Actas urologicas espanolas最新文献

{"title":"Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort","authors":"J. Romero Otero ,&nbsp;J. Justo Quintas ,&nbsp;E. García Rojo ,&nbsp;R. Sopeña Sutil ,&nbsp;E. Peña Vallejo ,&nbsp;F. Lista Mateos ,&nbsp;G. Bozzini ,&nbsp;D. Saenz Calzada ,&nbsp;A. Rodríguez Antolín ,&nbsp;B. García Gómez","doi":"10.1016/j.acuroe.2024.02.010","DOIUrl":"10.1016/j.acuroe.2024.02.010","url":null,"abstract":"<div><h3>Introduction</h3><p>Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate.</p></div><div><h3>Material and methods</h3><p>All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications.</p></div><div><h3>Results</h3><p>Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification.</p></div><div><h3>Discussion</h3><p>With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data.</p></div><div><h3>Conclusions</h3><p>TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139901056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The leaky pipeline and gender gaps in urology.","authors":"A Medina Gamero","doi":"10.1016/j.acuroe.2024.05.016","DOIUrl":"10.1016/j.acuroe.2024.05.016","url":null,"abstract":"","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty.","authors":"J Klemm, P Marks, R J Schulz, D K Filipas, D R Stelzl, R Dahlem, M Fisch, M W Vetterlein","doi":"10.1016/j.acuroe.2024.05.014","DOIUrl":"10.1016/j.acuroe.2024.05.014","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Female urethral strictures are a rare condition that significantly impacts patients' quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center.</p><p><strong>Patients and methods: </strong>We conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009-2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes).</p><p><strong>Results: </strong>Of 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction.</p><p><strong>Conclusions: </strong>Buccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.</p>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost analysis of next-generation imaging in high-risk prostate cancer staging","authors":"J.J. Szczesniewski ,&nbsp;C. Tellez Fouz ,&nbsp;A. García Tello ,&nbsp;M. de la Rubia Marcos ,&nbsp;M.P. García Alonso ,&nbsp;L. Llanes González","doi":"10.1016/j.acuroe.2023.12.003","DOIUrl":"10.1016/j.acuroe.2023.12.003","url":null,"abstract":"<div><h3>Introduction and objective</h3><p>Next-generation imaging (NGI) tests, such as choline<span><span> PET/CT and PSMA<span> PET<span>, have shown to increase sensitivity in the detection of nodal and metastatic disease in </span></span></span>prostate cancer<span>. However, their use implies an increase in diagnostic costs compared to conventional imaging (CI) tests such as CT and bone scan. The aim of our study was to determine which diagnostic pathway is more cost-effective in high-risk prostate cancer.</span></span></p></div><div><h3>Material and method</h3><p>Cost-effectiveness analysis of the available imaging tests (CI, Choline/PSMA PET) for the staging of high-risk prostate cancer. Sensitivity and specificity were estimated based on published evidence, and costs were collected from the Management Department. In order to carry out a cost-effectiveness analysis, five diagnostic pathways were proposed estimating the accurate diagnoses.</p></div><div><h3>Results</h3><p>PSMA PET was the most accurate diagnostic option. The CI diagnostic workup was the most economical and CI<!--> <!-->+<!--> <!-->PSMA the most expensive. Analyzing the diagnostic cost-effectiveness ratio, CI<!--> <!-->+<!--> <!-->PSMA proved to be the most expensive (€5627.30 per correct diagnosis) followed by PET PSMA (€4987.11), choline (€4599.84) and CI (€4444.22).</p></div><div><h3>Conclusions</h3><p>PSMA PET is the most accurate strategy in staging distant disease in patients<span> with high-risk prostate cancer. Radiotracer uptake tests such as CI have been shown to be the most cost-effective option, followed by choline and PSMA.