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

La depresión y la ansiedad se han asociado con síntomas del tracto urinario inferior (STUI) en varios estudios. En nuestra población la prevalencia de STUI es alta, por lo que es fundamental y objetivo de este estudio determinar la asociación entre ansiedad, depresión y STUI en una gran población hispana. Métodos Se realizó un subanálisis de un estudio poblacional transversal para estimar la prevalencia de STUI en la población colombiana (estudio COBaLT) (Plata et al. en Neurourol Urodyn 38:200–207, 2018). Para evaluar la salud mental se utilizó la Escala Hospitalaria de Ansiedad y Depresión (HADS). Se llevó a cabo una regresión logística para estimar la asociación de la depresión y la ansiedad con diferentes STUI. Las variables que resultaron estadísticamente significativas ( p  < 0,05) se incluyeron en un modelo multivariado. Resultados Se evaluaron un total de 1060 personas. La prevalencia de ansiedad en mujeres y hombres fue del 17,1% y 6,7%, respectivamente. La depresión en mujeres y hombres fue del 20,1% y 9,4%, respectivamente. Se encontró asociación entre ansiedad y vejiga hiperactiva (VH) sin incontinencia urinaria (OR = 3,7) y STUI moderados o graves en hombres (OR = 3,8). En las mujeres, la ansiedad se asoció con nicturia (OR = 4,2) e incontinencia urinaria de esfuerzo (OR = 2,4). Para la depresión, se encontró una asociación entre disfunción sexual (OR = 4,3) y STUI moderados o graves (OR = 4,0) en hombres; mientras que en las mujeres se asoció con la incontinencia urinaria de esfuerzo (OR = 2,3), la sensación de vaciado incompleto (OR = 1,7) y la disminución de la frecuencia de la actividad sexual (OR = 1,8). Conclusiones Las asociaciones encontradas son consistentes con otros informes. Es fundamental indagar sobre posibles síntomas relacionados con la esfera mental en la consulta de urología para realizar las derivaciones adecuadas y el manejo posterior.Q1Q1Depression 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.Revista Internacional - IndexadaS

Eficacia del consumo de licopenos en la prevención primaria de cáncer de próstata : una revisión sistemática de la literatura y meta-análisis

