Prevalence and management of urinary incontinece after pelvic organ prolapse surgery (sacrocolpopexy). A literature review.

INTRODUCTION: Stress urinary incontinence (SUI) is frequently associated with pelvic organ prolapse (POP) and may occur after its surgical treatment. AIM: To determine the incidence, risk factors and management of SUI during and after POP surgery through a review of the available literature. MATERIALS AND METHOD: Narrative literature review on the incidence and management of SUI after POP surgery after search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in Spanish and English between 2013 and 2023. RESULTS: Occult SUI is defined as visible urine leakage when prolapse is reduced in patients without SUI symptoms. De novo SUI develops after prolapse surgery without having previously existed. In continent patients, the number needed to treat (NNT) to prevent one case of de novo SUI is estimated to be 9 patients and about 17 to avoid repeat incontinence surgery. In patients with occult UI, the NNT to avoid repeat incontinence surgery is around 7. Patients with POP and concomitant SUI are the group most likely to benefit from combined surgery with a more favorable NNT (NNT 2). CONCLUSION: Quality studies on combined surgery for treatment SUI and POP repair are lacking. Continent patients with prolapse should be warned of the risk of de novo SUI, although concomitant incontinence treatment is not currently recommended. Incontinence surgery should be considered on an individual basis in patients with prolapse and SUI.

Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation.

INTRODUCTION AND OBJECTIVE: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS: A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n = 570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS: Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p > 0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n = 20), only 61% reported satisfactory sexual intercourse (p < 0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p < 0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p > 0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION: The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

Extracción renal en donante cadáver: revisión sistemática de la técnica quirúrgica / Deceased donor kidney procurement: systematic review of the surgical technique

Introducción El proceso de extracción renal debe ser una técnica estandarizada con el fin de optimizar las unidades renales para su posterior implante. Objetivos Revisión de la literatura disponible sobre el proceso de extracción renal. Material y métodos Revisión narrativa de la evidencia disponible sobre la técnica de extracción renal en paciente cadáver tras una búsqueda de los manuscritos relevantes indexados en PubMed, EMBASE y SciELO escritos en español e inglés. Resultados La extracción renal en paciente cadáver se divide en dos grupos, tras muerte encefálica (donation after brain death [DBD]) y tras muerte cardiaca (donation after circulatory death [DCD]). La extracción renal en DBD suele acompañarse de la extracción de otros órganos abdominales y/o torácicos, lo que requiere coordinación quirúrgica multidisciplinar. Durante el proceso de extracción debe asegurarse que los pedículos vasculares renales se mantienen íntegros para su posterior implante y disminuir el tiempo de isquemia. Conclusiones La ejecución adecuada y el perfecto conocimiento de la técnica quirúrgica de extracción y de la anatomía, permite disminuir el índice de pérdidas de injertos relacionados con una incorrecta extracción (AU)

Introduction Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. Objectives Review of the available literatura on kidney procurement procedure. Material and methods Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. Result Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. Conclusions Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques (AU)

Deceased donor kidney procurement: Systematic review of the surgical technique.

INTRODUCTION: Kidney procurement procedure must be carried out following a standardized technique in order to optimize kidney grafts for their subsequent implantation. OBJECTIVES: Review of the available literature on kidney procurement procedure. MATERIAL AND METHODS: Narrative review of the available evidence on deceased donor kidney procurement technique after a search of relevant manuscripts indexed in PubMed, EMBASE and Scielo written in English and Spanish. RESULTS: Deceased donor kidney procurement can be divided into two groups, donation after brain death (DBD) and donation after circulatory death (DCD). Kidney procurement in DBD frequently includes other chest and/or abdominal organs, requiring multidisciplinary surgical coordination. During the harvesting procedure, the renal vascular pedicle must remain intact for subsequent implantation and reduced ischemia time. CONCLUSIONS: Adequate execution and perfect knowledge of the technique for surgical removal and anatomy reduces the rate of graft losses associated to inadequate harvesting techniques.

Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía / Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis

INTRODUCCIÓN: Pocos son los estudios que comparan la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL) y sus resultados funcionales, como la continencia urinaria (CU), que es uno de los objetivos prioritarios tras el control oncológico. OBJETIVOS: Comparar la CU postoperatoria en los pacientes con adenocarcinoma de próstata localizado intervenidos mediante PRA frente a PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre los años 2007 y 2015. El estado de CU se recogió a los 3, 6, 12, 18 y 24meses. Para el manejo estadístico hemos agrupado la continencia en: a)CU, pacientes que no precisaron absorbentes, y b)incontinencia urinaria (IU), pacientes que precisaron absorbentes. Para el contraste de variables cualitativas se ha utilizado el test de la chi cuadrado para las variables cualitativas y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para la variable dependiente IU. La significación estadística se consideró cuando existió una p < 0,05. RESULTADOS: En el 51,7% se realizó conservación neurovascular. A los 24meses de la cirugía, el 72,4% presentaban CU, de los cuales el 87,8% con PRA frente al 78,1% con PRL (p = 0,004). El 22,7% presentaron recidiva bioquímica (RB), siendo el 83% tratados con radioterapia de rescate (RTR). Los pacientes con RTR presentaron mayor porcentaje de IU frente a los que no la recibieron (p = 0,036). Se objetivó mayor porcentaje de estenosis de la anastomosis en PRA (p = 0,03). CONCLUSIONES: La PRL, la no preservación de los fascículos neurovasculares y la RTR se relacionaron directamente con la CU postoperatoria

INTRODUCTION: There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES: To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS: Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI

Medicina Sexual. Número monográfico Ibero-Americano. Un Proyecto Global / Sexual Medicine. Ibero-American Issue. A Global Projec

No disponible

Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos / Surgical implant options in patients with penile fibrosis due to infection or previous explants

La fibrosis peneana por infección y/o explantes de prótesis peneanas previas condiciona situaciones de alta dificultad quirúrgica. El reimplante en estos casos debe seguir un esquema alternativo dirigido a minimizar las complicaciones peri y postoperatorias, así como conseguir la máxima eficacia del procedimiento y la mayor satisfacción postoperatoria del paciente y la pareja. En este artículo se revisan las principales alternativas quirúrgicas en estos casos

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases

Prótesis de pene inflable de 3 componentes: emplazamiento ectópico del reservorio / Three-piece inflatable penile prosthesis: Ectopic reservoir placement

INTRODUCCIÓN: Las complicaciones asociadas al emplazamiento del reservorio son infrecuentes pero pueden ser potencialmente graves, motivo por el cual se han desarrollado alternativas técnicas para el emplazamiento en lugares diferentes al habitual (ectópico). El objetivo de este trabajo es revisar, de acuerdo con la evidencia disponible, las diferentes opciones para el emplazamiento ectópico del reservorio. MATERIAL Y MÉTODO: Revisión narrativa basada en una búsqueda bibliográfica de artículos relevantes indexados en PubMed, en inglés o castellano, publicados en el periodo 2000-2019, empleando las palabras clave: «prótesis de pene», «reservorio ectópico», «prostatectomía radical», «cistectomía radical», «radioterapia pélvica» y «trasplante renal». Se descartaron los artículos no originales, casos aislados y revisiones. Se revisaron un total de 11 trabajos. RESULTADOS: Las alteraciones de la anatomía de la pelvis tras cirugía o radioterapia generan una dificultad añadida al emplazamiento del reservorio. Para minimizar el riesgo de complicaciones se han modificado los dispositivos y las técnicas que permiten el emplazamiento submuscular. La evidencia relativa a funcionalidad y complicaciones se limita a series retrospectivas, de instituciones únicas, bajo volumen y escaso seguimiento. La funcionalidad es adecuada con los dispositivos adaptados; las complicaciones, infrecuentes y de escasa gravedad. CONCLUSIONES: Aunque la evidencia es baja, el emplazamiento ectópico del reservorio puede considerarse una técnica segura, eficaz y reproducible. Además, puede resultar particularmente útil en casos de anatomía pélvica alterada

INTRODUCTION: The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. MATERIAL AND METHOD: Narrative review based on a bibliographical search limited to PubMed- indexed relevant manuscripts, in Spanish or English, for the period 2000-2019, using «penile prosthesis», «ectopic reservoir», radical prostatectomy», «radical cystectomy», «pelvic radiotherapy», and «renal transplantation» as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. RESULTS: Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. CONCLUSIONS: Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy

Three-piece inflatable penile prosthesis: Ectopic reservoir placement. / Prótesis de pene inflable de 3 componentes: emplazamiento ectópico del reservorio.

