Impacto de la patología psiquiátrica en el pronóstico y supervivencia de los varones con cáncer de próstata tratados mediante prostatectomía radical / The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy

Introducción y objetivo: La ansiedad específica del cáncer (CSA) es la reacción psicológica más frecuente tras la prostatectomía radical (PR). Evaluamos la prevalencia de la patología psiquiátrica pretratamiento de cáncer de próstata mediante PR e identificamos la influencia de los diagnósticos psiquiátricos en la supervivencia y pronóstico en los pacientes. Material y métodos Estudio retrospectivo multicéntrico observacional, 1.078 varones intervenidos mediante PR por cáncer de próstata órgano-confinado. Grupos: GP: pacientes con patología psiquiátrica previa a la PR; GNP: pacientes sin patología psiquiátrica previa a la PR, variables urológicas, oncológicas y psiquiátricas, estadística descriptiva y análisis multivariante. Resultados El 37,94% presentó algún diagnóstico psiquiátrico. Fue necesario tratamiento adyuvante de radioterapia (RT) en 27,83% y hormonoterapia (HT) en 23,38%; más frecuentes en GP. La supervivencia cáncer-específica fue superior en GNP. La ansiedad, depresión, insomnio, tabaquismo, psicosis y alcoholismo fueron los más frecuentes. La baja estadificación Tumor-Ganglios-Metástasis (TNM) y poca presencia de síntomas del tracto urinario inferior (STUI) e incontinencia urinaria de esfuerzo (IUE) incrementó la probabilidad de ausencia de patología psiquiátrica. En GP aumentó la fatiga, disfunción eréctil y deterioro cognitivo tras la PR junto con RT y/o HT. A mayor edad y mayor antígeno prostático específico (PSA) al diagnóstico, aumentó el riesgo relativo de patología psiquiátrica y peor evolución. Los factores más relacionados fueron la PR, PSA, la edad y el tiempo de supervivencia. Conclusiones La patología psiquiátrica está presente en pacientes tratados mediante PR debido a cáncer de próstata, teniendo alto impacto en los resultados de supervivencia y pronóstico (AU)

Introduction and Objective: Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. Material and Methods Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. Results 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. Conclusions Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes (AU)

The impact of psychiatric pathology on the prognosis and survival of men with prostate cancer undergoing radical prostatectomy.

INTRODUCTION AND OBJECTIVE: Cancer-specific anxiety is the most frequently reported psychological response after radical prostatectomy (RP). We evaluated the prevalence of pretreatment psychiatric pathology in patients with prostate cancer undergoing RP and identified the effects of psychiatric diagnoses on their survival and prognosis. MATERIAL AND METHODS: Retrospective multicenter observational study including 1078 men treated with RP for organ-confined prostate cancer. Groups: GP: patients with psychiatric pathology prior to RP; GNP: patients without psychiatric pathology prior to RP. Urological, oncological and psychiatric variables, descriptive statistics and multivariate analysis were included. RESULTS: 37.94% of patients presented a psychiatric diagnosis. Adjuvant radiotherapy was required in 27.83% and hormone therapy in 23.38%; being more frequent in GP. Cancer-specific survival was higher in GNP. Anxiety, depression, insomnia, smoking, psychosis and alcoholism were the most frequent. Low TNM and low presence of LUTS and SUI increased the probability of absence of psychiatric pathology. Fatigue, erectile dysfunction and cognitive impairment after RP with RT and/or HT were higher in GP. Older age and higher PSA at diagnosis increased the relative risk of psychiatric pathology and worse outcome. The most frequently related factors were RP, PSA, age and survival time. CONCLUSIONS: Psychiatric pathology is present in patients undergoing radical prostatectomy for prostate cancer, with a high impact on survival and prognostic outcomes.

¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica? / Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

Objetivo Estudiar el grado de concordancia diagnóstica entre vejiga hiperactiva (VH) e hiperactividad del detrusor (HD) en varones con síntomas del tracto urinario inferior (STUI) predominantemente de llenado, y el perfil clínico y urodinámico según presencia de HD y grado de obstrucción del tracto urinario inferior (OTUI).Material y métodos Estudio epidemiológico, transversal, multicéntrico y nacional. Se cumplimentaron: diario miccional de 3 días (DM3d), International Prostate Symptom Score (IPSS) y Cuestionario de Autoevaluación del Control de la Vejiga (CACV). Se determinó el volumen prostático (Vp) por ecografía y se realizó estudio urodinámico (EUD). Se analizó la prevalencia de VH y HD y la concordancia (kappa). Se realizó un análisis descriptivo de características clínicas y urodinámicas; posteriormente se comparó su frecuencia según presencia de HD y OTUI.ResultadosSe evaluaron 445 pacientes con edad media±DE de 54,8±9,9 años. Según el DM3d, un 89,8% presentaba frecuencia miccional aumentada, un 87,9% nicturia, un 72,8% urgencia y un 31,9% incontinencia urinaria de urgencia (IUU). Un 36,8% tenía OTUI. El 54,5% presentaba VH y HD. La concordancia diagnóstica entre HD y VH fue baja (κ=0,1702). Más pacientes con HD que sin ella presentaron urgencia (DM3d y CACV; p<0,001), IUU (DM3d; p=0,008) y nicturia (CACV; p<0,001). Hubo diferencias en IPSS-vaciado, flujo máximo (Qmax) y residuo posmiccional (p<0,05) según el grado de obstrucción.ConclusionesEn pacientes varones de 18 a 65 años con STUI predominantemente de llenado derivados a unidades especializadas, aproximadamente la mitad tienen coexistencia de VH y HD y un tercio tenía obstrucción. Hay baja concordancia diagnóstica entre VH y HD (AU)

Objective To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction.Material and methods Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction.ResultsA total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree.ConclusionsApproximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor (AU)

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

OBJECTIVES: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? / ¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica?

OBJECTIVE: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

El cateterismo vesical intermitente en la insuficiencia contráctil del detrusor / The role of clean intermittent catheterization in the treatment for detrusor underactivity

OBJETIVOS: Estudiar la influencia del cateterismo vesical intermitente (CVI) sobre la función del tracto urinario inferior (TUI) en pacientes con retención urinaria (RU) por insuficiencia contráctil (IC) del detrusor. MATERIAL Y MÉTODOS: Estudio longitudinal. Cuarenta y nueve pacientes (28 hombres/21 mujeres; edad media: 55 años) sometidos a CVI por RU por IC (frecuencia media 3,15 veces/día). El único criterio de inclusión fue la realización de CVI asociada a IC. Se realizó historia clínica y dos estudios urodinámicos con un intervalo de 4 años de media. Se compararon los datos urodinámicos pre y post CVI mediante test exacto de Fisher para variables dicotómicas y test de la t de Student para datos pareados (estudios antes y después del CVI) e independientes (comparación entre diferentes grupos) en el caso de las variables paramétricas. El nivel de significación se fijó en 5% bilateral. RESULTADOS: Se observó aumento significativo de la acomodación vesical, del índice de obstrucción (BOOI) y del índice de contractilidad vesical (BCI), sin alcanzar significación estadística. Respecto de los pacientes en los que su BCI mejoró después del CVI se observó un porcentaje significativamente mayor de pacientes con hiperplasia benigna de próstata (HBP) y detrusor acontráctil comparado con los pacientes en los que el BCI no mejoró después del CVI. El tiempo en que los pacientes estaban sometidos a CVI fue significativamente menor en el grupo de mejoría. CONCLUSIONES: El CVI mejoró la acomodación vesical en los pacientes de nuestra serie. El BCI mejoró en varones con HBP y en pacientes con detrusor acontráctil

OBJECTIVE: To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS: A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55 years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4 years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS: The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS: CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor

The role of clean intermittent catheterization in the treatment for detrusor underactivity. / El cateterismo vesical intermitente en la insuficiencia contráctil del detrusor.

OBJECTIVE: To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS: A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS: The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS: CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.

