Association between smoking and peri-implant diseases: A retrospective study.

OBJECTIVES: To determine the association between tobacco and peri-implant diseases in a sample of patients who had received implant-supported restorations in a university dental clinic. Furthermore, the study aimed to investigate patient- and implant-related variables associated with peri-implant diseases. MATERIALS AND METHODS: The present retrospective study analyzed data from 117 patients treated with implant-supported restorations from 2001 to 2013. A total of 450 implants were evaluated. Patients were selected from an electronic database, and patient- and implant-related variables were evaluated. Detailed information regarding the smoking history (i.e., smoking status, lifetime cumulative dose, duration of exposure, intensity of the habit, and smoking cessation) was recorded. The primary study outcome was peri-implant status [i.e., health (H), peri-implant mucositis (PM) and peri-implantitis (PI)]. Univariate and multinomial regression models comparing PM and PI versus peri-implant health were conducted. RESULTS: A total of 117 subjects [55 (47%) females and 62 (53%) males] with a mean age at examination of 64.2 years (SD 11.6) and rehabilitated with 450 implants were included. The average number of implants per patient was 4.6 (SD 3.3) with a mean time in function of 8.0 years (SD 1.9). Fifty-six patients (47.9%) were non-smokers, 42 (35.9%) were former-smokers, and 19 (16.2%) were current-smokers. Thirty-nine subjects (33.4%) were H, whereas 41 (35%) and 37 (31.6%) exhibited PM and PI, respectively. At implant level, the corresponding values were 142 (31.6%), 230 (51.1%) and 78 (17.3%). In the multinomial regression model, significant associations for peri-implant diseases were observed for the mean number of implants per patient (p = .016), function time (p = .048), implants placed simultaneously with guided bone regeneration (p = .016), implant surface (p = .020), keratinized mucosa at the buccal aspect (p = .032), and access to interproximal hygiene (p < .001). In addition, ever smokers >23 pack-years exhibited a significantly higher risk for peri-implantitis (p = .002). Finally, the multinomial regression analysis revealed that subjects who had stopped smoking more than 21 years before the last examination presented a significantly lower risk of peri-implant diseases than a smoking cessation of ≤21 years (p = .028). CONCLUSIONS: Smoke intensity was associated with an increased risk of the development of peri-implantitis. Moreover, the risk of peri-implant diseases might be similar in those subjects who had stopped smoking for more than 21 years with respect to never-smokers.

Geographic distribution of chronic obstructive pulmonary disease prevalence in Africa, Asia and Australasia.

OBJECTIVE: To visualise spatial data on chronic obstructive pulmonary disease (COPD) prevalence in Africa, Asia and Australasia using a Geographic Information System (GIS) inverse distance weighted (IDW) interpolation technique.DESIGN: Prevalence rates from population surveys on individuals aged ≥40, with spirometry-confirmed COPD, were searched systematically. The prevalence observed in 59 selected surveys and the geographic coordinates of the places where they were conducted informed a GIS computer programme. The prevalence was represented by an ascending chromatic scale (blue-green-yellow-orange-brown-red) in the GIS maps.RESULTS: IDW-interpolation GIS maps were obtained of all the geographic areas investigated, and even from regions lacking data. Areas of high/very high prevalence were found in: Southern Africa and in most of the Central and Eastern Africa regions; in practically all of Central Asia; in the western regions of Southern Asia; in the southern regions of the East European Plain and the West Siberian Plain of Northern Asia; and in the Malay Archipelago. Intermediate prevalence predominated in Oceania and in most of the other regions of Africa and Asia.CONCLUSION: Despite some biases inherent to the interpolation method used in the present study, our approach provided an understandable visual perspective of the COPD prevalence distribution in these geographic regions.

Sistema masculino transobturador ajustable (ATOMS(R)) como tratamiento de la incontinencia urinaria de esfuerzo secundaria a resección transuretral de la próstata / Adjustable transobturator male system (ATOMS(R)) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate

Objetivos: Estudio de viabilidad para evaluar la eficacia y la seguridad del sistema masculino transobturador ajustable (ATOMS(R)) para la incontinencia urinaria de esfuerzo (IUE) masculina después de la resección transuretral de la próstata. Materiales y métodos: Se implantó ATOMS(R) a 20 pacientes con IUE causada por resección transuretral de la próstata con o sin radioterapia. La severidad de la incontinencia fue evaluada como leve (2 compresas/día), moderada (3-5 compresas/día) o severa (≥6 compresas/día), y se consideró paciente seco aquel sin compresas o con una compresa de seguridad al día. Se investigó el cambio en el recuento de compresas (pad-count) y en el peso de las compresas (pad-test), así como otros parámetros operatorios, la satisfacción del paciente con el procedimiento, y el número y grado de complicaciones (Clavien-Dindo). Resultados: La mediana de edad fue de 76,5 años. Cinco pacientes habían recibido radioterapia pélvica (3 por cáncer de próstata, 2 por cáncer rectal) y 2 (10%) habían tenido esfínter urinario artificial con erosión uretral y fallo mecánico, respectivamente. La IUE preoperatoria fue leve en 4 (20%), moderada en 7 (35%) y severa en 9 (45%). La mediana de relleno del sistema fue de 13,5 ml. La mediana de pad-test disminuyó de 375 ± 855 ml basal a 10 ± 31,5 ml y el pad-count, de 4 ± 3 a 0 ± 1,5 tras el ajuste (1 ± 3 rellenos). La IUE postoperatoria fue leve en 2 (10%) pacientes, moderada en uno (5%) y severa en 2 (10%). La tasa de satisfacción fue del 80%, igual para pacientes con o sin radioterapia previa. Ningún paciente tuvo retención urinaria al retirar el catéter. Hubo complicaciones en 3 (15%) casos, todas menores. Tras una mediana de seguimiento de 38,5meses no se ha retirado ningún sistema; 19 (95%) pacientes se consideran mejor que antes y 11 (55%) muchísimo mejor. Conclusión: Según la eficacia a corto plazo y la satisfacción del paciente, ATOMS(R) puede considerarse una alternativa realista para IUE después de la resección transuretral de la próstata, incluso en pacientes radiados. La ausencia de erosión uretral y la escasez de problemas hacen esta alternativa especialmente atractiva para pacientes con destreza disminuida, edad avanzada y tratamientos previos fallidos

