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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.

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case-control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention.

Introduction and hypothesis In recent years the number of caesarean sections has increased worldwide for different reasons. to review the scientific evidence relating to the impact of the type of delivery on pelvic floor disorders (PFDs) such as urinary and faecal incontinence and pelvic organ prolapse. Methods A review of systematic reviews and meta-analysis, drawn from the following databases: MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud/Latin American and Caribbean Health Sciences Literature) prior to January 2019. The directives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in assessing article quality. Results Eleven systematic reviews were evaluated, 6 of which found a significantly decreased risk of urinary incontinence associated with caesarean section and 3 meta-analyses showed a significant reduction in POP for caesarean section, compared with vaginal delivery. Of 5 reviews that examined delivery type and faecal incontinence, only one indicated a lower incidence of faecal incontinence associated with caesarean delivery. However, most of the studies included in these reviews were not adjusted for important confounding factors and the risk of PFDs was not analysed by category of caesarean delivery (elective or urgent). Conclusion When compared with vaginal delivery, caesarean is associated with a reduced risk of urinary incontinence and pelvic organ prolapse. These results should be interpreted with caution and do not help to address the question of whether elective caesareans are protective of the maternal pelvic floor.

RESUMEN. Introducción: La información acerca de lesiones en piel y sus factores asociados, en trabajadores informales en América Latina y el Caribe aun es escasa. Objetivo: Determinar la relación existente entre las condiciones sociodemográficas, ambientales, laborales y la prevalencia de afecciones en la piel auto-reportada por trabajadores informales “venteros” del centro de Medellín. Material y Métodos: Estudio transversal con intención analítica y fuente primaria de información. Se incluyeron 686 trabajadores. Se aplicó encuesta asistida, previa realización de prueba piloto y estandarización de los encuestadores. Variable dependiente; prevalencia de afecciones en piel. Variables independientes; condiciones laborales, sociodemográficas y ambientales. Se realizó control de errores con análisis estadísticos y sesgos de selección e información. Se realizaron análisis univariado, bivariado y multivariado. Resultados: Trabajadores fundamentalmente hombres (57.6%), edades entre 45-59 años, 60,0% procedente de zona rural. Trabajaban > 8 horas/día (80,6%), toda la semana, con > 20 años (50,7%) en su labor. El 72,2% no utilizaba mecanismos de protección personal. 61,5% consideraba que la contaminación ambiental afectaba su labor y su salud. 19,83% presentó afectaciones cutáneas, como; alergias (12,0%), prurito y sarpullido. Menor prevalencia de alergias en hombres (24,0%) y ≥ 60 años. Mayores prevalencias en quienes laboraban >8 horas/día (94,0%), toda la semana (43,0%), con exposición a sustancias químicas (RP=1,88.IC=1,11;3,20), vendedores de mercancía y cacharro (RP =2,06.IC: 1,08;3,91). Conclusión: Explican mayor prevalencia de alergias proceder de la zona urbana, vender mercancía y cacharro, trabajar >8 horas/día, toda la semana, exponerse a sustancias químicas, considerar que la calidad del aire afecta su labor, y presentar comorbilidades.

Scientific societies have provided guidelines to reduce PSA-specific harms. We studied the potential non-compliance of PSA testing with current guidelines in general practice. A cross-sectional study of a random sample of 1291 patients with a PSA test was performed between January and April 2018 in primary health care. Patients with a previous prostate cancer diagnosis or those who were being followed-up for previous high PSA values were excluded. Two independent researchers classified whether each test was potentially non-compliant with recommendations. We estimated frequencies of potentially non-compliant PSA determinations and calculated prevalence ratios (PR) to assess their relationship with possible explanatory variables. A total of 66% (95% CI: 62-69%) of PSA requests in asymptomatic patients were potentially non-compliant with the current guideline. This was associated with having a previous diagnosis of neoplasm (PR adjusted by age and life expectancy: 1.18; 95% CI: 1.02-1.37) as well as being a current consumer of tobacco, alcohol, or other drugs (PR: 0.80; 95% CI: 0.67-0.97). Real world data shows that patients are still frequently exposed to overdiagnosis risk with a PSA potentially non-compliant with recommendations. Patients diagnosed with another neoplasm or non-consumers of toxic substances were more exposed, probably due to increased contact with doctors or health-seeking behaviour.

Background: This cross-sectional study aimed to examine the association of posttraumatic stress symptoms (PTSS; i.e., re- experiencing, avoidance/numbing, and hyperarousal) and depressive symptoms with: (a) physical health symptoms, (b) pain symptoms, (c) and the presence of chronic pain among trauma-exposed individuals. The mediational role of depressive symptoms in the relationship between each PTSS cluster and physical health symptoms, pain symptoms, or presence of chronic pain was also tested. Method: Individuals who reported to have suffered a traumatic experience (N = 100) participated in the study. They were recruited through organizations offering services for victims of violence, self- help groups, newspaper announcements, and the outpatient clinic. Participants were interviewed with the Diagnostic and Statistical Manual for DSM-IV and the German versions of the Clinician- Administered PTSD Scale, the Beck Depression Inventory, and the Freiburg Complaints Scale. Results: Regression analysis showed that both hyperarousal and depressive symptoms accounted for unique variances of physical health symptoms (partial r2 were .03 and .11, respectively). Bootstrap analysis indicated that whereas hyperarousal was both directly and indirectly (through depressive symptoms) related to physical health symptoms, avoidance/numbing and re-experience were only indirectly related with physical health symptoms via depressive symptoms. For pain symptoms, only depressive symptoms were uniquely related with this variable (partial r2 was .05). Depressive symptoms mediated the relationship between the three PTSS clusters and pain symptoms, but not the relationship between the clusters and the presence of chronic pain. Hyperarousal was the only variable uniquely and directly related with the presence of chronic pain (OR = 3.01; p

