Análisis de efectividad y costes sanitarios de la inmunoprofilaxis con autovacuna MV140, vacuna MV140 y tratamiento antibiótico continuado en la prevención de las infecciones urinarias recurrentes / Effectiveness and health cost analysis between immunoprophylaxis with MV140 autovaccine, MV140 vaccine and continuous treatment with antibiotics to prevent recurrent urinary tract infections

Introducción El objetivo de este estudio fue comparar los resultados del tratamiento antibiótico continuado, la autovacuna MV140 y la vacuna bacteriana polivalente MV140 de cepas de colección en la prevención de ITU recurrentes no complicadas. Métodos Se analizaron prospectivamente 377 pacientes desde enero de 2017 hasta agosto de 2019 y se dividieron en 3 grupos según la profilaxis administrada. Grupo A (126): tratamiento antibiótico, Grupo B (126), autovacuna MV140; Grupo C (125), vacuna bacteriana polivalente MV140 a partir cepas seleccionadas. Las variables analizadas fueron: sexo, edad, menopausia, número de episodios de ITU al inicio y a los 3 y 6 meses de finalizar la profilaxis, costes sanitarios a lo largo del seguimiento a los 3 y 6 meses. Resultados A los 3 meses, los episodios de ITU se redujeron a 0-1 en el 65% del grupo A, en el 80,8% del grupo B y en el 81,7% del grupo C. A los 6 meses, se presentaron 0-1 episodios de ITU en el 44,4% del grupo A, en el 61,6% del grupo B y en el 74,6% del grupo C. En cuanto a los costes sanitarios a lo largo del seguimiento, a los 3 meses el grupo A registró 21.171,87 euros, el grupo B 20.763,73 euros y el grupo C 18.866,14 euros. A los 6 meses, los costes sanitarios fueron de 32.980,35 euros en el grupo A, de 28.133,42 euros en el grupo B y de 23.629,19 euros en el grupo C. Conclusiones La autovacuna MV140 y la vacuna bacteriana polivalente MV140 fueron más eficaces reduciendo el número de episodios de ITU a los 3 y 6 meses y con unos costes sanitarios menores durante el seguimiento, en comparación con la profilaxis antibiótica continuada (p < 0,05). La vacuna bacteriana polivalente MV140 de cepas seleccionadas fue más eficaz en la reducción del número de episodios de ITU con unos costes sanitarios menores que la autovacuna (AU)

Introduction The objective of this study was to compare the results on prevention of uncomplicated recurrent UTI between continuous use of antibiotics, MV140 autovaccine and MV140 polybacterial vaccine from collection strain. Methods 377 patients were prospectively analyzed from January 2017 to August 2019 and divided into 3 groups according to the prophylaxis. Group A (126): antibiotics, Group B (126): MV140 autovaccine, Group C (125): MV140 polybacterial vaccine from the collection strain. Variables analyzed were: gender, age, menopause, number of UTI at baseline and 3 and 6 months after the end of prophylaxis, health cost along follow-up at 3 and 6 months. Results At 3 months, group A had 0-1 UTI in 65%, group B had 0-1 UTI in 80.8% and group C in 81.7%. At 6 months, group A had 0-1 UTI in 44.4%, group B had 0-1 UTI in 61.6% and group C in 74.6%. Regarding health cost along follow-up, at 3 months group A had €21,171.87, group B had €20,763.73 and group C €18,866.14. At 6 months, health cost was €32,980.35 in group A, €28,133.42 in group B, and €23,629.19 in group C. Conclusions MV140 autovaccine and MV140 polybacterial vaccine were more efficient with lower number of UTI at 3 and 6 months and lower health cost along follow-up compared to continued prophylaxis with antibiotics (p < .05). Polybacterial MV140 vaccine from collection strain had higher effect to reduce the number of UTI and less health cost than autovaccine (AU)

Effectiveness and health cost analysis between immunoprophylaxis with MV140 autovaccine, MV140 vaccine and continuous treatment with antibiotics to prevent recurrent urinary tract infections.

