Women in urology: what is their current situation in Spain?

OBJECTIVE: To analyze the current state of women in urology in Spain. MATERIAL AND METHODS: Descriptive study based on the results of an online survey sent between February and April 2020 through the database of the Residents and Young Urologists group (RAEU) of the Spanish Association of Urology (AEU). Characteristics of the survey and its results were analyzed. RESULTS: In total, 257 responses were obtained from 210 women (81.71%) and 47 men (18.29%) belonging to 111 hospitals. Statistically significant differences were observed (p < 0.001) with a higher proportion of men in all categories except for the group of young female and male attendings (29-39 years, p = 0.789), and the group of female residents against male residents (p = 0.814). The number of men was higher in hospitals with subspecialty units except for the Pelvic Floor Unit, where no statistically significant difference was observed (p = 0.06). Regarding positions of responsibility, only 7 out of 111 hospitals had female Department Chiefs. CONCLUSIONS: Women's representation in urology is increasing, mainly due to the younger generations. However, the access of these women to relevant positions is anecdotal.

Estado actual y evolución del manejo de la patología funcional y del suelo pélvico en los hospitales de la Comunidad de Madrid / Evolution and current status of the management of functional and pelvic floor pathology in the hospitals of the Community of Madrid

Introducción y objetivo Las disfunciones del suelo pélvico (DSP) incluyen un amplio número de patologías sujetas a una alta variabilidad en su manejo según los medios y capacitación de los centros y sus profesionales. El objetivo del estudio es constatar y describir la variabilidad clínica en el manejo de las DSP en los servicios de Urología de los centros sanitarios públicos de la Comunidad de Madrid, así como la dotación de medios disponibles en la actualidad en dichos centros. Material y métodos Encuesta realizada en septiembre de 2021 dirigida a facultativos especialistas en Urología Funcional de los hospitales públicos de la Comunidad de Madrid. Esta se basa en una encuesta realizada en 2011 por Díez et al. con la misma finalidad. Se analizaron las características asistenciales de los distintos centros y el manejo de las principales patologías funcionales del suelo pélvico. Se compararon los resultados con los de la encuesta de 2011 para las preguntas equiparables. Resultados El número de Unidades de Suelo Pélvico (USP) ha aumentado notablemente en los últimos 10 años. El uso de dispositivos ajustables en el tratamiento de la IUE masculina se ha extendido en los centros encuestados. La colposacropexia laparoscópica/robótica se ha convertido en el tratamiento de referencia del prolapso de órganos pélvicos (POP). Conclusiones Las USP multidisciplinares son el modelo a seguir para el manejo de las DSP. Se constata la variabilidad en el manejo de la incontinencia urinaria, POP, el síndrome de dolor vesical y la neuropatía del nervio pudendo (AU)

Introduction and objective Pelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals’ resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. Material and methods The survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. Results The number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). Conclusions Multidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized (AU)

Evolution and current status of the management of functional and pelvic floor pathology in the hospitals of the Community of Madrid.

INTRODUCTION AND OBJECTIVE: Pelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals' resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. MATERIAL AND METHODS: The survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. RESULTS: The number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). CONCLUSIONS: Multidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized.

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours.

INTRODUCTION: During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression-free survival rates and tumoral relapse specific characteristics. METHODS: Retrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. RESULTS: Median follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. CONCLUSION: BCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

Cirugía urológica funcional y SARS-CoV-2: cómo y por qué hay que retomar ya la actividad quirúrgica adaptados a la nueva realidad / Functional urology surgery and SARS-CoV-2: how and why surgical activity should be resumed now, adapting to the new reality

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Outcomes of an enhanced recovery after radical cystectomy program in a prospective multicenter study: compliance and key components for success.