Objectives: Feasibility study to evaluate efficacy and safety of Adjustable Transobturator Male System (ATOMS(R)) for male stress urinary incontinence (SUI) after transurethral resection of the prostate. Materials and methods: Twenty patients were implanted ATOMS(R) for SUI caused by transurethral resection of the prostate with or without radiotherapy. Incontinence severity was evaluated as mild (2 pads/day), moderate (3-5 pads/day) or severe (≥ 6pads/day), and dryness as none or one security pad/day. Changes in pad-test and pad-count after adjustment were investigated, together with operative parameters, patient satisfaction with the procedure, and number and grade of complications (Clavien-Dindo). Results: Median age was 76.5 years. Five patients received previous pelvic radiation (3 prostate, 2 rectal cancer) and 2 (10%) previous failed artificial urinary sphincter with urethral erosion and mechanical failure, respectively. Preoperative SUI was mild in 4 (20%), moderate in 7 (35%) and severe in 9 (45%). Median filling of the system was 13.5 ml. Median pad-test decreased from 375 ± 855 ml baseline to 10 ± 31.5 ml and pad-count from 4 ± 3 to 0 ± 1.5 after adjustment (1 ± 3 fillings). Postoperative SUI distribution was mild in 2 (10%), moderate in one (5%) and severe in 2 (10%). Satisfaction rate was 80%, equal for transurethral resection of the prostate with/without previous radiotherapy. No patient had urinary retention after catheter removal. Complications presented in 3 (15%) patients, all minor. After median 38.5mo follow-up no system has been removed, 19 (95%) self-considered better than before and 11 (55%) very much better. Conclusion: Based on short-term efficacy and patient satisfaction ATOMS(R) can be considered a realistic alternative for SUI after transurethral resection of the prostate, even after irradiation. Absence of urethral erosion and very limited problems make this alternative especially attractive for cases with diminished dexterity, advanced age and previous failed treatments

Tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable (ATOMS(R)) con puerto escrotal premontado / Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS(R)) with preattached scrotal port

Introducción: La incontinencia urinaria de esfuerzo (IUE) es una secuela importante del tratamiento quirúrgico del cáncer de próstata. Se presenta la técnica quirúrgica y se evalúa efectividad y seguridad del sistema masculino transobturador ajustable (ATOMS(R)) con puerto escrotal premontado. Material y método: Estudio abierto prospectivo realizado en un hospital universitario. El objetivo principal fue cambio de situación basal tras ajuste en el recuento diario de compresas (pad-count) y su peso húmedo (pad-test). Los objetivos secundarios fueron evaluación de calidad de vida (ICIQ-SF e IIQ-7 basal y al ajuste), resultados percibidos por el paciente (PGI y GRA al año) y evaluación de complicaciones según Clavien-Dindo. Los valores numéricos se expresan en mediana + RIC. Resultados: Se analizan 60 pacientes consecutivos con seguimiento de 21+22 meses. El pad-test basal fue 465 + 450 ml y pad-count 5 + 3 compresas/día. La IUE basal fue leve (11,6%), moderada (25%) y severa (63,3%). El tiempo operatorio fue 60 + 25 min, la estancia hospitalaria 1+0 días y la EVA de dolor en día-1 postoperatorio 0 + 1. El llenado total fue 16,5+7ml y el número de rellenos 1+2. Pad-test y pad-count tras ajuste fueron 0 + 20 ml y 0+1, respectivamente (ambos p<0,0001 respecto a basal). La IUE desapareció (81,7%) o se mantuvo leve (11,7%), moderada (5%) y severa (1,6%). Se objetivó reducción en ICIQ-SF (p < 0,0001) e IIQ-7 (p = 0,0003). Tanto la continencia (p=0,002) como la satisfacción (p = 0,03) resultaron peores en pacientes irradiados. Sucedieron complicaciones en 11 casos (18,6%), siendo 8(13,5%) grado I y 3(5,1%) grado III. La tasa de satisfacción con el tratamiento fue 91,7% y la percepción de mejoría global percibida por el paciente al año fue muy marcada (score PGI-I 1+1 y GRA 6+1). Conclusiones: El tratamiento de la IUE masculina con ATOMS(R) tercera generación es seguro y eficaz a corto plazo, incluso en pacientes con IUE severa. La tasa de pacientes secos tras el ajuste supera el 80% y la tasa de satisfacción el 90%. Los pacientes valoran muy positivamente este tratamiento

Introduction: Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS(R)) with preattached scrotal port. Material and method: An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. Results: We analysed 60 consecutive patients with a follow-up of 21 ± 22 months. The baseline pad-test was 465 ± 450 mL, and the pad-count was 5 + 3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60 ± 25 min, the hospital stay was 1 ± 0 days, and the visual analogue scale of pain on day 1 after surgery was 0 ± 1. The total filling was 16.5 ± 7 mL, and the number of refillings was 1 ± 2. The pad-test and pad-count after the adjustment were 0 ± 20 mL and 0±1, respectively (both p < .0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p < .0001) and IIQ-7 scores (p = .0003). Both continence (p=.002) and satisfaction (p = .03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1 ± 1; GRA, 6 ± 1). Conclusions: SUI treatment of men using third-generation ATOMS(R) is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively

Adjustable transobturator male system (ATOMS®) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate. / Sistema masculino transobturador ajustable (ATOMS®) como tratamiento de la incontinencia urinaria de esfuerzo secundaria a resección transuretral de la próstata.

