Focal Therapy of Prostate Cancer Index Lesion With Irreversible Electroporation. A Prospective Study With a Median Follow-up of 3 Years.

PURPOSE: Our aim was to assess oncologic, safety, and quality of life-related outcomes of focal therapy with irreversible electroporation in men with localized prostate cancer. MATERIALS AND METHODS: This was a single-center, phase II study. INCLUSION CRITERIA: prostate cancer International Society of Urological Pathology grade 1-2, prostate specific antigen ≤15 ng/ml, ≤cT2b. Patients were selected based on multiparametric magnetic resonance imaging and transperineal systematic and targeted magnetic resonance imaging-ultrasound fusion-guided biopsy. Ablation of index lesions with safety margin was performed. Primary end point was cancer control, defined as the absence of any biopsy-proven tumor. A control transperineal biopsy was planned at 12 months and when suspected based on prostate specific antigen and/or multiparametric magnetic resonance imaging information. Quality of life was assessed using Expanded Prostate Cancer Index Composite Urinary Continence domain, International Index of Erectile Function, and International Prostate Symptom Score. RESULTS: From November 2014 to July 2021, 41 consecutive patients were included with a median follow-up of 36 months. Thirty patients (73%) had International Society of Urological Pathology grade 1 tumors, 10 (24%) grade 2, and 1 (2.4%) grade 3. Recurrence was observed in 16 of 41 (39%) of the whole cohort, and 16 of 33 (48.4%) who underwent biopsy. In-field recurrence was detected in 5 (15%) and out-of-field in 11 (33.3%). Ten of 41 (24.6%) including 3 of 5 (60%) with in-field recurrences had significant tumors (Gleason pattern 4-5; more than 1 core or any >5 mm involved). Median recurrence-free survival was 32 months (95% CI 6.7-57.2). Twenty-six patients (63.4%) were free from salvage treatment. All patients preserved urinary continence. Potency was maintained in 91.8%. CONCLUSIONS: Irreversible electroporation can achieve satisfactory 3-year in-field tumor control with excellent quality of life results in selected patients.

PDE-5 inhibitors in monotherapy versus combination therapy in a sample of 1200 patients with erectile dysfunction.

OBJECTIVES: To compare the effectiveness in the treatment of erectile dysfunction when using PDE-5 inhibitors (PDE5i), alprostadil (PG-E1) and testosterone (TES) in monotherapy or combination therapy. MATERIAL AND METHODS: Observational multicentre retrospective study of men diagnosed and treated for ED between January 2008 and January 2014. Age, social and employment situation, pathological medical history, risk factors, usual treatments, IIEF-5 at the first consultation and at first and each 6 months follow-ups, physical examination, calculated total and free testosterone and received treatment were analysed. Descriptive statistics, one-way ANOVA analysis, Chi2 for qualitative data, t-test, Fisher's exact test and Pearson's correlation coefficient were used; p < 0.05 is considered significant. RESULTS: Average age was 58.61 years, SD5.02, average follow- up time 48.21 months, SD 6.21, range 6-174 months. Out of the patients 76.12% were married, 9.81% divorced/separated, 10.04% single, 4.03% widowed; 85.14% of the total in stable partnership but 66.16% were not accompanied by their partners. In total 844 patients received monotherapy (597 PDE5i; 62 PG-E1; 36 TES; 27 penile prosthesis; 121 psychotherapy/alternative therapies) and 357 combination therapy (167 PDE5i+TES; 124 PDE5i+PGE1; 66 PG-E1+TES). There was a homogeneous distribution between risk factors and medical history groups. Satisfactory response according to IIEF-5 was achieved for 72.33% of patients on PDE5i monotherapy, 46.65% of patients on PDE5i+PG-E1 combination therapy and 83.41% of patients on PDE5i+TES. CONCLUSIONS: The best therapeutic success for ED in this series was achieved through a combination of testosterone+PDE-5 inhibitors without increasing morbidity and maintaining the response over time. Larger studies with longer follow-up will corroborate these findings.

[Bilharziasis. Case report]. / Bilharziasis: presentación de un caso clínico.

