OAB score: A clinical model that predicts the probability of presenting overactive detrusor in the urodynamic study

ABSTRACT Purpose To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population. Materials and Methods A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD. Results presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were urgency, urgency incontinence, nocturia, absence of SUI symptoms, diabetes mellitus, reduction of vaginal trophism and bladder capacity below 150 mL. The probability of IDC diagnosis increases as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity was 71% and specificity 72%. The area under the curve of OAB score was 0.784 (p>0.001). Conclusions OAB score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone to predict overactive detrusor.

Hallazgos patológicos y evolución en prostatectomía radical de pacientes candidatos para vigilancia activa / Pathological findings and follow-up of radical prostatectomy patients candidates for active surveillance

El APE ha derivado en el diagnóstico de CaP en etapas más tempranas de la enfermedad. Por otra parte, existen evidencias de que muchos pacientes son sobretratados. La vigilancia activa tiene como premisa reducir el sobre tratamiento y la morbilidad relacionada con el tratamiento primario. El objetivo de este estudio fue evaluar las características patológicas desfavorables en pacientes sometidos a PR que fueron estratificados pre-operatoriamente de bajo riesgo según 10 modalidades para definir pacientes posibles de seguimiento activo. Realizamos un estudio retrospectivo y analítico de 230 pacientes con diagnóstico de CAP y tratados con PR, realizadas entre 1999 y 2011 en el Centro Urológico Profesor Bengió. Se evaluaron las características clínicas en 10 protocolos de seguimiento activo. Las variables anatomopatológicas evaluadas en la pieza de PR fueron el estadio patológico, SG de la pieza operatoria, la extensión extraprostática (EEP), invasión de vesículas seminales y compromiso de ganglios linfíticos regionales. El informe histopatológico fue realizado por un único uropatólogo (VB).En cada uno de los protocolos se evalúa el índice de recurrencia bioquímica. La población del estudio fue 198 pacientes. La media de edad fue 63 años. La media de APE 12,4/ml. Predominaron los estadíos clínicos T1c (48 por ciento) y T2 (48 por ciento). El índice de concordancia entre el SG de la biopsia y la PR en la serie se observó en 128 pacientes (64,6 por ciento). La extensión extraprostática, invasión de vesículas seminales e invasión ganglionar fue encontrada en 44 (22,2 por ciento), 38 (19,2 por ciento) y 3 (1,5 por ciento) pacientes respectivamente. La presencia de elementos patológicos desfavorables en pacientes candidatos a seguimiento activo oscila entre 12 por ciento y el 32 porciento. En nuestra serie de pacientes tratados con prostatectomía radical, los esquemas de vigilancia activa más estrictos, basados en APE <10ng/ml,...

The PSA has resulted in the diagnosis of prostate cancer in earlier stages of the disease. Moreover, there is evidence that many patients are over-treated. Active surveillance tries to prevent overtreatment and reduce the morbidity associated with primary treatment. The aim of this study was to evaluate the adverse pathologic features in patients who underwent RP and were stratified preoperatively as potential candidate for active surveillance through 10 different protocols. A retrospective study of 230 patients diagnosed with CAP treated with PR, conducted between 1999 and 2011 in the Urological Center Professor Bengio. Clinical characteristics were evaluated in 10 active surveillance protocols. Pathologic variables evaluated in RP specimens were pathological stage, surgical specimen SG, extraprostatic extension (EEP), seminal vesicle invasion and regional lymph nodes. The histopathological report was done by a single uropathologist (VB). In each of the protocols biochemical recurrence rate was evaluated. The study population was 198 patients. The average age was 63. The mean PSA 12.4 / ml. Predominant clinical stages T1c (48 percent) and T2 (48 percent). The concordance rate between the SG biopsy and RP in the series was observed in 128 patients (64.6 percent). Extraprostatic extension, seminal vesicle invasion and lymph node involvement was found in 44 (22.2 percent), 38 (19.2 percent) and 3 (1.5 percent) patients, respectively. The presence of unfavorable pathological elements in candidates for active surveillance patients ranges from 12 percent to 32 percent. In our series of patients treated with radical prostatectomy, stricter schemes of active surveillance based on PSA <10ng/ml, clinical stage T1c-T2a, biopsy Gleason score ¡Ü 6 and minimally invasive biopsy (<2 cylinders and <50 percent involvement) show better agreement with favorable histopathology findings in radical prostatectomy and correspond with greater biochemical recurrence-free survival...

