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Objective: Describe the medium-term safety of the tension free vaginal tape obturator (TVT-O) procedure in terms of complications, cure and changes in quality of life (QoL) after the surgery. Materials and methods: Descriptive historical cohort that included women over 18 years of age who underwent TVT-O due to objectively proven stress urinary incontinence, urethral hypermobility or mixed urinary incontinence in which the stress component predominated, confirmed on urodynamic testing between July 2013-April 2017, in a reference hospital located in the city of Murcia Spain. Women with previous anti-incontinence surgery, concomitant vaginal surgery and planning pregnancy were excluded. Follow-up was determined for each patient based on the time elapsed between surgery and the time when the research protocol was applied. Complications were stratified according to the modified Clavien-Dindo classification; also we evaluated subjective cure rate, quality of life using the ICIQ-SF score, before and after surgery. Results: The mean age was 52.6 (SD± 10.5) years and 80.1% of patients were at least overweight. The incidence of complications at 12 months was: 8.3% (12/144). We did not detect complications after this period in the followed patients at 24, 36 and 48 months. The subjective cure determined at 12, 24, 36 and 48 months was 62.5% (90/144), 59.09% (55/88), 50.81% (31/61) and 50% (7/14), respectively. There was a significant improvement in quality of life, as determined by the ICQ-SF mean score before and after surgery (13.76[6,34] vs 3.84[5.76]; p

Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher’s exact test, as appropriate established differences between groups of reclassification. A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management.

Objetivo La ratio digital del segundo y cuarto dedo de la mano (2D:4D) es un marcador de la exposición a andrógenos prenatal que presenta un dimorfismo sexual en mamíferos, siendo menor en hombres que en mujeres. El objetivo de nuestro estudio fue analizar la asociación entre la ratio 2D:4D (como marcador indirecto del ambiente hormonal intrauterino) y la severidad preoperatoria del cáncer de próstata (CaP). Material y métodos Se trata de un estudio transversal que incluyó 118 pacientes intervenidos de CaP y con confirmación histológica por biopsia desde abril de 2007 hasta julio de 2015. A cada paciente se le realizó una exploración física y se midió desde la base de la falange proximal hasta el extremo de la falange distal tanto en el cuarto como en el segundo dedo de la mano derecha. La asociación entre la ratio 2D:4D y los indicadores de severidad prequirúrgicos de CaP se realizaron mediante test de medias, correlación de Spearman y regresión lineal simple. Resultados La ratio 2D:4D se asoció significativamente con el PSA prequirúrgico (p = 0,023) y con el porcentaje de cilindros afectados en la biopsia (p = 0,05) Conclusión Nuestros resultados sugieren que una mayor exposición androgénica prenatal, reflejado en una ratio 2D:4D disminuida, estaría asociada con una mayor severidad prequirúrgica del CaP.

Resumen Objetivo La estenosis de la anastomosis uretrovesical (EAU-V) afecta al 8,4% de pacientes intervenidos de prostatectomía radical retropúbica por cáncer. Nuestro propósito fue estudiar los factores de riesgo de estenosis de cuello vesical asociada a prostatectomía radical por carcinoma prostático en nuestro centro. Material y Métodos Estudio de casos-controles en una cohorte constituida por 120 pacientes intervenidos por adenocarcinoma prostático entre 2005 y 2012. Realizamos un análisis descriptivo de la muestra y el cálculo de la incidencia de EAU-V, un análisis univariante de los factores asociados mediante la t de Student y la chi cuadrado de Pearson, un análisis del tiempo transcurrido hasta la aparición de estenosis y una predicción del riesgo de EAU-V. Resultados La incidencia de EAU-V tras prostatectomía radical en nuestro servicio fue del 22,5%. Encontramos mayor riesgo en aquellos pacientes con débito por drenaje Jackson-Pratt (J-P) mayor de 500cc, drenaje J-P retirado después del tercer día, estancia superior a 8 días, hemoglobina postoperatoria baja, PSA preoperatorio bajo, densidad de PSA elevada o que fueron intervenidos por el cirujano 1 o 5. Todas las estenosis se produjeron en los 3 primeros años tras la cirugía. Los pacientes con un débito del drenaje por encima de 500cc y en los que el drenaje se retiró después del tercer día tienen 7,7 y 3,2 veces, respectivamente, más riesgo de padecer una EAU-V. Conclusiones Nuestra incidencia de EAU-V y sus factores asociados coinciden con los publicados. El modelo predictivo desarrollado tiene utilidad meramente teórica ya que no abarca la totalidad de los factores que pueden influir en la aparición de la estenosis.