Revisión sobre la experiencia y evidencias del Pygeum africanum en Urología / Review of the experience and evidence of Pygeum africanum in urological practice

CONTEXTO: El Pygeum africanum (P. africanum) sigue siendo utilizado por parte de los urólogos para el tratamiento de los síntomas urinarios del tracto urinario inferior secundarios a hiperplasia benigna de próstata. Adquisición de la evidencia: Se ha realizado una revisión no exhaustiva sobre el P. africanum, sus mecanismos de acción, tanto «in vitro» como «in vivo», de los ensayos clínicos y en la práctica clínica habitual. Síntesis de la evidencia: Se muestran las conclusiones de la revisión y las reflexiones de los autores sobre la utilización del P. africanum. CONCLUSIONES: Aunque con un nivel de evidencia 4 (basado en la opinión de expertos), la utilización del P. africanum parece ser una opción en el arsenal terapéutico del urólogo

CONTEXT: Pygeum africanum(P. africanum) is still being employed in urology practice for the treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia. Evidence acquisition: A non-exhaustive review has been carried out about P. africanum, its mechanisms of action "in vitro" as well as "in vivo", clinical trials and routine clinical practice. Evidence synthesis: The conclusions of the review and the reflections of the authors on the use of P. africanum are described. CONCLUSIONS: Although with an evidence level IV (based on expert opinion) the use of P. africanum seems to be an option in the urological therapeutic arsenal

Review of the experience and evidence of Pygeum africanum in urological practice. / Revisión sobre la experiencia y evidencias del Pygeum africanum en Urología.

CONTEXT: Pygeum africanum(P. africanum) is still being employed in urology practice for the treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia. EVIDENCE ACQUISITION: A non-exhaustive review has been carried out about P. africanum, its mechanisms of action "in vitro" as well as "in vivo", clinical trials and routine clinical practice. EVIDENCE SYNTHESIS: The conclusions of the review and the reflections of the authors on the use of P. africanum are described. CONCLUSIONS: Although with an evidence level IV (based on expert opinion) the use of P. africanum seems to be an option in the urological therapeutic arsenal.

Investigación de la repercusión en el proceso de aprendizaje según la metodología docente en la infección urinaria / Research of the impact of urinary infection teaching methods on the learning process

Introducción: La metodología docente clásica se basaba en la transmisión pasiva de contenidos. El modelo ha cambiado hacia una orientación basada en que el eje del sistema enseñanza-aprendizaje es el alumno. Objetivo: El objetivo del estudio es evaluar la percepción del aprendizaje relacionado con las infecciones del tracto urinario que tienen los propios alumnos, y su perspectiva acerca de la docencia impartida sobre esta patología en las diferentes asignaturas que incluyen en su temario la ITU. Métodos: Se realiza un estudio analítico transversal de las respuestas a una encuesta anónima titulada: «Metodología sobre las infecciones de orina. Aspectos docentes» emitidas por 228 alumnos de quinto curso del Grado de Medicina de dos promociones. Se refirieron a las asignaturas de Farmacia, Fisiopatología, Ginecología y Obstetricia, Infecciosas, Microbiología, Nefrología, Pediatría y Urología. Resultados: Se analizan variables sobre aspectos del contenido docente, docencia de aspectos básicos del problema, consideración sobre la metodología docente y sugerencias de cambio de la misma. Se utiliza estadística descriptiva e inferencial. Conclusión: El estudio concluye que la docencia en la infección del tracto urinario se percibe más en asignaturas concretas relativas al microorganismo (Microbiología), el órgano diana (Infecciosas, Urología), pacientes afectados (Pediatría, Ginecología y Obstetricia) que en asignaturas transversales como la Fisiopatología o Farmacia. La metodología docente se considera la apropiada en más del 50% de los alumnos en cinco de las 8 asignaturas que imparten el concepto de infección del tracto urinario. Los alumnos sugieren la conveniencia de cambios en la metodología docente en varias asignaturas que imparten el concepto de infección del tracto urinario