OBJETIVO: Evaluar la eficacia del consumo de licopenos en la prevención primaria de CaP. MÉTODOS: Se realizó una búsqueda sistemática de la literatura en marzo de 2015 y se revisaron artículos publicados entre 1990-2015. Se utilizaron los términos de búsqueda: prostate cancer, prostatic neoplasm, lycopene, prevention, efficacy and effectiveness (MeSH). Se revisaron artículos de investigación en humanos, en inglés y cuyo texto completo fuera accesible. Los tipos de estudio fueron: ensayos clínicos, cohortes y casos y controles. Se encontraron 343 artículos, de los cuales se incluyeron 27 en la revisión sistemática. Después de que estos últimos fueron analizados en profundidad, se incluyeron 23 en el meta-análisis agrupando las razones de probabilidad (OR) y riesgos relativos (RR) de estudios de casos y controles y cohortes, respectivamente, y sus intervalos de confianza (IC 95%), utilizando modelos de efectos aleatorios con Review Manager 5.2. RESULTADOS: De los 27 artículos incluidos en la revisión sistemática, 22 fueron de casos y controles y 5 de cohortes. Para los estudios de casos y controles, el total de pacientes con CaP involucrados fue de 13.999; el total de controles fue 22.028. Los estudios de cohortes contaron con un total de 187.417 participantes y se diagnosticó CaP en 8.619 de estos. El meta-análisis determinó una razón de probabilidad (OR) de CaP de 0,94 (IC 95% 0,89-1,00) y riesgo relativo (RR) de 0,90 (0,85-0,95) en relación al consumo de licopenos y/o tomates crudos o cocidos. CONCLUSIONES: Aunque nuestro estudio encontró que existe una asociación inversa estadísticamente significativa entre la ingesta de licopenos y CaP, la magnitud de esta asociación es débil y proviene de estudios observacionales únicamente, lo cual no permite recomendar su uso como estándar de práctica clínica. Se requieren ensayos clínicos aleatorizados de alta calidad que permitan esclarecer la evidencia actual.Q4Q3Artículo de revisión187-197OBJECTIVE: To evaluate the efficacy of lycopene intake in primary prevention of prostate cancer (PCa). METHODS: A systematic search of the literature was conducted in March 2015 and the articles published between the years 1990-2015 were reviewed. The following search terms were used: prostate cancer, prostatic neoplasm, lycopene, prevention, effectiveness and efficacy (MeSH). Publications including research in humans, written in English and whose texts were accessible were reviewed. The types of studies included were: clinical trials, cohort and case-control studies. We found 343 articles; of these, 27 were included in the systematic review. After the latter were rigorously analyzed, 23 were included in the meta-analysis using the pooled odds ratios (OR) and risk ratios (RR) of case-control and cohort studies, respectively, and their confidence intervals (95% CI), using random-effects models with Review Manager 5.2. RESULTS: Out of the 27 articles included in the systematic review, 22 were case-control and 5 were cohort studies. For the case-control studies, the total number of patients with PCa was 13,999 and the total number of controls 22,028. Cohort studies included 187,417 patients and PCa was diagnosed in 8,619 of these. The metaanalysis determined an OR = 0.94 (IC 95% 0.89-1.00) and RR = 0.9 (IC 95% 0.85-0.95) of PCa related with lycopene and/or raw or cooked tomatoes intake. CONCLUSIONS: Although our study found that there is a statistically significant inverse association between lycopene intake and PCa, the magnitude of this association is weak and comes solely from observational studies, which do not allow recommending its use as a standard of practice. High-quality randomized clinical trials are required to clarify current evidence

Is the development of clinical practice guidelines for non-neurogenic overactive bladder trustworthy? A critical appraisal using the appraisal of Guidelines, Research and Evaluation (AGREE) II Instrument

Q1Q1921-92

Evaluation of the efficacy and safety of laser versus cold knife urethrotomy in the management of patients with urethral strictures : a systematic review and meta-analysis of randomized clinical trials

Q4Q2Artículo original453-459Introduction: Urethral strictures generate great morbidity. Two procedures have been described for their management - laser and cold knife techniques - which are still widely used. We aim to assess the safety and efficacy of laser versus cold knife urethrotomy. Materials and methods: We conducted a systematic search of the literature using MEDLINE, EMBASE, LILACS and Cochrane databases and gray literature. Primary outcomes were urethral stricture recurrence, time-to-recurrence and complication rate. Secondary outcomes were quality of life and maximum urinary flow rate (Qmax). Data analysis was obtained using Review Manager 5.2. Results: Out of 137 publications, 4 articles were included in the meta-analysis. At 3 months, the recurrence rate was similar in both groups (0.55, 95% CI 0.18-1.66), but at 6 and 12 months, it was significantly lower in the laser urethrotomy group (0.39, 95% CI 0.19-0.81 and 0.44, 95% CI 0.26-0.75). The analysis of Qmax at 6 months post-intervention suggested a greater improvement in the laser urethrotomy group. A qualitative analysis showed that complications in both procedures were minor and infrequent. Conclusions: Laser urethrotomy has a lower recurrence rate at 6 and 12 months compared to cold knife urethrotomy. Complications in both procedures are minor and infrequent. Results should be interpreted cautiously, since they were evaluated only for a short term

Photovaporization of the prostate with GreenLight™ laser 180 w xps versus transurethral resection of the prostate with monopolar energy for the treatment of benign prostatic enlargement : a cost-utility analysis from a healthcare perspective

Q2Q1861-866Purpose: To assess the cost-utility of the photovaporization of the prostate (PVP) with GreenLight™ laser 180 W XPS compared to transurethral resection of the prostate with monopolar energy (M-TURP) for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) from a healthcare perspective in Colombia. Methods: We designed a Markov model to compare four health states following treatment with either PVP or M-TURP to estimate expected costs and outcomes. We used the results of the only randomized clinical trial published to date comparing PVP versus M-TURP to estimate surgical outcomes, complications, re-operation and re-intervention rates. Time horizon was defined at 2 years with four cycles of 6 months each. Resource-use estimation involved a random selection of clinical records from a local institution and cost list from public healthcare system. Costs were obtained in Colombian pesos and converted to US dollars. Threshold was defined at three-times the Colombian gross domestic product (GDP) per capita. Quality-adjusted-life-years (QALYs) were used based on the utilities of the available literature. Uncertainty was analyzed with deterministic and probabilistic models using a Monte Carlo simulation. Results: Patients who underwent PVP gained 1.81 QALYs compared to 1.59 with M-TURP. Costs were US$6797.98 and US$7777.59 for M-TURP and PVP, respectively. Incremental cost-effectiveness ratio was US$4452.81 per QALY, favoring PVP as a cost-effective alternative in our context. Conclusions: In Colombia, with current prices, PVP is cost-effective when compared to M-TURP for LUTS due to BPE for a 2-year time horizon

Asociación entre obesidad, prostatectomía radical y pronóstico oncológico : un enigma que sigue vigente

OBJETIVO: Establecer las asociaciones entre hallazgos intraoperatorios y posoperatorios, así como la evolución oncológica de pacientes sometidos a prostatectomía radical según su índice de masa corporal (IMC). MÉTODOS: Estudio observacional analítico retrospectivo; se revisaron las historias clínicas de 272 pacientes sometidos a prostatectomía radical retropúbica y laparoscópica entre 2012-2014. Se realizó un análisis bivariado para estudiar asociaciones entre IMC y el procedimiento quirúrgico, sus complicaciones, hallazgos patológicos, y evolución oncológica. Se realizó un análisis multivariado para determinar si existía o no una relación independiente entre hallazgos patológicos posquirúrgicos e IMC, ajustando por edad, hipertensión arterial y diabetes mellitus. RESULTADOS: El total de pacientes sometidos a prostatectomía radical fue de 272: 98 (36,0%) tenían IMC normal, 142 (52,2%) sobrepeso y 32 (11,8%) obesidad. La mediana de edad fue de 61 (rango intercuartil (RIQ)=56-66) años. No se encontraron diferencias estadísticamente significativas en las características preoperatorias ni posoperatorias al estratificar por IMC. El tiempo quirúrgico fue mayor (176 minutos, RIQ=165,0-195,5) en los pacientes con obesidad; sin embargo, la diferencia no fue estadísticamente significativa (p=0,18). No se reportaron complicaciones intraoperatorias (lesión rectal, vascular o del nervio obturador). El análisis multivariado determinó que la edad, hipertensión arterial y diabetes mellitus no representaron factores modificadores del efecto. CONCLUSIONES: Nuestro estudio sugiere que no hay diferencias en hallazgos intraoperatorios y posoperatorios al estratificar por IMC. Este estudio representa un punto de partida para futuras investigaciones en nuestra población con miras a definir el impacto del IMC en el CaP y su manejo.Q4Q3517-52

Effectiveness of adjustable slings (Remeex system™) in women withstress urinary incontinence due to intrinsic sphincter deficiency

Q1Q3e1506–e1507Intrinsic sphincter deficiency (ISD) is a complex entity that urologistsare more frequently facing given a growing life expectancy and failure rates inherent to any treatmentmodality. Its diagnosis is based on clinical and urodynamic parameters. Pubovaginal sling has beenconsidered the standard of treatment for ISD, but strong evidence supporting its effectiveness is lackingand there are concerns regarding its morbidity. Adjustable slings appear as a safe and effective option.Our aim is to report our experience with adjustable sling treatment for SUI due to ISD