The effects of dutasteride or tamsulosin alone and in combination on storage and voiding symptoms in men with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH): 4-year data from the Combination of Avodart and Tamsulosin (CombAT) study.

OBJECTIVE: • To assess the effects of combined therapy with dutasteride and tamsulosin on voiding and storage symptoms compared with those of dutasteride or tamsulosin alone, using 4-year data from the Combination of Avodart and Tamsulosin (CombAT) study. PATIENTS AND METHODS: • Men (n = 4844) aged ≥ 50 years with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH), a prostate volume of ≥ 30 mL, and a serum prostate-specific antigen level of 1.5-10 ng/mL. • CombAT was a multicentre, double-blind, parallel-group study. • Oral dutasteride (0.5 mg) or tamsulosin (0.4 mg) alone or in combination was taken daily for 4 years. • Mean changes from baseline in storage and voiding symptoms at 4 years were assessed using subscales of the International Prostate Symptom Score. RESULTS: • At 4 years, the mean reduction in the storage subscore was significantly greater in the combined therapy group vs the dutasteride (adjusted mean difference -0.43) and tamsulosin (adjusted mean difference -0.96) monotherapy groups (P < 0.001). • Also at 4 years, the mean reduction in the voiding subscore was significantly greater in the combined therapy group vs the dutasteride (adjusted mean difference -0.51) and tamsulosin (adjusted mean difference -1.60) monotherapy groups (P < 0.001). • The improvement in the storage subscore with combined therapy was significantly better (P < 0.001) than dutasteride and tamsulosin from 3 months and 12 months, respectively. Similarly, the improvement in the voiding subscore with combined therapy was significantly better than dutasteride (P < 0.001) and tamsulosin (P ≤ 0.006) from 3 months and 6 months, respectively. • Improvements in the storage and voiding symptom subscores with combined therapy were achieved irrespective of prostate volume, although in men with the highest baseline prostate volumes (≥ 58 mL), combined therapy was not better than dutasteride. CONCLUSIONS: • In men with a prostate volume of ≥ 30 mL, combined therapy with dutasteride plus tamsulosin provided better long-term (up to 4 years) control of both storage and voiding LUTS compared with tamsulosin monotherapy. • Combined therapy was better than dutasteride monotherapy in men with prostate volumes of ≥ 30 to < 58 mL, but not in men with a prostate volume of ≥ 58 mL.

[Quality control plan for a primary bladder neoplastic process]. / Plan de calidad del proceso tumor vesical primario.

OBJECTIVES: Delays in the diagnosis and treatment of bladder cancer may change survival rates (6). We present the application of a plan for quality control in the management of primary bladder cancer, studying delays globally, and for individual indicators, as well as the impact of implemented improvement measures. METHODS: We performed a retrospective chart review to detect problems appeared through the whole clinical management process in a population of patients undergoing surgery for primary bladder cancer in the Hospital Costa del Sol during 2001. Causes were studied and corrective measures established, application of which has been evaluated during the first semester of 2002. Study indicators encompass from delay time for first visit to delay time for radical surgical treatment. RESULTS: Excessive average global delays for radical treatment of bladder tumor (208.3 days), and variability in the time to transurethral resection (one to 73.42 days) and to postoperative revision (54.4 days), were the most significant results. Evaluation of implemented measures shows a descent in global delays (134.2 days) and time to postoperative revision variability (32.4 days). CONCLUSIONS: Application of quality control procedures for clinical management is essential in daily clinical practice, for systematic, continuous, and rigorous evaluation will allow us to offer patients a product that satisfies their personal and social expectations.

Plan de calidad del proceso tumor vesical primario / Quality control procedure in the primary bladder tumor clinical management

OBJETIVO: El retraso en el diagnóstico y tratamiento de los tumores vesicales puede alterar su supervivencia (6).Presentamos la aplicación de un plan de calidad en el proceso tumor vesical primario, estudiando las demoras de cada indicador y su demora global, así como el impacto de las medidas de mejora aplicadas. MÉTODOS: Sobre la población de pacientes intervenidos de tumor vesical primario en el Hospital Costa del Sol durante el 2001, hemos detectado los problemas que se constituyen a lo largo de todo el proceso a través de los registros de las historias clínicas. Se han estudiado sus causas y establecido las medidas correctoras cuya aplicación se ha evaluado al fin del primer semestre del 2002.Los indicadores estudiados comprenden desde el tiempo de demora de {a primera consulta al tiempo de demora de tratamiento quirúrgico radical. RESULTADOS: Los resultados más importantes han sido la excesiva demora media global en el tratamiento radical del tumor vesical (208,3 días), variabilidad en el tiempo de resección transuretral (hasta 73,42 días) y de la revisión postquirúrgica (54,4 días). La evaluación de la implementación de las medidas ha arrojado como datos más importantes, el descenso de la demora global (134,2 días) y de la variabilidad en el tiempo de revisión postquirúrgica (32,4 días). CONCLUSIONES: La aplicación de planes de calidad se hace imprescindible en la práctica clínica diaria, para que una vez evaluado de manera rigurosa, continua y sistemática, nos permita ofrecer al paciente un producto que satisfaga sus expectativas personales y sociales (AU)

Ureterocele gigante ortotópico. diagnóstico por detección del jet ureteral mediante ecografía Doppler Color / Giant orthotopic ureterocele diagnosed by color doppler ultrasound detection of the ureteral jet

OBJETIVOS: Presentamos un nuevo caso de ureterocele ortotópico en adulto que debutó con hematuria y obstrucción infravesical. Destacamos la utilización de un procedimiento no invasivo, ecografía doppler color, para su diagnóstico. MÉTODO Y RESULTADOS: El diagnóstico se sospechó tras la detección del jet ureteral por eco doppler color en el interior de una lesión quística endovesical a nivel de la base de la misma. El diagnóstico fue confirmado por urogafia endovenosa y cistoscopia. Se practicó resección transuretral del mismo con buen resultado funcional. CONCLUSIÓN: La ecografía doppler color permite el diagnóstico de ureteroceles, siendo especialmente útil en pacientes en los que debe evitarse el uso de contraste o radiación ionizante (AU)