Recommendations on the treatment of metastatic hormone-sensitive prostate cancer: Patient selection.

The standard treatment for metastatic hormone-sensitive prostate cancer (mHSPC) is now a combination of androgen deprivation therapy plus an androgen receptor-targeted therapy (abiraterone, apalutamide, enzalutamide or darolutamide), with or without chemotherapy (docetaxel). The selection of suitable patients for each therapeutic approach has become a determining factor to ensure efficacy and minimize side effects. This article combines recent clinical evidence with the accumulated experience of experts in medical oncology, radiation oncology and urology, to provide a comprehensive view and therapeutic recommendations for mHSPC.

Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort.

INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSIONS: 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.

Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

¿Cómo diagnosticamos la diverticulitis aguda? Resultados de una encuesta nacional sobre el papel de las técnicas de imagen / How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques

Introducción: La elección de las técnicas de imagen en el diagnóstico de la diverticulitis aguda (DA) es un motivo de controversia. Los objetivos del estudio fueron conocer las preferencias de los radiólogos y el grado de utilización de las distintas técnicas en su manejo radiológico. Métodos: Se difundió una encuesta por Internet a través de la Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA) y Twitter, con preguntas sobre ámbito de trabajo, protocolización, preferencias personales y la realidad asistencial en el manejo radiológico de la DA. Resultados: Se obtuvieron 186 respuestas. El 72% de los radiólogos encuestados trabaja en servicios organizados por «órgano y sistema» (S-OS). Existe protocolo de manejo de DA en un el 48% de los servicios, siendo en el 47,5% la ecografía la técnica de inicio. El 73% de los encuestados cree que la ecografía debería ser la primera opción diagnóstica, pero en realidad esto solo se efectúa en un 24% de los servicios, realizándose tomografía computarizada en el 32,8%, con diferencias significativas en horario de guardia. La clasificación más utilizada es la de Hinchey (75%). El 96% de los encuestados desearía un consenso de especialidad para utilizar la misma clasificación. Existe mayor tasa de protocolización, utilización de clasificaciones y mayor creencia en la ecografía como técnica inicial en S-OS y en hospitales con más de 500 camas. Conclusiones: Hay una gran variabilidad en el manejo radiológico de la DA, con divergencias en los protocolos utilizados y entre las opiniones de los radiólogos y la práctica clínica real.(AU)

Introduction: The choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists’ preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. Methods: An online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents’ working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. Results: A total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with>500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. Conclusions: The radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists’ opinions, and actual clinical practice.(AU)

How do we diagnose acute diverticulitis? Results of a national survey about the role of imaging techniques.

INTRODUCTION: The choice of imaging techniques in the diagnosis of acute diverticulitis is controversial. This study aimed to determine radiologists' preferences for different imaging techniques in the management of acute diverticulitis and the extent to which they use the different radiologic techniques for this purpose. METHODS: An online survey was disseminated through the Spanish Society of Abdominal Imaging (Sociedad Española de Diagnóstico por Imagen del Abdomen (SEDIA)) and Twitter. The survey included questions about respondents' working environments, protocolization, personal preferences, and actual practice in the radiological management of acute diverticulitis. RESULTS: A total of 186 responses were obtained, 72% from radiologists working in departments organized by organ/systems. Protocols for managing acute diverticulitis were in force in 48% of departments. Ultrasonography was the initial imaging technique in 47.5%, and 73% of the respondents considered that ultrasonography should be the first-choice technique; however, in practice, ultrasonography was the initial imaging technique in only 24% of departments. Computed tomography was the first imaging technique in 32.8% of departments, and its use was significantly more common outside normal working hours. The most frequently employed classification was the Hinchey classification (75%). Nearly all (96%) respondents expressed a desire for a consensus within the specialty about using the same classification. Hospitals with >500 beds and those organized by organ/systems had higher rates of protocolization, use of classifications, and belief that ultrasonography is the best first-line imaging technique. CONCLUSIONS: The radiologic management of acute diverticulitis varies widely, with differences in the protocols used, radiologists' opinions, and actual clinical practice.

