[Urinary symptoms and urodynamic findings in argentinian patients with advanced pelvic organ prolapse (POP).] / Características clínicas urinarias y hallazgos urodinámicos en pacientes argentinas con prolapso de órganos pelvianos (POP) en estadío avanzado.

OBJECTIVE: To describe urinary symptoms and urodynamic findings in patients with advanced pelvic organ prolapse. MATERIAL AND METHODS: A descriptive and retrospective evaluation with advanced POP referred for urodynamic test before surgical repair between 2015 and 2017 were included. All patients under went a urogynexam, physical examination, uroflow and urodynamics exam. Clinical features (filling and emptying symptoms, stress incontinence questionnaire (ISIQ-SF) and urodynamics (sensitivity, capacity and hyperactive detrusor, internal sphincter deficiency and voiding symptoms). RESULTS: A total of 170 patients with advanced PRP were evaluated. The most prevalent symptoms were urgency (63%), urinary stream disturbance (64%), incomplete voiding (63%). Mixt urinary incontinence wasthe most commonly reported (30%). Only 11% had anormal urodynamics exam. 36% had a hidden stress incontinence. 47% had voiding symptoms related to infravesical obstruction (30%). CONCLUSIONS: Patients with advanced POP havea wide variety of urinary symptoms such as urgency, voiding dysfunction and mixt urinary incontinence. Urodynamics studies provide relevant information regardingat the bladder dysfunction that may decrease surgical outcomes.

OBJETIVO: Describir las características clínicas urinarias y los hallazgos urodinámicos en pacientes con Prolapso de Órganos Pelvianos (POP) deestadio III-IV. MATERIAL Y MÉTODOS: Realizamos un estudio descriptivo y retrospectivo evaluando a todas las pacientes con POP avanzado (estadío 3-4) derivadas para estudio urodinámico previo a tratamiento quirúrgico entre 2015 y 2017. A todas las pacientes se les realizó un interrogatorio uroginecológico, examen físico, uroflujometría yurodinamia completa. Se evaluaron características clínicas (síntomas de llenado y de vaciado, IOE con cuestionario ISIQ-SF) y urodinámicas (sensibilidad, capacidad, presencia de detrusor hiperactivo, presencia de DEI y disfunción de vaciado). RESULTADOS: Se evaluaron 170 pacientes con POP avanzado (estadio 3-4). Los síntomas más prevalentes fueron urgencia miccional (63,5%), alteración en el chorro miccional (64,7%) y sensación de vaciado incompleto (63,5%). Entre las formas de incontinencia urinaria, la IOM fue la más evidenciada (30%). Solo 11,3% tenían estudio urodinámico normal. Se evidenció 36,5% de IOE oculta y 47,6% de disfunción de vaciado principalmente asociado a obstrucción infravesical (30%). CONCLUSIONES: Los pacientes con POP avanzado presentan una gran variedad de síntomas urinarios principalmente urgencia miccional, trastornos de vaciado e IOM. El estudio urodinámico brinda información importante en la evaluación de la disfunción vesical que puede comprometer los resultados quirúrgicos.

Características clínicas urinarias y hallazgos urodinámicos en pacientes argentinas con prolapso de órganos pelvianos (pop) en estadío avanzado / Urinary clinical characteristics and urodynamic findings in Argentine patients with advanced stage pelvic organ prolapse (POP)

Objetivo: Describir las característicasclínicas urinarias y los hallazgos urodinámicos en pacientes con Prolapso de Órganos Pelvianos (POP) deestadio III-IV.Material y métodos: Realizamos un estudio descriptivo y retrospectivo evaluando a todas las pacientes conPOP avanzado (estadío 3-4) derivadas para estudiourodinámico previo a tratamiento quirúrgico entre 2015y 2017. A todas las pacientes se les realizó un interrogatorio uroginecológico, examen físico, uroflujometría yurodinamia completa. Se evaluaron características clínicas (síntomas de llenado y de vaciado, IOE con cuestionario ISIQ-SF) y urodinámicas (sensibilidad, capacidad,presencia de detrusor hiperactivo, presencia de DEI ydisfunción de vaciado).Resultados: Se evaluaron 170 pacientes con POPavanzado (estadio 3-4). Los síntomas más prevalentesfueron urgencia miccional (63,5%), alteración en el chorro miccional (64,7%) y sensación de vaciado incompleto (63,5%). Entre las formas de incontinencia urinaria, laIOM fue la más evidenciada (30%). Solo 11,3% teníanestudio urodinámico normal. Se evidenció 36,5% deIOE oculta y 47,6% de disfunción de vaciado principalmente asociado a obstrucción infravesical (30%).Conclusiones: Los pacientes con POP avanzadopresentan una gran variedad de síntomas urinarios principalmente urgencia miccional, trastornos de vaciadoe IOM. El estudio urodinámico brinda información importante en la evaluación de la disfunción vesical quepuede comprometer los resultados quirúrgicos.(AU)

