Long-Term Functional Outcomes and Quality of Life after Male Transobturator-Retrourethral Sling Surgery.

INTRODUCTION: Post-prostatectomy urinary incontinence (PPUI) has an enormous impact in quality of life (QoL). Transobturator-rethrourethral sling (AdVanceTMXP sling) is a well-established treatment option although there is paucity of data on long-term outcomes. Our objective was to assess the long-term functional outcomes and QoL in a cohort of men undergoing AdVanceTMXP sling surgery. METHODS: Retrospective observational study of men undergoing AdVanceTMXP sling in a tertiary referral institution from August 2013 to July 2020. 55 patients met the inclusion criteria, with a minimum follow-up of 12 months. Main outcomes were pre- and post-operative daily pad use and scoring in the ICIQ-SF questionnaire. Post-operative complications were assessed following the Clavien-Dindo classification system. QoL and satisfaction with the procedure were assessed through direct interview. RESULTS: Mean number of pads prior to surgery was 3.1, and mean ICIQ-SF score was 13.5. After surgery, mean daily pads use went to 1.2, and mean ICIQ-SF dropped to 5. With a mean follow-up of 42.36 months, 21.8% patients did not use any pads/day and 76.4% achieved social continence (0-1 pad/day). We found no statistically significant differences in outcomes of patients with follow-up of <36 months, 36-48 months, and >48 months (p = 0.067). CONCLUSIONS: AdVanceTMXP sling implantation in men with PPUI improves urinary incontinence and QoL, and their results are sustained over time.

Management of Acute Cystitis in the Era of COVID-19.

Purpose of Review: No specific guidelines have been developed for acute cystitis management during the COVID-19 pandemic. This review aims to provide up-to-date information about treatment and follow-up in patients with symptoms suggesting lower urinary tract infection. Recent Findings: Uncomplicated cystitis does not need microbiological confirmation; thus, clinical diagnosis via telephone interview or questionnaires may be done. When complicated infections are suspected, in-person evaluation or close follow-up is mandatory. Antibiotic treatment is still the gold standard for treatment, although non-pharmacological strategies have also been suggested and further investigations are warranted. Summary: Urinary tract infections are still a frequent reason for consultation that needs to be addressed in both primary care and specialized levels. Their management during the pandemic is similar than in precedent years, but telehealth options have emerged which can facilitate diagnosis and treatment.

Artificial Urinary Sphincter in a High-Risk Urethra: Transcorporal Gullwing Modification Description of the Technique.

BACKGROUND: In this report, we describe a modification of transcorporal artificial urinary sphincter place ment known as Gullwing modification. DESCRIPTION OF TECHNIQUE: Using a penoscrotal approach, bilateral corpora cavernosa flaps are harvested and sutured in the midline covering the lateral and ventral surfaces of the urethra. Transcorporal cuff placement provides dorsal reinforcement, thus having extra tissue buttressing all the circumference in cases of a fragile urethra due to previous urethral cuff erosion, urethroplasty, or pelvic radiotherapy. PATIENT AND METHODS: After previous urethral cuff erosion, radiotherapy, and urethral reconstruction, our patient complained of severe stress urinary incontinence. Due to the high risk of urethral complications, we proceed to a transcorporal artificial sphincter placement with urethral reinforcement through a bilateral cavernosal flap. RESULTS: The surgery was successfully completed, and after 6 weeks, sphincter was activated with satisfac tory results. Two years after surgery, his continence status is stable without complications. CONCLUSION: Urethral complications associated with artificial urinary sphincter surgery remain a challenge for the reconstructive surgeon. Reinforcement of the ventral aspect of the urethra through corpora cavernosal flaps may reduce the likelihood of urethral erosion in high-risk cases.

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults.

Purpose of review: Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations. Recent findings: Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined. Summary: Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.

Female Urethroplasty: Anterior Vaginal Wall Flap (Blandy Flap) - Simpler Tends to Be Better.

Urethral stricture is a rare condition in women, representing a diagnostic challenge for the urologist. Its main etiology is traumatic or due to labor. Definitive treatment can be by means of dilations or urethroplasty using both local flaps and free grafts. In this study, we report the case of a patient with voiding symptoms during a period of 9 years after childbirth, despite an attempt of urethral dilation and chronic self-catheterization. The patient was finally diagnosed of a long distal urethral stricture, and she underwent urethroplasty with an anterior vaginal wall flap with satisfactory results. We take the opportunity to briefly review the diagnostic pathway in women with obstructive symptoms and the main female urethroplasty techniques.

Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair-case report.

Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O'Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.

Pathological findings in very low risk prostate cancer in surgical specimens. / Hallazgos patológicos en el cáncer de próstata de muy bajo riesgo en piezas de prostatectomía radical.

OBJECTIVE: Perform a detailed anatomopathological analysis of consecutive surgical specimens in men with clinically very low risk prostate cancer according to National Comprehensive Cancer Network (NCCN) criteria.MATERIALS AND METHODS: The study included 799 prostate cancer patients who under went radical prostatectomy between January 2005 and December 2013. We identified 81 consecutive patients with clinically very low risk prostate cancer. The slides of the patients who fulfilled the inclusion criteria were re-reviewed. The parameters studied were: pathological stage, histological grade by Gleason score (GSS), margins involvement, tumor percentage (PT), and number of apparently independent tumor foci (FT). RESULTS: The patients had organ-confined tumors in almost all of them (pT2: 97.5%). Most of the cancers studied were bilateral (pT2c: 67.9%), multifocal (FT≥2:88.8%), with a low tumor percentage (PTand with a low Gleason Score (GSS≤6: 91,3%). Non-confined disease: 2.5%, all cases extra-prostatic extension (pT3a). GSS>6: 8,6%, all cases GSS7 (3+4). CONCLUSIONS: The NCCN criteria for very low risk prostate cancer help to make a good selection of non-aggressive tumors and are a useful tool for including patients in an active surveillance program.

OBJETIVO: Realizar un análisis patológic odetallado de las piezas de prostatectomía radical en pacientes diagnosticados con cáncer de próstata de muy bajo riesgo según los criterios de la NCCN. MATERIAL Y MÉTODOS: El estudio incluye 799 pacientes con cáncer de próstata a los que se realizó una prostatectomía radical entre 2005 y 2013. 81 pacientes con cáncer de próstata clínicamente de muy bajo riesgo fueron identificados. Las laminillas de los pacientes identificados fueron revisadas. Los parámetros estudiados fueron: estadio patológico, grado de Gleason, márgenes quirúrgicos, % de tumor, y el numero de focos tumorales aparentemente independientes. RESULTADOS: La gran mayoría de pacientes presentaron tumores órgano-confinados (pT2: 97,5%). El 68% de los canceres fue bilateral (pT2c), multifocal (mas de2 focos 88%), con un porcentaje tumoral de menos del 10% en el 80% de los casos y mas del 90% con Gleason 6. La enfermedad no órgano-confinada se evidencio en 2,5% pT3a. CONCLUSIONES: Los criterios de NCCN para muy bajo riesgo nos ayudan a clasificar pacientes con tumores poco agresivos y son una buena herramienta para seleccionar pacientes para programas de vigilancia activa.

Hallazgos patológicos en el cáncer de próstata de muy bajo riesgo en piezas de prostatectomía radical / Pathological findings in very low risk prostate cancer in surgical specimens

OBJETIVO: Realizar un análisis patológico detallado de las piezas de prostatectomía radical en pacientes diagnosticados con cáncer de próstata de muy bajo riesgo según los criterios de la NCCN. MATERIAL Y MÉTODOS: El estudio incluye 799 pacientes con cáncer de próstata a los que se realizó una prostatectomía radical entre 2005 y 2013. 81 pacientes con cáncer de próstata clínicamente de muy bajo riesgo fueron identificados. Las laminillas de los pacientes identificados fueron revisadas. Los parámetros estudiados fueron: estadio patológico, grado de Gleason, márgenes quirúrgicos, % de tumor, y el numero de focos tumorales aparentemente independientes. RESULTADOS: La gran mayoría de pacientes presentaron tumores órgano-confinados (pT2: 97,5%). El 68% de los canceres fue bilateral (pT2c), multifocal (mas de 2 focos 88%), con un porcentaje tumoral de menos del 10% en el 80% de los casos y mas del 90% con Gleason 6. La enfermedad no órgano-confinada se evidencio en 2,5% pT3a. CONCLUSIONES: Los criterios de NCCN para muy bajo riesgo nos ayudan a clasificar pacientes con tumores poco agresivos y son una buena herramienta para seleccionar pacientes para programas de vigilancia activa