OBJECTIVE: To report one case of bilharziasis treated at our centre and to briefly comment the literature in the current context of increase of parasitical diseases in Europe, imported from the Third World by immigrants and tourists. METHODS: We report the case of a male patient from a Central African country referred to our department due to penile pain with painful voiding and ejaculation for several months, without other clinical symptoms. We performed a bibliographic search in the PubMed and Up-to-date databases with the following search terms: schistosomiasis, bilharziasis, hematuria, bladder infection, parasitosis, combined by boolean operators. RESULTS: After cystoscopy and pathologic study of the biological material the final diagnosis was chronic bilharziasis. The patient remains asymptomatic 14 months after treatment with praziquantel. CONCLUSIONS: Bilharziasis or schistosomiasis is a rare parasite disease, potentially severe which can severely compromise the urinary tract. In developed countries the cases are mainly imported from sub-saharian countries and other areas of North Africa, South Africa, Asia and Middle East. The cause is a parasite, Schistosoma haematobium, from the family of trematodes, genus helmints. In the active phasee the diagnosis is facilitated by the presence of Schistosomal eggs in urine. In latent or non active phase it is necessary the performance of cystoscopy and analysis of the biological material to reach the diagnosis.

Bilharziasis: presentación de un caso clínico / Bilharziasis. Case report

OBJETIVO: Presentar un caso clínico atendido en nuestro centro y comentar brevemente la literatura en el contexto actual del incremento de las enfermedades parasitarias en Europa, importadas del tercer mundo con la inmigración y el turismo. MÉTODO: Estudio de un paciente varón procedente de un país centroafricano que fue remitido a nuestro servicio debido a dolor en pene acompañado de micciones y eyaculaciones dolorosas de varios meses de evolución sin otra clínica acompañante. Como estrategia de búsqueda bibliográfica se utilizó la bases Pubmed y Uptodate con los siguientes descriptores: Schistosomiasis, Bilharziasis, Haematuria, Vesical Infection, Parasitosis, combinados con operadores boleanos. RESULTADO: Tras cistoscopia y estudio anatomopatológico del material biológico se llegó al diagnóstico de Bilharziasis en estadio crónico. El paciente permanece asintomático 14 meses tras tratamiento con Praziquantel. CONCLUSIONES: La bilharziasis o esquistosomiasis es una enfermedad parasitaria poco frecuente pero potencialmente grave que puede comprometer seriamente el aparato urinario. En los países desarrollados los casos son importados principalmente del África subsahariana y también de otras zonas como África del Norte, Sudáfrica, zonas de Asia y de Oriente Medio. Su causante es el parásito Schistosoma haematobium del género platelminto, familia de los tremátodos. En fase activa el diagnóstico es facilitado por la presencia de los huevos del schistosoma en la orina. En fase latente o inactiva es necesario la realización de uretrocistoscopia y el análisis de materiales biológicos para llegar al diagnóstico

OBJECTIVE: To report one case of bilharziasis treated at our centre and to briefly comment the literature in the current context of increase of parasitical diseases in Europe, imported from the Third World by immigrants and tourists. METHODS: We report the case of a male patient from a Central African country referred to our department due to penile pain with painful voiding and ejaculation for several months, without other clinical symptoms. We performed a bibliographic search in the PubMed and Up-to-date databases with the following search terms: schistosomiasis, bilharziasis, hematuria, bladder infection, parasitosis, combined by boolean operators. RESULTS: After cystoscopy and pathologic study of the biological material the final diagnosis was chronic bilharziasis. The patient remains asymptomatic 14 months after treatment with praziquantel. CONCLUSIONS: Bilharziasis or schistosomiasis is a rare parasite disease, potentially severe which can severely compromise the urinary tract. In developed countries the cases are mainly imported from sub-saharian countries and other areas of North Africa, South Africa, Asia and Middle East. The cause is a parasite, Schistosoma haematobium, from the family of trematodes, genus helmints. In the active phasee the diagnosis is facilitated by the presence of Schistosomal eggs in urine. In latent or non active phase it is necessary the performance of cystoscopy and analysis of the biological material to reach the diagnosis