INTRODUCTION: The objective of this study was to compare the results on prevention of uncomplicated recurrent UTI between continuous use of antibiotics, MV140 autovaccine and MV140 polybacterial vaccine from collection strain. METHODS: 377 patients were prospectively analyzed from January 2017 to August 2019 and divided into 3 groups according to the prophylaxis. Group A (126): antibiotics, Group B (126): MV140 autovaccine, Group C (125): MV140 polybacterial vaccine from the collection strain. Variables analyzed were: gender, age, menopause, number of UTI at baseline and 3 and 6 months after the end of prophylaxis, health cost along follow-up at 3 and 6 months. RESULTS: At 3 months, group A had 0-1 UTI in 65%, group B had 0-1 UTI in 80.8% and group C in 81.7%. At 6 months, group A had 0-1 UTI in 44.4%, group B had 0-1 UTI in 61.6% and group C in 74.6%. Regarding health cost along follow-up, at 3 months group A had euro21,171.87, group B had euro20,763.73 and group C euro18,866.14. At 6 months, health cost was euro32,980.35 in group A, euro28,133.42 in group B, and euro23,629.19 in group C. CONCLUSIONS: MV140 autovaccine and MV140 polybacterial vaccine were more efficient with lower number of UTI at 3 and 6 months and lower health cost along follow-up compared to continued prophylaxis with antibiotics (p < 0.05). Polybacterial MV140 vaccine from collection strain had higher effect to reduce the number of UTI and less health cost than autovaccine.

Epidural analgesia in laparoscopic radical prostatectomy / Analgesia epidural en la prostatectomía radical laparoscópica

Introduction: Epidural analgesia is an effective technique for postoperative pain relief. Our aim in this retrospective study was to assess the postoperative pain control and complications relating to epidural technique in laparoscopic radical prostatectomy (LRP). Material and methods: A retrospective analysis of 193 patients who underwent LRP, in which epidural analgesia was the postoperative pain approach, was performed. The procedure is generally performed under combined anesthesia. Data collected was postoperative pain data; appearance of neurological disorders (Bromage scale was used for motor weakness assessment); data related to the epidural technique and possible difficulties when performing it; data on epidural infusion; catheter-related complications; hospital stay, postoperative complications, and outcome. Results: Firstly, average VAS at rest was 1.2 ± 1.6; and upon movement, average VAS was 1.9 ± 1.8 during the hospital stay. Secondly, complications related to epidural technique appeared in 37 % of patients. There were 3 cases of hematic puncture; 3 accidental catheter disconnections; 1 dural puncture, and 1 subdural block. As for neurological secondary effects of local anesthetics in the epidural technique, 56 patients (30.1 %) presented with motor block of one or both lower extremities after surgery, and 5 (2.7 %) with paresthesia. Statistical analysis showed that motor weakness was not related to age, weight, type of local anesthetic used, infusion rate, level of epidural puncture nor length of catheter within the epidural space (p > 0.05). Conclusion: Postoperative epidural analgesia offers excellent analgesic quality but it can be associated with several complications secondary to the use of local anesthetics, which could disagree with the terms of Fast-track surgery. New techniques like the TAP block could offer the same analgesic quality, without the epidural's technique potential complications (AU)