Una actualización en el protocolo en cáncer de próstata metastásico hormonosensible / Hormone sensitive protocol for metastatic prostate cancer, an update

Revisar y actualizar los últimos protocolos en cáncer de próstata metastásico hormonosensible para mejorar su manejo clínico en la práctica clínica. Realizar un análisis de los datos y los protocolos más recientes en el cáncer de próstata metastásico hormonosensible según paneles de expertos en este ámbito. Actualmente se necesita un grupo de consenso nominal para unificar y mejorar las recomendaciones para el manejo de pacientes sensibles con cáncer de próstata metastásico. Este documento unifica y mejora el manejo de los pacientes con cáncer de próstata metastásico hormonosensible, con una metodología que combina datos cuantitativos y cualitativos, y basada en la participación de un amplio comité científico designado por la Asociación Española de Urología (AU)

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology (AU)

European Association of Urology biochemical recurrence risk groups after radical prostatectomy: External validation and identification of independent risk factors for progression and death.

BACKGROUND: The EAU proposed a progression and death risk classification in patients with biochemical recurrence after radical prostatectomy (PR). OBJECTIVE: To validate the EAU BCR-risk classification in our setting and to find factors related to progression and death. MATERIAL AND METHODS: Multicenter, retrospective, observational study including 2140 patients underwent RP between 2011 and 2015. Patients with BCR were identified and stratified in low risk (PSA-DT >1yr and pGS <8) or high-risk (PSA-DT ≤1yr or pGS ≥8) grouping. PSA and metastatic free survival (PSA-PFS, MFS), cancer specific survival (CSS) and overall survival (OS) were calculated (Kaplan Meier curves and log-rank test). Independent risk factors were identified (Cox regression). RESULTS: 427 patients experienced BCR (32.3% low-risk and 67.7% high-risk). Median PSA-PFS was 135,0 mo (95% CI 129,63-140,94) and 115,0 mo (95% CI 104,02-125,98) (p<0,001), for low and high-risk groups, respectively. There were also significant differences in MFS and OS. The EAU BCR risk grouping was independent factor for PSA-progression (HR 2.55, p 0.009). Time from PR to BCR, was an independent factor for metastasis onset (HR 0.43, 95% CI 0.18-0.99; p 0.044) and death (HR 0.17, 95% CI 0.26.0.96; 23 p 0.048). Differences in MFS (p 0.001) and CSS (p 0.004) were found for <12, ≥12-<36 and ≥36 months from PR to BCR. Others independent factors were early salvage radiotherapy and PSA at BCR. CONCLUSIONS: High-risk group is a prognostic factor for biochemical progression, but it has a limited accuracy on MP and death in our setting. The inclusion of other factors could increase its predictive power.

Hormone sensitive protocol for metastatic prostate cancer, an update.

To review and update last protocols in hormone sensitive metastatic prostate cancer for improving clinical management in routine. Evidence analysis available about recent updates protocols in hormone sensitive metastatic prostate cancer according to expert panel of clinicians about this field. A nominal consensus group for unify and improve the recommendations to the management of sensitive metastatic prostate cancer patients is currently needed. This document unifies and improve the management of patients with hormone sensitive metastatic prostate cancer, with a methodology that combines data quantitative and qualitative and based on the participation of a broad scientific committee appointed by the Spanish Association of Urology.

Rehabilitación del sector anterosuperior mediante protocolo digital / Rehabilitation of the anterior-superior sector using digital protocol

Presentamos un caso clínico en el que todos los pasos y etapas (Diagnóstico, planificación, cirugía de inserción de implantes y rehabilitación prostodóncica) han sido realizados mediante recursos digitales (CBCT, impresión digital, escáner facial, planificación prostodóncica, cirugía guiada, carga inmediata, prótesis definitiva). La precisión del tratamiento y la predictibilidad del mismo, superan a la técnica habitual, si bien es preciso un entrenamiento previo para poder utilizar al máximo estos recursos. (AU)

We present a clinical case in which all the steps and stages (diagnosis, planning, implant insertion surgery, and prosthodontic rehabilitation) have been performed using digital resources (CBCT, digital impressions, facial scanning, prosthodontic planning, guided surgery, immediate loading, definitive prosthesis). The accuracy and predictability of the treatment surpass the traditional technique, although prior training is necessary to make the most of these resources. (AU)

Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area.

