Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system.

BACKGROUND: Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS: A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS: Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS: WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.

Does Time and Size Matter in Retrograde Intrarenal Surgery? Results Analysis Using a Low-Pressure Technique

Purpose: Kidney stone disease affects 5% of the population and is associated with non-negligible morbidity. Retrograde intrarenal surgery and percutaneous nephrolithotomy are the treatments of choice. We analyzed the results from our patients who underwent retrograde intrarenal surgery at controlled pressure. Materials and Methods: We conducted an observational, descriptive, retrospective study of 403 patients who underwent retrograde intrarenal surgery at the Hospital Clínico Universitario Lozano Blesa (Zaragoza, Spain) between January 2013 and December 2019. Results: The mean surgical time was 111.1 minutes, with a mean stone volume of 3.5 cm3 (maximum volume, 38.3 cm3). A total of 70 patients (17.3%) developed postoperative Clavien-Dindo complications—64 minor (91.4%) and 6 major (8.6%). In addition, 28 patients (6.9%) presented with an early complication (<3 months), with urinary tract infection and pyelonephritis being the most common. The stone-free rate was 69.0%, with a retreatment rate of 4.7%. Conclusions: Sex was statistically significantly related to the onset of minor Clavien postoperative complications (p = 0.001). Similarly, corticosteroid use was associated with the onset of major Clavien complications (p = 0.030). Neither surgical time nor stone volume was found to be statistically significantly related to the onset of Clavien postoperative complications or early complications (AU)

Using hyperrealistic simulations to improve digital informed consent for endourological procedures.

OBJECTIVES: To show that digital informed consent (DIC) improves the subjective understanding of information and, therefore, informed consent. PATIENTS AND METHODS: A nonblinded randomized controlled trial was performed in 84 patients who had undergone transurethral resection of bladder, transurethral resection of prostate, or ureterorenoscopy between July 2017 and March 2018. The DIC group watched a hyperrealistic simulation on a tablet device before surgery. After surgery and again 30 days later, both groups completed a validated questionnaire that measured subjective understanding, anxiety, and utility of and need for information. RESULTS: The mean ± SD age of the participants was 68.7 ± 11.1 years. Nine of 84 patients (10.7%) did not complete the questionnaire. A total of 42 patients were allocated to the DIC group and 42 to the control group. The mean ± SD score for immediate subjective understanding in the DIC group was 14.5% higher than in the control group (72% ± 17.5% vs 57.5% ± 23.5%, respectively; P = 0.006). There was no statistical difference in anxiety, utility of and need for information relative to delayed subjective understanding. In subgroup analysis, subjective understanding scores were higher, but not significantly so, among patients with low and higher education levels in the DIC group than in the control group (68% ± 18.1% vs 54% ± 22.5% [P = 0.06] and 76% ± 18.3% vs and 66% ± 21.9%, respectively [P = 0.89]). CONCLUSION: Hyperrealistic simulations improved subjective understanding of information and, therefore, informed consent for endourological procedures.

[Management of chylous fistulas, a rare complication after urologic surgery]. / Manejo de las fístulas de quilo, una rara complicación tras cirugía urológica.

OBJECTIVE: To analyze the different treatments for postoperative chylous fistulae. METHODS: A literature review of the main treatments for postoperative chylous fistula, providing our initial experience of two cases of patients with postsurgical chylorrea, with conservative treatment. RESULTS: There is very limited experience in the treatment of chylous ascites. According to the literature reviewed, Octreotide (somatostatin analogue) can be used, to decrease fistula output. Both our cases cases were treated successfully with subcutaneous octreotide, with drain debit decrease in about 3 days. CONCLUSIONS: The use of octreotide appears to be an effective treatment in the management of chylous fistulae, and it is suggested by some authors as first-line treatment in the management of these, thus decreasing the complications that can appear due to chyle loss.

