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Introduction/ObjectivesThis study aims to describe the procedure and effectiveness of the four-vertex technique for correcting urethral prolapse in women.Methods and Materialsincludes a retrospective case series of 17 patients who underwent surgery for urethral prolapse. Two study groups were distinguished based on the presence or absence of pelvic heaviness symptoms. The variables were analyzed, including age, BMI, concomitant diseases, obstetric and gynecological history, time from diagnosis to surgery, and outcomes of treatment.ResultsAll patients were postmenopausal, with a mean age at the time of the intervention of 70.41 years, with no differences between groups. Mean BMI was 23.67 kg/m2, higher in the group with a sensation of vaginal heaviness (p = 0.027). Mean time elapsed between diagnosis and operation was 231.58 days, with no differences between groups. Mean childbirth count was 2.29. The most frequent causes for consultation were urethrorrhagia (33.33%) and a bulging sensation (33.33%). After the intervention, 14 patients (82.35%) were asymptomatic, two (11.76%) had dysuria, and one (5.88%) had urinary urgency. Ten patients had pre-surgical urinary incontinence, which was resolved in nine patients. 17.46% subsequently presented pelvic organ prolapse. In three women there was secondary impairment of sexual activity.ConclusionThe four-vertex technique was effective in resolving symptoms in most patients. However, some patients experienced dysuria, urinary urgency, and pelvic organ prolapse after surgery. Urinary incontinence improved in most patients, but a few required additional treatments with suburethral tape. The study also identified associations between variables and the presence of cystocele, consultation for a bulging sensation, and bleeding from urethral prolapse. Overall, this study sheds light on the challenges and outcomes of surgical treatment for urethral prolapse and provides valuable insights for future research in this area.

Abstract 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.

Background: Although elevation of the sinus can be considered a predictable procedure, it is nonetheless not free of complications, for which reason there is a constant search for new tools and techniques that may reduce these complications. The present study focused on maxillary sinus lifts performed on pig heads cadavers, using a new device with the balloon technique. Materials and Methods: Fifteen ex vivo adult pig heads were used in this experimental study. Sinus floor elevation was performed using the new balloon elevation control system, which consists of a syringe containing latex and serum as well as a system of burs for membrane access and control. Each lift was performed within a 3 min time frame while constant pressure was applied to allow the tissue to adapt to the tension. Results: In 100% of cases, perforations do not occur during aperture or in the elevation of the wall. In the global sample, there was histological elevation in 73.33% compared to 26.66% non-elevation (p = 0.0268). Conclusions: Within the limits of this study, the maxillary sinus lifts employing the new device and the balloon technique were minimally invasive procedures. The elevations achieved proved sufficient to allow future placement of implants of varying lengths and diameters without risk of perforating the membranes, even in the presence of crests of less than 1 mm.

Introduction: Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men. Aims: To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease. Methodology: A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP—men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU—men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism. Variables: age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student’s t-test, Chi2, multivariate analysis. Results: There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006). Conclusions: Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease.

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.