OBJECTIVE: To analyze surgical safety through postoperative COVID-19 incidence and mortality at the urology department of a tertiary hospital located in Madrid (Spain). METHODS: Observational, prospective study including all patients undergoing urological surgery from 1st March 2020 to 28th February 2021. According to the hospital organization and local epidemiological situation we delimitate three epidemic waves. A set of screening and protective measures was applied from 4th May onwards. Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were collected. Telephone follow-up was performed at least 3 weeks after hospital discharge. RESULTS: 940 urological surgeries were performed, 12 of them had to be rescheduled due to active or recent SARS-CoV-2 infection identified by the screening protocol. Thirty-one patients developed COVID-19 (3.3% incidence) and 7 died (22.6% mortality). The average time to onset of symptoms was 62.6 days after discharge, being 25 cases attributable to community transmission. The remaining 6 cases, due to in-hospital transmission, had worse outcomes. Five of them were identified during the first wave, especially when no preoperative PCR was obtained. In contrast, during the second and third waves, fewer and milder cases were diagnosed, with just 1 in-hospital transmission among 857 urological patients. CONCLUSIONS: After implementing complete protective measures, postoperative in-hospital COVID-19 cases almost disappeared, even during the second and third waves. Most of the cases were due to community transmission and thus driven by the general epidemiological situation. While hospitals follow recommendations to avoid COVID-19 infection, urological surgery remains safe and can be maintained.

[Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era]. / Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19.

Introduction: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. Methods: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. Results: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). Conclusions: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19 / Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era

Introducción: La suspensión de la mayoría de las cirugías electivas durante la pandemia por COVID-19 ha aumentado las listas de espera de cirugía urológica. El objetivo de este estudio es evaluar el impacto de la pandemia COVID-19 en la lista de espera de cirugía urológica en un hospital de alto volumen.MétodosSe diseñó un estudio descriptivo observacional. Se analizaron todos los pacientes incluidos en la lista de espera de cirugía urológica de nuestro centro de alto volumen el 1 de mayo de 2020 (46 días después de la suspensión de la cirugía electiva). Se registraron las características basales, prioridad en la lista de espera, enfermedad urológica principal, tipo de cirugía programada y tiempo de espera. Otras variables registradas fueron la presencia de catéter urinario, el número de visitas al servicio de urgencias, evidencia de infección por COVID-19, el número de muertes y su causa. El tiempo de espera de cada enfermedad se comparó con el tiempo de espera para la cirugía en 2019.ResultadosUn total de 350 pacientes fueron incluidos en el estudio. El tiempo medio (DE) en la lista de espera fue de 97,33 (55,47) días. Los pacientes de prioridad 1, que normalmente deben ser operados en un plazo de 30 días, estuvieron en la lista de espera por un tiempo medio de 60,51 (20,14) días. Eran principalmente pacientes con litiasis ureteral (25,6%), cáncer de vejiga de alto riesgo o músculo-invasivo (20,9%) y cáncer de próstata de alto riesgo (13,9%). El tiempo medio de espera superaba significativamente el tiempo medio (DE) de espera para cistectomía radical (p = 0,04) y URS (p = 0,003) en 2019.ConclusionesLa suspensión de la mayoría de las cirugías electivas debido a la pandemia por COVID-19 tuvo un impacto significativo en la lista de espera de cirugía urológica de nuestro centro de alto volumen, especialmente en el grupo de prioridad 1. (AU)

Introduction: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital.MethodsAn observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019.ResultsA total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003).ConclusionsThe suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group. (AU)

Estudio de las infecciones relacionadas con la asistencia sanitaria tras la realización de cistectomía radical / Evaluation of health care-associated infections following radical cystectomy