Manejo de las fístulas de quilo, una rara complicación tras cirugía urológica / Management of chylous fistulas, a rare complication after urologic surgery

OBJETIVO: Analizar los diferentes tratamientos para la fístula de quilo postoperatorias. MÉTODOS: Realizamos una revisión bibliográfica de los principales tratamientos para la fístula de quilo postoperatorias, aportando nuestra experiencia inicial de dos casos de pacientes con quilorrea postquirúrgica, con tratamiento conservador. RESULTADO: Existe muy poca experiencia del tratamiento de la ascitis quilosa, puede utilizarse, según la literatura revisada, el octreótide (análogo de la somatostatina), aportamos fueron tratados exitosamente con octreótide subcutáneo, disminuyendo el débito del drenaje en 3 días aproximadamente. CONCLUSIONES: El uso del octreótide aparece como un tratamiento efectivo en el manejo de las fístulas quilosas, y sugerido por algunos autores como tratamiento de primera línea en el manejo de estas, disminuyendo así las complicaciones que la pérdida de quilo puede conllevar

OBJECTIVE: To analyze the different treatments for postoperative chylous fistulae. METHODS: A literature review of the main treatments for postoperative chylous fistula, providing our initial experience of two cases of patients with postsurgical chylorrea, with conservative treatment. RESULTS: There is very limited experience in the treatment of chylous ascites. According to the literature reviewed, Octreotide (somatostatin analogue) can be used, to decrease fistula output. Both our cases cases were treated successfully with subcutaneous octreotide, with drain debit decrease in about 3 days. CONCLUSIONS: The use of octreotide appears to be an effective treatment in the management of chylous fistulae, and it is suggested by some authors as first-line treatment in the management of these, thus decreasing the complications that can appear due to chyle loss

[Renal cell carcinoma molecular biology. Prognostic and therapeutic usefulness]. / Biología molecular en adenocarcinoma renal (RCC). Su utilidad pronóstica y terapéutica.

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomalies in renal adenocarcinoma with special emphasis in the Von HippelLindau gene.

[Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor]. / Formación e investigación en cirugía laparoscópica urológica. Diseño de programas formativos y modelos experimentales de tumor renal.

We present our experience with surgical training programs development for basic and advanced laparoscopic urological surgery. Both training programs consist of 21 and 28 hours respectively. Basic surgical programs start with general knowledge of ergonomics and instrumentation, there after, attendants acquire basic skills on physical simulator. Posteriorly, techniques on animal model are undertaken, always assisted by an expert. Advanced activities start with surgical tasks on physical simulator. Posteriorly, reconstructive urological surgical techniques are undertaken on animal model, focused on partial nephrectomy, and always assisted by an expert tutor. We present our results on exophytic renal tumour model creation based chromatic Alginate.

From open to robotic partial nephrectomy.

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease.

[New technologies in partial nephrectomy]. / Nuevas tecnologías en la nefrectomía parcial.

OBJECTIVES: We aim to analyse the role of new technologies in management of small renal cancer. METHODS: We perform a non-systematic review of the literature in Medline, Cochrane Database of Systematic Reviews between period 2000-2012, using following mesh terms: partial nephrectomy, renal ablative technologies, and renal cancer. RESULTS: We don't review in this article ablative technologies such as cryotherapy, radiofrequency, as they are the subject of others manuscripts within this monographic issue. We focus on high intensity ultrasounds (HIFU) microwaves therapy, radiosurgery, laser and water jet dissection. CONCLUSIONS: New technologies in partial nephrectomy are under constant and vertiginous evolution. Although efficacy has been demonstrated in short term and isolated studies, more studies, better designed, with bigger sample size and longer follow up are needed.

Cirugía mínimamente invasiva en cáncer renal / No disponible

No disponible

Biologia molecular en adenocarcinoma renal (RCC). Su utilidad pronóstica y terapéutica / Renal cell carcinoma molecular biology. Prognostic and therapeutic usefulness

El adenocarcinoma renal requiere caminos terapéuticos diferentes porque es uno de los tumores más resistentes a tratamiento, por contra es uno de los tumores biológicamente más atractivos. Su clasificación anatomopatológica tiene un fundamento genético. En el 80% de los adenocarcinomas existe una alteración del gen Von Hippel Lindau y este hecho ha sido determinante para conocer las características biológicas de la aparición y desarrollo tumoral así como la identificación de factores que pueden ser susceptibles de ser utilizados como dianas terapéuticas. Desde 2005 un grupo de moléculas se ha utilizado en el tratamiento de los adenocarcinomas metastásicos y aunque los resultados terapéuticos son significativos pero no todavía clínicamente relevantes, estamos seguros que son un camino clave para desarrollos posteriores más eficientes. El presente estudio pretende hacer un recorrido por la investigación de las alteraciones biológicas en adenocarcinoma renal haciendo especial énfasis en las alteraciones del gen Von Hippel Lindau(AU)

