Magnetic double-J stent: Evaluation of tolerance and impact on quality of life compared to traditional double-J stent.

INTRODUCTION: The placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients' quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®). MATERIAL AND METHODS: We conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal. RESULTS: There were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1.52 vs. 4, VAS, p = 0.001) and less difficulty during removal (1.61 vs. 3, p < 0.001) associated with a shorter procedure duration (11.65 min vs. 22.17 min p < 0.001). CONCLUSIONS: The tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use.

Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access.

INTRODUCTION: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology. MATERIAL AND METHODS: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin. RESULTS: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases. CONCLUSIONS: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy.

Catéter doble J magnético: evaluación de la tolerancia e impacto en la calidad de vida en comparación con el catéter doble J tradicional / Magnetic double-J stent: evaluation of tolerance and impact on quality of life compared to traditional double-J stent

Introducción: La colocación de un catéter doble J (DJ) es uno de los procedimientos más realizados en urología. Puede causar un impacto negativo en la calidad de vida, siendo necesaria una cistoscopia para su extracción. El objetivo de este estudio es evaluar la sintomatología e impacto en la calidad de vida derivados del uso del catéter DJ magnético (Black Star®) y compararla con la del DJ tradicional (OptiMed®).Material y métodosRealizamos un estudio comparativo, prospectivo y aleatorizado en 46 pacientes sometidos a ureterorrenoscopia (URS) en quienes se colocó un DJ entre agosto del 2019 y junio del 2020. De los pacientes incluidos, 23 llevaron un DJ tradicional (grupo A) y 23 un DJ magnético (grupo B). Valoramos en ambos grupos los resultados del cuestionario de síntomas de catéter ureteral (USSQ). Evaluamos el dolor de la extracción mediante la escala visual analógica (EVA) y la dificultad de la retirada. Revisamos la necesidad de atención médica por problemas relacionados con el catéter o surgidos tras la extracción.ResultadosNo observamos diferencias estadísticamente significativas en el cuestionario USSQ, ni en las complicaciones. El grupo B presentó: menor dolor de la extracción (EVA de 1,52 vs. 4, p = 0,001), menor dificultad en la retirada (1,61 vs. 3, p < 0,001) y menor tiempo de extracción (11,65 vs. 22,17 min p < 0,001).ConclusionesEl DJ magnético es un catéter ureteral que presenta una tolerancia equiparable a los tradicionales, ya que no genera un incremento de la sintomatología urinaria ni empeora la calidad de vida de los pacientes durante su uso. (AU)

Introduction: The placement of a ureteral stent is one of the most widely performed procedures in urology. It can have a negative impact on the patients’ quality of life, requiring a cystoscopy for its removal. The objective of this study is to evaluate the symptoms and impact on quality of life derived from the use of a magnetic double-J stent (Black Star ®) and compare them to those presented in patients with a traditional double-J stent (OptiMed®).Material and methodsWe conducted a comparative, prospective, randomized study in 46 patients who underwent ureterorenoscopy with double-J stent placement between August 2019 and June 2020. Of all patients included, 23 had a traditional double-J stent placed (group A) and 23 had a magnetic double-J stent (group B) placed. We evaluated the results of the Ureteral Stent Symptom Questionnaire (USSQ) in both groups, assessed the technical difficulty related to stent removal and the pain during the procedure using the Visual Analogue Scale (VAS). We also reviewed the need for medical attention due to problems related to the stent or after its removal.ResultsThere were no statistically significant differences between groups regarding the answers in the USSQ and the complications related to the use of the stent. Group B showed less pain (1,52 vs. 4, VAS, p = 0.001) and less difficulty during removal (1,61 vs. 3, p < 0,001) associated with a shorter procedure duration (11,65 min vs. 22,17 min p < 0,001).ConclusionsThe tolerance shown by the use of magnetic double-J is comparable to the tolerance of traditional stent, since it does not cause an increase in urinary symptoms nor worsens the quality of life of patients during its use. (AU)

Tratamiento de las fístulas uretrorrectales tras prostatectomía radical mediante la interposición de material biológico vía perineal / Treatment for rectourethral fistulas after radical prostatectomy with biological material interposition through a perineal access

Introducción: La lesión rectal es una complicación infrecuente de la prostatectomía radical laparoscópica extraperitoneal. El desarrollo de fístulas uretrorrectales (FUR), a partir de lesiones rectales, resulta uno de los problemas más temidos y de más compleja resolución en urología.Material y métodosEntre 2013 y 2020 hemos intervenido a un total de cinco pacientes con FUR tras prostatectomía radical endoscópica extraperitoneal, mediante un abordaje perineal utilizando la interposición de material biológico. Todas las fístulas presentaron un diámetro menor de 6 mm en la endoscopia y se encontraban a menos de 6 cm del margen anal.ResultadosLa media de edad de los pacientes fue 64 años. Todos los pacientes llevaban al menos tres meses de derivación intestinal y urinaria previas. Bajo anestesia general, y con el paciente en posición de litotomía forzada mediante un acceso perineal, se realizó fistulorrafia e interposición de material biológico de origen porcino (dermis porcina liofilizada [Permacol®, Medtronic]). La duración media de la cirugía fue de 174 min (140-210). La mayoría de los pacientes fueron dados de alta al tercer día postoperatorio. La sonda vesical se mantuvo una media de 40 días (30-60). Previa a la retirada de la misma, se realizó cistografía y enema opaco con Gastrografin®, que mostró resolución de la fístula en todos los casos.ConclusionesLa interposición de material biológico procedente de dermis porcina mediante abordaje perineal es una alternativa segura y con buenos resultados en pacientes sometidos a fistulorrafia uretrorrectal tras prostatectomía radical. (AU)

Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology.Material and methodsBetween 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin.ResultsThe mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 minutes (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases.ConclusionsThe interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy. (AU)

[New recommendations for prostate cancer screening with PSA]. / Nuevas recomendaciones en el screening de cáncer de próstata mediante PSA.

