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(1) Background: Providing the patient with the health care they need in a personalized and appropriate manner and without adverse effects (AEs) is a part of quality of care and patient safety. The aim of this applied research project was the assessment of AEs as a clinical risk in patients with high social vulnerability such as persons with intellectual and developmental disabilities (PwIDD). (2) Methods: A retrospective epidemiological cohort study was performed on exposed and unexposed groups (the control group) in order to estimate the incidence of AEs in PwIDDs and assess their importance for this category of patients. (3) Results: AEs were observed with a frequency of 30.4% (95% CI) in the PwIDD exposed group, with significant differences to the unexposed group (p = 0.009). No differences were observed with regards to gender. Age was as a marker of care risk, with the highest incidence of AEs in the group of 60–69 years. (4) Conclusions: PwIDDs have a high risk of suffering AEs while receiving health care assistance due to their high social and clinical vulnerability. Health care practitioners must therefore be aware of these results and keep these observations in mind in order to carry out personalized, preventive, competent, effective, and safe medical care.

(a) To correlate the clinical with the urodynamic diagnosis in a series of patients with UUI (urgency urinary incontinence) and SUI (stress urinary incontinence); (b) establish age, clinical and urodynamic differences; and (c) demonstrate the effectiveness of individualized rehabilitation treatment based on the clinical-urodynamic diagnosis in patients with SUI and UUI in the daily clinical practice of a third-level rehabilitation service. Retrospective study of 60 patients with SUI and UUI. Urodynamic study: (a) free flowmetry; (b) filling cystomanometry; (c) pressure-flow study. Outcome variables: daytime (DUF) and nighttime (NUF) urinary frequency, strength of the pelvic floor muscles (PFM) measured by manometry (maximum and mean pressure), and use of absorbents/day. Rehabilitation treatment: (a) pelvic floor muscle training (PFMT); (b) biofeedback (BFB), transcutaneous neuromodulation of the posterior tibial nerve (TTNM). Age, clinical, and urodynamic differences have been observed between patients with UUI versus SUI. UUI is more frequent in older patients (UUI 67.3 ± 10.19 years vs SUI 58.6 ± 8.54 years), p = 0.0028. Patients with UUI, when compared with patients with SUI, present more episodes of DUF (7.7 ± 5.1 vs 5.5 ± 3.99) and NUF (2.51 ± 1.67 vs 1.46 ± 1.42). Patients with SUI use more absorbents/day than patients with UUI (2.7 ± 1.53 vs 1.37 ± 1.5), p = 0.0243. The urodynamic study (UDS) confirmed the clinical diagnosis in UUI in 64.7%, while in SUI, it was only confirmed in 35.1%. In the urodynamic analysis (free flowmetry), patients with UUI have smaller bladders than patients with SUI (voiding volume in UUI 275.8 ± 178.95 vs 411.03 ± 203.62 in SUI), p = 0.083. The maximum flow (Qmax) is higher in patients with SUI compared to UUI (19.6 ± 7.07 vs 16.06 ± 8.54), p = 0.0836. In filling cystomanometry, the bladders of patients with UUI are smaller than those with SUI (bladder capacity UUI 266.3 ± 52.76 vs 308.6 ± 49.72 ml in SUI), p = 0.023. In SUI, the BFB/PFMT significantly improved DUF, NUF, PFM pressure, and absorbent use. In UUI, the BFB plus TTNM improved DUF, NUF, and the maximum and mean PFM pressure with statistical difference, while the use of absorbents decreased with a tendency to significance. There are age, clinical, manometric, and urodynamic differences in patients with UUI when compared with patients with SUI. UUI occurs in older patients; they present a greater number of daytime and nocturnal urinary frequency episodes and use fewer absorbents than patients with SUI. Patients with UUI evacuate a smaller urine volume have a lower peak flow (in flowmetry) and a lower bladder capacity (in cystomanometry) than patients with SUI. The rehabilitation treatment proposed in daily clinical practice (PFMT/BFB with or without TTNM improves SUI and UUI). In this study, the UDS has shown a greater clinical-urodynamic correlation in UUI than in SUI.

Introduction Prostate cancer (PCa) is the second most common male cancer in the world. Its incidence is estimated to grow to 1.7 million new cases and 499,000 new deaths by 2030. Treatment of OCPC can affect patients physically and mentally, as well as their close relationships and their job or career, which conditions health-related quality of life (QoL). Objective Evaluate the impact on QoL attributable to the treatment for Organ Confined Prostate Cancer (OCPC). Materials and methods Prospective multicenter observational study of 406 patients with OCPC treated from January 2015 to June 2018. The sample was divided into four study groups, according to the type of treatment: radical prostatectomy (RP) (GA), external radiotherapy (ERT) (GB), brachytherapy (BT) (GC) and other treatments different from monotherapy with RP, ERT or BT (GD). Results The age in GC was lower, the mean Prostate Specific Antigen (PSA) of all patients was 8.13 ng/ml, the group with the highest mean PSA was GB with a mean of 10.43 ng/dL, the mean Tumor Stage (TNM) was 3.82, and GD had the lowest post treatment quality of life. Conclusion OCPC treatment affects QoL. Curative monotherapies, specifically RP and BT, have less effect on QoL than external radiotherapy or other therapeutic alternatives. Urinary incontinence and fistulas secondary to OCPC have the highest impact on QOL impairment. The internationally validated SF 36 questionnaire is a useful cross-sectional measure of QOL to compare the impact of OCPC treatment modalities.

Resumen Introduccion El cancer de prostata (CP) es el segundo cancer mas frecuente del mundo y en los varones. Se estima que la incidencia crezca a 1,7 millones de casos nuevos y 499.000 nuevas muertes en 2030. El tratamiento del cancer de prostata organoconfinado (CPOC) puede afectar a un individuo tanto fisica como mentalmente, asi como sus relaciones cercanas y su trabajo o vocacion, lo cual condiciona la calidad de vida (CV) relacionada con la salud. Objetivo Conocer el impacto en la CV atribuible al tratamiento del CPOC. Materiales y metodos Es un estudio observacional multicentrico de caracter prospectivo de 406 pacientes con CPOC tratados desde enero del ano 2015 hasta junio del 2018. La muestra se dividio en cuatro grupos de estudio (GA, GB, GC y GD), correspondientes a los distintos metodos de abordaje quirurgico: prostatectomia radical (PR), radioterapia externa (RTE), braquiterapia (BT) y diferente a monoterapia con alguno de los otros, respectivamente. Resultados La edad en el GC fue inferior, la media del antigeno prostatico especifico (PSA, prostatic specific antigen) de todos los pacientes fue 8,13 ng/ml, el grupo de mayor media de PSA fue el GB con 10,43 ng/dL, la media del estadio tumoral (TNM,) fue 3,82, la CV postratamiento en GD fue inferior respecto a los demas grupos. Conclusion El tratamiento del CPOC afecta la CV La monoterapia curativa, concretamente la PR y la BT, afectan menos a la CV que la radioterapia externa u otras alternativas terapeuticas. La incontinencia urinaria y las fistulas secundarias al tratamiento del CPOC son las que producen mas deterioro en la CV. El cuestionario SF 36 validado internacionalmente es una medida transversal de la CV, util para comparar el impacto de los tratamientos del CPOC.

Resumen Introduccion Se analiza la influencia del tabaco en el espectro microbiologico, patron de resistencia-sensibilidad y evolucion en pacientes con infeccion de orina de repeticion (ITUR). Evaluacion del efecto de vacuna bacteriana polivalente en la prevencion de las ITUR y el estado como fumador. Material y metodos Estudio retrospectivo multicentrico de 855 mujeres con ITUR tratadas con pauta antibiotica supresiva o vacuna bacteriana entre 2009 y 2013. Grupo A (GA): Antibiotico (n = 495); Subgrupos: GA1 no fumadora (n = 417), GA2 fumadora (n = 78). Grupo B (GB): Vacuna (n = 360); Subgrupos: GB1 no fumadora (n = 263), GB2 fumadora (n = 97). Variables: edad, ITU pre-tratamiento, tiempo libre de enfermedad (TLE), especie microbiana, sensibilidad y resistencia. Seguimiento a 3, 6 y 12 meses con cultivo y cuestionario SF-36. Resultados Edad media 56,51 anos (18-75), similar entre grupos (p = 0,2257). Sin diferencia en numero de ITU pre-tratamiento (p = 0,1329) ni en distribucion del espectro bacteriano (p = 0,7471). El TLE fue superior en los subgrupos B respecto a los correspondientes A. Urocultivos en GA1: E. coli 62,71% con el 8,10% resistencia (33% quinolonas; 33% cotrimoxazol; 33% quinolonas + cotrimoxazol); en GA2 E. coli 61,53% con 75% resistencia (16,66% quinolonas; 33,33% quinolonas + cotrimoxazol; 16,66% amoxicilina/acido clavulanico; 16,66% eritromicina + fosfomicina + clindamicina) (p = 0,0133). En GA no hubo diferencias entre pacientes tratadas con cotrimoxazol y nitrofurantoina (p = 0,8724). Urocultivos en GB1: E. coli 47,36% con el 22,22% resistencias (5,55% ciprofloxacino; 5,55% cotrimoxazol; 5,55% ciprofloxacino + cotrimoxazol; 5,55% amoxicilina/acido clavulanico). En GB2 E. coli 70,02% con el 61,90% resistencias (30,76% quinolonas; 30,76% cotrimoxazol; 30,76% quinolonas + cotrimoxazol; 17,69% amoxicilina/acido clavulanico) (p = 0,0144). Conclusiones En mujeres con habito tabaquico e ITUR es mas frecuente la aparicion de bacterias resistentes, lo cual podria influir en una peor respuesta a los tratamientos preventivos, ya sea antibioticos o vacuna.

Introduction The influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status. Material and methods Retrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n = 495). Subgroups: GA1 non-smoker (n = 417), GA2 smoker (n = 78). Group B (GB): Vaccine (n = 360). Subgroups: GB1 non-smoker (n = 263), GB2 smoker (n = 97). Variables: Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire. Results Mean age 56.51 years (18–75), similar between groups (p = 0.2257). No difference in the number of pretreatment UTIs (p = 0.1329) or in the distribution of the bacterial spectrum (p = 0.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (p = 0, 0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (p = 0.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin / clavulanic acid). In GB2 E.coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (p = 0,0144). Conclusions The development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.

Introduction and hypothesis In randomized clinical trials onabotulinumtoxinA was demonstrated to be an effective and well-tolerated treatment for overactive bladder (OAB) with urinary incontinence (UI). However, data reporting onabotulinumtoxinA use in everyday clinical practice are limited. Here, we present the results from a large, first-of-its-kind real-world study in patients with OAB. Methods This was a prospective, observational, multinational study (GRACE; ClinicalTrials.gov, NCT02161159) performed in four European countries. Patients (N = 504) aged ≥ 18 years with OAB inadequately managed with ≥ 1 anticholinergic received onabotulinumtoxinA per their physician’s normal clinical practice. Results Physicians primarily used rigid cystoscopes for onabotulinumtoxinA injection; anesthesia/analgesia was utilized during most treatment procedures. Significant reductions in UI episodes/day from baseline to weeks 1 and 12 were observed as well as in micturition, urgency, and nocturia episodes/day. These improvements in urinary symptoms corresponded to higher scores on the treatment benefit scale at week 12. The use of other OAB medications dropped from baseline to weeks 1 and 12 and was sustained to week 52, which paralleled a reduction in the number of incontinence products used during that time frame. Adverse reactions were reported in 2.6% of patients throughout the study. Conclusions In this real-world study, significant improvements in urinary symptoms were seen following onabotulinumtoxinA treatment as early as week 1 and sustained to at least week 12. This was accompanied by a reduced reliance upon incontinence products and reduction in concomitant OAB medication use. OnabotulinumtoxinA was well tolerated with no new safety signals.

Resumen Introduccion El cancer de prostata es la neoplasia visceral mas frecuente en el varon, y en Estados Unidos es la segunda con mayor mortalidad, por detras del cancer de pulmon y por delante del cancer colorrectal. La mortalidad por cancer prostatico se ha reducido en Estados Unidos, Austria, Reino Unido y Francia, mientras que la supervivencia a los 5 anos ha aumentado en Suecia, debido probablemente al incremento de la actividad diagnostica y a una mayor deteccion de tumores no mortales. La biopsia transrectal de prostata (BTRP) suele tener una baja tasa de complicaciones graves, con un numero de complicaciones menores no despreciable. La mortalidad asociada directamente a este procedimiento es baja y suele estar en el contexto de un shock septico. Las principales complicaciones derivadas de la biopsia de prostata pueden ser infecciosas (leves o graves) y no infecciosas (hemorragia en forma de hematuria, uretrorragia, rectorragia o hemospermia, retencion aguda de orina [RAO], dolor o reacciones vagales). Material y metodo El objetivo del estudio es comparar tres protocolos habituales de BTRP y su relacion con la aparicion de complicaciones. Estudio retrospectivo multicentrico observacional realizado en tres paises (Espana, Italia y Portugal). Se revisaron los historiales clinicos de 3.350 varones a los que se ha realizo una BTRP para investigar la existencia de cancer de prostata, con un control evolutivo minimo de 6 meses. Resultados La edad media fue de 65,50 anos, mediana 66, rango 43-79. En el analisis de subgrupos se aprecio que en los pacientes mas jovenes hubo mas RAO (p = 0,0000001). Asi mismo, nuestros resultados arrojaron que los pacientes mas jovenes presentaron mas dolor relacionado con el procedimiento (p = 0,0000001) que los de mayor edad. En cuanto al PSA, la media fue de 10,44, DE 7,73, mediana 8,15, rango 0,98-68,09. El indice de masa corporal (IMC) mas elevado no se asocio a mas infeccion (p = 0,000004). Al realizar el analisis multivariante se comprobo que las variables significativas en el grupo general fueron: edad (p = 0,0013), PSA (p = 0,0402), anestesia con infiltracion local (p = 0,0001) y profilaxis con esquema metronidazol + tobramicina + amoxicilina-acido clavulanico + gentamicina (p = 0,0001), presentando una distribucion normal con alto intervalo de confianza (95%) y correlacion significativa. La variable mas significativa para ninguna complicacion y para el dolor es la profilaxis (p = 0,0001), para el sangrado son la edad (p = 0,0013) y la profilaxis (p = 0,0001), para la infeccion son la edad (p = 0,0013), la profilaxis y el PSA (p = 0,0001), y para la RAO son la edad (p = 0,0013), la anestesia con infiltracion local, la profilaxis (p = 0,0001) y el PSA (p = 0,0402). Conclusiones La aplicacion de sedacion general tiene menos efectos secundarios y complicaciones relacionadas con el procedimiento de la biopsia transrectal de prostata respecto a la aplicacion de anestesia local transrectal. La eleccion del tipo de pauta de profilaxis antibiotica resulta determinante en la aparicion de complicaciones derivadas de la realizacion de la biopsia transrectal de prostata.