Background Anogenital distance (AGD), the distance from the centre of the anus to the genitals, is a sexually dimorphic phenotype in mammals. Experimental studies have shown that AGD is a biomarker of prenatal androgen exposure during the masculinisation period of development. The aim of this study is to assess the relationship between anogenital distance (AGD), as an indirect marker of prenatal hormonal environment, and prostate cancer (PCa) severity. Materials We conducted a cross-sectional study with a total of 120 PCa patients with confirmed biopsy of the tumour from April 2007 to July 2015. Two variants of the anogenital distance were assessed, from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP ). We compared differences in groups to evaluate the association between AGD measurements and severity of the preoperative biopsy and clinical scores. Results Longer AGDAS was significantly associated with the highest Gleason score (P = 0.015) and D'Amico nomogram (P = 0.048). In contrast, no statistical differences were found in the AGDAP and severity of the preoperative biopsy. Conclusions These findings are consistent with the hypothesis that a higher prenatal androgen exposure is associated with higher severity of PCa. Prostate 77: 406-411, 2017. © 2016 Wiley Periodicals, Inc.

Primary mucinous epithelial tumors of the testis are extremely rare. Although isolated case reports and small series have been published, these interesting neoplasms are less well-known. We report a case of a primary intratesticular mucinous cystadenoma in an asymptomatic 44-year-old man. Right radical orchiectomy was performed because a malignant testicular tumor was suspected. We discuss the management of this uncommon testicular tumor based on the limited reports.

Pilar Palma1, Angel Ruiz2, Francesc Carmona1,∗, Ramon Soliba2, Elisabet Barrau3, David Paredes2 1 Sistema d’Emergencies Mediques, Catalonia, Spain 2 Donation Unit, Hospital Clinic, Barcelona, Spain 3 ABS Montclar, ICS, Sant Boi de Llobregat, Spain Purpose: To analyze how LUCAS® device has affected kidney transplant rate in a “donor after circulatory death” program (DACDP) and to describe donors’ characteristics after 10 years of the program start. Methods: A prospective analytic study was performed from January 2002 to December 2011. From all the potential donors in a DACDP, all those who finally accomplished the program criteria were entered in NECMO and were not rejected by other causes different than those related to perfusion. Studied variables were: donors’ sex, age, body mass index (BMI) and presence of cardio-circulatory risk factors (CCRF), total out-of-hospital CPR time (OHCPR), kidney transplantation and use of LUCAS® device. Qualitative data are presented as percents and compared with Chi square test. Quantitative data are presented as mean and standard deviation and compared with Student’s T test. A logistical regression model was performed to adjust the LUCAS® effect over transplantation by possible confounding factors. Results: From the 160 potential donors, 97 accomplished the study criteria. 91.8% (89) weremales. Themean age was 47.8 years (SD=12.3), mean BMI was 27.1 kg/m2 (SD=4), and mean OHCPR was 60.3min (SD=17.8). 48.5% (47) had CCRF and LUCAS was used in 52.6% of patients (51). 144 out of 194 kidneyswere transplanted. LUCAS® was associated with an increase of the transplant rate in a 13% (CI 95%=0.7–25) (p=0.039). Lower mean age and BMI were also associated with an increase of the transplant rate (p=0.004 and0.001). Noother significant statistical associationwas observed but a trend in lower OHCPRmean (p=0.145). After adjusting LUCAS effect by donors age and BMI, OHCPR and their first order interactions in a logistic regression model, the use of LUCAS® multiplies by 1.9 the transplantation odds (CI 95%=0.94–3.8). Conclusions: The use of LUCAS® increases the number of transplanted kidneys when used in a DACDP.