Objetive: To describe urinary symptoms and urodynamic findings in patients with advancedpelvic organ prolapse.Mmaterial and methods: A descriptive and retrospective evaluation with advanced POP referred for urodynamic test before surgical repair between 2015 and2017 were included. All patients underwent a urogynexam, physical examination, uroflow and urodynamicsexam. Clinical features (filling and emptying symptoms, stress incontinence questionnaire (ISIQ-SF) and urodynamics (sensitivity, capacity and hyperactive detrusor,internal sphincter deficiency and voiding symptoms).Results: A total of 170 patients with advanced PRPwere evaluated. The most prevalent symptoms wereurgency (63%), urinary stream disturbance (64%), incomplete voiding (63%). Mixt urinary incontinence wasthe most commonly reported (30%). Only 11% had anormal urodynamics exam. 36% had a hidden stressincontinence. 47% had voiding symptoms related to infravesical obstruction (30%).Conclusions: Patients with advanced POP havea wide variety of urinary symptoms such as urgency,voiding dysfunction and mixt urinary incontinence. Urodynamics studies provide relevant information regardingat the bladder dysfunction that may decrease surgicaloutcomes.(AU)

Clinical score predictive of abdominal leak point pressure (ALPP) <60 cm H2O in the urodynamics study of women with stress urinary incontinence.

OBJECTIVE: The aim of this study was to perform a score predictive of ALPP <60 cm H2O from clinical factors in women with stress urinary incontinence (SUI). STUDY DESIGN: We performed a descriptive and observational study of women referred for a urodynamic study for stress urinary incontinence. Patients were divided into three groups: ALPP: >90 cm H2O, between 60 and 90 cm H2O and <60 cm H2O. A logistic regression study was performed in order to complete clinical predictors of ALPP < 60 cm H2O. Variables that were significant in the multivariate analysis were included in the score. RESULTS: We studied 158 patients: 65 presented ALPP > 90 cm H2O, 64 between 60-90 cm H2O and 29 <60 cm H2O. In the multivariate analysis, were presented as independent predictors of ALPP < 60 cm H2O, the presence of a fixed urethra (p 0.01), empty bladder test positive (p 0.02) and presence of symptoms grade III in the classification of Stamey (p 0.03). The accuracy of the test was: score 0, 42%; score 1, 58%; score 2, 81%. Receiver Operating Characteristic (ROC) analysis for the overall cutoff points revealed an area under the curve of 0,75. CONCLUSIONS: Presence of a fixed urethra, positive empty bladder test and patients with a high degree of SUI symptoms according to the Stamey score are independent clinical predictors of intrinsic sphincter deficiency. This score could represent a useful clinical tool to predict the presence of ALPP <60 cm H2O based on clinical parameters.

[Is there a correlation between abdominal leak pressure point, incontinence severity and quality of life in patients with stress urinary incontinence?] / Existe una correlación entre punto de presión de pérdida abdominal, severidad de incontinencia y calidad de vida?