Introduction Prostate cancer is the most common visceral neoplasm in men and the second one in the United States with the highest mortality behind lung cancer and ahead of colorectal cancer. While prostate cancer mortality rates have been reduced in the United States, Austria, United Kingdom and France, 5-year survival rates have been incremented in Sweden, probably due to a higher diagnostic activity and non-lethal tumor detection. TRPB usually has low rates of serious complications, with a not negligible number of minor complications. Mortality directly associated with this procedure is low and usually related to septic shock. The main complications derived from prostate biopsy can be infectious (mild or severe) and non-infectious (hematuria consistent with hemorrhage, urethral bleeding, rectal bleeding or hemospermia, acute urinary retention, pain or vasovagal reactions). Material and method The objective of the study is to compare three usual TRPB protocols and their relationship with the incidence of complications. Retrospective multicenter observational study conducted in three countries (Spain, Italy and Portugal). We have reviewed the medical records of 3350 men who underwent TRPB to evaluate the existence of prostate cancer, with a minimum evolutionary control of 6 months. Results The mean age was 65,50 years, median 66, range 43–79. The subgroup analysis showed that younger patients had higher rates of acute urine retention (AUR) (p = .0000001). Likewise, our results revealed that younger patients presented more procedural pain (p = .0000001) than older patients. Regarding PSA, the mean value was 10.44, SD 7.73, median 8.15, range 0.98–68.09. A higher body mass index (BMI) was not associated with further infection (p = .000004). When performing the multivariate analysis, it was found that the significant variables in the general group were: age (p = .0013), PSA (p = .0402), local infiltration anesthesia (p = .0001) and prophylaxis with metronidazole + tobramycin + amoxicillin/clavulanic acid + gentamicin (p = .0001), presenting a normal distribution with high confidence interval (95%) and significant correlation. Prophylaxis is the most significant variable for no complications and pain (p = .0001), age (p = .0013) and prophylaxis (p = .0001) are for bleeding, age (p = .0013), prophylaxis and PSA (p = .0001) are for infection, and finally, age (p = .0013), anesthesia with local infiltration and prophylaxis (p = .0001) and PSA (p = .0402) are for AUR. Conclusions Sedation has fewer side effects and complications related to the transrectal prostate biopsy procedure with respect to transrectal local anesthesia. The choice of the antibiotic prophylaxis scheme is decisive in the onset of complications arising from the performance of a transrectal prostate biopsy.

Resumen Antecedentes y objetivo El tromboembolismo pulmonar es una de las causas mas comunes de muerte no quirurgica en pacientes sometidos a cirugia urologica abdominopelvica. Desde el inicio de la profilaxis para la enfermedad tromboembolica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente. Nuestro objetivo es analizar los predictores de la enfermedad tromboembolica, la variabilidad clinica en la utilizacion de la profilaxis farmacologica para esta enfermedad y los resultados de su aplicacion. Material y metodos Estudio retrospectivo multicentrico de 610 pacientes intervenidos mediante prostatectomia radical entre diciembre de 2013 y noviembre de 2014 en 7 hospitales generales de Espana, Italia y Portugal. Se clasifico a los pacientes segun sus caracteristicas basales en grupos de riesgo trombotico y grupos de riesgo hemorragico. Se evaluaron los eventos tromboembolicos venosos que se presentaron en los diferentes grupos. Resultados La edad media fue de 65,22 anos (48-78). El indice de masa corporal medio fue de 26,7 y la mediana del riesgo de ASA fue 2. En todos los pacientes se inicio la deambulacion en las primeras 24 h. En el 4,1% se utilizo compresion neumatica intermitente y en el 84,6%, profilaxis farmacologica con heparinas de bajo peso molecular. Solo en el 3,4% se utilizo la combinacion de profilaxis mecanica con la farmacologica. Se observo disminucion de la incidencia de eventos tromboembolicos en los pacientes que recibieron profilaxis farmacologica, con una reduccion absoluta del riesgo del 6,8%. No se objetivo aumento del riesgo hemorragico en los pacientes que recibieron profilaxis tromboembolica. Conclusiones En este estudio sobre pacientes sometidos a prostatectomia radical no hubo diferencia en las complicaciones hemorragicas derivadas del uso de profilaxis farmacologica para la enfermedad tromboembolica venosa. La profilaxis farmacologica reduce el riesgo de presentar un evento tromboembolico en pacientes sometidos a prostatectomia radical, si bien este riesgo no se asocia con la tecnica de abordaje.

Background and aim: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. Material and methods: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7 general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. Results: The average age was 65.22 years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24 hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. Conclusions: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique. © 2019 Elsevier España, S.L.U.

Urinary tract infections affect more than 50% of women. 25% derive from recurrent UTI (RUTI). It is not known the relationship between obstetric history and RUTI occurrence. Investigate the relationship between obstetric events and RUTI. Multicenter observational retrospective study. Groups: G.RUTI (n = 294): women with RUTI; G.NON.RUTI (n = 126): women without RUTI (treated and cured of renal cancer). Descriptive statistics, ANOVA analysis of variance (with Scheffe’s test for normal samples and Kruskal–Wallis for other distributions), Fisher's exact test, Pearson and Spearman correlation studies, and multivariate analysis multiple regression were used. Mean age 61.04 years (19–92), G.RUTI: 56.77 years SD 4.46 (19–85). G.NON.RUTI: 71 years SD 6.73 (25–92) (p = 0.0001). Obstetric history: Nulliparous G.RUTI: 20 (3.4%) G.NON.RUTI: 90 (71.42%) p 0.0001; Eutocic G.RUTI: 416 (70.74%) G.NON.RUTI: 30 (23.8%) p 0.0001. Dystocic G.RUTI: 58 (9.86%) G.NON.RUTI: 56 (44.44%) p 0.0001. G.RUTI abortion: 102 (17.34%) G.NON.RUTI: 30 (23.8%) p 0.1381. Hysterectomy without adnexectomy G.RUTI: 100 (17%) G.NON.RUTI: 18 (14.28%) p 0.5640. Hysterectomy with adnexectomy G.RUTI: 100 (17%) G.NON.RUTI: 66 (52.28%) p 0.0001. Nulliparity, dystocic delivery, and hysterectomy with adnexectomy are more frequent in women without RUTI, while eutocic births are more associated with RUTI. The most prevalent gynaecological-obstetric history in women with RUTI is eutocic delivery associated with a good health state.

INTRODUCTION AND OBJECTIVE:Women with recurrent urinary tract infections (rUTI) managed with antibiotics, suffer morbidity, while society is burdened with significant costs and the rising specter o...