OBJECTIVE: To investigate the effect of an Enhanced Recovery After Surgery (ERAS) program on complications and length of stay (LOS) after radical cystectomy (RC) and to assess if the number and type of components of ERAS play a key role on the decrease of surgical morbidity. MATERIALS AND METHODS: We analyzed the data of 277 patients prospectively recruited in 11 hospitals undergoing RC initially managed according to local practice (Group I) and later within an ERAS program (Group II). Two main outcomes were defined: 90-day complications rate and LOS. As secondary variables we studied 90-day mortality, 30-day readmission and transfusion rate. RESULTS: Patients in Group II had a higher use of ERAS measures (98.6%) than those in Group I (78.2%) (p < 0.05). Patients in Groups I and II experienced similar complications (70.5% vs. 66%, p = 0.42). LOS was not different between Groups I and II (12.5 and 14 days, respectively, p = 0.59). The risk of having any complication decreases for patients having more than 15 ERAS measures adopted [RR = 0.815; 95% confidence interval (CI) 0.667-0.996; p = 0.045]. Avoidance of transfusion and nasogastric tube, prevention of ileus, early ambulation and a fast uptake of a regular diet are independently associated with the absence of complications. CONCLUSIONS: Complications and LOS after RC were not modified by the introduction of an ERAS program. We hypothesize that at least 15 measures should be applied to maximize the benefit of ERAS.

Cincuenta consejos para mejorar las presentaciones en urología / Fifty ways to improve presentations in urology

CONTEXTO: Nuestra profesión exige permanentemente comunicar conocimiento médico entre colegas en ámbitos reducidos, como el hospital, o en entornos más numerosos, como los congresos o cursos académicos. Las nuevas tecnologías como PowerPoint(R) aún no han logrado grandes avances que resulten en buenas presentaciones y su utilización resulta frecuentemente en presentaciones inefectivas. OBJETIVO: Presentar de forma sencilla las herramientas que ayudan a corregir los errores más frecuentes en el formato de una presentación con el fin de mejorar nuestras exposiciones académicas. Adquisición de la evidencia: Búsqueda bibliográfica en PubMed y Google Scholar. Dividimos el análisis en 3 secciones: estructuración de la presentación, diseño de una diapositiva, presentación a la audiencia. Cada una de estas partes es desarrollada en forma de consejos breves en una lista del 1 al 50. RESULTADOS: Cincuenta consejos ajustados al objetivo planteado en el trabajo. CONCLUSIONES: La evidencia científica que respalda los consejos para mejorar las presentaciones está, en su mayoría, fundamentada en opiniones de expertos. Sin embargo, casi la totalidad de los trabajos coinciden en que las presentaciones deben ser estructuralmente más simples y no por eso menos científicas, su contenido debe estar desarrollado pensando en la audiencia y el orador es quien debe concentrar la atención, nunca una diapositiva. Hacer una presentación simple y didáctica de un contenido sofisticado apoyado en herramientas multimedia constituye uno de los desafíos intelectuales más altos del orador en estos tiempos

BACKGROUND: Our profession permanently demands intercommunication of medical knowledge among colleagues; either in small environments such as hospitals or at larger ones such as congresses or academic courses. New technologies such as PowerPoint® are not developed enough to provide good presentations, and its employment does not always grant effective results. OBJECTIVE: In order to improve our academic presentations, we present several tools that may help us avoid the most common mistakes. Evidence acquisition: Literature search in PubMed and Google Scholar. We have divided the analysis into 3 sections: structure of the presentation, slide design, presentation to the audience. Each section includes a list of 50 short tips. RESULTS: Fifty tips following the study objectives. CONCLUSIONS: The scientific evidence that supports the information on how to improve presentations is mostly based on expert opinions. However, almost every work agrees that presentations must use simple structures which does not make them less scientific; their content must be developed for a specific audience, and it must be the speaker, not the slides, who captures the audience attention. Making a simple and didactic presentation of complex content supported by multimedia tools is one of the speaker's highest intellectual challenges of these days

Fifty ways to improve presentations in urology. / Cincuenta consejos para mejorar las presentaciones en urología.

BACKGROUND: Our profession permanently demands intercommunication of medical knowledge among colleagues; either in small environments such as hospitals or at larger ones such as congresses or academic courses. New technologies such as PowerPoint® are not developed enough to provide good presentations, and its employment does not always grant effective results. OBJECTIVE: In order to improve our academic presentations, we present several tools that may help us avoid the most common mistakes. EVIDENCE ACQUISITION: Literature search in PubMed and Google Scholar. We have divided the analysis into 3 sections: structure of the presentation, slide design, presentation to the audience. Each section includes a list of 50 short tips. RESULTS: Fifty tips following the study objectives. CONCLUSIONS: The scientific evidence that supports the information on how to improve presentations is mostly based on expert opinions. However, almost every work agrees that presentations must use simple structures which does not make them less scientific; their content must be developed for a specific audience, and it must be the speaker, not the slides, who captures the audience attention. Making a simple and didactic presentation of complex content supported by multimedia tools is one of the speaker's highest intellectual challenges of these days.

El debate del Bosniak 3 o 4 y la vigente nosología quística / The current nosology on renal cysts: Bosniak III or IV?

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Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery. / Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido.

OBJECTIVE: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. MATERIAL AND METHOD: We analysed the authors' first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. RESULTS: We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. CONCLUSIONS: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues.

Poliquistosis del seno renal o hilioquistosis. Controversias, retos e historia de un descubrimiento compartido / Polycystosis of the renal sinus or polycystic kidney disease Controversies, challenges and history of a shared discovery

Objetivo: Recordar la historia del descubrimiento de la enfermedad quística no nefronal, detectada simultáneamente en 2 hospitales madrileños y las vicisitudes que sufrieron los autores para que el proceso, ignorado en la literatura mundial, fuese reconocido. Material y método: Se han analizado las primeras publicaciones y presentaciones de los autores, la correspondencia entre ellos con el relato de las dificultades habidas para denunciar la confusión con la enfermedad renal poliquística del adulto y la posterior identificación nosológica del proceso. Se han consultado colaboradores de ambos autores para mayor precisión y objetividad del relato histórico. Resultados: Se confirma el notable esfuerzo de los autores hasta conseguir el definitivo reconocimiento del proceso a pesar de señaladas dificultades. Conclusiones: La observación clínica rigurosa reconoce procesos ignorados por la literatura médica y la correcta aplicación del método científico permite identificar o desvelar nuevas entidades nosológicas, confirmando con la ejemplaridad de este relato que en Medicina no hay temas agotados

Objective: To recall the history of the discovery of non-nephron cystic disease, detected simultaneously in 2 hospitals in Madrid, and the vicissitudes that the authors endured during the process of recognising this disease, while being ignored by the international scientific literature. Material and method: We analysed the authors’ first publications and presentations, their correspondence relaying the difficulties in reporting the confusion with adult polycystic kidney disease (APKD) and the subsequent nosological identification of the process. We consulted with individuals who worked with the 2 authors to increase the accuracy and objectivity of the history report. Results. We confirmed the authors' remarkable efforts in getting the process definitively recognised despite the notable difficulties. Conclusions: Rigorous clinical observation recognises processes ignored by the medical literature, and the correct application of the scientific method helps identify and reveal new nosological entities, confirming with this story's example that, in medicine, there are no exhausted issues

Nefrectomía parcial laparoscópica previa embolización supraselectiva como tratamiento de angiomiolipomas renales gigantes / Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma

Objetivo: Los casos de angiomiolipoma renal gigante (> 9 cm) son un reto terapéutico por su baja frecuencia y su tamaño. El objetivo del tratamiento de los pacientes con angiomiolipoma renal debe ser la extirpación completa del tumor, con una técnica quirúrgica conservadora de nefronas, sin complicaciones y mediante un abordaje mínimamente invasivo. Material y métodos: Presentamos 3 casos de angiomiolipoma gigante (14, 12 y 10 cm) tratados mediante abordaje combinado: embolización supraselectiva y posterior nefrectomía parcial laparoscópica, en 3 hospitales diferentes. Resultados: Ningún caso precisó reconversión a cirugía abierta, en uno de los 3 pacientes se realizó clampaje arterial y ninguno experimentó complicaciones. Conclusiones: El abordaje combinado permite una cirugía con criterios de mínima invasión, conservadora de nefronas, con escaso sangrado y disminución del tiempo de isquemia caliente

Objective: Cases of giant renal angiomyolipoma (> 9 cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. Material and methods: We present 3 cases of giant angiomyolipoma (10 12 and 14 cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. Results: None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. Conclusions: The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time

Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma. / Nefrectomía parcial laparoscópica previa embolización supraselectiva como tratamiento de angiomiolipomas renales gigantes.

OBJECTIVE: Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach. MATERIAL AND METHODS: We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals. RESULTS: None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications. CONCLUSIONS: The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.

