Resultados comparativos de los "slings" en la cirugía de la incontinencia urinaria de esfuerzo femenina

El objetivo principal de esta tesis es determinar qué variables preoperatorias sirven para predecir el resultado del tratamiento quirúrgico de la incontinencia urinaria de esfuerzo femenina con las distintas técnicas de sling. Como objetivos secundarios se pretende analizar: por un lado, si la cirugía de la incontinencia urinaria de esfuerzo origina otros cambios en la fase de llenado del tracto urinario inferior y, en caso afirmativo, si existen variables predictivas respecto de esos cambios. Y por otro, si la cirugía de la incontinencia urinaria de esfuerzo origina cambios en la fase miccional del tracto urinario inferior y, en caso afirmativo, si existen variables predictivas respecto a esos cambios

Urethral reconstruction in patients previously treated with Memokath™ urethral endoprosthesis

Objetivo Evaluar el papel y la tasa de éxito de la reconstrucción ureteral en pacientes con estenosis de uretra tratada previamente con endoprótesis uretral termoexpandible Memokath™. Material y método Se presenta una serie de pacientes con estenosis de uretra y endoprótesis Memokath™ tratados con uretroplastia. La reconstrucción se decidió, bien debido a progresión de la estenosis, bien a complicaciones derivadas del tratamiento primario con el stent. Se evaluó la edad, la longitud de la estenosis y del stent, el tiempo entre la colocación del stent y la uretroplastia, el modo de retirada del stent, el tipo de uretroplastia, las complicaciones y los parámetros miccionales antes y después de la uretroplastia. Se considera resultado exitoso conseguir la micción espontánea sin necesidad de procedimiento postoperatorio. Resultados Se incluyeron 8 casos con estenosis de uretra bulbar. Memokath™ se retiró endoscópicamente antes de la uretroplastia en 6 casos (75%) y mediante uretrotomía abierta en el momento de la uretroplastia en 2 (25%). La técnica de uretroplastia fue: injerto de mucosa bucal onlay dorsolateral en 5 casos (62,5%) y escisión con anastomosis primaria, uretroplastia anastomótica e injerto de mucosa bucal onlay dorsal en un caso (12,5%) cada uno. No hubo ningún fracaso con una mediana de seguimiento de 26 ± 21,5 meses. El IPSS total, la CdV, el Qmáx y el residuo postmiccional mejoraron significativamente (p < 0,05). Como complicación, un paciente (12,5%) presentó epididimitis y acortamiento peneano. Conclusiones La uretroplastia tras reestenosis u otras complicaciones en pacientes con stent uretral temporal Memokath™ es una opción de reconstrucción viable y definitiva con excelentes resultados a corto plazo y pocas complicaciones. El injerto de mucosa bucal onlay dorsolateral de un solo lado es la técnica óptima para esta indicación.Purpose To evaluate the role and success rate of urethral reconstruction in patients with urethral stricture previously treated with thermos-expandable Memokath™ urethral endoprosthesis. Materials and method A case series of patients with urethral stricture and Memokath™ endoprosthesis treated with urethroplasty is presented. Reconstruction was decided due to stricture progression or complications derived from primary stent treatment. Age, stricture and stent length, time between stent placement and urethroplasty, mode of stent retrieval, type of urethroplasty, complications and voiding parameters before and after urethroplasty were evaluated. Successful outcome was defined as standard voiding, without need of any postoperative procedure. Results Eight cases with bulbar urethra stricture were included. Memokath™ was endoscopically retrieved before urethroplasty in 6 (75%) and by open urethrotomy at the time of urethroplasty in 2 (25%). Technique of urethroplasty was dorso-lateral onlay buccal mucosa graft in 5 (62.5%) cases and excision and primary anastomosis, anastomotic urethroplasty, and dorsal onlay buccal mucosa graft in one (12.5%) case each. There was no failure at 26 ± 21.5 months median follow-up. Total IPSS, QoL, Qmax and postvoid residual significantly improved (p < .05). The only complication presented was epididymitis and penile shortening in one patient (12.5%). Conclusions Urethroplasty after re-stricture or other complications in patients with temporary Memokath™ urethral stent is a viable and definite option of reconstruction with excellent results in the short term and few complications. One-side dorsolateral onlay buccal mucosa graft augmentation is the optimal technique for this indication.Sin financiación0.873 JCR (2019) Q4, 78/85 Urology & Nephrology0.303 SJR (2019) Q3, 75/109 UrologyUE

Cirugía transanal mínimamente invasiva para extracción de mucosa rectal en el tratamiento de la estenosis panuretral asociada a liquen escleroso mediante uretroplastia de Kulkarni

Sin financiación2.242 JCR (2021) Q3, 122/211 Surgery0.262 SJR (2021) Q3, 300/492 SurgeryNo data IDR 2021UE

Reconstrucción uretral en pacientes previamente tratados con endoprótesis uretral Memokath™

Purpose To evaluate the role and success rate of urethral reconstruction in patients with urethral stricture previously treated with thermos-expandable Memokath™ urethral endoprosthesis. Materials and method A case series of patients with urethral stricture and Memokath™ endoprosthesis treated with urethroplasty is presented. Reconstruction was decided due to stricture progression or complications derived from primary stent treatment. Age, stricture and stent length, time between stent placement and urethroplasty, mode of stent retrieval, type of urethroplasty, complications and voiding parameters before and after urethroplasty were evaluated. Successful outcome was defined as standard voiding, without need of any postoperative procedure. Results Eight cases with bulbar urethra stricture were included. Memokath™ was endoscopically retrieved before urethroplasty in 6 (75%) and by open urethrotomy at the time of urethroplasty in 2 (25%). Technique of urethroplasty was dorso-lateral onlay buccal mucosa graft in 5 (62.5%) cases and excision and primary anastomosis, anastomotic urethroplasty, and dorsal onlay buccal mucosa graft in one (12.5%) case each. There was no failure at 26 ± 21.5 months median follow-up. Total IPSS, QoL, Qmax and postvoid residual significantly improved (p < .05). The only complication presented was epididymitis and penile shortening in one patient (12.5%). Conclusions Urethroplasty after re-stricture or other complications in patients with temporary Memokath™ urethral stent is a viable and definite option of reconstruction with excellent results in the short term and few complications. One-side dorsolateral onlay buccal mucosa graft augmentation is the optimal technique for this indication.Objetivo Evaluar el papel y la tasa de éxito de la reconstrucción ureteral en pacientes con estenosis de uretra tratada previamente con endoprótesis uretral termoexpandible Memokath™. Material y método Se presenta una serie de pacientes con estenosis de uretra y endoprótesis Memokath™ tratados con uretroplastia. La reconstrucción se decidió, bien debido a progresión de la estenosis, bien a complicaciones derivadas del tratamiento primario con el stent. Se evaluó la edad, la longitud de la estenosis y del stent, el tiempo entre la colocación del stent y la uretroplastia, el modo de retirada del stent, el tipo de uretroplastia, las complicaciones y los parámetros miccionales antes y después de la uretroplastia. Se considera resultado exitoso conseguir la micción espontánea sin necesidad de procedimiento postoperatorio. Resultados Se incluyeron 8 casos con estenosis de uretra bulbar. Memokath™ se retiró endoscópicamente antes de la uretroplastia en 6 casos (75%) y mediante uretrotomía abierta en el momento de la uretroplastia en 2 (25%). La técnica de uretroplastia fue: injerto de mucosa bucal onlay dorsolateral en 5 casos (62,5%) y escisión con anastomosis primaria, uretroplastia anastomótica e injerto de mucosa bucal onlay dorsal en un caso (12,5%) cada uno. No hubo ningún fracaso con una mediana de seguimiento de 26 ± 21,5 meses. El IPSS total, la CdV, el Qmáx y el residuo postmiccional mejoraron significativamente (p < 0,05). Como complicación, un paciente (12,5%) presentó epididimitis y acortamiento peneano. Conclusiones La uretroplastia tras reestenosis u otras complicaciones en pacientes con stent uretral temporal Memokath™ es una opción de reconstrucción viable y definitiva con excelentes resultados a corto plazo y pocas complicaciones. El injerto de mucosa bucal onlay dorsolateral de un solo lado es la técnica óptima para esta indicación.Sin financiaciónNo data 2019UE