Introduction: The classical teaching methodology was based on passive transmission-based learning. The model has changed toward an orientation based on student-centered learning. Objective: The objective of the study has been to evaluate the students’ perception when learning about urinary tract infections, and their perspective about the teaching imparted on this pathology in the various subjects that include ITU in their syllabus. Methods: A cross-sectional analytical study of the responses to an anonymous survey entitled: "Methodology on urine infections. Teaching aspects" issued by 228 students at their fifth year of Medical School, from two promotions. They referred to the following subjects: Pharmacy, Pathophisiology, Gynecology and Obstetrics, Infectious diseases, Microbiology, Nephrology, Pediatrics and Urology. Results: The following variables have been analyzed: teaching content, teaching basic aspects of the disease, consideration of teaching methodology and improvement suggestions. Descriptive and inferential statistics were used. Conclusion: The study has concluded that teaching urinary tract infection is perceived in specific subjects related to microorganism (Microbiology), the target organ (Infectious diseases, Urology), affected patients (Pediatrics, Gynecology and Obstetrics) rather than transversal subjects such as Pathophysiology or Pharmacy. The teaching methodology has been considered appropriate by more than 50% of the students in five from the 8 subjects that teach the concept of urinary tract infection. The students suggest convenient changes in current teaching methodology in several subjects that impart the urinary tract infection concept

Estado actual de la actividad y formación académica de residentes y urólogos jóvenes en España. Resultados de una encuesta nacional / Current status of young urologists and residents' activity and academic training in Spain. National survey results

Objetivo: Conocer el estado actual de la actividad y formación académica de los residentes y urólogos jóvenes en España. Material y métodos: Se diseñó una encuesta anónima de 32 preguntas, desde el Grupo de Trabajo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología (RAEU), dirigida a evaluar la actividad académica de los residentes, definida por: número de comunicaciones a congresos, publicaciones en revistas nacionales e internacionales, rotaciones clínicas dentro de España y en el extranjero, realización de máster, doctorado (PhD), aplicaciones para presentar el examen de la European Board of Urology y competencias en idiomas de residentes. La encuesta fue enviada vía email y difundida vía redes sociales. Resultados: Se obtuvieron 91 respondedores; el 66% afirmaron no tener publicaciones en revistas científicas, el 67% no han realizado rotaciones en el extranjero. Solo el 21% afirmaron presentarse al examen EBU. Solo el 2% de los respondedores han realizado un fellowship, aunque la mayoría (82%) no lo han realizado, pero sí estarían interesados. Sin embargo, el 67% de los respondedores opinan que la relevancia de la actividad académica/investigadora es alta a muy elevada. Conclusiones: Los resultados indican que la actividad académica, la producción científica y la publicación de artículos de los residentes y urólogos jóvenes en España es baja. Así también, la participación en el examen EBU, así como la realización de máster, PhD, rotaciones y fellowship, son bajas. Sin embargo, la valoración de la actividad científica es considerada como muy relevante

Objective: To study the current status of the activity and academic training of residents and young urologists in Spain. Material and methods: From the working group of residents and young urologists of the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. Results: Ninety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. Conclusions: Our results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant

Research of the impact of urinary infection teaching methods on the learning process. / Investigación de la repercusión en el proceso de aprendizaje según la metodología docente en la infección urinaria.

INTRODUCTION: The classical teaching methodology was based on passive transmission-based learning. The model has changed towards an orientation based on student-centred learning. OBJECTIVE: The objective of the study has been to evaluate the students' perception when learning about urinary tract infections, and their perspective about the teaching imparted on this pathology in the various subjects that include ITU in their syllabus. METHODS: A cross-sectional analytical study of the responses to an anonymous survey entitled: "Methodology on urine infections. Teaching aspects "issued by 228 students at their fifth year of Medical School, from two promotions. They referred to the following subjects: Pharmacy, Pathophisiology, Gynecology and Obstetrics, Infectious diseases, Microbiology, Nephrology, Pediatrics and Urology. RESULTS: The following variables have been analysed: teaching content, teaching basic aspects of the disease, consideration of teaching methodology and improvement suggestions. Descriptive and inferential statistics were used. CONCLUSION: The study has concluded that teaching urinary tract infection is perceived in specific subjects related to microorganism (Microbiology), the target organ (Infectious diseases, Urology), affected patients (Pediatrics, Gynecology and Obstetrics) rather than transversal subjects such as Pathophysiology or Pharmacy. The teaching methodology has been considered appropriate by more than 50% of the students in five from the 8 subjects that teach the concept of urinary tract infection. The students suggest convenient changes in current teaching methodology in several subjects that impart the urinary tract infection concept.