INTRODUCTION: The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. MATERIAL AND METHOD: Narrative review based on a bibliographical search limited to PubMed- indexed relevant manuscripts, in Spanish or English, for the period 2000-2019, using «penile prosthesis¼, «ectopic reservoir¼, radical prostatectomy¼, «radical cystectomy¼, «pelvic radiotherapy¼, and «renal transplantation¼ as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. RESULTS: Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. CONCLUSIONS: Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy.

Surgical implant options in patients with penile fibrosis due to infection or previous explants. / Opciones quirúrgicas de implante en pacientes con fibrosis peneana por infección o explantes previos.

Penile fibrosis due to previous penile infection and/or prosthesis explants entails situations of high surgical complexity. In these cases, reimplantation should follow an alternative scheme, aimed at minimizing perioperative and postoperative complications, as well as achieving maximum efficiency of the procedure and greater postoperative satisfaction of the patient and his partner. This article reviews the main surgical alternatives for these cases.

Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis. / Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES: To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS: Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI.

Efecto de la quimioterapia adyuvante en el carcinoma urotelial de vejiga localmente avanzado tratado con cistectomía / Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy

INTRODUCCIÓN: El papel de la quimioterapia adyuvante (QTAdy) en el tumor vesical músculo-invasivo sigue siendo controvertido actualmente. OBJETIVO: Evaluar el efecto de la QTAdy en la supervivencia cáncer específica del tumor vesical músculo-invasivo tras cistectomía radical (CR). MATERIAL Y MÉTODOS: Análisis retrospectivo de 292 pacientes diagnosticados de tumor vesical urotelial tratados con CR entre 1986-2009 con estadio pT3-4pN0/+cM0, divididas en dos cohortes:185(63,4%) pacientes tratados con QTAdy y otra con 107(36,6%) sin QTAdy. Mediana de seguimiento de 40,5 meses (IQR 55-80,5). Análisis comparativo con test Chi cuadrado y t Student/ANOVA. Cálculo de supervivencia con el método de Kaplan-Meier y test de long-rank. Análisis multivariante (regresión de Cox) para identificar variables predictoras independientes de mortalidad cáncer específica (MCE). RESULTADOS: El 42,8% de la serie presentó afectación ganglionar tras CR. Al finalizar el seguimiento, 22,9% estaban libres de tumor vesical y 54,8% habían fallecido por esa causa. La mediana de supervivencia cáncer específica fue de 30 meses. No se observaron diferencias significativas en supervivencia cáncer específica en función del tratamiento con QTAdy en pacientes pT3pN0 (p = 0,25) ni pT4pN0 (p = 0,29), pero sí en pT3-4pN+ (p = 0,001). En el análisis multivariante se identificaron el estadio patológico (p = 0,0001) y el tratamiento con QTAdy (p = 0,007) como factores pronósticos independientes de MCE. La QTAdy redujo el riesgo de MCE (HR:0,59, IC95% 0,40-0,87, p = 0,007). CONCLUSIONES: El estadio pT y pN se identificaron como variables predictoras independientes de MCE tras CR. La administración de QTAdy en nuestra serie se comportó como factor protector reduciendo el riesgo de MCE, aunque en el análisis por estadios, únicamente los pacientes pN+ se vieron beneficiados

INTRODUCTION: Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE:To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS: Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5).comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS: 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p = .25) or pT4pN0 (p = .29) patients, but it was significant in pT3-4pN+ (p = .001). Multivariate analysis showed pathological stage (p = .0001) and treatment with ADJ (p = .007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p = .007). CONCLUSIONS: pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage análisis

Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria / Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay

INTRODUCCIÓN: Existen muy pocos estudios que comparen la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL). OBJETIVOS: Comparar el tiempo quirúrgico, las complicaciones postoperatorias y la estancia hospitalaria en los pacientes con cáncer de próstata clínicamente localizado tratados mediante PRA y PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre 2007 y 2015. Las complicaciones postoperatorias se recogieron siguiendo las recomendaciones de las guías clínicas de la EAU y se agruparon según la clasificación de Clavien-Dindo. Para el contraste de variables cualitativas se utilizó el test Chi-cuadrado y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para variables dependientes cualitativas y mediante regresión lineal para las variables dependientes continuas. RESULTADOS: La mediana de duración fue de 3:05 horas para la PRA y de 4:35 para la PRL (p = 0,0001). El 26,4% de pacientes presentaron alguna complicación en el postoperatorio. El 31,2% de PRA y el 19,3% de PRL (p = 0,003). La mediana de estancia fue de 4 días. En el grupo de PRA fue de 4 días, mientras que en el de PRL fue de 3 (p = 0,008). La PRL (p = 0,0001), la realización de linfadenectomía (p = 0,02) y la conservación neurovascular (p = 0,01) fueron factores predictores independientes de prolongación del tiempo quirúrgico. La PRL fue un factor protector independiente de complicaciones (OR = 0,48 p = 0,007). El tipo de prostatectomía no influyó en la estancia hospitalaria. CONCLUSIONES: La prostatectomía laparoscópica consumió mayor tiempo quirúrgico, presentó menor porcentaje de complicaciones y no influyó en la estancia hospitalaria