INTRODUCCIÓN Y OBJETIVO: La cistectomía radical es una cirugía compleja con una alta tasa de complicaciones, entre ellas las infecciones, conllevando un aumento de la morbimortalidad, estancia hospitalaria y costes. El objetivo de este trabajo es estudiar las infecciones relacionadas con la asistencia sanitaria (IRAS) en estos pacientes, así como de los microorganismos asociados, perfiles de resistencia antibiótica y factores de riesgo. MATERIAL Y MÉTODOS: Estudio prospectivo del 2012 al 2017. Se recogen variables epidemiológicas, comorbilidades y variables quirúrgicas. Se analizan los microorganismos implicados y patrones de susceptibilidad antibiótica. RESULTADOS: Estudio de 122 pacientes. Edad media 67 años (DE:18,42). Estancia hospitalaria media 23,5 días (18,42). Tasa de IRAS del 45%, predominando las infecciones del tracto urinario (43%) y de la herida quirúrgica (31%). Cultivos positivos en el 78,6% de los casos. Mayor aislamiento de Enterococcus (18%) y Escherichia coli (13%). El 43% de los microorganismos presentaban resistencia a la amoxicilina/ampicilina, 23% a las betalactamasas y 36% a las quinolonas. El tratamiento empírico fue adecuado en el 87,5%. Se observa un aumento en la estancia hospitalaria (17 días, p < 0,05) por padecer una IRAS. Menor tasa de complicaciones infecciosas en el abordaje laparoscópico frente al abierto (p < 0,001) y en las derivaciones ortotópicas frente al conducto ileal (p = 0,04). CONCLUSIONES: Encontramos una elevada tasa de IRAS en nuestra serie de cistectomías radicales, con un predominio de infecciones del tracto urinario y de la herida quirúrgica. E. coli y Enterococcus spp. son los microorganismos más frecuentemente aislados, con altas tasas de resistencia a algunos antibióticos de uso común

INTRODUCTION AND OBJECTIVE: Radical cystectomy is a complex surgery with a high rate of complications including infections, which lead to increased morbidity and mortality, longer hospital stay and higher costs. The aim of this work is to evaluate health care-associated infections (HAIs) in these patients, as well as associated microorganisms, antibiotic resistance profiles and risk factors. MATERIAL AND METHODS: Prospective study from 2012 to 2017. Epidemiologic variables, comorbidities and surgical variables are collected. The microorganisms involved and antibiotic susceptibility patterns are analyzed. RESULTS: 122 patients. Mean age 67 (SD:18,42). Mean hospital stay 23.5 days (18.42). HAIs rate of 45%, with predominant urinary tract infections (43%) and surgical wound infections (31%). Positive cultures in 78.6% of cases. Increased isolation of Enterococcus (18%) and Escherichia coli (13%). Forty-three percent of microorganisms were resistant to amoxicillin/ampicillin, 23% to beta-lactamases and 36% to quinolones. Empirical treatment was adequate in 87.5%. Hospital stay is increased (17 days, p < 0.05) due to HAIs. Lower rate of infectious complications in the laparoscopic vs. open approach (p < 0.001) and in orthotopic vs. ileal conduit diversion (p = 0.04) CONCLUSIONS: We found a high rate of HAIs in our radical cystectomy series, with predominant urinary tract and surgical wound infections. E.coli and Enterococcus spp. are the most frequently isolated microorganisms, with high rates of resistance to some commonly used antibiotics

Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era. / Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19.

INTRODUCTION: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. METHODS: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. RESULTS: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). CONCLUSIONS: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Evaluation of health care-associated infections following radical cystectomy. / Estudio de las infecciones relacionadas con la asistencia sanitaria tras la realización de cistectomía radical.