Current status of young urologists and residents' activity and academic training in Spain. National survey results. / Estado actual de la actividad y formación académica de residentes y urólogos jóvenes en España. Resultados de una encuesta nacional.

OBJECTIVE: To study the current status of the activity and academic training of residents and young urologists in Spain. MATERIAL AND METHODS: From the working group of residents and young urologists of the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. RESULTS: Ninety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. CONCLUSIONS: Our results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant.

Posicionamiento de la Asociación Española de Urología ante el documento de la Sociedad Española de Oncología Médica sobre la administración de tratamientos médicos a los pacientes oncológicos / Positioning statement of the Spanish Association of Urology on the document published by the Spanish Society of Medical Oncology about the use of medical treatments in oncological patients

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Enfermedad urológica y el tabaco. Una revisión para la concienciación del urólogo / Urological disease and tobacco. A review for raising the awareness of urologists

Contexto: El tabaquismo es la primera causa de muerte prevenible en nuestro entorno. Su relación con la enfermedad urológica está bien documentada. Objetivo: Mostrar una revisión actualizada sobre la relación entre enfermedad urológica y consumo del tabaco, y sobre la importancia de la implicación de los urólogos en la prevención del tabaquismo. Adquisición y síntesis de la evidencia: Se ha realizado una revisión de la bibliografía actual utilizando fundamentalmente la búsqueda en PubMed, y tomando como base principal el informe sobre las consecuencias de fumar en la salud realizado por The Surgeon General. Conclusión: Los urólogos desempeñan un papel fundamental para informar de la relación entre el tabaquismo y la enfermedad urológica. Es un deber de cada urólogo asumir un papel más activo en la educación de los pacientes para promover la abstinencia tabáquica

Context: Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. Objective: To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. Acquisition and synthesis of evidence: We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. Conclusion: Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation

Other radiological lesions of the Lower Urinary Tract in patients after isolated pelvic radiotherapy and combined with surgery. / Otras lesiones radiológicas del tracto urinario inferior (TUI) en pacientes sometidos a radioterapia pélvica en monoterapia y combinada con cirugía.

INTRODUCTION: The cystographic study of patients who have undergone radiotherapy (RT) and pelvic surgeries is uncommon in the literature, not described in patients without complications, and mostly related to urinary fistulae. OBJECTIVE: The study of the lower urinary tract (LUT) by cystography in these patients, with a description of some other types of radiation lesions. METHODS: 127 cystographies have been performed (88 men and 39 women) in consecutive patients undergoing radiotherapy (RT) (48 monotherapy and 79 cases combined with surgery), with a mean age of 69.6 years, and a mean time from radiation of 215 months (17 years). A General Electric X ray equipment has been used. We studied: behavior of the bladder neck at rest and during micturition, assessment of vesicoureteral reflux (VUR), bladder morphology (BM), urethral strictures (UE) and fistulas (F). RESULTS: We observed: Filling phase bladder neck incompetence (BNI) (37.8%), bladder smooth morphology (60.6%), coughing urinary incontinence (UI) (26.4%), basal cystocele (64.7%) and Valsalva cystocele (96.6%), a normal opening bladder neck (96,1%), reduction of the urethral diameter during voiding (41.3%), and vesicoureteral reflux (VUR) (13.2%). Five cases of filling BNI, were all related to prostate cancer (PC) (one of them with colon cancer as well). There were six cases of fistulae (4.14%), five of them women. Forty two patients (28.96%) had reduced urethral lumen, thirty five of them affecting the posterior urethra (83%), five (11.9%) the anterior and, finally, two cases of mixed lesion (5%). 95% were patients with PC without concurrent interventions (67%). Significant differences were found regarding the gender and the background of pelvic surgery. The filling BNI (p=0.007), the irregular bladder morphology (p=0.004) and the reduction of the urethral lumen (p<0.001) have been found to be more common in male patients, while the coughing UI was more common in women (p=0.007). The study shows that BNI (p=0.046), VUR (p=0.02) and the IU due to cough (p=0.03) were more frequent in operated patients, while reduced urethral lumen was less common (p<0.01). Patients with VUR present more time from radiotherapy, but not in other cystography variables. There was a relationship between RT and the BNI, stress urinary incontinence, anterior urethral stricture and VUR. The risk factor was increased by surgery. CONCLUSIONS: Bladder neck incompetence, stress UI, anterior urethral stricture and VUR have been related to radiotherapy. Surgery increased the risk factor in operated patients.