OBJECTIVES: To evaluate if there is a correlation between the abdominal leak pressure point (ALPP) of the urodynamic study and several tools to evaluate severity and quality of life associated to stress urine incontinence (SUI). METHODS: Prospective correlation study of women referred to urodynamic study for stress urinary incontinence in Centro Urológico Profesor Bengió between September 2014 and October 2015. Anamnesis, physical examination (where the SUI was demonstrated), ICIQSF urine incontinence questionnaire and incontinence impact questionnaire (IIQ-7) were performed to every patient. Uroflowmetry and complete urodynamic study were performed in all cases. Intrinsic sphincter deficiency (ISD) was defined as ALPP value ≤ 60 cm H2O. The relation between abdominal leak pressure point (ALPP) and incontinence severity measurements and quality of life (daily protectors, Sandvik score, ISIQ-SF score and short IIQ7 score) was evaluated with the Spearman coefficient correlation. RESULTS: 105 females were studied. Mean ALPP was 84 H2O cm (30-170). 21 and 84 patients had ALPP values lower and higher than 60 H2O cm respectively. There were no differences between the groups when general and demographic characteristics were evaluated. No correlation between ALPP and incontinence severity measurements was demonstrated: daily protectors (ρ 0.10; p NS), Sandvik severity score (ρ 0.05; p NS), ISIQ-SF score (ρ 0.0004; p NS) and IIQ7 Score (ρ 0.06; p NS). When patients with IED (ALPP ≤ 60 cm H2O) and those without IED DEI (ALPP > 60 cm H2O) were analyzed, there was no statistically significant difference between the groups in the comparison according to severity and quality of life questionnaires. CONCLUSIONS: In this series, there is not a significant correlation between abdominal leak pressure point and severity and quality of life measurements in patients with stress urinary incontinence.

Comparación de los síntomas de vejiga hiperactiva en mujeres con incontinencia urinaria mixta e incontinencia urinaria de urgencia pura / Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence

INTRODUCCIÓN: Diversos autores han argumentado que el componente de urgencia miccional en incontinencia urinaria mixta (IOM) es diferente a la incontinencia de urgencia pura (IOU). En este caso ha sugerido que la incontinencia en IOM puede ser sobrediagnosticada en pacientes con IOE que malinterpretan su pérdida como IOU. OBJETIVOS: Evaluar las características clínicas y urodinámicas de pacientes con IOM e IOU pura. MÉTODOS: Realizamos un estudio retrospectivo de nuestra base de datos de urodinamia evaluando 450 mujeres con IOM e IOU. Se excluyeron pacientes con vejiga neurogénica, fístulas, divertículo uretral, cirugía uroginecológica previa, obstrucción infravesical conocida, radioterapia pélvica previa, infección del tracto urinario e ingesta de psicofármacos. A todos se les realizó historia clínica completa, examen físico, uroflujometría, cistometría de llenado y estudio presión flujo. RESULTADOS: No existen diferencias en relación a edad, menopausia y número de partos. La presencia de nicturia fue mayor en el grupo de IOU (66,4% vs. 46,1%, p 0,0004) al igual que el aumento de la frecuencia miccional (53,6% vs. 34,6%, p 0,0006). Al examen físico la presencia de hipermovilidad uretral e IOE fue mayor en el grupo de IOM, mientras que la presencia de trofismo vaginal reducido fue mayor en IOU. No encontramos diferencias en la sensibilidad y capacidad vesical. La presencia de detrusor hiperactivo fue de 56,4% en IOU pura vs. 33,2% de IOM (p < 0,0001). No encontramos diferencias en estudio presión flujo. CONCLUSIONES: Existen diferencias significativas en los parámetros clínicos y urodinámicos entre pacientes con IOM e IOU pura. La urgencia en pacientes con IOU pura estaría más relacionada con detrusor hiperactivo. Es probable que muchos pacientes con IOM solo tengan IOE pura, lo que llevaría a efectos positivos en los resultados de cirugía antiincontinencia

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. Objetives: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p < 0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery

[Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence.] / Comparación de los síntomas de vejiga hiperactiva en mujeres con incontinencia urinaria mixta e incontinencia urinaria de urgencia pura.

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. OBJETIVES: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.

[Impact of tumor diameter on prognosis in patients with renal cancer stage pT3a.] / Impacto pronóstico del diámetro tumoral en pacientes con cáncer renal estadío pT3a.