OBJECTIVES: Feasibility study to evaluate efficacy and safety of Adjustable Transobturator Male System (ATOMS®) for male stress urinary incontinence (SUI) after transurethral resection of the prostate. MATERIALS AND METHODS: Twenty patients were implanted ATOMS® for SUI caused by transurethral resection of the prostate with or without radiotherapy. Incontinence severity was evaluated as mild (2 pads/day), moderate (3-5 pads/day) or severe (≥6pads/day), and dryness as none or one security pad/day. Changes in pad-test and pad-count after adjustment were investigated, together with operative parameters, patient satisfaction with the procedure, and number and grade of complications (Clavien-Dindo). RESULTS: Median age was 76.5years. Five patients received previous pelvic radiation (3 prostate, 2 rectal cancer) and 2 (10%) previous failed artificial urinary sphincter with urethral erosion and mechanical failure, respectively. Preoperative SUI was mild in 4 (20%), moderate in 7 (35%) and severe in 9 (45%). Median filling of the system was 13.5ml. Median pad-test decreased from 375±855ml baseline to 10±31.5ml and pad-count from 4±3 to 0±1.5 after adjustment (1±3fillings). Postoperative SUI distribution was mild in 2 (10%), moderate in one (5%) and severe in 2 (10%). Satisfaction rate was 80%, equal for transurethral resection of the prostate with/without previous radiotherapy. No patient had urinary retention after catheter removal. Complications presented in 3 (15%) patients, all minor. After median 38.5mo follow-up no system has been removed, 19 (95%) self-considered better than before and 11 (55%) very much better. CONCLUSION: Based on short-term efficacy and patient satisfaction ATOMS® can be considered a realistic alternative for SUI after transurethral resection of the prostate, even after irradiation. Absence of urethral erosion and very limited problems make this alternative especially attractive for cases with diminished dexterity, advanced age and previous failed treatments.

Diagnosis of alpha1-antitrypsin deficiency not just in severe COPD.

Alpha1-antitrypsin deficiency (AATD) is a well known genetic risk factor for pulmonary disease and is the most frequent hereditary disease diagnosed in adults. Despite being one of the most common hereditary diseases, AATD remains under-diagnosed because of its variable clinical presentation and the poor knowledge of this disease by physicians. With the aim of identifying clinical differences that could influence early diagnosis, we compared two groups of six AATD Pi*ZZ patients with different lung function severity and clinical expression at diagnosis. On comparing the two groups, we observed a younger mean age at diagnosis and more exacerbations in the severe group, but the percentage of smokers did not statistically differ between the two groups. Our results suggest that AATD continues being a disease suspected on younger patients with a worse lung function. In addition these findings confirm the clinical variability of the disease and that there are still unknown factors that contribute to its development. Therefore, early diagnosis may modify the prognosis of this disease.

Utilidad clínica de las biopsias aleatorias en el diagnóstico y tratamiento del tumor vesical no-músculo invasivo: revisión sistemática y metaanálisis / Clinical usefulness of random biopsies in diagnosis and treatment of non-muscle invasive bladder cancer: Systematic review and meta-analysis

Introducción y objetivo: Esta revisión sistemática de la literatura se ha focalizado en determinar la utilidad clínica de las biopsias aleatorias (BA) de vejiga para el diagnóstico de carcinoma in situ. Se realizó un metaanálisis para establecer los factores clinicopatológicos asociados a la positividad de dichas biopsias. Adquisición de la evidencia: Se realizó una revisión sistemática de la literatura usando la base de datos PubMed/Medline siguiendo los criterios PRISMA. Se incluyeron 37 artículos, reclutando un total de 12.657 pacientes, de los que 10.975 fueron sometidos a BA. Síntesis de la evidencia La incidencia global de BA positivas fue del 21,91%. Se encontraron diferencias significativas en la positividad de las BA cuando los pacientes fueron estratificados según resultado de la citología, multiplicidad, aspecto tumoral, estadio y grado. Los resultados del metaanálisis revelaron que la presencia de citología positiva, multiplicidad tumoral, tumores de aspecto no papilar, estadio T1 y grados histológicos G2 y G3 representan factores de riesgo que predicen anormalidades en las BA. Conclusiones: La incidencia de BA positivas en pacientes con tumor vesical no-músculo invasivo fue del 21,91%. El máximo rendimiento de estas biopsias se evidencia cuando se realizan de manera normativizada. Los resultados del metaanálisis muestran que, además de la citología positiva y el aspecto no papilar, la multiplicidad tumoral y los grados histológicos G2 y G3 representan factores asociados a BA positivas, por lo que el uso de dichas biopsias se puede hacer extensivo al grupo de riesgo intermedio de la European Organization for Research and Treatment of Cancer (EORTC)