</span></p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External urology consultation quality at a third-level public hospital in Mexico","authors":"R. Cortés-Ramírez ,&nbsp;C.B. Ruíz-Velasco ,&nbsp;A. González-Ojeda ,&nbsp;R.A. Ramírez-Aguado ,&nbsp;N.G. Barrera-López ,&nbsp;E. Gómez-Mejía ,&nbsp;K. Toala-Díaz ,&nbsp;G. Delgado-Hernández ,&nbsp;N.E. López-Bernal ,&nbsp;J.A. Tavares-Ortega ,&nbsp;J.M. Chejfec-Ciociano ,&nbsp;G. Cervantes-Guevara ,&nbsp;G. Cervantes-Cardona ,&nbsp;E. Cervantes-Pérez ,&nbsp;S. Ramírez-Ochoa ,&nbsp;A. Nápoles-Echauri ,&nbsp;A.S. Álvarez-Villaseñor ,&nbsp;A.O. Cortés-Flores ,&nbsp;C. Fuentes-Orozco","doi":"10.1016/j.acuroe.2023.12.004","DOIUrl":"10.1016/j.acuroe.2023.12.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Patient satisfaction is the degree of conformity with the healthcare they receive. It is real evidence and one of the most important factors in determining the effectiveness and quality of healthcare systems.</p></div><div><h3>Objective</h3><p>To identify the quality of care in the Urology outpatient department of a third-level hospital.</p></div><div><h3>Materials and methods</h3><p>The NHS (National Health Service) 2018 quality of care questionnaire with 11 sections, 133 items, and duration of approximately 25<!--> <!-->min was randomly administered to 250 patients attending Urology outpatients at a third-level public hospital in Mexico.</p></div><div><h3>Results</h3><p>According to responses, 92% (n<!--> <!-->=<!--> <!-->230) knew the reason for the consultation. 64.8% (n<!--> <!-->=<!--> <!-->162) had a consultation with the same physician by whom they were initially seen. The longest reported hospital wait time before being seen was more than 2<!--> <!-->h in 29.6% (n<!--> <!-->=<!--> <!-->74). As for consultation time, 212 patients responded and the duration was 11−20<!--> <!-->min in 52.8% (n<!--> <!-->=<!--> <!-->112). Finally, 33.2% (n<!--> <!-->=<!--> <!-->83) considered the quality of service to be good.</p></div><div><h3>Conclusions</h3><p>The use of the NHS 2018 survey in the Urology service at a third-level public hospital in Mexico is feasible, since we managed to obtain a significant and continuous improvement in all its indicators which is satisfactory for all.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tislelizumab, a novel PD-1 monoclonal antibody in urothelial cancer: A real-world study","authors":"Z. Wang,&nbsp;H. Bi,&nbsp;Y.D. Wang,&nbsp;Q. Liu,&nbsp;B. Shao,&nbsp;C.Q. Li,&nbsp;C. Fu,&nbsp;S. Fu,&nbsp;G.Y. Shan,&nbsp;A. Chen,&nbsp;C.C. Lv,&nbsp;Y. Zeng","doi":"10.1016/j.acuroe.2023.12.006","DOIUrl":"10.1016/j.acuroe.2023.12.006","url":null,"abstract":"<div><h3>Objective</h3><p>Tislelizumab, a monoclonal antibody against programed death protein-1 (PD-1), has shown encouraging antitumor activity in urothelial cancer. This study was designed to assess the efficacy and safety of tislelizumab in urotelial cancer in a real-world setting.</p></div><div><h3>Methods</h3><p>The study was a real-world retrospective study undertaken at Liaoning Cancer Hospital &amp; Institute, China. Eligible patients were ≥18 years. Patients received 200-mg tislelizumab monotherapy intravenously every 3 weeks until the disease progressed to intolerable toxicity. Outcomes included an objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety.</p></div><div><h3>Results</h3><p>Between March 2020 and December 2022, 33 patients were enrolled. The median follow-up was 10.17 (IQR 5.73–12.47) months. Of all 33 patients, ORR and DCR were 30.30% (95% CI 15.6%–48.7%) and 42.42% (95% CI 25.48%–60.78%), respectively. The median PFS was 5.73 (95% CI 3.27–13.00) months, with a 12-month PFS rate of 31.90% (95% CI 19.20%–53.00%). The median OS was 17.7 (95% CI 12.80-not reach) months, with a 12-month OS rate of 67.50% (95% CI 52.70%–86.40%). Eleven (33.33%) and 8 (24.24%) experienced ≥grade 3 treatment-related adverse events (TRAEs) and immune-related Aes, respectively. No treatment-related deaths occurred.</p></div><div><h3>Conclusion</h3><p>The excellent efficacy and controllable safety of tislelizumab in locally advanced or metastatic urothelial cancer suggest that it may be a promising therapeutic option for this population.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cocaine-related ischemic priapism. Systematic review and presentation of a single center series","authors":"C. Altez-Fernandez ,&nbsp;L. Lamas ,&nbsp;M. Bohorquez ,&nbsp;V. Chantada ,&nbsp;D. Ralph","doi":"10.1016/j.acuroe.2024.02.007","DOIUrl":"10.1016/j.acuroe.2024.02.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing.</p><p>This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism?</p></div><div><h3>Methods</h3><p>We conducted a systematic review according to PRISMA guidelines and described our case series.</p></div><div><h3>Results</h3><p>Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively.</p></div><div><h3>Conclusion</h3><p>Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139901053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty.","authors":"J. Klemm, P. Marks, R. J. Schulz, D. K. Filipas, D. Stelzl, R. Dahlem, M. Fisch, M. Vetterlein","doi":"10.1016/j.acuroe.2024.05.014","DOIUrl":"https://doi.org/10.1016/j.acuroe.2024.05.014","url":null,"abstract":"","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study","authors":"Ó. Legido-Gómez ,&nbsp;S. Rico-Marco ,&nbsp;M.V. Lorenzo-Sánchez ,&nbsp;S. Navarro-Jiménez ,&nbsp;M.A. Tárraga-Honrubia ,&nbsp;J. Martínez-Ruiz ,&nbsp;J.M. Giménez-Bachs ,&nbsp;M.J. Donate-Moreno ,&nbsp;I. Díaz de Mera-Sánchez-Migallón ,&nbsp;M. Segura-Martín ,&nbsp;R. Alcantud-Córcoles ,&nbsp;P. Abizanda-Soler ,&nbsp;A.S. Salinas-Sánchez","doi":"10.1016/j.acuroe.2024.02.012","DOIUrl":"10.1016/j.acuroe.2024.02.012","url":null,"abstract":"<div><h3>Introduction</h3><p>Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient’s quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis.</p></div><div><h3>Materials and methods</h3><p>PROSARC is a national (Spain) prospective observational study (May-2022–May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up.</p></div><div><h3>Results</h3><p>A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (<em>p</em> <!-->=<!--> <!-->0.666), decreased mean value of appendicular muscle mass (<em>p</em> <!-->=<!--> <!-->0.01) and increased percentage of fat mass (<em>p</em> <!-->=<!--> <!-->0.012).</p></div><div><h3>Conclusion</h3><p>In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary consensus document on the current treatment of bacille Calmette-Guérin-unresponsive non-muscle invasive bladder tumor","authors":"F. Guerrero-Ramos ,&nbsp;M. Álvarez-Maestro ,&nbsp;Á. Pinto Marín ,&nbsp;J.L. Domínguez Escrig ,&nbsp;Ó. Rodríguez Faba","doi":"10.1016/j.acuroe.2024.04.005","DOIUrl":"10.1016/j.acuroe.2024.04.005","url":null,"abstract":"<div><p>Radical cystectomy is the current treatment of choice for patients with BCG-unresponsive non-muscle invasive bladder tumor (NMIBC). However, the high comorbidity of this surgery and its effects on the quality of life of patients require the investigation and implementation of bladder-sparing treatment options. These must be evaluated individually by the uro-oncology committee based on the characteristics of the BCG failure, type of tumor, patient preferences and treatment options available in each center. Based on FDA-required oncologic outcomes (6-month complete response rate for CIS: 50%; duration of response in responders for CIS and papillary: 30% at 12 months and 25% at 18 months), there is not currently a strong preference for one treatment over another, although the intravesical route seems to offer less toxicity. This work summarizes the evidence on the management of BCG-unresponsive NMIBC based on current scientific evidence and provides consensus recommendations on the most appropriate treatment.</p></div>","PeriodicalId":94291,"journal":{"name":"Actas urologicas espanolas","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}