OBJECTIVE: To determine the prognostic impact that tumor size has in patients with pathological renal cancer stage pT3a. METHODS: Retrospective, descriptive study evaluating 261 patients diagnosed with renal cancer pathological stage pT1-3aN0M0 between 1995 and 2013. Clinical and pathological characteristics were evaluated in each group. A ROC curve was used to determine the optimum cutting point of tumor size in relation to the death by cancer. Metastasis-free survival and cancer specific survival were evaluated by the Kaplan Meier method and the differences between the groups were evaluated by the Log Rank test. Multivariate Cox regression analysis was used to evaluate the relationship of tumor size and survival of these patients. RESULTS: 261 patients were studied, 166 of which (63.6%) were Stage pT1a-b, 49 (18.8%) pT2 and 46 (17.6%) pT3a. Patients with pT3a tumors had higher proportion of symptomatic tumors (56.5% vs 33.6% p 0.003), tumor size (7.1 cm vs 5.5 cm; 0.0007), Fuhrman grade 3-4 (52.2% vs 19.1% p 0.0001), coagulative necrosis (62.8% vs 28.8% p 0.0001), distance metastasis (39.1% vs 14.9%; p 0.0001) and death by cancer (23.9% vs 8.9%; p 0.003) when compared with localized tumors (pT1-2). The ROC curve demonstrated that a cut-off point of 7cm is the ideal tumor size to determine renal cancer mortality. Metastasis-free survival at 5 year was 90% for tumors pT1a-b, 71% for pT2, 83% for pT3a <7cm and 48% for pT3a >7cm, with significant statistical differences (Log-rank test <0.001). In the multivariate analysis, only pT3a >7cm stage was an independent predictor of death by renal cancer. CONCLUSIONS: Although perirenal fat invasion and renal vein invasion (pT3a stage) are accepted as prognostic factors, to differentiate this category by tumor size could improve its predictive quality. The tumor diameter (7cm) should be applied to pT3a tumors in order to improve the accuracy of TNM system.

Impacto pronóstico del diámetro tumoral en pacientes con cáncer renal estadío pT3a / Impact of tumor diameter on prognosis in patients with renal cancer stage pT3a

OBJETIVO: Determinar el impacto pronóstico que tiene el tamaño tumoral en pacientes con cáncer renal estadio patológico pT3a. MÉTODOS: Estudio retrospectivo, descriptivo donde se evaluaron 261 pacientes con diagnóstico de cáncer renal estadío patológico pT1-3aN0M0 entre 1995 y 2013. En cada grupo se evaluaron características clínicas y patológicas. Para determinar el punto de corte óptimo del tamaño tumoral en relación a la muerte por cáncer se utilizó una curva ROC. La supervivencia libre de metástasis y la supervivencia cáncer específico, fueron evaluados por el método de Kaplan Meier y las diferencias entre los grupos fueron evaluadas por el Log Rank test. El análisis multivariado de regresión de Cox fue utilizado para evaluar la relación del tamaño tumoral en la supervivencia de estos pacientes. RESULTADOS: Se estudiaron 261 pacientes de los cuales 166 (63,6%) son estadío pT1a-b, 49 (18,8%) pT2 y 46 (17,6%) pT3a. Los pacientes con tumores pT3a presentaron mayor proporción de tumores sintomáticos (56,5% vs 33,6%; p 0,003), diámetro tumoral (7,1 cm vs 5,5 cm; p 0,0007), grado de Fuhrman 3-4 (52,2% vs 19,1%; p 0,0001), necrosis coagulativa (62,8% vs 28,8%; p 0,0001), metástasis a distancia (39,1% vs 14,9%; p 0,0001) y muerte por cáncer (23,9% vs 8,9%; p 0,003) al ser comparados con tumores localizados (pT1-2). Por medio de una curva ROC evidenciamos que un punto de corte de 7cm es el tamaño tumoral ideal para determinar mortalidad por cá7ncer renal. La supervivencia libre de metástasis a los 5 años fue 90% para tumores pT1a-b, 71% para pT2, 83% para pT3a <7cm y 48% para pT3a > 7cm, con diferencias estadísticamente significativas (Log rank test <0,001). En el análisis multivariado, evidenciamos al estadío pT3a >7cm como el único factor predictivo independiente de muerte por cáncer renal. CONCLUSIONES: Aunque la invasión de la grasa perirrenal y la invasión de la vena renal (estadío pT3a) son factores pronósticos aceptados, discriminar esta categoría según el tamaño tumoral podría mejorar su calidad predictiva. Nuestros datos demuestran que el diámetro tumoral (7cm) debería ser aplicado a tumores pT3a con el fin de mejorar la exactitud del sistema TNM

