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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...

Resumen: Fundamento: La educación inclusiva universitaria trata de transformar y mejorar el rol competencial de los futuros médicos en relación con las personas con discapacidad (PcD), grupo poblacional vulnerable y prevalente que necesita una atención de calidad para hacer efectivo su derecho a la salud. Objetivo: Analizar y valorar la sensibilización y la formación de una experiencia desarrollada en Medicina en relación con la atención integral a las PcD. Método: Se ha realizado un estudio de intervención, tipo antes y después, sin grupo control, en 120 alumnos del grado de Medicina. Resultados: Los estudiantes perciben que falta de formación en este tema y son conscientes de su rol sanitario y social en la reducción de desigualdades en las PcD. Entre los conocimientos profesionales que mejoran con la intervención, de manera significativa, están los relacionados con los derechos de las PcD, los factores de riesgo, el grado de discapacidad, el diseño universal, las medidas de acción positiva y las adaptaciones curriculares asociadas a la educación inclusiva. En relación con las competencias que deben ser adquiridas, se debe destacar su sensibilización sobre la necesidad de habilidades sociales y de comunicación, y la capacidad para emitir informes médicos sobre la incapacitación. Conclusión: La intervención formativa se muestra efectiva en relación con la sensibilización sobre la importancia del rol del médico en relación con los pacientes con discapacidad y, en consecuencia, se valoran los conocimientos y competencias necesarias para conseguir una mejor atención sanitaria. Abstract: Background: Inclusive higher education aims to transform and improve the competence role of the future doctors in relation to people with disabilities (PwD), a vulnerable and prevalent population group which needs Quality Care to fulfil the right to health. Aim: To analyse and assess the awareness and training received of an experience developed in the School of Medicine related to the comprehensive care for PwD. Method: A before- and after-intervention, with no control group, of 120 students enrolled in the School of Medicine. Results: Students perceive a lack of training on this topic and are aware of their health and social role to reduce inequalities in PwD. The professional knowledge that significantly improved with the intervention are the related with the rights of PwD, risk factors, degree of disability, universal design, positive action measures, and curriculum adaptations. As regards to the competences that must be acquired, the awareness of social and communications skills needed should be noted, as well as the ability to issue medical reports about disability. Conclusion: The training intervention is effective in terms of awareness about the importance of the medical role related to PwD, and consequently, the knowledge and skills needed to achieve a better Health Care are assessed. Palabras clave: Educación inclusiva, Personas con discapacidad, Estudio de intervención, Grado de Medicina, Keywords: Inclusive education, People with disabilities, Intervention study, School of Medicine

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7, GA) patients with mild SUI. Group B (n = 22, GB) patients with moderate SUI. Group C (n = 18, GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day, partial dryness as a &gt, 50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p &lt, 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

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.

Background Premature ejaculation (PE) is a common male neurobiological sexual disorder, related to a disturbance in central serotonin (5-hydroxytryptamine or 5-HT) neurotransmission. Aim To assess the efficacy of a single oral dose of 5HT1A receptor antagonist GSK958108 on ejaculation latency time (ELT) in male subjects suffering from PE. Methods A total of 35 male subjects were enrolled in a Phase 1 double-blind, placebo-controlled, parallel group masturbation-model study. All subjects completed the study. No subject was withdrawn from the study. There were no major protocol deviations reported during the study. Outcomes The primary outcome of the study was to evaluate the effect of a single oral dose of 5HT1A receptor antagonist GSK958108 on ELT as measured in the masturbation model; additionally, we investigated drug’s safety and tolerability. Results In the 3 mg GSK958108 treatment group, the ELT was estimated to be 16% longer (1.542 vs 1.328, 95% CI: -16% to +61%) than if the subjects had taken placebo. In the 7 mg GSK958108 treatment group, the ELT was estimated to be 77% longer (2.346 vs 1.328, 95% CI: +28% to +144%) than in the placebo group. The systemic exposure to GSK958108 increased with dosage between 3 mg and 7 mg. A significant trend toward an increase of ELT was observed with increasing plasma concentrations of GSK958108. A total of 4 patients all treated with 7 mg dose experienced minor drug related adverse events (5 adverse events in 4 patients): somnolence (n = 3), headache (n = 1), tinnitus (n = 1). Clinical Implications In the current double-blind, placebo-controlled parallel group study the 5HT1A receptor antagonist GSK958108 was tested in 3 mg and 7 mg doses for PE treatment in humans. It was shown that GSK958108 significantly delayed ejaculation showing a new and safe alternative in PE treatment. Strengths & Limitations The present study showed innovative results suggesting an important role of 5HT1A receptor antagonist in the PE treatment. However, the use of masturbation model and the small population are the main limitations of this investigation. Conclusion 5HT1A receptor antagonist GSK958108 3 mg per day and 7 mg per day was found to be well-tolerated, safe and effective for the treatment of PE subjects and demonstrated a strong association between 5HT1A receptors and ejaculation control in humans (NCT00861484). Migliorini F, Tafuri A, Bettica P, et al. A Double-Blind, Placebo-Controlled Parallel Group Study to Evaluate the Effect of a Single Oral Dose of 5-HT1A Antagonist GSK958108 on Ejaculation Latency Time in Male Patients Suffering From Premature Ejaculation. J Sex Med 2021;18:63–71.

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.

High performance female athletes may be a risk group for the development of urinary incontinence due to the imbalance of forces between the abdomen and the pelvis. Pelvic floor physiotherapy may be a useful treatment in these patients. Objectives: (1) To identify the scientific evidence for pelvic floor (PF) dysfunctions that are associated with urinary incontinence (UI) in high-performance sportswomen. (2) To determine whether pelvic floor physiotherapy (PT) corrects UI in elite female athletes. Materials and methods: Meta-analysis of published scientific evidence. The articles analyzed were found through the following search terms: (A) pelvic floor dysfunction elite female athletes, (B) urinary incontinence elite female athletes, (C) pelvic floor dysfunction elite female athletes physiotherapy, (D) urinary incontinence elite female athletes physiotherapy. Variables studied: type of study, number of individuals, age, prevalence of urinary incontinence described in the athletes, type of sport, type of UI, aspect investigated in the articles (prevalence, response to treatment, etiopathogenesis, response to PT treatment, concomitant health conditions or diseases. Study groups according to the impact of each sport on the PF: G1: low-impact (noncompetitive sports, golf, swimming, running athletics, throwing athletics), G2: moderate impact (cross-country skiing, field hockey, tennis, badminton, baseball) and G3: high impact (gymnastics, artistic gymnastics, rhythmic gymnastics, ballet, aerobics, jump sports (high, long, triple and pole jump)), judo, soccer, basketball, handball, volleyball). Descriptive analysis, ANOVA and meta-analysis. Results: Mean age 22.69 years (SD 2.70, 18.00&ndash, 29.49), with no difference between athletes and controls. Average number of athletes for each study was 284.38 (SD 373,867, 1&ndash, 1263). The most frequent type of study was case-control (39.60%), followed by cross-sectional (30.20%). The type of UI was most often unspecified by the study (47.20%), was stress UI (SUI, 24.50%), or was referred to as general UI (18.90%). Studies on prevalence were more frequent (54.70%), followed by etiopathogenesis (28.30%) and, lastly, on treatment (17.00%). In most cases sportswomen did not have any disease or concomitant pathological condition (77.40%). More general UI was found in G1 (36.40%), SUI in G2 (50%) and unspecified UI in G3 (63.64%). In the meta-analysis, elite athletes were found to suffer more UI than the control women. In elite female athletes, in general, physiotherapy contributed to gain in urinary continence more than in control women (risk ratio 0.81, confidence interval 0.78&ndash, 0.84)). In elite female athletes, former elite female athletes and in pregnant women who regularly engage in aerobic activity, physiotherapy was successful in delivering superior urinary continence compared to the control group. The risk of UI was the same in athletes and in the control group in volleyball female athletes, elite female athletes, cross-country skiers and runners. Treatment with PT was more effective in control women than in gymnastics, basketball, tennis, field hockey, track, swimming, volleyball, softball, golf, soccer and elite female athletes. Conclusions: There is pelvic floor dysfunction in high-performance athletes associated with athletic activity and urinary incontinence. Eating disorders, constipation, family history of urinary incontinence, history of urinary tract infections and decreased flexibility of the plantar arch are associated with an increased risk of UI in elite female athletes. Pelvic floor physiotherapy as a treatment for urinary incontinence in elite female athletes, former elite female athletes and pregnant athletes who engage in regular aerobic activity leads to a higher continence gain than that obtained by nonathlete women.

