Surgical Treatment for Recurrent Bulbar Urethral Stricture: A Randomised Open-label Superiority Trial of Open Urethroplasty Versus Endoscopic Urethrotomy (the OPEN Trial)

BackgroundUrethral stricture affects 0.9% of men. Initial treatment is urethrotomy. Approximately, half of the strictures recur within 4 yr. Options for further treatment are repeat urethrotomy or open urethroplasty.ObjectiveTo compare the effectiveness and cost-effectiveness of urethrotomy with open urethroplasty in adult men with recurrent bulbar urethral stricture.Design, setting, and participantsThis was an open label, two-arm, patient-randomised controlled trial. UK National Health Service hospitals were recruited and 222 men were randomised to receive urethroplasty or urethrotomy.InterventionUrethrotomy is a minimally invasive technique whereby the narrowed area is progressively widened by cutting the scar tissue with a steel blade mounted on a urethroscope. Urethroplasty is a more invasive surgery to reconstruct the narrowed area.Outcome measurements and statistical analysisThe primary outcome was the profile over 24 mo of a patient-reported outcome measure, the voiding symptom score. The main clinical outcome was time until reintervention.Results and limitationsThe primary analysis included 69 (63%) and 90 (81%) of those allocated to urethroplasty and urethrotomy, respectively. The mean difference between the urethroplasty and urethrotomy groups was –0.36 (95% confidence interval [CI] –1.74 to 1.02). Fifteen men allocated to urethroplasty needed a reintervention compared with 29 allocated to urethrotomy (hazard ratio [95% CI] 0.52 [0.31–0.89]).ConclusionsIn men with recurrent bulbar urethral stricture, both urethroplasty and urethrotomy improved voiding symptoms. The benefit lasted longer for urethroplasty.Patient summaryThere was uncertainty about the best treatment for men with recurrent bulbar urethral stricture. We randomised men to receive one of the following two treatment options: urethrotomy and urethroplasty. At the end of the study, both treatments resulted in similar and better symptom scores. However, the urethroplasty group had fewer reinterventions

Generación de vínculos interinstitucionales y redes en el centro bonaerense a partir del proyecto de extensión “Promoción de la Agroecología, otro modelo de producción es posible”

La demanda social hacia sistemas sustentables de producción requiere de una articulación interinstitucional que permita dar respuestas en el diseño, transición y acompañamiento para su transformación. En este proceso las instituciones públicas participantes efectúan aportes desde la investigación, extensión y transferencia, en diálogo con las necesidades y prácticas de los propios productores y sus organizaciones, desde una perspectiva de trabajo colaborativa y participativa. Esta presentación se centra en compartir parte de los resultados de la ejecución del proyecto de extensión titulado: “Promoción de la Agroecología, otro modelo de producción es posible” desarrollado durante el período 2020-2021 en el contexto de pandemia Covid19.EEA BalcarceFil: Block, Karina Alejandra. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía; Argentina.Fil: Wynne, María Josefina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía; Argentina.Fil: Menici, María Daniela. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía; Argentina.Fil: Zamora, Martín Sergio. Instituto Nacional de Tecnología Agropecuaria (INTA). Chacra Experimental Integrada Barrow; Argentina.Fil: Vázquez, Patricia. Actividad Privada; ArgentinaFil: Iturralde Elortegui, María del Rosario. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce. Agencia de Extensión Rural Olavarria; Argentina.Fil: Giaquinta, Alejandro Enzo. Ministerio de Desarrollo Agrario. Chacra Experimental Blanca Grande; Argentina.Fil: Farrando, Luis Adrián. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Agronomía; Argentina.Fil: Martinefsky, María Julia. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce. Agencia de Extensión Rural Olavarria; Argentina.Fil: Oyesqui, Lía Ana Eloisa. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce. Agencia de Extensión Rural Olavarria; Argentina.Fil: Andrich, Santiago. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce. Agencia de Extensión Rural Olavarria; Argentina

Physical properties, microstructure and stability of extra-virgin olive oil based mayonnaise.

Mayonnaise is an oil-in-water emulsion made with vegetable oil, egg yolk,vinegar, salt and other minor ingredients. Its structural and rheologicalbehaviour is of outstanding importance for the sensory properties andperceived texture as well as for the physical stability. Olive oil, despiteits use as seasoning, is increasingly added in formulated and processedfoods due to its peculiar sensory, nutritional and functional properties.However, its natural composition comprises endogenous molecules (e.g. freefatty acids, phospholipids and polyphenols) that, due to their surfaceactivity, may affect the formation of oil/water interfaces and the stabilityof dispersed emulsified systems.The aim of this work was thus to study the physical and structuralproperties of mayonnaises made with extra virgin olive oils (EVOO). To thispurpose, different EVOOs were selected according to their polyphenoliccontent along with other vegetable oils (peanut, sunflower) taken asreference. Mayonnaises were characterized by colour measurements, backextrusion test, rheological evaluations, optical microscopy. The samplesproduced with EVOO showed the lowest textural indices when compared tosunflower or peanut oils; similar results were obtained for the elastic andviscous modulus and the loss factor (tanδ) resulted to be inverselyrelated to the content in polyphenolic compounds. EVOOs mayonnaisespresented a peculiar sensory characterization; nonetheless highestpolyphenols contents in the oils caused a lower overall acceptability amongthe assessors.Olive oil could represent a valid ingredient in the formulation ofmayonnaises as long as the effect of high polyphenolic content on theirstructure and rheology is taken into consideration.[...

Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience.

PurposeRectourethral fistula is a known complication of prostate cancer treatment. Reports in the literature on rectourethral fistula repair technique and outcomes are limited to single institution series. We examined the variations in technique and outcomes of rectourethral fistula repair in a multi-institutional setting.Materials and methodsWe retrospectively identified patients who underwent rectourethral fistula repair after prostate cancer treatment at 1 of 4 large volume reconstructive urology centers, including University of California-San Francisco, University College London Hospitals, Lahey Clinic and Devine-Jordan Center for Reconstructive Surgery, in a 15-year period. We examined the types of prostate cancer treatment, technical aspects of rectourethral fistula repair and outcomes.ResultsAfter prostate cancer treatment 201 patients underwent rectourethral fistula repair. The fistula developed in 97 men (48.2%) after radical prostatectomy alone and in 104 (51.8%) who received a form of energy ablation. In the ablation group 84% of patients underwent bowel diversion before rectourethral fistula repair compared to 65% in the prostatectomy group. An interposition flap or graft was placed in 91% and 92% of the 2 groups, respectively. Concomitant bladder neck contracture or urethral stricture developed in 26% of patients in the ablation group and in 14% in the prostatectomy group. Postoperatively the rates of urinary incontinence and complications were higher in the energy ablation group at 35% and 25% vs 16% and 11%, respectively. The ultimate success rate of fistula repair in the energy ablation and radical prostatectomy groups was 87% and 99% with 92% overall success.ConclusionsRectourethral fistulas due to prostate cancer therapy can be reconstructed successfully in a high percent of patients. This avoids permanent urinary diversion in these complex cases

Open urethroplasty versus endoscopic urethrotomy for recurrent urethral stricture in men:the OPEN RCT

Background Men who suffer recurrence of bulbar urethral stricture have to decide between endoscopic urethrotomy and open urethroplasty to manage their urinary symptoms. Evidence of relative clinical effectiveness and cost-effectiveness is lacking. Objectives To assess benefit, harms and cost-effectiveness of open urethroplasty compared with endoscopic urethrotomy as treatment for recurrent urethral stricture in men. Design Parallel-group, open-label, patient-randomised trial of allocated intervention with 6-monthly follow-ups over 24 months. Target sample size was 210 participants providing outcome data. Participants, clinicians and local research staff could not be blinded to allocation. Central trial staff were blinded when needed. Setting UK NHS with recruitment from 38 hospital sites. Participants A total of 222 men requiring operative treatment for recurrence of bulbar urethral stricture who had received at least one previous intervention for stricture. Interventions A centralised randomisation system using random blocks allocated participants 1 : 1 to open urethroplasty (experimental group) or endoscopic urethrotomy (control group). Main outcome measures The primary clinical outcome was control of urinary symptoms. Cost-effectiveness was assessed by cost per quality-adjusted life-year (QALY) gained over 24 months. The main secondary outcome was the need for reintervention for stricture recurrence. Results The mean difference in the area under the curve of repeated measurement of voiding symptoms scored from 0 (no symptoms) to 24 (severe symptoms) between the two groups was –0.36 [95% confidence interval (CI) –1.78 to 1.02; p = 0.6]. Mean voiding symptom scores improved between baseline and 24 months after randomisation from 13.4 [standard deviation (SD) 4.5] to 6 (SD 5.5) for urethroplasty group and from 13.2 (SD 4.7) to 6.4 (SD 5.3) for urethrotomy. Reintervention was less frequent and occurred earlier in the urethroplasty group (hazard ratio 0.52, 95% CI 0.31 to 0.89; p = 0.02). There were two postoperative complications requiring reinterventions in the group that received urethroplasty and five, including one death from pulmonary embolism, in the group that received urethrotomy. Over 24 months, urethroplasty cost on average more than urethrotomy (cost difference £2148, 95% CI £689 to £3606) and resulted in a similar number of QALYs (QALY difference –0.01, 95% CI –0.17 to 0.14). Therefore, based on current evidence, urethrotomy is considered to be cost-effective. Limitations We were able to include only 69 (63%) of the 109 men allocated to urethroplasty and 90 (80%) of the 113 men allocated to urethrotomy in the primary complete-case intention-to-treat analysis. Conclusions The similar magnitude of symptom improvement seen for the two procedures over 24 months of follow-up shows that both provide effective symptom control. The lower likelihood of further intervention favours urethroplasty, but this had a higher cost over the 24 months of follow-up and was unlikely to be considered cost-effective. Future work Formulate methods to incorporate short-term disutility data into cost-effectiveness analysis. Survey pathways of care for men with urethral stricture, including the use of enhanced recovery after urethroplasty. Establish a pragmatic follow-up schedule to allow national audit of outcomes following urethral surgery with linkage to NHS Hospital Episode Statistics. Trial registration Current Controlled Trials ISRCTN98009168. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 61. See the NIHR Journals Library website for further project information