[Urolift®, a new minimally invasive treatment for patients with low urinary tract symptoms secondary to BPH. Preliminary results]. / Urolift®, un nuevo tratamiento mínimamente invasivo para los síntomas de tracto urinario inferior secundarios a HBP. Resultados preliminares.

OBJECTIVES: To report the preliminary results of one of the first series of patients treated with a new simple surgical technique for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and to evaluate its safety and feasibility. METHODS: We have performed a novel surgical treatment of BPH, the UroLift® System (Neotract, Inc). It opens the urethra directly by retracting the obstructing prostatic lobes without applying incisions, surgical resection or thermal injury to the prostate. RESULTS: The procedure was carried out in 20 patients with a mean age of 74.3 (43 hyphen;-90) years, with mean prostate volume of 42.6 mL (19 hyphen;109) using the same operative protocol in all case subjects. Mean operative time was 19.1 min (range: 12-45). International Prostate Symptom Score (IPSS) ) at 4 weeks reduced from 26.7 to 16.7 and peak urinary flow rate (Qmax) increased from 8.6 mL/s to 13.2 mL/s. No major complications were encountered, neither sexual dysfunction. Mean follow-up: 12.3 (2-22) months. CONCLUSIONS: The UroLift® System procedure appears to be safe and efficient at short term. This technique minimizes the bleeding of the urethra and, therefore, makes bladder catheter not always necessary, and can preserve sexual function with low morbidity. Further studies are warranted to determine long-term outcome.

Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system.

BACKGROUND: Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS: A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS: Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS: WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.

Transdermal iontophoresis with verapamil and dexamethasone in the acute phase of peyronie's disease. Our experience.

OBJECTIVES: To evaluate the treatment of Peyronie's disease (PD) with verapamil and dexamethasone iontophoresis. METHODS: Twenty nine patients with PD were treated by means of a Miniphysionize" dispositive 3 sessions a week during 4 consecutive weeks. 5mL of a combination of verapamil(10mg.) and dexamethasone (4mg.) were transdermally administered with a 2.5 mA current during 20 min. The aim is to evaluate treatment efficacy in correcting penile curvature (Kelami test), plaque size (penis ultrasound (US)) improvement of pain and, other parameters like erectile function (EF), intercourse capacity or adverse effects of the treatment, which were evaluated with questionnaires. RESULTS: All patients completed the treatment protocol (12 sessions) and a total number of 348 sessions of iontophoresis were performed. After treatment, 3 patients (10.7%) continued with pain, but it disappeared in 25 of them (89.3%). A decrease of the size of the plaque was observed in 13 patients (44.8%), even disappearance in 4 patients (13.8%). No patient had curvature decrease after treatment. However, EF (IIEF score) and ability for intercourse improved in 3 (10.3%) and 4 patients (13.8%) respectively. CONCLUSION: Verapamil and dexamethasone iontophoresis is a safe and reliable treatment resolving painful erections in the acute phase of PD. However its efficacy in solving penile curvature and erectile dysfunction (ED) is more limited.

Combination therapy with topical alprostadil and phosphodiesterase-5 inhibitors after failure of oral therapy in patients with erectile dysfunction: a prospective, two-arm, open-label, non-randomized study.

Phosphodiesterase type 5 inhibitors (PDE5Is) are the first-line therapeutic option for erectile dysfunction (ED), while second-line therapy includes the alprostadil. Due to the different pharmacodynamic mechanism of PDE5Is and alprostadil, a synergistic action is conceivable when they are administered in combination. The aim of present study was to evaluate the efficacy and safety of combination therapy with PDE5I and topical alprostadil in patients with ED non-responders to PDE5I alone. We designed a prospective, two-arm, open-label, non-randomized study. Patients over 18 years old, with a stable sexual relationship for at least 6 months, and ED non-responders to PDE5I monotherapy were included in the study. At baseline the variables assessed were 5-item version of the International Index of Erectile Function (IIEF-5), and Sexual Encounter Profile Questions 2 and 3 (SEP-2 and SEP-3). In addition, all subjects underwent penile dynamic duplex ultrasonography. All patients were assigned to the monotherapy group (Group A) or combination therapy group (Group B) based on their preference. Topical alprostadil 300 µg/100 mg (Virirec®) was the treatment assigned to Group A, while the combination therapy with the last PDE5I taken (at the maximum recommended dose) plus topical alprostadil 300 µg/100 mg (Virirec®) was assigned to Group B. After 3 months from assignment to groups were evaluated IIEF-5, SEP-2 and SEP-3 regarding the last sexual intercourse, and Global Assessment Questionnaire-Questions 1 and 2 (GAQ-1 and GAQ-2). All adverse events (AEs) that occurred during the study period were recorded. A total of 170 patients were included in the study (72 in Group A and 98 in Group B). Fifty-two patients were previously treated with sildenafil 100 mg (30.6%), 6 with vardenafil 20 mg (3.5%), 56 with tadalafil 20 mg (32.9%), and 56 with avanafil 200 mg (32.9%). No significant differences among the study groups were found at baseline (p > 0.05). The mean IIEF-5 score increased significantly in Group B after treatment compared to baseline (12.4 ± 3.4 vs. 17.1 ± 4.5; p < 0.001), conversely patients in Group A showed no significant increase (12.2 ± 2.5 vs. 12.7 ± 3.1; p = 0.148). The number of affirmative responses to SEP-2 was significantly higher after treatment compared to baseline only in Group B (57 vs. 78; p < 0.001). The number of affirmative responses to SEP-3 was significantly higher after treatment compared to baseline in both groups (p < 0.001). The number of affirmative responses to GAQ-Q1 and GAQ-Q2 was significantly higher in Group B compared to Group A (p < 0.001). A total of 59 (34.7%) patients experienced AEs. They were mild, self-limited, and did not cause discontinuation of treatment. No episode of priapism was recorded. No statistically significant difference was recorded between the AEs of the two groups, except for facial flushing that was reported only in Group B (p = 0.021). The combination therapy with topical alprostadil and PDE5I seems to be more effective than topical alprostadil alone without worsening the safety of the treatment.