Esta obra presenta un compendio resumido, claro y conciso, útil para los médicos no especializados en la materia, así como para los estudiantes en su formación de pregrado, sobre las patologías que afectan a los riñones, vías urinarias y aparato genital masculino para el ejercicio médico, puesto que, en lo que no corresponde a nuestra especialización, todos somos médicos generales. Esta obra aborda la Nefrología, la Urología y la Andrología con una concepción actual integradora e interdisciplinar, escrita por especialistas del campo de la Nefrología, la Urología y la Medicina de Familia. Todos ellos atienden diariamente enfermos y por ello han logrado verter en cada uno de los capítulos su proceder clínico habitual y la forma real de abordarlas junto a las actualizaciones de estos temas. Los editores de este manual somos profesores de la asignatura de Nefrología y de Urología en la Facultad de Medicina de Salamanca y en nuestra experiencia asistencial y docente hemos decidido elaborar este manual que se ciñe y glosa el contenido de la Nefrourología.

Objectives: To examine routine clinical practice in prostate health exams in asymptomatic males, and to identify which factors influence it. Materials and methods: Multicentre cross-sectional study in 1068 asymptomatic men aged 51-72. Groups: GA (n = 518): urban areas; GB (n = 550): rural areas. GA subgroups: GA1 (n = 364): prostate specific antigen (PSA) measured; GA2 (n = 154): PSA not measured. GB subgroups: GB1 (n = 346): PSA measured; GB2 (n = 204): PSA not measured. Variables: age, body mass index (BMI), digital rectal examination (DRE), PSA, prostate diagnosis, eating habits, physical exercise, marital status, number of children, occupational status, working hours, concomitant diseases and conditions, family history, attending physician. Descriptive statistics, Student’s t-test, chi-square test, Fisher’s exact test, ANOVA, Pearson and Spearman correlations were used. Results: Mean age 62.3 years (standard deviation: SD 5.12). Age in GA (60.89, SD 5.53) was lower than in GB (65.10, SD 5.03); age was higher in GA1 (61.22, SD 5.49) than in GA2 (59.04, SD 5.37). There was no difference in BMI between GA and GB. DRE: No exams were performed without prior PSA. No DRE were performed in GA; 11 (3.18%) were performed in GB1. GA1: 53 had PSA > 4 ng/mL, of whom 28 had no prostate disease, 17 had benign prostatic hyperplasia (BPH) and 8 had prostate cancer (PCa). PCa prevalence in men with PSA > 4 ng/mL was 9.24% in GA and 5.19% in GB. GA1: higher PSA was correlated with lower BMI, lower age, higher occupational status, and morning shifts; lower PSA was correlated with higher alcohol consumption; older patients worked shifts and consumed more alcohol; men with higher occupational status consumed less alcohol; more men were married in GA1 (n = 343, [94.23%]) than in GA2 (n = 100, [64.93%]). In GA1, there were more non-smoking men (n = 291, [80.11%]) and men who smoked < 5 cigarettes/day (n = 23, [6.37%]), 6-10 cigarettes/day (n = 15, [4.05%]), and 11.20 cigarettes/day (n = 27, [7.33%]) than in GA2. Older men and men with higher occupational status consumed fewer cigarettes. Men who worked rotating shifts smoked more. There was no relationship between smoking and PSA level. There were more university-educated men in GA (n = 309, [59.65%]) than in GB (n = 110, [20%]). More men did not take physical exercise in GA2 (n = 49, [31.81%]) than in GA1 (n = 75, [23.90%]). GB1: PSA > 4 ng/mL in 89 patients, of whom 32 had PCa; younger men had higher PSA. PSA was higher in GB1 (mean 18.95 ng/mL, SD 12.93) than in GA1 (mean 1.61, SD 1.63). Men in GB ate more fast food than GA, with no difference between GA1 and GA2, or between GB1 and GB2. In GA there was variability in approach among the attending physicians; in GB there was no variability among attending physicians. Conclusions: PSA tests are routinely given to 70.27% of asymptomatic men who consult a doctor in urban environments and to 62.09% of men in rural environments. In urban areas, the decision is affected by the preferences of the attending physician and by whether the patient is married. Occupational category, working hours and educational level have no impact. The decision to undergo a prostate health exam is associated with healthy habits such as physical exercise. No relationship was found between prostate disorders in asymptomatic men and high BMI, dyslipidemia or diet.

Background: Prostate cancer is currently the most common malignant tumour in men. Research on hormone therapy advances is necessary because, unfortunately, some tumours are not organ-confined. Objective: To review and analyse the current state of evidence regarding clinical trials with neoadjuvant or adjuvant hormone therapy for prostate cancer and determine the contribution of these trials to the clinical practice. Methods: A critical systematic analysis of hormone therapy clinical trials for prostate cancer in the American Society of Clinical Oncology (ASCO) 2022 official database was carried out and following the Cochrane Handbook for Systematic Reviews ofInterventions, a meta-analysis of random effects and standard mean descriptive statistics were performed. Groups: Group A = Neoadjuvant (n = 53) clinical trials and Group B = Adjuvant (n = 73) clinical hormone therapy. Variables: Phase of the trial, modality of primary treatment, investigated intervention or drug, molecular targets, trial length, sponsors and collaborators, country/countries of trial development, estimated enrolment, assignment of patients, intervention and masking model, trial purpose, related articles, the average number of studied patients, and conclusive results in clinical practice. Results: A total of 7.15% of the studies were in phase I, 14.28% between phase I-phase II, 52.38% in phase II, 0.23% between phase II-phase III and 23.80% in phase III. In the neoadjuvant group, enzalutamide and abiraterone were more frequently used, the androgen receptor was more frequently investigated as a molecular target. In the adjuvant group, abiraterone and prednisone were more frequently used and the androgen receptor and cytochrome P450 were more frequently investigated. The mean number of articles related to each trial was 5.26 (SD 3.15, 1–10). In 47.27% of the published articles directly related to the trials, the investigated treatment was superior to the standard treatment. Adjuvant investigated drugs showed more superiority (52.22%) than neoadjuvant drugs (41.33%). Conclusions: Only 41.33% of neoadjuvant studies and 52.22% of adjuvant studies show conclusive results of superiority for the proposed therapeutic strategies. About a third of related scientific publications that transfer the results to clinical practice did not report conclusive results for either neoadjuvant (32%) or adjuvant (37.78%) therapy.