OBJECTIVE: To determine the prognostic impact that tumor size has in patients with pathological renal cancer stage pT3a. METHODS: Retrospective, descriptive study evaluating 261 patients diagnosed with renal cancer pathological stage pT1-3aN0M0 between 1995 and 2013. Clinical and pathological characteristics were evaluated in each group. A ROC curve was used to determine the optimum cutting point of tumor size in relation to the death by cancer. Metastasis-free survival and cancer specific survival were evaluated by the Kaplan Meier method and the differences between the groups were evaluated by the Log Rank test. Multivariate Cox regression analysis was used to evaluate the relationship of tumor size and survival of these patients. RESULTS: 261 patients were studied, 166 of which (63.6%) were Stage pT1a-b, 49 (18.8%) pT2 and 46 (17.6%) pT3a. Patients with pT3a tumors had higher proportion of symptomatic tumors (56.5% vs 33.6%; p 0.003), tumor size (7.1 cm vs 5.5 cm; 0.0007), Fuhrman grade 3-4 (52.2% vs 19.1%; p 0.0001), coagulative necrosis (62.8% vs 28.8%; p 0,0001), distance metastasis (39.1% vs 14.9%; p 0.0001) and death by cancer (23.9% vs 8.9%; p 0.003) when compared with localized tumors (pT1-2). The ROC curve demonstrated that a cut-off point of 7cm is the ideal tumor size to determine renal cancer mortality. Metastasis-free survival at 5 year was 90% for tumors pT1a-b, 71% for pT2, 83% for pT3a <7cm and 48% for pT3a >7cm, with significant statistical differences (Log-rank test <0.001). In the multivariate analysis, only pT3a >7cm stage was an independent predictor of death by renal cancer. CONCLUSIONS: Although perirenal fat invasion and renal vein invasion (pT3a stage) are accepted as prognostic factors, to differentiate this category by tumor size could improve its predictive quality. The tumor diameter (7cm) should be applied to pT3a tumors in order to improve the accuracy of TNM system

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

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

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

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

Evaluation of microvascular invasion as a prognostic factor in the progression of non-metastatic renal cancer.

INTRODUCTION: The aim of this study was to describe the prognostic impact of microvascular invasion (MVI) in patients with non-metastatic renal cell cancer. MATERIAL AND METHODS: We carried out a retrospective, descriptive and analytical study of patients with non-metastatic renal cell carcinoma who had undergone a radical or partial nephrectomy. Patients were divided according to the presence of MVI. In each group, clinical and pathological characteristics were evaluated. Metastasis-free and cancer-specific survival was evaluated by the Kaplan Meier method. The multivariate analysis was performed with Cox proportional method in order to predict risk factors of metastasis and cancer-specific mortality. RESULTS: A total of 221 patients with a median of 40-month long follow-up were evaluated. Patients with MVI+ were 40 (18%) while those with MVI - were 181 (82%). In the univariate analysis, the presence of MVI had a strong correlation with symptomatic tumors (OR 3.56; p 0.0003), tumor size (OR 12.08; p <0.0001), nuclear grade (OR 6.99; p <0.0001), pathological stage (OR 35.8; p <0.0001), distance metastasis (OR 4.16; p 0.0001), and death by cancer (OR 4.7; p 0.0004). However, in the multivariate analysis it is not presented as an independent predictor of metastasis (HR 0.45; p 0.11) or cancer-specific mortality (HR 0.93; p 0.91). CONCLUSIONS: In our series, MVI is associated with unfavorable tumors characteristics. In spite of this, it does not seem to be an independent predictor for metastasis and death by non-metastatic renal cancer.

[Is CAPRA-S score a valid tool in our environment to predict biochemical recurrence, metastasis and death after radical prostatectomy?] / ?Es el Score CAPRA­S una herramienta válida en nuestro medio para predecir recurrencia bioquímica, metástasis y muerte posterior a prostatectomía radical?