OBJECTIVE: Perform a detailed anatomopathological analysis of consecutive surgical specimens in men with clinically very low risk prostate cancer according to National Comprehensive Cancer Network (NCCN) criteria. MATERIALS AND METHODS: The study included 799 prostate cancer patients who underwent radical prostatectomy between January 2005 and December 2013. We identified 81 consecutive patients with clinically very low risk prostate cancer. The slides of the patients who fulfilled the inclusion criteria were re-reviewed. The parameters studied were: pathological stage, histological grade by Gleason score (GSS), margins involvement, tumor percentage (PT), and number of apparently independent tumor foci (FT). RESULTS: The patients had organ-confined tumors in almost all of them (pT2: 97.5%). Most of the cancers studied were bilateral (pT2c: 67.9%), multifocal (FT≥2: 88.8%), with a low tumor percentage (PT<10%: 80.2%) and with a low Gleason Score (GSS≤6: 91,3%). Non-confined disease: 2.5%, all cases extra-prostatic extension (pT3a). GSS>6: 8,6%, all cases GSS7(3+4). CONCLUSIONS: The NCCN criteria for very low risk prostate cancer help to make a good selection of non-aggressive tumors and are a useful tool for including patients in an active surveillance program

Perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva - Estudio VHEXPECTA / Symptoms severity profile and expectations in hyperactive bladder patients - VHEXPECTA Study

OBJETIVOS: Evaluar la gravedad sintomática en pacientes con Vejiga Hiperactiva (VH) y sus expectativas respecto a evolución, manejo y Calidad de Vida Relacionada con la Salud (CVRS). MATERIALES Y MÉTODOS: Estudio epidemiológico, transversal, multicéntrico, realizado en práctica clínica habitual por 294 investigadores españoles. Se incluyeron mujeres adultas con síntomas de VH, de nuevo diagnóstico o en visita de seguimiento. Las pacientes completaron cuestionarios CACV, OABq-SF y una encuesta ad-hoc de expectativas. La asociación entre expectativas y gravedad sintomática, y entre expectativas y experiencia previa de tratamiento, se analizó mediante Chi-Cuadrado. La relación entre gravedad de la urgenciae impacto de los síntomas sobre la CVRS, y entre expectativas y molestia sintomática y CVRS, se evaluó mediante la prueba no-paramétrica Kruskal-Wallis. RESULTADOS: Se incluyeron 1107 pacientes, con una edad media de 58,8 años. El 60,6% era de nuevo diagnóstico, y la urgencia fue el síntoma más frecuente (93,3%). Según CACV, 58,7% tenía sintomatología grave o muy grave. Las expectativas en las pacientes sin tratamiento previo de que sus síntomas se curen para siempre eran mayores que en las pacientes tratadas previamente (p < 0,05). El porcentaje de pacientes que esperaban una respuesta positiva al tratamiento disminuía al aumentar la gravedad de VH (73,9% con sintomatología leve, 32,5% con sintomatología muy grave; p < 0,005). Igualmente, las pacientes con mayor molestia sintomática mostraban un menor acuerdo con todas las expectativas planteadas (p < 0,005), y la CVRS fue mayor en las pacientes con mejores expectativas (p < 0,005). CONCLUSIONES: Las expectativas de las pacientes con VH respecto a su patología y al resultado de los tratamientos están relacionadas con la gravedad sintomática y la CVRS

OBJECTIVES: To Evaluate the severity of symptoms in OAB patients and their outcomes expectations, symptoms management and Health-Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, multicentre, non-interventional, cross-sectional study, conducted by 294 physicians in Spain in clinical practice. Female adult patients with OAB symptoms, newly diagnosed or during follow-up were included. B-SAQ, OABq-SF and an ad-hoc patient expectation questionnaire were completed. Association between expectations, symptom severity and prior treatments was analyzed using Chi- Square. The non-parametric Kruskal-Wallis test was used to analyze the relationship between the intensity of the urgency and the impact of OAB symptoms on HRQoL and between expectative and symptoms characteristics and HRQoL. RESULTS: 1.107 patients were included. Mean age was 58 years. 60.6% were newly diagnosed and urinary urgency was the most frequent symptom reported (93.3%). According the B-SAQ score 58.7% suffered moderated or severe OAB. Expectations in patients without previous treatment about "their symptoms will be cured permanently" were higher than in patients previously treated (p < 0.005). The percentage of patients who expected a positive response to treatment decreased while the OAB symptom severity increased (73.9% mild symptoms, 32.5% very severe symptoms; p < 0.005). Moreover, patients with higher symptom discomfort were less agreement with all expectations (p < 0.005), and HRQL was higher in patients with higher expectations (p < 0.005). CONCLUSIONS: The expectations of patients with OAB regarding their pathology and the expected outcomes of treatments are related to symptom severity and HRQL

[Symptoms severity profile and expectations in hyperactive bladder patients - VHEXPECTA Study.] / Perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva - Estudio VHEXPECTA.

OBJECTIVES: To Evaluate the severity of symptoms in OAB patients and their outcomes expectations, symptoms management and Health-Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, multicentre, non-interventional, cross-sectional study, conducted by 294 physicians in Spain in clinical practice. Female adult patients with OAB symptoms, newly diagnosed or during follow-up were included. B-SAQ, OABq-SF and an ad-hoc patient expectation questionnaire were completed. Association between expectations, symptom severity and prior treatments was analyzed using Chi- Square. The non-parametric Kruskal-Wallis test was used to analyze the relationship between the intensity of the urgency and the impact of OAB symptoms on HRQoL and between expectative and symptoms characteristics and HRQoL. RESULTS: 1.107 patients were included. Mean age was 58 years. 60.6% were newly diagnosed and urinary urgency was the most frequent symptom reported (93.3%). According the B-SAQ score 58.7% suffered moderatedor severe OAB. Expectations in patients without previous treatment about " their symptoms will be cured permanently" were higher than in patients previously treated (p<0.005). The percentage of patients who expected a positive response to treatment decreased while the OAB symptom severity increased (73.9% mild symptoms, 32.5% very severe symptoms; p<0.005). Moreover, patients with higher symptom discomfort were less agreement with all expectations ( p<0.005), and HRQL was higher in patients with higher expectations (p<0.005). CONCLUSIONS: The expectations of patients with OAB regarding their pathology and the expected outcomes of treatments are related to symptom severity and HRQL.

OBJETIVOS: Evaluar la gravedad sintomática en pacientes con Vejiga Hiperactiva (VH) y sus expectativas respecto a evolución, manejo y Calidad de Vida Relacionada con la Salud (CVRS).MATERIALES Y MÉTODOS: Estudio epidemiológico, transversal, multicéntrico, realizado en práctica clínica habitual por 294 investigadores españoles. Se incluyeron mujeres adultas con síntomas de VH, de nuevo diagnóstico o en visita de seguimiento. Las pacientes completaron cuestionarios CACV, OABq-SF y una encuesta ad-hoc de expectativas. La asociación entre expectativas y gravedad sintomática, y entre expectativas y experiencia previa de tratamiento, se analizó mediante Chi-Cuadrado. La relación entre gravedad de la urgenciae impacto de los síntomas sobre la CVRS, y entre expectativas y molestia sintomática y CVRS, se evaluó mediante la prueba no-paramétrica Kruskal-Wallis. RESULTADOS: Se incluyeron 1107 pacientes, con una edad media de 58,8 años. El 60,6% era de nuevo diagnóstico, y la urgencia fue el síntoma más frecuente (93,3%). Según CACV, 58,7% tenía sintomatología grave o muy grave. Las expectativas en las pacientes  sin tratamiento previo de que sus síntomas se curen para siempre eran mayores que en las pacientes tratadas previamente (p<0,05). El porcentaje de pacientes que esperaban una respuesta positiva al tratamiento disminuía al aumentar la gravedad de VH (73,9% con sintomatología leve, 32,5% con sintomatología muy grave; p<0,005). Igualmente, las pacientes con mayor molestia sintomática mostraban un menor acuerdo con todas las expectativas planteadas (p<0,005), y la  CVRS fue mayor en las pacientes con mejores expectativas (p<0,005). CONCLUSIONES: Las expectativas de las pacientes con VH respecto a su patología y al resultado de los tratamientos están relacionadas con la gravedad sintomática y la CVRS.