Valoración objetiva de la continencia urinaria precoz mediante el análisis y la visualización de variables intraoperatorias de prostatectomías radicales robóticas con un editor de vídeos / Objective assessment of early urinary continence by analysis and visualisation of intraoperative variables of radical robotic prostatectomies with a video editor

Introducción: La IU tras PR es uno de los factores con mayor impacto en la calidad de vida de los pacientes y en el gasto sanitario asociado. La definición de IU es muy variable en la literatura. De igual modo, son múltiples los factores predictores estudiados que influyen en la recuperación de la continencia posquirúrgica, siendo los más importantes los factores intraoperatorios. Material y métodos: Estudio retrospectivo y observacional, desde septiembre del 2008 hasta marzo del 2015. Se realiza el análisis de factores intraoperatorios mediante la visualización, con un editor de vídeos, de 148 pacientes tratados mediante prostatectomía radical asistida por robot, junto con otros factores perioperatorios asociados a la continencia y descritos en la literatura. Valoramos la continencia mediante cuestionarios ICQ, pérdidas urinarias contabilizadas con absorbentes y entrevista clínica en el primer, el tercer y el sexto mes, y al año de la cirugía. Definimos continencia como el no uso de absorbente o uno como protección social o ICQ ≤ 7. Analizamos mediante regresión logística binaria y lineal qué relación tienen las variables intraoperatorias y perioperatorias sobre la continencia urinaria medidas el primer, el tercer y el sexto mes, y al año de la cirugía, y sobre la estabilidad de la continencia. Resultados: En nuestro estudio el 72,9% de los pacientes conseguían estar continentes al año de la cirugía, con un tiempo medio de estabilización de la misma a los 4,3 meses. En nuestro análisis de regresión logística binaria de las variables intraoperatorias, no hemos encontrado una relación significativa con la variable continencia, analizadas durante el primer año. En el análisis de regresión logística lineal hemos encontrado que las suturas libres de tensión tienen un efecto directo positivo (p ≤ 0,05) sobre el tiempo de estabilidad de la continencia, al igual que las pérdidas urinarias medidas en el primer mes de la cirugía. Conclusión: En conclusión, en nuestro estudio encontramos que aquellas suturas libre de tensión pueden ayudar a la estabilidad precoz de la continencia. No hemos encontrado otros predictores intraoperatorios que influyan en la continencia urinaria. Las pérdidas urinarias medidas en el primer mes se relacionan con la recuperación precoz de la continencia

Introduction: UI after RP is a factor that has a major impact on patients' quality of life and the associated healthcare costs. The definition of UI is very variable in the literature. Similarly, a great many predictors have been studied that affect recovery of continence after surgery, the most important of which are intraoperative. Material and methods: a retrospective and observational study performed between September 2008 and March 2015. We studied intraoperative factors through visualisation using a video editor of 148 patients who underwent robot-assisted radical prostatectomy, together with other perioperative factors associated with continence, and described in the literature. We assessed continence through ICQ questionnaires, urinary loss calculated by pad count, and clinical interview in the first, third, sixth month and at one year after surgery. We defined continence as not having to use a pad or using a pad for protection socially, or an ICQ ≤ 7. We used binary and lineal logistic regression analysis to study the relationship between the intraoperative and perioperative variables on urinary continence measured at the first, third, sixth month and one year after the operation, and on continence stability. Results: In our study, 72.9% of the patients were continent at one year after surgery with a mean continence stabilisation time at 4.3 months. In our lineal logistic regression analyses we found no significant relationship with the continence variable analysed during the first year. In the lineal logistic regression analysis we found that tension-free sutures had a direct positive effect (P≤.05) on the stability time of continence, as well as the urinary losses measured in the first month after surgery. Conclusion: In conclusion, we found in our study that the tension-free sutures were able to help towards early stability of continence. We found no other intraoperative predictors that influenced urinary continence. The urinary losses measured in the first month related to early recovery of continence

Objective assessment of early urinary continence by analysis and visualisation of intraoperative variables of radical robotic prostatectomies with a video editor. / Valoración objetiva de la continencia urinaria precoz mediante el análisis y la visualización de variables intraoperatorias de prostatectomías radicales robóticas con un editor de vídeos.

