A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications

ABSTRACT Objective: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). Materials and Methods: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). Inclusion criteria: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. Exclusion criteria: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. Results: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadadscale) and has a low risk of bias (Cochrane-Handbook). Conclusions: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

A prospective randomized study comparing bipolar plasmakinetic transurethral resection of the prostate and monopolar transurethral resection of the prostate for the treatment of Benign Prostatic Hyperplasia: efficacy, sexual function, Quality of Life, and complications.

OBJECTIVE: To generate high-quality data comparing the clinical efficacy and safety profile between monopolar transurethral resection of the prostate (M-TURP) and bipolar plasmakinetic resection of the prostate (PK-TURP) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Prospective, randomized, single-blinded study conducted in a tertiary-care public institution (Dec/2014-Aug/2016). INCLUSION CRITERIA: prostate of <80g in patients with drug-refractory lower urinary tract symptoms (LUTS), complications derived from BPH, or both. EXCLUSION CRITERIA: a history of pelvic surgery/radiotherapy, neurogenic bladder dysfunction or documented/suspected prostate carcinoma. Treatment efficacy evaluated at 1, 3, 6 and 12 months. Efficacy outcomes: international prostate symptom score (IPSS), quality-of-life (QoL) score, international index of erectile function-5 (IIEF-5), maximum urinary flow rate (Qmax), postvoid residual urine (PVRU) volume, and prostate volume (PV). Complications and sequelae also assessed. Comparisons performed with parametric/non-parametric tests. RESULTS: Out of the 100 hundred patients, 84 qualified for the analysis (45 M-TURP/39 PK-TURP). No significant differences found in baseline characteristics or operative data, except for a longer operative time in PK-TURP (MD:7.9min; 95%CI:0.13-15.74; p=0.04). No differences found in IPSS, Qmax or PVRU volume. QoL score at 12 months was higher in PK-TURP (MD:0,9points; 95%CI:0.18-1.64; p=0.01). No differences in sexual function, PV, complications or sequelae were found. This study is "rigorous" (Jadad-scale) and has a low risk of bias (Cochrane-Handbook). CONCLUSIONS: Based on this controlled trial, there is not significant variation in effectiveness and safety between M-TURP and PK-TURP for the treatment of BPH. The small difference in QoL between PK-TURP and M-TURP at the one-year follow-up is not perceivable by the patients and, therefore, not clinically relevant.

Comparación entre resección monopolar vs. resección bipolar transuretrales de próstata y su impacto sobre la función sexual / Comparison of monopolar versus bipolar transurethral resection of the prostate: Evaluation of the impact on sexual function

OBJETIVOS: Evaluar los efectos de la resección transuretral de próstata (RTUP) monopolar (M-RTUP) y bipolar (B-RTUP) sobre la función sexual general. MÉTODOS: De diciembre de 2014 a septiembre de 2016, 100 candidatos elegibles con hiperplasia benigna de próstata fueron reclutados prospectivamente y aleatorizados 1:1 en 2 grupos M-RTUP/B-RTUP (58 y 42 pacientes, respectivamente) y seguidos al mes, 3 y 6 meses. Se realizó un análisis univariado y multivariado utilizando la prueba de chi cuadrado y un modelo de regresión logística. Analizamos la edad, los antecedentes médicos de hipertensión arterial y diabetes, los antecedentes de tabaquismo, el volumen prostático preoperatorio, la escala de síntomas prostáticos, la evaluación de la función sexual, la experiencia del cirujano, los gramos resecados, el porcentaje de tejido resecado y la presencia de eyaculación retrógrada. Los síntomas prostáticos y la evaluación de la función eréctil (FE) se cuantificaron utilizando puntuaciones de IPSS autoadministradas y IIEF-5, respectivamente, al inicio del estudio y en cada visita posterior. RESULTADOS: La edad promedio fue de 66 años (50-82). No se encontraron diferencias estadísticas entre ambos grupos con respecto a comorbilidades médicas, IPSS preoperatorio e IIEF-5. El volumen prostático medio fue de 37,2cm3 (10-68) y la cantidad media de tejido resecado fue de 11,75g (6-58). Al inicio del estudio, el 77,6% de los pacientes presentaban STUI graves, y el 50% tenía una disfunción eréctil moderada-grave. El análisis univariado demostró que, en ambos grupos, los antecedentes de diabetes mellitus, la edad y el IIEF-5 preoperatorio se asociaron con una peor FE. Sin embargo, el análisis multivariado reveló que la edad fue el único factor asociado con una peor FE. Estos resultados fueron similares a los 3 y 6 meses postoperatorios. No encontramos una asociación entre la experiencia del cirujano, el tipo de energía empleada o el porcentaje de tejido resecado con el desarrollo de eyaculación retrógrada postoperatoria (52%). En el primer mes postoperatorio, el 44% de los pacientes aún referían síntomas prostáticos moderados y el 50% tenían disfunción eréctil grave mantenida a los 6 meses en ambos grupos. CONCLUSIONES: No existen diferencias estadísticamente significativas con respecto al tipo de energía empleada y los cambios en la función sexual global. La edad es el único factor que se asocia a una peor FE