Objective: To characterize the impact on kidney injury of recurrent urinary tract infections (RUTI) in the frail elderly. Methods: Prospective observational study in 200 frail elderly subjects for 1 year. Groups: GA ( n = 100): subjects without RUTI, GB ( n = 100): subjects with RUTI. Variables: age, concomitant diseases, glomerular filtration rate (GFR), urine neutrophil gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end (NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning (NAG-1) and the end (NAG-2) of the study, urine transforming growth factor-beta 1 (TGFβ-1). Descriptive statistics, Mann–Whitney test, Chi-squared test, Fisher’s exact test, and multivariate analysis were used. Results: Mean age was 84.33 (65–99) years old, with no difference between GA and GB. Mean NGAL-1 was 1.29 ng/ml (0.04–8). There was lower in GA than in GB. Mean NGAL-2 was 1.41 ng/ml (0.02–9.22). NGAL-2 was lower in GA than in GB. Mean NAG-1 was 0.38 UU.II/ml (0.01–2.63. NAG-1 in GA was lower than in GB. Mean NAG-2 was 0.44 UU.II/ml (0–3.41). NAG-2 was lower in GA compared with GB. Mean TGFβ-1 was 23.43 pg/ml (0.02–103.76). TGFβ-1 was lower in GA than GB. There were no differences in the presence of secondary diagnoses between GA and GB. NAG-2 and NGAL-1 were the most determining factors of renal function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1, followed by NAG-2. Conclusion: Frail elderly with RUTI have higher urinary levels of renal injury markers, specifically NGAL, NAG, and TGFβ-1, chronically in periods between urinary tract infection (UTI). Urinary markers of renal injury, specifically NGAL, NAG, and TGFβ-1, identify early deterioration of renal function, compared with serum creatinine, or albuminuria, in frail elderly with recurrent urinary infections.

Background: Anterior Lumbosacral Interbody Fusion (ALIF) is a type of back surgery with the advantages of direct access to the spinal interbody space and the potential lessening morbidity related to posterior approaches. Purpose: To describe a rare case of left ureteral lesion from ALIF surgery diagnosed 4 months after the procedure. Case description: A 37-year-old Caucasian man with a long history of painful post-traumatic spondylolisthesis and degenerative L5-S1 disc disease underwent a retroperitoneal anterior L5-S1 discectomy, insertion of an interbody tantallium cage, and placement of a pyramid titanium plate fixed with screws. Four months later, due to recurrent left lumbar pain and mild renal failure, a CT scan was performed showing left hydronephrosis with a homolateral urinoma of 17 cm in diameter. A left nephrostomy was placed and the nephrostography detected a filiform leakage at L5-S1 level in communication with the urinoma. The patient underwent laparoscopic urinoma drainage, distal left ureterectomy, and Casati-Boari flap ureterocystoneostomy with ureteral double J stent placement. The stent was held for six weeks and, 1 month later, the control ultrasound scan was negative for hydronephrosis, the creatinine level had normalized and the patient was asymptomatic. Conclusion: Ureteral lesion from ALIF surgery is a very rare event. Spinal surgeons should be more awareness regarding the susceptibility of ureteral injuries along with the clinical presentation, diagnostic work-up, and management options for this kind of complication.

Resumen Introduccion El objetivo fue conocer la reproductibilidad en modelo murino de tumores renales de diferentes estirpes histologicas que podria ser util para investigar la respuesta a farmacos diana. Material y metodos Desarrollo y analisis del modelo in vivo : xenoinjerto tumoral de carcinoma de celulas renales con ratones atimicos nude Balb/c. Se implanta tejido renal humano no tumoral en la region interescapular de 5 ratones, tumor renal tipo cromofobo en 5 ratones que tras comprobarse su crecimiento se preparo para implante en otros 10 ratones y tumor renal tipo carcinoma renal de celulas claras (CRCC) Fuhrman 2 en 5 ratones que tambien se implanto posteriormente en 10 ratones. Se monitoriza el tamano tumoral, la aparicion de metastasis y el aumento de tamano y numero de las mismas. Cuando alcanza tamano igual o superior a carcinoma localmente avanzado o metastasico los animales son sacrificados para estudio anatomopatologico, inmunohistoquimico y segunda fase de implante. Resultados El xenoinjerto subcutaneo del tejido sano no crecio, se sacrificaron a los 6 meses sin hallar tejido renal. El carcinoma renal de celulas cromofobas crecio en la primera fase (100%), pero en la segunda fase se observo reaccion inflamatoria cronica linfomonocitaria y a cuerpo extrano. El CRCC crecio a los 5-8 meses, tanto en la primera como en la segunda fase (100%), manteniendo el tipo y el grado tumoral. Conclusiones El modelo con ratones atimicos nude Balb/c es util para reproducir CRCC, con las mismas caracteristicas y agresividad histologica al tumor humano nativo, alentando al desarrollo de la segunda fase experimental.

Introduction The objective of this study was to determine the reproducibility in a murine model of renal tumors of various histological strains that could be useful for investigating the response to target drugs. Material and methods Development and analysis of the “in vivo” model: tumor xenograft of renal cell carcinomas with Balb/c nude athymic mice. Nontumourous human renal tissue was implanted in the interscapular region of 5 mice, chromophobe renal cell carcinoma was implanted in 5 mice (which, after checking its growth, was prepared for implantation in another 10 mice) and Fuhrman grade 2 clear cell renal cell carcinoma (CCRCC) was implanted in 5 mice (which was also subsequently implanted in 10 mice). We monitored the tumor size, onset of metastases and increase in size and number of tumors. When the size had reached a point greater than or equal to locally advanced or metastatic carcinoma, the animals were euthanised for a pathological and immunohistochemical study and a second phase of implantation. Results The subcutaneous xenograft of the healthy tissue did not grow. The animals were euthanised at 6 months and no renal tissue was found. The chromophobe renal cell carcinoma cells grew in the initial phase (100%); however, in the second phase, we observed a chronic lymphomonocyte inflammatory reaction and a foreign body reaction. The CCRCC grew at 5–8 months both in the first and second phase (100%), maintaining the tumor type and grade. Conclusions The model with athymic Balb/c nude mice is useful for reproducing CCRCC, with the same histological characteristics and aggressiveness as native human tumors, promoting the development of the second experimental phase.

INTRODUCTION AND OBJECTIVES:Objective: to report the experience in 4 tertiary hospitals with the pre-connected, pre-filled and refillable artificial urinary sphincter (AUS) ZSI 375 PF (Zephyr Surgi...

To evaluate the beneficial effects of exogenous NO and an inhibitor of the COX2, and their action levels in a model of SIRS/bacterial translocation (BT) induced by Zymosan A(®).Ninety Wistar rats were submitted to different treatments, and after 12h and 24h they were anaesthetized in order to collect blood, mesenteric lymph nodes, and kidney for subsequent biochemical analyses and microbiological examinations.A nitric oxide donor, Molsidomine(®), was compared with a COX2 inhibitor, Celecoxib(®).Zymosan A(®) was administered to Wistar rats. The animals were divided into 6 groups: one group for survival study, Group (1) No manipulation (BASAL); Group (2) vehicle of Zymosan A(®) given intraperitoneally (SHAM); Group I (control), with Zymosan A(®) (0.6g/kg) intraperitoneally; Group II (Molsidomine), with Molsidomine(®) (4mg/kg) through the penis dorsal vein, 30min prior to administration of the Zy(®) (0.6g/kg); Group III (Celecoxib), with Celecoxib(®) (400mg/kg) orally through a stomach tube, 6h prior to administration of the Zy (0.6g/kg).The parameters survival, bacterial translocation, renal function, neutrophil accumulation, oxygen free radicals (OFR), detoxifying enzymes, and cytokines were measured at different times after Zymosan administration.The model established induced a mortality rate of 100% and generated BT and systemic inflammatory response syndrome (SIRS) in all samples. It also significantly increased all variables, with p.001 for MPO and all pro-inflammatory cytokines, and p.01 for all OFR. Treatment with Molsidomine reduced mortality to 0%, decreased BT, MPO, pro-inflammatory cytokines and OFR (p.001) significantly and increased IL-10 and IL-6 production. Moreover, the Celecoxib(®) showed a lower capacity for SIRS regulation.The exogenous administration of NO prevented BT and controlled SIRS. Therefore these results suggest that Molsidomine could be used as a therapeutic strategy to protect against BT.