INTRODUCTION: UI after RP is a factor that has a major impact on patients' quality of life and the associated healthcare costs. The definition of UI is very variable in the literature. Similarly, a great many predictors have been studied that affect recovery of continence after surgery, the most important of which are intraoperative. MATERIAL AND METHODS: a retrospective and observational study performed between September 2008 and March 2015. We studied intraoperative factors through visualisation using a video editor of 148 patients who underwent robot-assisted radical prostatectomy, together with other perioperative factors associated with continence, and described in the literature. We assessed continence through ICQ questionnaires, urinary loss calculated by pad count, and clinical interview in the first, third, sixth month and at one year after surgery. We defined continence as not having to use a pad or using a pad for protection socially, or an ICQ ≤ 7. We used binary and lineal logistic regression analysis to study the relationship between the intraoperative and perioperative variables on urinary continence measured at the first, third, sixth month and one year after the operation, and on continence stability. RESULTS: In our study, 72.9% of the patients were continent at one year after surgery with a mean continence stabilisation time at 4.3 months. In our lineal logistic regression analyses we found no significant relationship with the continence variable analysed during the first year. In the lineal logistic regression analysis we found that tension-free sutures had a direct positive effect (P≤.05) on the stability time of continence, as well as the urinary losses measured in the first month after surgery. CONCLUSION: In conclusion, we found in our study that the tension-free sutures were able to help towards early stability of continence. We found no other intraoperative predictors that influenced urinary continence. The urinary losses measured in the first month related to early recovery of continence.

[Scrotal mass presenting as giant urethral diverticulum]. / Masa escrotal como presentación de divertículo uretral gigante.

Urethral diverticulum in the male is a rare entity that may be congenital or acquired. They are common in paraplegic patients, who are prone to developing this disorder on an acquired basis because of prolonged catheterization. The most common diseases in patients with spinal cord injury are stricture, fistula and diverticula. Patients with diverticula typically present with symptoms of urinary incontinence, dysuria, perineal pain, or a mass on the ventral aspect of the genitalia or perineum. Treatment of choice is always surgical and a complete extirpation should be performed.

Enucleación prostática con láser holmium / Prostatic enucleation with holmium laser

Objetivo: La hipertrofia prostática afecta a partir de los 40 años a un porcentaje creciente de varones, aumentando este con la edad, actualmente contamos con una nueva arma terapéutica, el láser Holmium. Método: Recogemos de manera retrospectiva los datos obtenidos de forma retrospectiva de los 300 enfermos intervenidos mediante HoLEP prostático en nuestro centro. Resultados: Obtenemos: una estancia media hospitalaria de 1,8 días (Rango 1-15 días, mediana 1,8), un tiempo medio de cateterismo de 30,6h (Rango 12-312, Mediana 30,3), el tiempo quirúrgico total desde que el enfermo entra hasta que sale del quirófano es de 75 min. (Rango 38-150, Mediana 71), El flujo máximo es de 24,7 ml/seg a 6 meses y de 23,9 ml/seg a 12 meses. El rendimiento quirúrgico, los gramos resecados por minuto es de 0,48 en el grupo completo. Observamos una variación en los datos que afecta a los 20 primeros casos, con un empeoramiento de los resultados en este grupo Conclusiones: en nuestra opinión la enucleación con láser de Holmium es un método adecuado que garantiza unos resultados óptimos, perfectamente comparables a los obtenidos mediante técnicas quirúrgicas endoscópica clásicas y cirugía abierta, con un número de complicaciones bajo y que beneficia al enfermo al disminuir la necesidad de trasfusiones, el tiempo de sondaje vesical y de estancia hospitalaria, en contrapartida, presenta una curva de aprendizaje en torno a 20 procedimientos, en la que se pueden presentar complicaciones que desanimen al cirujano y que paralicen el proyecto de implantación de la técnica en un centro, al tener procedimientos fáciles y asequibles a su alcance ya establecidos (AU)

Objectives: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser. Methods: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate (HoLEP) in our center. Results: The results are: mean hospital stay 1,8 days (range 1-15 days, median 1,8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group. Conclusions: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures (AU)

Masa escrotal como presentación de divertículo uretral gigante / Scrotal mass presenting as giant urethral diverticulum

El divertículo uretral en el varón es una entidad rara que puede ser congénita o adquirida. Son comunes en pacientes parapléjicos que son propensos a desarrollar este problema de forma adquirida debido a cateterizaciones prolongadas. Las enfermedades mas frecuentes en pacientes lesionados medulares son estenosis, fístulas y divertículos. Pacientes con divertículos típicamente se presentan con síntomas de incontinencia urinaria, disuria, dolor perineal o una masa genital o en periné. El tratamiento de elección es siempre quirúrgico y debería realizarse una extirpación completa del mismo (AU)

Urethral diverticulum in the male is a rare entity that may be congenital or acquired. They are common in paraplegic patients, who are prone to developing this disorder on an acquired basis because of prolonged catheterization. The most common diseases in patients with spinal cord injury are stricture, fistula and diverticula. Patients with diverticula typically present with symptoms of urinary incontinence, dysuria, perineal pain, or a mass on the ventral aspect of the genitalia or perineum. Treatment of choice is always surgical and a complete extirpation should be performed (AU)

[Prostatic enucleation with holmium laser]. / Enucleación prostática con láser holmium.

OBJECTIVES: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser. METHODS: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate (HoLEP) in our center. RESULTS: The results are: mean hospital stay 1.8 days (range 1-15 days, median 1.8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group. CONCLUSIONS: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures.