Corporoplasty under local anesthesia: Cost-effective improvement of the surgical treatment of Peyronie's disease / Corporoplastia bajo anestesia local: mejora del coste-efectividad del tratamiento quirúrgico de la enfermedad de Peyronie

Introduction and objectives: Peyronie's disease produces penile curvature that leads, in certain cases, to difficulties in having satisfactory sexual relations. The objective of this study is to evaluate the functional and cost-effectiveness results obtained in the surgical treatment of penile curvature due to Peyronie's disease under local anesthesia, comparing them with those performed under a general–spinal anesthesia regimen. Material and methods: Two groups of patients undergoing corporoplasty are compared according to the type of anesthesia used. Group 1 consists of 32 patients who underwent major outpatient surgery and under local anesthesia from June 2016 to June 2019. Their data are collected prospectively. Group 2 consists of 30 patients who underwent surgery under general/spinal anesthesia with hospital admission, from January 2013 to December 2015, with their data collected retrospectively. Anesthetic and surgical procedure, postoperative functional results, degree of satisfaction and hospital costs between both groups are analyzed, considering p≤0.05 as statistical significance and analyzing the results with the SPSS 20.0 program. Results: Of the 32 patients included in group 1, none required admission for intra or postoperative complications. In both groups, an improvement of the PDQ-test was observed without statistically significant differences, with the degree of global satisfaction above 95% in both groups. There were also no differences in the appearance of complications secondary to the anesthetic procedure or the hospital regime. We observed differences in hospital costs, being 44% lower for the group performed with local anesthesia. (AU)

Introducción y objetivos: La enfermedad de Peyronie produce una curvatura del pene que conduce, en ciertos casos, a dificultades para tener relaciones sexuales satisfactorias. El objetivo de este estudio es evaluar los resultados funcionales y de coste-efectividad obtenidos en el tratamiento quirúrgico de la curvatura peneana por enfermedad de Peyronie bajo anestesia local, comparándolos con los conseguidos bajo un régimen de anestesia general-raquídea. Material y métodos: Se comparan 2 grupos de pacientes sometidos a corporoplastia según el tipo de anestesia utilizada. El grupo 1 está formado por 32 pacientes que se sometieron a cirugía mayor ambulatoria y bajo anestesia local desde junio de 2016 a junio de 2019. Sus datos se recogen de forma prospectiva. El grupo 2 está formado por 30 pacientes intervenidos bajo anestesia general/raquídea con ingreso hospitalario, desde enero de 2013 hasta diciembre de 2015, con sus datos recogidos de forma retrospectiva. Se analiza el procedimiento anestésico y quirúrgico, los resultados funcionales postoperatorios, el grado de satisfacción y los costos hospitalarios entre ambos grupos, considerando p≤0,05 como significación estadística y analizando los resultados con el programa SPSS® 20.0. Resultados: De los 32 pacientes incluidos en el grupo 1, ninguno requirió ingreso por complicaciones intra o postoperatorias. En ambos grupos se observó una mejora en el test PDQ sin diferencias estadísticamente significativas, con un grado de satisfacción global superior al 95% en ambos grupos. Tampoco hubo diferencias en la aparición de complicaciones secundarias al procedimiento anestésico o al régimen hospitalario. Observamos diferencias en los costos hospitalarios, siendo un 44% menor para el grupo en el que se utilizó anestesia local. (AU)

Safety and Efficacy Study of Collagenase Clostridium Histolyticum Applied With an Intensive Protocol in the Treatment of Peyronie's Disease.

INTRODUCTION: Collagenase clostridium histolyticum (CCH) is a treatment for Peyronie's disease (PD) whose efficacy and safety has been demonstrated using a classic protocol and a shortened protocol. AIM: To evaluate the efficacy and safety of an even more intense protocol in which a CCH injection is applied for 3 separate cycles of 1 week. METHODS: Prospective, nonrandomized, clinical study of a cohort of 13 patients with PD and non-ventral curvatures, between 30 and 90 degrees and with stable disease were included. Under local anesthesia, 0.9 mg of CCH is infiltrated in 3 parallel and equidistant transverse bands across the plaque in 3 sessions separated by 1 week. Between sessions the patient is instructed to perform home modeling and penis stretching. MAIN OUTCOME MEASURES: The measurements collected were from girth, length of the penis and length of the plaque. Side and degree of curvature. Ultrasound evaluation of the plaque characteristics and assessing the interface between the tunica albuginea and Buck's fascia. Furthermore, questionnaires were collected: International Index of Erectile Function (IIEF) and 15-question and Peyronie's Disease Questionnaire (PDQ). All these parameters were evaluated before and after treatment. RESULTS: An improvement in curvature was obtained in 76.9% of patients, reaching an improvement in the angle of curvature after the treatment cycles by an average of 19 ° (range 0-35 °) from the beginning. There are also improvements in the results of the IIEF and PDQ questionnaires. Length, penis girth, and plate length measurements hardly changed after treatment. Reported adverse effects are mild and limited to the penis. CONCLUSIONS: We demonstrate the safety and efficacy of CCH in the treatment of PD using a more intense protocol than the previous ones. In addition, reducing the overall duration of allows for greater adherence and compliance of patients. Melgarejo-Segura MT, Funes-Padilla C, Morales-Martínez A, et al. Safety and Efficacy Study of Collagenase Clostridium Histolyticum Applied With an Intensive Protocol in the Treatment of Peyronie's Disease. Sex Med 2021;9:100375.

Estudio caso-control en hombres con liquen escleroso y atrófico genital / Case control study in men with sclerosus and atrophic genital lichen

Objetivo. Comparar los datos epidemiológicos de una muestra de pacientes con liquen escleroso genital versus un grupo control sin liquen escleroso genital. Material y métodos. Estudio caso-control que incluye 50 pacientes divididos en 2 grupos; grupo 1: 30 pacientes con liquen escleroatrófico genital y grupo 2: 20 pacientes sin liquen escleroatrófico. Se han estudiado variables clínicas, analíticas, antecedentes personales y hábitos de vida. El análisis estadístico se ha llevado a cabo mediante el programa SPSS 20.0, siendo la significación estadística p≤0,05. Resultados. La edad media de los pacientes del grupo 1 fue de 54,7años versus 52,5años en el grupo 2, sin que se observaran diferencias estadísticamente significativas. La principal diferencia observada entre los pacientes del grupo 1 y los del grupo 2 fue el índice de masa corporal, que fue más elevado en el grupo 1, 28,4kg/m2, con respecto al grupo 2, 23,4kg/m2 (p=0,0001), y el estado civil. No se observó una mayor prevalencia significativa en enfermedades autoinmunes en el grupo 1 respecto al grupo 2. Conclusión. Los pacientes con liquen escleroatrófico genital parecen tener mayor índice de masa corporal que los pacientes sin liquen, sin que exista una clara asociación con enfermedades autoinmunes, según los resultados de nuestro estudio (AU)

Objective. To compare epidemiologic dates in patients with sclerosus genital lichen versus control group without sclerosus genital lichen. Material and methods. Case-control study including 50 patients divided into 2 groups: Group 1: 30 patients with sclerosus and atrophic genital lichen and group 2: 20 patients without lichen sclerosus. Study of clinical variables, laboratory, medical history and lifestyle. Statistical analysis with SPSS 20.0 software and statistical significance P≤.05. Results. The mean age of patients in group 1 was 54.7 years versus 52.5 years in group 2, no statistically significant differences were observed. The main difference observed between patients in group 1 and group 2 was the BMI, which was higher in group 1, 28.4kg/m2, compared to group 2, 23.4kg/m2 (P=.0001) and marital status. It has not been observed significantly higher prevalence in autoimmune diseases in group 1 compared with group 2. Conclusion. Patients with genital sclerosus and atrophic lichen seem to be more body mass index than patients without lichen, without a clear association with autoimmune diseases according to the results of our study (AU)

[Is it possible to increase the specificity for the performance of prostatic biopsy in patients with PSA between 4 and 10 ng/ml and free/total PSA ratio < 20%]. / ¿ES POSSIBLE AUMENTAR LA ESPECIFICIDAD PARA LA REALIZACIÓN DE BIOPSIA PROSTÁTICA EN PACIENTES CON PSA ENTRE 4-10 NG/ML CON COCIENTE PSA LIBRE/PSA TOTAL < 20%?

OBJECTIVE: To investigate the manner to increase specificity in the decision-making process for the performance of prostate biopsy. METHODS: We include in this study men with PSA between 4 and 10 ng/ml and free/total PSA < 20%, candidates for prostate biopsy. Patients receiving 5 alpha reductase inhibitors or with previous biopsies were excluded. Analyzed variables: total PSA, total testosterone, free and bioavailable testosterone, FSH, LH, SHBG, 17 hydroxyprogesterone, Androstenedione, prostatic volume measured by transrectal ultrasound, total testosterone/PSA, testosterone/free PSA, bio available testos-terone/PSA and PSA density, total testosterone/prostate volume, free testosterone/prostate volume and bioavailable testosterone/prostate volume. RESULTS: A total 109 patients have been included, divided into 2 groups according to the results of the biopsy. Significant differences were observed in prostatic volume (Group 1: 36.6cc and Group 2: 52.8 cc; p=0.04), PSA density (Group 1: 0.24 Group 2: 0.17; p=0.002), total testosterone/prostate volume (Group 1: 0.15 and Group 2: 0.10; p=0.02) free testosterone/prostate volume (Group 1: 0.002 Group 2: 0.001; p=0.01) and bioavailable testosterone/prostate volume (Group 1: 0.06 Group 2: 0.04; p=0.007). CONCLUSION: The decision for a prostate biopsy on patients with a PSA between 4-10 ng/ml with free/total ratio < 20% continues to be an issue, however, we can optimize decision using other parameters such as prostate volume, PSA density and bioavailable testosterone/prostate volume.

¿Es posible aumentar la especificidad para la realización de biopsia prostática en pacientes con PSA entre 4-10 ng/ml con cociente PSA libre/PSA total < 20%? / Is it possible to increase the specificity for the performance of prostatic biopsy in patients with PSA between 4 and 10 ng/ml and free/total PSA ratio 20%?

OBJETIVO: En la actualidad sigue siendo un problema la toma de decisión para realizar biopsia de próstata en pacientes con PSA entre 4-10 ng/ml, a pesar del uso del cociente PSA libre/ PSA total. El objetivo de este estudio es investigar la manera de aumentar la especificidad en la toma de decisión de la realización de biopsia de próstata en este tipo de pacientes. MÉTODOS: Desde enero a diciembre de 2014, se incluyen en este estudio hombres con PSA entre 4-10ng/ml y cociente PSA libre/ PSA total <20%, candidatos a biopsia de próstata. Se excluyen del estudio pacientes que estén tomando inhibidores de la 5 alfa-reductasa y pacientes con biopsias de próstata previamente realizadas. Se analiza edad, PSA total, testosterona total, libre y biodisponible, FSH, LH, SHBG, 17-hidroxiprogesterona, Androstendiona, volumen prostático (medido por ecografía transrectal), cocientes testosterona total/PSA, testosterona libre/PSA, testosterona biodisponible/PSA y Densidad de PSA, testosterona total/volumen próstata, testosterona libre/volumen próstata y testosterona biodisponible/volumen próstata. Análisis estadístico con SPSS 20,0 y significación estadística p≤0,05. RESULTADOS: Un total de 109 pacientes se incluyeron, divididos en 2 grupos según resultado de la biopsia. Grupo 1: 49 pacientes con biopsia de próstata positiva; Grupo 2: 60 pacientes con biopsia de próstata negativa. Se observan diferencias estadísticamente significativas en relación al volumen prostático (Grupo 1: 37,6 cc; Grupo 2: 52,8 cc; p = 0,04), densidad PSA (Grupo 1: 0,24; Grupo 2: 0,17; p = 0,002), testosterona total/volumen próstata (Grupo 1: 0,15; Grupo 2: 0,10; p = 0,02), testosterona libre/volumen próstata (Grupo 1: 0,002; Grupo 2: 0,001; p = 0,01) y testosterona biodisponible/volumen próstata (Grupo 1: 0,06; Grupo 2: 0,04; p = 0,007). Se realiza curva ROC para determinación de punto de corte con especificidad 90%, observando que un volumen de próstata menor a 60,7cc, una densidad de PSA mayor a 0,27 y un valor testosterona biodisponible/volumen próstata mayor a 0,07. CONCLUSIÓN: La decisión de biopsia de próstata en pacientes con PSA entre 4-10 ng/ml con cociente PSA libre/PSA total < 20% sigue siendo controvertida, no obstante podemos optimizar la decisión utilizando otros parámetros como el volumen de próstata, la densidad PSA y el cociente testosterona biodisponible/volumen próstata

OBJECTIVE: To investigate the manner to increase specificity in the decision-making process for the performance of prostate biopsy. METHODS: We include in this study men with PSA between 4 and 10 ng/ml and free/total PSA < 20%, candidates for prostate biopsy. Patients receiving 5 alpha reductase inhibitors or with previous biopsies were excluded. Analyzed variables: total PSA, total testosterone, free and bioavailable testosterone, FSH, LH, SHBG, 17 hydroxyprogesterone, Androstenedione, prostatic volume measured by transrectal ultrasound, total testosterone/PSA, testosterone/free PSA, bio available testosterone/PSA and PSA density, total testosterone/prostate volume, free testosterone/prostate volume and bioavailable testosterone/prostate volume. RESULTS: A total 109 patients have been included, divided into 2 groups according to the results of the biopsy. Significant differences were observed in prostatic volume (Group 1: 36.6cc and Group 2: 52.8 cc; p = 0.04), PSA density (Group 1: 0.24 Group 2: 0.17; p = 0.002), total testosterone/prostate volume (Group 1: 0.15 and Group 2: 0.10; p = 0.02) free testosterone/ prostate volume (Group 1: 0.002 Group 2: 0.001; p = 0.01) and bioavailable testosterone/prostate volume (Group 1: 0.06 Group 2: 0.04; p = 0.007). CONCLUSION: The decision for a prostate biopsy on patients with a PSA between 4-10 ng/ml with free/total ratio < 20% continues to be an issue, however, we can optimize decision using other parameters such as prostate volume, PSA density and bioavailable testosterone/prostate volume

Estudio epidemiológico de los pacientes con liquen escleroatrófico genital. Resultados preliminares / Epidemiological study of patients with genital lichen sclerosus. Preliminary results

Introducción: El liquen escleroso y atrófico es una enfermedad crónica, inflamatoria, adquirida, que produce una pérdida de calidad de vida y aumento de la morbilidad. Las causas de la aparición del liquen son desconocidas y es importante estudiar la relación de esta enfermedad con diferentes entidades patológicas, hábitos de vida y factores demográficos. Objetivo: El objetivo de este estudio es presentar unos resultados preliminares de una pequeña casuística de pacientes con liquen escleroso y atrófico. Material y métodos: Presentamos 20 pacientes sometidos a circuncisión por liquen escleroso y atrófico confirmado histológicamente, en los que analizamos características clínicas, analíticas y demográficas para completar un perfil epidemiológico del paciente con esta enfermedad. Resultados: La media de edad de los pacientes estudiados fue de 54,8 años. Destaca que el 25% de los pacientes presenta una diabetes mellitus, el 50% hipercolesterolemia y el 75% sobrepeso. En términos globales el perfil lipídico y glúcídico está alterado en el 50% de los pacientes que presentan esta enfermedad. Los pacientes con liquen presentan en un porcentaje importante de casos alteraciones del meato uretral, por lo que es importante su exploración. Conclusión: Aunque es un estudio limitado por el número de pacientes, debemos tener en cuenta la posible asociación del liquen escleroso y atrófico con dislipidemia y otras enfermedades endocrino-metabólicas (AU)

Introduction: lichen sclerosus et atrophicus, or lichen sclerosus, is an acquired, chronic inflammatory disease, resulting in a loss of quality of life and increased morbidity. The causes of the appearance of lichen are unknown and it is important to study the relationship of this disease with different pathologies and lifestyle and demographic factors. Objective: the objective of this study was to obtain and present some preliminary results from a small series of patients with lichen sclerosus. Material and methods: we report 20 patients undergoing circumcision due to histologically confirmed lichen sclerosus, in whom we analysed demographic, clinical and analytical characteristics to complete an epidemiological profile of patients with this disease. Results: the mean patient age was 54.8 years. It is notable that 25% of patients had diabetes mellitus, 50%, hypercholesterolemia and 75% were overweight. Overall lipid and carbohydrate profile was altered in 50% of patients with this disease. Patients with lichen present, in a significant percentage of cases, alterations of the urethral meatus, so the physical examination is very important. Conclusion: although this study had a limited number of patients, we have to bear in mind the possible association of lichen sclerosus with dyslipidemia and other endocrine and metabolic diseases

Metabolic syndrome, hormone levels, and inflammation in patients with erectile dysfunction.

BACKGROUND: The end point of this study was to investigate the prevalence of MS in patients with ED in comparison with control subjects and to analyse the association with acute phase reactants (CRP, ESR) and hormone levels. METHODS: This case-control study included 65 patients, 37 with erectile dysfunction, according to the International Index of Erectile Function (IIEF) from the Urology Department of San Cecilio University Hospital, Granada (Spain) and 28 healthy controls. The prevalence of metabolic syndrome was calculated according to ATP-III criteria. Hormone levels and acute phase parameters were studied in samples drawn. RESULTS: The ATP-III criteria for MS were met by 64.9% of the patients with ED and only 9.5% of the controls (P < 0.0001, OR = 17.53, 95% CI: 3.52-87.37). Binary logistic regression analysis showed a strong association between patients with ED and MS, even after additional adjustment for confounding factors (OR = 20.05, 95% CI: 1.24-32.82, P < 0.034). Patients with hypogonadism presented a significantly higher prevalence of metabolic syndrome. Multiple linear regression analysis showed that systolic BP and CRP predicted 0.46 (model R²) of IIEF changes. CONCLUSION: Chronic inflammation found in patients with ED might explain the association between ED and metabolic syndrome.

