Prospective International Multicenter Pelvic Floor Study:Short-Term Follow-Up and Clinical Findings for Combined Pectopexy and Native Tissue Repair

Efforts to use traditional native tissue strategies and reduce the use of meshes have been made in several countries. Combining native tissue repair with sufficient mesh applied apical repair might provide a means of effective treatment. The study group did perform and publish a randomized trial focusing on the combination of traditional native tissue repair with pectopexy or sacrocolpopexy and observed no severe or hitherto unknown risks for patients (Noé G.K. J Endourol 2015;29(2):210–215). The short-term follow-up of this international multicenter study carried out now is presented in this article. Material and Methods: Eleven clinics and 13 surgeons in four European counties participated in the trial. In order to ensure a standardized approach and obtain comparable data, all surgeons were obliged to follow a standardized approach for pectopexy, focusing on the area of fixation and the use of a prefabricated mesh (PVDF PRP 3 × 15 Dynamesh). The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. Colposuspension or TVT were used for the treatment of incontinence. Data were collected independently for 14 months on a secured server; 501 surgeries were registered and evaluated. Two hundred and sixty-four patients out of 479 (55.1%) returned for the physical examination and interview after 12–18 months. Main Outcome and Results: The mean duration of follow-up was 15 months. The overall success of apical repair was rated positively by 96.9%, and the satisfaction score was rated positively by 95.5%. A positive general recommendation was expressed by 95.1% of patients. Pelvic pressure was reduced in 95.2%, pain in 98.0%, and urgency in 86.0% of patients. No major complications, mesh exposure, or mesh complication occurred during the follow-up period. Conclusion: In clinical routine, pectopexy and concomitant surgery, mainly using native tissue approaches, resulted in high satisfaction rates and favorable clinical findings. The procedure may also be recommended for use by general urogynecological practitioners with experience in laparoscopy

Polimorfismos de la metaloproteasa de matriz 9 (MMP-9) en el diagnóstico del carcinoma prostático. Experiencia preliminar

Abstract Polymorphisms Q279R, P574R and -1562 C/T of matrix metalloproteinase-9 (MMP-9) gene have been linked with the risk of cancer and with tumoral aggressiveness in various types of cancer. So far there are no studies in the literature analysing the link between polymorphisms Q279R, P574R and -1562 C/T of MMP-9 and prostate cancer. OBJECTIVES: To establish the presence of the MMP-9's gene polymorphisms (Q279R, P574R and -1562 C/T)in relation to results of prostate biopsy, PSA values and Gleason score. METHODS: Hospital cohort of 100 patients with suspected prostate cancer, subjected to prostate biopsy, in whom the MMP-9 polymorphisms (Q279R, P574R and -1562 C/T) were analysed using the PCR-RLFP technique. RESULTS: No statistically significant differences were found in the presence of the Q279R, P574R and -1562 C/T polymorphisms in terms of prostate biopsy results (p = 0.264, p = 0.406, p = 0.860, respectively), or Gleason score (p = 0.373, p = 0.367, p = 0.476). Comparing the genotypes of the Q279R, P574R and -1562 C/T polymorphisms resulting from prostate biopsy, using subgroups according to PSA values, no statistically significant differences were found either (p = 0.332 y p = 0.393, respectively ). However, statistically significant differences were found when comparing the genotypes of the -1562 C/T polymorphism of the MMP-9 in patients showing positive biopsy for malignant tumour in comparison to a negative biopsy for a malignant tumour in the subgroup of patients with PSA 10 ng/ml (p=0.049). The joint analysis of the three MMP-9 polymorphisms, using logistical regression study did not reveal any statistically significant differences as far as the risk of developing prostate cancer is concerned based on the presence of the Q279R, P574R and -1562 C/T polymorphisms. CONCLUSION: The Q279R, P574R and -1562 C/T polymorphisms are not linked with the aggressiveness in prostate cancer, neither they are linked to the risk of suffering prostate cance

Expresión de metaloproteasa de matriz 9 en el cáncer de próstata. Experiencia preliminar

Objetivo: Estudiar la validez de la metaloproteasa 9 (MMP-9) como marcador complementario al PSA en el diagnóstico y el pronóstico del carcinoma de próstata. Método: Estudio prospectivo estructurado como cohorte de base hospitalaria. Fueron incluidos 100 pacientes consecutivos a los que se iba a practicar una biopsia prostática. La determinación sérica de MMP-9 se realizó mediante inmunoensayo, y el análisis estadístico con el programa informático stata/SE 8.2. Resultados: 32 pacientes fueron diagnosticados de carcinoma prostático y el 52% de ellos con grado Gleason mayor o igual a 7. Los valores de MMP-9 sérica oscilaron entre 225,7 y 1932,3 nanogramos por mililitro, sin encontrar diferencias estadísticamente significativas entre los pacientes con histología benigna, maligna e incierta (p=0,429). Las diferencias se acercaron a la significación estadística en el subgrupo de pacientes con PSA 4-10 ng/ml (p=0,058) y en el subgrupo PSA libre/total menor de 15% se observaron diferencias significativas (p=0,037). No se encontró relación entre el grado Gleason y el nivel de MMP-9 (p=0,739). Los niveles de PSA y MMP-9 demostraron ser independientes (Coeficiente de correlación de Pearson -0,1). Conclusiones: No fue posible demostrar la eficacia de la MMP-9 para predecir el resultado de la biopsia. En el grupo de pacientes con elevaciones discretas del PSA (entre 4 y 10 ng/ml) todas las variables descriptivas fueron superiores en el grupo con histología maligna, sin alcanzar la significación estadística. Sí se alcanzó la significación cuando el cociente de PSA libre entre PSA total fue menor del 15%, pero este hallazgo no tiene relevancia en la práctica clínica, pues estos pacientes ya tienen indicación clara de biopsia. Tampoco se demuestra relación con el pronóstico al no existir diferencias de expresión de MMP-9 entre diferentes grados Gleaso