Objetivos: La analgesia epidural es una técnica eficaz para el control del dolor postoperatorio. Nuestro objetivo en este estudio retrospectivo fue evaluar el control del dolor postoperatorio mediante la escala visual analógica del dolor (EVA) y las complicaciones relacionadas con la técnica epidural, en la prostatectomía radical laparoscópica (PRL). Material y métodos: Llevamos a cabo un análisis retrospectivo de 193 pacientes sometidos a PRL, en los que se realizó la técnica epidural analgésica para el control del dolor postoperatorio. El procedimiento se hizo bajo una anestesia combinada. Registramos los datos relacionados con el dolor postoperatorio; la aparición de sintomatología neurológica (la escala de Bromage se utilizó para evaluar la debilidad motora); datos relacionados con la técnica epidural y posibles dificultades al realizarla; datos sobre la infusión epidural, como tipo de anestésico local utilizado; complicaciones relacionadas con el catéter y complicaciones postoperatorias asociadas al mismo, estancia hospitalaria y resultado. Resultados: En primer lugar, durante la estancia hospitalaria de los pacientes, el EVA promedio en reposo fue 1,2 ± 1,6; y durante el movimiento, el EVA promedio fue de 1,9 ± 1,8. En segundo lugar, las complicaciones relacionadas con la técnica epidural aparecieron en el 37 % de los pacientes. Hubo 3 casos de punción hemática; 3 desconexiones accidentales del catéter, 1 punción dural y 1 bloqueo subdural. En cuanto a las complicaciones neurológicas debidas a los efectos secundarios de los anestésicos locales en la técnica epidural, 56 (30,1 %) pacientes presentaron bloqueo motor de una o ambas extremidades inferiores después de la cirugía y 5 (2,7 %) refirieron parestesias. No hubo ninguna complicación neurológica que persistiese tras el alta hospitalaria. El análisis estadístico mostró que la debilidad motora no estaba relacionada con la edad, el peso, el tipo de anestésico local utilizado, la velocidad de infusión, el nivel de punción epidural ni la longitud del catéter en el espacio epidural (p > 0,05). Conclusión: La analgesia epidural postoperatoria ofrece una excelente calidad analgésica, pero puede estar asociada a varias complicaciones secundarias al uso de anestésicos locales, lo que podría estar en contraposición con las tendencias actuales de cirugía fastrack. Las nuevas técnicas emergentes podrían ofrecer la misma calidad analgésica evitando las potenciales complicaciones de la técnica epidural (AU)

[Comparison between open and laparoscopic approach in radical prostatectomy]. / Prostatectomia radical laparoscópica versus abierta.

INTRODUCTION: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). MATERIAL AND METHODS: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). RESULTS: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed. CONCLUSION: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

Prostatectomía radical laparoscópica versus abierta / Comparison between open and laparoscopic approach in radical prostatectomy

Objetivos. Analizar las diferencias entre la prostatectomía radical abierta (PRA) y la prostatectomía radical laparoscópica (PRL). Material y métodos. Se evalúan 180 cirugías prostáticas radicales realizadas en el 2004 y 2005, de las cuales 105 (58%) fueron laparoscópicas (PRL) y 75 (42%) por vía abierta. Más de la mitad de las intervenciones se realizaron por cirujanos expertos: 51% en las PRL y 56% en las PRA. Se compararon las variables: tiempo quirúrgico, sangrado intraoperatorio (diferencia entre hematocrito prequirúrgico y postquirúrgico) y los días de ingreso. El control oncológico y quirúrgico se evaluaron mediante los parámetros: margen maligno (MM) (margen positivo en un pT3) e incisión quirúrgica benigna (IQB) y maligna (IQM). Resultados. Los dos grupos son comparables respecto a la edad, estadio clínico, Gleason de la biopsia y volumen, sólo difiriendo en el valor de PSA. La media del tiempo quirúrgico fue significativamente mayor en la PRL (172 minutos) versus la PRA (145 minutos). La diferencia del hematocrito fue mayor en la PRA (10,7 puntos) respecto a la PRL (9,2 puntos) (p=0,03), así como los días de ingreso, representando un día más en la PRA (p=0,001). Un 26,7% de las PRL han presentado IQB, frente a un 48,7 % en las PRA (p=0,001). Desde el punto de vista oncológico se han observado un 5,4% de MM en las PRL versus un 16,9% en las PRA. (p=0,023). No obstante, no se han observado diferencias respecto a las IQM. Conclusión. En la PRL, a igualdad de estadio clínico y patológico, se observa un mejor control de los márgenes junto con una menor afectación quirúrgica de la pieza. También existe una menor pérdida sanguínea así como una reducción de los días de ingreso. Por tanto, se puede concluir que la PRL es, en nuestro entorno, una técnica válida para el tratamiento del cáncer de próstata organoconfinado, a pesar de un mayor tiempo quirúrgico (27 minutos) y de la dificultad de su aprendizaje

Introduction. To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). Material and Methods. From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). Results. Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p<0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9,2) (p=0.03), together with hospital stay, which was one day longer in the ORP group (p=0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p=0.001). Regarding oncologic results, LRP presented a 5.4 % of positive margins, which compared significantly with a 16.9% rate in the open group (p=0.023). However, no differences concerning malignant surgical incisions were observed. Conclusion. With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve