Quality of life in patients with non-muscle-invasive bladder cancer: one-year results of a multicentre prospective cohort study.

OBJECTIVE: Few studies describe the effect of non-muscle-invasive bladder cancer (NMIBC) on health-related quality of life (HRQL), although patients are mostly diagnosed at this stage of the disease. Taking into account this current evidence gap and the high incidence rates in Spain, we aimed to describe the evolution over time of HRQL in Spanish patients with NMIBC and to examine the clinical and treatment-related factors associated with HRQL change during the first year of management. METHODS AND MATERIALS: Observational multicenter prospective inception cohort study conducted in urology departments of 7 Spanish hospitals. A consecutive sample of 244 patients with anatomopathologically confirmed NMIBC, recruited from October 2010 to September 2011, was followed during the diagnostic process, and 6 and 12 months later. HRQL was assessed by generic and disease-specific instruments: the Short Form-36 (covering physical and mental health) and the Bladder Cancer Index, measuring urinary, bowel, and sexual domains (summary scores: 0-100). Bivariate analysis was performed and generalized estimating equation models were constructed to assess HRQL score change. RESULTS: Almost 52% of the patients were diagnosed at stage I, and 84% were men. The number of patients treated only with transurethral resection (TUR) was 144, and 82 also received intravesical therapy with bacillus Calmette-Guérin (BCG) or mitomycin C. Mental health was significantly worse than Short Form-36 reference norms at diagnosis (mean of 49.7 vs. 53.3, 95% CI: 52.5-54.2). Urinary domain improved significantly from diagnosis (85.2, 95% CI: 82.9-87.4) to 12-month evaluation (90.2, 95% CI: 87.7-92.8), whereas sexual domain showed deterioration from 56.4 (95% CI: 52.8-59.9) to 53.7 (95% CI: 50.0-57.4). Adjusted HRQL score changes from baseline to 12-month follow-up estimated with generalized estimating equation models showed improvement on the following parameters: urinary domain after TUR with or without intravesical therapy (+3.9, 95% CI: 0.1-7.7), bowel domain among patients treated with TUR and BCG (+7.0, 95% CI: 2.4-11.5), and sexual domain among those treated with TUR and mitomycin C (+13.1, 95% CI: 5.9-20.2). CONCLUSIONS: For the first time, a distinctive HRQL pattern of bladder cancer treatment benefits emerges for TUR alone, and in combination with BCG or mitomycin C, which deserves further research. Treatment differences cannot be interpreted in terms of efficacy but can be useful to generate hypotheses to test in future studies.

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation.

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients.

[Perioperative morbidity of radical prostatectomy in patients over 70 years of age]. / Morbilidad perioperatoria de la prostatectomía radical en pacientes mayores de 70 años.

INTRODUCTION: Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed. OBJECTIVES: To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy in patients older than 70 years. MATERIAL AND METHODS: A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures. RESULTS: The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinaryi fistula (15%) respectively. CONCLUSIONS: Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice.

Morbilidad perioperatoria de la prostatectomía radical en pacientes mayores de 70 años / Perioperative morbidity of radical prostatectomy in patients over 70 years of age

Introducción: Debido al incremento en la esperanza de vida, es posible el tratamiento radical del cáncer de próstata en pacientes mayores de 70 años. Se ha analizado poco la morbilidad perioperatoria de la prostatectomía radical en pacientes de edad avanzada en función de la técnica quirúrgica. Objetivos: Analizar la incidencia, la severidad y el manejo de las complicaciones perioperatorias de la prostatectomía radical en mayores de 70 años en función de la técnica quirúrgica, retropúbica o laparoscópica. Material y métodos: De una serie de 500 pacientes se revisa, retrospectivamente, a 68 mayores de 70 años (42 retropúbica frente a 26 laparoscópica). Empleamos la clasificación de Clavien modificada para estudiar las complicaciones de ambas técnicas quirúrgicas. Resultados: La tasa de complicaciones globales en la retropúbica fue del 59,5% y en la laparoscópica de 23% (p = 0,003). En la retropúbica se observaron 3 complicaciones de grado I, 2de grado Id, 19 de grado II y 1 de grado II d, mientras que en la laparoscópica se observaron2 de grado I y 5 de grado Id. Las complicaciones más frecuentes fueron el sangrado intraoperatorio (38%) y la fuga urinaria (15%), respectivamente. Conclusiones: La prostatectomía radical es una técnica no exenta de complicaciones, casi siempre leves, en pacientes mayores de 70 años. Las ventajas generalmente atribuidas a la laparoscopia se mantienen en los pacientes de edad avanzada, por lo que la consideramos la técnica de elección (AU)

Introduction: Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed. Objectives: To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy inpatients older than 70 years. Material and methods: A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures. Results: The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=0.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinary fistula (15%) respectively. Conclusions: Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice (AU)

Métodos diagnósticos de la diseminación prostática / The diagnosis of prostate cancer dissemination

El cáncer de próstata (CP) metastatiza a distancia preferentemente en los ganglios linfáticos regionalesy en el hueso. La incidencia de la diseminaciónse ha visto reducida en los últimos años debido principalmente al amplio uso del antígeno prostático específico(PSA). Por este motivo, la indicación de la realizaciónde las exploraciones complementarias ha ido evolucionando en un intento de mejorar su rentabilidad. Algunas de estas técnicas se encuentran actualmente en evaluación y pueden contribuir en un próximo futuro a cambiar la práctica clínica del estudio de extensión. En la evaluación de la diseminación ganglionar, el TC o la RM son las técnicas por imagen estándar mientras que en la evaluación ósea la GO continúa siendo el rastreo de rutina

Prostate cancer preferentially metastasizes to regional lymph nodes and bone. The incidence ofdissemination has been reduced over the last years mainly due to the compost use of PSA. For this reason, the indication of complementary diagnostic tests has evolved with the aim of improving the diagnostic yield. Some of these techniques are currently under evaluation and may contribute in the close future to change the study of dissemination in the clinical practice. CT scan or MRI are the standard imaging studies for lymph node dissemination, whereas bone scan continues to be the routine test for bone dissemination

Disfunción vésico-esfinteriana en 108 casos de esclerosis múltiple / Vesicosphincteric dysfunction in 108 cases of multiple sclerosis

OBJETIVOS: Estudiar la disfunción vesicoesfinteriana en 108 pacientes diagnosticados de esclerosis múltiple (EM). MÉTODOS: Se revisan 108 historias clínicas de pacientes diagnosticados de esclerosis múltiple, analizando los que presentaban sintomatología miccional. A estos pacientes se les practicaba un estudio urodinámico completo y las pruebas complementarias necesarias según su sintomatología. Para la clasificación clínica de la EM se utilizó la clasificación de Blaivas. RESULTADOS: 64 de los 108 pacientes presentaban clínica miccional atribuible a la EM (59,2 por ciento), en el 75 por ciento la clínica era a brotes y en el 25 por ciento era progresiva. En un 6 por ciento de los pacientes esta clínica miccional fue la primera sintomatología de la EM. En el estudio urodinámico, un 73 por ciento de los pacientes presentaba hiperreflexia del detrusor, un 14 por ciento hiporreflexia y un 13 por ciento un estudio urodinámico normal. Las complicaciones fueron siempre de tipo infeccioso y ningún paciente presentó complicaciones en el tracto urinario superior. CONCLUSIONES: La disfunción vesicoesfinteriana en la EM es frecuente, la mayoría de los paciente presentan hiperreflexia vesical. Las complicaciones urológicas suelen ser infecciosas y es rara la afectación del tracto urinario superior (AU)