Objectives: to demonstrate the benefits of physiotherapy (PT) with pelvic floor biofeedback (BFB) in improving health-related quality of life when used as a complementary therapy after surgical treatment of cystocele, in cases in which perineal pain or discomfort persists. Materials and methods: prospective observational study in 226 women who received complementary therapy after surgical treatment of cystocele due to persistent perineal discomfort or pain. Groups: GA (n = 78): women treated with 25 mg of oral pregabalin every 12 h plus BFB, consisting of 20 once-weekly therapy sessions, each 20 min long, with perineal pregelled surface electrodes connected to a screen which provides visual feedback, GB (n = 148): women treated with oral pregabalin 25 mg every 12 h without BFB. Variables: age, body mass index (BMI), time since onset of cystocele prior to surgery (TO), SF-36 health-related quality of life survey score, diseases and concomitant health conditions, follow-up time, success, or failure of postsurgical treatment. Results: average age 67.88 years (SD 12.33, 30&ndash, 88), with no difference between GA and GB. Average body mass index (BMI) 27.08 (SD 0.45, 18.74&ndash, 46.22), with no difference between GA and GB. Time since onset of cystocele prior to surgery (TO) was 6.61 years (SD 0.6), with no difference between GA and GB. Pretreatment SF-36 score was lower in GA success than GB success. Treatment was successful in 141 (63.20%) women and failed in 82 (36.80%). PT and age were the main predictors of success, and the least important were pretreatment SF-36 and the time elapsed after the intervention. In GA, 63 women (80.80%) showed improvement while 15 (19.20%) did not. Age was the main predictor of treatment success, while the least important was BMI. In GB, 78 women (53.80%) showed improvement while 67 (46.20%) did not improve. The main predictor was time since cystocele onset prior to surgery, while the least important was age. The odds ratio (OR) of improving quality of life for each unit increase in SF-36 was 11.5% (OR = 0.115) in all patients, with no difference between success and failure, in GA it was 23.80% (OR = 0.238), with a difference between success and failure, in GB it was 11.11% (OR = 0.111), with no difference between success and failure. GA and GB success had more history of eutocic delivery. GA success had more rUTI. GB success and GA failure both had more history of UI corrective surgery. The &ldquo, failure&rdquo, outcome had a higher number of patients with more than two concomitant pathological conditions. Conclusions: BFB as an adjunctive treatment improves quality of life in women suffering from persistent discomfort after surgery for cystocele. Young women who meet the criteria for recurrent urinary tract infection or who have a history of eutocic delivery show greater improvement. Body mass index does not influence response to treatment, while the presence of more than two concomitant conditions indicates a poor prognosis for improving quality of life.

En este articulo ya publicado, se ha detectado que por error no se incluyo el texto correspondiente al apartado «Resultados» de la pagina 116. El texto correcto de dicho apartado es el siguiente: Resultados. En la tabla 2 se exponen las caracteristicas basales de los dos grupos de estudio, el primer grupo con profilaxis tromboembolica y el segundo grupo sin ella. No hubo diferencias entre las variables estudiadas (edad media, IMC, ASA, PSA, Gleason de la biopsia, carga tumoral, TNM clinico o patologico. Se realizo el procedimiento quirurgico sin profilaxis tromboembolica en el 16% de prostatectomias retropubicas, en el 15,4% de las laparoscopicas y en el 9,7% de las asistidas por robot, sin diferencias significativas entre los grupos (p = 0,350) (tabla 3). En esta tabla tambien se puede observar que no hubo diferencias entre la profilaxis farmacologica pautada y su relacion con los eventos tromboembolicos entre las diferentes tecnicas. En la tabla 4 se presentan los resultados del uso de la profilaxis farmacologica tromboembolica venosa en pacientes sometidos a prostatectomia radical, segun los diferentes grupos de riesgo tromboembolico. En el grupo de bajo riesgo tromboembolico se utilizo profilaxis en el 85% de los casos, en el grupo de riesgo intermedio en el 80% y en el grupo de alto riesgo en el 71,4%. No hubo diferencias entre los grupos. En la tabla 5 se detallan los eventos tromboembolicos venosos en varones sometidos a prostatectomia radical conforme los grupos de riesgo tromboembolico y el uso de profilaxis farmacologica tromboembolica. En este analisis se observaron diferencias entre en el grupo de bajo riesgo tromboembolico, entre los pacientes que recibieron la profilaxis tromboembolica vs. los que no la recibieron. Es importante recalcar que en el grupo de bajo riesgo el tamano muestral es mayor que en los otros grupos. En la tabla 6 observamos que no hubo diferencias en el uso de profilaxis tromboembolica venosa en varones sometidos a prostatectomia radical, segun grupos de riesgo hemorragico. Tampoco se obtuvieron diferencias entre eventos hemorragicos en varones sometidos a prostatectomia radical de acuerdo con los grupos de riesgo hemorragico y el uso de profilaxis farmacologica tromboembolica (tabla 7).

Male, 64 year old male, whoconsults to the Dermatology office presentingtwo-month, progressive, skin lesions in thepubic region...Varón de 64 años que acudea la consulta de Dermatología por lesionescutáneas en la región púbica, de dosmeses de evolución y presentación progresiva...

Resumen Objetivos Desde 1999 realizamos el implante de una protesis regulable tipo Remeex® como tratamiento de rescate en incontinencia urinaria de esfuerzo (IUE) compleja o persistente tras el fracaso de otro tratamiento quirurgico (colposuspension tipo Burch, Marshall-Marchetti-Krantz o TVT hasta el ano 2003, TOT desde el ano 2003). Exponemos los resultados de nuestra serie, incluidos los casos de complicaciones graves. Material y metodo Estudio retrospectivo de mujeres diagnosticadas de IUE compleja o refractaria sometidas a implante de Remeex® entre octubre de 1999 y diciembre de 2013. En 5 casos se realizo correccion de cistocele simultanea a la colocacion del Remeex®. Resultados Sesenta mujeres de 66,87 anos de edad media (rango 39-85) fueron intervenidas. El procedimiento fue exitoso en 68,33% de los casos. Fracasos: 10% IU mixta con multiples diverticulos vesicales; 8,33% IUE leve; 13,33% urgencia sin IU. El 35% precisaron reajuste. Se registraron 3 casos con complicaciones graves: IU severa invalidante en paciente multioperada, hemorragia pelviana masiva en paciente con tratamiento antiagregante habitual y litiasis infectada vaginal de 7 cm sobre hilo extruido de Remeex® en paciente paraplejica 4 anos despues del implante. Conclusiones El Remeex® es un procedimiento eficaz y seguro para la consecucion de la continencia en casos de IUE compleja o refractaria, aunque no esta exento de presentar complicaciones graves. Seguir protocolos rigurosos ayuda a detectar complicaciones y a repararlas a tiempo.