Prostate cancer is the most frequently diagnosed cancer in men and the second cause of death in those worldwide. The fact that is a tumor with a long latency period has led to a confusion in the convenience of its diagnosis and treatment in patients at an early stage. Classically, European and American societies have not recommended prostate cancer screening with PSA, allowing physicians take this decision. In 2012, after many years full of controversy, the American organization United States Preventive Task Force recommended to abandon its use. The results of these statements carried an increase in the incidence of the metastatic prostate cancer and, therefore, a rise in its mortality. In 2018, after these consequences, the European Association of Urology released new recommendations in favor of screening based on PSA for the first time. In 2019, guidelines were updated with no changes in its recommendations.

[Greenlight Laser Photoselective vaporization of the prostate (PVP). Surgical advantages in risk patients]. / Fotovaporización prostática (FVP) mediante láser verde. Ventajas quirúrgicas en pacientes de riesgo.

It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.

[Use of urography by magnetic resonance for the study of the urinary apparatus versus conventional urography]. / Uso de la urografia por resonancia magnética en el estudio del aparato urinario frente a la urografía convencional.

UNLABELLED: Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed. OBJECTIVE: We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract: and a quality study of the urographic images obtained with MR versus IVU. MATERIALS AND METHODS: 150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR. RESULTS: High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%. a positive predictive value of 86.6% and a negative predictive value of 75%. CONCLUSION: MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.

Complicaciones de la prostatectomía radical: evolución y manejo conservador de la incontinencia urinaria / Radical prostatectomy complications: evolution and conservative management of urinary incontinence

Objetivos: La prostatectomía radical retropúbica continúa siendo el tratamiento de elección para el cáncer de próstata órganoconfinado. Realizamos un estudio retrospectivo en el que valoramos las complicaciones de esta cirugía y su evolución en el tiempo así como la cantidad del tratamiento conservador, especialmente la rehabilitación perineal precoz, en la recuperación de la continencia tras esta intervención. Material y métodos: Durante el período comprendido entre diciembre de 1998 a enero del 2005 hemos intervenido en nuestro servicio a 168 pacientes afectos de adenocarcinoma prostático confinado clínicamente a la glándula mediante prostatectomía radical retropúbica. Retiramos la sonda vesical el decimocuarto día del postoperatorio. A los pacientes que presentarion incontinencia urinaria (IU) de esfuerzo se les instruyó para la realización de ejercicios para fortalicer el suelo pélvico. Realizamos un seguimiento clínico el primer, tercer y sexto mes tras la cirugía, y posteriormente de forma semestral. Resultados: De los 168 pacientes intervenidos, el 15% requirió hemotransfusión en el postoperatorio inmediato. Otras complicaciones precoces, de mucha menos incidencia, fueron la perforación intestinal, la infección de la herida quirurgica y la foramción de hematoma en el lecho quirúrgico. Entre las complicaciones tardías más frecuentes registramos la disfunción eréctil, que se presentó en 164 pacientes (98%), alteraciones miccionales en 32 pacientes (19%) y alteraciones intestinales en aproximadamente el 11%. Entre las alteraciones miccionales encontradas, la más frecuente fue la IU (64%) si bien la mayoría de ellas eran de carácter leve (34%) y todas mejoraron durante los primeros seis meses posteriores a la cirugía. Conclusiones: La IU es el principal condicionante de la calidad de vida de los pacientes que son sometidos a prostatectomía radical. Si bien el porcentaje de pacientes que la presenta es alto, la mayoría son de grado leve o moderado y pueden mejorar ostensiblemente con los ejercicios de fortalecimiento del suelo pélvico, constituyéndose así como un arma fundamental en el menejo de estos pacientes, acompañada o no del uso de absorbentes, de la terapia farmacológica o del empleo de colectores peneanos

Objectives: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complication of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary incontinence. Materials and methods: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and there after every six monoths. Results. Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion inthe immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. Conclusions. Radical prostatectomy continues to the most effective treatment for the non spared prostate cancer, in spite, of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors

[Radical prostatectomy complications: evolution and conservative management of urinary incontinence]. / Complicaciones de la prostatectomia radical: evolución y manejo conservador de la incontinencia urinaria.

OBJECTIVES: Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complications of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary continence. MATERIALS AND METHODS: During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and thereafter every six months. RESULTS: Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion in the immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered were erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence. CONCLUSIONS: Radical prostatectomy continues to be the most effective treatment for the non spared prostate cancer, in spite of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors.