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Introduction To identify risk-predictive models for bladder-specific cancer mortality in patients undergoing radical cystectomy and assess their clinical utility and risk of bias. Methods Systematic review (CRD42021224626:PROSPERO) in Medline and EMBASE (from their creation until 31/10/2021) was screened to include articles focused on the development and internal validation of a predictive model of specific cancer mortality in patients undergoing radical cystectomy. CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias ASsessment Tool (PROBAST) were applied. Results Nineteen observational studies were included. The main predictors were sociodemographic variables, such as age (18 studies, 94.7%) and sex (17, 89.5% studies), tumour characteristics (TNM stage (18 studies, 94.7%), histological subtype/grade (15 studies, 78.9%), lymphovascular invasion (10 studies, 52.6%) and treatment with chemotherapy (13 studies, 68.4%). C-index values were presented in 14 studies. The overall risk of bias assessed using PROBAST led to 100% of studies being classified as high risk (the analysis domain was rated to be at high risk of bias in all the studies), and 52.6% showed low applicability. Only 5 studies (26.3%) included an external validation and 2 (10.5%) included a prospective study design. Conclusions Using clinical predictors to assess the risk of bladder-specific cancer mortality is a feasibility alternative. However, the studies showed a high risk of bias and their applicability is uncertain. Studies should improve the conducting and reporting, and subsequent external validation studies should be developed.

Sexuality is a component of great relevance in humans. Sexual disorders are a major public health problem representing a high prevalence in the general population. DSM-5 genito-pelvic pain/penetration disorder (GPPPD) includes dyspareunia and vaginismus (DSM-IV-TR). To assess the importance of research on these disorders in Spain, we evaluated the Spanish scientific publications of primary and community care. The objective was to quantify the magnitude of the publications of GPPPD in Spanish women in primary and community care. For this, we used the method of conducting a systematic review and meta-analysis of studies evaluating GPPPD. As main results, of the 551 items found, we selected 11 studies that met the inclusion criteria. In primary care in Spain, one in nine women has these disorders; the percentage of women with GPPPD in this study (raw data) was 11.23% (95% CI: 0-29%) (vaginismus 5%; penetration pain 8.33%; dyspareunia 16.45%). These percentages can differ of those from other countries, and they are at the top of the data of the European countries (9-11.9%). There is much variability in the studies found in the world with respect to the prevalence of these health problems.

Purpose This study aims to describe the incidence and severity of adverse events (AEs) following the mRNA-1273 SARS-CoV-2 vaccine and explore the risk perception of COVID-19 in allogeneic hematopoietic stem cell transplant (HCT) recipients. Methods We performed a single-center prospective study including recently transplanted (< 2 years post-infusion) allogeneic HCT recipients. AEs were assessed through phone calls and graded from 0 to 4, while COVID-19 risk perception was measured using the Brief Illness Perception Questionnaire (BIP-Q5). Results Fifty-four HCT recipients were evaluated. Incidence and grades of AE (94.4% and 85.2% after the first and second dose, respectively) were similar to those described in the general population. The most common AE was pain at the site of injection. Three patients (5.6%) developed a grade >= 3 AE. Vaccine-related cytopenias and graft-versus-host disease flares were not observed. Female sex (OR 3.94, 95% CI 1.14-13.58, p = 0.03) and time since HCT (per month since HCT: OR 1.09, 95% CI 1.01-1.18, p = 0.04) were associated with the occurrence of any AE. The patients' risk perception level of COVID-19 decreased over time (p < 0.05). Conclusion Our study confirms that the mRNA-1273 SARS-CoV-2 vaccine is safe in recent HCT recipients and suggests that the perceived risk of COVID-19 decreases over time.

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.

Aims To establish the long-term efficacy and safety of bladder augmentation in spina bifida patients. Material and Methods Sixteen patients were operated on using the Bramble technique. Preoperative and postoperative evaluation included clinical history, blood tests, urine cultures, cystography, pyelography, ultrasound, and filling cystometry. In the final review a standardized quality of life questionnaire was applied. Results Median follow-up was 20 years (15-26). Kidney function was stabilized except for one case that required a kidney transplant. Hydronephrosis disappeared or improved (p = 0.03). Vesicoureteral reflux grades I-II was cured without reimplantation and grades III-IV responded better with reimplantation than without (p = 0.03). Quality of life improved in all patients, with all stating they would undergo the procedure again. After surgery, 94% of the patients exhibited diurnal continence but 25% exhibited nocturnal incontinence. Pressure at capacity decreased and bladder capacity increased (p < 0.001). One patient presented ureteral fistula with another presenting hemorrhage. Both required immediate surgical review. Late complications included urinary sphincter cuff erosion, renal lithiasis, four instances of bladder lithiasis and repeated pyelonephritis in one 24-year-old patient. All required surgery. The mean of urinary infections fell, from 2.5 per year (0.7) to 1 (0.5) (p = 0.03). Conclusion Augmentation cystoplasty (AC) maintains its efficacy and improves quality of life in the long term. However, serious surgical complications can ensue, along with minor or major subsequent complications. This should be considered before surgery and makes lifelong monitoring of patients necessary.