INTRODUCTION AND OBJECTIVE: Radical cystectomy is a complex surgery with a high rate of complications including infections, which lead to increased morbidity and mortality, longer hospital stay and higher costs. The aim of this work is to evaluate health care-associated infections (HAIs) in these patients, as well as associated microorganisms, antibiotic resistance profiles and risk factors. MATERIAL AND METHODS: Prospective study from 2012 to 2017. Epidemiologic variables, comorbidities and surgical variables are collected. The microorganisms involved and antibiotic susceptibility patterns are analyzed. RESULTS: 122 patients. Mean age 67 (SD:18,42). Mean hospital stay 23.5 days (18.42). HAIs rate of 45%, with predominant urinary tract infections (43%) and surgical wound infections (31%). Positive cultures in 78.6% of cases. Increased isolation of Enterococcus (18%) and Escherichia coli (13%). Forty-three percent of microorganisms were resistant to amoxicillin/ampicillin, 23% to beta-lactamases and 36% to quinolones. Empirical treatment was adequate in 87.5%. Hospital stay is increased (17 days, p< 0.05) due to HAIs. Lower rate of infectious complications in the laparoscopic vs. open approach (p< 0.001) and in orthotopic vs. ileal conduit diversion (p = 0.04) CONCLUSIONS: We found a high rate of HAIs in our radical cystectomy series, with predominant urinary tract and surgical wound infections. E.coli and Enterococcus spp. are the most frequently isolated microorganisms, with high rates of resistance to some commonly used antibiotics.

Cirugía urológica durante la pandemia por SARS-CoV-2. Análisis descriptivo de la experiencia en un Servicio de Urología durante distintas fases epidemiológicas / Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases

INTRODUCCIÓN: La pandemia por SARS-CoV-2 ha cambiado la práctica urológica a nivel mundial. Nuestro objetivo es describir los resultados en salud observados en los pacientes intervenidos en el Servicio de Urología de un hospital terciario, a lo largo de diferentes fases epidemiológicas. MÉTODOS: Estudio de cohortes observacional que incluye todos los pacientes intervenidos entre el 1 de marzo y el 14 de mayo. Según la organización hospitalaria, distinguimos 3 periodos: durante las primeras 2 semanas no hubo cambios (1.er periodo), en las 7 semanas siguientes solo se realizaron intervenciones urgentes previa extracción de exudado nasofaríngeo (2.o periodo), y tras el 4 de mayo se reanudó la cirugía electiva aplicando un protocolo de cribado multidisciplinar (3.er periodo). Las variables demográficas y basales, las quirúrgicas y perioperatorias, así como los resultados postoperatorios, se obtuvieron de forma retrospectiva (periodos 1 y 2) y prospectiva (periodo 3). El seguimiento telefónico se realizó al menos 3 semanas tras el alta hospitalaria. RESULTADOS: Se realizaron 103 cirugías urológicas y fueron diagnosticados de COVID-19 11 pacientes, 8 de ellos en el 1.er periodo. El diagnóstico era conocido en un paciente, mientras que los otros 10 desarrollaron la enfermedad en una media de 25 días tras la intervención y 16,6 días tras el alta. Cuatro de 7 pacientes trasplantados resultaron afectados. Se registraron 3 muertes por la enfermedad: una mujer de 69 años trasplantada y 2 varones mayores de 80 años con comorbilidades y alto riesgo anestésico a los que se realizó drenaje de absceso retroperitoneal y cirugía retrógrada intrarrenal, respectivamente. CONCLUSIONES: La infección por SARS-CoV-2 afectó principalmente a trasplantados renales o pacientes añosos con alto riesgo anestésico, durante las 2 primeras semanas de la pandemia. Tras implantar la PCR preoperatoria y un protocolo completo de cribado, los casos se redujeron de manera sustancial y se pudo operar con seguridad

INTRODUCTION: The SARS-CoV-2 pandemic has changed the urological practice around the world. Our objective is to describe the outcomes presented by patients undergoing surgery in the urology department of a tertiary hospital, across the pandemic phases. METHODS: Observational, cohort study including all patients undergoing surgery from March 1 to May 14. According to the hospital organization, we identified three periods: there were no changes during the first two weeks (1st. period), the following seven weeks, when only urgent interventions were carried out after performance of nasopharyngeal swab test (2nd. period), and finally, elective surgery was resumed on May 4, after the implementation of a multidisciplinary screening protocol (3rd. period). Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were obtained in a retrospective (periods 1 and 2) and prospective (period 3) manner. Telephone follow-up was initiated at least 3 weeks after hospital discharge. RESULTS: 103 urological surgeries were performed, and 11 patients were diagnosed with COVID-19, 8 of them within the 1st. period. The diagnosis was already known in 1 patient, while the other 10 developed the disease in an average of 25 days after the intervention and 16,6 days after discharge. Of seven transplant patients, four got the infection. Three deaths were recorded due to the disease: a 69-year-old woman transplanted and two men over 80 with comorbidities and high anesthetic risk who underwent drainage of retroperitoneal abscess and retrograde intrarenal surgery, respectively. CONCLUSIONS: SARS-CoV-2 infection mainly affected renal transplant recipients or elderly patients with high anesthetic risk, during the first 2 weeks of the pandemic. After implementing preoperative PCR tests and a comprehensive screening protocol, cases were substantially reduced, and safe surgical procedures were achieved

Diseño de un protocolo asistencial para el reinicio de la cirugía urológica programada en periodo de epidemia COVID-19 / Design of an assistance protocol for the restart of scheduled urologic surgery in a COVID-19 epidemic period

OBJETIVO: Diseñar un protocolo asistencial para reiniciar la actividad quirúrgica programada en un servicio de Urología de un hospital de tercer nivel de la Comunidad de Madrid, de manera segura para nuestros pacientes y profesionales en el contexto de la epidemia por coronavirus SARS-CoV-2. MATERIAL Y MÉTODOS: Constituimos un grupo multidisciplinar que se encargó de analizar las diferentes recomendaciones de la literatura, organizaciones sanitarias nacionales e internacionales y sociedades científicas, así como de su aplicación a nuestro medio. Una vez reiniciada la cirugía programada, se está llevando a cabo un seguimiento de los pacientes intervenidos en cuanto a complicaciones relacionadas con COVID-19. RESULTADOS: Desde el reinicio de la actividad quirúrgica se han programado 19 pacientes, de los cuales 2 han sido suspendidos por presentar COVID-19, diagnosticado uno por PCR positiva para SARS-CoV-2, y otro por alteraciones analíticas y radiológicas compatibles con esta infección. En el seguimiento realizado no se han detectado complicaciones relacionadas con COVID-19, con una mediana de seguimiento de 10 días (4-14 días). CONCLUSIONES: Resultados preliminares indican que el protocolo diseñado para asegurar la correcta aplicación de medidas de prevención de transmisión de la infección por coronavirus está siendo seguro y efectivo

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to covid-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective

Nuevas inmunoterapias en el cáncer de vejiga no músculo-invasivo de alto riesgo: estado actual y perspectivas de futuro / New immunotherapies for high-risk non-muscle invasive bladder cancer: Current state and future perspectives

CONTEXTO: El tratamiento estándar de los tumores de vejiga no músculo-invasivos (TVNMI) de alto riesgo es la resección transuretral de vejiga e instilaciones de bacilo de Calmette-Guérin (BCG). Sin embargo, las respuestas son limitadas. Es necesario buscar nuevas alternativas terapéuticas para estos pacientes. Los resultados en tumores avanzados de los inhibidores de puntos de control han dado lugar al interés en el uso de estas moléculas en TVNMI. MÉTODOS: Hemos realizado una búsqueda en PubMed utilizando los términos «bladder cancer» y «check point inhibitors». Para la búsqueda de ensayos clínicos, hemos utilizado los buscadores clinicaltrials.gov y clinicaltrialsregister.eu RESULTADOS: Actualmente hay 5 ensayos en marcha de pacientes no tratados con BCG. No hay resultados disponibles. En cuanto a los pacientes no respondedores a BCG, existen 15 ensayos en marcha, 2 de ellos con resultados preliminares: el Keynote 057, con resultados prometedores con pembrolizumab y que ha llevado a la FDA a aprobar su uso en enero de 2020 y el SWOG S1605, que ha mostrado resultados similares con atezolizumab. Otros ensayos administran estos fármacos intravesicalmente, una opción atractiva si resulta efectiva para el control oncológico. CONCLUSIONES: Los inhibidores de puntos de control ofrecen una nueva posibilidad para los pacientes no respondedores al BCG. Probablemente en el futuro se podrán usar en pacientes no tratados previamente con BCG. Los datos preliminares de ensayos clínicos muestran resultados prometedores. Es importante un buen conocimiento de estas moléculas por los urólogos y la formación de equipos multidisciplinares para ofrecer las mejores alternativas terapéuticas a estos pacientes