Introduction and objective: This systematic review of the literature has been focused on determining the clinical usefulness of random bladder biopsies (RB) in the diagnosis of carcinoma in situ. A meta-analysis was performed to establish the clinic and pathological factors associated to positive biopsies. Evidence acquisition: A systematic review was performed using Pubmed/Medline database according to the PRISMA guidelines. Thirty-seven articles were included, recruiting a total of 12,657 patients, 10,975 were submitted to RB. Evidence synthesis: The overall incidence of positive RB was 21.91%. Significant differences were found in the incidence of positive RB when patients were stratified according to urine cytology result, tumor multiplicity, tumor appearance, stage and grade. The results of the meta-analysis revealed that the presence of positive cytology, tumor multiplicity, non-papillary appearance tumors, stage T1 and histological grades G2 and G3 represent the risk factors to predict abnormalities in RB. Conclusions: The incidence of positive RB in patients with non-muscle invasive bladder cancer was 21.91%. The maximum usefulness of RB was observed when these are performed in a standardized way. The results of the meta-analysis showed that besides positive cytology and non-papillary appearance tumors, tumor multiplicity and histological grades G2 and G3 represent risk factors associated to positive RB, suggesting that the use of RB might be extensive to the intermediate risk group of the European Organization for Research and Treatment of Cancer (EORTC)

Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. / Tratamiento de la incontinencia urinaria de esfuerzo tras prostatectomía con el sistema masculino transobturador ajustable (ATOMS®) con puerto escrotal premontado.

INTRODUCTION: Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD: An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS: We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS: SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.

Manejo postoperatorio de cistectomía radical. Revisión de la evidencia sobre la prevención y el tratamiento de las complicaciones urológicas / Postoperative management of radical cystectomy. Review of the evidence on the prevention and treatment of urological complications

Introducción y objetivos: Este artículo de revisión se ha focalizado en la prevención y manejo de las complicaciones urológicas más frecuentes en el postoperatorio de la cistectomía radical. Se revisó la literatura actual y se realizó un análisis de frecuencia, prevención y tratamiento de las complicaciones. Adquisición de la evidencia: Se realizó una búsqueda en Medline para identificar artículos originales, revisiones de la literatura y editoriales, focalizándose en las complicaciones urológicas de cistectomía radical durante los primeros 90 días postoperatorios. Se identificaron aquellas series que incluyeron un número mayor de 100 pacientes. Síntesis de la evidencia: La literatura en relación con la prevención y el tratamiento de complicaciones en el postoperatorio de cistectomía es en general retrospectiva y no estandarizada. En general el grado de evidencia es bajo y es difícil realizar recomendaciones basadas en la evidencia. Conclusiones: En los últimos años se han hecho progresos para reducir la mortalidad y prevenir complicaciones en cistectomía. Las complicaciones más frecuentes son las gastrointestinales, para las que se ha realizado un esfuerzo importante implementando protocolos ERAS y fast track. Las complicaciones que potencialmente pueden alterar más la calidad de vida del paciente son las del estoma urinario

Introduction and objectives: This review article focuses on the prevention and management of the most common postoperative urological complications of radical cystectomy. We reviewed the current literature and conducted an analysis of frequency, prevention and treatment of complications. Acquisition of evidence: We conducted a search on Medline to identify original articles, literature reviews and editorials focusing on the urological complications of radical cystectomy during the first 90 days after surgery. We identified those series that included more than 100 patients. Synthesis of the evidence: The literature regarding the prevention and treatment of complications after cystectomy is in general retrospective and nonstandardised. The level of evidence is generally low, and it is difficult to make evidence-based recommendations. Conclusions: Progress has been made in recent years in reducing mortality and preventing the complications of cystectomy. The most common complications are gastrointestinal, for which significant efforts have been made to implement ERAS and Fast Track protocols. The complications that can most significantly change patients’ quality of life are urinary stoma

Estudio prospectivo comparativo entre cistectomía radical laparoscópica y abierta: resultados operatorios y oncológicos / Prospective study comparing laparoscopic and open radical cystectomy: Surgical and oncological results

Introducción La cistectomía radical laparoscópica con linfadenectomía y derivación urinaria es una cirugía de empleo creciente. Se necesitan estudios que avalen la efectividad oncológica y la seguridad de este abordaje mínimamente invasivo. Pacientes y métodos: Estudio prospectivo comparativo no aleatorizado entre cistectomía radical abierta (CRA) y laparoscópica (CRL) llevado a cabo en un hospital universitario. El objetivo principal fue comparar la supervivencia cáncer-específica, y el objetivo secundario comparar resultados operatorios y complicaciones según la escala Clavien-Dindo. Resultados: Ciento cincuenta y seis pacientes con cáncer vesical invasivo de alto grado fueron tratados mediante CRA (n = 70) o CRL (n = 86). El seguimiento medio fue 33,5 ± 23,8 (rango 12-96) meses. La edad media fue 66,9 + 9,4 años y la proporción hombre/mujer 19:1. Ambos grupos fueron equivalentes en edad, estadio, ganglios positivos, carcinoma in situ, uropatía obstructiva preoperatoria, quimioterapia adyuvante y tipo de derivación urinaria. No hubo diferencias entre grupos en supervivencia cáncer-específica (log-rank; p = 0,71). El estadio histopatológico fue la única variable independiente predictiva de pronóstico. La estancia hospitalaria (p = 0,01) y la tasa de transfusión operatoria (p = 0,002) fueron menores para CRL. La duración de la cirugía fue mayor para CRL (p < 0,001). No hubo diferencias en la tasa de complicaciones totales (p = 0,62) ni complicaciones mayores (p = 0,69). El riesgo de evisceración (p = 0,02), infección de herida quirúrgica (p = 0,005) y neumonía (p = 0,017) fue mayor en CRA. El riesgo de lesión rectal (p = 0,017) y fístula uretrorrectal (p = 0,065) fue mayor en CRL. Conclusión: La CRL es un tratamiento equivalente a la CRA en términos de eficacia oncológica, y ventajoso respecto a tasa de transfusión y estancia hospitalaria, pero no respecto a la ocupación de quirófano o a la seguridad global. Se necesitan estudios que definan mejor el perfil de seguridad específico de cada abordaje

Introduction: Laparoscopic radical cystectomy with lymphadenectomy and urinary diversion is an increasingly widespread operation. Studies are needed to support the oncological effectiveness and safety of this minimally invasive approach. Patients and methods: A nonrandomised, comparative prospective study between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) was conducted in a university hospital. The main objective was to compare cancer-specific survival. The secondary objective was to compare the surgical results and complications according to the Clavien-Dindo scale. Results: We treated 156 patients with high-grade invasive bladder cancer with either ORC (n = 70) or LRC (n = 86). The mean follow-up was 33.5 ± 23.8 (range 12-96) months. The mean age was 66.9 + 9.4 years, and the male to female ratio was 19:1. Both groups were equivalent in age, stage, positive lymph nodes, in situ carcinoma, preoperative obstructive uropathy, adjuvant chemotherapy and type of urinary diversion. There were no differences between the groups in terms of cancer-specific survival (log-rank; P = .71). The histopathology stage was the only independent variable that predicted the prognosis. The hospital stay (P = .01) and operative transfusion rates (P = .002) were less for LRC. The duration of the surgery was greater for LRC (P < .001). There were no differences in the total complications rate (p = .62) or major complications (P = .69). The risk of evisceration (P = .02), surgical wound infection (P=.005) and pneumonia (P = .017) was greater for ORC. The risk of rectal lesion (P = .017) and urethrorectal fistulae (P = .065) was greater for LRC. Conclusion: LRC is an equivalent treatment to ORC in terms of oncological efficacy and is advantageous in terms of transfusion rates and hospital stays but not in terms of operating room time and overall safety. Studies are needed to better define the specific safety profile for each approach

Clinical usefulness of random biopsies in diagnosis and treatment of non-muscle invasive bladder cancer: Systematic review and meta-analysis. / Utilidad clínica de las biopsias aleatorias en el diagnóstico y tratamiento del tumor vesical no-músculo invasivo: revisión sistemática y metaanálisis.

INTRODUCTION AND OBJECTIVE: This systematic review of the literature has been focused on determining the clinical usefulness of random bladder biopsies (RB) in the diagnosis of carcinoma in situ. A meta-analysis was performed to establish the clinic and pathological factors associated to positive biopsies. EVIDENCE ACQUISITION: A systematic review was performed using Pubmed/Medline database according to the PRISMA guidelines. Thirty-seven articles were included, recruiting a total of 12,657 patients, 10,975 were submitted to RB. EVIDENCE SYNTHESIS: The overall incidence of positive RB was 21.91%. Significant differences were found in the incidence of positive RB when patients were stratified according to urine cytology result, tumor multiplicity, tumor appearance, stage and grade. The results of the meta-analysis revealed that the presence of positive cytology, tumor multiplicity, non-papillary appearance tumors, stage T1 and histological grades G2 and G3 represent the risk factors to predict abnormalities in RB. CONCLUSIONS: The incidence of positive RB in patients with non-muscle invasive bladder cancer was 21.91%. The maximum usefulness of RB was observed when these are performed in a standardized way. The results of the meta-analysis showed that besides positive cytology and non-papillary appearance tumors, tumor multiplicity and histological grades G2 and G3 represent risk factors associated to positive RB, suggesting that the use of RB might be extensive to the intermediate risk group of the European Organization for Research and Treatment of Cancer (EORTC).

Prospective study comparing laparoscopic and open radical cystectomy: Surgical and oncological results. / Estudio prospectivo comparativo entre cistectomía radical laparoscópica y abierta: resultados operatorios y oncológicos.

INTRODUCTION: Laparoscopic radical cystectomy with lymphadenectomy and urinary diversion is an increasingly widespread operation. Studies are needed to support the oncological effectiveness and safety of this minimally invasive approach. PATIENTS AND METHODS: A nonrandomised, comparative prospective study between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) was conducted in a university hospital. The main objective was to compare cancer-specific survival. The secondary objective was to compare the surgical results and complications according to the Clavien-Dindo scale. RESULTS: We treated 156 patients with high-grade invasive bladder cancer with either ORC (n=70) or LRC (n=86). The mean follow-up was 33.5±23.8 (range 12-96) months. The mean age was 66.9+9.4 years, and the male to female ratio was 19:1. Both groups were equivalent in age, stage, positive lymph nodes, in situ carcinoma, preoperative obstructive uropathy, adjuvant chemotherapy and type of urinary diversion. There were no differences between the groups in terms of cancer-specific survival (log-rank; P=.71). The histopathology stage was the only independent variable that predicted the prognosis. The hospital stay (P=.01) and operative transfusion rates (P=.002) were less for LRC. The duration of the surgery was greater for LRC (P<.001). There were no differences in the total complications rate (p=.62) or major complications (P=.69). The risk of evisceration (P=.02), surgical wound infection (P=.005) and pneumonia (P=.017) was greater for ORC. The risk of rectal lesion (P=.017) and urethrorectal fistulae (P=.065) was greater for LRC. CONCLUSION: LRC is an equivalent treatment to ORC in terms of oncological efficacy and is advantageous in terms of transfusion rates and hospital stays but not in terms of operating room time and overall safety. Studies are needed to better define the specific safety profile for each approach.

Postoperative management of radical cystectomy. Review of the evidence on the prevention and treatment of urological complications. / Manejo postoperatorio de cistectomía radical. Revisión de la evidencia sobre la prevención y el tratamiento de las complicaciones urológicas.