Introduction: Priapism is a prolonged erection that lasts longer than four hours. It is a rarepathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children peryear. The diagnostic sequence includes clinical history, physical examination and penile Dopplerultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish thedifferential diagnosis between high-flow and low-flow priapism. The treatment of choice inpediatric age is not well defined. Patients and methods: Multicentric, retrospective and descriptive study including patientsunder 14 years with high-flow priapism between 2010 and 2020. Literature review. Results: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. Conclusions: High-flow priapism is a very rare entity in pediatric age; therefore, knowing theproper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough fordiagnosis in most cases and allows obviating the use of blood gas analysis. Children should beinitially treated with a conservative management, reserving embolization for refractory cases. (c) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Objective: To determine whether the Thiel cadaveric model is better and more realistic than other surgical simulation techniques for learning pelvic floor and perineal surgical procedures according to the opinions of urogynecologists and surgeons participating in international postgraduate pelvic floor surgery courses using cadavers embalmed by the Thiel method. Study Design: An observational prospective study was performed in urogynecologists and surgeons attending international postgraduate pelvic floor and perineal surgery courses using cadavers embalmed by the Thiel method. A survey was completed by the participants after finishing the course. Based on the answers collected, we analyzed the differences, including in the satisfaction degree and teaching level for each surgical procedure, between different surgical simulation models that the participants had already used and the Thiel simulation method employed. Results: The students recognized that Thiel cadavers present more similarities to patients than other simulation methods. The Thiel cadaveric method was considered by most responders to be the best for the simulation of surgical procedures on the pelvic floor and perineum. Most of the surgeons surveyed recommended conducting these courses with Thiel cadavers for different colleagues in other specialties as a reliable simulation method for training for difficult surgical procedures. Conclusions: Participants in the course on pelvic floor surgery in Thiel cadavers recognized that this is the most realistic model for surgical simulation and the best way to gain confidence, self-determination and precise surgical skills for performing pelvic floor and perineal surgery. (C) 2020 Elsevier B.V. All rights reserved.

Aims To evaluate the usefulness of simultaneous laparoscopic assistance to improve understanding of the nonvisible surgical steps in Thiel-embalmed cadaver models for training in vaginal surgery using vaginal mesh kits and to evaluate opinions of this surgical learning procedure in comparison with other learning models. Methods Recording of anterior compartment prolapse repair with vaginal mesh kits using an external camera simultaneously with laparoscopic vision during the execution of the procedure at the dissection room. To measure the usefulness of this procedure, we designed an anonymous online survey that was made available to program participants via a computer application (a link to video 1 and the survey is available at encuesta@um.es). Results After watching the video, 97.2% of participants agreed that laparoscopic vision combined with the vaginal approach was useful in learning this surgical technique, and 95.8% agreed they had learned details of the surgical anatomy of the pelvis. All participants agreed that it should be mandatory to train in these techniques with cadavers before practice with live patients. In addition, 84.7% responded that the cadaveric model was superior to animal and other types of models. Conclusion Laparoscopic inspection of the procedure performed with the vaginal approach allowed a better understanding of the surgical technique by making "visible" the anatomical structures that were commonly only palpated. Use of the cadaverous model was considered most efficient for training in this surgical technique.

Introduction: Prostate-specific antigen (PSA) is the main tool for early detection, risk stratification and monitoring of prostate cancer (PCa). However, there are controversies about the use ofPSAas a population screening test because of the high potential for overdiagnosis and overtreatment associated. The net benefit of screening is unclear and according to the available recommendations, it should be offered to well-informedmen with an adequate health status and a life-expectancy of at least 10 years or tomen at elevated risk of having PCa. In addition, the factors that influence test results are unclear, as is impact of false positive or negative results on patient health. Our objective is to assess the clinical and analytical factors associated with the presence of false positive and false negative results and the diagnostic/therapeutic process followed by these patients. Methods and analysis: A prospective observational cohort study will be carried out. We will include a cohort of patients with a positive PSA result (1.081 patients) and a sample of patients with negative results (572 patients); both will be followed for 2 years by reviewingmedical records to assess the variables associated with these results, as well as characteristics of patient management after a positive PSA value. We will include those patients with a PSA determination from2 hospitals in the Valencian Community. Patients who have been previously diagnosed with prostate cancer or who are being followed for previous high PSA values will be excluded. Discussion: The study will estimate the frequency of false positive and false negative PSA results in routine clinical practice, and allow us to quantify the potential harm caused. Study registration: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03978299, June 7, 2019.

Background: Female urethral stricture is a rare condition. Different types of urethroplasty have been described. However, high quality studies are sparse. The most common technique used-the Blandy's technique-has resulted in our cases in a retrusive meatus and an inward urinary stream. Objective: To show the efficacy and safety of an alternative vaginal wall flap urethroplasty. Design, setting, and participants: A cross-sectional observational study was undertaken in a single University Hospital. Nine female patients previously diagnosed with urethral stricture at our institution underwent open surgery from 1993 to 2015. They were contacted and agreed to undergo a medical examination. Surgical procedure: A ventral lateral-based anterior vaginal wall flap urethroplasty inspired by the Orandi technique for male urethroplasty was performed. Measurements: A chart review was performed. Results and limitations: The mean age was 56 yr (41-78 yr). The mean follow-up was 80.7 mo (12-198). All patients had relief of symptoms. The meatus of all patients stayed in an orthotopic position without any impact on the direction of the urinary stream. The average caliber of the urethra increased from 10.8 Fr (6-18 Fr) to >= 20 Fr. Peak flow improved from a mean of 6.8 ml/s (3-11 ml/s) to 21 ml/s (14-35 ml/s). No patient developed stricture recurrence or de novo stress urinary incontinence. There were no other immediate or delayed complications. All patients achieved a better score on the Patient Global Impression of Improvement questionnaire. Conclusions: Our study, with the same limitations that the few studies published in this field had, that is the few patients included, demonstrates that lateral anterior vaginal wall flap urethroplasty is an effective technique, offering durable results without apparent complications. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.