A systematic review and meta-analysis on the efficacy of intravesical therapy for bladder pain syndrome/interstitial cystitis

Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterised by persistent irritating micturition symptoms and pain. The objective was to compare the clinical efficacy of currently available products for intravesical therapy of BPS/IC and to assess their pharmacoeconomic impact. A Pubmed/Medline database search was performed for articles on intravesical therapy for BPS/IC. A total of 345 publications were identified, from which 326 were excluded. Statistical evaluation was performed with effect size (ES) assessment of symptom reduction and response rates. The final set of 19 articles on intravesical BPS/IC therapy included 5 prospective controlled trials (CTs), the remaining were classified as uncontrolled clinical studies. The total number of patients included was 801, 228 of whom had been evaluated in a CT. For CTs, the largest ES for symptom reduction as well as response rate was observed for high molecular weight hyaluronic acid (HMW-HA), with similar findings in two uncontrolled studies with HMW-HA. The number needed to treat to achieve a response to intravesical therapy was 2.67 for intravesical pentosan polysulphate and 1.31 for HMW-HA which were superior to all other instillates. HMW-HA was significantly superior in cost effectiveness and cost efficacy to all other instillation regimes. The present meta-analysis combined medical and pharmacoeconomic aspects and demonstrated an advantage of HMW-HA over other instillation agents; however, direct comparisons between the different products have not been performed to date in properly designed controlled studies.Sin financiación1.921 JCR (2016) Q3, 43/80 Obstetrics & Gynecology, 40/77 Urology & NephrologyUE

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.Sin financiación2.6 Q3 JCR 20220.729 Q2 SJR 2023No data IDR 2022UE

Urorectal fistula repair using different approaches: operative results and quality of life issues

Purpose: To evaluate efficacy of urorectal fistula (URF) repair using different approaches and the clinical factor determinant of success, and also the morbidity associated to the procedure and health-related quality of life (HRQoL) in male survivors of pelvic malignancies. Material and methods: Retrospective evaluation of 39 patients with URF primarily intervened in three institutions using different surgical approaches. Success was defined as effective fistula closure. Variables evaluated included demographics, previous treatments, surgical approach, ancillary surgeries, complications and HRQoL by using a standardized non-validated specific questionnaire. Median follow-up from surgery to interview was 55 months (interquartile range 49, range 4-112). Factors determinant of success were investigated using logistic regression. Safety of the procedure was evaluated by Clavien-Dindo scale. Deterioration of continence and erectile function and other HRQoL issues were evaluated. Results: Prostate cancer treatment was the predominant etiology. The success rate for fistula repair was 89.5%. The surgical approach was not related to failed repair (p=0.35) or complications (p=0.29). Factors associated with failure were complications (p=0.025), radiotherapy (p=0.03), fistula location (p=0.04) and fistula size (p=0.007). Multivariate analysis revealed fistula size was the only independent determinant of failure (OR 6.904, 1.01-47.75). Complications occurred in 46.2% and severe complications in 12.8%. The mortality related to the procedure was 2.6%. Urinary incontinence was present before repair in 26.3% and erectile dysfunction in 89.5%. Fistula repair caused de novo urinary incontinence in 7.9% and deterioration of erectile status in 44.7%. Globally 79% were satisfied after repair and only 7.9% rated HRQoL as unhappy. Trans-sphincteric approach was related to less deterioration of erectile function (p=0.003), and higher perceived satisfaction in QoL (p=0.04). Conclusions: The surgical approach elected to correct URF is not determinant of success nor of complications. Fistula size appears as independent determinant for failure. Trans-sphincteric approach could be advantageous over other procedures regarding HRQoL issues.Sin financiaciónNo data JCR 20210.487 SJR (2021) 53/108 UrologyNo data IDR 2021UE