INTRODUCTION AND OBJECTIVES: This review article focuses on the prevention and management of the most common postoperative urological complications of radical cystectomy. We reviewed the current literature and conducted an analysis of frequency, prevention and treatment of complications. ACQUISITION OF EVIDENCE: We conducted a search on Medline to identify original articles, literature reviews and editorials focusing on the urological complications of radical cystectomy during the first 90 days after surgery. We identified those series that included more than 100 patients. SYNTHESIS OF THE EVIDENCE: The literature regarding the prevention and treatment of complications after cystectomy is in general retrospective and nonstandardised. The level of evidence is generally low, and it is difficult to make evidence-based recommendations. CONCLUSIONS: Progress has been made in recent years in reducing mortality and preventing the complications of cystectomy. The most common complications are gastrointestinal, for which significant efforts have been made to implement ERAS and Fast Track protocols. The complications that can most significantly change patients' quality of life are urinary stoma.

Eficacia de la terapia de ondas de choque de baja intensidad para la disfunción eréctil: revisión sistemática y metaanálisis / Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis

Contexto: La terapia con ondas de choque de baja intensidad (OCBI) es una modalidad de reciente uso en el tratamiento de la disfunción eréctil. Objetivo: Evaluar la eficacia de la terapia con OCBI para el tratamiento de la disfunción eréctil según se describe en la literatura. Adquisición de evidencia: Dos revisores independientes identificaron estudios elegibles para llevar a cabo revisión sistemática y metaanálisis de diferentes fuentes escritas en inglés y español, utilizando las bases de datos de PubMed, Embase y Web of Science. Se excluyeron los estudios sobre la enfermedad de Peyronie. Se utilizó el método Der Simonian-Laird para definir la heterogeneidad calculando la desviación estándar de la media (DME) agrupada. El objetivo primario de esta revisión es evaluar la eficacia según el cambio del Índice internacional de función eréctil (IIEF-EF) sobre basal al mes de inicio de tratamiento, tanto para el brazo de tratamiento como para el brazo placebo. El objetivo secundario se centra en analizar IIEF-EF a 3-6 meses tras el inicio de la terapia. Síntesis de evidencia: Los datos agrupados de 636 pacientes procedentes de 12 estudios mostraron que el tratamiento con OCBI conlleva un aumento significativo de IIEF-EF al mes con respecto a basal (DME = -2,92; p = 0,000), en un grado mayor que placebo (DME = -0,99; p = 0,000). El IIEF-EF a 3-6 meses en pacientes tratados fue significativamente mayor que basal (DME = -2,78; p = 0,000). Solo hay un estudio que compara eficacia de placebo a 3-6 meses vs basal (DME = -9,14). La comparación entre OCBI y placebo favorece el tratamiento activo (DME = 2,53; p = 0,000) al mes. No existen datos suficientes para evaluar respuesta sobre placebo a los 3-6 meses en la literatura. Conclusiones: El tratamiento con OCBI para la disfunción eréctil según la literatura resulta eficaz, tanto a corto como a medio plazo. A corto plazo se ha descrito incluso más eficaz que placebo. Los datos sobre eficacia a largo plazo son insuficientes. También se necesitan más estudios para dilucidar el papel de esta terapia según las causas específicas de la disfunción eréctil

Context: The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. Objective: To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature. Acquisition of evidence: Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3- 6 months from the start of the therapy. Summary of the evidence: The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, -2.92; P = .000), to a greater degree than placebo (SDM, -.99; P = .000). The IIEF-EF at 3-6 months for the treated patients was significantly greater than baseline (SDM, -2.78; P = .000). Only one study compared the efficacy of placebo at 3-6 months versus baseline (SDM, -9.14). The comparison between LISW and placebo favours active treatment (SDM, 2.53; P = .000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3-6 months. Conclusions: According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction

Reconstrucción fálica total con colgajo libre antebraquial radial tras amputación peneana iatrogénica / Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation

Introducción: La pérdida del pene de causa iatrogénica es una circunstancia muy infrecuente. Se presenta un caso desafiante de reconstrucción peneana total diferida en varón genético. Material y métodos: Varón de 57 años con pérdida del falo por absceso peneano y necrosis secundaria a cirugía de incurvadura peneana. La reconstrucción se realizó en varios tiempos empleando colgajo libre de antebrazo radial (CLAR) y colocación de prótesis inflable personalizada un año después. Resultados: En un primer tiempo quirúrgico se llevó a cabo drenaje de absceso peneano, desbridamiento de restos necróticos y colocación de talla hipogástrica. Siete semanas después se llevó a cabo faloplastia con CLAR y construcción de neouretra tubo-en-tubo, anastomosis microquirúrgica múltiple y recubrimiento del sitio donante con injerto de piel del muslo de espesor parcial. La duración de esta cirugía fue 10 horas y tuvo como complicación crecimiento de vello en la neouretra, que obligó a depilación mecánica endoscópica en repetidas ocasiones. El paciente recuperó sensibilidad peneana, y 18 meses tras la faloplastia se le implantó prótesis Zephyr (Ginebra, Suiza) inflable de un solo cuerpo, utilizando la propia albugínea del cuerpo cavernoso proximal. El paciente se encuentra satisfecho desde el punto de vista cosmético, miccional y sensitivo. Cuatro meses después se encuentra ganando confianza para abordar la penetración. Conclusiones: A pesar del riesgo de complicaciones postoperatorias y de la necesidad de operaciones múltiples, la reconstrucción fálica con CLAR y colocación de implante protésico personalizado puede mejorar el impacto en la función urinaria y sexual secundario a la pérdida del pene

Introduction: The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. Material and methods: A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. Results: During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10 hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. Conclusions: Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis

Análisis comparativo entre nefrectomía parcial LESS híbrida y laparoscópica convencional multipuerto / Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy

Objetivo: Comparar resultados operatorios y oncológicos de la nefrectomía parcial realizada mediante abordaje laparoendoscópico a través de puerto único (LESS) reutilizable y laparoscópico multipuerto. Material y método: Estudio comparativo prospectivo pareado no aleatorizado de pacientes tratados con nefrectomía parcial mediante abordaje LESS híbrido con trocar auxiliar de 3,5 mm (n = 20) y con laparoscopia multipuerto convencional (n = 26). Resultados: La media de seguimiento fue 31 ± 18,6 meses. Un caso LESS (5%) se reconvirtió a laparoscopia. No hubo diferencias significativas entre grupos con respecto a edad, sexo, índice de masa corporal, lateralidad, localización, tamaño tumoral o empleo de doble-J; aunque hubo dominancia de ASA-I (p = 0,09) y de histología benigna (p = 0,05) en el grupo LESS. Tampoco hubo diferencias en tiempo operatorio, tiempo de isquemia, empleo de materiales hemostáticos, sangrado estimado, hemoglobina postoperatoria, transfusión u otras complicaciones. Ningún caso precisó ampliar herida cutánea para extracción de espécimen. Los pacientes LESS tuvieron menor tiempo de drenaje (p = 0,006) y menor estancia hospitalaria (p = 0,003). No hubo diferencias en número ni severidad de complicaciones según escala Clavien-Dindo. Un paciente en grupo laparoscópico falleció por TEP tras el alta hospitalaria. No hubo márgenes positivos ni recidivas o progresión de la enfermedad tumoral en el tiempo evaluado. Conclusiones: La nefrectomía parcial LESS no implica ventajas en resultados operatorios salvo menor estancia hospitalaria, posiblemente debido a hemostasia operatoria más precisa y/o selección de casos. No conlleva riesgos operatorios y oncológicos, pero tampoco supone mejora en tiempo de isquemia, pérdida hemática o tasa de transfusión. Tampoco supone una ventaja evidente en términos cosméticos

Objective: To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Material and method: Hybrid LESS technique with auxiliary 3.5mm trocar (n = 20) was compared with conventional multiport laparoscopy (n = 26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. Results: Follow-up average was 31 ± 18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P = 0.09) and benign histology (P = 0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P = 0.006) and hospital stay (P = 0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. Conclusions: Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes

Tratamiento de la estenosis larga de uretra anterior asociada a liquen escleroso / Treatment of long anterior urethral stricture associated to lichen sclerosus

Introducción. La estenosis panuretral asociada a liquen escleroso supone un reto terapéutico. Presentamos el análisis de nuestros resultados empleando 2 técnicas de uretroplastia basadas en injerto de mucosa oral. Material y método. Estudio retrospectivo en pacientes con estenosis larga de uretra anterior (>8cm) asociada a liquen escleroso. Los pacientes recibieron uretroplastia con injerto de mucosa oral según técnica de Kulkarni (n=25) o uretroplastia en 2 tiempos tipo Bracka-Johanson (n=15). Se evalúan datos demográficos, tiempo operatorio, complicaciones (Clavien-Dindo), estancia hospitalaria, EAV de dolor postoperatorio, tasa de fracaso, necesidad de retratamiento y datos funcionales que incluyen IPSS, CdV y Qmáx, residuo posmiccional (RPM). Resultados. En todos los casos hubo afectación glandular y peneana y en el 75% de uretra bulbar. En el 22,5% se empleó un solo injerto, en el 72,5% 2 y en el 5% 3. Los pacientes tratados en un solo tiempo fueron más jóvenes (p=0,007). A pesar de que la longitud de la estenosis fue equivalente en ambas técnicas (p=0,96), la tasa de recidiva y de complicaciones fue superior en 2 tiempos (p=0,05 y p=0,03; respectivamente), así como el tiempo operatorio (p<0,0001) y la estancia global (p=0,0002). No hubo diferencias en IPSS, CdV, Qmáx o RPM preoperatorios, ni tampoco en los valores postoperatorios de IPSS o Qmáx; pero sí en CdV (p=0,006) y RPM (p=0,03) a favor de uretroplastia en un tiempo. La EAV de dolor en el 1.er día postoperatorio fue también menor en la uretroplastia de Kulkarni que en el primer tiempo de Johanson-Bracka (p<0,0001). Conclusiones. En pacientes con liquen escleroso y estenosis larga de uretra anterior la uretroplastia de Kulkarni proporciona resultados operatorios más eficientes y mejor valorados por el paciente que la uretroplastia de Johanson-Bracka. Además, evita el deterioro temporal cosmético, sexual y miccional inherente a la cirugía en 2 tiempos (AU)

Introduction. Panurethral stricture associated with lichen sclerosus is a therapeutic challenge. We present the analysis of our results using two urethroplasty techniques based on oral mucosa graft. Material and method. Retrospective study in patients with long anterior urethral stricture (>8cm) associated with lichen sclerosus. Patients received urethroplasty with oral mucosa graft technique according Kulkarni (n=25) or two-step Johanson-Bracka urethroplasty (n=15). Demographics, operative time, complications (Clavien-Dindo), hospital stay, days with catheter, EAV postoperative pain, failure rate, need for retreatment and functional data including IPSS, QoL, Qmax, post void residual (PVR) are evaluated. Results. In all cases there was involvement of glandular and penile urethra, and in 75% of bulbar urethra. A single graft was used in 22.5%, two in 72.5% and three in 5%. Patients treated at a single step were younger (P=.007). Although the length of the stenosis was equivalent in both techniques (P=.96), relapse and complication rates were higher in two-step surgery (P=.05 and P=.03; respectively) and so was operative time (P<.0001) and overall stay (P=.0002). There were no differences in preoperative IPSS, QoL, Qmax or PVR, neither in postoperative values of IPSS or Qmax; but there was a difference in QoL (P=.006) and PVR (P=.03) favouring single-step urethroplasty. VAS pain on postoperative day 1 was also lower in Kulkarni urethroplasty than in the first step of Johanson-Bracka technique (P<.0001). Conclusions. In patients with lichen sclerosus and long anterior urethral stricture Kulkarni urethroplasty provides more efficient and better patient reported outcomes than Johanson-Bracka urethroplasty. It also prevents cosmetic, sexual and voiding temporary deterioration inherent to 2-step surgery (AU)