Factores pronósticos de recidiva vesical en los pacientes con tumor de urotelio superior tratados con cirugía / Prognostic factors for vesical relapse in patients with upper urothelium tumours treated with surgery

Objetivo: Identificación de factores pronósticos de recidiva vesical en los pacientes con tumor de urotelio superior tratados con cirugía. Material y métodos: Análisis retrospectivo de pacientes con tumor de urotelio superior operados entre 1999 y 2011 en nuestro centro (139 pacientes). Se recogieron variables demográficas, clínicas, diagnósticas y patológicas, así como el tratamiento realizado, las complicaciones y la evolución. Análisis descriptivo mediante la prueba de la Chi cuadrado para variables categóricas y el test ANOVA para variables continuas. Análisis univariante y multivariante mediante modelo de riesgos proporcionales de Cox. La significación estadística se consideró cuando p<0,05. Todos los cálculos fueron realizados con SPSS satistics v-21. Resultados: Durante el seguimiento el 26,6% de los pacientes (37 casos) presentó recidiva vesical. El 19,6% de los pacientes sin historia de tumor vesical presentó una recidiva en la vejiga, frente al 48,6% de los pacientes con antecedentes de tumor vesical (p < 0,001). En el análisis multivariante solo se identificó como factor predictor independiente de recidiva en la vejiga la existencia de tumor vesical previo o concomitante al diagnóstico del TTUS (p = 0,007). Conclusión: En nuestra serie solamente la presencia de un tumor vesical previo o sincrónico se comportó como factor predictor independiente de recidiva en la vejiga en pacientes con tumor de urotelio superior tratado con cirugía

Objective: To identify the prognostic factors for vesical relapse in patients with tumours of the upper urothelium treated with surgery. Material and methods: We conducted a retrospective analysis of patients with tumours of the upper urothelium who underwent surgery between 1999 and 2011 at our centre (139 patients). We collected demographic, clinical, diagnostic and pathological variables, as well as the treatment, complications and progression. A descriptive analysis was performed using the chi-squared test for categorical variables and the ANOVA test for continuous variables. We also performed a univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered when P < .05. All calculations were performed with SPSS Statistics version 21. Results: During the follow-up, 26.6% of the patients (37 cases) showed vesical relapse. Some 19.6% of the patients with no history of bladder tumours showed a bladder tumour relapse compared with 48.6% of the patients with a history of bladder tumours (P < .001). In the multivariate analysis, only the presence of bladder tumours prior to or concomitant with the upper urinary tract tumour diagnosis was identified as an independent predictor of bladder tumour relapse (P=.007). Conclusion: In our series, only the presence of a prior or synchronous bladder tumour behaved as an independent predictor of bladder tumour relapse in patients with tumours of the upper urothelium treated with surgery

Comentario a «Costes y procesos hospitalarios en un servicio de urología de un hospital terciario. Análisis de los grupos relacionados por el diagnóstico» / Comment to «Costs and hospital procedures in an urology department of a tertiary hospital. Analysis of groups related by their diagnosis»

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Síndrome de supresión de acetato de abiraterona / Abiraterone acetate suppression syndrome

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Prognostic factors for vesical relapse in patients with upper urothelium tumours treated with surgery. / Factores pronósticos de recidiva vesical en los pacientes con tumor de urotelio superior tratados con cirugía.

OBJECTIVE: To identify the prognostic factors for vesical relapse in patients with tumours of the upper urothelium treated with surgery. MATERIAL AND METHODS: We conducted a retrospective analysis of patients with tumours of the upper urothelium who underwent surgery between 1999 and 2011 at our centre (139 patients). We collected demographic, clinical, diagnostic and pathological variables, as well as the treatment, complications and progression. A descriptive analysis was performed using the chi-squared test for categorical variables and the ANOVA test for continuous variables. We also performed a univariate and multivariate analysis using the Cox proportional hazards model. Statistical significance was considered when P<.05. All calculations were performed with SPSS Statistics version 21. RESULTS: During the follow-up, 26.6% of the patients (37 cases) showed vesical relapse. Some 19.6% of the patients with no history of bladder tumours showed a bladder tumour relapse compared with 48.6% of the patients with a history of bladder tumours (P<.001). In the multivariate analysis, only the presence of bladder tumours prior to or concomitant with the upper urinary tract tumour diagnosis was identified as an independent predictor of bladder tumour relapse (P=.007). CONCLUSION: In our series, only the presence of a prior or synchronous bladder tumour behaved as an independent predictor of bladder tumour relapse in patients with tumours of the upper urothelium treated with surgery.

Corynebacterium urealyticum: trascendencia histórica de su descubrimiento / Corynebacterium urealyticum: the historical importance of its discovery

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