Objectives Since 1999, we have performed implantations of Remeex ® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications. Material and method Retrospective study of women diagnosed with complex or refractory SUI who underwent Remeex ® implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex ® . Results Sixty women, with a mean age of 66.87 years (range 39–85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7 cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation. Conclusions Remeex ® is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner.

Resumen Introduccion La incontinencia urinaria se define como la manifestacion de cualquier escape involuntario de orina. Se clasifica clinicamente en incontinencia de esfuerzo, urgencia y mixta. Enfermedad infradiagnosticada con importante impacto social, economico y psicologico. Afecta a ambos sexos, deteriorando la calidad de vida de los que la padecen. Material y metodos La muestra se compone de 310 pacientes, varones y mujeres con distintos tipos de incontinencia urinaria. Todos fueron tratados con 20 sesiones de electromiografia- biofeedback con electrodos de superficie colocados alrededor del ano a las 3 y 9 h, realizadas bisemanalmente y evaluados con los cuestionarios/escalas ICIQ-SF y I -QOL especificos de calidad de vida en la incontinencia urinaria. Resultados La edad media fue de 57,3 ± 15,19 anos. Las mujeres fueron el 83,6% y los varones el 16,4%. Se ha encontrado significacion estadistica (p biofeedback se objetiva una variacion de mejoria del valor de las medianas con significacion estadistica para los 2 cuestionarios/escalas empleados, tanto en la muestra total de incontinentes, como para los distintos tipos de incontinencia y subescalas del cuestionario I -QOL. Conclusion Dado los resultados hallados en nuestro estudio y la bibliografia, concluimos que la electromiografia- biofeedback para el entrenamiento de la musculatura del suelo pelvico en la incontinencia urinaria mejora la incontinencia y la calidad de vida.

Background Ischemia-reperfusion injury (IRI) remains a major problem in renal transplantation, and the inflammatory response to IRI exacerbates the resultant renal injury. We have investigated whether the systemic administration of cardiotrophin-1 (CT-1) is able to improve renal function and to decrease inflammatory responses in a rat model of renal IRI. Methods IRI was induced by renal pedicle clamping (60 min) followed by reperfusion and contralateral nephrectomy. CT-1 was injected through the penile vein 30 min before clamping release and its effects were compared with a saline-treated group at five different time points of reperfusion. Results Survival in the CT-1-treated group was higher than in the untreated group and prevented IRI-induced reduction in the glomerular filtration rate, as shown by blunted increases in creatinine and urea plasma levels and less severe decrease in creatinine clearance. These effects of CT-1 seem to be mediated by reduction in oxygen-radical production, increased superoxide dismutase expression, attenuation of neutrophil and macrophage infiltration, lower adhesion molecule expression, lower inflammation demonstrated by a decrease of plasma levels of proinflammatory cytokine secretion such as tumor necrosis factor-α, interleukin-1β and interferon-γ, lower inducible nitric oxide synthase expression and lower nuclear factor-κB activation, and reduced apoptosis. Conclusions Therefore, these results suggest that CT-1 administration prevents IRI and it might be used as a therapeutic strategy to protect the kidney against IRI.

To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers.Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant.75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy.Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients.

Resumen Objetivos Identificar factores que llevaron al fracaso del tratamiento quirurgico en 302 mujeres con incontinencia urinaria de esfuerzo (IUE) tratadas mediante cinta suburetral transobturatriz (TOT) con seguimiento de 4 anos (rango 1-6). Material y metodos 302 mujeres incontinentes de 41-81 anos fueron intervenidas mediante TOT entre abril de 2003 y noviembre de 2010. Los datos se recogieron mediante el cuestionario validado para incontinencia de orina, el International Consultation on Incontinence Questionnaire — Short Form (ICIQ-SF), y los registros clinicos de la historia. En 262 se consiguio continencia (grupo A) y 40 siguieron incontinentes (grupo B). Se investigo: edad, tiempo de evolucion de IUE, tipo y numero de partos (eutocicos, distocicos, nuliparidad, multiparidad) y antecedentes medicos y/ o quirurgicos. Se empleo el cuestionario ICIQ-SF para asignar si los resultados de la cirugia fueron o no exitosos. Resultados El grupo A presento menor edad (p = 0,0001), menos tiempo de evolucion de IUE (p = 0,017) y mas partos eutocicos (p = 0,00002). El grupo B presento mas partos distocicos (p = 0,002), colocacion previa de cinta vaginal libre de tension (TVT) o TOT (p = 0,03), tratamiento antidepresivo-ansiolitico (p = 0,003), tratamiento antihipertensivo (p = 0,0005), DMID (p = 0.02), HTA (p = 0,0007), trastornos respiratorios (p = 0,025). No hubo diferencia en nuliparidad (p = 0,7), multiparidad (p = 0,4), obesidad (p = 0,18), trastornos intestinales (p = 0,59), anexectomia (p = 0,19), cesarea (p = 0,17), colposuspension (p = 0,29), histerectomia (p = 0,57), alergias (p = 0,48), artritis (p = 0,22), artrosis (p = 0,44), depresion (p = 0,74), DMNID (p = 0,44), tabaquismo (p = 0,28) o fibromialgia (p = 0,47). Conclusiones Edad avanzada, largo tiempo de evolucion de la incontinencia urinaria, antecedentes de partos distocicos y la colocacion de TVT o TOT previamente aparecen como los factores independientes mas asociados al fracaso del TOT, y pueden hacer aconsejable la indicacion de otra tecnica quirurgica.

Introduction and objectives: Stress urinary incontinence (SUI) and recurrent urinary tract infections (RUTIs) are highly prevalent diseases. Our purpose was to investigate the relationship between RUTIs and surgical correction of SUI with transobturator suburethral tape (TOT) and to describe the benefit gained from a sublingual polibacterial preparation on RUTIs developed after TOT. Materials and methods: A retrospective study was performed on 420 women who underwent TOT surgery due to SUI between April 2003 and October 2011. Group A: patients without urinary tract infections (UTIs) before TOT ( n = 294). Group B: patients with UTIs before TOT ( n = 126). Variables: age, personal history, number of UTIs/month prior to and after surgery, appearance of urgent urinary incontinence (UUI) with or without UTIs, response to International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Short Form 36 (SF-36) questionnaires. Results: Group A: 85% dry; 5% UUI; 4% de novo UTIs with good response to antibiotics over 6 days. No RUTIs during the follow-up period, 2% with sporadic UTIs. Group B: 47.61% RUTIs; 52.39% sporadic UTIs; greater incidence of diabetes mellitus ( p < 0.0025) and smoking ( p < 0.0031) than group A. After TOT: 79.36% dry; 10% RUTIs. After treatment with antibiotics for 6 days and bacterial preparation for 3 months, 82% of patients did not have a UTI anymore. Postoperative cystourethrogram revealed 38% of nondiagnosed cystoceles before TOT. No patient had a postvoiding volume greater than 100 cm3 after TOT. Improvement of ICIQ-SF ( p < 0.001) and SF-36 ( p < 0.0004) in both groups. Conclusion: After eliminating bias associated with the tape, the technique and the surgeon’s skills, SUI correction may decrease the number of UTIs and improve the quality of life. UTIs disappeared in 82% of patients with RUTIs after TOT.