Estudio comparativo entre laparoscopia multipuerto y LESS umbilical con plataforma reutilizable en el tratamiento de las masas renales / Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses

Introducción: La cirugía umbilical laparoendoscópica por puerto único (LESS) es una modalidad de uso creciente en el tratamiento de las masas renales. Se presenta una comparación prospectiva entre cirugía renal LESS y laparoscopia convencional. Material y método: Estudio pareado comparativo que evalúa resultados operatorios y complicaciones en pacientes con neoplasia renal tratada con cirugía LESS (n = 49) o laparoscopia multipuerto (n = 53). El abordaje LESS se realizó con material reutilizable colocado en el ombligo e instrumentos curvos de doble rotación, y en el 69,4% se empleó un puerto adicional de 3,5 mm. Se evalúan datos demográficos, tipo de técnica (nefrectomía, nefrectomía parcial o nefroureterectomía), tiempo operatorio, pérdida hemática, hemoglobina, necesidad de transfusión, número y gravedad de complicaciones (Clavien-Dindo), estancia hospitalaria, datos histológicos y pronóstico. Resultados: No hubo diferencias en seguimiento, edad, sexo, IMC, hemoglobina preoperatoria o tipo de cirugía. Hubo conversión en 2 casos (uno en cada grupo). El tiempo operatorio fue equivalente (p = 0,6). Transfusión intraoperatoria (p = 0,03) y pérdida hemática (p < 0,0001) fue menor en LESS, la hemoglobina postoperatoria mayor (p < 0,0001) y se emplearon también agentes hemostáticos más frecuentemente (p < 0,0001). No hubo diferencias en número (p = 0,6) ni gravedad (p = 0,47) de complicaciones. La estancia (p < 0,0001), la proporción de pacientes con drenaje (p = 0,04) y el número de días con drenaje (p = 0,0004) fueron menores en LESS. Un 25% de las lesiones intervenidas con LESS fueron benignas, pero el tamaño medio fue similar en ambos grupos (p = 0,5). La recurrencia y/o progresión tumoral fue más frecuente en laparoscopia multipuerto (p = 0,0013). Conclusiones: La cirugía LESS umbilical con plataforma reutilizable permite realizar diferentes técnicas quirúrgicas para el tratamiento de masas renales con consumo de tiempo y seguridad equiparable a laparoscopia convencional. El abordaje LESS resulta ventajoso en términos de pérdida hemática y estancia hospitalaria

Introduction: Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. Material and method: A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n = 49) or multiport laparoscopy (n = 53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. Results: There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P = .6). Intraoperative transfusion (P = .03) and blood loss (P < .0001) was lower with LESS, postoperative haemoglobin levels were higher (P < .0001) and haemostatic agents were used more frequently (P < .0001). There were no differences in the number (P = .6) or severity (P = .47) of complications. The length of stay (P < .0001), the proportion of patients with drainage (P = .04) and the number of days with drainage (P = .0004) were lower in LESS. Twenty-five percent of the lesions operated on with LESS were benign, but the mean size was similar in the 2 groups (P = .5). Tumour recurrence and/or progression were more frequent in multiport laparoscopy (P = .0013). Conclusions: Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay

Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses. / Estudio comparativo entre laparoscopia multipuerto y LESS umbilical con plataforma reutilizable en el tratamiento de las masas renales.

INTRODUCTION: Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. MATERIAL AND METHOD: A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. RESULTS: There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (P<.0001) was lower with LESS, postoperative haemoglobin levels were higher (P<.0001) and haemostatic agents were used more frequently (P<.0001). There were no differences in the number (P=.6) or severity (P=.47) of complications. The length of stay (P<.0001), the proportion of patients with drainage (P=.04) and the number of days with drainage (P=.0004) were lower in LESS. Twenty-five percent of the lesions operated on with LESS were benign, but the mean size was similar in the 2 groups (P=.5). Tumour recurrence and/or progression were more frequent in multiport laparoscopy (P=.0013). CONCLUSIONS: Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay.

Total phallic reconstruction using radial forearm free flap after iatrogenic penile amputation. / Reconstrucción fálica total con colgajo libre antebraquial radial tras amputación peneana iatrogénica.

INTRODUCTION: The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. MATERIAL AND METHODS: A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. RESULTS: During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage. Seven weeks later, phalloplasty was performed with RFFF and a tube-in-tube neourethra was constructed. Multiple microsurgical anastomosis was performed, and the donor site was coated with a skin graft from the thigh of partial thickness. The surgery lasted 10hours and had the complication of hair growth in the neourethra, which required mechanical endoscopic depilation on repeated occasions. The patient regained penile sensitivity. Eighteen months after the phalloplasty, a Zephyr single-body inflatable prosthesis (Geneva, Switzerland) was implanted, using the tunica albuginea of the proximal corpus cavernosum. The patient was satisfied with the aesthetics and urinary and sensory function. Four months later, the patient is gaining confidence to consider penetration. CONCLUSIONS: Despite the risk of postoperative complications and the need for multiple operations, phallic reconstruction with RFFF and the placement of a customised prosthetic implant can improve urinary and sexual function secondary to the loss of the penis.