Background Dapoxetine hydrochloride is a selective serotonin reuptake inhibitor and the first drug approved for the on-demand treatment of premature ejaculation (PE). Its safety was established in a thorough clinical development program. Objective To characterize the safety profile of dapoxetine in PE treatment and to report the incidence, severity, and type of adverse events. Design, setting, and participants We conducted a 12-wk, open-label, observational study with a 4-wk, postobservational contact. A total of 10 028 patients were enrolled, with 6712 patients (67.6%) treated with dapoxetine 30–60mg (group A)and 3316 (32.4%) treated with alternative care/nondapoxetine (group B). Interventions Treatment with dapoxetine or alternative care/nondapoxetine. Outcome measurements and statistical analysis Treatment-emergent adverse events (TEAEs) and concomitant therapy use during the 12-wk observational and the postobservational period were reported. Results and limitations The mean age for all patients was 40.5 yr. In group A, 93.0% of the patients were initially prescribed dapoxetine 30mg. Treatment options for group B patients included clomipramine, paroxetine, fluoxetine, sertraline, topical drugs, condoms, and behavioral counseling. Both treatment regimens were well tolerated. TEAEs were reported by 12.0% and 8.9% of group A and group B, respectively, with the highest incidence observed in patients aged >65 yr for group A (21.4%) and 30–39 yr (9.8%) for group B. The most commonly reported TEAEs were nausea, headache, and vertigo, with a higher incidence in group A (3.1%, 2.6%, and 1.0%, respectively) than in group B (oral drugs: 2.3%, 1.3%, and 0.9%, respectively). There were no cases of syncope in group A and one case in group B. A major limitation is that this was a nonrandomized, open-label, short-term study lacking efficacy data. Conclusions The results of this postmarketing observational study demonstrated that dapoxetine for treatment of PE has a good safety profile and low prevalence of TEAEs. Syncope and major cardiovascular adverse events were not reported. The high level of adherence by healthcare providers to the contraindications, special warnings, and precautions for dapoxetine minimizes the risk for its use in routine clinical practice. The current risk minimization measures for its identified and potential risks are effective.

Renal leiomyoma are uncommon mesenchymal tumours, which can arise from any organ of the genitourinary tract with smooth muscle cells. The diagnostic imaging techniques available can not differentiated easily leiomyoma from other malignant renal masses. Since preoperative diagnosis cannot be made, management usually involves radical nephrectomy as in the case described. After treatment, prognosis is excellent.

Los tumores retroperitoneales primarios son neoformaciones extremadamente raras, de naturaleza maligna en la mayoría de los casos. Presentamos el caso de un varón de 48 años con una gran masa retroperitoneal detectada durante el estudio de un síndrome constitucional. La masa fue tratada quirúrgicamente y el diagnóstico anatomopatológico fue de histiocitoma fibroso maligno. Realizamos una revisión de la literatura y analizamos su presentación clínica, hallazgos histológicos, pruebas diagnósticas de imagen y manejo terapéutico. Retroperitoneal tumours are extremely rare neoplasms, most of them malignant. We described the case of a 48-year-old man with a large retroperitoneal mass detected during the study of a constitutional syndrome. The mass was treated surgerically and pathological diagnosis was malignant fibrous histiocytoma. Literature is reviewed and clinical features, histological findings, radiological techniques and therapeutic management are analyzed.

Los tumores mesoteliales son un hallazgo excepcional en el tracto urinario. El leiomioma el más frecuente de ellos y puede generarse en cualquier órgano que contenga músculo liso. Aunque debe considerarse en el diagnóstico diferencial de una masa renal, las exploraciones radiológicas no permiten distinguirlo inequívocamente de otros tumores renales malignos. Por ello, el diagnóstico suele realizarse mediante el análisis histológico de la pieza quirúrgica como en el caso que presentamos. Tras el tratamiento el pronóstico es excelente. Renal leiomyoma are uncommon mesenchymal tumours, which can arise from any organ of the genitourinary tract with smooth muscle cells. The diagnostic imaging techniques available can not differentiated easily leiomyoma from other malignant renal masses. Since preoperative diagnosis cannot be made, management usually involves radical nephrectomy as in the case described. After treatment, prognosis is excellent.

La existencia de angiomiolipomas (AML) renales bilaterales es relativamente infrecuente, sobre todo cuando no se presentan asociados a síndromes como la esclerosis tuberosa o la linfangioleiomiomatosis. Presentamos el caso de una mujer de 40 años que durante la 33ª semana de gestación fue diagnosticada, de forma incidental en una ecografía abdominal de control, de AML renales bilaterales y que pudo ser tratada mediante cirugía conservadora del parénquima renal. Además realizamos una revisión de la literatura, centrándonos en el manejo de esta entidad y su relación con el embarazo. The existence of bilateral renal angiomyolipoma (AML) is fairly infrequent, especially when not associated with such syndromes as tuberous sclerosis or linfangioleimiomatosis. Here we present the case of a 40-year-old woman who was accidentally diagnosed at week 33rd of gestation by an ultrasound, of bilateral renal AML and that could be treated with kidney sparing conservative treatment. We have also done a review of the literature focusing on its management and its relationship with pregnancy.

Presentamos el caso clínico de un paciente sometido a un procedimiento endourológico (dilatación neumática con balón de estenosis ureteral) que presenta en el transcurso del mismo un bucle iatrogénico del catéter doble J y su posterior manejo terapéutico. We present a report of a patient that had a iatrogenic double J catheter loop after endourology procedure (neumatic balloon dilatation of ureteral estenosis) as well as its therapeutic management.