Urological disease and tobacco. A review for raising the awareness of urologists. / Enfermedad urológica y el tabaco. Una revisión para la concienciación del urólogo.

CONTEXT: Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. OBJECTIVE: To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. ACQUISITION AND SYNTHESIS OF EVIDENCE: We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. CONCLUSION: Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation.

El valor de la oxibutinina en parche transdérmico en el tratamiento de la vejiga hiperactiva / The value of oxybutynin in transdermal patches for treating overactive bladder

Contexto: Actualmente ya existe un amplio arsenal terapéutico de fármacos para el tratamiento del síndrome de vejiga hiperactiva (VH). Sin embargo, sigue siendo necesaria la aparición de nuevas moléculas o la evolución de fármacos conocidos para tratar de conseguir mejoras en cuanto a eficacia, adherencia y tolerabilidad. Objetivo: Describir la evidencia científica sobre la eficacia y seguridad de la oxibutinina transdérmica (OXI-TDS) en el tratamiento del síndrome de vejiga hiperactiva. Material y métodos: Se ha realizado una revisión sistemática sin restricciones temporales hasta mayo del 2015 en la base de datos bibliográfica MEDLINE/PubMed. Adicionalmente, se realizó una revisión manual de resúmenes publicados en congresos internacionales de Uroginecología. Resultados: Los estudios evaluados muestran que los pacientes tratados con OXI-TDS presentaron una reducción significativa en los episodios de incontinencia urinaria comparado con placebo y comparable con la observada en pacientes tratados con oxibutinina oral o con tolterodina. En todos los estudios se observó mejoría de los síntomas desde la segunda o la tercera semana de tratamiento y de forma mantenida hasta el final del tratamiento (6, 12 o 24 semanas). Asimismo, en el estudio de práctica clínica también se demostró mejora de la calidad de vida, obteniéndose beneficios en múltiples perfiles de pacientes, siendo la eficacia independiente de los tratamientos previos recibidos. La seguridad del fármaco se comprobó en los distintos perfiles de pacientes. Conclusiones: La OXI-TDS representa una alternativa eficaz en el tratamiento sintomático de los pacientes adultos con VH que, además, gracias a su perfil farmacocinético, mejor tolerabilidad, su diferente forma de administración y posología, podría suponer un valor añadido en el tratamiento de poblaciones especiales