Renal cell adenocarcinoma requires different therapeutic pathways because it is one of the most therapy-resistant tumors, on the other hand it is biologically one of the most attractive tumors. Its pathological classification has a genetic base. There is an anomaly of the Von Hippel Lindau gene in 80% of adenocarcinomas, being this fact determinant to know the biological characteristics of tumor initiation and development, as well as the identification of factors susceptible to be used as therapeutic targets. Since 2005 a group of molecules have been used in the treatment of metastatic adenocarcinomas and, even though therapeutic results are significant but not clinically relevant yet, we are sure they are a key way for more efficient future developments. The present study tries to make a tour on the research of the biological anomaliesin renal adenocarcinoma with special emphasis in the Von HippelLindau gene(AU)

Formación e investigación en cirugía laparoscópica urológica. Diseño de programas formativos y modelos experimentales de tumor renal / Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor

Presentamos nuestra experiencia en el desarrollo de programas de formación en cirugía laparoscópica urológica básica y avanzada. Ambos modelos formativos constan de 21 y 28 horas de duración respectivamente. El de tipo básico comienza con el conocimiento de aspectos generales de la ergonomía y del instrumental, tras lo cual los alumnos adquieren destrezas básicas mediante la práctica en simulador físico. Posteriormente se acometen las técnicas en modelo animal, siempre asistidos por profesorado experto. Las actividades avanzadas comienzan con prácticas directas en simulador físico. Posteriormente se acometen técnicas de urología reconstructiva en modelo animal, dando especial importancia a la nefrectomía parcial, siempre asistidos por profesorado experto. Así mismo presentamos los resultados de nuestra experiencia con un modelo basado en alginato cromático para la creación de pseudotumores exofíticos renales(AU)

We present our experience with surgical training programs development for basic and advanced laparoscopic urological surgery. Both training programs consist of 21 and 28 hours respectively. Basic surgical programs start with general knowledge of ergonomics and instrumentation, there after, attendants acquire basic skills on physical simulator. Posteriorly, techniques on animal model are undertaken, always assisted by an expert. Advanced activities start with surgical tasks on physical simulator. Posteriorly, reconstructive urological surgical techniques are undertaken on animal model, focused on partial nephrectomy, and always assisted by an expert tutor. We present our results on exophytic renal tumour model creation based chromatic Alginate(AU)

De la nefrectomía parcial abierta a la robótica / From open to robotic partial nephrectomy

En este trabajo no realizaremos un estudio comparativo de las distintas técnicas (abierta, laparoscópica y robótica) sino más bien analizaremos el cómo, el cuándo y el porqué de cada una de ellas desde una perspectiva histórica. Este análisis histórico comenzará desde finales del siglo XIX hasta llegar a nuestros días. En él, relataremos los principios; la incertidumbre de si se puede realizar. Los fracasos; las complicaciones y las dudas del saber si se está haciendo lo correcto. Y los éxitos de un tratamiento quirúrgico que hoy en día está fuera de toda duda. Todo ello resumido, ya que supone más de cien años de historia de la medicina. La historia que han escrito hombres y mujeres inconformistas que cambiaron el rumbo del tratamiento de la patología renal neoplásica(AU)

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease(AU)

Nuevas tecnologías en la nefrectomía parcial / New technologies in partial nephrectomy

OBJETIVO: Analizar el papel de las nuevas tecnologías en el manejo de los tumores renales. MÉTODOS: Se realizó una revisión no sistemática incluyendo las palabras clave nefrectomía parcial, técnicas ablativas renales, y cáncer renal en las bases de datos y fuentes de información tales como Medline, Cochrane Database of Systematic Reviews entre los periodos 2000 a 2012. RESULTADOS: No repasaremos en este artículo las técnicas ablativas para los tumores renales, tales como la crioablación, la ablación por radiofrecuencia (ARF), al ser objeto de otros artículos de este monográfico y nos centraremos en los ultrasonidos focalizados de alta intensidad (HIFU), la terapia con microondas (TM), la radiocirugía, las técnicas con láseres, y la hidrodisección. CONCLUSIONES: Las nuevas tecnologías en nefrectomía parcial tales como ultrasonidos focalizados de alta intensidad (HIFU), la terapia con microondas (TM), la radiocirugía, las técnicas con láseres, y la hidrodisección se encuentran actualmente en evolución constante y vertiginosa. Aunque han demostrado eficacia en estudios a corto plazo y aislados, se necesitan estudios mejor diseñados, con un tamaño muestral más elevado y un seguimiento más largo en el tiempo(AU)

OBJECTIVES: We aim to analyse the role of new technologies in management of small renal cancer. METHODS: We perform a non-systematic review of the literature in Medline, Cochrane Database of Systematic Reviews between period 2000-2012, using following mesh terms: partial nephrectomy, renal ablative technologies, and renal cancer. RESULTS: We don’t review in this article ablative technologies such as cryotherapy, radiofrequency, as they are the subject of others manuscripts within this monographic issue. We focus on high intensity ultrasounds (HIFU) microwaves therapy, radiosurgery, laser and water jet dissection. CONCLUSIONS: New technologies in partial nephrectomy are under constant and vertiginous evolution. Although efficacy has been demonstrated in short term and isolated studies, more studies, better designed, with bigger sample size and longer follow up are needed(AU)

How does endorectal MRI, PET-CT and transrectal ultrasound contribute to diagnosis and management of localized prostate cancer.

We analyze the main imaging techniques (transrectal ultrasound, Magnetic Resonance Imaging and Position Emission Tomography) that are currently used in the diagnosis and management of localised prostate cancer patients. We analyze the results that may be obtained with transrectal US and describe the latest advances in this technique (Doppler, power doppler and contrast media). With Magnetic Resonance Imaging, we describe the underlying principles, results and indications as well as some new applications (diffusion, perfusion, spectroscopy and the use of lymphotrophic nanoparticles). Finally we will describe the current state of positron emission tomography in diagnosis, follow up and recurrence detection using the different radiomarkers that are available.

¿Cómo contribuye la RMN, el PEC-TC y la ecografía transrectal en el diagnóstico y manejo del cáncer de próstata localizado? / How does endorectal MRI, PET-CT and transrectal ultrasound contributes to diagnostic and management of localized prostate cancer

Analizamos las principales técnicas (ecografía transrectal, resonancia magnética y la tomografia por emisión de positrones) utilizadas en el diagnóstico y manejo de los pacientes diagnosticados de adenocarcinoma de próstata localizado. De la ecografía transrectal analizamos los resultados obtenidos y describimos los últimos avances desarrollados con esta técnica (doppler, power doppler y medios de contraste).De la Resonancia Magnética analizamos los fundamentos, resultados e indicaciones así como las nuevas aplicaciones (difusión, perfusión, espectroscopia y la utilización de nanopartículas paramagnéticas linfotróficas).Y por último, comentaremos el estado actual de la Tomografía por emisión de positrones en el diagnóstico, en la monitorización y en la detección de recurrencias con los distintos radiotrazadores disponibles en el mercado(AU)

We analyze the main imaging techniques (transrectal ultrasound, Magnetic Resonance Imaging and Position Emission Tomography) that are currently used in the diagnosis and management of localised prostate cancer patients. We analyze the results that may be obtained with transrectal US and describe the latest advances in this technique (Doppler, power doppler and contrast media).With Magnetic Resonance Imaging, we describe the underlying principles, results and indications as well as some new applications (diffusion, perfusion, spectroscopy and the use of lymphotrophic nanoparticles).Finally we will describe the current state of positron emission tomography in diagnosis, follow up and recurrence detection using the different radiomarkers that are available(AU)

[Usefulness of PET scans in diagnosing recurrent prostate cancer. Prostate with PSA level < 5 ng/ml]. / Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml.

INTRODUCTION AND OBJECTIVES: We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment. MATERIAL AND METHODS: 92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-choline and 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 x 2 and 2 x X contingency tables and ROC curves. RESULTS: 1. Global PET: there is evidence of PET alteration regarding the PSA level (P=.003): the clinical stage (P=.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P< .0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET 18FDG: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P< .0001) with a specificity of 91% for a PSA of 5.15 ng/ml. CONCLUSIONS: PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment.

[Bladder leiomiosarcoma. A new case and a review of the literatura]. / Leiomiosarcoma vesical. Presentación de un nuevo caso y revisión de la literatura.

Bladder Leiomiosarcomas are exceptional mesenchimal tumours. Their differential diagnosis is basic to decide our therapeutic attitude. We present a new case of bladder leiomiosarcoma with a bad behavior and with multiple relapses, and perform a review of the literature in order to establish more properly the therapeutic attitudes.

Valor de la PET en la recurrencia del cáncer de próstata con PSA < 5 ng/ml / Usefulness of PET scans in diagnosing recurrent prostate cancer. Prostate with PSA level < 5 ng/ml

Introducción y objetivo: Evaluamos la utilidad de la tomografía por emisión de positrones (PET) en el diagnóstico de la recurrencia del cáncer de próstata tras tratamiento con intención curativa. Material y métodos: Se sometió a 92 pacientes consecutivos en progresión bioquímica tras cirugía radical (63) o radioterapia (29) a una PET. En todos los casos, se realizaron dos escáneres PET en el mismo día (11C-colina y 18F-FDG). Se evalúa la eficacia de la PET de manera global (utilizando los resultados con 11C-colina y 18F-FDG) y de manera independiente para detectar recurrencia en pacientes con progresión bioquímica. Para ello, se utilizan la comparación de medias para k muestras independientes, tablas de contingencia 2 × 2 y 2× X y curvas ROC. Resultados: 1. PET global: hay evidencia de la alteración de la PET en función del antígeno prostático específico (PSA) (p = 0,003), estadio clínico (p = 0,01). No existe una alteración de la PET estadísticamente significativa en función de la afectación de la biopsia (unilateral o bilateral), los márgenes quirúrgicos, el estadio patológico y el tiempo a progresión. La curva ROC PET-PSA es significativa (p < 0,0001) y permite calcular distintos puntos de corte; PSA = 4,3 ng/ml el que presenta una mayor especificidad (91%). 2. PET 18FDG: el área bajo la curva ROC es significativa (p < 0,0001), con una especificidad del 91% para un PSA =6,51 ng/ml. 3. PET 11colina: el área bajo la curva ROC es significativa (p < 0,0001), con una especificidad del 91% para un PSA = 5,15 ng/ml. Conclusiones: La PET es una herramienta útil en el diagnóstico de la recurrencia de cáncer de próstata tras tratamiento radical con intención curativa (AU)

Introduction and objectives: We intend to evaluate the usefulness of PET scans in diagnosing recurrent prostate cancer after a curative attempt using radical treatment. Material and methods: 92 consecutive prostate cancer patients in biochemical progression following radical surgery (63) or radiation treatment (29) were studied with positron emission tomography (PET). In all cases two scans were performed in the same day (11C-cholineand 18F-FDG). PET efficacy was evaluated both globally (by employing the results achieved with both 11C-choline and 18F-FDG) and using both radiotracers independently to detect recurrence in patients with biochemical progression. For this purpose, we used comparison of means for k-independent samples, 2 × 2 and 2 × X contingency tables and ROC curves. Results: 1. Global PET: there is evidence of PET alteration regarding the PSA level (P=0.003): the clinical stage (P=0.01). There are no statistically significant PET alterations regarding the affected biopsy (uni or bilateral), surgical margins, pathological stage and time to progression. ROC curve PET-PSA is statistically significant (P<0.0001) permitting calculation of different cut-off points, with a specificity of 91% (highest) for a PSA of 4.3 ng/ml. 2. PET18FDG: the area under the ROC curve is statistically significant (P<0.0001) with a specificity of91% for a PSA of 6.51 ng/ml. 3. PET 11choline: the area under the ROC curve is statistically significant (P<0.0001) with a specificity of 91% for a PSA of 5.15 ng/ml. Conclusions: PET is a useful tool for diagnosing prostate cancer recurrence after a curative attempt using radical treatment (AU)