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). Objetives: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p = .0001). The 26.4% of the patients presented any postoperative complication.31.2% of ORP and 19.3% of LRP (p = .003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p = .008). The LRP (p = .0001), lymphadenectomy (p = .02) and nerve-sparing (p = .01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR = 0.48 p = .007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay

Effect of adjuvant chemotherapy in locally advanced urothelial carcinoma of the bladder treated with cystectomy. / Efecto de la quimioterapia adyuvante en el carcinoma urotelial de vejiga localmente avanzado tratado con cistectomía.

INTRODUCTION: Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE: To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS: Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5). Comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS: 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p=.25) or pT4pN0 (p=.29) patients, but it was significant in pT3-4pN+ (p=.001). Multivariate analysis showed pathological stage (p=.0001) and treatment with ADJ (p=.007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p=.007). CONCLUSIONS: pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage analysis.

Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay. / Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). OBJETIVES: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p=.0001). The 26.4% of the patients presented any postoperative complication. 31.2% of ORP and 19.3% of LRP (p=.003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p=.008). The LRP (p=.0001), lymphadenectomy (p=.02) and nerve-sparing (p=.01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR=0.48 p=.007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay.

Control oncológico en cáncer de próstata de alto riesgo tras prostatectomía radical y radioterapia de rescate en comparación con radioterapia más hormonoterapia primaria / Oncological control in high-risk prostate cancer after radical prostatectomy and salvage radiotherapy compared to radiotherapy plus primary hormone therapy

Introducción: En pacientes con cáncer de próstata localizado de alto riesgo (CPAR) el tratamiento multimodal juega un papel fundamental. Objetivo: Comparar la supervivencia libre de recidiva (SLR) en pacientes con CPAR tratados de forma primaria con radioterapia (RT)+hormonoterapia (HT) frente a prostatectomía radical (PR) rescatados con RT de rescate (RTR) con o sin HT tras recidiva bioquímica (RB). Material y métodos: Análisis retrospectivo de 226 pacientes con CPAR (1996-2008), tratados de forma primaria con RT+HT (n = 137) o PR (n = 89). Utilizamos el método de Kaplan-Meier para evaluar la supervivencia y el test de log-rank para evaluar las diferencias entre las distintas categorías de las variables. Se realiza análisis multivariante mediante regresión de Cox para determinar variables con impacto en la SLR con significación estadística (p < 0,05). Resultados: La mediana de seguimiento de la serie fue de 111 (RIC 85-137,5) meses. Tras RT+HT recidivaron 32 (23,4%) pacientes, y 41 (46,1%) tras PR (p = 0,0001). Al comparar los tratamientos primarios, la SLR a los 5 y 10 años fue mayor tras RT+HT frente a PR en monoterapia (p = 0,001). El tratamiento primario con RT+HT redujo a más de la mitad el riesgo de RB al compararse con la PR (HR=0,41, p = 0,002). La estimación de la SLR a los 5 y 10 años después de PR+RTR±HT fue de 89,7 y 87,1%, mientras que tras RT+HT primaria fue de 91,6 y 71,1%, respectivamente (p = 0,01). El único factor que se comportó como predictor independiente de SLR fue el tratamiento multimodal mediante PR+RTR±HT cuando se presentó la RB (HR = 2,39, p = 0,01). Conclusión: En CPAR el tratamiento multimodal con PR + RTR ± HT si RB mejora significativamente la SLR con respecto al tratamiento con RT + HT

Introduction: In patients with high-risk localized prostate cancer (HRPCa), multimodal treatment plays a fundamental role. Objective: To compare relapse-free survival (RFS) in patients with HRPCa, treated primarily with radiotherapy (RT) + hormone therapy (HT) versus radical prostatectomy (RP) and salvage RT (sRT) ± HT when biochemical recurrence (BCR) appears. Material and methods: Retrospective analysis of 226 patients with HRPCa (1996-2008), treated primarily with RT+HT (n = 137) or RP (n = 89). The Kaplan-Meier method has been used to evaluate survival and the log-rank test has been used to evaluate the contrast between the different categories of the variables. Multivariate analysis has been performed using Cox regression to determine variables with an impact on RFS with statistical significance (P < 0.05). Results: The median follow-up of the series was 111 (IQR 85-137.5) months. After RT+HT, 32 (23.4%) patients relapsed, and after RP (P = 0.0001), 41 (46.1%) cases. When comparing the primary treatments, the RFS at 5 and 10 years was higher after RT+HT versus RP in monotherapy (P = 0.001). The primary treatment with RT+HT reduced the risk of BCR when compared to the RP (HR = 0.41, P = 0.002). The estimation of the RFS at 5 and 10 years after RP + sRT ± HT was 89.7 and 87.1%, while after primary RT + HT was 91.6 and 71.1%, respectively (P = 0.01). The only factor that behaved as an independent predictor of RFS was the multimodal treatment with RP + sRT ± HT when BCR showed up (HR = 2.39, P = 0.01). Conclusion: In HRPCa, multimodal treatment with RP + sRT ± HT if BCR, significantly improves RFS with respect to treatment with R RT + HT

Oncological control in high-risk prostate cancer after radical prostatectomy and salvage radiotherapy compared to radiotherapy plus primary hormone therapy. / Control oncológico en cáncer de próstata de alto riesgo tras prostatectomía radical y radioterapia de rescate en comparación con radioterapia más hormonoterapia primaria.

INTRODUCTION: In patients with high-risk localized prostate cancer (HRPCa), multimodal treatment plays a fundamental role. OBJECTIVE: To compare relapse-free survival (RFS) in patients with HRPCa, treated primarily with radiotherapy (RT)+hormone therapy (HT) versus radical prostatectomy (RP) and salvage RT (sRT)±HT when biochemical recurrence (BCR) appears. MATERIAL AND METHODS: Retrospective analysis of 226 patients with HRPCa (1996-2008), treated primarily with RT+HT (n=137) or RP (n=89). The Kaplan-Meier method has been used to evaluate survival and the log-rank test has been used to evaluate the contrast between the different categories of the variables. Multivariate analysis has been performed using Cox regression to determine variables with an impact on RFS with statistical significance (P<0.05). RESULTS: The median follow-up of the series was 111 (IQR 85-137.5) months. After RT+HT, 32 (23.4%) patients relapsed, and after RP (P=0.0001), 41 (46.1%) cases. When comparing the primary treatments, the RFS at 5 and 10 years was higher after RT+HT versus RP in monotherapy (P=0.001). The primary treatment with RT+HT reduced the risk of BCR when compared to the RP (HR=0.41, P=0.002). The estimation of the RFS at 5 and 10 years after RP+sRT±HT was 89.7 and 87.1%, while after primary RT+HT was 91.6 and 71.1%, respectively (P=0.01). The only factor that behaved as an independent predictor of RFS was the multimodal treatment with RP+sRT±HT when BCR showed up (HR=2.39, P=0.01). CONCLUSION: In HRPCa, multimodal treatment with RP+sRT±HT if BCR, significantly improves RFS with respect to treatment with RT+HT.

Diferencias en la supervivencia global y supervivencia cáncer específica en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado / Differences in overall survival and cancer-specific survival in high-risk prostate cancer patients according to the primary treatment

