscess successfully treated by inguinal orchiectomy (AU)

Análisis clínico y coste económico-sanitario de nuestra serie de 65 casos de incurvación de pene / Clinical analysis and economic-health cost of 65 cases of penile incurvation

Introducción. El objetivo del estudio es analizar las características epidemiológicas y clínicas, el gasto sanitario global medio y las variables que se han relacionado de forma estadísticamente significada con la aparición de la incurvación de pene. Material y métodos. el estudio analiza retrospectivamente 65pacientes intervenidos de incurvación peneana entre enero del 2000 y octubre del 2011. Para comprobar qué variables se relacionaban con la incurvación del pene, se utilizó el test chi-cuadrado de Pearson con corrección por continuidad, y Fisher en los casos que no se cumplieron las condiciones de aplicabilidad. Para las variables cuantitativas se utilizó el test t de Student. Resultados. La mediana de edad fue de 53años. La incurvación peneana diagnosticada con mayor frecuencia fue la dorsal (49,25%). El 80% de las incurvaciones fueron adquiridas. En la exploración se palpó placa indurada en el 50,8% de los pacientes con incurvación adquirida. La técnica quirúrgica empleada en el 81,5% de los casos fue la plicatura de la albugínea de Essed-Schröder. La estancia hospitalaria media fue de 24h. Se observó una relación estadísticamente significativas entre hipertensión (p=0.013), diabetes (p=0,033) y palpación de placa (p=0,009) e incurvación dorsal. En el 60% de los pacientes con incurvación ventral esta fue de causa congénita, encontrando una asociación estadísticamente significativa entre ambas (p=0,003). El coste sanitario global medio de un paciente intervenido de incurvación de pene fue de 2.142euros. Conclusiones. La incurvación de pene se está convirtiendo en una patología emergente en las consultas de urología, y presenta resultados quirúrgicos satisfactorios (AU)

Introduction. The aim of this study is to analyze the epidemiological and clinical characteristics, average overall health cost, and variables that have a statistically significant relationship with the appearance of penile incurvation. Materials and methods. This retrospective study analyzes 65 patients who received treatment for penile incurvation between January 2000 and October 2011. Pearson's chi-square test with correction for continuity was used to verify which variables are related to penile incurvation. Fisher's exact test was used in cases where applicability conditions were not met. The Student's t test was used for the quantitative variables. Results. Median age was 53years. Dorsal type (49.25%) was the most frequently diagnosed penile incurvation with 80% of the incurvations being acquired. Upon exploration, an indurated plaque was palpable in 50.8% of the patients with acquired incurvation. Schroeder-Essed plication of the tunica albuginea was the surgical technique used in 81.5% of the cases. Mean hospital stay was 24hours. A statistically significant relationship was observed between dorsal incurvation and hypertension (P=.013), diabetes (P=.033), and plaque palpation (P=.009). In 60% of the patients with ventral incurvation, it resulted from congenital causes, a statistically significant association being found between both (P=.003). Overall average health cost of a patient treated for penile incurvation was 2,142euros. Conclusions. Penile incurvation is an emerging condition in urology consultations with some satisfactory surgical results (AU)

Vesicoureteral refulx in overactive bladder: medical resolution through botulin toxin injection.

OBJECTIVE: Overactive bladder may have a neurogenic or non neurogenic origin. Sometimes, as a result of detrusor overactivity, disorders of the upper urinary tract function may appear. One of these alterations may be the appearance of associated vesicoureteral reflux. The treatment of overactive bladder may be done with anticholinergic drugs and if there is not response the use of botulin toxin type A is approved. The aim of this case report is to demonstrate the effect of botulin toxin type A in the treatment of overactive bladder and vesicoureteral reflux secondary to the overactive bladder. METHOD: We present the case of a 10-year-old patient without significant past medical history. When he was one year old he had a urinary infection and voiding cystourethrogram showed grade 1 right vesicoureteral reflux. When he was 4 year old he presented several episodes of pyelonephritis and then he was diagnosed of severe bilateral vesicoureteral reflux, which did not respond to treatment with Macroplastic ® or Deflux ®. Urodynamic study was performed showing overactive bladder with decreased bladder compliance. RESULTS: We performed intravesical injection of 200 U of botulin toxin type A and vesicoureteral reflux disappeared and urodynamic study improved. One year later we re-injected botulin toxin type A (300 U) and we repeated the injection after one year (300 U). The patient is currently well, without changes in the urodynamic study and without vesicoureteral reflux. CONCLUSION: Repeated injections of botulin toxin type A has shown great efficacy in the treatment of overactive bladder in children with vesicoureteral reflux improved secondary.