Hypercalciuria, hyperoxaluria, and hypocitraturia screening from random urine samples in patients with calcium lithiasis.

Calcium lithiasis is the most frequently diagnosed renal lithiasis and is associated with a high percentage of patients with metabolic disorders, such as hypercalciuria, hypocitraturia, and hyperoxaluria. The present study included 50 patients with recurrent calcium lithiasis. We conducted a random urine test during nocturnal fasting and a 24-h urine test, and examined calcium, oxalate, and citrate. A study of the linear correlation between the metabolites was performed, and the receiver operator characteristic (ROC) curves were analyzed in the random urine samples to determine the cutoff values for hypercalciuria (excretion greater than 200 mg), hyperoxaluria (excretion greater than 40 mg), and hypocitraturia (excretion less than 320 mg) in the 24-h urine. Linear relationships were observed between the calcium levels in the random and 24-h urine samples (R = 0.717, p = 0.0001), the oxalate levels in the random and 24-h urine samples (R = 0.838, p = 0.0001), and the citrate levels in the random and 24-h urine samples (R = 0.799, p = 0.0001). After obtaining the ROC curves, we observed that more than 10.15 mg/dl of random calcium and more than 16.45 mg/l of random oxalate were indicative of hypercalciuria and hyperoxaluria, respectively, in the 24-h urine. In addition, we found that the presence of less than 183 mg/l of random citrate was indicative of the presence of hypocitraturia in the 24-h urine. Using the proposed values, screening for hypercalciuria, hyperoxaluria, and hypocitraturia can be performed with a random urine sample during fasting with an overall sensitivity greater than 86%.

Relationship between biopsy Gleason score and radical prostatectomy specimen Gleason score in patients undergoing sextant vs 12 core biopsies.

OBJECTIVES: Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, instead of 6 (sextant biopsy), improves, or not, this correlation. METHODS: A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biopsy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy. RESULTS: Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason score concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy. CONCLUSIONS: We have noticed a low correlation between Gleason score after biopsy when it was compared with that obtained after radical prostatectomy, while these results are similar to those found in the literature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6.

Relación entre score gleason biópsico y score gleason tras prostatectomía radical en pacientes sometidos a biopsia sextante vs 12 cilindros / Relationship between biopsy gleason score and radical prostatectomy specimen gleason score in patients undergoing sextant vs 12 core biopsies

OBJETIVO: El cáncer de próstata es una patología cada vez más prevalente por la longevidad de la población. Es por ello que cada vez con más frecuencia se somete a los pacientes a realización de biopsia prostática para realizar su diagnóstico de certeza.Nuestro objetivo fue analizar la relación del score gleason obtenido en la biopsia de próstata con el obtenido tras prostatectomía radical. Se pretendió analizar si la obtención de 12 cilindros en lugar de 6 (biopsia sextante) mejora o no esta relación.MÉTODOS: Se realizó un estudio de casos y controles con 128 pacientes (98 casos en los que se obtuvó 6 cilindros y 30 controles en los que se obtuvieron 12 cilindros) que fueron sometidos a biopsia de próstata y posterior prostatectomía radical. Para ello se seleccionaron a pacientes con Gleason biópsico mayor o igual de 6 y candidatos a prostatectomía radical.RESULTADOS: La media de edad de los 128 pacientes incluidos en el estudio fue de 62,9 años, con una media de PSA de 8,53 ng/ml. Se observó igualdad de Score Gleason biopsia/prostatectomía en el 63,28 % de los pacientes y desigualdad en el 36,72 %. Tras comparar los resultados obtenidos entre la relación del score gleason tras extracción de 6 o 12 cilindros y tras prostatectomía radical no se apreciaron diferencias estadísticamente significativasCONCLUSIONES: La correlación gleason biopsia-prostatectomía radical es baja. No apreciamos mejoría significativa para esta correlación el obtener 12 cilindros en lugar de 6(AU)

OBJECTIVES: Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, ins-tead of 6 (sextant biopsy), improves, or not, this correla-tion.METHODS: A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biop-sy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy.RESULTS: Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason sco-re concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy.CONCLUSIONS: We have noticed a low correlation between Gleason score after biopsy when it was com-pared with that obtained after radical prostatectomy, while these results are similar to those found in the lite-rature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6(AU)