Evaluación de los criterios de Epstein para cáncer de próstata insignificante en nuestra serie de prostectomía radical / Evaluacion of the Epstein criteria for insignificant prostate cancer in our serie of radical prostatectomy

Los criterios de Epstein (densidad del antígeno prostático específico <0,15, score de Gleason en la biopsia <6, menos de 3 cilindros comprometidos, menos del 50 por ciento de afectación por cilindro) representan el método más utilizado para predecir cáncer de próstata clínicamente insignificante y, por lo tanto, susceptible de conductas conservadoras. Objetivos: Evaluar la existencia de elementos pronósticos desfavorables en el estudio de la pieza operatoria de pacientes con criterios preoperatorios de cáncer insignificante. Materiales y métodos: Entre 1999 y 2009, 220 pacientes fueron sometidos a prostatectomía radical (PR) en nuestra institución. Se incluyeron 183 pacientes que reunían los criterios de inclusión y exclusión. De los mismos 29 (15,3 por ciento) cumplían con todos los criterios de cáncer clínicamente insignificante. Se consideraron elementos de pronóstico patológicamente desfavorables, el score de Gleason 7 o más y/o enfermedad extra prostática en el estudio del espécimen quirúrgico. Resultados: La presencia de suma de Gleason 7 o mayor fue evidenciado en 6 pacientes (21,4 por ciento) con cáncer clínicamente insignificante. Tres de estos presentaron enfermedad extraprostática. Cuatro experimentaron recurrencia bioquímica con una media a la recurrencia de 24 meses. Comentarios: La correlación entre los criterios clínicos de Epstein para definir CaP insignificante con los resultados histopatológicos de la pieza operatoria muestra diferencias significativas en algunos casos. Las mismas residen básicamente en la diferencia de la evaluación del" score de Gleason de la biopsia y de la pieza operatoria, y entre la estadificación clínica y patológica...

Epstein criteria (prostate specific antigen density <0.15, Gleason score on biopsy <6, less than 3 cylinders engaged, less than 50 percent of affected per cylinder) are the most wide/y used method for predicting prostate cancer clinically insignificant and, therefore, susceptible to conservative behavior. Objectives: Evaluate the existence of unfavorable prognostic elements in the study of the surgical specimen of patients with preoperative criteria of insignificant cancer. Materials and methods: Between 1999 and 2009, 220 patients where treat by means of radical prostatectomy (RP) at our institution. We included 183 patients who met the inclusion and exclusion criteria. 29 (15.3 percent) met all criteria for clinically insignificant cancer. We considered as elements of pathologically unfavorable prognosis the Gleason score of 7 or more, and confined disease in the study of the surgical specimen. Results: The presence of Gleason sum 7 or greater was demonstrated in 6 patients (21.4 percent) wit clinically insignificant cancer. Three of these had organ confined disease. 4 experienced biochemical recurrence with a mean recurrence of 24 months. Comments: The correlation between clinical criteria to define insignificant prostate cancer with histopathological findings of the resected specimen shows significant difference in some cases. Basically the same lie in the difference in the assessment of Gleason score of biopsy and surgical specimen, and between clinical and pathological staging. This suggests that Epstein definitions based on clinical parameters must be assumed as elements of guidance only and not as absolute certainty criteria for qualification of insignificant cancer. Conclusions: Epstein criteria for clinically insignificant prostate cancer underestimate the malignant potential in the 21.4 percent of patients ¡n our series...