BACKGROUND: The standard treatment for high-risk non-muscle invasive bladder tumors (NMIBT) is transurethral resection of the bladder and BCG instillations. However, responses are limited, and new therapeutic alternatives for these patients are required. The results of checkpoint inhibitors in advanced tumors have led to interest in the use of these molecules in NMIBT. METHODS: We conducted a search on PubMed using the terms «bladder cancer» and «check point inhibitors». We have used the search engines clinicaltrials.gov and clinicaltrialsregister.eu for the search of clinical trials. RESULTS: There are currently 5 trials in progress on BCG untreated patients. There are no results available. As for BCG non-responders, there are 15 ongoing trials, two of them with preliminary results: Keynote 057, with promising results with pembrolizumab, which has led the FDA to approve its use in January 2020, and SWOG S1605, which has shown similar results with atezolizumab. Other trials are using intravesical administration of these drugs, which is an attractive option if it is effective for cancer control. CONCLUSIONS: Checkpoint inhibitors offer a new possibility for patients who do not respond to BCG. These will probably be used in the future for previously BCG untreated patients. Preliminary data from clinical trials show promising results. A good understanding of these molecules by urologists and the creation of multidisciplinary teams are crucial in order to offer the best therapeutic alternatives to these patients

Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases. / Cirugía urológica durante la pandemia por SARS-CoV-2. Análisis descriptivo de la experiencia en un Servicio de Urología durante distintas fases epidemiológicas.

INTRODUCTION: The SARS-CoV-2 pandemic has changed the urological practice around the world. Our objective is to describe the outcomes presented by patients undergoing surgery in the urology department of a tertiary hospital, across the pandemic phases. METHODS: Observational, cohort study including all patients undergoing surgery from March 1 to May 14. According to the hospital organization, we identified three periods: there were no changes during the first two weeks (1st. period), the following seven weeks, when only urgent interventions were carried out after performance of nasopharyngeal swab test (2nd. period), and finally, elective surgery was resumed on May 4, after the implementation of a multidisciplinary screening protocol (3rd. period). Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were obtained in a retrospective (periods 1 and 2) and prospective (period 3) manner. Telephone follow-up was initiated at least 3 weeks after hospital discharge. RESULTS: 103 urological surgeries were performed, and 11 patients were diagnosed with COVID-19, 8 of them within the 1st. PERIOD: The diagnosis was already known in 1 patient, while the other 10 developed the disease in an average of 25 days after the intervention and 16,6 days after discharge. Of seven transplant patients, four got the infection. Three deaths were recorded due to the disease: a 69-year-old woman transplanted and two men over 80 with comorbidities and high anesthetic risk who underwent drainage of retroperitoneal abscess and retrograde intrarenal surgery, respectively. CONCLUSIONS: SARS-CoV-2 infection mainly affected renal transplant recipients or elderly patients with high anesthetic risk, during the first 2 weeks of the pandemic. After implementing preoperative PCR tests and a comprehensive screening protocol, cases were substantially reduced, and safe surgical procedures were achieved.

Design of an assistance protocol for the restart of scheduled urologic surgery in a COVID-19 epidemic period. / Diseño de un protocolo asistencial para el reinicio de la cirugía urológica programada en periodo de epidemia COVID-19.

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to COVID-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective.