[Assessment and prevalence of urinary incontinence after radical prostatectomy: Analysis of a historical series]. / EVALUACIÓN Y PREVALENCIA DE INCONTINENCIA URINARIA TRAS PROSTATECTOMÍA RADICAL: ANÁLISIS DE UNA SERIE HISTÓRICA.

OBJECTIVES: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series. METHODS: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis. RESULTS: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p=0.013) and prostate volume (50cc) (OR:1.49, p=0.029). CONCLUSIONS: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence.

Evaluación y prevalencia de incontinencia urinaria tras prostatectomía radical: análisis de una serie histórica / Assessment and prevalence of urinary incontinence after radical prostatectomy: analysis of a historical series

OBJETIVO: El tratamiento del cáncer de próstata mediante prostatectomía radical puede ocasionar incontinencia urinaria. Nuestro objetivo es calcular la prevalencia de incontinencia urinaria a través del análisis de una serie histórica, analizar las características de las pérdidas y los factores influyentes en la aparición de incontinencia. MÉTODOS: Estudio descriptivo, observacional y retrospectivo de las variables clinicopatológicas de 1310 pacientes intervenidos entre 1989-2011. La prevalencia se calcula a los 12 meses de la cirugía usando la definición de ICS. Estudio transversal para completar el cuestionario ICIQ-SF y las protecciones usadas. Se estudia la serie completa y en dos grupos según características oncológicas. Se realiza estudio descriptivo, comparativo y predictivo. RESULTADOS: La prevalencia de la serie es de 23.5% con 296 pacientes. 279 incontinentes completaron el cuestionario ICIQ-SF con una media de 11.1±4.03. 16.4% de los pacientes intervenidos usan al menos 1 protección al día, de ellos el 69% usan compresas (11.4% del total), y el 22% pañales clásicos. El 8% usa más de una protección al día. Las características clinicopatológicas dividen la serie en dos grupos distintos: 1989-1999 con una prevalencia de 24.6% y grupo 2000-2011 con 22.8%. El análisis multivariado encontramos la edad (65 años) (OR:1.65, p = 0.013) y volumen prostático (50cc) (OR:1.49, p = 0.029) influyentes de forma independiente. CONCLUSIONES: La incontinencia urinaria es una enfermedad de cierta prevalencia, que varía según la definición que utilicemos. La situación más frecuente en los pacientes incontinentes es tener pérdidas varias veces al día (42.2%), poca cantidad (59.1%), usando protecciones tipo compresa (69%) y afectando la calidad de vida de forma leve-moderada (0-7: 88.2%). Las variables predictivas fueron la edad (65 años) y el volumen prostático (50cc). La evolución histórica de los pacientes no influye en la prevalencia de incontinencia urinaria

OBJECTIVES: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series. METHODS: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis. RESULTS: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p = 0.013) and prostate volume (50cc) (OR:1.49, p = 0.029). Concluisions: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence

MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy.

PURPOSE: Prostate cancer can be treated by radical prostatectomy (RP) and provoke a troublesome side effect: urinary incontinence (UI). We propose a verification of the usefulness of MRI and an identification of which structures are involved in UI after RP. METHODS: Between September 2002 and December 2011, 550 patients underwent RP. We performed MRI to evaluate extraprostatic disease before surgery. To evaluate patient status, we measured the following structures: length (LP), width (WP), height (HP) and volume (PV) of the prostate, membranous urethral length (MUL), urethral wall thickness (UWT), levator ani muscle (LAM) and obturator internus muscle (OIM) thickness, ratio of levator ani muscle/prostate volume (LAM/PV), volume of the urethra (VU). UI was defined according to ICS definition as the complaint of any involuntary leakage of urine and evaluated 1 year after surgery. Analyses were performed by mean comparisons, univariate and multivariate logistic regression with a 1000-resample bootstrapping. RESULTS: Means of measurements were: LP 4.46 cm, WP 5.15 cm, HP 3.9 cm, PV 49.3 cc; LAM 0.51 cm, OIM 1.46 cm; MUL 1.43 cm, UWT 1.38 cm; and LAM/PV 0.013 cm/cc, VU 2.33 cc. One hundred and twenty-two (22.2 %) patients complained of urine leakage. Univariate obtained differences in PV, OIM, MUL, and UWT. After adjusting by confounders, multivariate analysis showed: MUL: [OR 0.134; CI 95 % (0.022-0.493); P 0.006]; PV: [OR 1.016; CI 95 % (1.004-1.029); P 0.005]; UWT: [OR 6.03; CI 95 % (1.068-44.1); P 0.033]. CONCLUSIONS: MRI is a useful tool to predict UI after RP. The MUL and PV are well-identified structures that are involved in UI. Our study shows that UWT also influences UI.

Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment.

Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.

Complications of kidney transplantation with grafts from expanded criteria donors.

PURPOSE: The limited availability of kidneys for transplantation has been addressed by expanding the criteria for allowing a donor kidney to be transplanted, but this tendency may cause suboptimal kidneys to be implanted and could be associated with greater risk of complications. METHODS: A retrospective study of 407 kidney transplantations was done to compare complications of transplantation with non-expanded (n = 244) and expanded criteria donors (n = 163). Expanded criteria donors were donors older than 60 years, or donors aged 50-60 years who had ≥ 2 of the following risk factors: hypertension, diabetes mellitus (type 2), creatinine >1.5 mg/dL, or death caused by stroke. RESULTS: Compared with transplant recipients from non-expanded criteria donors, transplant recipients from expanded criteria donors had significantly greater frequency of graft loss, delayed graft function, pneumonia, overall surgical complications, early reoperation, wound eventration, hydronephrosis, postoperative hemorrhage, and wound infection. When analyzing surgical complications types, a significant greater frequency of urologic, wound, vascular, early and late surgical complications was found. In terms of severity, expanded donor criteria transplantation was related to Clavien I, III, and IV complications. CONCLUSIONS: Transplantation of kidneys from expanded criteria donors is associated with a significant higher risk of medical and surgical complications than kidneys from non-expanded criteria donors.

Recipient and donor risk factors for surgical complications following kidney transplantation.

OBJECTIVE: The aim of this study was to evaluate recipient and donor risk factors that are related to surgical complications after renal transplantation. MATERIAL AND METHODS: In total, 419 kidney transplantations were analysed with regard to the influence of recipient and donor risk factors on the main postoperative surgical complications. RESULTS: The mean follow-up for the entire group was 72.8 months (± 54.2 SD). Vascular complications were independently associated with donor age; and urological complications with recipient age >65 years and cyclosporine rather than tacrolimus therapy. Wound complications were independently associated with recipient age, preoperative dialysis time, recipient body mass index (BMI) and cyclosporine rather than tacrolimus therapy. Collections were independently associated with retransplantation, type 2 diabetes mellitus and wound complications. Overall surgical complications were associated with donor age and delayed graft function. In terms of severity, grade I complications were independently associated with recipient age and surgical revision, grade II with recipient age >50 years, grade III with recipient BMI, and grade IV with donor age. CONCLUSIONS: Recipient characteristics are the primary determinants of wound, urological and minor (Clavien grades I, II and III) complications; however, graft or donor characteristics are the primary risk factors for vascular, overall and major (Clavien grade IV) surgical complications.

Immediate renal Doppler ultrasonography findings (<24 h) and its association with graft survival.

PURPOSE: Renal Doppler ultrasonography (DUS) is the gold-standard image test for follow-up after renal transplantation, it is potentially useful to detect renal disease and it could be related with long-term survival. We evaluate whether renal graft survival can be predicted by immediate renal Doppler ultrasonography (IRDUS), defined as ultrasonography carried out in the first 24 h post-surgery. MATERIALS AND METHODS: Immediate renal DUS findings (resistance index, hydronephrosis, fluid collection, bruises, and vascularization abnormalities) and their association with graft survival were analyzed in a retrospective observational study of 343 renal allografts. Renal transplantation was done using a standard technique, and DUS was performed 24 h post-transplantation. The association of variables with graft survival was evaluated by Cox univariate and multivariate proportional hazards analysis. Kaplan-Meier survival analysis and the log-rank test were used to examine graft survival. RESULTS: The follow-up median was 85 months. On IRDUS, 137 patients (39.9%) had abnormal findings. The best RI cutpoint for the prediction of graft survival was 0.7; therefore, we defined two different groups: RI ≤ 0.7 (n = 247) versus RI > 0.7 (n = 96). Univariate analysis revealed that graft survival was significantly lower in patients with RI > 0.7 (P ≤ 0.001), vascularization abnormalities (P ≤ 0.001) or bruises (P = 0.026). In multivariate analysis, the only factors independently associated with graft survival were RI (odds ratio 2.4; 95% CI 1.4-4.1) and vascularization abnormalities (odds ratio 2.7; 95% CI 1.1-6.5). CONCLUSIONS: IRDUS can be useful, besides being highly useful in the diagnosis of graft primary dysfunction in the transplanted patient also yields information that can help to predict long-term graft survival.