Context: There is currently a broad therapeutic arsenal of drugs for treating overactive bladder syndrome (OAB). However, there is still a need for new compounds and for improving known drugs in terms of efficacy, compliance and tolerability. Objective: To report the scientific evidence on the safety and efficacy of transdermal oxybutynin (OXY-TDS) for treating OAB. Material and methods: A systematic review without time restrictions was conducted until May 2015 in the MEDLINE/PubMed database. We also performed a manual review of abstracts published in international urogynaecology congresses. Results: The evaluated studies show that patients treated with OXY-TDS experience a significant reduction in urinary incontinence episodes compared with placebo, which is comparable to that observed in patients treated with oral oxybutynin or with tolterodine. In all of the studies, we observed improvements in symptoms from the second or third week of treatment and in a sustained manner until the end of treatment (6, 12 or 24 weeks). The clinical practice study also showed improved quality of life, achieving benefits in numerous patient profiles, with an efficacy independent of previous treatments. The safety of the drug was demonstrated in the various patient profiles. Conclusions: OXY-TDS represents an effective alternative for the symptomatic treatment of adult patients with OAB, which, thanks to its pharmacokinetic profile, better tolerability, different administration method and dosage, could represent an added value in treating special populations

Encuesta sobre actitud y percepción de conocimientos para el abordaje del tabaquismo en los urólogos / Survey on attitude and perception of knowledge to approach smoking habit in the urologist

Introducción. Conocemos la actitud sobre el tabaquismo en algunos profesionales sanitarios, pero no en los urólogos. Material y métodos. Estudio observacional descriptivo mediante 150 encuestas aleatorias a urólogos españoles sobre actitud y percepción de conocimientos para el abordaje del tabaquismo. Se estudian: variables cuantitativas, asociación entre variables cualitativas y comparamos nuestros resultados con los de otros colectivos de nuestro país. Resultados. 150 respuestas (91% masculinas y 9% femeninas. Edad media 52,6 ± 8,7 años). 8% fumadores, 48% exfumadores y 43% no fumadores. 57% recogen el estatus de fumador, 54% informan de los riesgos del tabaco y 58% aconsejan dejar de fumar. Encontramos diferencia significativa entre urólogos fumadores vs. no fumadores en la recogida del hábito tabáquico (p = 0,074) y consejo para dejar de fumar (p = 0,0059), más frecuente entre los no fumadores. El 41% creen que no pueden ayudar a sus pacientes a dejar de fumar, 67% desconocen el consejo mínimo, y 82% dicen no tener conocimientos/habilidades para realizarlo. El 53% desconocen los fármacos y el 74% los recursos sanitarios disponibles, para la deshabituación tabáquica. El 27% piensan que no es fundamental la recomendación de dejar de fumar (más frecuente entre fumadores p = 0,0076). Conclusión. El 58% de los urólogos aconsejan dejar de fumar, pero el 67% desconocen el consejo mínimo y el 82% cómo realizarlo. 53% no conocen los fármacos y solo el 26% los recursos sanitarios disponibles para la deshabituación tabáquica. Estos resultados plantean una serie de oportunidades de mejora que se irán implementando en nuestra Asociación Española de Urología (AU)

Introduction. We have knowledge of the attitude on smoking in some health care professionals, but not in the urologists. Material and methods. Descriptive, observational study through 150 random surveys to Spanish urologists on the attitude and perception of knowledge to death with smoking habit. The following were studied: quantitative variables, association between qualitative variables and we compared our results with those of other groups of our country. Results. 150 responses (91% male and 9% female. Mean age 52.6 ± 8.7 years). 8% smokers, 48% exsmokers and 43% non-smokers. A total of 57% collect the status of smoker, 54% report on the risk of smoking and 58% recommend smoking cessation. We have found a significant difference between urologists who are smokers and non-smokers in the collection of smoking habit (p = 0.074) and recommendation to quit smoking (p = 0.0059), more frequent among the non-smokers. A total of 41% believe that their patients cannot be helped to quit smoking, 67% are not aware of the minimum advise and 82% state they do not have the knowledge/skills to do so. Of those surveyed, 53% do not know the drug and 74% the health care resources available for smoking cessation. A total of 27% think that recommending that one quits smoking is not essential (more frequent among smokers p = 0.0076). Conclusion. It was found that 58% of the urologists recommend smoking cessation, but 67% of them do not know the minimum advise and 82% do not know how to do it. The drugs for this are unknown by 53% and only 26% know the health care resources available for smoking cessation. These results suggest a series of opportunities for improvement that will be implemented in our Spanish Association of Urology (AU)