Anxiety and depression in association with lower urinary tract symptoms: results from the COBaLT study.

PURPOSE: Depression and anxiety have been associated with lower urinary tract symptoms (LUTS) in several studies. In our population, the prevalence of LUTS is high, consequently, it is essential and an objective of this study, to determine the association between anxiety, depression, and LUTS in a large Hispanic population. METHODS: A sub-analysis of a cross-sectional population-based study to estimate LUTS prevalence in the Colombian population was performed (COBaLT study) (Plata et al. in Neurourol Urodyn 38:200-207, 2018). The Hospital Anxiety and Depression Scale (HADS) was used to evaluate mental health. Logistic regression was carried out to estimate the association of depression and anxiety with different LUTS. Variables that proved statistically significant (p < 0.05) were included in a multivariate model. RESULTS: A total of 1060 individuals were assessed. The prevalence of anxiety in women and men was 17.1% and 6.7%, respectively. Depression in women and men was 20.1% and 9.4%, respectively. An association was found between anxiety and overactive bladder (OAB) without urinary incontinence (OR = 3.7) and moderate or severe LUTS in men (OR = 3.8). In women, anxiety was associated with nocturia (OR = 4.2) and stress urinary incontinence (OR = 2.4). For depression, an association was found between sexual dysfunction (OR = 4.3) and moderate or severe LUTS (OR = 4.0) in men; while in women it was associated with stress urinary incontinence (OR = 2.3), the sensation of incomplete emptying (OR = 1.7) and decreased frequency of sexual activity (OR = 1.8). CONCLUSIONS: The associations found are consistent with other reports. It is essential to inquire about possible symptoms related to the mental sphere in the urology consultation to make appropriate referrals and subsequent management.

Strategies to improve cost effectiveness of robotic assisted laparoscopic radical prostatectomy in emerging economies.

To assess the cost-effectiveness of the robotic-assisted laparoscopic radical prostatectomy (RALRP) compared to open radical prostatectomy (ORP) for localized prostate cancer from a healthcare perspective in Colombia. A systematic review was conducted in Embase, Scopus, Web of Science, PubMed, and Cochrane CENTRAL databases, to identify relevant publications up to January 2020 to summarize clinical outcomes related to effectiveness of robot-assisted and open radical prostatectomy. A tree decision model was designed given the clinical outcomes and possibilities of complication and success. Outcomes were defined as complications according to Clavien - Dindo classification and success measured as urethral stricture rate. Cost was divided into two categories: surgical procedure and complications. Incremental cost-effectiveness ratio (ICER) was calculated and a deterministic sensitivity analysis was performed to evaluate the impact of the uncertainty on the conclusions of the model. A 90-day horizon was defined. Direct medical costs associated with RALRP were $6.511 ($ 5.127- $8.138), and for ORP were $4.476 ($2.170-$ 6.511). The average cost for complication management was rated at $ 327 for RALRP and $ 382 for ORP, based on an augmented risk of post-operative urethral stricture in the ORP group (2.4% vs 10.8%). ICER was calculated in USD $18.987. The cost of RALRP has to be reduced to around USD 5.345 to achieve an ICER under 1 GDP making the intervention feasible. Using a 3 GDP per capita threshold, the implementation of RALRP could be cost-effective for the treatment of localized prostate cancer in emerging economies. Bolder measures including the use of one needle carrier, three robotic arms, and a shorten hospitalization program of 24 h, can save around $1000 for each patient, achieving the goal cost of $5345 needed for a favorable ICER.

Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections.

INTRODUCTION: Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating. OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC. METHODOLOGY: A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software. RESULTS: Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60). CONCLUSION: We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.

Female LUTS adaptations to COVID era: Lessons learned from the ICS TURNOVER (Transition of fUnctional uRology to New COVID ERa).

Introduction: The COVID-19 pandemic has dramatically affected the Female and Functional Urology (FFU) practice, leading to massive waiting lists, while patients' quality of life remains severely impaired. The aim of the present study is to develop consensual recommendations to guide clinicians on the management of FFU patients. The present paper focuses on female LUTS. Methods: The authors used the Delphi methodology to develop a robust survey questionnaire, covering the principal topics in FFU, based on literature review and expert opinions. Regarding female LUTS, a 98-question survey was distributed among FFU specialists to obtain optimized recommendations, under the auspicious of the International Continence Society (TURNOVER, ICS project). A quantitative analysis of the data was performed, categorizing the mean value from 0-10. Consensus achievement was defined as attaining ≥ 70% agreement. Results: 98 ICS members completed the F-LUTS survey. Recommendations for the diagnosis and management of female LUTS are summarized. Video-consultation should be used for initial assessment, sending questionnaires and bladder diaries in advance to the patient to be filled out before the consultation. However, face-to-face visits are mandatory if POP or continuous incontinence are suspected, and prior to any surgical procedure, regardless of the health alert. Moreover, prescribing medications such as anticholinergics or ß 3 agonists in a telemedicine setting is not considered a safe practice. Follow-up teleconsultations can be used to assess the efficacy and treatment-related adverse events.Urodynamic testing should be only performed if consequences on F-LUTS treatment are expected. The study should be postponed until the pandemic local behaviour flattens.Invasive procedures should be postponed during a high alert. In case surgery is scheduled, outpatient clinics and local anaesthesia should be prioritized. Every patient should be screened for SARS-CoV-2 infection before invasive tests or procedures, following local authorities' guidance. Conclusions: During a pandemic, telemedicine offers a novel way of communication, maintaining medical care while preventing viral transmission. Non-urgent procedures should be postponed until the pandemic curve flattens. Ambulatory procedures under regional or local anaesthesia should be prioritized, aiming to reduce bed occupancy and risk of transmission.

Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long-term real-world nationwide analysis.

PURPOSE: The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high-volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. METHODS: Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan-Meier analysis was used to determine AUS survival rate. RESULTS: Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow-up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow-up with the device still in place, 80.7% defined their urinary condition as "does not cause or causes minor discomfort," and 99% would recommend the device to a friend or relative in the same condition. CONCLUSIONS: This series from a community-based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real-world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision-making process before the procedure.

What is the real burden of the overactive bladder? Results from a national prevalence study.

OBJECTIVE: To describe the prevalence of overactive bladder determining patient-reported outcome measures (PROMS) and potential risk factors. METHODS: A cross-sectional population-based study to estimate lower urinary tract symptoms (LUTS) prevalence in the Colombian population was performed (COBaLT study). Overactive bladder (OAB) was assessed using 2002 International Continence Society definitions and the Report on the Terminology for Female Pelvic Floor Dysfunction. PROMS were included to evaluate participant's perceptions of health-related quality of life (QoL). Spanish validated questionnaires were used, including the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Patient Perception of Bladder Condition (PPBC) scale. RESULTS: A total of 1060 individuals were assessed. The mean age of participants was 42.2 years, and most participants were Hispanic (93.15%). The overall prevalence of OAB syndrome was 31.70%, and it was more frequently reported in women than in men (39.25% vs. 24.15%). Most participants with OAB did not perceive their symptoms as bothersome. The most bothersome symptom, associated with moderate/severe impact in QoL was urinary urgency. According to the PPBC questionnaire 75.6% of the participants reported that their bladder condition does not cause any problem, while 11.% reported moderate to severe bother. The multivariable model showed high blood pressure and anxiety were associated with OAB in men. In females, depression, obstructive sleep apnea, IBS, and pelvic organ prolapse were associated with OAB syndrome. CONCLUSIONS: Using the symptomatic definition of OAB can overestimate the real impact and burden of the condition, and treatment should be targeted to those symptomatic patients with QoL impairment as they would benefit from further management. The questionnaires seem to overestimate the condition, since we assessed it from a PROMS perspective there is not such a marked QoL impact.

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction.

INTRODUCTION: The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. METHODS: This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. RESULTS: A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. CONCLUSION: A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.

[Videourodynamics: Current indications, technique and considerations.] / Videourodinamia: indicaciones actuales, técnicas y consideraciones.

OBJECTIVES: Describe the technique, indications and the correct interpretation given the findings in different clinical entities, and to serve as a guide for urologists, urology residents and even medical students. MATERIAL AND METHODS: A literature search was performed using Pubmed, Cochrane and Scopus database for articles and guidelines published between January 1970 and June 2020. RESULTS: Videourodynamics is a diagnostic procedure that combines the urodynamic study with simultaneous images of the lower urinary tract to assess the anatomy and function during the different phases of micturition.This study provides important information that can modify therapeutic behavior and therefore clinical outcomes of patients. CONCLUSION: The role of videourodynamics becomes more relevant nowadays in the assessment of the pathophysiology of voiding dysfunction, being the gold standard for the workup of neurogenic bladder and voiding dysfunction in young people and women and, possibly in persistent/recurrent incontinence in both men and women.

OBJETIVO: Describir la técnica, las indicaciones y la correcta interpretación dados los hallazgos en diferentes entidades clínicas, y servir como guía para urólogos, residentes de urología e incluso estudiantes de medicina.MATERIAL Y MÉTODO: Se realizó una revisión bibliográfica internacional de artículos o guías en las bases de datos PubMed, Cochrane y Scopus entre enero de 1970 y junio de 2020. RESULTADOS: La videourodinamia es un procedimiento diagnóstico que integra el estudio urodinámico con imágenes simultáneas del tracto urinario inferior para evaluar la anatomía y la función durante las diferentes fases de micción. Este estudio aporta información relevante que puede modificar la conducta terapéutica y por ende los desenlaces clínicos de los pacientes.CONCLUSIÓN: El papel de la videourodinamia cada vez toma más relevancia en la evaluación de la fisiopatología de la disfunción miccional, siendo incluso el patrón de oro para el estudio de disfunción vesical neurogénica y trastornos del vaciado en jóvenes y mujeres y, posiblemente la incontinencia recidivada tanto en hombres como en mujeres.

Videourodinamia: indicaciones actuales, técnicas y consideraciones / Videourodynamics: current indications, techniques and considerations

Objetivo: Describir la técnica, las indicaciones y la correcta interpretación dados los hallazgosen diferentes entidades clínicas, y servir como guía paraurólogos, residentes de urología e incluso estudiantesde medicina.Material y métodos: Se realizó una revisión bibliográfica internacional de artículos o guías en las basesde datos PubMed, Cochrane y Scopus entre enero de1970 y junio de 2020.Resultados: La videourodinamia es un procedimiento diagnóstico que integra el estudio urodinámico conimágenes simultáneas del tracto urinario inferior para evaluar la anatomía y la función durante las diferentesfases de micción. Este estudio aporta información relevante que puede modificar la conducta terapéutica ypor ende los desenlaces clínicos de los pacientes.Conclusion: El papel de la videourodinamia cadavez toma más relevancia en la evaluación de la fisiopatología de la disfunción miccional, siendo incluso elpatrón de oro para el estudio de disfunción vesical neurogénica y trastornos del vaciado en jóvenes y mujeresy, posiblemente la incontinencia recidivada tanto enhombres como en mujeres.(AU)

Objetives: Describe the technique, in-dications and the correct interpretation given the findingsin different clinical entities, and to serve as a guide forurologists, urology residents and even medical students.Material and methods: A literature search was per-formed using Pubmed, Cochrane and Scopus databasefor articles and guidelines published between January1970 and June 2020.Results: Videourodynamics is a diagnostic procedurethat combines the urodynamic study with simultaneousimages of the lower urinary tract to assess the anatomyand function during the different phases of micturition. This study provides important information that can mod-ify therapeutic behavior and therefore clinical outcomesof patients.Conclusion: The role of videourodynamics be-comes more relevant nowadays in the assessment ofthe pathophysiology of voiding dysfunction, being thegold standard for the workup of neurogenic bladder andvoiding dysfunction in young people and women and,possibly in persistent/recurrent incontinence in both menand women:(AU)

Changing Paradigms: Green Laser Vaporization for Prostates over 80 mL: A Comparative Study.

Introduction and Objectives: Benign prostatic enlargement (BPE) and big prostates are common. Photovaporization of the prostate (PVP) with Greenlight™ laser 180 W XPS is considered a reliable therapy for prostates <80 mL and an alternative for the treatment of bigger ones in selected cases. The aim of this study is to evaluate efficacy, safety, and functional outcomes of PVP among patients with prostates over and under 80 mL. Materials and Methods: After protocol approbation by our Institutional Ethics Committee, a cohort of 840 patients with BPE who underwent PVP with Greenlight laser between 2012 and 2019 in a single center was evaluated. Groups were stratified according to prostate volume, to less and greater than 80 mL (Groups 1 and 2, respectively). The primary outcomes were efficacy [prostate-specific antigen (PSA) drop, improvement of International Prostatic Symptom Score (IPSS), and quality of life] and variables regarding safety of the procedure. Peri- and postoperative outcomes were analyzed. Complications were assessed according to Clavien-Dindo classification. Overall patient satisfaction was evaluated with visual analog scale. Results: Preoperative variables showed no statistical difference among groups. Mean follow-up was 47 [interquartile range; IQR = 26-70] months. Longer operative time and a higher energy use was seen in bigger prostates (p < 0.001). Efficacy was similar between groups, with a reduction of ≥4 points in IPSS score in 83.1% and 89.5% in Groups 1 and 2 (p = 0.053), PSA drop was 1 ± 2.6 and 1.7 ± 4.7 (p = 0.32). Group 2 had a higher conversion rate (0.3% vs 4.9%, p < 0.001) and higher blood transfusion rate (0% vs 2.4%, p < 0.001). There were no differences in hospital stay, catheterization time, urethral stricture, or re-treatment rates. Conclusions: GreenLight PVP is a safe and effective procedure in prostates ≥80 mL. It shows the same advantages demonstrated for those under that volume, particularly short hospital stay and catheterization time. Surgeon's experience is important to avoid complications, such as conversion and transfusion. PVP should be considered a first-line alternative for the treatment of bigger prostates.

Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study.

BACKGROUND: Female sexual dysfunction and erectile dysfunction (FSD/ED) have been linked with lower urinary tract symptoms (LUTS), from both epidemiological data and basic research studies, but few studies have been conducted in Latin America addressing these issues and most of them do not include the young population. AIM: To determine the prevalence of FSD/ED and its association with LUTS in Colombia. METHODS: Sub-analysis of a cross-sectional, population-based study conducted in subjects ≥18 years old to evaluate LUTS/OAB. The estimated sample size was 1,054. ED was defined as ≤21 points in the SHIM and FSD as ≤19 in the FSFI-6. For LUTS/OAB, we used the 2002 ICS and 2010 IUGA/ICS definitions and validated questionnaires. Descriptive and inferential statistics were employed. OUTCOMES: Prevalence of FSD/ED and association of FSD/ED and LUTS. RESULTS: We included 1,060 participants; the median age was 40 (IQR 27-54) years. Fifty-seven (11.4%) men and 182 (32.7%) women were sexually inactive. The prevalence of FSD/ED in sexually active participants was 47% (men 52.9%, women 38.9%). The most common FSD/ED symptoms were diminished/absent lubrication in women (42%) and diminished erection maintenance after penetration in men (13%). Individuals with FSD/ED had higher rates of various LUTS. The multivariable logistic regression model found that the city of residence (OR = 0.4, 95% CI 0.2-0.9), diabetes mellitus (DM) (OR = 8.4, 95% CI 1.4-48.7), menopause (OR=3.5, 95% CI 1.9-6.2), urge urinary incontinence (UUI) (OR=1.9, 95% CI 1.1-3.3) and nocturia ≥2 (OR = 2.2, 95% CI 1.2-4.2) were associated with FSD. In men, age 40-59 (OR = 2.3, 95% CI 1.4-3.7) and ≥60 (OR = 5.5, 95% CI 2.4-12.5), the city of residence (OR = 0.2, 95% CI 0.1-0.3), less than a high-school diploma vs higher education (OR = 2.0, 95% CI 1.2-3.2), depression (OR = 4.6, 95% CI 1.8-11.5), UUI (OR = 3.2, 95% CI 1.1-10.2) and feeling of incomplete bladder emptying (OR = 2.1, 95% CI 1.3-3.5) were associated with ED. CLINICAL IMPLICATIONS: This study underlines the importance of assessing LUTS in women and men of all affected age groups who present with symptoms of FSD/ED and vice versa, which could help achieve a better approach for these patients. STRENGTHS & LIMITATIONS: This is the first study in Colombia and one of the few in Latin America that addresses both FSD/ED and LUTS in men and women aged 18 years and older. Limitations include being a sub-analysis of a study aiming to determine the prevalence of LUTS/OAB and not FSD/ED. CONCLUSIONS: Regardless of age, LUTS were observed more frequently in patients with FSD/ED. Various LUTS were associated with FSD/ED. Bravo-Balado A, Trujillo CG, Caicedo JI, et al. Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study. J Sex Med 2021;18:1065-1074.

Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery.

INTRODUCTION AND OBJECTIVE: Previous studies suggest that men with detrusor underactivity (DUA) have less symptomatic improvement after prostate surgery than those with normal contractility, but the available data is controversial. We aim to determine the differences in functional outcomes of patients with or without DUA who underwent photovaporization of the prostate (PVP) with GreenLight™180 W XPS. METHODS: A cohort of patients with lower urinary tract symptoms (LUTS) who underwent PVP between 2012 and 2019 was evaluated. Patients were stratified according to bladder contractility index (BCI). DUA was defined as BCI < 100. Those with normal contractility (BCI = 100-150) were included in Group 1, and those with DUA (BCI < 100) in Group 2. Primary outcomes were symptomatic improvement defined as a reduction ≥ 4 points in the international prostate symptom score (IPSS) and a reduction of at least 1 point in the quality of life (IPSS-QoL). Complications according to the Clavien-Dindo classification were also recorded. RESULTS: A total of 271 patients who underwent PVP with GreenLight™ and met the inclusion criteria were assessed. Group 1 included 158 patients, while Group 2 included 113 patients. Mean follow-up was 24 months. Patients with normal contractility had a median reduction of 11 points (18.9 ± 8.0 to 7.1 ± 7.0) while patients with DUA had a median reduction of 10 points (19.3 ± 6.9 to 8.6 ± 8.4) in IPSS score; these differences were not statistically significant (p = .20). Patients in Group 1 had a 1.92 higher chance of QoL improvement (OR, 1.92; 90% CI, 1.10-3.37), compared to those in Group 2. Failure to void after PVP was most frequently reported in DUA patients (OR, 2.36; 90% CI, 1.26-4.43). Sociodemographic characteristics, intraoperative complications, conversion rates, hospital stay, and urinary catheterization time were similar between groups. CONCLUSIONS: Patients with LUTS, regardless of their BCI, improved their symptoms after PVP according to the IPSS. However, patients with DUA were more likely not to improve their QoL after the procedure and had a higher chance of failure to void in the immediate postoperative period. An appropriate counseling process with the patient discussing possible outcomes based on these findings should be encouraged.

Potential associations of adult nocturia. Results from a national prevalence study.

AIM: To determine the prevalence of nocturia and associated risk factors in the Colombian population aged ≥18 years old. METHODS: This is a cross-sectional population-based study conducted in 1060 participants in Colombia. Nocturia was assessed with the Spanish version of the ICIQ-OAB, using the ICS terminology. Descriptive statistics were used to evaluate nocturia prevalence. Logistic regression analysis was carried out to determine the association of nocturia with predefined variables. RESULTS: The prevalence of nocturia was 55.9% and it was more common in women than men (53.96% vs. 46.04%; p = .004). At least three episodes of nocturia were observed in 20.37% of the participants who had a severe alteration in their quality of life (p < .01). The bivariate model showed an association between nocturia and obesity (odds ratio [OR], 1.69; 90% confidence interval [CI]: 1.22-2.34), diabetes mellitus (OR, 2.99; 90% CI: 1.86-4.83), high blood pressure (OR, 2.04; 90% CI: 1.52-2.72), cardiovascular disease (OR, 1.75; 90% CI: 1.08 - 2.83), depression (OR, 1.89; 90% CI: 1.23-2.89), obstructive sleep apnea (OR, 1.70; 90% CI: 1.17 - 2.46), and childhood enuresis (OR, 1.45; 90% CI: 1.04-2.02). The multivariate model showed an association with obesity (OR, 2.0; 95% CI: 1.14 - 3.51) in women, as well as age ≥ 65 years (OR, 3.18; 95% CI: 1.26 - 8.02) and erectile dysfunction (OR, 3.44; 95% CI: 1.21 - 9.72) in men. Childhood enuresis was significantly associated with nocturia in both genders (OR, 1.61; 95% CI: 1.09 - 2.40 in women and OR, 1.66; 95% CI: 1.09-2.52 in men). CONCLUSION: There is a significant prevalence of nocturia in our population and a clear association with impaired quality of life. We consider important to inquire about history of childhood enuresis to define the risk of presenting nocturia in adulthood. Nocturia was associated with multiple comorbidities. Obesity and erectile dysfunction play an important role as modifiable risk factor.

Infección de vías urinarias no complicada en mujeres / Uncomplicated urinary tract infections in women

La infección de vías urinarias (IVU) es una patología común, que afecta a gran parte de la población y que generalmente se resuelve con manejo antibiótico. Se compone de una amplia variedad de entidades clínicas que pueden variar desde una cistitis no complicada hasta un shock séptico de origen urinario. Los patógenos etiológicos de la IVU no complicada están ampliamente establecidos y se han mantenido de forma consistente a lo largo del tiempo, siendo la Escherichia coli el microorganismo más predominante. En la actualidad, la resistencia bacteriana a los antibióticos es de gran preocupación y por esa razón, se busca optimizar la terapia antimicrobiana con el fin de disminuir la estancia hospitalaria, la severidad clínica de la infección y los costos a los sistemas de salud. La presente revisión, tiene como objetivo servir como guía para la correcta definición, clasificación, diagnóstico, tratamiento y prevención de la IVU no complicada.

A urinary tract infection (UTI) is a common pathology, that affects a large part of the population and generally resolves with antibiotic treatment. It embraces a variety of clinical entities that can vary from uncomplicated cystitis to septic shock. The etiological pathogens of uncomplicated UTI are widely established and have been consistent over time, with Escherichia coli being the most predominant microorganism. Currently, bacterial resistance to antibiotics is of great concern and for this reason we seek to optimize antimicrobial therapy in order to decrease hospital stay, clinical severity of the infection and costs to the health systems. The purpose of this review is to serve as a guide for the correct definition, classification, diagnosis, treatment and prevention of uncomplicated UTI.

Present value of the Urethral mobility test as a tool to assess Stress urinary incontinence due to Intrinsic sphincteric deficiency.

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = - 0.053 and r_s = - 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis.

PURPOSE: Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. MATERIALS AND METHODS: A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. RESULTS: A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. CONCLUSIONS: This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

Management of Female and Functional Urology Patients During the COVID Pandemic.

CONTEXT: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. OBJECTIVE: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). EVIDENCE ACQUISITION: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. EVIDENCE SYNTHESIS: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. CONCLUSIONS: Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. PATIENT SUMMARY: Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers.

Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement.

AIMS: Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). METHODS: A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated. RESULTS: The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization (23.7 [interquartile range {IQR} = 18.9-41.35] vs 21.8 hours [IQR = 18.7-26.6], P = .008) and catheterization (19.55 [IQR = 15.6-35.57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up, improvement of International Prostate Symptoms Score (IPSS) and QoL was significant in all patients when compared before and after surgery scores (P < .001). There were no difference between groups for QoL, however, IPSS was lower for the low-risk group (8 [IQR = 4-14.5] vs 5 [2-12], P = .001). CONCLUSION: PVP with GreenLight Laser is a safe and efficient procedure for all patients despite their comorbidities, with comparable middle-term outcomes which makes it a standard treatment for the entire aging population, improving their QoL.

Predicting the Probability of Lymph Node Involvement with Prostate Cancer Nomograms: Can We Trust the Prediction Models? / Predicción de la probabilidad de compromiso ganglionar con nomogramas para cáncer de próstata. ¿Podemos confiar en los modelos de predicción

Introduction Prediction of lymph node involvement (LNI) is of paramount importance for patients with prostate cancer (PCa) undergoing radical prostatectomy (RP). Multiple statistical models predicting LNI have been developed to support clinical decision-making regarding the need of extended pelvic lymph node dissection (ePLND). Our aim is to evaluate the prediction ability of the best-performing prediction tools for LNI in PCa in a Latin-American population. Methods Clinicopathological data of 830 patients with PCa who underwent RP and ePLND between 2007 and 2018 was obtained. Only data from patients who had ≥ 10 lymph nodes (LNs) harvested were included (n = 576 patients). Four prediction models were validated using this cohort: The Memorial Sloan Kettering Cancer Center (MSKCC) web calculator, Briganti v.2017, Yale formula and Partin tables v.2016. The performance of the prediction tools was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Results The median age was 61 years old (interquartile range [IQR] 56­66), the median Prostate specific antigen (PSA) was 6,81 ng/mL (IQR 4,8­10,1) and the median of LNs harvested was 17 (IQR 13­23), and LNI was identified in 53 patients (9.3%). Predictions from the 2017 Briganti nomogram AUC (0.85) and the Yale formula AUC (0.85) were the most accurate; MSKCC and 2016 Partin tables AUC were both 0,84. Conclusion There was no significant difference in the performance of the four validated prediction tools in a Latin-American population compared with the European or North American patients in whom these tools have been validated. Among the 4 models, the Briganti v.2017 and Yale formula yielded the best results, but the AUC overlapped with the other validated models.

Introducción La predicción del compromiso ganglionar es de suma importancia en pacientes con cáncer de próstata (CaP) que se van a someter a prostatectomía radical (PR). Múltiples modelos estadísticos se han desarrollado para predecir el riesgo de compromiso ganglionar y facilitar las decisiones clínicas de realizar o no linfadenectomía pélvica ampliada (LPA). Nuestro objetivo es evaluar la habilidad de predicción de las mejores herramientas de predicción de compromiso ganglionar en CaP en una población latinoamericana. Métodos Se evaluaron los datos clínico-patológicos de 830 pacientes con CaP sometidos a PR y LPA entre el 2007­2018. Solo se analizaron os pacientes con 10 o más ganglios extraídos (n = 576). Cuatro modelos de predicción fueron validados en esta cohorte: el modelo de la calculadora online del Memorial Sloan Kettering Cancer Center (MSKCC), el Briganti v.2017, la fórmula de Yale, y tablas de Partin v.2016. Se evaluó el desempeño de los modelos con curvas de características operativas del receptor (COR) y el área bajo la curva (ABC). Resultados La mediana de edad fue 61 años (rango intercuartílico [RI]: 56­66), mediana de Prostate specific antigen (PSA) 6,81 ng/mL (RI: 4,8­10,1), y mediana de ganglios extraídos 17 (RI: 13­23); se documentó compromiso ganglionar en 53 pacientes (9.3%). La habilidad de predicción del nomograma de Briganti v.2017 ABC (0,85) y la fórmula de Yale ABC (0,85) fueron las más precisas. El modelo del MSKCC y las tablas de Partin v.2016 mostraron AUC de 0,84 ambos. Conclusiones No encontramos diferencia estadisticamente significativa en el desempeño de los cuatro modelos de predicción validados en esta población latinoamericana comparada con pacientes norteamericanos o europeos en los que estas herramientas fueron desarrolladas. Entre los 4 modelos, el nomograma de Briganti v.2017 y la fórmula de Yale mostraron los mejores resultados; sin embargo, el AUC se sobrepone con los otros modelos validados.