Los efectos de resveratrol y otros polifenoles del vino sobre la proliferación, apoptosis y expresión de receptor androgénico en células LNCaP

The objective of this study is to address the effect of resveratrol and other red wine polyphenols on cell proliferation, apoptosis and androgen receptor (AR) expression in human prostate cancer LNCaP cells.1.022 JCR (2014) Q4, 60/76 Urology & nephrologyUE

Treatment for long bulbar urethral strictures with membranous involvement using urethroplasty with oral mucosa graft

Estudio prospectivo sobre 14 pacientes con estenosis de uretra bulbomembranosa sometidos a uretroplastia de ampliación con injerto de mucosa bucal entre 2005 y 2013, según la técnica de Barbagli modificada con anclaje proximal del injerto y fijación del mismo sobre la albugínea cavernosa en 12 casos (%) y ventralmente en 2 (%). El tiempo de seguimiento mínimo fue de un año. Se evaluaron resultados subjetivos (satisfacción del paciente) y objetivos (Qmáx y RPM pre y postoperatorios) y complicaciones. Se consideró fracaso la necesidad de cualquier instrumentación postoperatoria.1.022 JCR (2014) Q4, 60/76 Urology & nephrologyUE

Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port

Introducción: La incontinencia urinaria de esfuerzo (IUE) es una secuela importante del tratamiento quirúrgico del cáncer de próstata. Se presenta la técnica quirúrgica y se evalúa efectividad y seguridad del sistema masculino transobturador ajustable (ATOMS®) con puerto escrotal premontado. Material y método: Estudio abierto prospectivo realizado en un hospital universitario. El objetivo principal fue cambio de situación basal tras ajuste en el recuento diario de compresas (pad-count) y su peso húmedo (pad-test). Los objetivos secundarios fueron evaluación de calidad de vida (ICIQ-SF e IIQ-7 basal y al ajuste), resultados percibidos por el paciente (PGI y GRA al año) y evaluación de complicaciones según Clavien-Dindo. Los valores numéricos se expresan en mediana + RIC. Resultados: Se analizan 60 pacientes consecutivos con seguimiento de 21+22meses. El pad-test basal fue 465+450 ml y pad-count 5+3 compresas/día. La IUE basal fue leve (11,6%), moderada (25%) y severa (63,3%). El tiempo operatorio fue 60+25 min, la estancia hospitalaria 1+0 días y la EVA de dolor en día-1 postoperatorio 0+1. El llenado total fue 16,5+7 ml y el número de rellenos 1+2. Pad-test y pad-count tras ajuste fueron 0+20 ml y 0+1, respectivamente (ambos p<0,0001 respecto a basal). La IUE desapareció (81,7%) o se mantuvo leve (11,7%), moderada (5%) y severa (1,6%). Se objetivó reducción en ICIQ-SF (p<0,0001) e IIQ-7 (p=0,0003). Tanto la continencia (p=0,002) como la satisfacción (p=0,03) resultaron peores en pacientes irradiados. Sucedieron complicaciones en 11 casos (18,6%), siendo 8(13,5%) grado I y 3(5,1%) grado III. La tasa de satisfacción con el tratamiento fue 91,7% y la percepción de mejoría global percibida por el paciente al año fue muy marcada (score PGI-I 1+1 y GRA 6+1). Conclusiones: El tratamiento de la IUE masculina con ATOMS® tercera generación es seguro y eficaz a corto plazo, incluso en pacientes con IUE severa. La tasa de pacientes secos tras el ajuste supera el 80% y la tasa de satisfacción el 90%. Los pacientes valoran muy positivamente este tratamiento.Introduction: Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. Material and method: An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. Results: We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450 mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25 min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7 mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20 mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). Conclusions: SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.Sin financiación1.136 JCR (2018) Q4, 68/80 Urology & Nephrology0.332 SJR (2018) Q3, 66/107 UrologyNo data IDR 2018UE