Introduction: Prostate-specific antigen velocity (PSAV) is used to monitor men with clinical suspicion of prostate cancer (PCa), with a normal cut-off point of 0.3&ndash, 0.5 ng/mL/year. The aim of the study is to establish the predictive capacity of PSAV (value and acceleration) and of the free PSA/total PSA index or ratio. Method: Prospective multicentre observational study in 2035 men of over 47 years of age. Inclusion criteria: men who wished to be informed on the health of their prostate. Exclusion criteria: men with a previously diagnosed prostate condition. Groups: GA: (n = 518): men with serum PSA equal to or greater than 2.01 ng/mL. GB: (n = 775): men with serum PSA greater than or equal to 0.78 ng/mL and less than 2.01 ng/mL. GC: (n = 742): men with serum PSA less than 0.78 ng/mL. Variables: prostate-specific antigen (PSA), age, body mass index (BMI), PSA velocity (PSAV) (ng/mL per year), free PSA/total PSA index (iPSA), PSAV acceleration (increasing: positive, or decreasing: negative), prostate diagnosis (benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia (PIN), or infectious and non-infectious prostatitis and prostatic adenocarcinoma (PCa)), de novo diagnoses of urinary tract diseases or conditions, concomitant treatments, diseases and conditions, final diagnosis of prostate health. Results: Mean age 62.35 years (SD 8.12), median 61 (47&ndash, 94), age was lowest in GC. Mean BMI was 27.89 kg/m2 (SD 3.96), median 27.58 (18.56&ndash, 57.13), no differences between groups. Mean PSAV was 0.69, SD 2.16, median 0.13 (0.001&ndash, 34.46), PSAV was lowest in GC. Mean iPSA was 27.39 u/L (SD 14.25), median 24.29 (3.7&ndash, 115), iPSA was lowest in GA. PSAV had more positive acceleration in GA and more negative acceleration in GC. There were 1600 (78.62%) cases of normal prostate or BPH, 322 (15.82%) cases of PIN or non-infectious prostatitis, and 113 (5.55%) cases of PCa. There were more cases of BPH in GC and more cases of PIN or prostatitis and cancer in GA (p = 0.00001). De novo diagnoses: 15 cases of urinary incontinence (UI), 16 discomfort/pain in LUT, 112 cases of voiding disorders, 12 urethral strictures, 19 hematuria, 51 cystitis, 3 pyelonephritis, 4 pelvic inflammatory disease, no differences were found between groups. In the multivariate analysis, PSAV and the direction of PSAV acceleration (positive or negative) were the variables which were correlated most strongly with prostate health. iPSA was associated with the presence of prostatitis, PCa, and BPH. Men in GA had more prostatitis, PCa, treatment with alpha blockers, and history of previous smoking. GB had more cases of BPH and more positive acceleration of PSAV. GC had more normal prostates, more BPH, more use of ranitidine, and more PSAV with negative acceleration. Conclusions: PSAV, direction of PSAV acceleration, and iPSA in PSA cut-off points of 0.78 ng/mL and 2.01 ng/mL in a priori healthy men over 47 predict the probability of benign or malignant pathology of the prostate.

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.

Introduction: Stress urinary incontinence (SUI) has an incidence of 15&ndash, 80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. Aims: To assess the time for functional recovery in women operated on for SUI by TOT, to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery, and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. Materials and methods: A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (n = 443): patients with ASA I risk. GB (n = 306): patients with ASA II risk. GC (n = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student&rsquo, s t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for p &lt, 0.05. Results: Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m2 (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (p = 0.0221) and GA (10.51%) (p = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%), and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05), bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90), lowest for patients with bleeding. GC: 9.44 (SD 2.50), for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46), no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94), less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery, in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. Conclusions: Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.

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.