OBJECTIVES: To perform an external validation of CAPRA-S Score to determine prediction of biochemical recurrence, metastasis and death by PCa after RP in Argentinian population. METHODS: 216 patients were studied. The probability of the score to predict biochemical recurrence after RP was analyzed by the Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survivals were determined by Kaplan method. The accuracy of CAPRA-S score to predict biochemical recurrence, metastasis and death by PCa was made in accordance with Harrells concordance index. RESULTS: Median follow up was 74 months. Biochemical recurrence index increased proportionally with the increment of CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rates were 85%, 54% and 4% respectively. Concordance index (C-Index) for biochemical progression, metastasis and death by PCa were 0.85, 0.90 and 0.90 respectively. CONCLUSIONS: CAPRA-S score is an easily applicable tool and has high predictive accuracy to determine biochemical recurrence, metastasis and death by PCa probabilities in our population. Concordance Index in these variables was higher than 0.85.

¿Es el score CAPRA-S una herramienta válida en nuestro medio para predecir recurrencia bioquímica, metástasis y muerte posterior a prostatectomía radical? / Is CAPRA-S score a valid tool in our environment to predict biochemical recurrence, metastasis and death after radical prostatectomy?

OBJETIVOS: Realizar una validación externa del Score CAPRA-S para determinar si predice recurrencia bioquímica, metástasis y muerte por CAP tras PR en pacientes argentinos. MÉTODOS: Se estudiaron 216 pacientes. La probabilidad del Score para predecir recurrencia bioquímica después de PR fue analizada por método proporcional de Cox. La supervivencia libre de recurrencia bioquímica, metástasis y cáncer específico fue determinada por el método de Kaplan. La exactitud del Score de CAPRA-S para predecir recurrencia bioquímica, metástasis y muerte por CAP fue realizada de acuerdo al índice de concordancia de Harrell's. RESULTADOS: La media de seguimiento fue 74 meses. El índice de recurrencia bioquímica aumenta proporcionalmente al aumentar el Score CAPRA-S. Cuando estratificamos los pacientes en riesgo bajo, intermedio y alto, la tasa libre de recurrencia bioquímica fue 85%, 54% y 4% respectivamente. El índice de concordancia (C-Index) para progresión bioquímica, metástasis y muerte por CAP fue 0,85, 090 y 0,90 respectivamente. CONCLUSIONES: El Score CAPRA-S es una herramienta fácilmente aplicable y de gran exactitud predictiva para determinar la probabilidad de recurrencia bioquímica, metástasis y muerte por CAP en nuestra población. El índice de concordancia (C-Index) en estas variables es superior a 0,85

OBJECTIVES: To perform an external validation of CAPRA-S Score to determine prediction of biochemical recurrence, metastasis and death by PCa after RP in Argentinian population. METHODS: 216 patients were studied. The probability of the score to predict biochemical recurrence after RP was analyzed by the Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survivals were determined by Kaplan method. The accuracy of CAPRA-S score to predict biochemical recurrence, metastasis and death by PCa was made in accordance with Harrells concordance index. RESULTS: Median follow up was 74 months. Biochemical recurrence index increased proportionally with the increment of CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rates were 85%, 54% and 4% respectively. Concordance index (C-Index) for biochemical progression, metastasis and death by PCa were 0.85, 0.90 and 0.90 respectively. CONCLUSIONS: CAPRA-S score is an easily applicable tool and has high predictive accuracy to determine biochemical recurrence, metastasis and death by PCa probabilities in our population. Concordance Index in these variables was higher than 0.85

[Evaluation of the empty bladder stress test in supine position as a marker of severity and quality of life in women with stress urinary incontinence]. / Evaluación de la prueba de vejiga vacía en posición supina como marcador de severidad y calidad de vida en mujeres con incontinencia de orina de esfuerzo.

OBJECTIVES: To assess the association between empty bladder stress test and objective and subjective measures of stress urinary incontinence (SUI) severity. METHODS: Prospective, analytic and descriptive study of females with diagnosis of stress urinary incontinence referred for urodynamics study. Every patient underwent medical history (including number of daily pads) and physical examination, ISIQ-SF and short IIQ-7 questionnaires, and full urodynamic study, including the measurment of the abdominal leak pressure point (ALPP). Positive empty stress test was defined as stress urine leak on physical exam after uroflowmetry evacuation and in absence of significant post-void residual. To evaluate the relationship between empty bladder stress test and each one of the stress urinary incontinence severity measures, Stundent's t test was performed, considering a 〈0.05 value statistically significant. RESULTS: 107 patients were studied in the final analysis; of them 49 had empty bladder stress test (+) and 58 (-). Patients with positive test wet a greater number of protectors per day (3.9 vs 2.8; p 0.013), higher ICIQSF score (15.04 vs 12.22; p 0.0007), higher IIQ-7 score (52.2 vs 37.5; p 0.0049) and lower urodynamics ALPP (73 cm H2O vs 91 cm H2O; p 0.0002). CONCLUSIONS: Patients with SUI and positive empty bladder stress test had a strong association with the objective and subjective perception of urine incontinence severity with a negative impact in patients quality of life.

Evaluación de la prueba de vejiga vacía en posición supina como marcador de severidad y calidad de vida en mujeres con incontinencia de orina de esfuerzo / Evaluation of the empty bladder stress test in supine position as a marker of severity and quality of life in women with stress urinary incontinence

OBJETIVOS: Evaluar la asociación entre la prueba de vejiga vacía en posición supina y mediciones objetivas y subjetivas de severidad de incontinencia de orina de esfuerzo (IOE). MÉTODOS: Se realiza un estudio prospectivo, analítico y descriptivo de mujeres derivadas para estudio urodinámico por incontinencia de orina de esfuerzo. A todas las pacientes se les realizó interrogatorio (incluyendo número de protectores diarios) y examen físico, cuestionarios ISIQ-SF, IIQ-7 corto y estudio urodinámico completo (incluyendo medición de punto de presión de pérdida abdominal (VLPP)). La prueba de vejiga vacía en posición supina positiva fue definida como la pérdida de orina de esfuerzo al examen físico posterior a la evacuación vesical en la uroflujometría y en ausencia de residuo postmiccional significativo. Para evaluar la relación entre el resultado del test de vejiga vacía y cada una de las mediciones de severidad de incontinencia de orina de esfuerzo se realizó el test de Student, considerando un valor <0,05 como estadísticamente significativo. RESULTADOS: Se estudiaron 107 pacientes en el análisis final, de los cuales 49 presentaban test de vejiga vacía (+) y 58 test de vejiga vacía (-). Las pacientes con test (+) refirieron utilizar un mayor número de protectores por día (3,9 vs 2,8; p 0,013), mayor puntuación en el cuestionario ICIQ-SF (15,04 vs 12,22; p 0,0007), mayor puntaje en el cuestionario de impacto de incontinencia IIQ-7 (52,2 vs 37,5; p 0,0049) y menor VLPP en el estudio urodinámico (73 cm H2O vs 91 cm H2O; p 0,0002). CONCLUSIONES: Las pacientes con IOE que presentan test de vejiga vacía (+) tienen una fuerte asociación con la percepción objetiva y subjetiva de la severidad de la incontinencia de orina con un impacto negativo en la calidad de vida de la paciente

OBJECTIVE: To assess the association between empty bladder stress test and objective and subjective measures of stress urinary incontinence (SUI) severity. METHODS: Prospective, analytic and descriptive study of females with diagnosis of stress urinary incontinence for urodynamics study. Every patient underwent medical history (including number of daily pads) and physical examination, ISIQ-SF and short IIQ-7 questionnaires, and full urodynamic study, including the measurment of the abdominal leak pressure point (ALPP). Positive empty stress test was defined as stress urine leak on physical exam after uroflowmetry evacuation and in absence of significant post-void residual. To evaluate the relationship between empty bladder stress test and each one of the stress urinary incontinence severity measures, Stundent`s t test was performed, considering a <0.05 value statistically significant. RESULTS: 107 patients were studied in the final analysis; of them 49 had empty bladder stress test (+) and 58 (-). Patients with positive test wet a greater number of protectors per day (3.9 vs 2.8; p 0.013), higher ICIQSF score (15.04 vs 12.22; p 0.0007), higher IIQ-7 score (52.2 vs 37.5; p 0.0049) and lower urodynamics ALPP (73 cm H2O vs 91 cm H2O; p 0.0002). CONCLUSIONS: Patients with SUI and positive empty bladder stress test had a strong association with the objective and subjective perception of urine incontinence severity with a negative impact in patients quality of life

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

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

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

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

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

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