Superficial glans ischemia after penile prosthesis successfully treated by conservative treatment.

Glandular ischemia is an extremely uncommon dreaded postoperative complication of inflatable penile prosthesis surgery that may lead to penile gangrene and organ loss, whose incidence is difficult to determine. We report the case of a 56-year-old male admitted to our department with complaints of cold and painful glans penis after penile implant one month before. A color Doppler examination revealed the normal intracavernosal arteries with no vascularity in the superficial glans tissues. Due to the mild severity of the ischemia, conservative management was suggested, and consisted of oral pentoxifylline and hyperbaric therapy for 10 days, achieving a significant improvement at 4 months of follow-up.

Leiomyoma of the male urethra: case report and review of the literature.

OBJECTIVES: Case report of a 5 cm. male urethral leiomyoma (UL). METHOD: UL is extremely rare entity, with only seven cases in the literature. Its etiology is still unknown. Leiomyoma may be present in several locations inside the urinary tract. When located in the urethra it usually produces obstructive symptoms, but also may have asymptomatic behavior. Definitive diagnosis requires histological confirmation. Intraurethral neoplasms must be included in the differential diagnosis. RESULTS: Patient is free of lower urinary tract symptoms after complete excision of his urethral leiomyoma. CONCLUSIONS: Indication and surgical approach depend on tumor and size location. Prognostic is excellent after surgical removal.

[Cavernous tissue rehabilitation whit sildenafil 100 mg in patients after radical prostatectomy]. / Rehabilitación endotelial del tejido cavernoso con sildenafilo 100 mg en pacientes sometidos a prostatectomía radical.

OBJECTIVES: We try to figure out whether early penile rahabilitation ameliorates erectile dysfunction secondary to radical prostatectomy. MATERIAL AND METHODS: Retrospective study of 80 cases of patients that were operated between 2005-2008; all of them went under radical prostatectomy and were treated with sildenafil 100 mg every second day (Monday, Wednesday and Friday) plus 100 mg on demand after the surgery. As objective measurements, we used validated questionnaire IIEF-5 and also axil penile rigidity before and after surgery in the third and ninth month. RESULTS: Patients treated with sildenafil in fixed doses presented a 60% full erection recovery 9 months after radical prostatectomy. In the case where patients underwent bilateral or unilateral nerve sparing, they got a successful rate of almost 90%. Even 20% of those patients who did not have a nerve preservation got satisfactory erections, CONCLUSIONS: Our experience shows that early penile rehabilitation seems to be a good treatment for erectile dysfunction after radical prostatectomy with IPDE5 in fixed doses. Administration every other day plus on demand looks like also as an appropriate option.

[Transitional cell carcinoma of the bladder metastatic to bone marrow presenting as isolated anaemia and thrombocytopenia]. / Anemia y trombopenia aisladas por infiltración de médula ósea de un carcinoma urotelial de vejiga.

OBJECTIVES: Transitional cell carcinomas (TCC) of the bladder are usually aggressive and may produce bone metastases that infiltrate the bone marrow. Most of these cases present with bone symptoms and metastases and are detected with imaging tests. It is extremely rare for asymptomatic patients with a normal bone scan to have bone marrow involvement (anaemia and thrombocytopenia) due to tumour infiltration. We aim to examine that state with a case report. METHODS: We present the case of a 41-year old male with infiltrating TCC of the bladder, who presented with isolated, unexplained anaemia and thrombocytopenia after radical cystoprostatectomy. A bone marrow puncture was required, in which metastatic infiltration was revealed. We performed a literature search of similar cases. RESULTS: There are very few cases of TCC with bone marrow infiltration which become apparent only through haematological changes and have normal imaging tests. CONCLUSIONS: Patients with infiltrating carcinoma of the bladder with isolated haematological changes and a negative extension study should be assessed by bone marrow puncture for correct staging and to be able to offer the best treatment.

[Benign prostatic hyperplasia: a highly prevalent disease in the elderly]. / Hiperplasia benigna de próstata: una afección de elevada prevalencia en el paciente de edad avanzada.

The present review aims to provide an overview of benign prostatic hyperplasia (BPH), which has a remarkably high prevalence. The various theories of the aetiology of the disease are discussed, with special emphasis on those that concern the influence of growth factors. Questions related to the physiopathology of BPH are briefly summarized, since many symptoms apparently related to the disease may be caused by ageing or by interacting factors other than prostatism. The most common clinical manifestations, with symptoms divided into irritative and obstructive, as well as the currently available diagnostic procedures, are described. Finally, the therapeutic options are discussed, with special reference to KTP and Holmiun laser, which will drastically change treatment in the future.

Giant Abdominal Wall Pseudocyst After Open Radical Cystectomy.

An abdominal wall pseudocyst refers to an encapsulated collection of fluid located superficially in the rectus abdominal muscles. This uncommon complication is diagnosed based on physical examination and computed tomography results. However, the etiology of its formation remains unclear. Abdominal wall pseudocyst can be effectively treated by surgery including complete excision of the cyst. Here, we report imaging findings of a giant pseudocyst in the anterior abdominal wall after an open radical cystectomy.

Bladder Herpes Infection in a Patient With Low-grade Non-Muscle-invasive Bladder Cancer.

Bladder herpes is a very uncommon event related to herpes simplex virus infection. We report a 69-year-old man with 4-year history of bladder cancer who presented with dysuria and urinary frequency. Cystoscopy showed erythematous lesion of the bladder mucosa that was biopsied and revealed multilobed nuclei with eosinophilic intranuclear inclusions, and presence of intracytoplasmic vacuoles that were suggestive of bladder involvement by herpes simplex virus. Different bladder disorders have been associated with herpes virus, but spontaneous resolution generally occurs in 1-2 months.

Unclassifiable CD20-negative Testicular Diffuse Large B-cell Lymphoma.

CD20-negative diffuse large B-cell lymphoma (DLBCL) is a very uncommon neoplasm, and very rare unclassifiable cases that did not meet the criteria for well-established subtypes of CD20-negative DLBCLs have been reported. CD20-negative DLBCLs often present an aggressive clinical course with important chemoresistance and poor prognosis. Here, we report a case of CD20-negative DLBCL presented as a testicular mass. To the best of our knowledge, this is one of the first reported cases of testicular unclassifiable CD20-negative DLBCL.

Outpatient Microureteroscopy for Distal Ureteral Stone-A True Minimally Invasive Procedure.

INTRODUCTION: To describe microureteroscopy, a novel minimally invasive approach for treating distal ureteral lithiasis. TECHNICAL CONSIDERATIONS: Seven female patients with distal ureteral stones ≤ 10 mm were operated by microureteroscopy. The microureteroscope consist on a 4.85 Fr (16-gauge) sheath, a 0.9 mm diameter flexible optic system, and a 3-arm Luer-lock adapter to connect the sheath and insert the optics. Patients are placed in lithotomy position. Under sedative anesthesia and antimicrobial coverage, we performed microureteroscopy in patients with distal ureteral stones, describing key steps and perioperative and postoperative outcomes. Stone clearance was assessed using X-ray plain abdominal film of KUB at 15 days. Mean patients age was 54.5 years, and mean stone size was 7.98 mm. Stone-free rate was 100%. Patients were discharged 2-4 hours after the procedure without intraoperative or major perioperative complications. CONCLUSION: Microureteroscopy was developed to reduce dilation and ureteral wall damage and, thus, to decrease postoperative stenting and hospital stay.

Multicentre experience with ZSI 375 artificial urinary sphincter for the treatment of stress urinary incontinence in men.

OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of the artificial urinary sphincter ZSI 375 device in male patients with stress urinary incontinence (SUI) at 10 centres. METHODS: This was a retrospective, nonrandomised, multicentre study. From January 2012 to December 2014, and follow-up to February 2016, men with SUI were treated with the ZSI 375 device. The primary outcome was continence. The secondary outcome was complications rate. RESULTS: A total of 147 patients with moderate-to-severe stress incontinence and mean age of 70.67 (26-85) years underwent implantation of the ZSI 375 device at 10 centres.The most common indication for placement was incontinence after radical prostatectomy (121 patients: 82.31%). The ZSI 375 device was considered successful in 86.40% of cases after 12 months follow-up, 83.52% after 24 months follow-up and 78.26% after 36 months follow-up. The infection rate was 6.12%, urethral erosion was 12.92% and mechanical failure was limited to 3.40% leading to ZSI 375 improvement. CONCLUSIONS: This study confirmed safety and efficacy of ZSI 375 device to treat moderate-to-severe SUI in men.