Urologists daily evaluate many women with voiding disturbances, but proper physical examination has only rarely been previously performed.Case 1: 16-year-old woman presenting augmented daytime urinary frequency and nocturia without enuresis, with drop-by-drop micturition. Case 2: 80-year-old woman with urgency. She referred normal voiding with insensitive urinary loss the hour after.adhesion of the labia minora.Surgical section of the adhered area in the midline was performed with satisfactory aesthetic and clinical results.The adhesion of the labia minora is an acquired disease, more frequent in girls under 2 years. Several predisposing factors have been proposed: oestrogen deprivation, inadequate personal care, local irritants, infections or previous trauma. Differential diagnosis is required among three congenital pathologies: vaginal agenesis, imperforated hymen and ambiguous genitalia. Cases in postpubertal or postmenopausal women, or refractory to medical treatment are considered for surgery.

Levels of uronate, a basic component of urothelial glycosaminoglycans, are increased in urine specimens of patients with interstitial cystitis with severe symptoms. In this study we examined the urinary glycosaminoglycan profile and correlated the profile and urinary hyaluronic acid (a glycosaminoglycan) levels with symptom severity.Urine specimens and completed O'Leary-Sant interstitial cystitis symptom and problem indexes questionnaires were obtained from 29 patients with interstitial cystitis, 14 normal individuals, and 14 patients with other benign pelvic and bladder conditions. Patients with interstitial cystitis were divided into group 1-1 or both indexes less than 50% maximum score, and group 2-both indexes 50% of maximum score or greater. All patients met the National Institutes of Diabetes and Digestive and Kidney Diseases criteria except regarding glomerulation. In a followup study 30 urine specimens were collected from 8 patients with interstitial cystitis and from 4 normal individuals during 12 months. The urinary glycosaminoglycan profile was determined by gel filtration chromatography. Glycosaminoglycan peaks were analyzed by polyacrylamide gel electrophoresis. Urinary hyaluronic acid levels were determined by the hyaluronic acid test.Group 2 urine specimens contained 3 uronate peaks, whereas urine specimens from normal individuals and patients in group 1 contained 1 or 2 peaks. Peak 1 consisted of macromolecular glycosaminoglycans whereas peaks 2 and 3 contained oligosaccharides. Urinary hyaluronic acid levels were 3 to 4-fold increased in group 2. Glycosaminoglycan profile and hyaluronic acid levels detected interstitial cystitis severity with 83% sensitivity, and 89.7% and 74.4% specificity, respectively. Interstitial cystitis urothelial cells/tissues also over expressed hyaluronic acid synthase 1 (which synthesizes hyaluronic acid) compared to normal urothelial cells/tissues. In the followup study urinary uronate levels, glycosaminoglycan profile and hyaluronic acid levels detected patients with severe symptoms with 73% sensitivity and 87% to 94% specificity. In both studies uronate, glycosaminoglycan profile and hyaluronic acid levels significantly correlated with interstitial cystitis severity (p0.001).Urinary glycosaminoglycan profile, uronate content and hyaluronic acid levels are potentially useful markers for monitoring interstitial cystitis severity, and are likely to be involved in interstitial cystitis pathophysiology.

Introduction and hypothesis Urinary tract infections (UTIs) are considered the most common bacterial infections, especially in women. The objective of this study was to evaluate the use of the sublingual bacterial vaccine Uromune® in order to prevent recurrent UTIs (RUTIs). Methods This study was conceived as a multicenter observational study. The clinical history of 319 women who presented at least 2 episodes of UTI in the last 6 months or 3 in 12 months was reviewed. Data related to treatment and clinical evolution were recorded and analyzed. A total of 159 patients received prophylactic treatment with Uromune® for a period of 3 months (group A) and 160 with sulfamethoxazole/trimethoprim 200/40 mg/day for a period of 6 months (group B). Uromune® contained an inactivated bacterial cell suspension of selected strains of Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis. Results Patients in group A experienced a highly significant reduction in the number of infections compared to patients in group B. In the first 3 months, the mean number of infections was 0.36 versus 1.60 (P

PURPOSE We describe the successful repair of a large and complex urethral diverticulum in a female by transvaginal approach. Epidemiology, diagnostic methods, treatments and complications of female urethral diverticula are reviewed. PATIENTS AND METHODS A 35-year-old woman with a history of postvoid dribbling, dyspareunia and recurrent urinary tract infections for 4 months was referred. Magnetic resonance imaging demonstrated two fluido-filled collections in the pelvis of 3.5 and 1 cm in size respectively which may be a very large and complex diverticulum, however, Bartholin gland cyst could not be rule out. Cystourethroscopy revealed a urethral diverticulum at 10 mm from the bladder neck with two ostia. It was performed transvaginal diverticulectomy and an anterior vaginal wall flap was placed. The published literature on female urethral diverticula was identified using a Pubmed Medline search and analysed. RESULTS Convalescence was unremarkable. Suprapubic cystostomy tube was removed 2 weeks after surgery. The patient regained normal voiding. In the published literature there are no agreement neither in the diagnostic nor in the surgical techniques for female urethral diverticula. CONCLUSIONS Urethral diverticula are diagnosed with increasing frequency. However, this entity continues to be overlooked because the symptoms may mimic other disorders. Cystourethroscopy, retrograde urethrograme using a double balloon catheter and recently magnetic resonance imaging may diagnose this disease. The cure rate of urethral diverticula with appropriate surgical management has a range of 86-100%. Complete excision through the anterior vaginal wall is the most successful treatment modality with minimum postoperative complications.

Objectives: To compare the effectiveness in the treatment of erectile dysfunction when using PDE-5 inhibitors (PDE5i), alprostadil (PG-E1) and testosterone (TES) in monotherapy or combination therapy. Material and Methods: Observational multicentre retrospective study of men diagnosed and treated for ED between January 2008 and January 2014. Age, social and employment situation, pathological medical history, risk factors, usual treatments, IIEF-5 at the first consultation and at first and each 6 months follow-ups, physical examination, calculated total and free testosterone and received treatment were analysed. Descriptive statistics, one-way ANOVA analysis, Chi2 for qualitative data, t-test, Fisher's exact test and Pearson's correlation coefficient were used; p < 0.05 is considered significant. Results: Average age was 58.61 years, SD5.02, average follow- up time 48.21 months, SD 6.21, range 6-174 months. Out of the patients 76.12% were married, 9.81% divorced/separated, 10.04% single, 4.03% widowed; 85.14% of the total in stable partnership but 66.16% were not accompanied by their partners. In total 844 patients received monotherapy (597 PDE5i; 62 PG-E1; 36 TES; 27 penile prosthesis; 121 psychotherapy/alternative therapies) and 357 combination therapy (167 PDE5i+TES; 124 PDE5i+PGE1; 66 PG-E1+TES). There was a homogeneous distribution between risk factors and medical history groups. Satisfactory response according to IIEF-5 was achieved for 72.33% of patients on PDE5i monotherapy, 46.65% of patients on PDE5i+PG-E1 combination therapy and 83.41% of patients on PDE5i+TES. Conclusions: The best therapeutic success for ED in this series was achieved through a combination of testosterone+PDE-5 inhibitors without increasing morbidity and maintaining the response over time. Larger studies with longer follow-up will corroborate these findings.