OBJECTIVES: To assess the effects of monopolar transurethral resection of the prostate (M-TURP) and bipolar TURP (B-TURP) on overall sexual function. METHODS: From December 2014 to September 2016, 100 eligible candidates with benign prostatic hyperplasia were prospectively recruited and randomized 1:1 into M-TURP/B-TURP arms (58 and 42 patients, respectively) and followed up at 1, 3 and 6 months. A univariate and multivariate analyses using the chi-squared test and a logistic regression model were performed. We recorded the age, medical conditions such as hypertension and diabetes, history of smoking, preoperative prostatic volume, prostatic symptoms scale, sexual function assessment, surgeon experience, resected grams, percentage of resected tissue and presence of retrograde ejaculation. Prostatic symptoms and erectile function (EF) assessment were quantified using self-administered IPSS scores and IIEF-5, respectively, at baseline and in each subsequent visit. RESULTS: Mean age was 66 years (50-82). No statistical differences were found between both groups regarding medical comorbidities, preoperative IPSS and IIEF-5. Mean prostatic volume was 37.2 cm3 (10-68) and mean amount of resected tissue was 11.75g (6-58). At baseline 77,6% of patients has severe LUTS, and 50% has moderate-severe erectile dysfunction. Univariate analyses show that in both groups, history of diabetes mellitus, age and preoperative IIEF-5 were associated with poor EF. However, multivariate analyses revealed that age was the only factor associated with a poor EF. These results were similar at 3 and 6 postoperative months. We did not find an association between surgeon experience, source of energy employed or percentage of resected tissue with the development of postoperative retrograde ejaculation (52%). At first postoperative month, 44% of patients were still referring moderate prostatic symptoms and 50% had severe erectile dysfunction maintained at 6 months in both groups. CONCLUSIONS: There were no differences between the source of energy employed and changes on overall sexual function. Age is the only factor associated with a poor EF status

[Long term results of congenital penile curvature treated with cavernosa corpora rotation.] / Seguimiento a largo plazo de la incurvación peneana congénita tratada mediante rotación de los cuerpos cavernosos.

INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corporacavernosa, which causes difficulty in penetration, requiring surgical correction when inter course is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer. PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to inter course, were operated in a period of 36 months. Prior to the intervention,we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature throughself-photographs in three projections. By subcoronal approach,we perform denudation of the penis. On both sides of the urethra we incised Buck's fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test.  RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length,(p=0.08). Nine patients assured that they would under go the same intervention again. CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, main tainingits long-term results.

INTRODUCCIÓN: La incurvación peneana congénita (IPC) es un trastorno originado por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos, que condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. OBJETIVO: Analizar los resultados del tratamiento quirúrgico de la IPC mediante rotación de los cuerpos cavernosos(RCC) descrita y modificada por Shaeer. PACIENTES Y MÉTODOS: Diez pacientes diagnosticados de IPC con imposibilidad para el coito, fueron intervenidos en un período de 36 meses. Previo a la intervención aplicamos el cuestionario IIEF-5, medimos la longitud del pene y el ángulo de incurvación mediante autofotografías en tres proyecciones. Mediante abordaje subcoronal realizamos el denudamiento del pene. A ambos lados de la uretra incidimos la fascia de Buck y liberamos el paquete vasculonervioso desde la cara ventral hasta dorsal. Generamos una erección artificial evidenciando la incurvación. En la cara dorsal deambos cuerpos cavernosos realizamos dos incisiones longitudinales en la capa longitudinal externa de la túnica albugínea. Suturamos los bordes internos y externosde ambas incisiones entre sí con una sutura continuade monofilamento irreabsorbible de 4/0, comprobando mediante una erección artificial la corrección de la incurvación. Los pacientes fueron dados de alta al día siguiente de la intervención. Al sexto mes se determinaron la longitud e incurvación peneanas, y el cuestionario IIEF-5. Para la comparación de medias utilizamos el test de la U de Mann-Whitney. RESULTADOS: La edad media fue 26,8 años. El seguimiento promedio fue 20,7 meses (12-31) y la mediana 24. Antes de la intervención la incurvación media fue 68,5° (50-90°); la longitud media 14,2 cm (10-18) yel IIEF-5 de 21. Tras la intervención la longitud media fue 13,7 cm, la incurvación residual 25. No existieron diferencias estadísticamente significativas entre la longitud peneana pre y postquirúrgica,(p=0,08). Nueve pacientes aseguraron que volverían asometerse a la misma intervención. CONCLUSIONES: La RCC constituye una alternativa terapéutica eficaz a las técnicas de plicatura o alargamiento de la túnica albugínea para el tratamiento de la IPC, manteniendo sus resultados a largo plazo.

Seguimiento a largo plazo de la incurvación peneana congénita tratada mediante rotación de los cuerpos cavernosos / Long term results of congenital penile curvature treated with cavernosa corpora rotation

INTRODUCCIÓN: La incurvación peneana congénita (IPC) es un trastorno originado por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos, que condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. OBJETIVO: Analizar los resultados del tratamiento quirúrgico de la IPC mediante rotación de los cuerpos cavernosos (RCC) descrita y modificada por Shaeer. PACIENTES Y MÉTODOS: Diez pacientes diagnosticados de IPC con imposibilidad para el coito, fueron intervenidos en un período de 36 meses. Previo a la intervención aplicamos el cuestionario IIEF-5, medimos la longitud del pene y el ángulo de incurvación mediante autofotografías en tres proyecciones. Mediante abordaje subcoronal realizamos el denudamiento del pene. A ambos lados de la uretra incidimos la fascia de Buck y liberamos el paquete vasculonervioso desde la cara ventral hasta dorsal. Generamos una erección artificial evidenciando la incurvación. En la cara dorsal deambos cuerpos cavernosos realizamos dos incisiones longitudinales en la capa longitudinal externa de la túnica albugínea. Suturamos los bordes internos y externosde ambas incisiones entre sí con una sutura continuade monofilamento irreabsorbible de 4/0, comprobando mediante una erección artificial la corrección de la incurvación. Los pacientes fueron dados de alta al día siguiente de la intervención. Al sexto mes se determinaron la longitud e incurvación peneanas, y el cuestionario IIEF-5. Para la comparación de medias utilizamos el test de la U de Mann-Whitney. RESULTADOS: La edad media fue 26,8 años. El seguimiento promedio fue 20,7 meses (12-31) y la mediana 24. Antes de la intervención la incurvación media fue 68,5° (50-90°); la longitud media 14,2 cm (10-18) yel IIEF-5 de 21. Tras la intervención la longitud media fue 13,7 cm, la incurvación residual 25. No existieron diferencias estadísticamente significativas entre la longitud peneana pre y postquirúrgica, (p = 0,08). Nueve pacientes aseguraron que volverían asometerse a la misma intervención. CONCLUSIONES: La RCC constituye una alternativa terapéutica eficaz a las técnicas de plicatura o alargamiento de la túnica albugínea para el tratamiento de la IPC, manteniendo sus resultados a largo plazo

INTRODUCTION: Congenital penile curvature (PCC) is a disorder caused by an alteration in the embryonic development of the urethra and the corporacavernosa, which causes difficulty in penetration, requiring surgical correction when inter course is impossible. OBJECTIVE: To analyze the results of the surgical treatment of the IPC by means of rotation of the corpora cavernosa (RCC) described and modified by Shaeer. PATIENTS AND METHODS: Ten patients diagnosed with PCC with impossibility to inter course, were operated in a period of 36 months. Prior to the intervention,we applied the IIEF-5 questionnaire, measured the length of the penis and the angle of curvature throughself-photographs in three projections. By subcoronal approach,we perform denudation of the penis. On both sides of the urethra we incised Buck’s fascia and released the neurovascular bundle from the ventral to the dorsal side. We generate an artificial erection evidencing the curvature. On the dorsal aspect of both corpora cavernosa, we made two incisions in the external longitudinal layer of the tunica albuginea. We sutured the internal and external edges of both incisions together with a 4/0 non-reabsorbable monofilament continuous suture, checking the correction of the curvature by means of an artificial erection. The patients were discharged the day after the intervention. The penile length and curvature were determined in the sixth month, and the IIEF-5 questionnaire. For the comparison of means we used the Mann-Whitney U test. RESULTS: The mean age was 26.8 years. The average follow-up was 20.7 months (12-31) and the median was 24. Before the intervention, the average curvature was 68.5° (50-90°); the average length 14.2 cm (10-18) and the IIEF-5 of 21. After surgery, the average length was 13.7 cm, the residual curvature the IIEF-5 of 25. There were no statistically significant differences between pre and postoperative penile length, (p = 0.08). Nine patients assured that they would under go the same intervention again. CONCLUSIONS: RCC is an effective therapeutic alternative to the techniques of plication or lengthening of the tunica albuginea for the treatment of PCC, main tainingits long-term results

[Comparison of monopolar versus bipolar transurethral resection of the prostate: Evaluation of the impact on sexual function]. / Comparación entre resección monopolar vs. resección bipolar transuretrales de próstata y su impacto sobre la función sexual.

OBJECTIVES: To assess the effects of monopolar transurethral resection of the prostate (M-TURP) and bipolar TURP (B-TURP) on overall sexual function. METHODS: From December 2014 to September 2016, 100 eligible candidates with benign prostatic hyperplasia were prospectively recruited and randomized 1:1 into M-TURP/B-TURP arms (58 and 42 patients, respectively) and followed up at 1, 3 and 6 months. A univariate and multivariate analyses using the chi-squared test and a logistic regression model were performed. We recorded the age, medical conditions such as hypertension and diabetes, history of smoking, preoperative prostatic volume, prostatic symptoms scale, sexual function assessment, surgeon experience, resected grams, percentage of resected tissue and presence of retrograde ejaculation. Prostatic symptoms and erectile function (EF) assessment were quantified using self-administered IPSS scores and IIEF-5, respectively, at baseline and in each subsequent visit. RESULTS: Mean age was 66 years (50-82). No statistical differences were found between both groups regarding medical comorbidities, preoperative IPSS and IIEF-5. Mean prostatic volume was 37.2 cm3 (10-68) and mean amount of resected tissue was 11.75g (6-58). At baseline 77,6% of patients has severe LUTS, and 50% has moderate-severe erectile dysfunction. Univariate analyses show that in both groups, history of diabetes mellitus, age and preoperative IIEF-5 were associated with poor EF. However, multivariate analyses revealed that age was the only factor associated with a poor EF. These results were similar at 3 and 6 postoperative months. We did not find an association between surgeon experience, source of energy employed or percentage of resected tissue with the development of postoperative retrograde ejaculation (52%). At first postoperative month, 44% of patients were still referring moderate prostatic symptoms and 50% had severe erectile dysfunction maintained at 6 months in both groups. CONCLUSIONS: There were no differences between the source of energy employed and changes on overall sexual function. Age is the only factor associated with a poor EF status.

[Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux]. / Análisis actualizado sobre la efectividad de las opciones terapéuticas del reflujo vesico-ureteral primario.

OBJECTIVES: The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology. METHODS: A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. RESULTS: A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects. CONCLUSIONS: The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This conclusion cannot be applied on endoscopic treatment.

Análisis actualizado sobre la efectividad de las opciones terapéuticas del reflujo vesico-ureteral primario / Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux

Objetivo: El propósito principal de nuestro trabajo fue realizar una Revisión Sistemática (RS) sobre el manejo terapéutico del Reflujo Vésico Ureteral Primario (RVUP). Métodos: Para ello se ha realizado una RS de los artículos aparecidos en todas las bases de datos disponibles, aplicando unos criterios de inclusión y exclusión de calidad mínima imprescindible. Resultados: Se ha realizado lectura crítica de los artículos seleccionados y el estudio estadístico correspondiente de los datos agrupados, según el tipo de tratamiento y beneficios aportados, así como sus efectos indeseables. Conclusiones: El tratamiento médico y el quirúrgico presentan la misma efectividad en la resolución de los grados I, II y III de RVUP, recomendándose el primero de ellos como tratamiento inicial tras el diagnóstico. El manejo endoscópico es igual de efectivo que la cirugía abierta, con menores efectos secundarios, sin haber encontrado diferencias entre las distintas sustancias analizadas para la inyección. Para los reflujos de alto grado IV y V no existen evidencias suficientes que aconsejen o desaconsejen cualquiera de los tratamientos. El tratamiento quirúrgico abierto, para cualquier grado de RVU, sólo presenta superioridad con respecto al tratamiento médico en el número de episodios de pielonefritis aguda durante el seguimiento. Esta afirmación no es posible aplicarla para el tratamiento endoscópico (AU)

Objectives: The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology. Methods: A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. Results: A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects. Conclusions: The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This con-clusion cannot be applied on endoscopic treatment (AU)

El tiempo de doblaje de PSA como nuevo método diagnóstico y pronóstico del cáncer de próstata / PSA doubling time as a new diagnostic and prognostic method for prostate cancer

OBJETIVO: Evaluar el papel de la cinética del PSA en el diagnóstico y prosnóstico del cáncer de próstata.MÉTODOS: Revision sistemática de la literatura a través de Medline.RESULTADOS: Una cifra de PSAV 2 ng/ml/año se asocia a una mayor mortalidad por cáncer de próstata tras cirugía o radioterapia. Un PSADT10 meses tras fallo bioquímico despues cirugía situa a la recidiva local como causa más probable

OBJECTIVES: To review the value of PSA kinetics in the diagnosis and prognosis of prostate cancer.METHODS: Review of the literature through a Medline search.CONCLUSIONS: A pre-tretament PSAV value >2ng/ml/yr is a risk factor for increased mortality from prostate cancer after surgery or radiation therapy. A PSADT10 is more likely associated with local recurrence