Introducción y objetivos: No existe evidencia de alto nivel sobre qué tratamiento primario proporciona una ventaja de supervivencia global (SG) y supervivencia cáncer específica(SCE) en cáncer de próstata localizado de alto riesgo (CPAR). Nuestro objetivo es analizar las diferencias en supervivencia, así como sus factores predictores, en este grupo de pacientes según su tratamiento primario (prostatectomía radical [PR] o radioterapia y bloqueo androgénico [RT + HT]). Material y métodos: Estudio retrospectivo de 286 pacientes con CPAR diagnosticados entre 1996-2008, tratados mediante PR (n = 145) o RT+HT (n = 141). La supervivencia se evaluó con el método de Kaplan-Meier. La existencia de diferencias significativas entre las distintas variables se analizó mediante el test de log-rank. Para la identificación de factores de riesgo se utilizó un análisis uni y multivariante mediante regresión de Cox. Resultados: La mediana de seguimiento fue de 117,5 (IQR 87-158) meses. La SG fue mayor (p = 0,04) en los pacientes con PR, mientras que no existieron diferencias (p = 0,44) en la SCE entre ambos grupos. El tipo de tratamiento primario no se relacionó con la SG ni SCE. La edad (p = 0,002), la aparición durante el seguimiento de un segundo tumor (p = 0,0001) y el estadio cT3a (p = 0,009) se comportaron como variables predictoras independientes de SG. Ninguna de las variables se comportó como variable predictora independiente de SCE, aunque la recidiva bioquímica tras tratamiento de rescate (p = 0,058) y la aparición de un segundo tumor durante el seguimiento presentaron una tendencia importante a la significación estadística, reduciendo este último la mortalidad cáncer específica (hazard ratio 0,16, intervalo de confianza del 95% 0,02-1,18, p = 0,07). Conclusiones: El tratamiento primario no se relacionó con la SG ni SCE en pacientes con CPAR

Introduction and objectives: There is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC). Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT + HT)). Material and methods: A retrospective study of 286 HRLPC patients diagnosed between 1996-2008, treated by RP (n = 145) or RT + HT (n = 141). Survival was assessed using the Kaplan-Meier method. Significant differences between the different variables were analysed using the log-rank test. A uni and multivariate Cox regression analysis was performed to identify risk factors. Results: the median follow-up was 117.5 (IQR 87-158) months. The OS was longer (p = .04) in the RP patients, while there were no differences (P=.44) in CSS between either group. The type of primary treatment was not related to OS or CSS. Age (P = .002), the onset during follow-up of a 2 nd tumour (P=.0001), and stage cT3a (P = .009) behaved as independent predictive variables of OS. None of the variables behaved as an independent predictive variable of CSS, although biochemical recurrence after rescue treatment (P = .058), and the onset of a 2nd tumour during follow-up showed a significant trend to statistical significance, the latter reducing specific cancer mortality (HR .16, 95%CI .02-1.18, P = .07)

Incidencia de segundos tumores en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado / Incidence of second tumours in high risk prostate cancer patients according to the primary treatment applied

Introducción y objetivos: La aparición de segundos tumores primarios en pacientes con cáncer de próstata de alto riesgo debe tenerse en cuenta en la evolución natural de la enfermedad. Nuestro objetivo es evaluar la influencia del tratamiento primario con intención curativa de dichos pacientes en el desarrollo de segundos tumores primarios. Material y métodos: Estudio retrospectivo de 286 pacientes diagnosticados entre 1996 y 2008, tratados mediante prostatectomía radical (n = 145) o radioterapia y bloqueo androgénico (n = 141). La homogeneidad de ambas series fue analizada con el test de la Chi-cuadrado para las variables cualitativas y la t de Student para las cuantitativas. Se realizó un análisis multivariante mediante regresión de Cox, para evaluar si el tipo de tratamiento primario influía en el desarrollo de segundos tumores. Resultados: La mediana de edad fue de 66 años, y la mediana de seguimiento de 117,5 meses. Al final del seguimiento, 60 pacientes (21%) habían desarrollado un segundo tumor primario. En el grupo de prostatectomía se localizó en la pelvis en 13 (9%) casos y en 8 (5,7%) casos en los tratados con radioterapia y hormonoterapia (p = 0,29). Las localizaciones más frecuentes por órganos fueron: colorrectal en 17 (28,3%) pacientes, pulmón en 11 (18,3%) y vejiga en 6 (10%) pacientes. En el análisis multivariable, los tratados con radioterapia y hormonoterapia duplicaban el riesgo de segundo tumor (HR = 2,41, IC95%: 1,31-4,34; p = 0,005) con respecto a los pacientes tratados con prostatectomía. La edad y la radioterapia de rescate no se comportaron como factores predictores independientes. Conclusiones: La aparición de un segundo tumor primario se relacionó con el tratamiento primario administrado; así, los tratados con radioterapia y privación androgénica multiplicaron por más de 2 su riesgo

Introduction and objectives: The onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours. Material and methods: A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n = 145) or radiotherapy and androgen blockade (n = 141). The homogeneity of both series was analysed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours. Results: The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (P = .29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR = 2.41, 95%CI: 1.31-4.34, P= .005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors. Conclusions: The onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled